结节性硬化症的基因突变研究

目的研究1例中国汉族人结节性硬化症TSC1和TSC2基因的突变情况。方法采用聚合酶链反应(PCR)扩增该例结节性硬化症患者、家族中的正常人以及100名健康对照者的TSC1和TSC2基因的全部外显子,并进行DNA测序分析。结果该例患者TSC1基因第15外显子存在C.1884-1887del AAAG(P.Leu628Leu fs X23)移码突变,引起读码框移位,并在其后第23位氨基酸处提前出现终止密码子TGA。家族中的正常成员及100名无关正常对照未检测出该位点突变。结论 TSC1基因的新缺失突变C.1884-1887del AAAG可能是导致患者临床发病的主要原因,该突变为新突变。     

结节性硬化症双生子中TSC2基因突变的检测

目的:对一对结节性硬化症双生子患者及其父母候选基因的突变进行检测,揭示该病的遗传基础。方法:采用聚合酶链式反应,扩增结节性硬化症双生子患者TSC2基因的全部外显子,以及内含子外显子交接区,进行DNA直接测序分析;利用限制性片段长度多态性(RFLP)技术检测了患者的父母和500个健康人的突变,并分析本突变是否和结节性硬化症有关。结果:双生子患者中均发现一个TSC2基因的错义突变c.G2032A,该突变导致TSC2蛋白678位的丙氨酸被替换为苏氨酸(p.A678T);RFLP结果显示患者的父亲有c.G2032A突变,500个正常人中有3人也携带此突变。结论:在结节性硬化症人群中发现TSC2基因新的突变,这一发现丰富了该基因引起结节性硬化症的突变谱。     

结节性硬化症双生子中TSC2基因突变的检测

目的:对一对结节性硬化症双生子患者及其父母候选基因的突变进行检测,揭示该病的遗传基础。方法:采用聚合酶链式反应,扩增结节性硬化症双生子患者TSC2基因的全部外显子,以及内含子外显子交接区,进行DNA直接测序分析;利用限制性片段长度多态性(RFLP)技术检测了患者的父母和500个健康人的突变,并分析本突变是否和结节性硬化症有关。结果:双生子患者中均发现一个TSC2基因的错义突变c.G2032A,该突变导致TSC2蛋白678位的丙氨酸被替换为苏氨酸(p.A678T);RFLP结果显示患者的父亲有c.G2032A突变,500个正常人中有3人也携带此突变。结论:在结节性硬化症人群中发现TSC2基因新的突变,这一发现丰富了该基因引起结节性硬化症的突变谱。     

结节性硬化症致病基因及基因突变研究进展

结节性硬化症(tuberous sclerosis complex,TSC)是一种常染色体显性遗传病,典型临床特征是癫痫、智能减退、面部血管纤维瘤及各系统的错构瘤。该病具有遗传异质性,由TSC1或TSC2基因突变引起。TSC1编码错构瘤蛋白(hamartin),TSC2编码马铃薯球蛋白(tuberin)。这两种蛋白质在组织中广泛表达,于体内形成Hamartin-Tuberin复合体,若TSC1或TSC2基因发生突变,则影响Hamartin-Tuberin二聚体功能,使mTOR复合物1(mTOR complex 1,mTORC1)信号转导通路异常激活,导致结节性硬化症的发生。目前研究证实该病与TSC1或TSC2基因突变有关。该文就结节性硬化症的致病基因及基因突变研究进展作一综述。     

典型结节性硬化症1例临床表型及基因变异分析

【摘要】 目的 收集1例典型结节性硬化症患者的临床资料并检测其致病基因变异。方法 收集患者临床资料,应用二代测序法对患者进行致病基因筛查,采用Sanger测序法验证,构建迷你基因质粒转染至人肾上皮细胞系293T细胞,提取RNA进行转录分析。结果 患者临床表型包括反复癫痫发作,伴面部血管纤维瘤、甲周纤维瘤、肺淋巴管肌瘤病、肾血管平滑肌脂肪瘤及多发性骨质硬化。二代测序提示患者TSC2基因存在可疑致病变异,经Sanger测序验证,患者TSC2基因第4号外显子存在c.336_336+15delGGTAAGGCCCAGGGCG杂合突变,其父母及100名无关健康对照未检测出该位点变异。该突变位点既往未见报道。迷你基因实验显示,患者TSC2基因mRNA序列发生改变,原4号外显子剪切位点丢失,插入74 bp内含子序列,使剪切位置后移90 bp（r.336delins336+16_336+90）。结论 TSC2基因第4号外显子c.336_336+15delGGTAAGGCCCAGGGCG杂合变异可导致异常剪切,可能是该结节性硬化症患者病因。     

结节性硬化症一家系新发TSC2基因变异分析

目的 对一个结节性硬化症家系进行基因检测,明确其致病基因变异。方法 收集一个结节性硬化症家系的临床资料,分析其遗传学特点,采集先证者及其他家庭成员的外周血,提取基因组DNA,运用二代测序法筛查可疑致病基因变异,再通过Sanger测序验证。结果 该家系先证者皮损表现为面部红色丘疹、前额斑块,全身多处色素减退斑,伴有癫痫病史;先证者母亲皮损表现为面部肤色丘疹,全身多处色素减退斑。经二代测序及Sanger测序验证,先证者TSC2基因40号外显子存在c.5108dupT(p.Ser1704Valfs*2)杂合变异,先证者母亲也存在相同基因变异,其他家庭成员及100名无关正常对照未检测出该位点变异。根据美国医学遗传学与基因组学学会(ACMG)指南,TSC2:c.5108dupT(p.Ser1704Valfs*2)为致病变异(PSV1+PM2+PP1+PP4)。结论 本研究新发现的TSC2基因40号外显子c.5108dupT(p.Ser1704Valfs*2)杂合变异是该家系的致病原因。     

结节性硬化症的分子遗传学研究进展

结节性硬化症(TSC)是一种多系统疾病,主要的特征是脑、皮肤、眼睛、心、肺、肾等器官出现肿瘤样损害,称为错构瘤.它是一种由基因决定的常染色体显性遗传病,由于TSCI或TSC2基因的突变失活引起.近年来,在结节性硬化症的基因研究方面取得了一定进展,对于TSC1、TSC2基因多态性、基因功能及其产物的相互作用有了更加深入的了解,但是仍需要对这种复杂的疾病进行更深入地研究以降低其发病率和死亡率.概述近年来在结节性硬化症的分子遗传学方面取得的新进展.     

结节性硬化症

<正>患者男,14岁,广东惠州人。主诉:颜面、腰骶部渐进性增多皮疹5年。现病史:5年前,患者于左鼻翼部出现一米粒大小肤色丘疹,左侧臀部出现一约1.5 cm×0.5 cm大小长条状淡黄色软斑块,无痛痒,未予相关处理。后逐渐于鼻翼两侧、双面颊及下颌出现散在对称性分布的针尖至粟粒大小暗红色丘疹,伴双侧鼻唇沟出现绿豆至黄豆大小丘疹。原臀部黄色软斑块亦逐渐增至鸡蛋大     

结节性硬化症

图1 鼻翼两侧及双脸颊、下颌、颈部出现散在针尖至粟粒大小暗色毛细血管扩张性坚韧丘疹,伴双侧鼻唇沟绿豆至黄豆大小菜花样丘疹;图2左侧腰骶部见约4cn·×5CIn大小不规则增厚性鲨鱼皮样淡黄色软斑块,周围见沿皮纹走向的散在约l～2cm大小条叶状白色丘疹;图3鼻翼旁丘疹组织病理示：真皮浅层毛细血管增生、扩张,胶原纤维组织明显增生（HE,100×）;图4腰骶部斑块组织病理示：真皮内胶原纤维增生明显,浅层血管周围稀疏淋巴组织细胞浸润（HE,40×）     

结节性硬化症

结节性硬化症是一种常染色体显性遗传性神经皮肤综合征。近年来分子遗传学的发展已证实该病具有遗传异质性,发现了两个致病基因位点(TSC_1和TSC_2)。该病可多系统受累,临床表现多种多样,涉及临床各科,易漏诊、误诊。文中就该病的有关问题作一综述。     

Novel mutations in Chinese Han patients with tuberous sclerosis complex: Case series and review of the published work

Tuberous sclerosis complex (TSC) is an autosomal dominant genetic disease characterized by hamartomas in multiple organ systems. This study was performed in one familial and two sporadic cases with TSC. Two novel mutations (c.1884_1887delAAAG and c.5266A>G) and two previously reported mutations (c.4258_4261delTCAG and c.1960G>C) were identified by direct DNA sequencing. Of the four mutations, c.1884_1887delAAAG and c.1960G>C were found in a family and identified in the same allele by TA cloning sequencing. However, c.1960G>C was reported to be non‐pathogenic. Furthermore, correlations between genotypes and phenotypes of Chinese Han patients since 2014 were performed by paired χ²‐tests in our published work review, which has not been reported. The results showed that patients with TSC2 mutations had a higher frequency of mental retardation and there were no significant differences of seizures and skin lesions with TSC1 mutations. Genetically, they had a higher frequency of familial inheritance.     

Genital angiofibromas in tuberous sclerosis: two cases

Cutaneous lesions are an important feature of tuberous sclerosis (TS). Facial angiofibromas usually begin to appear at the end of the first decade of life and are considered to occur in about 88% of adults with TS. They are only rarely reported on sites other than the face or front. In this paper, we report two patients with the complete syndrome of TS that had, in addition to classic facial lesions, multiple papules on the genital area. Histopathology confirmed the diagnosis of angiofibroma. One patient's lesions were misdiagnosed as genital warts and were so being treated before the correct diagnosis was made. Although we don't know the incidence of genital angiofibromas in TS patients, we believe that they might be underreported, because dermatologists generally don't look for them when they see these patients.     

结节性硬化症67例临床分析

目的:了解结节性硬化症(tuberoussclerosis,TS)的特征性皮肤表现及常见的皮肤外病变,使该疾病及内脏病变得到早期诊断、早期发现。方法:回顾性分析67例TS患者的临床、实验室及辅助检查资料。结果:67例TS患者常常受累的器官为皮肤、脑及肾脏,神经系统损害多见,头颅CT检查阳性率高达94.3%。皮肤损害最常见和最早出现的表现是色素减退斑,有81.5%的患者其色素减退斑数目>3个,其次常见的是面部血管纤维瘤和鲨革样皮疹;前额纤维斑块、面部血管纤维瘤、鲨革样皮疹、甲周纤维瘤平均发现年龄分别为2.2、5.7、7.7、14.5岁。结论:临床医师对色素减退斑应提高警惕,尤其是伴有癫的患者,或者在婴儿期其色素减退斑数目>3个者;头颅CT检查对本病的诊断有帮助。     

Abnormal division and gene expression in cultured cells from a patient with tuberous sclerosis

Tuberous sclerosis is a dominant hereditary disease characterized by the appearance of angiofibromas on the face, epileptic attacks, and mental retardation. Attention has been paid to the atypical cells observed histologically in the stroma of the angiofibroma as they may play an important role in forming lesions. We have established a cell line from an angiofibroma to clarify the nature of these cells at the cellular and biochemical levels. The cultured cells have been stably maintained for four years and show an abnormal morphology resembling that of neuronal cells. In culture, these cells divide into daughter cells, which consist of both normal cells and abnormal ones whose nuclei disintegrate and cannot divide further. The cells resemble normal fibroblasts in their pattern of staining with antibodies against tubulin, actin, vimentin, and fibronectin. However, they also stain with an antibody against the glia-specific acidic protein, which is thought to be a specific marker protein for glial cells. The gel profile of cyclic-AMP binding proteins was not fibroblastic, but rather of the neuron cell type. These results indicate the gene expression of these cells is also abnormal. They are a useful tool for understanding this specific genetic disease.     

Topical 0.1% rapamycin for angiofibromas in paediatric patients with tuberous sclerosis: a pilot study of four patients

Tuberous sclerosis complex (TSC) is an autosomal dominant genodermatosis characterised by the development of hamartomatous tumours in multiple organs including the brain, skin, kidneys, heart and lungs. Facial angiofibromas are the most visible and unsightly of the cutaneous manifestations of TSC, often resulting in stigmatisation for both the affected individuals and their families. Current treatments include vascular laser, ablative lasers and other destructive techniques such as shave excision and electrodessication. For the best outcome these treatments have to be repeated throughout childhood and teenage years, necessitating multiple general anaesthetics. We report a pilot study of topical rapamycin in four children with TSC and facial angiofibromas. Two patients were trialled on 0.1% rapamycin in petrolatum and the other two patients with 0.1% rapamycin solution (Rapamune) applied topically. Both preparations were rapidly and equally effective, however the 0.1% in petrolatum was much better tolerated. Younger patients with smaller angiofibromas had the best response with near complete clearance. Both preparations were more cost effective than pulsed dye laser under general anaesthesia. Although larger studies are needed, this treatment shows a potential to be a first-line management for facial angiofibromas in TSC and appears safe to start in early childhood.     

结节性硬化症合并蜡泪样骨病一例

患儿男,7岁.全身起疹5年,手指畸形1天,2007年lO月5日来我科就诊.2岁时额、眼周、左颊及右耳轮出现数处褐色疣状皮损,并时常发生手中物体滑落、下肢抽搐、跌倒等症.