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Karamysheva T.V., Lebedev I.N., Minaycheva L.I., Nazarenko L.P., Kashevarova A.A., Fedotov D.A., Skryabin N.A., Lopatkina M.E., Cheremnykh A.D., Fonova .EA., Nikitina T.V., Sazhenova E.A., Skleimova M.M., Kolesnikov N.A., Drozdov G.V., Yakovleva Y.S., Seitova G.N., Orishchenko K.E., Rubtsov N.B.
Frontiers in Genetics. 2024. Mar 11;15:1331066.
DOI: 10.3389/fgene.2024.1331066.

Pallister-Killian syndrome (PKS) is a rare inherited disease with multiple congenital anomalies, profound intellectual disability, and the presence in the karyotype of sSMC - i(12)(p10). The frequency of PKS may be underestimated due to problems with cytogenetic diagnosis caused by tissue-specific mosaicism and usually a low percentage of peripheral blood cells containing sSMC. Such tissue-specific mosaicism also complicates a detailed analysis of the sSMC, which, along with the assessment of mosaicism in different tissues, is an important part of cytogenetic diagnosis in PKS. Unfortunately, a full-fledged diagnosis in PKS is either practically impossible or complicated. On the one hand, this is due to problems with the biopsy of various tissues (skin biopsy with fibroblast culture is most often used in practice); on the other - a low percentage of dividing peripheral blood cells containing sSMC, which often significantly complicates the analysis of its composition and organization. In the present study, a detailed analysis of sSMC was carried out in a patient with a characteristic clinical picture of PKS. A relatively high percentage of peripheral blood cells with sSMC (50%) made it possible to perform a detailed molecular cytogenetic analysis of de novo sSMC using chromosomal in situ suppression hybridization (CISS-hybridization), multicolor FISH (mFISH), multicolor chromosome banding (MCB), array CGH (aCGH), and quantitative real-time PCR (qPCR), and short tandem repeat (STR) - analysis. As a result, it was found that the sSMC is not a typical PKS derivative of chromosome 12. In contrast to the classical i(12)(p10) for PKS, the patient's cells contained an acrocentric chromosome consisting of 12p material. Clusters of telomeric repeats were found at the both ends of the sSMC. Furthemore, the results of aCGH and qPCR indicate the presence of interstitial 8.9 Mb duplication at 12p13.1-p12.1 within the sSMC, which leads to different representations of DNA from different segments of 12p within cells containing sSMC. The obtained data raise the question of the instability of the sSMC and, as a consequence, the possible presence of additional rearrangements, which, in traditional cytogenetic analysis of patients with PKS, are usually described as i(12)(p10).

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Golubenko M.V., Pavlyukova E.N., Salakhov R.R., Makeeva O.A., Puzyrev K.V., Glotov O.S., Puzyrev V.P., Nazarenko M.S
Frontiers in Bioscience: Scholar. 2024, 16(1), 1.
DOI: 10.31083/j.fbs1601001

Background: Hypertrophic cardiomyopathy is the most frequent autosomal dominant disease, yet due to genetic heterogeneity, incomplete penetrance, and phenotype variability, the prognosis of the disease course in pathogenic variant carriers remains an issue. Identifying common patterns among the effects of different genetic variants is important. Methods: We investigated the cause of familial hypertrophic cardiomyopathy (HCM) in a family with two patients suffering from a particularly severe disease. Searching for the genetic variants in HCM genes was performed using different sequencing methods. Results: A new missense variant, p.Leu714Arg, was identified in exon 19 of the beta-myosin heavy chain gene (MYH7). The mutation was found in a region that encodes the ‘converter domain’ in the globular myosin head. This domain is essential for the conformational change of myosin during ATP cleavage and contraction cycle. Most reports on different mutations in this region describe severe phenotypic consequences. The two patients with the p.Leu714Arg mutation had heart failure early in life and died from HCM complications. Conclusions: This case presents a new likely pathogenic variant in MYH7 and supports the hypothesis that myosin converter mutations constitute a subclass of HCM mutations with a poor prognosis for the patient.

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Vasilyeva T.A., Sukhanova N.V., Khalanskaya O.V., Marakhonov A.V., Prokhorov N.S., Kadyshev V.V., Skryabin N.A., Kutsev S.I., Zinchenko R.A..
Current Issues in Molecular Biology. 2023. 46(1), 96-105.
DOI: 10.3390/cimb46010008

This study investigates a unique and complex eye phenotype characterized by minimal iris defects, foveal hypoplasia, optic nerve coloboma, and severe posterior segment damage. Through genetic analysis and bioinformatic tools, a specific nonsynonymous substitution, p.(Asn114Ser), within the PAX6 gene's paired domain is identified. Although this substitution is not in direct contact with DNA, its predicted stabilizing effect on the protein structure challenges the traditional understanding of PAX6 mutations, suggesting a gain-of-function mechanism. Contrary to classical loss-of-function effects, this gain-of-function hypothesis aligns with research demonstrating PAX6's dosage sensitivity. Gain-of-function mutations, though less common, can lead to diverse phenotypes distinct from aniridia. Our findings emphasize PAX6's multifaceted influence on ocular phenotypes and the importance of genetic variations. We contribute a new perspective on PAX6 mutations by suggesting a potential gain-of-function mechanism and showcasing the complexities of ocular development. This study sheds light on the intricate interplay of the genetic alterations and regulatory mechanisms underlying complex eye phenotypes. Further research, validation, and collaboration are crucial to unravel the nuanced interactions shaping ocular health and development.

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Murtazina A.F., Borovikov A.O., Kuchina A., Ovsova O.V., Bulakh M.V., Chukhrova A.L., Braslavskaya S., Ryzhkova O., Skryabin N.A., Kutsev S.I., Dadali E.L.
International journal of molecular sciences. 2024. 25(1), 129.
DOI: 10.3390/ijms25010129

The HOXB1 gene encodes a homeobox transcription factor pivotal in the development of rhombomere 4. Biallelic pathogenic variants in this gene are associated with congenital facial paresis type 3 (HCFP3). Only seven single nucleotide variants have been reported in the literature to date. Here, we report a 27-year-old female with a unique presentation of HCFP3 with two novel compound-heterozygous missense variants: c.763C>G, p.(Arg255Gly), which arose de novo and an inherited c.781C>T, p.(Arg261Cys) variant. The patient exhibited HCFP3 symptoms with mild upward esodeviation and lacked the documented ear malformations common in HCFP. For many years, she was misdiagnosed with facio-scapulo-humeral muscular dystrophy, due to complaints of shoulder girdle and neck muscle weakness. No alternative genetic or acquired causes of neck and shoulder girdle weakness were found, suggesting its potential inclusion in the phenotypic spectrum.

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Zakharova, I.S.; Shevchenko, A.I.; Arssan, M.A.; Sleptcov, A.A.; Nazarenko, M.S.; Zarubin, A.A.; Zheltysheva, N.V.; Shevchenko, V.A.; Tmoyan, N.A.; Saaya, S.B.; Ezhov, M.V.; Kukharchuk, V.V.; Parfyonova, Y.V.; Zakian, S.M.
International Journal of Molecular Sciences. 2024, 25(2), 689.
DOI: 10.3390/ijms25020689

Defects in the low-density lipoprotein receptor (LDLR) are associated with familial hypercholesterolemia (FH), manifested by atherosclerosis and cardiovascular disease. LDLR deficiency in hepatocytes leads to elevated blood cholesterol levels, which damage vascular cells, especially endothelial cells, through oxidative stress and inflammation. However, the distinctions between endothelial cells from individuals with normal and defective LDLR are not yet fully understood. In this study, we obtained and examined endothelial derivatives of induced pluripotent stem cells (iPSCs) generated previously from conditionally healthy donors and compound heterozygous FH patients carrying pathogenic LDLR alleles. In normal iPSC-derived endothelial cells (iPSC-ECs), we detected the LDLR protein predominantly in its mature form, whereas iPSC-ECs from FH patients have reduced levels of mature LDLR and show abolished low-density lipoprotein uptake. RNA-seq of mutant LDLR iPSC-ECs revealed a unique transcriptome profile with downregulated genes related to monocarboxylic acid transport, exocytosis, and cell adhesion, whereas upregulated signaling pathways were involved in cell secretion and leukocyte activation. Overall, these findings suggest that LDLR defects increase the susceptibility of endothelial cells to inflammation and oxidative stress. In combination with elevated extrinsic cholesterol levels, this may result in accelerated endothelial dysfunction, contributing to early progression of atherosclerosis and other cardiovascular pathologies associated with FH.

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Reshetnikov E., Churnosova M., Reshetnikova Y., Stepanov V., Bocharova A., Serebrova V., Trifonova E., Ponomarenko I., Sorokina I., Efremova O., Orlova V., Batlutskaya I., Ponomarenko M., Churnosov V., Aristova I., Polonikov A., Churnosov M.
International Journal of Molecular Sciences. 2024. 25(5), 2647.
DOI: 10.3390/ijms25052647

FGR was appreciated by regression procedures (logistic/model-based multifactor dimensionality reduction [MB-MDR]) with subsequent in silico assessment of the assumed functionality pithy of FGR-related loci. Three mAAM-appertain loci were FGR-linked to genes such as KISS1 (rs7538038) (effect allele G-odds ratio (OR)allelic = 0.63/pperm = 0.0003; ORadditive = 0.61/pperm = 0.001; ORdominant = 0.56/pperm = 0.001), NKX2-1 (rs999460) (effect allele A-ORallelic = 1.37/pperm = 0.003; ORadditive = 1.45/pperm = 0.002; ORrecessive = 2.41/pperm = 0.0002), GPRC5B (rs12444979) (effect allele T-ORallelic = 1.67/pperm = 0.0003; ORdominant = 1.59/pperm = 0.011; ORadditive = 1.56/pperm = 0.009). The haplotype ACA FSHB gene (rs555621*rs11031010*rs1782507) was FRG-correlated (OR = 0.71/pperm = 0.05). Ten FGR-implicated interworking models were founded for 13 SNPs (pperm ≤ 0.001). The rs999460 NKX2-1 and rs12444979 GPRC5B interplays significantly influenced the FGR risk (these SNPs were present in 50% of models). FGR-related mAAM-appertain 15 polymorphic variants and 350 linked SNPs were functionally momentous in relation to 39 genes participating in the regulation of hormone levels, the ovulation cycle process, male gonad development and vitamin D metabolism. Thus, this study showed, for the first time, that the mAAM-appertain genes determine FGR risk.

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Mednova I.A., Pozhidaev I.V., Tiguntsev V.V., Bocharova A.V., Paderina D.Z., Boiko A.S., Fedorenko O.Y., Kornetova E.G., Bokhan N.A., Stepanov V.A., et al.
Biomedicines. 2024. 12(3), 627.
DOI: 10.3390/biomedicines12030627

Metabolic syndrome (MetS) is common among schizophrenia patients, and one of MetS’s causes may be an imbalance in nitric oxide regulation. In this study, we examined associations of three polymorphic variants of the nitric oxide synthase 1 adapter protein (NOS1AP) gene with MetS in schizophrenia. NOS1AP regulates neuronal nitric oxide synthase, which controls intracellular calcium levels and may influence insulin secretion. The aim of the investigation was to study polymorphic variants of the NOS1AP gene as possible markers of MetS in patients with schizophrenia. A total of 489 Caucasian patients with schizophrenia (ICD-10) from Siberia (Russia) were included in the study, and 131 (26.8%) patients had MetS (IDF classification, 2007). The participants were genotyped for three single-nucleotide polymorphisms in NOS1AP (rs12143842, rs10494366, and rs12029454). Logistic regression was used for association analysis. Single-nucleotide polymorphisms, sex, and age served as covariates; the dependent variable was the coded parameter of the presence/absence of MetS. Polymorphisms rs12143842 and rs10494366 showed a stable association even after Bonferroni’s correction for multiple comparisons (p = 0.005 and 0.002, respectively), indicating a statistically significant contribution of these polymorphic variants to the pathogenesis of MetS. Our results suggest that in patients with schizophrenia, NOS1AP may be involved in MetS pathophysiology.

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Kucher A.N., Iuliia A. Koroleva Iu.A., Nazarenko M.S.
Biochemistry (Moscow), 2024. 89(1), 130-147.
DOI: 10.1134/S0006297924010085

Aortic aneurysm (AA) is a life-threatening condition with a high prevalence and risk of severe complications. The aim of this review was to summarize the data on the role of long non-coding RNAs (lncRNAs) in the development of AAs of various location. Within less than a decade of studies on the role of lncRNAs in AA, using experimental and bioinformatic approaches, scientists have obtained the data confirming the involvement of these molecules in metabolic pathways and pathogenetic mechanisms critical for the aneurysm development. Regardless of the location of pathological process (thoracic or abdominal aorta), AA was found to be associated with changes in the expression of various lncRNAs in the tissue of the affected vessels. The consistency of changes in the expression level of lncRNA, mRNA and microRNA in aortic tissues during AA development has been recordedand regulatory networks implicated in the AA pathogenesis in which lncRNAs act as competing endogenous RNAs (ceRNA networks) have been identified. It was found that the same lncRNA can be involved in different ceRNA networks and regulate different biochemical and cellular events; on the other hand, the same pathological process can be controlled by different lncRNAs. Despite some similarities in pathogenesis and overlapping of involved lncRNAs, the ceRNA networks described for abdominal and thoracic AA are different. Interactions between lncRNAs and other molecules, including those participating in epigenetic processes, have also been identified as potentially relevant to the AA pathogenesis. The expression levels of some lncRNAs were found to correlate withclinically significant aortic features and biochemical parameters. Identification of regulatory RNAs functionally significant in the aneurysm development is important for clarification of disease pathogenesis and will provide a basis for early diagnostics and development of new preventive and therapeutic drugs.

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Kucher A.N.,Nazarenko M.S.
Russian Journal of Genetics. 2024. 60(1), 32–48.
DOI: 10.1134/S1022795424010101

The review analyses the scope of the genes of Mendelian cardiomyopathies (CM), specifically hypertrophic, dilated, arrhythmogenic, and restrictive cardiomyopathy. According to Simple ClinVar, pathogenic/likely pathogenic variants of 75 genes trigger one or more types of CM. At the same time, these genes are characterized by their expression in various tissues and organs (not only in the heart and blood vessels but also in various parts of the brain, gastrointestinal tract, etc.), as well as by their involvement in a variety of metabolic pathways and biological processes. These data are generally consistent with the results of genomewide association studies (GWAS). Polymorphisms of the CM genes are associated with various types of CM and other cardiovascular diseases, as well as obesity, various diseases of the musculoskeletal and nervous systems, and mental, oncological, infectious, and other diseases. In addition to pathological conditions, common variants of the CM genes contributed to the variation of a wide range of quantitative traits, including pathogenetically significant for various multifactorial diseases. The non-randomness of the identified associations of CM genes with a wide range of diseases is evidenced by comorbidity of CM with GWAS-associated diseases or the involvement of the latter as a symptom, a risk factor for the development of myocardial pathology, and a modifier of the clinical presentation; overlapping of the affected organ systems and the spectrum of pathologies associated with common variants (according to GWAS) and to which rare pathogenic variants (according to OMIM) of the CM genes lead; and confirmation of the involvement of CM genes in the pathogenesis of diseases of other organ systems at the molecular level. Thus, the data presented in the review indicate the wide scope of the genes of primary CMs, which goes beyond the cardiovascular system. That indicates the relevance of conducting comprehensive studies aimed at determining the cause-and-effect relationships between the CM.

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Кашеварова А.А., Деменева В.В., Зуев А.С., Михайлик Л.И., Лопаткина М.Е., Федотов Д.А., Васильев С.А., Лебедев И.Н.
Медицинская генетика. 2024. Т. 24. № 2. С.55-58.
DOI: 10.25557/2073-7998.2024.02.55-58

Сочетание инвертированной дупликации с терминальной делецией 8р (invdupdel(8p)) - редкая хромосомная перестройка, проявляющаяся задержкой нейропсихического развития, умственной отсталостью, пороками сердца и аномалиями мозга. Известно, что полиморфная парацентрическая инверсия в структуре хромосомы 8 матери может привести к перестройке invdupdel(8р) у ее ребенка. Нами создана система зондов для поиска FISH-методом скрытой инверсии в хромосоме 8 матери пациента с задержкой развития, гипотонией, черепно-лицевыми аномалиями и кольцевой хромосомой 8, обусловленной invdupdel(8р). Инверсия в структуре хромосомы 8 у женщины выявлена, что указывает на необходимость проведения пренатальной диагностики при наступлении беременности.

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Кучер А.Н., Назаренко М.С.
Бюллетень Сибирской медицины. 2024. Т. 23. № 1, С. 156-165.
DOI: 10.20538/1682-0363-2024-1-156-165

Цель настоящего исследования заключалась в обобщении данных о спектре наследственных заболеваний и их фенотипических проявлениях при структурно-функциональных нарушениях в 75 генах, патогенные варианты которых связаны с формированием различных типов кардиомиопатий (КМП). Поиск научных публикаций проведен в зарубежных (PubMed) и отечественных (eLibrary) электронных библиотеках. Анализ данных выполнен с использованием баз Simple ClinVar, An Online Catalog of Human Genes and Genetic Disorders, а также интернет-ресурса STRING.Показано, что подавляющее большинство генов КМП обладают плейотропизмом и при моногенных заболеваниях, вызванных мутациями в данных генах, регистрируют широкий спектр патологических проявлений в различных системах органов (сердечно-сосудистой, нервной, эндокринной, костно-мышечной системы и соединительной ткани, кожи и придатков, органов зрения и слуха, почек), а также нарушения метаболизма и иммунитета. В связи с этим вне зависимости от первичного диагноза при выявлении у пациентов в генах КМП патогенных / вероятно патогенных вариантов или вариантов с неопределенной значимостью рекомендуется проведение детального и комплексного клинического обследования. Это имеет важное значение для уточнения эффектов редких вариантов генов, выделения клинически и прогностически значимых признаков для КМП и моногенных заболеваний, связанных с генами КМП, а также выявления групп риска и управляемых триггеров, способствующих проявлению патогенных генетических вариантов.

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Афанасьев С.А., Корепанов В.А., Бабушкина Н.П., Реброва Т.Ю., Муслимова Э.Ф., Голубенко М.В., Гарганеева А.А., Атабеков Т.А.
Вестник аритмологии. 2024. Т. 31. № 1 С. 71-76.
DOI: 10.35336/VA-1294

Цель. Исследовать функциональную состоятельность митохондрий и полиморфизм митохондриальной ДНК (мтДНК) у пациентов с ишемической болезнью (ИБС), имеющих жизнеугрожающие нарушения ритма сердца (НРС).

Материал и методы исследования. Исследовали венозную кровь 45 пациентов с неосложненной ИБС и 120 пациентов, имеющих ИБС с НРС. Определяли скорости потребления кислорода митохондрий лейкоцитов в состояниях V3 и V4 в пируват-малатном и сукцинатном буферах, а также присутствии пальмитиновой кислоты (ПК). У пациентов с осложнённой ИБС определяли гаплогруппу мтДНК и замены в генах, кодирующих белки комплексов дыхательной цепи и рРНК митохондрий. Статистический анализ результатов проводили, используя тест Манна-Уитни, критерий Вилкоксона и критерий Хи-квадрат с поправкой Йейтса.

Результаты. Cкорость потребления кислорода интактных митохондрии при неосложненной ИБС и ИБС с НРС достоверно не различались ни в пируват-малатном, ни в сукцинатном буферах. При неосложненной ИБС, добавление ПК увеличивает скорость потребления кислорода митохондриями и в сукцинатном, и пируват-малатном буфере. Большинство (41%) пациентов, имеющих ИБС с НРС, являлись носителями гаплогруппы «Н» и по этому показателю рассматриваемая выборка не отличалась от пациентов с неосложнённой ИБС. Однако мтДНК пациентов с осложнённой ИБС характеризовались более частым сочетанным носительством двух и более миссенс-замен в генах дыхательной цепи и рРНК.

Выводы. Митохондрии пациентов с ишемической болезнью и жизнеугрожающими нарушениями ритма сердца имеют сниженный функциональный резерв. Распределение частот основных гаплогрупп мтДНК пациентов, имеющих ишемическую болезнь с жизнеугрожающими нарушениями ритма сердца, соответствует популяционному. Для мтДНК таких пациентов характерна высокая частота носительства сочетанных полиморфизмов в генах белков электрон-транспортной цепи и рРНК.

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Bragina E. Yu., Gomboeva D. E., Saik O. V., Ivanisenko V. A., Freidin M.B., Nazarenko M. S.,Puzyrev V. P.
International Journal of Molecular Sciences. 2023. 24(11), 9385.

Cancer and neurodegenerative disorders present overwhelming challenges for healthcare worldwide. Epidemiological studies showed a decrease in cancer rates in patients with neurodegenerative disorders, including the Huntington disease (HD). Apoptosis is one of the most important processes for both cancer and neurodegeneration. We suggest that genes closely connected with apoptosis and associated with HD may affect carcinogenesis. We applied reconstruction and analysis of gene networks associated with HD and apoptosis and identified potentially important genes for inverse comorbidity of cancer and HD. The top 10 high-priority candidate genes included APOEPSEN1INSIL6SQSTM1SP1HTTLEPHSPA4, and BDNF. Functional analysis of these genes was carried out using gene ontology and KEGG pathways. By exploring genome-wide association study results, we identified genes associated with neurodegenerative and oncological disorders, as well as their endophenotypes and risk factors. We used publicly available datasets of HD and breast and prostate cancers to analyze the expression of the identified genes. Functional modules of these genes were characterized according to disease-specific tissues. This integrative approach revealed that these genes predominantly exert similar functions in different tissues. Apoptosis along with lipid metabolism dysregulation and cell homeostasis maintenance in the response to environmental stimulus and drugs are likely key processes in inverse comorbidity of cancer in patients with HD. Overall, the identified genes represent the promising targets for studying molecular relations of cancer and HD.

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Kobzeva K.A., Soldatova M.O., Stetskaya T.A., Soldatov V.O., Deykin A.V., Freidin M.B., Bykanova M.A., Churnosov M.I., Polonikov A.V., Bushueva O.Y.
Genes. 2023. Т. 14. № 6. С. 1171.
DOI: 10.3390/genes14061171

HSPA8 is involved in many stroke-associated cellular processes, playing a pivotal role in the protein quality control system. Here we report the results of the pilot study aimed at determining whether HSPA8 SNPs are linked to the risk of ischemic stroke (IS). DNA samples from 2139 Russians (888 IS patients and 1251 healthy controls) were genotyped for tagSNPs (rs1461496, rs10892958, and rs1136141) in the HSPA8 gene using probe-based PCR. SNP rs10892958 of HSPA8 was associated with an increased risk (risk allele G) of IS in smokers (OR = 1.37; 95% CI = 1.07–1.77; p = 0.01) and patients with low fruit and vegetable consumption (OR = 1.36; 95% CI = 1.14–1.63; p =0.002). SNP rs1136141 of HSPA8 was also associated with an increased risk of IS (risk allele A) exclusively in smokers (OR = 1.68; 95% CI = 1.23–2.28; p = 0.0007) and in patients with a low fruit and vegetable intake (OR = 1.29; 95% CI = 1.05–1.60; p = 0.04). Sex-stratified analysis revealed an association of rs10892958 HSPA8 with an increased risk of IS in males (risk allele G; OR = 1.30; 95% CI =1.05–1.61; p = 0.01). Thus, SNPs rs10892958 and rs1136141 in the HSPA8 gene represent novel genetic markers of IS.

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Spirina L.V.; Kovaleva I.V.; Chizhevskaya S.Y.; Chebodaeva A.V.; Tarasenko N.V.
Genes. 2023. 14(3), 685.
DOI: 10.3390/ genes14030685

Background: Autophagy is a stress response mechanism that causes cellular components to degrade. Its defects were associated with multiple pathologies, including cancers. Thyroid cancer is known to be the most prevalent form of malignant neoplasm among endocrine tumors. The aim of the study was to seek and comprehensively explore the role of autophagy related genes and proteins play in thyroid cancers through bioinformatics analysis with their detection in the tissue samples.

Methods: Bioinformatics analysis was performed to investigate autophagy related proteins and genes involvement in thyroid cancer progression. The experimental verification was done in cancer samples of one hundred and three patients with thyroid pathology included in the study. The miR-125blevel was detected by PCR in real time.

Results and discussion: The bioinformatics analysis verified the miR-125b as a regulatory mechanism in autophagy. Its expression in patients with PTC was reduced by 6.75 times in cancer patients compared to the patients with benign tumors. The BRAFV600E mutations were associated with a decrease in hsa-miR-125b expression by 12.67 times compared to tumors with the wild-type gene.

Conclusions: Our findings revealed involvement of the autophagy related proteins in cancer progression. The significant mechanisms of regulation are non-coding RNA sequences implicated in a variety of oncogenic processes. We found that miR-125b is a potential maker in thyroid cancer invasion, BRAV600E mutational status and risk of recurrence.

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