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NBME 18 Answers

nbme18/Block 4/Question#4

36 yo woman, 2 weeks of fatigue, bleeding gums, bone pain

Histone acetylase

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Histone acetylation allows for relaxation of the DNA so that transcription can proceed. All trans retinoic acid causes the granulocytes in APML to further mature, which requires DNA transcription / translation.

osler_weber_rendu  The questions asks for response to ATRA. Should that not be decreased transcription to treat the cancer? Which makes methyl transferase (aka methylation) the more likely answer +  
pg32  @osler, no @sympathetikey is correct. ATRA's mechanism in treating APML is to encourage the cells to mature. Maturation would require gene transcription, meaning histone acetylases would be used. +  
nnp  but ATRA is letting transcription of an abnormal protein ( that is 15:17 translocation) +  

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submitted by banana(2),

I thought (incorrectly, obviously) that histone kinase also allowed transcription to proceed?

banana  Just kidding, dead wrong: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3469451/ histone-P demarcates DNA breakage for repair +