MELAS: Phenotype Classification into Classic-versus-Atypical Presentations.

BACKGROUND AND PURPOSE: An increased number of pathogenic variants have been described in mitochondrial encephalomyopathy lactic acidosis and strokelike episodes (MELAS). Different imaging presentations have emerged in parallel with a growing recognition of clinical and outcome variability, which pose a diagnostic challenge to neurologists and radiologists and may impact an individual patient's response to therapeutic interventions. By evaluating clinical, neuroimaging, laboratory, and genetic findings, we sought to improve our understanding of the sources of potential phenotype variability in patients with MELAS. MATERIALS AND METHODS: This retrospective single-center study included individuals who had confirmed mitochondrial DNA pathogenic variants and a diagnosis of MELAS and whose data were reviewed from January 2000 through November 2021. The approach included a review of clinical, neuroimaging, laboratory, and genetic data, followed by an unsupervised hierarchical cluster analysis looking for sources of phenotype variability in MELAS. Subsequently, experts identified "victory-variables" that best differentiated MELAS cohort clusters. RESULTS: Thirty-five patients with a diagnosis of mitochondrial DNA-based MELAS (median age, 12 years; interquartile range, 7-24 years; 24 female) were eligible for this study. Fifty-three discrete variables were evaluated by an unsupervised cluster analysis, which revealed that two distinct phenotypes exist among patients with MELAS. After experts reviewed the variables, they selected 8 victory-variables with the greatest impact in determining the MELAS subgroups: developmental delay, sensorineural hearing loss, vision loss in the first strokelike episode, Leigh syndrome overlap, age at the first strokelike episode, cortical lesion size, regional brain distribution of lesions, and genetic groups. Ultimately, 2-step differentiating criteria were defined to classify atypical MELAS. CONCLUSIONS: We identified 2 distinct patterns of MELAS: classic MELAS and atypical MELAS. Recognizing different patterns in MELAS presentations will enable clinical and research care teams to better understand the natural history and prognosis of MELAS and identify the best candidates for specific therapeutic interventions.

Identification of a collagen-binding protein from Necator americanus by using a cDNA-expression phage display library.

A phage display library was made starting from a cDNA library from the hematophagous human parasite Necator americanus. The cDNA library was transferred by polymerase chain reaction (PCR) cloning into phage display vectors (phagemids), using specially designed primers such that proteins would be expressed as fusions with the C-terminal part of the phage coat protein pVI. The vectors used are multicloning site variants of the original pDONG vectors described by Jespers et al. (1995). Electroporation of the ligation mixtures into electrocompetent Escherichia coli TGI cells yielded 3 x 10(8) pG6A, 1.9 x 10(8) pG6B, and 1 x 10(8) pG6C transfectants for N. americanus. The final libraries consisted of a mix of equal numbers of insert-containing phages from the A, B, and C libraries. Selection of phages for binding to human collagen was performed. Four rounds of panning on human collagens I and III resulted in a significant enrichment of collagen-binding phages from the N. americanus libraries. PCR analysis revealed various insert lengths; however, sequence determination indicated that all phages contained the same protein, albeit with different poly-A tail lengths. The encoded protein itself is a 135-amino acid protein (15 kDa), with no apparent homology to any other known protein. Next the protein was recloned into E. coli using the pET-15b-vector. Upon isopropyl-1-thio-beta-D-galactopyranoside induction, the recombinant protein, rNecH1, could be recovered by urea treatment from inclusion bodies. The rNecH1 protein binds to different collagens: human I > rat I > human III = calf skin I in a specific, dose-dependent, and saturable manner.

Anti-vWf antibodies induce GPIbalpha and FcgammaRII mediated platelet aggregation only at low shear forces.

BACKGROUND/METHODS: Anti-von Willebrand factor (vWf) antibody mediated platelet activation was studied using 2 monoclonal anti-vWf antibodies promoting the binding of vWf to GPIbalpha: 1C1E7 (IgG2a) reacting with the vWf N-terminus and 75H4B12 (IgM), characterized in this paper and studied in association with 1C1E7. RESULTS: 75H4B12 binds to an N-terminal epitope in vWf, different from that reacting with 1C1E7. When com-bined, 1C1E7 and 75H4B12 promoted vWf binding to isolated GPIb under static conditions, even in the absence of ristocetin or botrocetin, and induced platelet aggregation synergistically in the presence of zero to subthreshold ristocetin concentrations. Specific inhibitors of GPIbalpha-vWf interactions prevented vWf binding to GPIbalpha in ELISA and during platelet aggregation. In addition, the 1C1E7 dependent platelet aggregation involved Fc receptor mediated platelet activation, a phenomenon even more pronounced when 1C1E7 and 75H4B12 were combined. A 75H4B12 binding phage expressing a peptide homologous with vWf sequence 88-95 neutralized the antibody induced platelet activation. However, at arterial shear rates, both 1C1E7 and 75H4B12 potently prolonged cartridge closure times in the PFA-100, compatible with inhibition of platelets by vWf, unfolded by the combined action of shear stress and antibodies. CONCLUSIONS: We conclude that antibodies directed against different epitopes in the N-terminus of vWf modify the folded vWf structure synergistically and enhance A1 domain mediated vWf binding to platelet GPIb at low shear forces. In addition, once platelet-bound, IgG antibodies potently activate platelets via the FcgammaII receptor. Thus, such antibodies may promote immune mediated thrombosis at low shear rates, typical of the venous circulation. In contrast, at arterial shear rates, anti-vWf antibodies may rather compromise platelet function following enhanced binding of the unfolded vWf multimers to platelets, shielding platelets from interacting with subendothelial and soluble ligands.

Identification of peptides, selected by phage display technology, that inhibit von Willebrand factor binding to collagen.

A repeated selection of phages from a cyclic hexapeptide phage display library resulted in an enrichment of phages that bound to the monoclonal antibody (MoAb) 82D6A3 (an anti-von Willebrand Factor [vWF] antibody that inhibits binding of vWF to collagen). Two clones were selected that bound both to MoAb 82D6A3 and to rat tail collagen type I in a specific and dose-dependent manner. The two phage clones were further used in a two-direction competition experiment with vWF. vWF was able to displace phages from collagen in a dose-dependent manner with an IC50 of 35 micrograms/mL and phages were able to inhibit vWF binding to collagen. With the use of specific primers, the sequence of the cysteine-flanked hexapeptide inserts could be deduced. The two phage clones carried an almost identical sequence, CVWLWEQC and CVWLWENC, with a substitution of an N for a Q at position 6 of the hexapeptide. Sequence comparison with the known vWF sequence showed the presence of a comparable sequence at position 1129-1136 (VWTLPDQC), located between the collagen-binding A3-domain and the D4-domain. The two cyclic peptides, the putative corresponding vWF peptide, and a peptide with a scrambled cyclic sequence were synthesized. The two cyclic peptides inhibited vWF binding to rat tail collagen type I in a dose-dependent manner, whereas the linear vWF peptide and the scrambled cyclic peptide were inactive. For half maximal inhibition, 100 +/- 12.7 micromol/L and 34.8 +/- 8.59 micromol/L (mean +/- SEM, n = 3) of the N- and the Q-peptide, respectively, were needed. The two cyclic peptides were also able to inhibit vWF binding to calfskin and human collagen type I, but effective concentrations were some 5 to 10 times higher.

Morphological analysis of gastro-esophageal diseases by molecular cell techniques.

The molecular cell sciences have had a great impact in the analysis of the genetic and epigenetic events of esophageal and gastric tumorigenesis. In other regions of the alimentary tract such as the colon, the serial identification of the molecular events in the corresponding morphological lesions is perhaps most advanced. This is, in part, due to the relative ease of the histological characterisation of the premalignant lesions. In this regard the analysis of morphological and molecular adaptation in the alimentary tract is inextricable. This review aims, therefore, to judiciously assess the relative applications of contemporary techniques in investigative histopathology.

Differential expression of cytokeratin mRNA in hamster squamous epithelia as observed by in situ hybridization using human cytokeratin cRNA probes.

In this hybridohistochemical study, we investigated the expression of cytokeratin (CK) mRNA in the keratinizing squamous epithelium of hamster cheek pouch and esophagus, using eight different digoxigenin-labelled RNA probes complementary to human CK mRNAs. CK 4, CK 6, CK 8, CK 14, and CK 15 RNA probe obviously hybridized with hamster counterpart mRNA(s) in the cheek pouch as well as in the esophageal epithelium. However, using the CK 10-specific RNA probe, only the cheek pouch epithelium exhibited a positive reaction. We were not able to detect any positive signal for the CK 18 or for the CK 19 RNA probe. We observed three different CK mRNA distribution patterns in the cheek pouch epithelium, and four in the esophageal epithelium. The differences in expression and distribution pattern of CK mRNAs between the two types of epithelia suggest that the hamster CK polypeptide family comprises at least six different species. We also conclude that human cRNA probes for CK mRNAs may provide a way to detect changes in CK expression and distribution during induced non-neoplastic and neoplastic changes in the hamster cheek pouch model. This may also help to elucidate the molecular pathogenesis of squamous-cell carcinoma.

Expression of cytokeratin-mRNAs in squamous-cell carcinoma and balloon-cell formation of human oesophageal epithelium.

Using digoxigenin-labelled cRNA probes, relationships between morphological characteristics and in situ hybridization for cytokeratin (CK)-mRNAs were analysed in cases of squamous-cell carcinoma of variable differentiation and in balloon-cell formation within the oesophageal mucosa. The present results were correlated to our previous findings on normal oesophageal epithelium. Our results from in situ hybridization study on oesophageal squamous-cell carcinoma provide strong evidence that changes in CK expression occur with differences in malignant potential. Cells of poorly differentiated carcinoma lose an ability to produce CK-mRNAs characteristic of their normal progenitor cells. Moderately differentiated and, still more pronounced, well differentiated carcinoma cells retain an ability to produce CKs characteristic of their tissue of origin (CK 6, CK 14, CK 15 and CK 19). Furthermore, well differentiated carcinoma cells may also gain an ability to synthesize new types of CKs that are not characteristic of the normal oesophageal epithelium (CK 8 and CK 18 characteristic of most simple epithelia, and CK 10 characteristic of keratinizing epithelia). Moreover, some oesophageal CK-genes are expressed in an obviously higher amount (CK 6, CK 14, and CK 19), but the expression of genes coding for the oesophageal differentiation-related CKs (CK 4 and CK 13) is obviously decreased or apparently lost. At the interface zone, observed in sections of well differentiated carcinomas, CK 8 and CK 18 mRNA were expressed in intermediate cell layers, and the centrally located cell layers were found positive for CK 10 mRNA. These findings largely extend the existing results from immunoblotting and immunohistochemical studies. The reduced or non-detectable expression of oesophageal differentiation-related CK-mRNAs (CK 4 and CK 13) on the appearance of balloon cells, suggests molecular changes that may be a marker for pathological progression. In addition, the abundant expression of CK 6 and CK 14 mRNA within areas of balloon-cell formation showing basal hyperplasia, and the higher expression of CK 19 in comparison with normal epithelium, points rather to de-differentiation than to normal vertical differentiation of the oesophageal epithelium. Whether CK-mRNAs can be used as biomarkers for evaluation of oesophageal pathologies remains to be further elucidated.

Expression of cytokeratin mRNAs in normal human esophageal epithelium.

BACKGROUND: The cytokeratin (CK) pattern is accepted to be characteristic of a given epithelial cell or tissue. Specific changes in the CK pattern or in the expression of individual CKs may be characteristic in the early development of particular epithelial pathologies. Up to now no systematic hybridohistochemical study on the expression of CKs in normal human esophageal epithelium has been performed. Nevertheless, this knowledge may be of great importance for further research concerning the understanding of the structure and differentiation of normal esophageal epithelium and of the development of non-neoplastic and neoplastic esophageal malignancies. Therefore, we investigated the expression and distribution of nine different CK mRNAs throughout the normal human esophageal mucosa. METHODS: A non-radioactive in situ hydridization protocol was used to study the expression of CK mRNAs in fixed and paraffin-embedded human esophageal mucosa. Digoxigenin-labelled cRNA probes were produced by in vitro transcription of cDNA clones, coding for human CKs. RESULTS: In situ hybridization and immunodetection of the hybrids revealed a distinct but different distribution pattern for each specific CK mRNA. The described signal pattern was consistently found at all levels of the esophagus. We observed differences in the expression of some CK mRNAs between the interpapillar and papillar compartment of the esophageal epithelium. Mainly in the papillar regions some mRNAs are already expressed in more basally located cells in comparison with the interpapillar regions. Our results substantiate the hypothesis concerning the formation of papillae in the esophageal mucosa. We have also described some observations on the expression of CK mRNAs in fortuitous sections through excretory ducts of esophageal submucosal glands. CONCLUSIONS: The distinct, characteristic, and reproducible distribution pattern observed for each specific CK mRNA indicates that the expression of the genes encoding CKs in the esophageal epithelium as well depends on the cell proliferation, on vertical cell migration and differentiation, and on detachment from the basal lamina. The results presented should be considered as complementary to the already existing immunohistochemical results concerning the distribution of esophageal CK proteins.

Localization of cytokeratin 4 mRNA in human oesophageal epithelium by non-radioactive in situ hybridization.

An RNA probe complementary to human cytokeratin 4 mRNA was produced by in vitro transcription, and labelled with digoxigenin-UTP. Using this probe, an in situ hybridization protocol was established, tested and optimized for the localization of the cytokeratin 4 mRNA in formalin- or paraformaldehyde-fixed, paraffin-embedded human oesophageal mucosa. The hybridization signal was exclusively detected in the cytoplasm of epithelial cells as coarse brown granules. The positive signal always showed a consistent and distinct pattern throughout the epithelium, starting from the third to fourth layer of epithelial cells, and reaching into the superficial cell layers, but was never found in the basal cell layer, the suprabasal layers, and the upper adluminal strata. Some intermediate cell layers of the epithelium lining the upper part of the secretory duct of submucosal glands were also positive. Similar results could also be obtained in sections from routinely fixed, paraffin-embedded tissue samples. The described signal pattern was found at all levels of the oesophagus. The signal distribution was in agreement with previous biochemical and immunohistochemical studies on the spreading of the cytokeratin 4 protein throughout the oesophageal epithelium. We may conclude that also the expression of the gene(s) encoding cytokeratin 4 in the human oesophageal epithelium depends on the vertical cell differentiation and the detachment from the basal lamina. The developed simplified but sensitive in situ hybridization method may be a useful tool in routine histology, physiopathology, clinical research, and clinical diagnosis, concerning normal oesophageal epithelium structure and differentiation, and development of oesophageal malignancies.

Efficient expression of bovine alpha-lactalbumin in Saccharomyces cerevisiae.

A synthetic gene encoding the mature bovine alpha-lactalbumin fused to the preproregion of the yeast alpha-mating factor has been expressed and secreted at high level in Saccharomyces cerevisiae under the control of the alpha-mating promoter. Growth conditions were found to be critical for the expression: recombinant alpha-lactalbumin could only be detected in the medium provided the culture was grown at neutral pH. The secreted bovine alpha-lactalbumin is enzymatically active and identical to the whey protein, as confirmed by SDS/PAGE, IEF, ultraviolet and CD spectral analysis, and amino-terminal sequence determination.