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Hoffmann J, Shmeleva EV, Boag SE, Fiser K, Bagnall A, Murali S, Dimmick I, Pircher H, Martin-Ruiz C, Egred M, Keavney B, von Zglinicki T, Das R, Todryk S, Spyridopoulos I. Myocardial ischemia and reperfusion leads to transient CD8 immune deficiency and accelerated immunosenescence in CMV-seropositive patients. Circ Res 2014; 116:87-98. [PMID: 25385851 PMCID: PMC4280279 DOI: 10.1161/circresaha.116.304393] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
RATIONALE There is mounting evidence of a higher incidence of coronary heart disease in cytomegalovirus-seropositive individuals. OBJECTIVE The aim of this study was to investigate whether acute myocardial infarction triggers an inflammatory T-cell response that might lead to accelerated immunosenescence in cytomegalovirus-seropositive patients. METHODS AND RESULTS Thirty-four patients with acute myocardial infarction undergoing primary percutaneous coronary intervention were longitudinally studied within 3 months after reperfusion (Cohort A). In addition, 54 patients with acute myocardial infarction and chronic myocardial infarction were analyzed in a cross-sectional study (Cohort B). Cytomegalovirus-seropositive patients demonstrated a greater fall in the concentration of terminally differentiated CD8 effector memory T cells (TEMRA) in peripheral blood during the first 30 minutes of reperfusion compared with cytomegalovirus-seronegative patients (-192 versus -63 cells/μL; P=0.008), correlating with the expression of programmed cell death-1 before primary percutaneous coronary intervention (r=0.8; P=0.0002). A significant proportion of TEMRA cells remained depleted for ≥3 months in cytomegalovirus-seropositive patients. Using high-throughput 13-parameter flow cytometry and human leukocyte antigen class I cytomegalovirus-specific dextramers, we confirmed an acute and persistent depletion of terminally differentiated TEMRA and cytomegalovirus-specific CD8(+) cells in cytomegalovirus-seropositive patients. Long-term reconstitution of the TEMRA pool in chronic cytomegalovirus-seropositive postmyocardial infarction patients was associated with signs of terminal differentiation including an increase in killer cell lectin-like receptor subfamily G member 1 and shorter telomere length in CD8(+) T cells (2225 versus 3397 bp; P<0.001). CONCLUSIONS Myocardial ischemia and reperfusion in cytomegalovirus-seropositive patients undergoing primary percutaneous coronary intervention leads to acute loss of antigen-specific, terminally differentiated CD8 T cells, possibly through programmed cell death-1-dependent programmed cell death. Our results suggest that acute myocardial infarction and reperfusion accelerate immunosenescence in cytomegalovirus-seropositive patients.
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Affiliation(s)
- Jedrzej Hoffmann
- From the Institute of Genetic Medicine (J.H., E.V.S., S.E.B., S.M., B.K., I.S.), Institute of Aging and Health (C.M.-R., T.v.Z.), and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., S.T.), Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., I.S.); Flow Cytometry Core Facility, International Center for Life, Newcastle upon Tyne, United Kingdom (I.D.); Department of Immunology, Institute of Medical Microbiology and Hygiene, Freiburg University, Germany (H.P.); CLIP-Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic (K.F.); University Hospital Motol, Prague, Czech Republic (K.F.); Institute of Cardiovascular Sciences, The University of Manchester, United Kingdom (B.K.); and Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom (S.M., S.T.)
| | - Evgeniya V Shmeleva
- From the Institute of Genetic Medicine (J.H., E.V.S., S.E.B., S.M., B.K., I.S.), Institute of Aging and Health (C.M.-R., T.v.Z.), and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., S.T.), Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., I.S.); Flow Cytometry Core Facility, International Center for Life, Newcastle upon Tyne, United Kingdom (I.D.); Department of Immunology, Institute of Medical Microbiology and Hygiene, Freiburg University, Germany (H.P.); CLIP-Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic (K.F.); University Hospital Motol, Prague, Czech Republic (K.F.); Institute of Cardiovascular Sciences, The University of Manchester, United Kingdom (B.K.); and Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom (S.M., S.T.)
| | - Stephen E Boag
- From the Institute of Genetic Medicine (J.H., E.V.S., S.E.B., S.M., B.K., I.S.), Institute of Aging and Health (C.M.-R., T.v.Z.), and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., S.T.), Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., I.S.); Flow Cytometry Core Facility, International Center for Life, Newcastle upon Tyne, United Kingdom (I.D.); Department of Immunology, Institute of Medical Microbiology and Hygiene, Freiburg University, Germany (H.P.); CLIP-Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic (K.F.); University Hospital Motol, Prague, Czech Republic (K.F.); Institute of Cardiovascular Sciences, The University of Manchester, United Kingdom (B.K.); and Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom (S.M., S.T.)
| | - Karel Fiser
- From the Institute of Genetic Medicine (J.H., E.V.S., S.E.B., S.M., B.K., I.S.), Institute of Aging and Health (C.M.-R., T.v.Z.), and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., S.T.), Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., I.S.); Flow Cytometry Core Facility, International Center for Life, Newcastle upon Tyne, United Kingdom (I.D.); Department of Immunology, Institute of Medical Microbiology and Hygiene, Freiburg University, Germany (H.P.); CLIP-Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic (K.F.); University Hospital Motol, Prague, Czech Republic (K.F.); Institute of Cardiovascular Sciences, The University of Manchester, United Kingdom (B.K.); and Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom (S.M., S.T.)
| | - Alan Bagnall
- From the Institute of Genetic Medicine (J.H., E.V.S., S.E.B., S.M., B.K., I.S.), Institute of Aging and Health (C.M.-R., T.v.Z.), and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., S.T.), Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., I.S.); Flow Cytometry Core Facility, International Center for Life, Newcastle upon Tyne, United Kingdom (I.D.); Department of Immunology, Institute of Medical Microbiology and Hygiene, Freiburg University, Germany (H.P.); CLIP-Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic (K.F.); University Hospital Motol, Prague, Czech Republic (K.F.); Institute of Cardiovascular Sciences, The University of Manchester, United Kingdom (B.K.); and Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom (S.M., S.T.)
| | - Santosh Murali
- From the Institute of Genetic Medicine (J.H., E.V.S., S.E.B., S.M., B.K., I.S.), Institute of Aging and Health (C.M.-R., T.v.Z.), and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., S.T.), Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., I.S.); Flow Cytometry Core Facility, International Center for Life, Newcastle upon Tyne, United Kingdom (I.D.); Department of Immunology, Institute of Medical Microbiology and Hygiene, Freiburg University, Germany (H.P.); CLIP-Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic (K.F.); University Hospital Motol, Prague, Czech Republic (K.F.); Institute of Cardiovascular Sciences, The University of Manchester, United Kingdom (B.K.); and Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom (S.M., S.T.)
| | - Ian Dimmick
- From the Institute of Genetic Medicine (J.H., E.V.S., S.E.B., S.M., B.K., I.S.), Institute of Aging and Health (C.M.-R., T.v.Z.), and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., S.T.), Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., I.S.); Flow Cytometry Core Facility, International Center for Life, Newcastle upon Tyne, United Kingdom (I.D.); Department of Immunology, Institute of Medical Microbiology and Hygiene, Freiburg University, Germany (H.P.); CLIP-Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic (K.F.); University Hospital Motol, Prague, Czech Republic (K.F.); Institute of Cardiovascular Sciences, The University of Manchester, United Kingdom (B.K.); and Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom (S.M., S.T.)
| | - Hanspeter Pircher
- From the Institute of Genetic Medicine (J.H., E.V.S., S.E.B., S.M., B.K., I.S.), Institute of Aging and Health (C.M.-R., T.v.Z.), and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., S.T.), Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., I.S.); Flow Cytometry Core Facility, International Center for Life, Newcastle upon Tyne, United Kingdom (I.D.); Department of Immunology, Institute of Medical Microbiology and Hygiene, Freiburg University, Germany (H.P.); CLIP-Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic (K.F.); University Hospital Motol, Prague, Czech Republic (K.F.); Institute of Cardiovascular Sciences, The University of Manchester, United Kingdom (B.K.); and Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom (S.M., S.T.)
| | - Carmen Martin-Ruiz
- From the Institute of Genetic Medicine (J.H., E.V.S., S.E.B., S.M., B.K., I.S.), Institute of Aging and Health (C.M.-R., T.v.Z.), and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., S.T.), Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., I.S.); Flow Cytometry Core Facility, International Center for Life, Newcastle upon Tyne, United Kingdom (I.D.); Department of Immunology, Institute of Medical Microbiology and Hygiene, Freiburg University, Germany (H.P.); CLIP-Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic (K.F.); University Hospital Motol, Prague, Czech Republic (K.F.); Institute of Cardiovascular Sciences, The University of Manchester, United Kingdom (B.K.); and Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom (S.M., S.T.)
| | - Mohaned Egred
- From the Institute of Genetic Medicine (J.H., E.V.S., S.E.B., S.M., B.K., I.S.), Institute of Aging and Health (C.M.-R., T.v.Z.), and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., S.T.), Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., I.S.); Flow Cytometry Core Facility, International Center for Life, Newcastle upon Tyne, United Kingdom (I.D.); Department of Immunology, Institute of Medical Microbiology and Hygiene, Freiburg University, Germany (H.P.); CLIP-Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic (K.F.); University Hospital Motol, Prague, Czech Republic (K.F.); Institute of Cardiovascular Sciences, The University of Manchester, United Kingdom (B.K.); and Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom (S.M., S.T.)
| | - Bernard Keavney
- From the Institute of Genetic Medicine (J.H., E.V.S., S.E.B., S.M., B.K., I.S.), Institute of Aging and Health (C.M.-R., T.v.Z.), and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., S.T.), Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., I.S.); Flow Cytometry Core Facility, International Center for Life, Newcastle upon Tyne, United Kingdom (I.D.); Department of Immunology, Institute of Medical Microbiology and Hygiene, Freiburg University, Germany (H.P.); CLIP-Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic (K.F.); University Hospital Motol, Prague, Czech Republic (K.F.); Institute of Cardiovascular Sciences, The University of Manchester, United Kingdom (B.K.); and Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom (S.M., S.T.)
| | - Thomas von Zglinicki
- From the Institute of Genetic Medicine (J.H., E.V.S., S.E.B., S.M., B.K., I.S.), Institute of Aging and Health (C.M.-R., T.v.Z.), and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., S.T.), Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., I.S.); Flow Cytometry Core Facility, International Center for Life, Newcastle upon Tyne, United Kingdom (I.D.); Department of Immunology, Institute of Medical Microbiology and Hygiene, Freiburg University, Germany (H.P.); CLIP-Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic (K.F.); University Hospital Motol, Prague, Czech Republic (K.F.); Institute of Cardiovascular Sciences, The University of Manchester, United Kingdom (B.K.); and Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom (S.M., S.T.)
| | - Rajiv Das
- From the Institute of Genetic Medicine (J.H., E.V.S., S.E.B., S.M., B.K., I.S.), Institute of Aging and Health (C.M.-R., T.v.Z.), and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., S.T.), Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., I.S.); Flow Cytometry Core Facility, International Center for Life, Newcastle upon Tyne, United Kingdom (I.D.); Department of Immunology, Institute of Medical Microbiology and Hygiene, Freiburg University, Germany (H.P.); CLIP-Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic (K.F.); University Hospital Motol, Prague, Czech Republic (K.F.); Institute of Cardiovascular Sciences, The University of Manchester, United Kingdom (B.K.); and Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom (S.M., S.T.)
| | - Stephen Todryk
- From the Institute of Genetic Medicine (J.H., E.V.S., S.E.B., S.M., B.K., I.S.), Institute of Aging and Health (C.M.-R., T.v.Z.), and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., S.T.), Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., I.S.); Flow Cytometry Core Facility, International Center for Life, Newcastle upon Tyne, United Kingdom (I.D.); Department of Immunology, Institute of Medical Microbiology and Hygiene, Freiburg University, Germany (H.P.); CLIP-Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic (K.F.); University Hospital Motol, Prague, Czech Republic (K.F.); Institute of Cardiovascular Sciences, The University of Manchester, United Kingdom (B.K.); and Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom (S.M., S.T.)
| | - Ioakim Spyridopoulos
- From the Institute of Genetic Medicine (J.H., E.V.S., S.E.B., S.M., B.K., I.S.), Institute of Aging and Health (C.M.-R., T.v.Z.), and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., S.T.), Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom (A.B., M.E., R.D., I.S.); Flow Cytometry Core Facility, International Center for Life, Newcastle upon Tyne, United Kingdom (I.D.); Department of Immunology, Institute of Medical Microbiology and Hygiene, Freiburg University, Germany (H.P.); CLIP-Childhood Leukaemia Investigation Prague, Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic (K.F.); University Hospital Motol, Prague, Czech Republic (K.F.); Institute of Cardiovascular Sciences, The University of Manchester, United Kingdom (B.K.); and Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom (S.M., S.T.).
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114
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Waterworth DM, Li L, Scott R, Warren L, Gillson C, Aponte J, Sarov-Blat L, Sprecher D, Dupuis J, Reiner A, Psaty BM, Tracy RP, Lin H, McPherson R, Chissoe S, Wareham N, Ehm MG. A low-frequency variant in MAPK14 provides mechanistic evidence of a link with myeloperoxidase: a prognostic cardiovascular risk marker. J Am Heart Assoc 2014; 3:jah3667. [PMID: 25164947 PMCID: PMC4310399 DOI: 10.1161/jaha.114.001074] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Genetics can be used to predict drug effects and generate hypotheses around alternative indications. To support Losmapimod, a p38 mitogen-activated protein kinase inhibitor in development for acute coronary syndrome, we characterized gene variation in MAPK11/14 genes by exome sequencing and follow-up genotyping or imputation in participants well-phenotyped for cardiovascular and metabolic traits. METHODS AND RESULTS Investigation of genetic variation in MAPK11 and MAPK14 genes using additive genetic models in linear or logistic regression with cardiovascular, metabolic, and biomarker phenotypes highlighted an association of RS2859144 in MAPK14 with myeloperoxidase in a dyslipidemic population (Genetic Epidemiology of Metabolic Syndrome Study), P=2.3×10(-6)). This variant (or proxy) was consistently associated with myeloperoxidase in the Framingham Heart Study and Cardiovascular Health Study studies (replication meta-P=0.003), leading to a meta-P value of 9.96×10(-7) in the 3 dyslipidemic groups. The variant or its proxy was then profiled in additional population-based cohorts (up to a total of 58 930 subjects) including Cohorte Lausannoise, Ely, Fenland, European Prospective Investigation of Cancer, London Life Sciences Prospective Population Study, and the Genetics of Obesity Associations study obesity case-control for up to 40 cardiovascular and metabolic traits. Overall analysis identified the same single nucleotide polymorphisms to be nominally associated consistently with glomerular filtration rate (P=0.002) and risk of obesity (body mass index ≥30 kg/m(2), P=0.004). CONCLUSIONS As myeloperoxidase is a prognostic marker of coronary events, the MAPK14 variant may provide a mechanistic link between p38 map kinase and these events, providing information consistent with current indication of Losmapimod for acute coronary syndrome. If replicated, the association with glomerular filtration rate, along with previous biological findings, also provides support for kidney diseases as alternative indications.
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Affiliation(s)
| | - Li Li
- GlaxoSmithKline, Research Triangle Park, NC (L.L., L.W., J.A., S.C., M.G.E.)
| | - Robert Scott
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK (R.S., C.G., N.W.)
| | - Liling Warren
- GlaxoSmithKline, Research Triangle Park, NC (L.L., L.W., J.A., S.C., M.G.E.)
| | - Christopher Gillson
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK (R.S., C.G., N.W.)
| | - Jennifer Aponte
- GlaxoSmithKline, Research Triangle Park, NC (L.L., L.W., J.A., S.C., M.G.E.)
| | - Lea Sarov-Blat
- GlaxoSmithKline, Philadelphia, PA (D.M.W., L.S.B., D.S.)
| | | | - Josée Dupuis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA (J.D.) Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, WA (J.D.)
| | - Alex Reiner
- Group Health Research Institute, Group Health Cooperative, Seattle, WA (A.R.)
| | | | - Russell P Tracy
- Department of Medicine, Boston University School of Medicine, Boston, MA (R.P.T., H.L.)
| | - Honghuang Lin
- Boston University and National Heart, Lung and Blood Institute's Framingham Heart Study, Framingham, MA (H.L.) Department of Medicine, Boston University School of Medicine, Boston, MA (R.P.T., H.L.)
| | - Ruth McPherson
- Division of Cardiology and Lipoprotein and Atherosclerosis Research Group, University of Ottawa Heart Institute, Ottawa, Ontario, Canada (R.M.P.)
| | - Stephanie Chissoe
- GlaxoSmithKline, Research Triangle Park, NC (L.L., L.W., J.A., S.C., M.G.E.)
| | - Nick Wareham
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK (R.S., C.G., N.W.)
| | - Margaret G Ehm
- GlaxoSmithKline, Research Triangle Park, NC (L.L., L.W., J.A., S.C., M.G.E.)
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