Molecular mechanisms generating and stabilizing terminal 22q13 deletions in 44 subjects with Phelan/McDermid syndrome.

In this study, we used deletions at 22q13, which represent a substantial source of human pathology (Phelan/McDermid syndrome), as a model for investigating the molecular mechanisms of terminal deletions that are currently poorly understood. We characterized at the molecular level the genomic rearrangement in 44 unrelated patients with 22q13 monosomy resulting from simple terminal deletions (72%), ring chromosomes (14%), and unbalanced translocations (7%). We also discovered interstitial deletions between 17-74 kb in 9% of the patients. Haploinsufficiency of the SHANK3 gene, confirmed in all rearrangements, is very likely the cause of the major neurological features associated with PMS. SHANK3 mutations can also result in language and/or social interaction disabilities. We determined the breakpoint junctions in 29 cases, providing a realistic snapshot of the variety of mechanisms driving non-recurrent deletion and repair at chromosome ends. De novo telomere synthesis and telomere capture are used to repair terminal deletions; non-homologous end-joining or microhomology-mediated break-induced replication is probably involved in ring 22 formation and translocations; non-homologous end-joining and fork stalling and template switching prevail in cases with interstitial 22q13.3. For the first time, we also demonstrated that distinct stabilizing events of the same terminal deletion can occur in different early embryonic cells, proving that terminal deletions can be repaired by multistep healing events and supporting the recent hypothesis that rare pathogenic germline rearrangements may have mitotic origin. Finally, the progressive clinical deterioration observed throughout the longitudinal medical history of three subjects over forty years supports the hypothesis of a role for SHANK3 haploinsufficiency in neurological deterioration, in addition to its involvement in the neurobehavioral phenotype of PMS.

Mosaic 22q13 deletions: evidence for concurrent mosaic segmental isodisomy and gene conversion.

Although 22q terminal deletions are well documented, very few patients with mosaicism have been reported. We describe two new cases with mosaic 22q13.2-qter deletion, detected by karyotype analysis, showing the neurological phenotype of 22q13.3 deletion syndrome. Case 1 represents an exceptional case of mosaicism for maternal 22q13.2-qter deletion (45% of cells) and 22q13.2-qter paternal segmental isodisomy (55% of cells). This complex situation was suspected because cytogenetic, FISH and array-CGH analyses showed the presence of an 8.8 Mb mosaic 22q13.2-qter deletion, whereas microsatellite marker analysis was consistent with maternal deletion without any evidence of mosaic deletion. Molecular analysis led to the definition of very close, but not coincident, deletion and uniparental disomy (UPD) break points. Furthermore, we demonstrated that the segmental UPD arose by gene conversion in the same region. In Case 2, mosaicism for a paternal 8.9 Mb 22q13.2-qter deletion (73% of cells) was detected. In both patients, the level of mosaicism was also verified in saliva samples. We propose possible causative mechanisms for both rearrangements. Although the size of the deletions was quite similar, the phenotype was more severe in Case 2 than in Case 1. As maternal UPD 22 has not been generally associated with any defects and as the size of the deletion is very similar in the two cases, phenotype severity is likely to depend entirely on the degree of mosaicism in each individual.

Expression of non-muscle myosin heavy chain in rat heart after immunosuppressive treatment.

Myosins constitute a large family of molecular motors, hydrolyzing ATP and producing cellular movement. To date, a large number of novel isoforms have been found in muscle and non-muscle cells. Among non-muscle myosins, non-muscle myosin heavy chain (NMHC) II-A and II-B have been well characterized. An additional member of NMHC II-B, with a molecular weight of 220 kDa, was recently identified in bovine skeletal muscle. NMHC II-B proteins, in particular, have been suggested to be a useful early molecular marker for the detection of pathological conditions during acute or chronic organ rejection in which fibrotic changes occur. Since it is known that treatment with cyclosporine A (CsA), an immunosuppressive drug successfully used for preventing organ rejection and autoimmune diseases, is often associated with several side effects (hypertension and nephrotoxicity), the aims of this study were: (1) to demonstrate the homology of the new NMHC protein (220 kDa) in other mammalian species, such as Wistar rats; (2) to evaluate, by morphological and immunohistochemical studies, the possible changes induced by CsA treatment in NMHC protein (220 kDa) cellular localization and/or in its expression levels in myocardial tissue. First of all, our results showed a greater homology of the new NMHC within the same isoforms across species and between isoforms in the same specie; moreover, we observed that this protein increased following CsA treatment. This could be explained as a tentative of cardiac tissue to maintain the structural integrity of intercalated disks and so the contraction/relaxation process.

A solidão do analista na prática clínica / The solitude of the analyst in the practical clinic

Partimos de uma ampla conceitualização do sentimento de solidão para então abordá-lo, em suas diferentes nuances, desde o enfoque do analista na prática clínica. A solidão é considerada por nós segundo duas vertentes: enquanto sentimento de desamparo(vivência extremaente dolorosa que inunda o ser humano após seu nascimento, fundando em seu imaginário a primeira experiência de solidão) e enquanto espaço vital afetivo que se outorga ao outro. Este pode ser compreendido em seus dois extremos, desde um sentimento de distância afetiva à uma expansão narcisista sufocante e invasora do território de existência alheia. A partir destes dois eixos de reflexão, procuramos examinar como se desenha o sentimento de solidão no processo analítico. Este último é sempre visualizado por nós como campo dinâmico, no qual estão implicadas as subjetividades de ambos integrantes: analista e paciente