Ras-MAPK pathway in patients with lupus nephritis
Background Pathogenic mutations in genes encoding components of the Ras/mitogen-activated protein kinase (Ras-MAPK) pathway cause RASopathy. Here, we describe five unrelated patients with SLE carrying mutations associated with RASopathy and investigate the activity of the Ras-MAPK pathway.Methods Pa...
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BMJ Publishing Group
2025-03-01
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| Series: | Lupus Science and Medicine |
| Online Access: | https://lupus.bmj.com/content/12/1/e001345.full |
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| author | Dandan Liang Zhihong Liu Haitao Zhang Changming Zhang Jiahui Zhang Ying Jin Qing Zhong JingXian Yu Yangyang Zhang Xiaoman Jing Xingjian Gao |
| author_facet | Dandan Liang Zhihong Liu Haitao Zhang Changming Zhang Jiahui Zhang Ying Jin Qing Zhong JingXian Yu Yangyang Zhang Xiaoman Jing Xingjian Gao |
| author_sort | Dandan Liang |
| collection | DOAJ |
| description | Background Pathogenic mutations in genes encoding components of the Ras/mitogen-activated protein kinase (Ras-MAPK) pathway cause RASopathy. Here, we describe five unrelated patients with SLE carrying mutations associated with RASopathy and investigate the activity of the Ras-MAPK pathway.Methods Pathogenic variants were identified by whole-exome/whole-genome sequencing. The activity of the Ras-MAPK pathway in peripheral blood mononuclear cells (PBMC) and kidneys was evaluated using RNA sequencing and datasets from the nephroseq database, respectively.Results Five (likely) pathogenic variants in four Ras-MAPK genes were identified, including NRAS: c.G38A: p.G13D; ARAF: c.C1435T: p.R479C; KRAS: c.T341C: p.V114A; PTPN11: c.G455A: p.R152H and NRAS: c.G34A: p.G12S. Kidney injury is the main feature, presenting with nephrotic syndrome (2/5), proteinuria and haematuria (2/5). Acute kidney injury and rapidly progressive nephritic syndrome were noted in one patient each. Other clinical features included mucocutaneous lesions (5/5), cardiac involvement (4/5) and arthralgia (3/5). Laboratory abnormalities included hypocomplementaemia (5/5), presence of antiphospholipid antibodies (4/5), decreased regulatory T cells (3/3), pancytopenia (3/5) and persistent monocytosis (2/5). Kidney biopsy revealed lupus nephritis. Most patients responded well to standard therapy, with the exception of the patient with the NRAS p.G13D mutation who died. The Ras-MAPK pathway was activated in both PBMC and kidney of patients with LN as indicated by increased expression of NRAS, KRAS, RIT1, MRAS, PPP1CB, SHOC2, SOS2 and MAP2K1, as well as decreased expression of negative regulators of the Ras-MAPK pathway, CBL, LZTR1 and NF1.Conclusion Kidney involvement may be the main feature of the clinical spectrum of RASopathy. Genetic screening should be considered for patients with early onset lupus. |
| format | Article |
| id | doaj-art-b9a1ea97c58c47dd9bca2aabce47e42b |
| institution | DOAJ |
| issn | 2053-8790 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMJ Publishing Group |
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| series | Lupus Science and Medicine |
| spelling | doaj-art-b9a1ea97c58c47dd9bca2aabce47e42b2025-08-20T02:40:48ZengBMJ Publishing GroupLupus Science and Medicine2053-87902025-03-0112110.1136/lupus-2024-001345Ras-MAPK pathway in patients with lupus nephritisDandan Liang0Zhihong Liu1Haitao Zhang2Changming Zhang3Jiahui Zhang4Ying Jin5Qing Zhong6JingXian Yu7Yangyang Zhang8Xiaoman Jing9Xingjian Gao10National Clinical Research Center of Kidney Diseases, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, ChinaNational Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing University School of Meicine, Nanjing, China2 Department of Urology, Peking University Third Hospital, Beijing, ChinaNational Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing University School of Meicine, Nanjing, ChinaHeilongjiang Provincial Key Laboratory of Child Development and Genetic Research, Harbin Medical University, Harbin, Heilongjiang, ChinaNational Clinical Research Center of Kidney Diseases, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China3 Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fujian, ChinaDepartment of Liver Disease, Zhongshan Hospital Fudan University, Shanghai, ChinaDepartment of Cardiovascular Surgery, Shanghai Chest Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaSoutheast University School of Medicine, Nanjing, ChinaNational Clinical Research Center of Kidney Diseases, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, ChinaBackground Pathogenic mutations in genes encoding components of the Ras/mitogen-activated protein kinase (Ras-MAPK) pathway cause RASopathy. Here, we describe five unrelated patients with SLE carrying mutations associated with RASopathy and investigate the activity of the Ras-MAPK pathway.Methods Pathogenic variants were identified by whole-exome/whole-genome sequencing. The activity of the Ras-MAPK pathway in peripheral blood mononuclear cells (PBMC) and kidneys was evaluated using RNA sequencing and datasets from the nephroseq database, respectively.Results Five (likely) pathogenic variants in four Ras-MAPK genes were identified, including NRAS: c.G38A: p.G13D; ARAF: c.C1435T: p.R479C; KRAS: c.T341C: p.V114A; PTPN11: c.G455A: p.R152H and NRAS: c.G34A: p.G12S. Kidney injury is the main feature, presenting with nephrotic syndrome (2/5), proteinuria and haematuria (2/5). Acute kidney injury and rapidly progressive nephritic syndrome were noted in one patient each. Other clinical features included mucocutaneous lesions (5/5), cardiac involvement (4/5) and arthralgia (3/5). Laboratory abnormalities included hypocomplementaemia (5/5), presence of antiphospholipid antibodies (4/5), decreased regulatory T cells (3/3), pancytopenia (3/5) and persistent monocytosis (2/5). Kidney biopsy revealed lupus nephritis. Most patients responded well to standard therapy, with the exception of the patient with the NRAS p.G13D mutation who died. The Ras-MAPK pathway was activated in both PBMC and kidney of patients with LN as indicated by increased expression of NRAS, KRAS, RIT1, MRAS, PPP1CB, SHOC2, SOS2 and MAP2K1, as well as decreased expression of negative regulators of the Ras-MAPK pathway, CBL, LZTR1 and NF1.Conclusion Kidney involvement may be the main feature of the clinical spectrum of RASopathy. Genetic screening should be considered for patients with early onset lupus.https://lupus.bmj.com/content/12/1/e001345.full |
| spellingShingle | Dandan Liang Zhihong Liu Haitao Zhang Changming Zhang Jiahui Zhang Ying Jin Qing Zhong JingXian Yu Yangyang Zhang Xiaoman Jing Xingjian Gao Ras-MAPK pathway in patients with lupus nephritis Lupus Science and Medicine |
| title | Ras-MAPK pathway in patients with lupus nephritis |
| title_full | Ras-MAPK pathway in patients with lupus nephritis |
| title_fullStr | Ras-MAPK pathway in patients with lupus nephritis |
| title_full_unstemmed | Ras-MAPK pathway in patients with lupus nephritis |
| title_short | Ras-MAPK pathway in patients with lupus nephritis |
| title_sort | ras mapk pathway in patients with lupus nephritis |
| url | https://lupus.bmj.com/content/12/1/e001345.full |
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