The intronic BRCA1 c.5407-25T>A variant causing partly skipping of exon 23-a likely pathogenic variant with reduced penetrance?

Rare sequence variants in the non-coding part of the BRCA genes are often reported as variants of uncertain significance (VUS), which leave patients and doctors in a challenging position. The aim of this study was to determine the pathogenicity of the BRCA1 c.5407-25T>A variant found in 20 families from Norway, France and United States with suspected hereditary breast and ovarian cancer. This was done by combining clinical and family information with allele frequency data, and assessment of the variant’s effect on mRNA splicing. Mean age at breast (n = 12) and ovarian (n = 11) cancer diagnosis in female carriers was 49.9 and 60.4 years, respectively. The mean Manchester score in the 20 families was 16.4. The allele frequency of BRCA1 c.5407-25T>A was 1/64,566 in non-Finnish Europeans (gnomAD database v2.1.1). We found the variant in 1/400 anonymous Norwegian blood donors and 0/784 in-house exomes. Sequencing of patient-derived cDNA from blood, normal breast and ovarian tissue showed that BRCA1 c.5407-25T>A leads to skipping of exon 23, resulting in frameshift and protein truncation: p.(Gly1803GlnfsTer11). Western blot analysis of transiently expressed BRCA1 proteins in HeLa cells showed a reduced amount of the truncated protein compared with wild type. Noteworthily, we found that a small amount of full-length transcript was also generated from the c.5407-25T>A allele, potentially explaining the intermediate cancer burden in families carrying this variant. In summary, our results show that BRCA1 c.5407-25T>A leads to partial skipping of exon 23, and could represent a likely pathogenic variant with reduced penetrance.

Novel mutation in MYH7 gene associated with distal myopathy and cardiomyopathy

A 25-year-old woman had childhood-onset muscle weakness and dilated cardiomyopathy. She exhibited predominantly distal weakness with early toe walking. Dilated cardiomyopathy required cardiac transplantation at age 15 years. We identified a de-novo, heterozygous, missense mutation, c.2348G>C (p. Arg783Pro), in exon 21 of the MYH7 gene, which encodes slow skeletal muscle fiber/β-cardiac myosin heavy chain protein, that replaces a highly conserved arginine with a proline. This novel mutation that results in the unusual combined cardiac and skeletal muscle phenotype localizes to the essential light chain binding area, a region only previously shown to be mutated in hypertrophic cardiomyopathy.

Morphine, opioids, and the feline pulmonary vascular bed

BACKGROUND

Opioid-induced vasodepressor responses have been reported in a variety of species and laboratory models. The aim of this study was to ascertain the relative potencies of different clinically relevant opioids compared with traditional vasodepressor agents in the feline pulmonary vascular bed. A second aim was to study the effects of morphine and to identify the receptors involved in the mediation or the modulation of these effects.

METHODS

This was a prospective vehicle-controlled study involving an intact chest preparation of adult mongrel cats. The effects of various opioids, morphine, fentanyl, remifentanil, sufentanil, and meperidine were compared with other vasodepressor agents. Additionally, the effects of L-N(5)-(1-iminoethyl) ornithine hydrochloride (L-NIO) (nitric oxide synthase inhibitor), nimesulide [selective cyclooxygenase (COX)-2 inhibitor], glibenclamide (ATP-sensitive K+ channel blocker), naloxone (non-selective opioid receptor antagonist), and diphenhydramine (histamine H(1)-receptor antagonist) were investigated on pulmonary arterial responses to morphine and other selected agonists in the feline pulmonary vascular bed. The systemic pressure and lobar arterial perfusion pressure were continuously monitored, electronically averaged, and recorded.

RESULTS

In the cat pulmonary vascular bed of the isolated left lower lobe, morphine, remifentanil, fentanyl, sufentanil, and meperidine induced a dose-dependent moderate vasodepressor response and it appeared that sufentanil was the most potent on a nanomolar basis. The effects of morphine were not significantly altered after administration of L-NIO, nimesulide, and glibenclamide. However, the vascular responses to morphine were significantly attenuated following administration of naloxone and diphenhydramine.

CONCLUSION

The results of the present study suggest that sufentanil appears to have slightly more potency and morphine the least of the five opioid agonists studied on a nanomolar basis. Morphine-induced vasodilatory responses appeared to be mediated or modulated by both opioid receptor and histamine-receptor-sensitive pathways.

Rare etiology of autosomal recessive disease in a child with noncarrier parents

A child with maple syrup urine disease type 2 (MSUD2) was found to be homozygous for a 10-bp MSUD2-gene deletion on chromosome 1. Both purported parents were tested, and neither carries the gene deletion. Polymorphic simple-sequence repeat analyses at 15 loci on chromosome 1 and at 16 loci on other chromosomes confirmed parentage and revealed that a de novo mutation prior to maternal meiosis I, followed by nondisjunction in maternal meiosis II, resulted in an oocyte with two copies of the de novo mutant allele. Fertilization by a sperm that did not carry a paternal chromosome 1 or subsequent mitotic loss of the paternal chromosome 1 resulted in the propositus inheriting two mutant MSUD2 alleles on two maternal number 1 chromosomes.

Effects of sinker shapes on dissolution profiles

In dissolution testing, according to the U.S. Pharmacopeia, a nonreactive stainless steel wire helix is typically used to sink dosage forms that would otherwise float. The objective of this investigation was to determine if other sinker shapes will influence the rate, extent, or variability of dissolution. Criteria for the optimal sinker were defined. Various new sinker designs were fabricated, tested, and classified. Four classes of sinker shapes were defined: longitudinal, lateral, screen enclosures, and internal weights. Longitudinal sinkers contact the dosage forms on the long axis. Lateral sinkers either wrap around or contact capsule dosage forms in the middle, such as the line where the top and bottom halves of a capsule shell come together. Screen enclosures are of two types: either a wire cage, which holds the entire capsule, or a circular piece of wire screen placed on top of the capsule. Internal weights consist of two steel ball bearings, one inserted into each end of the capsule. The investigation consisted of four studies: (1) visual observation of the dissolution performance using 12 different sinkers; (2) the effect on drug release from nine classified sinkers on two different capsule formulations; (3) side-by-side comparison between the selected optimal longitudinal U clip and the wire helix lateral type sinkers; and (4) hydrodynamic effects caused by the use of the longitudinal U clip and the wire helix lateral type sinkers in the absence of capsule shells. We concluded that capsules sunk with either of the two longitudinal sinkers, the U clip or the paper clip, have faster, more complete dissolution and less variable results than did lateral type sinkers.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of multicomponent formulations containing pseudoephedrine HCl and chlorpheniramine maleate using first-derivative spectroscopy on a diode-array spectrophotometer

Pseudoephedrine HCl and chlorpheniramine maleate are compounds which have overlapping UV spectra in solutions of phosphate buffer (pH 7.2), water, and 0.1 M HCl. The quantitation of both compounds was achieved by using first-derivative spectroscopy on a diode-array spectrophotometer. The application of this method for the analysis of content uniformity testing and measuring dissolution profiles was demonstrated.