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Query: EC:2.7.10.1 (
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The subset of CD30-positive anaplastic large cell lymphomas (ALCL) with the NPM-
ALK
gene fusion arising from the t(2;5)(p23;q35) forms a distinct clinical and prognostic entity. Recently, various cytogenetic, molecular, and protein studies have provided evidence for the existence of several types of variant
ALK
fusions in up to 20% of ALK+ ALCL, of which only one, a TPM3-
ALK
fusion resulting from a t(1;2)(q25;p23), has so far been cloned. A cryptic inv(2)(p23q35) has been described as another recurrent cytogenetic alteration involving
ALK
and an unidentified fusion partner in some ALCL. In a screen for variant
ALK
gene fusions, we identified two ALCL that were negative for NPM-
ALK
by reverse transcriptase-polymerase chain reaction, but were positive for cytoplasmic
ALK
with both polyclonal and monoclonal antibodies to the
ALK
tyrosine kinase domain, consistent with
ALK
deregulation by an alteration other than the t(2;5) Case 1 was a T-lineage nodal and cutaneous ALCL in a 52-year-old woman, and Case 2 was a T-lineage nodal ALCL in a 12-year-old girl. FISH analysis confirmed
ALK
rearrangement in both cases. An inverse polymerase chain reaction approach was then used to identify the
ALK
translocation partner in Case 1. We found an in-frame fusion of
ALK
to
ATIC
, a gene previously mapped to 2q34-q35. We then confirmed by DNA polymerase chain reaction the localization of
ATIC
to yeast artificial chromosome (YAC) 914E7 previously reported to span the 2q35 break in the inv(2)(p23q35). FISH analysis in Case 1 confirmed rearrangement of YAC 914E7 and fusion to
ALK
. The
ATIC
-
ALK
fusion was confirmed in Case 1 and also identified in Case 2 by conventional reverse transcriptase-polymerase chain reaction using
ATIC
forward and
ALK
reverse primers.
ATIC
encodes an enzyme involved in purine biosynthesis which, like other fusion partners of
ALK
, is constitutively expressed and appears to contain a dimerization domain.
ATIC
-
ALK
fusion resulting from the inv(2)(p23q35) thus provides a third mechanism of
ALK
activation in ALK+ ALCL.
...
PMID:ATIC-ALK: A novel variant ALK gene fusion in anaplastic large cell lymphoma resulting from the recurrent cryptic chromosomal inversion, inv(2)(p23q35). 1070 93
Despite its clinical and histological heterogeneity, anaplastic large cell lymphoma (ALCL) is now a well-recognized clinicopathological entity accounting for 2% of all adult non-Hodgkin's lymphomas (NHL) and about 13% of pediatric NHL. Immunophenotypically, ALCL are of T cell (predominantly) or Null cell type; by definition, cases expressing B cell antigens are officially not included in this entity. The translocation (2;5)(p23;q35) is a recurring abnormality in ALCL; 46% of the ALCL patients bear this signature translocation. This translocation creates a fusion gene composed of nucleophosmin (NPM) and a novel receptor tyrosine kinase gene, named
anaplastic lymphoma kinase
(
ALK
). The NPM-
ALK
chimeric gene encodes a constitutively activated tyrosine kinase that has been shown to be a potent oncogene. The exact pathogenetic mechanisms leading to lymphomagenesis remain elusive; however, the synopsis of evidence obtained to date provides an outline of likely scenarios. Several t(2;5) variants have been described; in some instances, the breakpoints have been cloned and the genes forming a new fusion gene with
ALK
have been identified:
ATIC
-
ALK
, TFG-
ALK
and TPM3-
ALK
. Cloning the translocation breakpoint and identifying the
ALK
and NPM genes provided tools for screening material from patients with ALCL using various approaches at the chromosome, DNA, RNA, or protein level: positive signals in the reverse transcriptase-polymerase chain reaction (RT-PCR) and the immunostaining with anti-
ALK
monoclonal antibodies (McAb) serve as the most convenient tests for detection of the t(2;5) NPM-
ALK
since the fusion gene and
ALK
protein expression do not occur in normal or reactive lymphoid tissue. The wide range of NPM-
ALK
positivity reported in different series appears to be dependent on the inclusion and selection criteria of the ALCL cases studied. Overall, however, 43% of ALCL cases were NPM-ALK+ (83% of pediatric ALCL vs 31% of adult ALCL). Occasional non-ALCL B cell lymphomas (4%) with diffuse large cell and immunoblastic histology and Hodgkin's disease cases (3%) were NPM-
ALK
-, but these data are questionable. The aggregate results indicate that, in contrast to primary nodal (systemic) ALCL, the t(2;5) may be present in only 10-20% of primary cutaneous ALCL and rarely, if at all, in lymphomatoid papulosis, a potential precursor lesion; however, these 10-20% positive cases were not confirmed by anti-
ALK
McAb immunostaining and may represent an overestimate. Positivity for NPM-
ALK
is associated to various degrees with the following parameters: 44% and 45% of ALCL cases with T cell and Null cell immunophenotype, respectively, are positive, whereas only 8% of cases with a B cell immunoprofile are positive; the mean age of positive patients is significantly younger than that of negative patients; positive cases carry a better overall prognosis (but not in all studies). Recently, the homogenous category of
ALK
lymphoma ('ALKoma') has emerged as a distinct pathological entity within the heterogenous group of ALCL. The fact that patients with
ALK
lymphomas experience significantly better overall survival than
ALK
- ALCL demonstrates further that analysis of
ALK
expression has important prognostic implications. The term
ALK
lymphoma signifies a switch in the use of the diagnostic criteria: cases are selected on the basis of a genetic abnormality (the
ALK
rearrangement), instead of the review of morphological or immunophenotypical features which are clearly more prone to disagreement and controversy. Since its initial description in 1985 ALCL has become one of the best characterized lymphoma entities.
...
PMID:Pathobiology of NPM-ALK and variant fusion genes in anaplastic large cell lymphoma and other lymphomas. 1099 99
Anaplastic large cell lymphoma (ALCL) is frequently associated with the t(2;5)(p23;q35) translocation. It creates a NPM-
ALK
fusion gene, fusing the
anaplastic lymphoma kinase
(
ALK
) gene (2p23) and the nucleophosmin (NPM) gene (5q35). Other rearrangements involving the
ALK
gene have recently been shown to be associated with ALCL, among which the
ATIC
-
ALK
rearrangement resulting from the inv(2)(p23q35) translocation is probably the most recurrent. The aims of the present study were to investigate the presence of NPM-
ALK
and
ATIC
-
ALK
fusion genes in ALCL, using a real-time 5' exonuclease-based reverse-transcription polymerase chain reaction (RT-PCR). This sensitive technique was also applied to investigate whether both fusion genes might be detected in Hodgkin's disease cases and in reactive lymphoid tissue. Results of the RT-PCR were compared to
ALK
immunostaining, cytogenetics, and fluorescence in situ hybridization (FISH) results. RT-PCR detected the NPM-
ALK
and
ATIC
-
ALK
fusions at high levels in 8 and 3 of a total of 13
ALK
-positive ALCL cases. One
ALK
-positive ALCL case was negative for both fusion genes analyzed but revealed a new
ALK
-related translocation t(2;17)(p23;q25) by cytogenetic and FISH analysis. In addition, of the eight
ALK
-positive ALCL cases that were strongly positive for the NPM-
ALK
fusion, three cases also showed the presence of the
ATIC
-
ALK
fusion, although at much lower levels. Similarly, out of the three strongly positive
ATIC
-
ALK
cases, one case was positive for the NPM-
ALK
fusion, at low levels. Finally, the NPM-
ALK
and the
ATIC
-
ALK
fusions were detected, at equally low levels, respectively in 13 and 5
ALK
-negative ALCL cases, in 11 and 5 Hodgkin's disease cases and in 20 and 1 non-neoplastic lymphoid tissues. The distinction between the high- and low-level detection was confirmed by relative quantitative RT-PCR for a representative number of cases. Of interest is the fact that the high-level detection coincided with the presence of
ALK
gene rearrangement detected by cytogenetics and FISH and may reflect a central role of the transcript in the oncogenic mechanism of
ALK
-positive ALCL. Low-level detection is not supported by cytogenetics and FISH, presumably due to the presence of the transcripts in only a small minority of normal cells not detectable by these techniques. Our findings demonstrate that NPM-
ALK
and
ATIC
-
ALK
fusion transcripts may be detected in conditions other than
ALK
-positive ALCL including reactive lymphoid tissues, although at low levels, suggesting the presence of the transcripts in normal (bystander) cells. Moreover, they suggest that the
ALK
gene rearrangement by itself might be insufficient to induce tumor formation. They further question the validity of quantitative real-time RT-PCR for monitoring minimal residual disease in ALCL. Finally, the newly identified translocation t(2;17)(p23;q25) can be added to the list of
ALK
gene rearrangements occurring in
ALK
-positive ALCL.
...
PMID:The NPM-ALK and the ATIC-ALK fusion genes can be detected in non-neoplastic cells. 1139 96
ALK
-positive anaplastic large-cell lymphoma (ALCL) has been recognized as a distinct type of lymphoma in the heterogeneous group of T/Null-ALCL. While most of the
ALK
-positive ALCL (ALKomas) are characterized by the presence of the NPM-
ALK
fusion protein, the product of the t(2;5)(p23;q35), 10-20% of ALKomas contain variant
ALK
fusions, including
ATIC
-
ALK
, TFG-
ALK
, CLTC-
ALK
(previously designated CLTCL-
ALK
), TMP3-
ALK
, and MSN-
ALK
. TMP3-
ALK
and TMP4-
ALK
fusions also have been detected in inflammatory myofibroblastic tumors (IMTs), making clear that aberrations of the
ALK
gene are not associated exclusively with the pathogenesis of
ALK
-positive ALCL. Here we report results of molecular studies on two lymphoma cases and one IMT case with variant rearrangements of
ALK
. Our study led to the detection of the CLTC-
ALK
fusion in an ALCL case and to the identification of two novel fusion partners of
ALK
: ALO17 (KIAA1618), a gene with unknown function, which was fused to
ALK
in an ALCL case with a t(2;17)(p23;q25), and CARS, encoding the cysteinyl-tRNA synthetase, which was fused to
ALK
in an IMT case with a t(2;11;2)(p23;p15;q31). These results confirm the recurrent involvement of
ALK
in IMT and further demonstrate the diversity of
ALK
fusion partners, with the ability to homodimerize as a common characteristic.
...
PMID:Identification of novel fusion partners of ALK, the anaplastic lymphoma kinase, in anaplastic large-cell lymphoma and inflammatory myofibroblastic tumor. 1211 24
In anaplastic large cell lymphoma, the
ALK
gene at 2p23 is known to be fused to NPM, TPM3, TPM4, TFG,
ATIC
, CLTC, MSN, and ALO17. All of these translocations result in the expression of chimeric
ALK
transcripts that are translated into fusion proteins with tyrosine kinase activity and oncogenic properties. We report a case showing a restricted cytoplasmic staining pattern of
ALK
and a novel chromosomal abnormality, t(2;22)(p23;q11.2), demonstrated by fluorescence in situ hybridization analysis. The result of 5' RACE analysis showed that the
ALK
gene was fused in-frame to a portion of the non-muscle myosin heavy chain gene, MYH9. Nucleotide sequence of the MYH9-
ALK
chimeric cDNA revealed that the
ALK
breakpoint was different from all those previously reported. It is localized in the same exonic sequence as MSN-
ALK
, but 6 bp downstream, resulting in an in-frame fusion of the two partner proteins. In contrast to the previously reported
ALK
fusion proteins, MYH9-
ALK
may lack a functional oligomerization domain. However, biochemical analysis showed that the new fusion protein is tyrosine phosphorylated in vivo but seems to lack tyrosine kinase activity in vitro. If further investigations confirm this latter result, the in vivo tyrosine phosphorylation of MYH9-
ALK
protein could involve mechanisms different from those described in the other
ALK
hybrid proteins.
...
PMID:Non-muscle myosin heavy chain (MYH9): a new partner fused to ALK in anaplastic large cell lymphoma. 1280 Jan 56
In this report, we describe an inflammatory myofibroblastic tumor (IMT) of the urinary bladder in a 46-year-old man. Tumor cells presented striking cytoplasmatic
ALK
immunopositivity. Cytogenetic and FISH analysis, by use of a multicolor chromosome 2 banding probe, revealed a 46,XY,der(2)(2pter-->2p23:2q35-->2q37:2p11-->2q35:2p23-->2p11:2q37-->2qter) karyotype. Subsequent FISH and RT-PCR analysis confirmed the
ALK
-
ATIC
chimeric fusion in tumor cells. This is the first evidence of a variant rearrangement involving the
ATIC
gene in IMT and the first cytogenetic description of an IMT originating from the urinary bladder.
...
PMID:ALK-ATIC fusion in urinary bladder inflammatory myofibroblastic tumor. 1293 46
Anaplastic large cell lymphomas (ALCLs) represent a heterogeneous group of malignant lymphoproliferative diseases. Most of the cases are of T-cell line with a loss of cell surface receptors but with a production of cytotoxic cytoplasmatic granules--immunohistochemically (IHC) positive perforin, granzyme B, and TIA-1. The diagnostics of ALCL is based on morphological findings and results of IHC, which further stratify ALCLs to basic immunophenotypes according to
ALK
(
anaplastic lymphoma kinase
) protein expression--ALCL CD30+ ALK+ and ALCL CD30+ ALK+. The morphological investigations are supplemented by karyotyping and/or by a demonstration of breakpoint at 2p23 harboring
ALK
gene (FISH), and by molecular detection of chimeric genes characteristic of ALK+ lymphomas (NPM-
ALK
,
ATIC
-
ALK
, TPM3-
ALK
, TFG-
ALK
, and some even rarer rearrangements). Molecular diagnostics is important in monitoring minimal residual disease. As some of the characteristic molecular changes were demonstrated in healthy individuals and in Hodgkin's disease by quantitative PCR, the validation of these findings demands further studies.
ALK
protein positive ALCLs affect patients in age categories up to the third decade, whereas
ALK
protein negative cases occur in older patients with an average age of 60 years. Both subgroups of lymphomas are aggressive but ALK+ lymphomas react well to systemic treatment, and have a more favorable prognosis. Primary skin ALCLs belong to a group of T-cell lymphoproliferative diseases of the skin and have, in the majority of cases, a favorable course without generalization.
...
PMID:[Anaplastic large-cell lymphoma: review]. 1463 6
To evaluate t(2;5) and its variants, we studied 21 pediatric cases of
anaplastic lymphoma kinase
(
ALK
)+ anaplastic large cell lymphoma (ALCL) by using immunohistochemical staining, fluorescence in situ hybridization, cytogenetics, and reverse transcriptase-polymerase chain reaction. Results showed 7 (33%) cases with t(2;5), 6 (29%) with variant gene rearrangements, 7 (33%) with uncharacterized rearrangements, and 1 with
ALK
protein expression but no
ALK
rearrangement. Among 6 variant gene rearrangements, 1 had TPM4-
ALK
/t(2;19)(p23;p13) and 2 had inv(2) with the breakpoint proximate to
ATIC
-
ALK
and an unknown partner gene separately. The genetic features of the remaining 3 cases were as follows: ins(8;2) with an unknown partner gene; conversion from
ALK
- at diagnosis to ALK+ at recurrence with unspecified gene rearrangement; complex karyotype without involvement of 2p23, suggesting a cryptic translocation. Concordance between different laboratory results varied from 47% to 81%. These data suggest that
ALK
variants are not uncommon and underscore the necessity of integrating immunohistochemical, cytogenetic, and molecular genetic approaches to detect, characterize, and confirm t(2;5) and its variant translocations.
...
PMID:Assessment of t(2;5)(p23;q35) translocation and variants in pediatric ALK+ anaplastic large cell lymphoma. 1508 Mar 1
Majority of anaplastic large-cell lymphomas (ALCLs) are associated with the t(2;5)(p23;q35) translocation, fusing the NPM (nucleophosmin) and
ALK
(
anaplastic lymphoma kinase
) genes (NPM-
ALK
). Recent studies demonstrated that
ALK
may also be involved in variant translocations, namely, t(1;2)(q25;p23), t(2;3)(p23;q21), t(2;17)(p23;q23) and inv(2)(p23q35), which create the TPM3-
ALK
, TFG-ALK5, CLTC-
ALK
, and
ATIC
-
ALK
fusion genes, respectively. Although overexpression of NPM-
ALK
has previously been shown to transform fibroblasts, the transforming potential of variant X-
ALK
proteins has not been precisely investigated. We stably transfected the cDNAs coding for NPM-
ALK
, TPM3-
ALK
, TFG-
ALK
, CLTC-
ALK
or
ATIC
-
ALK
into nonmalignant NIH3T3 cells. All X-
ALK
variants are tyrosine phosphorylated and their subcellular distribution was in agreement with that observed in tumors. Moreover, our results show that the in vitro transforming capacity of NIH3T3-transfected cells are in relation to the level of X-
ALK
fusion proteins excepted for TPM3-
ALK
for which there is an inverse correlation. The differences between the five X-
ALK
variants with regard to proliferation rate, colony formation in soft agar, invasion, migration through the endothelial barrier and tumorigenicity seem to be due to differential activation of various signaling pathways such as PI3-kinase/AKT. These findings may have clinical implications in the pathogenesis and prognosis of
ALK
-positive ALCLs.
...
PMID:Differential effects of X-ALK fusion proteins on proliferation, transformation, and invasion properties of NIH3T3 cells. 1520 56
In anaplastic large-cell lymphomas positive for
anaplastic lymphoma kinase
(
ALK
) protein, the
ALK
gene is most commonly fused to the NPM gene, and less commonly to TPM3, TFG,
ATIC
, and other rare genes. Although this lymphoma is generally associated with a favorable clinical outcome, 25% of the patients die of the disease within 5 years. In this study, we developed three assays, all of which can be used with archival formalin-fixed, paraffin-embedded tissues: (1) a sensitive reverse transcription-polymerase chain reaction (RT-PCR) assay for various X-
ALK
fusion genes, (2) a 5' rapid amplification of cDNA ends (RACE) assay to identify unknown fusion partners, and (3) a real-time RT-PCR assay to quantify the amount of the NPM-
ALK
fusion transcript. In 26 cases of
ALK
(+) anaplastic large-cell lymphoma, the RT-PCR assay showed that the
ALK
was fused to NPM in 21 cases, to TPM3 in three, and to TFG in one. The 5' RACE assay detected
ATIC
-
ALK
fusion in the remaining case. The real-time quantitative RT-PCR assay showed that the NPM-
ALK
transcript was over expressed in four of 20 quantifiable cases. Patients with NPM-
ALK
overexpression showed a significantly unfavorable overall survival compared with those with a low expression of this transcript. The RT-PCR and 5' RACE assays developed here may be useful for identification of known and unknown gene partners fused to the
ALK
gene. Overexpression of the NPM-
ALK
fusion transcript may be associated with a poor prognosis of the patients with
ALK
(+) anaplastic large-cell lymphomas.
...
PMID:Prognostic significance of NPM-ALK fusion transcript overexpression in ALK-positive anaplastic large-cell lymphoma. 1746 20
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