1. Last 7 days
    1. The BCL-2 mutation G101V reduces venetoclax affinity and confers drug resistance in patients with chronic lymphocytic leukaemia. Here, the authors present crystal structures and biochemical analyses of venetoclax bound t

      [Paragraph-level] PMCID: PMC6547681 Section: ABSTRACT PassageIndex: 2

      Evidence Type(s): Predictive, Functional

      Justification: Predictive: The variant G101V is associated with drug resistance to venetoclax in patients, indicating a correlation with treatment response. Functional: The passage discusses the biochemical analyses of the G101V mutant, revealing how it alters the affinity of venetoclax, which relates to its molecular function.

      Gene→Variant (gene-first): 596:G101V

      Genes: 596

      Variants: G101V

    2. Venetoclax is a first-in-class cancer therapy that interacts with the cellular apoptotic machinery promoting apoptosis. Treatment of patients suffering chronic lymphocytic leukaemia with this BCL-2 antagonist has reveale

      [Paragraph-level] PMCID: PMC6547681 Section: ABSTRACT PassageIndex: 1

      Evidence Type(s): Predictive, Functional

      Justification: Predictive: The passage discusses the emergence of the G101V mutation in patients failing therapy with venetoclax, indicating a correlation between the variant and resistance to this specific therapy. Functional: The passage describes how the G101V mutation alters the binding of venetoclax to BCL-2, indicating a change in molecular function related to drug resistance.

      Gene→Variant (gene-first): 596:E152 596:E152A 596:G101V 596:V101

      Genes: 596

      Variants: E152 E152A G101V V101

    1. Advanced cholangiocarcinoma continues to harbor a difficult prognosis and therapeutic options have been limited. During the course of a clinical trial of whole genomic sequencing seeking druggable targets, we examined si

      [Paragraph-level] PMCID: PMC3923676 Section: ABSTRACT PassageIndex: 1

      Evidence Type(s): Predictive, Oncogenic

      Justification: Predictive: The passage discusses the use of erlotinib, an EGFR kinase inhibitor, in a patient with the ERRFI1 E384X mutation, noting rapid and robust disease regression, indicating a correlation between the variant and response to therapy. Oncogenic: The E384X variant in ERRFI1 is described as a somatic mutation that inactivates a negative regulator of EGFR activation, suggesting its contribution to tumor development or progression.

      Gene→Variant (gene-first): 672:E384X

      Genes: 672

      Variants: E384X

    1. The efficacy of osimertinib against HER2 exon 19, p.L755P mutations and other HER2 exon 19 aberrations should be tested in clinical trials to determine its efficacy as a potential HER2 targeted treatment for patients har

      [Paragraph-level] PMCID: PMC10183391 Section: RESULTS PassageIndex: 7

      Evidence Type(s): Predictive, Diagnostic

      Justification: Predictive: The passage discusses the efficacy of osimertinib as a potential treatment for patients harboring the p.L755P mutation, indicating a correlation with response to therapy. Diagnostic: The mention of "patients harboring these mutations" suggests that the p.L755P variant is used to classify or define a specific group of patients, indicating its role in diagnosis.

      Gene→Variant (gene-first): 2064:p.L755P

      Genes: 2064

      Variants: p.L755P

    2. Here we demonstrate for the first time in humans, that osimertinib was an effective and well tolerated treatment in a patient with stage IV NSCLC harboring HER2 exon 19, p.L755P mutation.

      [Paragraph-level] PMCID: PMC10183391 Section: RESULTS PassageIndex: 5

      Evidence Type(s): Predictive, Diagnostic

      Justification: Predictive: The passage indicates that the p.L755P mutation is associated with an effective response to the treatment with osimertinib in a patient with stage IV NSCLC. Diagnostic: The passage mentions that the patient harbors the p.L755P mutation, which is used to classify the patient's disease subtype (HER2 exon 19 mutation in NSCLC).

      Gene→Variant (gene-first): 2064:p.L755P

      Genes: 2064

      Variants: p.L755P

    3. Osimertinib, a 3rd generation EGFR-TKI has been found in pre-clinical studies, both in vitro and in vivo, to have activity against various HER2 exon 19 aberrations, including HER2 exon 19, p.L755P mutations.

      [Paragraph-level] PMCID: PMC10183391 Section: RESULTS PassageIndex: 4

      Evidence Type(s): Predictive, Oncogenic

      Justification: Predictive: The passage discusses the activity of Osimertinib against the p.L755P mutation, indicating a correlation with response to therapy. Oncogenic: The mention of the p.L755P mutation in the context of HER2 exon 19 aberrations suggests that it contributes to tumor development or progression, as it is associated with a specific cancer-related mutation.

      Gene→Variant (gene-first): 2064:p.L755P

      Genes: 2064

      Variants: p.L755P

    4. We present a case of a 68-year-old female with stage IV NSCLC harboring a ERBB2 exon 19 c.2262_2264delinsTCC, p.(L755P) mutation treated with osimertinib, resulting in intra- and extracranial response.

      [Paragraph-level] PMCID: PMC10183391 Section: RESULTS PassageIndex: 2

      Evidence Type(s): Predictive, Diagnostic

      Justification: Predictive: The passage discusses a patient treated with osimertinib, indicating that the variant correlates with a response to this specific therapy. Diagnostic: The variant is described as being present in a patient with stage IV NSCLC, suggesting its role in defining or classifying the disease.

      Gene→Variant (gene-first): 2064:c.2262_2264delinsTCC 2064:p.(L755P)

      Genes: 2064

      Variants: c.2262_2264delinsTCC p.(L755P)

    1. We found that ERBB2 E401G enhances C-terminal phosphorylation in a way similar to S310F. MD simulation analysis revealed that these variants maintain the stability of the EGFR-HER2 heterodimer in a ligand-independent man

      [Paragraph-level] PMCID: PMC8881279 Section: ABSTRACT PassageIndex: 6

      Evidence Type(s): Functional, Oncogenic

      Justification: Functional: The passage discusses how the variants E401G and S310F alter molecular function by enhancing C-terminal phosphorylation and maintaining the stability of the EGFR-HER2 heterodimer. Oncogenic: The passage indicates that ERBB2 E401G-transduced cells exhibit increased tumor growth capacity in vivo, suggesting that this variant contributes to tumor development or progression.

      Gene→Variant (gene-first): 2176:E401G 2064:S310F

      Genes: 2176 2064

      Variants: E401G S310F

    2. ERBB2 E401G was selected as VUS for analysis because multiple software tools predicted its pathogenicity. We prepared ERBB2 expression vectors with the E401G variant as well as vectors with S310F and E321G, which are kno

      [Paragraph-level] PMCID: PMC8881279 Section: ABSTRACT PassageIndex: 4

      Evidence Type(s): Functional, Oncogenic

      Justification: Functional: The passage discusses the evaluation of the phosphorylation of human epidermal growth factor receptor 2 and related proteins, as well as the investigation of the biological effects of the ERBB2 E401G variant, indicating an alteration in molecular function. Oncogenic: The mention of S310F and E321G as known activating mutations suggests that these variants contribute to tumor development or progression, aligning with the oncogenic evidence type.

      Gene→Variant (gene-first): 7157:E321G 2176:E401G 2064:S310F

      Genes: 7157 2176 2064

      Variants: E321G E401G S310F

    3. Dealing with variants of unknown significance (VUS) is an important issue in the clinical application of NGS-based cancer gene panel tests. We detected a novel ERBB2 extracellular domain VUS, c.1157A > G p.(E401G), in a

      [Paragraph-level] PMCID: PMC8881279 Section: ABSTRACT PassageIndex: 2

      Evidence Type(s): Functional

      Justification: Functional: The passage discusses the aim to clarify the biological functions of the ERBB2 E401G variant, indicating an interest in how this variant alters molecular or biochemical function.

      Gene→Variant (gene-first): 4609:1157A > G 2176:E401G

      Genes: 4609 2176

      Variants: 1157A > G E401G

    4. To examine tumor forming capacity in vivo, we constructed H460 cells that stably express ERBB2 (Fig. 8a) and assessed tumor growth after subcutaneous inoculation of these cells into mice. On the 21st day after transplant

      [Paragraph-level] PMCID: PMC8881279 Section: RESULTS PassageIndex: 17

      Evidence Type(s): Oncogenic

      Justification: Oncogenic: The passage discusses the tumor forming capacity of cells expressing the ERBB2 E401G variant, indicating that this somatic variant contributes to tumor development as evidenced by increased tumor growth in vivo.

      Gene→Variant (gene-first): 2176:E401G

      Genes: 2176

      Variants: E401G

    5. To examine the biologic effects of ERBB2 E401G in cancer cells, we evaluated the proliferative and invasive capacities of H460 cells. We found that cells expressing ERBB2 S310F exhibited a significantly higher proliferat

      [Paragraph-level] PMCID: PMC8881279 Section: RESULTS PassageIndex: 16

      Evidence Type(s): Functional, Oncogenic

      Justification: Functional: The passage discusses the effects of the ERBB2 E401G and S310F variants on the proliferative and invasive capacities of cancer cells, indicating that these variants alter molecular or biochemical functions related to cell behavior. Oncogenic: The evaluation of the proliferative and invasive capacities of cells expressing the ERBB2 variants suggests that these somatic variants contribute to tumor development or progression.

      Gene→Variant (gene-first): 2176:E401G 2064:S310F

      Genes: 2176 2064

      Variants: E401G S310F

    6. Our simulation data showed that the activating mechanisms of ERBB2 E401G and S310F were related to the EGFR-HER2 heterodimer. The dimerization partner appears to be an important determinant of signaling activity. The two

      [Paragraph-level] PMCID: PMC8881279 Section: RESULTS PassageIndex: 14

      Evidence Type(s): Functional, Oncogenic

      Justification: Functional: The passage discusses how the variants E401G and S310F alter the phosphorylation of downstream signaling pathway proteins, indicating a change in molecular function related to the MAPK pathway. Oncogenic: The evidence suggests that the variants contribute to tumor development or progression by activating signaling pathways associated with cancer, specifically through the ERBB2 dimerization and its effects on downstream signaling.

      Gene→Variant (gene-first): 2176:E401G 2064:S310F

      Genes: 2176 2064

      Variants: E401G S310F

    7. In a previous simulation study, the dimer interfaces of both the EGFR homodimer and the EGFR-HER2 heterodimer were destabilized when the EGFR lost EGF (a specific ligand of EGFR). We therefore conducted MD simulations of

      [Paragraph-level] PMCID: PMC8881279 Section: RESULTS PassageIndex: 12

      Evidence Type(s): Functional

      Justification: Functional: The passage discusses how the E401G and S310F mutations affect the dimer interface stability of the EGFR-HER2 complex, indicating that these variants alter molecular interactions and stability.

      Gene→Variant (gene-first): 2176:E401G 2064:S310F

      Genes: 2176 2064

      Variants: E401G S310F

    8. To confirm whether HER2 homodimers or EGFR-HER2 heterodimers are more relevant to the mechanisms of ERBB2 E401G and S310F activation, we analyzed HER-family dimers using microsecond-timescale MD simulations. With regard

      [Paragraph-level] PMCID: PMC8881279 Section: RESULTS PassageIndex: 11

      Evidence Type(s): None

      Justification: Not enough information in this passage.

      Gene→Variant (gene-first): 2176:E401G 2064:S310F

      Genes: 2176 2064

      Variants: E401G S310F

    9. HER2 p.(E401G) stabilizes ligand-free EGFR HER2 heterodimer

      [Paragraph-level] PMCID: PMC8881279 Section: RESULTS PassageIndex: 10

      Evidence Type(s): Functional

      Justification: Functional: The passage indicates that the variant p.(E401G) alters the stability of the ligand-free EGFR HER2 heterodimer, which suggests a change in molecular function.

      Gene→Variant (gene-first): 2176:p.(E401G)

      Genes: 2176

      Variants: p.(E401G)

    10. C-terminal phosphorylation of HER family proteins is caused by dimerization followed by trans-autophosphorylation, in which one receptor subunit of the dimer phosphorylates the other. Among the HER family proteins, EGFR,

      [Paragraph-level] PMCID: PMC8881279 Section: RESULTS PassageIndex: 9

      Evidence Type(s): Functional, Oncogenic

      Justification: Functional: The passage discusses how the variants E401G and S310F lead to increased phosphorylation levels of HER2 and EGFR, indicating that these variants alter molecular function related to protein activity. Oncogenic: The context of the passage suggests that the variants E401G and S310F contribute to tumor development or progression by enhancing the phosphorylation of key HER family proteins involved in oncogenesis.

      Gene→Variant (gene-first): 2176:E401G 2064:S310F

      Genes: 2176 2064

      Variants: E401G S310F

    11. Identification of potential dimerization partners of HER2 E401G protein

      [Paragraph-level] PMCID: PMC8881279 Section: RESULTS PassageIndex: 8

      Evidence Type(s): Functional

      Justification: Functional: The passage discusses the identification of potential dimerization partners of the HER2 E401G protein, indicating that the variant alters molecular interactions.

      Gene→Variant (gene-first): 2176:E401G

      Genes: 2176

      Variants: E401G

    12. Next, we analyzed C-terminal phosphorylation of HER2 using conventional SDS/PAGE and Western blotting. Compared with cells expressing ERBB2 WT, cells expressing ERBB2 S310F (a positive control variant elevating C-termina

      [Paragraph-level] PMCID: PMC8881279 Section: RESULTS PassageIndex: 7

      Evidence Type(s): Functional

      Justification: Functional: The passage discusses how the variants S310F and E401G alter the C-terminal phosphorylation of HER2, indicating a change in molecular function.

      Gene→Variant (gene-first): 2176:E401G 2064:S310F

      Genes: 2176 2064

      Variants: E401G S310F

    13. First, we examined whether E401G can form disulfide-linked dimers using SDS/PAGE under non-reducing conditions (for preserving disulfide bonds) and Western blotting. Compared with cells expressing ERBB2 WT, H460 cells ex

      [Paragraph-level] PMCID: PMC8881279 Section: RESULTS PassageIndex: 6

      Evidence Type(s): Functional

      Justification: Functional: The passage discusses the ability of the variants E321G, E401G, and S310F to form disulfide-linked dimers, indicating that these variants alter molecular function related to protein interactions.

      Gene→Variant (gene-first): 7157:E321G 2176:E401G 2064:S310F

      Genes: 7157 2176 2064

      Variants: E321G E401G S310F

    14. To examine the functional properties of ERBB2 E401G, an ECD III variant, we evaluated two types of mechanisms of activation of ECD variants previously reported: formation of disulfide-linked dimers and elevation of C-ter

      [Paragraph-level] PMCID: PMC8881279 Section: RESULTS PassageIndex: 5

      Evidence Type(s): Functional

      Justification: Functional: The passage mentions the evaluation of mechanisms for multiple ERBB2 variants, including E321G, E401G, S310F, and D845A, which suggests that these variants are being assessed for their biochemical functions.

      Gene→Variant (gene-first): 2064:D845A 7157:E321G 2176:E401G 2064:S310F

      Genes: 2064 7157 2176

      Variants: D845A E321G E401G S310F

    15. ERBB2 E401G has functional properties similar to those of S310F

      [Paragraph-level] PMCID: PMC8881279 Section: RESULTS PassageIndex: 4

      Evidence Type(s): Functional

      Justification: Functional: The passage indicates that ERBB2 E401G has functional properties similar to S310F, suggesting that these variants alter molecular or biochemical function.

      Gene→Variant (gene-first): 2176:E401G 2064:S310F

      Genes: 2176 2064

      Variants: E401G S310F

    16. A 67-year-old Japanese woman, previous healthy, presented with right inguinal pain with no family history of cancer. Fluorodeoxyglucose (FDG)-positron emission tomography with CT showed increased FDG accumulation in the

      [Paragraph-level] PMCID: PMC8881279 Section: RESULTS PassageIndex: 3

      Evidence Type(s): Oncogenic, Functional

      Justification: Oncogenic: The passage describes the ERBB2 E401G variant as a somatic mutation that is associated with ERBB2 gene amplification, indicating its contribution to tumor development or progression. Functional: The passage mentions that multiple computational tools supported a deleterious effect of the ERBB2 E401G variant on the encoded gene product, suggesting that it alters molecular or biochemical function.

      Gene→Variant (gene-first): 2176:E401G

      Genes: 2176

      Variants: E401G

    17. Detection of ERBB2 E401G VUS in a patient with CUP

      [Paragraph-level] PMCID: PMC8881279 Section: RESULTS PassageIndex: 2

      Evidence Type(s): Diagnostic

      Justification: Diagnostic: The passage mentions the detection of the ERBB2 E401G variant of uncertain significance (VUS) in a patient, indicating its use in defining or classifying a disease context, specifically in a patient with cancer of unknown primary (CUP).

      Gene→Variant (gene-first): 2176:E401G

      Genes: 2176

      Variants: E401G

    18. Purpose Dealing with variants of unknown significance (VUS) is an important issue in the clinical application of NGS-basedcancer gene panel tests. We detected a novel ERBB2 extracellular domain VUS, c.1157A > G p.(E401G), in a cancer genepanel test. Since the mechani

      test

    1. Somatic mutations in the epidermal growth factor receptor (EGFR) are a major cause of non-small cell lung cancer. Among these structurally diverse alterations, exon 20 insertions represent a unique subset that rarely res

      [Paragraph-level] PMCID: PMC11551396 Section: ABSTRACT PassageIndex: 3

      Evidence Type(s): Predictive, Oncogenic

      Justification: Predictive: The passage discusses the drug sensitivity and resistance of the exon 20 insertion variants, indicating their correlation with response to specific therapies, particularly EGFR tyrosine kinase inhibitors. Oncogenic: The passage describes somatic mutations in the EGFR gene, specifically the exon 20 insertion variants, which contribute to tumor development in non-small cell lung cancer.

      Gene→Variant (gene-first): 1956:L858R 1956:N771insSVD

      Genes: 1956

      Variants: L858R N771insSVD

    1. Around 95% of patients with clinical features that meet the diagnostic criteria for von Hippel-Lindau disease (VHL) have a detectable inactivating germline variant in VHL. The VHL protein (pVHL) functions as part of the

      [Paragraph-level] PMCID: PMC9402235 Section: ABSTRACT PassageIndex: 2

      Evidence Type(s): Diagnostic, Oncogenic

      Justification: Diagnostic: The passage discusses how the variant c.236A>G (p.Tyr79Cys) is associated with von Hippel-Lindau disease (VHL) and suggests that genetic testing for ELOC variants should be performed in individuals with suspected VHL disease, indicating its role in disease classification. Oncogenic: The variant is described as a de novo pathogenic variant identified in a proband with VHL disease and is linked to the development of renal cell carcinoma (RCC), suggesting its contribution to tumor development or progression.

      Gene→Variant (gene-first): 3091:c.236A>G 3091:p.Tyr79Cys

      Genes: 3091

      Variants: c.236A>G p.Tyr79Cys

    1. The above results suggest a bias against oncogenic mutations in the KrasC118S allele. While preliminary experiments revealed that ectopic KrasQ61L,C118S and KrasQ61L behaved rather similarly with regards to signaling, tr

      [Paragraph-level] PMCID: PMC4234187 Section: RESULTS PassageIndex: 16

      Evidence Type(s): Oncogenic, Functional

      Justification: Oncogenic: The passage discusses the behavior of Kras mutations, specifically KrasC118S and KrasG13D, in the context of transformation and signaling, indicating their role in tumor development and progression. Functional: The analysis of P-Erk1/2 levels upon EGF treatment suggests that the KrasC118S variant alters molecular function related to signaling pathways, as evidenced by the immunoblotting results.

      Gene→Variant (gene-first): 4843:C118 4843:C118S 3845:G13D 4893:Q61L

      Genes: 4843 3845 4893

      Variants: C118 C118S G13D Q61L

    2. We next tested whether there was a bias of oncogenic mutations induced by urethane in either the native or C118S Kras allele in Kras+/C118S mice. To this end, RNA was extracted from 65 lung tumors from 20 Kras+/C118S mic

      [Paragraph-level] PMCID: PMC4234187 Section: RESULTS PassageIndex: 15

      Evidence Type(s): Oncogenic, Functional

      Justification: Oncogenic: The passage discusses the identification of oncogenic mutations, specifically Q61R/L, in the context of tumor development in Kras+/C118S mice, indicating that these variants contribute to tumor progression. Functional: The mention of the C118S variant in the context of its allelic origin and mutation status suggests an alteration in molecular function related to the Kras gene, which is relevant to its role in oncogenesis.

      Gene→Variant (gene-first): 4843:C118S 4893:Q61R 3845:Q61R/L

      Genes: 4843 4893 3845

      Variants: C118S Q61R Q61R/L

    3. In the urethane-induced lung tumor model, typically only one Kras allele acquires an oncogenic mutation. While the oncogenic Kras allele is well established to promote tumorigenesis, the remaining non-oncogenic allele ha

      [Paragraph-level] PMCID: PMC4234187 Section: RESULTS PassageIndex: 13

      Evidence Type(s): Oncogenic, Functional

      Justification: Oncogenic: The passage discusses the KrasG12D allele as promoting lung tumorigenesis, indicating its role in tumor development. Functional: The passage describes the C118S mutation's effect on the tumorigenic activity of the oncogenic Kras allele and its interaction with the non-oncogenic allele, suggesting a change in molecular function related to tumor suppression.

      Gene→Variant (gene-first): 4843:C118S 3845:G12D

      Genes: 4843 3845

      Variants: C118S G12D

    4. Similar tumorigenesis between KrasLSL-G12D/+ and KrasLSL-G12D/C118S mice

      [Paragraph-level] PMCID: PMC4234187 Section: RESULTS PassageIndex: 12

      Evidence Type(s): Oncogenic

      Justification: Oncogenic: The passage indicates that the variants G12D and C118S are involved in similar tumorigenesis, suggesting that they contribute to tumor development or progression.

      Gene→Variant (gene-first): 4843:C118S 3845:G12D

      Genes: 4843 3845

      Variants: C118S G12D

    5. To assess whether there was also an impact on tumor progression, lesions were graded as being atypical adenomatous hyperplasia (AAH), adenoma (AD), or adenocarcinoma (AC) by histology (Supplementary Fig. 3). This analysi

      [Paragraph-level] PMCID: PMC4234187 Section: RESULTS PassageIndex: 11

      Evidence Type(s): Oncogenic, Functional

      Justification: Oncogenic: The passage discusses the impact of the KrasC118S variant on tumor progression and its association with different tumor types, indicating that this somatic variant contributes to tumor development or progression. Functional: The analysis shows that the KrasC118S variant is associated with reduced P-Akt signaling, suggesting that it alters molecular function related to signaling pathways involved in tumor biology.

      Gene→Variant (gene-first): 4843:C118S

      Genes: 4843

      Variants: C118S

    6. Comparison of the number and size of visible surface lung lesions revealed that Kras+/C118S or KrasC118S/C118S mice developed fewer tumors with a smaller average tumor size, resulting in an overall reduction in tumor bur

      [Paragraph-level] PMCID: PMC4234187 Section: RESULTS PassageIndex: 10

      Evidence Type(s): Oncogenic, Functional

      Justification: Oncogenic: The passage discusses how the KrasC118S variant contributes to tumor development by resulting in fewer tumors and smaller average tumor sizes in mice, indicating its role in tumor progression. Functional: The presence of the KrasC118S allele is shown to alter the tumor characteristics, specifically leading to a shift towards smaller tumors, which suggests an alteration in molecular or biochemical function related to tumor development.

      Gene→Variant (gene-first): 4843:C118S

      Genes: 4843

      Variants: C118S

    7. To determine the impact of the KrasC118S mutation on carcinogenesis, we assessed the effect of treating Kras+/+, Kras+/C118S, and KrasC118S/C118S mice with the carcinogen urethane (ethyl carbamate), which induces lung tu

      [Paragraph-level] PMCID: PMC4234187 Section: RESULTS PassageIndex: 9

      Evidence Type(s): Oncogenic, Functional

      Justification: Oncogenic: The passage discusses the KrasC118S mutation in the context of its role in carcinogenesis and tumor development, particularly in relation to urethane-induced lung tumors characterized by oncogenic Q61R/L mutations in Kras. Functional: The passage implies that the KrasC118S mutation alters the molecular behavior of Kras in the context of tumorigenesis, as it is assessed for its impact on carcinogenesis and tumor development.

      Gene→Variant (gene-first): 4843:C118S 3845:Q61R/L

      Genes: 4843 3845

      Variants: C118S Q61R/L

    8. Identification of genotypes of 580 offspring from crossing Kras+/C118S mice revealed that there was no statistical difference between the observed frequency versus the expected Mendelian ratio of the three genotypes of K

      [Paragraph-level] PMCID: PMC4234187 Section: RESULTS PassageIndex: 7

      Evidence Type(s): Oncogenic, Prognostic

      Justification: Oncogenic: The passage discusses the KrasC118S variant in the context of its role in mouse models, indicating that it does not lead to significant developmental or physiological defects, which suggests its involvement in tumor development or progression. Prognostic: The passage mentions the median lifespan of KrasC118S/C118S mice compared to Kras+/+ mice, indicating a potential correlation with disease outcome, although the difference was not statistically significant.

      Gene→Variant (gene-first): 4843:C118S

      Genes: 4843

      Variants: C118S

    9. We confirmed that the strategy to introduce the G353>C transversion into the Kras gene did not overtly affect alternative splicing of terminal exons 4A and 4B, an important consideration as both splice forms are importan

      [Paragraph-level] PMCID: PMC4234187 Section: RESULTS PassageIndex: 5

      Evidence Type(s): Functional, Oncogenic

      Justification: Functional: The passage discusses how the C118S mutation affects the ability of eNOS to stimulate the MAPK pathway and provides evidence of altered molecular function through immunoblot analysis of protein levels and activity. Oncogenic: The passage indicates that the C118S mutation is important for carcinogen-induced lung tumorigenesis, suggesting that it contributes to tumor development or progression.

      Gene→Variant (gene-first): 4843:C118S 4843:G353>C 4846:S1177D

      Genes: 4843 4846

      Variants: C118S G353>C S1177D

    10. To investigate the effect of mutating C118 on Ras function in vivo during tumorigenesis, a targeting vector was created to insert a single point mutation, namely a G353 transversion to C (G353>C) encoding the C118S mutat

      [Paragraph-level] PMCID: PMC4234187 Section: RESULTS PassageIndex: 3

      Evidence Type(s): Functional, Oncogenic

      Justification: Functional: The passage discusses how the C118S mutation specifically blocks redox-dependent reactions that lead to Ras activation, indicating an alteration in molecular function. Oncogenic: The context of the study involves investigating the effect of the C118S mutation on Ras function during tumorigenesis, suggesting that this somatic variant contributes to tumor development or progression.

      Gene→Variant (gene-first): 4843:C118 4843:C118S 4843:G353 transversion to C 4843:G353>C

      Genes: 4843

      Variants: C118 C118S G353 transversion to C G353>C

    1. All the mutations were in the TK domain that is critical for EGFR activity (Figure 2). Sequence alignment of the human wild- type EGFR with the Pfam model of protein kinase domain indicates W731, E734, T785, C797, Y801,

      [Paragraph-level] PMCID: PMC2970593 Section: RESULTS PassageIndex: 5

      Evidence Type(s): Functional, Oncogenic

      Justification: Functional: The passage discusses mutations in the TK domain of EGFR that are critical for its activity, indicating that these variants alter molecular function related to protein activity. Oncogenic: The context of the mutations being in the TK domain of EGFR suggests that they may contribute to tumor development or progression, as this domain is often implicated in oncogenic signaling pathways.

      Gene→Variant (gene-first): 1956:C797 NA:E734 NA:T785 1956:E868 1956:L858 1956:R831 NA:W731 1956:Y801

      Genes: 1956 NA

      Variants: C797 E734 T785 E868 L858 R831 W731 Y801

    2. We analyzed a cohort of MPM samples (n = 29) by DHPLC and sequencing analysis, and identified eight mutations in the tyrosine kinase domain (TKD) of EGFR. Of the 8 mutations in the TK domain, 7 were novel (W731L, E734Q,

      [Paragraph-level] PMCID: PMC2970593 Section: RESULTS PassageIndex: 3

      Evidence Type(s): Predictive, Oncogenic

      Justification: Predictive: The passage states that the L858R mutation was found to increase sensitivity to the EGFR inhibitor, Erlotinib, indicating a correlation with treatment response. Oncogenic: All mutations mentioned in the passage, including C797Y, E734Q, E868G, L831H, L858R, T785A, W731L, and Y801H, are described as somatic mutations that contribute to tumor development, as they were identified in the tyrosine kinase domain of EGFR in cancer samples.

      Gene→Variant (gene-first): 1956:C797Y 1956:E734Q 1956:E868G 1956:L831H 1956:L858R 1956:T785A 1956:W731L 1956:Y801H

      Genes: 1956

      Variants: C797Y E734Q E868G L831H L858R T785A W731L Y801H

    1. Since our data indicates that the SF3B1K700E mutation gives rise to an HR defect, we hypothesised that this could be exploited therapeutically to treat tumours that have acquired this mutation. To test this hypothesis, w

      [Paragraph-level] PMCID: PMC7612475 Section: RESULTS PassageIndex: 19

      Evidence Type(s): Predictive, Oncogenic

      Justification: Predictive: The passage discusses how the SF3B1K700E mutation can be therapeutically targeted, indicating a correlation with treatment response to etoposide and olaparib, which are specific therapies. Oncogenic: The SF3B1K700E mutation is implicated in tumor development, as the passage describes its role in creating an HR defect and its effects on tumor growth in xenograft models.

      Gene→Variant (gene-first): 23451:K700E

      Genes: 23451

      Variants: K700E

    2. Lastly, it is known that following replication arrest, several proteins, including BRCA1 and BRCA2, are required for preventing uncontrolled nucleolytic degradation of damaged forks and loss of this function contributes

      [Paragraph-level] PMCID: PMC7612475 Section: RESULTS PassageIndex: 17

      Evidence Type(s): Oncogenic, Functional

      Justification: Oncogenic: The passage discusses how the SF3B1 K700E variant contributes to cellular deficits characteristic of BRCA1/2 loss, indicating its role in tumor development or progression. Functional: The variant K700E is shown to alter the recruitment of Rad51 to replication forks and affects replication fork stability, demonstrating a change in molecular function.

      Gene→Variant (gene-first): 23451:K700E

      Genes: 23451

      Variants: K700E

    3. To assess whether the increased R-loops present in the SF3B1K700E mutant expressing cell line affects DNA replication, we examined replication fork dynamics using the DNA fibre assay (Figure 3B). Notably, this analysis r

      [Paragraph-level] PMCID: PMC7612475 Section: RESULTS PassageIndex: 14

      Evidence Type(s): Functional, Oncogenic

      Justification: Functional: The passage discusses how the SF3B1K700E variant affects replication fork dynamics and efficiency of replication fork restart, indicating an alteration in molecular function related to DNA replication. Oncogenic: The context of the study involves assessing the impact of the SF3B1K700E mutation on cellular processes relevant to tumor development, such as replication fork dynamics, which suggests a role in oncogenesis.

      Gene→Variant (gene-first): 23451:K700E

      Genes: 23451

      Variants: K700E

    4. Our data clearly suggests a role for SF3B1 in the DDR, particularly in HR mediated DNA repair following DNA damage. However, we have also observed increased DSBs and reduced HR in unperturbed SF3B1K700E cells. Importantl

      [Paragraph-level] PMCID: PMC7612475 Section: RESULTS PassageIndex: 13

      Evidence Type(s): Functional, Oncogenic

      Justification: Functional: The D210N variant is described as being catalytically inactivated, which alters its ability to resolve R-loops, indicating a change in molecular function. Oncogenic: The passage discusses the role of the D210N variant in the context of R-loop accumulation and genome instability, which are associated with tumor development and progression.

      Gene→Variant (gene-first): 246243:D210N

      Genes: 246243

      Variants: D210N

    5. SF3B1K700E mutation induces unscheduled R-loops, stalled replication forks, and reduced replication fork protection and restart

      [Paragraph-level] PMCID: PMC7612475 Section: RESULTS PassageIndex: 12

      Evidence Type(s): Functional

      Justification: Functional: The passage discusses how the K700E mutation alters molecular function by inducing unscheduled R-loops and affecting replication fork dynamics.

      Gene→Variant (gene-first): 23451:K700E

      Genes: 23451

      Variants: K700E

    6. To directly determine the impact of the SF3B1K700E mutation on HR, we assessed the formation and resolution of Rad51 foci, a key marker of HR function, in our isogenic models following IR induced DNA damage. Intriguingly

      [Paragraph-level] PMCID: PMC7612475 Section: RESULTS PassageIndex: 9

      Evidence Type(s): Functional, Oncogenic

      Justification: Functional: The passage discusses how the SF3B1K700E mutation alters the molecular function of homologous recombination (HR) by affecting the formation and resolution of Rad51 foci, indicating a defect in the later stages of HR. Oncogenic: The SF3B1K700E mutation is implicated in tumor development or progression as it affects the ability of cells to resolve recombination intermediates, which is a critical process in maintaining genomic stability in cancer cells.

      Gene→Variant (gene-first): 23451:K700E

      Genes: 23451

      Variants: K700E

    7. To assess the biological impact of this deregulated splicing and export, we performed Ingenuity Pathway Analysis (IPA) on genes with 3ASS and SE in SF3B1K700E cells. Consistent with a role for SF3B1 in DNA repair, this a

      [Paragraph-level] PMCID: PMC7612475 Section: RESULTS PassageIndex: 8

      Evidence Type(s): Functional, Oncogenic

      Justification: Functional: The passage discusses how the SF3B1K700E variant alters the ability of cells to resolve DNA double-strand breaks (DSBs) and impairs homologous recombination (HR) repair, indicating a change in molecular function related to DNA repair mechanisms. Oncogenic: The SF3B1K700E mutation is described as cancer-associated and is shown to contribute to defects in DNA repair, which is a characteristic of oncogenic variants that promote tumor development or progression.

      Gene→Variant (gene-first): 23451:K700E

      Genes: 23451

      Variants: K700E

    8. Mutations in SF3B1 have been identified across several cancer types. This key spliceosome component promotes the efficient mRNA splicing of thousands of genes including those with crucial roles in the cellular response t

      [Paragraph-level] PMCID: PMC7612475 Section: ABSTRACT PassageIndex: 1

      Evidence Type(s): Predictive, Functional

      Justification: Predictive: The K700E mutation in SF3B1 increases cellular sensitivity to ionising radiation and various chemotherapeutic agents, including PARP inhibitors, indicating a correlation with treatment response. Functional: The K700E mutation alters HR efficiency and induces unscheduled R-loop formation, replication fork stalling, and defective replication fork restart, demonstrating an impact on molecular function.

      Gene→Variant (gene-first): 23451:K700E

      Genes: 23451

      Variants: K700E

    1. In the placebo arm, patients with E545K/E542K mutation had shorter PFS and overall survival than those with wild-type PIK3CA (Supplementary Table 2), suggesting that PIK3CA mutations in the helical domain might play a ro

      [Paragraph-level] PMCID: PMC5355930 Section: RESULTS PassageIndex: 9

      Evidence Type(s): Predictive, Prognostic

      Justification: Predictive: The passage suggests that patients with E545K/E542K mutations had shorter progression-free survival (PFS) and overall survival, indicating a potential role of these mutations in resistance to hormone therapy. Prognostic: The mention of shorter PFS and overall survival in patients with the E545K/E542K mutations indicates a correlation with disease outcome independent of therapy.

      Gene→Variant (gene-first): 5290:E542K 5290:E545K

      Genes: 5290

      Variants: E542K E545K

    2. To examine the role of domain-specific mutations in PIK3CA on everolimus efficacy, patients were categorised by mutation site, H1047R in the catalytic domain, and E545K and E542K in the helical domain. Everolimus prolong

      [Paragraph-level] PMCID: PMC5355930 Section: RESULTS PassageIndex: 8

      Evidence Type(s): Predictive, Oncogenic

      Justification: Predictive: The passage discusses the correlation between PIK3CA mutations (H1047R, E545K, E542K) and the efficacy of everolimus, indicating that these variants are associated with prolonged progression-free survival (PFS) in patients treated with this therapy. Oncogenic: The mention of PIK3CA mutations in the context of their role in tumor development and the efficacy of a cancer treatment suggests that these somatic variants contribute to tumor progression.

      Gene→Variant (gene-first): 5290:E542K 5290:E545K 5290:H1047R

      Genes: 5290

      Variants: E542K E545K H1047R

    3. Of the 724 patients in BOLERO-2, 550 patients (76%) underwent PIK3CA cfDNA analysis. The baseline characteristics and clinical outcomes were similar between the cfDNA and overall population (Supplementary Table 1). PIK3C

      [Paragraph-level] PMCID: PMC5355930 Section: RESULTS PassageIndex: 3

      Evidence Type(s): Diagnostic, Predictive

      Justification: Diagnostic: The passage discusses the prevalence of PIK3CA mutations, including specific variants, in a patient population, indicating their association with the disease context. Predictive: The mention of higher prevalence of PIK3CA mutations in the everolimus arm compared to the placebo arm suggests a correlation with treatment response, indicating predictive value.

      Gene→Variant (gene-first): 5290:E542K 5290:E545K 5290:H1047R

      Genes: 5290

      Variants: E542K E545K H1047R

    1. We report the discovery of the GATA2 gene as a new myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML) predisposition gene. We found the same, novel heterozygous c.1061C>T (p.Thr354Met) missense mutation in the G

      [Paragraph-level] PMCID: PMC3184204 Section: ABSTRACT PassageIndex: 1

      Evidence Type(s): Predisposing, Diagnostic, Functional

      Justification: Predisposing: The passage describes the discovery of the GATA2 gene as a predisposition gene for myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML), indicating that the variants are associated with inherited risk for developing these diseases. Diagnostic: The variants are used to define and classify familial forms of MDS and AML, as they are reported to segregate with the disease in multiple families, which supports their role in diagnosis. Functional: The passage mentions that the mutations have differential effects on transactivation of target genes, cellular differentiation, apoptosis, and global gene expression, indicating that they alter molecular or biochemical function.

      Gene→Variant (gene-first): 2624:c.1061C>T 2624:c.1063_1065delACA 2624:p.Thr354Met 6688:p.Thr355del

      Genes: 2624 6688

      Variants: c.1061C>T c.1063_1065delACA p.Thr354Met p.Thr355del

    1. Advances in the understanding of the molecular basis for acute myeloid leukemia (AML) have generated new potential targets for treatment. Fms-like tyrosine kinase 3 (FLT3) is one of the most frequently mutated genes in A

      [Paragraph-level] PMCID: PMC5613053 Section: ABSTRACT PassageIndex: 2

      Evidence Type(s): Predictive, Oncogenic

      Justification: Predictive: The passage discusses the ability of gilteritinib to block mutated FLT3, including the D835Y and F691 mutations, and its correlation with improved survival in models of FLT3-driven AML, indicating a response to therapy. Oncogenic: The D835Y and F691 mutations in FLT3 are implicated in the pathogenesis of acute myeloid leukemia (AML), suggesting that these somatic variants contribute to tumor development or progression.

      Gene→Variant (gene-first): 2322:D835Y 2322:F691

      Genes: 2322

      Variants: D835Y F691

    1. Of the 106 variants tested, we classify 50 as Pathogenic, including 31 ASD. We further classify 10 variants, including 4 ASD, as Likely Pathogenic. We consider 24 variants to be Likely Benign, including 3 ASD: P354Q, T20

      [Paragraph-level] PMCID: PMC7190743 Section: RESULTS PassageIndex: 25

      Evidence Type(s): Diagnostic

      Justification: Diagnostic: The passage discusses the classification of variants as Pathogenic and Likely Pathogenic, indicating their association with specific diseases or subtypes, which aligns with the definition of diagnostic evidence.

      Gene→Variant (gene-first): 5728:A79T 5728:C211W 5728:E157G 5728:H123Q 5728:I135V 5728:I203V 5728:I400V 5728:K342N 5728:K402N 5728:L345V 5728:L70V 5728:M35V 5728:N117S 5728:N228S 5728:N340D 5728:N340H 5728:N356D 5728:P354Q 5728:Q298E 5728:S229T 5728:T202I 5728:T78A 5728:W274L 5728:Y176C 5728:Y180H 5728:Y65C

      Genes: 5728

      Variants: A79T C211W E157G H123Q I135V I203V I400V K342N K402N L345V L70V M35V N117S N228S N340D N340H N356D P354Q Q298E S229T T202I T78A W274L Y176C Y180H Y65C

    2. PTEN functions as a negative regulator of the PI3-AKT signaling pathway by decreasing the pool of available PI(3,4,5)P3 via its lipid phosphatase activity, causing a reduction in the level of activated, phosphorylated AK

      [Paragraph-level] PMCID: PMC7190743 Section: RESULTS PassageIndex: 16

      Evidence Type(s): Functional, Oncogenic

      Justification: Functional: The passage discusses how various PTEN variants, including A126D, A126P, C124S, G129E, H123Q, P354Q, P38H, Q396R, R130L, and R130Q, alter the molecular function of PTEN by affecting pAKT levels, indicating changes in biochemical activity. Oncogenic: The variants are described in the context of their effects on the PI3-AKT signaling pathway and their ability to exhibit loss of function (LoF) or gain of function (GoF), which are indicative of their roles in tumor development or progression.

      Gene→Variant (gene-first): 5728:A126D 5728:A126P 5728:C124S 5728:G129E 5728:H123Q 5728:P354Q 5728:P38H 5728:Q396R 5728:R130L 5728:R130Q

      Genes: 5728

      Variants: A126D A126P C124S G129E H123Q P354Q P38H Q396R R130L R130Q

    3. To identify molecular mechanisms underlying variable effects of MS variants, we measured impact on protein stability, a known mechanism of PTEN dysfunction. We measured PTEN protein abundance for WT and 97 variants teste

      [Paragraph-level] PMCID: PMC7190743 Section: RESULTS PassageIndex: 14

      Evidence Type(s): Functional

      Justification: Functional: The passage discusses how the variants affect protein stability and abundance, indicating that they alter molecular function, which is supported by the use of western blot analysis and flow cytometry to measure these changes.

      Gene→Variant (gene-first): 5728:H93Y 5728:P354Q 5728:R130L 5728:R14G 5728:R15S 5728:T78A

      Genes: 5728

      Variants: H93Y P354Q R130L R14G R15S T78A

    4. Since ASD is a behaviorally diagnosed disorder, and deficits in sensory processing are a core feature of ASD present in >95% of cases, we tested the effects of PTEN variants on sensorimotor neural circuit function in an

      [Paragraph-level] PMCID: PMC7190743 Section: RESULTS PassageIndex: 12

      Evidence Type(s): Functional, Oncogenic

      Justification: Functional: The passage discusses how PTEN variants affect sensorimotor neural circuit function and chemotaxis in C. elegans, indicating that these variants alter molecular or biochemical function. Oncogenic: The context of the passage suggests that the PTEN variants are involved in a pathway related to tumor development or progression, particularly given the focus on mutations in a cancer-related gene.

      Gene→Variant (gene-first): 5728:A79T 5728:C124S 5728:D268E 5728:G132D 5728:P354Q 5728:T167N 5728:Y176C

      Genes: 5728

      Variants: A79T C124S D268E G132D P354Q T167N Y176C

    5. Aberrant neuronal morphology and excitatory/inhibitory synapse balance are hallmarks of ASD, and ASD rodent models. Reducing PTEN expression results in increased neuronal growth, with larger soma size, increased dendriti

      [Paragraph-level] PMCID: PMC7190743 Section: RESULTS PassageIndex: 10

      Evidence Type(s): Functional, Oncogenic

      Justification: Functional: The passage discusses how various PTEN variants, including C124S, I101T, G132D, D268E, and A79T, alter neuronal growth processes and synapse density, indicating that these variants affect molecular or biochemical functions in neuronal cultures. Oncogenic: The passage mentions that the PHTS variant A79T exhibits a gain-of-function (GoF) phenotype in axonal growth, suggesting that it contributes to tumor development or progression in the context of its association with ASD.

      Gene→Variant (gene-first): 5728:A79T 5728:C124S 5728:D268E 5728:G132D 5728:I101T

      Genes: 5728

      Variants: A79T C124S D268E G132D I101T

    6. We generated 88 transgenic lines of Drosophila melanogaster expressing WT human PTEN and 86 PTEN variants, each integrated into the attP2 locus, with attP2 used as an empty vector (EV) control, allowing quantitative comp

      [Paragraph-level] PMCID: PMC7190743 Section: RESULTS PassageIndex: 8

      Evidence Type(s): Functional, Oncogenic

      Justification: Functional: The passage discusses how various PTEN variants, including C124S, G129E, N117S, and Q298E, alter developmental rates in Drosophila, indicating that these variants affect molecular or biochemical function related to insulin signaling and eclosion timing. Oncogenic: The mention of the known gain-of-function variant 4A inducing lethality suggests that some variants contribute to tumor development or progression, aligning with oncogenic behavior.

      Gene→Variant (gene-first): 5728:C124S 5728:G129E 5728:N117S 5728:Q298E

      Genes: 5728

      Variants: C124S G129E N117S Q298E

    7. We took advantage of the high-throughput capacity of the Saccharomyces cerevisiae synthetic dosage lethality screen as an unbiased assay to identify genetic interactions of PTEN. By overexpressing human WT PTEN (WT), emp

      [Paragraph-level] PMCID: PMC7190743 Section: RESULTS PassageIndex: 5

      Evidence Type(s): Functional, Oncogenic

      Justification: Functional: The passage discusses how the C124S variant alters molecular interactions and functions within the context of PI3P metabolism and signaling, indicating a change in biochemical activity. Oncogenic: The C124S variant is described in the context of genetic interactions that may contribute to tumor development or progression, as it is involved in a synthetic dosage lethality screen related to PTEN's role in cancer biology.

      Gene→Variant (gene-first): 5728:C124S

      Genes: 5728

      Variants: C124S

    8. We selected PTEN MS and nonsense (NS) mutations identified in individuals with ASD, intellectual disability (ID), developmental delay (DD), somatic cancer and PHTS, as well as variants found among the general population

      [Paragraph-level] PMCID: PMC7190743 Section: RESULTS PassageIndex: 3

      Evidence Type(s): Diagnostic, Oncogenic, Functional

      Justification: Diagnostic: The passage discusses the classification of variants, including C124S, G129E, R130X, and R335X, in relation to their association with conditions such as ASD, PHTS, and somatic cancer, indicating their role in defining or confirming these diseases. Oncogenic: The passage mentions that C124S and G129E have been found in somatic cancer, indicating that these variants contribute to tumor development or progression. Functional: The passage describes several variants, including C124S and G129E, as having well-characterized disruptions on protein function, indicating that they alter molecular or biochemical function.

      Gene→Variant (gene-first): 5728:C124S 5728:G129E 5728:R130X 5728:R335X 5728:Y138L

      Genes: 5728

      Variants: C124S G129E R130X R335X Y138L

    1. To clarify the relationship between CYP3A4 expression and resistance to FOLFIRI and cetuximab, we compared the expression levels of CYP3A4 in CRCs displaying different therapeutic responses (GEO data sets GSE13294 and GS

      [Paragraph-level] PMCID: PMC3973211 Section: RESULTS PassageIndex: 12

      Evidence Type(s): Predictive, Oncogenic

      Justification: Predictive: The passage discusses the relationship between p53 mutations (including R175H, R248W, R273H, R282W) and resistance to chemotherapy, specifically noting that cells with these mutations showed higher viability and increased IC50 for various drugs, indicating a correlation with drug resistance. Oncogenic: The passage implies that the p53 mutations contribute to tumor behavior by affecting cell response to chemotherapy, suggesting their role in tumor development or progression.

      Gene→Variant (gene-first): 7157:R175H 7157:R248W 7157:R273H 7157:R282W

      Genes: 7157

      Variants: R175H R248W R273H R282W

    2. The GSEA analysis revealed that most of the drug metabolism enzymes in association with p53 R248/R282 mutations are responsible for the clearance of chemotherapeutic drugs. Among these, the most relevant one was cytochro

      [Paragraph-level] PMCID: PMC3973211 Section: RESULTS PassageIndex: 10

      Evidence Type(s): Predictive, Functional

      Justification: Predictive: The passage discusses the association between p53 mutations (R248, R282) and the expression of CYP3A4, a drug metabolism enzyme, indicating a correlation with drug clearance and potential response to chemotherapeutic drugs. Functional: The passage describes how p53 mutations (R248, R282) alter the expression levels of the CYP3A4 enzyme, demonstrating a change in molecular function related to drug metabolism.

      Gene→Variant (gene-first): 7157:R175 7157:R175H 7157:R248 7157:R248W 7157:R273 7157:R273H 7157:R282 7157:R282W

      Genes: 7157

      Variants: R175 R175H R248 R248W R273 R273H R282 R282W

    3. To probe the characteristic pathways associated with different p53-hotspot mutations, we selected the colorectal cancer (CRC) data set in TCGA as an example. The CRC cases contain more mortality-associated mutations (R24

      [Paragraph-level] PMCID: PMC3973211 Section: RESULTS PassageIndex: 8

      Evidence Type(s): Prognostic, Functional

      Justification: Prognostic: The passage mentions that R248Q/W and R282W are associated with mortality, indicating a correlation with disease outcome. Functional: The passage discusses the enrichment of specific gene sets linked to cellular respiration and drug metabolism enzymes for certain mutations, suggesting alterations in molecular function.

      Gene→Variant (gene-first): 7157:R175H 7157:R248Q/W 7157:R248W 7157:R273H 7157:R282W

      Genes: 7157

      Variants: R175H R248Q/W R248W R273H R282W

    4. R248 and R282 mutations associate with drug metabolism enzymes

      [Paragraph-level] PMCID: PMC3973211 Section: RESULTS PassageIndex: 7

      Evidence Type(s): Diagnostic, Predictive

      Justification: Diagnostic: The passage indicates that the R282 mutation is associated with drug metabolism enzymes, suggesting its role in defining or classifying a specific biological context related to drug metabolism. Predictive: The mention of the R282 mutation in relation to drug metabolism enzymes implies a potential correlation with response or sensitivity to therapies that involve these enzymes.

      Gene→Variant (gene-first): 7157:R282

      Genes: 7157

      Variants: R282

    5. We tested the association between R248/R282 mutations and cancer patient survival using an independent data set extracted from published literatures (data in Supplementary Table 1), and found these mutations are indeed a

      [Paragraph-level] PMCID: PMC3973211 Section: RESULTS PassageIndex: 6

      Evidence Type(s): Prognostic, Oncogenic

      Justification: Prognostic: The passage discusses the association of R248 and R282 mutations with shorter patient survival, indicating a correlation with disease outcome independent of therapy. Oncogenic: The mention of mice carrying the humanized mutation on R248 exhibiting significantly shorter survival time suggests that this somatic variant contributes to tumor development or progression.

      Gene→Variant (gene-first): 7157:R175 7157:R248 7157:R273 7157:R282

      Genes: 7157

      Variants: R175 R248 R273 R282

    6. Kaplan-Meier survival analysis revealed that patients carrying p53 mutations on Arg248 and Arg282 residues had significantly shorter overall survival time than those carrying nonsense mutations (Figures 2a and b). Other

      [Paragraph-level] PMCID: PMC3973211 Section: RESULTS PassageIndex: 4

      Evidence Type(s): Prognostic, Oncogenic

      Justification: Prognostic: The passage discusses how mutations at Arg248 and Arg282 correlate with significantly shorter overall survival times, indicating a relationship between these variants and disease outcome independent of therapy. Oncogenic: The mention of p53 mutations, including those at Arg248 and Arg282, suggests a role in tumor development or progression, as these mutations are associated with survival outcomes in cancer patients.

      Gene→Variant (gene-first): 7157:Arg248 7157:Arg282 7157:G245 7157:R175 7157:R248 7157:R249S 7157:R273 7157:R282 7157:Y220

      Genes: 7157

      Variants: Arg248 Arg282 G245 R175 R248 R249S R273 R282 Y220

    7. Mutations on Arg282 and Arg248 residues associate with shorter patient survival

      [Paragraph-level] PMCID: PMC3973211 Section: RESULTS PassageIndex: 2

      Evidence Type(s): Prognostic

      Justification: Prognostic: The passage indicates that mutations at Arg282 and Arg248 are associated with shorter patient survival, which correlates with disease outcome independent of therapy.

      Gene→Variant (gene-first): 7157:Arg248 7157:Arg282

      Genes: 7157

      Variants: Arg248 Arg282

    1. Our next goal was to define the molecular signatures of each TSC hamartomatous lesion type using genome-wide DNA methylation and transcript profiling. Unsupervised clustering of DNA methylation array data revealed lesion

      [Paragraph-level] PMCID: PMC5481739 Section: RESULTS PassageIndex: 12

      Evidence Type(s): Functional, Oncogenic

      Justification: Functional: The passage discusses the somatic DNMT3A-V716F mutation and its predicted effect on methyltransferase activity, indicating that the variant alters molecular function. Oncogenic: The mention of the somatic DNMT3A-V716F mutation in the context of a tumor suggests that it contributes to tumor development or progression.

      Gene→Variant (gene-first): 1788:V716F

      Genes: 1788

      Variants: V716F

    1. Next, we determined whether metformin had superior antitumor activity in KRAS-mutated CRC cell lines to those with KRAS wild type through a cell-viability test. As shown in SI Appendix, Fig. S2A, metformin inhibited the

      [Paragraph-level] PMCID: PMC7293710 Section: RESULTS PassageIndex: 7

      Evidence Type(s): Predictive, Oncogenic

      Justification: Predictive: The passage discusses how the KRASG12V mutation correlates with increased sensitivity to the antiproliferation therapy of metformin, indicating a predictive relationship between the variant and treatment response. Oncogenic: The KRASG12V mutation is implicated in tumor development as it is mentioned in the context of its effect on cell viability and sensitivity to therapy in colorectal cancer cell lines.

      Gene→Variant (gene-first): 3845:G12V

      Genes: 3845

      Variants: G12V

    1. To analyze the response of KB1(L1363P)P mammary tumors to HRR deficiency-targeted therapy, we performed orthotopic transplantations with spontaneous donor tumors as previously described. To capture the heterogeneity of K

      [Paragraph-level] PMCID: PMC7612117 Section: RESULTS PassageIndex: 15

      Evidence Type(s): Predictive, Oncogenic, Functional

      Justification: Predictive: The passage discusses the response of KB1(L1363P)P mammary tumors to targeted therapies, indicating that these tumors responded significantly better to cisplatin and the PARP inhibitor AZD2461, which correlates the variant with treatment response. Oncogenic: The variant is associated with tumor development and progression, as it is discussed in the context of mammary tumors and their response to therapies, suggesting a role in cancer biology. Functional: The passage describes how the variant affects the ability of tumor cells to induce RAD51 foci in response to gamma-radiation, indicating an alteration in molecular function related to DNA repair mechanisms.

      Gene→Variant (gene-first): 7158:L1363P 7158:p.L1363P

      Genes: 7158

      Variants: L1363P p.L1363P

    2. KB1(L1363P)P mammary tumors respond to cisplatin and PARP inhibition

      [Paragraph-level] PMCID: PMC7612117 Section: RESULTS PassageIndex: 14

      Evidence Type(s): Predictive

      Justification: Predictive: The variant L1363P is associated with a response to cisplatin and PARP inhibition, indicating its correlation with treatment sensitivity.

      Gene→Variant (gene-first): 7158:L1363P

      Genes: 7158

      Variants: L1363P

    3. KB1P mammary tumors are mainly adenocarcinomas, defined by their epithelial nature and solid growth pattern (Fig. 3D; Supplementary Fig. S4B). In contrast, KB1(L1363P)P mammary tumors are predominantly carcinosarcomas wi

      [Paragraph-level] PMCID: PMC7612117 Section: RESULTS PassageIndex: 13

      Evidence Type(s): Diagnostic, Oncogenic

      Justification: Diagnostic: The passage discusses how KB1(L1363P)P mammary tumors are classified as predominantly carcinosarcomas, indicating that the variant is used to define and classify a specific tumor subtype. Oncogenic: The variant L1363P is associated with the development of carcinosarcomas, suggesting that it contributes to tumor progression and development, which aligns with oncogenic behavior.

      Gene→Variant (gene-first): 7158:L1363P 7158:p.L1363P

      Genes: 7158

      Variants: L1363P p.L1363P

    4. KB1(L1363P)P mammary tumors show EMT-like phenotypes and limited genomic instability

      [Paragraph-level] PMCID: PMC7612117 Section: RESULTS PassageIndex: 12

      Evidence Type(s): Oncogenic

      Justification: Oncogenic: The passage indicates that the variant L1363P is associated with mammary tumors exhibiting EMT-like phenotypes, suggesting a role in tumor development or progression.

      Gene→Variant (gene-first): 7158:L1363P

      Genes: 7158

      Variants: L1363P

    5. The embryonic lethality of Brca1LP/LP mice indicates that an intact BRCA1 coiled-coil domain is functionally important in vivo, in line with its requirement for BRCA1-mediated HRR. To analyze whether the functional defec

      [Paragraph-level] PMCID: PMC7612117 Section: RESULTS PassageIndex: 11

      Evidence Type(s): Oncogenic, Functional

      Justification: Oncogenic: The passage discusses how the Brca1 p.L1363P variant contributes to tumor formation and accelerates tumor development in a mouse model, indicating its role in tumor progression. Functional: The passage indicates that the Brca1 p.L1363P variant has a functional defect that compromises BRCA1-mediated homologous recombination repair (HRR), suggesting an alteration in molecular function.

      Gene→Variant (gene-first): 7158:L1363P 7158:p.L1363P

      Genes: 7158

      Variants: L1363P p.L1363P

    6. Brca1 p.L1363P shows a defect in mammary tumor suppression

      [Paragraph-level] PMCID: PMC7612117 Section: RESULTS PassageIndex: 10

      Evidence Type(s): Oncogenic

      Justification: Oncogenic: The variant p.L1363P is associated with a defect in mammary tumor suppression, indicating its contribution to tumor development or progression.

      Gene→Variant (gene-first): 7158:p.L1363P

      Genes: 7158

      Variants: p.L1363P

    7. To verify whether mouse Brca1 p.L1363P phenocopies human BRCA1 p.L1407P, we analyzed Brca1LP/LP;Trp53Delta/Delta (LP/LP) mutant and Brca1LP/+;Trp53Delta/Delta (LP/+) control MEFs for BRCA1-PALB2 interaction and HRR defec

      [Paragraph-level] PMCID: PMC7612117 Section: RESULTS PassageIndex: 9

      Evidence Type(s): Predictive, Functional

      Justification: Predictive: The passage discusses increased sensitivity to cisplatin and PARP1 inhibition in the context of the Brca1 p.L1363P variant, indicating a correlation with treatment response. Functional: The variant p.L1363P is shown to severely attenuate BRCA1-PALB2 binding, which alters the molecular function related to homologous recombination repair (HRR).

      Gene→Variant (gene-first): 672:leucine to proline 7158:p.L1363P 672:p.L1407P

      Genes: 672 7158

      Variants: leucine to proline p.L1363P p.L1407P

    8. BRCA1 p.L1363P is unable to bind PALB2 and shows hypomorphic activity in HRR

      [Paragraph-level] PMCID: PMC7612117 Section: RESULTS PassageIndex: 8

      Evidence Type(s): Functional

      Justification: Functional: The passage indicates that the variant p.L1363P alters the binding ability of BRCA1 to PALB2 and affects its activity in homologous recombination repair (HRR), demonstrating a change in molecular function.

      Gene→Variant (gene-first): 7158:p.L1363P

      Genes: 7158

      Variants: p.L1363P

    9. In the complete absence of TP53, Brca1LP/LP mice developed apparently normal until at least E13.5, although no postnatal survival was observed upon compound heterozygous intercrosses (Table 3). This allowed us to isolate

      [Paragraph-level] PMCID: PMC7612117 Section: RESULTS PassageIndex: 7

      Evidence Type(s): Functional

      Justification: Functional: The passage discusses the evaluation of the functional consequences of the Brca1 p.L1363P variant, indicating that it alters molecular or biochemical function.

      Gene→Variant (gene-first): 7158:p.L1363P

      Genes: 7158

      Variants: p.L1363P

    10. For a first functional analysis of Brca1 p.L1363P in vivo, heterozygous Brca1LP mice were intercrossed and their offspring was genotyped. No Brca1LP/LP mice were born; therefore, embryos were analyzed at different stages

      [Paragraph-level] PMCID: PMC7612117 Section: RESULTS PassageIndex: 5

      Evidence Type(s): Functional, Oncogenic

      Justification: Functional: The passage discusses a functional analysis of the Brca1 p.L1363P variant, indicating that it alters embryonic development and leads to growth defects in mice, which demonstrates its impact on molecular or biochemical function. Oncogenic: The analysis of the Brca1 p.L1363P variant in the context of embryonic development and its comparison to Brca1-null mice suggests that it may contribute to tumor development or progression, as it is associated with severe phenotypes similar to pathogenic mutations in Brca1.

      Gene→Variant (gene-first): 7158:p.L1363P

      Genes: 7158

      Variants: p.L1363P

    11. Homozygous Brca1 p.L1363P (FVB) mice die during embryonic development

      [Paragraph-level] PMCID: PMC7612117 Section: RESULTS PassageIndex: 4

      Evidence Type(s): Oncogenic

      Justification: Oncogenic: The passage indicates that the homozygous variant p.L1363P in Brca1 leads to embryonic lethality in mice, suggesting that it contributes to tumor development or progression.

      Gene→Variant (gene-first): 7158:p.L1363P

      Genes: 7158

      Variants: p.L1363P

    12. We used CRISPR/Cas9-mediated genome editing in FVB mouse zygotes to model the BRCA1 coiled-coil domain VUS c.4220T>C p.L1407P, which disrupts the interaction of BRCA1 with PALB2. The BRCA1 coiled-coil domain is well cons

      [Paragraph-level] PMCID: PMC7612117 Section: RESULTS PassageIndex: 3

      Evidence Type(s): Functional, Oncogenic

      Justification: Functional: The passage discusses how the variant p.L1407P disrupts the interaction of BRCA1 with PALB2 and predicts that it disables the alpha-helical structure of the coiled-coil domain, indicating an alteration in molecular function. Oncogenic: The use of CRISPR/Cas9 to model the BRCA1 variant in mice suggests that the variant contributes to tumor development or progression, as it is being studied in the context of a gene essential for embryonic development and cancer biology.

      Gene→Variant (gene-first): 672:4220T>C 7158:p.L1363P 672:p.L1407P

      Genes: 672 7158

      Variants: 4220T>C p.L1363P p.L1407P

    1. MIB-1 labeling indices correlated with the diagnosis and grade assigned prior to H3 K27M IHC testing (Table 1). For the adult cohort, 1 case met WHO criteria for diffuse astrocytoma, WHO grade II (MIB-1 < 1%), 7 cases me

      [Paragraph-level] PMCID: PMC5822176 Section: RESULTS PassageIndex: 6

      Evidence Type(s): Diagnostic

      Justification: Diagnostic: The passage discusses the correlation of MIB-1 labeling indices with the diagnosis and grade of tumors, indicating that the K27M variant is associated with specific tumor classifications.

      Gene→Variant (gene-first): 3417:K27M

      Genes: 3417

      Variants: K27M

    2. The known lower frequency of ATRX mutation/loss of ATRX nuclear immunostaining in only 10 - 15% of H3 K27M-mutant tumors makes this feature less amenable to comparisons between the 2 cohorts. However, of the 7 adult case

      [Paragraph-level] PMCID: PMC5822176 Section: RESULTS PassageIndex: 5

      Evidence Type(s): None

      Justification: Not enough information in this passage.

      Gene→Variant (gene-first): 3417:K27M

      Genes: 3417

      Variants: K27M

    3. Four cases had other morphologies at initial biopsy, including pure GG (n = 3, pediatric) and PA (n = 1, adult) histologies. One of the GGs was a 16-year-old girl with an original biopsy demonstrating a pure thalamic GG

      [Paragraph-level] PMCID: PMC5822176 Section: RESULTS PassageIndex: 4

      Evidence Type(s): Oncogenic

      Justification: Oncogenic: The passage discusses the transformation of tumors associated with the K27M variant, indicating its role in tumor development and progression, particularly in the context of glioblastoma transformation.

      Gene→Variant (gene-first): 3417:K27M

      Genes: 3417

      Variants: K27M

    4. Table 1 summarizes the ages, gender, anatomical location, initial histological diagnoses, and p53 IHC labeling indices discerned prior to H3 K27M IHC in the 28 H3 K27M-mutant tumors identified in our databases. There wer

      [Paragraph-level] PMCID: PMC5822176 Section: RESULTS PassageIndex: 2

      Evidence Type(s): Diagnostic, Oncogenic

      Justification: Diagnostic: The passage discusses the identification of H3 K27M-mutant tumors and provides demographic information, indicating that the variant is associated with specific histological diagnoses and patient characteristics. Oncogenic: The mention of H3 K27M in the context of tumors suggests that this somatic variant contributes to tumor development or progression, as it is identified in mutant tumors.

      Gene→Variant (gene-first): 3417:K27M

      Genes: 3417

      Variants: K27M

    5. Background: H3 K27M mutation was originally described in pediatric diffuse intrinsic pontine gliomas (DIPGs), but has been recently recognized to occur also in adult midline diffuse gliomas, as well as midline tumors wit

      [Paragraph-level] PMCID: PMC5822176 Section: ABSTRACT PassageIndex: 1

      Evidence Type(s): Diagnostic, Prognostic, Oncogenic

      Justification: Diagnostic: The passage discusses the H3 K27M mutation's association with various tumor types, indicating its role in defining and classifying these tumors, particularly in pediatric and adult cohorts. Prognostic: The passage mentions survival outcomes for patients with H3 K27M-mutant tumors, comparing mean survival times between adults and pediatric patients, which indicates a correlation with disease outcome. Oncogenic: The H3 K27M mutation is described as contributing to tumor development in various glioma types, indicating its role as a somatic variant involved in tumor progression.

      Gene→Variant (gene-first): 3417:K27M

      Genes: 3417

      Variants: K27M

    1. To identify somatic mutations in paediatric diffuse intrinsic pontine gliomas (DIPGs), we performed whole genome sequencing of 7 DIPGs and matched germline DNA, and targeted sequencing of an additional 43 DIPGs and 36 no

      [Paragraph-level] PMCID: PMC3288377 Section: ABSTRACT PassageIndex: 1

      Evidence Type(s): Diagnostic, Oncogenic

      Justification: Diagnostic: The passage discusses the frequency of the p.K27M mutation in DIPGs and its association with this specific subtype of brain tumors, indicating its role in defining or classifying the disease. Oncogenic: The p.K27M and p.G34R mutations are described as somatic mutations found in pediatric gliomas, suggesting their contribution to tumor development or progression.

      Gene→Variant (gene-first): 3021:p.G34R 3021:p.K27M

      Genes: 3021

      Variants: p.G34R p.K27M

    1. CDK4/6 inhibition with endocrine therapy is now a standard of care for advanced estrogen receptor positive breast cancer. Mechanisms of CDK4/6 inhibitor resistance have been described pre-clinically, with limited evidenc

      [Paragraph-level] PMCID: PMC6368247 Section: ABSTRACT PassageIndex: 1

      Evidence Type(s): Predictive, Oncogenic

      Justification: Predictive: The passage discusses the emergence of the ESR1 Y537S mutation in the context of resistance to CDK4/6 inhibitors, indicating a correlation with treatment response and resistance. Oncogenic: The mention of the ESR1 Y537S mutation as a new driver mutation suggests that it contributes to tumor development or progression, particularly in the context of breast cancer.

      Gene→Variant (gene-first): 5728:Y537S

      Genes: 5728

      Variants: Y537S

    1. Twenty-seven patients with a median age of 49 years (range 23-82) were treated with BRAF inhibitors. Eleven patients received dabrafenib with trametinib, and 16 were treated with vemurafenib. Patients received 150 mg of

      [Paragraph-level] PMCID: PMC5122709 Section: RESULTS PassageIndex: 3

      Evidence Type(s): Predictive, Diagnostic, Oncogenic

      Justification: Predictive: The passage discusses patients treated with BRAF inhibitors, specifically mentioning the BRAF V600E mutation, which correlates with response to these therapies. Diagnostic: The passage states that all patients tested positive for the BRAF V600E mutation, indicating its use in defining or confirming the presence of a specific subtype of melanoma. Oncogenic: The BRAF V600E mutation is implicated in the development of melanoma, suggesting its role as a somatic variant contributing to tumor progression.

      Gene→Variant (gene-first): 673:V600E

      Genes: 673

      Variants: V600E

    1. Although activating mutations of FGFR3 are frequent in bladder tumors, little information is available on their specific effects in urothelial cells or the basis for the observed mutation spectrum. We investigated the ph

      [Paragraph-level] PMCID: PMC2789045 Section: ABSTRACT PassageIndex: 1

      Evidence Type(s): Functional, Oncogenic

      Justification: Functional: The passage discusses how the FGFR3 mutations (S249C, Y375C, and K652E) alter molecular signaling pathways, specifically the phosphorylation of various proteins, indicating a change in biochemical function. Oncogenic: The passage describes how the mutant FGFR3 variants induce morphological transformation, cell proliferation, and anchorage-independent growth, which are indicative of their role in tumor development and progression.

      Gene→Variant (gene-first): 2261:K652E 2261:S249C 2261:Y375C

      Genes: 2261

      Variants: K652E S249C Y375C

    1. Conclusion: Our findings suggested that the SNPs (rs16879870, rs2641256, rs2761591, rs854936) might play a crucial role in prognosis of HNSCC.

      [Paragraph-level] PMCID: PMC7099049 Section: ABSTRACT PassageIndex: 4

      Evidence Type(s): Prognostic

      Justification: Prognostic: The passage indicates that the SNPs are suggested to play a crucial role in the prognosis of HNSCC, which correlates with disease outcome.

      Gene→Variant (gene-first): NA:rs16879870 388325:rs2641256 341019:rs2761591 NA:rs854936

      Genes: NA 388325 341019

      Variants: rs16879870 rs2641256 rs2761591 rs854936

    2. Results: After combining the result of the two stages, 4 SNPs were significantly associated with HNSCC survival (rs16879870 at 6q14.3: adjusted HR = 2.02, 95%CI = 1.50-2.73, P = 3.88 x 10-6; rs2641256 at 17p13.2: adjuste

      [Paragraph-level] PMCID: PMC7099049 Section: ABSTRACT PassageIndex: 3

      Evidence Type(s): Prognostic, Functional

      Justification: Prognostic: The passage discusses the association of SNPs with HNSCC survival, indicating that these variants correlate with disease outcome, specifically overall survival, independent of therapy. Functional: The passage mentions that the genotype of rs16879870 and rs854936 is significantly associated with the expression of specific genes in cancer tissues, suggesting that these variants alter molecular function.

      Gene→Variant (gene-first): NA:rs16879870 388325:rs2641256 341019:rs2761591 NA:rs854936

      Genes: NA 388325 341019

      Variants: rs16879870 rs2641256 rs2761591 rs854936

    1. Mutations in the KRAS oncogene are found in more than 90% of patients with pancreatic ductal adenocarcinoma (PDAC), with Gly-to-Asp mutations (KRASG12D) being the most common. Here, we tested the efficacy of a small-mole

      [Paragraph-level] PMCID: PMC9900321 Section: ABSTRACT PassageIndex: 3

      Evidence Type(s): Predictive, Oncogenic

      Justification: Predictive: The passage discusses the efficacy of a small-molecule KRASG12D inhibitor, MRTX1133, in treating pancreatic ductal adenocarcinoma, indicating a correlation between the Gly-to-Asp mutation and response to therapy. Oncogenic: The Gly-to-Asp mutation in the KRAS oncogene is described as contributing to tumor development in pancreatic ductal adenocarcinoma, as it is found in more than 90% of patients with this cancer type.

      Gene→Variant (gene-first): 3845:Gly-to-Asp

      Genes: 3845

      Variants: Gly-to-Asp

    1. Macrodactyly is a discrete congenital anomaly consisting of enlargement of all tissues localized to the terminal portions of a limb, typically within a 'nerve territory'. The classic terminology for this condition is 'li

      [Paragraph-level] PMCID: PMC3542862 Section: ABSTRACT PassageIndex: 1

      Evidence Type(s): Oncogenic, Functional

      Justification: Oncogenic: The passage discusses somatic mutations in PIK3CA (including R115P, E542K, H1047L, and H1047R) that contribute to the pathophysiology of macrodactyly, indicating their role in tumor development or progression through activation of the PI3K/AKT signaling pathway. Functional: The passage mentions that the identified mutations lead to AKT activation, which indicates that these variants alter molecular or biochemical function related to cell signaling pathways.

      Gene→Variant (gene-first): 5290:E542K 5290:H1047L 5290:H1047R 5163:R115P

      Genes: 5290 5163

      Variants: E542K H1047L H1047R R115P

    1. Mutations in KRAS and BRAF were associated with inferior PFS and OS of mCRC patients compared with patients with non-mutated tumors. KRAS exon 2 mutation variants were associated with heterogeneous outcome compared with

      [Paragraph-level] PMCID: PMC4999563 Section: ABSTRACT PassageIndex: 9

      Evidence Type(s): Prognostic, Diagnostic

      Justification: Prognostic: The passage indicates that KRAS G12C and G13D mutations are associated with inferior progression-free survival (PFS) and overall survival (OS) in mCRC patients, suggesting a correlation with disease outcome independent of therapy. Diagnostic: The mention of KRAS mutations being associated with heterogeneous outcomes compared to unmutated tumors implies that these variants can be used to classify or define a disease subtype in mCRC.

      Gene→Variant (gene-first): 3845:G12C 3845:G13D

      Genes: 3845

      Variants: G12C G13D

    2. In 664 tumors, no mutation was detected, 462 tumors were diagnosed with KRAS-, 39 patients with NRAS- and 74 patients with BRAF-mutation. Mutations in KRAS were associated with inferior progression-free survival (PFS) an

      [Paragraph-level] PMCID: PMC4999563 Section: ABSTRACT PassageIndex: 7

      Evidence Type(s): Prognostic, Diagnostic

      Justification: Prognostic: The passage discusses the correlation of KRAS mutations, including specific variants like G12C and G13D, with inferior overall survival (OS) and progression-free survival (PFS), indicating their impact on disease outcome independent of therapy. Diagnostic: The passage mentions that mutations in KRAS were diagnosed in tumors, indicating that these mutations are used to classify or define the disease.

      Gene→Variant (gene-first): 3845:G12C 3845:G12D 3845:G12V 3845:G13D

      Genes: 3845

      Variants: G12C G12D G12V G13D

    3. In this pooled analysis of metastatic colorectal cancer patients, mutations in KRAS, and BRAF were associated with inferior progression-free and overall survival compared with patients with non-mutated tumors. KRAS exon

      [Paragraph-level] PMCID: PMC4999563 Section: ABSTRACT PassageIndex: 1

      Evidence Type(s): Prognostic, Diagnostic

      Justification: Prognostic: The passage discusses how KRAS G12C and G13D mutations correlate with inferior progression-free and overall survival in metastatic colorectal cancer patients, indicating their prognostic significance. Diagnostic: The mention of KRAS mutations being associated with tumor characteristics suggests their role in classifying or defining the disease subtype in colorectal cancer.

      Gene→Variant (gene-first): 3845:G12C 3845:G13D

      Genes: 3845

      Variants: G12C G13D

    1. PIK3CA encoding the phosphoinositide 3-kinase (PI3K) p110alpha catalytic subunit is frequently mutated in cancer, with mutations occurring widely throughout the primary sequence. The full set of mechanisms underlying how

      [Paragraph-level] PMCID: PMC9837058 Section: ABSTRACT PassageIndex: 1

      Evidence Type(s): Oncogenic, Functional

      Justification: Oncogenic: The passage discusses how mutations in PIK3CA, including G1049R, H1047R, and M1043I/L, contribute to the activation of the PI3K pathway, indicating their role in tumor development or progression. Functional: The passage describes how specific mutations alter the conformation and binding properties of the p110alpha subunit, indicating that these variants affect molecular function related to PI3K activation.

      Gene→Variant (gene-first): 5290:G1049R 5290:H1047R 5290:M1043I/L

      Genes: 5290

      Variants: G1049R H1047R M1043I/L

    2. We also compared HDX-MS differences in full-length p110alpha-p85alpha between WT, H1047R and DeltaC in the presence and absence of pY (Supplementary Fig. 6). The binding of pY led to significant increases for all three c

      [Paragraph-level] PMCID: PMC9837058 Section: RESULTS PassageIndex: 19

      Evidence Type(s): Functional

      Justification: Functional: The passage discusses how the H1047R variant alters the binding interactions and structural dynamics of the protein in response to pY binding, indicating a change in molecular function.

      Gene→Variant (gene-first): 5290:H1047R

      Genes: 5290

      Variants: H1047R

    3. The H1047R, G1049R, and the DeltaCter constructs showed similar significant increases compared to the WT in the kinase domain (Fig. 5A-C). These included regions covering 850-858 (hinge between the N and C lobes), the ac

      [Paragraph-level] PMCID: PMC9837058 Section: RESULTS PassageIndex: 18

      Evidence Type(s): Functional, Oncogenic

      Justification: Functional: The passage discusses how the H1047R and G1049R variants alter the molecular interactions and conformations within the kinase domain, indicating a change in biochemical function related to the protein's activity. Oncogenic: The evidence suggests that the H1047R and G1049R variants contribute to activation through disruption of the inhibitory conformation, which is indicative of their role in tumor development or progression.

      Gene→Variant (gene-first): 5290:G1049R 5290:H1047R 5290:M1043L 5290:N1068fs

      Genes: 5290

      Variants: G1049R H1047R M1043L N1068fs

    4. HDX-MS experiments were carried out for 4-5 timepoints of exchange (3 s at 1 C, 3, 30, 300, and 3000 s at 20 C) for each complex. The full set of all peptides analysed for both p110alpha and p85alpha are shown in the Sou

      [Paragraph-level] PMCID: PMC9837058 Section: RESULTS PassageIndex: 17

      Evidence Type(s): Functional

      Justification: Functional: The passage discusses changes observed for the H1047R variant in the context of HDX-MS experiments, indicating that it alters molecular or biochemical function, specifically in terms of perturbations in conformation.

      Gene→Variant (gene-first): 5290:H1047R

      Genes: 5290

      Variants: H1047R

    5. To test if C-terminal mutations worked by disrupting the inhibitory interaction with the C-terminus, we carried out HDX-MS studies on six constructs of full-length p110alpha (WT, M1043L, H1047R, G1049R, N1068fs, and a co

      [Paragraph-level] PMCID: PMC9837058 Section: RESULTS PassageIndex: 16

      Evidence Type(s): Functional, Oncogenic

      Justification: Functional: The passage discusses how C-terminal mutations, including M1043L, H1047R, G1049R, and N1068fs, affect the inhibitory interaction with the C-terminus, indicating an alteration in molecular function. Oncogenic: The mention of "oncogenic mutation" in relation to M1043L, H1047R, and G1049R suggests that these somatic variants contribute to tumor development or progression.

      Gene→Variant (gene-first): 5290:G1049R 5290:H1047R 5290:M1043L 5290:N1068fs

      Genes: 5290

      Variants: G1049R H1047R M1043L N1068fs

    6. For these mutants, we had difficulty in obtaining sufficient yield of the proteins for extensive biophysical analysis. To circumvent this, we used the kinase dead variants to characterise their membrane binding using pro

      [Paragraph-level] PMCID: PMC9837058 Section: RESULTS PassageIndex: 14

      Evidence Type(s): Functional, Oncogenic

      Justification: Functional: The passage discusses how the variants H1047R, G1049R, M1043L, and N1068fs alter membrane binding and ATPase activity, indicating changes in molecular function. Oncogenic: The variants are described in the context of their effects on membrane binding and ATPase activity, which suggests a role in tumor development or progression.

      Gene→Variant (gene-first): 5290:G1049R 5290:H1047R 5290:M1043L 5290:N1068fs

      Genes: 5290

      Variants: G1049R H1047R M1043L N1068fs

    7. We characterised the intrinsic ATPase activity of each p110alpha mutant (Fig. 4A + B), and while this assay does not measure biologically relevant PIP3 activity, it can measure intrinsic differences in PI3K activity inde

      [Paragraph-level] PMCID: PMC9837058 Section: RESULTS PassageIndex: 13

      Evidence Type(s): Functional, Oncogenic

      Justification: Functional: The passage discusses the intrinsic ATPase activity of the p110alpha mutants, indicating that the variants G1049R, H1047R, and M1043L alter molecular function by exhibiting significantly increased ATPase activity compared to wild type. Oncogenic: The context of the passage implies that the variants are somatic mutations in a cancer-related gene, contributing to tumor development or progression through their altered biochemical activity.

      Gene→Variant (gene-first): 5290:G1049R 5290:H1047R 5290:M1043L 5290:N1068fs

      Genes: 5290

      Variants: G1049R H1047R M1043L N1068fs

    8. To understand the regulatory mechanisms underlying the inhibitory interface with the C-terminus we analysed the most frequent oncogenic mutants that occur at or near this interface. While H1047R/L is the most frequent mu

      [Paragraph-level] PMCID: PMC9837058 Section: RESULTS PassageIndex: 12

      Evidence Type(s): Oncogenic, Functional

      Justification: Oncogenic: The passage discusses frequent oncogenic mutants and their role in tumor samples, indicating that these variants contribute to tumor development or progression. Functional: The analysis of the mutants and their binding to full-length p85alpha suggests that these variants alter molecular or biochemical function, specifically in the context of their interaction with regulatory complexes.

      Gene→Variant (gene-first): 5290:G1049R 5290:H1047R 5290:H1047R/L 5290:M1043L 5290:M1043L/I 5290:N1044K 5290:N1068fs

      Genes: 5290

      Variants: G1049R H1047R H1047R/L M1043L M1043L/I N1044K N1068fs

    9. While the disengagement of the ABD and p85 being involved in membrane binding provides a molecular rationale for activation by oncogenic mutations in the ABD, C2, and helical domains, it does not fully explain the molecu

      [Paragraph-level] PMCID: PMC9837058 Section: RESULTS PassageIndex: 11

      Evidence Type(s): Oncogenic, Functional

      Justification: Oncogenic: The passage discusses the H1047R mutation in the context of its role in activating the kinase domain and increasing membrane binding, indicating its contribution to tumor development or progression. Functional: The passage describes how the H1047R mutation alters the molecular interactions and structural organization of the kinase domain, affecting its binding properties and functionality.

      Gene→Variant (gene-first): 5290:H1047R 5290:His1047 5290:Met1043

      Genes: 5290

      Variants: H1047R His1047 Met1043

    10. When comparing our data to the full set of missense oncogenic mutations in the ABD, ABD-RBD linker, C2, helical and the N-lobe of the kinase domain we find that all mutations found in >30 tumours except one (E726K) are l

      [Paragraph-level] PMCID: PMC9837058 Section: RESULTS PassageIndex: 9

      Evidence Type(s): Oncogenic, Functional

      Justification: Oncogenic: The passage discusses the E726K variant in the context of oncogenic mutations and its association with conformational changes that contribute to tumor development, indicating its role in cancer progression. Functional: The passage describes how the E726K variant leads to conformational changes affecting the interaction between the ABD and p85 with the catalytic core, suggesting an alteration in molecular function.

      Gene→Variant (gene-first): 5290:E726K

      Genes: 5290

      Variants: E726K

    11. We have extensively characterised the membrane binding of the p110alpha/p85alpha complex using HDX-MS, however, the disengagement of the ABD and p85 from the catalytic core has likely complicated the analysis of membrane

      [Paragraph-level] PMCID: PMC9837058 Section: RESULTS PassageIndex: 8

      Evidence Type(s): Functional

      Justification: Functional: The passage discusses how the N345K variant affects the molecular interactions and binding of the p110alpha/p85alpha complex to membranes, indicating an alteration in biochemical function.

      Gene→Variant (gene-first): 5290:N345K

      Genes: 5290

      Variants: N345K

    12. This data comparing the full-length heterodimer vs p110alpha core allowed us to define the effect of ABD removal on the contact site at the ABD-RBD linker. This region still is protected from exchange at early time point

      [Paragraph-level] PMCID: PMC9837058 Section: RESULTS PassageIndex: 4

      Evidence Type(s): Oncogenic, Functional

      Justification: Oncogenic: The passage discusses oncogenic mutants (N345K, G106V, and G118D) and their expected role in promoting ABD/iSH2 disengagement, indicating their contribution to tumor development or progression. Functional: The data suggests that the variants alter the dynamics of the ABD-p85 complex and its interaction with the p110alpha catalytic core, indicating a change in molecular function related to binding and mobility.

      Gene→Variant (gene-first): 5290:G106V 5290:G118D 5290:N345K

      Genes: 5290

      Variants: G106V G118D N345K

    13. To investigate the role of the ABD domain/p85 regulatory subunit in controlling PI3K enzyme activity, we needed a construct that allowed us to interrogate the dynamic effects of full ABD disengagement. We engineered and

      [Paragraph-level] PMCID: PMC9837058 Section: RESULTS PassageIndex: 2

      Evidence Type(s): Functional

      Justification: Functional: The passage discusses the D915N mutation in the context of its effect on protein conformation and membrane binding, indicating that it alters molecular function as assessed by HDX-MS experiments.

      Gene→Variant (gene-first): 5290:D915N

      Genes: 5290

      Variants: D915N

    1. Mutation of several genes, most notably TP53 or ASXL1 transcriptional regulator 1 (ASXL1), were shown to cause a broad pattern of drug resistance. Interestingly, a few drugs trended more sensitive to TP53 mutant cases, s

      [Paragraph-level] PMCID: PMC6280667 Section: RESULTS PassageIndex: 9

      Evidence Type(s): Predictive

      Justification: Predictive: The passage discusses the correlation of mutations, including those in splicing components like ZRSR2, with sensitivity to various drugs, indicating a relationship between the variant and treatment response.

      Gene→Variant (gene-first): 8233:serine/arginine

      Genes: 8233

      Variants: serine/arginine

    1. After collapsing smMIPs with the same barcode, we achieved > 150-fold coverage for 85% of the protein coding sequences for KRAS, BRAF, HRAS, NRAS, and MAP2K1. Because KRAS codon p.12G and BRAF codon p.600V somatic mutati

      [Paragraph-level] PMCID: PMC6938308 Section: RESULTS PassageIndex: 2

      Evidence Type(s): Diagnostic, Oncogenic

      Justification: Diagnostic: The passage indicates that KRAS codon p.12G and BRAF codon p.600V somatic mutations have been linked to brain AVMs, suggesting their role in defining or classifying the disease. Oncogenic: The mention of likely somatic disease-causing mutations, including KRAS mutations (p.G12D and p.G12V) and BRAF mutations (p.V600E and p.Q636X), indicates that these variants contribute to tumor development or progression.

      Gene→Variant (gene-first): 3845:p.12G 673:p.600V 3845:p.G12D 3845:p.G12V 673:p.Q636X 673:p.V600E

      Genes: 3845 673

      Variants: p.12G p.600V p.G12D p.G12V p.Q636X p.V600E

    1. EGFR mutation analysis in non-small-cell lung cancer (NSCLC) patients is currently standard-of-care. We determined the uptake of EGFR testing, test results and survival of EGFR-mutant NSCLC patients in the Netherlands, w

      [Paragraph-level] PMCID: PMC8307492 Section: ABSTRACT PassageIndex: 4

      Evidence Type(s): Predictive, Oncogenic

      Justification: Predictive: The passage discusses the association of the L858R variant with overall survival (OS) in patients treated with first-line EGFR inhibitors, indicating its relevance to treatment response. Oncogenic: The L858R variant is mentioned in the context of EGFR mutations in non-small-cell lung cancer (NSCLC), suggesting its role in tumor development or progression as part of the broader analysis of clinically actionable EGFR mutations.

      Gene→Variant (gene-first): 1956:L858R

      Genes: 1956

      Variants: L858R

    1. HOXC10 is overexpressed in 51% of primary KRAS-mutant tumors (Figure 3A; TCGA, >= 2SD over expression in normal lung), consistent with observations in cell lines (Figure 2B). By analyzing KRAS-mutant tumor/normal matched

      [Paragraph-level] PMCID: PMC10805385 Section: RESULTS PassageIndex: 17

      Evidence Type(s): Oncogenic, Predictive

      Justification: Oncogenic: The passage discusses the overexpression of HOXC10 in KRAS-mutant tumors, specifically mentioning the genotype KRAS G12C/TP53 G245V, indicating that these somatic variants contribute to tumor development or progression. Predictive: The passage mentions the efficacy of combined MEK/BET inhibitors causing tumor regression in KRAS-mutant patient-derived xenograft models, suggesting a correlation between the variants and response to therapy.

      Gene→Variant (gene-first): 3845:G12C 7157:G245V

      Genes: 3845 7157

      Variants: G12C G245V

    1. This drug combination was also tested on NCI "Rasless" MEFs carrying KRASG12C or KRASG12D mutations. KPT9274 synergized with MRTX849 at all dose combinations yielding suppressed growth of KRASG12C-mutant MEFs (Supplement

      [Paragraph-level] PMCID: PMC10690049 Section: RESULTS PassageIndex: 7

      Evidence Type(s): Predictive, Oncogenic

      Justification: Predictive: The passage discusses the response of KRASG12D mutant MEFs to a drug combination, indicating that the variant is associated with resistance to growth inhibition by the therapies tested. Oncogenic: The KRASG12D variant is implicated in tumor behavior, as it is described in the context of MEFs (mouse embryonic fibroblasts) and their growth characteristics, suggesting a role in tumor development or progression.

      Gene→Variant (gene-first): 3845:G12D

      Genes: 3845

      Variants: G12D

    2. KRAS G12C-mutant MIA PaCa-2 (PDAC) and NCI-H358 (NSCLC) cells were exposed to MRTX849/AMG510 and KPT9274 at different dose combinations. As shown in Fig. 2A and B, all three dose combinations tested demonstrated synergis

      [Paragraph-level] PMCID: PMC10690049 Section: RESULTS PassageIndex: 6

      Evidence Type(s): Predictive, Oncogenic

      Justification: Predictive: The passage discusses the response of KRAS G12C-mutant cells to specific therapies, indicating a correlation between the variant and sensitivity to the drugs MRTX849/AMG510 and KPT9274. Oncogenic: The variant KRAS G12C is implicated in tumor development, as the passage describes its presence in cancer cell lines and their proliferation in response to treatment, suggesting a role in cancer progression.

      Gene→Variant (gene-first): 3845:G12C

      Genes: 3845

      Variants: G12C

    1. Omit unneeded words, sounds, and graphics.

      This resonates with me very much as I often try to copy absolutely everything into my notes from a PowerPoint while simultaneously trying to keep up with what is being said. It is often impossible to know what information will be necessary to memorize for a test and you end up with way more to study than is necessary.

    2. Used well, these materials are integral to the session, and to be effective, they need the same careful level of planning and design as the rest of our lesson.

      I agree with this statement that emphasizes that the materials teachers use are not just add ons, but rather key components of teaching.

    3. Videos should be clear, accessible, and engaging, but they do not need to be fancy and full of complicated or high-tech add-ons. In fact, as with most instructional materials, less is usually more.

      I think that videos can be very beneficial, but how much instruction through videos is too much?

    4. Charts and graphs, in particular, can make complex information more comprehensible than it would be in raw-data form, and can make relationships among variables more readily apparent.

      I thought that this was useful information, I know that they can be helpful to us. I am wondering how we can make them more accessible and digestible for children.

    5. Choosing an appropriate font is the first step, and the focus should be on a clean, clear font with adequate spacing between letters (Kitchel, 2011/2019).

      I thought that this was interesting. I never thought how different fonts would change how children can read. I always knew that we shouldn't use crazy fonts, but I'm glad it has a list of acceptable fonts.

    1. Leveling ensures the appearance that weall start from the same place and then allows us to see how we stackup against other players, as we know they are going through the samethings we are. The status inequality Castronova believes we seek istranslated into a number that grows slowly over time and broadcastsour efforts and skill to everyone we encounter. However, the notionthat we all start from the same place requires deliberate inattentionto the resources players bring to a game in the first place.

      Leveling pushes the illusion of explanatory depth behind the myth of experience. It doesn't accumulate infinitely. But more than leveling, I'd argue, it's also skill trees and abilities. They learned forever, and this linear progress is plain false. You can't magically carry more and more guns, and become more and more strong in real life, and there are no augmentations or powerups without side effects.

      You know what fucking game portrays opression properly? Rain World.

    Annotators

    1. Cessna-arrest

      Dit betreft Cessna-I

      Cessna-II: De HR heeft ook geoordeeld, dat het feit dat de extra kosten die dit vliegtuig met zich mee brengen geen ondernemingskosten zijn, niet betekent dat de kosten van het vliegtuig in het geheel geen ondernemingskosten zijn. Dit betekent dus dat de ondernemer de kosten die een redelijk denkend ondernemer zou maken wel ten laste van het resultaat mag brengen.

    1. cultural rhetorics is a“temporarily, hopeful intervention” designed to make space for anothergeneration of scholars to write and research in their language, on theirterms, and for and with and alongside the communities they value.

      term / defintion

    Annotators

    1. tion." It is unclear, however, why the initial collecting focthese repositories, even if broadly defined and subject to revision,in writ

      I find the resistance to outlining an objective so interesting! We are Information Workers. We, of all people, should understand the significance of clear and written objectives. Where is the guidepost? Where is the organization? How are visitors meant to navigate these collections with such little direction? These are professional archivists choosing to muddy information they are tasked to make clear and accessible.

    2. ith its defined policy.4in situations when the case is not mnot accept an out-of-scope collectiotheir repository's collection developan occasional "tool" rathe

      Sauer challenges archivists to examine their own professional integrity when she questions whether collection development policies are treated as required guiding principles or merely convenient tools for assistance. If these policies are applied inconsistently, their authority and purpose weaken. They risk being perceived not as solid institutional commitments, but as flexible guidelines that can be adjusted at will. The major gap between principle and practice seems to encompass Sauer’s broader argument that collection development policies are crucial aspects to archiving in theory, but their impact solely depends on how seriously repositories commit to applying them in daily work. I can see how consistently committing to a policy could help set clearer expectations for donors, administrators, and even staff within the repository.

    1. ont mené cette discussion collective et ont partagé leurs expériences professionnelles, à partir de nos questions, concernant les publics de leur revue et le contact avec leur lectorat, et laissant entrevoir la réalité du travail d’édition en contexte scientifique, les ressources nécessaires à leur bon fonctionnement et les besoins réels des équipes des revues.

      la phrase est longue, peut-être la scinder en 2

    1. There is something so ugly about crushing an acoustic guitar. Making it buckle, making the middle of it explode in splinters. That might be personal to me, as someone who grew up with a dad who was what you might call a campfire guitarist — not a performer, just a dad who used to entertain us with songs like "Dark as a Dungeon," a little folk tune about the lethal dangers of coal mining. Maybe to you, it's not the guitar. Maybe it's the cameras or the vinyl records.

      She talks about how the ad is taking things that people love and are connected to and destroying them. While the ad is meant to show all the features of the ipad, many people saw it as saying they only need the ipad and the other things don't matter.

    1. LabscriptAI achieved 89.1% overall success in generating simulation-passing scripts, outperforming all baselines (Table 1)

      It would be interesting to know what percentage of these scripts you were able to run on the opentrons, I've seen scripts that pass simulation but then immediately throw errors when uploaded to the robot

    2. Performance was compared against direct LLM implementations (GPT-5, Claude 4, DeepSeek V3.2, Gemini-2.5 Pro) and OpentronsAI, a commercial LLM–based solution (Table 1).

      I'd be interested to see this comparison done with other agentic approaches like Claude Code or Cursor if they were given the same kind of context upfront

    1. CUCA.-   (Violenta.) Me voy. Estás jugando sucio. LALO.-  Hay que llegar hasta el final. CUCA.-  No puedo permitirte... LALO.-  Tú también has tratado de aprovecharte. CUCA.-  Lo que has hecho es imperdonable. Cada uno a su parte; fue lo convenido. LALO.-  ¿No me digas? Y tú, por si las moscas...

      Salen de personaje y se reclaman cosas

    2. LALO.-   (Prosigue, como hipnotizado.) Un día, jugando con mis hermanas, de repente, descubrí... CUCA.-   (Como un fiscal. Con súbito interés por la divagación de LALO.) ¿Qué descubrió? LALO.-   (En el tono anterior.)  Estábamos en la sala; no, miento... Estábamos en el último cuarto. Jugábamos... Es decir, representábamos...  (Sonríe como un idiota.)  A usted le parecerá una bobería, sin embargo... Yo era el padre. No, mentira. Creo que en ese momento era la madre. ¡Todo un juego!...  (Otro tono.) Pero, allí, en ese instante, llegó hasta mí esa idea... (Vuelve a sonreír como un idiota.)

      Representar, actuar como juego - Teatro y metateatro

    3. (BEBA agita la campanilla.)   Soy culpable. Sí, culpable. Júzgueme. Haga lo que quiera. Estoy en sus manos.   (BEBA vuelve a mover la campanilla como un juez. LALO, en otro tono, menos violento, pero con una actitud arrogante.)   Si el señor juez me permite...

      La campanilla le hace dócil

    1. Segregation analysis in the family revealed that her father (I:2) carried the c.4685 T > C variant, but the proband’s affected sister (II:4) did not, indicating that this ABCA4 variant was not relevant to the macular dystrophy in this family
    2. visual acuities were 6/60 OD and 6/7.5 OS. Fundoscopy revealed bilateral central atrophy, seen clearly on autofluorescence imaging (AF) (Fig. 1a and b). Eight years later AF imaging showed a preserved small central spot of AF, surrounded by a reduced AF signal corresponding to the area of atrophy, which increased in size over time, with a ring of AF. (Fig. 1c-f). Optical coherence tomography (OCT) imaging, 10 years after initial presentation, showed loss of the ellipsoid zone

      imaging showing atrophic maculae, Autofluorescence (AF) shows loss of signal centrally corresponding to atrophy with a surrounding band of increased AF within the arcades, optical coherence tomography (OCT) imaging showing the temporal extent of the loss of the ellipsoid zone demarcated, increased atrophy after a 4-year interval. Optos imaging shows increased bilateral macular atrophy, AF imaging shows extension of patchy AF surrounding the central atrophy with a small preserved foveal remnant, OCT showing further extension of the loss of the ellipsoid zone

    1. Patients who present with hemoptysis should be treated for their lung hemorrhage, as it responds to plasmapheresis

      No entiendo cuál es el tratamiento general entonces

    1. Synthèse d'Information : Troubles de la Communication, Comportements Défis et Transitions dans le Handicap Rare

      Résumé Analytique

      Ce document de synthèse récapitule les interventions clés de la journée d'étude organisée par les Équipes Relais Handicap Rare (ERHR) d'Occitanie.

      Marquant le dixième anniversaire de la création de ce réseau, l'événement s'inscrit dans le cadre du troisième schéma national handicap rare.

      Les points cardinaux de cette analyse soulignent que la communication est le levier fondamental de l'autonomie et de la socialisation.

      Une distinction rigoureuse est établie entre l'expression (manifestation passive) et la communication (acte intentionnel adressé).

      L'analyse démontre que les « comportements défis » sont intrinsèquement liés à des ruptures de communication, des particularités sensorielles non prises en compte ou des transitions mal préparées.

      La gestion de ces situations complexes repose sur une évaluation fonctionnelle systématique, l'anticipation des changements de parcours et l'utilisation impérative de supports visuels pour structurer l'environnement des personnes accompagnées.

      --------------------------------------------------------------------------------

      1. Cadre Institutionnel et Missions des ERHR

      Le réseau des Équipes Relais Handicap Rare (ERHR) célèbre en 2022 dix ans d'existence en Occitanie.

      Le cadre d'action actuel est défini par le troisième schéma national handicap rare, qui se concrétise régionalement par des Contrats d'Objectifs et de Moyens (CPOM) entre l'ARS et les porteurs de projets (IGA et SESDA 34).

      Missions fondamentales des équipes relais :

      Repérage : Identifier les besoins spécifiques liés au handicap rare et recenser les ressources (aidants, professionnels du sanitaire et du médico-social).

      Évaluation : Contribuer à l'élaboration de projets d'accompagnement personnalisés.

      Animation de réseau : Partager les expertises, étayer les pratiques professionnelles et organiser des communautés de pratique.

      Définition du Handicap Rare :

      Le handicap rare ne se limite pas à la faible prévalence d'une pathologie. Il se définit par :

      • La présence de déficiences sensorielles associées à d'autres déficiences graves ou maladies rares.

      • Une combinaison de déficiences qui engendre des situations de dépendance lourdes et complexes.

      • La rareté des expertises nécessaires pour l'évaluation et l'accompagnement.

      --------------------------------------------------------------------------------

      2. Analyse Conceptuelle de la Communication

      La communication est présentée comme l'outil d'action sur le monde. Sans elle, il n'y a ni autonomie, ni socialisation, ni comportement socio-adaptatif efficace.

      La Distinction Expression vs Communication

      Il est crucial pour les professionnels de ne pas confondre ces deux notions :

      L'Expression : Manifestation passive ou manifestation d'un état (ex: se gratter la tête, gémir).

      Elle peut être interprétée par l'entourage, mais elle n'est pas nécessairement une volonté de transmettre un message.

      La Communication : Un acte volontaire, intentionnel et adressé à un interlocuteur. Elle implique deux rôles distincts : le locuteur (qui initie) et l'interlocuteur (qui reçoit et est disponible).

      Typologie des Modes de Communication

      L'analyse propose une clarification terminologique pour sortir du clivage réducteur "parle / ne parle pas" :

      | Catégorie | Définition | Exemples | | --- | --- | --- | | Oral / Non-Oral | Ce qui sort ou non de la bouche (aspect moteur). | Parole vs Signes ou Images. | | Verbal / Non-Verbal | Utilisation du verbe, de la syntaxe et du sens. | Français, LSF, PECS vs Cris, mimiques, postures. |

      Note : Une personne peut être verbale sans être orale (ex : utilisation d'une synthèse vocale ou de la langue des signes).

      --------------------------------------------------------------------------------

      3. Compréhension et Gestion des Comportements Défis

      Les comportements défis (agressions, automutilations, destructions, stéréotypies) sont analysés comme des réponses inadaptées à des besoins légitimes ou des conséquences d'un environnement inadéquat.

      L'Analyse Fonctionnelle

      Toute intervention sur un comportement problème doit être précédée d'une évaluation pour en comprendre la fonction (demande, protestation, évitement).

      L'analyse doit prendre en compte :

      1. Le versant somatique : Vérifier systématiquement l'absence de douleur physique.

      2. Les particularités sensorielles : Identifier les hypersensibilités ou hyposensibilités (besoin de "se remplir" ou de "se vider" de sensations).

      3. Le déficit de communication : Le comportement devient le seul moyen d'agir sur l'environnement quand les outils de communication manquent.

      Stratégies de Prévention et d'Intervention

      Approche positive : Il est plus efficace d'enseigner des compétences nouvelles et des comportements adaptés que de chercher à supprimer les mauvais.

      Espaces de repli : Créer des lieux de retrait (distincts des salles d'isolement) pour permettre la régulation sensorielle, selon les besoins individuels évalués.

      Projet d'établissement : La gestion des comportements défis doit être une démarche institutionnelle partagée, inscrite dans le projet de la structure.

      --------------------------------------------------------------------------------

      4. La Problématique des Transitions

      La transition est définie comme un passage d'un état à un autre, impliquant intrinsèquement un changement.

      Pour les personnes en situation de handicap rare, ces changements sont sources d'angoisse majeure.

      Typologie des Transitions

      Transitions Développementales (Diachronie) : Passage de l'enfance à l'adolescence, puis à l'âge adulte et au vieillissement.

      Transitions Fonctionnelles (Synchronie) : Changements de lieux (domicile/IME/SESSAD), changements d'activités dans la journée, ou changements d'intervenants (départs en retraite, stagiaires).

      Aléas de la vie : Deuils, déménagements, séparations parentales.

      Méthodologie d'Accompagnement des Transitions

      L'objectif est que la personne ne "subisse" pas le changement. Trois piliers sont identifiés :

      1. Anticiper : Prévoir les changements prévisibles (fermetures annuelles, passages en structures adultes) longtemps à l'avance.

      2. Préparer par le Visuel : L'oralisation ne suffit pas en période de stress. L'utilisation de photos, de pictogrammes et de plannings visuels est indispensable pour créer des repères spatio-temporels.

      3. Communiquer : Une fois la personne rassurée par des repères visuels, la communication peut s'établir pour permettre l'expression des questions et des besoins.

      --------------------------------------------------------------------------------

      5. Conclusions et Recommandations Clés

      La journée d'étude conclut sur l'importance de la coordination des interventions.

      L'incohérence entre les différents lieux de vie (école, maison, institution) est un facteur aggravant des troubles.

      Évaluation permanente : Utiliser des échelles et des outils validés (profil sensoriel, Vineland, etc.) plutôt que des interventions intuitives.

      Soutien aux aidants et professionnels : La confrontation aux comportements défis impacte la qualité de vie de tout l'entourage ; un soutien institutionnel est nécessaire.

      Individualisation : Il n'existe pas de solution universelle (ex: l'espace de repli peut être la chambre pour l'un, et un espace ouvert pour l'autre).

      L'observation clinique reste le premier outil de l'accompagnant.

    1. CUCA.-   (Canta muy débilmente.) La sala no es la sala. La sala es la cocina.   (Las dos hermanas están situadas: BEBA, en el lateral derecho; CUCA, en el lateral izquierdo. Ambas a la vez, de espaldas al público, emiten un grito desgarrador. Entra LALO. Las hermanas se arrodillan.)   LALO.-   (Con el cuchillo entre las manos.) Silencio.   (Las dos hermanas comienzan a cantar en un murmullo apagado: «La sala no es la sala. La sala es la cocina. El cuarto no es el cuarto. El cuarto es el inodoro».)

      Canción?

    Annotators

    1. Document de Synthèse : Le Programme EVARS – Enjeux, Histoire et Mise en Application

      Résumé Exécutif

      L’adoption à l’unanimité du programme EVARS (Éducation à la Vie Affective, Relationnelle et Sexuelle) par le Conseil supérieur de l’éducation le 3 février 2025 marque un tournant historique dans le système éducatif français.

      Fruit de plus de 50 ans de luttes et d'évolutions législatives, ce programme vise à institutionnaliser une éducation complète à la sexualité, de la maternelle à la terminale.

      L'objectif central est de transformer une obligation légale souvent négligée — la loi Aubri de 2001 prévoyant trois séances annuelles — en une réalité pédagogique concrète.

      Les enjeux sont multiples : prévention des violences sexuelles (touchant statistiquement trois enfants par classe), lutte contre les stéréotypes de genre, promotion du consentement et déconstruction des représentations toxiques issues notamment de la pornographie.

      Malgré cette victoire institutionnelle, la mise en œuvre se heurte à des défis persistants : une désinformation active de mouvements traditionalistes, un manque de formation des personnels et des contraintes de financement.

      La réussite du programme repose désormais sur une synergie entre l'institution scolaire, les associations expertes et l'implication des familles.

      --------------------------------------------------------------------------------

      1. Perspective Historique et Évolution Légale

      L'éducation à la sexualité n'est pas un concept récent, mais son approche a radicalement évolué, passant d'une logique de contrôle à une logique d'émancipation.

      1.1. Les prémices (XIXe - milieu XXe siècle)

      Fin du XIXe siècle : Apparition des premiers textes, oscillant entre la préservation de l'innocence enfantine et des impératifs de santé publique (lutte contre la syphilis et enjeux démographiques).

      1947-1948 : Le rapport de l'inspecteur général François marque la première prise en compte institutionnelle de la nécessité d'une éducation à la sexualité.

      1.2. De l'information à l'éducation (1973 - 2001)

      1973 : Une circulaire fondamentale distingue l'information sexuelle (reproduction, assurée par les SVT) de l'éducation à la sexualité (dimension affective et sociale).

      1998 : Sous l'impulsion de Jack Lang, la circulaire "Toutmonde" met l'accent sur la prévention du sida.

      4 juillet 2001 (Loi Aubri/Péri) : La loi rend obligatoires trois séances d'éducation à la sexualité par an à chaque niveau de classe.

      Cependant, dans les faits, seuls 15 à 20 % des élèves en bénéficient réellement.

      1.3. Vers le programme EVARS de 2025

      • Le programme adopté en 2025 remplace des initiatives plus fragiles ou contestées comme les "ABCD de l'égalité" (2013).

      • Il s'inscrit dans un cadre européen standardisé, nommant l'enseignement "Éducation à la vie affective et relationnelle" (EVAR) pour le premier degré et y ajoutant le terme "Sexuelle" (EVARS) pour le second degré afin d'apaiser les craintes parentales.

      --------------------------------------------------------------------------------

      2. Les Enjeux Majeurs de l'EVARS

      Le programme repose sur trois piliers de compétences : se connaître et vivre avec son corps, construire des relations épanouies, et trouver sa place dans la société en tant que citoyen libre et responsable.

      2.1. Prévention des violences sexuelles

      Constat alarmant : Selon la CIIVISE, 160 000 enfants sont victimes de violences sexuelles chaque année, soit environ trois enfants par classe.

      Rôle de l'école : L'éducation permet de nommer les parties du corps (brisant le tabou de la "zette" ou du sexe), d'identifier l'intimité et d'apprendre à dénoncer les attouchements.

      Protection : L'absence de mots et une pudeur excessive favorisent les agresseurs. Le programme EVARS apprend aux enfants qu'ils ont le droit de dire "non".

      2.2. Lutte contre les stéréotypes et la masculinité toxique

      Impact du numérique : 73 % des adolescents garçons sont exposés en ligne à des stéréotypes de domination masculine (données d'octobre 2025).

      Déconstruction : Le programme vise à libérer les garçons de l'injonction à la violence ou à la répression émotionnelle ("apprendre à pleurer avant d'apprendre les armes") et les filles de l'intériorisation de la soumission.

      2.3. Accès à une information fiable

      • En l'absence d'éducation formelle, la pornographie devient la source principale d'information, véhiculant des modèles relationnels faussés et violents dès le CM1.

      • L'EVARS offre un cadre clinique et serein pour aborder des sujets complexes sans jugement.

      --------------------------------------------------------------------------------

      3. Modalités d'Application et Défis de Terrain

      3.1. Les "Ateliers de l'égalité" : Un modèle pédagogique

      Des associations comme En avant Toute(s) déploient des interventions concrètes (du CE2 à la 5e) :

      Méthodologie : Utilisation de l'éducation populaire (débats, théâtre-forum, jeux de cartes) pour partir de la parole de l'élève.

      Non-mixité : Des temps séparés entre filles et garçons sont parfois utilisés pour favoriser la libération de la parole sur les violences vécues avant une mise en commun.

      Outils pratiques : Création de "réseaux de soutien" où l'enfant identifie les adultes ressources en cas de problème.

      3.2. Obstacles institutionnels et financiers

      Formation : Il existe un besoin impérieux de former les enseignants via les INSPÉ pour leur donner la confiance nécessaire face aux sujets "sensibles".

      Statut des heures : Si les séances sont obligatoires, elles ne sont pas toujours intégrées aux programmes évalués, ce qui complexifie leur financement (nécessité de dotations horaires pour les heures supplémentaires dans le secondaire).

      Restriction des intervenants : Une circulaire limite l'intervention des associations dans les écoles primaires, laissant la charge aux seuls enseignants, ce qui peut freiner la mise en œuvre faute d'expertise externe.

      3.3. La résistance idéologique

      • L'école fait face à une "hystérie collective" ou des rumeurs persistantes (accusations infondées d'apprendre la masturbation aux jeunes enfants).

      • Des groupes traditionalistes et des mouvements d'extrême droite s'organisent pour délégitimer le programme, utilisant des plateformes médiatiques pour diffuser de la désinformation.

      --------------------------------------------------------------------------------

      4. Recommandations pour une Mise en Œuvre Réussie

      | Axe d'effort | Actions préconisées | | --- | --- | | Transparence | Rendre les programmes consultables par tous les parents sur Éduscol pour désamorcer les fantasmes. | | Implication parentale | Organiser des "cafés des parents" et les inciter à porter la demande d'EVARS dans les conseils d'école. | | Soutien aux enseignants | Assurer la protection institutionnelle des professeurs face aux menaces de groupes radicaux. | | Synergie associative | Maintenir le rôle des associations agréées qui apportent une expertise complémentaire et une posture d'adulte neutre. | | Élargissement | Étendre ces formations au secteur périscolaire et aux établissements spécialisés (IME, CFA). |

      Conclusion

      Le programme EVARS n'est pas une menace pour les familles, mais un "cadeau pour les générations futures".

      En enseignant le respect, le consentement et l'empathie au même titre que la grammaire ou les mathématiques, l'école remplit sa mission fondamentale : former des citoyens lucides, capables d'aimer sans posséder et de s'affirmer sans écraser.

      La réussite de ce projet repose sur le passage définitif de la "pudeur à la pédagogie".

    1. Because ^β0β^0\hat{\beta}_0 and ^β1β^1\hat{\beta}_1 are computed from a sample, the estimators themselves are random variables with a probability distribution — the so-called sampling distribution of the estimators — which describes the values they could take on over different samples.

      I'm sure this makes sense to people with a great deal of statistical knowledge and experience, but if you're aiming for a less sophisticated audience, you might want to rethink this sentence. I don't think the predicate clause is as self-evident as you make it seem and adding more clarity to this sentence will help readers.

    1. If you want Congress to protect farm owners, it may be wiseto elect more farm owners. And if you want Congress to stop pro-tecting farmers, it may be wise to stop electing them.

      Kansas isn't just voting against its own interests, it is against that of the country.

    2. Note, however, that the fact that thecoefficient on PAC contributions does not change much with theinclusion of other variables suggest that lobbying has an effect allof its own, i.e., that very little of what it captures is captured by law-maker preferences for agriculture or by electoral incentives

      Scary

    3. awmakers who received more money from farmgroups were more likely to support agriculture in each of the rollcall votes

      Would also be interesting to see the continuous effects

    4. both parties when we examined whichmembers were designated Friends of the Farm Bureau, our mostcomprehensive measure of support for agriculture.

      So there is evidence that time spent working on a farm has some effect

    5. x is a vector of otherlegislator- or district-specific attributes, d s is an indicator variablecapturing whether a legislator is a senator, dj is a vector of statefixed effects, dt is a vector of Congress fixed effects,

      Controls

    Annotators

    1. La Santé Mentale des Jeunes : Enjeux, État des Lieux et Pilotage en Milieu Scolaire

      Résumé Exécutif

      La santé mentale des jeunes est devenue une priorité gouvernementale et de santé publique majeure en France.

      Loin d'être une mission périphérique, elle est désormais reconnue comme une condition sine qua non de la réussite scolaire et du bien-être des élèves.

      Les données récentes révèlent une dégradation préoccupante de l'état psychique des jeunes, particulièrement chez les adolescentes, sans amélioration notable après la période COVID-19.

      La stratégie nationale repose sur un changement de paradigme : passer d'une gestion purement médicale des troubles à une approche globale d'« École promotrice de santé ».

      Cela implique la mobilisation de l'ensemble de la communauté éducative — et non seulement des professionnels de santé — pour créer des environnements favorables.

      Le pilotage repose sur des protocoles clairs (du repérage à la prise en charge), une exploitation rigoureuse des données statistiques et une formation accrue des personnels (secouristes en santé mentale).

      --------------------------------------------------------------------------------

      1. État des Lieux Statistique de la Santé Mentale des Jeunes

      Les données issues des enquêtes nationales (ENABY pour le primaire et « En Classe » pour le secondaire) dressent un constat de vulnérabilité croissante.

      Données par Cycle Scolaire

      | Niveau Scolaire | Prévalence des troubles probables | Observations Clés | | --- | --- | --- | | Maternelle (3-11 ans) | 8 % (soit 1 élève sur 12) | Les garçons sont deux fois plus concernés que les filles (troubles d'opposition, hyperactivité). | | Primaire (CP-CM2) | 13 % (soit + de 3 par classe) | Distinction selon le sexe : troubles émotionnels (anxiété, dépression) pour les filles ; troubles du comportement (TDAH) pour les garçons. | | Collège et Lycée | ~14 % de risque de dépression | Dégradation continue entre la 6ème et la terminale. Plus de 50 % des élèves présentent des symptômes physiques ou psychiques fréquents. |

      Focus sur les Risques Graves et Tendances

      Suicide au lycée : 13 % des lycéens déclarent avoir déjà fait une tentative de suicide ; 3 % ont fait une tentative ayant nécessité une hospitalisation (soit environ un élève par classe).

      Évolution temporelle : Tous les indicateurs se sont dégradés entre 2018 et 2022. La vulnérabilité des filles est le principal point d'alerte actuel.

      Contexte global : La santé mentale est impactée par un empilement de crises (économiques, sociales, géopolitiques et climatiques) et par l'influence des réseaux sociaux.

      --------------------------------------------------------------------------------

      2. Cadre Conceptuel et Institutionnel

      Une Définition Tripartite

      La santé mentale ne se résume pas à l'absence de pathologie. Elle comprend trois composantes essentielles :

      1. Le bien-être (santé mentale positive).

      2. Les troubles mentaux (souffrance psychique).

      3. Les maladies mentales (diagnostics cliniques).

      L'École Promotrice de Santé

      Ce dispositif, porté par le ministère depuis 2020, vise à fédérer la communauté éducative autour de la promotion de pratiques favorables au bien-être physique, mental et social.

      Objectif : Intégrer la santé mentale dans tous les actes quotidiens, pédagogiques et éducatifs.

      Priorité politique : Depuis 2022, les circulaires de rentrée placent le bien-être au même niveau que les apprentissages fondamentaux.

      --------------------------------------------------------------------------------

      3. Cadre Juridique : Secret Médical et Aménagements

      La prise en compte de la santé mentale doit s'équilibrer avec les droits fondamentaux des élèves.

      Le Secret Médical : Défini par l'article 226-13 du Code pénal, il est un droit fondamental du patient garantissant la confiance avec les personnels soignants.

      Sa violation est pénalement sanctionnée.

      Le Projet d'Accueil Individualisé (PAI) : Cet outil juridique permet d'organiser la scolarité des élèves ayant des problèmes de santé ou un handicap.

      Il permet d'aménager les régimes alimentaires, les horaires ou les activités de substitution sur prescription médicale, tout en respectant la confidentialité des diagnostics.

      --------------------------------------------------------------------------------

      4. Stratégies de Pilotage et Leviers Opérationnels

      Le pilotage de la santé mentale nécessite une approche à la fois verticale (institutionnelle) et horizontale (territoriale).

      Actions à l'Échelle de l'Établissement

      Le chef d'établissement doit agir comme un pilote en s'appuyant sur plusieurs leviers :

      Diagnostic local : Utiliser les indicateurs de climat scolaire (logiciels infirmiers, enquêtes sociales, évaluations d'établissement).

      Protocole Santé Mentale : Formaliser un document « du repérage à la prise en charge » qui précise le rôle de chaque acteur.

      Instances : Faire vivre le sujet au sein du CESCE, du conseil pédagogique et du conseil d'administration.

      Aménagements physiques : Intégrer le bien-être dans l'aménagement du bâti scolaire, des cours de récréation et de la restauration.

      Dispositifs et Outils Nationaux

      Secouristes en santé mentale : Formation de deux personnels par collège pour repérer les signes de crise (notamment suicidaire) et orienter les élèves.

      3114 : Le numéro national de prévention du suicide, désormais inscrit dans les carnets de correspondance.

      Infolettre EPSA : Publication sur Eduscol fournissant des données et des références pour le pilotage.

      Compétences Psychosociales (CPS) : Levier préventif majeur pour renforcer la résilience des élèves.

      --------------------------------------------------------------------------------

      5. Rôles et Responsabilités des Acteurs

      La santé mentale n'est pas uniquement l'affaire des spécialistes ; elle repose sur une chaîne de responsabilités partagées.

      Personnels de direction : Pilotes de la politique de santé et du climat scolaire.

      Personnels de santé et sociaux (Médecins, Infirmiers, Assistants Sociaux, Psychologues) : Experts-conseils et conseillers techniques. Ils assurent l'évaluation et l'orientation vers le soin extérieur.

      Personnels pédagogiques et éducatifs : Acteurs de première ligne pour le repérage et l'accueil de la parole.

      Partenaires territoriaux : Collectivités territoriales, Agences Régionales de Santé (ARS), et contrats locaux de santé pour assurer la continuité des soins hors de l'école.

      Familles : Reconnues comme les premières spécialistes de leurs enfants, elles sont des partenaires indispensables dans le suivi.

      Conclusion

      L'institution scolaire opère une mutation profonde en intégrant la santé mentale comme un axe de réussite scolaire au même titre que les savoirs académiques.

      Si les indicateurs statistiques restent préoccupants, la mobilisation collective — marquée par la déstigmatisation des troubles et la formation des personnels — constitue le levier principal pour stabiliser et améliorer le bien-être des jeunes générations.

      L'école ne soigne pas, mais elle repère, protège et oriente.

    1. eLife Assessment

      This study investigates the folding and unfolding behavior of the doubly knotted protein TrmD-Tm1570, providing insight into the molecular mechanisms underlying protein knotting. The findings reveal multiple unfolding pathways and suggest that the formation of double knots may require chaperone assistance, offering valuable insights into topologically complex proteins. The evidence is convincing, supported by consistent agreement between simulation and experiment, though some aspects of the presentation and experimental scope could be clarified or expanded.

    2. Reviewer #1 (Public review):

      Summary:

      This paper investigates the thermal and mechanical unfolding pathways of the doubly knotted protein TrmD-Tm1570 using molecular simulations, optical tweezers experiments, and other methods. In particular, the detailed analysis of the four major unfolding pathways using a well-established simulation method is an interesting and convincing result.

      Strengths:

      A key finding that lends credibility to the simulation results is that the molecular simulations at least qualitatively reproduce the characteristic force-extension distance profiles obtained from optical tweezers experiments during mechanical unfolding. Furthermore, a major strength is that the authors have consistently studied the folding and unfolding processes of knotted proteins, and this paper represents a careful advancement building upon that foundation.

      Weaknesses:

      While optical tweezers experiments offer valuable insights, the knowledge gained from them is limited, as the experiments are restricted to this single technique.

      The paper mentions that the high aggregation propensity of the TrmD-Tm1570 protein appears to hinder other types of experiments. This is likely the reason why a key aspect, such as whether a ribosome or molecular chaperones are essential for the folding of TrmD-Tm1570, has not been experimentally clarified, even though it should be possible in principle.

      Comments on revisions:

      According to reviewers' comments, the authors revised the manuscript appropriately.

    3. Reviewer #2 (Public review):

      Summary:

      In this manuscript, the authors combined coarse-grained structure-based model simulation, optical tweezer experiments, and AI-based analysis to assess the knotting behavior of the TrmD-Tm1570 protein. Interestingly, they found that while the structure-based model can fold the single knot from TrmD and Tm1570, the double-knot protein TrmD-Tm1570 cannot form a knot itself, suggesting the need for chaperone proteins to facilitate this knotting process. This study has strong potential to understand the molecular mechanism of knotted proteins, supported by many experimental and simulation evidence. However, there are a few places that appear to lack sufficient details, and more clarification in the presentation is needed.

      Strengths:

      A combination of both experimental and computational studies. The authors have addressed my questions in their revised manuscript. I appreciate their efforts.

    4. Author response:

      The following is the authors’ response to the original reviews

      Public Reviews:

      Reviewer #1 (Public review):

      Summary:

      This paper investigates the thermal and mechanical unfolding pathways of the doubly knotted protein TrmD-Tm1570 using molecular simulations, optical tweezers experiments, and other methods. In particular, the detailed analysis of the four major unfolding pathways using a well-established simulation method is an interesting and valuable result.

      Strengths:

      A key finding that lends credibility to the simulation results is that the molecular simulations at least qualitatively reproduce the characteristic force-extension distance profiles obtained from optical tweezers experiments during mechanical unfolding. Furthermore, a major strength is that the authors have consistently studied the folding and unfolding processes of knotted proteins, and this paper represents a careful advancement building upon that foundation.

      We appreciate and we thank the reviewer for reading our manuscript.

      Weaknesses:

      While optical tweezers experiments offer valuable insights, the knowledge gained from them is limited, as the experiments are restricted to this single technique.

      The paper mentions that the high aggregation propensity of the TrmD-Tm1570 protein appears to hinder other types of experiments. This is likely the reason why a key aspect, such as whether a ribosome or molecular chaperones are essential for the folding of TrmD-Tm1570, has not been experimentally clarified, even though it should be possible in principle.

      We appreciate the suggestion that clarifying the requirement for molecular chaperones or the ribosome in TrmD-Tm1570 folding is crucial. We are pleased to report that the experiment investigating the role of molecular chaperones in the folding of TrmD-Tm1570 is currently under investigation in our laboratory. These results will provide the clarification on this aspect and will be incorporated into a future manuscript.

      Reviewer #2 (Public review):

      Summary:

      In this manuscript, the authors combined coarse-grained structure-based model simulation, optical tweezer experiments, and AI-based analysis to assess the knotting behavior of the TrmD-Tm1570 protein. Interestingly, they found that while the structure-based model can fold the single knot from TrmD and Tm1570, the double-knot protein TrmD-Tm1570 cannot form a knot itself, suggesting the need for chaperone proteins to facilitate this knotting process. This study has strong potential to understand the molecular mechanism of knotted proteins, supported by much experimental and simulation evidence. However, there are a few places that appear to lack sufficient details, and more clarification in the presentation is needed.

      Strengths:

      A combination of both experimental and computational studies.

      We appreciate and we thank the reviewer for reading our manuscript.

      Weaknesses:

      There is a lack of detail to support some statements.

      (1) The use of the AI-based method, SOM, can be emphasized further, especially in its analysis of the simulated unfolding trajectories and discovery of the four unfolding/folding pathways. This will strengthen the statistical robustness of the discovery.

      We thank the reviewer for this observation. However, the AI-based method, SOM, was applied to obtain the main representative trajectories for the mechanical unfolding MD simulations. Specifically, for the TrmD, Tm1570, and fusion protein (TrmD-Tm1570) we extracted the representative conformational states by selecting the most highly populated SOM clusters shown in SI Figure 5 - figure supplement 3. Then, by identifying the cluster centroid, we selected the nearest point (simulations). These correspond to the clusters number 1 for Tm1570, number 11 for TrmD, and number 7 for TrmD-Tm1570. A sentence was added in the main manuscript to clarify how the main representative confirmation was obtained.

      On the other hand, no AI‑based methods were applied to the thermal unfolding simulations. The four thermal unfolding trajectories shown in Figure 3 were obtained as follows: (i) trajectories where TrmD unfolds first and its knot unties before Tm1570 unfolds, corresponding to pathway 1 (Figure 3A and E); (ii) trajectories where Tm1570 unfolds and unties first, followed by TrmD, corresponding to pathway 3 (Figure 3C and G); and (iii) trajectories where TrmD unfolds first, then Tm1570, after which the TrmD knot unties and finally the Tm1570 knot unties—this corresponds to pathway 2. Pathway 4 follows the same sequence but in the reverse order.

      (2) The manuscript would benefit from a clearer description of the correlation between the simulation and experimental results. The current correlation, presented in the paragraph starting from Line 250, focuses on measured distances. The authors could consider providing additional evidence on the order of events observed experimentally and computationally. More statistical analyses on the experimental curves presented in Figure 4 supplement would be helpful.

      We thank the reviewer for this suggestion. In response, we prepared additional statistical analyses in a table format reporting the average length‑change increments together with their standard deviations, and we clarified in the revised text that the ± values correspond to standard deviations. In addition, we quantified the percentage of TrmD, Tm1570, and TrmD-Tm1570 unfold completely, providing a clearer comparison of the order of events observed experimentally and computationally. These analyses have been incorporated into the revised manuscript, Tables 1 and 2.

      (3) How did the authors calibrate the timescale between simulation and experiment? Specifically, what is the value \tau used in Line 270, and how was it calculated? Relevant information would strengthen the connection between simulation and experiment.

      In our model time unit is defined by a relation , where m is the reduced mass unit, is an average average mass of an amino acid, m = 110 Da = 1.66 x 10<sup>-27</sup> kg, 𝜀 is the reduced energy unit, an average interaction energy between amino acids. We may assume that ε is around 2-3 kcal/mol = 2-3 x 6.95 x 10<sup>-21</sup> J, is a distance unit and is equal to 1 nm.

      After plugging this values into the equation defining 𝜏 , we get: 𝜏 = 3.2 ps.

      The definition of the time unit comes from the fact that this is how one can combine units of mass, distance and energy into an expression that has an unit of time.

      The pulling speeds used in the simulations (0.05–0.15 Å/) correspond to approximately 1.6 -4.7 m/s in real units. These speeds are necessarily much higher than the experimental pulling The pulling speeds used in the simulations (0.05–0.15 Å/ ) correspond to approximately 1.6 - speed (20 nm/s), which is a well‑known limitation of steered molecular dynamics. However, our coarse‑grained model is run in an implicit solvent regime and does not explicitly include hydrodynamic friction. As a consequence, the simulated dynamics do not reproduce absolute real time kinetics. Instead, the comparison between simulation and experiment is made through relative unfolding pathways, force extension behavior, and contour length changes, which remain robust across the range of simulated pulling speeds.

      Thus, 𝜏 = 3.2 ps is derived directly from the coarse‑grained model parameters rather than calibratedτ to experiment, and the connection between simulation and experiment is established through mechanistic agreement rather than matching absolute timescales.

      We have now added a clarifying sentence to the manuscript (Methods and Materials - Mechanical unfolding simulations) explaining how the timescale was defined and how the value of  was obtained.

      Reference: 

      Szymczak, P., and Marek Cieplak. "Stretching of proteins in a uniform flow." The Journal of chemical physics 125.16 (2006).

      (4) In Line 342, the authors comment that whether using native contacts or not, they cannot fold double-knotted TrmD-Tm1570. Could the authors provide more details on how non-native interactions were analyzed?

      To analyze the role of non‑native interactions, we calculated two non‑native contact maps, first using a distance cutoff criterion and second by identifying the highly frustrated contacts based on the frustration index using Frustratometer (http://frustratometer.qb.fcen.uba.ar/) - figure below. From this procedure, the non‑native interactions were incorporated in the SBM C-alpha model to potentially assist refolding or knot formation. However, in neither case we observe successful refolding or the formation of the double‑knotted native topology. These results indicate that the addition of these non‑native contacts are insufficient to drive the refolding of the TrmD–Tm1570 protein. This result may suggest that the protein needs the support of chaperones or the active role of ribosomes to tie the two knots. We have now clarified this point more explicitly in the revised manuscript .

      Author response image 1.

      Native and non‑native contact maps for TrmD–Tm1570. The upper triangle (blue dots) corresponds to the cutoff‑based contact map and shows only unique contacts not present in the native contact map. The lower triangle (red dots) represents highly frustrated contacts, again showing only unique contacts absent from the native map. Black dots indicate the native contacts derived from the structure, and the contact map was generated using the Shadow Contact Map software. The blue and orange shadows correspond to the knot position for TrmD and Tm1570 proteins, respectively. 

      (5) It appears that the manuscript lacks simulation or experimental evidence to support the statement at Line 343: While each domain can self-tie into its native knot, this process inhibits the knotting of the other domain. Specifically, more clarification on this inhibition is needed.

      Explaining this phenomenon remains challenging, and several contributing factors are likely.

      (1) The folding success rates of the individual TrmD and Tm1570 domains are low (<3%); folding of the double-knotted protein is therefore expected to be even less efficient. 

      (2) While formation of a single knot is observed when the two domains are examined, the folded domain adopts a native-like but not fully native conformation, regardless of whether it is TrmD or Tm1570. (2A) Fluctuations of the unfolded second domain may impose a destabilizing load, promoting unfolding of the folded domain. (2B) Conversely, folding of one domain restricts the conformational space available to the other. Such restriction may have either stabilizing or destabilizing effects: although reduced conformational space (crowding) is generally thought to increase the probability of knot formation in polymers, in this system the constraint is localized rather than global.

      (3) It is possible that extending the simulations to much longer timescales would allow formation of the second knot; however, within the timescales accessible here, unfolding of the first knot is observed instead.

      (4) The TrmD–Tm1570 protein forms a dimer with a well-defined interface, whereas our simulations were performed on a monomeric unit. Consequently, both domains are solvent-exposed, forming an open two-domain system with tRNA-binding elements that are not stabilized by intermolecular interactions.

      Taken together, these factors preclude a quantitative assessment of the dominant contribution. Our results suggest that efficient folding may require assistance from molecular chaperones or an active role of the ribosome in coordinating formation of the two knots.

      Recommendations for the authors:

      Reviewer #1 (Recommendations for the authors):

      (1) The paper notes at the beginning of its results section that simulations aiming to fully fold the TrmD-Tm1570 protein from a denatured state were unsuccessful. While the failure to achieve complete folding is itself an instructive and important result, there is room for improvement in how it's presented. The authors provide no specific details on what actually occurred during these simulations. It is plausible that some intermediate state was reached, and one can imagine that the knotting of the C-terminal part, Tm1570, was partially completed. A more detailed description of these outcomes would have been beneficial.

      In the main manuscript (Figure 3), we reported the folding trajectories and the probability of native contact formation for the TrmD–Tm1570 protein, focusing on the four main observed unfolding pathways from our simulations. In addition to these common pathways, we also examined a small number of trajectories which one or both domains may refold. These are presented in Figure 3 - figure supplements 1 and 2, where we highlight a set of trajectories that we classify as rare events. In these rare trajectories, partial refolding and the formation of intermediate states can indeed be observed. However, as described in the main text, successful refolding of the fusion protein only occurs when the knot remains close to its native position and does not undergo large fluctuations along the chain. When the knot drifts significantly, refolding is not completed.

      Figure 3 - figure supplement 1 shows six representative examples of intermediate states sampled during these simulations. As the reviewer suggested, some intermediate conformations were reached, including partial reformation of structural elements. However, only the trajectory which maintains the knot sufficiently close to its native location is able to do substantial refolding. We have now clarified this point more explicitly in the revised manuscript to better explain why full folding was not achieved and how the knot dynamics constrain the refolding process.

      (2) Is it not possible to plot the degree of knot formation as a function of time or Q in Figure 3A-H? Doing so would make the verbally described results much clearer.

      We thank the reviewer for the suggestion. Based on your observation, we have added a new figure in the SI manuscript (Figure 3 - figure supplement 3) showing the knot translocation as a function of the frames with their respective structure representations from the transitions, from folded to unfolded state and knot untied processes.

      (3) Placement of a paragraph starting from line 250 looks odd to me. The paragraph describes simulation results of the mechanical unfolding, which is fully described in the following section. Specifically, the simulation result is discussed before describing its method/outline, which is to be avoided as far as possible.

      According to the standard journal style, the Method section is described after the Discussion section. However, in the simulation's results, a sentence addressing the methods was included to guide the reader through the text. 

      (4) This is only an optional request. It is highly desired to examine the in vitro folding of TrmD-Tm1570 with and without molecular chaperones. At least, authors can envision/discuss this direction.

      We agree that examining the in vitro folding of TrmD–Tm1570 with and without molecular chaperones would provide important mechanistic insights into the role of the fold of knotted proteins. We are planning to perform these experiments as part of our ongoing work, and in the revised manuscript we will add a discussion on this direction and its potential impact.

      Reviewer #2 (Recommendations for the authors):

      (1) Figure 6C was not referenced or discussed in the manuscript.

      We thank the reviewer for pointing this out. Figure 6C is indeed referenced and discussed in the manuscript.

      (2) Several places refer to figures in the Supporting Information, and should be updated to refer to the supplement figures associated with the main figures. 

      In the revised version we ensure that all references are updated and clearly labeled.