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{{Infobox_gene}}
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'''ETV6''' (i.e. translocation-Ets-leukemia virus) protein is a [[transcription factor]] that in humans is encoded by the ''ETV6'' (previously known as ''TEL'') [[gene]]. The ETV6 protein regulates the development and growth of diverse cell types, particularly those of [[hematological]] tissues. However, its gene, ''ETV6'' frequently suffers various mutations that lead to an array of potentially lethal cancers, i.e., ''ETV6'' is a clinically significant [[Oncogene|proto-oncogene]] in that it can fuse with other genes to drive the development and/or progression of certain cancers. However, ''ETV6'' is also an anti-oncogene or [[tumor suppressor gene]] in that mutations in it that encode for a truncated and therefore inactive protein are also associated with certain types of cancers.
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| update_protein_box = yes
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== Gene ==
{{GNF_Protein_box
The human ''ETV6'' gene is located at position "13.2" on the short (i.e. "p") arm of chromosome 12, i.e. its notated position is 12p13.2. The gene has 8 [[exons]] and two [[start codon]]s, one located at exon 1 at the start of the gene and an alternative located upstream of exon 3. ''ETV6'' codes for a full length protein consisting of 452 amino acids; the gene is expressed in virtually all cell types and tissues.<ref name="pmid22578774">{{cite journal | vauthors = De Braekeleer E, Douet-Guilbert N, Morel F, Le Bris MJ, Basinko A, De Braekeleer M | title = ETV6 fusion genes in hematological malignancies: a review | journal = Leukemia Research | volume = 36 | issue = 8 | pages = 945–61 | year = 2012 | pmid = 22578774 | doi = 10.1016/j.leukres.2012.04.010 | url = }}</ref><ref>https://omim.org/entry/600618?search=etv6&highlight=etv6</ref> Mice depleted of the ''ETV6'' gene by [[Gene knockout]] die between day 10.5 and 11.5 of embryonic life with defective [[yolk sac]] [[angiogenesis]] and extensive losses in [[mesenchymal]] and [[neural]] cells due to [[apoptosis]]. Other genetic manipulation studies in mice indicate that the gene is required for the development and maintenance of [[bone marrow]]-based [[hematopoiesis|blood cell formation]] and the vascular network.<ref name="pmid22578774"/><ref name="pmid28416505">{{cite journal | vauthors = Songdej N, Rao AK | title = Hematopoietic Transcription Factors Mutations - Important Players in Inherited Platelet Defects | journal = Blood | volume = | issue = | pages = | year = 2017 | pmid = 28416505 | doi = 10.1182/blood-2016-11-709881 | url = }}</ref>
| image = PBB_Protein_ETV6_image.jpg
| image_source = [[Protein_Data_Bank|PDB]] rendering based on 1ji7.
| PDB = {{PDB2|1ji7}}, {{PDB2|1lky}}, {{PDB2|2dao}}
| Name = Ets variant gene 6 (TEL oncogene)
| HGNCid = 3495
| Symbol = ETV6
| AltSymbols =; TEL; TEL/ABL
| OMIM = 600618
| ECnumber = 
| Homologene = 37560
| MGIid = 109336
| GeneAtlas_image1 = PBB_GE_ETV6_205585_at_tn.png
| Function = {{GNF_GO|id=GO:0003700 |text = transcription factor activity}} {{GNF_GO|id=GO:0005515 |text = protein binding}} {{GNF_GO|id=GO:0043565 |text = sequence-specific DNA binding}}
| Component = {{GNF_GO|id=GO:0005634 |text = nucleus}}
| Process = {{GNF_GO|id=GO:0006350 |text = transcription}} {{GNF_GO|id=GO:0006355 |text = regulation of transcription, DNA-dependent}} {{GNF_GO|id=GO:0030154 |text = cell differentiation}}
| Orthologs = {{GNF_Ortholog_box
    | Hs_EntrezGene = 2120
    | Hs_Ensembl = ENSG00000139083
    | Hs_RefseqProtein = NP_001978
    | Hs_RefseqmRNA = NM_001987
    | Hs_GenLoc_db =
    | Hs_GenLoc_chr = 12
    | Hs_GenLoc_start = 11694055
    | Hs_GenLoc_end = 11939588
    | Hs_Uniprot = P41212
    | Mm_EntrezGene = 14011
    | Mm_Ensembl = ENSMUSG00000030199
    | Mm_RefseqmRNA = NM_007961
    | Mm_RefseqProtein = NP_031987
    | Mm_GenLoc_db = 
    | Mm_GenLoc_chr = 6
    | Mm_GenLoc_start = 134091327
    | Mm_GenLoc_end = 134235851
    | Mm_Uniprot = Q3U037
  }}
}}
'''ETV6''' is an [[oncogene]].


<!-- The PBB_Summary template is automatically maintained by Protein Box Bot.  See Template:PBB_Controls to Stop updates. -->
== Protein ==
{{PBB_Summary
The human ETV6 protein is a member of the [[ETS transcription factor family]]; however, it more often acts to inhibit than stimulate transcription of its target genes. ETV6 protein contains 3 [[Protein domain|domains]]: '''a)''' the pointed N-terminal (i.e. PNT) domain which forms [[oligomer]] partners with itself as well as other transcription factors (e.g. [[FLI1]]) and is required for ETV6's transcriptional repressing activity; '''b)''' the central regulatory domain; and '''c)''' the C-terminal [[DNA-binding domain]], ETS, which binds to the [[consensus sequence|consensus DNA sequence]], 5-GGAA/T-3 within a 9-to-10 bp sequence, in the target genes it regulates.<ref name="pmid22578774"/><ref name="pmid28450705">{{cite journal | vauthors = Sizemore GM, Pitarresi JR, Balakrishnan S, Ostrowski MC | title = The ETS family of oncogenic transcription factors in solid tumours | journal = Nature Reviews. Cancer | volume = | issue = | pages = | year = 2017 | pmid = 28450705 | doi = 10.1038/nrc.2017.20 | url = }}</ref> ETV6 [[Protein-protein interaction|interact]]s with other proteins that regulate the differentiation and growth of cells. It binds to and thereby inhibits [[FLI1]], another member of the [[ETS transcription factor family]], which is active in promoting the maturation of blood [[platelet]]-forming [[megakaryocytes]] and blocking the [[Cellular differentiation]] of [[erythroblasts]] into [[red blood cells]]; this results in the excessive proliferation and abnormal [[morphology (biology)|morphology]] of erythroblasts.<ref name=pmid9651344>{{cite journal | vauthors = Kwiatkowski BA, Bastian LS, Bauer TR, Tsai S, Zielinska-Kwiatkowska AG, Hickstein DD | title = The ets family member Tel binds to the Fli-1 oncoprotein and inhibits its transcriptional activity | journal = The Journal of Biological Chemistry | volume = 273 | issue = 28 | pages = 17525–30 | date = Jul 1998 | pmid = 9651344 | doi = 10.1074/jbc.273.28.17525 }}</ref><ref name="pmid28416505"/> ETV6 likewise binds to [[HTATIP]], a [[histone acetyl transferase]] that regulates the expression of various genes involved in gene transcription, [[DNA repair]], and cellular [[apoptosis]]; this binding promotes the transcription-repressing activity of ETV6.<ref name="pmid12737628">{{cite journal | vauthors = Nordentoft I, Jørgensen P | title = The acetyltransferase 60 kDa trans-acting regulatory protein of HIV type 1-interacting protein (Tip60) interacts with the translocation E26 transforming-specific leukaemia gene (TEL) and functions as a transcriptional co-repressor | journal = The Biochemical Journal | volume = 374 | issue = Pt 1 | pages = 165–73 | year = 2003 | pmid = 12737628 | pmc = 1223570 | doi = 10.1042/BJ20030087 | url = }}</ref>
| section_title =  
| summary_text = This gene encodes an ETS family transcription factor. The product of this gene contains two functional domains: a N-terminal pointed (PNT) domain that is involved in the protein-protein interactions with itself and other proteins, and a C-terminal DNA-binding domain. Gene knockout studies in mice suggest that it is required for hematopoiesis and maintenance of the developing vascular network. This gene is known to be involved in a large number of chromosomal rearrangements associated with leukemia and congenital fibrosarcoma.<ref>{{cite web | title = Entrez Gene: ETV6 ets variant gene 6 (TEL oncogene)| url = http://www.ncbi.nlm.nih.gov/sites/entrez?Db=gene&Cmd=ShowDetailView&TermToSearch=2120| accessdate = }}</ref>
}}


==See also==
== Medical significance ==
=== Inherited mutations ===
Rare [[Missense mutation|missense]] and other [[Mutation#By effect on function|loss of function]] mutations in ETV6 cause thrombocytopenia 5, an [[autosomal dominant]] familial disease characterized by variable [[thrombocytopenia]] ([[blood platelet]] counts from 5% to 90% of normal), mild to modest bleeding tendencies, and [[bone marrow]] biopsy findings of abnormal appearing megakaryocytes (i.e. nuclei with fewer than the normal number of lobulations) and red cell [[macrocytosis]].<ref name="pmid28416505"/><ref name="pmid27248996">{{cite journal | vauthors = Bannon SA, DiNardo CD | title = Hereditary Predispositions to Myelodysplastic Syndrome | journal = International Journal of Molecular Sciences | volume = 17 | issue = 6 | pages = | year = 2016 | pmid = 27248996 | pmc = 4926372 | doi = 10.3390/ijms17060838 | url = }}</ref> Thrombocytopenia 5 is associated with an increased incidence of developing hematological (e.g. [[chronic myelomonocytic leukemia]], [[acute myelocytic leukemia]], B cell [[acute lymphoblastic leukemia]], mixed phenotype acute leukemia, [[Myelodysplastic syndrome]], and [[multiple myeloma]]) and non-hematological (e.g. skin and colon) cancers as well as non-malignant diseases such as refractory [[anemia]] [[myopathies]], and [[gastroesophageal reflux disease]].<ref name="pmid27248996"/><ref name="pmid25581430">{{cite journal | vauthors = Zhang MY, Churpek JE, Keel SB, Walsh T, Lee MK, Loeb KR, Gulsuner S, Pritchard CC, Sanchez-Bonilla M, Delrow JJ, Basom RS, Forouhar M, Gyurkocza B, Schwartz BS, Neistadt B, Marquez R, Mariani CJ, Coats SA, Hofmann I, Lindsley RC, Williams DA, Abkowitz JL, Horwitz MS, King MC, Godley LA, Shimamura A | title = Germline ETV6 mutations in familial thrombocytopenia and hematologic malignancy | journal = Nature Genetics | volume = 47 | issue = 2 | pages = 180–5 | year = 2015 | pmid = 25581430 | pmc = 4540357 | doi = 10.1038/ng.3177 | url = }}</ref>
 
Two unrelated kindreds were found to have [[autosomal dominant]] inherited mutations in the ''ETV6'' gene, one family with a germline DNA substitution termed L349P that lead to replacing leucine with proline at amino acid 349 in the DNA binding domain of the ETV6, the second, termed N385fs, in germline DNA caused the lose of five base pairs ''ETV6'' and a truncated ETV6 protein. Both mutant proteins failed to enter cell nuclei normally and had a reduced capacity to target genes regulated by the normal ETV6 protein. Afflicted members of these families had low platelet counts (i.e. thrombocytopenia) and [[acute lymphoblastic leukemia]]. Fifteen members of the two kindreds had thrombocytopenia, five of whom also had acute lymphoblastic leukemia. The L249P kindred also had one family member with [[renal cell carcinoma]] and another family member with [[Duodenal cancer]]. The relationship of these two cancers to the L249P mutation has not been investigated. In all events these two familial thrombocytopenia syndromes appear distinctly different than the thrombocytopenia 5 syndrome.<ref name="pmid26102509">{{cite journal | vauthors = Topka S, Vijai J, Walsh MF, Jacobs L, Maria A, Villano D, Gaddam P, Wu G, McGee RB, Quinn E, Inaba H, Hartford C, Pui CH, Pappo A, Edmonson M, Zhang MY, Stepensky P, Steinherz P, Schrader K, Lincoln A, Bussel J, Lipkin SM, Goldgur Y, Harit M, Stadler ZK, Mullighan C, Weintraub M, Shimamura A, Zhang J, Downing JR, Nichols KE, Offit K | title = Germline ETV6 Mutations Confer Susceptibility to Acute Lymphoblastic Leukemia and Thrombocytopenia | journal = PLoS Genetics | volume = 11 | issue = 6 | pages = e1005262 | year = 2015 | pmid = 26102509 | pmc = 4477877 | doi = 10.1371/journal.pgen.1005262 | url = }}</ref>
 
==== Treatment ====
Family members with thrombocytopenia 5 need to be regularly monitored with [[complete blood count]] and [[Blood film|blood smear]] screenings to detect the early changes brought on by the malignant transformations of this disease into hematological neoplasms. Patients who developed these transformations have generally been treated similarly to patients who the have same hematological neoplasms but on a non-familial basis. Patients developing non-malignant hematological or non-hematological solid tumor manifestations of thrombocytopenia 5 are also treated like to patients with the same but no-familial disease.<ref name="pmid27248996"/><ref name="pmid25581430"/>
 
The acute lymphoblastic leukemia associated with L349P or N385fs mutations in ''ETV6'' appeared far less sensitive to standard [[chemotherapy]] for acute lymphoblastic leukemia with 2 among 3 family members moving rather quickly from chemotherapy to [[bone marrow transplantation]] and the third family member expiring. This suggest that these mutation-related forms of acute lymphoblastic leukemia require aggressive therapy.<ref name="pmid26102509"/>
 
=== Acquired mutations ===
The ''ETV6'' gene is prone to develop a wide range of acquired mutations in hematological precursor cells that lead to various types of [[leukemia]] and/or [[lymphoma]]. It may also suffer a smaller number of mutations in non-hematological tissues that leads to [[solid tumors]]. These mutations involve [[chromosome translocation]]s which fuse the ''ETV6'' on chromosome 12's the short (i.e. "p") arm ("q" stands for long arm) at position p13.2 (site notation: 12p12.2) near to a second gene on another chromosome or, more rarely, its own chromosome. This creates a [[fusion gene]] of the [[oncogene]] category which encodes a [[chimeric protein]] that promotes the malignant growth of its parent cells. It may be unclear which portion of the newly formed oncoprotein contributes to the ensuing malignancy but fusions between ETV6 and proteins with [[tyrosine kinase]] activity generally are converted from a protein with tightly regulated tyrosine kinase activity to an uncontrolled and continuously active tyrosine kinase that thereby promotes the malignant transformation of its parent cells.<ref name="pmid28028030">{{cite journal | vauthors = Reiter A, Gotlib J | title = Myeloid neoplasms with eosinophilia | journal = Blood | volume = 129 | issue = 6 | pages = 704–714 | year = 2017 | pmid = 28028030 | doi = 10.1182/blood-2016-10-695973 | url = }}</ref>
 
==== Hematological malignancies ====
The following table lists the more frequently occurring genes to which ETV6 fuses, the function of these genes, these genes' chromosomal locations, the notation designating the most common sites of the translocations of these fused genes, and the malignancies resulting from these translocations. These translocation mutations commonly occur in [[Cell potency#Pluripotency|pluripotent]] [[hematopoietic stem cell]]s that differentiate into various types of mature hematological cells. Consequently, a given mutation may lead to various types of [[Tumors of the hematopoietic and lymphoid tissues|hematological malignancies]].<ref name="pmid22578774"/><ref name="pmid28028030"/> The table includes abbreviations for tyrosine kinase receptor (TK receptor), non-receptor tyrosine kinase (non-receptor TK), homeobox protein type of transcription factor (homeobox protein), acute lymphocytic leukemia (ALL), Philadelphia chromosome negative chronic myelogenous leukemia (Ph(-)CML), myelodysplastic syndrome (MDS), myeloproliferative neoplasm (MPN), and acute myeloid leukemia (AML). (The presence of ''ETV6'' gene mutations in myelodysplastic syndromes is associated with shortened survival.<ref name="pmid26769228">{{cite journal | vauthors = Gangat N, Patnaik MM, Tefferi A | title = Myelodysplastic syndromes: Contemporary review and how we treat | journal = American Journal of Hematology | volume = 91 | issue = 1 | pages = 76–89 | year = 2016 | pmid = 26769228 | doi = 10.1002/ajh.24253 | url = }}</ref>)
 
transcription factors
 
{| class="wikitable"
|-
! Gene !! function !! location !! notation !! malignancies !!  !! gene !! function !! location !! notation !! malignancies       
|-
| ''[[PDGFRA]]'' || [[tyrosine kinase receptor|TK receptor]] || 4q12 || t(4;12)(q27?3;p13)|| 40% to 50% of [[clonal eosinophilia]] patients || || ''[[PDGFRB]]'' || [[tyrosine kinase receptor|TK receptor]] || 5q32 || t(5;12)(q31-33;p13) || rare [[clonal eosinophilia]] patients 
|-
| ''[[FLT3]]'' || [[tyrosine kinase receptor|TK receptor]] || 13q12.2  || t(12;13)(q13.1;p12.3-13) || rare [[Acute myeloid leukemia|AML]], [[Acute lymphoblastic leukemia|ALL]], and [[clonal eosinophilia]] patients ||  || ''[[ABL1]]'' || [[non-receptor tyrosine kinase|non-receptor TK]] || 9q34.12 || t(9;12)(q34;p13) || rare [[Acute myeloid leukemia|AML]], B-cell or T-cell [[Acute lymphoblastic leukemia|ALL]], Ph(-)[[Chronic myelogenous leukemia|CML]] patients   
|-
| ''[[RUNX1]]'' || [[transcription factor]] || 21q22.12 || t(12;21)(p13;q22) || 20-25% of pediatric [[Acute lymphoblastic leukemia|ALL]] patients || || ''[[PAX5]]'' || [[homeobox#Biological function|homeobox protein]] || 9p13.2 || t(9;12)(q11;p13) || 1% of pediatric [[Acute lymphoblastic leukemia|ALL]] patients 
|-
| ''[[MNX1]]'' || [[homeobox#Biological function|homeobox protein]] || 7q36.3 || t(7:12)(q36;p13) || 20-30% of pediatric [[Acute lymphoblastic leukemia|ALL]] patients less than 18 months old || || ''[[MECOM]]'' || [[Transcription factor]] || 3q26.2 || t(3;12)(q26;p13) || rare [[Myelodysplastic syndrome|MDS]], [[Myeloproliferative neoplasm|MPN]], and [[Acute myeloid leukemia|AML]] patients 
|-
|}
 
In addition to the fusion gene-producing translocations given in the table, ''ETV6'' has been reported to fuse with other genes in very rare cases (i.e. 1-10 published reports). These translocations lead to one or more of the same types of hematological malignancies listed in the table. Thus, the ''ETV6'' gene reportedly forms translocation-induced fusion genes with:<ref name="pmid22578774"/> '''a)''' tyrosine kinase receptor gene ''[[FGFR3]]''; '''b)''' non-receptor tyrosine kinase genes ''[[ABL2]], [[NTRK3]], [[JAK2]], [[SYK]], [[Fyn-related kinase|FRK]],'' and ''[[LYN]]''; '''c)''' transcription factor genes ''[[MN1 (gene)|MN1]]'' and ''[[PER1]]''; '''d)''' homeobox protein transcription factor ''[[CDX2]]''; '''e)''' Protein tyrosine phosphatase receptor-type R gene ''[[PTPRR]]'';<ref>https://www.ncbi.nlm.nih.gov/gene/5801</ref> '''f)''' transcriptional coactivator for nuclear hormone receptors gene [[NCOA2]]; '''f)''' [[Immunoglobulin heavy chain]] gene IGH;<ref>https://www.ncbi.nlm.nih.gov/gene/3492</ref> '''g)''' enzyme genes ''[[Tubulin—tyrosine ligase|TTL]]'' (adds and removes tyrosine residues on [[Tubulin#α-Tubulin|α-tubulin]]),<ref>https://www.ncbi.nlm.nih.gov/gene/150465</ref> ''[[GOT1]]'' (an [[Aspartate transaminase]]), and [[ACSL6]] (a [[Long-chain-fatty-acid—CoA ligase]]); '''h)''' transporter gene ''[[Aryl hydrocarbon receptor nuclear translocator|ARNT]]'' (binds to [[ligand]]-bound [[aryl hydrocarbon receptor]] to aid in its movement to the nucleus where it promotes the expression of genes involved in xenobiotic metabolism); '''i)''' unknown function genes ''CHIC2'',<ref>https://www.ncbi.nlm.nih.gov/gene/26511</ref> ''MDS2'',<ref>https://www.ncbi.nlm.nih.gov/gene/259283</ref> [[FCHO2]]<ref>https://www.ncbi.nlm.nih.gov/gene/115548</ref> and ''[[BAZ2A]]''.;<ref>https://www.ncbi.nlm.nih.gov/gene/11176</ref> and '''j)''' non-annotated gene ''STL'' (which has no long [[open reading frame]]<ref name="pmid9087565">{{cite journal | vauthors = Suto Y, Sato Y, Smith SD, Rowley JD, Bohlander SK | title = A t(6;12)(q23;p13) results in the fusion of ETV6 to a novel gene, STL, in a B-cell ALL cell line | journal = Genes, Chromosomes & Cancer | volume = 18 | issue = 4 | pages = 254–68 | year = 1997 | pmid = 9087565 | doi = | url = }}</ref>).
 
At least 9 [[frameshift mutation]]s in the'''ETV6'' gene have been associated with ~12% of adult T cell [[Acute lymphoblastic leukemia]] cases. These mutations involve insertions or deletions in the gene that lead to its encoding a truncated and therefore inactive ETV6 protein. These mutations commonly occur alongside mutations in another oncogene, ''[[NOTCH1]]'', which is associated with T cell acute lymphoblastic lymphoma quite independently of ETV6. It is suggested that suppressor mutations in the ''ETV6'' gene may be a contributing factor in the development ant/or progression of this leukemia type.<ref name="pmid28450705"/><ref name="pmid22162831">{{cite journal | vauthors = Van Vlierberghe P, Ambesi-Impiombato A, Perez-Garcia A, Haydu JE, Rigo I, Hadler M, Tosello V, Della Gatta G, Paietta E, Racevskis J, Wiernik PH, Luger SM, Rowe JM, Rue M, Ferrando AA | title = ETV6 mutations in early immature human T cell leukemias | journal = The Journal of Experimental Medicine | volume = 208 | issue = 13 | pages = 2571–9 | year = 2011 | pmid = 22162831 | pmc = 3244026 | doi = 10.1084/jem.20112239 | url = }}</ref><ref name="pmid28115368">{{cite journal | vauthors = Sanchez-Martin M, Ferrando A | title = The NOTCH1-MYC highway toward T-cell acute lymphoblastic leukemia | journal = Blood | volume = 129 | issue = 9 | pages = 1124–1133 | year = 2017 | pmid = 28115368 | doi = 10.1182/blood-2016-09-692582 | url = }}</ref>
 
===== Treatment =====
Patients developing hematological malignancies secondary to the ''ETV6'' gene fusion to receptor tyrosine kinases and non-receptor tyrosine kinases may be sensitive to therapy with [[tyrosine kinase inhibitors]].<ref name="pmid26404639">{{cite journal | vauthors = Gotlib J | title = Tyrosine Kinase Inhibitors and Therapeutic Antibodies in Advanced Eosinophilic Disorders and Systemic Mastocytosis | journal = Current Hematologic Malignancy Reports | volume = 10 | issue = 4 | pages = 351–61 | year = 2015 | pmid = 26404639 | doi = 10.1007/s11899-015-0280-3 | url = }}</ref> For example, patients with clonal eosinophilias due to ''[[PDGFRA#Myeloid and lymphoid cells|PDGFRA]]'' or ''[[PDGFRB#PDGFRB-ETV6 translocations|PDGFRB]]'' fusion genes experience long-term, complete remission when treated with are highly sensitive tyrosine kinase inhibitor, [[gleevec]].<ref name="pmid28028030"/> [[Larotrectinib]], [[entrectinib]], [[merestinib]], and server other broadly acting tyrosine kinase inhibitors target the ''NTRK3'' gene. Many of these drugs are in phase 1 or phase 2 [[Phases of clinical research|clinical trials]] for the treatment of ''ETV6-NTRK3''-related solid tumors and may ultimately prove useful for treating hematologic malignancies associated with this fusion gene.<ref name="pmid28174090">{{cite journal | vauthors = Khotskaya YB, Holla VR, Farago AF, Mills Shaw KR, Meric-Bernstam F, Hong DS | title = Targeting TRK family proteins in cancer | journal = Pharmacology & Therapeutics | volume = 173 | issue = | pages = 58–66 | year = 2017 | pmid = 28174090 | doi = 10.1016/j.pharmthera.2017.02.006 | url = }}</ref> Clinical trials have found that the first generation tyrosine kinase inhibitors [[sorafenib]], [[sunitinib]], [[midostaurin]], [[lestaurtinib]] have shown some promise in treating [[acute myelogenous leukemia]] associated with the ''FLT3-TKI'' fusion gene; the second generation tyrosine kinase inhibtors [[quizartinib]] and [[crenolanib]] which are highly selective in inhibiting the FLT3 protein, have shown significant promise in treating relapsed and refractory acute myelogenous leukemia related to the ''FLT3-TKI'' fusion gene.<ref name="pmid28538663">{{cite journal | vauthors = Tsapogas P, Mooney CJ, Brown G, Rolink A | title = The Cytokine Flt3-Ligand in Normal and Malignant Hematopoiesis | journal = International Journal of Molecular Sciences | volume = 18 | issue = 6 | pages = | year = 2017 | pmid = 28538663 | doi = 10.3390/ijms18061115 | url = }}</ref> One patient with ''ETV6-FLT3''-related myeloid/lymphoid neoplasm obtained a short term remission on sunitinib and following relapse, on sorafenib suggesting that the cited FLT3 protein tyrosine kinase inhibitors may prove useful for treating ''ETV6-FLT''-related hematologic malignancies.<ref name="pmid21705501">{{cite journal | vauthors = Walz C, Erben P, Ritter M, Bloor A, Metzgeroth G, Telford N, Haferlach C, Haferlach T, Gesk S, Score J, Hofmann WK, Hochhaus A, Cross NC, Reiter A | title = Response of ETV6-FLT3-positive myeloid/lymphoid neoplasm with eosinophilia to inhibitors of FMS-like tyrosine kinase 3 | journal = Blood | volume = 118 | issue = 8 | pages = 2239–42 | year = 2011 | pmid = 21705501 | doi = 10.1182/blood-2011-03-343426 | url = }}</ref> Two patients suffering hematologic malignancies related to ''PCM1-JAK2'' or ''BCR-JAK2'' fusion genes experienced complete and cytogenetic remissions in response to the tyrosine kinase inhibitor [[ruxolitinib]]; while both remissions were short-term (12 months), these results suggest that tyrosine kinase inhibitors that tarket JAK2 may be of some use for treating hemalologic malignancies associated with ''ETV6-JAK2'' fusion stems.<ref name="pmid28028030"/> An inhibitor of SYK tyrosine kinase, TAK-659 is currently undergoing Phase I clinical trials for advanced lymphoma malignancies and may prove to be useful in treating this disease when associated with the ''ETV6-SYK'' fusion gene.<ref name="pmid27839918">{{cite journal | vauthors = Lam B, Arikawa Y, Cramlett J, Dong Q, de Jong R, Feher V, Grimshaw CE, Farrell PJ, Hoffman ID, Jennings A, Jones B, Matuszkiewicz J, Miura J, Miyake H, Natala SR, Shi L, Takahashi M, Taylor E, Wyrick C, Yano J, Zalevsky J, Nie Z | title = Discovery of TAK-659 an orally available investigational inhibitor of Spleen Tyrosine Kinase (SYK) | journal = Bioorganic & Medicinal Chemistry Letters | volume = 26 | issue = 24 | pages = 5947–5950 | year = 2016 | pmid = 27839918 | doi = 10.1016/j.bmcl.2016.10.087 | url = }}</ref> It is possible that hematological malignancies associated with ''ETV6'' gene fusions to either the ''SYK'' or ''FRK'' tyrosine kinase genes may someday be shown susceptible to tyrosine kinase inhibitor therapy. However, children with ''ETV6-RUNX1''-associated [[acute lymphoblastic leukemia]] are in an especially good-risk subgroup and therefore have been almost uniformly treated with standard-risk [[chemotherapy]] protocols.<ref name="pmid24319172">{{cite journal | vauthors = Harrison CJ | title = Targeting signaling pathways in acute lymphoblastic leukemia: new insights | journal = Hematology. American Society of Hematology. Education Program | volume = 2013 | issue = | pages = 118–25 | year = 2013 | pmid = 24319172 | doi = 10.1182/asheducation-2013.1.118 | url = }}</ref>
 
Hematological malignancies associated with ''ETY6'' gene fusions to other transcription factor genes appear to reflect a loss or gain in function of ''ETV6'' and/or the other genes in regulating expression of their target genes; this results in the formation or lack of formation of products which influence cell growth, proliferation, and/or survival. In vitro studies of ''ETV6-RUNX, ETV6-MN1, ETV6-PER1'', and ''ETV6-MECOM'' fusion genes support this notion. Thus, the ''ETV6-MECOM'' fusion gene is overexpressed because it is driven by the [[Promoter (genetics)|promoter]] derived from ''ETV6''<ref name="pmid22578774"/> whereas the ''ETV6-RUNX, ETV6-MN1'', and '' ETV6-PER1'' fusion genes produce chimeric proteins which lack ETV6 protein's gene-suppressing activity.<ref name="pmid24066765">{{cite journal | vauthors = Kar A, Gutierrez-Hartmann A | title = Molecular mechanisms of ETS transcription factor-mediated tumorigenesis | journal = Critical Reviews in Biochemistry and Molecular Biology | volume = 48 | issue = 6 | pages = 522–43 | year = 2013 | pmid = 24066765 | pmc = 4086824 | doi = 10.3109/10409238.2013.838202 | url = }}</ref> The chimeric protein products of ''ETV6'' gene fusions with ''ARNT, TTL, BA22A, FCHO2, MDS2'', and ''CHIC2'' likewise lack ETV6 protein's transcription factor activity.<ref name="pmid24066765"/> Gene fusions between ''ETV6'' and the homeobox gens (i.e. ''CDX2, PAX5,'' and MNX1) produce chimeric proteins with lack either ETV6s and/or CDX2s, PAX5s or MNX1s transcription factor activity.<ref name="pmid22578774"/> In all events, hematological malignancies associated with these fusion genes have been treated with standard chemotherapy protocols selected on the basis of the malignancies [[phenotype]].
 
=== Solid Tumors ===
Mutations in the ''ETV6'' gene are also associated with [[solid tumor]]s. In particular, the ''ETV6-[[NTRK3]]'' fusion gene occurs in and is thought or proposed to drive certain types of cancers. These cancers include [[Breast cancer classification|secretory breast cancer]] (also termed juvenile breast cancer), [[mammary analogue secretory carcinoma]] of the [[parotid gland|parotid]] and other [[salivary glands]], [[fibrosarcoma#Infantile-type|congenital fibrosarcoma]], [[congenital mesoblastic nephroma]], [[inflammatory myofibroblastic tumor]], and radiation-induced [[papillary thyroid carcinoma]].<ref name="pmid28450705"/><ref name="pmid12450792">{{Cite journal | doi = 10.1016/S1535-6108(02)00180-0 | vauthors = Tognon C, Knezevich SR, Huntsman D, Roskelley CD, Melnyk N, Mathers JA, Becker L, Carneiro F, MacPherson N, Horsman D, Poremba C, Sorensen PH | title = Expression of the ETV6-NTRK3 gene fusion as a primary event in human secretory breast carcinoma | journal = Cancer Cell |date=Nov 2002| volume = 2 |issue =5 | pages = 367–76|pmid = 12450792}}</ref><ref>Majewska H, Skálová A, Stodulski D, Klimková A, Steiner P, Stankiewicz C, Biernat W. "Mammary analogue secretory carcinoma of salivary glands: a new entity associated with ETV6 gene rearrangement." Virchows Arch. 2015 Mar;466(3):245-54. doi: 10.1007/s00428-014-1701-8. Epub 2014 Dec 12.</ref><ref>{{Cite journal|last=Argani|first=P.|last2=Fritsch|first2=M.|last3=Kadkol|first3=S. S.|last4=Schuster|first4=A.|last5=Beckwith|first5=J. B.|last6=Perlman|first6=E. J.|date=2000-01-01|title=Detection of the ETV6-NTRK3 chimeric RNA of infantile fibrosarcoma/cellular congenital mesoblastic nephroma in paraffin-embedded tissue: application to challenging pediatric renal stromal tumors|url=https://www.ncbi.nlm.nih.gov/pubmed/10658907|journal=Modern Pathology: An Official Journal of the United States and Canadian Academy of Pathology, Inc|volume=13|issue=1|pages=29–36|doi=10.1038/modpathol.3880006|issn=0893-3952|pmid=10658907}}</ref><ref name="pmid28174090"/><ref name="pmid28060365">{{cite journal | vauthors = Skalova A, Michal M, Simpson RH | title = Newly described salivary gland tumors | journal = Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc | volume = 30 | issue = s1 | pages = S27–S43 | year = 2017 | pmid = 28060365 | doi = 10.1038/modpathol.2016.167 | url = }}</ref><ref name="pmid24066765"/><ref name="pmid27259007">{{cite journal | vauthors = Alassiri AH, Ali RH, Shen Y, Lum A, Strahlendorf C, Deyell R, Rassekh R, Sorensen PH, Laskin J, Marra M, Yip S, Lee CH, Ng TL | title = ETV6-NTRK3 Is Expressed in a Subset of ALK-Negative Inflammatory Myofibroblastic Tumors | journal = The American Journal of Surgical Pathology | volume = 40 | issue = 8 | pages = 1051–61 | year = 2016 | pmid = 27259007 | doi = 10.1097/PAS.0000000000000677 | url = }}</ref>
 
==== Treatment ====
The treatment of ''ETV6'' gene-associated solid tumors has not advanced as far as that for ''ETV6'' gene-associated hematological malignancies. It is proposed that [[tyrosine kinase inhibitor]]s with specificity for NTRK3's tyrosine kinase activity in ''ETV6-NTRK3'' gene-associated solid tumors may be of therapeutic usefulness. [[Entrectinib]], a pan-NTRK as well as an [[Anaplastic lymphoma kinase|ALK]] and [[ROS1]] tyrosine kinase inhibitor has been found useful in treating a single patient with ''ETV6-NRTK3'' fusion gene-associated [[Mammary analogue secretory carcinoma#Clinical course and treatment|mammary analogue secretory carcinoma]] and lends support to the clinical development of NTRK3-directed tyrosine kinase inhibitors to treat ETV6-NTRK3 fusion protein associated malignancies.<ref name="pmid28174090"/> Three clinical trials are in the recruitment phase for determining the efficacy of treating a wide range of solid tumors associated with mutated, overactive tyrosine kinase proteins, including the ETV6-TRK3 protein, with [[larotrectinib]], a non-selective inhibitor of NTRK1, NTRK2, and NTRK3 tyrosine kinases.<ref>https://clinicaltrials.gov/ct2/results?term=ETV6-NTRK3&Search=Search</ref>
 
== See also ==
* [[ETV6-NTRK3 gene fusion]]
* [[TEL-JAK2]]
* [[TEL-JAK2]]


==References==
== References ==
{{reflist|2}}
{{reflist|33em}}
==Further reading==
 
{{refbegin | 2}}
== Further reading ==
{{PBB_Further_reading
{{refbegin|33em}}
| citations =
* {{cite journal | vauthors = Keung YK, Beaty M, Steward W, Jackle B, Pettnati M | title = Chronic myelocytic leukemia with eosinophilia, t(9;12)(q34;p13), and ETV6-ABL gene rearrangement: case report and review of the literature | journal = Cancer Genetics and Cytogenetics | volume = 138 | issue = 2 | pages = 139–42 | date = Oct 2002 | pmid = 12505259 | doi = 10.1016/S0165-4608(02)00609-X }}
*{{cite journal | author=Keung YK, Beaty M, Steward W, ''et al.'' |title=Chronic myelocytic leukemia with eosinophilia, t(9;12)(q34;p13), and ETV6-ABL gene rearrangement: case report and review of the literature. |journal=Cancer Genet. Cytogenet. |volume=138 |issue= 2 |pages= 139-42 |year= 2003 |pmid= 12505259 |doi= }}
* {{cite journal | vauthors = Fainstein E, Einat M, Gokkel E, Marcelle C, Croce CM, Gale RP, Canaani E | title = Nucleotide sequence analysis of human abl and bcr-abl cDNAs | journal = Oncogene | volume = 4 | issue = 12 | pages = 1477–81 | date = Dec 1989 | pmid = 2687768 | doi =  }}
*{{cite journal | author=Fainstein E, Einat M, Gokkel E, ''et al.'' |title=Nucleotide sequence analysis of human abl and bcr-abl cDNAs. |journal=Oncogene |volume=4 |issue= 12 |pages= 1477-81 |year= 1990 |pmid= 2687768 |doi=  }}
* {{cite journal | vauthors = Buijs A, Sherr S, van Baal S, van Bezouw S, van der Plas D, Geurts van Kessel A, Riegman P, Lekanne Deprez R, Zwarthoff E, Hagemeijer A | title = Translocation (12;22) (p13;q11) in myeloproliferative disorders results in fusion of the ETS-like TEL gene on 12p13 to the MN1 gene on 22q11 | journal = Oncogene | volume = 10 | issue = 8 | pages = 1511–9 | date = Apr 1995 | pmid = 7731705 | doi =  }}
*{{cite journal | author=Buijs A, Sherr S, van Baal S, ''et al.'' |title=Translocation (12;22) (p13;q11) in myeloproliferative disorders results in fusion of the ETS-like TEL gene on 12p13 to the MN1 gene on 22q11. |journal=Oncogene |volume=10 |issue= 8 |pages= 1511-9 |year= 1995 |pmid= 7731705 |doi=  }}
* {{cite journal | vauthors = Golub TR, Barker GF, Bohlander SK, Hiebert SW, Ward DC, Bray-Ward P, Morgan E, Raimondi SC, Rowley JD, Gilliland DG | title = Fusion of the TEL gene on 12p13 to the AML1 gene on 21q22 in acute lymphoblastic leukemia | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 92 | issue = 11 | pages = 4917–21 | date = May 1995 | pmid = 7761424 | pmc = 41818 | doi = 10.1073/pnas.92.11.4917 }}
*{{cite journal | author=Golub TR, Barker GF, Bohlander SK, ''et al.'' |title=Fusion of the TEL gene on 12p13 to the AML1 gene on 21q22 in acute lymphoblastic leukemia. |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=92 |issue= 11 |pages= 4917-21 |year= 1995 |pmid= 7761424 |doi= }}
* {{cite journal | vauthors = Romana SP, Mauchauffé M, Le Coniat M, Chumakov I, Le Paslier D, Berger R, Bernard OA | title = The t(12;21) of acute lymphoblastic leukemia results in a tel-AML1 gene fusion | journal = Blood | volume = 85 | issue = 12 | pages = 3662–70 | date = Jun 1995 | pmid = 7780150 | doi =  }}
*{{cite journal | author=Romana SP, Mauchauffé M, Le Coniat M, ''et al.'' |title=The t(12;21) of acute lymphoblastic leukemia results in a tel-AML1 gene fusion. |journal=Blood |volume=85 |issue= 12 |pages= 3662-70 |year= 1995 |pmid= 7780150 |doi=  }}
* {{cite journal | vauthors = Papadopoulos P, Ridge SA, Boucher CA, Stocking C, Wiedemann LM | title = The novel activation of ABL by fusion to an ets-related gene, TEL | journal = Cancer Research | volume = 55 | issue = 1 | pages = 34–8 | date = Jan 1995 | pmid = 7805037 | doi =  }}
*{{cite journal | author=Papadopoulos P, Ridge SA, Boucher CA, ''et al.'' |title=The novel activation of ABL by fusion to an ets-related gene, TEL. |journal=Cancer Res. |volume=55 |issue= 1 |pages= 34-8 |year= 1995 |pmid= 7805037 |doi=  }}
* {{cite journal | vauthors = Golub TR, Barker GF, Lovett M, Gilliland DG | title = Fusion of PDGF receptor beta to a novel ets-like gene, tel, in chronic myelomonocytic leukemia with t(5;12) chromosomal translocation | journal = Cell | volume = 77 | issue = 2 | pages = 307–16 | date = Apr 1994 | pmid = 8168137 | doi = 10.1016/0092-8674(94)90322-0 }}
*{{cite journal | author=Golub TR, Barker GF, Lovett M, Gilliland DG |title=Fusion of PDGF receptor beta to a novel ets-like gene, tel, in chronic myelomonocytic leukemia with t(5;12) chromosomal translocation. |journal=Cell |volume=77 |issue= 2 |pages= 307-16 |year= 1994 |pmid= 8168137 |doi= }}
* {{cite journal | vauthors = Wlodarska I, Baens M, Peeters P, Aerssens J, Mecucci C, Brock P, Marynen P, Van den Berghe H | title = Biallelic alterations of both ETV6 and CDKN1B genes in a t(12;21) childhood acute lymphoblastic leukemia case | journal = Cancer Research | volume = 56 | issue = 11 | pages = 2655–61 | date = Jun 1996 | pmid = 8653712 | doi =  }}
*{{cite journal | author=Wlodarska I, Baens M, Peeters P, ''et al.'' |title=Biallelic alterations of both ETV6 and CDKN1B genes in a t(12;21) childhood acute lymphoblastic leukemia case. |journal=Cancer Res. |volume=56 |issue= 11 |pages= 2655-61 |year= 1996 |pmid= 8653712 |doi=  }}
* {{cite journal | vauthors = Baens M, Peeters P, Guo C, Aerssens J, Marynen P | title = Genomic organization of TEL: the human ETS-variant gene 6 | journal = Genome Research | volume = 6 | issue = 5 | pages = 404–13 | date = May 1996 | pmid = 8743990 | doi = 10.1101/gr.6.5.404 }}
*{{cite journal | author=Baens M, Peeters P, Guo C, ''et al.'' |title=Genomic organization of TEL: the human ETS-variant gene 6. |journal=Genome Res. |volume=6 |issue= 5 |pages= 404-13 |year= 1996 |pmid= 8743990 |doi= }}
* {{cite journal | vauthors = Bonaldo MF, Lennon G, Soares MB | title = Normalization and subtraction: two approaches to facilitate gene discovery | journal = Genome Research | volume = 6 | issue = 9 | pages = 791–806 | date = Sep 1996 | pmid = 8889548 | doi = 10.1101/gr.6.9.791 }}
*{{cite journal | author=Bonaldo MF, Lennon G, Soares MB |title=Normalization and subtraction: two approaches to facilitate gene discovery. |journal=Genome Res. |volume=6 |issue= 9 |pages= 791-806 |year= 1997 |pmid= 8889548 |doi= }}
* {{cite journal | vauthors = Hillier LD, Lennon G, Becker M, Bonaldo MF, Chiapelli B, Chissoe S, Dietrich N, DuBuque T, Favello A, Gish W, Hawkins M, Hultman M, Kucaba T, Lacy M, Le M, Le N, Mardis E, Moore B, Morris M, Parsons J, Prange C, Rifkin L, Rohlfing T, Schellenberg K, Bento Soares M, Tan F, Thierry-Meg J, Trevaskis E, Underwood K, Wohldman P, Waterston R, Wilson R, Marra M | title = Generation and analysis of 280,000 human expressed sequence tags | journal = Genome Research | volume = 6 | issue = 9 | pages = 807–28 | date = Sep 1996 | pmid = 8889549 | doi = 10.1101/gr.6.9.807 }}
*{{cite journal | author=Hillier LD, Lennon G, Becker M, ''et al.'' |title=Generation and analysis of 280,000 human expressed sequence tags. |journal=Genome Res. |volume=6 |issue= 9 |pages= 807-28 |year= 1997 |pmid= 8889549 |doi= }}
* {{cite journal | vauthors = Andreasson P, Johansson B, Arheden K, Billström R, Mitelman F, Höglund M | title = Deletions of CDKN1B and ETV6 in acute myeloid leukemia and myelodysplastic syndromes without cytogenetic evidence of 12p abnormalities | journal = Genes, Chromosomes & Cancer | volume = 19 | issue = 2 | pages = 77–83 | date = Jun 1997 | pmid = 9171997 | doi = 10.1002/(SICI)1098-2264(199706)19:2<77::AID-GCC2>3.0.CO;2-X }}
*{{cite journal  | author=Andreasson P, Johansson B, Arheden K, ''et al.'' |title=Deletions of CDKN1B and ETV6 in acute myeloid leukemia and myelodysplastic syndromes without cytogenetic evidence of 12p abnormalities. |journal=Genes Chromosomes Cancer |volume=19 |issue= 2 |pages= 77-83 |year= 1997 |pmid= 9171997 |doi= }}
* {{cite journal | vauthors = Lacronique V, Boureux A, Valle VD, Poirel H, Quang CT, Mauchauffé M, Berthou C, Lessard M, Berger R, Ghysdael J, Bernard OA | title = A TEL-JAK2 fusion protein with constitutive kinase activity in human leukemia | journal = Science | volume = 278 | issue = 5341 | pages = 1309–12 | date = Nov 1997 | pmid = 9360930 | doi = 10.1126/science.278.5341.1309 }}
*{{cite journal | author=Lacronique V, Boureux A, Valle VD, ''et al.'' |title=A TEL-JAK2 fusion protein with constitutive kinase activity in human leukemia. |journal=Science |volume=278 |issue= 5341 |pages= 1309-12 |year= 1997 |pmid= 9360930 |doi= }}
* {{cite journal | vauthors = Knezevich SR, McFadden DE, Tao W, Lim JF, Sorensen PH | title = A novel ETV6-NTRK3 gene fusion in congenital fibrosarcoma | journal = Nature Genetics | volume = 18 | issue = 2 | pages = 184–7 | date = Feb 1998 | pmid = 9462753 | doi = 10.1038/ng0298-184 }}
*{{cite journal  | author=Knezevich SR, McFadden DE, Tao W, ''et al.'' |title=A novel ETV6-NTRK3 gene fusion in congenital fibrosarcoma. |journal=Nat. Genet. |volume=18 |issue= 2 |pages= 184-7 |year= 1998 |pmid= 9462753 |doi= 10.1038/ng0298-184 }}
* {{cite journal | vauthors = Kwiatkowski BA, Bastian LS, Bauer TR, Tsai S, Zielinska-Kwiatkowska AG, Hickstein DD | title = The ets family member Tel binds to the Fli-1 oncoprotein and inhibits its transcriptional activity | journal = The Journal of Biological Chemistry | volume = 273 | issue = 28 | pages = 17525–30 | date = Jul 1998 | pmid = 9651344 | doi = 10.1074/jbc.273.28.17525 }}
*{{cite journal | author=Kwiatkowski BA, Bastian LS, Bauer TR, ''et al.'' |title=The ets family member Tel binds to the Fli-1 oncoprotein and inhibits its transcriptional activity. |journal=J. Biol. Chem. |volume=273 |issue= 28 |pages= 17525-30 |year= 1998 |pmid= 9651344 |doi= }}
* {{cite journal | vauthors = Hannemann JR, McManus DM, Kabarowski JH, Wiedemann LM | title = Haemopoietic transformation by the TEL/ABL oncogene | journal = British Journal of Haematology | volume = 102 | issue = 2 | pages = 475–85 | date = Jul 1998 | pmid = 9695962 | doi = 10.1046/j.1365-2141.1998.00803.x }}
*{{cite journal | author=Hannemann JR, McManus DM, Kabarowski JH, Wiedemann LM |title=Haemopoietic transformation by the TEL/ABL oncogene. |journal=Br. J. Haematol. |volume=102 |issue= 2 |pages= 475-85 |year= 1998 |pmid= 9695962 |doi= }}
* {{cite journal | vauthors = Chakrabarti SR, Sood R, Ganguly S, Bohlander S, Shen Z, Nucifora G | title = Modulation of TEL transcription activity by interaction with the ubiquitin-conjugating enzyme UBC9 | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 96 | issue = 13 | pages = 7467–72 | date = Jun 1999 | pmid = 10377438 | pmc = 22109 | doi = 10.1073/pnas.96.13.7467 }}
*{{cite journal | author=Chakrabarti SR, Sood R, Ganguly S, ''et al.'' |title=Modulation of TEL transcription activity by interaction with the ubiquitin-conjugating enzyme UBC9. |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=96 |issue= 13 |pages= 7467-72 |year= 1999 |pmid= 10377438 |doi= }}
* {{cite journal | vauthors = Cools J, Bilhou-Nabera C, Wlodarska I, Cabrol C, Talmant P, Bernard P, Hagemeijer A, Marynen P | title = Fusion of a novel gene, BTL, to ETV6 in acute myeloid leukemias with a t(4;12)(q11-q12;p13) | journal = Blood | volume = 94 | issue = 5 | pages = 1820–4 | date = Sep 1999 | pmid = 10477709 | doi =  }}
*{{cite journal | author=Cools J, Bilhou-Nabera C, Wlodarska I, ''et al.'' |title=Fusion of a novel gene, BTL, to ETV6 in acute myeloid leukemias with a t(4;12)(q11-q12;p13). |journal=Blood |volume=94 |issue= 5 |pages= 1820-4 |year= 1999 |pmid= 10477709 |doi= }}
* {{cite journal | vauthors = Yagasaki F, Jinnai I, Yoshida S, Yokoyama Y, Matsuda A, Kusumoto S, Kobayashi H, Terasaki H, Ohyashiki K, Asou N, Murohashi I, Bessho M, Hirashima K | title = Fusion of TEL/ETV6 to a novel ACS2 in myelodysplastic syndrome and acute myelogenous leukemia with t(5;12)(q31;p13) | journal = Genes, Chromosomes & Cancer | volume = 26 | issue = 3 | pages = 192–202 | date = Nov 1999 | pmid = 10502316 | doi = 10.1002/(SICI)1098-2264(199911)26:3<192::AID-GCC2>3.0.CO;2-E }}
*{{cite journal | author=Yagasaki F, Jinnai I, Yoshida S, ''et al.'' |title=Fusion of TEL/ETV6 to a novel ACS2 in myelodysplastic syndrome and acute myelogenous leukemia with t(5;12)(q31;p13). |journal=Genes Chromosomes Cancer |volume=26 |issue= 3 |pages= 192-202 |year= 2000 |pmid= 10502316 |doi=  }}
* {{cite journal | vauthors = Wai DH, Knezevich SR, Lucas T, Jansen B, Kay RJ, Sorensen PH | title = The ETV6-NTRK3 gene fusion encodes a chimeric protein tyrosine kinase that transforms NIH3T3 cells | journal = Oncogene | volume = 19 | issue = 7 | pages = 906–15 | date = Feb 2000 | pmid = 10702799 | doi = 10.1038/sj.onc.1203396 }}
*{{cite journal  | author=Wai DH, Knezevich SR, Lucas T, ''et al.'' |title=The ETV6-NTRK3 gene fusion encodes a chimeric protein tyrosine kinase that transforms NIH3T3 cells. |journal=Oncogene |volume=19 |issue= 7 |pages= 906-15 |year= 2000 |pmid= 10702799 |doi= 10.1038/sj.onc.1203396 }}
}}
{{refend}}
{{refend}}


==External links==
== External links ==
* {{MeshName|ETV6+protein,+human}}
* {{MeshName|ETV6+protein,+human}}
* [http://www.sdbonline.org/fly/neural/yan.htm ''Drosophila'' ''anterior open'' - The Interactive Fly]


{{protein-stub}}
{{NLM content}}
{{NLM content}}
{{Transcription factors}}
{{PDB Gallery|geneid=2120}}
{{Transcription factors|g3}}
 
[[Category:Oncogenes]]
[[Category:Tyrosine kinases]]
[[Category:Transcription factors]]
[[Category:Transcription factors]]
{{WikiDoc Sources}}

Revision as of 14:10, 17 September 2017

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ETV6 (i.e. translocation-Ets-leukemia virus) protein is a transcription factor that in humans is encoded by the ETV6 (previously known as TEL) gene. The ETV6 protein regulates the development and growth of diverse cell types, particularly those of hematological tissues. However, its gene, ETV6 frequently suffers various mutations that lead to an array of potentially lethal cancers, i.e., ETV6 is a clinically significant proto-oncogene in that it can fuse with other genes to drive the development and/or progression of certain cancers. However, ETV6 is also an anti-oncogene or tumor suppressor gene in that mutations in it that encode for a truncated and therefore inactive protein are also associated with certain types of cancers.

Gene

The human ETV6 gene is located at position "13.2" on the short (i.e. "p") arm of chromosome 12, i.e. its notated position is 12p13.2. The gene has 8 exons and two start codons, one located at exon 1 at the start of the gene and an alternative located upstream of exon 3. ETV6 codes for a full length protein consisting of 452 amino acids; the gene is expressed in virtually all cell types and tissues.[1][2] Mice depleted of the ETV6 gene by Gene knockout die between day 10.5 and 11.5 of embryonic life with defective yolk sac angiogenesis and extensive losses in mesenchymal and neural cells due to apoptosis. Other genetic manipulation studies in mice indicate that the gene is required for the development and maintenance of bone marrow-based blood cell formation and the vascular network.[1][3]

Protein

The human ETV6 protein is a member of the ETS transcription factor family; however, it more often acts to inhibit than stimulate transcription of its target genes. ETV6 protein contains 3 domains: a) the pointed N-terminal (i.e. PNT) domain which forms oligomer partners with itself as well as other transcription factors (e.g. FLI1) and is required for ETV6's transcriptional repressing activity; b) the central regulatory domain; and c) the C-terminal DNA-binding domain, ETS, which binds to the consensus DNA sequence, 5-GGAA/T-3 within a 9-to-10 bp sequence, in the target genes it regulates.[1][4] ETV6 interacts with other proteins that regulate the differentiation and growth of cells. It binds to and thereby inhibits FLI1, another member of the ETS transcription factor family, which is active in promoting the maturation of blood platelet-forming megakaryocytes and blocking the Cellular differentiation of erythroblasts into red blood cells; this results in the excessive proliferation and abnormal morphology of erythroblasts.[5][3] ETV6 likewise binds to HTATIP, a histone acetyl transferase that regulates the expression of various genes involved in gene transcription, DNA repair, and cellular apoptosis; this binding promotes the transcription-repressing activity of ETV6.[6]

Medical significance

Inherited mutations

Rare missense and other loss of function mutations in ETV6 cause thrombocytopenia 5, an autosomal dominant familial disease characterized by variable thrombocytopenia (blood platelet counts from 5% to 90% of normal), mild to modest bleeding tendencies, and bone marrow biopsy findings of abnormal appearing megakaryocytes (i.e. nuclei with fewer than the normal number of lobulations) and red cell macrocytosis.[3][7] Thrombocytopenia 5 is associated with an increased incidence of developing hematological (e.g. chronic myelomonocytic leukemia, acute myelocytic leukemia, B cell acute lymphoblastic leukemia, mixed phenotype acute leukemia, Myelodysplastic syndrome, and multiple myeloma) and non-hematological (e.g. skin and colon) cancers as well as non-malignant diseases such as refractory anemia myopathies, and gastroesophageal reflux disease.[7][8]

Two unrelated kindreds were found to have autosomal dominant inherited mutations in the ETV6 gene, one family with a germline DNA substitution termed L349P that lead to replacing leucine with proline at amino acid 349 in the DNA binding domain of the ETV6, the second, termed N385fs, in germline DNA caused the lose of five base pairs ETV6 and a truncated ETV6 protein. Both mutant proteins failed to enter cell nuclei normally and had a reduced capacity to target genes regulated by the normal ETV6 protein. Afflicted members of these families had low platelet counts (i.e. thrombocytopenia) and acute lymphoblastic leukemia. Fifteen members of the two kindreds had thrombocytopenia, five of whom also had acute lymphoblastic leukemia. The L249P kindred also had one family member with renal cell carcinoma and another family member with Duodenal cancer. The relationship of these two cancers to the L249P mutation has not been investigated. In all events these two familial thrombocytopenia syndromes appear distinctly different than the thrombocytopenia 5 syndrome.[9]

Treatment

Family members with thrombocytopenia 5 need to be regularly monitored with complete blood count and blood smear screenings to detect the early changes brought on by the malignant transformations of this disease into hematological neoplasms. Patients who developed these transformations have generally been treated similarly to patients who the have same hematological neoplasms but on a non-familial basis. Patients developing non-malignant hematological or non-hematological solid tumor manifestations of thrombocytopenia 5 are also treated like to patients with the same but no-familial disease.[7][8]

The acute lymphoblastic leukemia associated with L349P or N385fs mutations in ETV6 appeared far less sensitive to standard chemotherapy for acute lymphoblastic leukemia with 2 among 3 family members moving rather quickly from chemotherapy to bone marrow transplantation and the third family member expiring. This suggest that these mutation-related forms of acute lymphoblastic leukemia require aggressive therapy.[9]

Acquired mutations

The ETV6 gene is prone to develop a wide range of acquired mutations in hematological precursor cells that lead to various types of leukemia and/or lymphoma. It may also suffer a smaller number of mutations in non-hematological tissues that leads to solid tumors. These mutations involve chromosome translocations which fuse the ETV6 on chromosome 12's the short (i.e. "p") arm ("q" stands for long arm) at position p13.2 (site notation: 12p12.2) near to a second gene on another chromosome or, more rarely, its own chromosome. This creates a fusion gene of the oncogene category which encodes a chimeric protein that promotes the malignant growth of its parent cells. It may be unclear which portion of the newly formed oncoprotein contributes to the ensuing malignancy but fusions between ETV6 and proteins with tyrosine kinase activity generally are converted from a protein with tightly regulated tyrosine kinase activity to an uncontrolled and continuously active tyrosine kinase that thereby promotes the malignant transformation of its parent cells.[10]

Hematological malignancies

The following table lists the more frequently occurring genes to which ETV6 fuses, the function of these genes, these genes' chromosomal locations, the notation designating the most common sites of the translocations of these fused genes, and the malignancies resulting from these translocations. These translocation mutations commonly occur in pluripotent hematopoietic stem cells that differentiate into various types of mature hematological cells. Consequently, a given mutation may lead to various types of hematological malignancies.[1][10] The table includes abbreviations for tyrosine kinase receptor (TK receptor), non-receptor tyrosine kinase (non-receptor TK), homeobox protein type of transcription factor (homeobox protein), acute lymphocytic leukemia (ALL), Philadelphia chromosome negative chronic myelogenous leukemia (Ph(-)CML), myelodysplastic syndrome (MDS), myeloproliferative neoplasm (MPN), and acute myeloid leukemia (AML). (The presence of ETV6 gene mutations in myelodysplastic syndromes is associated with shortened survival.[11])

transcription factors

Gene function location notation malignancies gene function location notation malignancies
PDGFRA TK receptor 4q12 t(4;12)(q27?3;p13) 40% to 50% of clonal eosinophilia patients PDGFRB TK receptor 5q32 t(5;12)(q31-33;p13) rare clonal eosinophilia patients
FLT3 TK receptor 13q12.2 t(12;13)(q13.1;p12.3-13) rare AML, ALL, and clonal eosinophilia patients ABL1 non-receptor TK 9q34.12 t(9;12)(q34;p13) rare AML, B-cell or T-cell ALL, Ph(-)CML patients
RUNX1 transcription factor 21q22.12 t(12;21)(p13;q22) 20-25% of pediatric ALL patients PAX5 homeobox protein 9p13.2 t(9;12)(q11;p13) 1% of pediatric ALL patients
MNX1 homeobox protein 7q36.3 t(7:12)(q36;p13) 20-30% of pediatric ALL patients less than 18 months old MECOM Transcription factor 3q26.2 t(3;12)(q26;p13) rare MDS, MPN, and AML patients

In addition to the fusion gene-producing translocations given in the table, ETV6 has been reported to fuse with other genes in very rare cases (i.e. 1-10 published reports). These translocations lead to one or more of the same types of hematological malignancies listed in the table. Thus, the ETV6 gene reportedly forms translocation-induced fusion genes with:[1] a) tyrosine kinase receptor gene FGFR3; b) non-receptor tyrosine kinase genes ABL2, NTRK3, JAK2, SYK, FRK, and LYN; c) transcription factor genes MN1 and PER1; d) homeobox protein transcription factor CDX2; e) Protein tyrosine phosphatase receptor-type R gene PTPRR;[12] f) transcriptional coactivator for nuclear hormone receptors gene NCOA2; f) Immunoglobulin heavy chain gene IGH;[13] g) enzyme genes TTL (adds and removes tyrosine residues on α-tubulin),[14] GOT1 (an Aspartate transaminase), and ACSL6 (a Long-chain-fatty-acid—CoA ligase); h) transporter gene ARNT (binds to ligand-bound aryl hydrocarbon receptor to aid in its movement to the nucleus where it promotes the expression of genes involved in xenobiotic metabolism); i) unknown function genes CHIC2,[15] MDS2,[16] FCHO2[17] and BAZ2A.;[18] and j) non-annotated gene STL (which has no long open reading frame[19]).

At least 9 frameshift mutations in the'ETV6 gene have been associated with ~12% of adult T cell Acute lymphoblastic leukemia cases. These mutations involve insertions or deletions in the gene that lead to its encoding a truncated and therefore inactive ETV6 protein. These mutations commonly occur alongside mutations in another oncogene, NOTCH1, which is associated with T cell acute lymphoblastic lymphoma quite independently of ETV6. It is suggested that suppressor mutations in the ETV6 gene may be a contributing factor in the development ant/or progression of this leukemia type.[4][20][21]

Treatment

Patients developing hematological malignancies secondary to the ETV6 gene fusion to receptor tyrosine kinases and non-receptor tyrosine kinases may be sensitive to therapy with tyrosine kinase inhibitors.[22] For example, patients with clonal eosinophilias due to PDGFRA or PDGFRB fusion genes experience long-term, complete remission when treated with are highly sensitive tyrosine kinase inhibitor, gleevec.[10] Larotrectinib, entrectinib, merestinib, and server other broadly acting tyrosine kinase inhibitors target the NTRK3 gene. Many of these drugs are in phase 1 or phase 2 clinical trials for the treatment of ETV6-NTRK3-related solid tumors and may ultimately prove useful for treating hematologic malignancies associated with this fusion gene.[23] Clinical trials have found that the first generation tyrosine kinase inhibitors sorafenib, sunitinib, midostaurin, lestaurtinib have shown some promise in treating acute myelogenous leukemia associated with the FLT3-TKI fusion gene; the second generation tyrosine kinase inhibtors quizartinib and crenolanib which are highly selective in inhibiting the FLT3 protein, have shown significant promise in treating relapsed and refractory acute myelogenous leukemia related to the FLT3-TKI fusion gene.[24] One patient with ETV6-FLT3-related myeloid/lymphoid neoplasm obtained a short term remission on sunitinib and following relapse, on sorafenib suggesting that the cited FLT3 protein tyrosine kinase inhibitors may prove useful for treating ETV6-FLT-related hematologic malignancies.[25] Two patients suffering hematologic malignancies related to PCM1-JAK2 or BCR-JAK2 fusion genes experienced complete and cytogenetic remissions in response to the tyrosine kinase inhibitor ruxolitinib; while both remissions were short-term (12 months), these results suggest that tyrosine kinase inhibitors that tarket JAK2 may be of some use for treating hemalologic malignancies associated with ETV6-JAK2 fusion stems.[10] An inhibitor of SYK tyrosine kinase, TAK-659 is currently undergoing Phase I clinical trials for advanced lymphoma malignancies and may prove to be useful in treating this disease when associated with the ETV6-SYK fusion gene.[26] It is possible that hematological malignancies associated with ETV6 gene fusions to either the SYK or FRK tyrosine kinase genes may someday be shown susceptible to tyrosine kinase inhibitor therapy. However, children with ETV6-RUNX1-associated acute lymphoblastic leukemia are in an especially good-risk subgroup and therefore have been almost uniformly treated with standard-risk chemotherapy protocols.[27]

Hematological malignancies associated with ETY6 gene fusions to other transcription factor genes appear to reflect a loss or gain in function of ETV6 and/or the other genes in regulating expression of their target genes; this results in the formation or lack of formation of products which influence cell growth, proliferation, and/or survival. In vitro studies of ETV6-RUNX, ETV6-MN1, ETV6-PER1, and ETV6-MECOM fusion genes support this notion. Thus, the ETV6-MECOM fusion gene is overexpressed because it is driven by the promoter derived from ETV6[1] whereas the ETV6-RUNX, ETV6-MN1, and ETV6-PER1 fusion genes produce chimeric proteins which lack ETV6 protein's gene-suppressing activity.[28] The chimeric protein products of ETV6 gene fusions with ARNT, TTL, BA22A, FCHO2, MDS2, and CHIC2 likewise lack ETV6 protein's transcription factor activity.[28] Gene fusions between ETV6 and the homeobox gens (i.e. CDX2, PAX5, and MNX1) produce chimeric proteins with lack either ETV6s and/or CDX2s, PAX5s or MNX1s transcription factor activity.[1] In all events, hematological malignancies associated with these fusion genes have been treated with standard chemotherapy protocols selected on the basis of the malignancies phenotype.

Solid Tumors

Mutations in the ETV6 gene are also associated with solid tumors. In particular, the ETV6-NTRK3 fusion gene occurs in and is thought or proposed to drive certain types of cancers. These cancers include secretory breast cancer (also termed juvenile breast cancer), mammary analogue secretory carcinoma of the parotid and other salivary glands, congenital fibrosarcoma, congenital mesoblastic nephroma, inflammatory myofibroblastic tumor, and radiation-induced papillary thyroid carcinoma.[4][29][30][31][23][32][28][33]

Treatment

The treatment of ETV6 gene-associated solid tumors has not advanced as far as that for ETV6 gene-associated hematological malignancies. It is proposed that tyrosine kinase inhibitors with specificity for NTRK3's tyrosine kinase activity in ETV6-NTRK3 gene-associated solid tumors may be of therapeutic usefulness. Entrectinib, a pan-NTRK as well as an ALK and ROS1 tyrosine kinase inhibitor has been found useful in treating a single patient with ETV6-NRTK3 fusion gene-associated mammary analogue secretory carcinoma and lends support to the clinical development of NTRK3-directed tyrosine kinase inhibitors to treat ETV6-NTRK3 fusion protein associated malignancies.[23] Three clinical trials are in the recruitment phase for determining the efficacy of treating a wide range of solid tumors associated with mutated, overactive tyrosine kinase proteins, including the ETV6-TRK3 protein, with larotrectinib, a non-selective inhibitor of NTRK1, NTRK2, and NTRK3 tyrosine kinases.[34]

See also

References

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Further reading

  • Keung YK, Beaty M, Steward W, Jackle B, Pettnati M (Oct 2002). "Chronic myelocytic leukemia with eosinophilia, t(9;12)(q34;p13), and ETV6-ABL gene rearrangement: case report and review of the literature". Cancer Genetics and Cytogenetics. 138 (2): 139–42. doi:10.1016/S0165-4608(02)00609-X. PMID 12505259.
  • Fainstein E, Einat M, Gokkel E, Marcelle C, Croce CM, Gale RP, Canaani E (Dec 1989). "Nucleotide sequence analysis of human abl and bcr-abl cDNAs". Oncogene. 4 (12): 1477–81. PMID 2687768.
  • Buijs A, Sherr S, van Baal S, van Bezouw S, van der Plas D, Geurts van Kessel A, Riegman P, Lekanne Deprez R, Zwarthoff E, Hagemeijer A (Apr 1995). "Translocation (12;22) (p13;q11) in myeloproliferative disorders results in fusion of the ETS-like TEL gene on 12p13 to the MN1 gene on 22q11". Oncogene. 10 (8): 1511–9. PMID 7731705.
  • Golub TR, Barker GF, Bohlander SK, Hiebert SW, Ward DC, Bray-Ward P, Morgan E, Raimondi SC, Rowley JD, Gilliland DG (May 1995). "Fusion of the TEL gene on 12p13 to the AML1 gene on 21q22 in acute lymphoblastic leukemia". Proceedings of the National Academy of Sciences of the United States of America. 92 (11): 4917–21. doi:10.1073/pnas.92.11.4917. PMC 41818. PMID 7761424.
  • Romana SP, Mauchauffé M, Le Coniat M, Chumakov I, Le Paslier D, Berger R, Bernard OA (Jun 1995). "The t(12;21) of acute lymphoblastic leukemia results in a tel-AML1 gene fusion". Blood. 85 (12): 3662–70. PMID 7780150.
  • Papadopoulos P, Ridge SA, Boucher CA, Stocking C, Wiedemann LM (Jan 1995). "The novel activation of ABL by fusion to an ets-related gene, TEL". Cancer Research. 55 (1): 34–8. PMID 7805037.
  • Golub TR, Barker GF, Lovett M, Gilliland DG (Apr 1994). "Fusion of PDGF receptor beta to a novel ets-like gene, tel, in chronic myelomonocytic leukemia with t(5;12) chromosomal translocation". Cell. 77 (2): 307–16. doi:10.1016/0092-8674(94)90322-0. PMID 8168137.
  • Wlodarska I, Baens M, Peeters P, Aerssens J, Mecucci C, Brock P, Marynen P, Van den Berghe H (Jun 1996). "Biallelic alterations of both ETV6 and CDKN1B genes in a t(12;21) childhood acute lymphoblastic leukemia case". Cancer Research. 56 (11): 2655–61. PMID 8653712.
  • Baens M, Peeters P, Guo C, Aerssens J, Marynen P (May 1996). "Genomic organization of TEL: the human ETS-variant gene 6". Genome Research. 6 (5): 404–13. doi:10.1101/gr.6.5.404. PMID 8743990.
  • Bonaldo MF, Lennon G, Soares MB (Sep 1996). "Normalization and subtraction: two approaches to facilitate gene discovery". Genome Research. 6 (9): 791–806. doi:10.1101/gr.6.9.791. PMID 8889548.
  • Hillier LD, Lennon G, Becker M, Bonaldo MF, Chiapelli B, Chissoe S, Dietrich N, DuBuque T, Favello A, Gish W, Hawkins M, Hultman M, Kucaba T, Lacy M, Le M, Le N, Mardis E, Moore B, Morris M, Parsons J, Prange C, Rifkin L, Rohlfing T, Schellenberg K, Bento Soares M, Tan F, Thierry-Meg J, Trevaskis E, Underwood K, Wohldman P, Waterston R, Wilson R, Marra M (Sep 1996). "Generation and analysis of 280,000 human expressed sequence tags". Genome Research. 6 (9): 807–28. doi:10.1101/gr.6.9.807. PMID 8889549.
  • Andreasson P, Johansson B, Arheden K, Billström R, Mitelman F, Höglund M (Jun 1997). "Deletions of CDKN1B and ETV6 in acute myeloid leukemia and myelodysplastic syndromes without cytogenetic evidence of 12p abnormalities". Genes, Chromosomes & Cancer. 19 (2): 77–83. doi:10.1002/(SICI)1098-2264(199706)19:2<77::AID-GCC2>3.0.CO;2-X. PMID 9171997.
  • Lacronique V, Boureux A, Valle VD, Poirel H, Quang CT, Mauchauffé M, Berthou C, Lessard M, Berger R, Ghysdael J, Bernard OA (Nov 1997). "A TEL-JAK2 fusion protein with constitutive kinase activity in human leukemia". Science. 278 (5341): 1309–12. doi:10.1126/science.278.5341.1309. PMID 9360930.
  • Knezevich SR, McFadden DE, Tao W, Lim JF, Sorensen PH (Feb 1998). "A novel ETV6-NTRK3 gene fusion in congenital fibrosarcoma". Nature Genetics. 18 (2): 184–7. doi:10.1038/ng0298-184. PMID 9462753.
  • Kwiatkowski BA, Bastian LS, Bauer TR, Tsai S, Zielinska-Kwiatkowska AG, Hickstein DD (Jul 1998). "The ets family member Tel binds to the Fli-1 oncoprotein and inhibits its transcriptional activity". The Journal of Biological Chemistry. 273 (28): 17525–30. doi:10.1074/jbc.273.28.17525. PMID 9651344.
  • Hannemann JR, McManus DM, Kabarowski JH, Wiedemann LM (Jul 1998). "Haemopoietic transformation by the TEL/ABL oncogene". British Journal of Haematology. 102 (2): 475–85. doi:10.1046/j.1365-2141.1998.00803.x. PMID 9695962.
  • Chakrabarti SR, Sood R, Ganguly S, Bohlander S, Shen Z, Nucifora G (Jun 1999). "Modulation of TEL transcription activity by interaction with the ubiquitin-conjugating enzyme UBC9". Proceedings of the National Academy of Sciences of the United States of America. 96 (13): 7467–72. doi:10.1073/pnas.96.13.7467. PMC 22109. PMID 10377438.
  • Cools J, Bilhou-Nabera C, Wlodarska I, Cabrol C, Talmant P, Bernard P, Hagemeijer A, Marynen P (Sep 1999). "Fusion of a novel gene, BTL, to ETV6 in acute myeloid leukemias with a t(4;12)(q11-q12;p13)". Blood. 94 (5): 1820–4. PMID 10477709.
  • Yagasaki F, Jinnai I, Yoshida S, Yokoyama Y, Matsuda A, Kusumoto S, Kobayashi H, Terasaki H, Ohyashiki K, Asou N, Murohashi I, Bessho M, Hirashima K (Nov 1999). "Fusion of TEL/ETV6 to a novel ACS2 in myelodysplastic syndrome and acute myelogenous leukemia with t(5;12)(q31;p13)". Genes, Chromosomes & Cancer. 26 (3): 192–202. doi:10.1002/(SICI)1098-2264(199911)26:3<192::AID-GCC2>3.0.CO;2-E. PMID 10502316.
  • Wai DH, Knezevich SR, Lucas T, Jansen B, Kay RJ, Sorensen PH (Feb 2000). "The ETV6-NTRK3 gene fusion encodes a chimeric protein tyrosine kinase that transforms NIH3T3 cells". Oncogene. 19 (7): 906–15. doi:10.1038/sj.onc.1203396. PMID 10702799.

External links

This article incorporates text from the United States National Library of Medicine, which is in the public domain.