Pentosyltransferases

戊糖基转移酶
  • 文章类型: Journal Article
    恶性疟原虫是疟疾的主要病原体,一种主要影响五岁以下儿童的致命疾病。以青蒿素为基础的联合疗法在控制疾病方面至关重要,但是不同地区出现了抵抗,增加治疗失败的风险。非甲羟戊酸途径对于疟原虫中的类异戊二烯合成至关重要,并提供了一些尚未开发的靶标,用于发现新的抗疟疾药。1-脱氧-D-木酮糖-5-磷酸合酶(DXPS)是该途径的第一个和限速酶。尽管它很重要,任何疟原虫都没有可用的结构。,由于复杂的序列包含大量高度无序的区域,使结晶成为一项艰巨的任务。在这份手稿中,我们使用低温电子显微镜来解决恶性疟原虫DXPS结构,最终分辨率为2.42µ。总的来说,该结构类似于其他DXPS酶,但包括疟原虫属独有的独特N末端结构域。突变研究表明,帽结构域界面的不稳定对蛋白质的稳定性和活性产生负面影响。此外,在活性位点发现辅因子硫胺素二磷酸酯的密度。我们的工作强调了冷冻EM获得恶性疟原虫蛋白质结构的潜力,这些结构通过晶体学是不可行的。
    Plasmodium falciparum is the main causative agent of malaria, a deadly disease that mainly affects children under five years old. Artemisinin-based combination therapies have been pivotal in controlling the disease, but resistance has arisen in various regions, increasing the risk of treatment failure. The non-mevalonate pathway is essential for the isoprenoid synthesis in Plasmodium and provides several under-explored targets to be used in the discovery of new antimalarials. 1-deoxy-D-xylulose-5-phosphate synthase (DXPS) is the first and rate-limiting enzyme of the pathway. Despite its importance, there are no structures available for any Plasmodium spp., due to the complex sequence which contains large regions of high disorder, making crystallisation a difficult task. In this manuscript, we use cryo-electron microscopy to solve the P. falciparum DXPS structure at a final resolution of 2.42 Å. Overall, the structure resembles other DXPS enzymes but includes a distinct N-terminal domain exclusive to the Plasmodium genus. Mutational studies show that destabilization of the cap domain interface negatively impacts protein stability and activity. Additionally, a density for the co-factor thiamine diphosphate is found in the active site. Our work highlights the potential of cryo-EM to obtain structures of P. falciparum proteins that are unfeasible by means of crystallography.
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  • 文章类型: Journal Article
    最近对单基因替代疗法治疗神经肌肉疾病的临床研究表明,它们可以减缓或阻止疾病进展,但是这种疗法对逆转已经存在的肌肉疾病几乎没有影响。为了逆转肌营养不良患者的疾病,新的肌肉质量和力量必须在基因替代防止后续疾病的同时重建。这里,我们表明,FKRPP448L小鼠用包装在单个AAV载体中的双重FKRP/FST基因治疗治疗,可以建立超过野生型小鼠的肌肉力量和质量,并且可以在一小时步行试验中诱导正常的步行耐力.双重FKRP/FST疗法还显示出相对于单独的任一单一基因疗法,两个基因的肌肉质量和扩增的肌肉表达更均匀的增加。这些数据表明,用携带FKRP/FST双重基因疗法的单一AAV治疗可以通过改善肌肉力量同时防止随后的肌肉损伤来克服步行损失。该设计平台可用于创建其他形式的肌营养不良症的疗法,以改善患者的预后。
    Recent clinical studies of single gene replacement therapy for neuromuscular disorders have shown they can slow or stop disease progression, but such therapies have had little impact on reversing muscle disease that was already present. To reverse disease in patients with muscular dystrophy, new muscle mass and strength must be rebuilt at the same time that gene replacement prevents subsequent disease. Here, we show that treatment of FKRPP448L mice with a dual FKRP/FST gene therapy packaged into a single adeno-associated virus (AAV) vector can build muscle strength and mass that exceed levels found in wild-type mice and can induce normal ambulation endurance in a 1-h walk test. Dual FKRP/FST therapy also showed more even increases in muscle mass and amplified muscle expression of both genes relative to either single gene therapy alone. These data suggest that treatment with single AAV-bearing dual FKRP/FST gene therapies can overcome loss of ambulation by improving muscle strength at the same time it prevents subsequent muscle damage. This design platform could be used to create therapies for other forms of muscular dystrophy that may improve patient outcomes.
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  • 文章类型: Case Reports
    脊柱眼综合征(SOS)是一种罕见的常染色体隐性遗传骨骼和眼部疾病,具有不同的表型。它是由XYLT2基因的致病性突变引起的,它编码的酶是木基转移酶,合成蛋白聚糖所必需的。它的特点是全身性骨质疏松症,身材矮小,听力障碍,眼睛异常,和心脏缺陷。迄今为止,全世界仅报告了24例病例,印度没有病例记录。我们对患者进行了相关的生化检查和双能X射线吸收测定(DEXA)扫描以及下一代临床外显子组测序(NGCES)。我们报告了一例23岁的男性,他表现为复发性长骨骨折,先天性心脏缺陷,眼睛异常(双侧角膜混浊和萎缩性球部),身材矮小。此外,我们的患者还患有Genuvalgum和右侧鞘膜积液,迄今为止从未在SOS中报告过。在遗传分析中,NGCES揭示了一种新的致病性移码变体c.191_192delCA,p.(Thr64fs*22)中的XYLT2基因。患者在6个月注射唑来膦酸后情况良好。
    Spondyloocular syndrome (SOS) is a rare autosomal recessive skeletal and ocular disorder with variable phenotypes. It is caused by pathogenic mutation in the XYLT2 gene, which encodes the enzyme xylo-transferase, necessary for the synthesis of proteoglycan. It is characterized by generalized osteoporosis, short stature, hearing impairment, eye abnormalities, and cardiac defects. Till date only 24 cases have been reported worldwide with no cases documented from India. We subjected the patient to relevant biochemical investigations and Dual Energy X-ray Absorptiometry (DEXA) scan along with Next Generation Clinical Exome Sequencing (NGCES). We report a case of 23-year-old male who presented with recurrent long bone fractures, congenital heart defects, eye abnormalities (bilateral corneal opacities and atrophic bulbi), and short stature. In addition, our patient also had genu valgum and right-sided hydrocele which have never been reported in SOS till date. On genetic analysis, NGCES revealed a novel pathogenic frameshift variant c.191_192 delCA, p.(Thr64fs*22) in the XYLT2 gene. The patient is doing well on six monthly zoledronic acid infusions.
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  • 文章类型: Journal Article
    背景:间充质干细胞(MSCs)因其亲肿瘤特性而引起了极大的兴趣,使它们成为癌症治疗的潜在治疗载体。我们先前已经使用具有编码胞嘧啶脱氨酶和尿嘧啶磷酸核糖转移酶(CDUPRT)和绿色荧光蛋白(GFP)的治疗性转基因的非病毒工程化MSC在患有天然存在的癌症的小鼠临床前模型和伴侣动物中显示出显著的抗肿瘤活性。临床研究表明,在腹膜癌(PC)中,5-氟尿嘧啶和干扰素-β(IFNb)的组合治疗可改善反应率。然而,高的全身毒性限制了这种药物的临床应用。
    方法:在本研究中,我们评估了腹膜内给予非病毒工程化MSCs共同递送CDUPRT/5-氟胞嘧啶前药系统和IFNb以潜在增强cGAS-STING信号轴的可行性.这里,将MSC工程化以表达CDUPRT或CDUPRT-IFNb。流式细胞术和ELISA证实CDUPRT和IFNb的表达,分别。在体外和体内模型中评估工程化MSC的抗癌功效。将ES2、HT-29和Colo-205与工程化MSC以各种比例共培养。用MTS测定法测量有或没有5-氟胞嘧啶的细胞活力。为了进一步比较工程MSCs的抗癌功效,通过腹腔注射表达荧光素酶的ES2稳定细胞建立腹膜癌变小鼠模型。通过生物发光跟踪测量肿瘤负荷。
    结果:首先,尽管编码CDUPRT和IFNb(CDUPRT-IFNb)的转基因高表达,但MSCs的表型没有变化。Transwell迁移测定和体内跟踪表明,多种转基因的共表达不会影响MSC的迁移能力。在体外ES2、HT-29和Colo-205中证明了CDUPRT-IFNb优于表达CDUPRT的MSC。在腹膜内ES2卵巢癌异种移植模型中观察到类似的观察结果。在用表达CDUPRT-IFNb或CDUPRT的MSCs治疗的小鼠中,肿瘤块的生长被抑制约90%和46%,分别。
    结论:综合来看,这些结果确立了共表达CDUPRT和IFNb的MSC在控制和靶向PC生长中的有效性。本研究为开发使用多基因武装的MSCs进行PC的临床试验奠定了基础。
    BACKGROUND: Mesenchymal stem cells (MSCs) have garnered significant interest for their tumor-tropic property, making them potential therapeutic delivery vehicles for cancer treatment. We have previously shown the significant anti-tumour activity in mice preclinical models and companion animals with naturally occurring cancers using non-virally engineered MSCs with a therapeutic transgene encoding cytosine deaminase and uracil phosphoribosyl transferase (CDUPRT) and green fluorescent protein (GFP). Clinical studies have shown improved response rate with combinatorial treatment of 5-fluorouracil and Interferon-beta (IFNb) in peritoneal carcinomatosis (PC). However, high systemic toxicities have limited the clinical use of such a regime.
    METHODS: In this study, we evaluated the feasibility of intraperitoneal administration of non-virally engineered MSCs to co-deliver CDUPRT/5-Flucytosine prodrug system and IFNb to potentially enhance the cGAS-STING signalling axis. Here, MSCs were engineered to express CDUPRT or CDUPRT-IFNb. Expression of CDUPRT and IFNb was confirmed by flow cytometry and ELISA, respectively. The anti-cancer efficacy of the engineered MSCs was evaluated in both in vitro and in vivo model. ES2, HT-29 and Colo-205 were cocultured with engineered MSCs at various ratio. The cell viability with or without 5-flucytosine was measured with MTS assay. To further compare the anti-cancer efficacy of the engineered MSCs, peritoneal carcinomatosis mouse model was established by intraperitoneal injection of luciferase expressing ES2 stable cells. The tumour burden was measured through bioluminescence tracking.
    RESULTS: Firstly, there was no changes in phenotypes of MSCs despite high expression of the transgene encoding CDUPRT and IFNb (CDUPRT-IFNb). Transwell migration assays and in-vivo tracking suggested the co-expression of multiple transgenes did not impact migratory capability of the MSCs. The superiority of CDUPRT-IFNb over CDUPRT expressing MSCs was demonstrated in ES2, HT-29 and Colo-205 in-vitro. Similar observations were observed in an intraperitoneal ES2 ovarian cancer xenograft model. The growth of tumor mass was inhibited by ~ 90% and 46% in the mice treated with MSCs expressing CDUPRT-IFNb or CDUPRT, respectively.
    CONCLUSIONS: Taken together, these results established the effectiveness of MSCs co-expressing CDUPRT and IFNb in controlling and targeting PC growth. This study lay the foundation for the development of clinical trial using multigene-armed MSCs for PC.
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  • 文章类型: Journal Article
    现代,已知高度进化的核苷加工酶对N9处嘌呤核碱基的糖基化表现出完美的区域选择性。我们在此报告了这一范式的一个例外。野生型核苷磷酸化酶还提供N7-黄嘌呤,黄苷的“非天然核糖基化区域异构体”。这种不寻常的核苷具有几种非典型的物理化学性质,如红移吸收光谱,磷解和低酸度的高平衡常数。最终,这种以前未知的天然产物的生物合成说明了甚至是高度进化的,来自初级代谢的必需酶是不完美的催化剂。
    Modern, highly evolved nucleoside-processing enzymes are known to exhibit perfect regioselectivity over the glycosylation of purine nucleobases at N9. We herein report an exception to this paradigm. Wild-type nucleoside phosphorylases also furnish N7-xanthosine, a \"non-native\" ribosylation regioisomer of xanthosine. This unusual nucleoside possesses several atypical physicochemical properties such as redshifted absorption spectra, a high equilibrium constant of phosphorolysis and low acidity. Ultimately, the biosynthesis of this previously unknown natural product illustrates how even highly evolved, essential enzymes from primary metabolism are imperfect catalysts.
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  • 文章类型: Journal Article
    次黄嘌呤-鸟嘌呤-黄嘌呤磷酸核糖基转移酶活性的抑制减少了DNA和RNA合成所需的6-氧代和6-氨基嘌呤核苷单磷酸。导致细胞生长减少。因此,这种酶的抑制剂有可能控制感染,由恶性疟原虫和间日疟原虫引起,布鲁氏锥虫,结核分枝杆菌,和幽门螺杆菌。此处合成的五种化合物含有嘌呤碱基,其通过脯氨酸醇基团与一个或两个膦酸酯基团共价连接,其Ki值范围为3nM至>10μM,取决于抑制剂的结构和酶的生物来源。X射线晶体结构表明,关于绑定,这些含脯氨酸醇的抑制剂刺激了酶中活性位点环的运动。针对细胞培养中的TBr,前药表现出10μM的EC50。因此,这些化合物是进一步开发的优秀候选药物,作为抗感染性疾病的药物,也是潜在的抗癌剂。
    Inhibition of hypoxanthine-guanine-xanthine phosphoribosyltransferase activity decreases the pool of 6-oxo and 6-amino purine nucleoside monophosphates required for DNA and RNA synthesis, resulting in a reduction in cell growth. Therefore, inhibitors of this enzyme have potential to control infections, caused by Plasmodium falciparum and Plasmodium vivax, Trypanosoma brucei, Mycobacterium tuberculosis, and Helicobacter pylori. Five compounds synthesized here that contain a purine base covalently linked by a prolinol group to one or two phosphonate groups have Ki values ranging from 3 nM to >10 μM, depending on the structure of the inhibitor and the biological origin of the enzyme. X-ray crystal structures show that, on binding, these prolinol-containing inhibitors stimulated the movement of active site loops in the enzyme. Against TBr in cell culture, a prodrug exhibited an EC50 of 10 μM. Thus, these compounds are excellent candidates for further development as drug leads against infectious diseases as well as being potential anticancer agents.
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  • 文章类型: Journal Article
    背景:围产期抑郁症(包括产前-,Postnatal-,和跨越两个时间点的抑郁症)是一种流行的疾病,发病率高,影响母亲和孩子。即使围产期抑郁症的完整生物学蓝图仍然不完整,多项研究表明,至少对于产前抑郁症,该疾病具有炎症成分,可能与酶促犬尿氨酸途径的失调有关。在这个通路中产生神经活性代谢物,包括喹啉酸(QUIN),由于怀孕期间代谢物的多种免疫学作用,在胎盘中上调。由于该途径产生的神经活性代谢物也可能通过直接影响谷氨酸神经传递来影响情绪,我们试图调查控制QUIN产生的犬尿氨酸途径酶的胎盘表达是否与妊娠期间的外周炎症和抑郁症状相关.
    方法:使用qPCR分析出生时获得的68个胎盘,以确定犬尿氨酸途径酶的表达。使用高灵敏度电致发光和超高效液相色谱法定量血浆中的细胞因子和代谢物,分别。在整个怀孕和产后期间,使用爱丁堡产后抑郁量表(EPDS)评估产妇的抑郁症状。使用具有排序酶的稳健线性回归评估这些因素之间的关联。
    结果:胎盘喹啉酸磷酸核糖转移酶(QPRT)低,负责降解QUIN的酶,在妊娠晚期与更高的IL-6和更高的QUIN/犬尿烯酸比率相关。此外,妊娠晚期有严重抑郁症状的女性,QPRT和2-氨基-3-羧基羧酸-6-半醛脱羧酶(ACMSD)的胎盘表达均显著降低;这两种酶活性受损导致QUIN积累.
    结论:总体而言,我们的数据支持胎盘环境受损,关键犬尿氨酸途径酶的低表达与妊娠期间抑郁妇女中观察到的血浆细胞因子水平升高和犬尿氨酸代谢异常模式相关。
    BACKGROUND: Perinatal depression (including antenatal-, postnatal-, and depression that spans both timepoints) is a prevalent disorder with high morbidity that affects both mother and child. Even though the full biological blueprints of perinatal depression remain incomplete, multiple studies indicate that, at least for antenatal depression, the disorder has an inflammatory component likely linked to a dysregulation of the enzymatic kynurenine pathway. The production of neuroactive metabolites in this pathway, including quinolinic acid (QUIN), is upregulated in the placenta due to the multiple immunological roles of the metabolites during pregnancy. Since neuroactive metabolites produced by the pathway also may affect mood by directly affecting glutamate neurotransmission, we sought to investigate whether the placental expression of kynurenine pathway enzymes controlling QUIN production was associated with both peripheral inflammation and depressive symptoms during pregnancy.
    METHODS: 68 placentas obtained at birth were analyzed using qPCR to determine the expression of kynurenine pathway enzymes. Cytokines and metabolites were quantified in plasma using high-sensitivity electroluminescence and ultra-performance liquid chromatography, respectively. Maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) throughout pregnancy and the post-partum. Associations between these factors were assessed using robust linear regression with ranked enzymes.
    RESULTS: Low placental quinolinate phosphoribosyl transferase (QPRT), the enzyme responsible for degrading QUIN, was associated with higher IL-6 and higher QUIN/kynurenic acid ratios at the 3rd trimester. Moreover, women with severe depressive symptoms in the 3rd trimester had significantly lower placental expression of both QPRT and 2-amino-3-carboxymuconate-6-semialdehyde decarboxylase (ACMSD); impaired activity of these two enzymes leads to QUIN accumulation.
    CONCLUSIONS: Overall, our data support that a compromised placental environment, featuring low expression of critical kynurenine pathway enzymes is associated with increased levels of plasma cytokines and the dysregulated kynurenine metabolite pattern observed in depressed women during pregnancy.
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  • 文章类型: Journal Article
    草木聚糖由β-1,4-连接的木糖基残基的线性链组成,该残基通常形成仅被阿拉伯呋喃糖(Araf)或(甲基)葡糖醛酸[(Me)GlcA]残基取代的结构域,并且缺乏独特的还原末端四糖序列在双子木聚糖中发现。草木聚糖主链延伸的启动机制以及如何确定其独特的取代模式仍然难以捉摸。这里,我们进行了水稻木聚糖生物合成酶的生化表征,包括木聚糖合酶,葡糖醛酸转移酶和甲基转移酶。水稻木聚糖合酶的活性测定表明,它们需要短的木聚糖低聚物作为其活性的受体。虽然稻木聚糖葡糖醛酸基转移酶有效地将未取代的木二己糖受体葡糖醛酸化,他们将少量的GlcA残基转移到Araf取代的木糖六糖上,而水稻木聚糖3-O-阿拉伯糖基转移酶不能阿拉伯糖基化GlcA取代的木糖六糖,表明它们的内在生化特性可能有助于水稻木聚糖的独特取代模式。此外,我们发现水稻木聚糖甲基转移酶表现出低的底物结合亲和力,这可以解释水稻木聚糖中GlcA的部分甲基化。此外,木聚糖在水稻和拟南芥木质部细胞中的免疫定位表明,它与纤维素一起沉积在次生壁中,而没有形成富含木聚糖的纳米结构域。一起,我们的发现为草类木聚糖主链延伸和取代的生化机制提供了新的见解。
    Grass xylan consists of a linear chain of β-1,4-linked xylosyl residues that often form domains substituted only with either arabinofuranose (Araf) or glucuronic acid (GlcA)/methylglucuronic acid (MeGlcA) residues, and it lacks the unique reducing end tetrasaccharide sequence found in dicot xylan. The mechanism of how grass xylan backbone elongation is initiated and how its distinctive substitution pattern is determined remains elusive. Here, we performed biochemical characterization of rice xylan biosynthetic enzymes, including xylan synthases, glucuronyltransferases and methyltransferases. Activity assays of rice xylan synthases demonstrated that they required short xylooligomers as acceptors for their activities. While rice xylan glucuronyltransferases effectively glucuronidated unsubstituted xylohexaose acceptors, they transferred little GlcA residues onto (Araf)-substituted xylohexaoses and rice xylan 3-O-arabinosyltransferase could not arabinosylate GlcA-substituted xylohexaoses, indicating that their intrinsic biochemical properties may contribute to the distinctive substitution patterns of rice xylan. In addition, we found that rice xylan methyltransferase exhibited a low substrate binding affinity, which may explain the partial GlcA methylation in rice xylan. Furthermore, immunolocalization of xylan in xylem cells of both rice and Arabidopsis showed that it was deposited together with cellulose in secondary walls without forming xylan-rich nanodomains. Together, our findings provide new insights into the biochemical mechanisms underlying xylan backbone elongation and substitutions in grass species.
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  • 文章类型: Journal Article
    背景:由于超过30种不同的基因突变,四肢带肌营养不良(LGMDs)的特征是肩部和臀部带肌进行性无力。本研究旨在对该组疾病进行临床结果评估。
    方法:本研究的主要目标是评估一系列结果测量对广泛的LGMD表型和能力水平的实用性,以确定是否可以在具有不同表型的个体之间使用相似的结果。我们将执行多中心,在已建立的遗传分辨率和评估中对188名LGMD患者进行了为期12个月的研究,以解决LGMD(GRASP-LGMD)研究联盟的表型,它由美国的11个站点和欧洲的2个站点组成。登记的患者将在临床上受到影响,并且在CAPN3(LGMDR1)中有突变,ANO5(LGMDR12),DYSF(LGMDR2),DNAJB6(LGMDD1),SGCA(LGMDR3),SGCB(LGMDR4),SGCD(LGMDR6),或SGCG(LGMDR5或FKRP相关(LGMDR9)。
    结论:据我们所知,这将是组织的最大的联盟,以前瞻性验证LGMD的临床结果评估(COA)完成。这些评估将通过确定可靠的临床试验,有效,和响应性结果指标,并为未来LGMD治疗剂的临床试验提供数据驱动的临床试验决策。这项研究的结果将允许更有效的临床试验设计。在本研究结束后,所有相关数据将适用于参与LGMD治疗开发的研究人员或公司。
    背景:Clinicaltrials.govNCT03981289;注册日期:6/10/2019。
    BACKGROUND: The Limb Girdle Muscular Dystrophies (LGMDs) are characterized by progressive weakness of the shoulder and hip girdle muscles as a result of over 30 different genetic mutations. This study is designed to develop clinical outcome assessments across the group of disorders.
    METHODS: The primary goal of this study is to evaluate the utility of a set of outcome measures on a wide range of LGMD phenotypes and ability levels to determine if it would be possible to use similar outcomes between individuals with different phenotypes. We will perform a multi-center, 12-month study of 188 LGMD patients within the established Genetic Resolution and Assessments Solving Phenotypes in LGMD (GRASP-LGMD) Research Consortium, which is comprised of 11 sites in the United States and 2 sites in Europe. Enrolled patients will be clinically affected and have mutations in CAPN3 (LGMDR1), ANO5 (LGMDR12), DYSF (LGMDR2), DNAJB6 (LGMDD1), SGCA (LGMDR3), SGCB (LGMDR4), SGCD (LGMDR6), or SGCG (LGMDR5, or FKRP-related (LGMDR9).
    CONCLUSIONS: To the best of our knowledge, this will be the largest consortium organized to prospectively validate clinical outcome assessments (COAs) in LGMD at its completion. These assessments will help clinical trial readiness by identifying reliable, valid, and responsive outcome measures as well as providing data driven clinical trial decision making for future clinical trials on therapeutic agents for LGMD. The results of this study will permit more efficient clinical trial design. All relevant data will be made available for investigators or companies involved in LGMD therapeutic development upon conclusion of this study as applicable.
    BACKGROUND: Clinicaltrials.gov NCT03981289; Date of registration: 6/10/2019.
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  • 文章类型: Case Reports
    Fukutin相关蛋白(FKRP)突变导致广泛的肌营养不良,从相对轻度的9型肢带肌营养不良(LGMDR9)到严重的先天性肌营养不良(CMD)。这项研究旨在报告两个属于非近亲突尼斯家族的兄弟姐妹,他们拥有一种新型的复合杂合FKRP变体,并表现出轻度的LGDMR9表型。对于突变筛选,进行大规模平行测序,然后进行Sanger测序和多重连接依赖性探针扩增(MLPA)以验证发现的变体的存在。通过免疫组织化学确定不存在α-营养不良聚糖。进行脑部和大腿磁共振成像(MRI)以检测大腿和脑部异常。这两个兄弟姐妹的发病年龄较晚,临床检查显示,骨盆带主要是近端和对称分布的无力,没有心脏或呼吸道的参与。他们的改良Gardner-MedwinWalton量表mGMWS评分均为4级,改良Rankin量表(mRS)评分均为1分。DNA测序揭示了一个等位基因中外显子2和3的新缺失和一个错义突变c.1364C>A,据报道,这是在第二个等位基因上导致先天性肌营养不良和智力低下的原因。在两种情况下同时存在两种变异表明变异与病理生理学分离。
    Fukutin-related protein (FKRP) mutations cause a broad spectrum of muscular dystrophies, from a relatively mild limb-girdle muscular dystrophy type 9 (LGMDR9) to severe congenital muscular dystrophy (CMD). This study aims to report two siblings belonging to a non-consanguineous Tunisian family harboring a novel compound heterozygous FKRP variant and presenting a mild LGDMR9 phenotype. For mutation screening, massive parallel sequencing was performed, followed by Sanger sequencing and multiplex ligation-dependent probe amplification (MLPA) to validate the existence of the discovered variants. The absence of alpha-dystroglycan was determined by immunohistochemistry. Brain and thigh magnetic resonance imaging (MRI) were performed to detect thigh and brain abnormalities. The two siblings had a late age at onset and clinical examination showed that the pelvic girdles had a predominantly proximal and symmetrical distribution of weakness without cardiac or respiratory involvement. They both had a modified Gardner-Medwin Walton Scale mGMWS grade of 4 and a modified Rankin Scale (mRS) score of 1. The DNA sequencing revealed a novel deletion of exons 2 and 3 in one allele and a missense mutation c.1364C > A, which has been reported to be responsible for congenital muscular dystrophy and mental retardation on the second allele. The simultaneous presence of the two variations in the two cases suggests that the variants segregate with the pathophysiology.
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