1
|
Dodd DO, Mechaussier S, Yeyati PL, McPhie F, Anderson JR, Khoo CJ, Shoemark A, Gupta DK, Attard T, Zariwala MA, Legendre M, Bracht D, Wallmeier J, Gui M, Fassad MR, Parry DA, Tennant PA, Meynert A, Wheway G, Fares-Taie L, Black HA, Mitri-Frangieh R, Faucon C, Kaplan J, Patel M, McKie L, Megaw R, Gatsogiannis C, Mohamed MA, Aitken S, Gautier P, Reinholt FR, Hirst RA, O'Callaghan C, Heimdal K, Bottier M, Escudier E, Crowley S, Descartes M, Jabs EW, Kenia P, Amiel J, Bacci GM, Calogero C, Palazzo V, Tiberi L, Blümlein U, Rogers A, Wambach JA, Wegner DJ, Fulton AB, Kenna M, Rosenfeld M, Holm IA, Quigley A, Hall EA, Murphy LC, Cassidy DM, von Kriegsheim A, Papon JF, Pasquier L, Murris MS, Chalmers JD, Hogg C, Macleod KA, Urquhart DS, Unger S, Aitman TJ, Amselem S, Leigh MW, Knowles MR, Omran H, Mitchison HM, Brown A, Marsh JA, Welburn JPI, Ti SC, Horani A, Rozet JM, Perrault I, Mill P. Ciliopathy patient variants reveal organelle-specific functions for TUBB4B in axonemal microtubules. Science 2024; 384:eadf5489. [PMID: 38662826 DOI: 10.1126/science.adf5489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/20/2024] [Indexed: 05/03/2024]
Abstract
Tubulin, one of the most abundant cytoskeletal building blocks, has numerous isotypes in metazoans encoded by different conserved genes. Whether these distinct isotypes form cell type- and context-specific microtubule structures is poorly understood. Based on a cohort of 12 patients with primary ciliary dyskinesia as well as mouse mutants, we identified and characterized variants in the TUBB4B isotype that specifically perturbed centriole and cilium biogenesis. Distinct TUBB4B variants differentially affected microtubule dynamics and cilia formation in a dominant-negative manner. Structure-function studies revealed that different TUBB4B variants disrupted distinct tubulin interfaces, thereby enabling stratification of patients into three classes of ciliopathic diseases. These findings show that specific tubulin isotypes have distinct and nonredundant subcellular functions and establish a link between tubulinopathies and ciliopathies.
Collapse
Affiliation(s)
- Daniel O Dodd
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Sabrina Mechaussier
- Laboratory of Genetics in Ophthalmology, INSERM UMR_1163, Institute of Genetic Diseases, Institut Imagine, Université de Paris, Paris 75015, France
| | - Patricia L Yeyati
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Fraser McPhie
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Jacob R Anderson
- Department of Biological Chemistry and Molecular Pharmacology, Blavatnik Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Chen Jing Khoo
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Amelia Shoemark
- Respiratory Research Group, Molecular and Cellular Medicine, University of Dundee, Dundee DD1 9SY, UK
- Respiratory Paediatrics, Royal Brompton Hospital, London SW3 6NP, UK
| | - Deepesh K Gupta
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63130, USA
| | - Thomas Attard
- Wellcome Trust Centre for Cell Biology, School of Biological Sciences, University of Edinburgh, Edinburgh EH9 3BF, UK
| | - Maimoona A Zariwala
- Department of Pathology and Laboratory Medicine, Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7248, USA
| | - Marie Legendre
- Molecular Genetics Laboratory, Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Armand Trousseau, Paris 75012, France
- Sorbonne Université, INSERM, Childhood Genetic Disorders, Paris 75012, France
| | - Diana Bracht
- Department of General Pediatrics, University Children's Hospital Münster, Münster 48149, Germany
| | - Julia Wallmeier
- Department of General Pediatrics, University Children's Hospital Münster, Münster 48149, Germany
| | - Miao Gui
- Department of Biological Chemistry and Molecular Pharmacology, Blavatnik Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Mahmoud R Fassad
- Genetics and Genomic Medicine Department, UCL Institute of Child Health, University College London, London WC1N 1EH, UK
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria 21561, Egypt
| | - David A Parry
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Peter A Tennant
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Alison Meynert
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Gabrielle Wheway
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Lucas Fares-Taie
- Laboratory of Genetics in Ophthalmology, INSERM UMR_1163, Institute of Genetic Diseases, Institut Imagine, Université de Paris, Paris 75015, France
| | - Holly A Black
- Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
- South East of Scotland Genetics Service, Western General Hospital, Edinburgh EH4 2XU, UK
| | - Rana Mitri-Frangieh
- Department of Anatomy, Cytology and Pathology, Hôpital Intercommuncal de Créteil, Créteil 94000, France
- Biomechanics and Respiratory Apparatus, IMRB, U955 INSERM - Université Paris Est Créteil, CNRS ERL 7000, Créteil 94000, France
| | - Catherine Faucon
- Department of Anatomy, Cytology and Pathology, Hôpital Intercommuncal de Créteil, Créteil 94000, France
| | - Josseline Kaplan
- Laboratory of Genetics in Ophthalmology, INSERM UMR_1163, Institute of Genetic Diseases, Institut Imagine, Université de Paris, Paris 75015, France
| | - Mitali Patel
- Genetics and Genomic Medicine Department, UCL Institute of Child Health, University College London, London WC1N 1EH, UK
- MRC Prion Unit, Institute of Prion Diseases, University College London, London W1W 7FF, UK
| | - Lisa McKie
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Roly Megaw
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
- Princess Alexandra Eye Pavilion, Edinburgh EH3 9HA, UK
| | - Christos Gatsogiannis
- Center for Soft Nanoscience and Institute of Medical Physics and Biophysics, Münster 48149, Germany
| | - Mai A Mohamed
- Genetics and Genomic Medicine Department, UCL Institute of Child Health, University College London, London WC1N 1EH, UK
- Biochemistry Division, Chemistry Department, Faculty of Science, Zagazig University, Ash Sharqiyah 44519, Egypt
| | - Stuart Aitken
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Philippe Gautier
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Finn R Reinholt
- Core Facility for Electron Microscopy, Department of Pathology, Oslo University Hospital-Rikshospitalet, Oslo 0372, Norway
| | - Robert A Hirst
- Centre for PCD Diagnosis and Research, Department of Respiratory Sciences, University of Leicester, Leicester LE1 9HN, UK
| | - Chris O'Callaghan
- Centre for PCD Diagnosis and Research, Department of Respiratory Sciences, University of Leicester, Leicester LE1 9HN, UK
| | - Ketil Heimdal
- Department of Medical Genetics, Oslo University Hospital, Oslo 0407, Norway
| | - Mathieu Bottier
- Respiratory Research Group, Molecular and Cellular Medicine, University of Dundee, Dundee DD1 9SY, UK
| | - Estelle Escudier
- Sorbonne Université, INSERM, Childhood Genetic Disorders, Paris 75012, France
- Department of Anatomy, Cytology and Pathology, Hôpital Intercommuncal de Créteil, Créteil 94000, France
| | - Suzanne Crowley
- Paediatric Department of Allergy and Lung Diseases, Oslo University Hospital, Oslo 0407, Norway
| | - Maria Descartes
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL 35294-0024, USA
| | - Ethylin W Jabs
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York 10029-6504, New York, USA
- Department of Clinical Genomics, Mayo Clinic, Rochester, NY 55905, USA
| | - Priti Kenia
- Department of Paediatric Respiratory Medicine, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham B15 2TG, UK
| | - Jeanne Amiel
- Département de Génétique, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris (AP-HP), Paris 75015, France
- Laboratory of Embryology and Genetics of Human Malformations, INSERM UMR 1163, Institut Imagine, Université de Paris, Paris 75015, France
| | - Giacomo Maria Bacci
- Pediatric Ophthalmology Unit, Meyer Children's Hospital IRCCS, Florence 50139, Italy
| | - Claudia Calogero
- Pediatric Pulmonary Unit, Meyer Children's Hospital IRCCS, Florence 50139, Italy
| | - Viviana Palazzo
- Medical Genetics Unit, Meyer Children's Hospital IRCCS, Florence 50139, Italy
| | - Lucia Tiberi
- Medical Genetics Unit, Meyer Children's Hospital IRCCS, Florence 50139, Italy
| | | | - Andrew Rogers
- Respiratory Paediatrics, Royal Brompton Hospital, London SW3 6NP, UK
| | - Jennifer A Wambach
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63130, USA
| | - Daniel J Wegner
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63130, USA
| | - Anne B Fulton
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Margaret Kenna
- Department of Otolaryngology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Margaret Rosenfeld
- Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Research Institute, Seattle, WA 98015, USA
| | - Ingrid A Holm
- Division of Genetics and Genomics and the Manton Center for Orphan Diseases Research, Boston Children's Hospital, Boston, MA 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115 USA
| | - Alan Quigley
- Department of Paediatric Radiology, Royal Hospital for Children and Young People, Edinburgh EH16 4TJ, UK
| | - Emma A Hall
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Laura C Murphy
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Diane M Cassidy
- Respiratory Research Group, Molecular and Cellular Medicine, University of Dundee, Dundee DD1 9SY, UK
| | - Alex von Kriegsheim
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Jean-François Papon
- ENT Department, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Saclay University, Le Kremlin-Bicêtre 94270, France
| | - Laurent Pasquier
- Medical Genetics Department, CHU Pontchaillou, Rennes 35033, France
| | - Marlène S Murris
- Department of Pulmonology, Transplantation, and Cystic Fibrosis Centre, Larrey Hospital, Toulouse 31400, France
| | - James D Chalmers
- Respiratory Research Group, Molecular and Cellular Medicine, University of Dundee, Dundee DD1 9SY, UK
| | - Claire Hogg
- Respiratory Paediatrics, Royal Brompton Hospital, London SW3 6NP, UK
| | - Kenneth A Macleod
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh EH16 4TJ, UK
| | - Don S Urquhart
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh EH16 4TJ, UK
- Department of Child Life and Health, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Stefan Unger
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh EH16 4TJ, UK
- Department of Child Life and Health, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Timothy J Aitman
- Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Serge Amselem
- Molecular Genetics Laboratory, Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Armand Trousseau, Paris 75012, France
- Sorbonne Université, INSERM, Childhood Genetic Disorders, Paris 75012, France
| | - Margaret W Leigh
- Department of Pediatrics, Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7248, USA
| | - Michael R Knowles
- Department of Medicine, Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7248, USA
| | - Heymut Omran
- Department of General Pediatrics, University Children's Hospital Münster, Münster 48149, Germany
| | - Hannah M Mitchison
- Genetics and Genomic Medicine Department, UCL Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Alan Brown
- Department of Biological Chemistry and Molecular Pharmacology, Blavatnik Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Joseph A Marsh
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Julie P I Welburn
- Wellcome Trust Centre for Cell Biology, School of Biological Sciences, University of Edinburgh, Edinburgh EH9 3BF, UK
| | - Shih-Chieh Ti
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Amjad Horani
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63130, USA
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jean-Michel Rozet
- Laboratory of Genetics in Ophthalmology, INSERM UMR_1163, Institute of Genetic Diseases, Institut Imagine, Université de Paris, Paris 75015, France
| | - Isabelle Perrault
- Laboratory of Genetics in Ophthalmology, INSERM UMR_1163, Institute of Genetic Diseases, Institut Imagine, Université de Paris, Paris 75015, France
| | - Pleasantine Mill
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| |
Collapse
|
2
|
Marziali E, Landini S, Fiorentini E, Rocca C, Tiberi L, Artuso R, Zaroili L, Dirupo E, Fortunato P, Bargiacchi S, Caputo R, Bacci GM. Broadening the ocular phenotypic spectrum of ultra-rare BRPF1 variants: report of two cases. Ophthalmic Genet 2024:1-5. [PMID: 38590032 DOI: 10.1080/13816810.2024.2337879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/27/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION BRPF1 gene on 3p26-p25 encodes a protein involved in epigenetic regulation, through interaction with histone H3 lysine acetyltransferases KAT6A and KAT6B of the MYST family. Heterozygous pathogenic variants in BRPF1 gene are associated with Intellectual Developmental Disorder with Dysmorphic Facies and Ptosis (IDDDFP), characterized by global developmental delay, intellectual disability, language delay, and dysmorphic facial features. The reported ocular involvement includes strabismus, amblyopia, and refraction errors. This report describes a novel ocular finding in patients affected by variants in the BRPF1 gene. METHODS We performed exome sequencing and deep ocular phenotyping in two unrelated patients (P1, P2) with mild intellectual disability, ptosis, and typical facies. RESULTS Interestingly, P1 had a Chiari Malformation type I and a subclinical optic neuropathy, which could not be explained by variations in other genes. Having detected a peculiar ocular phenotype in P1, we suggested optical coherence tomography (OCT) for P2; such an exam also detected bilateral subclinical optic neuropathy in this case. DISCUSSION To date, only a few patients with BRPF1 variants have been described, and none were reported to have optic neuropathy. Since subclinical optic nerve alterations can go easily undetected, our experience highlights the importance of a more detailed ophthalmologic evaluation in patients with BRPF1 variant.
Collapse
Affiliation(s)
- Elisa Marziali
- Pediatric Ophthalmology Unit, Meyer Children's Hospital IRCSS, Florence, Italy
| | - Samuela Landini
- Medical Genetics Unit, Meyer Children's Hospital IRCSS, Florence, Italy
| | - Erika Fiorentini
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Camilla Rocca
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Lucia Tiberi
- Medical Genetics Unit, Meyer Children's Hospital IRCSS, Florence, Italy
| | - Rosangela Artuso
- Medical Genetics Unit, Meyer Children's Hospital IRCSS, Florence, Italy
| | - Laila Zaroili
- Medical Genetics Unit, Meyer Children's Hospital IRCSS, Florence, Italy
| | - Elia Dirupo
- Medical Genetics Unit, Meyer Children's Hospital IRCSS, Florence, Italy
| | - Pina Fortunato
- Pediatric Ophthalmology Unit, Meyer Children's Hospital IRCSS, Florence, Italy
| | - Sara Bargiacchi
- Medical Genetics Unit, Meyer Children's Hospital IRCSS, Florence, Italy
| | - Roberto Caputo
- Pediatric Ophthalmology Unit, Meyer Children's Hospital IRCSS, Florence, Italy
| | - Giacomo Maria Bacci
- Pediatric Ophthalmology Unit, Meyer Children's Hospital IRCSS, Florence, Italy
| |
Collapse
|
3
|
Contenti J, Guo Y, Mazzu A, Irondelle M, Rouleau M, Lago C, Leva G, Tiberi L, Ben-Sahra I, Bost F, Mazure NM. The mitochondrial NADH shuttle system is a targetable vulnerability for Group 3 medulloblastoma in a hypoxic microenvironment. Cell Death Dis 2023; 14:784. [PMID: 38036520 PMCID: PMC10689432 DOI: 10.1038/s41419-023-06275-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/26/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023]
Abstract
Medulloblastoma is a cancerous brain tumor that affects mostly children. Among the four groups defined by molecular characteristics, Group 3, the least well characterized, is also the least favorable, with a survival rate of 50%. Current treatments, based on surgery, radiotherapy, and chemotherapy, are not adequate and the lack of understanding of the different molecular features of Group 3 tumor cells makes the development of effective therapies challenging. In this study, the problem of medulloblastoma is approached from a metabolic standpoint in a low oxygen microenvironment. We establish that Group 3 cells use both the mitochondrial glycerol-3 phosphate (G3PS) and malate-aspartate shuttles (MAS) to produce NADH. Small molecules that target G3PS and MAS show a greater ability to decrease cell proliferation and induce apoptosis specifically of Group 3 cells. In addition, as Group 3 cells show improved respiration in hypoxia, the use of Phenformin, a mitochondrial complex 1 inhibitor, alone or in combination, induced significant cell death. Furthermore, inhibition of the cytosolic NAD+ recycling enzyme lactate dehydrogenase A (LDHA), enhanced the effects of the NADH shuttle inhibitors. In a 3D model using Group 3 human cerebellar organoids, tumor cells also underwent apoptosis upon treatment with NADH shuttle inhibitors. Our study demonstrates metabolic heterogeneity depending on oxygen concentrations and provides potential therapeutic solutions for patients in Group 3 whose tumors are the most aggressive.
Collapse
Affiliation(s)
- J Contenti
- Université Côte d'Azur, INSERM U1065, C3M, 151 Route de St Antoine de Ginestière, BP2 3194, CEDEX 03, 06204, Nice, France.
- Pasteur II Hospital, Department of Emergency Medicine, University Hospital Center, 30 voie Romaine, 06000, Nice, France.
| | - Y Guo
- Université Côte d'Azur, INSERM U1065, C3M, 151 Route de St Antoine de Ginestière, BP2 3194, CEDEX 03, 06204, Nice, France
| | - A Mazzu
- Université Côte d'Azur, INSERM U1065, C3M, 151 Route de St Antoine de Ginestière, BP2 3194, CEDEX 03, 06204, Nice, France
| | - M Irondelle
- Université Côte d'Azur, INSERM U1065, C3M, 151 Route de St Antoine de Ginestière, BP2 3194, CEDEX 03, 06204, Nice, France
| | - M Rouleau
- Université Côte d'Azur, Laboratoire de PhysioMédecine Moléculaire - LP2M, CNRS-UMR 7370, Faculty of Medicine, 28 ave de Valombrose, 06107, Nice Cedex 02, France
| | - C Lago
- Armenise-Harvard Laboratory of Brain Disorders and Cancer, Department of Cellular, Computational and Integrative Biollogy - CIBIO, University of Trento, Via Sommarive 9, 38123, Trento, Italy
| | - G Leva
- Armenise-Harvard Laboratory of Brain Disorders and Cancer, Department of Cellular, Computational and Integrative Biollogy - CIBIO, University of Trento, Via Sommarive 9, 38123, Trento, Italy
| | - L Tiberi
- Armenise-Harvard Laboratory of Brain Disorders and Cancer, Department of Cellular, Computational and Integrative Biollogy - CIBIO, University of Trento, Via Sommarive 9, 38123, Trento, Italy
| | - I Ben-Sahra
- Northwestern University Feinberg School of Medicine, Robert H. Lurie Cancer Center, 303 East Superior Street, Chicago, IL, 60611, USA
| | - F Bost
- Université Côte d'Azur, INSERM U1065, C3M, 151 Route de St Antoine de Ginestière, BP2 3194, CEDEX 03, 06204, Nice, France
| | - N M Mazure
- Université Côte d'Azur, INSERM U1065, C3M, 151 Route de St Antoine de Ginestière, BP2 3194, CEDEX 03, 06204, Nice, France.
| |
Collapse
|
4
|
Contenti J, Guo Y, Larcher M, Mirabal-Ortega L, Rouleau M, Irondelle M, Tiroille V, Mazzu A, Duranton-Tanneur V, Pedeutour F, Ben-Sahra I, Lago C, Leva G, Tiberi L, Robert G, Pouponnot C, Bost F, Mazure NM. HIF-1 inactivation empowers HIF-2 to drive hypoxia adaptation in aggressive forms of medulloblastoma. bioRxiv 2023:2023.10.17.562750. [PMID: 37905067 PMCID: PMC10614856 DOI: 10.1101/2023.10.17.562750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Medulloblastoma (MB) is the most prevalent brain cancer in children. Four subgroups of MB have been identified; of these, Group 3 is the most metastatic. Its genetics and biology remain less clear than the other groups, and it has a poor prognosis and few effective treatments available. Tumor hypoxia and the resulting metabolism are known to be important in the growth and survival of tumors but, to date, have been only minimally explored in MB. Here we show that Group 3 MB tumors do not depend on the canonical transcription factor hypoxia-inducible factor-1α (HIF-1α) to mount an adaptive response to hypoxia. We discovered that HIF-1α is rendered inactive either through post-translational methylation, preventing its nuclear localization specifically in Group 3 MB, or by a low expression that prevents modulation of HIF-target genes. Strikingly, we found that HIF-2 takes over the role of HIF-1 in the nucleus and promotes the activation of hypoxia-dependent anabolic pathways. The exclusion of HIF-1 from the nucleus in Group 3 MB cells enhances the reliance on HIF-2's transcriptional role, making it a viable target for potential anticancer strategies. By combining pharmacological inhibition of HIF-2α with the use of metformin, a mitochondrial complex I inhibitor to block respiration, we effectively induced Group 3 MB cell death, surpassing the effectiveness observed in Non-Group 3 MB cells. Overall, the unique dependence of MB cells, but not normal cells, on HIF-2-mediated anabolic metabolism presents an appealing therapeutic opportunity for treating Group 3 MB patients with minimal toxicity.
Collapse
|
5
|
Attardi E, Andolfo I, Russo R, Tiberi L, Raddi MG, Rosato BE, Marra R, Formicola D, Del Giudice F, Brogi A, Consagra A, Amato C, Sanna A, Artuso R, Iolascon A, Santini V. PIEZO1 mutations impact on early clinical manifestations of myelodysplastic syndromes. Am J Hematol 2023; 98:E72-E75. [PMID: 36695705 DOI: 10.1002/ajh.26863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 01/26/2023]
Affiliation(s)
- Enrico Attardi
- MDS Unit, Hematology, AOU Careggi - Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Immacolata Andolfo
- Department of Molecular Medicine and Medical Biotechnologies, "Federico II" University of Naples, Naples, Italy
- CEINGE, Biotecnologie Avanzate, Naples, Italy
| | - Roberta Russo
- Department of Molecular Medicine and Medical Biotechnologies, "Federico II" University of Naples, Naples, Italy
- CEINGE, Biotecnologie Avanzate, Naples, Italy
| | - Lucia Tiberi
- Department of Biomedical Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
- Medical Genetics Unit, Meyer University Hospital, Florence, Italy
| | - Marco Gabriele Raddi
- MDS Unit, Hematology, AOU Careggi - Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Barbara Eleni Rosato
- Department of Molecular Medicine and Medical Biotechnologies, "Federico II" University of Naples, Naples, Italy
- CEINGE, Biotecnologie Avanzate, Naples, Italy
| | - Roberta Marra
- Department of Molecular Medicine and Medical Biotechnologies, "Federico II" University of Naples, Naples, Italy
- CEINGE, Biotecnologie Avanzate, Naples, Italy
| | | | | | - Alice Brogi
- MDS Unit, Hematology, AOU Careggi - Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Angela Consagra
- MDS Unit, Hematology, AOU Careggi - Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Cristina Amato
- MDS Unit, Hematology, AOU Careggi - Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessandro Sanna
- MDS Unit, Hematology, AOU Careggi - Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Rosangela Artuso
- Medical Genetics Unit, Meyer University Hospital, Florence, Italy
| | - Achille Iolascon
- Department of Molecular Medicine and Medical Biotechnologies, "Federico II" University of Naples, Naples, Italy
- CEINGE, Biotecnologie Avanzate, Naples, Italy
| | - Valeria Santini
- MDS Unit, Hematology, AOU Careggi - Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| |
Collapse
|
6
|
Becherucci F, Landini S, Palazzo V, Cirillo L, Raglianti V, Lugli G, Tiberi L, Dirupo E, Bellelli S, Mazzierli T, Lomi J, Ravaglia F, Sansavini G, Allinovi M, Giannese D, Somma C, Spatoliatore G, Vergani D, Artuso R, Rosati A, Cirami C, Dattolo PC, Campolo G, De Chiara L, Papi L, Vaglio A, Lazzeri E, Anders HJ, Mazzinghi B, Romagnani P. A Clinical Workflow for Cost-Saving High-Rate Diagnosis of Genetic Kidney Diseases. J Am Soc Nephrol 2023; 34:706-720. [PMID: 36753701 PMCID: PMC10103218 DOI: 10.1681/asn.0000000000000076] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/19/2022] [Indexed: 01/22/2023] Open
Abstract
SIGNIFICANCE STATEMENT To optimize the diagnosis of genetic kidney disorders in a cost-effective manner, we developed a workflow based on referral criteria for in-person evaluation at a tertiary center, whole-exome sequencing, reverse phenotyping, and multidisciplinary board analysis. This workflow reached a diagnostic rate of 67%, with 48% confirming and 19% modifying the suspected clinical diagnosis. We obtained a genetic diagnosis in 64% of children and 70% of adults. A modeled cost analysis demonstrated that early genetic testing saves 20% of costs per patient. Real cost analysis on a representative sample of 66 patients demonstrated an actual cost reduction of 41%. This workflow demonstrates feasibility, performance, and economic effect for the diagnosis of genetic kidney diseases in a real-world setting. BACKGROUND Whole-exome sequencing (WES) increases the diagnostic rate of genetic kidney disorders, but accessibility, interpretation of results, and costs limit use in daily practice. METHODS Univariable analysis of a historical cohort of 392 patients who underwent WES for kidney diseases showed that resistance to treatments, familial history of kidney disease, extrarenal involvement, congenital abnormalities of the kidney and urinary tract and CKD stage ≥G2, two or more cysts per kidney on ultrasound, persistent hyperechoic kidneys or nephrocalcinosis on ultrasound, and persistent metabolic abnormalities were most predictive for genetic diagnosis. We prospectively applied these criteria to select patients in a network of nephrology centers, followed by centralized genetic diagnosis by WES, reverse phenotyping, and multidisciplinary board discussion. RESULTS We applied this multistep workflow to 476 patients with eight clinical categories (podocytopathies, collagenopathies, CKD of unknown origin, tubulopathies, ciliopathies, congenital anomalies of the kidney and urinary tract, syndromic CKD, metabolic kidney disorders), obtaining genetic diagnosis for 319 of 476 patients (67.0%) (95% in 21 patients with disease onset during the fetal period or at birth, 64% in 298 pediatric patients, and 70% in 156 adult patients). The suspected clinical diagnosis was confirmed in 48% of the 476 patients and modified in 19%. A modeled cost analysis showed that application of this workflow saved 20% of costs per patient when performed at the beginning of the diagnostic process. Real cost analysis of 66 patients randomly selected from all categories showed actual cost reduction of 41%. CONCLUSIONS A diagnostic workflow for genetic kidney diseases that includes WES is cost-saving, especially if implemented early, and is feasible in a real-world setting.
Collapse
Affiliation(s)
- Francesca Becherucci
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Samuela Landini
- Medical Genetics Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Viviana Palazzo
- Medical Genetics Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Luigi Cirillo
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Valentina Raglianti
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Gianmarco Lugli
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Lucia Tiberi
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
- Medical Genetics Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Elia Dirupo
- Medical Genetics Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | | | - Tommaso Mazzierli
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Jacopo Lomi
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | | | - Giulia Sansavini
- Nephrology and Dialysis Unit, Santo Stefano Hospital, Prato, Italy
| | - Marco Allinovi
- Nephrology, Dialysis and Transplantation Unit, Careggi University Hospital, Florence, Italy
| | | | - Chiara Somma
- Nephrology Unit Florence 1, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Giuseppe Spatoliatore
- Nephrology and Dialysis Unit, San Giovanni di Dio Hospital, AUSL Toscana Centro, Florence, Italy
| | - Debora Vergani
- Medical Genetics Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Rosangela Artuso
- Medical Genetics Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Alberto Rosati
- Nephrology and Dialysis Unit, San Giovanni di Dio Hospital, AUSL Toscana Centro, Florence, Italy
| | - Calogero Cirami
- Nephrology, Dialysis and Transplantation Unit, Careggi University Hospital, Florence, Italy
| | - Pietro Claudio Dattolo
- Nephrology Unit Florence 1, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Gesualdo Campolo
- Nephrology and Dialysis Unit, Santo Stefano Hospital, Prato, Italy
| | - Letizia De Chiara
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Laura Papi
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Elena Lazzeri
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Hans-Joachim Anders
- Division of Nephrology, Medizinische Klinik and Poliklinik IV, Klinikum der LMU München, Munich, Germany
| | - Benedetta Mazzinghi
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Paola Romagnani
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
| |
Collapse
|
7
|
Palterer B, Salvati L, Capone M, Mecheri V, Maggi L, Mazzoni A, Cosmi L, Volpi N, Tiberi L, Provenzano A, Giglio S, Parronchi P, Maggiore G, Gallo O, Bartoloni A, Annunziato F, Zammarchi L, Liotta F. Variants Disrupting CD40L Transmembrane Domain and Atypical X-Linked Hyper-IgM Syndrome: A Case Report With Leishmaniasis and Review of the Literature. Front Immunol 2022; 13:840767. [PMID: 35572607 PMCID: PMC9096836 DOI: 10.3389/fimmu.2022.840767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
X-linked hyper-IgM (XHIGM) syndrome is caused by mutations of the CD40LG gene, encoding the CD40L protein. The clinical presentation is characterized by early-onset infections, with profound hypogammaglobulinemia and often elevated IgM, susceptibility to opportunistic infections, such as Pneumocystis jirovecii pneumonia, biliary tract disease due to Cryptosporidium parvum, and malignancy. We report a 41-year-old male presenting with recurrent leishmaniasis, hypogammaglobulinemia, and myopathy. Whole-exome sequencing (WES) identified a missense variant in the CD40LG gene (c.107T>A, p.M36K), involving the transmembrane domain of the protein and a missense variant in the carnitine palmitoyl-transferase II (CPT2; c.593C>G; p.S198C) gene, leading to the diagnosis of hypomorphic XHIGM and CPT2 deficiency stress-induced myopathy. A review of all the previously reported cases of XHIGM with variants in the transmembrane domain showcased that these patients could present with atypical clinical features. Variants in the transmembrane domain of CD40LG act as hypomorphic generating a protein with a lower surface expression. Unlike large deletions or extracellular domain variants, they do not abolish the interaction with CD40, therefore preserving some biological activity.
Collapse
Affiliation(s)
- Boaz Palterer
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Flow Cytometric Diagnostic Centre and Immunotherapy, Careggi University Hospital, Florence, Italy
| | - Lorenzo Salvati
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Manuela Capone
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Valentina Mecheri
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Laura Maggi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessio Mazzoni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lorenzo Cosmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Immunology and Cell Therapies Unit, Careggi University Hospital, Florence, Italy
| | - Nila Volpi
- Unit of Neurology and Neurophysiology, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Lucia Tiberi
- Department of Biomedical Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy.,Medical Genetics Unit, Meyer University Hospital, Firenze, Italy
| | - Aldesia Provenzano
- Department of Biomedical Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Sabrina Giglio
- Medical Genetics Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Paola Parronchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Immunology and Cell Therapies Unit, Careggi University Hospital, Florence, Italy
| | | | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | - Alessandro Bartoloni
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Francesco Annunziato
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Flow Cytometric Diagnostic Centre and Immunotherapy, Careggi University Hospital, Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Francesco Liotta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Immunology and Cell Therapies Unit, Careggi University Hospital, Florence, Italy
| |
Collapse
|
8
|
Cirillo L, Becherucci F, Bellelli S, Mazzinghi B, Raglianti V, Lugli G, Landini S, Palazzo V, Tiberi L, Vaglio A, Anders HJ, Romagnani P. MO1057: Cost-Analysis of a Clinical Workflow for Diagnosis of Inherited Kidney Diseases. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac092.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
In the last decade, the use of whole-exome sequencing techniques (WES) has provided many insights into inherited kidney diseases that are thought to represent at least 10%–15% of cases of end-stage CKD [1]. However, among others, cost concerns limit the widespread of genomics use in daily practice [1, 2]. Publicly funded genomic testing is restricted in most health care systems [2]. Consequently, the evaluation of cost-effectiveness is urgently required in order to establish genomic sequencing as a standard diagnostic test for nephropathic patients.
The aim of this study was to perform a cost-analysis of genetic testing use in a diagnostic workflow.
METHOD
We recently set up a diagnostic workflow for the selection of patients that should undergo genetic testing in the suspicion of a genetic disease. This algorithm is applied by a network of nephrology centres on the regional territory. Selected patients are referred to a tertiary centre, Meyer University Hospital of Florence (Italy), for genetic diagnosis by WES.
We enrolled paediatric and adult patients referred to the outpatient service based on the pre-specified clinical criteria. All the patients underwent genetic testing from 2018 to June 2021.
We conducted a cost-analysis in two parts: (1) assessment of the cost-effectiveness cut-off; and (2) exploratory modeled cost-analysis using WES in different phases of the diagnostic trajectory.
As a surrogate of the cost-effectiveness analysis, we calculated the cost-effectiveness cut-off, indicating the amount of expenses for diagnostic examinations at which WES sequencing would be cost-effective.
For the exploratory cost-analysis, we defined two diagnostic trajectories: Model I, considering an ideal complete diagnostic pathway and late use of WES; and Model II, considering an early use of WES allowing to save a certain number of examinations. Genomic and non-genomic investigations were obtained from local practice, available clinical evidence and guidelines. We then calculated the cost per diagnosis according to each Model for different clinical categories and for the whole study population using the diagnostic rates of this study.
We considered only direct medical costs, based on the regional health reimbursement system, which is comprehensive of materials and human resources. The prices are expressed in euros. The analysis was conducted from a regional healthcare system perspective.
RESULTS
The analysis included 402 patients. WES performed after the standard non-conclusive diagnostic work-up (at a mean cost of €2992/patient) resulted in cost-effectiveness at a cost of <€2004/patient in the study population. Looking at different clinical categories, WES was cost-effective at a cost ranging from €3336 to €770.
Overall, the exploratory cost-analysis showed Model II as cost reducing in comparison to Model I. The mean cost per diagnosis in Model I with late use of WES was estimated at €7700. Early use of WES in Model II had an estimated cost per diagnosis of €6340, leading to a cost saving of €1360/patient tested. Regarding the single clinical categories, the highest cost saving per diagnosis was obtained in podocytopathies (Model I: €13.010 versus Model II: €7261). The early use of WES produced a slight increase in estimated costs per diagnosis for tubulopathies, as well as for ciliopathies, while for syndromic CKD and metabolic kidney disorders, the costs per diagnosis did not result in major changes.
CONCLUSION
Early use of WES in the diagnostic pathway of inherited diseases, guided by a framework of specific criteria, is feasible and has the potential to produce substantial cost savings in healthcare.
Collapse
Affiliation(s)
- Luigi Cirillo
- Nephrology and Dialysis, University Hospital Meyer, Firenze, Italy
- Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Firenze, Italy
| | | | | | | | - Valentina Raglianti
- Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Firenze, Italy
| | - Gianmarco Lugli
- Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Firenze, Italy
| | | | | | - Lucia Tiberi
- Genetics, University Hospital Meyer, Firenze, Italy
| | - Augusto Vaglio
- Nephrology and Dialysis, University Hospital Meyer, Firenze, Italy
- Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Firenze, Italy
| | - Hans-Joachim Anders
- Renal Division, Department of Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | - Paola Romagnani
- Nephrology and Dialysis, University Hospital Meyer, Firenze, Italy
- Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Firenze, Italy
| |
Collapse
|
9
|
Becherucci F, Cirillo L, Landini S, Palazzo V, Raglianti V, Lugli G, Tiberi L, Vaglio A, Anders HJ, Mazzinghi B, Romagnani P. FC036: A Clinical Workflow for Selection of Patients and Cost-Efficient Diagnosis of Genetic Kidney Diseases. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac102.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
With the spread of whole-exome sequencing techniques (WES), genetic kidney diseases are increasingly recognized across all age groups. However, accessibility, interpretation of results and costs limit the widespread of genomics use in daily practice [1]. In the very last years, first experiences in the implementation of renal genetic services have been started [2]. In this work, we explored the feasibility and diagnostic performance of a service delivery model based on a territorial network for patients’ selection, followed by referral to the renal genetic clinic of a tertiary centre for WES, results interpretation and counseling. We hypothesized that higher diagnostic yield and cost-effectiveness could be achieved by implementing a workflow that could solve three problems: (1) Give clear indications to the nephrologist about which patients with kidney diseases should undergo genetic testing, (2) Increase the rate and accuracy of genetic testing and evaluate the clinical impact and (3) Identify the kidney diseases for which early genetic testing is not only clinically, but also economically convenient for the healthcare provider based on pre-specified clinical criteria for tertiary centre referral.
METHOD
We set up a multi-step diagnostic workflow. We established specific clinical criteria for evaluation of patients who should undergo genetic testing on the suspicion of a genetic disease by a network of nephrology centres. Patients selected were referred to a tertiary centre for genetic diagnosis by WES, reverse-phenotyping and multidisciplinary board analysis.
This workflow has been applied to pediatric and adult patients with kidney diseases belonging to eight clinical categories (Podocytopathies, Collagenopathies, Tubulopathies, Unknown familial nephropathies, Ciliopathies, Congenital anomalies of the kidney and urinary tract, Syndromic chronic kidney disease and Metabolic kidney disorders). We recorded clinical-laboratory-radiological information of patients included. We also performed a cost-analysis of the diagnostic workflow modelling the possible economic saving using it.
RESULTS
We included 402 patients, of note, 188 patients were female (46.8%) and 132 patients (33%) were >16 years of age. We obtained a global diagnostic yield of 69.2% (278–402), with category-specific diagnostic rates ranging from 38.5% to 87%. By reverse phenotyping, we reclassified diagnoses in 74–278 (26.6%) patients, thus increasing diagnostic accuracy. Overall, reverse phenotyping increased the diagnostic rate in an average of 20% of cases, irrespective of the age at clinical onset of the disease. Diagnostic yield was independent of the age at the onset of kidney disease. Genetic testing was offered as cascade screening to 67 families, providing a genetic diagnosis in 62 family members with previously unsuspected or unspecified kidney disorders. The clinical work-up changed and was redirected on average in 50% of patients. In 11.5% of patients, the results of genetic testing helped in guiding kidney transplant decisions. Finally, cost-analysis showed that our workflow is cost-efficient allowing to potentially save a mean of 1360 euros per patient.
CONCLUSION
Ordering genetic testing, interpreting results, counselling patients and their families, and tailoring clinical management (i.e. personalized nephrology) is feasible and saves costs in a real-world setting.
Collapse
Affiliation(s)
| | - Luigi Cirillo
- Nephrology and Dialysis, University Hospital Meyer, Firenze, Italy
- Experimental and Clinical Biomedical Sciences ‗Mario Serio‘, University of Florence, Firenze, Italy
| | | | | | - Valentina Raglianti
- Experimental and Clinical Biomedical Sciences ‗Mario Serio‘, University of Florence, Firenze, Italy
| | - Gianmarco Lugli
- Experimental and Clinical Biomedical Sciences ‗Mario Serio‘, University of Florence, Firenze, Italy
| | - Lucia Tiberi
- Genetics, University Hospital Meyer, Firenze, Italy
| | - Augusto Vaglio
- Nephrology and Dialysis, University Hospital Meyer, Firenze, Italy
- Experimental and Clinical Biomedical Sciences ‗Mario Serio‘, University of Florence, Firenze, Italy
| | - Hans-Joachim Anders
- Renal Division, Department of Medicine IV, Ludwig Maximilian University Hospital, München, Germany
| | | | - Paola Romagnani
- Nephrology and Dialysis, University Hospital Meyer, Firenze, Italy
- Experimental and Clinical Biomedical Sciences ‗Mario Serio‘, University of Florence, Firenze, Italy
| |
Collapse
|
10
|
Antonica F, Santomaso L, Aiello G, Pernici D, Miele E, Tiberi L. OS13.3.A Establishment of a novel system to specifically trace and ablate quiescent/slow cycling cells in high-grade glioma. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
High-grade gliomas are the most common malignant brain tumors, with poor prognosis due to recurrence and tumor infiltration after surgical removal and chemotherapy. Quiescent/slow cycling stem cells have been proposed to be one of the main players of tumor relapse but their involvement in in the infiltration remain unclear. Despite they have been described in mouse models or after transcriptional profiling of human tumor samples, their direct visualization, targeting and ablation remains a challenge.
MATERIAL AND METHODS
Tumors were induced over-expressing oncogenic forms of MET and p53 in the subventricular zone (SVZ) of P2 mouse brain as well as human forebrain organoids. The co-expression with specific cell cycle sensors as well as lineage specific CreERT2 under control of stem cells promoters allowed to visualize and target glioma stem cells.
RESULTS
Here, we used a fluorescent cell cycle sensor to visualize quiescent tumor cells in mouse brain cancer and human cancer organoids. In particular, we characterized them within the tumor revealing the invasiveness capacity of slow cycling tumor cells. Furthermore, we generated a new system to specifically trace and ablate such cells. Indeed, lineage tracing experiments allowed to trace quiescent Prom1 progeny in the tumors after temozolomide treatment. In addition, the selective ablation of qProm1 in mouse brain cancer reduced tumor infiltration. Finally, time-lapse experiments showed that slow cycling cells are also able to infiltrate co-cultured human brain cancer organoids.
CONCLUSION
Overall, our data show that quiescent/slow cycling cells are key driver of tumor invasiveness, the major malignant feature of high-grade brain cancer.
Collapse
Affiliation(s)
| | | | - G Aiello
- University of Trento, Trento, Italy
| | | | - E Miele
- Bambino Gesù Children’s Hospital, Rome, Italy
| | - L Tiberi
- University of Trento, Trento, Italy
| |
Collapse
|
11
|
Provenzano A, La Barbera A, Scagnet M, Pagliazzi A, Traficante G, Pantaleo M, Tiberi L, Vergani D, Kurtas NE, Guarducci S, Bargiacchi S, Forzano G, Artuso R, Palazzo V, Kura A, Giordano F, di Feo D, Mortilla M, De Filippi C, Mattei G, Garavelli L, Giusti B, Genitori L, Zuffardi O, Giglio S. Chiari 1 malformation and exome sequencing in 51 trios: the emerging role of rare missense variants in chromatin-remodeling genes. Hum Genet 2020; 140:625-647. [PMID: 33337535 PMCID: PMC7981314 DOI: 10.1007/s00439-020-02231-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023]
Abstract
Type 1 Chiari malformation (C1M) is characterized by cerebellar tonsillar herniation of 3–5 mm or more, the frequency of which is presumably much higher than one in 1000 births, as previously believed. Its etiology remains undefined, although a genetic basis is strongly supported by C1M presence in numerous genetic syndromes associated with different genes. Whole-exome sequencing (WES) in 51 between isolated and syndromic pediatric cases and their relatives was performed after confirmation of the defect by brain magnetic resonance image (MRI). Moreover, in all the cases showing an inherited candidate variant, brain MRI was performed in both parents and not only in the carrier one to investigate whether the defect segregated with the variant. More than half of the variants were Missense and belonged to the same chromatin-remodeling genes whose protein truncation variants are associated with severe neurodevelopmental syndromes. In the remaining cases, variants have been detected in genes with a role in cranial bone sutures, microcephaly, neural tube defects, and RASopathy. This study shows that the frequency of C1M is widely underestimated, in fact many of the variants, in particular those in the chromatin-remodeling genes, were inherited from a parent with C1M, either asymptomatic or with mild symptoms. In addition, C1M is a Mendelian trait, in most cases inherited as dominant. Finally, we demonstrate that modifications of the genes that regulate chromatin architecture can cause localized anatomical alterations, with symptoms of varying degrees.
Collapse
Affiliation(s)
- Aldesia Provenzano
- Medical Genetics Unit, Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.
| | - Andrea La Barbera
- Medical Genetics Unit, Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Mirko Scagnet
- Department of Neurosurgery, "A. Meyer" Children Hospital of Florence, Florence, Italy
| | - Angelica Pagliazzi
- Medical Genetics Unit, Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Giovanna Traficante
- Medical Genetics Unit, "A. Meyer" Children Hospital of Florence, Florence, Italy
| | - Marilena Pantaleo
- Medical Genetics Unit, "A. Meyer" Children Hospital of Florence, Florence, Italy
| | - Lucia Tiberi
- Medical Genetics Unit, Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Debora Vergani
- Medical Genetics Unit, "A. Meyer" Children Hospital of Florence, Florence, Italy
| | - Nehir Edibe Kurtas
- Medical Genetics Unit, "A. Meyer" Children Hospital of Florence, Florence, Italy
| | - Silvia Guarducci
- Medical Genetics Unit, "A. Meyer" Children Hospital of Florence, Florence, Italy
| | - Sara Bargiacchi
- Medical Genetics Unit, "A. Meyer" Children Hospital of Florence, Florence, Italy
| | - Giulia Forzano
- Medical Genetics Unit, Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Rosangela Artuso
- Medical Genetics Unit, "A. Meyer" Children Hospital of Florence, Florence, Italy
| | - Viviana Palazzo
- Medical Genetics Unit, "A. Meyer" Children Hospital of Florence, Florence, Italy
| | - Ada Kura
- Department of Experimental and Clinical Medicine, Atherothrombotic Diseases Center, University of Florence, Careggi Hospital, Florence, Italy
| | - Flavio Giordano
- Department of Neurosurgery, "A. Meyer" Children Hospital of Florence, Florence, Italy
| | - Daniele di Feo
- Department of Radiology, "A. Meyer" Children Hospital of Florence, Florence, Italy
| | - Marzia Mortilla
- Department of Radiology, "A. Meyer" Children Hospital of Florence, Florence, Italy
| | - Claudio De Filippi
- Department of Radiology, "A. Meyer" Children Hospital of Florence, Florence, Italy
| | - Gianluca Mattei
- Department of Information Engineering, University of Florence, Florence, Italy
| | - Livia Garavelli
- Medical Genetics Unit, Department of Mother and Child, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, Atherothrombotic Diseases Center, University of Florence, Careggi Hospital, Florence, Italy
| | - Lorenzo Genitori
- Department of Neurosurgery, "A. Meyer" Children Hospital of Florence, Florence, Italy
| | - Orsetta Zuffardi
- Unit of Medical Genetics, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Sabrina Giglio
- Medical Genetics Unit, Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.,Medical Genetics Unit, "A. Meyer" Children Hospital of Florence, Florence, Italy
| |
Collapse
|
12
|
Spinelli M, Affatato S, Tiberi L, Carmignato S, Viceconti M. Integrated friction measurements in hip wear simulations: Short-term results. Proc Inst Mech Eng H 2009; 224:865-76. [DOI: 10.1243/09544119jeim683] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hip joint wear simulators are used extensively to simulate the dynamic behaviour of the human hip joint and, through the wear rate, gain a concrete indicator about the overall wear performance of different coupled bearings. Present knowledge of the dynamic behaviour of important concurrent indicators, such as the coefficient of friction, could prove helpful for the continuing improvement in applied biomaterials. A limited number of commercial or custom-made simulators have been designed specifically for friction studies but always separately from wear tests; thus, analysis of these two important parameters has remained unconnected. As a result, a new friction sensor has been designed, built, and integrated in a commercial biaxial rocking motion hip simulator. The aim of this study is to verify the feasibility of an experimental set-up in which the dynamic measurement of the friction factor could effectively be implemented in a standard wear test without compromising its general accuracy and repeatability. A short wear test was run with the new set-up for 1×106 cycles. In particular, three soft-bearings (metal-on-polyethylene, Φ = 28 mm) were tested; during the whole test, axial load and frictional torque about the vertical loading axis were synchronously recorded in order to calculate the friction factor. Additional analyses were performed on the specimens, before and after the test, in order to verify the accuracy of the wear test. The average friction factor was 0.110 ± 0.025. The friction sensors showed good accuracy and repeatability throughout. This innovative set-up was able to reproduce stable and reliable measurements. The results obtained encourage further investigations of this set-up for long-term assessment and using different combinations of materials.
Collapse
Affiliation(s)
- M Spinelli
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - S Affatato
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - L Tiberi
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - S Carmignato
- Laboratorio di Metrologia Geometrica e Industriale, Padova University, Padova, Italy
| | - M Viceconti
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy
| |
Collapse
|
13
|
Pandolfi S, Bonafè M, Di Tella L, Tiberi L, Salvioli S, Monti D, Sorbi S, Franceschi C. p66shc is highly expressed in fibroblasts from centenarians. Mech Ageing Dev 2005; 126:839-44. [PMID: 15992607 DOI: 10.1016/j.mad.2005.03.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2004] [Revised: 03/01/2005] [Accepted: 03/04/2005] [Indexed: 11/21/2022]
Abstract
p66(shc-/-) mice exhibit prolonged lifespan and increased resistance to oxidative and hypoxic stress. To investigate p66(shc) involvement in human longevity, p66(shc) mRNA and protein were evaluated in fibroblasts from young people, elderly and centenarians, exposed to oxidative or hypoxic stress. Unexpectedly, centenarians showed the highest basal levels of p66(shc). Oxidative stress induced p66(shc) in all samples. At variance, hypoxic stress caused p66(shc) reduction only in cells from centenarians. These changes occurred in absence of any modification of p66(shc) promoter methylation pattern. Intriguingly, in cells from centenarians, p66(shc) induction was affected by p53 codon 72 polymorphism. Thus, cells from centenarians present a peculiar regulation of p66(shc), suggesting that its role in mammalian longevity is more complex than previously thought.
Collapse
Affiliation(s)
- S Pandolfi
- Department of Experimental Pathology, University of Bologna, via S. Giacomo 12, 40126 Bologna, Italy
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Morganti P, Fionda A, Elia U, Tiberi L. Extraction and analysis of cosmetic active ingredients from an anti-cellulitis transdermal delivery system by high-performance liquid chromatography. J Chromatogr Sci 1999; 37:51-5. [PMID: 10065405 DOI: 10.1093/chromsci/37.2.51] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A new transdermal delivery system that controls cellulitis is evaluated using reversed-phase high-performance liquid chromatography coupled with photodiode array detection. An extraction procedure and the validation of the analytical method to assay the active excipients from the Centella asiatica plant (asiaticoside, madacessic acid, and asiatic acid) are described. Excellent results ae obtained in terms of linearity, accuracy, and specificity of the analytical method.
Collapse
Affiliation(s)
- P Morganti
- Mavi Sud, Research & Development Laboratories, Aprilia, Italy
| | | | | | | |
Collapse
|
15
|
Pietrobattista A, Cordaro M, Cicciarelli S, Tiberi L. [Calculation of overjet, overbite, and skeletal overjet in relation to the Frankfort plane]. Mondo Ortod 1988; 13:33-7. [PMID: 3256775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|