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Alzahrani AS, Hussein M, Alswailem M, Mouna A, Albalawi L, Moria Y, Jabbar MA, Shi Y, Günzel D, Dasouki M. A novel claudin-10 mutation with a unique mechanism in two unrelated families with HELIX syndrome. Kidney Int 2021; 100:415-429. [PMID: 33675844 DOI: 10.1016/j.kint.2021.02.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 02/01/2021] [Accepted: 02/10/2021] [Indexed: 02/05/2023]
Abstract
HELIX syndrome, characterized by hypohidrosis, electrolyte imbalance, lacrimal gland dysfunction, ichthyosis, and xerostomia due to claudin-10 (CLDN10) mutations, was recognized in 2017. Here we describe two unrelated Saudi families with this syndrome due to a novel CLDN10 mutation with a unique mechanism of CLDN10 inactivation. The two consanguineous families include 12 affected individuals (three siblings in family 1 and nine members in family 2). They presented with hypokalemia and the above-mentioned features of HELIX syndrome. The underlying mutation was detected by whole exome sequencing, confirmed by Sanger sequencing and functionally indicated by RT-PCR, electrophysiological studies and immunohistochemical staining of transfected HEK293 and MDCK C7 cells, and skin and kidney biopsy tissues. A novel biallelic single nucleotide deletion was identified in exon 5 of CLDN10 (NM_182848.3: c.647delC, p.P216Lfs∗19 for CLDN10a or NM_006984.4: c.653delC, p.P218Lfs∗21 for CLDN10b). The mutation led to frameshift and extension of the original termination codon by nine amino acids with loss of the C-terminus pdz-binding motif. Functional studies showed mRNA degradation and protein retention in intracellular compartments and that the pdz-binding motif is crucial for proper localization of claudin-10 in tight junctions. In the kidney, claudin-10 was replaced by translocation of claudin-2 (proximal tubule) and claudin-19 (thick ascending limb), and in the sweat gland by claudin-3 and occludin. However, these claudins did not functionally compensate for loss of claudin-10. Thus, this novel CLDN10 mutation identified in these two families disrupted the C-terminus pdz-binding motif of claudin-10 causing HELIX syndrome.
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Affiliation(s)
- Ali S Alzahrani
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; Department of Molecular Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
| | - Maged Hussein
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Meshael Alswailem
- Department of Molecular Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ahmad Mouna
- Clinical Physiology/Nutritional Medicine, Charité-Universitätsmedizin Berlin, Germany
| | - Lina Albalawi
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; Department of Medicine, Al Majma'ah University, Al Majma'ah, Saudi Arabia
| | - Yosra Moria
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mai Abdel Jabbar
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Yufei Shi
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Dorothee Günzel
- Clinical Physiology/Nutritional Medicine, Charité-Universitätsmedizin Berlin, Germany
| | - Majed Dasouki
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Alzahrani AS, Albalawi L, Mazi S, Mukhtar N, Aljamei H, Moria Y, Elsayed T, Amer L, Alanazi F, Alnasser L, Alqarni B, Fadel R, AlMatar A, Alqahtani A, Tuttle RM. How Does The AJCC/TNM Staging System Eighth Edition Perform in Thyroid Cancer at A Major Middle Eastern Medical Center? Endocr Pract 2020; 27:607-613. [PMID: 34120701 DOI: 10.1016/j.eprac.2020.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/24/2020] [Accepted: 11/01/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The American Joint Committee on Cancer tumor node metastasis (TNM) staging system eighth edition (TNM-8) for differentiated thyroid cancer (DTC) has been introduced as a replacement for tumor node metastasis staging system seventh edition (TNM-7). We present the first study from a Middle Eastern population comparing these 2 versions of the TNM staging system. METHODS We compared TNM-8 with TNM-7 in 701 patients with DTC seen during a 3-year period with a median age of 37 years (6-83) and a female-to-male ratio of 558 (79.6%) to 143 (20.4%). RESULTS The number (%) of patients within each stage in TNM-7 and TNM-8, respectively, are as follows: stage I = 503 (71.6%) and 583 (83.2%), stage II = 52 (7.4%) and 81 (11.4%), stage III = 53 (7.6%) and 6 (0.9%), and stage IV = 93 (13.2%) and 31 (4.6%). Overall, 172 patients (24.5%) were downstaged in TNM-8 compared to that in TNM-7, as follows: 26, 30, and 24 patients from stages II, III, and IV in TNM-7 to stage I in TNM-8; 23 and 32 patients from TNM-7 stages III and IV to TNM-8 stage II; 6 patients from stage IVa in TNM-7 to stage III in TNM-8; and 31 patients from stage IVc in TNM-7 to stage IVb in TNM-8. TNM-7 and TNM-8 predicted the long-term outcome well (median follow-up, 7.9 years), but Kaplan-Meier analysis showed better separation of cancer-specific survival in TNM-8 compared to TNM-7. CONCLUSIONS Compared with TNM-7, TNM-8 approximately downstaged a quarter of DTC patients and was more robust in separating the outcome of different stages over time.
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Affiliation(s)
- Ali S Alzahrani
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
| | - Lina Albalawi
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia; Department of Medicine, College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Sedra Mazi
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Noha Mukhtar
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Hadeel Aljamei
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Yosra Moria
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Tarek Elsayed
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Lama Amer
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Faisal Alanazi
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia; Department of Medicine, College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Layla Alnasser
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Bayan Alqarni
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Roqyah Fadel
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Ahmed AlMatar
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Ashwag Alqahtani
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - R Michael Tuttle
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
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Alzahrani AS, Moria Y, Mukhtar N, Aljamei H, Mazi S, Albalawi L, Aljomaiah A. Course and Predictive Factors of Incomplete Response to Therapy in Low- and Intermediate-Risk Thyroid Cancer. J Endocr Soc 2020; 5:bvaa178. [PMID: 33367194 PMCID: PMC7745668 DOI: 10.1210/jendso/bvaa178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Context Controversy surrounds the extent and intensity of the management of American Thyroid Association (ATA) intermediate- and low-risk patients with differentiated thyroid cancer (DTC). Understanding the natural history and factors that predict outcome is important for properly tailoring the management of these patients. Objective This work aims to study the natural course and predictive factors of incomplete response to therapy in low- and intermediate-risk DTC. Patients and Methods We studied a cohort of 506 consecutive patients [418 women (82.6%) and 88 men (17.4%)] with low and intermediate risk with a median age of 35 years (interquartile range [IQR], 27-46 years). We analyzed the natural course and the predictive factors of biochemically or structurally incomplete response. Results Of 506 patients studied, 297 (58.7%) patients were in the low-risk group and 209 (41.3%) were in the intermediate-risk group. Over a median follow-up of 102 months (IQR, 66-130 months), 458 (90.5%) patients achieved an excellent response, 17 (3.4%) had a biochemically incomplete status, and 31 (6.1%) had a structurally incomplete status. In univariable and multivariable analyses, age (≥ 33 years) (P < .0001, odds ratio 1.06 [1.04-1.08]) and lateral lymph node metastasis (LNM; P < .0001, odds ratio 3.2 [1.7-5.9]) were strong predictive factors for biochemically and structurally incomplete response to therapy. Sex, tumor size, multifocality, extrathyroidal extension, and lymphovascular invasion did not predict incomplete response to therapy. Conclusions Patients with low- and intermediate-risk DTC have favorable outcomes. Age and lateral LNM are strong predictors of an incomplete response to therapy. This suggests that older patients and those with LNM should be managed and followed up more actively than younger patients and those without LNM.
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Affiliation(s)
- Ali S Alzahrani
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Yosra Moria
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Noha Mukhtar
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Hadeel Aljamei
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Sedra Mazi
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Lina Albalawi
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Abeer Aljomaiah
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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