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McIntosh RC, Lobo J, Paparozzi J, Goodman Z, Kornfeld S, Nomi J. Neutrophil to lymphocyte ratio is a transdiagnostic biomarker of depression and structural and functional brain alterations in older adults. J Neuroimmunol 2022; 365:577831. [PMID: 35217366 PMCID: PMC11092564 DOI: 10.1016/j.jneuroim.2022.577831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/30/2022] [Accepted: 02/14/2022] [Indexed: 12/30/2022]
Abstract
The neutrophil to lymphocyte ratio (N:L) is an emergent transdiagnostic biomarker shown to predict peripheral inflammation as well as neuropsychiatric impairment. The afferent signaling of inflammation to the central nervous system has been implicated in the pathophysiology of sickness behavior and depression. Here, the N:L was compared to structural and functional limbic alterations found concomitant with depression within a geriatric cohort. Venous blood was collected for a complete blood count, and magnetic resonance imaging as well as phenotypic data were collected from the 66 community-dwelling older adults (aged 65-86 years). The N:L was regressed on gray matter volume and resting-state functional connectivity (rsFC) of the subgenual anterior cingulate (sgACC). Thresholded parameter estimates were extracted from structural and functional brain scans and bivariate associations tested with scores on the geriatric depression scale. Greater N:L predicted lower volume of hypothalamus and rsFC of sgACC with ventromedial prefrontal cortex. Both parameters were correlated (p < 0.05) with greater symptomology in those reporting moderate to severe levels of depression. These findings support the N:L as a transdiagnostic biomarker of limbic alteration underpinning mood disturbance in non-treated older adults.
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Affiliation(s)
- Roger C McIntosh
- Department of Psychology, University of Miami, Coral Gables, FL 33124, United States of America.
| | - Judith Lobo
- Department of Psychology, University of Miami, Coral Gables, FL 33124, United States of America
| | - Jeremy Paparozzi
- Department of Psychology, University of Miami, Coral Gables, FL 33124, United States of America
| | - Zach Goodman
- Department of Psychology, University of Miami, Coral Gables, FL 33124, United States of America
| | - Salome Kornfeld
- Department of Psychology, University of Miami, Coral Gables, FL 33124, United States of America
| | - Jason Nomi
- Department of Psychology, University of Miami, Coral Gables, FL 33124, United States of America
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2
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Puri R, Nissen SE, Arsenault BJ, St John J, Riesmeyer JS, Ruotolo G, McErlean E, Menon V, Cho L, Wolski K, Lincoff AM, Nicholls SJ. Effect of C-Reactive Protein on Lipoprotein(a)-Associated Cardiovascular Risk in Optimally Treated Patients With High-Risk Vascular Disease: A Prespecified Secondary Analysis of the ACCELERATE Trial. JAMA Cardiol 2020; 5:1136-1143. [PMID: 32639518 DOI: 10.1001/jamacardio.2020.2413] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Importance Although lipoprotein(a) (Lp[a]) is a causal genetic risk factor for atherosclerotic cardiovascular disease, it remains unclear which patients with established atherosclerotic cardiovascular disease stand to benefit the most from Lp(a) lowering. Whether inflammation can modulate Lp(a)-associated cardiovascular (CV) risk during secondary prevention is unknown. Objective To examine whether Lp(a)-associated CV risk is modulated by systemic inflammation in optimally treated patients at high risk of CV disease. Design, Setting, and Participants A prespecified secondary post hoc analysis of the double-blind, multicenter randomized clinical Assessment of Clinical Effects of Cholesteryl Ester Transfer Protein Inhibition With Evacetrapib in Patients at a High Risk for Vascular Outcomes (ACCELERATE) trial was conducted between October 1, 2012, and December 31, 2013; the study was terminated October 12, 2015. The study was conducted at 543 academic and community hospitals in 36 countries among 12 092 patients at high risk of CV disease (acute coronary syndrome, stroke, peripheral arterial disease, or type 2 diabetes with coronary artery disease) with measurable Lp(a) and high-sensitivity C-reactive protein (hsCRP) levels during treatment. Statistical analysis for this post hoc analysis was performed from September 26, 2018, to March 28, 2020. Interventions Participants received evacetrapib, 130 mg/d, or matching placebo. Main Outcomes and Measures The ACCELERATE trial found no significant benefit or harm of evacetrapib on 30-month major adverse cardiovascular events (CV death, myocardial infarction [MI], stroke, coronary revascularization, or hospitalization for unstable angina). This secondary analysis evaluated rates of CV death, MI, and stroke across levels of Lp(a). Results High-sensitivity C-reactive protein and Lp(a) levels were measured in 10 503 patients (8135 men; 8561 white; 10 134 received concurrent statins; mean [SD] age, 64.6 [9.4] years). In fully adjusted analyses, in patients with hsCRP of 2 mg/L or more but not less than 2 mg/L, increasing quintiles of Lp(a) were significantly associated with greater rates of death, MI, and stroke (P = .006 for interaction). Each unit increase in log Lp(a) levels was associated with a 13% increased risk of CV death, nonfatal MI, or stroke only in those with hsCRP levels of 2 mg/L or more (P = .008 for interaction). There was also a significant stepwise relationship between increasing Lp(a) quintiles and time to first CV death, MI, or stroke (log-rank P < .001) when hsCRP levels were 2 mg/L or more but not less than 2 mg/L. Sensitivity analyses in the ACCELERATE placebo-treated group yielded similar significant associations exclusively in the group with hsCRP of 2 mg/L or more. Conclusions and Relevance Elevated Lp(a) levels during treatment are related to CV death, MI, and stroke when hsCRP levels are 2 mg/L or more but not less than 2mg/L. This finding suggests a potential benefit of lowering Lp(a) in patients with residual systemic inflammation despite receipt of optimal medical therapy. Trial Registration ClinicalTrials.gov Identifier: NCT01687998.
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Affiliation(s)
- Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.,Cleveland Clinic Coordinating Center for Clinical Research, Cleveland Clinic, Cleveland, Ohio
| | - Steven E Nissen
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.,Cleveland Clinic Coordinating Center for Clinical Research, Cleveland Clinic, Cleveland, Ohio
| | - Benoit J Arsenault
- Québec Heart & Lung Institute, Université de Laval, Québec, Québec, Canada
| | - Julie St John
- Cleveland Clinic Coordinating Center for Clinical Research, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Ellen McErlean
- Cleveland Clinic Coordinating Center for Clinical Research, Cleveland Clinic, Cleveland, Ohio
| | - Venu Menon
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.,Cleveland Clinic Coordinating Center for Clinical Research, Cleveland Clinic, Cleveland, Ohio
| | - Leslie Cho
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Kathy Wolski
- Cleveland Clinic Coordinating Center for Clinical Research, Cleveland Clinic, Cleveland, Ohio
| | - A Michael Lincoff
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.,Cleveland Clinic Coordinating Center for Clinical Research, Cleveland Clinic, Cleveland, Ohio
| | - Stephen J Nicholls
- MonashHeart, Department of Cardiology, Monash University, Clayton, Victoria, Australia
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Jena M, Tripathy A, Mishra A, Maiti R. Effect of canakinumab on clinical and biochemical parameters in acute gouty arthritis: a meta-analysis. Inflammopharmacology 2020; 29:35-47. [PMID: 32918702 DOI: 10.1007/s10787-020-00753-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/28/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Targeted anti-IL-1β therapy may be a valuable option for the management of gouty arthritis. The present meta-analysis has evaluated the effect of canakinumab, an anti-IL-1β monoclonal antibody in gouty arthritis. METHODS A standard meta-analysis protocol was developed and after performing a comprehensive literature search in MEDLINE, Cochrane, and International Clinical Trial Registry Platform (ICTRP), reviewers assessed eligibility and extracted data from three relevant articles. A random-effects model was used to estimate the pooled effect size as the mean difference in Visual Analouge Scale (VAS) score, serum hsCRP, serum Amyloid A, and risk ratio for global assessment between the groups. Quality assessment was done using the risk of bias assessment tool and summary of findings was prepared using standard Cochrane methodology with GradePro GDT. RESULTS Treatment with canakinumab showed a mean reduction of VAS score by 14.59 mm [95% CI - 19.42 to - 9.77], serum hsCRP by 15.36 mg/L [95% CI 1.62-29.11], serum Amyloid A by 67.18 mg/L [95% CI 17.06-117.31], and improvement in patient global assessment (RR = 1.478; 95% CI 1.29-1.67) and physician global assessment (RR = 1.44; 95% CI 1.28-1.61). The probability that future studies may have a mean difference in VAS score less than zero has been calculated to be 27.3% using a cumulative distribution function (CDF) calculator. CONCLUSION This meta-analysis shows the beneficial effect of canakinumab over triamcinolone by reducing VAS score, serum hsCRP, serum amyloid A, and improvement in global assessments in acute gouty arthritis.
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Affiliation(s)
- Monalisa Jena
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, 751019, Odisha, India
| | - Amruta Tripathy
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, 751019, Odisha, India
| | - Archana Mishra
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Rituparna Maiti
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, 751019, Odisha, India.
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Kasapoğlu Aksoy M, Altan L, Görükmez O, Güner A, Ayar K. The relationship between CRP gene polymorphism (rs2794521, rs3091244), ASDAS-CRP and ASDAS-ESR in ankylosing spondylitis. Mod Rheumatol 2019; 30:715-720. [PMID: 31267817 DOI: 10.1080/14397595.2019.1639916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: We aimed to investigate the haplotypes and alleles of two variants (rs2794521 and rs3091244) in AS patients and to examine their relationship with ASDAS-CRP and ASDAS-ESR values.Methods: We evaluated 160 AS patients diagnosed according to the ASAS criteria. ASDAS-CRP and ASDAS-ESR values were calculated. ESR and CRP were examined. The restriction fragment length polymorphism (RFLP) method was used for detecting the rs2794521 and rs3091244 regions on the CRP gene.Results: As a result of the evaluation of rs2794521 gene polymorphism using PCR, TT, TC and CC genotypes were observed in 90, 81 and 9 individuals, respectively. As a result of the evaluation of rs3091244 gene polymorphism, CC, AC and TT genotypes were observed in 104, 51 and 5 individuals, respectively. T allele and C allele were found in rs2794521 gene by 75% and 25%, respectively. In addition, T allele, C allele and A allele were found in rs3091244 gene by 80%, 17% and 3%, respectively. With the help of regression equation, ASDAS-CRP level was 0.34 units higher in cases with rs3091244 C allele than cases without rs3091244 C alleles.Conclusion: CRP rs3091244 C allele may be associated with the increased relative risk for ASDAS-CRP.
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Affiliation(s)
- Meliha Kasapoğlu Aksoy
- Department of Physical Medicine and Rehabilitation, Bursa Yüksek İhtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Lale Altan
- Department of Physical Medicine and Rehabilitation, Bursa Yüksek İhtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey.,Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Orhan Görükmez
- Department of Genetics, Bursa Yüksek İhtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Altuğ Güner
- Department of Physical Medicine and Rehabilitation, Bursa Yüksek İhtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Koray Ayar
- Department of Romatology, Bursa Yüksek İhtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
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5
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Meeusen JW, Donato LJ, Bryant SC, Baudhuin LM, Berger PB, Jaffe AS. Plasma Ceramides. Arterioscler Thromb Vasc Biol 2018; 38:1933-1939. [DOI: 10.1161/atvbaha.118.311199] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
Ceramides are sphingolipids involved with cellular signaling. Synthesis of ceramides occurs in all tissues. Ceramides accumulate within tissues and the blood plasma during metabolic dysfunction, dyslipidemia, and inflammation. Elevations of ceramides are predictive of cardiovascular mortality. We sought to verify the utility of plasma concentrations of 4 ceramides: N-palmitoyl-sphingosine [Cer(16:0)], N-stearoyl-sphingosine [Cer(18:0)], N-nervonoyl-sphingosine [Cer(24:1)], and N-lignoceroyl-sphingosine [Cer(24:0)] in predicting major adverse cardiovascular events in a diverse patient population referred for coronary angiography.
Approach and Results—
Plasma ceramides were measured in 495 participants before nonurgent coronary angiography. Coronary artery disease, defined as >50% stenosis in ≥1 coronary artery, was identified 265 (54%) cases. Ceramides were not significantly associated with coronary artery disease. Patients were followed for a combined primary end point of myocardial infarction, percutaneous intervention, coronary artery bypass, stroke, or death within 4 years. Ceramides were significantly predictive of outcomes after adjusting for age, sex, body mass index, hypertension, smoking, LDL (low-density lipoprotein) cholesterol, HDL (high-density lipoprotein) cholesterol, triglycerides, serum glucose, and family history of coronary artery disease. The fully adjusted per SD hazard ratios (95% confidence interval) were 1.50 (1.16–1.93) for Cer(16:0), 1.42 (1.11–1.83) for Cer(18:0), 1.43 (1.08–1.89) for Cer(24:1), and 1.58 (1.22–2.04) for the ceramide risk score.
Conclusions—
Elevated plasma concentrations of ceramides are independently associated with major adverse cardiovascular events in patients with and without coronary artery disease.
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Affiliation(s)
- Jeffrey W. Meeusen
- From the Department of Laboratory Medicine and Pathology (J.W.M., L.J.D., L.M.B., A.S.J.)
| | - Leslie J. Donato
- From the Department of Laboratory Medicine and Pathology (J.W.M., L.J.D., L.M.B., A.S.J.)
| | | | - Linnea M. Baudhuin
- From the Department of Laboratory Medicine and Pathology (J.W.M., L.J.D., L.M.B., A.S.J.)
| | - Peter B. Berger
- Department of Cardiology (P.B.B., A.S.J.), Mayo Clinic, Rochester, MN
| | - Allan S. Jaffe
- From the Department of Laboratory Medicine and Pathology (J.W.M., L.J.D., L.M.B., A.S.J.)
- Department of Cardiology (P.B.B., A.S.J.), Mayo Clinic, Rochester, MN
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Interleukin-1 genotypes modulate the long-term effect of lipoprotein(a) on cardiovascular events: The Ioannina Study. J Clin Lipidol 2018; 12:338-347. [DOI: 10.1016/j.jacl.2017.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/11/2017] [Accepted: 12/13/2017] [Indexed: 12/22/2022]
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7
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Kornman KS, Giannobile WV, Duff GW. Quo vadis: what is the future of periodontics? How will we get there? Periodontol 2000 2017; 75:353-371. [DOI: 10.1111/prd.12217] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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8
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Association of 86 bp variable number of tandem repeat (VNTR) polymorphism of interleukin-1 receptor antagonist (IL1RN) with susceptibility and clinical activity in rheumatoid arthritis. Clin Rheumatol 2017; 36:1247-1252. [DOI: 10.1007/s10067-017-3610-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/15/2017] [Accepted: 03/19/2017] [Indexed: 11/27/2022]
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9
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Wilkins LM, Kaye EK, Wang HY, Rogus J, Doucette-Stamm L, Kornman K, Garcia RI. Influence of Obesity on Periodontitis Progression Is Conditional on Interleukin-1 Inflammatory Genetic Variation. J Periodontol 2017; 88:59-68. [DOI: 10.1902/jop.2016.160408] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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10
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Wang Z, Qu Z, Fu C, Xu F, Chen Y, Wang Z, Liu Y. Interleukin 1 Polymorphisms Contribute to Intervertebral Disc Degeneration Risk: A Meta-Analysis. PLoS One 2016; 11:e0156412. [PMID: 27253397 PMCID: PMC4890740 DOI: 10.1371/journal.pone.0156412] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 05/13/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE We performed a meta-analysis to assess association between interleukin 1 (IL-1) polymorphisms and the risk of Intervertebral Disc Degeneration (IDD). BACKGROUND A series of studies have investigated the association between common single nucleotide polymorphisms in IL-1 and IDD risk; however, the overall results are inconclusive. METHODS Two independent investigators conducted a systematic search for relevant available studies. Allele frequencies were extracted from each study. The association between the IL-1α (+889C/T) or IL-1β (+3954C/T) polymorphism and IDD risk was measured by odds ratios (OR) with 95% confidence intervals (95% CI). RESULTS Five and six studies, respectively, were ultimately included in the meta-analysis for the IL-1α (+889C/T) and IL-1β (+3954C/T) polymorphism. The combined results showed that the IL-1α (+889C/T) polymorphism was significantly associated with increased susceptibility to IDD, particularly in Caucasians (TT versus CC: OR = 2.95, 95% CI: 1.45, 6.04; Pheterogeneity = 0.82; TT versus CC/CT OR = 2.29, 95% CI: 1.18, 4.47; Pheterogeneity = 0.20). In contrast, the IL-1β (+3954C/T) polymorphism showed a trend towards increased risk in Caucasians but no association in Asians. CONCLUSION This meta-analysis suggested that the IL-1α (+889C/T) polymorphism is significantly associated with risk of IDD, especially in Caucasian populations.
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Affiliation(s)
- Zheng Wang
- Department of Spinal Surgery, The First Hospital of Jilin University, No.71, Xinmin Avenue, Chaoyang District, Changchun, Jilin Province, 130021, China
| | - Zhigang Qu
- Department of Spinal Surgery, The First Hospital of Jilin University, No.71, Xinmin Avenue, Chaoyang District, Changchun, Jilin Province, 130021, China
| | - Changfeng Fu
- Department of Spinal Surgery, The First Hospital of Jilin University, No.71, Xinmin Avenue, Chaoyang District, Changchun, Jilin Province, 130021, China
| | - Feng Xu
- Department of Spinal Surgery, The First Hospital of Jilin University, No.71, Xinmin Avenue, Chaoyang District, Changchun, Jilin Province, 130021, China
| | - Yong Chen
- Department of Neurosurgery, The First Hospital of Jilin University, No.71, Xinmin Avenue, Chaoyang District, Changchun, Jilin Province, 130021, China
| | - Zhenyu Wang
- Department of Spinal Surgery, The First Hospital of Jilin University, No.71, Xinmin Avenue, Chaoyang District, Changchun, Jilin Province, 130021, China
- * E-mail: (ZYW); (YL)
| | - Yi Liu
- Department of Spinal Surgery, The First Hospital of Jilin University, No.71, Xinmin Avenue, Chaoyang District, Changchun, Jilin Province, 130021, China
- * E-mail: (ZYW); (YL)
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Sousa H, Mesquita L, Ribeiro J, Catarino R, Breda E, Medeiros R. Polymorphisms in host immune response associated genes and risk of nasopharyngeal carcinoma development in Portugal. Immunobiology 2016; 221:145-52. [PMID: 26391153 DOI: 10.1016/j.imbio.2015.09.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 08/21/2015] [Accepted: 09/08/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Host genetic susceptibility markers in immune response associated genes may contribute to identify individuals with high risk of developing viral infection and viral-associated cancers. We aimed to characterize different polymorphisms in immune response associated genes and evaluate its association with nasopharyngeal carcinoma (NPC) development. METHODS We have developed a hospital-based case-control study selecting 134 patients with NPC (cases) and 732 healthy individuals (controls) from the Northern Region of Portugal. Eight single nucleotide polymorphisms (SNP) were selected: -56C>T IFNGR1 (rs2234711), +4854G>T IL1A (rs17561), +3954C>T IL1B (rs1143634), +1902A>G IL4RA (rs1801275), -1082G>A IL10 (rs1800896), +2018T>C IL1RN (rs419598), HLA-A locus A>T (rs2530388), HCGA9 locus A>T (rs6457110). All polymorphisms were analysed by real-time methodology using TaqMan(®) SNP Genotyping Assays. RESULTS The overall analysis revealed no statistical significant differences between genotypes distributions in all of studied polymorphisms (p>0.05). However, the results for HCGA9 rs6457110 polymorphism showed a tendency for an increased risk of NPC development among TT carriers with an almost of 2-fold increased risk (OR=1.86; 95%CI 1.00-3.65). CONCLUSIONS This is the first study to characterize these polymorphisms in NPC patients in Portugal. Our study indicates that HCGA9 rs6457110 polymorphism might represent a risk marker for NPC development in our population and that other SNPs should be further studied in larger populations to clarify the evidences. This data reinforces the need for more studies, especially in NPC low-prevalent populations.
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Affiliation(s)
- Hugo Sousa
- Molecular Oncology & Viral Pathology Group (CI-IPOP), Rua Dr. António Bernardino Almeida, 4200-072 Porto, Portugal; Virology Service, Rua Dr. António Bernardino Almeida, 4200-072 Porto, Portugal.
| | - Letícia Mesquita
- Molecular Oncology & Viral Pathology Group (CI-IPOP), Rua Dr. António Bernardino Almeida, 4200-072 Porto, Portugal
| | - Joana Ribeiro
- Molecular Oncology & Viral Pathology Group (CI-IPOP), Rua Dr. António Bernardino Almeida, 4200-072 Porto, Portugal; Virology Service, Rua Dr. António Bernardino Almeida, 4200-072 Porto, Portugal; Research Department, Portuguese League against Cancer (Liga Portuguesa Contra o Cancro - Núcleo Regional do Norte), Porto, Portugal
| | - Raquel Catarino
- Molecular Oncology & Viral Pathology Group (CI-IPOP), Rua Dr. António Bernardino Almeida, 4200-072 Porto, Portugal
| | - Eduardo Breda
- Molecular Oncology & Viral Pathology Group (CI-IPOP), Rua Dr. António Bernardino Almeida, 4200-072 Porto, Portugal; Otorhinolaryngology Service, Portuguese Institute of Oncology of Porto Porto FG EPE, Rua Dr. António Bernardino Almeida, 4200-072 Porto, Portugal
| | - Rui Medeiros
- Molecular Oncology & Viral Pathology Group (CI-IPOP), Rua Dr. António Bernardino Almeida, 4200-072 Porto, Portugal; Virology Service, Rua Dr. António Bernardino Almeida, 4200-072 Porto, Portugal; Abel Salazar Institute for the Biomedical Sciences (ICBAS), University of Porto, Porto, Portugal; Research Department, Portuguese League against Cancer (Liga Portuguesa Contra o Cancro - Núcleo Regional do Norte), Porto, Portugal
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Variants in the interleukin-1 alpha and beta genes, and the risk for periodontal disease in dogs. J Genet 2015; 94:651-9. [DOI: 10.1007/s12041-015-0576-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Gliddon T, Salman S, Robinson JO, Manning L. Modeling C-reactive protein kinetic profiles for use as a clinical prediction tool in patients with Staphylococcus aureus bacteremia. Biomark Med 2015; 9:947-55. [DOI: 10.2217/bmm.15.73] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We hypothesized that C-reactive protein (CRP) kinetics can be accurately modeled and might have clinical utility in a cohort of patients with Staphylococcus aureus bacteremia. Materials & methods: We constructed and validated a nonlinear mixed effects model using CRP values obtained during the first week of illness. Results: Hematological malignancy, prosthetic heart valves and metastatic seeding were identified as major covariates that influenced CRP kinetics. When considering the presence of metastatic infection as an ‘unknown’, the model could predict its presence through analysis of the observed CRP profile with an Area-under-the-Receiver-Operator-Characteristic curve of 0.81, indicating some diagnostic accuracy. Conclusion: We conclude that early CRP kinetics can be accurately modeled and can help identify patients with metastatic seeding in S. aureus bacteremia. Further validation is required.
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Affiliation(s)
- Thomas Gliddon
- Pathwest Laboratory Medicine, Nedlands, WA, Australia
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Sam Salman
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- Harry Perkins Research Institute, School of Medicine & Pharmacology, University of Western Australia, Fiona Stanley Hospital, Western Australia, University of Western Australia, WA, Australia
| | - James Owen Robinson
- Pathwest Laboratory Medicine, Nedlands, WA, Australia
- Australian Collaborating Centre for Enterococcus & Staphylococcus Species (ACCESS) Typing & Research, School of Veterinary & Life Sciences, Murdoch University & School of Biomedical Sciences, Curtin University, Perth, WA, Australia
- Royal Perth Hospital, Perth, WA, Australia
- Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Laurens Manning
- Harry Perkins Research Institute, School of Medicine & Pharmacology, University of Western Australia, Fiona Stanley Hospital, Western Australia, University of Western Australia, WA, Australia
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Andraweera PH, Dekker GA, Jayasekara RW, Dissanayake VHW, Roberts CT. Polymorphisms in the inflammatory pathway genes and the risk of preeclampsia in Sinhalese women. J Matern Fetal Neonatal Med 2015; 29:1072-6. [DOI: 10.3109/14767058.2015.1034102] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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Counterpoint: Risk factors, including genetic information, add value in stratifying patients for optimal preventive dental care. J Am Dent Assoc 2015; 146:174-8. [DOI: 10.1016/j.adaj.2015.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 01/16/2015] [Indexed: 12/23/2022]
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Haroon J, Hussain S, Javed Q. Heritability ofIL-1AGene Promoter Polymorphism in Patients With Coronary Artery Disease: A Trio-Family Study. Lab Med 2015; 46:20-5. [DOI: 10.1309/lm1sapzqrnqt4bo9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Tsimikas S, Duff GW, Berger PB, Rogus J, Huttner K, Clopton P, Brilakis E, Kornman KS, Witztum JL. Pro-inflammatory interleukin-1 genotypes potentiate the risk of coronary artery disease and cardiovascular events mediated by oxidized phospholipids and lipoprotein(a). J Am Coll Cardiol 2014; 63:1724-34. [PMID: 24530664 PMCID: PMC4008715 DOI: 10.1016/j.jacc.2013.12.030] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 12/03/2013] [Accepted: 12/04/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of this study was to assess the influence of pro-inflammatory interleukin (IL)-1 genotype status on the risk for coronary artery disease (CAD), defined as >50% diameter stenosis, and cardiovascular events mediated by oxidized phospholipids (OxPLs) and lipoprotein (Lp) (a). BACKGROUND OxPLs are pro-inflammatory, circulate on Lp(a), and mediate CAD. Genetic variations in the IL-1 region are associated with increased inflammatory mediators. METHODS IL-1 genotypes, OxPL on apolipoprotein B-100 (OxPL/apoB), and Lp(a) levels were measured in 499 patients undergoing coronary angiography. The composite genotype termed IL-1(+) was defined by 3 single-nucleotide polymorphisms in the IL-1 gene cluster associated with higher levels of pro-inflammatory cytokines. All other IL-1 genotypes were termed IL-1(-). RESULTS Among IL-1(+) patients, the highest quartile of OxPL/apoB was significantly associated with a higher risk for CAD compared with the lowest quartile (odds ratio [OR]: 2.84; p = 0.001). This effect was accentuated in patients age ≤60 years (OR: 7.03; p < 0.001). In IL-1(-) patients, OxPL/apoB levels showed no association with CAD. The interaction was significant for OxPL/apoB (OR: 1.99; p = 0.004) and Lp(a) (OR: 1.96; p < 0.001) in the IL-1(+) group versus the IL-1(-) group in patients age ≤60 years but not in those age >60 years. In IL-1(+) patients age ≤60 years, after adjustment for established risk factors, high-sensitivity C-reactive protein, and Lp(a), OxPL/apoB remained an independent predictor of CAD. IL-1(+) patients above the median OxPL/apoB presented to the cardiac catheterization laboratory a mean of 3.9 years earlier (p = 0.002) and had worse 4-year event-free survival (death, myocardial infarction, stroke, and need for revascularization) compared with other groups (p = 0.006). CONCLUSIONS Our study suggests that IL-1 genotype status can stratify population risk for CAD and cardiovascular events mediated by OxPL. These data suggest a clinically relevant biological link between pro-inflammatory IL-1 genotype, oxidation of phospholipids, Lp(a), and genetic predisposition to CAD and cardiovascular events.
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Affiliation(s)
- Sotirios Tsimikas
- Division of Cardiovascular Diseases, University of California San Diego, La Jolla, California.
| | - Gordon W Duff
- Division of Genomic Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Peter B Berger
- Department of Cardiology, Geisinger Health System, Danville, Pennsylvania
| | - John Rogus
- Interleukin Genetics, Inc., Waltham, Massachusetts
| | | | - Paul Clopton
- Veterans Affairs Medical Center, San Diego, California
| | | | | | - Joseph L Witztum
- Division of Endocrinology and Metabolism, University of California San Diego, La Jolla, California
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Oliveira A, Dinis-Oliveira RJ, Nogueira A, Gonçalves F, Silva P, Vieira C, Silvestre R, Carvalho F, Medeiros R. Interleukin-1β genotype and circulating levels in cancer patients: metastatic status and pain perception. Clin Biochem 2014; 47:1209-13. [PMID: 24747159 DOI: 10.1016/j.clinbiochem.2014.04.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 03/20/2014] [Accepted: 04/08/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Proinflammatory cytokines released during inflammation can cause hyperexcitability in pain transmission neurons, leading to hyperalgesia and allodynia. Polymorphisms in interleukin 1 (IL-1) family of genes (IL1A, IL1B) and in IL-1 receptor antagonist (IL-1Ra, coded by IL1RN) may therefore induce alterations in cytokine levels/effects and pain related response. Our purpose was to investigate the influence of polymorphisms in IL1A/B/RN on cytokine serum levels and its correlation with pain intensity, performance status, adverse effects, metastases and breakthrough pain in Caucasian cancer patients. DESIGN AND METHODS Serum IL-1α/β levels of 74 cancer patients were measured by competitive enzyme immunosorbent assay. All patients were also genotyped for the polymorphisms in IL1A (rs17561), IL1B (rs1143634) and IL1RN (rs419598) with Real-Time PCR. Results were then correlated to the appearance of bone or CNS metastases and several pain-related parameters. RESULTS IL-1β rs1143634 homozygous for T allele were associated with lower levels of IL1-β (p=0.032, Mann-Whitney test) and presented a trend for lower levels of pain (p=0.06, Fisher's Exact Test). Also, IL1-β levels were related with cancer onset status, since a four-fold increase probability of metastatic disease was observed in high IL-1β individuals (OR=4.074, p=0.010, Pearson χ(2) test). Among the female patients presenting metastatic disease and carriers of the TT genotype we observed a trend to lower levels of IL1-β (p=0.053, Pearson χ(2) test). CONCLUSIONS Our results indicate that genetic variation at IL1-β gene may influence serum levels of IL1-β, with proportional consequences in cancer-related pain.
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Affiliation(s)
- Ana Oliveira
- REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal; Molecular Oncology GRP and Virology LB, Portuguese Institute of Oncology-Porto, Porto, Portugal; IINFACTS - Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, Advanced Institute of Health Sciences - North, CESPU, CRL, Gandra, Portugal.
| | - Ricardo J Dinis-Oliveira
- REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal; IINFACTS - Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, Advanced Institute of Health Sciences - North, CESPU, CRL, Gandra, Portugal; Department of Legal Medicine and Forensic Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Center of Forensic Sciences (CENCIFOR), Portugal
| | - Augusto Nogueira
- Molecular Oncology GRP and Virology LB, Portuguese Institute of Oncology-Porto, Porto, Portugal
| | - Ferraz Gonçalves
- Palliative Care Unit, Portuguese Institute of Oncology-Porto, Porto, Portugal
| | - Paula Silva
- Palliative Care Unit, Portuguese Institute of Oncology-Porto, Porto, Portugal
| | - Cláudia Vieira
- Medical Oncology Department, Francisco Gentil Portuguese Institute of Oncology, Porto, Portugal
| | - Ricardo Silvestre
- IINFACTS - Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, Advanced Institute of Health Sciences - North, CESPU, CRL, Gandra, Portugal
| | - Félix Carvalho
- REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Rui Medeiros
- Molecular Oncology GRP and Virology LB, Portuguese Institute of Oncology-Porto, Porto, Portugal; ICBAS, Abel Salazar Institute for the Biomedical Sciences, Porto, Portugal; Faculty of Health Sciences of Fernando Pessoa University, Porto, Portugal; LPCC, Portuguese League Against Cancer, Regional Center of the North, Porto, Portugal.
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Liu Y, Li S, Zhang G, Nie G, Meng Z, Mao D, Chen C, Chen X, Zhou B, Zeng G. Genetic variants in IL1A and IL1B contribute to the susceptibility to 2009 pandemic H1N1 influenza A virus. BMC Immunol 2013; 14:37. [PMID: 23927441 PMCID: PMC3750637 DOI: 10.1186/1471-2172-14-37] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 07/31/2013] [Indexed: 11/10/2022] Open
Abstract
Background Host genetic variations may contribute to disease susceptibility of influenza. IL-1A and IL-1B are important inflammatory cytokines that mediate the inflammation and initiate the immune response against virus infection. In this study, we investigated the relationship between single-nucleotide polymorphisms (SNPs) of Interleukin-1A (IL-1A) and Interleukin-1B (IL-1B) and the susceptibility to 2009 pandemic A/H1N1 influenza (A(H1N1)pdm09). 167 patients whom were confirmed with A(H1N1)pdm09 and 192 healthy controls were included in this study. Four SNPs (rs1304037, rs16347, rs17561, rs2071373) in IL1A gene and three SNPs (rs1143623, rs3917345, rs1143627) in IL1B gene were genotyped by using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry platform, and the associations of the genetic variants of IL-1 with susceptibility to A(H1N1)pdm09 were then assessed. Results The polymorphisms of rs17561 in IL1A gene and rs1143627 in IL1B gene were found to be associated with susceptibility to A(H1N1)pdm09 with P values of 0.003 (OR 2.08, 95% CI 1.27-3.41) and 0.002 (OR 1.62 , 95% CI 1.20-2.18), respectively. However, no significant difference in allelic frequency was observed for other SNPs between cases and controls. Conclusions This study provides a new insight into pathogenesis of A(H1N1)pdm09, suggesting that genetic variants of IL-1A and IL-1B may exert a substantial impact on the susceptibility of A(H1N1)pdm09 virus infection.
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Affiliation(s)
- Yingxia Liu
- Guangdong Key Laboratory for Emerging Infectious Diseases, Shenzhen Third People’s Hospital, Guangdong Medical College, Shenzhen, China
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The Role of Interleukin-1 Genotype in the Association between Coronary Heart Disease and Periodontitis in a Syrian Population. ISRN DENTISTRY 2013; 2013:195678. [PMID: 23691333 PMCID: PMC3649497 DOI: 10.1155/2013/195678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 03/17/2013] [Indexed: 12/17/2022]
Abstract
Objective. To determine whether differences exist between periodontitis subjects with and without Coronary Heart Disease (CHD) in a Syrian population in the distribution of IL-1 alleles at positions IL-1α+4845, IL-1β+3954, IL-1β−511, and IL-1RN VNTR. Background. The role of Interleukin-1 genes in the association between periodontitis and CHD has been demonstrated in previous studies. No study has been carried out on the Syrian population to asses for such a role. Methods. 200 Syrian Arab periodontitis patients (184 males, 16 females; mean age 52.61) were divided into two groups: cases group 100 subjects with CHD (92 males, 8 females; mean age 52.06); controls group 100 subjects without CHD (92 males, 8 females; mean age 53.16). Probing depth (PD), clinical attachment loss (CAL), and alveolar bone loss (ABL) were performed for patients. Blood samples were collected for genotyping analysis of IL-1α+4845, IL-1β+3954, and IL-1β−511 using PCR-RFLP technique and IL-1RN VNTR using normal PCR. Results. An association between both (CAL and ABL) and CHD was shown after adjustment for other confounders (OR: 7.659, P = 0.001; OR: 3.645, P = 0.006, resp.). Also, an association between allele 2 of IL-1α+4845, IL-1β+3954, and IL-1β−511 and ABL was shown. Allele 2 of IL-1α+4845 and IL-1β−511 was associated with ABL among individuals with and without CHD. But after adjustment for other confounders, the association remained only between allele 2 of IL-11α+4845 and both CHD and severe ABL (OR: 0.189, P < 0.001). Conclusion. Allele 2 of IL-11α+4845 may be considered a risk indicator for having both CHD and severe ABL in the investigated Syrian population.
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Marsden L, Cox A, Makris M, Daly ME. Lack of association between polymorphisms in the interleukin-1 gene cluster and familial thrombophilia. Thromb Res 2012; 129:629-34. [DOI: 10.1016/j.thromres.2011.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 05/31/2011] [Accepted: 07/05/2011] [Indexed: 10/17/2022]
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Lee A, Ghaname CB, Braun TM, Sugai JV, Teles RP, Loesche WJ, Kornman KS, Giannobile WV, Kinney JS. Bacterial and Salivary Biomarkers Predict the Gingival Inflammatory Profile. J Periodontol 2012; 83:79-89. [PMID: 21563952 DOI: 10.1902/jop.2011.110060] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Angie Lee
- Department of Periodontics and Oral Medicine, Michigan Center for Oral Health Research, University of Michigan, Ann Arbor, MI 48106, USA
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Curti MLR, Jacob P, Borges MC, Rogero MM, Ferreira SRG. Studies of gene variants related to inflammation, oxidative stress, dyslipidemia, and obesity: implications for a nutrigenetic approach. J Obes 2011; 2011:497401. [PMID: 21773006 PMCID: PMC3136190 DOI: 10.1155/2011/497401] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 02/15/2011] [Accepted: 03/14/2011] [Indexed: 01/05/2023] Open
Abstract
Obesity is currently considered a serious public health issue due to its strong impact on health, economy, and quality of life. It is considered a chronic low-grade inflammation state and is directly involved in the genesis of metabolic disturbances, such as insulin resistance and dyslipidemia, which are well-known risk factors for cardiovascular disease. Furthermore, there is evidence that genetic variation that predisposes to inflammation and metabolic disturbances could interact with environmental factors, such as diet, modulating individual susceptibility to developing these conditions. This paper aims to review the possible interactions between diet and single-nucleotide polymorphisms (SNPs) in genes implicated on the inflammatory response, lipoprotein metabolism, and oxidative status. Therefore, the impact of genetic variants of the peroxisome proliferator-activated receptor-(PPAR-)gamma, tumor necrosis factor-(TNF-)alpha, interleukin (IL)-1, IL-6, apolipoprotein (Apo) A1, Apo A2, Apo A5, Apo E, glutathione peroxidases 1, 2, and 4, and selenoprotein P exposed to variations on diet composition is described.
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Affiliation(s)
| | | | | | | | - Sandra Roberta G. Ferreira
- Department of Nutrition, School of Public Health, University of São Paulo, Avenida Dr. Arnaldo, 715, 01246-904, São Paulo, SP, Brazil
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Schlesinger N, De Meulemeester M, Pikhlak A, Yücel AE, Richard D, Murphy V, Arulmani U, Sallstig P, So A. Canakinumab relieves symptoms of acute flares and improves health-related quality of life in patients with difficult-to-treat Gouty Arthritis by suppressing inflammation: results of a randomized, dose-ranging study. Arthritis Res Ther 2011; 13:R53. [PMID: 21439048 PMCID: PMC3132043 DOI: 10.1186/ar3297] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 02/11/2011] [Accepted: 03/25/2011] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION We report the impact of canakinumab, a fully human anti-interleukin-1β monoclonal antibody, on inflammation and health-related quality of life (HRQoL) in patients with difficult-to-treat Gouty Arthritis. METHODS In this eight-week, single-blind, double-dummy, dose-ranging study, patients with acute Gouty Arthritis flares who were unresponsive or intolerant to--or had contraindications for--non-steroidal anti-inflammatory drugs and/or colchicine were randomized to receive a single subcutaneous dose of canakinumab (10, 25, 50, 90, or 150 mg) (N = 143) or an intramuscular dose of triamcinolone acetonide 40 mg (N = 57). Patients assessed pain using a Likert scale, physicians assessed clinical signs of joint inflammation, and HRQoL was measured using the 36-item Short-Form Health Survey (SF-36) (acute version). RESULTS At baseline, 98% of patients were suffering from moderate-to-extreme pain. The percentage of patients with no or mild pain was numerically greater in most canakinumab groups compared with triamcinolone acetonide from 24 to 72 hours post-dose; the difference was statistically significant for canakinumab 150 mg at these time points (P < 0.05). Treatment with canakinumab 150 mg was associated with statistically significant lower Likert scores for tenderness (odds ratio (OR), 3.2; 95% confidence interval (CI), 1.27 to 7.89; P = 0.014) and swelling (OR, 2.7; 95% CI, 1.09 to 6.50, P = 0.032) at 72 hours compared with triamcinolone acetonide. Median C-reactive protein and serum amyloid A levels were normalized by seven days post-dose in most canakinumab groups, but remained elevated in the triamcinolone acetonide group. Improvements in physical health were observed at seven days post-dose in all treatment groups; increases in scores were highest for canakinumab 150 mg. In this group, the mean SF-36 physical component summary score increased by 12.0 points from baseline to 48.3 at seven days post-dose. SF-36 scores for physical functioning and bodily pain for the canakinumab 150 mg group approached those for the US general population by seven days post-dose and reached norm values by eight weeks post-dose. CONCLUSIONS Canakinumab 150 mg provided significantly greater and more rapid reduction in pain and signs and symptoms of inflammation compared with triamcinolone acetonide 40 mg. Improvements in HRQoL were seen in both treatment groups with a faster onset with canakinumab 150 mg compared with triamcinolone acetonide 40 mg. TRIAL REGISTRATION clinicaltrials.gov: NCT00798369.
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Affiliation(s)
- Naomi Schlesinger
- Division of Rheumatology, Department of Medicine, Robert Wood Johnson Medical School, 125 Patterson Street, New Brunswick, NJ 089010, USA
| | - Marc De Meulemeester
- Pratique Médicale, Cabinet de Là-Haut, Rue de Marchienne 113, 6534 Gozée, Belgium
| | - Andrey Pikhlak
- Moscow State University of Medicine and Dentistry, Clinical-Diagnostic Center MSMSU, Dolgorukovskaya Street 4, Moscow 127006, Russia
| | - A Eftal Yücel
- Baskent University, Faculty of Medicine, Baglica Kampusu, Eskisehir Yolu 20.km, Baglica 06530, Ankara, Turkey
| | - Dominik Richard
- Immunology & Infectious Disease Therapeutic Area, Novartis Pharma AG, Lichtstrasse 35, CH-4056, Basel, Switzerland
| | - Valda Murphy
- Immunology & Infectious Disease Therapeutic Area, Novartis Pharma AG, Lichtstrasse 35, CH-4056, Basel, Switzerland
| | - Udayasankar Arulmani
- Immunology & Infectious Disease Therapeutic Area, Novartis Pharma AG, Lichtstrasse 35, CH-4056, Basel, Switzerland
| | - Peter Sallstig
- Immunology & Infectious Disease Therapeutic Area, Novartis Pharma AG, Lichtstrasse 35, CH-4056, Basel, Switzerland
| | - Alexander So
- Service de Rhumatologie, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Av. Pierre-Decker 5, CH-1005, Lausanne, Switzerland
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Abstract
Low-grade inflammation, a minor elevation in the baseline concentration of inflammatory markers such as C-reactive protein (CRP), is nowadays recognized as an important underlying condition in many common diseases. Concentrations of CRP under 10 mg/1 are called low-grade inflammation and values above that are considered as clinically significant inflammatory states. Epidemiological studies have revealed demographic and socioeconomic factors that associate with CRP concentration; these include age, sex, birth weight, ethnicity, socioeconomic status, body mass index (BMI), fiber consumption, alcohol intake, and dietary fatty acids. At the molecular level, production of CRP is induced by proinflammatory cytokines IL-1, IL-6, and IL-17 in the liver, although extra hepatic production most likely contributes to systemic concentrations. The cytokines are produced in response to, for example, steroid hormones, thrombin, C5a, bradykinin, other cytokines, UV-light, neuropeptides and bacterial components, such as lipopolysaccharide. Cytokines exert their biological effects on CRP by signaling through their receptors on hepatic cells and activating different kinases and phosphatases leading to translocation of various transcription factors on CRP gene promoter and production of CRP protein. Genetic polymorphisms in the interleukin genes as well as in CRP gene have been associated with minor elevation in CRP. As minor elevation in CRP is associated with both inflammatory and noninflammatory conditions, it should be noticed that the elevation might just reflect distressed or injured cells homeostasis maintenance in everyday life, rather than inflammation with classical symptoms of redness, swelling, heat, and pain.
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Affiliation(s)
- Carita M Eklund
- Department of Microbiology and Immunology, University of Tampere, Medical School, 33520 Tampere, Finland.
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Gurven M, Kaplan H, Winking J, Eid Rodriguez D, Vasunilashorn S, Kim JK, Finch C, Crimmins E. Inflammation and infection do not promote arterial aging and cardiovascular disease risk factors among lean horticulturalists. PLoS One 2009; 4:e6590. [PMID: 19668697 PMCID: PMC2722089 DOI: 10.1371/journal.pone.0006590] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 07/09/2009] [Indexed: 01/08/2023] Open
Abstract
Background Arterial aging is well characterized in industrial populations, but scantly described in populations with little access to modern medicine. Here we characterize health and aging among the Tsimane, Amazonian forager-horticulturalists with short life expectancy, high infectious loads and inflammation, but low adiposity and robust physical fitness. Inflammation has been implicated in all stages of arterial aging, atherogenesis and hypertension, and so we test whether greater inflammation associates with atherosclerosis and CVD risk. In contrast, moderate to vigorous daily activity, minimal obesity, and low fat intake predict minimal CVD risk among older Tsimane. Methods and Findings Peripheral arterial disease (PAD), based on the Ankle-Brachial Index (ABI), and hypertension were measured in Tsimane adults, and compared with rates from industrialized populations. No cases of PAD were found among Tsimane and hypertension was comparatively low (prevalence: 3.5%, 40+; 23%, 70+). Markers of infection and inflammation were much higher among Tsimane than among U.S. adults, whereas HDL was substantially lower. Regression models examine associations of ABI and BP with biomarkers of energy balance and metabolism and of inflammation and infection. Among Tsimane, obesity, blood lipids, and disease history were not significantly associated with ABI. Unlike the Tsimane case, higher cholesterol, C-reactive protein, leukocytes, cigarette smoking and systolic pressure among North Americans are all significantly associated with lower ABI. Conclusions Inflammation may not always be a risk factor for arterial degeneration and CVD, but instead may be offset by other factors: healthy metabolism, active lifestyle, favorable body mass, lean diet, low blood lipids and cardiorespiratory health. Other possibilities, including genetic susceptibility and the role of helminth infections, are discussed. The absence of PAD and CVD among Tsimane parallels anecdotal reports from other small-scale subsistence populations and suggests that chronic vascular disease had little impact on adult mortality throughout most of human evolutionary history.
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Affiliation(s)
- Michael Gurven
- Department of Anthropology, University of California Santa Barbara, Santa Barbara, CA, USA.
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Nakajima T, Honda T, Domon H, Okui T, Kajita K, Ito H, Takahashi N, Maekawa T, Tabeta K, Yamazaki K. Periodontitis-associated up-regulation of systemic inflammatory mediator level may increase the risk of coronary heart disease. J Periodontal Res 2009; 45:116-22. [PMID: 19602107 DOI: 10.1111/j.1600-0765.2009.01209.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Although an elevation in the concentration of high-sensitivity C-reactive protein (hs-CRP) as a result of periodontal infection may account for an increased risk of developing coronary heart disease (CHD), the effect of periodontal infection on the level of hs-CRP in an otherwise healthy Japanese population has not yet been reported. The aim of the present study was to confirm, on a larger scale, our previous pilot study findings that both chronic periodontitis and subsequent periodontal treatment alter the serum levels of C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha). MATERIAL AND METHODS The concentrations of serum hs-CRP, IL-6 and TNF-alpha were measured in 78 periodontitis patients at baseline and at re-assessment, and in 40 periodontally healthy subjects at the time of examination. RESULTS The concentrations of hs-CRP and IL-6 in the sera of periodontitis patients were significantly higher than those in control subjects. By contrast, the concentration of TNF-alpha was significantly lower in periodontitis patients than in control subjects. Whereas periodontal treatment decreased the levels of serum hs-CRP and IL-6, no such effect was observed for TNF-alpha. When the patients were subdivided into four groups according to their initial concentration of hs-CRP, only the CRP and IL-6 concentrations of the highest quartile group showed a significant reduction following periodontal treatment. No significant difference in the initial clinical parameters was observed in any quartile. CONCLUSION Although periodontal infection does affect the concentration of hs-CRP and IL-6 in serum, a subgroup of patients exist who are highly susceptible to an increased risk of CHD associated with periodontitis, suggesting that there may be subjects who have an elevated risk of CHD independent of susceptibility to periodontal tissue destruction per se.
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Affiliation(s)
- T Nakajima
- Laboratory of Periodontology and Immunology, Department of Oral Health and Welfare, Niigata University Faculty of Dentistry, Niigata, Japan
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Landvik NE, Hart K, Skaug V, Stangeland LB, Haugen A, Zienolddiny S. A specific interleukin-1B haplotype correlates with high levels of IL1B mRNA in the lung and increased risk of non-small cell lung cancer. Carcinogenesis 2009; 30:1186-92. [PMID: 19461122 DOI: 10.1093/carcin/bgp122] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Epidemiological evidence suggests a relationship between chronic inflammation and lung cancer. Inflammation in the lung may be modulated by host genetic factors such as polymorphisms in inflammatory genes. Identification of polymorphisms in inflammatory genes may help understanding interindividual differences in susceptibility to lung cancer. We have investigated single-nucleotide polymorphisms (SNPs) and their haplotypes in the regulatory region of the IL1B gene in association to non-small cell lung cancer (NSCLC) risk. Our previous work showed that two promoter SNPs C-511T and T-31C modulated NSCLC risk. In the present study, we show that G-3893A and G-1464C located in the enhancer region of the IL1B gene may also affect this risk, with odds for developing NSCLC being 0.69 [95% confidence interval (CI), 0.52-0.92] for -3893 A-allele and 0.63 (95% CI, 0.47 - 0.83) for -1464 C-allele. The associations were particularly prominent in patients with TP53 mutations in the tumor. Inference of the haplotype structures showed that -3893 G, -1464 G, -511 C and -31 T formed a specific haplotype (GGCT) with near complete linkage disequilibrium in lung cancer patients but not in controls. Furthermore, the risk haplotype (GGCT) was present in 65% of cases compared with 36% of controls. Quantitative analysis of RNA in normal lung tissue of the patients showed that the risk haplotype was correlated with significantly higher IL1B messenger RNA (mRNA) levels compared with the non-risk haplotype (ACTC). These data suggest that a specific IL1B haplotype associated with increased IL1B gene expression increases the risk of NSCLC.
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Affiliation(s)
- Nina E Landvik
- Section of Toxicology, Department of Chemical and Biological Work Environment, National Institute of Occupational Health, Oslo, Norway
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Liangos O, Jaber BL. Multiple organ dysfunction syndrome in children with sepsis: role of genetic factors. Semin Nephrol 2008; 28:499-509. [PMID: 18790371 DOI: 10.1016/j.semnephrol.2008.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This review summarizes current knowledge on the impact of genetic markers on susceptibility, severity, and outcome of acute inflammatory disorders in children, with a special focus on systemic infections. A 14-year-old child with Neisseria meningitides bacteremia, complicated by septic shock and multiple organ dysfunction, is discussed as an exemplary case, and linked to the application of genetic epidemiology and the study of common disorders in children. The current pertinent literature is comprehensively reviewed and limitations and future directions are discussed.
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Affiliation(s)
- Orfeas Liangos
- Division of Nephrology, Caritas St. Elizabeth's Medical Center and Tufts University School of Medicine, 736 Cambridge Street, Boston, MA 02135, USA
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Reiner AP, Wurfel MM, Lange LA, Carlson CS, Nord AS, Carty CL, Rieder MJ, Desmarais C, Jenny NS, Iribarren C, Walston JD, Williams OD, Nickerson DA, Jarvik GP. Polymorphisms of the IL1-receptor antagonist gene (IL1RN) are associated with multiple markers of systemic inflammation. Arterioscler Thromb Vasc Biol 2008; 28:1407-12. [PMID: 18451331 PMCID: PMC2748384 DOI: 10.1161/atvbaha.108.167437] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Circulating levels of acute phase reactant proteins such as plasma C-reactive protein (CRP) are likely influenced by multiple genes regulating the innate immune response. METHODS AND RESULTS We screened a set of 16 inflammation-related genes for association with CRP in a large population-based study of healthy young adults (n=1627). Results were validated in 2 independent studies (n=1208 and n=4310), including a pooled analysis of all 3 studies. In the pooled analysis, the minor allele of IL1RN 1018 (rs4251961) within the gene encoding interleukin (IL)-1 receptor antagonist (IL-1RA) was significantly associated with higher mean plasma log(CRP) level (P<1 x 10(-4)). The same IL1RN 1018 allele was associated with higher mean plasma log(IL-6) levels (P=0.004). In the pooled analysis, the minor allele of IL1RN 13888 (rs2232354) was associated with higher fibrinogen, (P=0.001). The IL1RN 1018 and 13888 variant alleles tag a clade of IL1RN haplotypes linked to allele 1 of an 86-bp VNTR polymorphism. We confirmed that the IL1RN 1018 variant (rs4251961) was associated with decreased cellular IL-1RA production ex vivo. CONCLUSIONS Common functional polymorphisms of the IL1RN gene are associated with several markers of systemic inflammation.
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Affiliation(s)
- Alexander P Reiner
- Department of Epidemiology, Box 357236, University of Washington, Seattle, Washington 98195, USA.
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Rhodes B, Morris DL, Subrahmanyan L, Aubin C, de Leon CFM, Kelly JF, Evans DA, Whittaker JC, Oksenberg JR, De Jager PL, Vyse TJ. Fine-mapping the genetic basis of CRP regulation in African Americans: a Bayesian approach. Hum Genet 2008; 123:633-42. [PMID: 18500540 DOI: 10.1007/s00439-008-0517-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 05/16/2008] [Indexed: 01/07/2023]
Abstract
Basal levels of C-reactive protein (CRP) have been associated with disease, particularly future cardiovascular events. Twin studies estimate 50% CRP heritability, so the identification of genetic variants influencing CRP expression is important. Existing studies in populations of European ancestry have identified numerous cis-acting variants but leave significant ambiguity over the identity of the key functional polymorphisms. We addressed this issue by typing a dense map of CRP single-nucleotide polymorphisms (SNPs), and quantifying serum CRP in 594 unrelated African Americans. We used Bayesian model choice analysis to select the combination of SNPs best explaining basal CRP and found strong support for triallelic rs3091244 alone, with the T allele acting in an additive manner (Bayes factor > 100 vs. null model), with additional support for a model incorporating both rs3091244 and rs12728740. Admixture analysis suggested SNP rs12728740 segregated with haplotypes predicted to be of recent European origin. Using a cladistic approach we confirmed the importance of rs3091244(T) by demonstrating a significant partition of haplotype effect based on the rs3091244(C/T) mutation (F = 8.91, P = 0.006). We argue that weaker linkage disequilibrium across the African American CRP locus compared with Europeans has allowed us to establish an unambiguous functional role for rs3091244(T), while also recognising the potential for additional functional mutations present in the European genome.
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Affiliation(s)
- Benjamin Rhodes
- Section of Molecular Genetics and Rheumatology, Faculty of Medicine, Imperial College, Du Cane Road, London W12 0NN, UK
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Enquobahrie DA, Rice K, Williams OD, Williams MA, Gross MD, Lewis CE, Schwartz SM, Siscovick DS. IL1B genetic variation and plasma C-reactive protein level among young adults: the CARDIA study. Atherosclerosis 2008; 202:513-20. [PMID: 18573495 DOI: 10.1016/j.atherosclerosis.2008.05.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Revised: 05/06/2008] [Accepted: 05/10/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Interleukin-1B (IL1B) modulates C-reactive protein (CRP) expression. However, whether IL1B genetic variation is associated with CRP level is unknown. Further, obesity, a state of low-grade inflammation that influences cellular IL-1 functions may modify this association. METHODS AND RESULTS Study participants (N=3289), 48% blacks and 52% whites, had CRP level measurements at year 7 and year 15 examinations as part of the CARDIA study. Ten tag single nucleotide polymorphisms (SNPs) that characterize common IL1B gene variation were genotyped. In SNP analysis, no significant associations with either level or change in time CRP were observed after multiple testing adjustments. However, global ILIB gene variation was associated with year 7 to year 15 change in CRP (global nominal p=0.004, multiple testing corrected p=0.048) among obese blacks. Compared to the commonest haplotype, a common haplotype that includes the SNP rs1143642 was associated with greater increases in CRP from year 7 to year 15 among obese blacks and whites while another common haplotype that includes the SNP rs3917356 was associated with decreased change in CRP from year 7 to year 15 among obese blacks. The rare alleles of ILIB SNPs, SNP 7114 (rs1143642) and SNP 3298 (rs3917356), were associated with greater increases and decreases in CRP from year 7 to year 15 among blacks, respectively, compared to their common variants. CONCLUSION IL1B genetic variation may have a role in CRP level regulation and this association may be modified by obesity.
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Affiliation(s)
- Daniel A Enquobahrie
- Cardiovascular Health Research Unit, Department of Epidemiology, University of Washington, Seattle, WA, USA.
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Sainz J, Pérez E, Gómez-Lopera S, Jurado M. IL1 gene cluster polymorphisms and its haplotypes may predict the risk to develop invasive pulmonary aspergillosis and modulate C-reactive protein level. J Clin Immunol 2008; 28:473-85. [PMID: 18484169 DOI: 10.1007/s10875-008-9197-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Accepted: 03/11/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether interleukin-1 alpha (IL1alpha), interleukin-1 beta (IL1beta), and IL1 receptor antagonist (IL1Ra) polymorphisms are implicated in invasive pulmonary aspergillosis (IPA) pathogenesis. MATERIALS AND METHODS Subjects comprised 110 hematological patients and 148 healthy controls. Genotypic and allelic frequencies were similar between hematological patients and controls. IPA was diagnosed in 59 of the 110 patients according to consensus criteria published by the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group (EORTC/IFICG). RESULTS AND DISCUSSIONS Individual locus analysis showed that IL1alpha and IL1Ra polymorphisms were not associated with the presence of IPA (p = 0.560 and p = 0.680, respectively). However, a trend towards a higher presence of IL1beta( - ) (511TT) genotype (or IL1beta(-511T) allele) in the IPA group than in the non-IPA patient group (p = 0.092 and p = 0.095, respectively) was found. Haplotype analysis revealed that VNTR2/-889C/-511T haplotype was strongly associated with susceptibility to develop IPA infection (p = 0.020). Haplotype analysis also showed an association between VNTR2/-889C/-511C haplotype and resistance to IPA infection (p = 0.028). Furthermore, patients with IL1Ra VNTR2/2 and IL1beta(-511)T/T genotypes had a higher positive serum galactomannan percentage versus patients with other genotypes. Finally, C-reactive protein (CRP) production was significantly associated with IL1 gene cluster polymorphisms, although CRP values were similar between IPA and non-IPA groups. CONCLUSION These findings indicate a critical role of IL1 gene cluster polymorphisms in the susceptibility to IPA infection and CRP production.
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Affiliation(s)
- J Sainz
- Unidad de Investigación, Hospital Universitario Virgen de las Nieves, Granada, Spain.
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Engels EA. Inflammation in the development of lung cancer: epidemiological evidence. Expert Rev Anticancer Ther 2008; 8:605-15. [PMID: 18402527 DOI: 10.1586/14737140.8.4.605] [Citation(s) in RCA: 209] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The lung is a site for repeated or chronic inflammatory insults. Epidemiologic research has provided evidence to support the hypothesis that tissue damage caused by inflammation can initiate or promote the development of lung cancer, possibly in conjunction with tobacco use. For example, some studies suggest an increased risk of lung cancer among persons with lung infections, such as tuberculosis, bacterial pneumonia, or inflammatory lung diseases. Elevated serum levels of C-reactive protein, an inflammation marker, are associated with heightened lung cancer risk. Recent studies also demonstrate increased lung cancer risk among immunosuppressed individuals infected with HIV. Other research indicates an association between genetic polymorphisms in the inflammation pathway, which might modulate the inflammatory response and lung cancer risk.
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Affiliation(s)
- Eric A Engels
- Infections & Immunoepidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, 6120 Executive Blvd, EPS 7076, Rockville, MD 20892, USA.
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Rogus J, Beck JD, Offenbacher S, Huttner K, Iacoviello L, Latella MC, de Gaetano M, Wang HY, Kornman KS, Duff GW. IL1B gene promoter haplotype pairs predict clinical levels of interleukin-1beta and C-reactive protein. Hum Genet 2008; 123:387-98. [PMID: 18369665 DOI: 10.1007/s00439-008-0488-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Accepted: 03/17/2008] [Indexed: 01/25/2023]
Abstract
Interleukin-1beta (IL-1beta) activates inflammatory mediator cascades and has been implicated in the pathogenesis of several diseases. Single nucleotide polymorphisms (SNPs) of the IL1B promoter have been associated with various inflammatory diseases. We recently reported that IL1B gene transcription was influenced by four promoter SNPs, and that individual SNP function in vitro was governed by haplotype context. In the present study we tested the in vivo relevance of this observation by comparing IL1B promoter haplotype-pairs with IL-1beta protein levels in 900 gingival tissue fluid samples. Three SNPs (-511, -1464, -3737) defined four IL1B promoter haplotypes that occurred in the study population and could be assigned unambiguously to each chromosome. The four haplotypes defined ten haplotype-pairs of which four pairs, representing 57% of the population, were associated with 28-52% higher IL-1beta protein levels in vivo. Two of these pairs, characterized by homozygosity for the common allele at -3737, were also associated with raised serum levels of C-reactive protein (p = 0.02). We validated these findings in stimulated peripheral blood mononuclear cells (PBMCs) from a separate population (N = 70). PBMCs with IL1B haplotype-pairs associated with higher in vivo levels of IL-1beta produced 86-287% more IL-1beta in vitro than the reference group. We believe that this is the first demonstration of a relationship between in vivo levels of an inflammatory mediator and gene promoter haplotypes on both chromosomes. These findings may apply to other inducible genes and could provide a logical framework for exploring disease risk related to genetic variability in pathogenic mediators.
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Affiliation(s)
- John Rogus
- Interleukin Genetics Inc, 135 Beaver Street, Waltham, MA, 02452, USA
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Rhodes B, Meek J, Whittaker JC, Vyse TJ. Quantification of the genetic component of basal C-reactive protein expression in SLE nuclear families. Ann Hum Genet 2008; 72:611-20. [PMID: 18373721 DOI: 10.1111/j.1469-1809.2008.00444.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
C-reactive protein (CRP) is a heritable acute-phase plasma protein also expressed at low, basal, levels in healthy individuals. Elevated basal CRP has been associated with increased cardiovascular risk, while CRP dysregulation may be a feature of systemic lupus erythematosus (SLE). In this cohort of 496 Caucasian SLE families we estimated basal CRP heritability, h(2)= 27.7%. We typed a dense map of CRP single nucleotide polymorphisms (SNPs) and found that seven were associated with basal CRP using both a regression approach and an orthogonal family-based test (P = 0.001-0.011), as were haplotypes carrying the minor allele of these SNPs. SNPs in the interleukin-1beta and interleukin-6 genes were associated with basal CRP. No association was seen between CRP genotype and SLE. Using a variance components approach we estimated that the CRP genotype accounted for only 15% of the total genetic component of basal CRP variation, perhaps explaining the limited evidence of association between CRP and disease. Most of the genetic determinants of basal CRP variation therefore remain unknown. Multiple genes may be involved and identifying them will provide an insight into pathways regulating CRP expression, highlight potential cardiovascular disease and SLE candidates and improve the ability of basal CRP to predict cardiovascular risk.
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Affiliation(s)
- B Rhodes
- Department of Rheumatology, Molecular Genetics and Rheumatology Section, Imperial College London, UK
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Crossman DC, Morton AC, Gunn JP, Greenwood JP, Hall AS, Fox KAA, Lucking AJ, Flather MD, Lees B, Foley CE. Investigation of the effect of Interleukin-1 receptor antagonist (IL-1ra) on markers of inflammation in non-ST elevation acute coronary syndromes (The MRC-ILA-HEART Study). Trials 2008; 9:8. [PMID: 18298837 PMCID: PMC2289802 DOI: 10.1186/1745-6215-9-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Accepted: 02/25/2008] [Indexed: 12/18/2022] Open
Abstract
Background Acute Coronary Syndromes account for 15% of deaths in the UK, and patients remain at significant risk of re-admission for future complications and death. Pathologically the underlying process of atherosclerosis is driven by inflammatory mechanisms, which are activated in ACS patients. Previous studies have investigated the role of inflammatory markers in this process, including interleukin 1 (IL-1) and C Reactive Protein (CRP). Pre-clinical studies indicate that IL-1 may be a primary driver of ACS and that the naturally occurring interleukin-1 receptor antagonist (IL-1ra) may inhibit the atherosclerotic process. This study will investigate the effects of IL-1ra on inflammatory markers in man. Methods/design Three centres in the UK are planning to recruit 186 Non-ST elevation myocardial infarction patients to receive either interleukin-1 receptor antagonist (Anakinra) or matching placebo. Patients will receive a daily subcutaneous injection of either study drug or placebo over a 14 day period. The primary outcome is area under the curve of high sensitivity C-Reactive Protein (CRP) over the first 7 days. Discussion The MRC-ILA-HEART Study is a proof of concept clinical trial investigating the effects of IL-1ra upon markers of inflammation in patients with Non-ST elevation myocardial infarction. It is hoped this will provide new and exciting information in relation to an "anti-inflammatory" strategy for patients with acute coronary syndrome. Trial registration ISRCTN89369318
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Affiliation(s)
- David C Crossman
- Cardiovascular Research Unit, School of Medicine & Biomedical Sciences, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK.
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Pitiphat W, Joshipura KJ, Gillman MW, Williams PL, Douglass CW, Rich-Edwards JW. Maternal periodontitis and adverse pregnancy outcomes. Community Dent Oral Epidemiol 2008; 36:3-11. [PMID: 18205634 DOI: 10.1111/j.1600-0528.2006.00363.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Maternal periodontal diseases have been associated with increased risk of preterm birth and restricted fetal growth among relatively low socioeconomic groups. Whether the association can be generalized to middle-class populations remains uncertain. We evaluated periodontitis in relation to preterm birth (<37 weeks' gestation) and small-for-gestational-age (SGA, birth weight below the 10th percentile of birth weight for gestational age) among a group of medically insured women. METHODS We conducted a prospective study among participants of Project Viva, a US cohort study of pregnant women and their offspring from 1999 to 2002. Pregnancy outcomes were obtained from medical records. Self-reported periodontitis was assessed during the second trimester of pregnancy, and validated against radiographs. Logistic regression analyses were employed to evaluate the association of periodontitis with pregnancy outcomes adjusted for age, race/ethnicity, smoking status, income, frequency of dental check-ups, prepregnancy body mass index, pregnancy weight gain, gravidity, prior history of preterm birth and history of genitourinary infection. RESULTS Of the 1635 women, 72.7% were Caucasian, 65.0% had annual household income >$70 000, 3.8% reported having periodontitis, 6.4% delivered preterm, 5.4% delivered SGA babies, and 11.0% had poor pregnancy outcome (either preterm birth or SGA). The odds ratio (OR) associated with periodontitis was 1.74 (95% CI 0.65-4.66) for preterm delivery and 2.11 (95% CI 0.76-5.86) for SGA individually. When preterm delivery and/or SGA were combined, the OR was 2.26 (95% CI 1.05-4.85) relating periodontitis with poor pregnancy outcome. CONCLUSION Within the limitations of the study, the results suggest that periodontitis is an independent risk factor for poor pregnancy outcome among middle-class women.
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Affiliation(s)
- Waranuch Pitiphat
- Department of Oral Health Policy & Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA.
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Werba JP, Veglia F, Amato M, Baldassarre D, Massironi P, Meroni PL, Riboldi P, Tremoli E, Camera M. Patients with a history of stable or unstable coronary heart disease have different acute phase responses to an inflammatory stimulus. Atherosclerosis 2008; 196:835-40. [PMID: 17335831 DOI: 10.1016/j.atherosclerosis.2007.01.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2006] [Revised: 01/17/2007] [Accepted: 01/29/2007] [Indexed: 10/23/2022]
Abstract
Increased levels of acute phase proteins (APP) in serum are associated with vulnerability of atherosclerotic plaques and acute manifestations of coronary heart disease (CHD). APP have been viewed as indexes of active vascular inflammation or as mediators of atherothrombosis. In the present study we tested the hypothesis that individuals who develop stable or unstable forms of CHD might have different innate responses to an inflammatory stimulus. We compared changes in plasma C-reactive protein (CRP) and serum amyloid A (SAA) concentrations 48 h after a standardized inflammatory stimulus (adjuvanted influenza vaccination) in patients with quiescent CHD that had been manifested at onset as inducible myocardial ischemia (Group 1, n=26) or as acute coronary syndromes (ACS) (Group 2, n=34). Selected patients were free from inflammatory or other conditions that might affect the immune response. CRP concentration increased significantly after vaccination in both groups (Group 1: 0.47 [0.21-0.86] to 0.56 [0.32-1.17]mg/L, p=0.005; Group 2: 0.64 [0.21-1.09] to 0.75 [0.33-1.48]mg/L, p=0.003), without significant differences between groups in absolute or percentage changes. By contrast, SAA did not change after vaccination in Group 1 (14.4 [8.9-19.5] to 14.8 [10.3-18.8]mg/L, p=0.88) but increased significantly in Group 2 (16.9 [10.0-21.5] to 19.2 [11.3-29.1]mg/L, p=0.002), with significant differences between the groups in absolute and percentage terms (p=0.015 and 0.019, respectively). Changes in CRP and SAA, both absolute and percentage, were significantly correlated in Group 2 (r=0.60 and 0.66, both p<0.001). The responsiveness of plasma SAA to an inflammatory stimulus in Group 2 alone suggests a pro-inflammatory status in patients prone to acute coronary syndrome but not in those with inducible myocardial ischemia.
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Sigurdson AJ, Bhatti P, Doody MM, Hauptmann M, Bowen L, Simon SL, Weinstock RM, Linet MS, Rosenstein M, Stovall M, Alexander BH, Preston DL, Struewing JP, Rajaraman P. Polymorphisms in apoptosis- and proliferation-related genes, ionizing radiation exposure, and risk of breast cancer among U.S. Radiologic Technologists. Cancer Epidemiol Biomarkers Prev 2008; 16:2000-7. [PMID: 17932347 DOI: 10.1158/1055-9965.epi-07-0282] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although genes involved in apoptosis pathways and DNA repair pathways are both essential for maintaining genomic integrity, genetic variants in DNA repair have been thought to increase susceptibility to radiation carcinogenesis, but similar hypotheses have not generally been raised about apoptosis genes. For this reason, potential modification of the relationship between ionizing radiation exposure and breast cancer risk by polymorphic apoptosis gene variants have not been investigated among radiation-exposed women. METHODS In a case-control study of 859 cases and 1,083 controls within the U.S. Radiologic Technologists cohort, we assessed breast cancer risk with respect to 16 candidate variants in eight genes involved in apoptosis, inflammation, and proliferation. Using carefully reconstructed cumulative breast dose estimates from occupational and personal diagnostic ionizing radiation, we also investigated the joint effects of these polymorphisms on the risk of breast cancer. RESULTS In multivariate analyses, we observed a significantly decreased risk of breast cancer associated with the homozygous minor allele of CASP8 D302H [rs1045485, odds ratio (OR), 0.3; 95% confidence interval (95% CI), 0.1-0.8]. We found a significantly increased breast cancer risk with increasing minor alleles for IL1A A114S (rs17561); heterozygote OR 1.2 (95% CI, 1.0-1.4) and homozygote OR 1.5 (95% CI, 1.1-2.0), P(trend) = 0.008. Assuming a dominant genetic model, IL1A A114S significantly modified the dose-response relationship between cumulative personal diagnostic radiation and breast cancer risk, adjusted for occupational dose (P(interaction) = 0.004). CONCLUSION The U.S. Radiologic Technologists breast cancer study provided a unique opportunity to examine the joint effects of common genetic variation and ionizing radiation exposure to the breast using detailed occupational and personal diagnostic dose data. We found evidence of effect modification of the radiation and breast cancer dose-response relationship that should be confirmed in studies with more cases and controls and quantified radiation breast doses in the low-to-moderate range.
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Affiliation(s)
- Alice J Sigurdson
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, 6120 Executive Boulevard, EPS 7092, MSC 7238, Bethesda, MD 20892-7238, USA.
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Genetic determinants of basal C-reactive protein expression in Filipino systemic lupus erythematosus families. Genes Immun 2008; 9:153-60. [PMID: 18216863 DOI: 10.1038/sj.gene.6364459] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Basal C-reactive protein (CRP) is a heritable trait associated with long-term cardiovascular disease risk. Existing studies leave ambiguity over the key functional polymorphisms and fail to adjust for trans-acting effects. In a novel cohort of 285 Filipino systemic lupus erythematosus probands and their first-degree relatives, we quantified serum CRP and typed a dense map of CRP single-nucleotide polymorphisms (SNPs), along with SNPs in the interleukin-1 beta, interleukin-6 and apolipoprotein E genes. Ten CRP SNPs demonstrated association with basal CRP in a regression model (P=0.011-0.002). These delineated two haplotypes associated with high and low basal CRP expression (P=0.002). Differences in allele frequency were seen compared with Caucasian populations, enabling us to argue for an independent genetic effect from a phylogenetically distinct haplotype tagged by SNP rs1800947. We demonstrated an association between Apo epsilon 2 and higher basal CRP. Interleukin-6 genotype was associated with basal CRP, highlighting a role for acute-phase cytokines even in basal expression. Identifying these trans-acting variants may improve the use of basal CRP as a predictor cardiovascular risk, and increase our power to detect associations between CRP and disease.
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Edberg JC, Wu J, Langefeld CD, Brown EE, Marion MC, McGwin G, Petri M, Ramsey-Goldman R, Reveille JD, Frank SG, Kaufman KM, Harley JB, Alarcón GS, Kimberly RP. Genetic variation in the CRP promoter: association with systemic lupus erythematosus. Hum Mol Genet 2008; 17:1147-55. [DOI: 10.1093/hmg/ddn004] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Goteiner D, Ashmen R, Lehrman N, Janal MN, Eskin B. Presence and Significance of Interleukin-1 Polymorphism in Patients Who Present With Acute Coronary Syndrome, Angina, and Chronic Periodontitis: An Epidemiologic Pilot Study. J Periodontol 2008; 79:138-43. [DOI: 10.1902/jop.2008.070206] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Abstract
PCI (percutaneous coronary intervention) now outnumbers CABG (coronary artery bypass grafting) by more than 3:1 for the treatment of coronary heart disease. In this article, we discuss the current challenges faced by interventional cardiologists including restenosis and its treatment options and potential therapies for the future. The impact of stent geometry on restenosis and strategies to deal with challenging lesions such as bifurcations and lesions in the left main stem are also discussed.
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Kornman K, Rogus J, Roh-Schmidt H, Krempin D, Davies AJ, Grann K, Randolph RK. Interleukin-1 genotype-selective inhibition of inflammatory mediators by a botanical: a nutrigenetics proof of concept. Nutrition 2007; 23:844-52. [PMID: 17884346 DOI: 10.1016/j.nut.2007.08.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 08/02/2007] [Accepted: 08/03/2007] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Although observational studies have shown that genotype may influence nutritional effects on target outcomes, there are few reported studies that stratified subjects by genotype before a nutritional intervention. This proof-of-concept trial determined whether specifically formulated botanical mixtures reduced inflammation in individuals with genetic variations that predispose to overexpression of interleukin-1beta (IL-1beta) and early heart disease. METHODS Healthy adults with elevated C-reactive protein (CRP) were stratified into genetic groups based on being positive (IL1(Pos)) or negative (IL1(Neg)) for the at-risk IL-1 gene variations. IL1(Pos) (n = 39) and IL1(Neg) (n = 40) subjects were then randomized to the candidate botanical formulation or placebo. The botanical formulation included rose hips, a blueberry and blackberry mixture, and a grapevine extract. RESULTS At 12 wk of dosing with the botanical formulation, IL-1beta gene expression by stimulated peripheral blood mononuclear cells was significantly lower than at baseline and significantly lower than placebo in IL1(Pos) and IL1(Neg) subjects. Mean IL-1beta gene expression treatment effect over the 12-wk period was greater in IL1(Pos) than in IL1(Neg) subjects. At 12 wk of dosing the botanical mixture produced no mean change in serum CRP levels. However, in IL1(Pos) subjects, significantly more subjects achieved a reduction in CRP with the botanical mixture than with placebo. No CRP effect was observed in the IL1(Neg) subjects. CONCLUSION This study represents one of a few prospective clinical trials in which genetic variations were shown to differentially influence nutrient effects on outcomes.
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Hage FG, Szalai AJ. C-Reactive Protein Gene Polymorphisms, C-Reactive Protein Blood Levels, and Cardiovascular Disease Risk. J Am Coll Cardiol 2007; 50:1115-22. [PMID: 17868801 DOI: 10.1016/j.jacc.2007.06.012] [Citation(s) in RCA: 156] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Revised: 05/07/2007] [Accepted: 06/05/2007] [Indexed: 10/22/2022]
Abstract
C-reactive protein (CRP), a blood marker of inflammation and a hallmark of the acute-phase response, has been shown to be a powerful and specific predictor of cardiovascular event risk in populations of otherwise healthy persons. Here we review what is known about CRP gene polymorphisms, discuss how these might affect the epidemiology of CRP and our understanding of CRP's contribution to cardiovascular disease, and examine their potential clinical usefulness. Evidence shows that certain subtle variations in the CRP gene sequence, mostly single nucleotide polymorphisms, predictably and strongly influence the blood level of CRP. Some of these variations are associated with clinical correlates of cardiovascular disease. If future studies can establish with certainty that CRP influences cardiovascular biology, then CRP gene profiling could have clinical utility.
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Affiliation(s)
- Fadi G Hage
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Dai DF, Chiang FT, Lin JL, Huang LY, Chen CL, Chang CJ, Lai LP, Hsu KL, Tseng CD, Tseng YZ, Hwang JJ. Human C-reactive protein (CRP) gene 1059G>C polymorphism is associated with plasma CRP concentration in patients receiving coronary angiography. J Formos Med Assoc 2007; 106:347-54. [PMID: 17561469 DOI: 10.1016/s0929-6646(09)60319-3] [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: 11/29/2022] Open
Abstract
BACKGROUND/PURPOSE Elevation of C-reactive protein (CRP) level is associated with increased risk of cardiovascular events. The 1059 G>C polymorphism in exon 2 of the CRP gene has been shown to affect plasma concentration of CRP. We want to elucidate the effect of this polymorphism on the development of coronary artery disease (CAD) among the Chinese population in Taiwan. METHODS We scrutinized 536 patients undergoing coronary angiography (365 patients with CAD and 171 controls with patent coronaries) and evaluated the association of CRP gene 1059 G>C polymorphism with CAD. Genotyping of the polymorphism was performed by polymerase chain reaction and MaeIII restriction enzyme digestion. RESULTS The CC genotype was associated with lower plasma CRP concentration (GG, 6.5+/-5.8; GC, 3.3+/-4.4; CC, 2.3+/-3.1 mg/L; p=0.02). Subjects with CAD or myocardial infarction (MI) had significantly higher plasma CRP concentration than that in controls (CAD vs. controls, 8.9+/-18.9 vs. 3.3+/-7.2 mg/L; p<0.001), while patients with MI showed higher CRP when compared to those with chronic stable angina (13.5+/-22.9 vs. 5.2+/-14.1 mg/L; p<0.001). However, this polymorphism was not associated with CAD in our population. CONCLUSION Our data suggest that human CRP gene 1059 G>C polymorphism is associated with plasma CRP concentration among Chinese in Taiwan receiving coronary angiography.
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Affiliation(s)
- Dao-Fu Dai
- Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Engels EA, Wu X, Gu J, Dong Q, Liu J, Spitz MR. Systematic Evaluation of Genetic Variants in the Inflammation Pathway and Risk of Lung Cancer. Cancer Res 2007; 67:6520-7. [PMID: 17596594 DOI: 10.1158/0008-5472.can-07-0370] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Inflammatory responses to environmental exposures, such as tobacco smoke, may play a role in lung carcinogenesis. To test this hypothesis, we studied genetic polymorphisms in the inflammation pathway in relation to lung cancer risk. We evaluated a panel of 59 single nucleotide polymorphisms (SNP) in 37 inflammation-related genes among non-Hispanic Caucasian lung cancer cases (N=1,553) and controls (N=1,730) from Houston, Texas. Logistic regression was used to assess associations with lung cancer under a dominant genetic model adjusted for sex, age, and smoking. Haplotypes were estimated with the expectation-maximization algorithm. False-positive report probabilities (FPRP) were calculated for significant associations. Interleukin 1 beta (IL1B) C3954T was associated with lung cancer [odds ratio (OR), 1.27; 95% confidence interval (95% CI), 1.10-1.47; FPRP 0.148]. Two IL1A SNPs (C-889T and Ala(114)Ser) were also related to lung cancer (OR, 1.18-1.22), although FPRPs were higher. One IL1A-IL1B haplotype, containing only the IL1B 3954T allele, was associated with elevated lung cancer risk (OR, 1.80; 95% CI, 1.24-2.61). These associations were stronger in heavy smokers, particularly for IL1B C3954T (OR, 1.59; 95% CI, 1.28-1.97; FPRP 0.004). Lung cancer risk was unrelated to polymorphisms in IL1 receptor or antagonist genes. Associations with lung cancer were also seen for SNPs in granulocyte macrophage colony stimulating factor and peroxisome proliferator-activated factor-delta, but FPRPs were high. IL1A and IL1B polymorphisms are associated with increased lung cancer risk, especially among heavy smokers. IL1A and IL1B are critical signals in initiating inflammation. Our results suggest that a dysregulated inflammatory response to tobacco-induced lung damage promotes carcinogenesis.
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Affiliation(s)
- Eric A Engels
- Viral Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland 20892, USA.
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Broeckel U, Hengstenberg C, Mayer B, Maresso K, Gaudet D, Seda O, Tremblay J, Holmer S, Erdmann J, Glöckner C, Harrison M, Martin LJ, Williams JT, Schmitz G, Riegger GAJ, Jacob HJ, Hamet P, Schunkert H. A locus on chromosome 10 influences C-reactive protein levels in two independent populations. Hum Genet 2007; 122:95-102. [PMID: 17530289 DOI: 10.1007/s00439-007-0380-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Accepted: 05/09/2007] [Indexed: 01/08/2023]
Abstract
High sensitivity C-reactive protein (hsCRP) is an independent risk factor for cardiovascular disease, such as stroke or coronary artery disease. Genetic factors influence significantly the inter-individual variability of hsCRP. The aim of this study was to identify genomic regions influencing hsCRP levels. A genome scan was performed in two independent studies of Caucasian populations, namely 513 Western-European families ascertained for myocardial infarction (n = 1,406) and 120 French-Canadian families diagnosed with hypertension (n = 758). In the myocardial infarction families, 31% of the inter-individual variation of hsCRP levels was explained by genetic factors (P = 0.0000015) and loci influencing hsCRP were identified on chromosomes 10 (at 141 cM) and 5 (at 150 cM) with multipoint LOD scores of 3.15 and 2.23, respectively. An additional suggestive signal was detected on chromosome 2 in subset analyses. A similar degree of heritability has been observed in a second independent population of French-Canadian hypertensive families for hsCRP (30%) and linkage results for chromosome 10 were confirmed with maximum LOD score of 2.7. We identified a chromosomal region in two independent populations which influences hsCRP in addition to several unique regions. This provides targets for the identification of genes involved in the regulation of hsCRP and the development and progression of vascular disease, including stroke.
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Affiliation(s)
- Ulrich Broeckel
- Department of Medicine, Medical College of Wisconsin, Milwaukee 53226, USA.
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