1 58 161 A GENOME-WIDE SCAN TO LOCATE REGIONS ASSOCIATED WITH FAMILIAL VESICOURETERAL REFLUX. VESICOURETERAL REFLUX (VUR) IS A CONGENITAL MALFORMATION CARRYING A HIGH RISK OF RECURRENT URINARY TRACT INFECTIONS (UTI) AND, AT WORST, CHRONIC RENAL FAILURE. FAMILIAL CLUSTERING IMPLIES A GENETIC ETIOLOGY, BUT STUDIES DURING THE PAST FEW DECADES HAVE DEMONSTRATED A CAUSAL GENE VARIANT IN <10% OF PATIENTS WITH VUR. THE AIM OF THE PRESENT STUDY WAS TO SEARCH FOR FULLY OR PARTIALLY SHARED ANCESTRAL HAPLOTYPES IN 14 FAMILIES FROM SOUTH-WESTERN SWEDEN WITH AT LEAST THREE AFFECTED MEMBERS. HIGH-DENSITY SINGLE NUCLEOTIDE POLYMORPHISM MICROARRAY WAS USED FOR GENOTYPING PRIOR TO ANALYSIS WITH A COMPATIBILITY MATCHING METHOD DEVELOPED IN-HOUSE, AND THE ANALYSIS OF COPY NUMBER VARIATIONS (CNV). NO SINGLE UNIQUE HAPLOTYPE WAS REVEALED TO BE SHARED BY THE FAMILIES, THEREBY EXCLUDING A COMMON ANCESTRY AND FOUNDER MUTATIONS AS A PROBABLE CAUSE OF VUR. AFTER EVALUATION OF HAPLOTYPES SHARED BY SUBSETS OF FAMILIES, A HAPLOTYPE SHARED BY NINE FAMILIES WAS FOUND TO BE OF PARTICULAR INTEREST. THIS HAPLOTYPE, LOCATED AT CHROMOSOMAL REGION 4Q21.21, HARBOURS TWO TENTATIVE CANDIDATE GENES (BONE MORPHOGENETIC PROTEIN 3 AND FIBROBLAST GROWTH FACTOR 5), BOTH EXPRESSED IN METANEPHROS AND WITH KNOWN FUNCTIONS DURING NEPHROGENESIS. AS TO CNV, ONLY ONE FAMILY HAD A SPECIFIC CNV SHARED BY ALL AFFECTED MEMBERS. THIS WAS A FOCAL DELETION AT 5Q31.1 INCLUDING FOLLISTATIN-LIKE 4, A GENE WITHOUT A PREVIOUS KNOWN CONNECTION TO VUR. THESE DATA DEMONSTRATED THE GENETIC HETEROGENEITY OF VUR AND INDICATED THAT AN INTERACTION OF ENVIRONMENTAL AND GENETIC FACTORS, INCLUDING NON-CODING AND EPIGENETIC REGULATORS, ALL CONTRIBUTE TO THE COMPLEXITY OF VUR. 2022 2 6160 42 THE GENETICS AND PATHOGENESIS OF CAKUT. CONGENITAL ANOMALIES OF THE KIDNEY AND URINARY TRACT (CAKUT) COMPRISE A LARGE VARIETY OF MALFORMATIONS THAT ARISE FROM DEFECTIVE KIDNEY OR URINARY TRACT DEVELOPMENT AND FREQUENTLY LEAD TO KIDNEY FAILURE. THE CLINICAL SPECTRUM RANGES FROM SEVERE MALFORMATIONS, SUCH AS RENAL AGENESIS, TO POTENTIALLY MILDER MANIFESTATIONS, SUCH AS VESICOURETERAL REFLUX. ALMOST 50% OF CASES OF CHRONIC KIDNEY DISEASE THAT MANIFEST WITHIN THE FIRST THREE DECADES OF LIFE ARE CAUSED BY CAKUT. EVIDENCE SUGGESTS THAT A LARGE NUMBER OF CAKUT ARE GENETIC IN ORIGIN. TO DATE, MUTATIONS IN ~54 GENES HAVE BEEN IDENTIFIED AS MONOGENIC CAUSES OF CAKUT, CONTRIBUTING TO 12-20% OF THE AETIOLOGY OF THE DISEASE. PATHOGENIC COPY NUMBER VARIANTS HAVE ALSO BEEN SHOWN TO CAUSE CAKUT AND CAN BE DETECTED IN 4-11% OF PATIENTS. FURTHERMORE, ENVIRONMENTAL AND EPIGENETIC FACTORS CAN INCREASE THE RISK OF CAKUT. THE DISCOVERY OF NOVEL CAKUT-CAUSING GENES IS CHALLENGING OWING TO VARIABLE EXPRESSIVITY, INCOMPLETE PENETRANCE AND VARIABLE GENOTYPE-PHENOTYPE CORRELATION. HOWEVER, SUCH A DISCOVERY COULD ULTIMATELY LEAD TO IMPROVEMENTS IN THE ACCURATE MOLECULAR GENETIC DIAGNOSIS, ASSESSMENT OF PROGNOSIS AND MULTIDISCIPLINARY CLINICAL MANAGEMENT OF PATIENTS WITH CAKUT, POTENTIALLY INCLUDING PERSONALIZED THERAPEUTIC APPROACHES. 2023 3 1055 32 CLINICAL INTEGRATION OF GENOME DIAGNOSTICS FOR CONGENITAL ANOMALIES OF THE KIDNEY AND URINARY TRACT. REVOLUTIONS IN GENETICS, EPIGENETICS, AND BIOINFORMATICS ARE CURRENTLY CHANGING THE OUTLINE OF DIAGNOSTICS AND CLINICAL MEDICINE. FROM A NEPHROLOGIST'S PERSPECTIVE, INDIVIDUALS WITH CONGENITAL ANOMALIES OF THE KIDNEY AND URINARY TRACT (CAKUT) ARE AN IMPORTANT PATIENT CATEGORY: NOT ONLY IS CAKUT THE PREDOMINANT CAUSE OF KIDNEY FAILURE IN CHILDREN AND YOUNG ADULTS, BUT THE STRONG PHENOTYPIC AND GENOTYPIC HETEROGENEITY OF KIDNEY AND URINARY TRACT MALFORMATIONS HAS HAMPERED STANDARDIZATION OF CLINICAL DECISION MAKING UNTIL NOW. HOWEVER, PATIENTS WITH CAKUT MAY BENEFIT FROM PRECISION MEDICINE, INCLUDING AN INTEGRATED DIAGNOSTICS TRAJECTORY, GENETIC COUNSELING, AND PERSONALIZED MANAGEMENT TO IMPROVE CLINICAL OUTCOMES OF DEVELOPMENTAL KIDNEY AND URINARY TRACT DEFECTS. IN THIS REVIEW, WE DISCUSS THE PRESENT UNDERSTANDING OF THE MOLECULAR ETIOLOGY OF CAKUT AND THE CURRENTLY AVAILABLE GENOME DIAGNOSTIC MODALITIES IN THE CLINICAL CARE OF PATIENTS WITH CAKUT. FINALLY, WE DISCUSS HOW CLINICAL INTEGRATION OF FINDINGS FROM LARGE-SCALE GENETIC, EPIGENETIC, AND GENE-ENVIRONMENT INTERACTION STUDIES MAY IMPROVE THE PROGNOSIS OF ALL INDIVIDUALS WITH CAKUT. 2020 4 4101 28 MDCT AND MR UROGRAM SPECTRUM OF CONGENITAL ANOMALIES OF THE KIDNEY AND URINARY TRACT DIAGNOSED IN ADULTHOOD. OBJECTIVE: CONGENITAL ANOMALIES OF THE KIDNEYS AND URINARY TRACT (CAKUT) ENCOMPASS A SPECTRUM OF ANOMALIES THAT RESULT FROM GENETIC, EPIGENETIC, ENVIRONMENTAL, AND MOLECULAR SIGNAL ABERRATIONS AT KEY STAGES OF URINARY TRACT DEVELOPMENT. CAKUT CAN BE SEEN INCIDENTALLY ON CROSS-SECTIONAL IMAGING OF THE ABDOMEN OR CAN BE A CAUSE FOR ADULT-ONSET CHRONIC KIDNEY DISEASE, POSING NEW CHALLENGES FOR NEPHROLOGISTS, UROLOGISTS, AND RADIOLOGISTS. CONCLUSION: AWARENESS OF CAKUT AND FAMILIARITY WITH THEIR IMAGING FINDINGS PERMIT OPTIMAL PATIENT MANAGEMENT AND THOROUGH WORKUP TO PREVENT HYPERTENSION AND PROGRESSION FROM CAKUT TO RENAL FAILURE. THE PURPOSE OF THIS ARTICLE IS TO REVIEW THE CROSS-SECTIONAL IMAGING FINDINGS OF CAKUT THAT MAY PRESENT IN ADULTHOOD. 2015 5 4559 37 MUTATIONS OF THE TRANSCRIPTIONAL COREPRESSOR ZMYM2 CAUSE SYNDROMIC URINARY TRACT MALFORMATIONS. CONGENITAL ANOMALIES OF THE KIDNEY AND URINARY TRACT (CAKUT) CONSTITUTE ONE OF THE MOST FREQUENT BIRTH DEFECTS AND REPRESENT THE MOST COMMON CAUSE OF CHRONIC KIDNEY DISEASE IN THE FIRST THREE DECADES OF LIFE. DESPITE THE DISCOVERY OF DOZENS OF MONOGENIC CAUSES OF CAKUT, MOST PATHOGENIC PATHWAYS REMAIN ELUSIVE. WE PERFORMED WHOLE-EXOME SEQUENCING (WES) IN 551 INDIVIDUALS WITH CAKUT AND IDENTIFIED A HETEROZYGOUS DE NOVO STOP-GAIN VARIANT IN ZMYM2 IN TWO DIFFERENT FAMILIES WITH CAKUT. THROUGH COLLABORATION, WE IDENTIFIED IN TOTAL 14 DIFFERENT HETEROZYGOUS LOSS-OF-FUNCTION MUTATIONS IN ZMYM2 IN 15 UNRELATED FAMILIES. MOST MUTATIONS OCCURRED DE NOVO, INDICATING POSSIBLE INTERFERENCE WITH REPRODUCTIVE FUNCTION. HUMAN DISEASE FEATURES ARE REPLICATED IN X. TROPICALIS LARVAE WITH MORPHOLINO KNOCKDOWNS, IN WHICH EXPRESSION OF TRUNCATED ZMYM2 PROTEINS, BASED ON INDIVIDUAL MUTATIONS, FAILED TO RESCUE RENAL AND CRANIOFACIAL DEFECTS. MOREOVER, HETEROZYGOUS ZMYM2-DEFICIENT MICE RECAPITULATED FEATURES OF CAKUT WITH HIGH PENETRANCE. THE ZMYM2 PROTEIN IS A COMPONENT OF A TRANSCRIPTIONAL COREPRESSOR COMPLEX RECENTLY LINKED TO THE SILENCING OF DEVELOPMENTALLY REGULATED ENDOGENOUS RETROVIRUS ELEMENTS. USING PROTEIN-PROTEIN INTERACTION ASSAYS, WE SHOW THAT ZMYM2 INTERACTS WITH ADDITIONAL EPIGENETIC SILENCING COMPLEXES, AS WELL AS CONFIRMING THAT IT BINDS TO FOXP1, A TRANSCRIPTION FACTOR THAT HAS ALSO BEEN LINKED TO CAKUT. IN SUMMARY, OUR FINDINGS ESTABLISH THAT LOSS-OF-FUNCTION MUTATIONS OF ZMYM2, AND POTENTIALLY THAT OF OTHER PROTEINS IN ITS INTERACTOME, AS CAUSES OF HUMAN CAKUT, OFFERING NEW ROUTES FOR STUDYING THE PATHOGENESIS OF THE DISORDER. 2020 6 3107 32 GENOMICS OF CHRONIC NEUTROPHILIC LEUKEMIA. CHRONIC NEUTROPHILIC LEUKEMIA (CNL) IS A DISTINCT MYELOPROLIFERATIVE NEOPLASM WITH A HIGH PREVALENCE (>80%) OF MUTATIONS IN THE COLONY-STIMULATING FACTOR 3 RECEPTOR (CSF3R). THESE MUTATIONS ACTIVATE THE RECEPTOR, LEADING TO THE PROLIFERATION OF NEUTROPHILS THAT ARE A HALLMARK OF CNL. RECENTLY, THE WORLD HEALTH ORGANIZATION GUIDELINES HAVE BEEN UPDATED TO INCLUDE CSF3R MUTATIONS AS PART OF THE DIAGNOSTIC CRITERIA FOR CNL. BECAUSE OF THE HIGH PREVALENCE OF CSF3R MUTATIONS IN CNL, IT IS TEMPTING TO THINK OF THIS DISEASE AS BEING SOLELY DRIVEN BY THIS GENETIC LESION. HOWEVER, RECENT ADDITIONAL GENOMIC CHARACTERIZATION DEMONSTRATES THAT CNL HAS MUCH IN COMMON WITH OTHER CHRONIC MYELOID MALIGNANCIES AT THE GENETIC LEVEL, SUCH AS THE CLINICALLY RELATED DIAGNOSIS ATYPICAL CHRONIC MYELOID LEUKEMIA. THESE COMMONALITIES INCLUDE MUTATIONS IN SETBP1, SPLICEOSOME PROTEINS (SRSF2, U2AF1), AND EPIGENETIC MODIFIERS (TET2, ASXL1). SOME OF THESE SAME MUTATIONS ALSO HAVE BEEN CHARACTERIZED AS FREQUENT EVENTS IN CLONAL HEMATOPOIESIS OF INDETERMINATE POTENTIAL, SUGGESTING A MORE COMPLEX DISEASE EVOLUTION THAN WAS PREVIOUSLY UNDERSTOOD AND RAISING THE POSSIBILITY THAT AN AGE-RELATED CLONAL PROCESS OF PRELEUKEMIC CELLS COULD PRECEDE THE DEVELOPMENT OF CNL. THE ORDER OF ACQUISITION OF CSF3R MUTATIONS RELATIVE TO MUTATIONS IN SETBP1, EPIGENETIC MODIFIERS, OR THE SPLICEOSOME HAS BEEN DETERMINED ONLY IN ISOLATED CASE REPORTS; THUS, FURTHER WORK IS NEEDED TO UNDERSTAND THE IMPACT OF MUTATION CHRONOLOGY ON THE CLONAL EVOLUTION AND PROGRESSION OF CNL. UNDERSTANDING THE COMPLETE LANDSCAPE AND CHRONOLOGY OF GENOMIC EVENTS IN CNL WILL HELP IN THE DEVELOPMENT OF IMPROVED THERAPEUTIC STRATEGIES FOR THIS PATIENT POPULATION. 2017 7 2987 29 GENETIC EPIDEMIOLOGY IN KIDNEY DISEASE. FAMILIAL AGGREGATION OF CHRONIC KIDNEY DISEASE AND ITS COMPONENT PHENOTYPES-REDUCED GLOMERULAR FILTRATION RATE, PROTEINURIA AND RENAL HISTOLOGIC CHANGES-HAS LONG BEEN RECOGNIZED. RATES OF SEVERE KIDNEY DISEASE ARE ALSO KNOWN TO DIFFER MARKEDLY BETWEEN POPULATIONS BASED ON ANCESTRY. THESE EPIDEMIOLOGIC OBSERVATIONS SUPPORT THE EXISTENCE OF NEPHROPATHY SUSCEPTIBILITY GENES. SEVERAL MOLECULAR GENETIC TECHNOLOGIES ARE NOW AVAILABLE TO IDENTIFY CAUSATIVE LOCI. THE PRESENT ARTICLE SUMMARIZES AVAILABLE STRATEGIES USEFUL FOR IDENTIFYING NEPHROPATHY SUSCEPTIBILITY GENES, INCLUDING CANDIDATE GENE ASSOCIATION, FAMILY-BASED LINKAGE, GENOME-WIDE ASSOCIATION AND ADMIXTURE MAPPING (MAPPING BY ADMIXTURE LINKAGE DISEQUILIBRIUM) APPROACHES. EXAMPLES OF LOCI DETECTED USING THESE TECHNIQUES ARE PROVIDED. EPIGENETIC STUDIES AND FUTURE DIRECTIONS ARE ALSO DISCUSSED. THE IDENTIFICATION OF NEPHROPATHY SUSCEPTIBILITY GENES, COUPLED WITH MODIFIABLE ENVIRONMENTAL TRIGGERS IMPACTING THEIR FUNCTION, IS LIKELY TO IMPROVE RISK PREDICTION AND TRANSFORM CARE. DEVELOPMENT OF NOVEL THERAPIES TO PREVENT PROGRESSION OF KIDNEY DISEASE WILL FOLLOW. 2017 8 852 33 CHOLANGIOCARCINOMA IN PATIENTS WITH PRIMARY SCLEROSING CHOLANGITIS (PSC): A COMPREHENSIVE REVIEW. CHOLANGIOCARCINOMA (CCA) IS THE MOST COMMON MALIGNANCY IN PATIENTS WITH PRIMARY SCLEROSING CHOLANGITIS (PSC) AND CARRIES A HIGH RATE OF MORTALITY. ALTHOUGH THE PATHOGENESIS OF CCA IN PSC IS LARGELY UNKNOWN, INFLAMMATION-DRIVEN CARCINOGENESIS CONCOMITANT WITH VARIOUS GENETIC AND EPIGENETIC ABNORMALITIES ARE UNDERLYING FACTORS. THE MAJORITY OF CCA CASES DEVELOP FROM A DOMINANT STRICTURE (DS), WHICH IS DEFINED AS A STRICTURE WITH A DIAMETER < 1.5 MM IN THE COMMON BILE DUCT OR < 1.0 MM IN THE HEPATIC DUCT. IN PSC PATIENTS PRESENTING WITH AN ABRUPT AGGRAVATION OF JAUNDICE, PAIN, FATIGUE, PRURITUS, WEIGHT LOSS, OR WORSENING LIVER BIOCHEMISTRIES, CCA SHOULD BE SUSPECTED AND EVALUATED UTILIZING A VARIETY OF DIAGNOSTIC MODALITIES. HOWEVER, EARLY RECOGNITION OF CCA IN PSC REMAINS A MAJOR CHALLENGE. IMPORTANTLY, 30-50% OF CCA IN PSC PATIENTS ARE OBSERVED WITHIN THE FIRST YEAR FOLLOWING THE DIAGNOSIS OF PSC FOLLOWED BY AN ANNUAL INCIDENCE RANGING FROM 0.5 TO 1.5 PER 100 PERSONS, WHICH IS NEARLY 10 TO 1000 TIMES HIGHER THAN THAT IN THE GENERAL POPULATION. CUMULATIVE 5-YEAR, 10-YEAR, AND LIFETIME INCIDENCES ARE 7%, 8-11%, AND 9-20%, RESPECTIVELY. WHEN PSC-ASSOCIATED CCA IS DIAGNOSED, MOST TUMORS ARE UNRESECTABLE, AND NO EFFECTIVE MEDICATIONS ARE AVAILABLE. GIVEN THE POOR THERAPEUTIC OUTCOME, THE SURVEILLANCE AND MANAGEMENT OF PSC PATIENTS WHO ARE AT AN INCREASED RISK OF DEVELOPING CCA ARE OF IMPORTANCE. SUCH PATIENTS INCLUDE OLDER MALES WITH LARGE-DUCT PSC AND POSSIBLY CONCURRENT ULCERATIVE COLITIS. THUS, MORE ATTENTION SHOULD BE PAID TO PATIENTS WITH THESE CLINICAL FEATURES, IN PARTICULAR WITHIN THE FIRST YEAR AFTER PSC DIAGNOSIS. IN CONTRAST, CCA IS LESS FREQUENTLY OBSERVED IN PEDIATRIC OR FEMALE PSC PATIENTS OR IN THOSE WITH SMALL-DUCT PSC OR CONCURRENT CROHN'S DISEASE. RECENTLY, NEW BIOMARKERS SUCH AS ANTIBODIES TO GLYCOPROTEIN 2 HAVE BEEN FOUND TO BE ASSOCIATED WITH AN INCREASED RISK OF DEVELOPING CCA IN PSC. HEREIN, WE REVIEW THE LITERATURE ON THE PATHOGENESIS, INCIDENCE, CLINICAL FEATURES, AND RISK FACTORS, WITH A FOCUS ON VARIOUS DIAGNOSTIC MODALITIES OF PSC-ASSOCIATED CCA. 2020 9 2936 30 GENETIC AND EPIGENETIC ABNORMALITIES IN PRIMARY SCLEROSING CHOLANGITIS-ASSOCIATED CHOLANGIOCARCINOMA. PRIMARY SCLEROSING CHOLANGITIS (PSC) IS A CHOLESTATIC LIVER DISEASE OF UNKNOWN ETIOLOGY, CHARACTERIZED BY CHRONIC INFLAMMATION OF THE BILIARY TREE WITH SUBSEQUENT FIBROSIS AND CIRRHOSIS OF THE LIVER. PATIENTS WITH PSC ARE AT INCREASED RISK FOR THE DEVELOPMENT OF CHOLANGIOCARCINOMA (CCA), A HIGHLY MALIGNANT EPITHELIAL TUMOR ARISING FROM THE INTRAHEPATIC AND EXTRAHEPATIC BILE DUCTS. CURRENTLY, ORTHOTOPIC LIVER TRANSPLANTATION IS THE ONLY CURATIVE TREATMENT. THE LACK OF EFFICIENT DIAGNOSTIC METHODS FOR EARLY DETECTION AND THE LIMITED THERAPEUTIC OPTIONS FOR CCA ARE MAJOR PROBLEMS AND ARE ASSOCIATED WITH POOR SURVIVAL. THE PATHOGENESIS OF PSC-ASSOCIATED CCA IS COMPLEX AND POORLY UNDERSTOOD. IT SEEMS THAT PRO-INFLAMMATORY CYTOKINES PLAY AN IMPORTANT ROLE IN GENETIC AND EPIGENETIC CHANGES THAT CONTRIBUTE TO THE CARCINOGENIC PROCESS. THE MAPPING OF GENETIC ALTERATIONS MAY ELUCIDATE MOLECULAR TARGETS THAT MAY BE APPLIED AS BIOMARKERS TO FACILITATE EARLY DIAGNOSIS OF MALIGNANT DEGENERATION TO IMPROVE PATIENT OUTCOME. IN THE LAST DECADE, THE INTRODUCTION OF SEVERAL NOVEL MOLECULAR TECHNIQUES AVAILABLE FOR GENOME-WIDE SCREENING HAS ADVANCED OUR KNOWLEDGE ON MANY OF THE GENETIC ABNORMALITIES THAT ARE PREVALENT IN CCA AND PSC-ASSOCIATED CCA. THIS REVIEW SUMMARIZES GENETIC AND EPIGENETIC ABNORMALITIES, WHICH HAVE IMPORTANT POTENTIAL FOR CLINICAL APPLICATION. 2013 10 1034 39 CKD IN ABORIGINAL AUSTRALIANS. CHRONIC KIDNEY DISEASE (CKD) IS ONE COMPONENT OF A SPECTRUM OF CHRONIC DISEASE IN ABORIGINAL AUSTRALIANS. CKD IS MARKED BY ALBUMINURIA, WHICH PREDICTS RENAL FAILURE AND NONRENAL NATURAL DEATH. RATES VARY GREATLY BY COMMUNITY AND REGION AND ARE MUCH HIGHER IN REMOTE AREAS. THIS REFLECTS THE HETEROGENEOUS CHARACTERISTICS AND CIRCUMSTANCES OF ABORIGINAL PEOPLE. CKD IS MULTIDETERMINANT, AND EARLY-LIFE INFLUENCES (NOTABLY LOW BIRTH WEIGHT), INFECTIONS (INCLUDING POSTSTREPTOCOCCAL GLOMERULONEPHRITIS), METABOLIC/HEMODYNAMIC PARAMETERS, AND EPIGENETIC/GENETIC FACTORS PROBABLY CONTRIBUTE. CKD IS ASSOCIATED INTIMATELY WITH CARDIOVASCULAR RISK. ALBUMINURIA PROGRESSES OVER TIME, WITH A HIGH INCIDENCE OF NEW ONSET OF PATHOLOGIC LEVELS OF ALBUMINURIA IN ALL AGE GROUPS. ALL THE USUAL MORPHOLOGIC FINDINGS ARE FOUND IN RENAL BIOPSY SPECIMENS. HOWEVER, GLOMERULAR ENLARGEMENT IS NOTABLE IN INDIVIDUALS FROM REMOTE REGIONS, BUT NOT THOSE LIVING CLOSER TO POPULATION CENTERS. GLOMERULOMEGALY PROBABLY REPRESENTS COMPENSATORY HYPERTROPHY CAUSED BY LOW NEPHRON NUMBER, WHICH PROBABLY UNDERLIES THE ACCENTUATED SUSCEPTIBILITY TO RENAL DISEASE. IN THE LAST DECADE, HEALTH CARE SERVICES HAVE BEEN TRANSFORMED TO ACCOMMODATE SYSTEMATIC CHRONIC DISEASE SURVEILLANCE AND MANAGEMENT. AFTER A RELENTLESS INCREASE FOR 3 DECADES, RATES OF ABORIGINAL PEOPLE STARTING RENAL REPLACEMENT THERAPY, AS WELL AS CHRONIC DISEASE DEATHS, APPEAR TO BE STABILIZING IN SOME REGIONS. OFFICIAL ENDORSEMENT OF THESE SYSTEM CHANGES, PLUS ONGOING REDUCTIONS IN THE INCIDENCE OF LOW BIRTH WEIGHT AND INFECTIONS, HOLD PROMISE FOR CONTINUED BETTER OUTCOMES. 2010 11 4743 23 NOVEL INSIGHTS FROM GENETIC AND EPIGENETIC STUDIES IN UNDERSTANDING THE COMPLEX URAEMIC PHENOTYPE. LIKE IN MANY OTHER COMMON COMPLEX DISORDERS, STUDIES OF CHRONIC KIDNEY DISEASE (CKD) CAN NOW MAKE USE OF THE INCREASING KNOWLEDGE OF THE HUMAN GENOME, ITS VARIATIONS AND IMPACT ON DISEASE SUSCEPTIBILITY, INITIATION, PROGRESSION AND COMPLICATIONS. SUCH STUDIES ARE FACILITATED BY NOVEL READILY AVAILABLE HIGH THROUGH-PUT GENOTYPING METHODS AND SOPHISTICATED ANALYTICAL APPROACHES TO SCAN THE GENOME FOR DNA VARIATIONS AND EPIGENETIC MODIFICATIONS. HERE, WE REVIEW SOME OF THE RECENT DISCOVERIES THAT HAVE EMERGED FROM THESE STUDIES AND EXPANDED OUR KNOWLEDGE OF GENETIC RISK LOCI AND EPIGENETIC MARKERS IN CKD PATHOPHYSIOLOGY. OBSTACLES AND PRACTICAL ISSUES IN THIS FIELD ARE DISCUSSED. 2014 12 2444 26 EPIGENETIC STATES OF NEPHRON PROGENITORS AND EPITHELIAL DIFFERENTIATION. IN MAMMALS, FORMATION OF NEW NEPHRONS ENDS PERINATALLY DUE TO CONSUMPTION OF MESENCHYMAL PROGENITOR CELLS. PREMATURE DEPLETION OF PROGENITORS DUE TO PREMATURITY OR POSTNATAL LOSS OF NEPHRONS DUE TO INJURY CAUSES CHRONIC KIDNEY DISEASE AND HYPERTENSION. INTENSIVE EFFORTS ARE CURRENTLY INVESTED IN DESIGNING REGENERATIVE STRATEGIES TO FORM NEW NEPHRON PROGENITORS FROM PLURIPOTENT CELLS, WHICH UPON FURTHER DIFFERENTIATION PROVIDE A POTENTIAL SOURCE OF NEW NEPHRONS. TO KNOW IF REPROGRAMED RENAL CELLS CAN MAINTAIN THEIR IDENTITY AND FATE REQUIRES KNOWLEDGE OF THE EPIGENETIC STATES OF NATIVE NEPHRON PROGENITORS AND THEIR PROGENY. IN THIS ARTICLE, WE SUMMARIZE CURRENT KNOWLEDGE AND GAPS IN THE EPIGENOMIC LANDSCAPE OF THE DEVELOPING KIDNEY. WE NOW KNOW THAT PAX2/PTIP/H3K4 METHYLTRANSFERASE ACTIVITY PROVIDES THE INITIAL EPIGENETIC SPECIFICATION SIGNAL TO THE METANEPHRIC MESENCHYME. DURING NEPHROGENESIS, THE CAP MESENCHYME HOUSING NEPHRON PROGENITORS IS ENRICHED IN BIVALENT CHROMATIN MARKS; AS TUBULOGENESIS PROCEEDS, THE TUBULAR EPITHELIUM ACQUIRES H3K79ME2. THE LATTER MARK IS UNIQUELY INDUCED DURING EPITHELIAL DIFFERENTIATION. ANALYSIS OF HISTONE LANDSCAPES IN CLONAL METANEPHRIC MESENCHYME CELL LINES AND IN WILMS TUMOR AND NORMAL FETAL KIDNEY HAS REVEALED THAT PROMOTERS OF POISED NEPHROGENESIS GENES CARRY BIVALENT HISTONE SIGNATURES IN PROGENITORS. DIFFERENTIATION OR STIMULATION OF WNT SIGNALING PROMOTES RESOLUTION OF BIVALENCY; THIS DOES NOT OCCUR IN WILMS TUMOR CELLS CONSISTENT WITH THEIR DEVELOPMENTAL ARREST. THE USE OF SMALL CELL NUMBER CHIP-SEQ SHOULD FACILITATE THE CHARACTERIZATION OF THE CHROMATIN LANDSCAPE OF THE METANEPHRIC MESENCHYME AND VARIOUS NEPHRON COMPARTMENTS DURING NEPHROGENESIS. ONLY THEN WE WILL KNOW IF STEM AND SOMATIC CELL REPROGRAMMING INTO KIDNEY PROGENITORS RECAPITULATES NORMAL DEVELOPMENT. 2015 13 3575 33 IMPACT OF MOLECULAR PROFILING ON THE MANAGEMENT OF PATIENTS WITH MYELOFIBROSIS. MYELOFIBROSIS (MF) IS A CHRONIC MYELOPROLIFERATIVE NEOPLASM (MPN) CHARACTERIZED BY A HIGHLY HETEROGENEOUS CLINICAL COURSE, WHICH CAN BE COMPLICATED BY SEVERE CONSTITUTIONAL SYMPTOMS, MASSIVE SPLENOMEGALY, PROGRESSIVE BONE MARROW FAILURE, CARDIOVASCULAR EVENTS, AND DEVELOPMENT OF ACUTE LEUKEMIA. CONSTITUTIVE SIGNALING THROUGH THE JAK-STAT PATHWAY PLAYS A FUNDAMENTAL ROLE IN ITS PATHOGENESIS, GENERALLY DUE TO ACTIVATING MUTATIONS OF JAK2, CALR AND MPL GENES (I.E., THE MPN DRIVER MUTATIONS), PRESENT IN MOST MF PATIENTS. NEXT GENERATION SEQUENCING (NGS) PANEL TESTING HAS SHOWN THAT ADDITIONAL SOMATIC MUTATIONS CAN ALREADY BE DETECTED AT THE TIME OF DIAGNOSIS IN MORE THAN HALF OF PATIENTS, AND THAT THEY ACCUMULATE ALONG THE DISEASE COURSE. THESE MUTATIONS, MOSTLY AFFECTING EPIGENETIC MODIFIERS OR SPLICEOSOME COMPONENTS, MAY COOPERATE WITH MPN DRIVERS TO FAVOR CLONAL DOMINANCE OR INFLUENCE THE CLINICAL PHENOTYPE, AND SOME, SUCH AS HIGH MOLECULAR RISK MUTATIONS, CORRELATE WITH A MORE AGGRESSIVE CLINICAL COURSE WITH POOR TREATMENT RESPONSE. THE CURRENT MAIN ROLE OF MOLECULAR PROFILING IN CLINICAL PRACTICE IS PROGNOSTICATION, PRINCIPALLY FOR SELECTING HIGH-RISK PATIENTS WHO MAY BE CANDIDATES FOR TRANSPLANTATION, THE ONLY CURATIVE TREATMENT FOR MF TO DATE. TO THIS END, CONTEMPORARY PROGNOSTIC MODELS INCORPORATING MOLECULAR DATA ARE USEFUL TOOLS TO DISCRIMINATE DIFFERENT RISK CATEGORIES. ASIDE FROM CERTAIN CLINICAL SITUATIONS, DECISIONS REGARDING MEDICAL TREATMENT ARE NOT BASED ON PATIENT MOLECULAR PROFILING, YET THIS APPROACH MAY BECOME MORE RELEVANT IN NOVEL TREATMENT STRATEGIES, SUCH AS THE USE OF VACCINES AGAINST THE MUTANT FORMS OF JAK2 OR CALR, OR DRUGS DIRECTED AGAINST ACTIONABLE MOLECULAR TARGETS. 2022 14 1031 40 CIRCULATING TUMOR DNA DETECTION AND ITS APPLICATION STATUS IN GASTRIC CANCER: A NARRATIVE REVIEW. CIRCULATING TUMOR DNA (CTDNA) IS THE SMALL GENOMIC FRAGMENT RELEASED BY TUMOR CELLS INTO THE CIRCULATING SYSTEM, WHICH CARRIES THE GENE VARIATION FEATURES, SUCH AS MUTATION, INSERTION, DELETION, REARRANGEMENT, COPY NUMBER VARIATION (CNV) AND METHYLATION, RENDERING IT AN IMPORTANT BIOMARKER. IT CAN BE USED NOT ONLY TO DIAGNOSE CERTAIN TYPES OF SOLID TUMORS, BUT ALSO TO MONITOR THE THERAPEUTIC RESPONSE AND EXPLORE THE MINIMAL RESIDUAL DISEASE (MRD) AND RESISTANT MUTATION OF TARGETED THERAPY. THEREFORE, CTDNA DETECTION MAY BECOME THE PREFERRED NON-INVASIVE TUMOR SCREENING METHOD. FOR PATIENTS WHO CANNOT RECEIVE FURTHER GENE DETECTION DUE TO INSUFFICIENT OR RESTRICTED SAMPLE COLLECTION WITH THE DEFINED PATHOLOGICAL DIAGNOSIS, CTDNA DETECTION CAN BE CARRIED OUT TO DETERMINE THE GENE MUTATION TYPE, WITH NO NEED FOR REPEATED SAMPLING. GASTRIC CANCER (GC) IS A MALIGNANCY WITH EXTREMELY HIGH MORBIDITY AND MORTALITY, AND ITS GENESIS AND DEVELOPMENT ARE THE CONSEQUENCE OF INTERACTIONS OF MULTIPLE FACTORS, INCLUDING ENVIRONMENT, DIET, HEREDITY, HELICOBACTER PYLORI INFECTION, CHRONIC INFLAMMATORY INFILTRATION, AND PRECANCEROUS LESION. AS THE RESEARCH ON GC MOVES FORWARD, THE EXISTING RESEARCH MAINLY FOCUSES ON GENETIC AND EPIGENETIC CHANGES, INCLUDING DNA METHYLATION, HISTONE MODIFICATION, NON-CODING RNA CHANGES, GENE MUTATION, GENE HETEROZYGOSITY LOSS AND MICROSATELLITE INSTABILITY. THIS PAPER AIMED TO SUMMARIZE THE CONTENTS OF CTDNA DETECTION, ITS APPLICATION STATUS IN GC AND CLINICAL SIGNIFICANCE. 2021 15 6040 31 THE CHRONIC MYELOPROLIFERATIVE DISORDERS: CLONALITY AND CLINICAL HETEROGENEITY. THE CHRONIC MYELOPROLIFERATIVE DISORDERS (MPD), POLYCYTHEMIA VERA (PV), CHRONIC IDIOPATHIC MYELOFIBROSIS (IMF), ESSENTIAL THROMBOCYTOSIS (ET), AND CHRONIC MYELOGENOUS LEUKEMIA (CML), ARE THOUGHT TO BE CLONAL DISORDERS ARISING IN A MULTIPOTENT HEMATOPOIETIC PROGENITOR CELL. HOWEVER, ESTABLISHING THE DIAGNOSIS OF AN MPD OTHER THAN CML IS PROBLEMATIC DUE TO A LACK OF CLINICALLY APPLICABLE CLONAL MARKERS. FURTHERMORE, IN SOME PATIENTS, IN WHOM A CLASSICAL MPD PHENOTYPE IS PRESENT, THE HEMATOPOIETIC STEM CELLS APPEAR TO BE POLYCLONAL, SUGGESTING THAT THE CHRONIC MPD OTHER THAN CML MAY ACTUALLY BE A GENETICALLY HETEROGENEOUS GROUP OF DISORDERS. FURTHERMORE, SINCE THE ABERRANT CLONE IS BELIEVED TO ARISE FROM A MULTIPOTENT HEMATOPOIETIC STEM CELL, THE NON-CML CHRONIC MPD-ET, PV, AND IMF-COULD BE RELATED. ADDITIONAL UNRESOLVED ISSUES REGARDING THE MPD INCLUDE: IDENTIFICATION OF THE MULTIPOTENT HEMATOPOIETIC PROGENITOR CELL INVOLVED, THE MOLECULAR BASIS FOR THE CLINICAL HETEROGENEITY AMONGST THE INDIVIDUAL MPD, THE CLINICAL SIGNIFICANCE OF CLONALITY IN NON-CML MPD, AND RECONCILIATION OF THERAPY WITH THE CLONAL AND CLINICAL HETEROGENEITY OF THESE DISORDERS. DETERMINATION OF CLONALITY HAS LARGELY BEEN CARRIED OUT USING X CHROMOSOME-LINKED POLYMORPHISMS, BUT SUCH STUDIES ARE LIMITED TO WOMEN AND WITH INCREASING PATIENT AGE ARE COMPROMISED BY SKEWING OF ALLELIC EXPRESSION IN BOTH NEUTROPHILS AND T LYMPHOCYTES, MAKING THE RESULTS DIFFICULT TO INTERPRET. X CHROMOSOME-LINKED POLYMORPHISM STUDIES HAVE INDICATED THAT IN PV THE TARGET STEM CELL IS ONE THAT GIVES RISE TO BOTH LYMPHOID AND MYELOID PROGENITORS. RECENTLY, TWO EPIGENETIC MARKERS HAVE BEEN IDENTIFIED IN THE MPD: IMPAIRED EXPRESSION OF THE THROMBOPOIETIN RECEPTOR, MPL, IN PLATELETS AND MEGAKARYOCYTES, AND OVEREXPRESSION IN NEUTROPHILS OF THE MRNA OF A GENE DESIGNATED POLYCYTHEMIA RUBRA VERA-1 (PRV-1). THE ROLE OF THESE EPIGENETIC ABNORMALITIES IN THE DIAGNOSIS OF THE MPD REMAINS TO BE ESTABLISHED. CURRENTLY, GIVEN THE UNRESOLVED ISSUES WITH RESPECT TO THE CLINICAL AND CLONAL HETEROGENEITY OF THE MPD, TREATMENT NEEDS TO BE TAILORED INDIVIDUALLY IN PATIENTS WITH AN MPD. 2004 16 5025 27 PERSONALIZED MANAGEMENT OF CARDIOVASCULAR DISORDERS. PERSONALIZED MANAGEMENT OF CARDIOVASCULAR DISORDERS (CVD), ALSO REFERRED TO AS PERSONALIZED OR PRECISION CARDIOLOGY IN ACCORDANCE WITH GENERAL PRINCIPLES OF PERSONALIZED MEDICINE, IS SELECTION OF THE BEST TREATMENT FOR AN INDIVIDUAL PATIENT. IT INVOLVES THE INTEGRATION OF VARIOUS "OMICS" TECHNOLOGIES SUCH AS GENOMICS AND PROTEOMICS AS WELL AS OTHER NEW TECHNOLOGIES SUCH AS NANOBIOTECHNOLOGY. MOLECULAR DIAGNOSTICS AND BIOMARKERS ARE IMPORTANT FOR LINKING DIAGNOSIS WITH THERAPY AND MONITORING THERAPY. BECAUSE CVD INVOLVE PERTURBATIONS OF LARGE COMPLEX BIOLOGICAL NETWORKS, A SYSTEMS BIOLOGY APPROACH TO CVD RISK STRATIFICATION MAY BE USED FOR IMPROVING RISK-ESTIMATING ALGORITHMS, AND MODELING OF PERSONALIZED BENEFIT OF TREATMENT MAY BE HELPFUL FOR GUIDING THE CHOICE OF INTERVENTION. BIOINFORMATICS TOOLS ARE HELPFUL IN ANALYZING AND INTEGRATING LARGE AMOUNTS OF DATA FROM VARIOUS SOURCES. PERSONALIZED THERAPY IS CONSIDERED DURING DRUG DEVELOPMENT, INCLUDING METHODS OF TARGETED DRUG DELIVERY AND CLINICAL TRIALS. INDIVIDUALIZED RECOMMENDATIONS CONSIDER MULTIPLE FACTORS - GENETIC AS WELL AS EPIGENETIC - FOR PATIENTS' RISK OF HEART DISEASE. EXAMPLES OF PERSONALIZED TREATMENT ARE THOSE OF CHRONIC MYOCARDIAL ISCHEMIA, HEART FAILURE, AND HYPERTENSION. SIMILAR APPROACHES CAN BE USED FOR THE MANAGEMENT OF ATRIAL FIBRILLATION AND HYPERCHOLESTEROLEMIA, AS WELL AS THE USE OF ANTICOAGULANTS. PERSONALIZED MANAGEMENT INCLUDES PHARMACOTHERAPY, SURGERY, LIFESTYLE MODIFICATIONS, AND COMBINATIONS THEREOF. FURTHER PROGRESS IN UNDERSTANDING THE PATHOMECHANISM OF COMPLEX CARDIOVASCULAR DISEASES AND IDENTIFICATION OF CAUSATIVE FACTORS AT THE INDIVIDUAL PATIENT LEVEL WILL PROVIDE OPPORTUNITIES FOR THE DEVELOPMENT OF PERSONALIZED CARDIOLOGY. APPLICATION OF PRINCIPLES OF PERSONALIZED MEDICINE WILL IMPROVE THE CARE OF THE PATIENTS WITH CVD. 2017 17 3035 28 GENETICS/GENOMICS IN CHRONIC KIDNEY DISEASE--TOWARDS PERSONALIZED MEDICINE? THE PROGRESSION RATE OF CHRONIC KIDNEY DISEASE (CKD) TO ITS TERMINAL STAGE, END-STAGE RENAL DISEASE (ESRD), AND THE DEVELOPMENT AND SEVERITY OF VARIOUS COMPLICATIONS, ARE AT LEAST INDIRECTLY INFLUENCED BY GENETIC--AND EPIGENETIC--FACTORS. FOR YEARS, SCIENTISTS HAVE HELD OUT HOPE THAT THE RAPIDLY EVOLVING FIELD OF GENETICS COULD TRANSFORM MEDICAL DIAGNOSIS AND TREATMENT, MOVING BEYOND A TRIAL-AND-ERROR APPROACH TOWARDS "PERSONALIZED MEDICINE." INDEED, THERE ARE NOW SIGNS THAT THE ROLE OF GENETICS AND THE PURSUIT OF "PERSONALIZED MEDICINE" IN MEDICAL CARE WILL BE A PRIORITY FOR GOVERNMENTS DURING YEARS TO COME. BUT THE VISION OF INDIVIDUALIZED TREATMENT BASED ON A PATIENT'S GENETIC MAKEUP AND OTHER BIOLOGICAL MARKERS HAS YET TO MATERIALIZE IN THE FIELD OF CKD AND ESRD. AS THE TOXIC UREMIC ENVIRONMENT MAY RENDER CKD PATIENTS MORE SENSITIVE TO THE EFFECTS OF GENETIC VARIANTS, IT IS LIKELY THAT GENETIC FACTORS COULD BE OF SPECIAL IMPORTANCE IN THIS HIGH-RISK POPULATION. THEREFORE, OUTCOME IN THE CKD POPULATION MAY BE IMPROVED BY ESTABLISHING INDIVIDUAL GENETIC/EPIGENETIC PROFILES, THUS ENABLING PHYSICIANS TO DESIGN AN INDIVIDUALIZED THERAPEUTIC STRATEGY. PERSONALIZED MEDICINE BASED ON A MORE INDIVIDUALIZED THERAPY COULD BE APPLIED IN, FOR EXAMPLE, PHARMACOTHERAPY (CYP GENES), DIALYSIS THERAPY, AND NUTRITIONAL AND LIFESTYLE MODIFICATIONS. 2009 18 1502 31 DNA METHYLATION AND EPIGENETIC EVENTS UNDERLYING RENAL CELL CARCINOMAS. RENAL CELL CARCINOMA (RCC) REFERS TO A GROUP OF TUMORS THAT DEVELOP FROM THE EPITHELIUM OF THE KIDNEY TUBES, INCLUDING CLEAR CELL RCC, PAPILLARY RCC, AND CHROMOPHOBE RCC. MOST CLEAR CELL RENAL CARCINOMAS HAVE A LARGE HISTOLOGIC SUBTYPE, GENETIC OR EPIGENETIC VON HIPPEL-LINDAU (VHL). A COMPREHENSIVE ANALYSIS OF THE GENETIC MODIFICATION GENOME SUGGESTED THAT CHROMOSOME 3P LOSS AND CHROMOSOME GAINS 5Q AND 7 MAY BE SIGNIFICANT COPY DEFECTS IN THE DEVELOPMENT OF CLEAR RCC. A MORE POTENT RCC MAY DEVELOP IF CHROMOSOME 1P, 4, 9, 13Q, OR 14Q IS ALSO LOST. RENAL CARCINOGENESIS IS NOT ASSOCIATED WITH CHRONIC INFLAMMATION OR HISTOLOGICAL CHANGES. HOWEVER, IF REGIONAL HYPERMETHYLATION OF DNA IN CPG C-TYPE ISLANDS HAS ALREADY ACCUMULATED IN CANCER-FREE KIDNEY TISSUE, IT IMPLIES THAT THE PRESENCE OF MALIGNANT KIDNEY LESIONS MAY ALSO BE DETECTED BY MODIFIED DNA METHYLATION. MODIFICATION OF DNA METHYLATION IN CANCEROUS KIDNEY TISSUE MAY ADVANCE KIDNEY TISSUE TO EPIGENETIC MUTATIONS AND GENES, LEADING TO MORE SERIOUS CANCERS AND EVEN DETERMINING A PATIENT'S OUTCOME. THE GENETIC AND EPIGENETIC PROFILE PROVIDES ACCURATE PREDICTORS FOR PATIENTS WITH KIDNEY CANCER. NEW GENETIC AND EPIGENETIC ANALYSIS TECHNOLOGIES WILL HELP TO SPEED UP THE IDENTIFICATION OF VITAL CELLS FOR KIDNEY CANCER PREVENTION, DIAGNOSIS, AND TREATMENT. 2022 19 5473 27 RESPONSES OF PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS TO METHOTREXATE: A GENOMIC OUTLOOK. INTRODUCTION: JUVENILE IDIOPATHIC ARTHRITIS (JIA) IS A CHRONIC DISEASE CHARACTERIZED BY PERSISTENT JOINT INFLAMMATION. JIA IS THE MOST COMMON PEDIATRIC CHRONIC RHEUMATIC DISEASE AND NO CURATIVE THERAPY IS CURRENTLY AVAILABLE. METHOTREXATE (MTX) IS AN IMPORTANT TREATMENT FOR JIA EVEN THOUGH A HIGH INTER-INDIVIDUAL VARIABILITY IN RESPONSE IS OBSERVED IN PATIENTS. AMONG THE FACTORS OF THIS VARIABILITY, GENETICS AND EPIGENETICS MIGHT PLAY AN IMPORTANT ROLE. AREAS COVERED: THIS REVIEW SUMMARIZES THE RESULTS OF PHARMACOGENETIC AND PHARMACOEPIGENETIC STUDIES REGARDING MTX RESPONSE IN JIA. STUDIES CONSIDERING EPIGENETIC FACTORS IN JIA PATIENTS ARE STILL VERY LIMITED, THEREFORE THIS REVIEW INCLUDES ALSO STUDIES PERFORMED IN ADULT PATIENTS WITH RHEUMATOID ARTHRITIS. MOREOVER, THE RELEVANCE OF BIOMARKERS MEASURED IN BLOOD OR URINE OF JIA PATIENTS IN RELATION TO MTX TREATMENT IS DISCUSSED. EXPERT OPINION: NOWADAYS, EVEN THOUGH MANY PHARMACOGENOMICS STUDIES HAVE BEEN PUBLISHED, A SPECIFIC GENETIC MARKER PREDICTOR OF MTX EFFICACY OR ADVERSE EVENTS HAS NOT YET BEEN IDENTIFIED. ENCOURAGING RESULTS ARE AVAILABLE AND GREAT EXPECTATIONS RELY ON THE STUDY OF EPIGENETICS. FUTURE STUDIES ARE NEEDED IN ORDER TO IDENTIFY GENETIC AND EPIGENETIC BIOMARKERS THAT CAN BE IMPLEMENTED IN THE CLINICAL PRACTICE. 2021 20 4566 17 MYELOID SOMATIC MUTATION PANEL TESTING IN MYELOPROLIFERATIVE NEOPLASMS. MYELOPROLIFERATIVE NEOPLASMS ARE CHARACTERISED BY SOMATIC MUTATIONS IN PATHWAYS THAT REGULATE CELL PROLIFERATION, EPIGENETIC MODIFICATIONS, RNA SPLICING OR DNA REPAIR. ASSESSMENT OF THE MUTATIONAL PROFILE ASSISTS DIAGNOSIS AND CLASSIFICATION, BUT ALSO AIDS ASSESSMENT OF PROGNOSIS, AND MAY GUIDE THE USE OF EMERGING TARGETED THERAPIES. THE MOST PRACTICAL WAY TO PROVIDE INFORMATION ON NUMEROUS GENETIC VARIANTS IS BY USING MASSIVELY PARALLEL SEQUENCING, COMMONLY IN THE FORM OF DISEASE SPECIFIC NEXT GENERATION SEQUENCING (NGS) PANELS. THIS REVIEW SUMMARISES THE DIAGNOSTIC AND PROGNOSTIC VALUE OF SOMATIC MUTATION TESTING IN PHILADELPHIA-NEGATIVE MYELOPROLIFERATIVE NEOPLASMS: POLYCYTHAEMIA VERA, ESSENTIAL THROMBOCYTHAEMIA, PRIMARY MYELOFIBROSIS, CHRONIC NEUTROPHILIC LEUKAEMIA, SYSTEMIC MASTOCYTOSIS, AND CHRONIC EOSINOPHILIC LEUKAEMIA. NGS PANEL TESTING IS INCREASING IN ROUTINE PRACTICE AND PROMISES TO IMPROVE THE ACCURACY AND EFFICIENCY OF PATHOLOGICAL DIAGNOSIS AND PROGNOSIS. 2021