Mutation spectrum of MLL2 in a cohort of kabuki syndrome patients

ABSTRACT: BACKGROUND: Kabuki syndrome (Niikawa-Kuroki syndrome) is a rare, multiple congenital anomalies/mental retardation syndrome characterized by a peculiar face, short stature, skeletal, visceral and dermatoglyphic abnormalities, cardiac anomalies, and immunological defects. Recently mutations in the histone methyl transferase MLL2 gene have been identified as its underlying cause. METHODS: Genomic DNAs were extracted from 62 index patients clinically diagnosed as affected by Kabuki syndrome. Sanger sequencing was performed to analyze the whole coding region of the MLL2 gene including intron-exon junctions. The putative causal and possible functional effect of each nucleotide variant identified was estimated by in silico prediction tools. RESULTS: We identified 45 patients with MLL2 nucleotide variants. 38 out of the 42 variants were never described before. Consistently with previous reports, the majority are nonsense or frameshift mutations predicted to generate a truncated polypeptide. We also identified 3 indel, 7 missense and 3 splice site. CONCLUSIONS: This study emphasizes the relevance of mutational screening of the MLL2 gene among patients diagnosed with Kabuki syndrome. The identification of a large spectrum of MLL2 mutations possibly offers the opportunity to improve the actual knowledge on the clinical basis of this multiple congenital anomalies/mental retardation syndrome, design functional studies to understand the molecular mechanisms underlying this disease, establish genotype-phenotype correlations and improve clinical management

Pigmentação testicular em Physalaemus nattereri (Steindachner) (Amphibia, Anura) com observações anatômicas sobre o sistema pigmentar extracutâneo Testicular pigmentation in Physalaemus nattereri (Steindachner) (Amphibia, Anura) with anatomical observations on the extracutaneous pigmentary system

O presente estudo foi realizado com o intuito de relatar a ocorrência e morfologia de células pigmentares viscerais constituintes do "sistema pigmentar extracutâneo" em Physalaemus nattereri (Steindachner, 1863) (Leptodactylidae). Foram utilizados dez exemplares machos para a análise macroscópica e obtenção de fragmentos testiculares incluídos em resina e corados com H/E. Os anuros, dentre outros animais exotérmicos, possuem células especiais, os melanócitos, que se caracteriza por intensa pigmentação e sintetiza melanina, além de melanomacrófagos, que se caracteriza por atividade fagocítica e muitas vezes apresentam intensa pigmentação. A nomenclatura destas células não é consensual e, por isso, várias denominações são apresentadas, principalmente nos seguintes órgãos: fígado (como sinônimo de células de Kupffer), rins, baço e menos freqüentemente em outras localizações, com os termos - células pigmentares, células pigmentares extracutâneas, macrófagos pigmentados, melanomacrófagos, melanófagos, melanóforos e melanócitos. Para os anuros os estudos são recentes e relatam células pigmentares em poucas espécies. Em Physalaemus nattereri e alguns anuros, os pigmentos melânicos são encontrados, além da cútis, em outros órgãos constituindo um sistema pigmentar extracutâneo, com diferentes ocorrências, tipos e quantidade em distintas espécies. Associados ao aparelho reprodutor de P. nattereri, os melanócitos foram observados nas gônadas, na albugínea e no interstício, especialmente associado com vasos sangüíneos. A notória presença de numerosas células com pigmento distribuídas no testículo confere uma coloração que varia do preto mesclado com branco ao preto intenso. Trata-se de uma rara peculiaridade e não há informações sobre seu significado funcional ou valor biológico.<br>The testes in the anurans are paired ovoid organs constituted by seminiferous structures surrounded by the fibrous connective tissue, commonly unprovided of pigments. This study tried to analyze the morphological characteristics of rare and conspicuous pigment-containing cells and their relationship with other structures. The pigment cells are variously and indistinctly also termed Kuppfer cells in the liver, pigment cells, extracutaneous pigment cells, pigmented macrophages, melanomacrophages, melanophage, melanophores and melanocytes in the liver, spleen and kidney and other visceral structures of exothermic vertebrates. Ten male samples of Physalaemus nattereri (Steindachner, 1863) (Leptodactylidae) were used. After macroscopic analyses, the testicular fragments were submitted to the histological routine, fixed with karnovisky, embedded Historesin and coloration with Haematoxylin/Eosin. A rare peculiarity was the presence of numerous pigment-containing cells (melanocytes) randomly distributed in the albuginea tunic and testicular interstitium, giving the testes a dark brown coloration. This unusual characteristic has been rarely described and in other lower vertebrates, the pigment cells can be found in different organs, constituting an extracutaneous pigmentary system of unknown function. Further, it was identified a conspicuous variation, as to presence and distribution pattern due to possible species-specific aspects. However, histologically there is no difference in the germ epithelium arrangement. Between the seminiferous locules, there is an inter-locular tissue composed by Leydig interstitial cells, fibroblasts, efferent ductules, melanocytes and blood vessels. This inter-locular tissue is relatively scarce, presenting melanocytes in all specimens analyzed intimate associated with blood vessels. They are irregular cells with numerous melanosomes and long cytoplasmic processes

Mutation spectrum of MLL2 in a cohort of Kabuki syndrome patients

Kabuki syndrome (Niikawa-Kuroki syndrome) is a rare, multiple congenital anomalies/mental retardation syndrom characterizes by a peculiar face, short stature, skeletal, visceral and dermatoglyphic abnormalities, cardiac anomalies and immunological defects. recently mutations in the histone methy transferase MLL2 gene have been identified as its underlying cause. Genomic DNAs were extracted from 62 index patients clinically diagnosed as affected by Kabuki syndrome. Sanger sequencing was performed to analyze the whole coding region of the MLL2 gene including intro-exon juctions. The putative causal and possible functional effect of each nucleotide variant identified estimated by in silico prediction tools. We identified 45 patients with MLL2 nucleotide variants. 38 out of the 42 variants were never described before. Consistently with previous reports, the majority are nonsense or frameshift mutations predicted to generate a truncated polypeptide. We also identified 3 indel, 7 missense and 3 splice site. This study emphasizes the relevance of mutational screening of the MLL2 gene among patients diagnosed with Kabuki syndrome. The identification od a large spectrum of MLL2 mutations possibly offers the opportunity to improve the actual knowledge on the clinical basis of this multiple congenital anomalies/mental retardation syndrome, design functional studies to understand the molecula mechanism underlying this disease, establish genotype-phenotype correlations and improve clinical management

Gout, allopurinol intake and clinical outcomes in the hospitalized multimorbid elderly.

Increased serum uric acid has been considered a cardiovascular risk factor but no study has assessed its relation with hospital mortality or length of stay. On the basis of data obtained from a prospective registry, the prevalence of gout/hyperuricemia and its association with these and other clinical parameters was evaluated in an Italian cohort of elderly patients acutely admitted to internal medicine or geriatric wards

La terapia insulinica sottocutanea continua (CSII) in Italia. Terza indagine nazionale

Continuous subcutaneous insulin infusion (CSII) is increasingly being used worldwide, mostly thanks to technical improvements. This study examined the current status of CSII in Italy. Physicians in charge of 272 diabetes centers caring for patients using CSII were sent a questionnaire investigating clinical features, pump technology and management of these patients; a large proportion (217 centers, 79.8%) joined the study. By end-April 2013, data had been collected on 10152 patients treated with CSII; 98.2% had type 1 diabetes, 82.4% were adults, 57% female. Only just over half the centers (59%) managed more than 20 CSII patients each. The distribution of patients varied widely both among and within different regions. The main indication for CSII was the de- sire to improve glycemic control. Dropouts (8.65%) were mainly due to difficulties with pump wearability or non-optimal glycemic control. Among CSII patients 61% used a traditional pump, 39% a sensor augmented pump. Only 68% used the CSII advanced functions and glucose sensors were used twelve days per month on average. Round-the-clock assistance was guaranteed in 81% of centers; a full diabetes team followed patients in only 40% of adult-care centers and 50% of pediatric units. CSII is increasingly used in Italy, by adults and pediatric patients. However, further work is needed to unify treatment strategies throughout the country and to encourage optimal pump use and applications