Increased KCNJ18 promoter activity as a mechanism in atypical normokalemic periodic paralysis

Identification of Potentially Pathogenic Variants Associated with Recurrence in Medication-Related Osteonecrosis of the Jaw (MRONJ) Patients Using Whole-Exome Sequencing

Background: Bisphosphonates are antiresorptive and antiangiogenic drugs that prevent and treat bone loss and mineralization in women with postmenopausal osteoporosis and cancer patients. Medication-related osteonecrosis of the jaw (MRONJ) is commonly caused by tooth extraction and dental trauma. Although genetic and pathological studies about MRONJ have been conducted, the pathogenesis of MRONJ still remains unclear. Methods: We aimed to identify genetic variants associated with MRONJ, using whole-exome sequencing (WES). Ten MRONJ patients prescribed bisphosphonates were recruited for WES, and jawbone tissue and blood samples were collected from the patients. Results: The analysis of the WES data found a total of 1866 SNP and 40 InDel variants which are specific to MRONJ. The functional classification assay using Gene Ontology and pathway analysis discovered that genes bearing the MRONJ variants are significantly enriched for keratinization and calcium ion transport. Some of the variants are potential pathogenic variants (24 missense mutations and seven frameshift mutations) with MAF < 0.01. Conclusions: The variants are located in eight different genes (KRT18, MUC5AC, NBPF9, PABPC3, MST1L, ASPN, ATN1, and SLAIN1). Nine deleterious SNPs significantly associated with MRONJ were found in the KRT18 and PABPC3 genes. It suggests that KRT18 and PABPC3 could be MRONJ-related key genes.

Statistical Methods to Support Difficult Diagnoses

Far too often, one meets patients who went for years or even decades from doctor to doctor without obtaining a valid diagnosis. This brings pain to millions of patients and their families, not to speak of the enormous costs. Often patients cannot tell precisely enough which factors (or combinations thereof) trigger their problems. If conventional methods fail, we propose the use of statistics and algebra to provide doctors much more useful inputs from patients. We use statistical regression for triggering factors of medical problems, and in particular, "balanced incomplete block designs" for factors detection. These methods can supply doctors with much more valuable inputs and can also find combinations of multiple factors through very few tests. In order to show that these methods do work, we briefly describe a case in which these methods helped to solve a 60-year-old problem in a patient and provide some more examples where these methods might be particularly useful. As a conclusion, while regression is used in clinical medicine, it seems to be widely unknown in diagnosing. Statistics and algebra can save the health systems much money, as well as the patients a lot of pain.

[What entertainment television can do to convey medical knowledge to students and laypeople-raising awareness of rare diseases]

Menschen mit komplexen und seltenen Erkrankungen haben es in unserem Gesundheitssystem oft schwer. Bis zur Diagnosefindung kann es Jahre dauern und häufig fehlt eine geeignete Therapie. Dabei sind seltene Erkrankungen in der Summe der Patienten alles andere als selten: Allein in Deutschland sind etwa 4 Mio. Menschen betroffen. Dennoch gilt, dass eine seltene Erkrankung oft erst dann entdeckt werden kann, wenn sie bekannt genug ist und die Bevölkerung für ihre Existenz sensibilisiert ist – dies gilt sowohl für Laien als auch die Ärzteschaft. Die eher ungewöhnliche Form der Wissensvermittlung über das Unterhaltungsfernsehen kann einen wichtigen Beitrag zur Verbreitung von medizinischem Wissen und zur Sensibilisierung für medizinische Themen leisten. In konkreten Fällen kann das Unterhaltungsfernsehen so zur Diagnosefindung bei seltenen Erkrankungen beitragen oder Laien zu lebensrettenden Maßnahmen ermutigen, was in diesem Artikel anhand einiger Fallbeispiele verdeutlicht wird.

Serien und Quizshows erreichen sehr viel mehr Zuschauer als klassische Gesundheitssendungen. Auch im Studierendenunterricht haben sie sich als außergewöhnlich wirksam erwiesen. Da die Erzählform das Mitfiebern und Mitraten in den Mittelpunkt stellt; anstelle des reinen Vermittelns von Fakten werden die medizinischen Themen als Gedächtnisinhalte emotional stärker verankert und leichter erinnerlich. Das Unterhaltungsfernsehen bietet somit einen innovativen Ansatz, um die Gesundheitskompetenz der Bevölkerung zu steigern – ein Potenzial, das in Deutschland noch besser genutzt werden könnte.

Decipher the complexity of cis-regulatory regions by a modified Cas9

BACKGROUND

Understanding complex mechanisms of human transcriptional regulation remains a major challenge. Classical reporter studies already enabled the discovery of cis-regulatory elements within the non-coding DNA; however, the influence of genomic context and potential interactions are still largely unknown. Using a modified Cas9 activation complex we explore the complexity of renin transcription in its native genomic context.

METHODS

With the help of genomic editing, we stably tagged the native renin on chromosome 1 with the firefly luciferase and stably integrated a programmable modified Cas9 based trans-activation complex (SAM-complex) by lentiviral transduction into human cells. By delivering five specific guide-RNA homologous to specific promoter regions of renin we were able to guide this SAM-complex to these regions of interest. We measured gene expression and generated and compared computational models.

RESULTS

SAM complexes induced activation of renin in our cells after renin specific guide-RNA had been provided. All possible combinations of the five guides were subjected to model analysis in linear models. Quantifying the prediction error and the calculation of an estimator of the relative quality of the statistical models for our given set of data revealed that a model incorporating interactions in the proximal promoter is the superior model for explanation of the data.

CONCLUSION

By applying our combined experimental and modelling approach we can show that interactions occur within the selected sequences of the proximal renin promoter region. This combined approach might potentially be useful to investigate other genomic regions. Our findings may help to better understand the transcriptional regulation of human renin.

Thyrotoxic Periodic Paralysis: An Incidental Diagnosis!

Thyrotoxic periodic paralysis is a rare presentation of thyrotoxicosis where the patient develops a transient motor deficit secondary to acute hypokalemia. The thyroid hormone augments gene transcription and post-transcriptional modification of Na-K ATPase, a cell membrane protein that regulates the electrical potential of the cell. Na-K ATPase increases active transport of potassium (K+) ions into the intracellular compartment causing hypokalemia without total body potassium deficit. Severe hypokalemia affects depolarization of the muscle cell membrane, clinically evidenced as paralysis. Other factors that may trigger hypokalemia and paralysis in the setting of hyperthyroidism include diet intake high in carbohydrates and salt, alcohol ingestion, trauma, infections, certain medication, and strenuous exercise. This rare but possible clinical presentation of thyrotoxicosis is significantly more predominant in males of Asian descent. We are reporting a case of a 44-year-old Asian-American male who presented to the emergency department with complaints of acute onset of bilateral lower extremity weakness. He had severe hypokalemia and was diagnosed with primary hyperthyroidism due to Graves' disease.

Contribution of Asian Haplotype of KCNJ18 to Susceptibility to and Ethnic Differences in Thyrotoxic Periodic Paralysis

CONTEXT AND OBJECTIVES

Thyrotoxic periodic paralysis (TPP) is an acute complication of thyrotoxicosis that can be lethal. TPP is rare in Caucasians but often affects young men in East Asian populations. This study aimed to clarify the contribution of KCNJ18 to susceptibility to TPP in East Asian populations.

PARTICIPANTS AND METHODS

The study comprised 635 participants including 13 Japanese patients with TPP, 208 Japanese patients with Graves disease without TPP, and 414 healthy control subjects from the Japanese (n = 208), Korean (n = 111), and Caucasian populations (n = 95). DNA samples from 29 participants (13 with TPP, 8 with Graves disease, and 8 controls) were sequenced for KCNJ18, and all participants (n = 635) were genotyped for six variants of KCNJ18 and a polymorphism of KCNJ2 (rs312691).

RESULTS

Six single-nucleotide variants (SNVs) with amino acid substitutions were identified by direct sequencing of KCNJ18. Among these, four SNVs comprised three haplotypes under strong linkage disequilibrium. Haplotype 1 (AAAG) of KCNJ18 was significantly associated with susceptibility to TPP in the Japanese population (OR = 19.6; 95% CI, 1.5 to 256.9; P = 0.013). Haplotype frequencies in the general East Asian (Japanese and Korean) and Caucasian populations differed significantly (haplotype 1: 80.8% vs 48.4%, P = 1.1×10-27).

CONCLUSION

A major haplotype of KCNJ18 in East Asian populations is significantly associated with susceptibility to TPP. The haplotype is much more common in East Asian than Caucasian populations, suggesting its contribution to the high prevalence of TPP in East Asian populations.