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Genetic causes of focal segmental glomerulosclerosis (FSGS)

Genetic causes of focal segmental glomerulosclerosis (FSGS)
Gene locus Protein Protein function Phenotype Inheritance Response to therapy
Slit diaphragm associated proteins
NPHS1
19q13.1
Nephrin

Member of the immunoglobulin family

Essential component of the slit diaphragm
Finnish type congenital nephrotic syndrome, sporadic childhood FSGS, rarely adult onset FSGS AR Resistant to immunosuppression, reported cases of response to immunosuppression in heterozygous mutations or variants
NPHS2
1q25.2
Podocin Transmembrane protein involved in recruitment of nephrin to the slit diaphragm Familial or sporadic FSGS or DMS in early childhood-, adolescence-, or adult-onset FSGS in particular in compound heterozygotes for one pathogenic NPHS2 mutation and p.R229Q polymorphism AR Resistant to immunosuppression, reported cases of response to immunosuppression in heterozygous mutations or variants
CD2AP
6p12
CD2-associated protein Scaffolding molecule between slit diaphragm and actin cytoskeleton Childhood-onset FSGS AD, rarely AR Resistant to immunosuppression
PLCE1
10q23.33
Phospholipase C epsilon 1 Signaling protein, interacts with nephrin Isolated DMS, sporadic and familial early childhood-onset FSGS AR Reported cases of (partial) response to immunosuppression
TRPC6
11q22.1
Transient receptor potential cation channel 6 Receptor-activated calcium channel localized at the foot process membrane, interacts with nephrin and podocin Familial or sporadic adult-onset FSGS, childhood-onset FSGS has also been described AD Reported cases of (partial) response to immunosuppression
MAGI2
7q11.23-q21.11
Membrane-associated guanylate kinase, WW, and PDZ domain-containing 2 Scaffolding molecule between slit diaphragm and actin cytoskeleton Familial and sporadic congenital nephrotic syndrome AR Resistant to immunosuppression
Actin cytoskeleton and regulation
ACTN4
19q13
Alpha-actinin-4 Member of the spectrin gene superfamily, cytoskeletal protein Familial or sporadic adult-onset FSGS AD Resistant to immunosuppression
MYO1E
15q22.2
Nonmuscle myosin 1e

Member of the nonmuscle class I myosins

Involved in intracellular movement and membrane trafficking
Familial childhood-onset FSGS AR Reported cases of (partial) response to cyclosporine
ANLN
7p15-p14
Anillin F-actin binding protein, involved in slit diaphragm-cytoskeleton binding Familial adult-onset FSGS AD Resistant to immunosuppression
ARHGDIA
17q25.3
Rho GDP dissociation inhibitor alpha Regulation of podocyte migratory phenotype and shape Congenital or early childhood-onset nephrotic syndrome AR Resistant to immunosuppression, may respond to RAC1 inhibitors (eplerenone)
ARHGAP24
4q22.1
Rho GTPase activating protein 24 Regulation of podocyte migratory phenotype and shape Adolescence-onset FSGS AD Resistant to immunosuppression
TTC21B
2q24.3
Tetratricopeptide repeat domain 21B Intraflagellar transport-A component, regulation cytoskeleton adult podocytes Adolescence- or adult-onset FSGS associated with atrophic tubules AR Resistant to immunosuppression
KANK2
19p13.2
Kidney ankyrin repeat-containing protein 2 Regulation Rho GTPase activity in podocytes (cell migration and shape) Familial early-onset SRNS AR Resistant to immunosuppression
INF2
14q32.33
Inverted formin 2 Member of the formin family, function in depolymerization and polymerization of actin filaments Familial or sporadic adolescence- and adult-onset FSGS AD Resistant to immunosuppression
Nuclear pore complex proteins
NUP93
16q13
Nucleoporine 93 kDa Component of the nuclear pore complex Familial childhood-onset SRNS AR Resistant to immunosuppression
NUP205
7q33
Nucleoporine 205 kDa Component of the nuclear pore complex Familial childhood-onset SRNS AR Resistant to immunosuppression
XPO5
6p21.1
Exportin 5 Component of the nuclear pore complex Familial childhood-onset SRNS AR Resistant to immunosuppression
NUP107
12q15
Nucleoporine 107 kDa Component of the nuclear pore complex Childhood-onset FSGS AR Resistant to immunosuppression
Cell membrane-associated proteins
PTPRO
12p13-p12
Protein tyrosine phosphatase, receptor type O Member of the R3 subtype family of protein tyrosine phosphatases at the apical surface of polarized cells Childhood-onset FSGS AR Resistant to immunosuppression, reported cases of (partial) response to immunosuppression
EMP2
16p13.2
Epithelial membrane protein 2 Regulation of the amount of CAVEOLIN-1, EMP2 depletion causes decreased cell proliferation Childhood-onset FSGS AR Reported cases of response to steroids
PODXL
7q32.3
Podocalyxin Component of glycocalyx Familial childhood- and adult-onset FSGS AD Resistant to immunosuppression
GBM protein
LAMA5
20q13.2-q13.3
Laminin alpha-5 Member of the alpha-subfamily of laminin chains, major component of basement membranes Adult-onset FSGS AR/AD Likely resistant to immunosuppression
AD: autosomal dominant; AR: autosomal recessive; DMS: diffuse mesangial sclerosis; FSGS: focal segmental glomerulosclerosis; GBM: glomerular basement membrane; GDP: guanosine diphosphate; GTP: guanosine triphosphate; kDA: kilodalton; SRNS: steroid-resistant nephrotic syndrome.
Adapted with permission from: De Vriese AS, Sethi S, Nath KA, et al. Differentiating primary, genetic, and secondary FSGS in adults: A clinicopathologic approach. J Am Soc Nephrol 2018; 29:759. Copyright © 2018 American Society of Nephrology.
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