Deciphering congenital heart defects, facial dysmorphism and intellectual developmental disorder (CHDFIDD) associated with constitutional CDK13 pathogenic variants - case report and literature review.

There are 21 human cyclin-dependent kinases which are involved in regulation of the cell cycle, transcription, RNA splicing, apoptosis and neurogenesis. Five of them: CDK4, CDK5, CDK6, CDK10 and CDK13 are associated with human phenotypes. To date, only 62 patients have been presented with mutated CDK13 gene. Those patients had developmental delay, dysmorphic facial features, feeding difficulties, different structural heart and brain defects. 36 of them had missense mutation affecting the protein kinase domain of CDK13. Our patient is the first person reported so far with a frameshift mutation which introduce premature stop codon in the first exon of the CDK13 gene. She has symptoms characteristic for congenital heart defects, facial dysmorphism and intellectual developmental disorder (CHDFIDD).

Diagnostic approach to a paediatric patient with Wiedemann-Steiner syndrome with de novo missense variant in the KMT2A gene - a case report.

INTRODUCTION: Wiedemann-Steiner syndrome is caused by mutations in the KMT2A gene (11q23.3). It might be inherited autosomal dominant or appear de novo. Features described in the syndrome include developmental delay, short stature, hypotonia, hypertrichosis, facial dysmorphic features, and intellectual disability. CASE REPORT: A boy aged 5.5 months was admitted to the Genetics Outpatient Clinic due to delayed psychomotor development. Microsomia, hypotonia, joint laxity, and facial dysmorphic features were noticed. No genomic imbalance was found in microarray, based on comparative genomic hybridization. The c.3528G>T variant of the KMT2A gene was identified on chromosome 11 of the missense type in next-generation sequencing. The reasons for phenotypic features were confirmed in genetic research. CONCLUSIONS: Wiedemann-Steiner syndrome has a variable clinical phenotype. There is a strong need to pay attention to phenotypic features that may suggest the syndrome and refer patients for appropriate genetic diagnostics.

The Importance of Selected Dysregulated microRNAs in Diagnosis and Prognosis of Childhood B-Cell Precursor Acute Lymphoblastic Leukemia.

B-cell precursor acute lymphoblastic leukemia (BCP-ALL) is a frequent type of childhood hematological malignancy. The disease is classified into several subtypes according to genetic abnormalities. MicroRNAs (miRNAs) are involved in pathological processes (e.g., proliferation, apoptosis, differentiation). A miRNA is a group of short non-coding RNAs with relevant regulatory effects on gene expression achieved by suppression of the translation or degradation of messenger RNA (mRNA). These molecules act as tumor suppressors and/or oncogenes in the pathogenesis of pediatric leukemias. The characteristic features of miRNAs are their stable form and the possibility of secretion to the circulatory system. The role of miRNA in BCP-ALL pathogenesis is still emerging, but several studies have suggested using miRNA expression profiles as biomarkers for diagnosis, prognosis, and response to therapy in leukemia. The dysregulation of some miRNAs involved in childhood acute lymphoid leukemia, such as miR-155, miR-200c, miR-100, miR-181a, miR125b, and miR146a is discussed, showing their possible employment as therapeutic targets. In the current review, the capabilities of miRNAs in non-invasive diagnostics and their prognostic potential as biomarkers are presented.

Gene Therapy in ALS and SMA: Advances, Challenges and Perspectives.

Gene therapy is defined as the administration of genetic material to modify, manipulate gene expression or alter the properties of living cells for therapeutic purposes. Recent advances and improvements in this field have led to many breakthroughs in the treatment of various diseases. As a result, there has been an increasing interest in the use of these therapies to treat motor neuron diseases (MNDs), for which many potential molecular targets have been discovered. MNDs are neurodegenerative disorders that, in their most severe forms, can lead to respiratory failure and death, for instance, spinal muscular atrophy (SMA) or amyotrophic lateral sclerosis (ALS). Despite the fact that SMA has been known for many years, it is still one of the most common genetic diseases causing infant mortality. The introduction of drugs based on ASOs-nusinersen; small molecules-risdiplam; and replacement therapy (GRT)-Zolgensma has shown a significant improvement in both event-free survival and the quality of life of patients after using these therapies in the available trial results. Although there is still no drug that would effectively alleviate the course of the disease in ALS, the experience gained from SMA gene therapy gives hope for a positive outcome of the efforts to produce an effective and safe drug. The aim of this review is to present current progress and prospects for the use of gene therapy in the treatment of both SMA and ALS.

Case Report: Two Newly Diagnosed Patients With KBG Syndrome-Two Different Molecular Changes.

Mutations or deletions of ANKRD11 gene are responsible for the symptoms of KBG syndrome. The KBG syndrome is a rare genetic disorder which is inherited in an autosomal dominant manner. Affected patients usually have characteristic facial features, macrodontia of the upper central incisors, hand abnormalities, developmental delay and short stature. In the present article we would like to report a clinical and molecular case study of two patients affected by KBG syndrome. The diagnosis of the first patient was confirmed by the identification of the novel pathogenic variant in ANKRD11 gene by next-generation sequencing. The second patient was diagnosed after the detection of a 16q24.2q24.3 deletion encompassing the ANKRD11 gene microarray.

Optimal Endoscopic Resection Technique for Selected Gastric GISTs. The Endoscopic Suturing System Combined with ESD-a New Alternative?

Background and Study Aim: In terms of therapeutic management, gastrointestinal stromal tumors (GISTs) seem to be the most difficult group of subepithelial gastrointestinal lesions (SELs). Despite various treatment option, choice of optimal management remains a dilemma in daily practice. Our aim was to evaluate a new hybrid resection technique of gastric GISTs type III as a modality of endoscopic full-thickness resection. Methods: Three males and one female (mean age of 68) were qualified for the procedure. Endoscopic full-thickness resections consisted of the endoscopic resection combined with suturing by Apollo OverStitch System. The main inclusion criterium was a complete diagnosis of GISTs (computed tomography (CT), endoscopic ultrasound (EUS), fine-needle biopsy (FNB)) with the evaluation of the tumor features, especially, the location in the gastric wall. All of the tumors were type III with a diameter between 20-40 mm. The lesions were located in the corpus (1), antrum (1) and between gastric body and fundus (2). All procedures were performed in 2019. Results: The technical and therapeutic success rate was 100% and the mean resection time 107.5 min. Neither intra- nor postprocedural complications were observed. In all four cases, R0 resection was achieved. Histopathologic assessment confirmed GIST with <5mitose/50HPF in all of the tumors, with very low risk. Conclusion: Based on our outcomes, endoscopic resection combined with the sewing by Apollo OverStitch of gastric GISTs type III, with the diameter between 20-40 mm, seems to be an effective therapeutic option with a good safety profile, however further studies with a larger treatment group are needed.

Breakpoint Mapping of Symptomatic Balanced Translocations Links the EPHA6, KLF13 and UBR3 Genes to Novel Disease Phenotype.

De novo balanced chromosomal aberrations (BCAs), such as reciprocal translocations and inversions, are genomic aberrations that, in approximately 25% of cases, affect the human phenotype. Delineation of the exact structure of BCAs may provide a precise diagnosis and/or point to new disease loci. We report on six patients with de novo balanced chromosomal translocations (BCTs) and one patient with a de novo inversion, in whom we mapped breakpoints to a resolution of 1 bp, using shallow whole-genome mate pair sequencing. In all seven cases, a disruption of at least one gene was found. In two patients, the phenotypic impact of the disrupted genes is well known (NFIA, ATP7A). In five patients, the aberration damaged genes: PARD3, EPHA6, KLF13, STK24, UBR3, MLLT10 and TLE3, whose influence on the human phenotype is poorly understood. In particular, our results suggest novel candidate genes for retinal degeneration with anophthalmia (EPHA6), developmental delay with speech impairment (KLF13), and developmental delay with brain dysembryoplastic neuroepithelial tumor (UBR3). In conclusion, identification of the exact structure of symptomatic BCTs using next generation sequencing is a viable method for both diagnosis and finding novel disease candidate genes in humans.

IL-6, IL-10, c-Jun and STAT3 expression in B-CLL.

Chronic lymphocytic leukemia is characterized by the accumulation of functionally abnormal, monoclonal B lymphocytes in the peripheral blood, bone marrow, lymph nodes and spleen, resulting in a reduction count of normal immunocompetent cells and their impaired immune function. The defect in transmission of signals from various types of extracellular receptors, leading to aberrant cytokines and transcription factors gene expression, may underlie the basis of immune failure in B-CLL. The aim of the study was to assess of IL-6, IL-10, c-Jun, and STAT3 expression. In response to antigenic stimulation IL-6, IL-10, c-Jun, and STAT3 proteins induce mutual activity. The subject of the study was subpopulations of leukemic lymphocytes (CD5+ CD19+) and CD19+ B cells from healthy donors (control group). Our results provide evidence that the regulation of IL-6, IL-10, c-Jun, and STAT3 gene expression in CLL B cells is clearly different from normal B lymphocytes. In B-CLL STAT3 expression in unstimulated lymphocytes is significantly higher (p<0.0001) compared with normal subpopulation of B cell. In contrast, IL-6, IL-10, and c-Jun mRNA expressions are statistically lower in B-CLL in comparison with the control group, in all cases (p<0.0001). When analyzing the relationship between c-Jun expression and B-CLL stage according Rai we revealed decreasing c-Jun expression, both at the mRNA and protein levels, along with advancing stage of disease.

[Alterations in tears aqueous layer during cytostatics treatment]. / Zmiany w warstwie wodnej lez podczas leczenia cytostatykami.

PURPOSE: The aim of the study was to evaluate tears secretion, pH and lysozyme activity in tears aqueous layer during chemotherapy in lung, breast and bowel cancer. MATERIAL AND METHODS: 36 patients were enrolled to the study. Depending on the type of cancer and type of chemotherapy patients were divided into three groups. Group I (12 patients) diagnosed with non-small-cell lung cancer treated with PE schema (cisplatin, etoposide), Group II (12 patients) with breast cancer treated with FAC schema (fluorouracil, doxorubicin, cyclophosphamide), Group III (12 patients) with bowel cancer treated with FU/LV schema (fluorouracil, leucovorin). In all the patients: Schirmer's I test, pH measurements and lysozyme test were performed. Patients were examined before chemotherapy, after 2nd, 4th, 6th cycle. RESULTS: In group I and II lowering of tears secretion (p < 0.001) was revealed. In group III there was higher tears secretion (p < 0.001). PH was lowered after 2nd chemotherapy course in group I and II. In further treatment pH value were in the same lower level as after the second course. In group III there was higher pH--more alkaline (p < 0.001) after 2nd cycle of treatment and it was on the same level to the end of the examination process. Lowering of lysozyme activity in the tears film in all groups (p < 0.001) was established. The higher alterations of the lysozyme activity were observed in group treated with FAC schema. CONCLUSIONS: Cytostatic treatment has major influence on tears aqueous layer causing alterations of tears secretions. PH alterations depending on type of chemotherapy was observed. Lowering of lysozyme activity in tears was observed. All the deteriorations aggravate with duration of chemotherapy. Alterations of tears film parameters during chemotherapy may influence upon eye surface homeostasis and infectious complication. tears aqueous layer, Schirmer's test, lysozyme activity, tears pH.

[Influence of cancer chemotherapy on conjunctival epithelium and goblet cells]. / Wplyw chemioterapii stosowaney w leczeniu nowotworów zlosliwych na stan nablonka i komórek kubkowych spojówki.

PURPOSE: Evaluation of different types of chemotherapy schemes administered in lung, breast and bowel cancer on conjunctival epithelium and goblet cells morphology. MATERIAL AND METHODS: 36 patients (72 eyes) were enrolled to the study. Patients were divided into three groups depending on type of cancer and chemotherapy: group I - patients diagnosed with non- small cells lung cancer treated with PE schema (cisplatin, etoposide), group II - with breast cancer treated with FAC schema (fluorouracil, doxorubicin, cyclophosphamide), group Ill - bowel cancer treated with FU/LV schema (fluorouracil, leucovorin). Examinations were performed before chemotherapy and after Il'th, IV'th, VI'th chemotherapy cycle. Conjuntival specimen were obtained with exfoliative cytology, stained with PAS and hematoxyline. RESULTS: Statistically significant deterioration of conjunctival epithelium and goblet cells in all the groups in each time of examination (p<0.001) was observed. Alterations were aggravated with duration of chemotherapy. Before chemotherapy all the patients had normal epithelium and goblet cells (grade 0 or 1 according to the Nelson's scale). Conjunctival cells status gradually deteriorated and altered from the normal glandular epithelium to the squamous cells epithelium through the process of squamous metaplasia. In further chemotherapy cycles each patient (1,0 fraction) had abnormal morphology of epithelium and goblet cells (grade 2 or 3 of Nelson's scale). CONCLUSIONS: Chemotherapy induces squamous metaplasia of epithelium and the reduction of number of conjunctival goblet cells. This abnormalities were time dependent and increased with duration of chemotherapy and were not depended on type of chemotherapy scheme.

Clinical approach to visceral pain in irritable bowel syndrome - pathophysiology, symptoms, and treatment.

Visceral pain has been defined as a pain resulting from activation of pain receptors localized in mucous membrane, serous membrane, and smooth muscles of hollow organs. The great majority of these organs are innervated by parasympathetic and sympathetic outflows. Afferent nerve fibres are involved in conduction of both acute and persistent pain and hyperalgesia. Visceral pain differs significantly from other types of pain in the way it originates and in clinical presentation. It can be misleading as a symptom, producing several problems in the diagnostic process. Sometimes, severe visceral pain is observed in the course of non-lifethreatening functional gastrointestinal disorders, while slight abdominal discomfort may be a first symptom of malignant tumours. For many years, the treatment of visceral pain has been considered as not satisfactory enough and covered a wide variety of pharmacological substances. For example, the complex therapy of pain and other manifestations associated with irritable bowel syndrome include psychotherapy/behavioural therapy, bulk-forming agents, probiotics, laxatives, antidiarrheals, antibacterial agents, antispasmodics, and antidepressants. The current knowledge about the pathogenesis of visceral pain gives a rationale for the development of new, more efficacious drugs with a positive benefit/risk ratio. Unfortunately, experience gained so far with the use of some agents affecting serotoninergic transmission in the gastrointestinal tract have shown a serious danger associated with their administration for patients with irritable bowel syndrome.

[The estimation of systemic chemotherapy treatment administered in breast cancer on lysozyme activity in tears--preliminary report]. / Ocena wplywu systemowej chemioterapii stosowanej w leczeniu raka sutka na aktywnosc lizozymu zawartego we lzach--doniesienie wstepne.

PURPOSE: Estimation of cytostatics influence used in breast cancer treatment on lysozyme activity in human tears depend on time of treatment. MATERIAL AND METHODS: 8 women were treated at the base of chemotherapy schema: docetaxel with doxorubicin and 4 women treated with schema CMF: cyclophosphamide, methotrexate, 5-fluorouracil. Lysozyme activity in tears was assessed by measurement of diameter zone of Micrococcus lysodeicticus growth inhibition. RESULTS: It was revealed that both chemotherapy schema caused statistically significant reduction of diameter zone of M. lysodeicticus growth inhibition, after first and second course of chemotherapy treatment. After second chemotherapy course CMF schema induced loss of lysozyme activity in patient's tears (zero mm of M. lysodeicticus diameter zone growth inhibition). CONCLUSIONS: Systemic chemotherapy administered in breast cancer induce reduction of lysozyme activity in tears, that may cause higher morbidity of ocular surface infections caused by Gram-positive bacteria.

Influence of prednisolone on glucose and uric acid transport across peritoneal membrane in vitro.

Prednisolone and other glucocorticosteroids are used by some peritoneal dialysis patients because of underlying diseases such as peritonitis. Although corticosteroids are potent inhibitors of various processes during inflammation, their influence on the transport properties of peritoneum is little known. Our study investigated the influence of prednisolone (0.001 g/dL) on glucose (1.8 g/dL) and uric acid (0.02 g/dL) transfer across isolated parietal peritoneum taken from the anterior abdominal wall of white Hyplus 59 rabbits and placed inside a modified Ussing-type chamber. Values for transfer from the interstitial (I) to the mesothelial (M) side of membrane (I-->M) and in the opposite direction (M-->I) were calculated using the mathematical model of mass transport and are expressed as a coefficient of diffusive permeability [P (in centimeters per second)]. Four separate series of experiments were done. In the first and second series, we respectively examined glucose transport under control conditions (for 120 minutes) and then before (15-60 minutes) and after (75-120 minutes) introduction of prednisolone on the M side of the membrane. In the third and fourth series, similar studies of uric acid transfer were done. In the control (first and third) series, the stability of bidirectional transport for solute of interest was observed. The values of P +/- standard error of the mean (all x0.0001) for I-->M and M-->I transfer of glucose were, respectively, 2.489 +/- 0.329 cm/s and 2.259 +/- 0.493 cm/s. In the case of uric acid, the transport values were lower and amounted 1.936 +/- 0.324 cm/s and 1.895 +/- 0.596 cm/s for I-->M and M-->I respectively. Application of prednisolone on the M side of membrane lowered bidirectional transfer of glucose across peritoneal membrane by a mean of 73% (p < 0.02) and transport of uric acid by a mean of 19% (p < 0.003). These results show that, in vitro, prednisolone lowers glucose and uric acid transport across the peritoneal membrane, modifying the transfer dynamics of glucose to a greater extent. These observations may have clinical importance, especially in patients with disorders of peritoneal permeability, diabetes, and hyperuricemia.

Influence of osmotic and oncotic factors on gentamicin and insulin transport across the peritoneal membrane in vitro.

Glucose or its polymer is usually added to dialysis solution for the development of sufficient ultrafiltration during peritoneal dialysis. The aim of the present study was to determine the influence of glucose and icodextrin on the transport of gentamicin and insulin from the mesothelial to the interstitial side of the peritoneal membrane. Transfer values are expressed as a coefficient of diffusive permeability, P, in centimeters per second. Each of the molecules was tested in 3 series of experiments using rabbit parietal peritoneum, a modified Ussing chamber, and a mathematical model of mass transport. First, transperitoneal transfers of gentamicin (0.040 g/dL) and insulin (0.1 g/dL) were analyzed in control conditions for 120 minutes. Then, transport parameters for gentamicin and insulin were separately determined before (15-60 minutes) and after (75-120 minutes or 75-130 minutes) the application of glucose (1.8 g/dL) or icodextrin (2 g/ dL) on the mesothelial side of the peritoneal membrane. Insulin transport was observed to be stable in the control series. Gentamicin transfer was not stable; its passage declined by 52% (p < 0.01) in the control series. The mean transfer parameters were 7.41 +/- 1.40 cm/s (x0.0001) over 15-30 minutes and 3.21 +/- 0.54 cm/s (x0.0001) over 75-130 minutes. Gentamicin transfer declined less in the series with glucose or icodextrin, by 21% (p < 0.04) and 30% (p < 0.05) respectively, than in the control series. For insulin, the mean P (+ standard error of the mean) was 0.15 +/- 0.02 cm/s (x0.0001) at the first hour of transfer and 0.14 - 0.02 cm/s (x0.0001) at the second. Glucose induced a nonsignificant intensification of insulin transport. Icodextrin increased insulin passage by 107% (p < 0.03). Osmotic and oncotic factors (glucose and icodextrin) both stabilize the transfer of gentamicin across the peritoneal membrane in vitro. Glucose polymer intensifies insulin transport from the mesothelial to the interstitial side of the peritoneum. Similar modifications might be observed in vivo during peritoneal dialysis or continuous intraperitoneal administration of insulin, influencing the efficiency of those treatments.

Investigation of V600E BRAF mutation in papillary thyroid carcinoma in the Polish population.

UNLABELLED: Papillary thyroid carcinoma (PTC) is the most common malignancy of the thyroid gland. The high incidence of RET/PTC and Trk rearrangements or point mutations in RAS and c-MET oncogenes are the genetic hallmarks of PTC. Recently, oncogene BRAF has become a subject of great interest. The mutation of BRAF gene is characteristic for PTC and poorly differentiated and/or undifferentiated cancers derived from PTC. The predominant mutation of this gene, reported in PTC, is a single transversion in exon 15 (T1799A), which results in substitution of valine to glutamate at residue 600 (BRAF V600E, formerly position 1796 and residue V599E). It has been proved that the frequency of this mutation in PTC varies within the range of 29% to 69% in different populations. OBJECTIVES: The aim of this study was to estimate the frequency of BRAF (V600E) mutation in PTC in the Polish population, and to evaluate the possible relationships between the presence of BRAF mutation and such parameters, as patient's age, gender, histopathological variant and the clinical staging of PTC. METHODS: Analysis of BRAF (V600E) mutation was performed by single strand conformation polymorphism (SSCP) analysis and real-time allele-specific polymerase chain reaction (ASPCR) in tumour tissues from 25 patients with PTC. We compared the sensitivity of real-time AS-PCR, SSCP method and direct DNA sequencing of PCR products. We used 25 PTC tissues (including the follicular variant of PTC - 8 cases, the classic variant of PTC - 14 cases and the tall-cell variant of PTC - 3 cases). RESULTS: V600E mutation in BRAF gene was detected in 12/25 (48%) cases of PTC. Mutation screening of exon 15 gene BRAF revealed three types of mutations, i.e. V600E, V600M, and overlapping mutations V600E/V600K. No correlation was found between BRAF mutation and patient's age and sex and particular stage in clinical staging systems (TNM Staging, the University of Chicago clinical class, and Ohio State University Staging). Regarding the histopathological variants of PTC, mutation in BRAF gene was more frequent in classic variant of PTC as compared with follicular variant of PTC. CONCLUSION: The real-time AS-PCR method proved to be more sensitive than SSCP and sequencing of PCR products. Our study is the first one in which the frequency of BRAF (V600E) mutation in PTC was reported for the Polish population. Similarly to the results obtained by others, there was no coexistence of BRAF (V600E) mutation and RET/PTC and/or Trk rearrangements or RAS mutation in PTC tissue. Our results do not confirm the relationship between the BRAF (V600E) mutation and the clinical outcome of PTC.

Genetic background of carcinogenesis in the thyroid gland.

The process of carcinogenesis is permanently one of the most interesting and significant issues for researchers in different fields of medicine. Therefore, we attempted to bring closer the problem of neoplastic transformation in the thyroid gland. This article covers the latest data about genetic factors, involved in thyroid carcinogenesis. We have presented results of the most recent studies referred to molecular biology of thyroid neoplasms. We have demonstrated not only the genetic background of cancers, derived from the thyroid follicular cell, but also genetic aspects related to medullary thyroid carcinoma and some benign thyroid lesions. The review describes DNA methylation disturbances and the mutations in thyrotropin receptor and G protein genes. Furthermore, we introduce the results of studies performed at our laboratory, concerning mutations in the following protooncogenes: RAS, RET, Trk, MET, and BRAF. Also, we present our data, regarding the loss of heterozygosity (LOH) in the short arm of chromosome 3. Additionally, we discuss overexpression of cyclin D1 gene in benign and malignant thyroid lesions. Previous studies performed at our laboratory indicate the role of IGF-I in the pathogenesis and invasiveness of thyroid cancers. The review indicates that progress in genetics of the thyroid cancer is extremely rapid.

BRAF mutations in papillary thyroid carcinoma.

Papillary thyroid carcinoma (PTC) is the most frequent malignant neoplasm of the thyroid originating from the thyroid follicular cell (TFC). Although the formation of PTC is believed to result from rearrangements of RET or TRK oncogenes or MET point mutations, these structural aberrations or point mutations do not correlate with the clinicopathological features of PTC and do not seem to be a useful prognostic marker of the disease. Therefore, further experiments should be carried out in order to find new practical clinical markers. Recently, oncogene BRAF has become a subject of great interest. The mutation of BRAF gene is characteristic for PTC and poorly differentiated and/or undifferentiated cancers derived from PTC. The occurrence of BRAF mutation has often been observed in various human tumours. The presence of mutation was confirmed in melanoma, colon cancer, gliomas and lung cancer. In the majority of cases, there is only one type of point mutation - V600E. The RAS/RAF/MEK/MAPK kinase pathway mediates the cellular response to mitogenic signals. BRAF gene mutation results in increased kinase activity, leading to excessive activation of the above mitogenic pathway and to uncontrolled proliferation of cancer cells. Some correlation was noticed between BRAF gene mutation and the clinical stage of the neoplastic disease in question. Preliminary investigations indicate that the presence of BRAF mutation might be a valuable diagnostic and prognostic marker of the disease. Further investigations could also bring further improvements into the therapeutic management of thyroid cancer. There are reports emphasizing the possibility of using the inhibitors of BRAF proteins in the treatment of PTC. Certainly, in order to confirm the diagnostic usefulness of this marker, further studies should be carried out.