201
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Smith JC, Chen Q, Denny JC, Roden DM, Johnson KB, Miller RA. Evaluation of a Novel System to Enhance Clinicians' Recognition of Preadmission Adverse Drug Reactions. Appl Clin Inform 2018; 9:313-325. [PMID: 29742757 DOI: 10.1055/s-0038-1646963] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Often unrecognized by providers, adverse drug reactions (ADRs) diminish patients' quality of life, cause preventable admissions and emergency department visits, and increase health care costs. OBJECTIVE This article evaluates whether an automated system, the Adverse Drug Effect Recognizer (ADER), could assist clinicians in detecting and addressing inpatients' ongoing preadmission ADRs. METHODS ADER uses natural language processing to extract patients' medications, findings, and past diagnoses from admission notes. It compares excerpted information to a database of known medication adverse effects and promptly warns clinicians about potential ongoing ADRs and potential confounders via alerts placed in patients' electronic health records (EHRs). A 3-month intervention trial evaluated ADER's impact on antihypertensive medication ordering behaviors. At the time of patient admission, ADER warned providers on the Internal Medicine wards of Vanderbilt University Hospital about potential ongoing preadmission antihypertensive medication ADRs. A retrospective control group, comprised similar physicians from a period prior to the intervention, received no alerts. The evaluation compared ordering behaviors for each group to determine if preadmission medications changed during hospitalization or at discharge. The study also analyzed intervention group participants' survey responses and user comments. RESULTS ADER identified potential preadmission ADRs for 30% of both groups. Compared with controls, intervention providers more often withheld or discontinued suspected ADR-causing medications during the inpatient stay (p < 0.001). Intervention providers who responded to alert-related surveys held or discontinued suspected ADR-causing medications more often at discharge (p < 0.001). CONCLUSION Results indicate that ADER helped physicians recognize ADRs and reduced ordering of suspected ADR-causing medications. In hospitals using EHRs, ADER-like systems could improve clinicians' recognition and elimination of ongoing ADRs.
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Affiliation(s)
- Joshua C Smith
- Department of Biomedical Informatics, Vanderbilt University Medical Center and Vanderbilt University School of Medicine, Nashville, Tennessee, United States
| | - Qingxia Chen
- Department of Biomedical Informatics, Vanderbilt University Medical Center and Vanderbilt University School of Medicine, Nashville, Tennessee, United States.,Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
| | - Joshua C Denny
- Department of Biomedical Informatics, Vanderbilt University Medical Center and Vanderbilt University School of Medicine, Nashville, Tennessee, United States.,Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
| | - Dan M Roden
- Department of Biomedical Informatics, Vanderbilt University Medical Center and Vanderbilt University School of Medicine, Nashville, Tennessee, United States.,Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States.,Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
| | - Kevin B Johnson
- Department of Biomedical Informatics, Vanderbilt University Medical Center and Vanderbilt University School of Medicine, Nashville, Tennessee, United States.,Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
| | - Randolph A Miller
- Department of Biomedical Informatics, Vanderbilt University Medical Center and Vanderbilt University School of Medicine, Nashville, Tennessee, United States.,Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States.,School of Nursing, Vanderbilt University, Nashville, Tennessee, United States
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202
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Grouthier V, Lebrun-Vignes B, Glazer AM, Touraine P, Funck-Brentano C, Pariente A, Courtillot C, Bachelot A, Roden DM, Moslehi JJ, Salem JE. Increased long QT and torsade de pointes reporting on tamoxifen compared with aromatase inhibitors. Heart 2018; 104:1859-1863. [PMID: 29720397 DOI: 10.1136/heartjnl-2017-312934] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/19/2018] [Accepted: 04/09/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE A prolonged QTc (LQT) is a surrogate for the risk of torsade de pointes (TdP). QTc interval duration is influenced by sex hormones: oestradiol prolongs and testosterone shortens QTc. Drugs used in the treatment of breast cancer have divergent effects on hormonal status. METHODS We performed a disproportionality analysis using the European database of suspected adverse drug reaction (ADR) reports to evaluate the reporting OR (ROR χ2) of LQT, TdP and ventricular arrhythmias associated with selective oestrogen receptor modulators (SERMs: tamoxifen and toremifene) as opposed to aromatase inhibitors (AIs: anastrozole, exemestane and letrozole). When the proportion of an ADR is greater in patients exposed to a drug (SERMs) compared with patients exposed to control drug (AIs), this suggests an association between the specific drug and the reaction and is a potential signal for safety. Clinical and demographic characterisation of patients with SERMs-induced LQT and ventricular arrhythmias was performed. RESULTS SERMs were associated with higher proportion of LQT reports versus AIs (26/8318 vs 11/14851, ROR: 4.2 (2.11-8.55), p<0.001). SERMs were also associated with higher proportion of TdP and ventricular arrhythmia reports versus AIs (6/8318 vs 2/14851, ROR: 5.4 (1.29-26.15), p:0.02; 16/8318 vs 12/14851, ROR: 2.38 (1.15-4.94), p:0.02, respectively). Mortality was 38% in patients presenting ventricular arrhythmias associated with SERMs. CONCLUSIONS SERMs are associated with more reports of drug-induced LQT, TdP and ventricular arrhythmias compared with AIs. This finding is consistent with oestradiol-like properties of SERMs on the heart as opposed to effects of oestrogen deprivation and testosterone increase induced by AIs. TRIAL REGISTRATION NUMBER NCT03259711.
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Affiliation(s)
- Virginie Grouthier
- Department of Endocrinology and Reproductive Medicine, Sorbonne Universités, AP-HP, Pitié-Salpêtrière Hospital, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Centre de Référence des Pathologies Gynécologiques Rares, Paris, France
| | - Benedicte Lebrun-Vignes
- AP-HP, Pitié-Salpêtrière Hospital Department of Pharmacology CIC-1421 Pharmacovigilance Unit INSERM UMR ICAN 1166 Sorbonne Université UPMC, Univ Paris 06, Institute of CArdiometabolism and Nutrition (ICAN), Paris, France
| | - Andrew M Glazer
- Cardio-oncology Program, Departments of Medicine and Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Philippe Touraine
- Department of Endocrinology and Reproductive Medicine, Sorbonne Universités, AP-HP, Pitié-Salpêtrière Hospital, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Centre de Référence des Pathologies Gynécologiques Rares, Paris, France
| | - Christian Funck-Brentano
- AP-HP, Pitié-Salpêtrière Hospital Department of Pharmacology CIC-1421 Pharmacovigilance Unit INSERM UMR ICAN 1166 Sorbonne Université UPMC, Univ Paris 06, Institute of CArdiometabolism and Nutrition (ICAN), Paris, France
| | - Antoine Pariente
- Department of Pharmacology, Team Pharmaco-Epidemiology, CHU de Bordeaux, INSERM, CIC-1401, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - Carine Courtillot
- Department of Endocrinology and Reproductive Medicine, Sorbonne Universités, AP-HP, Pitié-Salpêtrière Hospital, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Centre de Référence des Pathologies Gynécologiques Rares, Paris, France
| | - Anne Bachelot
- Department of Endocrinology and Reproductive Medicine, Sorbonne Universités, AP-HP, Pitié-Salpêtrière Hospital, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Centre de Référence des Pathologies Gynécologiques Rares, Paris, France
| | - Dan M Roden
- Cardio-oncology Program, Departments of Medicine and Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Javid J Moslehi
- Cardio-oncology Program, Departments of Medicine and Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joe-Elie Salem
- AP-HP, Pitié-Salpêtrière Hospital Department of Pharmacology CIC-1421 Pharmacovigilance Unit INSERM UMR ICAN 1166 Sorbonne Université UPMC, Univ Paris 06, Institute of CArdiometabolism and Nutrition (ICAN), Paris, France.,Cardio-oncology Program, Departments of Medicine and Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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203
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Roden DM, Van Driest SL, Mosley JD, Wells QS, Robinson JR, Denny JC, Peterson JF. Benefit of Preemptive Pharmacogenetic Information on Clinical Outcome. Clin Pharmacol Ther 2018; 103:787-794. [PMID: 29377064 PMCID: PMC6134843 DOI: 10.1002/cpt.1035] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/08/2018] [Accepted: 01/22/2018] [Indexed: 12/13/2022]
Abstract
The development of new knowledge around the genetic determinants of variable drug action has naturally raised the question of how this new knowledge can be used to improve the outcome of drug therapy. Two broad approaches have been taken: a point-of-care approach in which genotyping for specific variant(s) is undertaken at the time of drug prescription, and a preemptive approach in which multiple genetic variants are typed in an individual patient and the information archived for later use when a drug with a "pharmacogenetic story" is prescribed. This review addresses the current state of implementation, the rationale for these approaches, and barriers that must be overcome. Benefits to pharmacogenetic testing are only now being defined and will be discussed.
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Affiliation(s)
- Dan M. Roden
- Department of Medicine, Vanderbilt University Medical Center Nashville, TN
- Department of Pharmacology, Vanderbilt University Medical Center Nashville, TN
- Department of Biomedical Informatics, Vanderbilt University Medical Center Nashville, TN
| | - Sara L. Van Driest
- Department of Medicine, Vanderbilt University Medical Center Nashville, TN
- Department of Pediatrics, Vanderbilt University Medical Center Nashville, TN
| | - Jonathan D. Mosley
- Department of Medicine, Vanderbilt University Medical Center Nashville, TN
- Department of Biomedical Informatics, Vanderbilt University Medical Center Nashville, TN
| | - Quinn S. Wells
- Department of Medicine, Vanderbilt University Medical Center Nashville, TN
| | - Jamie R. Robinson
- Department of Biomedical Informatics, Vanderbilt University Medical Center Nashville, TN
- Department of Surgery, Vanderbilt University Medical Center Nashville, TN
| | - Joshua C. Denny
- Department of Medicine, Vanderbilt University Medical Center Nashville, TN
- Department of Biomedical Informatics, Vanderbilt University Medical Center Nashville, TN
| | - Josh F. Peterson
- Department of Medicine, Vanderbilt University Medical Center Nashville, TN
- Department of Biomedical Informatics, Vanderbilt University Medical Center Nashville, TN
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204
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Affiliation(s)
- Dan M Roden
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Andrew M Glazer
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brett Kroncke
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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205
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Abstract
The rise in available longitudinal patient information in electronic health records (EHRs) and their coupling to DNA biobanks has resulted in a dramatic increase in genomic research using EHR data for phenotypic information. EHRs have the benefit of providing a deep and broad data source of health-related phenotypes, including drug response traits, expanding the phenome available to researchers for discovery. The earliest efforts at repurposing EHR data for research involved manual chart review of limited numbers of patients but now typically involve applications of rule-based and machine learning algorithms operating on sometimes huge corpora for both genome-wide and phenome-wide approaches. We highlight here the current methods, impact, challenges, and opportunities for repurposing clinical data to define patient phenotypes for genomics discovery. Use of EHR data has proven a powerful method for elucidation of genomic influences on diseases, traits, and drug-response phenotypes and will continue to have increasing applications in large cohort studies.
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Affiliation(s)
- Jamie R Robinson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN.,Department of General Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Wei-Qi Wei
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Dan M Roden
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.,Department of Pharmacology, Vanderbilt University Medical Center
| | - Joshua C Denny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
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206
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Alexandre J, Moslehi JJ, Bersell KR, Funck-Brentano C, Roden DM, Salem JE. Anticancer drug-induced cardiac rhythm disorders: Current knowledge and basic underlying mechanisms. Pharmacol Ther 2018; 189:89-103. [PMID: 29698683 DOI: 10.1016/j.pharmthera.2018.04.009] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Significant advances in cancer treatment have resulted in decreased cancer related mortality for many malignancies with some cancer types now considered chronic diseases. Despite these improvements, there is increasing recognition that many cancer patients or cancer survivors can develop cardiovascular diseases, either due to the cancer itself or as a result of anticancer therapy. Much attention has focused on heart failure; however, other cardiotoxicities, notably cardiac rhythm disorders, can occur without underlying cardiomyopathy. Supraventricular tachycardias occur in cancer patients treated with cytotoxic chemotherapy (anthracyclines, gemcitabine, cisplatin and alkylating-agents) or kinase-inhibitors (KIs) such as ibrutinib. Ventricular arrhythmias, with a subset of them being torsades-de-pointes (TdP) favored by QTc prolongation have been reported: this may be the result of direct hERG-channel inhibition or a more recently-described mechanism of phosphoinositide-3-kinase inhibition. The major anticancer drugs responsible for QTc prolongation in this context are KIs, arsenic trioxide, anthracyclines, histone deacetylase inhibitors, and selective estrogen receptor modulators. Anticancer drug-induced cardiac rhythm disorders remain an underappreciated complication even by experienced clinicians. Moreover, the causal relationship of a particular anticancer drug with cardiac arrhythmia occurrence remains challenging due in part to patient comorbidities and complex treatment regimens. For example, any cancer patient may also be diagnosed with common diseases such as hypertension, diabetes or heart failure which increase an individual's arrhythmia susceptibility. Further, anticancer drugs are generally usually used in combination, increasing the challenge around establishing causation. Thus, arrhythmias appear to be an underappreciated adverse effect of anticancer agents and the incidence, significance and underlying mechanisms are now being investigated.
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Affiliation(s)
- Joachim Alexandre
- CHU Caen, PICARO Cardio-oncology Program, Department of Pharmacology, F-14033 Caen, France; Normandie Univ, UNICAEN, CHU Caen, EA 4650, Signalisation, Électrophysiologie et Imagerie des Lésions d'Ischémie-Reperfusion Myocardique, 14000 Caen, France
| | - Javid J Moslehi
- Vanderbilt University Medical Center, Cardio-oncology Program, Department of Medicine, Nashville, Tennessee, USA
| | - Kevin R Bersell
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christian Funck-Brentano
- Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Department of Pharmacology, F-75013 Paris, France
| | - Dan M Roden
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joe-Elie Salem
- Vanderbilt University Medical Center, Cardio-oncology Program, Department of Medicine, Nashville, Tennessee, USA; Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA; Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Department of Pharmacology, F-75013 Paris, France.
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207
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Bergmeijer TO, Reny JL, Pakyz RE, Gong L, Lewis JP, Kim EY, Aradi D, Fernandez-Cadenas I, Horenstein RB, Lee MTM, Whaley RM, Montaner J, Gensini GF, Cleator JH, Chang K, Holmvang L, Hochholzer W, Roden DM, Winter S, Altman RB, Alexopoulos D, Kim HS, Déry JP, Gawaz M, Bliden K, Valgimigli M, Marcucci R, Campo G, Schaeffeler E, Dridi NP, Wen MS, Shin JG, Simon T, Fontana P, Giusti B, Geisler T, Kubo M, Trenk D, Siller-Matula JM, Ten Berg JM, Gurbel PA, Hulot JS, Mitchell BD, Schwab M, Ritchie MD, Klein TE, Shuldiner AR. Genome-wide and candidate gene approaches of clopidogrel efficacy using pharmacodynamic and clinical end points-Rationale and design of the International Clopidogrel Pharmacogenomics Consortium (ICPC). Am Heart J 2018; 198:152-159. [PMID: 29653637 PMCID: PMC5903579 DOI: 10.1016/j.ahj.2017.12.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 12/10/2017] [Indexed: 02/07/2023]
Abstract
RATIONALE The P2Y12 receptor inhibitor clopidogrel is widely used in patients with acute coronary syndrome, percutaneous coronary intervention, or ischemic stroke. Platelet inhibition by clopidogrel shows wide interpatient variability, and high on-treatment platelet reactivity is a risk factor for atherothrombotic events, particularly in high-risk populations. CYP2C19 polymorphism plays an important role in this variability, but heritability estimates suggest that additional genetic variants remain unidentified. The aim of the International Clopidogrel Pharmacogenomics Consortium (ICPC) is to identify genetic determinants of clopidogrel pharmacodynamics and clinical response. STUDY DESIGN Based on the data published on www.clinicaltrials.gov, clopidogrel intervention studies containing genetic and platelet function data were identified for participation. Lead investigators were invited to share DNA samples, platelet function test results, patient characteristics, and cardiovascular outcomes to perform candidate gene and genome-wide studies. RESULTS In total, 17 study sites from 13 countries participate in the ICPC, contributing individual patient data from 8,829 patients. Available adenosine diphosphate-stimulated platelet function tests included vasodilator-stimulated phosphoprotein assay, light transmittance aggregometry, and the VerifyNow P2Y12 assay. A proof-of-principle analysis based on genotype data provided by each group showed a strong and consistent association between CYP2C19*2 and platelet reactivity (P value=5.1 × 10-40). CONCLUSION The ICPC aims to identify new loci influencing clopidogrel efficacy by using state-of-the-art genetic approaches in a large cohort of clopidogrel-treated patients to better understand the genetic basis of on-treatment response variability.
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Affiliation(s)
- Thomas O Bergmeijer
- St Antonius Center for Platelet Function Research, Department of Cardiology, St Antonius Hospital Nieuwegein, the Netherlands
| | - Jean-Luc Reny
- Internal Medicine, Béziers Hospital, France, Geneva Platelet Group, University of Geneva School of Medicine, Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Ruth E Pakyz
- Department of Medicine, Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Li Gong
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Joshua P Lewis
- Department of Medicine, Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Eun-Young Kim
- Department of Clinical Pharmacology, Inje University Busan Paik Hospital, Busan, South Korea
| | - Daniel Aradi
- Heart Center Balatonfüred and Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Israel Fernandez-Cadenas
- Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mútua Terrassa, Neurovascular Research Laboratory, Valle d'Hebron Hebron Institute of Research, Barcelona, Spain
| | - Richard B Horenstein
- Department of Medicine, Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Ryan M Whaley
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Gian Franco Gensini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - John H Cleator
- Departments of Medicine and Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Kiyuk Chang
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Lene Holmvang
- Department of Cardiology and Cardiac Catheterization Laboratory, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Willibald Hochholzer
- University Heart Center Freiburg, Bad Krozingen, Department of Cardiology and Angiology II, Bad Krozingen, Germany
| | - Dan M Roden
- Departments of Medicine, Pharmacology, and Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Stefan Winter
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart and University of Tübingen, Tübingen, Germany
| | - Russ B Altman
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA; Departments of Bioengineering and Genetics, Stanford University, Stanford, CA, USA; Department of Medicine, Stanford University, Stanford, CA, USA
| | | | - Ho-Sook Kim
- Department of Pharmacology and Pharmacogenomics Research Center, College of Medicine, Inje University, Busan, South Korea
| | | | - Meinrad Gawaz
- Department of Cardiology and Cardiovascular Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Kevin Bliden
- Inova Center for Thrombosis Research and Drug Development. Inova Heart and Vascular Institute, Falls Church, VA, USA
| | - Marco Valgimigli
- Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Atherothrombotic Diseases Center, Careggi Hospital, Florence, Italy
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitria di Ferrara, Cona (FE) and Maria Cecilia Hospital, GVM Care and Research, Cotignola, (RA), Italy
| | - Elke Schaeffeler
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart and University of Tübingen, Tübingen, Germany
| | - Nadia P Dridi
- Department of Cardiology and Cardiac Catheterization Laboratory, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ming-Shien Wen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou and School of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Jae Gook Shin
- Department of Pharmacology and Pharmacogenomics Research Center, College of Medicine, Inje University, Busan, South Korea
| | | | - Pierre Fontana
- Geneva Platelet Group, University of Geneva School of Medicine, Division of Angiology and Haemostasis, University Hospitals of Geneva, Geneva, Switzerland
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, University of Florence, Atherothrombotic Diseases Center, Careggi Hospital, Florence, Italy
| | - Tobias Geisler
- Department of Cardiology and Cardiovascular Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Michiaki Kubo
- Laboratory for Genotyping Development, RIKEN Center for Integrative Medical Sciences, Tokyo, Japan
| | - Dietmar Trenk
- Department of Cardiology and Cardiovascular Medicine, University Hospital Tübingen, Tübingen, Germany
| | | | - Jurriën M Ten Berg
- St Antonius Center for Platelet Function Research, Department of Cardiology, St Antonius Hospital Nieuwegein, the Netherlands
| | - Paul A Gurbel
- Inova Center for Thrombosis Research and Drug Development. Inova Heart and Vascular Institute, Falls Church, VA, USA
| | - Jean-Sebastien Hulot
- Sorbonne Universités, UPMC Univ Paris 06, Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière Hospital, F-75013 Paris, France
| | - Braxton D Mitchell
- Department of Medicine, University of Maryland, Baltimore, MD, USA; Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Baltimore, MD
| | - Matthias Schwab
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart and University of Tübingen, Tübingen, Germany; Department of Clinical Pharmacology, University Hospital, Tübingen, Germany
| | - Marylyn DeRiggi Ritchie
- Department of Biomedical and Translational Informatics, Geisinger Health System, Danville, PA, USA
| | - Teri E Klein
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA; Department of Medicine, Stanford University, Stanford, CA, USA
| | - Alan R Shuldiner
- Department of Medicine, Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
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208
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Volpi S, Bult CJ, Chisholm RL, Deverka PA, Ginsburg GS, Jacob HJ, Kasapi M, McLeod HL, Roden DM, Williams MS, Green ED, Rodriguez LL, Aronson S, Cavallari LH, Denny JC, Dressler LG, Johnson JA, Klein TE, Leeder JS, Piquette-Miller M, Perera M, Rasmussen-Torvik LJ, Rehm HL, Ritchie MD, Skaar TC, Wagle N, Weinshilboum R, Weitzel KW, Wildin R, Wilson J, Manolio TA, Relling MV. Research Directions in the Clinical Implementation of Pharmacogenomics: An Overview of US Programs and Projects. Clin Pharmacol Ther 2018; 103:778-786. [PMID: 29460415 DOI: 10.1002/cpt.1048] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/31/2018] [Accepted: 02/14/2018] [Indexed: 12/29/2022]
Abstract
Response to a drug often differs widely among individual patients. This variability is frequently observed not only with respect to effective responses but also with adverse drug reactions. Matching patients to the drugs that are most likely to be effective and least likely to cause harm is the goal of effective therapeutics. Pharmacogenomics (PGx) holds the promise of precision medicine through elucidating the genetic determinants responsible for pharmacological outcomes and using them to guide drug selection and dosing. Here we survey the US landscape of research programs in PGx implementation, review current advances and clinical applications of PGx, summarize the obstacles that have hindered PGx implementation, and identify the critical knowledge gaps and possible studies needed to help to address them.
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Affiliation(s)
- Simona Volpi
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Carol J Bult
- The Jackson Laboratory for Mammalian Genetics, Bar Harbor, Maine, USA
| | - Rex L Chisholm
- Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Geoffrey S Ginsburg
- Duke Center for Applied Genomic and Precision Medicine, Duke University, Durham, North Carolina, USA
| | - Howard J Jacob
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama, USA
| | - Melpomeni Kasapi
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Howard L McLeod
- DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, Florida, USA
| | - Dan M Roden
- Department of Medicine, Pharmacology, and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marc S Williams
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania, USA
| | - Eric D Green
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Laura Lyman Rodriguez
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Larisa H Cavallari
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, Gainesville, Florida, USA
| | - Joshua C Denny
- Departments of Biomedical Informatics and Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Lynn G Dressler
- Mission Health, Personalized Medicine Program, Asheville, North Carolina, USA
| | - Julie A Johnson
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, Gainesville, Florida, USA
| | - Teri E Klein
- Department of Biomedical Data Science, Stanford University, Stanford, California, USA
| | - J Steven Leeder
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy Hospital, Kansas City, Missouri, USA
| | | | - Minoli Perera
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laura J Rasmussen-Torvik
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Heidi L Rehm
- Department of Pathology, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Marylyn D Ritchie
- Department of Genetics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Todd C Skaar
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Nikhil Wagle
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Richard Weinshilboum
- Department of Molecular Pharmacology and Experimental Therapeutics and Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kristin W Weitzel
- Department of Pharmacotherapy & Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Robert Wildin
- Departments of Pathology and Laboratory Medicine, and Pediatrics, University of Vermont Medical Center, Burlington, Vermont, USA
| | | | - Teri A Manolio
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Mary V Relling
- Pharmaceutical Sciences Department, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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209
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Yang T, Meoli DF, Moslehi J, Roden DM. Inhibition of the α-Subunit of Phosphoinositide 3-Kinase in Heart Increases Late Sodium Current and Is Arrhythmogenic. J Pharmacol Exp Ther 2018; 365:460-466. [PMID: 29563327 DOI: 10.1124/jpet.117.246157] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/28/2018] [Indexed: 02/06/2023] Open
Abstract
Although inhibition of phosphoinositide 3-kinase (PI3K) is an emerging strategy in cancer therapy, we and others have reported that this action can also contribute to drug-induced QT prolongation and arrhythmias by increasing cardiac late sodium current (INaL). Previous studies in mice implicate the PI3K-α isoform in arrhythmia susceptibility. Here, we have determined the effects of new anticancer drugs targeting specific PI3K isoforms on INaL and action potentials (APs) in mouse cardiomyocytes and Chinese hamster ovary cells (CHO). Chronic exposure (10-100 nM; 5-48 hours) to PI3K-α-specific subunit inhibitors BYL710 (alpelisib) and A66 and a pan-PI3K inhibitor (BKM120) increased INaL in SCN5A-transfected CHO cells and mouse cardiomyocytes. The specific inhibitors (10-100 nM for 5 hours) markedly prolonged APs and generated triggered activity in mouse cardiomyocytes (9/12) but not in controls (0/6), and BKM120 caused similar effects (3/6). The inclusion of water-soluble PIP3, a downstream effector of the PI3K signaling pathway, in the pipette solution reversed these arrhythmogenic effects. By contrast, inhibition of PI3K-β, -γ, and -δ isoforms did not alter INaL or APs. We conclude that inhibition of cardiac PI3K-α is arrhythmogenic by increasing INaL and this effect is not seen with inhibition of other PI3K isoforms. These results highlight a mechanism underlying potential cardiotoxicity of PI3K-α inhibitors.
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Affiliation(s)
- Tao Yang
- Departments of Medicine (T.Y., D.F.M, J.M., D.M.R.), Pharmacology (T.Y., D.M.R.), and Biomedical Informatics (D.M.R.), Vanderbilt University School of Medicine, Nashville, Tennessee
| | - David F Meoli
- Departments of Medicine (T.Y., D.F.M, J.M., D.M.R.), Pharmacology (T.Y., D.M.R.), and Biomedical Informatics (D.M.R.), Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Javid Moslehi
- Departments of Medicine (T.Y., D.F.M, J.M., D.M.R.), Pharmacology (T.Y., D.M.R.), and Biomedical Informatics (D.M.R.), Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Dan M Roden
- Departments of Medicine (T.Y., D.F.M, J.M., D.M.R.), Pharmacology (T.Y., D.M.R.), and Biomedical Informatics (D.M.R.), Vanderbilt University School of Medicine, Nashville, Tennessee
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210
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Bastarache L, Hughey JJ, Hebbring S, Marlo J, Zhao W, Ho WT, Van Driest SL, McGregor TL, Mosley JD, Wells QS, Temple M, Ramirez AH, Carroll R, Osterman T, Edwards T, Ruderfer D, Velez Edwards DR, Hamid R, Cogan J, Glazer A, Wei WQ, Feng Q, Brilliant M, Zhao ZJ, Cox NJ, Roden DM, Denny JC. Phenotype risk scores identify patients with unrecognized Mendelian disease patterns. Science 2018; 359:1233-1239. [PMID: 29590070 PMCID: PMC5959723 DOI: 10.1126/science.aal4043] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 08/25/2017] [Accepted: 01/22/2018] [Indexed: 12/11/2022]
Abstract
Genetic association studies often examine features independently, potentially missing subpopulations with multiple phenotypes that share a single cause. We describe an approach that aggregates phenotypes on the basis of patterns described by Mendelian diseases. We mapped the clinical features of 1204 Mendelian diseases into phenotypes captured from the electronic health record (EHR) and summarized this evidence as phenotype risk scores (PheRSs). In an initial validation, PheRS distinguished cases and controls of five Mendelian diseases. Applying PheRS to 21,701 genotyped individuals uncovered 18 associations between rare variants and phenotypes consistent with Mendelian diseases. In 16 patients, the rare genetic variants were associated with severe outcomes such as organ transplants. PheRS can augment rare-variant interpretation and may identify subsets of patients with distinct genetic causes for common diseases.
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Affiliation(s)
- Lisa Bastarache
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jacob J Hughey
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott Hebbring
- Center for Human Genetics, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Joy Marlo
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wanke Zhao
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Wanting T Ho
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sara L Van Driest
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tracy L McGregor
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan D Mosley
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Quinn S Wells
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Temple
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrea H Ramirez
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert Carroll
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Travis Osterman
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Todd Edwards
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Douglas Ruderfer
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Digna R Velez Edwards
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rizwan Hamid
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joy Cogan
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew Glazer
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wei-Qi Wei
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - QiPing Feng
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Murray Brilliant
- Center for Human Genetics, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Zhizhuang J Zhao
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Nancy J Cox
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dan M Roden
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joshua C Denny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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211
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Denny JC, Van Driest SL, Wei WQ, Roden DM. The Influence of Big (Clinical) Data and Genomics on Precision Medicine and Drug Development. Clin Pharmacol Ther 2018; 103:409-418. [PMID: 29171014 PMCID: PMC5805632 DOI: 10.1002/cpt.951] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/15/2017] [Accepted: 11/19/2017] [Indexed: 12/30/2022]
Abstract
Drug development continues to be costly and slow, with medications failing due to lack of efficacy or presence of toxicity. The promise of pharmacogenomic discovery includes tailoring therapeutics based on an individual's genetic makeup, rational drug development, and repurposing medications. Rapid growth of large research cohorts, linked to electronic health record (EHR) data, fuels discovery of new genetic variants predicting drug action, supports Mendelian randomization experiments to show drug efficacy, and suggests new indications for existing medications. New biomedical informatics and machine-learning approaches advance the ability to interpret clinical information, enabling identification of complex phenotypes and subpopulations of patients. We review the recent history of use of "big data" from EHR-based cohorts and biobanks supporting these activities. Future studies using EHR data, other information sources, and new methods will promote a foundation for discovery to more rapidly advance precision medicine.
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Affiliation(s)
- Joshua C. Denny
- Department of Biomedical Informatics, Vanderbilt University Medical Center
- Department of Medicine, Vanderbilt University Medical Center
| | - Sara L. Van Driest
- Department of Medicine, Vanderbilt University Medical Center
- Department of Pediatrics, Vanderbilt University Medical Center
| | - Wei-Qi Wei
- Department of Biomedical Informatics, Vanderbilt University Medical Center
| | - Dan M. Roden
- Department of Biomedical Informatics, Vanderbilt University Medical Center
- Department of Medicine, Vanderbilt University Medical Center
- Department of Pharmacology, Vanderbilt University Medical Center
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212
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Robinson JR, Denny JC, Roden DM, Van Driest SL. Genome-wide and Phenome-wide Approaches to Understand Variable Drug Actions in Electronic Health Records. Clin Transl Sci 2018; 11:112-122. [PMID: 29148204 PMCID: PMC5866959 DOI: 10.1111/cts.12522] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/14/2017] [Indexed: 12/24/2022] Open
Affiliation(s)
- Jamie R. Robinson
- Department of Biomedical InformaticsVanderbilt University Medical CenterNashvilleTennesseeUSA
- Department of SurgeryVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Joshua C. Denny
- Department of Biomedical InformaticsVanderbilt University Medical CenterNashvilleTennesseeUSA
- Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Dan M. Roden
- Department of Biomedical InformaticsVanderbilt University Medical CenterNashvilleTennesseeUSA
- Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
- Department of PharmacologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Sara L. Van Driest
- Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
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213
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Karnes JH, Bastarache L, Shaffer CM, Gaudieri S, Xu Y, Glazer AM, Mosley JD, Zhao S, Raychaudhuri S, Mallal S, Ye Z, Mayer JG, Brilliant MH, Hebbring SJ, Roden DM, Phillips EJ, Denny JC. Phenome-wide scanning identifies multiple diseases and disease severity phenotypes associated with HLA variants. Sci Transl Med 2018; 9:9/389/eaai8708. [PMID: 28490672 DOI: 10.1126/scitranslmed.aai8708] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 03/27/2017] [Indexed: 12/22/2022]
Abstract
Although many phenotypes have been associated with variants in human leukocyte antigen (HLA) genes, the full phenotypic impact of HLA variants across all diseases is unknown. We imputed HLA genomic variation from two populations of 28,839 and 8431 European ancestry individuals and tested association of HLA variation with 1368 phenotypes. A total of 104 four-digit and 92 two-digit HLA allele phenotype associations were significant in both discovery and replication cohorts, the strongest being HLA-DQB1*03:02 and type 1 diabetes. Four previously unidentified associations were identified across the spectrum of disease with two- and four-digit HLA alleles and 10 with nonsynonymous variants. Some conditions associated with multiple HLA variants and stronger associations with more severe disease manifestations were identified. A comprehensive, publicly available catalog of clinical phenotypes associated with HLA variation is provided. Examining HLA variant disease associations in this large data set allows comprehensive definition of disease associations to drive further mechanistic insights.
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Affiliation(s)
- Jason H Karnes
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, AZ 85721, USA
| | - Lisa Bastarache
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Christian M Shaffer
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Silvana Gaudieri
- School of Anatomy, Physiology and Human Biology, University of Western Australia, Nedlands, Western Australia, Australia.,Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.,Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
| | - Yaomin Xu
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.,Center for Quantitative Sciences, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Andrew M Glazer
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Jonathan D Mosley
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Shilin Zhao
- Center for Quantitative Sciences, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Soumya Raychaudhuri
- Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.,Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.,Program in Medical and Population Genetics, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA.,Partners Center for Personalized Genetic Medicine, Boston, MA 02115, USA.,Institute of Inflammation and Repair, University of Manchester, Manchester, UK.,Department of Medicine, Karolinska Institutet and Karolinska University Hospital Solna, Stockholm, Sweden
| | - Simon Mallal
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.,Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia.,Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Zhan Ye
- Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, WI 54449, USA
| | - John G Mayer
- Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, WI 54449, USA
| | - Murray H Brilliant
- Center for Human Genetics, Marshfield Clinic Research Foundation, Marshfield, WI 54449, USA
| | - Scott J Hebbring
- Center for Human Genetics, Marshfield Clinic Research Foundation, Marshfield, WI 54449, USA
| | - Dan M Roden
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.,Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.,Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Elizabeth J Phillips
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.,Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Joshua C Denny
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA. .,Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
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214
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Goldstein JA, Bastarache LA, Denny JC, Roden DM, Pulley JM, Aronoff DM. Calcium channel blockers as drug repurposing candidates for gestational diabetes: Mining large scale genomic and electronic health records data to repurpose medications. Pharmacol Res 2018; 130:44-51. [PMID: 29448118 DOI: 10.1016/j.phrs.2018.02.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 12/28/2017] [Accepted: 02/09/2018] [Indexed: 02/07/2023]
Abstract
New therapeutic approaches are needed for gestational diabetes mellitus (GDM), but must show safety and efficacy in a historically understudied population. We studied associations between electronic medical record (EMR) phenotypes and genetic variants to uncover drugs currently considered safe in pregnancy that could treat or prevent GDM. We identified 129 systemically active drugs considered safe in pregnancy targeting the proteins produced from 196 genes. We tested for associations between GDM and/or type 2 diabetes (DM2) and 306 SNPs in 130 genes represented on the Illumina Infinium Human Exome Bead Chip (DM2 was included due to shared pathophysiological features with GDM). In parallel, we tested the association between drugs and glucose tolerance during pregnancy as measured by the glucose recorded during a routine 50-g glucose tolerance test (GTT). We found an association between GDM/DM2 and the genes targeted by 11 drug classes. In the EMR analysis, 6 drug classes were associated with changes in GTT. Two classes were identified in both analyses. L-type calcium channel blocking antihypertensives (CCBs), were associated with a 3.18 mg/dL (95% CI -6.18 to -0.18) decrease in glucose during GTT, and serotonin receptor type 3 (5HT-3) antagonist antinausea medications were associated with a 3.54 mg/dL (95% CI 1.86-5.23) increase in glucose during GTT. CCBs were identified as a class of drugs considered safe in pregnancy could have efficacy in treating or preventing GDM. 5HT-3 antagonists may be associated with worse glucose tolerance.
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Affiliation(s)
- Jeffery A Goldstein
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, United States
| | - Lisa A Bastarache
- Department of Biomedical Informatics, Vanderbilt University Medical Center, United States
| | - Joshua C Denny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, United States; Department of Medicine, Vanderbilt University Medical Center, United States
| | - Dan M Roden
- Department of Biomedical Informatics, Vanderbilt University Medical Center, United States; Department of Medicine, Vanderbilt University Medical Center, United States; Department of Pharmacology, Vanderbilt University School of Medicine, United States
| | - Jill M Pulley
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, United States
| | - David M Aronoff
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, United States; Department of Medicine, Vanderbilt University Medical Center, United States.
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215
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Phillips EJ, Wei WQ, Shaffer CM, Feng Q, Stone CA, Stein CM, Roden DM, Denny JC. A High-Throughput Genetic Analysis of Common Drug Allergy Labels Using Data from a Large Biobank. J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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216
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Liu DJ, Peloso GM, Yu H, Butterworth AS, Wang X, Mahajan A, Saleheen D, Emdin C, Alam D, Alves AC, Amouyel P, di Angelantonio E, Arveiler D, Assimes TL, Auer PL, Baber U, Ballantyne CM, Bang LE, Benn M, Bis JC, Boehnke M, Boerwinkle E, Bork-Jensen J, Bottinger EP, Brandslund I, Brown M, Busonero F, Caulfield MJ, Chambers JC, Chasman DI, Chen YE, Chen YDI, Chowdhury R, Christensen C, Chu AY, Connell JM, Cucca F, Cupples LA, Damrauer SM, Davies G, Deary IJ, Dedoussis G, Denny JC, Dominiczak A, Dubé MP, Ebeling T, Eiriksdottir G, Esko T, Farmaki AE, Feitosa MF, Ferrario M, Ferrieres J, Ford I, Fornage M, Franks PW, Frayling TM, Frikke-Schmidt R, Fritsche L, Frossard P, Fuster V, Ganesh SK, Gao W, Garcia ME, Gieger C, Giulianini F, Goodarzi MO, Grallert H, Grarup N, Groop L, Grove ML, Gudnason V, Hansen T, Harris TB, Hayward C, Hirschhorn JN, Holmen OL, Huffman J, Huo Y, Hveem K, Jabeen S, Jackson AU, Jakobsdottir J, Jarvelin MR, Jensen GB, Jørgensen ME, Jukema JW, Justesen JM, Kamstrup PR, Kanoni S, Karpe F, Kee F, Khera AV, Klarin D, Koistinen HA, Kooner JS, Kooperberg C, Kuulasmaa K, Kuusisto J, Laakso M, Lakka T, Langenberg C, Langsted A, Launer LJ, Lauritzen T, Liewald DCM, Lin LA, Linneberg A, Loos RJ, Lu Y, Lu X, Mägi R, Malarstig A, Manichaikul A, Manning AK, Mäntyselkä P, Marouli E, Masca NGD, Maschio A, Meigs JB, Melander O, Metspalu A, Morris AP, Morrison AC, Mulas A, Müller-Nurasyid M, Munroe PB, Neville MJ, Nielsen JB, Nielsen SF, Nordestgaard BG, Ordovas JM, Mehran R, O’Donnell CJ, Orho-Melander M, Molony CM, Muntendam P, Padmanabhan S, Palmer CNA, Pasko D, Patel AP, Pedersen O, Perola M, Peters A, Pisinger C, Pistis G, Polasek O, Poulter N, Psaty BM, Rader DJ, Rasheed A, Rauramaa R, Reilly D, Reiner AP, Renström F, Rich SS, Ridker PM, Rioux JD, Robertson NR, Roden DM, Rotter JI, Rudan I, Salomaa V, Samani NJ, Sanna S, Sattar N, Schmidt EM, Scott RA, Sever P, Sevilla RS, Shaffer CM, Sim X, Sivapalaratnam S, Small KS, Smith AV, Smith BH, Somayajula S, Southam L, Spector TD, Speliotes EK, Starr JM, Stirrups KE, Stitziel N, Strauch K, Stringham HM, Surendran P, Tada H, Tall AR, Tang H, Tardif JC, Taylor KD, Trompet S, Tsao PS, Tuomilehto J, Tybjaerg-Hansen A, van Zuydam NR, Varbo A, Varga TV, Virtamo J, Waldenberger M, Wang N, Wareham NJ, Warren HR, Weeke PE, Weinstock J, Wessel J, Wilson JG, Wilson PWF, Xu M, Yaghootkar H, Young R, Zeggini E, Zhang H, Zheng NS, Zhang W, Zhang Y, Zhou W, Zhou Y, Zoledziewska M, Howson JMM, Danesh J, McCarthy MI, Cowan C, Abecasis G, Deloukas P, Musunuru K, Willer CJ, Kathiresan S. Exome-wide association study of plasma lipids in >300,000 individuals. Nat Genet 2017; 49:1758-1766. [PMID: 29083408 PMCID: PMC5709146 DOI: 10.1038/ng.3977] [Citation(s) in RCA: 391] [Impact Index Per Article: 55.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 09/26/2017] [Indexed: 02/02/2023]
Abstract
We screened variants on an exome-focused genotyping array in >300,000 participants (replication in >280,000 participants) and identified 444 independent variants in 250 loci significantly associated with total cholesterol (TC), high-density-lipoprotein cholesterol (HDL-C), low-density-lipoprotein cholesterol (LDL-C), and/or triglycerides (TG). At two loci (JAK2 and A1CF), experimental analysis in mice showed lipid changes consistent with the human data. We also found that: (i) beta-thalassemia trait carriers displayed lower TC and were protected from coronary artery disease (CAD); (ii) excluding the CETP locus, there was not a predictable relationship between plasma HDL-C and risk for age-related macular degeneration; (iii) only some mechanisms of lowering LDL-C appeared to increase risk for type 2 diabetes (T2D); and (iv) TG-lowering alleles involved in hepatic production of TG-rich lipoproteins (TM6SF2 and PNPLA3) tracked with higher liver fat, higher risk for T2D, and lower risk for CAD, whereas TG-lowering alleles involved in peripheral lipolysis (LPL and ANGPTL4) had no effect on liver fat but decreased risks for both T2D and CAD.
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Affiliation(s)
- Dajiang J. Liu
- Department of Public Health Sciences, Institute of Personalized Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Gina M. Peloso
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA
| | - Haojie Yu
- Department of Stem Cell and Regenerative Biology, Harvard Stem Cell Institute, Harvard University, Cambridge, Massachusetts, USA
| | - Adam S. Butterworth
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- The National Institute for Health Research Blood and Transplant Unit (NIHR BTRU) in Donor Health and Genomics at the University of Cambridge, Cambridge, UK
| | - Xiao Wang
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anubha Mahajan
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Danish Saleheen
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, USA
- Center for Non-Communicable Diseases, Karachi, Pakistan
| | - Connor Emdin
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - Philippe Amouyel
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE - Risk factors and molecular determinants of aging-related diseases, Lille, France
| | - Emanuele di Angelantonio
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- The National Institute for Health Research Blood and Transplant Unit (NIHR BTRU) in Donor Health and Genomics at the University of Cambridge, Cambridge, UK
| | - Dominique Arveiler
- Department of Epidemiology and Public Health, EA 3430, University of Strasbourg, Strasbourg, France
| | - Themistocles L. Assimes
- VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Paul L. Auer
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Usman Baber
- Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | | | - Lia E. Bang
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marianne Benn
- Department of Clinical Biochemistry and The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark
- Faculty of Health and Medical Sciences, University of Denmark, Denmark
| | - Joshua C. Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Michael Boehnke
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Eric Boerwinkle
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas, USA
| | - Jette Bork-Jensen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Erwin P. Bottinger
- The Charles Bronfman Institute for Personalized Medicine, Ichan School of Medicine at Mount Sinai, New York, New York, USA
| | - Ivan Brandslund
- Department of Clinical Biochemistry, Lillebaelt Hospital, Vejle, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Morris Brown
- Clinical Pharmacology Unit, University of Cambridge, Addenbrookes Hospital, Cambridge, UK
| | - Fabio Busonero
- Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche (CNR), Monserrato, Cagliari, Italy
| | - Mark J Caulfield
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London, Queen Mary University of London, Charterhouse Square, London, UK
- The Barts Heart Centre, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, UK
| | - John C Chambers
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, UK
- Department of Cardiology, Ealing Hospital NHS Trust, Uxbridge Road, Southall, Middlesex, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Daniel I. Chasman
- Division of Preventive Medicine, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Y. Eugene Chen
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Yii-Der Ida Chen
- The Institute for Translational Genomics and Population Sciences, LABioMed at Harbor-UCLA Medical Center, Departments of Pediatrics and Medicine, Los Angeles, California, USA
| | - Rajiv Chowdhury
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Audrey Y. Chu
- Division of Preventive Medicine, Boston, Massachusetts, USA
- NHLBI Framingham Heart Study, Framingham, Massachusetts, USA
| | - John M Connell
- Medical Research Institute, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Francesco Cucca
- Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche (CNR), Monserrato, Cagliari, Italy
- Dipartimento di Scienze Biomediche, Universita’ degli Studi di Sassari, Sassari, Italy
| | - L. Adrienne Cupples
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
- NHLBI Framingham Heart Study, Framingham, Massachusetts, USA
| | - Scott M. Damrauer
- Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gail Davies
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Ian J Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - George Dedoussis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Joshua C. Denny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anna Dominiczak
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Marie-Pierre Dubé
- Montreal Heart Institute, Montreal, Quebec, Canada
- Université de Montréal Beaulieu-Saucier Pharmacogenomics Center, Montreal, Quebec, Canada
- Université de Montréal, Montreal, Quebec, Canada
| | - Tapani Ebeling
- Department of Medicine, Oulu University Hospital and University of Oulu, Oulu, Finland
| | | | - Tõnu Esko
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Aliki-Eleni Farmaki
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Mary F Feitosa
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Marco Ferrario
- Research Centre in Epidemiology and Preventive Medicine – EPIMED, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Jean Ferrieres
- Department of Epidemiology, UMR 1027- INSERM, Toulouse University-CHU Toulouse, Toulouse, France
| | - Ian Ford
- University of Glasgow, Glasgow, UK
| | - Myriam Fornage
- Institute of Molecular Medicine, the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Paul W. Franks
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Malmö, Sweden
- Department of Public Health & Clinical Medicine, Umeå University, Umeå, Sweden
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Timothy M. Frayling
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ruth Frikke-Schmidt
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars Fritsche
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | | | - Valentin Fuster
- Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Santhi K. Ganesh
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Human Genetics, University of Michigan, Ann Arbor, Michigan, USA
| | - Wei Gao
- Department of Cardiology, Peking University Third Hospital, Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, Beijing, China
| | | | - Christian Gieger
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
- Institute of Genetic Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | | | - Mark O. Goodarzi
- Department of Medicine and Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Division of Endocrinology, Diabetes and Metabolism, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Harald Grallert
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
- Institute of Genetic Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Niels Grarup
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Leif Groop
- Department of Clinical Sciences, Diabetes and Endocrinology, Clinical Research Centre, Lund University, Malmö, Sweden
| | - Megan L. Grove
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Vilmundur Gudnason
- The Icelandic Heart Association, Kopavogur, Iceland
- The University of Iceland, Reykjavik, Iceland
| | - Torben Hansen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Tamara B. Harris
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, Maryland, USA
| | - Caroline Hayward
- Medical Research Council Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Joel N. Hirschhorn
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA
- Division of Endocrinology and Center for Basic and Translational Obesity Research, Boston Children’s Hospital, Boston, MA, USA
| | - Oddgeir L. Holmen
- Department of Public Health and General Practice, HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway
- St Olav Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
| | - Jennifer Huffman
- Medical Research Council Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Kristian Hveem
- K. G. Jebsen Center for Genetic Epidemiology, Dept of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | | | - Anne U Jackson
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Johanna Jakobsdottir
- The Icelandic Heart Association, Kopavogur, Iceland
- The University of Iceland, Reykjavik, Iceland
| | | | - Gorm B Jensen
- The Copenhagen City Heart Study, Frederiksberg Hospital, Denmark
| | - Marit E. Jørgensen
- Steno Diabetes Center, Gentofte, Denmark
- National Institute of Public Health, Southern Denmark University, Denmark
| | - J. Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- The Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
| | - Johanne M. Justesen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pia R. Kamstrup
- Department of Clinical Biochemistry and The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark
| | - Stavroula Kanoni
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Fredrik Karpe
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, UK
| | - Frank Kee
- Director, UKCRC Centre of Excellence for Public Health, Queens University, Belfast, Northern Ireland
| | - Amit V. Khera
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Derek Klarin
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Heikki A. Koistinen
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
- University of Helsinki; and Department of Medicine, and Abdominal Center: Endocrinology, Helsinki University Central Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Jaspal S Kooner
- Department of Cardiology, Ealing Hospital NHS Trust, Uxbridge Road, Southall, Middlesex, UK
- Imperial College Healthcare NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Kari Kuulasmaa
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Johanna Kuusisto
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Markku Laakso
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Timo Lakka
- Department of Physiology, Institute of Biomedicine, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
- Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Claudia Langenberg
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Anne Langsted
- Department of Clinical Biochemistry and The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark
- Faculty of Health and Medical Sciences, University of Denmark, Denmark
| | - Lenore J. Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, Maryland, USA
| | - Torsten Lauritzen
- Department of Public Health, Section of General Practice, University of Aarhus, Aarhus, Denmark
| | - David CM Liewald
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Li An Lin
- Institute of Molecular Medicine, the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Allan Linneberg
- Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Research Center for Prevention and Health, Capital Region of Denmark, Copenhagen, Denmark
| | - Ruth J.F. Loos
- The Charles Bronfman Institute for Personalized Medicine, Ichan School of Medicine at Mount Sinai, New York, New York, USA
- The Mindich Child Health and Development Institute, Ichan School of Medicine at Mount Sinai, New York, New York, USA
| | - Yingchang Lu
- The Charles Bronfman Institute for Personalized Medicine, Ichan School of Medicine at Mount Sinai, New York, New York, USA
| | - Xiangfeng Lu
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Reedik Mägi
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Anders Malarstig
- Cardiovascular Genetics and Genomics Group, Cardiovascular Medicine Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Pharmatherapeutics Clinical Research, Pfizer Worldwide R&D, Sollentuna, Sweden
| | - Ani Manichaikul
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia, USA
| | - Alisa K. Manning
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pekka Mäntyselkä
- Unit of Primary Health Care, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Eirini Marouli
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Nicholas GD Masca
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester UK
| | - Andrea Maschio
- Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche (CNR), Monserrato, Cagliari, Italy
| | - James B. Meigs
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Olle Melander
- Department of Clinical Sciences, University Hospital Malmo Clinical Research Center, Lund University, Malmo, Sweden
| | | | - Andrew P Morris
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Alanna C. Morrison
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Antonella Mulas
- Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche (CNR), Monserrato, Cagliari, Italy
| | - Martina Müller-Nurasyid
- Department of Medicine I, Ludwig-Maximilians-University, Munich, Germany
- DZHK German Centre for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany
- Chair of Genetic Epidemiology, IBE, Faculty of Medicine, LMU Munich, Germany
| | - Patricia B. Munroe
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London, Queen Mary University of London, Charterhouse Square, London, UK
- NIHR Barts Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK
| | - Matt J Neville
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Jonas B. Nielsen
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Sune F Nielsen
- Department of Clinical Biochemistry and The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark
- Faculty of Health and Medical Sciences, University of Denmark, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry and The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark
- Faculty of Health and Medical Sciences, University of Denmark, Denmark
| | - Jose M. Ordovas
- Department of Cardiovascular Epidemiology and Population Genetics, National Center for Cardiovascular Investigation, Madrid, Spain
- IMDEA-Alimentacion, Madrid, Spain
- Nutrition and Genomics Laboratory, Jean Mayer-USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts, USA
| | - Roxana Mehran
- Cardiovascular Institute, Mount Sinai Medical Center, Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Christoper J. O’Donnell
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Marju Orho-Melander
- Department of Clinical Sciences, University Hospital Malmo Clinical Research Center, Lund University, Malmo, Sweden
| | - Cliona M. Molony
- Genetics, Merck Sharp & Dohme Corp., Kenilworth, New Jersey, USA
| | | | - Sandosh Padmanabhan
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Colin NA Palmer
- Medical Research Institute, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Dorota Pasko
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Aniruddh P. Patel
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Oluf Pedersen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Markus Perola
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
- Institute of Molecular Medicine FIMM, University of Helsinki, Finland
| | - Annette Peters
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
- Institute of Genetic Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- DZHK German Centre for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany
| | - Charlotta Pisinger
- Research Center for Prevention and Health, Capital Region of Denmark, Copenhagen, Denmark
| | - Giorgio Pistis
- Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche (CNR), Monserrato, Cagliari, Italy
| | - Ozren Polasek
- Faculty of Medicine, University of Split, Split, Croatia
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Neil Poulter
- International Centre for Circulatory Health, Imperial College London, UK
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
- Departments of Epidemiology and Health Services, University of Washington, Seattle, Washington, USA
| | - Daniel J. Rader
- Departments of Genetics, Medicine, and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Asif Rasheed
- Center for Non-Communicable Diseases, Karachi, Pakistan
| | - Rainer Rauramaa
- Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Dermot Reilly
- Genetics, Merck Sharp & Dohme Corp., Kenilworth, New Jersey, USA
| | - Alex P. Reiner
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Frida Renström
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Malmö, Sweden
- Department of Biobank Research, Umeå University, Umeå, Sweden
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia, USA
| | - Paul M Ridker
- Division of Preventive Medicine, Boston, Massachusetts, USA
| | | | - Neil R Robertson
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Dan M. Roden
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jerome I. Rotter
- The Institute for Translational Genomics and Population Sciences, LABioMed at Harbor-UCLA Medical Center, Departments of Pediatrics and Medicine, Los Angeles, California, USA
| | - Igor Rudan
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Veikko Salomaa
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester UK
| | - Serena Sanna
- Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche (CNR), Monserrato, Cagliari, Italy
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Ellen M. Schmidt
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert A. Scott
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Peter Sever
- International Centre for Circulatory Health, Imperial College London, UK
| | | | - Christian M. Shaffer
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Xueling Sim
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, 117549, Singapore
| | - Suthesh Sivapalaratnam
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, NL
| | - Kerrin S Small
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, UK
| | - Albert V. Smith
- The Icelandic Heart Association, Kopavogur, Iceland
- The University of Iceland, Reykjavik, Iceland
| | - Blair H Smith
- Division of Population Health Sciences, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland
- Generation Scotland, Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK
| | | | - Lorraine Southam
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
| | - Timothy D Spector
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, UK
| | - Elizabeth K. Speliotes
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | - John M Starr
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Kathleen E Stirrups
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Department of Haematology, University of Cambridge, Cambridge, UK
| | - Nathan Stitziel
- Cardiovascular Division, Departments of Medicine and Genetics, Washington University School of Medicine, St. Louis, Missouri, USA
- The McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Konstantin Strauch
- Institute of Genetic Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Medical Informatics, Biometry and Epidemiology, Chair of Genetic Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany
| | - Heather M Stringham
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Praveen Surendran
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Hayato Tada
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Alan R. Tall
- Division of Molecular Medicine, Department of Medicine, Columbia University, New York, New York, USA
| | - Hua Tang
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA
| | - Jean-Claude Tardif
- Montreal Heart Institute, Montreal, Quebec, Canada
- Université de Montréal, Montreal, Quebec, Canada
| | - Kent D Taylor
- The Institute for Translational Genomics and Population Sciences, LABioMed at Harbor-UCLA Medical Center, Departments of Pediatrics and Medicine, Los Angeles, California, USA
| | - Stella Trompet
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Philip S. Tsao
- VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jaakko Tuomilehto
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
- Dasman Diabetes Institute, Dasman, Kuwait
- Centre for Vascular Prevention, Danube-University Krems, Krems, Austria
- Saudi Diabetes Research Group, King Abdulaziz University, Fahd Medical Research Center, Jeddah, Saudi Arabia
| | - Anne Tybjaerg-Hansen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Natalie R van Zuydam
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
- Medical Research Institute, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Anette Varbo
- Department of Clinical Biochemistry and The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark
- Faculty of Health and Medical Sciences, University of Denmark, Denmark
| | - Tibor V Varga
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Malmö, Sweden
| | - Jarmo Virtamo
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Melanie Waldenberger
- Institute of Genetic Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Nan Wang
- Division of Molecular Medicine, Department of Medicine, Columbia University, New York, New York, USA
| | - Nick J. Wareham
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Helen R Warren
- Clinical Pharmacology, William Harvey Research Institute, Barts and The London, Queen Mary University of London, Charterhouse Square, London, UK
- NIHR Barts Cardiovascular Biomedical Research Unit, Queen Mary University of London, London, UK
| | - Peter E. Weeke
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- The Heart Centre, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Joshua Weinstock
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Jennifer Wessel
- Department of Epidemiology, Indiana University Fairbanks School of Public Health, Indianapolis, Indiana, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - James G. Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Peter W. F. Wilson
- Atlanta VA Medical Center, Decatur, Georgia, USA
- Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia, USA
| | - Ming Xu
- Department of Cardiology, Institute of Vascular Medicine, Peking University Third Hospital, Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, China
| | - Hanieh Yaghootkar
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Robin Young
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - He Zhang
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Weihua Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, UK
| | - Yan Zhang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Wei Zhou
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
| | - Yanhua Zhou
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Magdalena Zoledziewska
- Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche (CNR), Monserrato, Cagliari, Italy
| | | | - Joanna MM Howson
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - John Danesh
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- The National Institute for Health Research Blood and Transplant Unit (NIHR BTRU) in Donor Health and Genomics at the University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
| | - Mark I McCarthy
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, UK
| | - Chad Cowan
- Department of Stem Cell and Regenerative Biology, Harvard Stem Cell Institute, Harvard University, Cambridge, Massachusetts, USA
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Goncalo Abecasis
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Panos Deloukas
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders (PACER-HD), King Abdulaziz University, Jeddah, Saudi Arabia
| | - Kiran Musunuru
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cristen J. Willer
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Human Genetics, University of Michigan, Ann Arbor, Michigan, USA
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
| | - Sekar Kathiresan
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
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217
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Thorolfsdottir RB, Sveinbjornsson G, Sulem P, Helgadottir A, Gretarsdottir S, Benonisdottir S, Magnusdottir A, Davidsson OB, Rajamani S, Roden DM, Darbar D, Pedersen TR, Sabatine MS, Jonsdottir I, Arnar DO, Thorsteinsdottir U, Gudbjartsson DF, Holm H, Stefansson K. A Missense Variant in PLEC Increases Risk of Atrial Fibrillation. J Am Coll Cardiol 2017; 70:2157-2168. [PMID: 29050564 DOI: 10.1016/j.jacc.2017.09.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/07/2017] [Accepted: 09/05/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Genome-wide association studies (GWAS) have yielded variants at >30 loci that associate with atrial fibrillation (AF), including rare coding mutations in the sarcomere genes MYH6 and MYL4. OBJECTIVES The aim of this study was to search for novel AF associations and in doing so gain insights into the mechanisms whereby variants affect AF risk, using electrocardiogram (ECG) measurements. METHODS The authors performed a GWAS of 14,255 AF cases and 374,939 controls, using whole-genome sequence data from the Icelandic population, and tested novel signals in 2,002 non-Icelandic cases and 12,324 controls. They then tested the AF variants for effect on cardiac electrical function by using measurements in 289,297 ECGs from 62,974 individuals. RESULTS The authors discovered 2 novel AF variants, the intergenic variant rs72700114, between the genes LINC01142 and METTL11B (risk allele frequency = 8.1%; odds ratio [OR]: 1.26; p = 3.1 × 10-18), and the missense variant p.Gly4098Ser in PLEC (frequency = 1.2%; OR: 1.55; p = 8.0 × 10-10), encoding plectin, a cytoskeletal cross-linking protein that contributes to integrity of cardiac tissue. The authors also confirmed 29 reported variants. p.Gly4098Ser in PLEC significantly affects various ECG measurements in the absence of AF. Other AF variants have diverse effects on the conduction system, ranging from none to extensive. CONCLUSIONS The discovery of a missense variant in PLEC affecting AF combined with recent discoveries of variants in the sarcomere genes MYH6 and MYL4 points to an important role of myocardial structure in the pathogenesis of the disease. The diverse associations between AF variants and ECG measurements suggest fundamentally different categories of mechanisms contributing to the development of AF.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Dan M Roden
- Departments of Medicine, Pharmacology, and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dawood Darbar
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Terje R Pedersen
- Center For Preventive Medicine, Oslo University Hospital and Medical Faculty, University of Oslo, Oslo, Norway
| | - Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ingileif Jonsdottir
- deCODE genetics/Amgen, Inc., Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Immunology, Landspitali University Hospital, Reykjavik, Iceland
| | - David O Arnar
- deCODE genetics/Amgen, Inc., Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Medicine, Landspitali University Hospital, Reykjavik, Iceland
| | - Unnur Thorsteinsdottir
- deCODE genetics/Amgen, Inc., Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Daniel F Gudbjartsson
- deCODE genetics/Amgen, Inc., Reykjavik, Iceland; School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | - Hilma Holm
- deCODE genetics/Amgen, Inc., Reykjavik, Iceland
| | - Kari Stefansson
- deCODE genetics/Amgen, Inc., Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
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218
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Schildcrout JS, Denny JC, Roden DM. On the Potential of Preemptive Genotyping Towards Preventing Medication-Related Adverse Events: Results from the South Korean National Health Insurance Database. Drug Saf 2017; 40:1-2. [PMID: 27873192 DOI: 10.1007/s40264-016-0476-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Jonathan S Schildcrout
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA. .,Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - Joshua C Denny
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Dan M Roden
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA
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219
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Hellwege JN, Jeff JM, Wise LA, Gallagher CS, Wellons M, Hartmann KE, Jones SF, Torstenson ES, Dickinson S, Ruiz-Narváez EA, Rohland N, Allen A, Reich D, Tandon A, Pasaniuc B, Mancuso N, Im HK, Hinds DA, Palmer JR, Rosenberg L, Denny JC, Roden DM, Stewart EA, Morton CC, Kenny EE, Edwards TL, Velez Edwards DR. Erratum to: A multi-stage genome-wide association study of uterine fibroids in African Americans. Hum Genet 2017; 136:1497-1498. [PMID: 28975356 PMCID: PMC5909202 DOI: 10.1007/s00439-017-1846-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
The article "A multi-stage genome-wide association study of uterine fibroids in African Americans", written by Jacklyn N. Hellwege, was originally published Online First without open access. After publication in volume 136, issue 10, page 1363-1373 the author decided to opt for Open Choice and to make the article an open access publication. Therefore, the copyright of the article has been changed to
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Affiliation(s)
- Jacklyn N Hellwege
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA.,Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Janina M Jeff
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Slone Epidemiology Center at Boston University, Boston, MA, USA
| | | | - Melissa Wellons
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katherine E Hartmann
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah F Jones
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric S Torstenson
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott Dickinson
- Section of Genetic Medicine, The University of Chicago, Chicago, IL, USA
| | | | - Nadin Rohland
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Alexander Allen
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - David Reich
- Department of Genetics, Harvard Medical School, Boston, MA, USA.,Howard Hughes Medical Institute, Chevy Chase, MD, USA.,Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Arti Tandon
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Bogdan Pasaniuc
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.,Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Nicholas Mancuso
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Hae Kyung Im
- Section of Genetic Medicine, The University of Chicago, Chicago, IL, USA
| | | | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Joshua C Denny
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Dan M Roden
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Elizabeth A Stewart
- Departments of Obstetrics and Gynecology and Surgery, Mayo Clinic and Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Cynthia C Morton
- Broad Institute of Harvard and MIT, Cambridge, MA, USA.,University of Manchester Academic Health Science Centre, Manchester, England, UK.,Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eimear E Kenny
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Todd L Edwards
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA.,Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Digna R Velez Edwards
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA. .,Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA. .,Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA.
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220
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Hellwege JN, Jeff JM, Wise LA, Gallagher CS, Wellons M, Hartmann KE, Jones SF, Torstenson ES, Dickinson S, Ruiz-Narváez EA, Rohland N, Allen A, Reich D, Tandon A, Pasaniuc B, Mancuso N, Im HK, Hinds DA, Palmer JR, Rosenberg L, Denny JC, Roden DM, Stewart EA, Morton CC, Kenny EE, Edwards TL, Velez Edwards DR. A multi-stage genome-wide association study of uterine fibroids in African Americans. Hum Genet 2017; 136:1363-1373. [PMID: 28836065 PMCID: PMC5628188 DOI: 10.1007/s00439-017-1836-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/16/2017] [Indexed: 12/17/2022]
Abstract
Uterine fibroids are benign tumors of the uterus affecting up to 77% of women by menopause. They are the leading indication for hysterectomy, and account for $34 billion annually in the United States. Race/ethnicity and age are the strongest known risk factors. African American (AA) women have higher prevalence, earlier onset, and larger and more numerous fibroids than European American women. We conducted a multi-stage genome-wide association study (GWAS) of fibroid risk among AA women followed by in silico genetically predicted gene expression profiling of top hits. In Stage 1, cases and controls were confirmed by pelvic imaging, genotyped and imputed to 1000 Genomes. Stage 2 used self-reported fibroid and GWAS data from 23andMe, Inc. and the Black Women's Health Study. Associations with fibroid risk were modeled using logistic regression adjusted for principal components, followed by meta-analysis of results. We observed a significant association among 3399 AA cases and 4764 AA controls at rs739187 (risk-allele frequency = 0.27) in CYTH4 (OR (95% confidence interval) = 1.23 (1.16-1.30), p value = 7.82 × 10-9). Evaluation of the genetic association results with MetaXcan identified lower predicted gene expression of CYTH4 in thyroid tissue as significantly associated with fibroid risk (p value = 5.86 × 10-8). In this first multi-stage GWAS for fibroids among AA women, we identified a novel risk locus for fibroids within CYTH4 that impacts gene expression in thyroid and has potential biological relevance for fibroids.
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Affiliation(s)
- Jacklyn N Hellwege
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Janina M Jeff
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | | | - Melissa Wellons
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katherine E Hartmann
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah F Jones
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric S Torstenson
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott Dickinson
- Section of Genetic Medicine, The University of Chicago, Chicago, IL, USA
| | | | - Nadin Rohland
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Alexander Allen
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - David Reich
- Department of Genetics, Harvard Medical School, Boston, MA, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Arti Tandon
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Bogdan Pasaniuc
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Nicholas Mancuso
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Hae Kyung Im
- Section of Genetic Medicine, The University of Chicago, Chicago, IL, USA
| | | | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Joshua C Denny
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Dan M Roden
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Elizabeth A Stewart
- Departments of Obstetrics and Gynecology and Surgery, Mayo Clinic and Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Cynthia C Morton
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- University of Manchester Academic Health Science Centre, Manchester, England, UK
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eimear E Kenny
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Todd L Edwards
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Digna R Velez Edwards
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA.
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA.
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221
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Luzum JA, Pakyz RE, Elsey AR, Haidar CE, Peterson JF, Whirl-Carrillo M, Handelman SK, Palmer K, Pulley JM, Beller M, Schildcrout JS, Field JR, Weitzel KW, Cooper-DeHoff RM, Cavallari LH, O’Donnell PH, Altman RB, Pereira N, Ratain MJ, Roden DM, Embi PJ, Sadee W, Klein TE, Johnson JA, Relling MV, Wang L, Weinshilboum RM, Shuldiner AR, Freimuth RR. The Pharmacogenomics Research Network Translational Pharmacogenetics Program: Outcomes and Metrics of Pharmacogenetic Implementations Across Diverse Healthcare Systems. Clin Pharmacol Ther 2017; 102:502-510. [PMID: 28090649 PMCID: PMC5511786 DOI: 10.1002/cpt.630] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/11/2017] [Indexed: 12/23/2022]
Abstract
Numerous pharmacogenetic clinical guidelines and recommendations have been published, but barriers have hindered the clinical implementation of pharmacogenetics. The Translational Pharmacogenetics Program (TPP) of the National Institutes of Health (NIH) Pharmacogenomics Research Network was established in 2011 to catalog and contribute to the development of pharmacogenetic implementations at eight US healthcare systems, with the goal to disseminate real-world solutions for the barriers to clinical pharmacogenetic implementation. The TPP collected and normalized pharmacogenetic implementation metrics through June 2015, including gene-drug pairs implemented, interpretations of alleles and diplotypes, numbers of tests performed and actionable results, and workflow diagrams. TPP participant institutions developed diverse solutions to overcome many barriers, but the use of Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines provided some consistency among the institutions. The TPP also collected some pharmacogenetic implementation outcomes (scientific, educational, financial, and informatics), which may inform healthcare systems seeking to implement their own pharmacogenetic testing programs.
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Affiliation(s)
- Jasmine A. Luzum
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
- Center for Pharmacogenomics, College of Medicine, Ohio State University, Columbus, OH, USA
| | - Ruth E. Pakyz
- Program for Personalized and Genomic Medicine, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Amanda R. Elsey
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, Gainesville, FL, USA
| | - Cyrine E. Haidar
- Department of Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Josh F. Peterson
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Samuel K. Handelman
- Center for Pharmacogenomics, College of Medicine, Ohio State University, Columbus, OH, USA
| | - Kathleen Palmer
- Program for Personalized and Genomic Medicine, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Jill M. Pulley
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Marc Beller
- Office of Research Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jonathan S. Schildcrout
- Department of Statistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Julie R. Field
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Kristin W. Weitzel
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, Gainesville, FL, USA
| | - Rhonda M. Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, Gainesville, FL, USA
| | - Larisa H. Cavallari
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, Gainesville, FL, USA
| | - Peter H. O’Donnell
- Center for Personalized Therapeutics, University of Chicago, Chicago, IL, USA
| | - Russ B. Altman
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Naveen Pereira
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Mark J. Ratain
- Center for Personalized Therapeutics, University of Chicago, Chicago, IL, USA
| | - Dan M. Roden
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Peter J. Embi
- Department of Biomedical Informatics, Ohio State University, Columbus, OH, USA
| | - Wolfgang Sadee
- Center for Pharmacogenomics, College of Medicine, Ohio State University, Columbus, OH, USA
- Department of Cancer Biology and Genetics, College of Medicine, Ohio State University, Columbus, OH, USA
| | - Teri E. Klein
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Julie A. Johnson
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, University of Florida, Gainesville, FL, USA
| | - Mary V. Relling
- Department of Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Liewei Wang
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Richard M. Weinshilboum
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Alan R. Shuldiner
- Program for Personalized and Genomic Medicine, School of Medicine, University of Maryland, Baltimore, MD, USA
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222
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Karnes JH, Shaffer CM, Cronin R, Bastarache L, Gaudieri S, James I, Pavlos R, Steiner H, Mosley JD, Mallal S, Denny JC, Phillips EJ, Roden DM. Influence of Human Leukocyte Antigen (HLA) Alleles and Killer Cell Immunoglobulin-Like Receptors (KIR) Types on Heparin-Induced Thrombocytopenia (HIT). Pharmacotherapy 2017; 37:1164-1171. [PMID: 28688202 PMCID: PMC5600645 DOI: 10.1002/phar.1983] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Heparin-induced thrombocytopenia (HIT) is an unpredictable, life-threatening, immune-mediated reaction to heparin. Variation in human leukocyte antigen (HLA) genes is now used to prevent immune-mediated adverse drug reactions. Combinations of HLA alleles and killer cell immunoglobulin-like receptors (KIR) are associated with multiple autoimmune diseases and infections. The objective of this study is to evaluate the association of HLA alleles and KIR types, alone or in the presence of different HLA ligands, with HIT. HIT cases and heparin-exposed controls were identified in BioVU, an electronic health record coupled to a DNA biobank. HLA sequencing and KIR type imputation using Illumina OMNI-Quad data were performed. Odds ratios for HLA alleles and KIR types and HLA*KIR interactions using conditional logistic regressions were determined in the overall population and by race/ethnicity. Analysis was restricted to KIR types and HLA alleles with a frequency greater than 0.01. The p values for HLA and KIR association were corrected by using a false discovery rate q<0.05 and HLA*KIR interactions were considered significant at p<0.05. Sixty-five HIT cases and 350 matched controls were identified. No statistical differences in baseline characteristics were observed between cases and controls. The HLA-DRB3*01:01 allele was significantly associated with HIT in the overall population (odds ratio 2.81 [1.57-5.02], p=2.1×10-4 , q=0.02) and in individuals with European ancestry, independent of other alleles. No KIR types were associated with HIT, although a significant interaction was observed between KIR2DS5 and the HLA-C1 KIR binding group (p=0.03). The HLA-DRB3*01:01 allele was identified as a potential risk factor for HIT. This class II HLA gene and allele represent biologically plausible candidates for influencing HIT pathogenesis. We found limited evidence of the role of KIR types in HIT pathogenesis. Replication and further study of the HLA-DRB3*01:01 association is necessary.
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Affiliation(s)
- Jason H Karnes
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, AZ
- Sarver Heart Center, Tucson, AZ
| | - Christian M Shaffer
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Robert Cronin
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville
| | - Lisa Bastarache
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville
| | - Silvana Gaudieri
- School of Anatomy, Physiology and Human Biology, University of Western Australia, Nedlands, Western Australia, Australia
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
| | - Ian James
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
| | - Rebecca Pavlos
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
| | - Heidi Steiner
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, AZ
| | - Jonathan D Mosley
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Simon Mallal
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN
| | - Joshua C Denny
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville
| | - Elizabeth J Phillips
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN
| | - Dan M Roden
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
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Husser D, Ueberham L, Hindricks G, Büttner P, Ingram C, Weeke P, Shoemaker MB, Adams V, Arya A, Sommer P, Darbar D, Roden DM, Bollmann A. Rare variants in genes encoding the cardiac sodium channel and associated compounds and their impact on outcome of catheter ablation of atrial fibrillation. PLoS One 2017; 12:e0183690. [PMID: 28837624 PMCID: PMC5570360 DOI: 10.1371/journal.pone.0183690] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 08/09/2017] [Indexed: 12/19/2022] Open
Abstract
Aim Rare variants of genes encoding the cardiac sodium channel and associated compounds have been linked with atrial fibrillation (AF). Nevertheless, current expert consensus does not support genetic testing in AF, which is in part based on the fact that “there is no therapeutic impact derived from AF genetic test results”. However, there are no studies available supporting this recommendation. Consequently, this study analyzed the impact of rare variants affecting the cardiac sodium channel on rhythm outcome of AF catheter ablation. Methods and results In 137 consecutive patients with lone AF enrolled in the Leipzig Heart Center AF ablation registry, screening for mutations in SCN5A, SCN1B – 4B, CAV3, GPD1L, SNTA1 and MOG1 was performed. We identified 3 rare non-synonymous variants in SCN5A, 5 in SCN1B, 1 in SCN4B, 1 in CAV3, 6 in GPD1L, 3 in SNTA1 and 3 in MOG1 (16%). Variant carriers were otherwise comparable with non-variant carriers. Analysis of AF recurrence rates after radiofrequency AF catheter ablation by serial 7-day Holter ECG monitoring between 3 and 12 months revealed no difference between groups, i.e. 45% in variant carriers vs. 49% in non-variant carriers. Conclusions Rare variants in genes encoding the cardiac sodium channel and associated compounds are frequently found in lone AF but were not found to impact the outcome of AF catheter ablation. This finding supports current recommendations not to screen for rare variants for the ablation outcome in AF. Nevertheless, it may at least be helpful for understanding AF mechanisms and larger studies are needed to further explore the possible association between genotype and response to AF therapies.
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Affiliation(s)
- Daniela Husser
- Department of Electrophysiology, University of Leipzig, Heart Center, Germany
- * E-mail:
| | - Laura Ueberham
- Department of Electrophysiology, University of Leipzig, Heart Center, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, University of Leipzig, Heart Center, Germany
| | - Petra Büttner
- Department of Electrophysiology, University of Leipzig, Heart Center, Germany
| | - Christie Ingram
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Peter Weeke
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States of America
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, DK
| | - M. Benjamin Shoemaker
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Volker Adams
- Department of Electrophysiology, University of Leipzig, Heart Center, Germany
| | - Arash Arya
- Department of Electrophysiology, University of Leipzig, Heart Center, Germany
| | - Philipp Sommer
- Department of Electrophysiology, University of Leipzig, Heart Center, Germany
| | - Dawood Darbar
- Division of Cardiology, University of Illinois, Chicago, IL, United States of America
| | - Dan M. Roden
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Andreas Bollmann
- Department of Electrophysiology, University of Leipzig, Heart Center, Germany
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Relling MV, Krauss RM, Roden DM, Klein TE, Fowler DM, Terada N, Lin L, Riel-Mehan M, Do TP, Kubo M, Yee SW, Johnson GT, Giacomini KM. New Pharmacogenomics Research Network: An Open Community Catalyzing Research and Translation in Precision Medicine. Clin Pharmacol Ther 2017; 102:897-902. [PMID: 28795399 DOI: 10.1002/cpt.755] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/17/2017] [Accepted: 05/21/2017] [Indexed: 12/25/2022]
Abstract
The goal of pharmacogenomics research is to discover genetic polymorphisms that underlie variation in drug response. Increasingly, pharmacogenomics research involves large numbers of patients and the application of new technologies and methodologies to enable discovery. The Pharmacogenomics Research Network (PGRN) has become a community-driven network of investigators spanning scientific and clinical disciplines. Here, we highlight the activities and types of resources that enable PGRN members to enhance and drive basic and translational research in pharmacogenomics.
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Affiliation(s)
- M V Relling
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - R M Krauss
- Children's Hospital Oakland Research Institute, Oakland, California, USA
| | - D M Roden
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - T E Klein
- Department of Biomedical Data Science, Stanford University, Palo Alto, California, USA
| | - D M Fowler
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA.,Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - N Terada
- Department of Pathology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - L Lin
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California, USA
| | - M Riel-Mehan
- Animated Cell, Allen Institute for Cell Biology, Seattle, Washington, USA
| | - T P Do
- Animated Cell, Allen Institute for Cell Biology, Seattle, Washington, USA
| | - M Kubo
- RIKEN Center for Integrative Medical Science, Yokohama, Japan
| | - S W Yee
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California, USA
| | - G T Johnson
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California, USA.,Animated Cell, Allen Institute for Cell Biology, Seattle, Washington, USA
| | - K M Giacomini
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California, USA.,Institute for Human Genetics, University of California, San Francisco, San Francisco, California, USA
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225
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Christophersen IE, Rienstra M, Roselli C, Yin X, Geelhoed B, Barnard J, Lin H, Arking DE, Smith AV, Albert CM, Chaffin M, Tucker NR, Li M, Klarin D, Bihlmeyer NA, Low SK, Weeke PE, Müller-Nurasyid M, Smith JG, Brody JA, Niemeijer MN, Dörr M, Trompet S, Huffman J, Gustafsson S, Schurmann C, Kleber ME, Lyytikäinen LP, Seppälä I, Malik R, R V R Horimoto A, Perez M, Sinisalo J, Aeschbacher S, Thériault S, Yao J, Radmanesh F, Weiss S, Teumer A, Choi SH, Weng LC, Clauss S, Deo R, Rader DJ, Shah SH, Sun A, Hopewell JC, Debette S, Chauhan G, Yang Q, Worrall BB, Paré G, Kamatani Y, Hagemeijer YP, Verweij N, Siland JE, Kubo M, Smith JD, Van Wagoner DR, Bis JC, Perz S, Psaty BM, Ridker PM, Magnani JW, Harris TB, Launer LJ, Shoemaker MB, Padmanabhan S, Haessler J, Bartz TM, Waldenberger M, Lichtner P, Arendt M, Krieger JE, Kähönen M, Risch L, Mansur AJ, Peters A, Smith BH, Lind L, Scott SA, Lu Y, Bottinger EB, Hernesniemi J, Lindgren CM, Wong JA, Huang J, Eskola M, Morris AP, Ford I, Reiner AP, Delgado G, Chen LY, Chen YDI, Sandhu RK, Li M, Boerwinkle E, Eisele L, Lannfelt L, Rost N, Anderson CD, Taylor KD, Campbell A, Magnusson PK, Porteous D, Hocking LJ, Vlachopoulou E, Pedersen NL, Nikus K, Orho-Melander M, Hamsten A, Heeringa J, Denny JC, Kriebel J, Darbar D, Newton-Cheh C, Shaffer C, Macfarlane PW, Heilmann-Heimbach S, Almgren P, Huang PL, Sotoodehnia N, Soliman EZ, Uitterlinden AG, Hofman A, Franco OH, Völker U, Jöckel KH, Sinner MF, Lin HJ, Guo X, Dichgans M, Ingelsson E, Kooperberg C, Melander O, J F Loos R, Laurikka J, Conen D, Rosand J, van der Harst P, Lokki ML, Kathiresan S, Pereira A, Jukema JW, Hayward C, Rotter JI, März W, Lehtimäki T, Stricker BH, Chung MK, Felix SB, Gudnason V, Alonso A, Roden DM, Kääb S, Chasman DI, Heckbert SR, Benjamin EJ, Tanaka T, Lunetta KL, Lubitz SA, Ellinor PT. Erratum: Large-scale analyses of common and rare variants identify 12 new loci associated with atrial fibrillation. Nat Genet 2017; 49:1286. [PMID: 28747752 DOI: 10.1038/ng0817-1286c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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226
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Lee HJ, Jiang M, Wu Y, Shaffer CM, Cleator JH, Friedman EA, Lewis JP, Roden DM, Denny J, Xu H. A comparative study of different methods for automatic identification of clopidogrel-induced bleedings in electronic health records. AMIA Jt Summits Transl Sci Proc 2017; 2017:185-192. [PMID: 28815128 PMCID: PMC5543340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Electronic health records (EHRs) linked with biobanks have been recognized as valuable data sources for pharmacogenomic studies, which require identification of patients with certain adverse drug reactions (ADRs) from a large population. Since manual chart review is costly and time-consuming, automatic methods to accurately identify patients with ADRs have been called for. In this study, we developed and compared different informatics approaches to identify ADRs from EHRs, using clopidogrel-induced bleeding as our case study. Three different types of methods were investigated: 1) rule-based methods; 2) machine learning-based methods; and 3) scoring function-based methods. Our results show that both machine learning and scoring methods are effective and the scoring method can achieve a high precision with a reasonable recall. We also analyzed the contributions of different types of features and found that the temporality information between clopidogrel and bleeding events, as well as textual evidence from physicians' assertion of the adverse events are helpful. We believe that our findings are valuable in advancing EHR-based pharmacogenomic studies.
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Affiliation(s)
- Hee-Jin Lee
- University of Texas Health Science Center at Houston, Houston, TX
| | - Min Jiang
- University of Texas Health Science Center at Houston, Houston, TX
| | - Yonghui Wu
- University of Texas Health Science Center at Houston, Houston, TX
| | - Christian M Shaffer
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - John H Cleator
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Eitan A Friedman
- Division of Cardiovascular Medicine, Vanderbilt University, Nashville, TN
| | - Joshua P Lewis
- Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD
| | - Dan M Roden
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Josh Denny
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN
| | - Hua Xu
- University of Texas Health Science Center at Houston, Houston, TX
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Nadkarni GN, Galarneau G, Ellis SB, Nadukuru R, Zhang J, Scott SA, Schurmann C, Li R, Rasmussen-Torvik LJ, Kho AN, Hayes MG, Pacheco JA, Manolio TA, Chisholm RL, Roden DM, Denny JC, Kenny EE, Bottinger EP. Apolipoprotein L1 Variants and Blood Pressure Traits in African Americans. J Am Coll Cardiol 2017; 69:1564-1574. [PMID: 28335839 DOI: 10.1016/j.jacc.2017.01.040] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 11/06/2016] [Accepted: 01/03/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND African Americans (AA) are disproportionately affected by hypertension-related health disparities. Apolipoprotein L1 (APOL1) risk variants are associated with kidney disease in hypertensive AAs. OBJECTIVES This study assessed the APOL1 risk alleles' association with blood pressure traits in AAs. METHODS The discovery cohort included 5,204 AA participants from Mount Sinai's BioMe biobank. Replication cohorts included additional BioMe (n = 1,623), Vanderbilt BioVU (n = 1,809), and Northwestern NUgene (n = 567) AA biobank participants. Single nucleotide polymorphisms determining APOL1 G1 and G2 risk alleles were genotyped in BioMe and imputed in BioVU/NUgene participants. APOL1 risk alleles' association with blood pressure-related traits was tested in the discovery cohort, a meta-analysis of replication cohorts, and a combined meta-analysis under recessive and additive models after adjusting for age, sex, body mass index, and estimated glomerular filtration rate. RESULTS There were 14% to 16% of APOL1 variant allele homozygotes (2 copies of G1/G2) across cohorts. APOL1 risk alleles were associated under an additive model with systolic blood pressure (SBP) and age at diagnosis of hypertension, which was 2 to 5 years younger in the APOL1 variant allele homozygotes (Cox proportional hazards analysis, p value for combined meta-analysis [pcom] = 1.9 × 10-5). APOL1 risk alleles were associated with overall SBP (pcom = 7.0 × 10-8) and diastolic blood pressure (pcom = 2.8 × 10-4). After adjustment for all covariates, those in the 20- to 29-year age range showed an increase in SBP of 0.94 ± 0.44 mm Hg (pcom = 0.01) per risk variant copy. APOL1-associated estimated glomerular filtration rate decline was observed starting a decade later in life in the 30- to 39-year age range. CONCLUSIONS APOL1 risk alleles are associated with higher SBP and earlier hypertension diagnoses in young AAs; this relationship appears to follow an additive model.
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Affiliation(s)
- Girish N Nadkarni
- Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Geneviève Galarneau
- Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stephen B Ellis
- Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rajiv Nadukuru
- Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jinglan Zhang
- Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stuart A Scott
- Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Claudia Schurmann
- Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rongling Li
- Division of Genomic Medicine, National Human Genome Research Institute, Bethesda, Maryland
| | - Laura J Rasmussen-Torvik
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Abel N Kho
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - M Geoffrey Hayes
- Division of Endocrinology, Metabolism, & Molecular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jennifer A Pacheco
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Teri A Manolio
- Division of Genomic Medicine, National Human Genome Research Institute, Bethesda, Maryland
| | - Rex L Chisholm
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dan M Roden
- Department of Medicine and Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville Tennessee
| | - Joshua C Denny
- Department of Medicine and Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville Tennessee
| | - Eimear E Kenny
- Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Erwin P Bottinger
- Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
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228
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Wei WQ, Bastarache LA, Carroll RJ, Marlo JE, Osterman TJ, Gamazon ER, Cox NJ, Roden DM, Denny JC. Evaluating phecodes, clinical classification software, and ICD-9-CM codes for phenome-wide association studies in the electronic health record. PLoS One 2017; 12:e0175508. [PMID: 28686612 PMCID: PMC5501393 DOI: 10.1371/journal.pone.0175508] [Citation(s) in RCA: 202] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 03/27/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To compare three groupings of Electronic Health Record (EHR) billing codes for their ability to represent clinically meaningful phenotypes and to replicate known genetic associations. The three tested coding systems were the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, the Agency for Healthcare Research and Quality Clinical Classification Software for ICD-9-CM (CCS), and manually curated "phecodes" designed to facilitate phenome-wide association studies (PheWAS) in EHRs. METHODS AND MATERIALS We selected 100 disease phenotypes and compared the ability of each coding system to accurately represent them without performing additional groupings. The 100 phenotypes included 25 randomly-chosen clinical phenotypes pursued in prior genome-wide association studies (GWAS) and another 75 common disease phenotypes mentioned across free-text problem lists from 189,289 individuals. We then evaluated the performance of each coding system to replicate known associations for 440 SNP-phenotype pairs. RESULTS Out of the 100 tested clinical phenotypes, phecodes exactly matched 83, compared to 53 for ICD-9-CM and 32 for CCS. ICD-9-CM codes were typically too detailed (requiring custom groupings) while CCS codes were often not granular enough. Among 440 tested known SNP-phenotype associations, use of phecodes replicated 153 SNP-phenotype pairs compared to 143 for ICD-9-CM and 139 for CCS. Phecodes also generally produced stronger odds ratios and lower p-values for known associations than ICD-9-CM and CCS. Finally, evaluation of several SNPs via PheWAS identified novel potential signals, some seen in only using the phecode approach. Among them, rs7318369 in PEPD was associated with gastrointestinal hemorrhage. CONCLUSION Our results suggest that the phecode groupings better align with clinical diseases mentioned in clinical practice or for genomic studies. ICD-9-CM, CCS, and phecode groupings all worked for PheWAS-type studies, though the phecode groupings produced superior results.
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Affiliation(s)
- Wei-Qi Wei
- Departments of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Lisa A. Bastarache
- Departments of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Robert J. Carroll
- Departments of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Joy E. Marlo
- Departments of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Travis J. Osterman
- Departments of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Departments of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Eric R. Gamazon
- Vanderbilt Genetic Institute and the Division of Genetic Medicine, Vanderbilt University, Nashville, TN, United States of America
- Department of Clinical Epidemiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Nancy J. Cox
- Vanderbilt Genetic Institute and the Division of Genetic Medicine, Vanderbilt University, Nashville, TN, United States of America
| | - Dan M. Roden
- Departments of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Departments of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Department of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Joshua C. Denny
- Departments of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Departments of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
- * E-mail:
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229
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Zhang B, Novitskaya T, Wheeler DG, Xu Z, Chepurko E, Huttinger R, He H, Varadharaj S, Zweier JL, Song Y, Xu M, Harrell FE, Su YR, Absi T, Kohr MJ, Ziolo MT, Roden DM, Shaffer CM, Galindo CL, Wells QS, Gumina RJ. Kcnj11 Ablation Is Associated With Increased Nitro-Oxidative Stress During Ischemia-Reperfusion Injury: Implications for Human Ischemic Cardiomyopathy. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.116.003523. [PMID: 28209764 DOI: 10.1161/circheartfailure.116.003523] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/06/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite increased secondary cardiovascular events in patients with ischemic cardiomyopathy (ICM), the expression of innate cardiac protective molecules in the hearts of patients with ICM is incompletely characterized. Therefore, we used a nonbiased RNAseq approach to determine whether differences in cardiac protective molecules occur with ICM. METHODS AND RESULTS RNAseq analysis of human control and ICM left ventricular samples demonstrated a significant decrease in KCNJ11 expression with ICM. KCNJ11 encodes the Kir6.2 subunit of the cardioprotective KATP channel. Using wild-type mice and kcnj11-deficient (kcnj11-null) mice, we examined the effect of kcnj11 expression on cardiac function during ischemia-reperfusion injury. Reactive oxygen species generation increased in kcnj11-null hearts above that found in wild-type mice hearts after ischemia-reperfusion injury. Continuous left ventricular pressure measurement during ischemia and reperfusion demonstrated a more compromised diastolic function in kcnj11-null compared with wild-type mice during reperfusion. Analysis of key calcium-regulating proteins revealed significant differences in kcnj11-null mice. Despite impaired relaxation, kcnj11-null hearts increased phospholamban Ser16 phosphorylation, a modification that results in the dissociation of phospholamban from sarcoendoplasmic reticulum Ca2+, thereby increasing sarcoendoplasmic reticulum Ca2+-mediated calcium reuptake. However, kcnj11-null mice also had increased 3-nitrotyrosine modification of the sarcoendoplasmic reticulum Ca2+-ATPase, a modification that irreversibly impairs sarcoendoplasmic reticulum Ca2+ function, thereby contributing to diastolic dysfunction. CONCLUSIONS KCNJ11 expression is decreased in human ICM. Lack of kcnj11 expression increases peroxynitrite-mediated modification of the key calcium-handling protein sarcoendoplasmic reticulum Ca2+-ATPase after myocardial ischemia-reperfusion injury, contributing to impaired diastolic function. These data suggest a mechanism for ischemia-induced diastolic dysfunction in patients with ICM.
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Affiliation(s)
- Bo Zhang
- From the Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute (B.Z., D.G.W., Z.X., R.H., H.H., S.V., J.L.Z.), Department of Physiology and Cell Biology (B.Z., J.L.Z., M.J.K., M.T.Z.), The Ohio State University, Columbus; Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, HuBei, China (B.Z.); Department of Biostatistics (Y.S., M.X., F.E.H.), Division of Clinical Pharmacology, Department of Medicine (D.M.R., C.M.S.), Division of Cardiac Surgery, Department of Surgery (T.A.), Division of Cardiovascular Medicine (T. N., E. C., Y.R.S., D.R., C.L.G., Q.S.W, R.J.G.), Department of Pharmacology and Department of Pathology, Immunology, and Microbiology (R.J.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Tatiana Novitskaya
- From the Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute (B.Z., D.G.W., Z.X., R.H., H.H., S.V., J.L.Z.), Department of Physiology and Cell Biology (B.Z., J.L.Z., M.J.K., M.T.Z.), The Ohio State University, Columbus; Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, HuBei, China (B.Z.); Department of Biostatistics (Y.S., M.X., F.E.H.), Division of Clinical Pharmacology, Department of Medicine (D.M.R., C.M.S.), Division of Cardiac Surgery, Department of Surgery (T.A.), Division of Cardiovascular Medicine (T. N., E. C., Y.R.S., D.R., C.L.G., Q.S.W, R.J.G.), Department of Pharmacology and Department of Pathology, Immunology, and Microbiology (R.J.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Debra G Wheeler
- From the Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute (B.Z., D.G.W., Z.X., R.H., H.H., S.V., J.L.Z.), Department of Physiology and Cell Biology (B.Z., J.L.Z., M.J.K., M.T.Z.), The Ohio State University, Columbus; Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, HuBei, China (B.Z.); Department of Biostatistics (Y.S., M.X., F.E.H.), Division of Clinical Pharmacology, Department of Medicine (D.M.R., C.M.S.), Division of Cardiac Surgery, Department of Surgery (T.A.), Division of Cardiovascular Medicine (T. N., E. C., Y.R.S., D.R., C.L.G., Q.S.W, R.J.G.), Department of Pharmacology and Department of Pathology, Immunology, and Microbiology (R.J.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Zhaobin Xu
- From the Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute (B.Z., D.G.W., Z.X., R.H., H.H., S.V., J.L.Z.), Department of Physiology and Cell Biology (B.Z., J.L.Z., M.J.K., M.T.Z.), The Ohio State University, Columbus; Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, HuBei, China (B.Z.); Department of Biostatistics (Y.S., M.X., F.E.H.), Division of Clinical Pharmacology, Department of Medicine (D.M.R., C.M.S.), Division of Cardiac Surgery, Department of Surgery (T.A.), Division of Cardiovascular Medicine (T. N., E. C., Y.R.S., D.R., C.L.G., Q.S.W, R.J.G.), Department of Pharmacology and Department of Pathology, Immunology, and Microbiology (R.J.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Elena Chepurko
- From the Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute (B.Z., D.G.W., Z.X., R.H., H.H., S.V., J.L.Z.), Department of Physiology and Cell Biology (B.Z., J.L.Z., M.J.K., M.T.Z.), The Ohio State University, Columbus; Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, HuBei, China (B.Z.); Department of Biostatistics (Y.S., M.X., F.E.H.), Division of Clinical Pharmacology, Department of Medicine (D.M.R., C.M.S.), Division of Cardiac Surgery, Department of Surgery (T.A.), Division of Cardiovascular Medicine (T. N., E. C., Y.R.S., D.R., C.L.G., Q.S.W, R.J.G.), Department of Pharmacology and Department of Pathology, Immunology, and Microbiology (R.J.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Ryan Huttinger
- From the Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute (B.Z., D.G.W., Z.X., R.H., H.H., S.V., J.L.Z.), Department of Physiology and Cell Biology (B.Z., J.L.Z., M.J.K., M.T.Z.), The Ohio State University, Columbus; Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, HuBei, China (B.Z.); Department of Biostatistics (Y.S., M.X., F.E.H.), Division of Clinical Pharmacology, Department of Medicine (D.M.R., C.M.S.), Division of Cardiac Surgery, Department of Surgery (T.A.), Division of Cardiovascular Medicine (T. N., E. C., Y.R.S., D.R., C.L.G., Q.S.W, R.J.G.), Department of Pharmacology and Department of Pathology, Immunology, and Microbiology (R.J.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Heng He
- From the Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute (B.Z., D.G.W., Z.X., R.H., H.H., S.V., J.L.Z.), Department of Physiology and Cell Biology (B.Z., J.L.Z., M.J.K., M.T.Z.), The Ohio State University, Columbus; Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, HuBei, China (B.Z.); Department of Biostatistics (Y.S., M.X., F.E.H.), Division of Clinical Pharmacology, Department of Medicine (D.M.R., C.M.S.), Division of Cardiac Surgery, Department of Surgery (T.A.), Division of Cardiovascular Medicine (T. N., E. C., Y.R.S., D.R., C.L.G., Q.S.W, R.J.G.), Department of Pharmacology and Department of Pathology, Immunology, and Microbiology (R.J.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Saradhadevi Varadharaj
- From the Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute (B.Z., D.G.W., Z.X., R.H., H.H., S.V., J.L.Z.), Department of Physiology and Cell Biology (B.Z., J.L.Z., M.J.K., M.T.Z.), The Ohio State University, Columbus; Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, HuBei, China (B.Z.); Department of Biostatistics (Y.S., M.X., F.E.H.), Division of Clinical Pharmacology, Department of Medicine (D.M.R., C.M.S.), Division of Cardiac Surgery, Department of Surgery (T.A.), Division of Cardiovascular Medicine (T. N., E. C., Y.R.S., D.R., C.L.G., Q.S.W, R.J.G.), Department of Pharmacology and Department of Pathology, Immunology, and Microbiology (R.J.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Jay L Zweier
- From the Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute (B.Z., D.G.W., Z.X., R.H., H.H., S.V., J.L.Z.), Department of Physiology and Cell Biology (B.Z., J.L.Z., M.J.K., M.T.Z.), The Ohio State University, Columbus; Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, HuBei, China (B.Z.); Department of Biostatistics (Y.S., M.X., F.E.H.), Division of Clinical Pharmacology, Department of Medicine (D.M.R., C.M.S.), Division of Cardiac Surgery, Department of Surgery (T.A.), Division of Cardiovascular Medicine (T. N., E. C., Y.R.S., D.R., C.L.G., Q.S.W, R.J.G.), Department of Pharmacology and Department of Pathology, Immunology, and Microbiology (R.J.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Yanna Song
- From the Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute (B.Z., D.G.W., Z.X., R.H., H.H., S.V., J.L.Z.), Department of Physiology and Cell Biology (B.Z., J.L.Z., M.J.K., M.T.Z.), The Ohio State University, Columbus; Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, HuBei, China (B.Z.); Department of Biostatistics (Y.S., M.X., F.E.H.), Division of Clinical Pharmacology, Department of Medicine (D.M.R., C.M.S.), Division of Cardiac Surgery, Department of Surgery (T.A.), Division of Cardiovascular Medicine (T. N., E. C., Y.R.S., D.R., C.L.G., Q.S.W, R.J.G.), Department of Pharmacology and Department of Pathology, Immunology, and Microbiology (R.J.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Meng Xu
- From the Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute (B.Z., D.G.W., Z.X., R.H., H.H., S.V., J.L.Z.), Department of Physiology and Cell Biology (B.Z., J.L.Z., M.J.K., M.T.Z.), The Ohio State University, Columbus; Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, HuBei, China (B.Z.); Department of Biostatistics (Y.S., M.X., F.E.H.), Division of Clinical Pharmacology, Department of Medicine (D.M.R., C.M.S.), Division of Cardiac Surgery, Department of Surgery (T.A.), Division of Cardiovascular Medicine (T. N., E. C., Y.R.S., D.R., C.L.G., Q.S.W, R.J.G.), Department of Pharmacology and Department of Pathology, Immunology, and Microbiology (R.J.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Frank E Harrell
- From the Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute (B.Z., D.G.W., Z.X., R.H., H.H., S.V., J.L.Z.), Department of Physiology and Cell Biology (B.Z., J.L.Z., M.J.K., M.T.Z.), The Ohio State University, Columbus; Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, HuBei, China (B.Z.); Department of Biostatistics (Y.S., M.X., F.E.H.), Division of Clinical Pharmacology, Department of Medicine (D.M.R., C.M.S.), Division of Cardiac Surgery, Department of Surgery (T.A.), Division of Cardiovascular Medicine (T. N., E. C., Y.R.S., D.R., C.L.G., Q.S.W, R.J.G.), Department of Pharmacology and Department of Pathology, Immunology, and Microbiology (R.J.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Yan Ru Su
- From the Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute (B.Z., D.G.W., Z.X., R.H., H.H., S.V., J.L.Z.), Department of Physiology and Cell Biology (B.Z., J.L.Z., M.J.K., M.T.Z.), The Ohio State University, Columbus; Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, HuBei, China (B.Z.); Department of Biostatistics (Y.S., M.X., F.E.H.), Division of Clinical Pharmacology, Department of Medicine (D.M.R., C.M.S.), Division of Cardiac Surgery, Department of Surgery (T.A.), Division of Cardiovascular Medicine (T. N., E. C., Y.R.S., D.R., C.L.G., Q.S.W, R.J.G.), Department of Pharmacology and Department of Pathology, Immunology, and Microbiology (R.J.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Tarek Absi
- From the Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute (B.Z., D.G.W., Z.X., R.H., H.H., S.V., J.L.Z.), Department of Physiology and Cell Biology (B.Z., J.L.Z., M.J.K., M.T.Z.), The Ohio State University, Columbus; Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, HuBei, China (B.Z.); Department of Biostatistics (Y.S., M.X., F.E.H.), Division of Clinical Pharmacology, Department of Medicine (D.M.R., C.M.S.), Division of Cardiac Surgery, Department of Surgery (T.A.), Division of Cardiovascular Medicine (T. N., E. C., Y.R.S., D.R., C.L.G., Q.S.W, R.J.G.), Department of Pharmacology and Department of Pathology, Immunology, and Microbiology (R.J.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Mark J Kohr
- From the Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute (B.Z., D.G.W., Z.X., R.H., H.H., S.V., J.L.Z.), Department of Physiology and Cell Biology (B.Z., J.L.Z., M.J.K., M.T.Z.), The Ohio State University, Columbus; Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, HuBei, China (B.Z.); Department of Biostatistics (Y.S., M.X., F.E.H.), Division of Clinical Pharmacology, Department of Medicine (D.M.R., C.M.S.), Division of Cardiac Surgery, Department of Surgery (T.A.), Division of Cardiovascular Medicine (T. N., E. C., Y.R.S., D.R., C.L.G., Q.S.W, R.J.G.), Department of Pharmacology and Department of Pathology, Immunology, and Microbiology (R.J.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Mark T Ziolo
- From the Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute (B.Z., D.G.W., Z.X., R.H., H.H., S.V., J.L.Z.), Department of Physiology and Cell Biology (B.Z., J.L.Z., M.J.K., M.T.Z.), The Ohio State University, Columbus; Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, HuBei, China (B.Z.); Department of Biostatistics (Y.S., M.X., F.E.H.), Division of Clinical Pharmacology, Department of Medicine (D.M.R., C.M.S.), Division of Cardiac Surgery, Department of Surgery (T.A.), Division of Cardiovascular Medicine (T. N., E. C., Y.R.S., D.R., C.L.G., Q.S.W, R.J.G.), Department of Pharmacology and Department of Pathology, Immunology, and Microbiology (R.J.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Dan M Roden
- From the Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute (B.Z., D.G.W., Z.X., R.H., H.H., S.V., J.L.Z.), Department of Physiology and Cell Biology (B.Z., J.L.Z., M.J.K., M.T.Z.), The Ohio State University, Columbus; Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, HuBei, China (B.Z.); Department of Biostatistics (Y.S., M.X., F.E.H.), Division of Clinical Pharmacology, Department of Medicine (D.M.R., C.M.S.), Division of Cardiac Surgery, Department of Surgery (T.A.), Division of Cardiovascular Medicine (T. N., E. C., Y.R.S., D.R., C.L.G., Q.S.W, R.J.G.), Department of Pharmacology and Department of Pathology, Immunology, and Microbiology (R.J.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Christian M Shaffer
- From the Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute (B.Z., D.G.W., Z.X., R.H., H.H., S.V., J.L.Z.), Department of Physiology and Cell Biology (B.Z., J.L.Z., M.J.K., M.T.Z.), The Ohio State University, Columbus; Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, HuBei, China (B.Z.); Department of Biostatistics (Y.S., M.X., F.E.H.), Division of Clinical Pharmacology, Department of Medicine (D.M.R., C.M.S.), Division of Cardiac Surgery, Department of Surgery (T.A.), Division of Cardiovascular Medicine (T. N., E. C., Y.R.S., D.R., C.L.G., Q.S.W, R.J.G.), Department of Pharmacology and Department of Pathology, Immunology, and Microbiology (R.J.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Cristi L Galindo
- From the Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute (B.Z., D.G.W., Z.X., R.H., H.H., S.V., J.L.Z.), Department of Physiology and Cell Biology (B.Z., J.L.Z., M.J.K., M.T.Z.), The Ohio State University, Columbus; Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, HuBei, China (B.Z.); Department of Biostatistics (Y.S., M.X., F.E.H.), Division of Clinical Pharmacology, Department of Medicine (D.M.R., C.M.S.), Division of Cardiac Surgery, Department of Surgery (T.A.), Division of Cardiovascular Medicine (T. N., E. C., Y.R.S., D.R., C.L.G., Q.S.W, R.J.G.), Department of Pharmacology and Department of Pathology, Immunology, and Microbiology (R.J.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Quinn S Wells
- From the Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute (B.Z., D.G.W., Z.X., R.H., H.H., S.V., J.L.Z.), Department of Physiology and Cell Biology (B.Z., J.L.Z., M.J.K., M.T.Z.), The Ohio State University, Columbus; Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, HuBei, China (B.Z.); Department of Biostatistics (Y.S., M.X., F.E.H.), Division of Clinical Pharmacology, Department of Medicine (D.M.R., C.M.S.), Division of Cardiac Surgery, Department of Surgery (T.A.), Division of Cardiovascular Medicine (T. N., E. C., Y.R.S., D.R., C.L.G., Q.S.W, R.J.G.), Department of Pharmacology and Department of Pathology, Immunology, and Microbiology (R.J.G.), Vanderbilt University Medical Center, Nashville, TN
| | - Richard J Gumina
- From the Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute (B.Z., D.G.W., Z.X., R.H., H.H., S.V., J.L.Z.), Department of Physiology and Cell Biology (B.Z., J.L.Z., M.J.K., M.T.Z.), The Ohio State University, Columbus; Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, HuBei, China (B.Z.); Department of Biostatistics (Y.S., M.X., F.E.H.), Division of Clinical Pharmacology, Department of Medicine (D.M.R., C.M.S.), Division of Cardiac Surgery, Department of Surgery (T.A.), Division of Cardiovascular Medicine (T. N., E. C., Y.R.S., D.R., C.L.G., Q.S.W, R.J.G.), Department of Pharmacology and Department of Pathology, Immunology, and Microbiology (R.J.G.), Vanderbilt University Medical Center, Nashville, TN.
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Hill JA, Ardehali R, Clarke KT, Del Zoppo GJ, Eckhardt LL, Griendling KK, Libby P, Roden DM, Sadek HA, Seidman CE, Vaughan DE. Fundamental Cardiovascular Research: Returns on Societal Investment: A Scientific Statement From the American Heart Association. Circ Res 2017; 121:e2-e8. [PMID: 28652256 DOI: 10.1161/res.0000000000000155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Recent decades have witnessed robust successes in conquering the acutely lethal manifestations of heart and vascular diseases. Many patients who previously would have died now survive. Lifesaving successes like these provide a tremendous and easily recognized benefit to individuals and society. Although cardiovascular mortality has declined, the devastating impact of chronic heart disease and comorbidities on quality of life and healthcare resources continues unabated. Future strides, extending those made in recent decades, will require continued research into mechanisms underlying disease prevention, pathogenesis, progression, and therapeutic intervention. However, severe financial constraints currently jeopardize these efforts. To chart a path for the future, this report analyzes the challenges and opportunities we face in continuing the battle against cardiovascular disease and highlights the return on societal investment afforded by fundamental cardiovascular research.
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Roden DM. Reprint of Editiorial Commentary: Genomics and drug discovery: The next frontier in precision medicine. Trends Cardiovasc Med 2017; 27:360-362. [PMID: 28601251 DOI: 10.1016/j.tcm.2017.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Dan M Roden
- Departments of Medicine, Pharmacology, and Biomedical Informatics, Vanderbilt University Medical Center, 2215B Garland Ave, 1285 MRBIV, Nashville, TN 37232-0575.
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Mosley JD, Shoemaker MB, Wells QS, Darbar D, Shaffer CM, Edwards TL, Bastarache L, McCarty CA, Thompson W, Chute CG, Jarvik GP, Crosslin DR, Larson EB, Kullo IJ, Pacheco JA, Peissig PL, Brilliant MH, Linneman JG, Witte JS, Denny JC, Roden DM. Investigating the Genetic Architecture of the PR Interval Using Clinical Phenotypes. ACTA ACUST UNITED AC 2017; 10:CIRCGENETICS.116.001482. [PMID: 28416512 DOI: 10.1161/circgenetics.116.001482] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 03/03/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND One potential use for the PR interval is as a biomarker of disease risk. We hypothesized that quantifying the shared genetic architectures of the PR interval and a set of clinical phenotypes would identify genetic mechanisms contributing to PR variability and identify diseases associated with a genetic predictor of PR variability. METHODS AND RESULTS We used ECG measurements from the ARIC study (Atherosclerosis Risk in Communities; n=6731 subjects) and 63 genetically modulated diseases from the eMERGE network (Electronic Medical Records and Genomics; n=12 978). We measured pairwise genetic correlations (rG) between PR phenotypes (PR interval, PR segment, P-wave duration) and each of the 63 phenotypes. The PR segment was genetically correlated with atrial fibrillation (rG=-0.88; P=0.0009). An analysis of metabolic phenotypes in ARIC also showed that the P wave was genetically correlated with waist circumference (rG=0.47; P=0.02). A genetically predicted PR interval phenotype based on 645 714 single-nucleotide polymorphisms was associated with atrial fibrillation (odds ratio=0.89 per SD change; 95% confidence interval, 0.83-0.95; P=0.0006). The differing pattern of associations among the PR phenotypes is consistent with analyses that show that the genetic correlation between the P wave and PR segment was not significantly different from 0 (rG=-0.03 [0.16]). CONCLUSIONS The genetic architecture of the PR interval comprises modulators of atrial fibrillation risk and obesity.
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Affiliation(s)
- Jonathan D Mosley
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.).
| | - M Benjamin Shoemaker
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Quinn S Wells
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Dawood Darbar
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Christian M Shaffer
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Todd L Edwards
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Lisa Bastarache
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Catherine A McCarty
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Will Thompson
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Christopher G Chute
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Gail P Jarvik
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - David R Crosslin
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Eric B Larson
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Iftikhar J Kullo
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Jennifer A Pacheco
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Peggy L Peissig
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Murray H Brilliant
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - James G Linneman
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - John S Witte
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Josh C Denny
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
| | - Dan M Roden
- From the Department of Medicine (J.D.M., M.B.S., Q.S.W., C.M.S., J.C.D., D.M.R.), Vanderbilt Epidemiology Center (T.L.E.), Department of Biomedical Informatics (L.B., J.C.D., D.M.R.), Department of Pharmacology (D.M.R.), Vanderbilt University, Nashville, TN; Division of Cardiology, University of Illinois at Chicago (D.D.); Essentia Institute of Rural Health, Duluth, MN (C.A.M.); Center for Biomedical Research Informatics, NorthShore University Health System, Evanston, IL (W.T.); School of Medicine (C.G.C.), School of Public Health (C.G.C.), and School of Nursing (C.G.C.), Johns Hopkins University, Baltimore, MD; Division of Medical Genetics, Department of Medicine (G.P.J.), Department of Genome Sciences (G.P.J.), Department of Biomedical Informatics (D.R.C.), Department of Medical Education (D.R.C.), University of Washington; Group Health Research Institute, Seattle, WA (E.B.L.); Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (I.J.K.); Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.A.P.); Biomedical Informatics Research Center (P.L.P.), Center for Human Genetics (M.H.B., J.G.L.), Marshfield Clinic Research Foundation, WI; and Department of Epidemiology and Biostatistics, University of California, San Francisco (J.S.W.)
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Yang Z, Prinsen JK, Bersell KR, Shen W, Yermalitskaya L, Sidorova T, Luis PB, Hall L, Zhang W, Du L, Milne G, Tucker P, George AL, Campbell CM, Pickett RA, Shaffer CM, Chopra N, Yang T, Knollmann BC, Roden DM, Murray KT. Azithromycin Causes a Novel Proarrhythmic Syndrome. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.115.003560. [PMID: 28408648 DOI: 10.1161/circep.115.003560] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 01/26/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND The widely used macrolide antibiotic azithromycin increases risk of cardiovascular and sudden cardiac death, although the underlying mechanisms are unclear. Case reports, including the one we document here, demonstrate that azithromycin can cause rapid, polymorphic ventricular tachycardia in the absence of QT prolongation, indicating a novel proarrhythmic syndrome. We investigated the electrophysiological effects of azithromycin in vivo and in vitro using mice, cardiomyocytes, and human ion channels heterologously expressed in human embryonic kidney (HEK 293) and Chinese hamster ovary (CHO) cells. METHODS AND RESULTS In conscious telemetered mice, acute intraperitoneal and oral administration of azithromycin caused effects consistent with multi-ion channel block, with significant sinus slowing and increased PR, QRS, QT, and QTc intervals, as seen with azithromycin overdose. Similarly, in HL-1 cardiomyocytes, the drug slowed sinus automaticity, reduced phase 0 upstroke slope, and prolonged action potential duration. Acute exposure to azithromycin reduced peak SCN5A currents in HEK cells (IC50=110±3 μmol/L) and Na+ current in mouse ventricular myocytes. However, with chronic (24 hour) exposure, azithromycin caused a ≈2-fold increase in both peak and late SCN5A currents, with findings confirmed for INa in cardiomyocytes. Mild block occurred for K+ currents representing IKr (CHO cells expressing hERG; IC50=219±21 μmol/L) and IKs (CHO cells expressing KCNQ1+KCNE1; IC50=184±12 μmol/L), whereas azithromycin suppressed L-type Ca++ currents (rabbit ventricular myocytes, IC50=66.5±4 μmol/L) and IK1 (HEK cells expressing Kir2.1, IC50=44±3 μmol/L). CONCLUSIONS Chronic exposure to azithromycin increases cardiac Na+ current to promote intracellular Na+ loading, providing a potential mechanistic basis for the novel form of proarrhythmia seen with this macrolide antibiotic.
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Affiliation(s)
- Zhenjiang Yang
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Joseph K Prinsen
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Kevin R Bersell
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Wangzhen Shen
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Liudmila Yermalitskaya
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Tatiana Sidorova
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Paula B Luis
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Lynn Hall
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Wei Zhang
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Liping Du
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Ginger Milne
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Patrick Tucker
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Alfred L George
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Courtney M Campbell
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Robert A Pickett
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Christian M Shaffer
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Nagesh Chopra
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Tao Yang
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Bjorn C Knollmann
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Dan M Roden
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Katherine T Murray
- From the Department of Medicine and Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN.
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Pulley JM, Shirey-Rice JK, Lavieri RR, Jerome RN, Zaleski NM, Aronoff DM, Bastarache L, Niu X, Holroyd KJ, Roden DM, Skaar EP, Niswender CM, Marnett LJ, Lindsley CW, Ekstrom LB, Bentley AR, Bernard GR, Hong CC, Denny JC. Accelerating Precision Drug Development and Drug Repurposing by Leveraging Human Genetics. Assay Drug Dev Technol 2017; 15:113-119. [PMID: 28379727 DOI: 10.1089/adt.2016.772] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The potential impact of using human genetic data linked to longitudinal electronic medical records on drug development is extraordinary; however, the practical application of these data necessitates some organizational innovations. Vanderbilt has created resources such as an easily queried database of >2.6 million de-identified electronic health records linked to BioVU, which is a DNA biobank with more than 230,000 unique samples. To ensure these data are used to maximally benefit and accelerate both de novo drug discovery and drug repurposing efforts, we created the Accelerating Drug Development and Repurposing Incubator, a multidisciplinary think tank of experts in various therapeutic areas within both basic and clinical science as well as experts in legal, business, and other operational domains. The Incubator supports a diverse pipeline of drug indication finding projects, leveraging the natural experiment of human genetics.
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Affiliation(s)
- Jill M Pulley
- 1 Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Jana K Shirey-Rice
- 1 Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Robert R Lavieri
- 1 Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Rebecca N Jerome
- 1 Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Nicole M Zaleski
- 1 Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center , Nashville, Tennessee
| | - David M Aronoff
- 2 Department of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine , Nashville, Tennessee.,3 Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Lisa Bastarache
- 4 Department of Biomedical Informatics, Vanderbilt University School of Medicine , Nashville, Tennessee
| | - Xinnan Niu
- 4 Department of Biomedical Informatics, Vanderbilt University School of Medicine , Nashville, Tennessee
| | - Kenneth J Holroyd
- 1 Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center , Nashville, Tennessee.,5 Center for Technology Transfer and Commercialization, Vanderbilt University , Nashville, Tennessee
| | - Dan M Roden
- 6 Office of Research, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Eric P Skaar
- 7 Department of Pathology, Microbiology, and Immunology, Division of Molecular Pathogenesis, Vanderbilt University School of Medicine , Nashville, Tennessee
| | - Colleen M Niswender
- 8 Department of Pharmacology, Vanderbilt Center for Neuroscience Drug Discovery, Vanderbilt University Medical Center , Nashville, Tennessee.,9 Vanderbilt Kennedy University Center for Excellence in Development Disabilities, Nashville, Tennessee
| | - Lawrence J Marnett
- 10 Department of Chemistry, Vanderbilt University , Nashville, Tennessee.,11 Department of Biochemistry, Vanderbilt University Medical School , Nashville Tennessee
| | - Craig W Lindsley
- 10 Department of Chemistry, Vanderbilt University , Nashville, Tennessee.,12 Department of Medicinal Chemistry, Vanderbilt Center for Neuroscience Drug Discovery, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Leeland B Ekstrom
- 1 Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center , Nashville, Tennessee.,13 Nashville Biosciences, Nashville, Tennessee
| | - Alan R Bentley
- 5 Center for Technology Transfer and Commercialization, Vanderbilt University , Nashville, Tennessee
| | - Gordon R Bernard
- 1 Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center , Nashville, Tennessee.,6 Office of Research, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Charles C Hong
- 14 Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University School of Medicine , Nashville, Tennessee.,15 Department of Cell and Developmental Biology, Vanderbilt University School of Medicine , Nashville, Tennessee
| | - Joshua C Denny
- 4 Department of Biomedical Informatics, Vanderbilt University School of Medicine , Nashville, Tennessee
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236
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Roden DM. Phenome-wide association studies: a new method for functional genomics in humans. J Physiol 2017; 595:4109-4115. [PMID: 28229460 DOI: 10.1113/jp273122] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 02/01/2017] [Indexed: 01/08/2023] Open
Abstract
In experimental physiological research, a common study design for examining the functional role of a gene or a genetic variant is to introduce that genetic variant into a model organism (such as yeast or mouse) and then to search for phenotypic consequences. The development of DNA biobanks linked to dense phenotypic information enables such an experiment to be applied to human subjects in the form of a phenome-wide association study (PheWAS). The PheWAS paradigm takes advantage of a curated medical phenome, often derived from electronic health records, to search for associations between 'input functions' and phenotypes in an unbiased fashion. The most commonly studied input function to date has been single nucleotide polymorphisms (SNPs), but other inputs, such as sets of SNPs or a disease or drug exposure, are now being explored to probe the genetic and phenotypic architecture of human traits. Potential outcomes of these approaches include defining subsets of complex diseases (that can then be targeted by specific therapies) and drug repurposing.
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Affiliation(s)
- Dan M Roden
- Departments of Medicine, Pharmacology and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
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237
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Dumitrescu L, Ritchie MD, Denny JC, El Rouby NM, McDonough CW, Bradford Y, Ramirez AH, Bielinski SJ, Basford MA, Chai HS, Peissig P, Carrell D, Pathak J, Rasmussen LV, Wang X, Pacheco JA, Kho AN, Hayes MG, Matsumoto M, Smith ME, Li R, Cooper-DeHoff RM, Kullo IJ, Chute CG, Chisholm RL, Jarvik GP, Larson EB, Carey D, McCarty CA, Williams MS, Roden DM, Bottinger E, Johnson JA, de Andrade M, Crawford DC. Genome-wide study of resistant hypertension identified from electronic health records. PLoS One 2017; 12:e0171745. [PMID: 28222112 PMCID: PMC5319785 DOI: 10.1371/journal.pone.0171745] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 01/25/2017] [Indexed: 12/11/2022] Open
Abstract
Resistant hypertension is defined as high blood pressure that remains above treatment goals in spite of the concurrent use of three antihypertensive agents from different classes. Despite the important health consequences of resistant hypertension, few studies of resistant hypertension have been conducted. To perform a genome-wide association study for resistant hypertension, we defined and identified cases of resistant hypertension and hypertensives with treated, controlled hypertension among >47,500 adults residing in the US linked to electronic health records (EHRs) and genotyped as part of the electronic MEdical Records & GEnomics (eMERGE) Network. Electronic selection logic using billing codes, laboratory values, text queries, and medication records was used to identify resistant hypertension cases and controls at each site, and a total of 3,006 cases of resistant hypertension and 876 controlled hypertensives were identified among eMERGE Phase I and II sites. After imputation and quality control, a total of 2,530,150 SNPs were tested for an association among 2,830 multi-ethnic cases of resistant hypertension and 876 controlled hypertensives. No test of association was genome-wide significant in the full dataset or in the dataset limited to European American cases (n = 1,719) and controls (n = 708). The most significant finding was CLNK rs13144136 at p = 1.00x10-6 (odds ratio = 0.68; 95% CI = 0.58–0.80) in the full dataset with similar results in the European American only dataset. We also examined whether SNPs known to influence blood pressure or hypertension also influenced resistant hypertension. None was significant after correction for multiple testing. These data highlight both the difficulties and the potential utility of EHR-linked genomic data to study clinically-relevant traits such as resistant hypertension.
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Affiliation(s)
- Logan Dumitrescu
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Marylyn D. Ritchie
- Biomedical and Translational Informatics, Geisinger Health System, Danville, Pennsylvania, United States of America
| | - Joshua C. Denny
- Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Nihal M. El Rouby
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, Florida, United States of America
| | - Caitrin W. McDonough
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, Florida, United States of America
| | - Yuki Bradford
- Biomedical and Translational Informatics, Geisinger Health System, Danville, Pennsylvania, United States of America
| | - Andrea H. Ramirez
- Department of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Suzette J. Bielinski
- Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Melissa A. Basford
- Office of Research, Vanderbilt University, Nashville, Tennessee, United States of America
| | - High Seng Chai
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Peggy Peissig
- Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, Wisconsin, United States of America
| | - David Carrell
- Group Health Research Institute, Seattle, Washington, United States of America
| | - Jyotishman Pathak
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Luke V. Rasmussen
- Department of Preventive Medicine, Division of Health and Biomedical Informatics, Northwestern University, Chicago, Illinois, United States of America
| | - Xiaoming Wang
- Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Jennifer A. Pacheco
- Center for Genetic Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Abel N. Kho
- Department Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - M. Geoffrey Hayes
- Department Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Martha Matsumoto
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Maureen E. Smith
- Center for Genetic Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Rongling Li
- Division of Genomic Medicine, National Human Genome Research Institute, Bethesda, Maryland, United States of America
| | - Rhonda M. Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, Florida, United States of America
- Epidemiology and Biostatistics, Institute for Computational Biology, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Iftikhar J. Kullo
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Christopher G. Chute
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Rex L. Chisholm
- Center for Genetic Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Gail P. Jarvik
- Department of Medicine, University of Washington Medical Center, Seattle, Washington, United States of America
| | - Eric B. Larson
- Group Health Research Institute, Seattle, Washington, United States of America
| | - David Carey
- Weis Center for Research, Geisinger Health System, Danville, Pennsylvania, United States of America
| | | | - Marc S. Williams
- Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania, United States of America
| | - Dan M. Roden
- Department of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Pharmacology, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Erwin Bottinger
- Charles R. Bronfman Institute for Personalized Medicine, Mount Sinai, New York, New York, United States of America
| | - Julie A. Johnson
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, Florida, United States of America
- Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States of America
| | - Mariza de Andrade
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Dana C. Crawford
- Epidemiology and Biostatistics, Institute for Computational Biology, Case Western Reserve University, Cleveland, Ohio, United States of America
- * E-mail:
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238
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Abstract
The QT interval on surface electrocardiograms provides a model of a multicomponent integrated readout of many biological systems, including ion channels, modulatory subunits, signaling systems that modulate their activity, and mechanisms that regulate the expression of their responsible genes. The problem of drug exposure causing exaggerated QT interval prolongation and torsades de pointes highlights the multicomponent nature of cardiac repolarization and the way in which simple perturbations can yield exaggerated responses. Future directions will involve cellular approaches coupled to evolving technologies that can interrogate multicellular systems and provide a sophisticated view of mechanisms in this previously idiosyncratic drug reaction.
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Affiliation(s)
- Dan M Roden
- Oates Institute for Experimental Therapeutics, Vanderbilt University School of Medicine, 1285 MRB IV, Nashville, TN 37232-0575, USA.
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239
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Strauss DG, Vicente J, Johannesen L, Blinova K, Mason JW, Weeke P, Behr ER, Roden DM, Woosley R, Kosova G, Rosenberg MA, Newton-Cheh C. Common Genetic Variant Risk Score Is Associated With Drug-Induced QT Prolongation and Torsade de Pointes Risk: A Pilot Study. Circulation 2017; 135:1300-1310. [PMID: 28213480 DOI: 10.1161/circulationaha.116.023980] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 01/26/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Drug-induced QT interval prolongation, a risk factor for life-threatening ventricular arrhythmias, is a potential side effect of many marketed and withdrawn medications. The contribution of common genetic variants previously associated with baseline QT interval to drug-induced QT prolongation and arrhythmias is not known. METHODS We tested the hypothesis that a weighted combination of common genetic variants contributing to QT interval at baseline, identified through genome-wide association studies, can predict individual response to multiple QT-prolonging drugs. Genetic analysis of 22 subjects was performed in a secondary analysis of a randomized, double-blind, placebo-controlled, crossover trial of 3 QT-prolonging drugs with 15 time-matched QT and plasma drug concentration measurements. Subjects received single doses of dofetilide, quinidine, ranolazine, and placebo. The outcome was the correlation between a genetic QT score comprising 61 common genetic variants and the slope of an individual subject's drug-induced increase in heart rate-corrected QT (QTc) versus drug concentration. RESULTS The genetic QT score was correlated with drug-induced QTc prolongation. Among white subjects, genetic QT score explained 30% of the variability in response to dofetilide (r=0.55; 95% confidence interval, 0.09-0.81; P=0.02), 23% in response to quinidine (r=0.48; 95% confidence interval, -0.03 to 0.79; P=0.06), and 27% in response to ranolazine (r=0.52; 95% confidence interval, 0.05-0.80; P=0.03). Furthermore, the genetic QT score was a significant predictor of drug-induced torsade de pointes in an independent sample of 216 cases compared with 771 controls (r2=12%, P=1×10-7). CONCLUSIONS We demonstrate that a genetic QT score comprising 61 common genetic variants explains a significant proportion of the variability in drug-induced QT prolongation and is a significant predictor of drug-induced torsade de pointes. These findings highlight an opportunity for recent genetic discoveries to improve individualized risk-benefit assessment for pharmacological therapies. Replication of these findings in larger samples is needed to more precisely estimate variance explained and to establish the individual variants that drive these effects. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01873950.
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Affiliation(s)
- David G Strauss
- From Office of Clinical Pharmacology, Center for Drug Evaluation and Research (D.G.S., J.V., L.J.) and Office of Science and Engineering Laboratories, Center for Devices and Radiological Health (D.G.S., J.V., L.J., K.B.), US Food and Drug Administration, Silver Spring, MD; BSICoS Group, Aragón Institute for Engineering Research (I3A), IIS Aragón, University of Zaragoza, Spain (J.V.); Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden (L.J.); Division of Cardiology, University of Utah, Salt Lake City (J.W.M.); Spaulding Clinical Research, West Bend, WI (J.W.M.); Departments of Medicine (P.W., D.R.), Pharmacology (D.R.), and Biomedical Informatics (D.R.), Vanderbilt University Medical Center, Nashville, TN; Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark (P.W.); Cardiology Clinical Academic Group, St. George's University of London, London, UK (E.R.B.); AZCERT, Inc, Oro Valley, AZ (R.W.); Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA (G.K., M.A.R., C.N.-C.); Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (G.K., M.A.R., C.N.-C.); and Division of Cardiac Electrophysiology, Veterans Administration Hospital System of Boston, Harvard Medical School, West Roxbury, MA (M.A.R.).
| | - Jose Vicente
- From Office of Clinical Pharmacology, Center for Drug Evaluation and Research (D.G.S., J.V., L.J.) and Office of Science and Engineering Laboratories, Center for Devices and Radiological Health (D.G.S., J.V., L.J., K.B.), US Food and Drug Administration, Silver Spring, MD; BSICoS Group, Aragón Institute for Engineering Research (I3A), IIS Aragón, University of Zaragoza, Spain (J.V.); Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden (L.J.); Division of Cardiology, University of Utah, Salt Lake City (J.W.M.); Spaulding Clinical Research, West Bend, WI (J.W.M.); Departments of Medicine (P.W., D.R.), Pharmacology (D.R.), and Biomedical Informatics (D.R.), Vanderbilt University Medical Center, Nashville, TN; Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark (P.W.); Cardiology Clinical Academic Group, St. George's University of London, London, UK (E.R.B.); AZCERT, Inc, Oro Valley, AZ (R.W.); Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA (G.K., M.A.R., C.N.-C.); Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (G.K., M.A.R., C.N.-C.); and Division of Cardiac Electrophysiology, Veterans Administration Hospital System of Boston, Harvard Medical School, West Roxbury, MA (M.A.R.)
| | - Lars Johannesen
- From Office of Clinical Pharmacology, Center for Drug Evaluation and Research (D.G.S., J.V., L.J.) and Office of Science and Engineering Laboratories, Center for Devices and Radiological Health (D.G.S., J.V., L.J., K.B.), US Food and Drug Administration, Silver Spring, MD; BSICoS Group, Aragón Institute for Engineering Research (I3A), IIS Aragón, University of Zaragoza, Spain (J.V.); Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden (L.J.); Division of Cardiology, University of Utah, Salt Lake City (J.W.M.); Spaulding Clinical Research, West Bend, WI (J.W.M.); Departments of Medicine (P.W., D.R.), Pharmacology (D.R.), and Biomedical Informatics (D.R.), Vanderbilt University Medical Center, Nashville, TN; Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark (P.W.); Cardiology Clinical Academic Group, St. George's University of London, London, UK (E.R.B.); AZCERT, Inc, Oro Valley, AZ (R.W.); Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA (G.K., M.A.R., C.N.-C.); Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (G.K., M.A.R., C.N.-C.); and Division of Cardiac Electrophysiology, Veterans Administration Hospital System of Boston, Harvard Medical School, West Roxbury, MA (M.A.R.)
| | - Ksenia Blinova
- From Office of Clinical Pharmacology, Center for Drug Evaluation and Research (D.G.S., J.V., L.J.) and Office of Science and Engineering Laboratories, Center for Devices and Radiological Health (D.G.S., J.V., L.J., K.B.), US Food and Drug Administration, Silver Spring, MD; BSICoS Group, Aragón Institute for Engineering Research (I3A), IIS Aragón, University of Zaragoza, Spain (J.V.); Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden (L.J.); Division of Cardiology, University of Utah, Salt Lake City (J.W.M.); Spaulding Clinical Research, West Bend, WI (J.W.M.); Departments of Medicine (P.W., D.R.), Pharmacology (D.R.), and Biomedical Informatics (D.R.), Vanderbilt University Medical Center, Nashville, TN; Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark (P.W.); Cardiology Clinical Academic Group, St. George's University of London, London, UK (E.R.B.); AZCERT, Inc, Oro Valley, AZ (R.W.); Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA (G.K., M.A.R., C.N.-C.); Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (G.K., M.A.R., C.N.-C.); and Division of Cardiac Electrophysiology, Veterans Administration Hospital System of Boston, Harvard Medical School, West Roxbury, MA (M.A.R.)
| | - Jay W Mason
- From Office of Clinical Pharmacology, Center for Drug Evaluation and Research (D.G.S., J.V., L.J.) and Office of Science and Engineering Laboratories, Center for Devices and Radiological Health (D.G.S., J.V., L.J., K.B.), US Food and Drug Administration, Silver Spring, MD; BSICoS Group, Aragón Institute for Engineering Research (I3A), IIS Aragón, University of Zaragoza, Spain (J.V.); Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden (L.J.); Division of Cardiology, University of Utah, Salt Lake City (J.W.M.); Spaulding Clinical Research, West Bend, WI (J.W.M.); Departments of Medicine (P.W., D.R.), Pharmacology (D.R.), and Biomedical Informatics (D.R.), Vanderbilt University Medical Center, Nashville, TN; Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark (P.W.); Cardiology Clinical Academic Group, St. George's University of London, London, UK (E.R.B.); AZCERT, Inc, Oro Valley, AZ (R.W.); Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA (G.K., M.A.R., C.N.-C.); Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (G.K., M.A.R., C.N.-C.); and Division of Cardiac Electrophysiology, Veterans Administration Hospital System of Boston, Harvard Medical School, West Roxbury, MA (M.A.R.)
| | - Peter Weeke
- From Office of Clinical Pharmacology, Center for Drug Evaluation and Research (D.G.S., J.V., L.J.) and Office of Science and Engineering Laboratories, Center for Devices and Radiological Health (D.G.S., J.V., L.J., K.B.), US Food and Drug Administration, Silver Spring, MD; BSICoS Group, Aragón Institute for Engineering Research (I3A), IIS Aragón, University of Zaragoza, Spain (J.V.); Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden (L.J.); Division of Cardiology, University of Utah, Salt Lake City (J.W.M.); Spaulding Clinical Research, West Bend, WI (J.W.M.); Departments of Medicine (P.W., D.R.), Pharmacology (D.R.), and Biomedical Informatics (D.R.), Vanderbilt University Medical Center, Nashville, TN; Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark (P.W.); Cardiology Clinical Academic Group, St. George's University of London, London, UK (E.R.B.); AZCERT, Inc, Oro Valley, AZ (R.W.); Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA (G.K., M.A.R., C.N.-C.); Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (G.K., M.A.R., C.N.-C.); and Division of Cardiac Electrophysiology, Veterans Administration Hospital System of Boston, Harvard Medical School, West Roxbury, MA (M.A.R.)
| | - Elijah R Behr
- From Office of Clinical Pharmacology, Center for Drug Evaluation and Research (D.G.S., J.V., L.J.) and Office of Science and Engineering Laboratories, Center for Devices and Radiological Health (D.G.S., J.V., L.J., K.B.), US Food and Drug Administration, Silver Spring, MD; BSICoS Group, Aragón Institute for Engineering Research (I3A), IIS Aragón, University of Zaragoza, Spain (J.V.); Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden (L.J.); Division of Cardiology, University of Utah, Salt Lake City (J.W.M.); Spaulding Clinical Research, West Bend, WI (J.W.M.); Departments of Medicine (P.W., D.R.), Pharmacology (D.R.), and Biomedical Informatics (D.R.), Vanderbilt University Medical Center, Nashville, TN; Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark (P.W.); Cardiology Clinical Academic Group, St. George's University of London, London, UK (E.R.B.); AZCERT, Inc, Oro Valley, AZ (R.W.); Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA (G.K., M.A.R., C.N.-C.); Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (G.K., M.A.R., C.N.-C.); and Division of Cardiac Electrophysiology, Veterans Administration Hospital System of Boston, Harvard Medical School, West Roxbury, MA (M.A.R.)
| | - Dan M Roden
- From Office of Clinical Pharmacology, Center for Drug Evaluation and Research (D.G.S., J.V., L.J.) and Office of Science and Engineering Laboratories, Center for Devices and Radiological Health (D.G.S., J.V., L.J., K.B.), US Food and Drug Administration, Silver Spring, MD; BSICoS Group, Aragón Institute for Engineering Research (I3A), IIS Aragón, University of Zaragoza, Spain (J.V.); Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden (L.J.); Division of Cardiology, University of Utah, Salt Lake City (J.W.M.); Spaulding Clinical Research, West Bend, WI (J.W.M.); Departments of Medicine (P.W., D.R.), Pharmacology (D.R.), and Biomedical Informatics (D.R.), Vanderbilt University Medical Center, Nashville, TN; Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark (P.W.); Cardiology Clinical Academic Group, St. George's University of London, London, UK (E.R.B.); AZCERT, Inc, Oro Valley, AZ (R.W.); Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA (G.K., M.A.R., C.N.-C.); Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (G.K., M.A.R., C.N.-C.); and Division of Cardiac Electrophysiology, Veterans Administration Hospital System of Boston, Harvard Medical School, West Roxbury, MA (M.A.R.)
| | - Ray Woosley
- From Office of Clinical Pharmacology, Center for Drug Evaluation and Research (D.G.S., J.V., L.J.) and Office of Science and Engineering Laboratories, Center for Devices and Radiological Health (D.G.S., J.V., L.J., K.B.), US Food and Drug Administration, Silver Spring, MD; BSICoS Group, Aragón Institute for Engineering Research (I3A), IIS Aragón, University of Zaragoza, Spain (J.V.); Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden (L.J.); Division of Cardiology, University of Utah, Salt Lake City (J.W.M.); Spaulding Clinical Research, West Bend, WI (J.W.M.); Departments of Medicine (P.W., D.R.), Pharmacology (D.R.), and Biomedical Informatics (D.R.), Vanderbilt University Medical Center, Nashville, TN; Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark (P.W.); Cardiology Clinical Academic Group, St. George's University of London, London, UK (E.R.B.); AZCERT, Inc, Oro Valley, AZ (R.W.); Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA (G.K., M.A.R., C.N.-C.); Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (G.K., M.A.R., C.N.-C.); and Division of Cardiac Electrophysiology, Veterans Administration Hospital System of Boston, Harvard Medical School, West Roxbury, MA (M.A.R.)
| | - Gulum Kosova
- From Office of Clinical Pharmacology, Center for Drug Evaluation and Research (D.G.S., J.V., L.J.) and Office of Science and Engineering Laboratories, Center for Devices and Radiological Health (D.G.S., J.V., L.J., K.B.), US Food and Drug Administration, Silver Spring, MD; BSICoS Group, Aragón Institute for Engineering Research (I3A), IIS Aragón, University of Zaragoza, Spain (J.V.); Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden (L.J.); Division of Cardiology, University of Utah, Salt Lake City (J.W.M.); Spaulding Clinical Research, West Bend, WI (J.W.M.); Departments of Medicine (P.W., D.R.), Pharmacology (D.R.), and Biomedical Informatics (D.R.), Vanderbilt University Medical Center, Nashville, TN; Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark (P.W.); Cardiology Clinical Academic Group, St. George's University of London, London, UK (E.R.B.); AZCERT, Inc, Oro Valley, AZ (R.W.); Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA (G.K., M.A.R., C.N.-C.); Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (G.K., M.A.R., C.N.-C.); and Division of Cardiac Electrophysiology, Veterans Administration Hospital System of Boston, Harvard Medical School, West Roxbury, MA (M.A.R.)
| | - Michael A Rosenberg
- From Office of Clinical Pharmacology, Center for Drug Evaluation and Research (D.G.S., J.V., L.J.) and Office of Science and Engineering Laboratories, Center for Devices and Radiological Health (D.G.S., J.V., L.J., K.B.), US Food and Drug Administration, Silver Spring, MD; BSICoS Group, Aragón Institute for Engineering Research (I3A), IIS Aragón, University of Zaragoza, Spain (J.V.); Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden (L.J.); Division of Cardiology, University of Utah, Salt Lake City (J.W.M.); Spaulding Clinical Research, West Bend, WI (J.W.M.); Departments of Medicine (P.W., D.R.), Pharmacology (D.R.), and Biomedical Informatics (D.R.), Vanderbilt University Medical Center, Nashville, TN; Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark (P.W.); Cardiology Clinical Academic Group, St. George's University of London, London, UK (E.R.B.); AZCERT, Inc, Oro Valley, AZ (R.W.); Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA (G.K., M.A.R., C.N.-C.); Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (G.K., M.A.R., C.N.-C.); and Division of Cardiac Electrophysiology, Veterans Administration Hospital System of Boston, Harvard Medical School, West Roxbury, MA (M.A.R.)
| | - Christopher Newton-Cheh
- From Office of Clinical Pharmacology, Center for Drug Evaluation and Research (D.G.S., J.V., L.J.) and Office of Science and Engineering Laboratories, Center for Devices and Radiological Health (D.G.S., J.V., L.J., K.B.), US Food and Drug Administration, Silver Spring, MD; BSICoS Group, Aragón Institute for Engineering Research (I3A), IIS Aragón, University of Zaragoza, Spain (J.V.); Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden (L.J.); Division of Cardiology, University of Utah, Salt Lake City (J.W.M.); Spaulding Clinical Research, West Bend, WI (J.W.M.); Departments of Medicine (P.W., D.R.), Pharmacology (D.R.), and Biomedical Informatics (D.R.), Vanderbilt University Medical Center, Nashville, TN; Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark (P.W.); Cardiology Clinical Academic Group, St. George's University of London, London, UK (E.R.B.); AZCERT, Inc, Oro Valley, AZ (R.W.); Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA (G.K., M.A.R., C.N.-C.); Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge (G.K., M.A.R., C.N.-C.); and Division of Cardiac Electrophysiology, Veterans Administration Hospital System of Boston, Harvard Medical School, West Roxbury, MA (M.A.R.).
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Heit JA, Armasu SM, McCauley BM, Kullo IJ, Sicotte H, Pathak J, Chute CG, Gottesman O, Bottinger EP, Denny JC, Roden DM, Li R, Ritchie MD, de Andrade M. Identification of unique venous thromboembolism-susceptibility variants in African-Americans. Thromb Haemost 2017; 117:758-768. [PMID: 28203683 DOI: 10.1160/th16-08-0652] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 01/12/2017] [Indexed: 12/30/2022]
Abstract
To identify novel single nucleotide polymorphisms (SNPs) associated with venous thromboembolism (VTE) in African-Americans (AAs), we performed a genome-wide association study (GWAS) of VTE in AAs using the Electronic Medical Records and Genomics (eMERGE) Network, comprised of seven sites each with DNA biobanks (total ~39,200 unique DNA samples) with genome-wide SNP data (imputed to 1000 Genomes Project cosmopolitan reference panel) and linked to electronic health records (EHRs). Using a validated EHR-driven phenotype extraction algorithm, we identified VTE cases and controls and tested for an association between each SNP and VTE using unconditional logistic regression, adjusted for age, sex, stroke, site-platform combination and sickle cell risk genotype. Among 393 AA VTE cases and 4,941 AA controls, three intragenic SNPs reached genome-wide significance: LEMD3 rs138916004 (OR=3.2; p=1.3E-08), LY86 rs3804476 (OR=1.8; p=2E-08) and LOC100130298 rs142143628 (OR=4.5; p=4.4E-08); all three SNPs validated using internal cross-validation, parametric bootstrap and meta-analysis methods. LEMD3 rs138916004 and LOC100130298 rs142143628 are only present in Africans (1000G data). LEMD3 showed a significant differential expression in both NCBI Gene Expression Omnibus (GEO) and the Mayo Clinic gene expression data, LOC100130298 showed a significant differential expression only in the GEO expression data, and LY86 showed a significant differential expression only in the Mayo expression data. LEMD3 encodes for an antagonist of TGF-β-induced cell proliferation arrest. LY86 encodes for MD-1 which down-regulates the pro-inflammatory response to lipopolysaccharide; LY86 variation was previously associated with VTE in white women; LOC100130298 is a non-coding RNA gene with unknown regulatory activity in gene expression and epigenetics.
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Affiliation(s)
- John A Heit
- John A. Heit, MD, Stabile 6-Hematology Research, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA, Tel.: +1 507 284 4634, Fax: +1 507 266 9302, E-mail:
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241
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Schmidt AF, Swerdlow DI, Holmes MV, Patel RS, Fairhurst-Hunter Z, Lyall DM, Hartwig FP, Horta BL, Hyppönen E, Power C, Moldovan M, van Iperen E, Hovingh GK, Demuth I, Norman K, Steinhagen-Thiessen E, Demuth J, Bertram L, Liu T, Coassin S, Willeit J, Kiechl S, Willeit K, Mason D, Wright J, Morris R, Wanamethee G, Whincup P, Ben-Shlomo Y, McLachlan S, Price JF, Kivimaki M, Welch C, Sanchez-Galvez A, Marques-Vidal P, Nicolaides A, Panayiotou AG, Onland-Moret NC, van der Schouw YT, Matullo G, Fiorito G, Guarrera S, Sacerdote C, Wareham NJ, Langenberg C, Scott R, Luan J, Bobak M, Malyutina S, Pająk A, Kubinova R, Tamosiunas A, Pikhart H, Husemoen LLN, Grarup N, Pedersen O, Hansen T, Linneberg A, Simonsen KS, Cooper J, Humphries SE, Brilliant M, Kitchner T, Hakonarson H, Carrell DS, McCarty CA, Kirchner HL, Larson EB, Crosslin DR, de Andrade M, Roden DM, Denny JC, Carty C, Hancock S, Attia J, Holliday E, O'Donnell M, Yusuf S, Chong M, Pare G, van der Harst P, Said MA, Eppinga RN, Verweij N, Snieder H, Christen T, Mook-Kanamori DO, Gustafsson S, Lind L, Ingelsson E, Pazoki R, Franco O, Hofman A, Uitterlinden A, Dehghan A, Teumer A, Baumeister S, Dörr M, Lerch MM, Völker U, Völzke H, Ward J, Pell JP, Smith DJ, Meade T, Maitland-van der Zee AH, Baranova EV, Young R, Ford I, Campbell A, Padmanabhan S, Bots ML, Grobbee DE, Froguel P, Thuillier D, Balkau B, Bonnefond A, Cariou B, Smart M, Bao Y, Kumari M, Mahajan A, Ridker PM, Chasman DI, Reiner AP, Lange LA, Ritchie MD, Asselbergs FW, Casas JP, Keating BJ, Preiss D, Hingorani AD, Sattar N. PCSK9 genetic variants and risk of type 2 diabetes: a mendelian randomisation study. Lancet Diabetes Endocrinol 2017; 5:97-105. [PMID: 27908689 PMCID: PMC5266795 DOI: 10.1016/s2213-8587(16)30396-5] [Citation(s) in RCA: 263] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/17/2016] [Accepted: 11/17/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Statin treatment and variants in the gene encoding HMG-CoA reductase are associated with reductions in both the concentration of LDL cholesterol and the risk of coronary heart disease, but also with modest hyperglycaemia, increased bodyweight, and modestly increased risk of type 2 diabetes, which in no way offsets their substantial benefits. We sought to investigate the associations of LDL cholesterol-lowering PCSK9 variants with type 2 diabetes and related biomarkers to gauge the likely effects of PCSK9 inhibitors on diabetes risk. METHODS In this mendelian randomisation study, we used data from cohort studies, randomised controlled trials, case control studies, and genetic consortia to estimate associations of PCSK9 genetic variants with LDL cholesterol, fasting blood glucose, HbA1c, fasting insulin, bodyweight, waist-to-hip ratio, BMI, and risk of type 2 diabetes, using a standardised analysis plan, meta-analyses, and weighted gene-centric scores. FINDINGS Data were available for more than 550 000 individuals and 51 623 cases of type 2 diabetes. Combined analyses of four independent PCSK9 variants (rs11583680, rs11591147, rs2479409, and rs11206510) scaled to 1 mmol/L lower LDL cholesterol showed associations with increased fasting glucose (0·09 mmol/L, 95% CI 0·02 to 0·15), bodyweight (1·03 kg, 0·24 to 1·82), waist-to-hip ratio (0·006, 0·003 to 0·010), and an odds ratio for type diabetes of 1·29 (1·11 to 1·50). Based on the collected data, we did not identify associations with HbA1c (0·03%, -0·01 to 0·08), fasting insulin (0·00%, -0·06 to 0·07), and BMI (0·11 kg/m2, -0·09 to 0·30). INTERPRETATION PCSK9 variants associated with lower LDL cholesterol were also associated with circulating higher fasting glucose concentration, bodyweight, and waist-to-hip ratio, and an increased risk of type 2 diabetes. In trials of PCSK9 inhibitor drugs, investigators should carefully assess these safety outcomes and quantify the risks and benefits of PCSK9 inhibitor treatment, as was previously done for statins. FUNDING British Heart Foundation, and University College London Hospitals NHS Foundation Trust (UCLH) National Institute for Health Research (NIHR) Biomedical Research Centre.
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Affiliation(s)
- Amand F Schmidt
- Institute of Cardiovascular Science, University College London, UK; Farr Institute of Health Informatics Research, UCL Institute of Health Informatics, University College London, UK.
| | - Daniel I Swerdlow
- Institute of Cardiovascular Science, University College London, UK; Department of Medicine, Imperial College London, London, UK
| | - Michael V Holmes
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit at the University of Oxford, University of Oxford, Oxford, UK
| | - Riyaz S Patel
- Institute of Cardiovascular Science, University College London, UK; Farr Institute of Health Informatics Research, UCL Institute of Health Informatics, University College London, UK; The Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | | | - Donald M Lyall
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Bernardo Lessa Horta
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Elina Hyppönen
- Centre for Population Health Research, Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia; Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK; South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Christine Power
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Max Moldovan
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia; South Australian Health and Medical Research Institute-EMBL Australia, Adelaide, SA, Australia
| | - Erik van Iperen
- Durrer Center for Cardiovascular Research, Netherlands Heart Institute, Utrecht, Netherlands; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center Amsterdam, Netherlands
| | - G Kees Hovingh
- Department of Vascular Medicine, Academic Medical Center Amsterdam, Netherlands
| | - Ilja Demuth
- Charité Research Group on Geriatrics, Charité-Universitätsmedizin Berlin, Berlin, Germany; Institute of Medical and Human Genetics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kristina Norman
- Charité Research Group on Geriatrics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Lars Bertram
- Neuroepidemiology and Ageing Research Unit, Imperial College London, London, UK; Lübeck Interdisciplinary Platform for Genome Analytics (LIGA), Institutes of Neurogenetics and Integrative and Experimental Genomics, University of Lübeck, Lübeck, Germany
| | - Tian Liu
- Max Planck Institute for Human Development, Berlin, Germany; Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Stefan Coassin
- Division of Genetic Epidemiology Innsbruck, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Johann Willeit
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Karin Willeit
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Dan Mason
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Richard Morris
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Goya Wanamethee
- Department of Primary Care & Population Health, University College London, UK
| | - Peter Whincup
- Population Health Research Institute, St George's, University of London, London, UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Stela McLachlan
- Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Jackie F Price
- Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, University College London, UK
| | - Catherine Welch
- Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, University College London, UK
| | - Adelaida Sanchez-Galvez
- Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, University College London, UK
| | - Pedro Marques-Vidal
- Internal Medicine Unit, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Andrew Nicolaides
- Department of Vascular Surgery, Imperial College London, London, UK; Department of Surgery, Nicosia Medical School, University of Nicosia, Nicosia, Cyprus
| | - Andrie G Panayiotou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Giuseppe Matullo
- Human Genetics Foundation, HuGeF, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giovanni Fiorito
- Human Genetics Foundation, HuGeF, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Simonetta Guarrera
- Human Genetics Foundation, HuGeF, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Carlotta Sacerdote
- Cancer Epidemiology Unit, San Giovanni Battista Hospital, Turin, Italy; Centre for Oncology Prevention, CPO Piemonte, Turin, Italy
| | - Nicholas J Wareham
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Claudia Langenberg
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Robert Scott
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jian'an Luan
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Martin Bobak
- Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, University College London, UK
| | - Sofia Malyutina
- Novosibirsk State Medical University, Novosibirsk, Russia; Institute of Internal and Preventive Medicine, Siberian Branch of the Russian Academy of Medical Sciences, Novosibirsk, Russia
| | - Andrzej Pająk
- Jagiellonian University Collegium Medicum, Krakow, Poland
| | | | | | - Hynek Pikhart
- Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, University College London, UK
| | | | - Niels Grarup
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Oluf Pedersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Allan Linneberg
- Research Centre for Prevention and Health, Capital Region of Denmark, Denmark; Department of Clinical Experimental Research, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Jackie Cooper
- Centre for Cardiovascular Genetics, University College London, UK
| | | | - Murray Brilliant
- Center for Human Genetics, Marshfield Clinic Research Foundation, Marshfield, WI, USA
| | - Terrie Kitchner
- Center for Human Genetics, Marshfield Clinic Research Foundation, Marshfield, WI, USA
| | | | | | | | | | | | | | - Mariza de Andrade
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Dan M Roden
- Departments of Medicine and Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Joshua C Denny
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Cara Carty
- George Washington University, Washington, DC, USA
| | | | - John Attia
- University of Newcastle, Newcastle, NSW, Australia
| | | | | | - Salim Yusuf
- Population Health Research Institute, Hamilton, ON, Canada
| | - Michael Chong
- Population Health Research Institute, Hamilton, ON, Canada
| | - Guillaume Pare
- Population Health Research Institute, Hamilton, ON, Canada
| | - Pim van der Harst
- Durrer Center for Cardiovascular Research, Netherlands Heart Institute, Utrecht, Netherlands; Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands; Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - M Abdullah Said
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ruben N Eppinga
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Niek Verweij
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Harold Snieder
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Tim Christen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Dennis O Mook-Kanamori
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Stefan Gustafsson
- Molecular Epidemiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Lars Lind
- Molecular Epidemiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Erik Ingelsson
- Molecular Epidemiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Science for Life Laboratory, Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Raha Pazoki
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Oscar Franco
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Andre Uitterlinden
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Abbas Dehghan
- Faculty of Medicine, and Department of Biostatistics and Epidemiology, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), Greifswald, Germany
| | - Sebastian Baumeister
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany; Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), Greifswald, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Uwe Völker
- Interfaculty Institute of Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), Greifswald, Germany
| | - Joey Ward
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Jill P Pell
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel J Smith
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Tom Meade
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Anke H Maitland-van der Zee
- Department of Respiratory Medicine, Academic Medical Center Amsterdam, Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, Netherlands
| | - Ekaterina V Baranova
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, Netherlands
| | - Robin Young
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Archie Campbell
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Sandosh Padmanabhan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Philippe Froguel
- Department of Genomics of Common Disease, Imperial College London, London, UK; CNRS UMR 8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur de Lille, University of Lille, Lille, France
| | - Dorothée Thuillier
- CNRS UMR 8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur de Lille, University of Lille, Lille, France
| | - Beverley Balkau
- Renal and Cardiovascular Epidemiology, Centre de Recherche en Epidémiologie et Santé des Populations (CESP), INSERM U1018, Villejuif, France
| | - Amélie Bonnefond
- Department of Genomics of Common Disease, Imperial College London, London, UK; CNRS UMR 8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur de Lille, University of Lille, Lille, France
| | - Bertrand Cariou
- I'institut du Thorax, INSERM, CNRS, University of Nantes, CHU de Nantes, Nantes, France
| | - Melissa Smart
- Institute for Social and Economic Research, University of Essex, Colchester, Essex, UK
| | - Yanchun Bao
- Institute for Social and Economic Research, University of Essex, Colchester, Essex, UK
| | - Meena Kumari
- Institute for Social and Economic Research, University of Essex, Colchester, Essex, UK
| | - Anubha Mahajan
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Paul M Ridker
- Harvard Medical School Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Boston, MA, USA
| | - Daniel I Chasman
- Harvard Medical School Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Boston, MA, USA
| | - Alex P Reiner
- Department of Epidemiology, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - Leslie A Lange
- Anschutz Medical Campus, University of Colorado Denver, Denver, CO, USA
| | - Marylyn D Ritchie
- Biomedical and Translational Informatics, Geisinger Health System, Danville, PA, USA; Department of Biochemistry and Molecular Biology, Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, USA
| | - Folkert W Asselbergs
- Institute of Cardiovascular Science, University College London, UK; Farr Institute of Health Informatics Research, UCL Institute of Health Informatics, University College London, UK; Durrer Center for Cardiovascular Research, Netherlands Heart Institute, Utrecht, Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands; Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Juan-Pablo Casas
- Farr Institute of Health Informatics Research, UCL Institute of Health Informatics, University College London, UK
| | - Brendan J Keating
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - David Preiss
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit at the University of Oxford, University of Oxford, Oxford, UK
| | - Aroon D Hingorani
- Institute of Cardiovascular Science, University College London, UK; Farr Institute of Health Informatics Research, UCL Institute of Health Informatics, University College London, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
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Wiley LK, Vanhouten JP, Samuels DC, Aldrich MC, Roden DM, Peterson JF, Denny JC. STRATEGIES FOR EQUITABLE PHARMACOGENOMIC-GUIDED WARFARIN DOSING AMONG EUROPEAN AND AFRICAN AMERICAN INDIVIDUALS IN A CLINICAL POPULATION. Pac Symp Biocomput 2017; 22:545-556. [PMID: 27897005 PMCID: PMC5389380 DOI: 10.1142/9789813207813_0050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The blood thinner warfarin has a narrow therapeutic range and high inter- and intra-patient variability in therapeutic doses. Several studies have shown that pharmacogenomic variants help predict stable warfarin dosing. However, retrospective and randomized controlled trials that employ dosing algorithms incorporating pharmacogenomic variants under perform in African Americans. This study sought to determine if: 1) including additional variants associated with warfarin dose in African Americans, 2) predicting within single ancestry groups rather than a combined population, or 3) using percentage African ancestry rather than observed race, would improve warfarin dosing algorithms in African Americans. Using BioVU, the Vanderbilt University Medical Center biobank linked to electronic medical records, we compared 25 modeling strategies to existing algorithms using a cohort of 2,181 warfarin users (1,928 whites, 253 blacks). We found that approaches incorporating additional variants increased model accuracy, but not in clinically significant ways. Race stratification increased model fidelity for African Americans, but the improvement was small and not likely to be clinically significant. Use of percent African ancestry improved model fit in the context of race misclassification.
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Affiliation(s)
- Laura K Wiley
- Div. of Biomedical Informatics and Personalized Med., University of Colorado, 13001 E. 17th Pl. MS F-563 Aurora, CO 80045, USA,
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243
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Abstract
The manuscript "Anticoagulation Endpoints With Clinical Implementation of Warfarin Pharmacogenetic Dosing in a Real- World Setting: A Proposal for a New Pharmacogenetic Dosing Approach" describes process outcomes in an institutional program to use pharmacogenetic testing to optimize warfarin dose in a cohort of 257 patients of diverse ancestries. The strengths and weaknesses of the approach and program are discussed, along with the current and potential future status of warfarin as a model for pharmacogenetic testing.
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Affiliation(s)
- D M Roden
- Departments of Medicine, Pharmacology, and Biomedical Informatics, Oates Institute for Experimental Therapeutics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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244
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Affiliation(s)
- Calum A MacRae
- From Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (C.A.M., J.L.); Harvard Medical School, Boston, MA (C.A.M., J.L.); and Cardiology Division, Department of Medicine, Vanderbilt University Medical School, Nashville, TN (D.M.R.).
| | - Dan M Roden
- From Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (C.A.M., J.L.); Harvard Medical School, Boston, MA (C.A.M., J.L.); and Cardiology Division, Department of Medicine, Vanderbilt University Medical School, Nashville, TN (D.M.R.)
| | - Joseph Loscalzo
- From Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA (C.A.M., J.L.); Harvard Medical School, Boston, MA (C.A.M., J.L.); and Cardiology Division, Department of Medicine, Vanderbilt University Medical School, Nashville, TN (D.M.R.)
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Kolek MJ, Graves AJ, Xu M, Bian A, Teixeira PL, Shoemaker MB, Parvez B, Xu H, Heckbert SR, Ellinor PT, Benjamin EJ, Alonso A, Denny JC, Moons KGM, Shintani AK, Harrell FE, Roden DM, Darbar D. Evaluation of a Prediction Model for the Development of Atrial Fibrillation in a Repository of Electronic Medical Records. JAMA Cardiol 2016; 1:1007-1013. [PMID: 27732699 DOI: 10.1001/jamacardio.2016.3366] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Importance Atrial fibrillation (AF) contributes to substantial morbidity, mortality, and health care expenditures. Accurate prediction of incident AF would enhance AF management and potentially improve patient outcomes. Objective To validate the AF risk prediction model originally developed by the Cohorts for Heart and Aging Research in Genomic Epidemiology-Atrial Fibrillation (CHARGE-AF) investigators using a large repository of electronic medical records (EMRs). Design, Setting, and Participants In this prediction model study, deidentified EMRs of 33 494 individuals 40 years or older who were white or African American and had no history of AF were reviewed and analyzed. The participants were followed up in the internal medicine outpatient clinics at Vanderbilt University Medical Center for incident AF from December 31, 2005, until December 31, 2010. Adjusting for differences in baseline hazard, the CHARGE-AF Cox proportional hazards model regression coefficients were applied to the EMR cohort. A simple version of the model with no echocardiographic variables was also evaluated. Data were analyzed from October 31, 2013, to January 31, 2014. Main Outcomes and Measures Incident AF. Predictors in the model included age, race, height, weight, systolic and diastolic blood pressure, treatment for hypertension, smoking status, type 2 diabetes, heart failure, history of myocardial infarction, left ventricular hypertrophy, and PR interval. Results Among the 33 494 participants, the median age was 57 (interquartile range, 49-67) years; 57% of patients were women, 43% were men, 85.7% were white, and 14.3% were African American. During the mean (SD) follow-up of 4.8 (0.9) years, 2455 individuals (7.3%) developed AF. Both models had poor calibration in the EMR cohort, with underprediction of AF among low-risk individuals and overprediction of AF among high-risk individuals (10th and 90th percentiles for predicted probability of incident AF, 0.005 and 0.179, respectively). The full CHARGE-AF model had a C index of 0.708 (95% CI, 0.699-0.718) in our cohort. The simple model had similar discrimination (C index, 0.709; 95% CI, 0.699-0.718; P = .70 for difference between models). Conclusions and Relevance Despite reasonable discrimination, the CHARGE-AF models showed poor calibration in this EMR cohort. This study highlights the difficulties of applying a risk model derived from prospective cohort studies to an EMR cohort and suggests that these AF risk prediction models be used with caution in the EMR setting. Future risk models may need to be developed and validated within EMR cohorts.
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Affiliation(s)
- Matthew J Kolek
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Amy J Graves
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Meng Xu
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Pedro Luis Teixeira
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - M Benjamin Shoemaker
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Babar Parvez
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Hua Xu
- School of Biomedical Informatics, University of Texas Health Science Center at Houston
| | | | | | - Emelia J Benjamin
- Framingham Heart Study, National Heart Lung and Blood Institute and Boston University, Framingham, Massachusetts8Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Joshua C Denny
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Karel G M Moons
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee10Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Frank E Harrell
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Dan M Roden
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Dawood Darbar
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee12Division of Cardiology, University of Illinois at Chicago
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Husser D, Ueberham L, Dinov B, Kosiuk J, Kornej J, Hindricks G, Shoemaker MB, Roden DM, Bollmann A, Büttner P. Genomic contributors to atrial electroanatomical remodeling and atrial fibrillation progression: Pathway enrichment analysis of GWAS data. Sci Rep 2016; 6:36630. [PMID: 27857207 PMCID: PMC5114680 DOI: 10.1038/srep36630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/11/2016] [Indexed: 12/18/2022] Open
Abstract
In atrial fibrillation (AF), left atrial diameter (LAD) and low voltage area (LVA) are intermediate phenotypes that are associated with AF type and progression. In this study, we tested the hypothesis, that these phenotypes share common, genetically-determined pathways using pathway enrichment analysis of GWAS data. Samples from 660 patients with paroxysmal (n = 370) or persistent AF (n = 290) were genotyped for ~1,000,000 SNPs. SNPs found significantly associated with LAD, LVA or AF type were used for gene-based association tests in a systematic biological Knowledge-based mining system for Genome-wide Genetic studies (KGG). Associated genes were tested for pathway enrichment using two enrichment tools (WebGestalt and GATHER) and the databases provided by Kyoto Encyclopedia of Genes and Genomes. The calcium signaling pathway (hsa04020) was the only pathway that reached statistical significance for LAD and LVA in both enrichment tools and was also significantly associated with AF type. Within this pathway, there were 39 genes (i.e. CACNA1C, RyR2) that were associated with LAD, LVA and AF type. In conclusion, there is a genomic contribution to electroanatomical remodeling (LAD, LVA) and AF type via the calcium signaling pathway. Future and larger studies are necessary to replicate and apply these findings.
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Affiliation(s)
- Daniela Husser
- Department of Electrophysiology, Heart Center Leipzig, Leipzig University, Germany
| | - Laura Ueberham
- Department of Electrophysiology, Heart Center Leipzig, Leipzig University, Germany
| | - Borislav Dinov
- Department of Electrophysiology, Heart Center Leipzig, Leipzig University, Germany
| | - Jedrzej Kosiuk
- Department of Electrophysiology, Heart Center Leipzig, Leipzig University, Germany
| | - Jelena Kornej
- Department of Electrophysiology, Heart Center Leipzig, Leipzig University, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig, Leipzig University, Germany
| | | | - Dan M Roden
- Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig, Leipzig University, Germany
| | - Petra Büttner
- Department of Electrophysiology, Heart Center Leipzig, Leipzig University, Germany
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247
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Johnson DB, Balko JM, Compton ML, Chalkias S, Gorham J, Xu Y, Hicks M, Puzanov I, Alexander MR, Bloomer TL, Becker JR, Slosky DA, Phillips EJ, Pilkinton MA, Craig-Owens L, Kola N, Plautz G, Reshef DS, Deutsch JS, Deering RP, Olenchock BA, Lichtman AH, Roden DM, Seidman CE, Koralnik IJ, Seidman JG, Hoffman RD, Taube JM, Diaz LA, Anders RA, Sosman JA, Moslehi JJ. Fulminant Myocarditis with Combination Immune Checkpoint Blockade. N Engl J Med 2016; 375:1749-1755. [PMID: 27806233 PMCID: PMC5247797 DOI: 10.1056/nejmoa1609214] [Citation(s) in RCA: 1472] [Impact Index Per Article: 184.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Immune checkpoint inhibitors have improved clinical outcomes associated with numerous cancers, but high-grade, immune-related adverse events can occur, particularly with combination immunotherapy. We report the cases of two patients with melanoma in whom fatal myocarditis developed after treatment with ipilimumab and nivolumab. In both patients, there was development of myositis with rhabdomyolysis, early progressive and refractory cardiac electrical instability, and myocarditis with a robust presence of T-cell and macrophage infiltrates. Selective clonal T-cell populations infiltrating the myocardium were identical to those present in tumors and skeletal muscle. Pharmacovigilance studies show that myocarditis occurred in 0.27% of patients treated with a combination of ipilimumab and nivolumab, which suggests that our patients were having a rare, potentially fatal, T-cell-driven drug reaction. (Funded by Vanderbilt-Ingram Cancer Center Ambassadors and others.).
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Affiliation(s)
- Douglas B Johnson
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Justin M Balko
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Margaret L Compton
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Spyridon Chalkias
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Joshua Gorham
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Yaomin Xu
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Mellissa Hicks
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Igor Puzanov
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Matthew R Alexander
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Tyler L Bloomer
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Jason R Becker
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - David A Slosky
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Elizabeth J Phillips
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Mark A Pilkinton
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Laura Craig-Owens
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Nina Kola
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Gregory Plautz
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Daniel S Reshef
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Jonathan S Deutsch
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Raquel P Deering
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Benjamin A Olenchock
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Andrew H Lichtman
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Dan M Roden
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Christine E Seidman
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Igor J Koralnik
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Jonathan G Seidman
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Robert D Hoffman
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Janis M Taube
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Luis A Diaz
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Robert A Anders
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Jeffrey A Sosman
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
| | - Javid J Moslehi
- From the Departments of Medicine (D.B.J., J.M.B., M.H., I.P., M.R.A., T.L.B., J.R.B., D.A.S., E.J.P., M.A.P., D.M.R., J.A.S., J.J.M.), Cancer Biology (J.M.B., J.J.M.), Pathology, Microbiology, and Immunology (M.L.C., L.C.-O., R.D.H.), Biostatistics (Y.X.), Pharmacology (D.M.R.), and Biomedical Informatics (Y.X., D.M.R.), the Cardio-oncology Program (D.A.S., J.J.M.), the Breast Cancer Research Program (J.M.B.), and the Center for Quantitative Sciences (Y.X.), Vanderbilt University Medical Center, Nashville; the Department of Medicine (S.C.) and the Division of Neuroimmunology (S.C., I.J.K.), Beth Israel Deaconess Medical Center, the Departments of Medicine (B.A.O., C.E.S., J.G.S.) and Pathology (A.H.L.), Brigham and Women's Hospital, the Department of Genetics, Harvard Medical School (J.G., C.E.S., J.G.S.) - all in Boston; Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.); Bristol-Myers Squibb, New York (N.K., G.P., D.S.R., J.S.D.); Neon Therapeutics, Cambridge, MA (R.P.D.); and the Departments of Pathology (J.M.T., R.A.A.), Dermatology (J.M.T.), and Oncology (L.A.D.), Johns Hopkins University, Baltimore
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Stroud DM, Yang T, Bersell K, Kryshtal DO, Nagao S, Shaffer C, Short L, Hall L, Atack TC, Zhang W, Knollmann BC, Baudenbacher F, Roden DM. Contrasting Nav1.8 Activity in Scn10a-/- Ventricular Myocytes and the Intact Heart. J Am Heart Assoc 2016; 5:JAHA.115.002946. [PMID: 27806966 PMCID: PMC5210363 DOI: 10.1161/jaha.115.002946] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Genome-wide association studies have implicated variants in SCN10A, which encodes Nav1.8, as modulators of cardiac conduction. Follow-up work has indicated the SCN10A sequence includes an intronic enhancer for SCN5A. Yet the role of the Nav1.8 protein in the myocardium itself is still unclear. To investigate this, we use homozygous knockout mice (Scn10a-/-) generated by disruption of exons 4 and 5, leaving the Scn5a enhancer intact. METHODS AND RESULTS We previously reported that pharmacologic blockade of Nav1.8 in wild-type animals blunts action potential prolongation by ATX-II at slow drive rates (≤1 Hz). Here we present evidence of the same blunting in Scn10a-/- compared to wild-type ventricular myocytes, supporting the conclusion that Nav1.8 contributes to late sodium current at slow rates. In contrast to earlier studies, we found no differences in electrocardiographic parameters between genotypes. Low-dose ATX-II exposure in lightly anesthetized animals and Langendorff-perfused hearts prolonged QTc and generated arrhythmias to the same extent in wild-type and Scn10a-/-. RNA sequencing failed to identify full-length Scn10a transcripts in wild-type or knockout isolated ventricular myocytes. However, loss of late current in Scn10a-/- myocytes was replicated independently in a blinded set of experiments. CONCLUSIONS While Scn10a transcripts are not detectible in ventricular cardiomyocytes, gene deletion results in reproducible loss of late sodium current under extreme experimental conditions. However, there are no identifiable consequences of this Scn10a deletion in the intact mouse heart at usual rates. These findings argue that common variants in SCN10A that affect ventricular conduction do so by modulating SCN5A.
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Affiliation(s)
- Dina Myers Stroud
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Tao Yang
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.,Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN
| | - Kevin Bersell
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN
| | - Dymtro O Kryshtal
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Satomi Nagao
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Christian Shaffer
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Laura Short
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Lynn Hall
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Thomas C Atack
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Wei Zhang
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Bjorn C Knollmann
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.,Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN
| | - Franz Baudenbacher
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN
| | - Dan M Roden
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN .,Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
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249
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Kirby JC, Speltz P, Rasmussen LV, Basford M, Gottesman O, Peissig PL, Pacheco JA, Tromp G, Pathak J, Carrell DS, Ellis SB, Lingren T, Thompson WK, Savova G, Haines J, Roden DM, Harris PA, Denny JC. PheKB: a catalog and workflow for creating electronic phenotype algorithms for transportability. J Am Med Inform Assoc 2016; 23:1046-1052. [PMID: 27026615 PMCID: PMC5070514 DOI: 10.1093/jamia/ocv202] [Citation(s) in RCA: 213] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/27/2015] [Accepted: 11/25/2015] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE Health care generated data have become an important source for clinical and genomic research. Often, investigators create and iteratively refine phenotype algorithms to achieve high positive predictive values (PPVs) or sensitivity, thereby identifying valid cases and controls. These algorithms achieve the greatest utility when validated and shared by multiple health care systems.Materials and Methods We report the current status and impact of the Phenotype KnowledgeBase (PheKB, http://phekb.org), an online environment supporting the workflow of building, sharing, and validating electronic phenotype algorithms. We analyze the most frequent components used in algorithms and their performance at authoring institutions and secondary implementation sites. RESULTS As of June 2015, PheKB contained 30 finalized phenotype algorithms and 62 algorithms in development spanning a range of traits and diseases. Phenotypes have had over 3500 unique views in a 6-month period and have been reused by other institutions. International Classification of Disease codes were the most frequently used component, followed by medications and natural language processing. Among algorithms with published performance data, the median PPV was nearly identical when evaluated at the authoring institutions (n = 44; case 96.0%, control 100%) compared to implementation sites (n = 40; case 97.5%, control 100%). DISCUSSION These results demonstrate that a broad range of algorithms to mine electronic health record data from different health systems can be developed with high PPV, and algorithms developed at one site are generally transportable to others. CONCLUSION By providing a central repository, PheKB enables improved development, transportability, and validity of algorithms for research-grade phenotypes using health care generated data.
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Affiliation(s)
| | - Peter Speltz
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Luke V Rasmussen
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | | | - Omri Gottesman
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | | | | | - Todd Lingren
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Will K Thompson
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Guergana Savova
- Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Dan M Roden
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paul A Harris
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joshua C Denny
- Vanderbilt University Medical Center, Nashville, TN, USA
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250
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Goswami S, Yee SW, Xu F, Sridhar SB, Mosley JD, Takahashi A, Kubo M, Maeda S, Davis RL, Roden DM, Hedderson MM, Giacomini KM, Savic RM. A Longitudinal HbA1c Model Elucidates Genes Linked to Disease Progression on Metformin. Clin Pharmacol Ther 2016; 100:537-547. [PMID: 27415606 PMCID: PMC5534241 DOI: 10.1002/cpt.428] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 06/20/2016] [Accepted: 06/22/2016] [Indexed: 12/20/2022]
Abstract
One-third of type-2 diabetic patients respond poorly to metformin. Despite extensive research, the impact of genetic and nongenetic factors on long-term outcome is unknown. In this study we combine nonlinear mixed effect modeling with computational genetic methodologies to identify predictors of long-term response. In all, 1,056 patients contributed their genetic, demographic, and long-term HbA1c data. The top nine variants (of 12,000 variants in 267 candidate genes) accounted for approximately one-third of the variability in the disease progression parameter. Average serum creatinine level, age, and weight were determinants of symptomatic response; however, explaining negligible variability. Two single nucleotide polymorphisms (SNPs) in CSMD1 gene (rs2617102, rs2954625) and one SNP in a pharmacologically relevant SLC22A2 gene (rs316009) influenced disease progression, with minor alleles leading to less and more favorable outcomes, respectively. Overall, our study highlights the influence of genetic factors on long-term HbA1c response and provides a computational model, which when validated, may be used to individualize treatment.
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Affiliation(s)
- S Goswami
- University of California, San Francisco, San Francisco, California, USA
| | - S W Yee
- University of California, San Francisco, San Francisco, California, USA
| | - F Xu
- Kaiser Permanente Northern California, Oakland, California, USA
| | - S B Sridhar
- Kaiser Permanente Northern California, Oakland, California, USA
| | - J D Mosley
- Vanderbilt University, Nashville, Tennessee, USA
| | - A Takahashi
- RIKEN Institute, Center for Genomic Medicine, Saitama, Japan
| | - M Kubo
- RIKEN Institute, Center for Genomic Medicine, Saitama, Japan
| | - S Maeda
- RIKEN Institute, Center for Genomic Medicine, Saitama, Japan
| | - R L Davis
- Kaiser Permanente Georgia, Atlanta, Georgia, USA
- Center for Biomedical Informatics, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - D M Roden
- Vanderbilt University, Nashville, Tennessee, USA
| | - M M Hedderson
- Kaiser Permanente Northern California, Oakland, California, USA
| | - K M Giacomini
- University of California, San Francisco, San Francisco, California, USA.
| | - R M Savic
- University of California, San Francisco, San Francisco, California, USA.
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