Etiology of early hearing loss in Brazilian children / Etiologia da perda auditiva precoce em crianças brasileiras

Abstract Introduction Hearing loss etiology depends on the population studied as well as on the ethnicity and the socio-economic condition of the analyzed region. Etiological diagnosis contributes to the improvement of preventive measures and to the early identification of this deficiency. Objective To identify the etiological factors of hearing loss and its prevalence in a tertiary hospital in southern Brazil, to verify the frequency of mutations in GJB2 and GJB6 genes, and to correlate the degree of hearing loss with the etiological factors of deafness. Methods This prevalence study involved 140 children with bilateral sensorineural or mixed hearing loss. Medical history, physical examination, audiometry, and evoked auditory brainstem response were conducted. Imaging and genetic examinations were also performed. Results Etiologies and their prevalence were as follows: (a) indeterminate causes, 31.4%; (b) conditions related to neonatal period, 22.1%; (c) genetic, 22.1%; (d) auditory neuropathy, 10%; (e) other factors (cortical malformation, intracranial hemorrhage, and internal ear malformations), 7.9% and (f) congenital infections, 6.4%. Within the genetic cases, ten homozygous and seven heterozygotes of the 35delG mutation were identified, besides two cases of rare variants of GJB2: p.Try172* and p.Arg184Pro. One case with homozygosis of del(GJB6-D13S1830) was found. Regarding severity of hearing loss, in 78.6% of the cases the degree of hearing loss was profound and there were no significant differences when comparing between etiologies. Conclusion The number of indeterminate etiologies is still high and congenital CMV infection may be a possible cause of undiagnosed etiology for hearing loss. The predominance of etiologies related to neonatal conditions and infectious causes are characteristic of developing countries. The most prevalent mutation was 35delG, the main GJB2 gene, probably because of the European influence in the genotype of our population.

Resumo Introdução A etiologia da perda auditiva depende da população estudada, da etnia e da condição socioeconômica da região analisada. O diagnóstico etiológico contribui para o aprimoramento das medidas preventivas e para a identificação precoce dessa deficiência. Objetivos Identificar os fatores etiológicos da perda auditiva e sua prevalência em um hospital terciário do sul do Brasil, verificar a frequência de mutações nos genes GJB2 e GJB6 e correlacionar o grau da perda auditiva com os fatores etiológicos da deficiência auditiva. Método Este estudo de prevalência avaliou 140 crianças com perda auditiva neurossensorial bilateral ou mista. Foram submetidos a anamnese com histórico médico, exame físico, audiometria e potencial evocado auditivo de tronco encefálico. Exames de imagem e genéticos também foram feitos. Resultados As etiologias e sua prevalência foram as seguintes: (a) causas indeterminadas, 31,4%; (b) condições relacionadas ao período neonatal, 22,1%; (c) genética, 22,1%; (d) neuropatia auditiva, 10%; (e) outros fatores (malformação cortical, hemorragia intracraniana e malformações da orelha interna), 7,9% e (f) infecções congênitas, 6,4%. Entre os casos genéticos, foram identificados dez casos homozigotos e sete heterozigotos da mutação 35delG, além de dois casos de variantes raras do GJB2: p.Try172* e p.Arg184Pro. Foi encontrado um caso homozigoto da mutação del (GJB6‐D13S1830). Em relação à gravidade da perda auditiva, em 78,6% dos casos o grau da perda auditiva foi profundo e não houve diferenças significantes na comparação entre as etiologias. Conclusão O número de etiologias indeterminadas ainda é elevado e a infecção congênita por CMV pode ser uma possível causa de etiologia não diagnosticada para perda auditiva. A predominância das etiologias relacionadas às condições neonatais e às causas infecciosas são características de países em desenvolvimento. A mutação mais prevalente foi a 35delG e o principal gene foi o GJB2, provavelmente devido à influência europeia no genótipo de nossa população.

Effect of gap junctions on anti-proliferation effect of miR-124 and its mechanism / 中国药理学通报

was observed by patch clamp. Results Cx32 or Cx26 expression and GJ function were induced by doxycycline (Dox, the promotor for PBI plasmid) in transfected Hela cells. MiR-124 reduced the proliferation of Hela cells, dox incubation alone did not affect Hela cell growth, and also had no effect on anti-tumor effect of miR-124 when combined with miR-124 transfection. Compare with U 87shRNA-Cx43 , the Cx43 expression and GJ function significantly decreased in U87shRNA-Cx43. Similar to the effect on Hela cells, MiR-124 also reduced U87 cell growth. Reducing Cx43 expression did not influence U87 cell proliferation, but attenuated the growth-inhibition effect of miR-124 when combined with miR-124 transfection. Under the microscope, the transfer of fluorescence-labelled miR-124 from "donor" cell to adjacent " non-injection " cell was observed. Conclusions The role of GJ on anti-tumor effect of miR-124 possesses connexin heterogeneity. Compare with Cx26 or Cx32, GJ composed of Cx43 has more obvious effect, which may be related to the maximum permeability of junction channel to miR-124.

Hipoacusia neurosensorial no sindrómica: caracterización molecular, desempeño auditivo y tratamiento en pacientes con mutaciones en las conexinas 26 y 30 / Non-syndromic sensorineural hearing loss: molecular characterization, auditory performance, and treatment in patients with connexin 26 and 30 mutations

La hipoacusia congénita o de aparición temprana es un trastorno sensorial muy frecuente en niños. Las causas son diversas, pueden intervenir factores genéticos y/o ambientales. El 80% de la sordera hereditaria es no sindrómica y de herencia autosómica recesiva. Hasta un 50% de estos casos se deben a mutaciones en el locus DFNB1 donde están localizados los genes GJB2 y GJB6, que codifican las conexinas 26 y 30, dos proteínas que se expresan predominantemente en la cóclea. Se han reportado más de 100 mutaciones en el gen GJB2, con una mutación muy frecuente, 35delG, que representa hasta un 85% de los alelos mutados. Una deleción en el gen GJB6, (delGJB6-D13S1830), surge como la segunda mutación más frecuente. La hipoacusia debida a mutaciones en estos genes es de inicio prelocutivo, con un grado de severidad que varía de moderado a profundo, existiendo casos leves en menor proporción, con variaciones inter e intrafamiliares. Es generalmente estable, bilateral, y afecta a todas las frecuencias. El conocimiento de las causas genéticas de la hipoacusia ha permitido contar con nuevas herramientas para el diagnóstico, y como consecuencia, se ha optimizado el asesoramiento genético y facilitado el diagnóstico precoz de los pacientes, incluso en el período prenatal. La detección precoz tiene un impacto inmediato en la implementación de terapias que permiten una estimulación auditiva temprana. En esta revisión se describe el papel de las conexinas en la fisiología auditiva, así como también las características moleculares y audiológicas y el desempeño auditivo con audífonos e implante coclear en pacientes que presentan mutaciones en las conexinas 26 y 30.

Congenital or early appearing hearing loss is a very common sensory disorder in children. The causes for the disorder are diverse and genetic as well as environmental factors may be involved. Overall, 80% of the hereditary deafness is non-syndromic and of autosomal recessive inheritance. Up to 50% of the cases are associated with mutations in the DFNB1 locus that contains the GJB2 and the GJB6 genes encoding connexins 26 and 30, two proteins that are predominantly expressed in the cochlea. More than 100 mutations of the GJB2 have been reported. The 35delG is a common mutation accounting for up to 85% of the mutated alleles. A deletion in the GJB6 gene, (delGJB6-D13S1830), is the second most frequent mutation found. Hearing loss due to mutations in these genes has an onset before speech develops and degree of severity varies from moderate to severe, with a lower incidence of mild cases and inter- and intrafamily variations. The condition is usually stable, bilateral, and affecting all frequencies. Increased knowledge on the genetic causes of hearing loss has allowed for the development of new diagnostic tools and consequently, improvement of genetic counseling and early, even prenatal, diagnosis. Early detection has an immediate impact with implementation of early auditory stimulation therapies. In this review the role of connexins in auditory physiology described, as well as molecular and audiological features and auditory performance with hearing aids and cochlear implants in patients with connexins 26 and 30 mutations.

Evaluation of electrocardiographic parameters in patients with hearing loss genotyped for the connexin 26 gene (GJB2) mutations / Avaliação dos parâmetros eletrocardiográficos em pacientes com perda auditiva genotipada para mutações do gene conexina 26 (GJB2)

Abstract Introduction: Several studies have associated congenital sensorineural hearing loss in children with prolongation of the cardiac parameter QTc. The cause of this association is unknown. At the same time, mutations in GJB2, which encodes connexin 26, are the most common cause of congenital hearing impairment. Objective: To compare electrocardiographic parameters (PR interval, QRS complex, and QTc interval) in patients with hearing loss who were tested for mutations in GJB2 and GJB6 to investigate whether these mutations affect electrical activity of the heart. Methods: 346 patients (176 males, 170 females) with sensorineural hearing loss of 30 dB HL or more, aged 21.8 ± 19.9 years (including 147 children <14 years), underwent both genetic study for GJB2 and GJB6 mutations and electrocardiography. Results: Mutations in GJB2, including homozygotes and heterozygotes, were found in 112 (32%) patients. There were no significant differences in ECG parameters between groups of patients with and without mutations in GJB2. No differences were observed either in men (mean PR with mutation: 155 ± 16.6 vs. 153.6 ± 30.1 without; QRS: 99.9 ± 9.9 vs. 101.1 ± 15.4; QTc: 414.9 ± 29.9 vs. 412.4 ± 25.7) or women (mean PR with: 148.7 ± 21 vs. 143.8 ± 22.8 without; QRS: 94.8 ± 7.6 vs. 92.9 ± 9.6; QTc: 416.8 ± 20.6 vs. 424.9 ± 22.8). In similar fashion, we did we find any significant differences between groups of children with and without GJB2 mutations (mean PR with: 126.3 ± 19.6 vs. 127 ± 19.7 without; QRS: 80.7 ± 9.5 vs. 79.4 ± 11.6; QTc: 419.7 ± 23.5 vs. 419.8 ± 24.8). Conclusion: No association was found between the presence of GJB2 mutations encoding connexin 26 in patients with hearing loss and their ECG parameters (PR, QRS, QTc).

Resumo Introdução: Vários estudos têm associado a perda auditiva neurossensorial congênita em crianças ao prolongamento do parâmetro cardíaco QTc. A causa dessa associação é desconhecida. Ao mesmo tempo, as mutações no GJB2, que codifica a conexina 26, são a causa mais comum de deficiência auditiva congênita. Objetivo: Comparar parâmetros eletrocardiográficos (intervalo PR, complexos QRS e intervalo QTc) em pacientes com perda auditiva que foram testados para mutações no GJB2 e GJB6 para investigar se essas mutações afetam a atividade elétrica do coração. Método: Foram submetidos a estudo genético para mutações de GJB2 e GJB6 e eletrocardiograma 346 pacientes (176 homens, 170 mulheres) com perda auditiva neurossensorial de 30 dB ou mais, com média de 21,8 ± 19,9 anos (incluindo 147 crianças <14 anos). Resultados: Mutações no GJB2, inclusive homozigóticos e heterozigóticos, foram encontradas em 112 (32%) pacientes. Não houve diferenças significativas nos parâmetros de ECG entre grupos de pacientes com e sem mutações no GJB2. Não foram observadas diferenças em homens (PR médio com mutação: 155 ± 16,6 vs. 153,6 ± 30,1 sem mutação; QRS: 99,9 ± 9,9 vs. 101,1 ± 15,4; QTc: 414,9 ± 29,9 vs. 412,4 ± 25,7) nem em mulheres (PR médio com: 148,7 ± 21 vs. 143,8 ± 22,8, sem; QRS: 94,8 ± 7,6 vs. 92,9 ± 9,6; QTc: 416,8 ± 20,6 vs. 424,9 ± 22,8). Da mesma forma, encontramos diferenças significativas entre os grupos de crianças com e sem mutações de GJB2 (PR médio com: 126,3 ± 19,6 vs. 127 ± 19,7, sem; QRS: 80,7 ± 9,5 vs. 79,4 ± 11,6; QTc: 419,7 ± 23,5 vs. 419,8 ± 24,8). Conclusão: Não foi encontrada associação entre a presença de mutações de GJB2 que codificam conexina 26 em pacientes com perda auditiva e seus parâmetros de ECG (PR, QRS, QTc).

Study on the gap junction protein Connexin26 gene of neonatal congenital cytomegalovirus infection / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJECTIVETo investigate the cytomegalovirus infection in neonates, characteristics of gap junction protein Connexin26 gene mutation and the hearing follow-up results, and to analyze their correlations. METHODS60 CMV-DNA positive and 40 CMV-DNA negative neonatal newborn from The Second Affiliated Hospital of Wenzhou Medical University and The first people's Hospital of Yongkang were screened, the blood biochemistry was analyzed, and the umbilical cord blood was reserved to detect the Connexin26 gene expression of mRNA with RT-PCR.PCR results was sequenced to track the newborn hearing, and analyze the correlations between neonatal cytomegalovirus types, the mutation of Connexin26 gene and hearing test results.RESULTS 26 cases from 60 CMV-DNA positive newborns were found with blood biochemical abnormalities. In all of the newborns, a total of 41 cases had 235delC mutation, 11 cases in the mutations for the development of hearing impairment. The results of correlation analysis showed that there were correlations between cytomegalovirus infection, gene mutation and hearing impairment.CONCLUSION Cytomegalovirus infection in neonates can lead to mutations in the Connexin26 gene, and may further lead to hearing impairment, and the probability of the mutation of Connexin26 gene and sensorineural hearing loss were higher in symptomatic cytomegalovirus infection neonates.

The Apoptosis-Related Gene Differential Expression in the Cochlea of GJB2 Gene Conditional Knockout Mice / 听力学及言语疾病杂志

Objective To study the differential expression of apoptosis related genes in GJB2 gene conditional knockout mice (cCx26Pax2Cre ) cochlea membranous labyrinth ,and to explore the mechanism of GJB2 gene mutations causing deafness .Methods Two developmental stages of P10 and P18 were selected from the knock out mice and the wild type ones (BALB/C) .The total RNA was isolated from cochlear membranous labyrinth and PCR array was performed using mouse apoptosis PCR arrays .Results Compared with wild -type mice ,significant up or down -regulation in gene expression was detected in 16 genes in cCx26Pax2Cre ones at P10 .Of the 16 genes ,14 ones were down-regulated .Among the 14 genes ,9 ones can be classified as anti -apoptosis or pro -proliferation genes ,5 ones can be classified as pro -apoptosis or pro -inflammation genes .The other 2 genes expression was up-regula-ted ,and their main role was to promote apoptosis .Compared with time -matched controls ,significant up or down-regulation in gene expression was detected in 4 genes in cCx26Pax2Cre mice at P18 .Of the 4 genes ,3 ones expression was down-regulated ,were anti-apoptosis ones .The expression of the other one gene among the 4 ones was up-regulated ,which acted as pro -apoptosis genes .Bcl2l10 and Tnfrsf10b expression showed significant down or up -regulation at both stages . Compared with P10 , the expression of caspase - 8 was up - ragulated at P18 in cCx26Pax2Cre mice .Conclusion It is suggested that GJB2 mutation may up -regulate the expression of DR5 ,which can trigger the death receptor pathway to cause apoptosis in cCx 26Pax2Cre mice cochlea directly .At the same time , caspase-8 in death receptor pathway may activate the mitochondria pathway indirectly and amplify the apoptosis further in cCx26Pax2Cre mice cochlea .The final result of the above activated pathways is the wide range of cochlear cells apoptosis and the profound hearing loss in cCx 26Pax2Cre mice .

Inhibitory effect of lentivirus targeting interference Cx26 on proliferation and migration of human highly metastatic hepatocellular carcinoma HCCLM3 cells / 中国药理学通报

Aim To investigate effects of Cx26 on pro-liferation,apoptosis,migration of human highly meta-static hepatocellular carcinoma HCCLM3 cells.Meth-ods The HCCLM3 cells were infected with lentiviral vector targeting interference of Cx26 and the stable transfectants were selected by puromycin.The interfer-ence efficiency of Cx26 was detected by Real-time PCR and Western blot.Gap junction function was assessed by “parachute”dye-coupling assay. The effects of Cx26 interference on proliferation,apoptosis,migra-tion of HCCLM3 cells were determined by MTT assay, flow cytometry,transwell migration assay,respective-ly.Results The mRNA and protein expression of Cx26 in LV-Cx26 group was significantly lower than the LV-NC group and wide group (P<0.01),and GJ function in LV-Cx26 group also significantly reduced compared with LV-NC group and wild group (P <0.01 ).The Cx26 interference significantly inhibited the proliferation (P<0.01)),promoted the apoptosis (P <0.01 ),and decreased migration of HCCLM3 cells in vitro (P <0.01 ).Conclusion Lentiviral vector targeting interference Cx26 expression of HC-CLM3 cells can significantly reduce its GJ function,in-hibit the proliferation and migration,promote apopto-sis,and reduce its malignant properties.

Importancia del diagnóstico de mutaciones en el gen de la conexina 26 en el manejo integral de la sordera congénita no sindrómica / Importance of the diagnosis of connexin 26 gene mutations in the integral management of non-syndromic congenital deafness

Introducción. La sordera congénita es un problema de salud pública. Su incidencia en México es de 2-3 por cada 1000 recién nacidos. El diagnóstico oportuno con el tamiz auditivo neonatal es fundamental para un mejor pronóstico funcional. Aproximadamente 70% de las sorderas congénitas son de origen genético, con herencia autosómica recesiva. La mayoría de estos casos se asocia con mutaciones en el gen GJB2 , que codifica para la proteína conexina 26. Hay tres mutaciones reportadas como las más frecuentes en este gen: c.35delG, c.167delT y c.235delC. Métodos. Previo consentimiento informado de los pacientes, se obtuvo 1 ml de sangre periférica para la extracción de ADN. Mediante las técnicas de PCR-RFLP o PCR seguida de secuenciación, se buscaron las tres mutaciones más frecuentes del gen GJB2 . Resultados. Se realizó el estudio molecular en 11 pacientes: Se encontró un cambio en la secuencia codificante en cinco de ellos. Un paciente fue homocigoto para c.35delG; otro resultó heterocigoto para c.35insG, mutación no reportada previamente; un tercero fue heterocigoto para c.34G>T y dos más fueron heterocigotos para el polimorfismo c.79G>A (p.V27I). En ningún caso se hallaron las mutaciones c.167delT y c.235delC. Conclusiones. Se encontraron cambios de secuencias que correspondieron a dos polimorfismos y a tres mutaciones. La frecuencia de las tres mutaciones investigadas fue menor a lo reportado en la literatura y se encontró una mutación no reportada previamente. Este estudio evidencia la importancia del diagnóstico oportuno con manejo integral, incluyendo el asesoramiento genético con base en estudios moleculares, y resalta la importancia de conocer el perfil genotípico de este grupo de pacientes.

Background. Congenital deafness is a public health problem affecting 2-3:1000 newborns in Mexico. Neonatal audiologic screening allows early detection with important implications for the functional prognosis. About 70% of cases of congenital deafness are associated with a genetic etiology with an autosomal recessive pattern of inheritance. Most cases are caused by mutations in the GJB2 gene, which codifies conexin 26. The three most commonly reported mutations in this gene are c.35delG, c.167delT and c.235delC. Methods. After obtaining informed consent, DNA was extracted from a blood sample, and the three previously mentioned mutations were searched for using PCR-RFLP or PCR followed by sequencing. Results. Molecular analysis was carried out in 11 patients. In five of these patients, a change in sequence was observed. In none of the patients were c.167delT and c.235delC mutations found. One patient was homozygous for c.35delG and another patient was heterozygous for c.35insG, which is a mutation not previously reported. A third patient was heterozygous for c.34G>T. Two additional patients had the c.79G>A (p.V27I) polymorphism. Conclusions. Frequency of the three mutations analyzed was lower compared to other populations. Five sequence changes were observed, two polymorphisms and three mutations, one of them novel. This study also demonstrates the relevance of early diagnosis and multidisciplinary management and the importance of determining the genetic basis of this disease in pediatric patients with congenital deafness.

Influencia de las mutaciones en los genes de conexina en el desarrollo de hipoacusia neurosensorial no sindrómica / Impact of mutations in connexin genes on the development of non-syndromic sensorineural hearing loss

La principal causa de hipoacusia no-sindrómica autosómica recesiva (HNSAR) son mutaciones en el locus DFNB1, que contiene los genes GJB2 (conexina 26) y GJB6 (conexina 30). Se han descripto más de 100 mutaciones diferentes en GJB2. Dos deleciones en GJB6, del (GJB6-D13S1830) y del(GJB6-D13S1854) mostraron ser prevalentes en España. El objetivo de este trabajo fue determinar la prevalencia de mutaciones en los genes GJB2 y GJB6, en niños con HNSAR de Argentina. Este estudio incluyó 113 niños no relacionados con hipoacusia neurosensorial no-sindrómica moderada a profunda. Para el análisis molecular se utilizó una estrategia en etapas. La mutación 35delG (gen GJB2) se analizó mediante PCR-RFLP. La presencia de deleciones en GJB6 se investigó por PCR múltiple. Las muestras no resueltas en las dos primeras etapas fueron analizadas por secuenciación directa del gen GJB2. En 58 pacientes se encontraron alteraciones en la secuencia de los genes GJB2/GJB6. La mutación 35delG se detectó en 52 de los 84 alelos con mutaciones patogénicas. Se identificaron 16 variantes de secuencia diferentes; entre ellas una mutación no descripta previamente, 262G>C (A88P). La deleción del (GJB6-D13S1830) fue identificada en 7 alelos. La frecuencia de mutaciones en GJB2/GJB6 encontrada en este trabajo está en concordancia con la de otras poblaciones caucásicas. La mutación más prevalente fue 35delG y la segunda mutación más común la deleción del (GJB6-D13S1830), con frecuencias similares a las encontradas en España, desde donde Argentina recibió una de sus mayores olas inmigratorias. Estos resultados destacan la importancia del estudio de los genes GJB2/GJB6 en el diagnóstico etiológico de sordera permitiendo un tratamiento precoz y un asesoramiento genético oportuno.

The main cause of autosomal recessive nonsyndromic hear-ing loss (ARNSHL) are mutations in genes GJB2 (connexin 26) and GJB6 (connexin 30) at the DFNB1 locus. More than 100 different mutations in GJB2 have been described. Two dele-tions in GJB6, of (GJB6-D13S1830) and of (GJB6-D13S1854) have been found prevalent in Spain. The aim of this study was to determine the prevalence of GJB2 and GJB6 gene muta-tions in children with ARNSHL in Argentina. In the study, 113 non-related children with moderate to profound nonsyndromic sensorineural hearing loss were included. A staging strategy was used for molecular analysis. The 35delG mutation (gene GJB2) was analyzed using PCR-RFLP. The presence of de-letions in GJB6 was tested by multiplex PCR. Samples that were not resolved in the first two stages were subsequently assessed by direct sequencing of the GJB2 gene. In 58 patients abnormal patterns were found in the GJB2/GJB6 sequences. The 35delG mutation was detected in 52 of the 84 alleles with pathogenic mutations. Sixteen different sequence variants were identified of which one, 262G>C (A88P), was not previously described. Deletion of (GJB6-D13S1830) was identified in 7 alleles. The rate of mutations in GJB2/GJB6 found in this study is similar to that reported in other Caucasian populations. The most prevalent mutation was 35delG followed by a deletion of (GJB6-D13S1830), with a rate similar to that found in Spain from which Argentina received one of the largest waves of immigrants. These results emphasize the need to study GJB2/GJB6 genes in the etiological diagnosis of hearing loss allowing for early treatment and adequate genetic counseling.

Genetic Screening of GJB2 and SLC26A4 in Korean Cochlear Implantees: Experience of Soree Ear Clinic

OBJECTIVES: Genetic hearing loss is highly heterogeneous and more than 100 genes are predicted to cause this disorder in humans. In spite of this large genetic heterogeneity, mutations in SLC26A4 and GJB2 genes are primarily responsible for the major etiologies of genetic hearing loss among Koreans. The purpose of this study is to investigate the genetic cause of deafness in Korean cochlear implantees by performing a genetic screening of the SLC26A4 and GJB2 genes. METHODS: The study cohort included 421 unrelated Korean patients with sensorineural hearing loss (SNHL) and who had received cochlear implants (CI) at Soree Ear Clinic from July 2002 to December 2010. Among 421 CI patients, we studied 230 cases who had received the genetic screening for SLC26A4 or GJB2 genes. Written informed consent was obtained from all participants. All patients had severe to profound, bilateral hearing loss. For 56 patients who showed enlarged vestibular aqueduct on their computed tomography (CT) scan, we analyzed SLC26A4. For 174 CT negative patients, GJB2 gene was sequenced. RESULTS: For the 56 SLC26A4 patients, 32 (57.1%) had two pathogenic recessive mutations in SLC26A4. A single recessive SLC26A4 mutation was identified in 14 patients (25%). H723R and IVS7-2A>G were the most commonly found mutations, accounting for 60.3% (47/78) and 30.8% (24/78) of the mutated alleles, respectively. For the 174 GJB2 patients, 20 patients (11.5%) had two pathogenic recessive mutations in GJB2. 235delC was the most common mutation, accounting for 43.0% (31/72) of mutant alleles. CONCLUSION: The two major genes, SLC26A4 and GJB2, contribute major causes of deafness in CI patients. Continuous studies are needed to identify new genes that can cause hearing loss to Korean CI patients.

Apoptosis Progression in the Hair Cells in the Organ of Corti of GJB2 Conditional Knockout Mice

OBJECTIVES: Apoptosis may play an important role in the mechanism underlying the GJB2 gene conditional knockout (cCx26) mice cochlear cell death. The objective of this study was to explore the the damage mode of the outer hair cells (OHCs) and its real time point of apoptosis and provide information to further explore the role of apoptosis in the happening of hearing loss in cCx26 mice. METHODS: Cochleae from mice at various developmental stages (P8, P12, and P21) were dissected out and first used to be observed under the scanning electron microscope (SEM). Basilar membranes from mice at P8, P14, P18, and P21 were stained by fluorescein isothiocyanate-conjugated phalloidin and propidium iodide (PI) and examined under confocal microscope. RESULTS: The loss of OHCs of cCx26 knockout mice was first set between P12 and P21 under SEM. Whole mount phalloidin and PI staining revealed that obvious apoptotic appearance of the OHCs surface morphology was observed at P18. CONCLUSION: Typical apoptotic morphology was found in the OHCs in the organ of Corti of the cCx26 mice at P18. This may provide information to further study the role of apoptosis in the occurrence of hearing loss of cCx26 mice.

Pesquisa audiológica y molecular para pérdida auditiva por mutación 35delG en el gen de la conexina 26 e infección congénita por citomegalovirus / Audiologic and molecular screening for hearing loss by 35delG mutation in connexin 26 gene and congenital cytomegalovirus infection

Las pérdidas auditivas pueden ser atribuidas a factores genéticos o ambientales. Las mutaciones en el gen de la proteína Cx26 (conexina 26) son responsables de un 30-80% de los casos de pérdida auditiva profunda no sindrómica. La variante 35delG es la prevalente en la población caucásica. Entre los factores ambientales, el citomegalovirus (CMV) es la principal causa de infección congénita. Objetivos. Determinar la prevalencia de infección congénita por CMV y la frecuencia de la mutación 35delG en recién nacidos. Identifcar aquellos con riesgo de pérdida de audición con el fn de realizar un seguimiento audiológico para detectar precozmente las hipoacusias. Material y métodos. Se analizaron 1020 muestras de sangre seca, en papel, de recién nacidos, por PCR convencional y en tiempo real. Se efectuaron las otoemisiones acústicas antes del alta hospitalaria a todos los niños. El seguimiento audiológico se realizó tanto a los portadores de 35delG como a los que tuvieron infección congénita por CMV. Resultados. De los pacientes estudiados, 15 fueron heterocigotas para la mutación 35delG. No se detectaron homocigotas. Seis de las muestras fueron positivas para CMV (resultados confirmados en orina); de ellos, solo un neonato fue sintomático. A todos estos niños se les realizaron las evaluaciones audiológicas; presentaron hipoacusia tres niños con infección congénita por CMV y dos portadores de la mutación 35delG. Conclusión. Se detectó un 1,3% de portadores de la mutación 35delG y una frecuencia de infección congénita por CMV del 0,6%. El seguimiento audiológico de estas dos poblaciones permitió la detección de hipoacusias tardías.

Introduction. Hearing loss may be attributed to genetic and environmental factors. Mutations in the gene of the CX26 protein (connexin 26), are responsible for 30-80% of all cases of non-syndromic profound hearing loss. The 35delG is the most frequent variant in the caucasian population. As to environmental factors, the cytomegalovirus (CMV) is the main cause of congenital infection. Objetives. To determine the prevalence of congenital CMV infection and the frequency of the 35delG mutation in newborns. To identify those at risk of suffering hearing loss in order to do an audiologic follow-up of detected cases. Materials y methods. One thousand and twenty samples of dry blood spots corresponding to newborns were tested using conventional and real time PCR. Audiologic screening was performed to all newborns before hospital discharge. Results. Fifteen out of 1020 subjects were heterozygous for the mutation. No homozygous patients were found. Six out of the samples tested positive for CMV (confrmed by a urine sample), out of which only one newborn was symptomatic. The auditory brainstem response was recorded in all these children. Hearing loss was found in three children with congenital CMV infection and two with 35delG mutation. Conclusion. The frecuency of 35delG mutation carriers in our population was 1.3% and the CMV congenital infection prevalence was 0.6%. Audiologic monitoring of these two populations allowed detection of hearing loss of late onset.

In Silico Study of Human Gap Junction Beta-2 Protein by Homology Modeling

Asp66his, Asp54Lys, and Asp50Asn are mutations in connexin 26 that are observed in the clinic and give rise to autosomal dominant syndromes. They are the result of point mutations in the human gap junction beta-2 gene. In order to investigate the structural mechanism of Bart-Pumphrey Syndrome, Keratitis-Ichthyosis-Deafness Syndrome, and Vohwinkel Syndrome, homology modeling was carried out. Asp66 has direct contact with Asn62 by two hydrogen bonds in the wild-type protein, and in Asp66His, the biggest change observed is a tremendous energy increase caused by hydrogen bond breakage to Asn62. Shifts in the side chain and new hydrogen bond formation are observed for Lys54 compared to the wild-type protein (Asn54) and result in closer contact to Val84. Asp50Asn causes a significant decrease in bond energy, and residual charge reversal repels the ion and metabolites and, hence, inhibits their transportation. Such perturbations are likely to be a factor contributing to abnormal functioning of ion channels, resulting cell death and disease.

Hereditary Palmoplantar Keratoderma and Deafness Resulting from Genetic Mutation of Connexin 26

Gap junctions, which mediate rapid intercellular communication, consist of connexins, small transmembrane proteins that belong to a large family of proteins found throughout the species. Mutations in the GJB2 gene, encoding Connexin 26, can cause nonsyndromic autosomal recessive or dominant hearing loss with or without skin manifestations. A 3-yr-old Korean female and her mother presented to our clinic with diffuse hyperkeratosis of the palms and soles (May 3, 2007). Skin biopsies from the soles of both patients demonstrated histopathological evidence of palmoplantar keratoderma. The patient and a number of her maternal family members also had congenital hearing loss. The combination of congenital hearing loss and palmoplantar keratoderma, inherited as an autosomal dominant trait, led us to test for a mutation in the GJB2 gene in both patients. The results showed the R75W mutation of the GJB2 gene in both. In conclusion, the simultaneous occurrence of a GJB2 mutation in a mother and daughter suggests that R75W mutation cause autosomal dominant hearing loss presenting with palmoplantar keratoderma. To the best of our knowledge, this is the first report of a GJB2 mutation associated with syndromic autosomal dominant hearing loss and palmoplantar keratoderma in a Korean family.

A novel missense mutation p. L76P in the GJB2 gene causing nonsyndromic recessive deafness in a Brazilian family

Mutations in the GJB2 gene, encoding connexin 26 (Cx26), are a major cause of nonsyndromic recessive hearing loss in many countries. We report here on a novel point mutation in GJB2, p.L76P (c.227C>T), in compound heterozygosity with a c.35delG mutation, in two Brazilian sibs, one presenting mild and the other profound nonsyndromic neurosensorial hearing impairment. Their father, who carried a wild-type allele and a p.L76P mutation, had normal hearing. The mutation leads to the substitution of leucine (L) by proline (P) at residue 76, an evolutionarily conserved position in Cx26 as well as in other connexins. This mutation is predicted to affect the first extracellular domain (EC1) or the second transmembrane domain (TM2). EC1 is important for connexon-connexon interaction and for the control of channel voltage gating. The segregation of the c.227C>T (p.L76P) mutation together with c.35delG in this family indicates a recessive mode of inheritance. The association between the p.L76P mutation and hearing impairment is further supported by its absence in a normal hearing control group of 100 individuals, 50 European-Brazilians and 50 African-Brazilians.

Absence of mutations in GJB2 (Connexin-26) gene in an ethnic group of southwest Iran.

BACKGROUND: The common GJB2 gene mutation (35delG) has been previously reported from Iranian patients that were affected with nonsyndromic autosomal recessive deafness. We, therefore, for the first time, investigated the prevalence and frequency of the GJB2 gene mutation in the Iranian deaf population with Arabian origins. MATERIALS AND METHODs: We amplified and sequenced the entire coding sequence of the GJB2 gene from 61 deaf patients and 26 control subjects. RESULT: None of the analyzed samples revealed deafness-associated mutation. CONCLUSION: This finding differs from several reports from Iran as we have focused on the GJB2 gene that possesses various mutations as the cause of congenital recessive deafness.

Construction of GJB2 mutations common in Chinese EGFP fusion protein vectors / 临床耳鼻咽喉头颈外科杂志

Objective:To construct GJB2 gene mutaitons common in Chinese EGFP fusion protein vectors, and to search for better way to study the mechanism of deletion mutaitons in GJB2 gene. Method: Non-fusion protein vectors of 235delC, 299-300 del AT and 176 del 16 bp were first made by point mutaiton methods in vitro. Then expression part of the upper 3 mutations were amplified by PCR and the PCR products were cloned into TA cloning vector. After cutting by restriction enzymes EcoRI/BamHI, three deletion mutaions were inserted into pEG-FP-N1 vector. Sequencing was used to verify the validity of the fusion protein vectors. HEK293 cells were trans-fected with the recombinant DNA samples by the liposome complex method. Results The recombined plasmids were highly expressed in HEK293 cells. Green fluorescence singals were distributed uniformly in cytoplasm. Conclusion; GJB2 mutations common in Chinese EGFP fusion protein vectors were constructed successfully. It may provide a better way to explore the reasons of nonsyndromic hearing loss common in Chinese.

Expression of Human Connexin26 in COS-7 Cells / 热带医学杂志

Objective To construct the eukaryotic expression plasmid for the expression of human Connexin26 in COS-7 cells.Methods Total RNA was isolated from human peripheral blood lymphocytes and used as template for the PCR cloning of the human Connexin26 gene.The human Cx26 cDNA containing the 678 bp whole coding region of the human Connexin26 gene was amplified by PCR using specific primers and cloned into the pCI-neo vector to construct the recombinant eukaryotic expression plasmid,pCI-Cx26.The recombinant plasmid was identified by restriction endonuclease digestion,and transfected into COS-7 cells by liposome.The expression of Cx26 mRNA and the protein were analyzed by RT-PCR and SDS-PAGE,respectively.Results Restriction endonuclease digestion analysis verified successful construction of the recombinant plasmid,pCI-Cx26.The expression of Cx26 mRNA and protein in the transfected COS-7 cells were detected by RT-PCR and SDS-PAGE,respectively.Conclusion The eukaryotic expression plasmid for human Cx26 has been constructed successfully with the capability of expression in COS-7 cells.

The Significance of Connexin 26 Expression in Squamous Cell Lesions of the Larynx / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Gap junctional intercellular communication (GJIC) is a mechanism for direct cell to cell signalling and is mediated by gap junctions, which consist of transmembrane proteins called connexins (Cxs). The authors investigated the role of connexin 26 as a biomarker that helps diagnose laryngeal squamous cell lesions. SUBJECTS AND METHOD: Paraffin-embedded tissue specimens from 50 patients, who were diagnosed with laryngeal invasive squamous cell carcinoma (n=15), carcinoma in situ (n=10), dysplasia (n=15), and non-neoplastic epithelial hyperplasia (n=10) between 1993 and 2005, were immunohistochemically stained for connexin 26 protein. RESULTS: Intracytoplasmic positive expression of connexin 26 was found in 100% of invasive squamous cell carcinoma and in 20% of carcinoma in situ. However, in dysplasia and hyperplasia, there were no positive expressions. Moreover, the majority of intercellular or membranous staining tended to decline in dysplasia, carcinoma in situ, and squamous cell carcinoma. CONCLUSION: These results suggest that aberrant expression of connexin 26 in laryngeal squamous cell lesions can be associated with tumorigenesis and invasion. Further studies are needed to investigate these expressions of connexin 26 and that it may represent more aggressive pathology of the larynx.

Expression Pattern of Gap Junction Protein, Connexin 26 and 43 in Human Middle Ear Cholesteatomas / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A human cholesteatoma in the middle ear is characterized by the presence of a keratinizing epithelium from hyperproliferative properties. It needs intercellular signal exchange through gap junctions as well as intracellular signal pathway for hyperproliferation. Connexin (Cx) is a gap junction protein for intercellular communication, and especially Cx26 and Cx43 are plenty in human epithelial cells. The objective of this study was to analyze the expression pattern of Cx43 and Cx26 in human middle ear cholesteatomas against normal epitheliums. SUBJECTS AND METHOD: Ten retroauricular skins (RAS), ear canal skins (ECS), and cholesteatomas were taken during middle ear operations at the Department of Otolaryngology. Immunohistochemical staining, reverse transcription-polymerase chain reaction (RT-PCR), and Western blotting were used to detect Cx43 and Cx26. RESULTS: In human cholesteatomas, Cx43 were expressed in the whole suprabasal layers, especially in the middle portion, except in the basal layer, and Cx26 were usually expressed in the supra layer and in the basal layers. But normal RASs showed weak expression of Cx43 in the upper spinosal and granular layers, but not in the basal layers, and the restricted localization of Cx26 in the basal layer. The expression of Cx43 and Cx26 in EASs was weak but showed similar patterns to that of cholesteatomas. In RT-PCR and Western blot, the expression of Cx43 and Cx26 were increased in cholesteatomas than in RASs. CONCLUSION: Human middle ear cholesteatomas showed upregulated expression and different localization of Cx43 and Cx26, gap junction proteins for intercellular communication, compared with normal RASs, suggesting that perturbations of intercellular communication through gap junctions may be associated with the pathology of human middle ear cholesteatomas.