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Apolipoprotein E ε4 Polymorphism as a Risk Factor for Ischemic Stroke: A Systematic Review and Meta-Analysis. DISEASE MARKERS 2022; 2022:1407183. [PMID: 35154509 PMCID: PMC8831053 DOI: 10.1155/2022/1407183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/21/2021] [Accepted: 01/05/2022] [Indexed: 11/18/2022]
Abstract
Introduction Rising studies indicate that the apolipoprotein E (APOE) gene is related to the susceptibility of ischemic stroke (IS). However, certain consensus is limited by the lack of a large sample size of researches. This meta-analysis was performed to explore the potential association between the APOE gene and IS. Methods To identify relevant case control studies in English publications by October 2020, we searched PubMed, Embase, Web of Science, and the Cochrane Library. Pooled odds ratios (ORs) with fixed- or random-effect models and corresponding 95% confidence intervals (CIs) were calculated to analyze potential associations. Results A total of 55 researches from 32 countries containing 12207 IS cases and 27742 controls were included. The association between APOE gene ε4 mutation and IS was confirmed (ε4 vs. ε3 allele: pooled OR = 1.374, 95% CI, 1.214-1.556; ε2/ε4 vs. ε3/ε3: pooled OR = 1.233, 95% CI, 1.056-1.440; ε3/ε4 vs. ε3/ε3: pooled OR = 1.340, 95% CI, 1.165-1.542; ε4/ε4 vs. ε3/ε3: pooled OR = 1.833, 95% CI, 1.542-2.179; and APOE ε4 carriers vs. non-ε4 carriers: pooled OR = 1.377; 95% CI, 1.203-1.576). Interestingly, APOE ε4 mutation showed a dose-response correlation with IS risk (ε4/ε4 vs. ε2/ε4: pooled OR = 1.625; 95% CI, 1.281-2.060; ε4/ε4 vs. ε3/ε4: pooled OR = 1.301; 95% CI, 1.077-1.571). Similar conclusions were drawn in the small artery disease (SAD) subtype, but not in large artery atherosclerosis (LAA) or in cardioaortic embolism (CE), by subgroup analysis. Conclusions These observations reveal that specific APOE ε4 mutation was significantly associated with the risk of IS in a dose-dependent manner, while APOE ε4 mutation was related to SAD subtype onset without a cumulative effect.
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Liang HJ, Zhang QY, Hu YT, Liu GQ, Qi R. Hypertriglyceridemia: A Neglected Risk Factor for Ischemic Stroke? J Stroke 2022; 24:21-40. [PMID: 35135057 PMCID: PMC8829486 DOI: 10.5853/jos.2021.02831] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/27/2021] [Indexed: 11/11/2022] Open
Abstract
Hypertriglyceridemia is caused by defects in triglyceride metabolism and generally manifests as abnormally high plasma triglyceride levels. Although the role of hypertriglyceridemia may not draw as much attention as that of plasma cholesterol in stroke, plasma triglycerides, especially nonfasting triglycerides, are thought to be correlated with the risk of ischemic stroke. Hypertriglyceridemia may increase the risk of ischemic stroke by promoting atherosclerosis and thrombosis and increasing blood viscosity. Moreover, hypertriglyceridemia may have some protective effects in patients who have already suffered a stroke via unclear mechanisms. Therefore, further studies are needed to elucidate the role of hypertriglyceridemia in the development and prognosis of ischemic stroke.
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Affiliation(s)
- Hai-jie Liang
- Department of Pharmacology, School of Basic Medical Sciences, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, China
| | - Qing-yi Zhang
- Department of Pharmacology, School of Basic Medical Sciences, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, China
- State Key Laboratory of Natural and Biomimetic Drugs, Beijing, China
- NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, China
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery Systems, Peking University Health Science Center, Beijing, China
| | - Yi-tong Hu
- Department of Pharmacology, School of Basic Medical Sciences, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, China
| | - Guo-qing Liu
- Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, China
| | - Rong Qi
- Department of Pharmacology, School of Basic Medical Sciences, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, China
- State Key Laboratory of Natural and Biomimetic Drugs, Beijing, China
- NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing, China
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery Systems, Peking University Health Science Center, Beijing, China
- Correspondence: Rong Qi Department of Pharmacology, School of Basic Medical Sciences, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing 100191, China Tel: +86-10-8280-5164 Fax: +86-10-8280-5164 E-mail:
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Chen J, Zhang C, Yan T, Yang L, Wang Y, Shi Z, Li M, Chen Q. Atorvastatin ameliorates early brain injury after subarachnoid hemorrhage via inhibition of pyroptosis and neuroinflammation. J Cell Physiol 2021; 236:6920-6931. [PMID: 33792028 DOI: 10.1002/jcp.30351] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 12/15/2022]
Abstract
Subarachnoid hemorrhage (SAH) is a subtype of stroke with high mortality and morbidity due to the lack of effective therapy. Atorvastatin has been reported to alleviate early brain injury (EBI) following subarachnoid hemorrhage (SAH) via reducing reactive oxygen species, antiapoptosis, regulated autophagy, and neuroinflammation. Which was the related to the pyroptosis? Pyroptosis can be defined as a highly specific inflammatory programmed cell death, distinct from classical apoptosis and necrosis. However, the precise role of pyroptosis in atorvastatin-mediated neuroprotection following SAH has not been confirmed. The present study aimed to investigate the neuroprotection and potential molecular mechanisms of atorvastatin in the SAH-induced EBI via regulating neural pyroptosis using the filament perforation model of SAH in male C57BL/6 mice, and the hemin-induced neuron damage model in HT-22. Atorvastatin or vehicle was administrated 2 h after SAH and hemin-induced neuron damage. The mortality, neurological score, brain water content, and neuronal death were evaluated. The results show that the atorvastatin treatment markedly increased survival rate, neurological score, greater survival of neurons, downregulated the protein expression of NLRP1, cleaved caspase-1, interleukin-1β (IL-1β), and IL-18, which indicated that atorvastatin-inhibited pyroptosis and neuroinflammation, ameliorated neuron death in vivo/vitro subjected to SAH. Taken together, this study demonstrates that atorvastatin improved the neurological outcome in rats and reduced the neuron death by against neural pyroptosis and neuroinflammation.
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Affiliation(s)
- Junhui Chen
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
- Department of Neurosurgery, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, China
| | - Chunlei Zhang
- Department of Neurosurgery, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, China
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Tengfeng Yan
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lixiang Yang
- Department of Neurosurgery, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, China
| | - Yuhai Wang
- Department of Neurosurgery, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, China
| | - Zhonghua Shi
- Department of Neurosurgery, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi Clinical College of Anhui Medical University, Wuxi, China
| | - Mingchang Li
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qianxue Chen
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
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Chauhan G, Adams HHH, Satizabal CL, Bis JC, Teumer A, Sargurupremraj M, Hofer E, Trompet S, Hilal S, Smith AV, Jian X, Malik R, Traylor M, Pulit SL, Amouyel P, Mazoyer B, Zhu YC, Kaffashian S, Schilling S, Beecham GW, Montine TJ, Schellenberg GD, Kjartansson O, Guðnason V, Knopman DS, Griswold ME, Windham BG, Gottesman RF, Mosley TH, Schmidt R, Saba Y, Schmidt H, Takeuchi F, Yamaguchi S, Nabika T, Kato N, Rajan KB, Aggarwal NT, De Jager PL, Evans DA, Psaty BM, Rotter JI, Rice K, Lopez OL, Liao J, Chen C, Cheng CY, Wong TY, Ikram MK, van der Lee SJ, Amin N, Chouraki V, DeStefano AL, Aparicio HJ, Romero JR, Maillard P, DeCarli C, Wardlaw JM, Hernández MDCV, Luciano M, Liewald D, Deary IJ, Starr JM, Bastin ME, Muñoz Maniega S, Slagboom PE, Beekman M, Deelen J, Uh HW, Lemmens R, Brodaty H, Wright MJ, Ames D, Boncoraglio GB, Hopewell JC, Beecham AH, Blanton SH, Wright CB, Sacco RL, Wen W, Thalamuthu A, Armstrong NJ, Chong E, Schofield PR, Kwok JB, van der Grond J, Stott DJ, Ford I, Jukema JW, Vernooij MW, Hofman A, Uitterlinden AG, van der Lugt A, Wittfeld K, Grabe HJ, Hosten N, von Sarnowski B, Völker U, Levi C, Jimenez-Conde J, Sharma P, Sudlow CLM, Rosand J, Woo D, Cole JW, Meschia JF, Slowik A, Thijs V, Lindgren A, Melander O, Grewal RP, Rundek T, Rexrode K, Rothwell PM, Arnett DK, Jern C, Johnson JA, Benavente OR, Wasssertheil-Smoller S, Lee JM, Wong Q, Mitchell BD, Rich SS, McArdle PF, Geerlings MI, van der Graaf Y, de Bakker PIW, Asselbergs FW, Srikanth V, Thomson R, McWhirter R, Moran C, Callisaya M, Phan T, Rutten-Jacobs LCA, Bevan S, Tzourio C, Mather KA, Sachdev PS, van Duijn CM, Worrall BB, Dichgans M, Kittner SJ, Markus HS, Ikram MA, Fornage M, Launer LJ, Seshadri S, Longstreth WT, Debette S. Genetic and lifestyle risk factors for MRI-defined brain infarcts in a population-based setting. Neurology 2019; 92:e486-e503. [PMID: 30651383 PMCID: PMC6369905 DOI: 10.1212/wnl.0000000000006851] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 10/01/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To explore genetic and lifestyle risk factors of MRI-defined brain infarcts (BI) in large population-based cohorts. METHODS We performed meta-analyses of genome-wide association studies (GWAS) and examined associations of vascular risk factors and their genetic risk scores (GRS) with MRI-defined BI and a subset of BI, namely, small subcortical BI (SSBI), in 18 population-based cohorts (n = 20,949) from 5 ethnicities (3,726 with BI, 2,021 with SSBI). Top loci were followed up in 7 population-based cohorts (n = 6,862; 1,483 with BI, 630 with SBBI), and we tested associations with related phenotypes including ischemic stroke and pathologically defined BI. RESULTS The mean prevalence was 17.7% for BI and 10.5% for SSBI, steeply rising after age 65. Two loci showed genome-wide significant association with BI: FBN2, p = 1.77 × 10-8; and LINC00539/ZDHHC20, p = 5.82 × 10-9. Both have been associated with blood pressure (BP)-related phenotypes, but did not replicate in the smaller follow-up sample or show associations with related phenotypes. Age- and sex-adjusted associations with BI and SSBI were observed for BP traits (p value for BI, p [BI] = 9.38 × 10-25; p [SSBI] = 5.23 × 10-14 for hypertension), smoking (p [BI] = 4.4 × 10-10; p [SSBI] = 1.2 × 10-4), diabetes (p [BI] = 1.7 × 10-8; p [SSBI] = 2.8 × 10-3), previous cardiovascular disease (p [BI] = 1.0 × 10-18; p [SSBI] = 2.3 × 10-7), stroke (p [BI] = 3.9 × 10-69; p [SSBI] = 3.2 × 10-24), and MRI-defined white matter hyperintensity burden (p [BI] = 1.43 × 10-157; p [SSBI] = 3.16 × 10-106), but not with body mass index or cholesterol. GRS of BP traits were associated with BI and SSBI (p ≤ 0.0022), without indication of directional pleiotropy. CONCLUSION In this multiethnic GWAS meta-analysis, including over 20,000 population-based participants, we identified genetic risk loci for BI requiring validation once additional large datasets become available. High BP, including genetically determined, was the most significant modifiable, causal risk factor for BI.
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Vasudeva K, Munshi A. Genetics of platelet traits in ischaemic stroke: focus on mean platelet volume and platelet count. Int J Neurosci 2018; 129:511-522. [PMID: 30371123 DOI: 10.1080/00207454.2018.1538991] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose/Aim of the study: The aim of this review is to summarize the role of genetic variants affecting mean platelet volume (MPV) and platelet count (PLT) leading to higher platelet reactivity and in turn to thrombotic events like stroke and cardiovascular diseases. MATERIALS AND METHODS A search was conducted in PUBMED, MEDLINE, EMBASE, PROQUEST, Science Direct, Cochrane Library, and Google Scholar related to the studies focussing on genome-wide association studies (GWAS), whole exome sequencing (WES), whole genome sequencing (WGS), phenome-wide association studies (PheWAS) and multi-omic analysis that have been employed to identify the genetic variants influencing MPV and PLT. RESULTS Antiplatelet agents underscore the crucial role of platelets in the pathogenesis of stroke. Higher platelet reactivity in terms of mean platelet volume (MPV) and platelet count (PLT) contributes significantly to the interindividual variation in platelet reaction at the site of vessel wall injury. Some individuals encounter thrombotic events as platelets get occluded at the site of vessel wall injury whereas others heal the injury without occluding the circulation. Evidence suggests that MPV and PLT have a strong genetic component. High throughput techniques including genome-wide association studies (GWAS), whole exome sequencing (WES), whole genome sequencing (WGS), phenome-wide association studies (PheWAS) and multi-omic analysis have identified different genetic variants influencing MPV and PLT. CONCLUSIONS Identification of complex genetic cross talks affecting PLT and MPV might help to develop novel treatment strategies in treating neurovascular diseases like stroke.
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Affiliation(s)
- Kanika Vasudeva
- a Department of Human Genetics and Molecular Medicine , Central University of Punjab Bathinda , Punjab , India
| | - Anjana Munshi
- a Department of Human Genetics and Molecular Medicine , Central University of Punjab Bathinda , Punjab , India
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Cao L, Li Q, Chen X. The HindIII and PvuII polymorphisms of lipoprotein lipase (LPL) gene reduce the risk of ischemic stroke (IS): A meta-analysis. Medicine (Baltimore) 2018; 97:e0483. [PMID: 29718838 PMCID: PMC6392787 DOI: 10.1097/md.0000000000010483] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Lipoprotein lipase (LPL) polymorphisms were suggested to be the risk factor for ischemic stroke (IS). However, controversial results were obtained. Our objective was to investigate the association of LPL polymorphisms at Ser447Ter, HindIII (+/-), and PvuII (+/-) with IS risk. METHODS Literatures search were carried out on databases: PubMed, Web of science, the Cochrane database of system reviews, Chinese National Knowledge Infrastructure, and Embase. Pooled odds ratio (OR) with 95% confidence interval (CI) was calculated to detect the relationship between LPL polymorphisms and the risk of IS. RESULTS No significant association was detected between LPL Ser447Ter and IS in allelic, dominant, or recessive models (P > .05). Significant lower frequencies of allelic and dominant models of LPL HindIII (+/-) and PvuII (+/-) in cases were detected (HindIII (+/-): allelic model: P = .0002, OR[95%CI] = 0.80 [0.71, 0.90]; dominant model: P = 0.003, OR[95%CI] = 0.80 [0.69, 0.92]; PvuII (+/-): allelic model: P < 0.0001, OR[95%CI] = 0.75[0.65-0.86]; dominant model: P = 0.02, OR[95%CI] = 0.67[0.48-0.93]). And the recessive model of PvuII (+/-) was significantly associated with the IS risk (P = .01, OR[95%CI] = .71[0.55-0.93]). Subgroup analysis stratified by ethnicity showed that the frequencies of allelic, dominant, and recessive models of HindIII (+/-), as well as dominant model of PvuII (+/-) were significant lower in Asian cases (HindIII (+/-): allelic model: P < .00001, OR[95%CI] = 0.69 [0.59, 0.79]; dominant model: P < .0001, OR[95%CI] = 0.69 [0.58, 0.83]; recessive model: P = .005, OR[95%CI] = 0.66 [0.50, 0.89]; PvuII (+/-): dominant model: P = .0008, OR[95%CI] = 0.66 [0.51-0.84]), but not in Caucasian cases (P > .05). In addition, the frequencies of allelic and recessive models of PvuII (+/-) significantly decreased in Caucasian cases (P < .05). CONCLUSION the HindIII (+/-) and PvuII (+/-), but not the Ser447Ter might be the protective factors for IS.
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Kumar A, Kumar P, Prasad M, Misra S, Kishor Pandit A, Chakravarty K. Association between Apolipoprotein ε4 Gene Polymorphism and Risk of Ischemic Stroke: A Meta-Analysis. Ann Neurosci 2016; 23:113-21. [PMID: 27647962 DOI: 10.1159/000443568] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 04/25/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Previous studies examining the association of apolipoprotein E (APOE) gene polymorphism with the risk of ischemic stroke (IS) have yielded conflicting results. Therefore, we performed a meta-analysis to investigate the association between APOE ε4 gene polymorphism and risk of IS. SUMMARY A literature search for genetic association studies published before May 30, 2015, was conducted in the PubMed, EMBASE and Google Scholar databases. The following search terms were used: (apolipoprotein E) or (APOE) and (ε4) and (polymorphism) or (polymorphisms) and ('ischemic stroke' or 'IS') and ('cerebral infarction' or 'CI') and ('genetic polymorphism' or 'single nucleotide polymorphisms' or 'SNP'). ORs and 95% CIs were used to calculate the strength of association. Begg's funnel plot was used to assess the potential for publication bias. In our meta-analysis, 26 case-control studies involving 6,397 IS cases and 19,053 controls were included. Overall significant association between carrier of ε4 allele and risk of IS was observed (OR 1.43, 95% CI 1.10-1.85, p = 0.007). In the subgroup analysis based on ethnicity, a significant association between Apo ε4 carrier and risk of IS was observed in Asian studies (OR 1.53, 95% CI 1.04-2.25, p = 0.031) whereas borderline significant association between APO ε4 carrier and risk of IS was observed in Caucasian studies (OR 1.36, 95% CI 0.95-1.93, p = 0.093). KEY MESSAGES Our meta-analysis suggests that APOE ε4 allele is associated with higher risk of IS in Asian population as compared to Caucasian population.
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Affiliation(s)
- Amit Kumar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Kumar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Manya Prasad
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Shubham Misra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Awadh Kishor Pandit
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Kamalesh Chakravarty
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Titov BV, Matveeva NA, Martynov MY, Favorova OO. Ischemic stroke as a complex polygenic disease. Mol Biol 2015. [DOI: 10.1134/s0026893315020120] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Cocchi E, Drago A, de Ronchi D, Serretti A. The genetics of vascular incidents associated with second-generation antipsychotic administration. Expert Rev Clin Pharmacol 2013; 7:75-90. [PMID: 24325740 DOI: 10.1586/17512433.2014.865515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Second-generation antipsychotics (SGA) have been associated with risk of stroke in elderly patients, but the molecular and genetic background under this association has been poorly investigated. The aim of the present study was to prioritize a list of genes with an SGA altered expression in order to characterize the genetic background of the SGA-associated stroke risk. Genes with evidence of an altered expression after SGA treatments in genome-wide investigations, both in animals and men, were identified. The Genetic Association Database (GAD) served to verify which of these genes had a proven positive association with an increased stroke risk, and along with it each evidence was tested and recorded. Seven hundred and forty five genes had evidence of a change of their expression profile after SGA administration in various studies. Nine out of them have also been significantly related to an increased strokes risk. We identified and described nine genes as potential candidates for future genetic studies aimed at identifying the genetic background of the SGA-related stroke risk. Further, we identify the molecular pathways in which these genes operate in order to provide a molecular framework to understand on which basis SGA may enhance the risk for stroke.
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Affiliation(s)
- Enrico Cocchi
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Italy
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APOE modulates the correlation between triglycerides, cholesterol, and CHD through pleiotropy, and gene-by-gene interactions. Genetics 2013; 195:1397-405. [PMID: 24097412 DOI: 10.1534/genetics.113.157719] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Relationship loci (rQTL) exist when the correlation between multiple traits varies by genotype. rQTL often occur due to gene-by-gene (G × G) or gene-by-environmental interactions, making them a powerful tool for detecting G × G. Here we present an empirical analysis of apolipoprotein E (APOE) with respect to lipid traits and incident CHD leading to the discovery of loci that interact with APOE to affect these traits. We found that the relationship between total cholesterol (TC) and triglycerides (ln TG) varies by APOE isoform genotype in African-American (AA) and European-American (EA) populations. The e2 allele is associated with strong correlation between ln TG and TC while the e4 allele leads to little or no correlation. This led to a priori hypotheses that APOE genotypes affect the relationship of TC and/or ln TG with incident CHD. We found that APOE*TC was significant (P = 0.016) for AA but not EA while APOE*ln TG was significant for EA (P = 0.027) but not AA. In both cases, e2e2 and e2e3 had strong relationships between TC and ln TG with CHD while e2e4 and e4e4 results in little or no relationship between TC and ln TG with CHD. Using ARIC GWAS data, scans for loci that significantly interact with APOE produced four loci for African Americans (one CHD, one TC, and two HDL). These interactions contribute to the rQTL pattern. rQTL are a powerful tool to identify loci that modify the relationship between risk factors and disease and substantially increase statistical power for detecting G × G.
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Lipoprotein lipase Ser447Ter polymorphism associated with the risk of ischemic stroke: a meta-analysis. Thromb Res 2011; 128:e107-12. [PMID: 21816453 DOI: 10.1016/j.thromres.2011.07.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 06/28/2011] [Accepted: 07/11/2011] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Previous studies suggested lipoprotein lipase (LPL) Ser447Ter and Asn291Ser polymorphisms were associated with the risk of ischemic heart disease, however, their effects on ischemic stroke were controversial. A meta-analysis was performed to assess the associations between these two LPL polymorphisms and the risk of ischemic stroke. METHODS The electronic databases PubMed and Embase were used to identify relevant studies by two interviews independently. The pooled odds ratios (ORs) and weighted mean differences (WMD) with 95% confidence interval (CI) were estimated for the risk of ischemic stroke and the plasma lipids in various Ser447Ter genotypes respectively. A fixed or random effect model was selected for pooling data based on homogeneity test. RESULTS 13 studies including 4,681 ischemic stroke cases and 8,516 controls were involved in this meta-analysis. Overall, LPL Ter447 variant was associated with a significantly reduced risk for ischemic stroke (OR=0.79, 95% CI: 0.68-0.93) both in Caucasian (OR=0.87, 95% CI: 0.77-0.97) and East-Asian (OR=0.65, 95% CI: 0.43-0.99), whereas no significant association of Ser291 variant was observed (OR=1.25, 95% CI: 0.96-1.63). The Ser447Ter polymorphism may be more important in association with the decreased risk of atherosclerotic stroke (OR=0.44, 95% CI: 0.32-0.62) which derived from significantly increased high density lipoprotein cholesterol, decreased triglyceride and total cholesterol in Ter447 carriers compared with non-carriers. CONCLUSIONS This meta-analysis indicated that LPL Ser447Ter polymorphism was associated with a significant reduction in the risk of ischemic stroke, especially atherosclerotic stroke subtype in both Caucasian and East-Asian.
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Yang Y, Du D, Gao P, Zhang X, Wu N, Wang F, Wang Z, Ye L, Wu J, Megson IL, Wei J. Investigation of the Interaction Between the Ser447Term Polymorphism of Lipoprotein Lipase and the Stroke-Related Risk Factors in Ischemic Stroke. Transl Stroke Res 2011; 2:101-5. [PMID: 24323588 DOI: 10.1007/s12975-010-0045-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 09/18/2010] [Accepted: 09/23/2010] [Indexed: 11/24/2022]
Abstract
The present study aimed to investigate the interaction between the Ser447Term polymorphism in the lipoprotein lipase (LPL) gene and some common risk factors for stroke. A total of 704 unrelated patients with ischemic stroke were recruited for genetic analysis; they were all of Han Chinese origin. These patients were classified into subgroups based on their exposure to stroke-related risk factors, including type 2 diabetes, hypertension, smoking, and hyperlipidemia. The Ser447Term polymorphism was genotyped by PCR-based restriction fragment length polymorphism analysis. The chi-square (χ (2)) test showed that the frequency of Ser447Term G allele was significantly higher in stroke patients with a history of diabetes than in those without a history of diabetes (χ (2) = 7.25, P = 0.007, OR = 1.78, 95%CI 1.18-2.68). Allelic association was not observed in patients exposed to the other three stroke-related risk factors. The combined effect of the LPL gene polymorphisms and diabetes may contribute to the development of a subgroup of ischemic stroke.
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Affiliation(s)
- Yumei Yang
- Research Centre for Neuroscience and Department of Neurology, Jilin University First Hospital, 71 Xinmin Street, Changchun, 130021, China
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Abstract
BACKGROUND Inflammation plays a pivotal role in the pathogenesis of atherosclerosis and of cerebrovascular complications. Transforming growth factor-β (TGF-β) is a pleiotropic cytokine with a central role in inflammation. To investigate whether polymorphisms of the TGF-β1 gene can modify the risk of ischemic stroke (IS) in Chinese population, we conduct this hospital-based, case-control study. METHODS Transforming growth factor-β1 genotype was determined in 450 Chinese patients (306 male and 144 female) with IS and 450 control subjects (326 male and 124 female). RESULTS Subjects carrying 869TT were susceptible to IS (odds ratio [OR] =1.58; P=0.003). Further analysis of IS data partitioned by gender revealed the female-specific association with 869T/C (OR=2.64; P=0.001). CONCLUSIONS Findings suggest that the TT genotype of 869T/C might be a risk factor of IS in Chinese, especially in females.
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Predictive role of polymorphisms in interleukin-5 receptor alpha-subunit, lipoprotein lipase, integrin A2 and nitric oxide synthase genes on ischemic stroke in type 2 diabetes--an 8-year prospective cohort analysis of 1327 Chinese patients. Atherosclerosis 2010; 215:130-5. [PMID: 21193198 DOI: 10.1016/j.atherosclerosis.2010.11.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 10/27/2010] [Accepted: 11/30/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Ischemic stroke is prevalent in type 2 diabetes and may be due to metabolic, vascular and inflammatory factors. Genetic variants implicated in these pathways may have joint effects on stroke risk. In this proof-of-concept study, we examined gene-gene interactions on risk of incident ischemic stroke in an 8-year prospective cohort of Chinese type 2 diabetic patients. METHODS Seventy-seven single nucleotide polymorphisms (SNPs) of 53 candidate genes for cardiovascular disease and inflammation were genotyped in 1327 patients with no past history of ischemic stroke. The association of SNPs with stroke was tested using Cox proportional hazard regression analysis. Permutation procedure was performed to control for multiple statistical comparisons. RESULTS Genetic variants including A/A of IL5RA (interleukin-5 alpha subunit) -5091G>A, X/X of LPL (lipoprotein lipase) S447X, A/A of ITGA2 (integrin A2) G873A and T/T or G/T of NOS3 (endothelial nitric oxide synthase) G894T showed significant correlations with incident ischemic stroke. The hazard ratios (HR) increased with number of genetic risk factors reaching an adjusted HR (confidence interval) of 3.68 (1.78-7.62, P=4.4×10(-4)) in those with ≥2 genetic risk factors compared to those without. CONCLUSION Polymorphisms in IL5RA, LPL, ITGA2 and NOS3 genes were independently associated with ischemic stroke in Chinese diabetic population.
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Stankovic S, Majkic-Singh N. Genetic aspects of ischemic stroke: coagulation, homocysteine, and lipoprotein metabolism as potential risk factors. Crit Rev Clin Lab Sci 2010; 47:72-123. [DOI: 10.3109/10408361003791520] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Arajo L, Cendoroglo M, Gigek C, Chen E, Smith MDEA. Association of lipase lipoprotein polymorphisms with high-density lipoprotein and triglycerides in elderly men. GENETICS AND MOLECULAR RESEARCH 2010; 9:89-96. [DOI: 10.4238/vol9-1gmr689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Debette S, Bis JC, Fornage M, Schmidt H, Ikram MA, Sigurdsson S, Heiss G, Struchalin M, Smith AV, van der Lugt A, DeCarli C, Lumley T, Knopman DS, Enzinger C, Eiriksdottir G, Koudstaal PJ, DeStefano AL, Psaty BM, Dufouil C, Catellier DJ, Fazekas F, Aspelund T, Aulchenko YS, Beiser A, Rotter JI, Tzourio C, Shibata DK, Tscherner M, Harris TB, Rivadeneira F, Atwood LD, Rice K, Gottesman RF, van Buchem MA, Uitterlinden AG, Kelly-Hayes M, Cushman M, Zhu Y, Boerwinkle E, Gudnason V, Hofman A, Romero JR, Lopez O, van Duijn CM, Au R, Heckbert SR, Wolf PA, Mosley TH, Seshadri S, Breteler MMB, Schmidt R, Launer LJ, Longstreth WT. Genome-wide association studies of MRI-defined brain infarcts: meta-analysis from the CHARGE Consortium. Stroke 2009; 41:210-7. [PMID: 20044523 DOI: 10.1161/strokeaha.109.569194] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies examining genetic associations with MRI-defined brain infarct have yielded inconsistent findings. We investigated genetic variation underlying covert MRI infarct in persons without histories of transient ischemic attack or stroke. We performed meta-analysis of genome-wide association studies of white participants in 6 studies comprising the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium. METHODS Using 2.2 million genotyped and imputed single nucleotide polymorphisms, each study performed cross-sectional genome-wide association analysis of MRI infarct using age- and sex-adjusted logistic regression models. Study-specific findings were combined in an inverse-variance-weighted meta-analysis, including 9401 participants with mean age 69.7 (19.4% of whom had >or=1 MRI infarct). RESULTS The most significant association was found with rs2208454 (minor allele frequency, 20%), located in intron 3 of MACRO domain containing 2 gene and in the downstream region of fibronectin leucine-rich transmembrane protein 3 gene. Each copy of the minor allele was associated with lower risk of MRI infarcts (odds ratio, 0.76; 95% confidence interval, 0.68-0.84; P=4.64x10(-7)). Highly suggestive associations (P<1.0x10(-5)) were also found for 22 other single nucleotide polymorphisms in linkage disequilibrium (r(2)>0.64) with rs2208454. The association with rs2208454 did not replicate in independent samples of 1822 white and 644 black participants, although 4 single nucleotide polymorphisms within 200 kb from rs2208454 were associated with MRI infarcts in the black population sample. CONCLUSIONS This first community-based, genome-wide association study on covert MRI infarcts uncovered novel associations. Although replication of the association with top single nucleotide polymorphisms failed, possibly because of insufficient power, results in the black population sample are encouraging, and further efforts at replication are needed.
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Affiliation(s)
- Stéphanie Debette
- Department of Neurology, Boston University School of Medicine, Boston, Mass, USA
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Parfenov MG, Titov BV, Sudomoina MA, Martynov MY, Favorov AV, Ochs MF, Gusev EI, Favorova OO. Genetic susceptibility to ischemic stroke in Russians. Mol Biol 2009. [DOI: 10.1134/s0026893309050185] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Sagoo GS, Tatt I, Salanti G, Butterworth AS, Sarwar N, van Maarle M, Jukema JW, Wiman B, Kastelein JJP, Bennet AM, de Faire U, Danesh J, Higgins JPT. Seven lipoprotein lipase gene polymorphisms, lipid fractions, and coronary disease: a HuGE association review and meta-analysis. Am J Epidemiol 2008; 168:1233-46. [PMID: 18922999 DOI: 10.1093/aje/kwn235] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Lipoprotein lipase (LPL) is a key enzyme in lipoprotein metabolism and a major candidate gene for coronary heart disease (CHD). The authors assessed associations between 7 LPL polymorphisms and lipid fractions and CHD risk in population-based cohort, case-control, and cross-sectional studies published by January 2007. Meta-analyses of 22,734 CHD cases and 50,177 controls in 89 association studies focused on the relations of the T-93G (rs1800590), D9N (rs1801177), G188E, N291S (rs268), PvuII (rs285), HindIII (rs320), and S447X (rs328) polymorphisms to high density lipoprotein cholesterol, triglycerides, myocardial infarction, or coronary stenosis. Carriers of 9N or 291S had modestly adverse lipid profiles. Carriers of the less common allele of HindIII or of 447X had modestly advantageous profiles. The combined odds ratio for CHD among carriers was 1.33 (95% confidence interval (CI): 1.14, 1.56) for 9N, 1.07 (95% CI: 0.96, 1.20) for 291S, 0.89 (95% CI: 0.81, 0.98) for the less common HindIII allele, and 0.84 (95% CI: 0.75, 0.94) for 447X. For T-93G (odds ratio (OR) = 1.22, 95% CI: 0.98, 1.52) and PvuII (OR = 0.96, 95% CI: 0.89, 1.04), there were null associations with lipid levels or CHD risk; information on G188E was limited (OR = 2.80, 95% CI: 0.88, 8.87). The study of LPL genotypes confirms the existence of close interrelations between high density lipoprotein cholesterol and triglyceride pathways. The influence of these genotypes on CHD risk warrants further investigation.
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Affiliation(s)
- Gurdeep S Sagoo
- United Kingdom HuGENet Coordinating Centre, Strangeways Research Laboratory, Cambridge, United Kingdom
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Kostulas K, Brophy VH, Moraitis K, Manolescu A, Kostulas V, Gretarsdottir S, Cheng S, Hillert J. Genetic profile of ischemic cerebrovascular disease and carotid stenosis. Acta Neurol Scand 2008; 118:146-52. [PMID: 18325076 DOI: 10.1111/j.1600-0404.2008.00995.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Carotid artery stenosis (CS) is a major risk factor for ischemic cerebrovascular disease (ICVD) and is therefore of interest in genetic investigating. Here we report the distribution of 100 polymorphisms in 47 suspected susceptibility genes for ICVD and its risk factors. MATERIALS AND METHODS Previously published markers in suspected susceptibility genes were genotyped in ICVD patients and controls (928/602). Genotyping was performed using multiplex polymerase chain reaction (PCR) and linear immobilized probe array assays. ICVD cases were subtyped according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) or subdivided into CS and non-CS patients by ultrasonography in a separate analysis. RESULTS Three polymorphisms located in the lipoprotein lipase (LPL), angiotensinogen (AGT) and guanine nucleotide-binding protein beta-3 (GNB3) genes were significantly associated with ICVD after correction for age and gender. The strongest association was found for the protective LPL Ser447Term polymorphism. All the significant markers showed varying frequencies in different subphenotypes of ICVD. Factor VII, apolipoprotein E and two renin polymorphisms were differentially frequent in patients with evidence of CS compared with non-CS patients. CONCLUSIONS We have found that some previously described susceptibility polymorphisms are weakly associated with ICVD and that subdivision of patients into CS and non-CS groups may help to identify new candidate polymorphisms.
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Affiliation(s)
- K Kostulas
- Department of Neurology, Neuro-Angiological Research Center, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden.
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Bersano A, Ballabio E, Bresolin N, Candelise L. Genetic polymorphisms for the study of multifactorial stroke. Hum Mutat 2008; 29:776-95. [PMID: 18421701 DOI: 10.1002/humu.20666] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Single-gene disorders explain only a minority of stroke cases. Stroke represents a complex trait, which is usually assumed to be polygenic. On this topic, the role of a wide number of candidate genes has been investigated in stroke through association studies, with controversial results. Therefore, it is difficult for the clinician to establish the validity and the level of clinical applicability of the previously reported associations between genetic factors and stroke. This review is an update and an extensive analysis of the more recent association studies conducted in stroke. We evaluated a number of studies on several candidate genes (including F5, F2, FGA/FGB/FGG, F7, F13A1, vWF, F12, SERPINE1, ITGB3/PLA1/PLA2/ITGA2B, ITGA2, GP1BA, ACE, AGT, NOS3, APOE, LPL, PON1, PDE4D, ALOX5AP, MTHFR, MTR, and CBS), providing a final panel of genes and molecular variants. We categorized this panel in relation to the degree of association with stroke, supported by the results of meta-analyses and case-control studies. Our findings could represent a useful tool to address further molecular investigations and to realize more detailed meta-analyses.
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Affiliation(s)
- A Bersano
- Dipartimento di Scienze Neurologiche, Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Università degli Studi di Milano, Milano, Italy
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Xu E, Li W, Zhan L, Guan G, Wang X, Chen S, Shi Y. Polymorphisms of the lipoprotein lipase gene are associated with atherosclerotic cerebral infarction in the Chinese. Neuroscience 2008; 155:403-8. [PMID: 18590804 DOI: 10.1016/j.neuroscience.2008.06.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 06/01/2008] [Accepted: 06/02/2008] [Indexed: 01/03/2023]
Abstract
BACKGROUND Lipoprotein lipase (LPL), which plays an essential role in plasma lipoprotein metabolism and transportation, appears to be a risk factor for ischemic vascular diseases. Several studies have recently reported the presence of relationship between HindIII, PvuII, Ser447Ter (C-->G) polymorphisms of LPL and ischemic vascular diseases. PURPOSE We first studied the relationship between LPL polymorphisms and the risk of atherosclerotic cerebral infarction (CI) by detecting the frequencies of LPL HindIII, PvuII and Ser447Ter genotypes and combined genotypes in the Chinese. METHODS We recruited 185 CI patients, confirmed by cranial computed tomography or magnetic resonance imaging/angiography, or both, and 186 control subjects. Polymerase chain reaction-restriction fragment length polymorphisms technique was used to detect HindIII, PvuII and Ser447Ter polymorphisms of the LPL gene. RESULTS The frequencies of the H+H+ genotype and H+ allele did not differ between CI and control groups. The frequencies of the P+P+ genotype and P+ allele gene were significantly higher in the CI group (P=0.040, P=0.015). The frequencies of CG+GG genotype and G allele were lower in the CI group (P<0.001, P<0.001). In the CI group, the individuals with P+P+ genotype had a significantly higher level of plasma triglyceride (TG) and a lower level of plasma high density lipoprotein cholesterol (HDL-c). CG+GG genotypes were correlated with significantly higher levels of plasma total cholesterol (TC), HDL-c and low density lipoprotein cholesterol (LDL-c) in the CI group. The frequencies of H+/C and P+/C combined genotypes were higher in the CI group than in controls (P<0.001, P<0.001). The frequency of H+/P+/C combined genotype was significantly higher in the CI group than in controls (P<0.001). CONCLUSIONS Our study suggests that PvuII and Ser447Ter polymorphisms are associated with lipid profile and CI.
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Affiliation(s)
- E Xu
- Institute of Neurosciences, The 2nd Affiliated Hospital of Guangzhou Medical College, 250 Changgang Dong RD, Guangzhou 510260, PR China.
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Pasdar A, Yadegarfar G, Cumming A, Whalley L, St Clair D, MacLeod MJ. The effect of ABCA1 gene polymorphisms on ischaemic stroke risk and relationship with lipid profile. BMC MEDICAL GENETICS 2007; 8:30. [PMID: 17553166 PMCID: PMC1894956 DOI: 10.1186/1471-2350-8-30] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Accepted: 06/06/2007] [Indexed: 11/13/2022]
Abstract
Background Ischaemic stroke is a common disorder with genetic and environmental components contributing to overall risk. Atherothromboembolic abnormalities, which play a crucial role in the pathogenesis of ischaemic stroke, are often the end result of dysregulation of lipid metabolism. The ATP Binding Cassette Transporter (ABCA1) is a key gene involved in lipid metabolism. It encodes the cholesterol regulatory efflux protein which mediates the transfer of cellular phospholipids and cholesterol to acceptor apolipoproteins such as apolipoprotein A-I (ApoA-I). Common polymorphisms in this gene affect High Density Lipoprotein Cholesterol (HDL-C) and Apolipoprotein A-I levels and so influence the risk of atherosclerosis. This study has assessed the distribution of ABCA1 polymorphisms and haplotype arrangements in patients with ischaemic stroke and compared them to an appropriate control group. It also examined the relationship of these polymorphisms with serum lipid profiles in cases and controls. Methods We studied four common polymorphisms in ABCA1 gene: G/A-L158L, G/A-R219K, G/A-G316G and G/A-R1587K in 400 Caucasian ischaemic stroke patients and 487 controls. Dynamic Allele Specific Hybridisation (DASH) was used as the genotyping assay. Results Genotype and allele frequencies of all polymorphisms were similar in cases and controls, except for a modest difference in the ABCA1 R219K allele frequency (P-value = 0.05). Using the PHASE2 program, haplotype frequencies for the four loci (158, 219, 316, and 1587) were estimated in cases and controls. There was no significant difference in overall haplotypes arrangement in patients group compared to controls (p = 0.27). 2211 and 1211 haplotypes (1 = common allele, 2 = rare allele) were more frequent in cases (p = 0.05). Adjusted ORs indicated 40% and 46% excess risk of stroke for these haplotypes respectively. However, none of the adjusted ORs were statistically significant. Individuals who had R219K "22" genotype had a higher LDL level (p = 0.001). Conclusion Our study does not support a major role for the ABCA1 gene as a risk factor for ischaemic stroke. Some haplotypes may confer a minor amount of increased risk or protection. Polymorphisms in this gene may influence serum lipid profile.
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Affiliation(s)
| | - Ghasem Yadegarfar
- Public Health Sciences & Medical Statistics Group, University of Southhampton, UK
| | - Alastair Cumming
- Department of Molecular and Cell Biology, University of Aberdeen, UK
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Fortunato G, Di Taranto MD. Polymorphisms and the expression of genes encoding enzymes involved in cardiovascular diseases. Clin Chim Acta 2007; 381:21-5. [PMID: 17368599 DOI: 10.1016/j.cca.2007.02.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Accepted: 02/13/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Atherosclerosis, a multi-factorial disease, is the main determinant of cardiovascular disease (CVD) leading to high mortality and morbidity in westernized countries. Gene polymorphisms and gene expression related to the atherosclerosis process can be identified using a genome-wide approach or looking for candidate disease-causing genes. METHODS Using genome wide strategy or candidate gene approach various genes, including paraoxonase genes, which are involved in lipid metabolism, oxidation, inflammation and coagulation, have been associated to atherosclerosis. CONCLUSION Evaluation of gene polymorphisms, together with traditional and novel biochemical parameters, may help identify individuals at a high risk for CVD. Genetic characterization of susceptibility genes may also lead to new drugs for atherosclerosis prevention and treatment. In addition, gene expression studies can provide novel insights into the molecular mechanism of lesion development and progression.
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Affiliation(s)
- Giuliana Fortunato
- Dipartimento di Biochimica e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy.
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Gigek CDO, Chen ES, Cendoroglo MS, Ramos LR, Araujo LMQ, Payão SLM, Smith MDAC. Association of lipase lipoprotein polymorphisms with myocardial infarction and lipid levels. Clin Chem Lab Med 2007; 45:599-604. [PMID: 17484619 DOI: 10.1515/cclm.2007.115] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Lipoprotein lipase has an important role in lipid metabolism. Elevated levels of very-low-density lipoprotein (VLDL) and low-density lipoprotein (LDL) are associated with increased risk of coronary artery disease and low levels of high-density lipoprotein (HDL) are potentially atherogenic. The HindIII and S447X polymorphisms of the lipoprotein lipase (LPL) gene are associated with cardiovascular disease in some populations. METHODS LPL HindIII and S447X polymorphisms were analyzed in 343 individuals of 66-97 years of age from a cohort of a Brazilian elderly longitudinal study. Allele frequencies, genotype distribution and allele association with major morbidities and with serum lipid, urea, creatinine and albumin levels were also investigated. The whole sample was genotyped by PCR-restriction fragment length polymorphism (RFLP). Descriptive statistics, logistic regression analysis and t-test were used. RESULTS Allele frequencies were H(+)=0.652 and H(-)=0.348 for LPL HindIII and S=0.824 and X=0.176 for LPL S447X polymorphism. Both polymorphisms have frequencies similar to those in some European populations. LPL HindIII polymorphism showed significant association of the H(+) allele with myocardial infarction. The H(-) allele showed a tendency to associate with higher HDL levels. The LPL S447X S allele was associated with higher triglyceride levels. CONCLUSIONS These findings may help to identify risk factors for subjects and families and clarify the physiopathological role of these polymorphisms in age-related diseases.
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Affiliation(s)
- Carolina de Oliveira Gigek
- Departamento de Morfologia e Genética, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Liew G, Shankar A, Wang JJ, Klein R, Bray MS, Couper DJ, Wong TY. Apolipoprotein E gene polymorphisms are not associated with diabetic retinopathy: the atherosclerosis risk in communities study. Am J Ophthalmol 2006; 142:105-11. [PMID: 16815257 DOI: 10.1016/j.ajo.2006.02.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Revised: 02/08/2006] [Accepted: 02/11/2006] [Indexed: 11/29/2022]
Abstract
PURPOSE Polymorphism of the apolipoprotein E (APOE) gene has been associated with dyslipidemia and cardiovascular disease. This study examines the association of APOE polymorphisms and diabetic retinopathy. DESIGN Population-based cross-sectional study. METHODS We studied 1,398 people aged 49 to 73 years with diabetes selected from four United States communities. We performed retinal photography on one randomly selected eye and graded for the presence and severity of diabetic retinopathy using a modification of the Early Treatment Diabetic Retinopathy Study scale. We performed genotyping of common polymorphic APOE alleles using polymerase chain reaction on genomic DNA from venous blood leukocytes. RESULTS The prevalence of diabetic retinopathy and hard exudates was 15.0% and 5.3% in Caucasians (n = 935), and 24.6% and 9.7% in African-Americans (n = 463), with type 2 diabetes. APOE gene polymorphisms were not associated with diabetic retinopathy in either Caucasians or African-Americans. In African-Americans, the 2/4 genotype (n = 6) was associated with increased prevalence of hard exudates (odds ratio [OR] 4.10, 95% confidence interval [CI] 1.30 to 12.90), as was the 2/3 genotype (n = 9, OR 2.64, 95% CI 1.01 to 6.95). No association between APOE genotypes and hard exudates was found in Caucasians. CONCLUSIONS These data suggest that APOE gene polymorphisms are not associated with diabetic retinopathy in either Caucasians or African-Americans with type 2 diabetes.
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Affiliation(s)
- Gerald Liew
- Centre for Vision Research, University of Sydney, Sydney, Australia
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Baum L, Ng HK, Wong KS, Tomlinson B, Rainer TH, Chen X, Cheung WS, Tang J, Tam WWS, Goggins W, Tong CSW, Chan DKY, Thomas GN, Chook P, Woo KS. Associations of apolipoprotein E exon 4 and lipoprotein lipase S447X polymorphisms with acute ischemic stroke and myocardial infarction. Clin Chem Lab Med 2006; 44:274-81. [PMID: 16519597 DOI: 10.1515/cclm.2006.047] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Because apolipoprotein E (apoE) and lipopoprotein lipase (LPL) polymorphisms interact with each other and with other factors to affect lipid metabolism, we sought to determine their separate and combined effects in association with ischemic vascular disease. METHODS We performed a case-control study of 816 subjects: 246 acute ischemic stroke patients, 234 acute myocardial infarction patients, and 336 controls. APOE exon 4 and LPL S447X genotypes were determined. RESULTS APOE epsilon2 and epsilon4 homozygotes were increased in stroke (4.5% vs. 1.0%, p = 0.008), while in myocardial infarction the epsilon4 allele was increased (12.6% vs. 9.5%, p = 0.006) but epsilon2 was decreased (3.7% vs. 12.1%, p = 0.000006). For subjects with either APOE epsilon2 or epsilon4 alleles, LPL X alleles were increased in vascular disease (OR = 2.2, p = 0.01). LPL X alleles displayed opposite tendencies toward association with disease when subjects were divided by sex, smoking, or APOE genotype. Meta-analysis and regression analysis of previous studies supported the sex and smoking dichotomies. CONCLUSION This is the first report of an association of vascular disease with an interaction of APOE exon 4 and LPL S447X genotypes. Therefore, APOE genotypes and LPL S447X interactions with apoE, sex, and smoking may affect the risk of myocardial infarction and ischemic stroke.
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Affiliation(s)
- Larry Baum
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong.
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Rip J, Nierman MC, Ross CJ, Jukema JW, Hayden MR, Kastelein JJP, Stroes ESG, Kuivenhoven JA. Lipoprotein lipase S447X: a naturally occurring gain-of-function mutation. Arterioscler Thromb Vasc Biol 2006; 26:1236-45. [PMID: 16574898 DOI: 10.1161/01.atv.0000219283.10832.43] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lipoprotein lipase (LPL) hydrolyzes triglycerides in the circulation and promotes the hepatic uptake of remnant lipoproteins. Since the gene was cloned in 1989, more than 100 LPL gene mutations have been identified, the majority of which cause loss of enzymatic function. In contrast to this, the naturally occurring LPL(S447X) variant is associated with increased lipolytic function and an anti-atherogenic lipid profile and can therefore be regarded as a gain-of-function mutation. This notion combined with the facts that 20% of the general population carries this prematurely truncated LPL and that it may protect against cardiovascular disease has led to extensive clinical and basic research into this frequent LPL mutant. It is only until recently that we begin to understand the molecular mechanisms that underlie the beneficial effects associated with LPL(S447X). This review summarizes the current literature on this interesting LPL variant.
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Affiliation(s)
- Jaap Rip
- Department of Vascular Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands
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Fidani L, Hatzitolios AI, Goulas A, Savopoulos C, Basayannis C, Kotsis A. Cholesteryl ester transfer protein TaqI B and lipoprotein lipase Ser447Ter gene polymorphisms are not associated with ischaemic stroke in Greek patients. Neurosci Lett 2005; 384:102-5. [PMID: 15896905 DOI: 10.1016/j.neulet.2005.04.061] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Revised: 04/16/2005] [Accepted: 04/19/2005] [Indexed: 11/26/2022]
Abstract
Cholesteryl ester transfer protein (CETP) and lipoprotein lipase (LPL) are both key players in plasma lipoprotein homeostasis and, as such, genetically induced alterations in their respective activities may affect susceptibility to cerebrovascular diseases. In this study, we examined the distribution of two common polymorphisms, namely CETP TaqI B and LPL Ser447Ter in a cohort of Greek clinically diagnosed late-onset ischaemic stroke patients (n = 98) and an ethnicity-, age- and sex-matched control group with no manifestations of vascular disease (n = 100). Our study revealed no statistically significant differences with respect to the distribution of either polymorphism, examined separately or in combination, between the two groups.
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Affiliation(s)
- Liana Fidani
- Department of General Biology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece.
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Behrendt CE, Ruiz RB. Cerebral Ischemic Events in Patients with Advanced Lung or Prostate Cancer. Neuroepidemiology 2005; 24:230-6. [PMID: 15832061 DOI: 10.1159/000085172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Conventional stroke risks are thought responsible for most cerebral ischemic events (CIE) in adult cancer patients. Also suspected as a risk is cisplatin chemotherapy, alone or in combination with tumor angiogenesis inhibitor. We investigated whether treatment or tumor characteristics, independently of conventional stroke risks, are associated with CIE in a retrospective cohort study of 1,559 patients with advanced non-small cell lung cancer or hormone-refractory prostate cancer followed during 3 clinical trials of matrix metalloprotease inhibitor (prinomastat) versus placebo, with chemotherapy (gemcitabine/cisplatin, paclitaxel/carboplatin or mitoxantrone/prednisone). During 11,907 patient-months, 28 CIE (17 cerebral infarction, 11 transient ischemic attack) were diagnosed in 24 patients, all but 1 over 55 years. Neither prinomastat, platinum-based chemotherapy nor their combination was associated with CIE after age 55. However, such events were predicted by the presence of distant metastases in the liver or lungs and not in distant lymph nodes (hazard estimate 4.6, 95% CI 2.0-10.5, adjusted for conventional stroke risks). Further studies are needed to verify this preliminary finding and determine its generalizability to advanced tumors other than lung or prostate cancer.
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Affiliation(s)
- Carolyn E Behrendt
- Epidemiology, Safety and Risk Management, Pfizer Global Research and Development, La Jolla, CA, USA.
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Garenc C, Aubert S, Laroche J, Girouard J, Vohl MC, Bergeron J, Rousseau F, Julien P. Population prevalence of APOE, APOC3 and PPAR-α mutations associated to hypertriglyceridemia in French Canadians. J Hum Genet 2004; 49:691-700. [PMID: 15549499 DOI: 10.1007/s10038-004-0208-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2004] [Accepted: 09/22/2004] [Indexed: 10/26/2022]
Abstract
Hypertriglyceridemia (HTG) is known as a common metabolic disorder associated with increased production, decrease catabolism and/or decreased hepatic uptake of triglyceride (TG)-rich particles. We assessed, in the Quebec City population, the allele frequency and haplotype distributions of mutations in genes related to HTG, such as the apolipoprotein E (APOE) (C112R and C158R), the apolipoprotein CIII (APOC3) (C-482T and C3238G) and the peroxisome proliferator-activated receptor alpha (PPARalpha) (L162V) genes. A total of 938 anonymous unlinked newborns from the metropolitan Quebec City area have been genotyped. Allele frequencies observed in the Quebec City population differed from known frequencies determined in other Caucasian populations. The co-transmitted allele distribution between the two-marker genotypes APOE/APOC3(C3238G) and APOC3(C-482T)/PPARalpha(L162V) presented a weak deviation from the assumption of genetic independence. Also, we observed a non-independent distribution of the T-482/G3238 allele combinations within the APOC3 gene, suggesting strong linkage disequilibrium between the C-482T and C3238G polymorphisms. Moreover, comparisons of allele frequencies observed in the population of Québec City to those obtained in other Caucasian populations suggested that the population of Québec City may be at a lower risk of developing HTG due to APOE, APOC3 and PPARalpha genetic variants. However, the strong linkage disequilibrium and the two-marker genotype distributions observed in the APOC3 gene suggest that these two variants may functionally interact in the Québec City population.
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Affiliation(s)
- Christophe Garenc
- Department of Medicine, Lipid Research Center (CRML), Centre de Recherche du Centre Hospitalier de l'Université Laval du CHUQ, Pavilion CHUL, TR-93, Laval University, 2705 Boulevard Laurier, Sainte-Foy, QC, G1V 4G2, Canada
| | - Samuel Aubert
- Department of Medicine, Lipid Research Center (CRML), Centre de Recherche du Centre Hospitalier de l'Université Laval du CHUQ, Pavilion CHUL, TR-93, Laval University, 2705 Boulevard Laurier, Sainte-Foy, QC, G1V 4G2, Canada
| | - Jèrôme Laroche
- Department of Medical Biology, Faculty of Medicine, Unité de Recherche en Génétique Humaine et Moléculaire, Center for the Development, Evaluation and Rational Implementation of Diagnostic Tests (CEDERINDT), Centre de Recherche de l'Hôpital St-François d'Assise du CHUQ, Laval University, Québec, QC, Canada
- Bioinformatic Center, Laval University, QC, Canada
| | - Joël Girouard
- Department of Medical Biology, Faculty of Medicine, Unité de Recherche en Génétique Humaine et Moléculaire, Center for the Development, Evaluation and Rational Implementation of Diagnostic Tests (CEDERINDT), Centre de Recherche de l'Hôpital St-François d'Assise du CHUQ, Laval University, Québec, QC, Canada
| | - Marie-Claude Vohl
- Department of Medicine, Lipid Research Center (CRML), Centre de Recherche du Centre Hospitalier de l'Université Laval du CHUQ, Pavilion CHUL, TR-93, Laval University, 2705 Boulevard Laurier, Sainte-Foy, QC, G1V 4G2, Canada
| | - Jean Bergeron
- Department of Medicine, Lipid Research Center (CRML), Centre de Recherche du Centre Hospitalier de l'Université Laval du CHUQ, Pavilion CHUL, TR-93, Laval University, 2705 Boulevard Laurier, Sainte-Foy, QC, G1V 4G2, Canada
| | - François Rousseau
- Department of Medical Biology, Faculty of Medicine, Unité de Recherche en Génétique Humaine et Moléculaire, Center for the Development, Evaluation and Rational Implementation of Diagnostic Tests (CEDERINDT), Centre de Recherche de l'Hôpital St-François d'Assise du CHUQ, Laval University, Québec, QC, Canada
| | - Pierre Julien
- Department of Medicine, Lipid Research Center (CRML), Centre de Recherche du Centre Hospitalier de l'Université Laval du CHUQ, Pavilion CHUL, TR-93, Laval University, 2705 Boulevard Laurier, Sainte-Foy, QC, G1V 4G2, Canada.
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Liu A, Lee L, Zhan S, Cao W, Lv J, Guo X, Hu Y. The S447X polymorphism of the lipoprotein lipase gene is associated with lipoprotein lipid and blood pressure levels in Chinese patients with essential hypertension. J Hypertens 2004; 22:1503-9. [PMID: 15257172 DOI: 10.1097/01.hjh.0000125456.28861.e4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the association between the S447X polymorphism of the lipoprotein lipase (LPL) gene and lipoprotein lipid and blood pressure (BP) levels in 904 Chinese subjects with essential hypertension. METHOD Five hundred and sixty-three male and 341 female patients (aged 35-69 years) were randomly selected from hypertensive patients diagnosed in the Community-based Comprehensive Studies on Prevention and Control of Hypertension Project in China (CCPACH) and not treated with antihypertensive medications for at least 2 weeks immediately before blood collection. RESULTS After multivariate adjustment for age, body mass index (BMI), smoking status, alcohol intake and serum glucose, the X447 allele was significantly associated with low triglyceride, log triglyceride : high-density lipoprotein (HDL)-cholesterol ratio and high HDL-cholesterol levels compared with the S447S genotype, but not with BP levels in the whole study population. However, upon stratification for dyslipidemic status, the X447 allele was associated with higher systolic blood pressure (SBP) (P < 0.05) and pulse pressure (PP) (P < 0.05) compared with the S447S genotype after multivariate adjustment in dyslipidemic subjects, but not in those without dyslipidemia. A statistically significant interaction between the LPL S447X polymorphism and dyslipidemic status was observed for SBP and PP levels, suggesting that dyslipidemic status might modify the effect of the LPL S447X polymorphism on BP levels. CONCLUSIONS Our findings suggest that a high concentration of triglyceride and/or low concentration of HDL-cholesterol are associated with high SBP and PP in hypertensive patients with the X447 allele of the LPL gene.
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Affiliation(s)
- Aiping Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
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Abstract
BACKGROUND AND PURPOSE Coding single nucleotide polymorphisms (cSNPs) in the lipoprotein lipase (LPL) gene have been associated with lipoprotein phenotypes and vascular disease risk. We studied the association between LPL cSNPs and a novel noninvasive measure of disease, namely, cross-sectional carotid plaque area (CPA) on B-mode ultrasound. METHODS Four hundred fifty-two patients from an atherosclerosis prevention clinic had determinations of baseline and total CPA. Traditional atherosclerosis risk factors were recorded, and the LPL D9N, N291S, and S447X cSNPs were genotyped. Multiple regression analysis was used to identify determinants of CPA. RESULTS Minor allele frequencies for LPL D9N, N291S, and S447X were 2.8%, 0.9%, and 4.4%, respectively. There were no significant between-genotype differences in treated fasting lipids. The LPL D9N genotype was a significant predictor of both baseline CPA (P=0.008) and plaque progression from baseline to 1 year later (P=0.001). Heterozygotes for the N9 allele had higher mean baseline CPA and plaque progression than did LPL D9/D9 homozygotes. CONCLUSIONS LPL D9N genotype may be a determinant of atherosclerosis as estimated by static baseline CPA and by progression of CPA.
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Affiliation(s)
- J David Spence
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, London, Ontario, Canada.
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Ziouzenkova O, Perrey S, Asatryan L, Hwang J, MacNaul KL, Moller DE, Rader DJ, Sevanian A, Zechner R, Hoefler G, Plutzky J. Lipolysis of triglyceride-rich lipoproteins generates PPAR ligands: evidence for an antiinflammatory role for lipoprotein lipase. Proc Natl Acad Sci U S A 2003; 100:2730-5. [PMID: 12606719 PMCID: PMC151409 DOI: 10.1073/pnas.0538015100] [Citation(s) in RCA: 174] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Increased levels of triglyceride-rich lipoproteins provoke lipid accumulation in the artery wall, triggering early inflammatory responses central to atherosclerosis like endothelial adhesion molecule expression. The endogenous mechanisms limiting such reactions remain poorly defined. Lipoprotein lipase (LPL) plays a central role in lipid metabolism by hydrolyzing triglyceride rich lipoproteins and releasing fatty acids. We found that LPL treatment reversed tumor necrosis factor alpha and very low-density lipoprotein (VLDL)-stimulated endothelial vascular cell adhesion molecule 1 (VCAM1) induction and VCAM1 promoter responses, thus recapitulating effects reported with synthetic peroxisome proliferator-activated receptor (PPAR) agonists. In fact, these LPL effects on VCAM1 were absent in endothelial cells isolated from PPAR alpha-deficient mice. This finding suggests a novel antiinflammatory role for LPL. Further studies reveal specificity for PPAR activation through lipolysis in regards to lipoprotein substrate (VLDL >> LDL > HDL), PPAR isoform (PPAR alpha >> PPAR delta > PPAR gamma), and among fatty acid-releasing lipases. These PPAR responses required intact LPL catalytic activity. In vivo, transgenic mice overexpressing LPL had increased peroxisome proliferation, but not in the genetic absence of PPAR alpha. Although human plasma possesses minimal PPAR alpha activation despite containing abundant free fatty acids, marked PPAR alpha activation is seen with human plasma after LPL is added in vitro or systemically released in vivo. These data suggest a previously uncharacterized pathway in which the key lipolytic enzyme LPL can act on circulating lipoproteins to generate PPAR alpha ligands, providing a potentially important link between lipoprotein metabolism and distal PPAR alpha transcriptional effects.
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MESH Headings
- Animals
- Anti-Inflammatory Agents/pharmacology
- Blotting, Northern
- Cells, Cultured
- Dose-Response Relationship, Drug
- Fatty Acids/metabolism
- Humans
- Immunohistochemistry
- Ligands
- Lipid Metabolism
- Lipolysis
- Lipoprotein Lipase/physiology
- Lipoproteins/metabolism
- Lipoproteins, VLDL/metabolism
- Mice
- Mice, Transgenic
- Microscopy, Fluorescence
- Models, Biological
- Protein Isoforms
- Receptors, Cytoplasmic and Nuclear/genetics
- Receptors, Cytoplasmic and Nuclear/metabolism
- Transcription Factors/genetics
- Transcription Factors/metabolism
- Transcription, Genetic
- Transfection
- Triglycerides/metabolism
- Vascular Cell Adhesion Molecule-1/metabolism
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Affiliation(s)
- Ouliana Ziouzenkova
- Cardiovascular Division, Brigham and Women's Hospital, Harvard University, Boston, MA 02115, USA
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Affiliation(s)
- Mark J Alberts
- Northwestern University Medical School, Chicago, Ill 60611, USA.
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