Mutation landscape in melanoma patients clinical implications of heterogeneity of BRAF mutations.

BACKGROUND: The detection of V600E BRAF mutations has fundamental clinical consequences as the treatment option with BRAF inhibitors such as vemurafenib or dabrafenib yields response rates of ~48%. Heterogeneity with respect to BRAF mutation in different metastases has been described in single cases. As this has important implications for the determination of BRAF status and treatment of patients, it is essential to acquire more data. METHODS: A total of 300 tumour samples from 187 melanoma patients were analysed for BRAF mutations by pyrosequencing. Equivocal results were confirmed by capillary sequencing. Clinical data with respect to melanoma type, tumour site and survival were summarised for 53 patients with multiple analysed tumour samples (2-13 per patient). RESULTS: BRAF mutations were found in 84 patients (44.9%) and 144 tumour samples (48%) with BRAF mutations in 45.5% of primary tumours and 51.3% of metastases, respectively. In 10 out of 53 patients (18.9%) where multiple samples were analysed results were discordant with respect to mutation findings with wild-type and mutated tumours in the same patient. Mutations did not appear more frequently over the course of disease nor was its occurrence associated with a specific localisation of metastases. CONCLUSION: As heterogeneity with respect to BRAF mutation status is detected in melanoma patients, subsequent testing of initially wild-type patients can yield different results and thus make BRAF inhibitor therapy accessible. The role of heterogeneity in testing and for clinical response to therapy with a BRAF inhibitor needs to be further investigated.

Rare BRAF mutations in melanoma patients: implications for molecular testing in clinical practice.

BACKGROUND: The detection of V600E BRAF mutation in melanoma is fundamental since here BRAF inhibitors represent an effective treatment. Non-V600E BRAF mutations that may also respond are not detected by certain screening methods. Thus, knowledge about detection of these mutations is needed. METHODS: A total of 276 tumour samples from 174 melanoma patients were investigated for BRAF mutations by pyrosequencing. Rare mutations were confirmed by capillary sequencing and compared with findings from COBAS test and immunohistochemistry using a novel BRAF antibody. Melanoma type, localisation, and survival were summarised. RESULTS: BRAF mutations were found in 43% of patients (124 tumours in 75 patients). Among those, 14 patients (18.7%) exhibited rare mutations. The V600EK601del and V600DK601del mutations have never been described before in melanoma. Furthermore, V600K, V600E2, and V600D, V600G, V600R, and L597S mutations were detected. Mutations were not detected by COBAS test in 7 out of these 14 patients and immunohistochemistry only reliably detected patients with the V600E2 and V600EK601del mutation. CONCLUSION: Accurate diagnosis of rare BRAF mutations is crucial. We show that pyrosequencing is accurate, highly sensitive, reliable, and time saving to detect rare BRAF mutations. Missing these rare variant mutations would exclude a subset of patients from available effective BRAF-targeting therapy.

Filling state of intracellular Ca2+ pools triggers trans plasma membrane Na+ and Ca2+ influx by a tyrosine kinase-dependent pathway.

The relations between the filling state of intracellular calcium stores that are regulated by the endoplasmic Ca(2+)-ATPase and trans plasma membrane sodium and calcium influx were investigated. The effects of specific inhibition of endoplasmic Ca(2+)-ATPase by thapsigargin, cyclopiazonic acid, and 2,5-di-(tert-butyl)-1,4-benzohydroquinone (BHQ) on cytosolic free sodium concentration ([Na+]i) and cytosolic free calcium concentration ([Ca2+]i) were evaluated in lymphocytes from healthy subjects using the fluorescent dyes sodium-binding benzofuran isophthalate and fura2. The specific inhibition of endoplasmic Ca(2+)-ATPase by thapsigargin, cyclopiazonic acid, or BHQ increased lymphocytic [Na+]i and [Ca2+]i. The thapsigargin-induced [Na+]i increase was abolished in the absence of external sodium, indicating that thapsigargin induced a trans plasma membrane sodium influx. In the absence of external calcium the thapsigargin-induced [Ca2+]i increase was significantly reduced, whereas the thapsigargin-induced [Na+]i increase remained the same. This finding indicates that the filling state of intracellular calcium pools rather than the elevation of [Ca2+]i per se regulates the plasma membrane permeability for sodium in lymphocytes. The inhibition of the tyrosine kinase by genistein inhibited the thapsigargin-induced increases of both [Na+]i and [Ca2+]i in lymphocytes. The present study shows that the filling state of intracellular thapsigargin-sensitive calcium pools regulates trans plasma membrane sodium and calcium influx via a tyrosine kinase-dependent pathway.