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1.
Biol Open ; 13(5)2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38713004

RESUMO

Recent research has shown that membrane trafficking plays an important role in canonical Wnt signaling through sequestration of the ß-catenin destruction complex inside multivesicular bodies (MVBs) and lysosomes. In this study, we introduce Ouabain, an inhibitor of the Na,K-ATPase pump that establishes electric potentials across membranes, as a potent inhibitor of Wnt signaling. We find that Na,K-ATPase levels are elevated in advanced colon carcinoma, that this enzyme is elevated in cancer cells with constitutively activated Wnt pathway and is activated by GSK3 inhibitors that increase macropinocytosis. Ouabain blocks macropinocytosis, which is an essential step in Wnt signaling, probably explaining the strong effects of Ouabain on this pathway. In Xenopus embryos, brief Ouabain treatment at the 32-cell stage, critical for the earliest Wnt signal in development-inhibited brains, could be reversed by treatment with Lithium chloride, a Wnt mimic. Inhibiting membrane trafficking may provide a way of targeting Wnt-driven cancers.


Assuntos
Neoplasias do Colo , Ouabaína , Pinocitose , ATPase Trocadora de Sódio-Potássio , Via de Sinalização Wnt , Neoplasias do Colo/metabolismo , Neoplasias do Colo/etiologia , ATPase Trocadora de Sódio-Potássio/metabolismo , Animais , Humanos , Ouabaína/farmacologia , Linhagem Celular Tumoral , Xenopus
2.
BMC Bioinformatics ; 25(1): 179, 2024 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-38714913

RESUMO

BACKGROUND: As genomic studies continue to implicate non-coding sequences in disease, testing the roles of these variants requires insights into the cell type(s) in which they are likely to be mediating their effects. Prior methods for associating non-coding variants with cell types have involved approaches using linkage disequilibrium or ontological associations, incurring significant processing requirements. GaiaAssociation is a freely available, open-source software that enables thousands of genomic loci implicated in a phenotype to be tested for enrichment at regulatory loci of multiple cell types in minutes, permitting insights into the cell type(s) mediating the studied phenotype. RESULTS: In this work, we present Regulatory Landscape Enrichment Analysis (RLEA) by GaiaAssociation and demonstrate its capability to test the enrichment of 12,133 variants across the cis-regulatory regions of 44 cell types. This analysis was completed in 134.0 ± 2.3 s, highlighting the efficient processing provided by GaiaAssociation. The intuitive interface requires only four inputs, offers a collection of customizable functions, and visualizes variant enrichment in cell-type regulatory regions through a heatmap matrix. GaiaAssociation is available on PyPi for download as a command line tool or Python package and the source code can also be installed from GitHub at https://github.com/GreallyLab/gaiaAssociation . CONCLUSIONS: GaiaAssociation is a novel package that provides an intuitive and efficient resource to understand the enrichment of non-coding variants across the cis-regulatory regions of different cells, empowering studies seeking to identify disease-mediating cell types.


Assuntos
Software , Variação Genética , Humanos , Genômica/métodos , Biologia Computacional/métodos , Fenótipo , Sequências Reguladoras de Ácido Nucleico/genética , Desequilíbrio de Ligação
3.
bioRxiv ; 2023 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-37905111

RESUMO

Motivation: To understand whether sets of genomic loci are enriched at the regulatory loci of one or more cell types, we developed the gaiaAssociation package to perform Regulatory Landscape Enrichment Analysis (RLEA). RLEA is a novel analytical process that tests for enrichment of sets of loci in cell type-specific open chromatin regions (OCRs) in the genome. Results: We demonstrate that the application of RLEA to genome-wide association study (GWAS) data reveals cell types likely to be mediating the phenotype studied, and clusters OCRs based on their shared regulatory profiles. GaiaAssociation is Python code that is freely available for use in functional genomics studies. Availability and Implementation: Gaia Association is available on PyPi (https://pypi.org/project/gaiaAssociation/0.6.0/#description) for pip download and use on the command line or as an inline Python package. Gaia Association can also be installed from GitHub at https://github.com/GreallyLab/gaiaAssociation.

4.
Mol Cell Oncol ; 10(1): 2218147, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37260544

RESUMO

Chordin (CHRD) is a secreted protein important in early development, yet a role for CHRD in human disease has not been identified. In this study we investigated CHRD in cancer and normal adult tissues using the wealth of genome-wide data available in public databases. We found that Chordin is amplified in the DNA of specific cancers such as lung squamous cell and others, although copy number variation did not strictly correlate with higher mRNA expression. In some cancers, such as renal and stomach carcinomas, increased CHRD expression significantly correlated with poor survival. In normal adult human tissues, CHRD mRNA was highest in hepatocytes. Crossveinless-2/BMPER, a component of the Chordin morphogenetic pathway expressed at the opposite side in embryos, was expressed in liver stellate cells. This raises the intriguing possibility that a BMP gradient might be established in the extracellular matrix of the space of Disse that surrounds portal sinusoid capillaries.

5.
Epigenetics Chromatin ; 16(1): 14, 2023 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-37118773

RESUMO

BACKGROUND: Single-cell technologies to analyze transcription and chromatin structure have been widely used in many research areas to reveal the functions and molecular properties of cells at single-cell resolution. Sample multiplexing techniques are valuable when performing single-cell analysis, reducing technical variation and permitting cost efficiencies. Several commercially available methods have been used in many scRNA-seq studies. On the other hand, while several methods have been published, multiplexing techniques for single nuclear assay for transposase-accessible chromatin (snATAC)-seq assays remain under development. We developed a simple nucleus hashing method using oligonucleotide-conjugated antibodies recognizing nuclear pore complex proteins, NuHash, to perform snATAC-seq library preparations by multiplexing. RESULTS: We performed multiplexing snATAC-seq analyses on a mixture of human and mouse cell samples (two samples, 2-plex, and four samples, 4-plex) using NuHash. The analyses on nuclei with at least 10,000 read counts showed that the demultiplexing accuracy of NuHash was high, and only ten out of 9144 nuclei (2-plex) and 150 of 12,208 nuclei (4-plex) had discordant classifications between NuHash demultiplexing and discrimination using reference genome alignments. The differential open chromatin region (OCR) analysis between female and male samples revealed that male-specific OCRs were enriched in chromosome Y (four out of nine). We also found that five female-specific OCRs (20 OCRs) were on chromosome X. A comparative analysis between snATAC-seq and deeply sequenced bulk ATAC-seq on the same samples revealed that the bulk ATAC-seq signal intensity was positively correlated with the number of cell clusters detected in snATAC-seq. Moreover, when we categorized snATAC-seq peaks based on the number of cell clusters in which the peak was present, we observed different distributions over different genomic features between the groups. This result suggests that the peak intensities of bulk ATAC-seq can be used to identify different types of functional loci. CONCLUSIONS: Our multiplexing method using oligo-conjugated anti-nuclear pore complex proteins, NuHash, permits high-accuracy demultiplexing of samples. The NuHash protocol is straightforward, works on frozen samples, and requires no modifications for snATAC-seq library preparation.


Assuntos
Núcleo Celular , Sequenciamento de Cromatina por Imunoprecipitação , Masculino , Feminino , Humanos , Animais , Camundongos , Análise de Sequência de DNA/métodos , Núcleo Celular/genética , Núcleo Celular/metabolismo , Cromatina/genética , Cromatina/metabolismo , Oligonucleotídeos/metabolismo
6.
Horiz. sanitario (en linea) ; 20(1): 69-78, ene.-abr. 2021. tab
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1346281

RESUMO

Resumen Objetivo: El estudio tuvo como objetivo explorar la confiabilidad y consistencia interna del Test de Dependencia de Videojuegos [TDV] (Chóliz & Marco, 2011), con el propósito de obtener evidencia sobre sus propiedades psicométricas en el contexto mexicano. Material y Métodos: El estudio fue de corte transversal (tipo psicométrico, validación de un instrumento). La muestra estuvo conformada por 581 adolescentes de entre los 11 y 16 años (281 hombres y 300 mujeres). Para la validación del instrumento se realizó un análisis factorial exploratorio, análisis de componentes principales Varimax y un análisis de consistencia interna. Resultados: Se obtuvo una estructura factorial similar a la versión original española, se encontraron cuatro factores a) Abstinencia, b) Abuso y tolerancia, c) Problemas ocasionados por los videojuegos y d) Dificultad para el control. La escala mostró una consistencia interna aceptable (a=0.94) es decir, que esta mide de forma consistente el concepto. Conclusiones: El TDV es un instrumento confiable y de fácil aplicación para medir, diagnosticar e intervenir sobre el fenómeno en adolescentes mexicanos.


Abstract Objective: To assess the reliability and the internal consistency of the video games dependence test [TDV] in order to obtain evidence of its psychometric properties in Mexican context. Material and Methods: A cross-sectional study (psychometric type, instrument validation).581 teenagers among 11 and 16 years old were part of the sample (281 men and 300 women). An exploratory factor analysis, a principal component analysis Varimax and an analysis of internal consistency were carried out for validation. Results: A similar factorial structure to the Spanish original version was obtained and there were found four factors. A) abstinence, B) abuse and tolerance, C) problems caused by videogames and D) difficulty to stay in control. An acceptable internal consistency was showed by the scale (a=0.94) that is to say, the concept is measured consistently. Conclusions: TDV is a reliable instrument and easy to apply in order to measure, diagnose and focus on Mexican teenagers' phenomenon.

7.
Sci Rep ; 10(1): 21555, 2020 12 09.
Artigo em Inglês | MEDLINE | ID: mdl-33299006

RESUMO

The canonical Wnt pathway serves as a hub connecting diverse cellular processes, including ß-catenin signaling, differentiation, growth, protein stability, macropinocytosis, and nutrient acquisition in lysosomes. We have proposed that sequestration of ß-catenin destruction complex components in multivesicular bodies (MVBs) is required for sustained canonical Wnt signaling. In this study, we investigated the events that follow activation of the canonical Wnt receptor Lrp6 using an APEX2-mediated proximity labeling approach. The Wnt co-receptor Lrp6 was fused to APEX2 and used to biotinylate targets that are recruited near the receptor during Wnt signaling at different time periods. Lrp6 proximity targets were identified by mass spectrometry, and revealed that many endosomal proteins interacted with Lrp6 within 5 min of Wnt3a treatment. Interestingly, we found that Trk-fused gene (TFG), previously known to regulate the cell secretory pathway and to be rearranged in thyroid and lung cancers, was strongly enriched in the proximity of Lrp6. TFG depletion with siRNA, or knock-out with CRISPR/Cas9, significantly reduced Wnt/ß-catenin signaling in cell culture. In vivo, studies in the Xenopus system showed that TFG is required for endogenous Wnt-dependent embryonic patterning. The results suggest that the multivesicular endosomal machinery and the novel player TFG have important roles in Wnt signaling.


Assuntos
DNA Liase (Sítios Apurínicos ou Apirimidínicos)/metabolismo , Endonucleases/metabolismo , Complexos Endossomais de Distribuição Requeridos para Transporte/metabolismo , Proteína-6 Relacionada a Receptor de Lipoproteína de Baixa Densidade/metabolismo , Enzimas Multifuncionais/metabolismo , Receptor trkA/metabolismo , Via de Sinalização Wnt/fisiologia , Fusão Gênica , Células HEK293 , Humanos
8.
Front Plant Sci ; 11: 573, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32528490

RESUMO

Agaves resist extreme heat and drought. In A. tequilana var. azul, the central spike of the rosette -containing the shoot apical meristem and folded leaves in early stages of development- is remarkably heat tolerant. We found that the most abundant protein in this organ is a 27 kDa protein. This protein was named mayahuelin to honor Mayáhuel, the agave goddess in the Aztec pantheon. LC-MS/MS analyses identified mayahuelin as a type I RIP (Ribosome Inactivating Protein). In addition to the spike, mayahuelin was expressed in the peduncle and in seeds, whereas in mature leaves, anthers, filaments, pistils, and tepals was absent. Anti-mayahuelin antibody raised against the A. tequilana var. azul protein revealed strong signals in spike leaves of A. angustifolia, A. bracteosa, A. rhodacantha, and A. vilmoriniana, and moderate signals in A. isthmensis, A. kerchovei, A. striata ssp. falcata, and A. titanota, indicating conservation at the protein level throughout the Agave genus. As in charybdin, a type I RIP characterized in Drimia maritima, mayahuelin from A. tequilana var. azul contains a natural aa substitution (Y76D) in one out of four aa comprising the active site. The RIP gene family in A. tequilana var. azul consists of at least 12 genes and Mayahuelin is the only member encoding active site substitutions. Unlike canonical plant RIPs, expression of Mayahuelin gene in S. cerevisiae did not compromise growth. The inhibitory activity of the purified protein on a wheat germ in vitro translation system was moderate. Mayahuelin orthologs from other Agave species displayed one of six alleles at Y76: (Y/Y, D/D, S/S, Y/D, Y/S, D/S) and proved to be useful markers for phylogenetic analysis. Homozygous alleles were more frequent in wild accessions whereas heterozygous alleles were more frequent in cultivars. Mayahuelin sequences from different wild populations of A. angustifolia and A. rhodacantha allowed the identification of accessions closely related to azul, manso, sigüín, mano larga, and bermejo varieties of A. tequilana and var. espadín of A. angustifolia. Four A. rhodacantha accessions and A. angustifolia var. espadín were closer relatives of A. tequilana var. azul than A. angustifolia wild accessions or other A. tequilana varieties.

9.
Int J Dev Biol ; 63(6-7): 301-309, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31250914

RESUMO

Animal embryos have the remarkable property of self-organization. Over 125 years ago, Hans Driesch separated the two blastomeres of sea urchin embryos and obtained twins, in what was the foundation of experimental embryology. Since then, embryonic twinning has been obtained experimentally in many animals. In a recent study, we developed bisection methods that generate identical twins reliably from Xenopus blastula embryos. In the present study, we have investigated the transcriptome of regenerating half-embryos after sagittal and dorsal-ventral (D-V) bisections. Individual embryos were operated at midblastula (stage 8) with an eyelash hair and cultured until early gastrula (stage 10.5) or late gastrula (stage 12) and the transcriptome of both halves were analyzed by RNA-seq. Since many genes are activated by wound healing in Xenopus embryos, we resorted to stringent sequence analyses and identified genes up-regulated in identical twins but not in either dorsal or ventral fragments. At early gastrula, cell division-related transcripts such as histones were elevated, whereas at late gastrula, pluripotency genes (such as sox2) and germ layer determination genes (such as eomesodermin, ripply2 and activin receptor ACVRI) were identified. Among the down-regulated transcripts, sizzled, a regulator of Chordin stability, was prominent. These findings are consistent with a model in which cell division is required to heal damage, while maintaining pluripotency to allow formation of the organizer with a displacement of 90 0 from its original site. The extensive transcriptomic data presented here provides a valuable resource for data mining of gene expression during early vertebrate development.


Assuntos
Embrião não Mamífero/metabolismo , Regulação da Expressão Gênica no Desenvolvimento , Regeneração , Transcriptoma , Proteínas de Xenopus/metabolismo , Xenopus laevis/embriologia , Animais , Blastocisto/citologia , Blastocisto/metabolismo , Embrião não Mamífero/citologia , Gástrula/citologia , Gástrula/metabolismo , Proteínas de Xenopus/genética , Xenopus laevis/genética , Xenopus laevis/metabolismo
10.
Proc Natl Acad Sci U S A ; 115(39): E9135-E9144, 2018 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-30209221

RESUMO

The Xenopus laevis embryo has been subjected to almost saturating screens for molecules specifically expressed in dorsal Spemann organizer tissue. In this study, we performed high-throughput RNA sequencing of ectodermal explants, called animal caps, which normally give rise to epidermis. We analyzed dissociated animal cap cells that, through sustained activation of MAPK, differentiate into neural tissue. We also microinjected mRNAs for Cerberus, Chordin, FGF8, BMP4, Wnt8, and Xnr2, which induce neural or other germ layer differentiations. The searchable database provided here represents a valuable resource for the early vertebrate cell differentiation. These analyses resulted in the identification of a gene present in frog and fish, which we call Bighead. Surprisingly, at gastrula, it was expressed in the Spemann organizer and endoderm, rather than in ectoderm as we expected. Despite the plethora of genes already mined from Spemann organizer tissue, Bighead encodes a secreted protein that proved to be a potent inhibitor of Wnt signaling in a number of embryological and cultured cell signaling assays. Overexpression of Bighead resulted in large head structures very similar to those of the well-known Wnt antagonists Dkk1 and Frzb-1. Knockdown of Bighead with specific antisense morpholinos resulted in embryos with reduced head structures, due to increased Wnt signaling. Bighead protein bound specifically to the Wnt coreceptor lipoprotein receptor-related protein 6 (Lrp6), leading to its removal from the cell surface. Bighead joins two other Wnt antagonists, Dkk1 and Angptl4, which function as Lrp6 endocytosis regulators. These results suggest that endocytosis plays a crucial role in Wnt signaling.


Assuntos
Endocitose/fisiologia , Proteína-6 Relacionada a Receptor de Lipoproteína de Baixa Densidade/metabolismo , Proteínas Wnt/metabolismo , Via de Sinalização Wnt/fisiologia , Proteína 4 Semelhante a Angiopoietina , Angiopoietinas/genética , Angiopoietinas/metabolismo , Animais , Endoderma/citologia , Endoderma/metabolismo , Gástrula/citologia , Gástrula/metabolismo , Peptídeos e Proteínas de Sinalização Intercelular/genética , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo , Proteína-6 Relacionada a Receptor de Lipoproteína de Baixa Densidade/genética , Ligação Proteica , Proteínas Wnt/genética , Proteínas de Xenopus/genética , Proteínas de Xenopus/metabolismo , Xenopus laevis
11.
Behav Processes ; 138: 142-151, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28323074

RESUMO

Diets consisting of refined foods (REF) are associated with poor physical (e.g., obesity and diabetes) and mental (e.g., depression) health and impaired cognition. Few animal studies have explored the causal links between diet processing and health. Instead, most studies focus on the role of macronutrients, especially carbohydrate and fat concurrently with how processed are the ingredients. We previously showed that a REF low fat diet (LFD) caused greater adiposity and impaired motivation compared to an unrefined control (CON) diet consisting of similar macronutrient ratios (Blaisdell et al., 2014). Here we test the hypothesis that the same REF LFD adversely affects attentional processes and behavioral control relative to the CON diet. Rats with ad libitum access to the REF diet for two months gained greater adiposity than rats consuming the CON diet. Rats then completed training on a vigilance task involving pressing the correct lever signaled by a brief visual cue whose onset varied across trials. A REF diet reduced accuracy when there was a delay between the start of the trial and cue onset. Poorer accuracy was due to increased premature responses, reflecting impulsivity, and omissions, indicating an inability to sustain attention. These results corroborate the links between consumption of refined foods, obesity, and poor cognition in humans. We discuss the possible causal models that underlie this link.


Assuntos
Atenção , Dieta com Restrição de Gorduras/efeitos adversos , Adiposidade , Animais , Condicionamento Operante , Masculino , Ratos
12.
Proc Natl Acad Sci U S A ; 114(15): E3081-E3090, 2017 04 11.
Artigo em Inglês | MEDLINE | ID: mdl-28348214

RESUMO

The earliest event in Xenopus development is the dorsal accumulation of nuclear ß-catenin under the influence of cytoplasmic determinants displaced by fertilization. In this study, a genome-wide approach was used to examine transcription of the 43,673 genes annotated in the Xenopus laevis genome under a variety of conditions that inhibit or promote formation of the Spemann organizer signaling center. Loss of function of ß-catenin with antisense morpholinos reproducibly reduced the expression of 247 mRNAs at gastrula stage. Interestingly, only 123 ß-catenin targets were enriched on the dorsal side and defined an early dorsal ß-catenin gene signature. These genes included several previously unrecognized Spemann organizer components. Surprisingly, only 3 of these 123 genes overlapped with the late Wnt signature recently defined by two other groups using inhibition by Dkk1 mRNA or Wnt8 morpholinos, which indicates that the effects of ß-catenin/Wnt signaling in early development are exquisitely regulated by stage-dependent mechanisms. We analyzed transcriptome responses to a number of treatments in a total of 46 RNA-seq libraries. These treatments included, in addition to ß-catenin depletion, regenerating dorsal and ventral half-embryos, lithium chloride treatment, and the overexpression of Wnt8, Siamois, and Cerberus mRNAs. Only some of the early dorsal ß-catenin signature genes were activated at blastula whereas others required the induction of endomesoderm, as indicated by their inhibition by Cerberus overexpression. These comprehensive data provide a rich resource for analyzing how the dorsal and ventral regions of the embryo communicate with each other in a self-organizing vertebrate model embryo.


Assuntos
Regulação da Expressão Gênica no Desenvolvimento , Organizadores Embrionários/fisiologia , Transcriptoma , Proteínas de Xenopus/metabolismo , Xenopus laevis/genética , Sequência de Aminoácidos , Animais , Proteínas de Homeodomínio/genética , Proteínas de Homeodomínio/metabolismo , Proteína Nodal/genética , Proteína Nodal/metabolismo , Homologia de Sequência , Proteínas Wnt/genética , Proteínas Wnt/metabolismo , Proteínas de Xenopus/genética , Xenopus laevis/crescimento & desenvolvimento , Xenopus laevis/metabolismo , beta Catenina/genética , beta Catenina/metabolismo
13.
Dev Biol ; 426(2): 176-187, 2017 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-27016259

RESUMO

RNA sequencing has allowed high-throughput screening of differential gene expression in many tissues and organisms. Xenopus laevis is a classical embryological and cell-free extract model system, but its genomic sequence had been lacking due to difficulties arising from allotetraploidy. There is currently much excitement surrounding the release of the completed X. laevis genome (version 9.1) by the Joint Genome Institute (JGI), which provides a platform for genome-wide studies. Here we present a deep RNA-seq dataset of transcripts expressed in dorsal and ventral lips of the early Xenopus gastrula embryo using the new genomic information, which was further annotated by blast searches against the human proteome. Overall, our findings confirm previous results from differential screenings using other methods that uncovered classical dorsal genes such as Chordin, Noggin and Cerberus, as well as ventral genes such as Sizzled, Ventx, Wnt8 and Bambi. Complete transcriptome-wide tables of mRNAs suitable for data mining are presented, which include many novel dorsal- and ventral-specific genes. RNA-seq was very quantitative and reproducible, and allowed us to define dorsal and ventral signatures useful for gene set expression analyses (GSEA). As an example of a new gene, we present here data on an organizer-specific secreted protein tyrosine kinase known as Pkdcc (protein kinase domain containing, cytoplasmic) or Vlk (vertebrate lonesome kinase). Overexpression experiments indicate that Pkdcc can act as a negative regulator of Wnt/ ß-catenin signaling independently of its kinase activity. We conclude that RNA-Seq in combination with the X. laevis complete genome now available provides a powerful tool for unraveling cell-cell signaling pathways during embryonic induction.


Assuntos
Padronização Corporal/genética , Gástrula/metabolismo , Regulação da Expressão Gênica no Desenvolvimento , Transcriptoma , Xenopus laevis/embriologia , Animais , Embrião não Mamífero/metabolismo , Etiquetas de Sequências Expressas , Biblioteca Gênica , Cabeça/embriologia , Microinjeções , Organizadores Embrionários/metabolismo , Proteínas Tirosina Quinases/biossíntese , Proteínas Tirosina Quinases/genética , RNA/genética , RNA Mensageiro/biossíntese , RNA Mensageiro/genética , Análise de Sequência de RNA , Via de Sinalização Wnt , Proteínas de Xenopus/biossíntese , Proteínas de Xenopus/genética , Xenopus laevis/genética , Xenopus laevis/metabolismo
14.
Rev. Inst. Nac. Cancerol. (Méx.) ; 38(3): 1605-10, jul.-sept. 1992. tab
Artigo em Espanhol | LILACS | ID: lil-117837

RESUMO

Se analiza la experiencia en el Instituto Nacional de Cancerología en 93 casos de tumor primario desconocido vistos entre los años 1981 a 1985. De ellos, 43 correpondieron al sexo masculino (46 por ciento) y 50 al femenino (54 por ciento), no representando mayor diferencia estadística. El promedio de edad a la presentación fue de 56 años y el tiempo de evolución tuvo un rango de 1 a 36 meses con media de seis. El sitio inicial de mayor a menor afección fue el ganglio linfático en 30 por ciento de los casos, seguido de Higado, hueso y pulmón. La estripe tumoral que con mayor frecuencia fue responsable de esta entidad fue el adenocarcinoma (57 por ciento), seguido de Ca epidermoide (13 por ciento) y carcinoma indiferenciado (12 por ciento). El método de estudio de estos pacientes no fue único ni sistematizado. Se realizaron un total de 1,283 estudios de laboratorio con un promedio de 13.7 exámenes por paciente, 434 estudios raqdiológicos simples y contrastados para un promedio de 4.6 estudios por paciente, 81 tomografías computadas, 38 estudios endoscópicos dando un costo aproximado y actualizado por paciente de 2'000,000 (dos millones) de pesos para un total aproximado de 200'000,000 (docientos millones) de pesos. El consumo de tiempo en los estudios tomó un promedio de dos semanas por paciente antes de decidir un manejo terapéutico. En ningún caso se identificó el sitio primario de origen de la metástasis. Desde el punto de vista terapéutico, 30 casos no recibieron nungún manejo (32 por ciento) por lo avanzado de la enfermedad y las malas condiciones generales del enfermo. Seis casos recibieron manejo quirúrgico, 14 tratamiento con radioterapia y 43 quimioterapia sistémica. De todos ellos, solamente tres correspondieron a tumores epidermoides del área de cabeza y cuello, siendo manejados con cirugía y radioterapia y hallándose vivos y en control hasta el momento actual. Los restantes fallecieron en un lapso menor a un año, con progresión generalmente visceral. Se concluye que se sebe identificar a un subgrupo de pacientes que probablemente se beneficiarán del estudio exhaustivo y del tratamiento dirigido (tumores potencialmente curables como germinales, linfoproliferativos, etc.) y que el uso indiscriminado de estudios que intenta identificar el sitio primario no conlleva a mejoría en la sobrevida ni respuesta al tratamiento de los pacientes, debiendo de protocolizarse su estudio y manejo que redituará en un menor costo y mayor calidad de vida para los pro


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adenocarcinoma/diagnóstico , Neoplasias Ósseas/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Carcinoma/diagnóstico , Neoplasias Pulmonares/diagnóstico , Metástase Linfática/diagnóstico , Neoplasias Primárias Desconhecidas/diagnóstico , Neoplasias Primárias Desconhecidas/epidemiologia , Neoplasias Primárias Desconhecidas/terapia , Linfonodos
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