RESUMEN
BACKGROUND: While the majority of germline inactivating mutations in BRCA1/2 are small-scale mutations, large genomic rearrangements (LGRs) are also detected in a variable proportion of patients. However, routine genetic methods are incapable of detecting LGRs, and comprehensive genetic testing algorithm is necessary. METHODS: We performed multiplex ligation-dependent probe amplification assay for small-scale mutation negative patients at high-risk for LGR, based on previously published LGR risk criteria. The inclusion criteria for the high-risk subgroup were personal history of 1) early-onset breast cancer (diagnosed at ≤36 years); 2) two breast primaries; 3) breast cancer diagnosed at any age, with ≥1 close blood relatives (includes first-, second-, or third-degree) with breast and/or epithelial ovarian cancer; 4) both breast and epithelial ovarian cancer diagnosed at any age; and 5) epithelial ovarian cancer with ≥1 close blood relatives with breast and/or epithelial ovarian cancer. RESULTS: Two LGRs were identified. One was a heterozygous deletion of exon 19 and the other was a heterozygous duplication of exon 4-6. The prevalence of LGRs was 7% among Sanger-negative, high-risk patients, and accounted for 13% of all BRCA1 mutations and 2% of all patients. Moreover, LGRs reported in Korean patients, including our 2 newly identified cases, were found exclusively in families with at least one high-risk feature. CONCLUSIONS: Our result suggests that selective LGR screening for Sanger-negative, high-risk patients is necessary for Korean patients.
Asunto(s)
Pueblo Asiatico/genética , Proteína BRCA1/genética , Proteína BRCA2/genética , Adulto , Alelos , Neoplasias de la Mama/genética , Neoplasias de la Mama/patología , Carcinoma Epitelial de Ovario , ADN/química , ADN/aislamiento & purificación , ADN/metabolismo , Exones , Femenino , Reordenamiento Génico , Heterocigoto , Humanos , Persona de Mediana Edad , Neoplasias Glandulares y Epiteliales/genética , Neoplasias Glandulares y Epiteliales/patología , Neoplasias Ováricas/genética , Neoplasias Ováricas/patología , Linaje , República de Corea , Factores de Riesgo , Análisis de Secuencia de ADN , Eliminación de SecuenciaRESUMEN
OBJECTIVE: We performed small-scale mutation and large genomic rearrangement (LGR) analysis of BRCA1/2 in ovarian cancer patients to determine the prevalence and the characteristics of the mutations. METHODS: All ovarian cancer patients who visited a single institution between September 2015 and April 2017 were included. Sanger sequencing, multiplex ligation-dependent probe amplification (MLPA), and long-range polymerase chain reaction (PCR) were performed to comprehensively study BRCA1/2. The genetic risk models BRCAPRO, Myriad, and BOADICEA were used to evaluate the mutation analysis. RESULTS: In total, 131 patients were enrolled. Of the 131 patients, Sanger sequencing identified 16 different BRCA1/2 small-scale mutations in 20 patients (15.3%). Two novel nonsense mutations were detected in 2 patients with a serous borderline tumor and a large-cell neuroendocrine carcinoma. MLPA analysis of BRCA1/2 in Sanger-negative patients revealed 2 LGRs. The LGRs accounted for 14.3% of all identified BRCA1 mutations, and the prevalence of LGRs identified in this study was 1.8% in 111 Sanger-negative patients. The genetic risk models showed statistically significant differences between mutation carriers and non-carriers. The 2 patients with LGRs had at least one blood relative with breast or ovarian cancer. CONCLUSION: Twenty-two (16.8%) of the unselected ovarian cancer patients had BRCA1/2 mutations that were detected through comprehensive BRCA1/2 genetic testing. Ovarian cancer patients with Sanger-negative results should be considered for LGR detection if they have one blood relative with breast or ovarian cancer. The detection of more BRCA1/2 mutations in patients is important for efforts to provide targeted therapy to ovarian cancer patients.
Asunto(s)
Proteína BRCA1/genética , Proteína BRCA2/genética , Reordenamiento Génico/genética , Mutación/genética , Neoplasias Ováricas/genética , Adulto , Anciano , Codón sin Sentido/genética , Análisis Mutacional de ADN , Neoplasias de las Trompas Uterinas/genética , Neoplasias de las Trompas Uterinas/patología , Femenino , Predisposición Genética a la Enfermedad/genética , Pruebas Genéticas , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/patología , Linaje , Neoplasias Peritoneales/genética , Neoplasias Peritoneales/patología , República de Corea , Análisis de Secuencia de ADN/métodosRESUMEN
The nuclear receptors PPARs (peroxisome proliferator-activated receptors) are transcription factors that play important roles in multiple disease conditions. The activation of PPARs by specific ligands is associated with growth suppression of several different types of human cancer, but the molecular mechanism responsible for this growth suppressive effect remains elusive. The aim of this study was to determine the distribution of PPARgamma protein/mRNA expression in uterine leiomyomas and to identify the PPARgamma induced signaling pathways responsible for the growth inhibition induced by treatment with ciglitizone, a synthetic ligand of PPARgamma, in view of identifying targets that could possibly affect the viability and proliferation of uterine leiomyoma cells. Dose-response studies on proliferation found that uterine leiomyoma was more sensitive to inhibition by ciglitizone treatments than normal myometrium. We also found that ciglitizone significantly stimulated gene expression driven by a PPAR-responsive element in cultured leiomyoma cells and reduced the survival of leiomyoma cells relative to the control cells. The reduced survival of ciglitizone treated leiomyoma cells resulted from a mechanism that involved the Fas receptor-mediated apoptosis signaling cascade. These results suggest that uterine leiomyomas growth and differentiation might be modulated through PPARgamma receptors and that PPARgamma ligands may be of potential use for uterine leiomyoma treatment.
Asunto(s)
Apoptosis/efectos de los fármacos , PPAR gamma/antagonistas & inhibidores , Tiazolidinedionas/farmacología , Western Blotting , Caspasa 8/metabolismo , Ciclo Celular/efectos de los fármacos , Proliferación Celular/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Inmunohistoquímica , Etiquetado Corte-Fin in Situ , Leiomioma/genética , Leiomioma/metabolismo , Leiomioma/patología , PPAR gamma/genética , PPAR gamma/metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Transducción de Señal/efectos de los fármacos , Neoplasias Uterinas/genética , Neoplasias Uterinas/metabolismo , Neoplasias Uterinas/patologíaAsunto(s)
Neoplasias de la Médula Ósea/genética , Mutación , Trastornos Mieloproliferativos/genética , Proteínas/genética , Proteínas Adaptadoras Transductoras de Señales , Animales , Estudios de Casos y Controles , Codón sin Sentido , Femenino , Humanos , Péptidos y Proteínas de Señalización Intracelular , Janus Quinasa 2/genética , Masculino , Ratones , Persona de Mediana Edad , Mutación Missense , Policitemia Vera/genética , Polimorfismo de Nucleótido Simple , Mielofibrosis Primaria/genética , Trombocitemia Esencial/genéticaRESUMEN
A nationwide survey on the status of plasma exchange in Korea was performed during the 2 year period 2001-02. Data from 496 patients were collected from 15 major hospitals. The most common indication was myasthenia gravis (15.3%), followed by thrombotic thrombocytopenic purpura (14.5%) and hemolytic uremic syndrome (9.7%). Clinical improvement was noted in 70.1% of the 415 cases. Plasma exchange by centrifugation alone accounted for 92.4%. Postcentrifugal filtration was carried out in 5.6% and double filtration in 2.0% of treatments. The most common instruments for the centrifugation were Cobe Spectra (71.3%) and Fenwal CS3000 (15.8%). Filtration was performed by either Kuraray KM8300 or Kuraray KM8800. The overall frequency of complications was 11.1% (293/2647 cases), of which symptomatic hypocalcemia was the most common (2.3%).
Asunto(s)
Encuestas de Atención de la Salud/estadística & datos numéricos , Intercambio Plasmático/estadística & datos numéricos , Sistema de Registros , Síndrome Hemolítico-Urémico/epidemiología , Síndrome Hemolítico-Urémico/terapia , Humanos , Corea (Geográfico)/epidemiología , Miastenia Gravis/epidemiología , Miastenia Gravis/terapia , Intercambio Plasmático/instrumentación , Intercambio Plasmático/métodos , Púrpura Trombocitopénica Trombótica/epidemiología , Púrpura Trombocitopénica Trombótica/terapiaRESUMEN
Loss-of-function mutations in the putative tumor suppressor gene, Ten-Eleven Ttranslocation 2(TET2), have been identified recently in myeloproliferative neoplasms (MPNs). The present study analyzed the TET2 gene in 99 MPNs patients. The overall TET2 mutational frequency was 12.1% (22.2% in polycythemia vera (PV), 9.7% in essential thrombocythemia (ET), 18.2% in primary myelofibrosis (PMF,) and 0% in unclassified MPNs), and 11 mutations (p.Lys95Asnfs*18, p.Gln967Asnfs*40, p.Lys1022Glufs*4, p.Asp1314Metfs*49, p.Gln1534Alafs*43, p.Tyr1618Leufs*4, p.Leu1609Glufs*45, p.Gly1735*, Q599R, c.3409+1G>T, c.4044+2insT) were identified. All the patients with TET2 mutation were accompanied by the JAK2 V617F mutation. The existence of the TET2 mutation was not related to the patient's age, hematologic indices, JAK2 V617F allele burden, frequencies of organomegaly, marrow fibrosis, or thrombotic/hemorrhagic complications in entire MPN patients. However, tendencies toward higher JAK2 V617F allele burdens (88.0±4.3% vs. 19.1±28.7%, P=0.034) and higher Hct (47.4±5.4% vs. 25.5±6.2%, P=0.037) were detected in PMF patients harboring TET2 mutations. Moreover, a significantly higher frequency of organomegaly was identified in ET patients harboring the TET2 mutation (50% vs. 19.6%, P=0.018). The TET2 mutation most likely contributes to clinical phenotypes and shows a high accompanying rate with JAK2 V617F; larger scale studies involving more MPN patients are needed.
Asunto(s)
Neoplasias de la Médula Ósea/genética , Proteínas de Unión al ADN/genética , Mutación/genética , Proteínas Proto-Oncogénicas/genética , Adulto , Anciano , Médula Ósea/patología , Codón sin Sentido/genética , Dioxigenasas , Femenino , Mutación del Sistema de Lectura/genética , Humanos , Masculino , Persona de Mediana Edad , Mutación Missense/genética , Policitemia Vera/genética , Mielofibrosis Primaria/genética , Trombocitemia Esencial/genéticaAsunto(s)
Carcinoma de Células Pequeñas/diagnóstico , Citofagocitosis , Neoplasias de la Vejiga Urinaria/diagnóstico , Anciano , Antineoplásicos , Células Sanguíneas/patología , Médula Ósea/patología , Encéfalo/diagnóstico por imagen , Carcinoma de Células Pequeñas/complicaciones , Hemorragia Cerebral/patología , Humanos , Masculino , Trombocitopenia/complicaciones , Trombocitopenia/diagnóstico , Tomografía Computarizada por Rayos X , Neoplasias de la Vejiga Urinaria/complicacionesRESUMEN
BACKGROUND: Accurate and early detection of vancomycin-resistant enterococci (VRE) is critical for controlling nosocomial infection. In this study, we evaluated the usefulness of a selective chromogenic agar medium and of multiplex PCR for detection of VRE, and both these techniques were compared with the conventional culture method for VRE detection. METHODS: We performed the following 3 methods for detecting VRE infection in stool specimens: the routine culture method, culturing in selective chromogenic agar medium (chromID VRE, bioMérieux, France), and multiplex PCR using the Seeplex® VRE ACE Detection kit (Seegene Inc., Korea) with additional PCR for vanC genes. RESULTS: We isolated 109 VRE strains from 100 stool specimens by the routine culture method. In chromID VRE, all the isolates showed purple colonies, including Enterococcus gallinarum and E. raffinosus, which were later identified using the Vitek card. All VRE isolates were identified by the multiplex PCR method; 100 were vanA-positive E. faecium, 8 were vanA- and vanC-1-positive E. gallinarum, and 1 was vanA-positive E. raffinosus. CONCLUSIONS: For VRE surveillance, culturing the isolates in chromID VRE after broth enrichment appears to be an accurate, rapid, and easy method for routine screening test. Multiplex PCR is relatively expensive and needs skilled techniques for detecting VRE, but it can be an auxiliary tool for rapid detection of genotype during a VRE outbreak.
Asunto(s)
Compuestos Cromogénicos/química , Enterococcus/aislamiento & purificación , Reacción en Cadena de la Polimerasa/métodos , Resistencia a la Vancomicina , Agar/química , Enterococcus/efectos de los fármacos , Enterococcus/genética , Enterococcus faecium/genética , Enterococcus faecium/aislamiento & purificación , Heces/microbiología , Genotipo , Humanos , Fenotipo , Juego de Reactivos para DiagnósticoAsunto(s)
Bronquiectasia/diagnóstico , Infecciones por Mycobacterium/diagnóstico , Mycobacterium/genética , Anciano , Bronquiectasia/microbiología , Humanos , Masculino , Mycobacterium/clasificación , Mycobacterium/aislamiento & purificación , Infecciones por Mycobacterium/microbiología , Filogenia , Reacción en Cadena de la Polimerasa , ARN Ribosómico 16S/química , ARN Ribosómico 16S/genética , ARN Ribosómico 16S/metabolismo , República de Corea , Análisis de Secuencia de ADNRESUMEN
A 15q25-qter partial trisomy characterized by pre or postnatal overgrowth, tall stature, macrocephaly and craniosynostosis has rarely been reported. The cause of overgrowth has been thought to be the triplication of the insulin-like growth factor 1 receptor (IGF1R) gene located on the 15q26.3. We report a patient with partial trisomy 15q25.3-qter showing mental retardation, developmental delay, macrocephaly, long narrow face, ptosis, high palate arch, scoliosis, clinodactyly and overgrowth. Additional material located on terminal 2q was found in karyotyping analysis. In bacterial artificial chromosome (BAC) clone-based-array comparative genomic hybridization (aCGH) analysis, a gain of 31 clones on 15q25.3-qter and a loss of 2 clones on 2q37.3 were observed. An extra copy of IGF1R gene was observed on derivative chromosome 2 in FISH analysis. In conclusion, the patient was diagnosed to have de novo 46,XX,der(2)t(2;15)(q37.3;q25.3) chromosome complement. Adequate genetic counseling and regular follow-ups would be needed for the patient.
Asunto(s)
Cromosomas Humanos Par 15 , Receptor IGF Tipo 1/genética , Trisomía , Anomalías Múltiples/genética , Preescolar , Hibridación Genómica Comparativa , Femenino , Humanos , Hibridación Fluorescente in Situ , Cariotipificación , Translocación GenéticaRESUMEN
In the present day, pretransfusion tests include ABO and RhD grouping, antibody screening, antibody identification, and cross matching. Although error rates for these tests have decreased compared to those in the past, clerical errors still occur. When exposed to RhD positive RBCs, a RhD negative person can produce anti-D that causes a severe hemolytic disease of the fetus and the newborn in addition to hemolytic transfusion reactions. Therefore, administration of RhD positive RBCs to a RhD negative person should be avoided. We experienced a RhD negative patient who had been misidentified as positive and transfused 35 units of RhD positive RBCs eight years ago, but did not have detectable anti-D in present. The red cells of the patient showed no agglutination with the anti-D reagent and a negative result in the standard weak D test. The multiplex PCR with sequence-specific priming revealed that the patient was RhD negative.
Asunto(s)
Incompatibilidad de Grupos Sanguíneos , Eritrocitos/inmunología , Isoanticuerpos/análisis , Sistema del Grupo Sanguíneo Rh-Hr/análisis , Transfusión Sanguínea , Humanos , Isoanticuerpos/inmunología , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Sistema del Grupo Sanguíneo Rh-Hr/inmunología , Globulina Inmune rho(D)RESUMEN
Though the pathogenic significance and the reservoir of Ewingella americana have not been clarified, this organism has caused several pathogenic infections, especially in immunocompromised patients. We report a pneumonia in a patient with chronic renal failure, who had chronic rejection of transplanted kidney. E. americana was identified to be the pathogen of pneumonia with clinical symptoms and signs and radiological examination. As soon as he was treated with ceftriaxone and isepamicin, clinical improvement was followed with no further growth of E. americana or other pathogenic isolates from sputum culture. This suggests to be the case of pneumonia caused by E. americana for the first time in the Korean literature.