SPATA33
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Also known as FLJ31606
Summary
SPATA33 (spermatogenesis associated 33, HGNC:26463) is a protein-coding gene on chromosome 16q24.3, encoding Spermatogenesis-associated protein 33 (Q96N06). Plays an important role in sperm motility and male fertility.
Predicted to be involved in mitophagy. Predicted to act upstream of or within fertilization; flagellated sperm motility; and protein localization. Predicted to be located in male germ cell nucleus and sperm mitochondrial sheath. Predicted to be active in cytoplasm and nucleus.
Source: NCBI Gene 124045 — RefSeq curated summary.
At a glance
- GWAS associations: 13
- Clinical variants (ClinVar): 44 total
- MANE Select transcript:
NM_001271907
Identifiers
Gene identifiers
| Field | Value |
|---|---|
| HGNC ID | HGNC:26463 |
| Approved symbol | SPATA33 |
| Name | spermatogenesis associated 33 |
| Location | 16q24.3 |
| Locus type | gene with protein product |
| Status | Approved |
| Aliases | FLJ31606 |
| Ensembl gene | ENSG00000167523 |
| Ensembl biotype | protein_coding |
| OMIM | 615409 |
| Entrez | 124045 |
Gene structure
Transcript identifiers
Ensembl transcripts: 10 — 6 protein_coding, 3 nonsense_mediated_decay, 1 protein_coding_CDS_not_defined
ENST00000301031, ENST00000457689, ENST00000564238, ENST00000565890, ENST00000566204, ENST00000566857, ENST00000567827, ENST00000568929, ENST00000579310, ENST00000611218
RefSeq mRNA: 6 — MANE Select: NM_001271907
NM_001271907, NM_001271908, NM_001271909, NM_001271910, NM_001387226, NM_153025
CCDS: CCDS10983, CCDS62012, CCDS73929
Canonical transcript exons
ENST00000579310 — 3 exons
| Exon | Start | End |
|---|---|---|
| ENSE00003489999 | 89657836 | 89657948 |
| ENSE00003570283 | 89658248 | 89658421 |
| ENSE00003920048 | 89669286 | 89670458 |
Expression profiles
Bgee: expression breadth ubiquitous, 183 present calls, max score 97.72.
FANTOM5 (CAGE): breadth ubiquitous, TPM avg 11.0485 / max 350.0419, expressed in 1775 samples.
FANTOM5 promoters (3 alternative TSS)
| Promoter ID | TPM avg | Samples expressed |
|---|---|---|
| 155632 | 6.3232 | 1744 |
| 155630 | 4.6986 | 1384 |
| 155631 | 0.0267 | 5 |
Top tissues by expression
246 total, by Bgee expression score (0-100, higher = more expressed):
| Tissue | Anatomy ID | Expression score | Quality |
|---|---|---|---|
| sperm | CL:0000019 | 97.72 | gold quality |
| left testis | UBERON:0004533 | 97.13 | gold quality |
| right testis | UBERON:0004534 | 97.11 | gold quality |
| testis | UBERON:0000473 | 94.57 | gold quality |
| adult organism | UBERON:0007023 | 93.37 | gold quality |
| pancreatic ductal cell | CL:0002079 | 92.22 | silver quality |
| bronchial epithelial cell | CL:0002328 | 90.19 | gold quality |
| right uterine tube | UBERON:0001302 | 89.95 | gold quality |
| bronchus | UBERON:0002185 | 88.76 | gold quality |
| olfactory segment of nasal mucosa | UBERON:0005386 | 86.89 | gold quality |
| male germ line stem cell (sensu Vertebrata) in testis | CL:0000089 ∩ UBERON:0000473 | 84.27 | gold quality |
| cortical plate | UBERON:0005343 | 82.65 | gold quality |
| primordial germ cell in gonad | CL:0000670 ∩ UBERON:0000991 | 82.21 | gold quality |
| ventricular zone | UBERON:0003053 | 82.04 | gold quality |
| prefrontal cortex | UBERON:0000451 | 80.67 | gold quality |
| anterior cingulate cortex | UBERON:0009835 | 80.56 | gold quality |
| right frontal lobe | UBERON:0002810 | 80.21 | gold quality |
| ganglionic eminence | UBERON:0004023 | 79.99 | gold quality |
| Brodmann (1909) area 9 | UBERON:0013540 | 79.48 | gold quality |
| adenohypophysis | UBERON:0002196 | 78.96 | gold quality |
| hypothalamus | UBERON:0001898 | 78.91 | gold quality |
| small intestine Peyer’s patch | UBERON:0003454 | 78.21 | gold quality |
| pituitary gland | UBERON:0000007 | 77.77 | gold quality |
| mucosa of transverse colon | UBERON:0004991 | 77.62 | gold quality |
| amygdala | UBERON:0001876 | 77.58 | gold quality |
| fallopian tube | UBERON:0003889 | 77.32 | gold quality |
| neocortex | UBERON:0001950 | 77.14 | gold quality |
| metanephros cortex | UBERON:0010533 | 77.08 | gold quality |
| dorsolateral prefrontal cortex | UBERON:0009834 | 77.00 | gold quality |
| left lobe of thyroid gland | UBERON:0001120 | 76.90 | gold quality |
Single-cell (SCXA)
Detected in 3 experiment(s), a significant marker in 3.
| Experiment | Marker? | Max mean expression |
|---|---|---|
| E-GEOD-134144 | yes | 30.71 |
| E-CURD-114 | yes | 11.43 |
| E-ANND-3 | yes | 6.69 |
Regulation
Is transcription factor: no
miRNA regulators (miRDB)
41 targeting SPATA33, top 30 by miRDB confidence (max_score; target_count = how many genes the miRNA targets in total — lower means more specific):
| miRNA | Max score | Avg score | miRNA target_count |
|---|---|---|---|
| HSA-MIR-513A-5P | 100.00 | 69.77 | 2465 |
| HSA-MIR-4531 | 99.99 | 69.70 | 3181 |
| HSA-MIR-1229-3P | 99.97 | 66.49 | 906 |
| HSA-MIR-185-3P | 99.95 | 67.01 | 1743 |
| HSA-MIR-6721-5P | 99.93 | 68.92 | 2981 |
| HSA-MIR-6835-3P | 99.93 | 70.49 | 2904 |
| HSA-MIR-3151-5P | 99.86 | 63.83 | 1069 |
| HSA-MIR-6756-5P | 99.82 | 67.97 | 2466 |
| HSA-MIR-92A-2-5P | 99.75 | 67.01 | 2164 |
| HSA-MIR-4729 | 99.69 | 72.18 | 4233 |
| HSA-MIR-6766-5P | 99.68 | 67.70 | 2325 |
| HSA-MIR-5197-5P | 99.64 | 69.08 | 1494 |
| HSA-MIR-4516 | 99.61 | 67.78 | 3390 |
| HSA-MIR-17-3P | 99.55 | 66.77 | 1311 |
| HSA-MIR-12123 | 99.52 | 71.79 | 2990 |
| HSA-MIR-4735-5P | 99.43 | 68.49 | 1780 |
| HSA-MIR-664A-3P | 99.22 | 71.08 | 2696 |
| HSA-MIR-6815-3P | 99.13 | 68.98 | 1530 |
| HSA-MIR-4434 | 99.10 | 67.01 | 1984 |
| HSA-MIR-5703 | 99.10 | 67.09 | 2053 |
| HSA-MIR-6770-5P | 98.97 | 66.76 | 1853 |
| HSA-MIR-3196 | 98.96 | 63.91 | 326 |
| HSA-MIR-3154 | 98.94 | 66.55 | 1455 |
| HSA-MIR-6829-5P | 98.86 | 65.12 | 1480 |
| HSA-MIR-548Q | 98.71 | 65.35 | 563 |
| HSA-MIR-4700-5P | 98.63 | 67.43 | 1915 |
| HSA-MIR-3180 | 98.46 | 64.68 | 348 |
| HSA-MIR-3180-3P | 98.46 | 64.68 | 348 |
| HSA-MIR-6816-5P | 98.46 | 64.35 | 364 |
| HSA-MIR-3179 | 98.22 | 65.90 | 1445 |
Literature-anchored findings (GeneRIF, showing 1)
- the current study illustrated that alterations in SPATA33 gene, at least those found in this study, may not impair spermatogenesis in patients with nonobstructive azoospermia. (PMID:30098056)
Cross-species orthologs
0 orthologs
Protein
Protein identifiers
Spermatogenesis-associated protein 33 — Q96N06 (reviewed: Q96N06)
All UniProt accessions (7): Q96N06, H3BQG0, H3BSG8, J3KRC8, J3KS00, J3KS58, J3KSB2
UniProt curated annotations — full annotation on UniProt →
Function. Plays an important role in sperm motility and male fertility. Required for sperm midpiece flexibility and for the localization of sperm calcineurin to the mitochondria. Promotes mitophagy as well as acts as an autophagy mediator in male germline cells. Links damaged mitochondria to autophagosomes via its binding to the outer mitochondrial membrane protein VDAC2, as well as to key autophagy machinery component ATG16L1.
Subunit / interactions. Interacts (via PQIIIT motif) with PPP3R1, PPP3R2, PPP3CA, PPP3CB and PPP3CC. Interacts with VDAC2. Interacts with ATG16L1 (via WD repeats).
Subcellular location. Cytoplasm. Cytosol. Nucleus. Mitochondrion.
Isoforms (2)
| UniProt ID | Names | Canonical? |
|---|---|---|
| Q96N06-1 | 1 | yes |
| Q96N06-2 | 2 |
RefSeq proteins (6): NP_001258836, NP_001258837, NP_001258838, NP_001258839, NP_001374155, NP_694570 (=MANE)
Domains & families (InterPro)
| ID | Name | Type |
|---|---|---|
| IPR027930 | DUF4609 | Family |
Pfam: PF15382
UniProt features (12 total): region of interest 4, compositionally biased region 3, chain 1, splice variant 1, sequence variant 1, short sequence motif 1, modified residue 1
Structure
Experimental structures (PDB)
0 structures.
Predicted structure (AlphaFold)
| Model | pLDDT | Fraction very-high |
|---|---|---|
| AF-Q96N06-F1 | 66.26 | 0.07 |
Functional residue map
Curated UniProt residues grouped by drug-discovery relevance — catalytic, ligand-binding, modification, and mutation-validated positions. Source: UniProtKB sequence features.
Post-translational modifications (1): 94
Function
Pathways and Gene Ontology
Reactome pathways
0 pathways
MSigDB gene sets: 65 (showing top):
GSE45365_HEALTHY_VS_MCMV_INFECTION_CD8_TCELL_IFNAR_KO_DN, GOBP_MACROAUTOPHAGY, NIKOLSKY_BREAST_CANCER_16Q24_AMPLICON, SENGUPTA_NASOPHARYNGEAL_CARCINOMA_DN, GOCC_MOTILE_CILIUM, GOCC_SPERM_MIDPIECE, GOCC_CILIUM, DODD_NASOPHARYNGEAL_CARCINOMA_DN, GOBP_AUTOPHAGY_OF_MITOCHONDRION, GOBP_MITOPHAGY, BAKKER_FOXO3_TARGETS_DN, GOBP_PROCESS_UTILIZING_AUTOPHAGIC_MECHANISM, DELACROIX_RARG_BOUND_MEF, DELACROIX_RAR_BOUND_ES, GOCC_9PLUS2_MOTILE_CILIUM
GO Biological Process (2): mitophagy (GO:0000423), autophagy (GO:0006914)
GO Molecular Function (1): protein binding (GO:0005515)
GO Cellular Component (6): nucleus (GO:0005634), cytoplasm (GO:0005737), mitochondrion (GO:0005739), cytosol (GO:0005829), sperm midpiece (GO:0097225), sperm mitochondrial sheath (GO:0097226)
GO top-level categories
Rollup of top GO terms by namespace:
| Category | Terms |
|---|---|
| cellular anatomical structure | 4 |
| intracellular membrane-bounded organelle | 2 |
| cytoplasm | 2 |
| autophagy of mitochondrion | 1 |
| macroautophagy | 1 |
| catabolic process | 1 |
| transmembrane transport | 1 |
| process utilizing autophagic mechanism | 1 |
| binding | 1 |
| intracellular anatomical structure | 1 |
| sperm flagellum | 1 |
| sperm midpiece | 1 |
Protein interactions and networks
STRING
244 interactions, top by confidence (×1000):
| Protein A | Protein B | Partner UniProt | Score |
|---|---|---|---|
| SPATA33 | DEF8 | Q6ZN54 | 599 |
| SPATA33 | SPMIP10 | Q6ZNM6 | 560 |
| SPATA33 | DBNDD1 | Q9H9R9 | 557 |
| SPATA33 | CDK10 | Q15131 | 528 |
| SPATA33 | SPIRE2 | Q8WWL2 | 464 |
| SPATA33 | KBTBD2 | Q8IY47 | 447 |
| SPATA33 | CENPBD1P | B2RD01 | 435 |
| SPATA33 | SPATA2L | Q8IUW3 | 430 |
| SPATA33 | CHMP1A | Q9HD42 | 399 |
| SPATA33 | SYPL2 | Q5VXT5 | 393 |
| SPATA33 | VPS9D1 | Q9Y2B5 | 386 |
| SPATA33 | DPEP1 | P16444 | 385 |
| SPATA33 | SPESP1 | Q6UW49 | 384 |
| SPATA33 | MC1R | Q01726 | 371 |
| SPATA33 | ZNF276 | Q8N554 | 359 |
IntAct
21 interactions, top by confidence:
| A | B | Type | Score |
|---|---|---|---|
| RUBCN | BECN1 | psi-mi:“MI:0914”(association) | 0.920 |
| PPP3CC | SPATA33 | psi-mi:“MI:0915”(physical association) | 0.670 |
| ACOT2 | ACOT1 | psi-mi:“MI:0914”(association) | 0.530 |
| KCNE3 | RIOK3 | psi-mi:“MI:0914”(association) | 0.530 |
| SPATA33 | AP1G1 | psi-mi:“MI:0914”(association) | 0.350 |
| LBX2 | GGPS1 | psi-mi:“MI:0914”(association) | 0.350 |
| ZNF492 | HPR | psi-mi:“MI:0914”(association) | 0.350 |
| TCF15 | TCF4 | psi-mi:“MI:0914”(association) | 0.350 |
| DTWD1 | ACTA2 | psi-mi:“MI:0914”(association) | 0.350 |
| MTERF3 | ACOT4 | psi-mi:“MI:0914”(association) | 0.350 |
| PPP3CA | ZNF593 | psi-mi:“MI:0914”(association) | 0.350 |
| MAPT | PITPNM1 | psi-mi:“MI:2364”(proximity) | 0.270 |
| MAPT | DCTN6 | psi-mi:“MI:2364”(proximity) | 0.270 |
| MAPT | psi-mi:“MI:2364”(proximity) | 0.270 | |
| SPATA33 | PPP3CC | psi-mi:“MI:0915”(physical association) | 0.000 |
BioGRID (25): SPATA33 (Affinity Capture-MS), SPATA33 (Two-hybrid), PPP3CB (Affinity Capture-MS), SPATA33 (Affinity Capture-MS), AP1S2 (Affinity Capture-MS), AP1M1 (Affinity Capture-MS), PPP3CA (Affinity Capture-MS), SPATA33 (Affinity Capture-MS), SPATA33 (Affinity Capture-MS), SPATA33 (Affinity Capture-MS), SPATA33 (Affinity Capture-MS), AP1B1 (Affinity Capture-MS), AP1S1 (Affinity Capture-MS), SPATA33 (Affinity Capture-MS), PPP3CC (Affinity Capture-MS)
ESM2 similar proteins: A0A1B0GUA9, A0JNH1, A1L170, A2TJV2, A6H7B4, A6NFA0, A6NGY1, A6X8Z5, A7YY35, B2RQL2, D3Z1D3, M0RD54, P43359, Q05860, Q0VF49, Q1RMX6, Q1RN00, Q2M1Z3, Q32LI3, Q3URK1, Q5EBJ4, Q5M831, Q5RJL0, Q62100, Q640N3, Q64256, Q642A3, Q66H53, Q66LM6, Q68D20, Q68DA7, Q68US1, Q6AXN6, Q6AYA8, Q6IR42, Q711Q0, Q80VY2, Q86UF4, Q8IY42, Q8TDR4
Diamond homologs: Q8C624, Q96N06
SIGNOR signaling
0 interactions.
Disease & clinical
Clinical variants and AI predictions
ClinVar
44 variants total. Per-class counts are floors (≥ shown; pagination cap):
| Classification | Count (floor) |
|---|---|
| Pathogenic | 0 |
| Likely pathogenic | 0 |
| Uncertain significance | 38 |
| Likely benign | 2 |
| Benign | 0 |
Top pathogenic / likely-pathogenic (0)
SpliceAI
511 predictions. Top by Δscore:
| Variant | Effect | Δscore |
|---|---|---|
| 16:89669284:A:AG | acceptor_gain | 0.9900 |
| 16:89669285:G:GG | acceptor_gain | 0.9900 |
| 16:89669285:GA:G | acceptor_gain | 0.9900 |
| 16:89669285:GAGA:G | acceptor_gain | 0.9900 |
| 16:89669285:GAGAA:G | acceptor_gain | 0.9900 |
| 16:89657836:G:GG | donor_gain | 0.9700 |
| 16:89669280:CTCTA:C | acceptor_loss | 0.9700 |
| 16:89669282:CTA:C | acceptor_loss | 0.9700 |
| 16:89669283:TA:T | acceptor_loss | 0.9700 |
| 16:89669284:A:AT | acceptor_loss | 0.9700 |
| 16:89669285:G:GA | acceptor_loss | 0.9700 |
| 16:89658419:AAGGT:A | donor_loss | 0.9600 |
| 16:89658421:GGTAG:G | donor_loss | 0.9600 |
| 16:89658423:T:G | donor_loss | 0.9600 |
| 16:89658419:A:T | donor_gain | 0.9500 |
| 16:89658209:GGTA:G | donor_loss | 0.9400 |
| 16:89658210:G:A | donor_loss | 0.9400 |
| 16:89658211:T:TC | donor_loss | 0.9400 |
| 16:89658210:G:GG | donor_gain | 0.9300 |
| 16:89663376:C:G | donor_gain | 0.9200 |
| 16:89658213:AGT:A | donor_loss | 0.9000 |
| 16:89661398:T:A | acceptor_gain | 0.8900 |
| 16:89658242:TTTCA:T | acceptor_loss | 0.8800 |
| 16:89658243:TTCA:T | acceptor_loss | 0.8800 |
| 16:89658244:TCAGG:T | acceptor_loss | 0.8800 |
| 16:89658245:CAGG:C | acceptor_loss | 0.8800 |
| 16:89658246:A:T | acceptor_loss | 0.8800 |
| 16:89658247:G:GA | acceptor_loss | 0.8800 |
| 16:89658247:GGT:G | acceptor_gain | 0.8800 |
| 16:89658241:ATTTC:A | acceptor_loss | 0.8700 |
AlphaMissense
916 scored. Top likely-pathogenic:
| Variant | Protein change | am_pathogenicity |
|---|---|---|
| 16:89669340:T:C | I88T | 0.995 |
| 16:89669340:T:G | I88S | 0.994 |
| 16:89669459:A:C | S128R | 0.992 |
| 16:89669461:T:A | S128R | 0.992 |
| 16:89669461:T:G | S128R | 0.992 |
| 16:89669346:T:A | I90N | 0.985 |
| 16:89669346:T:G | I90S | 0.983 |
| 16:89669412:T:C | I112T | 0.978 |
| 16:89669340:T:A | I88N | 0.976 |
| 16:89669449:C:A | H124Q | 0.973 |
| 16:89669449:C:G | H124Q | 0.973 |
| 16:89669334:C:A | P86Q | 0.972 |
| 16:89669447:C:G | H124D | 0.972 |
| 16:89669412:T:A | I112N | 0.971 |
| 16:89669346:T:C | I90T | 0.970 |
| 16:89669456:C:T | P127S | 0.966 |
| 16:89669412:T:G | I112S | 0.965 |
| 16:89669457:C:A | P127H | 0.964 |
| 16:89669471:G:C | A132P | 0.964 |
| 16:89669333:C:A | P86T | 0.962 |
| 16:89669333:C:T | P86S | 0.962 |
| 16:89669448:A:G | H124R | 0.960 |
| 16:89669334:C:G | P86R | 0.958 |
| 16:89669460:G:T | S128I | 0.953 |
| 16:89669474:T:G | Y133D | 0.951 |
| 16:89669452:G:C | R125S | 0.949 |
| 16:89669452:G:T | R125S | 0.949 |
| 16:89669472:C:A | A132D | 0.948 |
| 16:89669460:G:A | S128N | 0.942 |
| 16:89669432:G:C | G119R | 0.941 |
dbSNP variants (sampled 300 via entrez): RS1000034231 (16:89664295 G>A,C,T), RS1000251385 (16:89662835 C>G,T), RS1000335852 (16:89659132 C>G), RS1000388476 (16:89659228 G>A), RS1000680806 (16:89670391 A>G), RS1000876604 (16:89656743 G>C), RS1000887887 (16:89656207 G>A), RS1001135515 (16:89670244 C>T), RS1001600508 (16:89660470 G>T), RS1001806658 (16:89668198 G>C), RS1002005247 (16:89658177 C>A,G,T), RS1002060523 (16:89658332 A>G), RS1002319282 (16:89657314 G>C,T), RS1002373265 (16:89656890 G>C), RS1002488526 (16:89664058 G>A,T)
Disease associations
OMIM: gene MIM:615409 | disease phenotypes:
GenCC curated gene-disease
Mondo (0):
Orphanet (0):
HPO phenotypes
0 total (0 of 0 shown, HPO-id order):
GWAS associations
13 associations (top):
| Study | Trait | p-value |
|---|---|---|
| GCST001885_11 | Height | 9.000000e-07 |
| GCST002785_3 | Facial pigmentation | 9.000000e-15 |
| GCST003327_11 | Squamous cell carcinoma | 1.000000e-20 |
| GCST004067_174 | Hip circumference adjusted for BMI | 9.000000e-07 |
| GCST004067_76 | Hip circumference adjusted for BMI | 7.000000e-10 |
| GCST004604_27 | Hematocrit | 7.000000e-11 |
| GCST004615_108 | Hemoglobin concentration | 1.000000e-09 |
| GCST007488_10 | Skin pigmentation traits | 3.000000e-08 |
| GCST007927_52 | Medication use (beta blocking agents) | 2.000000e-11 |
| GCST010083_322 | Hemoglobin levels | 3.000000e-22 |
| GCST010703_280 | Brain morphology (MOSTest) | 2.000000e-15 |
| GCST012020_135 | Serum metabolite levels | 3.000000e-11 |
| GCST90002403_692 | Red blood cell count | 1.000000e-12 |
EFO canonical traits (7, from GWAS)
| EFO ID | Trait name |
|---|---|
| EFO:0008039 | BMI-adjusted hip circumference |
| EFO:0004348 | hematocrit |
| EFO:0004509 | hemoglobin measurement |
| EFO:0003963 | freckles |
| EFO:0009929 | Beta blocking agent use measurement |
| EFO:0004346 | neuroimaging measurement |
| EFO:0004305 | erythrocyte count |
Drugs & pharmacology
Drug and pharmacology data
Is drug target: no
PharmGKB: 1 entry (VIP=true, CPIC=false)
CTD chemical–gene interactions
20 total (human), top 20 by PubMed support.
| Chemical | Actions (top 5) | PubMed papers |
|---|---|---|
| sodium arsenite | decreases expression, increases expression, affects expression | 3 |
| trichostatin A | affects expression | 1 |
| beta-lapachone | decreases expression | 1 |
| tris(1,3-dichloro-2-propyl)phosphate | decreases expression | 1 |
| di-n-butylphosphoric acid | affects expression | 1 |
| abrine | decreases expression | 1 |
| Sunitinib | decreases expression | 1 |
| Air Pollutants | increases abundance, increases expression | 1 |
| Benzo(a)pyrene | affects methylation | 1 |
| Cadmium | increases abundance, increases expression | 1 |
| Cisplatin | decreases expression | 1 |
| Diethylhexyl Phthalate | decreases expression | 1 |
| Methyl Methanesulfonate | increases expression | 1 |
| Phthalic Acids | increases methylation | 1 |
| Quercetin | increases expression | 1 |
| Smoke | increases abundance, increases expression | 1 |
| Tobacco Smoke Pollution | decreases expression | 1 |
| Triclosan | increases expression | 1 |
| Valproic Acid | increases methylation | 1 |
| Cadmium Chloride | increases abundance, increases expression | 1 |
Clinical trials (associated diseases)
0 trials via MONDO — disease-level, not drug-specific.
Related Atlas pages
- Disease cohort memberships (association, not causation — diseases whose associated-gene cohort lists this gene; a subset are also under Associated diseases): squamous cell carcinoma