No description available.

Breast cancer is the most common cancer in South African women. Approximately 5¬10% of all breast cancer cases are due to an inherited predisposition, resulting from mutations in tumour suppressor genes. The BRCA1 gene on chromosome 17q is one such tumour suppressor gene, that when mutated confers an increased risk of breast/ovarian cancer in carriers. To date, more than 500 different BRCA 1 mutations have been reported worldwide. Some of these mutations are frequently reported and others occur commonly in certain population groups. These population-specific differences in mutations represent founder effects, whereby a single ancestral mutation accounts for the majority of breast cancer cases. This study was undertaken as the nature and frequency of BRCA1 mutations in South African breast/ovarian cancer families is unknown. Fifty-one breast/ovarian cancer families were screened for three commonly occurring mutations (185deIAG, 4184del4 and 5382insC) using polymerase chain reaction (PCR) and allele-specific oligonucleotide (ASO) hybridisation. The protein truncation test (PTT) was utilised to detect truncating mutations in the large exon 11, and the remaining coding exons were screened for mutations using exon-by-exon PCR single strand conformation polymorphism/heteroduplex analysis (SSCP/HA). Seven disease-causing mutations were identified in 15 families, consisting of five different frameshift mutations and two different nonsense mutations. Four Ashkenazi Jewish families were found to harbour the 185delAG mutation; the 5382insC mutation was identified in two Afrikaner families and one Ashkenazi Jewish family. Haplotype analysis revealed that the four Ashkenazi families share the common Ashkenazi Jewish haplotype, suggesting a common ancestor for these families. Similarly, the two Afrikaner families share the same haplotype as families of north and east European ancestry with the 5382insC mutation. The haplotype of the Ashkenazi Jewish family with this mutation was however different to the linked haplotype, indicating a recombination event or an independent mutation. Both these mutations are thought to have occurred in or before the medieval period. Furthermore, four Afrikaner families were found to carry the novel E881X nonsense mutation, which has not been previously described. Haplotype analysis of these families suggested that these patients share a common ancestor, and genealogic studies have identified the founding couple for this mutation, who both arrived in the Cape from France in the late 1600s. Four additional families were found to harbour BRCA1 mutations by SSCP/HA. Three of these mutations have not been previously reported - the S451X nonsense mutation (identified in a family of Scottish origin), the 1493delC mutation identified in an Afrikaner family, and the 4957insC mutation identified in an Indian family. The 448insA mutation was identified in a family of German origin, where the patient had cancer of the fallopian tubes. A number of different described polymorphisms and variants of unknown functional significance were also identified. This is the first study to show that BRCA1 is involved in South African breast/ovarian cancer families, to the extent that 29.4% (15/51) of families have BRCA1 mutations. Furthermore, minor founder effects in the Afrikaner population have been demonstrated. These results enable improved genetic counselling and clinical management of mutation positive families as well as subsequent testing of family members. / Dissertation (MSc (Human Genetics))--University of Pretoria, 2005. / Genetics / unrestricted

Introduction: Hypertrophic cardiomyopathy (HCM) is a heterogeneous disorder of the cardiac sarcomere, resulting in myocyte hypertrophy and disarray, interstitial fibrosis, and cardiac dysfunction. Our aim was to determine whether the amount of fibrosis in HCM correlates with echocardiographic measures of diastolic dysfunction, presence of HCM-susceptibility mutations, or polymorphisms in the renin-angiotensin-aldosterone system (RAAS). Methods: Surgical specimens from patients with obstructive HCM undergoing septal myectomy at the Mayo Clinic (2001-2004) were examined and compared with autopsy-derived tissues from age- and sex-matched normal controls. Digital image analysis was used to quantitate the fibrosis in representative microscopic sections. Genotyping was performed for myofilament-HCM using polymerase chain reaction, high-performance liquid chromatography, and direct DNA sequencing. RAAS polymorphism status was similarly established. Results: The study included 59 HCM cases and 44 controls. Patients with HCM exhibited more fibrosis (mean 17%, range 3-45%) than controls (mean 8%, range 3-17%) (P<.0001). A significant relationship existed between amount of fibrosis and maximum wall thickness (P=.02), left ventricular ejection fraction (P=.02), and peak early/late diastolic mitral annulus velocity (E/A ratio) (P=.002). Although there was no association between amount of fibrosis and myofilament-HCM genotype status or polymorphisms in the RAAS cascade, there was a trend toward more fibrosis in patients with ≥1 C-encoding allele in CYP11B2-encoded aldosterone synthase. Conclusions: Patients with HCM undergoing septal myectomy had significantly more myocardial interstitial fibrosis than controls. The amount of fibrosis in HCM patients correlated with degree of septal hypertrophy and left ventricular systolic and diastolic function. Notably, neither mutations in cardiac myofilament proteins or polymorphisms in RAAS exhibited strong associations with severity of myocardial fibrosis.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / A doença de Parkinson (DP) é uma das desordens neurodegenerativas mais comuns associada ao envelhecimento, alcançando 2% aos 70 anos. É uma doença caracterizada pela degeneração progressiva de neurônios dopaminérgicos nigrais nos gânglios basais e pela presença de inclusões protéicas citoplasmáticas denominadas corpúsculos e neuritos de Lewy nos neurônios sobreviventes. A etiologia da DP é pouco conhecida, sendo considerada, na maioria dos casos, idiopática. Conhecimentos alcançados nos últimos 15 anos sobre a base genética da DP demonstram, claramente, que os fatores genéticos desempenham um importante papel na etiologia desta desordem. Neste trabalho, rastreamos mutações nos genes que codificam proteínas participantes de vias metabólicas mitocondriais (Parkin, PINK1 e DJ-1) em 136 pacientes brasileiros com manifestação precoce da DP, através do sequenciamento automático e da técnica de MLPA. Avaliamos a presença de variantes de sequência por meio do sequenciamento dos exons 1 a 12 do gene Parkin e dos exons 1 a 8 do gene PINK1. Em Parkin foram identificadas três mutações patogênicas ou potencialmente patogênicas, ambas em heterozigose: p.T240M, p.437L e p.S145N. Em PINK1 não encontramos variantes de ponto patogênicas. Através da técnica de MLPA investigamos alterações de dosagem nos genes Parkin, PINK1 e DJ-1. Identificamos cinco alterações no gene Parkin em quatro pacientes: uma duplicação heterozigota do exon 4 no paciente PAR2256, uma deleção heterozigota do exon 4 no probando PAR2099, uma deleção homozigota do exon 4 na paciente PAR3380 e um probando heterozigoto composto (PAR2396) com duas alterações, uma duplicação do exon 3 e uma deleção dos exons 5 e 6. No gene PINK1 identificamos uma deleção heterozigota do exon 1, que nunca foi descrita na literatura, em um paciente (PAR2083). Não encontramos alteração quantitativa no gene DJ-1. Neste estudo obtivemos uma frequência total de mutações patogênicas (pontuais e de dosagem) nos genes estudados de 7,3%, sendo 6,6% no gene Parkin e 0,7% no gene PINK1. / Parkinson's disease (PD) is one of the most common neurodegenerative disorders associated with aging, reaching 2% at age 70. It is a disease characterized by progressive degeneration of nigra dopaminergic neurons in the basal ganglia and the presence of cytoplasmic protein inclusions known as Lewy bodies and neurites in surviving neurons. The etiology of PD is poorly understood, being considered, in most cases, idiopathic. Knowledge achieved in the last 15 years about the genetic basis of PD clearly shows that genetic factors play an important role in the etiology of this disorder. In this study, we screened mutations in genes that encode proteins participating in mitochondrial metabolic pathways (Parkin, PINK1 and DJ-1) in 136 Brazilian patients with early onset PD, through automatic sequencing and MLPA technique. We evaluated the presence of sequence variants by means of sequencing of exons 1 to 12 of Parkin gene and exons 1 to 8 of PINK1 gene. In Parkin gene were identified three pathogenic or potentially pathogenic mutations, both in heterozygous state: p.T240M, p.437L e p.S145N. In PINK1 gene we did not find pathogenic point mutations. Through the MLPA technique we investigated dosage changes in Parkin, PINK1 and DJ-1 genes. We identified five exon rearrangements in Parkin gene in four patients: a heterozygous duplication of exon 4 in patient PAR2256, a heterozygous deletion of exon 4 in proband PAR2099, a homozygous deletion of exon 4 in patient PAR3380 and a compound heterozygote (PAR2396) with two changes, a duplication of exon 3 and a deletion of exons 5 and 6. In PINK1 gene we identified a heterozygous deletion of exon 1, which has never been described in literature, in one patient (PAR2083). We found no quantitative change in DJ-1 gene. In this study, we obtained an overall frequency of pathogenic mutations (sequence and dosage) in the genes studied of 7.3%, being 6.6% in Parkin gene and 0.7% in PINK1 gene.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / A doença de Parkinson (DP) é uma das desordens neurodegenerativas mais comuns associada ao envelhecimento, alcançando 2% aos 70 anos. É uma doença caracterizada pela degeneração progressiva de neurônios dopaminérgicos nigrais nos gânglios basais e pela presença de inclusões protéicas citoplasmáticas denominadas corpúsculos e neuritos de Lewy nos neurônios sobreviventes. A etiologia da DP é pouco conhecida, sendo considerada, na maioria dos casos, idiopática. Conhecimentos alcançados nos últimos 15 anos sobre a base genética da DP demonstram, claramente, que os fatores genéticos desempenham um importante papel na etiologia desta desordem. Neste trabalho, rastreamos mutações nos genes que codificam proteínas participantes de vias metabólicas mitocondriais (Parkin, PINK1 e DJ-1) em 136 pacientes brasileiros com manifestação precoce da DP, através do sequenciamento automático e da técnica de MLPA. Avaliamos a presença de variantes de sequência por meio do sequenciamento dos exons 1 a 12 do gene Parkin e dos exons 1 a 8 do gene PINK1. Em Parkin foram identificadas três mutações patogênicas ou potencialmente patogênicas, ambas em heterozigose: p.T240M, p.437L e p.S145N. Em PINK1 não encontramos variantes de ponto patogênicas. Através da técnica de MLPA investigamos alterações de dosagem nos genes Parkin, PINK1 e DJ-1. Identificamos cinco alterações no gene Parkin em quatro pacientes: uma duplicação heterozigota do exon 4 no paciente PAR2256, uma deleção heterozigota do exon 4 no probando PAR2099, uma deleção homozigota do exon 4 na paciente PAR3380 e um probando heterozigoto composto (PAR2396) com duas alterações, uma duplicação do exon 3 e uma deleção dos exons 5 e 6. No gene PINK1 identificamos uma deleção heterozigota do exon 1, que nunca foi descrita na literatura, em um paciente (PAR2083). Não encontramos alteração quantitativa no gene DJ-1. Neste estudo obtivemos uma frequência total de mutações patogênicas (pontuais e de dosagem) nos genes estudados de 7,3%, sendo 6,6% no gene Parkin e 0,7% no gene PINK1. / Parkinson's disease (PD) is one of the most common neurodegenerative disorders associated with aging, reaching 2% at age 70. It is a disease characterized by progressive degeneration of nigra dopaminergic neurons in the basal ganglia and the presence of cytoplasmic protein inclusions known as Lewy bodies and neurites in surviving neurons. The etiology of PD is poorly understood, being considered, in most cases, idiopathic. Knowledge achieved in the last 15 years about the genetic basis of PD clearly shows that genetic factors play an important role in the etiology of this disorder. In this study, we screened mutations in genes that encode proteins participating in mitochondrial metabolic pathways (Parkin, PINK1 and DJ-1) in 136 Brazilian patients with early onset PD, through automatic sequencing and MLPA technique. We evaluated the presence of sequence variants by means of sequencing of exons 1 to 12 of Parkin gene and exons 1 to 8 of PINK1 gene. In Parkin gene were identified three pathogenic or potentially pathogenic mutations, both in heterozygous state: p.T240M, p.437L e p.S145N. In PINK1 gene we did not find pathogenic point mutations. Through the MLPA technique we investigated dosage changes in Parkin, PINK1 and DJ-1 genes. We identified five exon rearrangements in Parkin gene in four patients: a heterozygous duplication of exon 4 in patient PAR2256, a heterozygous deletion of exon 4 in proband PAR2099, a homozygous deletion of exon 4 in patient PAR3380 and a compound heterozygote (PAR2396) with two changes, a duplication of exon 3 and a deletion of exons 5 and 6. In PINK1 gene we identified a heterozygous deletion of exon 1, which has never been described in literature, in one patient (PAR2083). We found no quantitative change in DJ-1 gene. In this study, we obtained an overall frequency of pathogenic mutations (sequence and dosage) in the genes studied of 7.3%, being 6.6% in Parkin gene and 0.7% in PINK1 gene.

Bei der Untersuchung von Dequalinium Chloride wurden alle relevanten genetischen Endpunkte berücksichtigt. Einer absolut negativen Datenlage steht lediglich ein spezifischer mutagener In vitro-Effekt im Ames-Test entgegen: In einem Bakterienstamm wurden eine bestimmte Art von Genmutationen, Frameshift-Mutationen, ausgelöst. Die Relevanz dieses Ergebnisses wurde in vivo im Spot Test überprüft. Der Spot Test war deshalb ausgewählt worden, da er die Erfassung von Mutagenen erlaubt, welche spezifisch Frameshift-Mutationen auslösen (Fahrig, 1995). Dies war eine notwendige Voraussetzung für den Einsatz des Tests, da im Ames-Test gerade diese Art von Mutationen ausgelöst worden war und deshalb dieser Endpunkt auch verfolgt werden musste. Die Verfolgung dieses genetischen Endpunkts in vivo im Spot Test mit Mäusen brachte trotz Verabreichung toxischer Dosen (5 und 7 mg/kg) ein negatives Ergebnis. Da zuvor schon der HPRT-Test ein negatives Ergebnis gezeigt hatte, stehen der spezifischen Frameshift-induzierenden Wirkung von Dequalinium Chloride in Bakterien eindeutig negative Ergebnisse im Säuger in vitro und in vivo gegenüber. Für die Relevanz der Ergebnisse im Spot Test und damit für die Wertung ist entscheidend, dass Dequalinium Chloride die Zielzellen in genügenden Konzentrationen erreicht, um eine Wirkung ausüben zu können. Bedenkt man, dass Dequalinium Chloride toxische Wirkung auf Muttertiere und Neugeborene ausübte und daß die Häufigkeit von gelben Missdifferenzierungssflecken und weißen, auf der Abtötung von Pigmentzellen beruhenden Bauchflecken gegenüber der Kontrolle erhöht war, so kann davon ausgegangen werden, dass Dequalinium Chloride die Zielzellen erreicht, aber weder mutagene noch rekombinogene Wirkung ausgeübt hat. Isoliert dastehenden positiven In-vitro-Befunden sollte von vornherein keine große Bedeutung beigemessen werden. Im vorliegenden Falle konnte gezeigt werden, dass eine mutagene Wirkung nur bei Bakterien und weder in vivo noch in vitro in Säugerzellen auftrat. Aus diesem Grunde kann dem Befund mit Bakterien keine Bedeutung für den Menschen beigemessen werden.:I. Datenlage 1. Genmutationen in vitro 1.1 Salmonella-Mikrosomen (Ames)-Test 1.2. HPRT-Test mit V79 Zellen des Chinesischen Hamsters 2. Chromosomenaberrationen in vitro 2.1 Chromosomenaberrationen in menschlichen Lymphozyten 3. Genmutationen in vivo 3.1 Spot Test mit Mäusen II. Wertung

Thesis (MScMedSc)--Stellenbosch University, 2012. / Bibliography / ENGLISH ABSTRACT: Evidence suggests that biological mechanisms, such as energy dependant efflux pumps, in addition to the rpoB gene mutations, define the level of rifampicin (RIF) resistance in drug resistant Mycobacterium tuberculosis (M. tuberculosis) strains with similar genetic backgrounds. Additionally, proteomic studies showed up-regulation of components of F1F0-ATP synthase enzyme, encoded by the atpBEFHAGDC operon which is responsible for ATP production, in response to RIF. The hypothesis of the current study is that the exposure of a multi-drug resistant (MDR) M. tuberculosis strain to RIF leads to the initiation of a signalling cascade of events. This results in the increased expression of F1F0-ATP synthase leading to an increase in energy production and subsequent activation of efflux pumps. RIF will thus be actively extruded from the cell, increasing the level of RIF resistance. This study aims to identify genetic regions responsible for the regulation of expression of the atpBEFHAGDC operon. Additionally we aim to identify other novel mechanisms contributing to the level of RIF resistance in M. tuberculosis. A specialised reporter vector was constructed to monitor the expression of atpBEFHAGDC, with the use of a fluorescent protein. Subsequently a library of random knockouts was created by transposon mutagenesis in order to identify possible regulators, as well as novel mechanisms contributing to RIF resistance. Two hypothetical proteins, Rv2005c and Rv2417c, were identified in M. tuberculosis transposon mutants showing decreased fluorescence correlating to decreased expression of atpBEFHAGDC. Rv2005c encodes a universal stress protein, suggesting its potential role in a signalling cascade initiated upon RIF exposure. In a model pathway of regulation we propose that the product of Rv2005c is responsible for releasing a repressor protein, Rv1049, thereby stimulating a cascade of signalling events resulting in the up-regulation of atpBEFHAGDC. This increase in ATP production thereby fuels the extrusion of RIF from the cell via efflux pumps. In addition, it was found that disruptions in Rv2524c (fatty acid synthase), Rv1048c (hypothetical protein) and Rv3163c (probable conserved secreted protein) resulted in an increase in the level of RIF resistance in a RIF resistant clinical isolate. Interestingly, Rv2524c also showed to have a potential role in regulation of atpBEFHAGDC, whereby it ensures the repression of atpBEFHAGDC. Another gene identified to be involved in the increase in RIF resistance, Rv0260c, is annotated as a possible transcriptional regulator. This study was successful in identifying possible regulatory proteins involved in regulation of the F1F0-ATP synthase in response to RIF, and highlights the complexity of the regulatory events that occur in response to RIF in a MDR M. tuberculosis strain. This study was also successful in identifying candidates for functional analysis to determine novel mechanisms contributing to the level of RIF resistance in M. tuberculosis. Together these findings demonstrate that RIF resistance in M. tuberculosis is more complex than originally thought. Considering that anti-Tuberculosis (TB) drug TMC207 targets the F1F0-ATP synthase, a key enzyme in the production of energy in mycobacteria, the newly identified regulatory genes of F1F0-ATP synthase may represent ideal targets for novel anti-TB drug design. / AFRIKAANSE OPSOMMING: Huidige dogma toon dat mutasies in die rpoB geen vir rifampicin (RIF) weerstandigheid in Mycobacterium tuberculosis (M. tuberculosis) verantwoordelik is. Onlangs is egter bevind dat ander biologiese meganismes, soos energie afhanklike membraanpompe, saam met mutasies in hierdie geen, die verskillende vlakke van RIF weerstandigheid in M. tuberculosis isolate met soortgelyke genetiese agtergrond kan verklaar. Addisionele proteïen studies het gewys dat die komponente van die F1F0-ATP sintase ensiem, wat verantwoordelik vir ATP sintese is en gekodeer word deur die atpBEFHAGDC operon, opgereguleer word na RIF blootstelling. Die hipotese van hierdie studie is dat blootstelling van ‘n multi-middelweerstandige M. tuberculosis isolaat aan RIF aanleiding sal gee tot ʼn aanvanklike sein wat dan verskeie ander biologiese paaie sal aanskakel. Hierdie gebeure sal dan lei tot ‘n verhoging in geenuitdrukking van die F1F0-ATP sintase operon met gevolglike verhoging in energie produksie, wat uiteindelik energie afhanklike membraan pompe sal aanskakel. Die aktiewe uitpomp van RIF uit die sel sal dan ʼn verhoging in die vlak van RIF weerstandigheid veroorsaak. Die eerste doel van hierdie studie is om genetiese areas te identifiseer wat verantwoordelik is vir die regulering van geenuitdrukking van die atpBEFHAGDC operon. Die tweede doel is om nuwe meganismes te identifiseer wat verskille in die vlakke van RIF weerstandigheid in verskillende nou verwante kliniese isolate sal verklaar. ʼn Gespesialiseerde vektor wat die geenuitdrukking van die atpBEFHAGDC operon sal monitor is suksesvol ontwikkel met die gebruik van ʼn fluoresserende proteïen. Daarna is van die transposon mutagenese metode gebruik gemaak om ʼn biblioteek van ewekansige geenuitlatings te maak en hierdie biblioteek is dan gebruik om nuwe meganismes van RIF weerstandigheid te ondersoek. Hierdie studie het twee hipotetiese proteïene, Rv2005c en Rv2417c, in M. tuberculosis transposon mutante geïdentifiseer wat verantwoordelik is vir verlaagde fluoressensie. Dit korreleer met die verwagte verlaagde geenuitdrukking van atpBEFHAGDC. Die geen Rv2005c kodeer vir ʼn universele spanningsproteïen en die resultaat voorspel dat Rv2005c ʼn potensiële rol het om ʼn netwerk van seine in die bakterium aan te skakel direk na blootstelling aan RIF. In ʼn voorgestelde model van regulerende paaie voorspel ons dat die produk van Rv2005c verantwoordelik is vir die vrystelling van ʼn onderdrukker proteïen, Rv1049. Dit lei dan tot die stimulering van ʼn netwerk van intrasellulêre seine wat aanleiding gee tot die opregulering van atpBEFHAFDC. Die opregulering van atpBEFHAFDC sal dan aanleiding gee tot ʼn verhoging in ATP produksie wat die uitpomp van RIF uit die sel sal versnel met die gebruik van energie afhanklike membraan pompe. Dit is verder gevind dat uitskakeling van die gene Rv2524c (vetsuur sintase), Rv1048c (hipotetiese proteïen) en Rv3163c (moontlike konserwatiewe uitskei proteïen) aanleiding gegee het tot die verhoging in die vlakke van RIF weerstandigheid in ʼn RIF weerstandige kliniese isolaat. In die studie is ook bewys dat Rv2524c ʼn potensiële rol in die regulering van atpBEFHAGDC het deurdat dit die onderdrukking van atpBEFHAGDC verseker. Rv0260c is voorheen gelys as ʼn moontlike transkripsionele reguleerder wat betrokke is by die verhoging van RIF weerstandigheid. Hierdie studie was suksesvol in die identifisering van moontlike gene en proteïne wat betrokke is in die regulering van die F1F0-ATP sintase in reaksie tot RIF blootstelling. Dit beklemtoon die kompleksiteit van die regulerende gebeurtenisse wat plaasvind in reaksie tot RIF blootstelling in ʼn multi-middelweerstandige M. tuberculosis isolaat. Verder was daar suksesvol kandidaat gene en ʼn reguleerder geïdentifiseer wat in toekomstige studies ondersoek kan word vir hulle funksionele bydrae om nuwe meganismes te vind wat die varierende vlakke van RIF weerstandigheid in M. tuberculosis sal verklaar. Opsommend demonstreer hierdie studie dat RIF weerstandigheid meer kompleks is as wat voorheen aangeneem was. Die nuwe baie belowende teen-Tuberkulose middel, TMC207, se aanslag is gemik op die belangrike ensiem (F1F0-ATP sintase) wat in hierdie studie ondersoek was. Dus kan nuut geïdentifiseerde proteïene wat betrokke is by die regulering van hierdie ensiem beskou word as ideale kandidate vir die ontwikkeling van nuwe teen -Tuberkulosemiddels. / The National Research Foundation and the Department of Biomedical Sciences

Die b -Thalassämie gehört weltweit zu den häufigsten monogenen Erbkrankheiten. Die Thalassämien treten endemisch in der Bevölkerung des Mittelmeerraumes, in Westafrika und in weiten Teilen Asiens auf. In der einheimischen Bevölkerung der Bundesrepublik Deutschland gehört die homozygote Form der b -Thalassämie zu den seltenen Erkrankungen. Häufiger ist das Auftreten der heterozygoten Form, die als Differentialdiagnose der mikrozytären, hypochromen Anämie eine besondere Rolle spielt. Blutproben von 214 deutschen Personen mit einer heterozygoten b -Thalassämie wurden mittels Allel-spezifischer Oligonukleotid-Hybridisierung, Restriktionsanalyse und direkter Sequenzierung PCR-amplifizierter DNA analysiert. Insgesamt konnten 96,3 % (206/214) der Proben molekular charakterisiert werden. Die mediterranen Mutationen stellen einen Anteil von etwa 2/3 aller identifizierten Veränderungen, häufig sind insbesondere NS 39, IVS1-110 G ® A und IVS1-1 G ® A. Das übrige Mutationsspektrum setzt sich aus sehr seltenen Mutationen (IVS1-1 G ® T, IVS1-2 T ® G, IVS1-2 T ® C, NS 15 G ® A, NS 121 G ® T, FS 8/9 +G, FS 44 -C, FS 51 -C, FS 82/83 -G, Initiations-Kodon-Mutationen ATG ® ACG/ ® GTG/ ® ATA) und einer neuen Mutation (IVS1-129 A ® G) zusammen. In 6 Fällen konnte nach vollständiger molekularer Analyse kein Gendefekt als Ursache der b -Thalassämie gefunden werden. Diese Probanden könnten b -Thalassämiedeterminanten tragen, die nicht an den b -Globingen-Komplex gekoppelt sind oder regulative Sequenzen außerhalb des b -Globingens darstellen. Die erhobenen Daten zeigen, daß der Ursprung der b -Thalassämie in der deutschen Bevölkerung in den Mittelmeerländern liegt, ein Drittel der Fälle scheint sich jedoch lokal entwickelt zu haben. / The b -thalassemia belongs to the most common monogenic disorders worldwide. Endemically in the Mediterranean population, some parts of Asia and Western Africa, b -thalassemia is a rare disease in Germany. Nevertheless, heterozygous forms of b -thalassemia minor occur more frequently in the German population and should be considered in the differential diagnosis of hypochromic anemia. To investigate the molecular biological background of b -thalassemia in Germany, 214 non-immigrant German individuals suffering from heterozygous b -thalassemia were characterized by allele-specific oligonucleotid hybridization, restriction analysis and sequencing of the b -globin gene. By these techniques, 26 different mutations were identified. Most frequently, the Mediterranean mutations NS 39, IVS1-110 G ® A, and IVS1-1 G ® A were detected. Although otherwise rare, the frameshift mutation of codon 83 (FS 83 -G) was also relatively common (5 %) in the analyzed population. Other previously described mutations (IVS1-1 G ® T, IVS1-2 T ® G, IVS1-2 T ® C, NS 15 G ® A, NS 121 G ® T, FS 8/9 +G, FS 44 -C, FS 51 -C, initiation codon mutation ATG ® ACG/ ® GTG/ ® ATA) were demonstrated in < 10 individuals. Interestingly, sequence analysis identified a novel mutation affecting position -2 of the splice acceptor site (IVS1-129 A ® G). In 6 individuals diagnosed as heterozygous b -thalassemia, a mutation of the b -globin gene could not be demonstrated. The data indicate the b -thalassemia to be introduced from the Mediterranean population into Germans in two-thirds of the cases whereas the remaining third probably is of local origin.

Many breast cancer diagnoses and second cancers are associated with BRCA gene mutations. Early detection of cancer is necessary to improve health outcomes, particularly with second cancers. Little is known about the influence of risk factors on time to diagnosis of second primary cancers after diagnosis with BRCA-related breast cancer. The purpose of this cohort study was to examine the risk of diagnosis of second primary cancers among women diagnosed with breast cancer after adjusting for BRCA status, age, and ethnicity. The study was guided by the empirical evidence supporting the mechanism of action in the mutation of BRCA leading to the development of cancer. Composite endpoint was used to define second primary cancer occurrences, and Kaplan-Meier survival curves were used to compare the median time-to-event among comparison groups and BRCA gene mutation status. Cox proportional hazards was used to examine the relationships between age at diagnosis, ethnicity, BRCA gene mutation status, and diagnosis of a second primary cancer. The overall median time to event for diagnosis of second primary cancers was 14 years. The hazard ratios for BRCA2 = 1.47, 95% CI [1.03 - 2.11], White = 1.511, 95% CI [1.18 - 1.94], and American Indian/Hawaiian = 1.424, 95% CI [1.12 -1.81] showing positive significant associations between BRCA2 mutation status and risk of diagnosis of second primary colorectal, endometrial, cervical, kidney, thyroid, and bladder cancers. Data on risk factors for development of second cancers would allow for identification of appropriate and timely screening procedures, determining the best course of action for prevention and treatment, and improving quality of life among breast cancer survivors.

La leucémie myélomonocytaire chronique (LMMC) est une pathologie clonale de la cellule souche hématopoïétique qui touche principalement les personnes âgées. Le seul traitement curatif de cette maladie est la greffe allogénique de cellules souches hématopoïétiques, souvent difficile à mettre en oeuvre. Les patients qui ne peuvent être greffés et dont la maladie présente des critères de gravité se voient proposer un agent déméthylant de l'ADN. Chez 30 à 40% d'entre eux, ce traitement induit une réponse objective dont le bénéfice en termes de survie n'est pas démontré. Le séquençage de gènes candidats a identifié une trentaine de gènes mutés de façon récurrente. Il s'agit de gènes codant des régulateurs épigénétiques, des facteurs d'épissage, des facteurs de transcription, et des protéines de la signalisation intracellulaire. Cette approche ne donnait qu'une vision partielle des événements génétiques associés à la maladie.Le premier objectif de cette thèse a été de recenser l'ensemble des mutations touchant les régions codantes et non codantes de l'ADN dans les cellules leucémiques des patients.Le séquençage de l'exome de cellules malades et de cellules contrôles a été réalisé chez 49 patients. Nos analyses ont montré qu'en moyenne, un patient porte 14 mutations somatiques dans les régions codantes. Nous avons confirmé que les mutations récurrentes les plus fréquentes affectaient les gènes TET2, SRSF2 et ASXL1. Nous avons aussi identifié 8 nouveaux gènes mutés de façon récurrente à une faible fréquence. En moyenne, 3 des 14 mutations affectent des gènes touchés de façon récurrente.Le séquençage du génome de cellules malades et de cellules contrôles a été réalisé chez 17 patients. L'analyse réalisée a détecté 475 mutations par patient dans les régions non répétées du génome. Dans l'exome, comme dans le reste du génome, les altérations principales sont des transitions. Deux signatures mutationnelles ont été identifiées et sont observées dans de nombreux cancers, traduisant probablement des altérations de la méthylation des cytosines au cours du vieillissement. Une troisième signature, jamais observée jusqu'alors et de signification indéterminée, a été détectée chez 2 patients.Nous avons alors répété l'analyse de l'exome dans les monocytes triés de 17 patients prélevés de façon séquentielle sur plus de 2 années : 6 n'ont pas été traités et 11 ont été traités par un agent déméthylant, parmi lesquels 6 sont restés stables et 5 ont montré une réponse clinique et biologique objective. L'analyse montre que 1) l'accumulation de mutations est un événement rare ; 2) l'hétérogénéité génétique du clone malade est limitée ; 3) la charge allélique des mutations reste inchangée, même chez les répondeurs ; 4) de nouvelles mutations peuvent apparaître alors que le patient est répondeur.Nous avons alors sélectionné 9 patients, 3 non traités, 3 stables sous traitement sans réponse objective, et 3 répondeurs. Nous avons collecté leurs monocytes avant tout traitement et quelques mois plus tard, alors que 6 d'entre eux étaient traités par un agent déméthylant. Nous avons analysé l'expression des gènes et la méthylation globale de l'ADN à ces deux temps. Chez les patients non traités, nous avons observé une remarquable stabilité de l'expression des gènes et de la méthylation de l'ADN. Chez les patients répondeurs, le traitement induit un changement significatif du niveau d'expression d'environ 500 gènes et la déméthylation d'environ 35,000 régions de l'ADN. Chez les patients stables sous traitement, le traitement induit un changement d'expression d'une soixantaine de gènes et du niveau de méthylation d'une centaine de régions seulement. Ces résultats suggèrent que les agents déméthylants n'affectent l'expression des gènes et la méthylation de l'ADN que chez les répondeurs, fournissant un argument important pour un effet essentiellement épigénétique et très peu cytotoxique de ces médicaments. / Chronic myelomonocytic leukemia is a clonal disorder of the hematopoietic stem cell, affecting mainly the elderly. The only curative therapeutic is allogeneic stem cell transplantation, which is rarely feasible. When transplantation is not an option, patients with a severe disease can be treated with a demethylating agent. Thirty to 40% of these patients show hematological improvement, but it remains unknown if these drugs increase overall survival. Analysis of candidate genes by Sanger sequencing, then by New Generation Sequencing, identified about thirty genes that are frequently mutated. These genes encode epigenetic regulators, splicing factors, transcription factors and cell signalling regulators. However, this approach catched only part of the genetic events that characterize this disease.The first objective of this study was to determine the mutational landscape of CMML cells by analyzing the coding and non coding regions of leukemic cell genome.We first performed whole exome sequencing analysis of leukemic and control cells in 49 patients. These analyses showed that in average, a patient carries 14 somatic mutations in its coding regions. We confirmed that the most frequent mutations were in TET2, SRSF2 and ASXL1 genes. We identified also recurrent mutations in 8 new genes, these recurrent mutations occurring at a low frequency. In average, 3 out of the 14 mutations identified in each patient affected recurrently mutated genes.Secondly, we performed whole genome sequencing of leukemic and control cells in 17 patients. These analyses showed that in average, a patient carries 475 somatic mutations in the non repeated regions of the genome. In both the coding and non coding sequences, alterations were observed to be mainly transitions. As a signature of CMML, two mutational processes were identified in all 17 patients and are found in various other cancer types, most likely resulting from the cytosine methylation observed with ageing. A third process, never seen before and without known significance, was also detected in two patients.We collected several samples from 17 patients on a more than two year period: 6 of these patients remained untreated whereas 11 were treated with demethylating agent, among which 6 showed a stable disease and 5 fulfilled criteria of hematological improvement. These sequential analyses showed that 1) the occurence of new mutations is a relatively rare event ; 2) the genetic heterogeneity of the malignant clone is limited ; 3) the mutation allele burden remains unchanged under treatment, whatever the response ; 4) new mutations can appear, even in responding patients.We selected 9 patients, 3 untreated, 3 stable on therapy and 3 responders. We collected monocytes before treatment and a few months later and we analyzed gene expression and DNA methylation in sorted monocytes at these two time points. We did not detect any significant change in gene expression and DNA methylation pattern in untreated patients. In those who responded to treatment, we noticed significant changes in both gene expression, with about 500 deregulated genes, and the DNA methylation pattern, with about 35,000 demethylated regions. In stable patients, the treatment had a limited effect with changes in the expression of about 60 genes, and in the DNA methylation pattern of about 100 regions. These results show that demethylating agents affect gene expression and DNA methylation of responding patients only, suggesting they have mostly an epigenetic effect rather than a cytotoxic one.