Sickle Cell Disease Erythrocyte Stiffness and Cytoadhesion Investigated via Atomic Force Microscopy

The biomechanical properties of red blood cells (RBCs), including increased stiffness and abnormal cytoadherence, are integral components in the cascade of events resulting to vasoocclusive episodes (VOEs) in sickle cell disease (SCD). VOEs are the main cause of morbidity in SCD and sickle cell trait (SCT). Using experimental techniques based on atomic force microscopy (AFM), we studied the stiffness and adhesion of RBCs from SCD patients and from subjects with SCT. We found that SCD and SCT RBCs are three-fold stiffer than normal RBCs. Further, a ten-fold increase in the stiffness of sickled RBCs was measured upon deoxygenation. In an effort to rectify the increased stiffness of sickle RBCs, mice were fed a diet supplemented with docosahexanoic acid (DHA), an omega-3 fatty acid. A decrease in RBC stiffness was measured suggesting therapeutic benefits of DHA. Cytoadherence of RBCs to subendothelial laminin via the basal cell adhesion molecule/Lutheran (BCAM/Lu) is implicated in vasculopathy, a common condition in SCD patients. We established the in vitro technique of single-molecule force spectroscopy (SMFS) which enables detection of single BCAM/Lu proteins on the RBC surface via measurement of the unbinding force with laminin. It was shown that epinephrine, acting through the cyclic adenosine monophosphate (cAMP) signaling pathway, increases the population of active BCAM/Lu receptors on SCT RBCs, suggesting a role in exercise-induced VOEs. The sensitivity of the SMFS system was validated in a neuronal system to quantitatively map SK channels and then employed to investigate the effects of cAMP pathway targeting on BCAM/Lu receptor expression on normal and SCD RBCs. We illustrated that A-kinase anchoring proteins are crucial for BCAM/Lu receptor activation. To examine the relevance of results based on SMFS in the cytoadhesion of entire RBCs, single-cell force spectroscopy (SCFS) was established to measure the adhesion of whole cells with a functionalized substrate. We established a correspondence between the SMFS and SCFS results. Both techniques were able to detect significant changes in the adhesive response of RBCs to cAMP pathway modulation and variability was measured amongst human subjects, suggesting that RBCs maintain diverse intracellular levels of tonic protein kinase A

Detection of SK2 Channels on Hippocampal Neurons

Calcium-activated small conductance potassium channels (SK) are crucial for synaptic plasticity, sleep, and learning and memory (Hammond, Bond et al. 2006; Cueni, Canepari et al. 2008; Lin, Lujan et al. 2008). Despite the recent progress on SK channel physiology, the precise spatial organization of SK channels in neurons has remained unknown. Such knowledge is critical as the subcellular distribution of SK channels is an important determinant of neuronal excitability. Currently, there are no techniques to image ion channel distribution quantitatively at the nanometer scale in living cells. Here, it is demonstrated that integration of natural toxins with single molecule atomic force microscopy (AFM) allows for the mapping of native SK channels in living cells. By measuring the adhesive forces between cell surface expressed SK channels and apamin, a toxin that specifically binds to SK channels, it was found that SK channels are spatially organized in nanodomains of one to three channels. It is also shown that SK channel distribution in pyramidal neurons is polarized, increasing by 40 fold between the soma and dendrites. Additionally, the SK channel dendritic maps are dynamic under the control of the cAMP second messenger cascade. Together, our study demonstrates that integration of pharmacology with single molecule AFM allows to quantitatively reveal ion channel distribution in living cells thus providing a new tool for the study of ion channels and receptors in cell physiology

Optimising clinical care through CDH1-specific germline variant curation: improvement of clinical assertions and updated curation guidelines

BackgroundGermline pathogenic variants in CDH1 are associated with increased risk of diffuse gastric cancer and lobular breast cancer. Risk reduction strategies include consideration of prophylactic surgery, thereby making accurate interpretation of germline CDH1 variants critical for physicians deciding on these procedures. The Clinical Genome Resource (ClinGen) CDH1 Variant Curation Expert Panel (VCEP) developed specifications for CDH1 variant curation with a goal to resolve variants of uncertain significance (VUS) and with ClinVar conflicting interpretations and continues to update these specifications.MethodsCDH1 variant classification specifications were modified based on updated genetic testing clinical criteria, new recommendations from ClinGen and expert knowledge from ongoing CDH1 variant curations. The CDH1 VCEP reviewed 273 variants using updated CDH1 specifications and incorporated published and unpublished data provided by diagnostic laboratories.ResultsUpdated CDH1-specific interpretation guidelines include 11 major modifications since the initial specifications from 2018. Using the refined guidelines, 97% (36 of 37) of variants with ClinVar conflicting interpretations were resolved to benign, likely benign, likely pathogenic or pathogenic, and 35% (15 of 43) of VUS were resolved to benign or likely benign. Overall, 88% (239 of 273) of curated variants had non-VUS classifications. To date, variants classified as pathogenic are either nonsense, frameshift, splicing, or affecting the translation initiation codon, and the only missense variants classified as pathogenic or likely pathogenic have been shown to affect splicing.ConclusionsThe development and evolution of CDH1-specific criteria by the expert panel resulted in decreased uncertain and conflicting interpretations of variants in this clinically actionable gene, which can ultimately lead to more effective clinical management recommendations

Integrated genomic analysis identifies UBTF tandem duplications as a recurrent lesion in pediatric acute myeloid leukemiaUBTF tandem duplications in pediatric acute myeloid leukemia

The genetics of relapsed pediatric acute myeloid leukemia (AML) has yet to be comprehensively defined. Here, we present the spectrum of genomic alterations in 136 relapsed pediatric AMLs. We identified recurrent exon 13 tandem duplications (TD) in upstream binding transcription factor (UBTF) in 9% of relapsed AML cases. UBTF-TD AMLs commonly have normal karyotype or trisomy 8 with cooccurring WT1 mutations or FLT3-ITD but not other known oncogenic fusions. These UBTF-TD events are stable during disease progression and are present in the founding clone. In addition, we observed that UBTF-TD AMLs account for approximately 4% of all de novo pediatric AMLs, are less common in adults, and are associated with poor outcomes and MRD positivity. Expression of UBTF-TD in primary hematopoietic cells is sufficient to enhance serial clonogenic activity and to drive a similar transcriptional program to UBTF-TD AMLs. Collectively, these clinical, genomic, and functional data establish UBTF-TD as a new recurrent mutation in AML.SignificanceWe defined the spectrum of mutations in relapsed pediatric AML and identified UBTF-TDs as a new recurrent genetic alteration. These duplications are more common in children and define a group of AMLs with intermediate-risk cytogenetic abnormalities, FLT3-ITD and WT1 alterations, and are associated with poor outcomes. See related commentary by Hasserjian and Nardi, p. 173. This article is highlighted in the In This Issue feature, p. 171

Survival Benefit for Individuals With Constitutional Mismatch Repair Deficiency Undergoing Surveillance

Purpose: Constitutional mismatch repair deficiency syndrome (CMMRD) is a lethal cancer predisposition syndrome characterized by early-onset synchronous and metachronous multiorgan tumors. We designed a surveillance protocol for early tumor detection in these individuals. Patients and methods: Data were collected from patients with confirmed CMMRD who were registered in the International Replication Repair Deficiency Consortium. Tumor spectrum, efficacy of the surveillance protocol, and malignant transformation of low-grade lesions were examined for the entire cohort. Survival outcomes were analyzed for patients followed prospectively from the time of surveillance implementation. Results: A total of 193 malignant tumors in 110 patients were identified. Median age of first cancer diagnosis was 9.2 years (range: 1.7-39.5 years). For patients undergoing surveillance, all GI and other solid tumors, and 75% of brain cancers were detected asymptomatically. By contrast, only 16% of hematologic malignancies were detected asymptomatically (P < .001). Eighty-nine patients were followed prospectively and used for survival analysis. Five-year overall survival (OS) was 90% (95% CI, 78.6 to 100) and 50% (95% CI, 39.2 to 63.7) when cancer was detected asymptomatically and symptomatically, respectively (P = .001). Patient outcome measured by adherence to the surveillance protocol revealed 4-year OS of 79% (95% CI, 54.8 to 90.9) for patients undergoing full surveillance, 55% (95% CI, 28.5 to 74.5) for partial surveillance, and 15% (95% CI, 5.2 to 28.8) for those not under surveillance (P < .0001). Of the 64 low-grade tumors detected, the cumulative likelihood of transformation from low-to high-grade was 81% for GI cancers within 8 years and 100% for gliomas in 6 years. Conclusion: Surveillance and early cancer detection are associated with improved OS for individuals with CMMRD