Recommendations on scuba diving in Birt-Hogg-Dubé syndrome

INTRODUCTION

Although very uncommon, severe injury and death can occur during scuba diving. One of the main causes of scuba diving fatalities is pulmonary barotrauma due to significant changes in ambient pressure. Pathology of the lung parenchyma, such as cystic lesions, might increase the risk of pulmonary barotrauma.

AREAS COVERED

Birt-Hogg-Dubé syndrome (BHD), caused by pathogenic variants in the FLCN gene, is characterized by skin fibrofolliculomas, an increased risk of renal cell carcinoma, multiple lung cysts and spontaneous pneumothorax. Given the pulmonary involvement, in some countries patients with BHD are generally recommended to avoid scuba diving, although evidence-based guidelines are lacking. We aim to provide recommendations on scuba diving for patients with BHD, based on a survey of literature on pulmonary cysts and pulmonary barotrauma in scuba diving.

EXPERT OPINION

In our opinion, although the absolute risks are likely to be low, caution is warranted. Given the relative paucity of literature and the potential fatal outcome, patients with BHD with a strong desire for scuba diving should be informed of the potential risks in a personal assessment. If available a diving physician should be consulted, and a low radiation dose chest computed tomography (CT)-scan to assess pulmonary lesions could be considered.

Impaired DNA repair capacity in skin fibroblasts from various hereditary cancer-prone syndromes

Host-cell reactivation (HCR) of UV-C-irradiated herpes simplex virus type 1 (HSV-1) has been determined in skin fibroblasts from the following hereditary cancer-prone syndromes: aniridia (AN), dysplastic nevus syndrome (DNS), Von Hippel-Lindau syndrome (VHL), Li-Fraumeni syndrome (LFS) and a family with high incidence of breast and ovarian cancer. Cells from AN, DNS or VHL patients were found to exhibit heterogeneity in HCR. Cells from individuals belonging to an LFS family show reduced HCR in all cases where the cells were derived from persons carrying one mutated p53 allele, whereas cells derived from members with two wild-type alleles show normal HCR. LFS cells with reduced HCR also reveal reduced genome overall repair, and a slower gene-specific repair of the active adenosine deaminase (ADA) gene, but little if any repair of the inactive 754 gene. In the breast/ovarian cancer family, reduced HCR is observed in skin fibroblasts derived from both afflicted and unaffected individuals. In addition, these cells display lower survival after exposure to UV-C and exhibit higher levels of SCEs than those in normal cells. These observations indicate that various hereditary cancer-prone syndromes, carrying mutations in different tumor-suppressor genes, exhibit an unexplained impairment of the capacity to repair UV-damaged DNA.

Inheritance of abnormal expression of SOS-like response in xeroderma pigmentosum and hereditary cancer-prone syndromes

The time course of induction of SOS-like stress responses such as enhanced reactivation (ER) and enhanced mutagenesis (EM) has been investigated in UV-C-irradiated skin fibroblasts from a xeroderma pigmentosum (XP) family, using herpes simplex virus type 1 as a probe. Similar ER studies were performed in a Li-Fraumeni syndrome (LFS) family and in a family with a high incidence of breast, ovarian, and colon cancer. In two XP (complementation group B) patients, with a striking absence of skin tumors even at an age of >40 years, only induction of EM was observed, whereas ER was absent (XPER-). The ER- phenotype was inherited from the father, whereas cells from the mother exhibited normal expression of ER and EM. This suggests that the absence of ER is a hereditary trait that is not correlated with a repair-deficient phenotype. Abnormally high levels of ER were observed in UV-C-exposed skin fibroblasts from rive LFS patients. The inheritance of the ER response was studied in one LFS family. High levels of ER were observed only in cells derived from affected individuals carrying one mutated p53 allele, whereas cells from unaffected family members, carrying two wild-type p53 alleles, exhibited normal ER levels. This result shows that abnormally high levels of ER positively correlate with the occurrence of cancer in affected individuals from a LFS family. Interestingly, abnormally high levels of ER were observed in cells from afflicted as well as from unafflicted members of a family with a high incidence of breast, ovarian, colon, and stomach cancer. This suggests that these latter individuals have inherited a mutated, putative predisposing gene, resulting in abnormal expression of ER, but that cancer had not yet developed. The results indicate that the ER response can possibly be used as a prognostic marker to identify carriers in various hereditary cancer-prone syndromes at an early age.

Characterization of 911: a new helper cell line for the titration and propagation of early region 1-deleted adenoviral vectors

Currently, the preferred host for the production of early region-1 (E1)-deleted recombinant adenoviruses (rAdV) is cell line 293, which was generated by transformation of human embryonic kidney cells by sheared adenovirus 5 (Ad5) DNA. To develop alternative hosts for the production of rAdV, we generated adenovirus-transformed human cell lines by transformation of human embryonic retinoblasts (HER) with a plasmid containing base pairs 79-5789 of the Ad5 genome. One of the established HER cell lines, which we called 911, exhibited favorable growth characteristics and was chosen for further study. This cell line is demonstrated to have several characteristics in common with the well-known 293 cell line: The 911 cell line is highly transfectable, and exhibits similar frequencies of homologous recombination. However, it has additional characteristics that make it a useful alternative for 293. The 911 cells perform particularly well in plaque assays. Upon infection with E1-deleted adenoviruses, plaques become apparent in monolayers of 911 cells already after 3-4 days versus 4-10 days in monolayers of 293 cells, thereby reducing the time required for quantitative plaque assays. Furthermore, yields of E1-deleted adenovirus vectors up to three times as high as those achieved with 293 cells can be obtained with 911 cells. Finally, the Ad5-DNA content of the 911 cell line is completely known. These features make the 911 cell line a useful alternative for the construction, propagation, and titration of E1-deleted recombinant adenoviruses.

Different regulation of p53 stability in UV-irradiated normal and DNA repair deficient human cells

The stabilization of p53 protein was studied after UV exposure of normal human skin fibroblasts and cells derived from patients suffering from xeroderma pigmentosum (XP) and trichothiodystrophy (TTD). The data show that p53 is transiently stabilized both in UV-irradiated normal and repair deficient cells. However, particularly at later times after UV irradiation, stabilization of p53 persists much longer in repair deficient XP and TTD cells than in normal cells. The stabilization of p53 was found to be dose-dependent in normal and XP cells. These results indicate that unremoved DNA damage could possibly be responsible for the induction of transient stabilization of p53.

High levels of enhanced reactivation of herpes simplex virus in skin fibroblasts from various hereditary cancer-prone syndromes

The dose response of the enhanced reactivation (ER) of herpes simplex virus type 1 has been studied in UV-irradiated normal human skin fibroblasts and fibroblasts from the following hereditary cancer-prone syndromes: retinoblastoma, aniridia, polyposis coli, neurofibromatosis type 1 and 2, dysplastic nevus syndrome, Von Hippel-Lindau syndrome, multiple endocrine neoplasia type 2, and Bloom's syndrome. Surprisingly, much higher levels of ER were observed in all these genetically heterogeneous hereditary disorders than in normal human skin fibroblasts. These results suggest that loss of one allele of putative tumor suppressor genes may activate cellular processes that result in the induction of the ER response, and they support our previous observation suggesting that ER may somehow be related to the process of carcinogenesis (P. J. Abrahams et al., Cancer Res., 48: 6054-6057, 1988).

Similar effects of adenovirus E1A and glucocorticoid hormones on the expression of the metalloprotease stromelysin

The stromelysin (sml) gene encodes a secreted protease which degrades components of the extracellular matrix. Transformation of NRK49F cells by the E1A region of adenovirus (Ad) type 5 or 12 reduces sml RNA levels, whereas various growth factors or EJras-mediated transformation stimulate sml gene expression in these cells. Nuclear run-on experiments show that AdE1A, growth factors and EJras act on sml gene expression at the level of transcription. Although the sml gene is strongly suppressed in AdE1A-transformed cells, treatment with growth factors or transfection of EJras still causes a raise in sml mRNA levels, indicating that E1A does not block the induction mechanism itself. The effect of glucocorticoid hormones on sml gene expression is very similar to that of AdE1A, in that mRNA levels are lowered without affecting the induction phenomenon. This similarity may provide a clue to the mechanism by which AdE1A represses cellular gene activity.

Post-transcriptional control of class I MHC mRNA expression in adenovirus 12-transformed cells

Expression of the class I transplantation antigens of the major histocompatibility complex (MHC) is suppressed in cells transformed by the oncogenic human adenovirus 12 (Ad12). This suppression of class I antigen expression, which contributes to the tumorigenic phenotype of the transformed cells, has also been observed in some naturally occurring cancers. In the present study, the rate of transcription initiation of class I genes was measured by a nuclear run-on assay in Ad5- and Ad12-transformed cells of three different types. The rate of transcription was the same in all three. The stability of the class I messenger RNA was also examined and found to be the same in all three cell types. The results indicate that in Ad12-transformed cells the suppression is caused by an inhibition of the post-transcriptional processing of class I MHC messenger RNA in the nucleus.

Different adenovirus E1A-controlled properties of transformed cells require different levels of E1A expression

We have transformed primary baby rat kidney cells with a plasmid containing the adenovirus(Ad)12E1 region in which the E1A promoter was replaced by the dexamethasone inducible mouse mammary tumor virus promoter. In the uninduced state the level of E1A expression is less than 10% of that in the induced state. We have investigated the effects of decreasing the levels of E1A on a number of E1A-mediated processes. First, expression of the E1B region is reduced several-fold upon reducing E1A expression. Second, a radical change in cell morphology is observed. Third, despite the decrease in E1A expression, down-regulation of the class-I major histocompatibility complex genes by Ad12E1A is not affected. These results are discussed in terms of different threshold levels of E1A expression required for various E1A-mediated processes.

Different activities of the adenovirus types 5 and 12 E1A regions in transformation with the EJ Ha-ras oncogene

We have compared the capacities of the E1A regions of nononcogenic adenovirus type 5 (Ad5) and highly oncogenic Ad12 to cooperate with the EJ bladder carcinoma Ha-ras-1 oncogene in the transformation of primary baby rat kidney cells. Both E1A regions, when cotransfected with the Ha-ras oncogene, transformed the primary cells with a low frequency. Ad5 E1A plus Ha-ras-transformed cells differed in phenotype from cells transformed by Ad12 E1A plus Ha-ras. The cells expressing Ad5 E1A appeared highly transformed and practically failed to adhere to plastic. This phenotype may be due to the virtually complete absence of fibronectin gene expression in these cells. In contrast, the cells expressing Ad12 E1A were flatter and adhered to plastic, whereas fibronectin gene expression was reduced but not absent. The oncogenic potential of the two types of E1A plus ras-transformed cells was tested by their injection into both athymic nude mice and weanling syngeneic rats. The Ad5 E1A plus ras-transformed cells were found to be highly oncogenic in both animal species, whereas the Ad12 E1A plus ras-transformed cells were only weakly oncogenic in both syngeneic rats and nude mice. The difference in oncogenic potential of the Ad5 E1A plus ras- and the Ad12 E1A plus ras-transformed cells is discussed in terms of the different capacities of the Ad5 and Ad12 E1A-encoded proteins to modulate cellular gene expression.

Role of the adenovirus early region 1B tumor antigens in transformation and lytic infection

We have investigated the contribution of each of the two adenovirus type 5 (Ad5) major early region 1b (E1b) proteins in cell transformation and in lytic infection. An Ad5 E1 plasmid, in which the reading frame for the 19-kDa E1b protein was abolished by a stop codon close to the initiation codon, transformed primary baby rat kidney (BRK) cells with an efficiency of about half of that of a wild type Ad5 E1 plasmid, whereas a plasmid with a mutation in the gene for the 58-kDa E1b protein transformed the same primary cells with only one-third of the wild type efficiency. Plasmids containing region E1a only or a plasmid carrying mutations in the genes for major E1b proteins all transformed primary cells with an efficiency of approximately 5% of wild type. To test the effect of the E1b mutations in virion-mediated cell transformation, the mutant E1b regions were introduced into intact viral genomes by overlap recombination and were subsequently used in a transformation assay on BRK cells. The 19 and 58-kDa mutant viruses were found to transform BRK cells with 11 and 25% of the efficiency of wild type virus, respectively. These results suggest that the 19-kDa E1b protein is essential for virus-mediated cell transformation, in agreement with results of others, but not for plasmid-mediated cell transformation. In lytic infection, the 19-kDa mutant virus was some 30-fold reduced in yield on HeLa cells, whereas the 58-kDa mutant virus was 3000-fold reduced in its ability to grow on HeLa cells at low multiplicity of infection, but showed a marked multiplicity-dependent leakiness. The 58-kDa mutant virus was not defective when its growth was assayed on human embryonic kidney (HEK) cells. This may indicate that cellular proteins are expressed in HEK cells that are functionally homologous to the 58-kDa E1b protein.

Adenovirus E1A-mediated regulation of class I MHC expression

Expression of class I MHC transplantation antigens has been shown to be reduced in baby rat kidney (BRK) cells transformed by highly oncogenic adenovirus type 12 (Ad12), as compared with untransformed cells and cells transformed by non-oncogenic Ad5. Here we show that this reduction of class I expression also occurs in a variety of other primary cell cultures transformed by Ad12, and that reduction of class I gene expression occurs for all class I loci. Transfection of Ad5E1 into class I-negative Ad12-transformed BRK cells leads to complete restoration of class I expression. Introduction of Ad12E1 into most class I-positive established cell lines does not result in suppression of class I expression. However, transfection of the Ad12E1A region into a class I-positive cell line which was immortalized by a mutant Ad12E1A region resulted in suppression of class I gene expression, implying that the suppression of class I activity in Ad12-transformed cells is due to an active switching-off process.

Oncogenicity by adenovirus is not determined by the transforming region only

We have constructed a nondefective recombinant virus between the nononcogenic adenovirus 5 (Ad5) and the highly oncogenic Ad12. The recombinant genome consists essentially of Ad5 sequences, with the exception of the transforming early region 1 (E1) which is derived from Ad12. HeLa cells infected with the recombinant virus were shown to contain the Ad12-specific E1 proteins of 41 kilodaltons (E1a) and 19 and 54 kilodaltons (both encoded by E1b). The recombinant virus replicated efficiently in human embryonic kidney cells and HeLa cells, showing that the transforming regions of Ad5 and Ad12 had similar functions in productive infection. After the recombinant virus was injected into newborn hamsters, no tumors were produced during an observation period of 200 days. Thus, despite the fact that all products required for oncogenic transformation in vitro were derived from the highly oncogenic Ad12, the recombinant virus did not produce tumors in vivo. These data show that tumor induction by adenovirus virions is not determined only by the gene products of the transforming region.

Morphological transformation of human adenoviruses is determined to a large extent by gene products of region E1a

The role of region E1a and E1b of human adenovirus (Ad) types 5 and 12 in determining the morphology of transformed colonies has been studied. Primary baby rat kidney cells were transfected with a mixture of plasmids containing Ad5 region E1a and Ad12 region E1b, or vice versa, and the morphology of the resulting transformed colonies was studied. It was found that the morphology of the colonies was correlated with the identity of the E1a region present in the cells; i.e., colonies transformed by Ad5 E1a plus Ad12 E1b resembled Ad5-transformed colonies, whereas those transformed by Ad12 E1a plus Ad5E1b resembled Ad12-transformed colonies. This suggested that the morphology of Ad-transformed cells is determined mainly by region E1a. To exclude the possibility that this phenomenon is due to an E1a-mediated and serotype-specific regulation of E1b expression and that the transformed phenotype is largely determined by region E1b, the experiments were repeated with Ad5 E1b plasmids in which the transcription regulation sequences had been replaced by the SV40 early promoter segment. In these plasmids E1b expression has become independent of region E1a. Foci of cells transformed by these E1b-SV40 promoter plasmids in the presence of either E1a of Ad5 or E1a of Ad12 again showed the same phenomenon, i.e., an Ad5-specific morphology with Ad5 E1a and Ad12-specific morphology with Ad12 E1a. Preliminary evidence showing that region E1b may regulate the concentration of E1a transcripts is discussed.

Expression of class I major histocompatibility antigens switched off by highly oncogenic adenovirus 12 in transformed rat cells

Rat cells transformed by the highly oncogenic adenovirus 12 lack at least two cellular proteins which are present in cells transformed by the non-oncogenic adenovirus 5 and in untransformed cells. One protein has been identified as the heavy chain of the rat class I major histocompatibility complex. This finding may explain the difference in oncogenicity between adenoviral species.

Tumorigenicity of cells transformed by adenovirus type 12 by evasion of T-cell immunity

Evidence is presented that cells transformed by adenovirus type 12 are oncogenic because they escape from T-cell immunity. This effect is brought about by reducing the expression of class I transplantation antigens and is a function of the protein translated from the 13S mRNA, transcribed from early region 1a. These findings establish a novel mechanism by which transformed cells can acquire an oncogenic phenotype.

Expression of region E1b of human adenoviruses in the absence of region E1a is not sufficient for complete transformation

Previous work has suggested that morphological transformation of cultured cells by human adenoviruses of subgroups A, B, and C is predominantly a function of early region 1b (E1b), and that region E1a has a role in immortalization. To test the hypothesis that region E1b is essentially responsible for the induction of the transformed phenotype the transforming activity of region E1b in the absence of region E1a was reinvestigated. In agreement with previous results, region E1b had no detectable transforming activity in primary baby rat kidney (BRK) cells nor in established rat cell lines. Since recent experimental evidence indicates that expression of E1b is blocked by a cellular factor which is inactivated by region E1a products, the regulatory signals in front of the coding sequence of region E1b were removed and replaced by the early promoter of SV40. These E1b-SV40pr plasmids had no detectable transforming activity in primary BRK cells, but they transformed normally in the presence of region E1a plasmids, demonstrating that both subregions are required for complete transformation of primary BRK cells. Transfection of the established rat cell line 3Y1 with the E1b-SV40pr plasmids did not result in complete morphological transformation either. Cotransfection of 3Y1 cells with E1b-SV40pr plasmids and pAG60 (a plasmid which harbors the kanamycin-resistance gene of Tn5) resulted in the appearance of foci of cells resistant to the antibiotic G-418. These colonies expressed the region E1b polypeptides to levels comparable to those found in cells transformed with intact region E1. Despite the presence of the E1b proteins the cells appeared essentially untransformed, in contrast to foci obtained after cotransfection of 3Y1 cells with mixtures of p5XhoI C (comprising region E1 DNA) and pAG60. These results indicate that complete transformation is a function of both regions E1a and E1b and that region E1a must have an important role in morphological transformation.

The relationship between region E1a and E1b of human adenoviruses in cell transformation

Baby rat kidney (BRK) cells were transfected either with intact region E1 DNA of adenovirus type 5 (Ad5) or with mixtures of DNA fragments containing the separated E1a and E1b regions. The results showed that mixtures of regions E1a and E1b transform with a similar efficiency as intact region E1. DNA fragments containing region E1b alone have no detectable transforming activity in primary BRK cells nor in established rat cell lines. When region E1a and Ad5 was combined with region E1b and Ad12 complete transformation was also obtained. Characterization of the cell lines transformed by separated E1a and E1b regions have led to the following conclusions: (1) Expression of region E1b is not dependent on specific linkage to region E1a as it occurs in the intact E1 region. (2) Region E1b is normally expressed into the corresponding major adenovirus T antigens (65,000 and 19,000 Mr with region E1b of Ad5; 60,000 and 19,000 Mr with E1b or AD12). (3) Region E1b of Ad12 can be activated by region E1a of Ad5 indicating that the Ela regions of both serotypes are functionally similar in transformation. (4) Cell lines containing region E1b of Ad5 are weakly oncogenic in nude mice whereas cells containing E1b of Ad12 are highly oncogenic in nude mice, indicating that the degree of oncogenicity is determined by region E1b.

Transformation with specific fragments of adenovirus DNAs. II. Analysis of the viral DNA sequences present in cells transformed with a 7% fragment of adenovirus 5 DNA

Five clones of rat kidney cells transformed by a small restriction endonuclease fragment of adenovirus 5 (Ad5) DNA (fragment HsuI G, which represents the left terminal 7% of the adenovirus genome) were analyzed with respect to the viral DNA sequences present in the cellular DNAs. In these analyses, the kinetics of renaturation of 32P-labeled specific fragments of Ad5 DNA was measured in the presence of a large amount of DNA extracted either from each of the transformed cell lines or from untransformed cells. The fragments were produced by digestion of 32P-labeled adenovirus 5 DNA with endo R.HsuI, or by digestion of 32P-labeled fragment HsuI G of adeno 5 DNA with endo R.HpaI. All five transformed lines were found to contain DNA sequences homologous to 75--80% of Ad5 fragment HsuI G only. Clones II and V contained approximately 48 copies per quantity of diploid cell DNA, clone VI about 35 copies, clone IV 22 copies and clone III 5--10 copies. These results indicate that a viral DNA segment as small as 5.5% of the Ad5 genome, contains sufficient information for the maintenance of transformation.