Nephrotic syndrome is characterized by proteinuria, hypoproteinemia, edemas and hyperlipidemia. It occurs in primary (e.g. focal segmental glomerulosclerosis, FSGS or minimal change disease, MCD) and in secondary glomerulopathies (e.g. kidney amyloidosis). In primary forms, great attention is paid to the potential genetic background of the disease and due to new molecular genetic methods genes, whose mutations cause different nephropathies (e.g. ACTN4 or INF2) were identified. The aims of presented doctoral thesis were following. Firstly, to continue the mutational analysis of ACTN4 that was described in the author's diploma thesis in other glomerulopathies. Secondly, to implement the mutational analysis of INF2 and subsequently analyse this gene in patients with FSGS/MCD and in patients from special group characterized by positive family history for end stage renal disease (ESRD) in combination with advanced chronic kidney disease (CKD) or already developed ESRD at the time of diagnosis. Thirdly, mutational analysis of NPHS2 and TRPC6 (methods implemented in laboratory earlier) in selected patients from the special group. Finally, expression analyses of genes important for podocyte function or connected with human immune system. This part also verifies the applicability of NPHS2/SYNPO expression...

Abstract Mutations in the currently known breast cancer susceptibility genes account for only 25–30% of all familial cases. Novel susceptibility genes can be identified by several methods, including candidate gene re-sequencing and genome-wide microarrays. We have applied microarrays for the detection of a new genomic variation class, copy number variants (CNVs), which potentially could disrupt genes in multiple pathways related to breast cancer susceptibility. The aim of the current study was to evaluate the role of the RNF8, UBC13, MMS2 and RAD51C DNA damage response genes in breast cancer susceptibility as well as to study if rare CNVs are associated with the predisposition to this disease. The analysis of 123 familial breast cancer cases revealed altogether nine different changes in the RNF8 and UBC13 candidate genes. However, none of the observed alterations were considered pathogenic. No alterations were observed in MMS2. The obtained results suggest that breast cancer predisposing alterations in RNF8, UBC13 and MMS2 are rare, or even absent. The RAD51C mutation screening of 147 familial breast cancer cases and 232 unselected ovarian cancer cases revealed two deleterious mutations: c.-13_14del27 was observed in a breast cancer case with familial history of ovarian cancer and c.774delT in an ovarian cancer case. Both mutations were absent in the control cohort. The results of the study support the hypothesis that rare variants of RAD51C predispose predominantly to ovarian cancer. A genome-wide scan of CNVs was performed for 103 familial breast cancer cases and 128 controls. The biological networks of the genes disrupted by CNVs were different between the two groups. In familial breast cancer cases, the observed mutations disrupted genes, which were significantly overrepresented in cellular functions related to maintenance of genomic integrity (P=0.0211). Biological network analysis showed that the disrupted genes were closely related to estrogen signaling and TP53-centered tumor suppressor network, and this result was confirmed by the analysis of an independent young breast cancer cohort of 75 cases. These results suggest that rare CNVs represent an alternative source of genetic variation contributing to hereditary risk for breast cancer. / Tiivistelmä Tunnetut rintasyöpäalttiusgeenien mutaatiot selittävät vain 25–30 prosenttia kaikista perinnöllisistä rintasyöpätapauksista. Uusia alttiusgeenejä voidaan tunnistaa useilla eri menetelmillä, kuten kandidaattigeenien mutaatiokartoituksella ja genomin-laajuisilla mikrosirutekniikoilla. Tässä tutkimuksessa sovelsimme mikrosirutekniikkaa uuden geneettisen variaatioluokan, kopiolukuvariaation (CNV), tutkimiseen. CNV:t voivat vaurioittaa lukuisia rintasyöpäalttiuteen liittyviä biokemiallisia reittejä. Tämän tutkimuksen tarkoitus oli arvioida RNF8-, UBC13-, MMS2- ja RAD51C -DNA- vauriovastegeenien sekä harvinaisten CNV:iden yhteyttä rintasyöpä-alttiuteen. 123 familiaalisen rintasyöpätapauksen analyysissä löytyi yhteensä yhdeksän muutosta RNF8- ja UBC13-geeneistä, joista yksikään ei osoittautunut patogeeniseksi. MMS2-geenissä ei havaittu muutoksia. Tulosten perusteella rintasyövälle altistavat muutokset RNF8-, UBC13- ja MMS2- geeneissä ovat joko erittäin harvinaisia tai niitä ei esiinny lainkaan. RAD51C-geenin mutaatiokartoitus 147 familiaalisesta rintasyöpätapauksesta sekä 232 valikoimattomasta munasarjasyöpätapauksesta paljasti kaksi haitallista mutaatiota. c.-13_14del27 havaittiin rintasyöpäpotilaalla, jonka suvussa esiintyi munasarjasyöpää, ja c.774delT todettiin munasarjasyöpäpotilaalta. Kumpaakaan mutaatiota ei havaittu verrokkiaineistossa. Tulokset vahvistavat hypoteesia RAD51C-geenin harvinaisten varianttien yhteydestä pääasiassa munasarjasyöpäriskiin. CNV:iden genomin-laajuinen skannaaminen suoritettiin 103 familiaaliselle rintasyöpätapaukselle ja 128 verrokille. CNV:iden häiritsemien geenien muodostamat biologiset verkostot olivat erilaiset näiden kahden ryhmän välillä. Familiaalisilla rintasyöpätapauksilla havaitut CNV:t vaikuttivat geeneihin, jotka olivat voimakkaasti korostuneita genomin eheyttä ylläpitävissä tehtävissä (P=0.0211). Biologisten verkostojen analyysi paljasti, että CNV:iden vahingoittamat geenit liittyivät läheisesti estrogeenisignalointiin sekä TP53-tuumorisupressoriverkostoon, ja tämä tulos vahvistettiin analysoimalla riippumatonta nuorista rintasyöpäpotilaista koostuvaa kohorttia (N=75). Tutkimuksen tulosten mukaan harvinaiset CNV:t ovat vaihtoehtoinen geneettisen variaation lähde perinnölliseen rintasyöpäalttiuteen.

A neoplasia endócrina múltipla tipo 2 (NEM-2) é uma síndrome tumoral herdada por mutações germinativas no proto-oncogene RET (RET) e transmitida por herança autossômica dominante. Atualmente, a indicação de tireoidectomia total preventiva é recomendada a indivíduos portadores de mutações no RET. Analisamos a aplicação do método Eletroforese em Gel Sensível à Conformação (CSGE) no rastreamento de mutações hot-spots do RET. Sete famílias com NEM-2 foram rastreadas pelo CSGE, seqüenciamento gênico e análise do Polimorfismo Conformacional de Cadeia Simples (SSCP). Usando o CSGE e SSCP, identificamos cinco das seis (83,3%) mutações verificadas pelo seqüenciamento: Cys620Arg, Cys634Arg, Cys634Tyr, Val648Ile e Met918Thr. Foram analisados 128 amplicons englobando mutações hot-spots do RET e 116 dentre 128 (90.6%) concordaram com o seqüenciamento genético. Os polimorfismos 691 e 769 também foram documentados pelo CSGE e SSCP. Os dados obtidos por CSGE e SSCP foram totalmente (100%) concordantes. O CSGE revelou ser metodologia sensível, rápida, fácil de ser executada e de baixo custo na detecção de mutações nos códons 620, 634, 648, e 918, as quais constituem grande maioria (~95%) dos pacientes com NEM-2. Quanto à mutação Val804Met (prevalência na população inferior a 3%), o método necessita ser otimizado. Concluímos que o CSGE é uma metodologia efetiva para o rastreamento de mutações que mais freqüentemente ocorrem no RET como causadora de NEM-2. / Multiple endocrine neoplasia type 2 (MEN2) is an autosomal dominant inherited tumor syndrome caused by activating germline mutations in RET proto-oncogene (RET). Presently, the prophylactic total thyroidectomy is recommended to all RET mutations carriers. Here we tested the Conformation Sensitive Gel Electrophoresis (CSGE) as a screening method for the RET hot-spot mutations. Seven MEN2 families were studied by CSGE, as well as by Single Strand Conformational Polymorphism (SSCP) and direct sequencing analysis. Using CSGE and SSCP, we were able to detect five out of the six (83.3%) RET mutations verified by direct sequencing analysis: Cys620Arg, Cys634Arg, Cys634Tyr, Val648Ile and Met918Thr. RET polymorphisms 691 and 769 were verified by CSGE and SSCP. In our sample, data obtained using CSGE were fully concordant (100%) with SSCP findings. Thus, CSGE showed to be a sensitive, fast, low-cost, and ease procedure to detect RET mutations in codons 620, 634, 648, and 918 which are reported as the most prevalent RET variants (~95%) in large MEN2 series. As to the Val804Met mutation (prevalence in the population lower than 3%), this method still needs to be optimized. We concluded that CSGE is an effective screening method for the most frequent RET hot-spot disease-causing mutations.

A neoplasia endócrina múltipla tipo 2 (NEM-2) é uma síndrome tumoral herdada por mutações germinativas no proto-oncogene RET (RET) e transmitida por herança autossômica dominante. Atualmente, a indicação de tireoidectomia total preventiva é recomendada a indivíduos portadores de mutações no RET. Analisamos a aplicação do método Eletroforese em Gel Sensível à Conformação (CSGE) no rastreamento de mutações hot-spots do RET. Sete famílias com NEM-2 foram rastreadas pelo CSGE, seqüenciamento gênico e análise do Polimorfismo Conformacional de Cadeia Simples (SSCP). Usando o CSGE e SSCP, identificamos cinco das seis (83,3%) mutações verificadas pelo seqüenciamento: Cys620Arg, Cys634Arg, Cys634Tyr, Val648Ile e Met918Thr. Foram analisados 128 amplicons englobando mutações hot-spots do RET e 116 dentre 128 (90.6%) concordaram com o seqüenciamento genético. Os polimorfismos 691 e 769 também foram documentados pelo CSGE e SSCP. Os dados obtidos por CSGE e SSCP foram totalmente (100%) concordantes. O CSGE revelou ser metodologia sensível, rápida, fácil de ser executada e de baixo custo na detecção de mutações nos códons 620, 634, 648, e 918, as quais constituem grande maioria (~95%) dos pacientes com NEM-2. Quanto à mutação Val804Met (prevalência na população inferior a 3%), o método necessita ser otimizado. Concluímos que o CSGE é uma metodologia efetiva para o rastreamento de mutações que mais freqüentemente ocorrem no RET como causadora de NEM-2. / Multiple endocrine neoplasia type 2 (MEN2) is an autosomal dominant inherited tumor syndrome caused by activating germline mutations in RET proto-oncogene (RET). Presently, the prophylactic total thyroidectomy is recommended to all RET mutations carriers. Here we tested the Conformation Sensitive Gel Electrophoresis (CSGE) as a screening method for the RET hot-spot mutations. Seven MEN2 families were studied by CSGE, as well as by Single Strand Conformational Polymorphism (SSCP) and direct sequencing analysis. Using CSGE and SSCP, we were able to detect five out of the six (83.3%) RET mutations verified by direct sequencing analysis: Cys620Arg, Cys634Arg, Cys634Tyr, Val648Ile and Met918Thr. RET polymorphisms 691 and 769 were verified by CSGE and SSCP. In our sample, data obtained using CSGE were fully concordant (100%) with SSCP findings. Thus, CSGE showed to be a sensitive, fast, low-cost, and ease procedure to detect RET mutations in codons 620, 634, 648, and 918 which are reported as the most prevalent RET variants (~95%) in large MEN2 series. As to the Val804Met mutation (prevalence in the population lower than 3%), this method still needs to be optimized. We concluded that CSGE is an effective screening method for the most frequent RET hot-spot disease-causing mutations.