Multiple Endocrine Neoplasia Type 2 Kindred with Novel Tandem RET mutations: Case report with an Applied in Silico Mutational Tolerance Analysis is an article that describes the American Thyroid Association (ATA) strategies on the rearrangement of prophylactic thyroidectomy in some endocrine neoplasia type 2A (MEN2A) during transfection mutations. According to the authors, Medullary Thyroid Carcinoma (MTC) is a neoplasm that has encompassed over 3.8% of thyroid growths in the United States. There has been a study of genotype-phenotype relationships over the past 20 years and on families who have various Rearranged Transfection (RET) mutations which have revealed the diverse relationship between the age of commencement for malignant alteration of C-cell hyperplasia to MTC and certain mutations in the RET gene.
The recommendations of the study from ATA describe three categories of risk for the growth of aggressive MTC. The categories are divided into highest, high or moderate. Some RET mutations are only found in few patients making it hard to evaluate the mutations pathogenicity established on epidemiological data. The traditional method, vitro analysis, used in the analysis of RET mutation oncogenic potential is time-consuming, does not always relate to the illness severity and expensive. In this method, development curves are examined when the mutation is presented into cell lines. The silico analysis which is computer based permits for high output analysis of protein change. The program can evaluate mutations simultaneously after the other. The analysis has revealed a correlation between in vitro studies and RETS mutations and from a study of 7 unknown and six known mutations, it was discovered that there is a direct correlation between the silico analysis score and converting capability of a specific mutation in cell lines.
A silico method was used on a 32-year-old patient with MTC in the analysis of MEN2B mutations where the examinations involved RET mutations on similar allele. The result was that prediction of the intensity of the disease related to the aggressiveness of the ailment. In a study of a 45-year father and two sons aged 10 and seven years old who have MEN2A and share RET mutation and a mutation of uncertain significance p.C634Y and p.1852M respectively, the father proved to be an MTC with a dominant 1.7cm thyroid nodule. Bilateral adrenalectomies were used to treat pheochromocytomas and included thyroidectomy and the removal of the parathyroid gland. Out of 24 central compartment lymph nodes, four were positive for MTC, but there was no extrathyroidal spread of the primary tumor. The 10-year-old son was found with C-cell hyperplasia and had undergone a prophylactic thyroidectomy while the younger son had MTC with extrathyroidal extension. Most of the mutations causing MEN2A transpire on 1 of 5 cysteine deposits in the catalytic domain initiating constitutive stimulation of the tyrosine kinase action.
Align Grantham-Variation Grantham-Deviation (GVGD), a web-based software predicts proteins changes that happen on mutations and DeepView Swiss-Pbd Viewer that enables an individual to create 3-D models of proteins were used in the calculation of GV component and GD component to evaluate the outcome in the alteration of the structure of a missense mutation. It is important to form an alignment of RET gene before performing an in silico analysis of known RET mutations to allows conservation of regions of the RET gene that is perceived to be useful for the function of the protein. The calculation of the effect of the p.1852M and p.C634Y was done through the utilization of the Align-GVGD score, and it created a 3-dimensional model of the RET protein with the p.1852M mutation. It was impossible to create a 3-dimensional model for p.C634Y mutation due to the crystal structure of the RET protein used in the evaluation to make it go below 700 position to aid in solubility. DeepView-Swiss PbdViewer was used as the protein modeler.
From the results of the study, mutations with high overall GVGD score possess low GV score and a high GD score while those that were less severe possessed low GD score and high GV score. P.1852M minimally altered the protein structure while p.C634Y caused severe RET changes. When the two mutations were combined, they were less in altering the protein structure and indicated an Align-GVGD of 65. RET mutations that were aggressive were thought to cause visible alterations in the protein gene structure depending on their GVGD scores. The analysis of p.1852M mutation in the 3D RET structure showed various relationships. It indicated the resistance of the p.1852M and at the bottom, there was an added structure conflict caused by an amino acid substitution at position 852.
The analysis of RET mutations in the GVGD model affirms the ability of the model to predict clinical diseases accurately using changes in the protein functions. In the father and sons case, the youngest son had N+ ailment at his age representing an outlier based on the progression of MTC in the presence of p.C634Y RET mutation; the father had a tumor that was at the intermediate stage, and the elder son had C-cell hyperplasia. It is, therefore, evident that p.1852M and p.C634Y mutation occur one after the other when there are changes in the protein structure and the mutations take place separately.
Cranston, A. N., C. Carniti, K. Oakhill, E. Radzio-Andzelm, E. A. Stone, A. S. McCallion, and S. Hodgson et al. 2006. "RET Is Constitutively Activated By Novel Tandem Mutations That Alter The Active Site Resulting In Multiple Endocrine Neoplasia Type 2B". Cancer Research 66 (20): 10179-10187.
Joshi, Rohan R., Thomas E. Heineman, David I. Kutler, Marc A. Cohen, and William I. Kuhel. "Multiple endocrine neoplasia type 2 kindred with novel tandem RET mutations: Case report with an applied in silico mutational tolerance analysis." Head & neck 38, no. S1 (2015): E1881-E1885.
Krampitz, Geoffrey W. and Jeffrey A. Norton. 2014. "RET Gene Mutations (Genotype And Phenotype) Of Multiple Endocrine Neoplasia Type 2 And Familial Medullary Thyroid Carcinoma". Cancer120 (13): 1920-1931.
Machens, Andreas, Kerstin Lorenz, Carsten Sekulla, Wolfgang Hoppner, Karin Frank-Raue, Friedhelm Raue, and Henning Dralle. "Molecular epidemiology of multiple endocrine neoplasia 2: implications for RET screening in the new millenium." European Journal of Endocrinology 168, no. 3 (2013): 307-314.
Nakao, Kanako-Tanase, Takeshi Usui, Mayumi Ikeda, Yusuke Mori, Tetsuro Yamamoto, Sachiko-Tsukamoto Kawashima, and Kazutaka Nanba et al. 2013. "Novel Tandem Germline RET Proto-Oncogene Mutations In A Patient With Multiple Endocrine Neoplasia Type 2B: Report Of A Case And A Literature Review Of Tandem RET Mutations With In Silico Analysis". Head Neck 35 (12): E363-E368.
Xu, Lei, Xu Li, Bo Feng, Yafang Ni, Hua Wang, and Lin Wang. 2010. "A Novel Mutation Of The MEN1 Gene In A Chinese Kindred With Multiple Endocrine Neoplasia Type 2". Endocrine Journal 57 (9): 839-845.
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