Connexins

连接蛋白
  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    背景:细胞外三磷酸腺苷(ATP)是重要的信号分子。在以往的研究中,深入研究揭示了具有序列相似性的家族3成员A(FAM3A)在控制肝糖脂代谢中的关键作用,胰岛β细胞功能,脂肪细胞分化,血压,以及其他生物学和病理生理过程。尽管线粒体蛋白FAM3A通过刺激ATP释放激活P2受体通路在调节糖脂代谢中发挥关键作用,其促进肝细胞ATP释放的机制仍未揭示。
    方法:db/db,高脂肪饮食(HFD)喂养,和全局pannexin1(PANX1)基因敲除小鼠,以及个体的肝脏切片,在这项研究中使用。腺病毒和腺相关病毒用于体内基因过表达或抑制。为了评估小鼠的代谢状态,口服葡萄糖耐量试验(OGTT),丙酮酸耐量试验(PTT),胰岛素耐量试验(ITT),和磁共振成像(MRI)。蛋白质-蛋白质相互作用通过免疫共沉淀与质谱(MS)测定来确定。
    结果:在患有脂肪变性的个体和小鼠的肝脏中,ATP通透性通道PANX1的表达增加(P<0.01)。肝PANX1过表达改善肥胖小鼠糖脂代谢失调。肝PANX1敲除或全局PANX1敲除的小鼠表现出糖脂代谢紊乱。肝脏PANX1的恢复挽救了PANX1缺陷小鼠的代谢紊乱(P<0.05)。机械上,ATP释放由PANX1激活的蛋白激酶B叉头盒蛋白O1(Akt-FOXO1)途径介导,通过P2Y受体抑制肝细胞中的糖异生。PANX1介导的ATP释放也激活了钙调蛋白(CaM)(P<0.01),与c-Jun氨基末端激酶(JNK)相互作用以抑制其活性,从而使转录因子激活蛋白-1(AP1)失活,抑制脂肪酸合成酶(FAS)的表达和脂质合成(P<0.05)。FAM3A通过热休克因子1(HSF1)刺激肝细胞中PANX1的表达(P<0.05)。值得注意的是,FAM3A过表达未能促进ATP释放,抑制糖异生和脂肪生成基因的表达,并抑制PANX1缺乏的肝细胞和肝脏中的糖异生和脂质沉积。
    结论:PANX1介导的ATP释放在维持肝糖脂稳态中起着至关重要的作用,它赋予FAM3A对肝糖异生和脂肪生成的抑制作用。
    BACKGROUND: Extracellular adenosine triphosphate (ATP) is an important signal molecule. In previous studies, intensive research had revealed the crucial roles of family with sequence similarity 3 member A (FAM3A) in controlling hepatic glucolipid metabolism, islet β cell function, adipocyte differentiation, blood pressure, and other biological and pathophysiological processes. Although mitochondrial protein FAM3A plays crucial roles in the regulation of glucolipid metabolism via stimulating ATP release to activate P2 receptor pathways, its mechanism in promoting ATP release in hepatocytes remains unrevealed.
    METHODS: db/db, high-fat diet (HFD)-fed, and global pannexin 1 (PANX1) knockout mice, as well as liver sections of individuals, were used in this study. Adenoviruses and adeno-associated viruses were utilized for in vivo gene overexpression or inhibition. To evaluate the metabolic status in mice, oral glucose tolerance test (OGTT), pyruvate tolerance test (PTT), insulin tolerance test (ITT), and magnetic resonance imaging (MRI) were conducted. Protein-protein interactions were determined by coimmunoprecipitation with mass spectrometry (MS) assays.
    RESULTS: In livers of individuals and mice with steatosis, the expression of ATP-permeable channel PANX1 was increased (P < 0.01). Hepatic PANX1 overexpression ameliorated the dysregulated glucolipid metabolism in obese mice. Mice with hepatic PANX1 knockdown or global PANX1 knockout exhibited disturbed glucolipid metabolism. Restoration of hepatic PANX1 rescued the metabolic disorders of PANX1-deficient mice (P < 0.05). Mechanistically, ATP release is mediated by the PANX1-activated protein kinase B-forkhead box protein O1 (Akt-FOXO1) pathway to inhibit gluconeogenesis via P2Y receptors in hepatocytes. PANX1-mediated ATP release also activated calmodulin (CaM) (P < 0.01), which interacted with c-Jun N-terminal kinase (JNK) to inhibit its activity, thereby deactivating the transcription factor activator protein-1 (AP1) and repressing fatty acid synthase (FAS) expression and lipid synthesis (P < 0.05). FAM3A stimulated the expression of PANX1 via heat shock factor 1 (HSF1) in hepatocytes (P < 0.05). Notably, FAM3A overexpression failed to promote ATP release, inhibit the expression of gluconeogenic and lipogenic genes, and suppress gluconeogenesis and lipid deposition in PANX1-deficient hepatocytes and livers.
    CONCLUSIONS: PANX1-mediated release of ATP plays a crucial role in maintaining hepatic glucolipid homeostasis, and it confers FAM3A\'s suppressive effects on hepatic gluconeogenesis and lipogenesis.
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  • 文章类型: Journal Article
    术后腹膜粘连是引起并发症的严重问题,比如肠梗阻,不孕症,和痛苦。目前没有预防手术后粘连的有效方法。免疫细胞和贴壁成纤维细胞过度分泌促炎细胞因子和促纤维化分子是促进术后纤维化瘢痕形成的主要机制。尽管已经对这种疾病的病理原因进行了许多研究,这件事仍然有许多未知的事实,因此,评估不同分子在引起炎症和粘连中的作用可以导致新的治疗方法的产生。连接蛋白是一组与间隙连接相关的蛋白质,在细胞通讯和相邻细胞之间传递信号中起作用。在不同类型的连接蛋白亚型之间,已知连接蛋白43与炎症和纤维化相关的病理状况有关。最近的研究报道,抑制连接蛋白43有可能通过减少参与粘附形成早期阶段的α-SMA和纤溶酶原激活物抑制剂(PAI)等分子的表达来减少炎症和纤维化。Further,抑制连接蛋白43可能具有作为预防手术后腹膜粘连的靶点的治疗潜力.
    Post-surgical peritoneal adhesions are a serious problem causing complications, such as bowel obstruction, infertility, and pain. There are currently no effective ways of preventing post-surgical adhesions. Excess secretion of proinflammatory cytokines and profibrotic molecules by immune cells and adherent fibroblasts is the main mechanism thatpromotes post-operative fibrotic scars. Although many studies have been conducted on the pathological causes of this disorder, there are still many unknown facts in this matter, so assessment of the role of different molecules in causing inflammation and adhesion can lead to the creation of new treatment methods. Connexins are a group of proteins related to gap junctions that have a role in cell communication and transmitted signaling between adjacent cells. Between different types of connexin protein isoforms, connexin43 is known to be involved in pathological conditions related to inflammation and fibrosis. Recent studies have reported that inhibition of connexin43 has the potential to reduce inflammation and fibrosis by reducing the expression of molecules like α-SMA and plasminogen activator inhibitor (PAI) that are involved in the early stages of adhesion formation. Further, inhibition of connexin43 may have therapeutic potential as a target to prevent post-surgical peritoneal adhesions.
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  • 文章类型: Journal Article
    在哺乳动物细胞质膜上表达的连接蛋白半通道(HC)对于细胞间通讯至关重要。在生理条件下,HC可以形成间隙连接(GJ)通道,提供相邻细胞之间的直接扩散路径。此外,不成对的HC为细胞质和细胞外环境之间的溶质交换提供了管道,包括参与旁分泌信号的信使分子。膜电位和Ca2离子的协同作用控制连接蛋白HC的大且相对非选择性的孔的门控。对细胞外([Ca2]e)和胞质([Ca2]c)Ca2浓度的门控敏感性的四个数量级差异表明可能存在至少两种不同的Ca2传感器。虽然[Ca2+]e充当HC开口的空间调制器,这很可能取决于细胞层,隔间,和器官,[Ca2+]c触发HC开放和信使分子胞外爆发的释放。这些分子包括ATP,cAMP,谷氨酸,NAD+,谷胱甘肽,D-丝氨酸,还有前列腺素.由Ca2+引起的HC调节丢失或异常与几种疾病有关,包括耳聋,角膜炎鱼鳞病,掌plant角化病,Charcot-Marie-Tooth神经病,眼指发育不良,和先天性白内障。Ca2敏感性的增加和降低与病理状况有关的事实表明,健康细胞中的Ca2可以很好地调节正常的HC功能。总的来说,需要进一步研究以阐明[Ca2]e和[Ca2]c变化过程中连接蛋白HC的结构和化学修饰。考虑Ca2和跨膜电压变化的分子模型无疑将增强我们对实验结果的解释,并为开发针对特定HC功能障碍的治疗化合物铺平道路。
    Connexin hemichannels (HCs) expressed at the plasma membrane of mammalian cells are of paramount importance for intercellular communication. In physiological conditions, HCs can form gap junction (GJ) channels, providing a direct diffusive path between neighbouring cells. In addition, unpaired HCs provide conduits for the exchange of solutes between the cytoplasm and the extracellular milieu, including messenger molecules involved in paracrine signalling. The synergistic action of membrane potential and Ca2+ ions controls the gating of the large and relatively unselective pore of connexin HCs. The four orders of magnitude difference in gating sensitivity to the extracellular ([Ca2+]e) and the cytosolic ([Ca2+]c) Ca2+ concentrations suggests that at least two different Ca2+ sensors may exist. While [Ca2+]e acts as a spatial modulator of the HC opening, which is most likely dependent on the cell layer, compartment, and organ, [Ca2+]c triggers HC opening and the release of extracellular bursts of messenger molecules. Such molecules include ATP, cAMP, glutamate, NAD+, glutathione, D-serine, and prostaglandins. Lost or abnormal HC regulation by Ca2+ has been associated with several diseases, including deafness, keratitis ichthyosis, palmoplantar keratoderma, Charcot-Marie-Tooth neuropathy, oculodentodigital dysplasia, and congenital cataracts. The fact that both an increased and a decreased Ca2+ sensitivity has been linked to pathological conditions suggests that Ca2+ in healthy cells finely tunes the normal HC function. Overall, further investigation is needed to clarify the structural and chemical modifications of connexin HCs during [Ca2+]e and [Ca2+]c variations. A molecular model that accounts for changes in both Ca2+ and the transmembrane voltage will undoubtedly enhance our interpretation of the experimental results and pave the way for developing therapeutic compounds targeting specific HC dysfunctions.
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  • 文章类型: Journal Article
    人类基因组中的调谐直向同源物仅包含19,872个蛋白质编码基因中的84个基因和16,528个非编码基因中的23个,但它们却站在Olfactores进化枝的底部,辐射产生数千种被膜动物和脊椎动物。这些基因中有哪些强大的驱动因素促成了这一过程?许多这些直系同源物存在于基因家族中。我们讨论了每个家庭的生物学作用以及直系同源物对家庭的定量贡献。最重要的是第二种钙粘蛋白的进化。这个,一种II型钙黏着蛋白,具有从表达I型类别的细胞中分离含有该钙黏着蛋白的细胞的性质。这种II型钙粘蛋白的集合现在可以脱离并远离它们的I型邻居,这个过程最终会演变成神经峰的形成,“第四胚层”,为进一步的进化发明提供了广泛的可能性。第二个重要贡献是对肌肉和神经蛋白以及视觉感知工具包的广泛开发的关键补充。机动性和视野方面的这些发展为Vertebrata的有效掠夺性能力的发展提供了基础。
    Tunicate orthologs in the human genome comprise just 84 genes of the 19,872 protein-coding genes and 23 of the 16,528 non-coding genes, yet they stand at the base of the Olfactores clade, which radiated to generate thousands of tunicate and vertebrate species. What were the powerful drivers among these genes that enabled this process? Many of these orthologs are present in gene families. We discuss the biological role of each family and the orthologs\' quantitative contribution to the family. Most important was the evolution of a second type of cadherin. This, a Type II cadherin, had the property of detaching the cell containing that cadherin from cells that expressed the Type I class. The set of such Type II cadherins could now detach and move away from their Type I neighbours, a process which would eventually evolve into the formation of the neural crest, \"the fourth germ layer\", providing a wide range of possibilities for further evolutionary invention. A second important contribution were key additions to the broad development of the muscle and nerve protein and visual perception toolkits. These developments in mobility and vision provided the basis for the development of the efficient predatory capabilities of the Vertebrata.
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  • 文章类型: Journal Article
    我们试图确定pannexin/嘌呤能依赖性信号在介导通过骨骼肌收缩的毛细血管刺激引起的传导血管舒张中的生理相关性。使用仓鼠提子肌肉和活体显微镜,我们通过局部肌肉收缩刺激毛细血管,同时观察相关的上游小动脉。在不存在和存在pannexin阻滞剂甲氟喹(MEF;10-5M)的情况下,在低收缩和高收缩(6和60CPM)和刺激频率(4和40Hz)下刺激毛细血管,嘌呤能受体拮抗剂苏拉明(SUR10-5M)和间隙连接解偶联剂氟烷(HALO,0.07%)施加在毛细血管刺激部位和上游小动脉观察部位之间。在6CPM引起的传导血管舒张被HALO抑制,而在60CPM引起的血管舒张被MEF和SUR抑制。在4Hz下引起的传导反应被MEF抑制,而在40Hz下的血管舒张不受任何阻断剂的影响。因此,通过肌肉收缩刺激毛细血管引起的上游血管舒张依赖于pannexin/嘌呤能依赖性通路,该通路似乎依赖于刺激参数.我们的数据强调了pannexin/嘌呤能途径在促进毛细血管和上游小动脉微脉管系统之间的联系方面的生理重要性,因此,这表明该途径可能在调节骨骼肌收缩时的血流中起关键作用。
    We sought to determine the physiological relevance of pannexin/purinergic-dependent signaling in mediating conducted vasodilation elicited by capillary stimulation through skeletal muscle contraction. Using hamster cremaster muscle and intravital microscopy we stimulated capillaries through local muscle contraction while observing the associated upstream arteriole. Capillaries were stimulated with muscle contraction at low and high contraction (6 and 60CPM) and stimulus frequencies (4 and 40 Hz) in the absence and presence of pannexin blocker mefloquine (MEF; 10-5 M), purinergic receptor antagonist suramin (SUR 10-5 M) and gap-junction uncoupler halothane (HALO, 0.07%) applied between the capillary stimulation site and the upstream arteriolar observation site. Conducted vasodilations elicited at 6CPM were inhibited by HALO while vasodilations at 60CPM were inhibited by MEF and SUR. The conducted response elicited at 4 Hz was inhibited by MEF while the vasodilation at 40 Hz was unaffected by any blocker. Therefore, upstream vasodilations resulting from capillary stimulation via muscle contraction are dependent upon a pannexin/purinergic-dependent pathway that appears to be stimulation parameter-dependent. Our data highlight a physiological importance of the pannexin/purinergic pathway in facilitating communication between capillaries and upstream arteriolar microvasculature and, consequently, indicating that this pathway may play a crucial role in regulating blood flow in response to skeletal muscle contraction.
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  • 文章类型: Journal Article
    目的:Pannexin-1(PANX1)是一种在打开时释放ATP的半通道,引发炎症,细胞增殖,和移民。然而,PANX1通道在结肠癌中的作用仍然知之甚少,从而构成了本研究的重点。
    方法:使用多个癌症数据库分析PANX1mRNA表达。采用免疫组化法检测PANX1蛋白在结肠癌患者原发肿瘤组织和非肿瘤结肠黏膜中的表达和分布。PANX1抑制剂(丙磺舒或10Panx)用于评估结肠癌细胞系活力。为了研究PANX1在体内的作用,在BALB/cNOD/SCID免疫缺陷小鼠中使用HCT116细胞进行皮下异种移植模型,以评估使用丙磺舒在PANX1抑制下的肿瘤生长.
    结果:与非肿瘤结肠粘膜相比,PANX1mRNA在结肠癌组织中上调。肿瘤中PANX1mRNA表达升高与无疾病生存率降低相关。与成对样品中的上皮细胞相比,肿瘤细胞上的PANX1蛋白丰度增加,以癌症分期的方式。体外和体内实验表明阻断PANX1降低了细胞活力和肿瘤生长。
    结论:PANX1可用作结肠癌进展的生物标志物,阻断PANX1通道开放可用作针对该疾病的潜在治疗策略。
    OBJECTIVE: Pannexin-1 (PANX1) is a hemichannel that releases ATP upon opening, initiating inflammation, cell proliferation, and migration. However, the role of PANX1 channels in colon cancer remains poorly understood, thus constituting the focus of this study.
    METHODS: PANX1 mRNA expression was analyzed using multiple cancer databases. PANX1 protein expression and distribution were evaluated by immunohistochemistry on primary tumor tissue and non-tumor colonic mucosa from colon cancer patients. PANX1 inhibitors (probenecid or 10Panx) were used to assess colon cancer cell lines viability. To study the role of PANX1 in vivo, a subcutaneous xenograft model using HCT116 cells was performed in BALB/c NOD/SCID immunodeficient mice to evaluate tumor growth under PANX1 inhibition using probenecid.
    RESULTS: PANX1 mRNA was upregulated in colon cancer tissue compared to non-tumor colonic mucosa. Elevated PANX1 mRNA expression in tumors correlated with worse disease-free survival. PANX1 protein abundance was increased on tumor cells compared to epithelial cells in paired samples, in a cancer stage-dependent manner. In vitro and in vivo experiments indicated that blocking PANX1 reduced cell viability and tumor growth.
    CONCLUSIONS: PANX1 can be used as a biomarker of colon cancer progression and blocking PANX1 channel opening could be used as a potential therapeutic strategy against this disease.
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  • 文章类型: Journal Article
    非编码RNA(ncRNA)是一类不能翻译成肽的核苷酸序列。ncRNA可以通过剪接mRNA或其他ncRNA的互补序列或通过直接参与蛋白质相互作用而在转录后起作用。在过去的几十年里,已经确定了ncRNAs在细胞生理学中的普遍性及其在各种疾病中的关键作用。由ncRNAs调控的一个靶标是连接蛋白(Cx),形成间隙连接和半通道并促进细胞间分子交换的蛋白质。连接蛋白的异常表达和分布与中枢神经系统疾病有关。心血管疾病,骨疾病,和癌症。当前的数据库和技术使研究人员能够识别ncRNAs和连接蛋白之间的直接或间接关系,从而阐明它们与疾病的相关性。在这次审查中,我们选择了过去5年发表的有关ncRNAs通过相应连接蛋白调节的疾病的文献.其中,调节Cx43表达的microRNAs在疾病发展中起着至关重要的作用,主要进行综述。ncRNA-Cx轴的独特视角以表观遗传学方式解释病理学,并有望激发生物标志物和治疗剂开发的研究。
    Noncoding RNAs (ncRNAs) are a class of nucleotide sequences that cannot be translated into peptides. ncRNAs can function post-transcriptionally by splicing complementary sequences of mRNAs or other ncRNAs or by directly engaging in protein interactions. Over the past few decades, the pervasiveness of ncRNAs in cell physiology and their pivotal roles in various diseases have been identified. One target regulated by ncRNAs is connexin (Cx), a protein that forms gap junctions and hemichannels and facilitates intercellular molecule exchange. The aberrant expression and misdistribution of connexins have been implicated in central nervous system diseases, cardiovascular diseases, bone diseases, and cancer. Current databases and technologies have enabled researchers to identify the direct or indirect relationships between ncRNAs and connexins, thereby elucidating their correlation with diseases. In this review, we selected the literature published in the past five years concerning disorders regulated by ncRNAs via corresponding connexins. Among it, microRNAs that regulate the expression of Cx43 play a crucial role in disease development and are predominantly reviewed. The distinctive perspective of the ncRNA-Cx axis interprets pathology in an epigenetic manner and is expected to motivate research for the development of biomarkers and therapeutics.
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  • 文章类型: Journal Article
    卵母细胞和卵丘细胞(CC)之间的结构和功能特性差异可能导致卵丘-卵母细胞复合物(COCs)的玻璃化效率低。我们已经提出,为了以各种方式进一步冷冻保存,CC和卵母细胞的断开将积极影响解冻后的生存能力,而进一步的体外共培养将有助于恢复丢失的细胞间缝隙连接。本研究旨在确定将CCs悬液冷冻保存到体外成熟GV卵母细胞的最佳方法,并确定基因(GJA1,GJA4;BCL2,BAX)的mRNA表达水平以及基因特异性表观遗传标记(DNMT3A)在各种培养系统中的冷冻保存和体外成熟(IVM)。我们已经表明,与玻璃化和微滴中的缓慢冷冻方法相比,微吸管中CC的缓慢冷冻保留了最大数量的具有完整DNA的活细胞。冷冻保存导致卵母细胞中基因Cx37和Cx43的上调,以恢复细胞之间的间隙连接。总之,在卵母细胞的IVM过程中,共培养系统中CCs的存在在调节细胞间蛋白Cx37和Cx43的表达,凋亡变化中发挥了重要作用,和卵母细胞甲基化。在微吸管中缓慢冷冻被认为是低温保存CC的最佳方法。
    Differences in structural and functional properties between oocytes and cumulus cells (CCs) may cause low vitrification efficiency for cumulus-oocyte complexes (COCs). We have suggested that the disconnection of CCs and oocytes in order to further cryopreservation in various ways will positively affect the viability after thawing, while further co-culture in vitro will contribute to the restoration of lost intercellular gap junctions. This study aimed to determine the optimal method of cryopreservation of the suspension of CCs to mature GV oocytes in vitro and to determine the level of mRNA expression of the genes (GJA1, GJA4; BCL2, BAX) and gene-specific epigenetic marks (DNMT3A) after cryopreservation and in vitro maturation (IVM) in various culture systems. We have shown that the slow freezing of CCs in microstraws preserved the largest number of viable cells with intact DNA compared with the methods of vitrification and slow freezing in microdroplets. Cryopreservation caused the upregulation of the genes Cx37 and Cx43 in the oocytes to restore gap junctions between cells. In conclusion, the presence of CCs in the co-culture system during IVM of oocytes played an important role in the regulation of the expression of the intercellular proteins Cx37 and Cx43, apoptotic changes, and oocyte methylation. Slow freezing in microstraws was considered to be an optimal method for cryopreservation of CCs.
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    文章类型: Journal Article
    目的:确定非综合征性听力损失(NSHL)患者中致病变异的频谱和频率,并研究应用的遗传方法的诊断率。
    方法:该研究招募了306名儿童期发病的无关患者,在2006年3月至2023年10月之间,轻度至深度的NSHL转诊至萨格勒布儿童医院进行基因检测。用多重连接依赖性探针扩增方法和GJB2基因编码区的Sanger测序分析GJB2变体。在21例GJB2双等位基因变异阴性的患者中,进行临床外显子组测序(CES).
    结果:在检测到的234个疾病相关GJB2等位基因中,19是临床相关的,其中18例报告为致病性/可能致病性。c.35delG变体占突变等位基因的73.5%。超过一半的具有双等位基因GJB2变体的患者(64/110,58.2%)是35delG纯合子。在10个基因中发现了17种非GJB2变体(TECTA,NOG,SLC26A4,PCDH15,TMPRSS3,USH2A,GATA3,MYO15A,SOX10,COL2A1)在11名参与者中,和5个变体(在TECTA中,NOG,PCDH15和SOX10)是新的(29.4%)。
    结论:我们能够阐明121例患者听力损失的遗传原因,总体诊断率为39.5%。c.35delG是最常见的变体。CES使我们能够诊断几乎一半的HL患者;在表型不明确或从小就没有症状的情况下,将NSHL与HL的综合征形式区分开来;并发现新的变体。
    OBJECTIVE: To determine the spectrum and frequency of disease-causing variants in patients with non-syndromic hearing loss (NSHL) and to investigate the diagnostic yield of the applied genetic methods.
    METHODS: The study enrolled 306 unrelated patients with childhood-onset, mild-to-profound NSHL referred to Children\'s Hospital Zagreb for genetic testing between March 2006 and October 2023. The GJB2 variants were analyzed with the multiplex ligation-dependent probe amplification method and Sanger sequencing of the coding region of the GJB2 gene. In 21 patients negative for GJB2 biallelic variants, clinical exome sequencing (CES) was performed.
    RESULTS: Among 234 disease-associated GJB2 alleles detected, 19 were clinically relevant, of which 18 were reported as pathogenic/likely pathogenic. The c.35delG variant accounted for 73.5% of the mutated alleles. More than half of the patients with biallelic GJB2 variants (64/110, 58.2%) were 35delG homozygotes. Seventeen non-GJB2 variants were found in 10 genes (TECTA, NOG, SLC26A4, PCDH15, TMPRSS3, USH2A, GATA3, MYO15A, SOX10, COL2A1) in 11 participants, and 5 variants (in TECTA, NOG, PCDH15, and SOX10) were novel (29.4%).
    CONCLUSIONS: We were able to elucidate the genetic cause of hearing loss in 121 patients, with an overall diagnostic rate of 39.5%. The c.35delG was the most common variant. CES allowed us to diagnose almost half of the patients with HL; to distinguish NSHL from the syndromic form of HL in cases where the phenotype was unclear or where symptoms were absent from an early age; and to discover novel variants.
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