ABSTRACT
Objective:To explore the clinical phenotype and gene characteristics of a case of TSC2/PKD1 adjacency gene syndrome, so as to improve the clinical understanding of the disease.Methods:A case of TSC2/PKD1 adjacency gene syndrome diagnosed in the Department of Neurology of the Children′s Hospital Affiliated to Zhengzhou University was analyzed retrospectively. The clinical data, laboratory examination, imaging characteristics and gene variation characteristics of the child were summarized.Results:The patient was a 17 months old girl, with the main complaint of "intermittent convulsion with 17 months of underdevelopment". The clinical manifestations were epileptic seizures, which were in the form of a series of spastic seizures, absence seizures, focal seizures, and depigmentation spots can be seen in the trunk and neck. Cranial magnetic resonance imaging showed multiple patchy signals in the cortex and subcortical areas of the bilateral cerebral hemispheres, multiple small nodular shadows under the ependyma of the bilateral lateral ventricles, the heart color Doppler ultrasound showed patent foramen ovale and pericardial effusion, and the abdomen color Doppler ultrasound showed polycystic kidney. Ophthalmic color Doppler ultrasound showed that there were localized small swelling lesions around the optic disc of the left eye. The whole exon gene sequencing of the pedigree showed the proband had partial deletion of TSC2 gene (NM_000548) at chromosome position chr16: 2125799-2185690. The real-time quantitative detection system verified that exons 23-42 were deleted, and all exons of PKD1 gene were deleted (NM_001009944), and multiple ligation dependent probe amplification verified that exons 1-46 were deleted, and no downstream gene deletion was found. The overall deletion size was about 60 kb. Both of the girl's father and mother had normal phenotypes and were wild-type.Conclusions:TSC2/PKD1 adjacency gene syndrome is relatively rare. It can have clinical manifestations of tuberous sclerosis/autosomal dominant polycystic kidney disease. Most of the nervous system and kidney are seriously affected, and the prognosis is poor. TSC2/PKD1 gene deletion and variation is the genetic cause of the TSC2/PKD1 adjacency gene syndrome.
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@#Objective To explore the effects of PKD1 gene on mouse aortic smooth muscle (MOVAS) cells autophagy. Methods The shRNA and over-expression lentiviral vectors for the target gene of PKD1 were constructed. MOVAS cells were infected by a number of successful packaging shRNA (PKD1 knockdown) or ETS-1 (PKD1 over-expressing) lentiviral vectors, and qPCR was used to test interference and over-expressing effects. Then qPCR and Western blotting were used to detect the expression levels of autophagy markers including Atg5, Beclin1 and LC3 in control group, shPKD1 group and ETS-1 group. Results Compared with the control group, PKD1 mRNA level was decreased in the shPKD1 group (P<0.05); ETS-1 and PKD1 mRNA levels were increased in the ETS-1 group (P<0.05). In contrast with the control group, the mRNA levels of autophagy markers including Atg5 (P<0.05) and Beclin1 (P<0.01) were obviously decreased in the shPKD1 group, but they were obviously increased in the ETS-1 group (P<0.001). Protein levels of Atg5, Beclin1 and LC3 were significantly decreased in the shPKD1 group (P<0.05), but they were increased obviously in the ETS-1 group (P<0.05) in contrast with the control group. Conclusion PKD1 gene is involved in MOVAS cells autophagy, low expression of PKD1 gene can inhibit autophagy and high expression of PKD1 promotes autophagy in vascular smooth muscle cells.
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Objective To explore the clinical phenotype and genotype characteristics of infantile polycystic kidney. Method The clinical data of polycystic kidney disease in one infant were retrospectively analyzed, and the correlation between clinical phenotype and genotype was analyzed. Results In this infant the polycystic kidney was discoved in the fetal period, and shortness of breath, foaming at the mouth were present after birth. Abdominal magnetic resonance imaging indicated that there was medullary sponge kidney in both kidneys accompanied by mild effusion and cysts were found in the right kidney. Gene detection showed a missense mutation c.1123 C>T (Arg375Trp) of exon15 in PKHD1 gene. The exon31 of PKHD1 gene had a missense mutation c.3617G>T (Gly1206Val), which was a new missense mutation. The exon18 of PKD1 gene had a missense mutation c.7211G>A (Arg2404Gln), which is a complex heterozygous mutant of homozygote. All of the mutations are missense mutations. The infant was improved and discharged after treatment, and renal function was normal during 4 months of follow-up. Conclusion Gene detection can be used for early diagnosis of infantile polycystic kidney disease. Newborns with two missense mutations can survive, and exon31 mutation c.3617G>T (Gly1206Val) is a new finding.
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Autosomal dominant polycystic kidney disease (ADPKD) is a common hereditary kidney disease caused due to a mutation in PKD1 gene and the PKD2 gene located at chromosome level 16 and chromosome 4. ADPKD often leads to progressive kidney (renal) failure, primarily due to continued enlargement of the cysts and replacement of normal kidney tissue. The present case is of a 70-year-old male diabetic patient with ADPKD along with acute pyelonephritis caused by multi-drug resistant Staphylococcus D group and Candida albicans, treated with a new antibiotic adjuvant entity ceftriaxone/sulbactam/disodium edetate, and fluconazole recovered completely.
ABSTRACT
Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common human life-threatening monogenic disorders. The disease is characterized by bilateral, progressive renal cystogenesis and cyst and kidney enlargement, often leading to end-stage renal disease, and may include extrarenal manifestations. ADPKD is caused by mutation in one of two genes, PKD1 and PKD2, which encode polycystin-1 (PC1) and polycystin-2 (PC2), respectively. PC2 is a non-selective cation channel permeable to Ca2+, while PC1 is thought to function as a membrane receptor. The cyst cell phenotype includes increased proliferation and apoptosis, dedifferentiation, defective planar polarity, and a secretory pattern associated with extracellular matrix remodeling. The two-hit model for cyst formation has been recently extended by the demonstration that early gene inactivation leads to rapid and diffuse development of renal cysts, while inactivation in adult life is followed by focal and late cyst formation. Renal ischemia/reperfusion, however, can function as a third hit, triggering rapid cyst development in kidneys with Pkd1 inactivation induced in adult life. The PC1-PC2 complex behaves as a sensor in the primary cilium, mediating signal transduction via Ca2+ signaling. The intracellular Ca2+ homeostasis is impaired in ADPKD, being apparently responsible for the cAMP accumulation and abnormal cell proliferative response to cAMP. Activated mammalian target for rapamycin (mTOR) and cell cycle dysregulation are also significant features of PKD. Based on the identification of pathways altered in PKD, a large number of preclinical studies have been performed and are underway, providing a basis for clinical trials in ADPKD and helping the design of future trials.
Subject(s)
Humans , Polycystic Kidney, Autosomal Dominant/genetics , TRPP Cation Channels/genetics , Apoptosis/genetics , Calcium/metabolism , Disease Progression , Gene Silencing , Mutation , Membrane Proteins/genetics , Polycystic Kidney, Autosomal Dominant/metabolismABSTRACT
A doença renal policística do adulto é uma desordem genética de caráter autossômico dominante, caracterizada por progressivo desenvolvimento e crescimento de cistos renais, que culminam com a falência renal terminal na meia-idade. Outras manifestações clínicas associadas incluem cistos hepáticos e pancreáticos, hipertensão, aneurismas cerebrais e defeitos cardiovasculares. Aspectos celulares e moleculares dos mecanismos de cistogênese envolvem proliferação e apoptose celular, remodelamento da matriz extracelular, secreção e acúmulo de fluidos. Geneticamente heterogênea, na maioria dos casos (aproximadamente 85%) são mutações no gene PKD1, localizado no cromossomo 16p13.3, com o segundo gene, PKD2, localizado nos intervalos do cromossomo 4q13-q23, respondendo por 15% das mutações, ambos já seqüenciados e caracterizados. Existem evidências da interação comum das proteínas policistinas 1 e 2 em rotas de eventos de adesão extracelular e transporte iônico, possibilitando a regulação do fluxo de Ca++ transmembrana. Inúmeros trabalhos vêm tentando correlacionar o genótipo mutado ao fenótipo expresso em termos da progressão e severidade daautosomal dominant polycystic kidney disease. A análise das mutações autosomal dominant polycystic kidney disease é fundamental para a compreensão dos mecanismos de atuação envolvidos na doença. Métodos de detecção baseados na reação em cadeia da polimerase têm sido amplamente empregados, como a reação em cadeia da polimerase via transcriptase reversa, protein truncation test, single-strand conformational polymorphism e denaturing high performance liquid chromatography, importantes ferramentas que auxiliam no seqüenciamento e caracterização dessas mutações
Adult polycystic kidney disease is an autosomal dominant genetic disorder, characterized by progressive development and growth of renal cysts, which result in terminal renal failure in middle age. Other associated clinical manifestations include hepatic and pancreatic cysts, hypertension, cerebral aneurysms and cardiovascular disorders. Cellular and mononuclear aspects of the mechanisms of cytogenesis comprehend cellular proliferation and apoptosis, remodeling of the extracellular matrix, secretion and accumulation of fluids. This disease is genetically heterogeneous; in most cases (approximately 85%), the gene involved is PKD1, which is located on chromosome 16p13.3. In the remaining cases (15%), the disease is caused by mutational changes in another gene (PKD2), which is located at chromosome intervals 4q13-q23. Both genes have been sequenced and characterized. There is evidence of the common interaction of polycystins 1 and 2 in pathways of extracellular adhesion and ionic transportation events, which promotes the regulation of transmembrane Ca++ flow. Several studies have tried to correlate the mutant genotype with the phenotype expressed in terms of progression and severity of the autosomal dominant polycystic kidney disease. Analyzing mutations in the autosomal dominant polycystic kidney disease is crucial for understanding the action mechanisms involved in this disease. Detection methods based on the polymerase chain reaction have been widely used, such as the reverse transcriptase polymerase chain reaction, protein truncation test, single-strand conformational polymorphism, and denaturing high performance liquid chromatography. They are important tools that help sequencing and characterizing those mutations