Hanemann C O
Clinical Neurobiology, Peninsula Medical School, The John Bull Building, Tamar Science Park, Research Way, Plymouth, PL6 8BU, UK.
Brain. 2008 Mar;131(Pt 3):606-15. doi: 10.1093/brain/awm249. Epub 2007 Oct 16.
Alterations in the NF2 gene coding for merlin cause all tumours that occur in patients suffering from neurofibromatosis type 2, all spontaneous schwannomas and the majority of meningiomas. Thus merlin's tumours are quite frequent and also numerous when inherited as part of meurofibromatosis type 2. Tumours caused by mutations in the NF2 gene are benign and thus do not respond to classical chemotherapy. Surgery and radiosurgery are only local therapies and the patients frequently require multiple treatments. This highlights the medical need to understand how merlin loss results in tumourigenesis and the need to find new systemic therapies. The benign, and therefore genetically stable and homogenous character of the tumours allows establishment of meaningful tumour models. This brings about the rather unique opportunity to both analyse the consequences of the gene defect and identify new therapeutic targets. In this review, I will first describe the phenotypes associated with 'merlin' mutations and consider differential diagnosis, in particular Schwannomatosis, for which a gene defect has been described recently. Existing therapeutic options, surgery and radiosurgery, including new data on the latter will be reviewed. Finally, I will discuss how loss of merlin leads to tumourigenesis in order to understand the rationale for emerging new therapeutic targets.
编码默林蛋白的NF2基因发生改变会导致2型神经纤维瘤病患者出现的所有肿瘤、所有自发性神经鞘瘤以及大多数脑膜瘤。因此,默林蛋白相关肿瘤相当常见,作为2型神经纤维瘤病的一部分遗传时数量也很多。由NF2基因突变引起的肿瘤是良性的,因此对传统化疗无反应。手术和放射外科只是局部治疗方法,患者常常需要多次治疗。这凸显了了解默林蛋白缺失如何导致肿瘤发生的医学需求以及寻找新的全身治疗方法的必要性。肿瘤的良性特征,以及由此具有的基因稳定性和同质性,使得建立有意义的肿瘤模型成为可能。这带来了一个相当独特的机会,既能分析基因缺陷的后果,又能确定新的治疗靶点。在本综述中,我将首先描述与“默林蛋白”突变相关的表型,并考虑鉴别诊断,特别是最近已描述了基因缺陷的施万细胞瘤病。将回顾现有的治疗选择,即手术和放射外科,包括后者的新数据。最后,我将讨论默林蛋白缺失如何导致肿瘤发生,以便理解新出现的治疗靶点的原理。