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Updated: Feb 14, 2026

Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
Published on: September 15, 2023
Oncogenic mutations in KEAP1 disturbing inhibitory Nrf2-Keap1 interaction: Activation of antioxidative pathway in
Debora Lucia Seguro Danilovic1,2, Evandro Sobroza de Mello3, Eliana Salgado Turri Frazzato1
1Laboratorio de Endocrinologia Celular e Molecular (LIM25), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
Background:
Nuclear factor erythroid 2-like 2 (NFE2L2) encodes Nrf2, transcription factor of antioxidative genes. In the presence of reactive oxygen species, Keap1 (Kelch-ECH-associating protein-1) inhibitor complex undergoes conformational changes disrupting Keap1-Nrf2 binding and Nrf2 translocates into nucleus. We evaluated the presence of mutations in NFE2L2 and KEAP1 in papillary thyroid carcinomas (PTCs) and correlated them with clinical presentation.
Methods:
Coding regions of NFE2L2 and KEAP1 were sequenced in 131 patients with PTC. Clinical and histopathological features were analyzed. Immunohistochemical analysis of Nrf2 expression was performed in mutated carcinomas.
Results:
Although no mutations were found in NFE2L2, missense mutations in KEAP1 were observed in 6 patients with PTC (4.6%). Immunohistochemistry showed increased Nrf2 expression in nuclei of all mutated carcinomas, which presented poor prognostic features in histopathology.
Conclusion:
We identified mutations in KEAP1 associated with Nrf2 overexpression in PTC. Mutations favored disruption of inhibitory interaction Nrf2-Keap1 to enable increased antioxidant Nrf2 activity, possibly with prognostic consequences.
Insights
Mutations in KEAP1 were found in papillary thyroid carcinomas (PTCs), leading to increased Nrf2 expression. This suggests potential prognostic implications for PTC patients with KEAP1 mutations.
Area of Science:
- Oncology
- Molecular Biology
- Genetics
Background:
- Nuclear factor erythroid 2-like 2 (NFE2L2) encodes Nrf2, a key transcription factor for antioxidative genes.
- Nrf2 activity is regulated by the Keap1 (Kelch-ECH-associating protein-1) inhibitor complex, which is disrupted by reactive oxygen species.
- Investigating mutations in NFE2L2 and KEAP1 in papillary thyroid carcinomas (PTCs) can provide insights into disease mechanisms and clinical presentation.
Purpose of the Study:
- To evaluate the presence of mutations in NFE2L2 and KEAP1 in papillary thyroid carcinomas (PTCs).
- To correlate these mutations with clinical presentation and histopathological features.
- To assess the impact of mutations on Nrf2 expression levels.
Main Methods:
- Sequencing of coding regions of NFE2L2 and KEAP1 in 131 PTC patients.
- Analysis of clinical and histopathological features.
- Immunohistochemical analysis of Nrf2 expression in mutated carcinomas.
Main Results:
- No mutations were found in NFE2L2.
- Missense mutations in KEAP1 were identified in 4.6% (6/131) of PTC patients.
- Immunohistochemistry revealed increased nuclear Nrf2 expression in all KEAP1-mutated carcinomas, which exhibited poor prognostic histopathological features.
Conclusions:
- KEAP1 mutations are associated with Nrf2 overexpression in PTC.
- These mutations likely disrupt the Nrf2-Keap1 inhibitory interaction, enhancing antioxidant Nrf2 activity.
- The identified KEAP1 mutations may have prognostic consequences in papillary thyroid carcinomas.
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