Pleiotropic effects of TCF7L2 gene variants and its modulation in the metabolic syndrome: from the LIPGENE study

AIMS/HYPOTHESIS

Variants of the TCF7L2 gene predict the development of type 2 diabetes mellitus (T2DM). We investigated the associations between gene variants of TCF7L2 and clinical features of the metabolic syndrome (MetS) (an entity often preceding T2DM), and their interaction with non-genetic factors, including plasma saturated fatty acids (SFA) concentration and insulin resistance (IR).

METHODS

Fasting lipid profiles, insulin sensitivity, insulin secretion, anthropometrics, blood pressure and 10 gene variations of the TCF7L2 gene were determined in 450 subjects with MetS.

RESULTS

Several single nucleotide polymorphisms (SNP) showed phenotypic associations independent of SFA or IR. Carriers of the rare T allele of rs7903146, and of three other SNPs in linkage disequilibrium with rs7903146, had lower blood pressure and insulin secretion. High IR and the presence of the T-allele of rs7903146 acted synergistically to define those with reduced insulin secretion. Carriers of the minor allele of rs290481 exhibited an altered lipid profile, with increased plasma levels of apolipoprotein B, non-esterified fatty acids, cholesterol and apolipoprotein B in triglyceride rich lipoproteins, and LDL cholesterol. Carriers of the minor allele of rs11196224 that had higher plasma SFA levels showed elevated procoagulant/proinflammatory biomarkers, impaired insulin secretion and increased IR, whereas carriers of the minor allele of rs17685538 with high plasma SFA levels exhibited higher blood pressure.

CONCLUSIONS/INTERPRETATION

SNP in the TCF7L2 gene are associated with differences in insulin secretion, blood pressure, blood lipids and coagulation in MetS patients, and may be modulated by SFA in plasma or IR.

Cytoskeletal forces span the nuclear envelope to coordinate meiotic chromosome pairing and synapsis

During meiosis, each chromosome must pair with its unique homologous partner, a process that usually culminates with the formation of the synaptonemal complex (SC). In the nematode Caenorhabditis elegans, special regions on each chromosome known as pairing centers are essential for both homologous pairing and synapsis. We report that during early meiosis, pairing centers establish transient connections to the cytoplasmic microtubule network. These connections through the intact nuclear envelope require the SUN/KASH domain protein pair SUN-1 and ZYG-12. Disruption of microtubules inhibits chromosome pairing, indicating that these connections promote interhomolog interactions. Dynein activity is essential to license formation of the SC once pairing has been accomplished, most likely by overcoming a barrier imposed by the chromosome-nuclear envelope connection. Our findings thus provide insight into how homolog pairing is accomplished in meiosis and into the mechanisms regulating synapsis so that it occurs selectively between homologs. For a video summary of this article, see the PaperFlick file with the Supplemental Data available online.

Differential activation of dendritic cells by Toll-like receptor agonists isolated from the Gram-positive vaccine vector Streptococcus gordonii

The oral commensal bacterium Streptococcus gordonii has been gathering interest as a candidate live mucosal vaccine delivery vector. S. gordonii has been shown to be capable of activating antigen presenting immune cells in a manner which leads to their activation and maturation, yet the mechanism used by S. gordonii to do so is poorly understood. The aim of this work was to investigate the immunostimulatory components of S. gordonii in inducing murine dendritic cell (DC) activation and maturation. Lipoteichoic acid (LTA), lipoprotein (LP), peptidoglycan (PGN), and DNA were isolated from S. gordonii, and used to stimulate murine DC. Cytokine production and DC surface marker upregulation in response to the bacterial components was quantified by enzyme-linked immunosorbent assay and flow cytometry respectively. The results were contrasted against data obtained from DC derived from MyD88, TRIF [TIR(Toll/Interleukin-1 Receptor)-domain-containing adapter-inducing interferon-beta] or toll-like receptor-2 (TLR-2) knockout mice. The four S. gordonii bacterial components were found to differentially induce cytokine production and surface marker upregulation by murine DC. Activation of DC by both whole S. gordonii cells and the four bacterial components was abrogated in the absence of MyD88, but not in the absence of TRIF. LTA, LP and PGN, but not DNA and whole S. gordonii, required TLR-2 to induce a DC response. The results collectively indicate that S. gordonii activates DC predominantly through a MyD88-dependent and TRIF-independent pathway. This activation can be attributed to multiple immunostimulatory components present within S. gordonii bacterial cells.

A family of zinc-finger proteins is required for chromosome-specific pairing and synapsis during meiosis in C. elegans

Homologous chromosome pairing and synapsis are prerequisite for accurate chromosome segregation during meiosis. Here, we show that a family of four related C2H2 zinc-finger proteins plays a central role in these events in C. elegans. These proteins are encoded within a tandem gene cluster. In addition to the X-specific HIM-8 protein, three additional paralogs collectively mediate the behavior of the five autosomes. Each chromosome relies on a specific member of the family to pair and synapse with its homolog. These "ZIM" proteins concentrate at special regions called meiotic pairing centers on the corresponding chromosomes. These sites are dispersed along the nuclear envelope during early meiotic prophase, suggesting a role analogous to the telomere-mediated meiotic bouquet in other organisms. To gain insight into the evolution of these components, we characterized homologs in C. briggsae and C. remanei, which revealed changes in copy number of this gene family within the nematode lineage.

Chromosome sites play dual roles to establish homologous synapsis during meiosis in C. elegans

We have investigated the role of pairing centers (PCs), cis-acting sites required for accurate segregation of homologous chromosomes during meiosis in C. elegans. We find that these sites play two distinct roles that contribute to proper segregation. Chromosomes lacking PCs usually fail to synapse and also lack a synapsis-independent stabilization activity. The presence of a PC on just one copy of a chromosome pair promotes synapsis but does not support synapsis-independent pairing stabilization, indicating that these functions are separable. Once initiated, synapsis is highly processive, even between nonhomologous chromosomes of disparate lengths, elucidating how translocations suppress meiotic recombination in C. elegans. These findings suggest a multistep pathway for chromosome synapsis in which PCs impart selectivity and efficiency through a "kinetic proofreading" mechanism. We speculate that concentration of these activities at one region per chromosome may have coevolved with the loss of a point centromere to safeguard karyotype stability.

HIM-8 binds to the X chromosome pairing center and mediates chromosome-specific meiotic synapsis

The him-8 gene is essential for proper meiotic segregation of the X chromosomes in C. elegans. Here we show that loss of him-8 function causes profound X chromosome-specific defects in homolog pairing and synapsis. him-8 encodes a C2H2 zinc-finger protein that is expressed during meiosis and concentrates at a site on the X chromosome known as the meiotic pairing center (PC). A role for HIM-8 in PC function is supported by genetic interactions between PC lesions and him-8 mutations. HIM-8 bound chromosome sites associate with the nuclear envelope (NE) throughout meiotic prophase. Surprisingly, a point mutation in him-8 that retains both chromosome binding and NE localization fails to stabilize pairing or promote synapsis. These observations indicate that stabilization of homolog pairing is an active process in which the tethering of chromosome sites to the NE may be necessary but is not sufficient.

Ethnic-difference markers for use in mapping by admixture linkage disequilibrium

Mapping by admixture linkage disequilibrium (MALD) is a potentially powerful technique for the mapping of complex genetic diseases. The practical requirements of this method include (a) a set of markers spanning the genome that have large allele-frequency differences between the parental ethnicities contributing to the admixed population and (b) an understanding of the extent of admixture in the study population. To this end, a DNA-pooling technique was used to screen microsatellite and diallelic insertion/deletion markers for allele-frequency differences between putative representatives of the parental populations of the admixed Mexican American (MA) and African American (AA) populations. Markers with promising pooled differences were then confirmed by individual genotyping in both the parental and admixed populations. For the MA population, screening of >600 markers identified 151 ethnic-difference markers (EDMs) with delta>0.30 (where delta is the absolute value of each allele-frequency difference between two populations, summed over all marker alleles and divided by two) that are likely to be useful for MALD analysis. For the AA population, analysis of >400 markers identified 97 EDMs. In addition, individual genotyping of these markers in Pima Amerindians, Yavapai Amerindians, European American (EA) individuals, Africans from Zimbabwe, MA individuals, and AA individuals, as well as comparison to the CEPH genotyping set, suggests that the differences between subpopulations of an ethnicity are small for many markers with large interethnic differences. Estimates of admixture that are based on individual genotyping of these markers are consistent with a 60% EA:40% Amerindian contribution to MA populations and with a 20% EA:80% African contribution to AA populations. Taken together, these data suggest that EDMs with large interpopulation and small intrapopulation differences can be readily identified for MALD studies in both AA and MA populations.

The role of religion in predicting adolescent alcohol use and problem drinking

OBJECTIVE

There are racial differences in adolescents' propensity to consume alcohol--with white adolescents tending to consume more alcohol than black adolescents--but there is no clear explanation for why such differences exist. The purpose of this study was to examine the relationship between religiosity, a cultural factor that is not well understood currently, and racial differences in adolescent alcohol use.

METHOD

Participants were white and black ninth-grade adolescents (N = 899; 54% female, 57.5% white) involved in a 3-year longitudinal study of ways to reduce alcohol use and sexual risk-taking behavior among adolescents in Ohio and Kentucky.

RESULTS

Findings indicate that religiosity is differentially associated with alcohol use and problem drinking for white and black adolescents. Religious service attendance was the most significant predictor of alcohol use for black adolescents, whereas religious fundamentalism was most important for white adolescents. In contrast, frequency of prayer was the significant predictor of problem drinking for black adolescents, whereas the level of importance placed on religion was the significant predictor for white adolescents. Important gender differences also emerged in both prediction models and are discussed.

CONCLUSIONS

Since there is great heterogeneity among adolescents (in terms of race and gender) in their alcohol use and misuse, the "one-size-fits-all" approach to alcohol treatment and prevention is likely inappropriate. Moreover, conceptualizations of alcohol use and misuse, and its prevention and treatment, should include the consideration of such key cultural factors as religiosity.

Do people aggress to improve their mood? Catharsis beliefs, affect regulation opportunity, and aggressive responding

Do people aggress to make themselves feel better? We adapted a procedure used by G. K. Manucia, D. J. Baumann, and R. B. Cialdini (1984), in which some participants are given a bogus mood-freezing pill that makes affect regulation efforts ineffective. In Study 1, people who had been induced to believe in the value of catharsis and venting anger responded more aggressively than did control participants to insulting criticism, but this aggression was eliminated by the mood-freezing pill. Study 2 showed similar results among people with high anger-out (i.e., expressing and venting anger) tendencies. Studies 3 and 4 provided questionnaire data consistent with these interpretations, and Study 5 replicated the findings of Studies 1 and 2 using measures more directly concerned with affect regulation. Taken together, these results suggest that many people may engage in aggression to regulate (improve) their own affective states.

Dermatology teleconsultations to Central Prison: experience at East Carolina University

OBJECTIVE

To review our experience with dermatology teleconsultations between East Carolina University School of Medicine in Greenville and Central Prison in Raleigh, NC.

MATERIALS AND METHODS

Consultation forms kept on file in the Department of Internal Medicine served as the source of data. One physician reviewed the forms from the initial 22 months of our dermatology teleconsultation service to Central Prison. Patient demographics and the diagnoses made by the consulting physician were recorded. Recommendations were tabulated as either diagnostic or therapeutic. Diagnoses and recommendations for known HIV-positive individuals were separately recorded.

RESULTS

One hundred thirty-eight dermatology teleconsultations were performed over the 22-month period. Seventy two per cent of the patients seen were African-American. The average age was 32 years. One hundred fifty-nine diagnoses were made. The most common problems were eczema and acneiform eruptions. Fifty-nine diagnostic and 252 therapeutic recommendations were made.

CONCLUSION

Consultants generally were confident of their diagnoses and management decisions. Dermatologists can assist primary care physicians through telemedicine consultation.

Reliability of telemedicine in evaluating skin tumors

OBJECTIVES

To determine the reliability of videoconferencing technology in evaluating skin tumors, the impact of the technology on the clinicians' degree of suspicion that a skin tumor is malignant, and the recommendation to do a biopsy.

MATERIALS AND METHODS

Four skin cancer screenings were conducted at rural health care facilities in eastern North Carolina that were connected to East Carolina University School of Medicine. A dermatologist saw the patients in person at the local facility, and the same patient was seen by a dermatologist via a T-1 connection to Greenville, North Carolina.

RESULTS

The two physicians were in absolute agreement on 59% of the 107 skin tumors evaluated. There were five lesions identified by the on-site dermatologist as a probable or definite malignancy. The degree of concern about a lesion being malignant and the decision whether to do a biopsy were not significantly different, as shown by kappa analysis.

CONCLUSION

The concern about the malignancy of a particular skin lesion and the recommendation whether to do a biopsy were not significantly affected by telemedicine technology.

Reliability of dermatology teleconsultations with the use of teleconferencing technology

BACKGROUND

Recent advances in telecommunications technology allow physicians to consult on patients at a distance via an interactive video format. Few data exist as to the reliability of this form of consultation.

OBJECTIVE

Our purpose was to measure the degree of concordance between a dermatologist seeing a patient in a clinic and another dermatologist seeing the same patient over a commercially available videoconferencing system.

METHODS

Patients referred to a general dermatology clinic were seen by both a "live" dermatologist and a "teledermatologist" via a T1 connection. Diagnosis and recommendations were recorded by both physicians and compared. The physicians were also asked to rate the degree of confidence they had in their diagnosis.

RESULTS

Seventy-nine diagnoses were made on 60 patients. The two physicians were in absolute agreement on 61 of the diagnoses (77.2%). Race or sex of the patient, nature of the skin problems, or which of the two physicians was the teledermatologist did not statistically correlate with the concordance of the two physicians.

CONCLUSION

There was a reasonable degree of agreement between the two examining physicians. Despite the relatively high degree of concordance the teledermatologist had a significantly lower degree of confidence in his diagnoses.

Teledermatology and underserved populations

BACKGROUND

The dermatologic needs of many communities in the United States and worldwide are underserved. Telemedicine enables physicians and non-physician primary care providers to use modern telecommunications devices to gain access to specialist consultations promptly and with much less travel. The independently developed telemedicine programs described herein support 3 traditionally underserved populations: Pacific Islanders, migrant farmworkers, and prison inmates.

OBSERVATIONS

In 3 independently designed telemedicine programs, dermatology emerged as the specialty most used by remote practitioners. Patients were presented for both diagnosis and treatment and in the setting of initial evaluation and as part of follow-up care.

CONCLUSION

Teledermatology is a useful way to provide dermatologic support to remote or underserved communities.

Psoriasis and pregnancy: hormone and immune system interaction

BACKGROUND

Various hormonal states are known to be associated with the waxing and waning of psoriasis. Patients with psoriasis commonly experience changes in their cutaneous disease during pregnancy or post partum.

OBJECTIVE

We evaluated 100 women with psoriasis by questionnaire and interview. The women had been seen at the Baylor Psoriasis Center, Dallas, and had experienced a pregnancy while having psoriasis. The answers were sorted and tabulated. In addition, we reviewed the literature to ascertain possible causes of clinical changes in psoriasis during pregnancy.

RESULTS

Ninety questionnaires were completed. Sixty-nine women (76.7%) described a change in their psoriasis during pregnancy with 57 (63.3%) noting improvement. Seventy-nine patients (87.7%) had a postpartum flare, most within 4 months of delivery.

CONCLUSIONS

The majority of women with psoriasis, who become pregnant, experience a change, usually an improvement, in their cutaneous disease. Pregnancy is associated with hormonal changes in estrogens and progesterone resulting in a state of altered immune surveillance.

Ultrafast thermally induced unfolding of RNase A

A temperature jump (T-jump) method capable of initiating thermally induced processes on the picosecond time scale in aqueous solutions is introduced. Protein solutions are heated by energy from a laser pulse that is absorbed by homogeneously dispersed molecules of the dye crystal violet. These act as transducers by releasing the energy as heat to cause a T-jump of up to 10 K with a time resolution of 70 ps. The method was applied to the unfolding of RNase A. At pH 5.7 and 59 degrees C, a T-jump of 3-6 K induced unfolding which was detected by picosecond transient infrared spectroscopy of the amide I region between 1600 and 1700 cm-1. The difference spectral profile at 3.5 ns closely resembled that found for the equilibrium (native-unfolded) states. The signal at 1633 cm-1, corresponding to the beta-sheet structure, achieved 15 +/- 2% of the decrease found at equilibrium, within 5.5 ns. However, no decrease in absorbance was detected until 1 ns after the T-ump. The disruption of beta-sheet therefore appears to be subject to a delay of approximately 1 ns. Prior to 1 ns after the T-jump, water might be accessing the intact hydrophobic regions.

Dynamics of parvalbumin studied by fluorescence emission and triplet absorption spectroscopy of tryptophan

Fluorescence emission and triplet-triplet absorbance spectroscopy of the single tryptophan in cod parvalbumin were used to study the stability and dynamics of the protein as influenced by Ca2+ binding and interaction with a chaotropic agent. The concentrations for half-saturation for Ca binding were 3.6 x 10(-9), 3.3 x 10(-4), 7.1 x 10(-3), and 0.14 M in the presence of 0, 2, 3, and 4 M guanidine hydrochloride, respectively. As predicted for thermodynamic reversibility, the guanidine hydrochloride unfolding reaction depends upon Ca2+, and the delta G are as follows: 22.9, 29.3, 35.2, and 44.2 kJ/mol for no added Ca2+, 1, 2, and 5 mM Ca2+, respectively. The stability toward denaturation imparted by the binding of two Ca2+ is about -60 kJ/mol. For Ca(2+)-bound parvalbumin in the presence of excess Ca2+, the decay of the triplet state tryptophan is approximately exponential, and the lifetime decreases from 6.5 to 3.8 ms as the temperature increases from 10 to 40 degrees C. In contrast, the triplet decay of the calcium-free protein is nonexponential over the time range of microseconds to milliseconds, a result that may indicate that the Ca-free protein is molten-globule-like. At Ca2+ concentrations where the protein is partially saturated with Ca2+, the lifetime of the longest decay component is less than that for the Ca-saturated protein; this finding suggests an exchange of Ca2+ and a conformational change during the triplet lifetime. From these data, a rate constant for the process that includes calcium-related protein conformational change can be surmised to range between 200 and 500 s-1.

How residents spend their time in clinic and the effects of clerical support

The authors conducted a time study of residents in clinic to determine the effects of providing clerical assistance. The residents recorded their activities at 5-minute intervals at baseline and six months after hiring three clerical assistants. Before and after introduction of the clerical assistants, approximately 40% of the time was devoted to direct interaction with patients. Statistically significant improvements were observed in the availability of medical records (89% vs 100%) and the time spent looking up test results (5% vs 3% of the clinic time). The residents felt the clerical assistants greatly improved their clinic experience and the quality of patient care.

Excited states of tryptophan in cod parvalbumin. Identification of a short-lived emitting triplet state at room temperature

The fluorescence and phosphorescence spectra of model indole compounds and of cod parvalbumin III, a protein containing a single tryptophan and no tyrosine, were examined in the time scale ranging from subnanoseconds to milliseconds at 25 degrees C in aqueous buffer. For both Ca- bound and Ca-free parvalbumin and for model indole compounds that contained a proton donor, a phosphorescent species emitting at 450 nm with a lifetime of approximately 20-40 ns could be identified. A longer-lived phosphorescence is also apparent; it has approximately the same absorption and emission spectrum as the short-lived triplet molecule. For Ca parvalbumin, the decay of the long-lived triplet tryptophan is roughly exponential with a lifetime of 4.7 ms at 25 degrees C whereas for N-acetyltryptophanamide in aqueous buffer the decay lifetime was 30 microseconds. In contrast, the lifetime of the long-lived tryptophan species is much shorter in the Ca-free protein compared with Ca parvalbumin, and the decay shows complex nonexponential kinetics over the entire time range from 100 ns to 1 ms. It is concluded that the photochemistry of tryptophan must take into account the existence of two excited triplet species and that there are quenching moieties within the protein matrix that decrease the phosphorescence yield in a dynamic manner for the Ca-depleted parvalbumin. In contrast, for Ca parvalbumin, the tryptophan site is rigid on the time scale of milliseconds.

The annual cost of psoriasis

BACKGROUND

The need for comparative cost figures for psoriasis therapy has become increasingly important.

OBJECTIVE

Our purpose was to compare the yearly costs of various psoriasis treatments.

METHODS

Ten patients were selected for each treatment modality and the average total cost per year, per patient was evaluated.

RESULTS

All treatments evaluated were cheaper than inpatient therapy, with Goeckerman treatment in the day-care setting the most expensive and hydroxyurea the cheapest. Cyclosporine, which was used for comparison, was at least twice as expensive as all the other treatments except for Goeckerman treatment in the day-care setting, compared with which it was about 70% more expensive.

CONCLUSION

No single treatment appears to be universally superior to others. In considering specific treatment for psoriasis, cost analyses, including appropriate laboratory and other specialized evaluations, must be taken into account. With use of these data, practitioners and health care organizations may be better able to select appropriate therapy.

Ecology of the rufous hare-wallaby, Lagorchestes hirsutus Gould (Marsupialia : Macropodidae) in the Tanami Desert, Northern Territory. III Interactions with introduced mammal species

This paper reports a study of the interactions between a remnant population of the rufous hare-wallaby, Lagorchestes hirsutus, and populations of several introduced mammal species in a region of the Tanami Desert. Transect counts of faecal pellets and tracks were used to determine the local distributions of all species and analysis of faeces from both predators and competitors of hare-wallabies was undertaken. Six species of introduced mammals were recorded within the study area: dingoes, rabbits, camels, foxes, feral cats and cattle. The local distributions for a number of these species were found to be significantly correlated with that of L. hirsutus during some seasons. Analysis of dingo scats collected from fire trails within the study area identified a total of 12 different food classes including harewallabies which occurred in 6.9% of the scats. Foxes and feral cats appear to be more important predators as demonstrated by their impacts on natural and reintroduced populations of hare-wallabies. Comparison of the diets of the rabbit and L. hirsutus identified significant overlap in utilised plant species, particularly during drier times. Competition between rabbits and L. hirsutus seems probable, given the overlap of their diets and their similar body sizes and metabolic requirements. Cattle and camels are potentially as important at densities above present levels. The complex web of interactions between L. hirsutus and these introduced species have important implications for management of remnant and reintroduced hare-wallaby populations.

Ecology of the rufous hare-wallaby, Lagorchestes hirsutus Gould (Marsupialia : Macropodidae) in the Tanami Desert, Northern Territory.II Diet and feeding strategy

The diet preferences and selectivity of the rufous hare-wallaby in the Tanami Desert were examined at a number of sites and over a number of seasons by microscopic analysis of faecal pellets and direct observations. Perennial grasses were the most consistent plant items in the diet. Grass seeds were seasonally important as were the seeds and bulbs of sedges. Species of dicots were also used but most represented only minor components in the diet. Several species of plant common to the area were noticeably absent from the diet. Differences in the diets between four sites of varying floristic composition and fire history were consistent with differences in vegetation cover at each site. Overall, the absolute proportions and ratios of monocots and dicots and of leaf and seed portions were strongly similar for all sites, as were seasonal changes in the proportions of the four main plant categories (monocots, dicots, seeds and fruits). These changes correlated with local rainfall. Comparisons of plants eaten and plants available indicate the hare-wallabies' preference for monocots, particularly seed and fruit components. In contrast consumption of dicots was influericed by the declining quality of other preferred plants. Insects were seasonally important in the diet and appear to be a potentially important nitrogen supplement during drier times. The feeding strategy of the rufous hare-wallaby is flexible and enables it to exploit fully food resources whose availability is often limited in both time and space. During droughts it seems likely that the species is food stressed and this could lead to localised declines.

Oral lesions in patients with psoriasis: a controlled study

Stomatitis areata migrans was found in 5.4 percent of patients with psoriasis compared to 1 percent of control patients, while benign migratory glossitis was identified in 10.3 percent of patients with psoriasis and 2.5 percent of control patients. The association of these disorders with psoriasis indicates that they may be manifestations of psoriasis of the oral mucosa.