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Muchão FP, Souza AVD, Souza JME, Silva LVRFD. Association between beta-2 adrenergic receptor variants and clinical outcomes in children and adolescents with acute asthma. EINSTEIN-SAO PAULO 2022; 20:eAO6412. [PMID: 35352766 PMCID: PMC8932728 DOI: 10.31744/einstein_journal/2022ao6412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/04/2021] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate whether different genotypes of p.Arg16Gly, p.Gln27Glu, p.Arg19Cys and p.Thr164Ile variants interfere in response to treatment in children and adolescents with moderate to severe acute asthma. Methods This sample comprised patients aged 2 to 17 years with a history of at least two wheezing episodes and current moderate to severe asthma exacerbation. All patients received multiple doses of albuterol and ipratropium bromide delivered via pressurized metered-dose inhaler with holding chamber and systemic corticosteroids. Hospital admission was defined as the primary outcome. Secondary outcomes were changes in forced expiratory volume in the first second after 1 hour of treatment, and for outpatients, length of stay in the emergency room. Variants were genotyped by sequencing. Results A total of 60 patients were evaluated. Hospital admission rates were significantly higher in carriers of the genotype AA relative to those with genotype AG or GG, within the p.Arg16Gly variant (p=0.03, test χ2, alpha=0.05). Secondary outcomes did not differ between genotypes. Conclusion Hospital admission rates were significantly higher among carriers of the genotype AA within the p.Arg16Gly variant. Trial registration: ClinicalTrials.gov: NCT01323010
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Motamed H, Verki MM, Nematollahi AV, Hesam S. Evaluation of efficacy of nebulized low molecular weight heparin as an adjunctive extra treatment for acute mild-moderate asthma attack; a randomized clinical trial study. Pulm Pharmacol Ther 2021; 68:102037. [PMID: 33989812 DOI: 10.1016/j.pupt.2021.102037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 03/14/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Asthma is the most common chronic disorders of the respiratory tract. This study aimed to evaluate the effect of low-molecular-weight heparins (LMWHs) in the treatment of acute asthma. METHODS In this randomized clinical trial, patients with acute asthma attacks were enrolled. The patients were divided randomly into two groups. Patients in the intervention group received nebulized LMWH (1 mg/kg) with albuterol (2.5 mg) every 20 min for 10 min. The patients in the control group received nebulized albuterol with the same dose. Then peak expiratory flow rates (PEFR) and forced expiratory volume in 1 s (FEV1), and hemodynamic parameters in both groups were assessed for every 20 min. RESULTS In total 70 patients enrolled in this study. We found that the mean PEFR at 40 min was higher in the LMWH group than the control group (202.51 L/min and 180.2 L/min) (p = 0.001). Moreover, this difference remains significant in the 60th minute (p < 0.001). Further, FEV1 was significantly higher in the LMWH group after 60 min (1.82 L/min vs 1.48 L/min, p < 0.001). Moreover, we found that the hemodynamic parameters were sustainable in the intervention group. CONCLUSION The study suggests that LMWH in mild-moderate asthma attacks may be beneficial in the short term and could be prescribed in addition to standard albuterol therapy.
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Affiliation(s)
- Hassan Motamed
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohamadreza Maleki Verki
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Ali Vefagh Nematollahi
- Emergency Medicine Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeed Hesam
- Epidemiology and Statistics Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Zhang E, Levin AM, Williams LK. How does race and ethnicity effect the precision treatment of asthma? EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2019; 4:337-356. [PMID: 33015363 DOI: 10.1080/23808993.2019.1690396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction Asthma is a common condition that affects large numbers of children and adults, yet the burden of disease is not equally distributed amongst groups. In the United States, African Americans and Puerto Ricans have higher rates of asthma and its complications when compared with European Americans. However, clinical trials and genetic studies have largely focused on the latter group. Areas covered Here we examine what is known regarding differences in asthma treatment response by race-ethnicity. We also review existing genetic studies related to the use of asthma medications, paying special attention to studies that included substantial numbers of non-white population groups. Publicly accessible search engines of the medical literature were queried using combinations of the terms asthma, race, ethnicity, pharmacogenomics, and pharmacogenetics, as well as the names of individual asthma medication classes. The list of articles reviewed was supplemented by bibliographies and expert knowledge. Expert opinion A substantial and coordinated effort is still needed to both identify and validate genetic biomarkers of asthma medication response, as currently there are no clinically actionable genetic markers available for this purpose. The path to identifying such markers in non-white populations is even more formidable, since these groups are underrepresented in existing data.
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Affiliation(s)
- Ellen Zhang
- Center for Individualized and Genomic Medicine Research (CIGMA), Department of Internal Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Albert M Levin
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - L Keoki Williams
- Center for Individualized and Genomic Medicine Research (CIGMA), Department of Internal Medicine, Henry Ford Health System, Detroit, MI, USA
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Association of β2-adrenergic receptor gene polymorphisms (rs1042713, rs1042714, rs1042711) with asthma risk: a systematic review and updated meta-analysis. BMC Pulm Med 2019; 19:202. [PMID: 31699066 PMCID: PMC6836544 DOI: 10.1186/s12890-019-0962-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 10/17/2019] [Indexed: 01/08/2023] Open
Abstract
Background The published data on the association between β2-adrenergic receptor gene polymorphisms and asthma susceptibility are inconclusive. To derive a more precise estimation of this association, a meta-analysis was performed. Methods A literature search was conducted in PubMed, Web of Science, EMBASE, Wanfang, and the China National Knowledge Infrastructure (CNKI) databases to identify eligible studies. The pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were used to calculate the strength of the association. A sensitivity analysis was performed to evaluate the influence of individual studies on the overall effect estimates, and funnel plots and Egger’s tests were used for indications of publication bias. Results Seventy three studies with three single nucleotide polymorphisms (SNP) (rs1042713, c.G46A, p.Gly16Arg; rs1042714, c.G79C, p.Gln27Glu; rs1042711, c.T-47C, p.Cys19Arg) were finally identified. For the rs1042713 polymorphism, no significant association with asthma risk was found in the overall population. However, a significant protective association was found in the Indian population in the dominant model comparison (OR = 0.72, 95% CI = 0.59–0.87, I2 = 25%, studies = 5, cases = 1190, controls = 1241). A significant risk association was found in the Arab population in the dominant model comparison (OR = 1.75, 95% CI = 1.14–2.70, I2 = 0%, studies = 2, cases = 307, controls = 361) and the homozygote model comparison (OR = 1.88, 95% CI = 1.17–3.02, I2 = 0%, studies = 2, cases = 307, controls = 361), and in the Hispanic-Latino population in the dominant model comparison (OR = 1.68, 95% CI = 1.10–2.55, I2 = 77%, studies = 5, cases = 1026, controls = 1412). For the rs1042714 polymorphism, we found a significant association in the recessive model comparison (OR = 0.83, 95% CI = 0.70–0.98, I2 = 44%, studies = 52, cases = 8242, controls = 16,832), the homozygote genotype comparison (OR = 0.84, 95% CI = 0.72–0.98, I2 = 25%, studies = 52, cases = 8242, controls = 16,832) and the allelic genetic model (OR = 0.91, 95% CI = 0.83–0.99, I2 = 59%, studies = 52, cases = 8242, controls = 16,832) in the overall population. When stratified by age, a significant association was also found in children in the recessive model comparison (OR = 0.59, 95% CI = 0.39–0.88, I2 = 58%, studies = 18, cases = 2498, controls = 2510) and the homozygote genotype comparison (OR = 0.63, 95% CI = 0.43–0.92, I2 = 46%, studies = 18, cases = 2498, controls = 2510), but not in adult. For the rs1042711 polymorphism, no significant associations were found in the any genetic model. Conclusion The meta-analysis suggests that the ADRB2 rs1042714 polymorphism has a protective association with asthma in the overall population and the pediatric subgroup.
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Samedy-Bates LA, Oh SS, Nuckton TJ, Elhawary JR, White M, Elliot T, Zeiger AM, Eng C, Salazar S, LeNoir MA, Meade K, Farber HJ, Serebrisky D, Brigino-Buenaventura E, Rodriguez-Cintron W, Bibbins-Domingo K, Kumar R, Thyne S, Borrell LN, Rodriguez-Santana JR, Pino-Yanes M, Burchard EG. Racial/Ethnic-Specific Differences in the Effects of Inhaled Corticosteroid Use on Bronchodilator Response in Patients With Asthma. Clin Pharmacol Ther 2019; 106:1133-1140. [PMID: 31209858 PMCID: PMC6778006 DOI: 10.1002/cpt.1555] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/20/2019] [Indexed: 12/30/2022]
Abstract
American Thoracic Society guidelines recommend inhaled corticosteroid (ICS) therapy, plus a short-acting bronchodilator, in patients with persistent asthma. However, few prior studies have examined the efficacy of this combination in children of all racial/ethnic groups. We evaluated the association between ICS use and bronchodilator response (BDR) in three pediatric populations with persistent asthma (656 African American, 916 Puerto Rican, and 398 Mexican American children). The association was assessed using multivariable quantile regression. After adjusting for baseline forced expiratory volume in one second and use of controller medications, ICS use was significantly associated with increased BDR only among Mexican Americans (1.56%, P = 0.028) but not African Americans (0.49%, P = 0.426) or Puerto Ricans (0.16%, P = 0.813). Our results demonstrate that ICS augmentation is disproportionate across racial/ethnic groups, where improved BDR is observed in Mexican Americans only. This study highlights the complexities of treating asthma in children, and reinforces the importance of investigating the influence of race/ethnicity on pharmacological response.
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Affiliation(s)
- Lesly-Anne Samedy-Bates
- Department of Medicine, University of California, San Francisco, CA, USA
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA
| | - Sam S. Oh
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Thomas J. Nuckton
- Department of Medicine, University of California, San Francisco, CA, USA
| | | | - Marquitta White
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Tyronda Elliot
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Andy M. Zeiger
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Celeste Eng
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Sandra Salazar
- Department of Medicine, University of California, San Francisco, CA, USA
| | | | - Kelley Meade
- Children’s Hospital and Research Center Oakland, Oakland, CA, USA
| | - Harold J. Farber
- Department of Pediatrics, Section of Pulmonology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
| | | | | | | | | | - Rajesh Kumar
- The Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Shannon Thyne
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA, USA
| | - Luisa N. Borrell
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, USA
| | | | - Maria Pino-Yanes
- Genomics and Health Group, Department of Biochemistry, Microbiology, Cell Biology and Genetics, Universidad de La Laguna, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Esteban G. Burchard
- Department of Medicine, University of California, San Francisco, CA, USA
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA
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Efficacy of adjuvant treatment with nebulized lidocaine in improving clinical and pulmonary function parameters of acute asthma attacks: a randomized double-blind clinical trial. DRUGS & THERAPY PERSPECTIVES 2018. [DOI: 10.1007/s40267-018-0550-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Sahi PK, Shastri S, Lodha R, Gupta N, Pandey RM, Kabra SK, Kabra M. ADRB2 Polymorphism and Salbutamol Responsiveness in Northern Indian Children with Mild to Moderate Exacerbation of Asthma. Indian Pediatr 2016; 53:211-5. [PMID: 27029682 DOI: 10.1007/s13312-016-0822-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The primary objective was to determine the association between beta-2 adrenergic receptor (ADRB2) gene polymorphism (rs1042713, c.46A>G, p.Arg16Gly) and the response to inhaled salbutamol in North Indian children aged 5 to 15 years, with mild to moderate exacerbation of asthma. METHODS This cross-sectional study was done at a tertiary-care hospital in Northern India from June 2011 to May 2013. 120 children with asthma with mild to moderate exacerbation underwent spirometry at baseline and after administration of three doses of salbutamol. An increase in FEV1 =15% was considered as positive response. Blood samples from these children were analysed for ADRB2 polymorphism (p.Arg16Gly). 94 non-asthmatic adult controls were also studied to determine the prevalence of ADRB2 polymorphism. RESULTS In asthmatic children, the frequency of AA, GG, AG genotypes were 24.2%, 24.2% and 51.7% compared to 20.2%, 20.2% and 59.6%, respectively in the non-asthmatic adults. Salbutamol responsiveness showed no correlation with the studied ADRB2 polymorphism (p= 0.55). A trend towards greater bronchodilator responsiveness amongst AA genotype, compared to GG genotype was observed (Median change in percent predicted FEV1 14.5% and 7.5%, respectively). CONCLUSION No correlation was found between salbutamol responsiveness and ADRB2 genotype in Northern Indian children with asthma with mild-to moderate exacerbation.
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Affiliation(s)
- Puneet Kaur Sahi
- Departments of Pediatrics and #Biostatistics, All India Institute of Medical Sciences, New Delhi, India. Correspondence to: Dr Madhulika Kabra, Professor, Division of Genetics, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
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Bandaru S, Akka J, Marri VK, Alvala M, Ponnala D, Mundluru HP. Analysis of ADRB2 (Arg16Gly) Gene Variant with Susceptibility, Pharmacogenetic Response and Disease Severity in South Indian Asthmatics. Inflammation 2016; 38:2146-55. [PMID: 26071206 DOI: 10.1007/s10753-015-0197-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
β2-Adrenergic receptor (β2-AR) plays a crucial role in asthma pathophysiology by regulating, processes of the lung function, and clinical response to bronchodilators. The +46G>A- Gly16Arg polymorphism in the gene encoding β2 adrenergic receptor (ADRB2) has been associated with receptor non-responsiveness after β2-agonist exposure. In the present study, we sought to evaluate the possible association of Gly16Arg polymorphism with asthma susceptibility, pharmacogenetic response to Salbutamol, and varying degrees of disease severity. Three hundred ninety-eight clinically diagnosed patients and 456 healthy controls were enrolled for the study. Patients were classified into severity classes according to Global Initiative for Asthma guidelines. To assess bronchodilator response, spirometry was performed before and 15 min after Salbutamol (200 μg) delivery. Responders to Salbutamol were categorized if percentage reversibility was greater than or equal to 12% in them, while those showing reversibility less than 12% were classified as non-responders. Genotyping was carried out by ARMS-PCR technique. Statistical methods were applied to test for the significance of the results. In the present study, there was lack of significant association of polymorphism with disease susceptibility as well as with bronchodilator response. The polymorphism was not associated with mild and moderate asthma subtypes; however, there was a notable association with severe asthma subtype. In addition, the polymorphism was associated with severe asthma compared to subtypes of mild and moderate asthma combined. In a South Indian population, the ADRB2 Arg/Gly may not form a susceptible variant to develop asthma nor can be a standard predictive marker to bronchodilator response; nevertheless, the patterns in asthma severity can be predicted by analyzing this variant.
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Affiliation(s)
- Srinivas Bandaru
- National Institute of Pharmaceutical Education and Research, Hyderabad, 500 037, India.
- Department of Toxicology, Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Hyderabad, 500 016, India.
| | - Jyothy Akka
- Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Hyderabad, 500 016, India
| | - Vijaya Kumar Marri
- Government General and Chest Hospital, Gandhi Medical College and Osmania Medical College, Hyderabad, 500 038, India
| | - Mallika Alvala
- National Institute of Pharmaceutical Education and Research, Hyderabad, 500 037, India
| | - Deepika Ponnala
- Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Hyderabad, 500 016, India
| | - Hema Prasad Mundluru
- Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Hyderabad, 500 016, India
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Schuh S, Sweeney J, Freedman SB, Coates AL, Johnson DW, Thompson G, Gravel J, Ducharme FM, Zemek R, Plint AC, Beer D, Klassen T, Curtis S, Black K, Nicksy D, Willan AR. Magnesium nebulization utilization in management of pediatric asthma (MagNUM PA) trial: study protocol for a randomized controlled trial. Trials 2016; 17:261. [PMID: 27220675 PMCID: PMC4879727 DOI: 10.1186/s13063-015-1151-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 12/30/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Up to 30 % of children with acute asthma are refractory to initial therapy, and 84 % of this subpopulation needs hospitalization. Finding safe, noninvasive, and effective strategies to treat this high-risk group would substantially decrease hospitalizations, healthcare costs, and the psycho-social burden of the disease. Whereas intravenous magnesium (Mg) is effective in severe refractory asthma, its use is sporadic due to safety concerns, with the main treatment goal being to prevent intensive care unit admission. In contrast, nebulized Mg is noninvasive, allows higher pulmonary drug concentrations, and has a much higher safety potential due to the lower rate of systemic delivery. Previous studies of inhaled Mg show disparate results due to the use of unknown/inefficient delivery methods and other methodological flaws. METHODS/DESIGN The study is a randomized double-blind controlled trial in seven Canadian pediatric Emergency Departments (two-center pilot 2011 to 2014, Canada-wide November 2014 to December 2017). The trial will include 816 otherwise healthy children who are 2 to 17 years old, having had at least one previous wheezing episode, have received systemic corticosteroids, and have a Pediatric Respiratory Assessment Measure (PRAM) ≥ 5 points after three salbutamol and ipratropium treatments for a current acute asthma exacerbation. Eligible consenting children will receive three experimental treatments of nebulized salbutamol with either 600 mg of Mg sulfate or placebo 20 min apart, using an Aeroneb Go nebulizer, which has been shown to maximize pulmonary delivery while maintaining safety. The primary outcome is hospitalization within 24 h of the start of the experimental therapy for persistent respiratory distress or supplemental oxygen. Secondary outcomes include all-cause hospitalization within 24 h, PRAM, vital signs, number of bronchodilator treatments by 240 min, and the association between the difference in the primary outcome between the groups, age, gender, baseline PRAM, atopy, and "viral induced wheeze" phenotype (Fig. 1). DISCUSSION If effective, inhaled Mg may represent an effective strategy to minimize morbidity in pediatric refractory acute asthma. Unlike previous works, this trial targets nonresponders to optimized initial therapy who are the most likely to benefit from inhaled Mg. Future dissemination of results will include knowledge translation, incorporation into a Cochrane Review, presentation at scientific meetings, and a peer-reviewed publication. TRIAL REGISTRATION NCTO1429415 , registered 2 September 2011.
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Affiliation(s)
- Suzanne Schuh
- />Division of Paediatric Emergency Medicine, The Hospital for Sick Children, Child Health Evaluative Sciences, SickKids Research Institute, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - Judy Sweeney
- />SickKids Research Institute, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8 Canada
| | - Stephen B. Freedman
- />Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB T3B 6AB Canada
| | - Allan L. Coates
- />SickKids Research Institute, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - David W. Johnson
- />Departments of Paediatrics, Pharmacology and Physiology, Alberta Children’s Hospital Research Institute, Faculty of Medicine, University of Calgary, C4,643, 2888 Shaganappi Trail NW, Calgary, AB T3B 6AB Canada
| | - Graham Thompson
- />Division of Pediatric Emergency Medicine, Alberta Children’s Hospital, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB T3B 6AB Canada
| | - Jocelyn Gravel
- />Division of Paediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, 3175 Cote Sainte-Catherine, Montreal, QC H3T 1C5 Canada
| | - Francine M. Ducharme
- />Department of Pediatrics, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, 175 Cote Sainte-Catherine, Montreal, QC H3T 1C5 Canada
| | - Roger Zemek
- />Division of Pediatric Emergency Medicine, Children’s Hospital of Eastern Ontario (CHEO), 401 Smyth Road, Ottawa, ON K1H 8L1 Canada
| | - Amy C. Plint
- />Division of Emergency Medicine, Children’s Hospital of Eastern Ontario (CHEO), 401 Smyth Road, Ottawa, ON K1H 8L1 Canada
| | - Darcy Beer
- />Divsion of Pediatric Emergency Medicine, The Children’s Hospital of Winnipeg, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3J 1R9 Canada
| | - Terry Klassen
- />Children’s Hospital Research Institute of Manitoba (formerly Manitoba Institute of Child Health), Academic Faculty of Medicine, 715 McDermot Ave, Winnipeg, MB R3E 3P4 Canada
- />Department of Pediatrics and Child Health, University of Manitoba, 715 McDermot Ave, Winnipeg, MB R3E 3P4 Canada
- />Child Health Program, Winnipeg Health Region MICH, 715 McDermot Ave, Winnipeg, MB R3E 3P4 Canada
| | - Sarah Curtis
- />Division of Paediatric Emergency Medicine, Stollery Children’s Hospital, University of Alberta, 8440 112 Street Northwest, Edmonton, AB T6G 2B7 Canada
| | - Karen Black
- />Division of Pediatric Emergency Medicine, University of British Columbia, BC Children’s Hospital, 4480 Oak St, Vancouver, BC V6H 3N1 Canada
| | - Darcy Nicksy
- />SickKids Research Institute, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8 Canada
| | - Andrew R. Willan
- />Child Health Evaluative Sciences, SickKids Research Institute, Dalla Lana School of Public Health, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - on behalf of Pediatric Emergency Research Canada Group
- />Division of Paediatric Emergency Medicine, The Hospital for Sick Children, Child Health Evaluative Sciences, SickKids Research Institute, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8 Canada
- />Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB T3B 6AB Canada
- />Departments of Paediatrics, Pharmacology and Physiology, Alberta Children’s Hospital Research Institute, Faculty of Medicine, University of Calgary, C4,643, 2888 Shaganappi Trail NW, Calgary, AB T3B 6AB Canada
- />Division of Pediatric Emergency Medicine, Alberta Children’s Hospital, University of Calgary, 2888 Shaganappi Trail NW, Calgary, AB T3B 6AB Canada
- />Division of Paediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, 3175 Cote Sainte-Catherine, Montreal, QC H3T 1C5 Canada
- />Department of Pediatrics, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, 175 Cote Sainte-Catherine, Montreal, QC H3T 1C5 Canada
- />Division of Pediatric Emergency Medicine, Children’s Hospital of Eastern Ontario (CHEO), 401 Smyth Road, Ottawa, ON K1H 8L1 Canada
- />Division of Emergency Medicine, Children’s Hospital of Eastern Ontario (CHEO), 401 Smyth Road, Ottawa, ON K1H 8L1 Canada
- />Divsion of Pediatric Emergency Medicine, The Children’s Hospital of Winnipeg, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB R3J 1R9 Canada
- />Children’s Hospital Research Institute of Manitoba (formerly Manitoba Institute of Child Health), Academic Faculty of Medicine, 715 McDermot Ave, Winnipeg, MB R3E 3P4 Canada
- />Department of Pediatrics and Child Health, University of Manitoba, 715 McDermot Ave, Winnipeg, MB R3E 3P4 Canada
- />Child Health Program, Winnipeg Health Region MICH, 715 McDermot Ave, Winnipeg, MB R3E 3P4 Canada
- />Division of Paediatric Emergency Medicine, Stollery Children’s Hospital, University of Alberta, 8440 112 Street Northwest, Edmonton, AB T6G 2B7 Canada
- />Division of Pediatric Emergency Medicine, University of British Columbia, BC Children’s Hospital, 4480 Oak St, Vancouver, BC V6H 3N1 Canada
- />SickKids Research Institute, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8 Canada
- />Child Health Evaluative Sciences, SickKids Research Institute, Dalla Lana School of Public Health, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8 Canada
- />SickKids Research Institute, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8 Canada
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Liang SQ, Chen XL, Deng JM, Wei X, Gong C, Chen ZR, Wang ZB. Beta-2 adrenergic receptor (ADRB2) gene polymorphisms and the risk of asthma: a meta-analysis of case-control studies. PLoS One 2014; 9:e104488. [PMID: 25111792 PMCID: PMC4128804 DOI: 10.1371/journal.pone.0104488] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 07/14/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVE A number of studies have assessed the relationship between beta-2 adrenergic receptor (ADRB2) gene polymorphisms and asthma risk. However, the results are inconsistent. A meta-analysis that focused on the association between asthma and all ADRB2 polymorphisms with at least three case-control studies was thus performed. METHODS A literature search of the PubMed, Embase, Web of Science, CNKI, and Wangfang databases was conducted. Odds ratios with 95% confidence intervals were used to assess the strength of associations. RESULTS Arg16Gly, Gln27Glu, Thr164Ile, and Arg19Cys single nucleotide polymorphisms (SNPs) were identified in 46 case-control studies. The results showed that not all of the SNPs were associated with asthma in the overall population. Significant associations were found for the Arg16Gly polymorphism in the South American population via dominant model comparison (OR = 1.754, 95% CI = 1.179-2.609, I2 = 16.9%, studies = 2, case = 314, control = 237) in an analysis stratified by ethnicity. For the Gln27Glu polymorphism, a protective association was found in children via recessive model comparison (OR = 0.566, 95% CI = 0.417-0.769, I2 = 0.0%, studies = 11, case = 1693, control = 502) and homozygote genotype comparison (OR = 0.610, 95% CI = 0.434-0.856, I2 = 0.0%, studies = 11, case = 1693, control = 1502), and in adults via dominant model comparison (OR = 0.864, 95% CI = 0.768-0.971, I2 = 46.9%, n = 18, case = 3160, control = 3433). CONCLUSIONS None of the ADRB2 gene polymorphisms were reproducibly associated with a risk of asthma across ethnic groups in the general population.
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Affiliation(s)
- Si-Qiao Liang
- Department of Respiratory Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiao-Li Chen
- Department of Respiratory Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jing-Min Deng
- Department of Respiratory Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- * E-mail: .
| | - Xuan Wei
- Department of Respiratory Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Chen Gong
- Department of Respiratory Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Zhang-Rong Chen
- Department of Respiratory Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Zhi-Bo Wang
- Department of Respiratory Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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Lima JJ. Do genetic polymorphisms alter patient response to inhaled bronchodilators? Expert Opin Drug Metab Toxicol 2014; 10:1231-40. [PMID: 25102170 DOI: 10.1517/17425255.2014.939956] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Short- and long-acting β agonists (SABA and LABA) are bronchodilators for treating asthma. Bronchodilator response (BDR) is quantified by measuring air expired in the first second during a forced expiratory maneuver, prior to and following inhalation of SABA. BDR has been associated with a significant degree of heterogeneity, in part attributable to genetic variation. Heritability, the proportion of phenotypic variability accounted for by genetic variation is estimated to account for 50% of pulmonary function and 28.5% for BDR. AREAS COVERED A MEDLINE search for English articles published from January 1990 to June 2014 was completed using the terms: bronchodilator, bronchodilator response, short-acting bronchodilator, long-acting bronchodilator, β2 adrenergic receptor gene (ADRB2), asthma and pharmacogenomics. The effects of ADRB2 variants on BDR and the safety of SABA and LABA + inhaled corticosteroids have been studied with equivocal results. Single and candidate gene studies have identified variants in other genes that alter response to bronchodilators. Associations were recently observed between hospital admission rates and two rare ADRB2 polymorphisms: Thr164Ile and a 25 base pair insertion-deletion at nucleotide -376. This was the first report of life-threatening events associated with LABA being linked to rare ADRB2 variants. EXPERT OPINION Pharmacogenomic studies over the last two decades clearly demonstrate that polymorphisms alter patient response to bronchodilators in patients with asthma.
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Affiliation(s)
- John J Lima
- Center for Pharmacogenomics and Translational Research, Nemours Children's Clinic , 807 Children's Way, Jacksonville, FL 32207 , USA , +1 904 697 3683 ; +1 904 687 7988 ;
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12
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Ahles A, Engelhardt S. Polymorphic Variants of Adrenoceptors: Pharmacology, Physiology, and Role in Disease. Pharmacol Rev 2014; 66:598-637. [DOI: 10.1124/pr.113.008219] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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13
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Anand KJS. Pediatric critical care: grand challenges for a glowing future. Front Pediatr 2014; 2:35. [PMID: 24818121 PMCID: PMC4012217 DOI: 10.3389/fped.2014.00035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 04/16/2014] [Indexed: 01/19/2023] Open
Affiliation(s)
- Kanwaljeet J S Anand
- Pain Neurobiology Laboratory, Department of Pediatrics, University of Tennessee Neuroscience Institute, University of Tennessee Health Science Center , Memphis, TN , USA
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14
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Levin AM, Mathias RA, Huang L, Roth LA, Daley D, Myers RA, Himes BE, Romieu I, Yang M, Eng C, Park JE, Zoratti K, Gignoux CR, Torgerson DG, Galanter JM, Huntsman S, Nguyen EA, Becker AB, Chan-Yeung M, Kozyrskyj AL, Kwok PY, Gilliland FD, Gauderman WJ, Bleecker ER, Raby BA, Meyers DA, London SJ, Martinez FD, Weiss ST, Burchard EG, Nicolae DL, Ober C, Barnes KC, Williams LK. A meta-analysis of genome-wide association studies for serum total IgE in diverse study populations. J Allergy Clin Immunol 2012; 131:1176-84. [PMID: 23146381 DOI: 10.1016/j.jaci.2012.10.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 09/28/2012] [Accepted: 10/02/2012] [Indexed: 01/27/2023]
Abstract
BACKGROUND IgE is both a marker and mediator of allergic inflammation. Despite reported differences in serum total IgE levels by race-ethnicity, African American and Latino subjects have not been well represented in genetic studies of total IgE. OBJECTIVE We sought to identify the genetic predictors of serum total IgE levels. METHODS We used genome-wide association data from 4292 subjects (2469 African Americans, 1564 European Americans, and 259 Latinos) in the EVE Asthma Genetics Consortium. Tests for association were performed within each cohort by race-ethnic group (ie, African American, Latino, and European American) and asthma status. The resulting P values were meta-analyzed, accounting for sample size and direction of effect. Top single nucleotide polymorphism associations from the meta-analysis were reassessed in 6 additional cohorts comprising 5767 subjects. RESULTS We identified 10 unique regions in which the combined association statistic was associated with total serum IgE levels (P<5.0×10(-6)) and the minor allele frequency was 5% or greater in 2 or more population groups. Variant rs9469220, corresponding to HLA-DQB1, was the single nucleotide polymorphism most significantly associated with serum total IgE levels when assessed in both the replication cohorts and the discovery and replication sets combined (P=.007 and 2.45×10(-7), respectively). In addition, findings from earlier genome-wide association studies were also validated in the current meta-analysis. CONCLUSION This meta-analysis independently identified a variant near HLA-DQB1 as a predictor of total serum IgE levels in multiple race-ethnic groups. This study also extends and confirms the findings of earlier genome-wide association analyses in African American and Latino subjects.
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Affiliation(s)
- Albert M Levin
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
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15
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Birbian N, Singh J, Jindal SK, Singla N. Association of β(2)-adrenergic receptor polymorphisms with asthma in a North Indian population. Lung 2012; 190:497-504. [PMID: 22821646 DOI: 10.1007/s00408-012-9407-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 06/23/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND β(2)-Adrenergic receptor (β(2)AR), a G-protein coupled receptor, is present on the bronchial smooth muscle cells and results in bronchodilation upon activation. The genetic factors determining β(2)AR expression and function may not only alter the response of an individual to the therapy but also may serve as predictive markers for response to the agonists used in the therapy. The present study aimed at evaluating the role of β(2)AR-16 and β(2)AR-27 gene polymorphisms in asthma. METHODS A case-control study was performed with a total of 824 adult subjects, including 410 asthmatics and 414 healthy controls from regions of North India. The β(2)AR-16 and β(2)AR-27 polymorphisms were genotyped by PCR-RFLP. RESULTS Statistical analysis for the β(2)AR-16 polymorphism revealed that the mutant Gly16 allele was significantly associated with asthma, with OR = 0.80, 95 % CI = 0.65-0.99, and P = 0.032. The Gly16/Gly16 mutant genotype also confers decreased risk toward asthma, with OR = 0.65, 95 % CI = 0.41-1.02, and P = 0.049. However, the β(2)AR-27 polymorphism was not associated with asthma as it did not reach statistical significance, with OR = 0.86, 95 % CI = 0.69-1.07, and P = 0.163. CONCLUSION The β(2)AR-16 polymorphism confers a decreased risk toward asthma while the β(2)AR-27 polymorphism is not associated with asthma in the studied North Indian population.
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Affiliation(s)
- Niti Birbian
- Department of Biotechnology, Panjab University, Chandigarh, India.
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16
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Kumar R, Williams LK, Kato A, Peterson EL, Favoreto S, Hulse K, Wang D, Beckman K, Thyne S, LeNoir M, Meade K, Lanfear DE, Levin AM, Favro D, Yang JJ, Weiss K, Boushey HA, Grammer L, Avila PC, Burchard EG, Schleimer R. Genetic variation in B cell-activating factor of the TNF family (BAFF) and asthma exacerbations among African American subjects. J Allergy Clin Immunol 2012; 130:996-9.e6. [PMID: 22728080 DOI: 10.1016/j.jaci.2012.04.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 01/30/2012] [Accepted: 04/11/2012] [Indexed: 10/28/2022]
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17
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Blake K, Raissy H. Pharmacogenomic Testing in the Asthma Clinic: Will Inhaled Corticosteroids Lead the Way? PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2012; 25:44-47. [DOI: 10.1089/ped.2012.0144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Kathryn Blake
- Center for Clinical Pharmacogenomics and Translational Research, Nemours Children's Clinic, Jacksonville, Florida
| | - Hengameh Raissy
- Health Sciences Center, School of Medicine, Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico
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18
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Fu WP, Zhao ZH, Zhong L, Sun C, Fang LZ, Liu L, Zhang JQ, Wang L, Shu JK, Wang XM, Dai LM. Relationship between polymorphisms in the 5' leader cistron, positions 16 and 27 of the adrenergic β2 receptor gene and asthma in a Han population from southwest China. Respirology 2012; 16:1221-7. [PMID: 21801278 DOI: 10.1111/j.1440-1843.2011.02028.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Adrenergic β2 receptors (ADRB2) play an important role in regulating pulmonary function. Many previous studies have investigated possible associations between polymorphisms in the ADRB2 gene and asthma, but have yielded conflicting results. Furthermore, little is known regarding the possible role of the Arg19Cys polymorphism in susceptibility to asthma among Chinese. METHODS This case-control association study involved 238 patients with asthma and 265 healthy subjects from a Han population in southwest China. For all subjects, the 5' leader cistron Arg19Cys, Arg16Gly and Gln27Glu polymorphisms in the ADRB2 gene were characterized by direct sequencing. Genotype, allele and haplotype frequencies were determined. In addition, to evaluate the association between the ADRB2 polymorphisms and lung function, bronchodilator response to inhaled β2 agonists (400 µg of albuterol) was assessed in the asthmatic patients. RESULTS There were no significant differences in genotype or allele frequencies for the three ADRB2 polymorphisms between the two cohorts. The Arg19/Arg16/Gln27 haplotype was more frequent among asthmatic patients than control subjects (odds ratio 2.24, 95% confidence interval (CI): 1.05-4.73, P=0.04). Moreover, the Arg19/Cys19 genotype was associated with a lower FEV₁% (mean difference -4.5, 95% CI: -12.5 to 3.6, P=0.02) and FEV₁/FVC (mean difference 8.9, 95% CI: 8.5-9.4, P=0.01). The bronchodilator response to albuterol was also marginally lower in individuals who were homozygous for the Arg19 genotype (mean difference 4.2, 95% CI: 3.7-4.8, P=0.03). CONCLUSIONS The Arg19/Cys19 genotype was an independent risk factor for lower FEV₁% and FEV₁/FVC. Asthmatic patients with the Arg19/Arg19 genotype showed decreased responsiveness to albuterol. Furthermore, the Arg19/Arg16/Gln27 haplotype may contribute to increased susceptibility to asthma in the Chinese population.
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Affiliation(s)
- Wei-Ping Fu
- Department of Respiratory Critical Care Medicine, The First Affiliated Hospital of Kunming Medical College, Chinese Academy of Sciences, Kunming, China
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19
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Akuete K, Oh SS, Thyne S, Rodriguez-Santana JR, Chapela R, Meade K, Rodriguez-Cintron W, LeNoir M, Ford JG, Williams LK, Avila PC, Burchard EG, Tcheurekdjian H. Ethnic variability in persistent asthma after in utero tobacco exposure. Pediatrics 2011; 128:e623-30. [PMID: 21859918 PMCID: PMC3164096 DOI: 10.1542/peds.2011-0640] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The effects of in utero tobacco smoke exposure on childhood respiratory health have been investigated, and outcomes have been inconsistent. OBJECTIVE To determine if in utero tobacco smoke exposure is associated with childhood persistent asthma in Mexican, Puerto Rican, and black children. PATIENTS AND METHODS There were 295 Mexican, Puerto Rican, and black asthmatic children, aged 8 to 16 years, who underwent spirometry, and clinical data were collected from the parents during a standardized interview. The effect of in utero tobacco smoke exposure on the development of persistent asthma and related clinical outcomes was evaluated by logistic regression. RESULTS Children with persistent asthma had a higher odds of exposure to in utero tobacco smoke, but not current tobacco smoke, than did children with intermittent asthma (odds ratio [OR]: 3.57; P = .029). Tobacco smoke exposure from parents in the first 2 years of life did not alter this association. Furthermore, there were higher odds of in utero tobacco smoke exposure in children experiencing nocturnal symptoms (OR: 2.77; P = .048), daily asthma symptoms (OR: 2.73; P = .046), and emergency department visits (OR: 3.85; P = .015) within the year. CONCLUSIONS Exposure to tobacco smoke in utero was significantly associated with persistent asthma among Mexican, Puerto Rican, and black children compared with those with intermittent asthma. These results suggest that smoking cessation during pregnancy may lead to a decrease in the incidence of persistent asthma in these populations.
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Affiliation(s)
- Kwei Akuete
- Departments of Medicine and Pediatrics, Case Western Reserve University, Cleveland Ohio
| | - Sam S. Oh
- Center for Tobacco Control Research and Education, ,Department of Medicine and Cardiovascular Research Institute
| | - Shannon Thyne
- Department of Pediatrics, San Francisco General Hospital, San Francisco, California
| | | | - Rocio Chapela
- Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Kelley Meade
- Children's Hospital and Research Institute, Oakland, California
| | | | | | - Jean G. Ford
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - L. Keoki Williams
- Center for Health Services Research, Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan
| | - Pedro C. Avila
- Division of Allergy-Immunology, Northwestern University, Chicago, Illinois; and
| | - Esteban González Burchard
- Department of Bioengineering and Therapeutic Sciences, ,Lung Biology Center, and ,Institute for Human Genetics, University of California, San Francisco, California
| | - Haig Tcheurekdjian
- Departments of Medicine and Pediatrics, Case Western Reserve University, Cleveland Ohio; ,Allergy/Immunology Associates Inc, Cleveland, Ohio
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20
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Abstract
Asthma and allergy are common conditions with complex etiologies involving both genetic and environmental contributions. Recent genome-wide association studies (GWAS) and meta-analyses of GWAS have begun to shed light on both common and distinct pathways that contribute to asthma and allergic diseases. Associations with variation in genes encoding the epithelial cell-derived cytokines, interleukin-33 (IL-33) and thymic stromal lymphopoietin (TSLP), and the IL1RL1 gene encoding the IL-33 receptor, ST2, highlight the central roles for innate immune response pathways that promote the activation and differentiation of T-helper 2 cells in the pathogenesis of both asthma and allergic diseases. In contrast, variation at the 17q21 asthma locus, encoding the ORMDL3 and GSDML genes, is specifically associated with risk for childhood onset asthma. These and other genetic findings are providing a list of well-validated asthma and allergy susceptibility genes that are expanding our understanding of the common and unique biological pathways that are dysregulated in these related conditions. Ongoing studies will continue to broaden our understanding of asthma and allergy and unravel the mechanisms for the development of these complex traits.
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Affiliation(s)
- Carole Ober
- Department of Human Genetics, The University of Chicago, Chicago, IL 60637, USA.
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21
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Galant SP, Morphew T, Newcomb RL, Hioe K, Guijon O, Liao O. The relationship of the bronchodilator response phenotype to poor asthma control in children with normal spirometry. J Pediatr 2011; 158:953-959.e1. [PMID: 21232757 PMCID: PMC3160763 DOI: 10.1016/j.jpeds.2010.11.029] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 08/31/2010] [Accepted: 11/10/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the relationship of poor asthma control to bronchodilator response (BDR) phenotypes in children with normal spirometry. STUDY DESIGN Children with asthma were assessed for clinical indexes of poorly controlled asthma. Pre- and post-bronchodilator spirometry were performed, and the percent BDR was determined. Multivariate logistic regression assessed the relationship of the clinical indices to BDR at ≥ 8%, ≥ 10%, and ≥ 12% BDR thresholds. RESULTS There were 510 controller naïve children and 169 on controller medication. In the controller naïve population the mean age (± 1 SD) was 9.5 (3.4); 57.1% were male, 85.7% Hispanic. Demographics were similar in both populations. In the adjusted profile, significant clinical relationships were found particularly to positive BDR phenotypes ≥ 10% and ≥ 12% versus negative responses including younger age, (OR 2.0, 2.5; P < .05), atopy (OR 1.9, 2.6; P < .01), nocturnal symptoms in females (OR 3.4, 3.8; P < .01); β₂ agonist use (OR 1.7, 2.8; P < .01); and exercise limitation (OR 2.2, 2.5; P < .01) only in the controller naïve population. CONCLUSIONS The BDR phenotype ≥ 10% is significantly related to poor asthma control, providing a potentially useful objective tool in controller naïve children even when the pre-bronchodilator spirometry result is normal.
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Piana C, Surh L, Furst-Recktenwald S, Iolascon A, Jacqz-Aigrain EM, Jonker I, Russo R, van Schaik RHN, Wessels J, Della Pasqua OE. Integration of pharmacogenetics and pharmacogenomics in drug development: implications for regulatory and medical decision making in pediatric diseases. J Clin Pharmacol 2011; 52:704-16. [PMID: 21566202 DOI: 10.1177/0091270011401619] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This article aims to provide an overview of the current situation regarding pharmacogenetic and pharmacogenomic (PG) studies in pediatrics, with a special focus on the role of PG data in the regulatory decision-making process. Despite the gap in pharmacogenetic research due to the lack of translational studies in adults and children, several technologies exist in drug development and biomarkers validation, which could supply valuable information concerning labeling and dosing recommendations. If performed under strict good clinical practice quality criteria, such findings could be included in the submission package of new chemical entities and used as additional information for prescribers, supporting further evaluation and understanding of the efficacy and safety profile of new medicines. Even though regulatory authorities may be aware of the potential role of PG in medical practice and guidances are available about the integration of PG in drug development, most data obtained from PG studies are not used by prescribers. The challenge is to better understand whether PG markers can be used to assess potential differences in drug response during the clinical program, so PG data can be integrated into the regulatory decision-making process, enabling the introduction of labeling information that promotes optimal dosing in the pediatric population.
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Affiliation(s)
- Chiara Piana
- Division of Pharmacology, Leiden/Amsterdam Center for Drug Research, Leiden, the Netherlands
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23
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Hur GY, Park HJ, Lee HY, Koh DH, Lee BJ, Choi GS, Kim SH, Ye YM, Park HS. Association of β₂-adrenergic receptor polymorphism with work-related symptoms in workers exposed to wheat flour. Yonsei Med J 2011; 52:488-94. [PMID: 21488193 PMCID: PMC3101046 DOI: 10.3349/ymj.2011.52.3.488] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Our previous study indicated that the presence of wheat-specific IgG1 and IgG4 antibodies was associated with work-related symptoms in workers exposed to wheat flour. We performed this study to investigate the genetic polymorphisms of β₂-adrenergic receptors and wheat-specific antibodies in association with the clinical parameters of baker's asthma. MATERIALS AND METHODS In total, 379 subjects working in a single industrial bakery were enrolled in this study. The skin prick test was performed with common inhalant allergens and wheat flour extract. The presence of serum- specific IgE, IgG1, and IgG4 antibodies to wheat flour were determined by ELISA. Whole blood samples were obtained for genotype analysis. Subjects were genotyped with regard to five candidate single nucleotide polymorphisms (SNPs) of the β₂-adrenergic receptor gene (ADRB2; -47 T>C, 46 A>G, 79 C>G, 252 G>A, and 523 C>A) using a single-base extension method. RESULTS No significant associations were observed between the genotype/allele frequencies of any of the SNPs tested and any clinical parameters. The haplotype of ADRB2 (GAA composed of 46 A>G, 252 G>A, and 523 C>A) was significantly associated with work-related symptoms (p<0.05). Moreover, in subjects with the AG or GG genotype at 46 A>G and haplotype [GAA] of ADRB2, the prevalence rates of wheat-specific IgG1 antibodies and lower respiratory symptoms increased significantly with exposure intensity (both p<0.05). CONCLUSION The findings of the present study suggest that ADRB2 genetic polymorphism may contribute to the development of work-related symptoms in workers exposed to wheat flour, which can lead to baker's asthma.
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Affiliation(s)
- Gyu-Young Hur
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Han-Jung Park
- Department of Internal Medicine, Seobuk Hospital, Seoul, Korea
| | - Hyun-Young Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Dong-Hee Koh
- Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Incheon, Korea
| | - Byung-Jae Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gil-Soon Choi
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Seung-Hyun Kim
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Young-Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
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Salpeter SR. An update on the safety of long-acting beta-agonists in asthma patients using inhaled corticosteroids. Expert Opin Drug Saf 2010; 9:407-19. [PMID: 20408768 DOI: 10.1517/14740330903535852] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD Pooled trial data have shown that long-acting beta-agonists increase the risk for asthma hospitalizations and deaths by two to fourfold compared with placebo. Until recently, it was unclear whether concomitant inhaled corticosteroids (ICSs) could eliminate this risk. AREAS COVERED IN THIS REVIEW This review summarizes the available data on the safety of long-acting beta-agonist use in asthma, with and without concomitant ICSs. The results from an updated meta-analysis are presented, with data through December 2008. WHAT THE READER WILL GAIN In pooled trial data, catastrophic asthma events (defined as asthma-related intubation or death) were increased fourfold for concomitant treatment with long-acting beta-agonists and ICSs compared with corticosteroids alone (odds ratio 3.7; 95% CI 1.4 - 9.6). It is estimated that the addition of long-acting beta-agonists to ICS therapy is associated with an absolute increase of one catastrophic event per 1500 patient-years. TAKE HOME MESSAGE When the available trial data are pooled together, it is clear that long-acting beta-agonists significantly increase the risk for asthma-related intubations and deaths, even when used in a controlled fashion with concomitant ICSs. Clinical guidelines should readdress the role long-acting beta-agonists have in the management of asthma.
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Affiliation(s)
- Shelley R Salpeter
- Department of Medicine, Stanford University School of Medicine, California, USA.
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25
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Hobgood DK. Personality and illness: genetic connections? Med Hypotheses 2010; 76:89-93. [PMID: 20826063 DOI: 10.1016/j.mehy.2010.08.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 07/30/2010] [Accepted: 08/07/2010] [Indexed: 10/19/2022]
Abstract
Illness is strongly influenced by genetics. Personality traits are influenced by genetics and have linkages with, at least, affective illness. Because genetics influences both personality and illness, we studied by literature review the genes that illness and personality traits share and, by office assessment, our patient population's illnesses and personality traits. This led to the following hypothesis: illness is related to more Submissive than Dominant personality trait and thus to lower norepinephrine activity. Patient affect and personality are often noted to be subdued in chronic illness, but whether from cause or effect is difficult to determine. After reviewing the literature on wellness, personality and genes, we endeavored to explore and better delineate our impressions of illness and personality relationships and to set the stage for a genetic hypothesis by using an online personality test in an ob-gyn practice to determine which traits could be used as proxies for personality trait genes. We thus confirmed our clinical impression that women with psychiatric and/or medical illness have more Submissive personality. The medical literature on gene markers shared by Submissive personality and illness in our population suggests the hypothesis that this relationship could be mediated by genetically lower neurotransmitter activity. Both norepinephrine activity and monoamine oxidase A, the enzyme controlling its catabolism, are in concert to blunt neuronal activity in such diverse states as depression, asthma, obesity, autoimmune illness, and in smokers. Conversely, norepinephrine activity is enhanced in breastfeeders and in other settings known to be related to good health. A point for possible divergence from the hypothesis is that African-Americans have enhanced norepinephrine activity yet poorer health outcomes although the effect of environmental risk factors in African-Americans is considered prominent by researchers. The possible importance of this hypothesis is that it changes emphasis slightly from one of splitting diagnoses to one of grouping them to achieve fresh insight. If we assess what is found in common in diverse illnesses of mind and body, we have yet another tool to assess causation. Although this hypothesis is offered somewhat in a boldness of spirit to take a new look at our many perplexing clinical problems, it is also offered with humility in light of the complexity with which we deal in patient care.
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Affiliation(s)
- Donna K Hobgood
- Women's Institute for Specialized Health, University of Tennessee at Chattanooga Medical Units, Chattanooga, TN 37403, USA.
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GSNO reductase and beta2-adrenergic receptor gene-gene interaction: bronchodilator responsiveness to albuterol. Pharmacogenet Genomics 2010; 20:351-8. [PMID: 20335826 DOI: 10.1097/fpc.0b013e328337f992] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Short-acting inhaled beta2-agonists such as albuterol are used for bronchodilation and are the mainstay of asthma treatment worldwide. There is significant variation in bronchodilator responsiveness to albuterol not only between individuals but also across racial/ethnic groups. The beta2-adrenergic receptor (beta2AR) is the target for beta2-agonist drugs. The enzyme, S-nitrosoglutathione reductase (GSNOR), which regulates levels of the endogenous bronchodilator S-nitrosoglutathione, has been shown to modulate the response to beta2-agonists. OBJECTIVE We hypothesized that there are pharmacogenetic interactions between GSNOR and beta2AR gene variants that are associated with variable response to albuterol. METHODS We performed family-based analyses to test for association between GSNOR gene variants and asthma and related phenotypes in 609 Puerto Rican and Mexican families with asthma. In addition, we tested these individuals for pharmacogenetic interaction between GSNOR and beta2AR gene variants and responsiveness to albuterol using linear regression. Cell transfection experiments were performed to test the potential effect of the GSNOR gene variants. RESULTS Among Puerto Ricans, several GSNOR SNPs and a haplotype in the 3'UTR were significantly associated with increased risk for asthma and lower bronchodilator responsiveness (P=0.04-0.007). The GSNOR risk haplotype affects expression of GSNOR mRNA and protein, suggesting a gain of function. Furthermore, gene-gene interaction analysis provided evidence of pharmacogenetic interaction between GSNOR and beta2AR gene variants and the response to albuterol in Puerto Rican (P=0.03), Mexican (P=0.15) and combined Puerto Rican and Mexican asthmatics (P=0.003). Specifically, GSNOR+17059*beta2AR+46 genotype combinations (TG+GG*AG and TG+GG*GG) were associated with lower bronchodilator response. CONCLUSION Genotyping of GSNOR and beta2AR genes may be useful in identifying Latino individuals, who might benefit from adjuvant therapy for refractory asthma.
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Moore PE, Williams SM, Gebretsadik T, Jiang L, Minton PL, Shintani A, Phillips Iii JA, Dawson EP, Hartert TV. beta(2)-adrenergic receptor promoter haplotype influences spirometric response during an acute asthma exacerbation. Clin Transl Sci 2010; 1:155-61. [PMID: 20443840 DOI: 10.1111/j.1752-8062.2008.00036.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Genetic variants in the beta(2)-adrenergic receptor (ADRB2) coding block have been associated with different parameters of asthma severity, but there is no consensus on which variants are most important. Our objective was to determine whether the genetic variants in the 5'- or 3'-flanking regions of ADRB2 impact the response to therapy. DNA was obtained initially from 72 adults hospitalized for an asthma exacerbation. We sequenced a 5,000 bp region of the ADRB2 gene that spanned the flanking regions and identified 31 single nucleotide polymorphisms (SNPs). Nonresponders to asthma therapy were defined as patients whose forced expiratory volume in 1 second (FEV(1)) worsened by >10% at 24 hours after admission. We then evaluated the relationship between the 19 common SNPs and response to asthma-specific therapy during acute disease exacerbations. Our results showed a significant association between nonresponders and a haplotype of five promoter SNPs in a nearly complete linkage disequilibrium. An analysis of the promoter and coding block polymorphisms in an extended cohort of 99 patients confirmed that promoter haplotype was the genetic component most strongly associated with asthmatic nonresponders, which was statistically significant among whites (p < 0.05). An identification of this promoter haplotype may provide an alternate explanation for the variation in the asthma responses observed with ADRB2 coding block polymorphisms.
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Affiliation(s)
- Paul E Moore
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Nguyen TP, Jordán F. A quantitative approach to study indirect effects among disease proteins in the human protein interaction network. BMC SYSTEMS BIOLOGY 2010; 4:103. [PMID: 20670417 PMCID: PMC2924296 DOI: 10.1186/1752-0509-4-103] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Accepted: 07/29/2010] [Indexed: 12/02/2022]
Abstract
Background Systems biology makes it possible to study larger and more intricate systems than before, so it is now possible to look at the molecular basis of several diseases in parallel. Analyzing the interaction network of proteins in the cell can be the key to understand how complex processes lead to diseases. Novel tools in network analysis provide the possibility to quantify the key interacting proteins in large networks as well as proteins that connect them. Here we suggest a new method to study the relationships between topology and functionality of the protein-protein interaction network, by identifying key mediator proteins possibly maintaining indirect relationships among proteins causing various diseases. Results Based on the i2d and OMIM databases, we have constructed (i) a network of proteins causing five selected diseases (DP, disease proteins) plus their interacting partners (IP, non-disease proteins), the DPIP network and (ii) a protein network showing only these IPs and their interactions, the IP network. The five investigated diseases were (1) various cancers, (2) heart diseases, (3) obesity, (4) diabetes and (5) autism. We have quantified the number and strength of IP-mediated indirect effects between the five groups of disease proteins and hypothetically identified the most important mediator proteins linking heart disease to obesity or diabetes in the IP network. The results present the relationship between mediator role and centrality, as well as between mediator role and functional properties of these proteins. Conclusions We show that a protein which plays an important indirect mediator role between two diseases is not necessarily a hub in the PPI network. This may suggest that, even if hub proteins and disease proteins are trivially of great interest, mediators may also deserve more attention, especially if disease-disease associations are to be understood. Identifying the hubs may not be sufficient to understand particular pathways. We have found that the mediators between heart diseases and obesity, as well as heart diseases and diabetes are of relatively high functional importance in the cell. The mediator proteins suggested here should be experimentally tested as products of hypothetical disease-related proteins.
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Affiliation(s)
- Thanh-Phuong Nguyen
- The Microsoft Research, University of Trento, Centre for Computational and Systems Biology, Piazza Manci 17, 38100 Trento, Italy
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Kumar R, Seibold MA, Aldrich MC, Williams LK, Reiner AP, Colangelo L, Galanter J, Gignoux C, Hu D, Sen S, Choudhry S, Peterson EL, Rodriguez-Santana J, Rodriguez-Cintron W, Nalls MA, Leak TS, O'Meara E, Meibohm B, Kritchevsky SB, Li R, Harris TB, Nickerson DA, Fornage M, Enright P, Ziv E, Smith LJ, Liu K, Burchard EG. Genetic ancestry in lung-function predictions. N Engl J Med 2010; 363:321-30. [PMID: 20647190 PMCID: PMC2922981 DOI: 10.1056/nejmoa0907897] [Citation(s) in RCA: 191] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Self-identified race or ethnic group is used to determine normal reference standards in the prediction of pulmonary function. We conducted a study to determine whether the genetically determined percentage of African ancestry is associated with lung function and whether its use could improve predictions of lung function among persons who identified themselves as African American. METHODS We assessed the ancestry of 777 participants self-identified as African American in the Coronary Artery Risk Development in Young Adults (CARDIA) study and evaluated the relation between pulmonary function and ancestry by means of linear regression. We performed similar analyses of data for two independent cohorts of subjects identifying themselves as African American: 813 participants in the Health, Aging, and Body Composition (HABC) study and 579 participants in the Cardiovascular Health Study (CHS). We compared the fit of two types of models to lung-function measurements: models based on the covariates used in standard prediction equations and models incorporating ancestry. We also evaluated the effect of the ancestry-based models on the classification of disease severity in two asthma-study populations. RESULTS African ancestry was inversely related to forced expiratory volume in 1 second (FEV(1)) and forced vital capacity in the CARDIA cohort. These relations were also seen in the HABC and CHS cohorts. In predicting lung function, the ancestry-based model fit the data better than standard models. Ancestry-based models resulted in the reclassification of asthma severity (based on the percentage of the predicted FEV(1)) in 4 to 5% of participants. CONCLUSIONS Current predictive equations, which rely on self-identified race alone, may misestimate lung function among subjects who identify themselves as African American. Incorporating ancestry into normative equations may improve lung-function estimates and more accurately categorize disease severity. (Funded by the National Institutes of Health and others.)
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Affiliation(s)
- Rajesh Kumar
- Division of Allergy and Immunology, Children's Memorial Hospital, 2300 Children's Plaza, Box 60, Chicago IL 60614, USA.
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Asano K, Yamada-Yamasawa W, Kudoh H, Matsuzaki T, Nakajima T, Hakuno H, Hiraoka R, Fukunaga K, Oguma T, Sayama K, Yamaguchi K, Nagabukuro A, Harada Y, Ishizaka A. Association between beta-adrenoceptor gene polymorphisms and relative response to beta 2-agonists and anticholinergic drugs in Japanese asthmatic patients. Respirology 2010; 15:849-54. [PMID: 20546196 DOI: 10.1111/j.1440-1843.2010.01786.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Whether beta(2)-adrenoceptor gene (ADRB2) polymorphisms are associated with airway responsiveness to beta(2)-agonist medications remains controversial, partly due to factors that may confound pharmacogenetic associations, including age, cigarette smoking and airway remodelling. To overcome these problems, we performed an analysis using parameters that reflected the specific bronchodilator response to beta(2)-agonists. METHODS The increases in FEV(1) after inhalation of procaterol hydrochloride (Delta FEV(1) procaterol) or oxitropium bromide (Delta FEV(1) oxitropium), and after sequential inhalation of procaterol and oxitropium (total airway reversibility), were measured in 81 Japanese patients with moderate to severe asthma. Approximately 3 kb of the DNA sequence of the coding and 5'-flanking regions of ADRB2 were genotyped by direct sequencing and PCR-restriction fragment length polymorphism assay. RESULTS The mean age of the participants was 54 years, and 38 (47%) were smokers. Although Delta FEV(1) procaterol and Delta FEV(1) oxitropium adjusted for predicted FEV(1) were not associated with ADRB2 polymorphisms, the ratio of Delta FEV(1) procaterol to total airway reversibility was significantly associated with the ADRB2 A46G genotype (P < 0.05). Patients who were homozygous for the A46 allele (arginine at amino acid 16) were more responsive than carriers of the G46 (glycine 16) allele (P = 0.008). Multivariate linear regression analysis showed that Delta FEV(1) procaterol was correlated with the number of A46 alleles (P = 0.014), and also with total airway reversibility (P < 0.001) and smoking index in current smokers (P = 0.009). CONCLUSIONS The ADRB2 A46G polymorphism was associated with a relatively greater bronchodilator responsiveness to beta(2)-agonists even in elderly asthmatic patients and smokers.
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Affiliation(s)
- Koichiro Asano
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
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Genetic variations in GRIA1 on chromosome 5q33 related to asparaginase hypersensitivity. Clin Pharmacol Ther 2010; 88:191-6. [PMID: 20592726 DOI: 10.1038/clpt.2010.94] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The genetic variations that result in allergy to asparaginase are as yet undetermined. We interrogated more than 500,000 single-nucleotide polymorphisms (SNPs) in 485 children with acute lymphoblastic leukemia (ALL), 322 in a discovery cohort, and 163 in a validation cohort. In the top 100 SNPs associated with allergy in the discovery cohort, chromosome 5 was overrepresented as compared with other chromosomes (P = 0.00032), hosting 10 SNPs annotated to genes. Among these 10 SNPs, one SNP (rs4958351) [corrected], in GRIA1 on chromosome 5q33, was replicated in the validation cohort (P = 1.8 x 10(-5), 2.9 x 10(-3), and 3.5 x 10(-7) in the discovery, validation, and combined cohorts, respectively). Four additional SNPs annotated to GRIA1 were also significantly associated with allergy (P < 0.05) in both cohorts. Chromosome 5q33 has previously been associated with asthma and atopy. These data contribute to the growing body of evidence that there is an inherited component to predisposition to drug allergy.
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Kaminuma O, Suko M, Mori A. Genetic factors in the treatment of bronchial asthma. Expert Rev Clin Immunol 2010; 2:727-35. [PMID: 20477628 DOI: 10.1586/1744666x.2.5.727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Owing to the recent vast progress in analytical tools and procedures to elucidate the relationship between genes and diseases, many candidate genes leading to the development of bronchial asthma have been reported. However, the quantitative phenotypes of asthma, such as decrease in forced expiratory volume in the first second, serum hyper-IgE, bronchial hyperresponsiveness and blood hyper-eosinophilia, do not represent this disease completely. On the other hand, eosinophilic inflammation of the bronchial mucosa represents accurately the feature of bronchial asthma, although accurate quantification of its status is difficult. While the production of interleukin (IL)-5 in peripheral CD4(+) T cells probably correlates with eosinophilic inflammation of the airway, the effectiveness of anti-IL-5 antibody for the treatment of bronchial asthma is controversial. Since intervention with asthma-causing gene products may not be sufficient for the treatment of this disease, identification of therapy-responsive genes should become more important in the near future.
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Affiliation(s)
- Osamu Kaminuma
- The Tokyo Metropolitan Institute of Medical Science, Department of Allergy and Immunology, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo 113-8613, Japan.
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Kazani S, Wechsler ME, Israel E. The role of pharmacogenomics in improving the management of asthma. J Allergy Clin Immunol 2010; 125:295-302; quiz 303-4. [PMID: 20159237 DOI: 10.1016/j.jaci.2009.12.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 11/30/2009] [Accepted: 12/03/2009] [Indexed: 01/01/2023]
Abstract
There is a large amount of interindividual variability in both therapeutic and adverse responses to asthma therapies. Genetic variability can account for 50% to 60% of this variability. Pharmacogenomics holds out the promise of allowing clinicians to prospectively choose therapies that have the greatest likelihood to be effective for individual patients and to avoid those that might have a high likelihood of producing adverse effects. In this article we review the principles of pharmacogenomic investigation. We explore the data developed from the early pharmacogenomic studies with the most common asthma therapies. Furthermore, we explore the potential use of pharmacogenomics, as well as caveats in interpreting such information.
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Affiliation(s)
- Shamsah Kazani
- Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Via M, Ziv E, Burchard EG. Recent advances of genetic ancestry testing in biomedical research and direct to consumer testing. Clin Genet 2010; 76:225-35. [PMID: 19793051 DOI: 10.1111/j.1399-0004.2009.01263.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In the post-Human Genome Project era, the debate on the concept of race/ethnicity and its implications for biomedical research are dependent on two critical issues: whether and how to classify individuals and whether biological factors play a role in health disparities. The advent of reliable estimates of genetic (or biogeographic) ancestry has provided this debate with a quantitative and more objective tool. The estimation of genetic ancestry allows investigators to control for population stratification in association studies and helps to detect biological causation behind population-specific differences in disease and drug response. New techniques such as admixture mapping can specifically detect population-specific risk alleles for a disease in admixed populations. However, researchers have to be mindful of the correlation between genetic ancestry and socioeconomic and environmental factors that could underlie these differences. More importantly, researchers must avoid the stigmatization of individuals based on perceived or real genetic risks. The latter point will become increasingly sensitive as several 'for profit companies' are offering ancestry and genetic testing directly to consumers and the consequences of the spread of the services of these companies are still unforeseeable.
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Affiliation(s)
- M Via
- Institute for Human Genetics, University of California, San Francisco, CA 94143-2911, USA.
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Finkelstein Y, Bournissen FG, Hutson JR, Shannon M. Polymorphism of the ADRB2 gene and response to inhaled beta- agonists in children with asthma: a meta-analysis. J Asthma 2009; 46:900-5. [PMID: 19905915 DOI: 10.3109/02770900903199961] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND About 9% of children have asthma, corresponding to almost 6.8 million children in the USA and 1.1 million in the UK. Asthma exacerbations are the leading cause of pediatric emergency room visits and impose a large burden on the individual, family, and society. There is mounting evidence that therapeutic failure of inhaled beta-agonists is associated with polymorphisms of the beta(2)-adrenergic receptor gene (ADRB2); specifically, mutations leading to amino acid changes at positions 16 and 27, which alter down-regulation of the beta(2)-adrenergic receptor (beta(2)AR), induce resistance to the smooth-muscle relaxing effect of beta(2)-adrenergic agonists. METHODS We conducted a meta-analysis to examine the association between ADRB2 polymorphisms and the response to inhaled beta(2)-adrenergic agonists in children with asthma. We included all published studies until November 2008, in which asthmatic children underwent testing for acute bronchodilator response, defined as > or = 15% improvement in forced expiratory volume in 1 second (FEV(1)) and single nucleotide polymorphism (SNP) genotyping for positions 16 and/or 27 of the beta(2)AR. Individual and summary odds ratios were calculated using a random effects model. RESULTS We identified three case-control or family-based studies involving 960 asthmatic children (692 children with negative beta(2)-bronchodilator response, defined as < 15% improvement in FEV(1) and 268 children with positive bronchodilator response). We found a significant association between favorable therapeutic response to inhaled beta(2)-adrenergic agonists in asthmatic children and the Arg/Arg phenotype at position 16 of the beta(2)AR [OR = 1.77; 95% CI (1.01; 3.1); p = 0.029], compared with the Arg/Gly or Gly/Gly phenotypes. The beneficial effect of Arg at position 16 of the beta(2)AR was most pronounced in African-American asthmatic children [OR = 3.54; 95% CI (1.37, 9.13)]. There was no association between clinical response to beta(2)-agonists and polymorphism at amino acid position 27 of the beta(2)AR (OR = 1.04; 95% CI [0.76,1.42]). CONCLUSIONS Failure of bronchodilator response to inhaled beta-agonists in asthmatic children is associated with the Gly allele (Arg/Gly and Gly/Gly genotypes) at position 16 of the beta(2)-adrenergic receptor. Genetic typing for beta(2)AR polymorphism may help identify children with drug-resistant asthma.
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Affiliation(s)
- Yaron Finkelstein
- Clinical Pharmacology Unit, and Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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A genome-wide association study on African-ancestry populations for asthma. J Allergy Clin Immunol 2009; 125:336-346.e4. [PMID: 19910028 DOI: 10.1016/j.jaci.2009.08.031] [Citation(s) in RCA: 141] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 08/06/2009] [Accepted: 08/21/2009] [Indexed: 12/18/2022]
Abstract
BACKGROUND Asthma is a complex disease characterized by striking ethnic disparities not explained entirely by environmental, social, cultural, or economic factors. Of the limited genetic studies performed on populations of African descent, notable differences in susceptibility allele frequencies have been observed. OBJECTIVES We sought to test the hypothesis that some genes might contribute to the profound disparities in asthma. METHODS We performed a genome-wide association study in 2 independent populations of African ancestry (935 African American asthmatic cases and control subjects from the Baltimore-Washington, DC, area and 929 African Caribbean asthmatic subjects and their family members from Barbados) to identify single-nucleotide polymorphisms (SNPs) associated with asthma. RESULTS A meta-analysis combining these 2 African-ancestry populations yielded 3 SNPs with a combined P value of less than 10(-5) in genes of potential biologic relevance to asthma and allergic disease: rs10515807, mapping to the alpha-1B-adrenergic receptor (ADRA1B) gene on chromosome 5q33 (3.57 x 10(-6)); rs6052761, mapping to the prion-related protein (PRNP) gene on chromosome 20pter-p12 (2.27 x 10(-6)); and rs1435879, mapping to the dipeptidyl peptidase 10 (DPP10) gene on chromosome 2q12.3-q14.2. The generalizability of these findings was tested in family and case-control panels of United Kingdom and German origin, respectively, but none of the associations observed in the African groups were replicated in these European studies. Evidence for association was also examined in 4 additional case-control studies of African Americans; however, none of the SNPs implicated in the discovery population were replicated. CONCLUSIONS This study illustrates the complexity of identifying true associations for a complex and heterogeneous disease, such as asthma, in admixed populations, especially populations of African descent.
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Szczepankiewicz A, Breborowicz A, Sobkowiak P, Kramer L, Popiel A. Role of ADRB2 gene polymorphism in asthma and response to beta(2)-agonists in Polish children. J Appl Genet 2009; 50:275-81. [PMID: 19638684 DOI: 10.1007/bf03195683] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aims of this study were: (1) to find associations of asthma with single-nucleotide polymorphisms (SNPs) within the ADRB2 gene: Arg16Gly, Gln27Glu, -1023 G/A, -367 T/C, -47 C/T ; (2) to define linkage disequilibrium in the gene region, basing on the analyzed SNPs; and (3) to analyze the importance of ADRB2 polymorphism for response to bronchodilator drugs in children diagnosed with bronchial asthma. We compared 113 asthmatic children and 123 healthy subjects from the Polish population. Genotyping was performed by PCR-RFLP. We found an association of the A allele of -1023A/G ADRB2 polymorphism with asthma (P = 0.024). No significant associations with other SNPs were detected. Moderate linkage was found between Gln27Glu and -47C/T polymorphisms in linkage disequilibrium analysis (D' = 0.85, r(2) = 0.429, LOD = 31.97). No significant differences were found in haplotype frequencies in comparison to the control group, implicating that they are not associated with susceptibility to asthma in the analyzed population. There was no significant correlation between the analyzed SNPs of the ADRB2 gene and the response to beta(2)-agonists. This is the first report providing suggestive evidence for association of -1023A/G ADRB2 polymorphism with an increased risk of asthma. The analyzed SNPs may not play a major role in response to beta(2)-agonists in asthmatic children.
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Affiliation(s)
- A Szczepankiewicz
- Department of Pediatric Pulmonology, Allergy and Clinical Immunology, Poznan University of Medical Sciences, Poland.
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Prevalence of beta-2 adrenergic receptor (beta 2 AR) polymorphisms and its influence on a model used to assess endothelial function using pulse wave analysis (PWA). Clin Chim Acta 2009; 409:62-6. [PMID: 19723516 DOI: 10.1016/j.cca.2009.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2009] [Revised: 08/24/2009] [Accepted: 08/24/2009] [Indexed: 11/21/2022]
Abstract
BACKGROUND Pulse wave analysis (PWA) combined with beta(2)-agonist challenge has recently been used to assess endothelial function. beta-2 adrenergic receptor (beta(2)AR) polymorphisms may affect response to beta(2)-agonist. We determined whether beta(2)AR polymorphisms influence endothelial response in our model using PWA and salbutamol. METHODS 388 healthy Malay subjects (177 males, 211 females) were genotyped for 5 functionally important single nucleotide polymorphisms (SNPs) of beta(2)AR; 298 subjects proceeded with assessment of endothelial function. The parameter augmentation index (AIx) was recorded non-invasively using SphygmoCor. Recording of AIx at baseline was followed by administration of 500 microg sublingual glyceryl trinitrate (GTN). AIx recordings were repeated at 3, 5, 10, 15 and 20 min post-GTN. Subjects then inhaled 400 microg of salbutamol before AIx recordings at 5 min intervals up to 20 min. Maximum changes in AIx after GTN and salbutamol represented endothelium independent and endothelium dependent vasodilatation (EDV) respectively. RESULTS Allele frequencies of mutated Gly16, Glu27, Ile164, -20C and -47C were 47%, 6.8%, 0%, 30% and 9.3% respectively. No significant differences in EDV were noted between genotype groups of each studied SNPs. CONCLUSIONS Assessment of endothelial function using PWA and salbutamol was not influenced by beta(2)AR polymorphisms.
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Collins FA. Genetics terminology for respiratory physicians. Paediatr Respir Rev 2009; 10:124-33. [PMID: 19651383 DOI: 10.1016/j.prrv.2009.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Genes affect our susceptibility to almost all diseases, from the rare single gene disorders such as cystic fibrosis to common multifactorial disorders such as asthma. They also influence our response to specific therapies. Scientific advances in genetics, starting with projects such as the mapping of the human genome [International Human Genome Sequencing Consortium. Finishing the euchromatic sequence of the human genome. Nature 2004; 431: 931-945] are likely to improve healthcare in the coming decades. Internationally, government initiatives have been established to address strategies to implement these changes [NHS Genetics White Paper. "Our Inheritance - Our Future": Realising the potential of Genetics in the NHS. UK: Department of Health 2003; Family Health History Initiative. National Human Genome Research Institute and Office of Surgeon General, Department of Health and Human Services. 2004]. A knowledge of basic genetic principles and familiarity with genetic 'jargon' associated with new technologies will be important for those practicing in this era of 'genomic medicine' [Collins FS, Green ED, Guttmacher AE, Guyer MS. A vision for the future of genomics research. Nature 2003; 422; April 24; 835-847]. The aim of this article is to review genetic terminology using examples from paediatric respiratory medicine.
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Affiliation(s)
- Felicity A Collins
- Dept of Clinical Genetics, Children's Hospital at Westmead Clinical School, Locked Bag 4001, Westmead, New South Wales 2145, Australia.
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Genetic ancestry modifies pharmacogenetic gene-gene interaction for asthma. Pharmacogenet Genomics 2009; 19:489-96. [PMID: 19503017 DOI: 10.1097/fpc.0b013e32832c440e] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE A recent admixture mapping analysis identified interleukin 6 (IL6) and IL6 receptor (IL6R) as candidate genes for inflammatory diseases. In the airways during allergic inflammation, IL6 signaling controls the production of proinflammatory and anti-inflammatory factors. In addition, albuterol, a commonly prescribed asthma therapy, has been shown to influence IL6 gene expression. Therefore, we reasoned that interactions between the IL6 and IL6R genes might be associated with bronchodilator drug responsiveness to albuterol in asthmatic patients. METHODS Four functional IL6 single nucleotide polymorphisms (SNPs) and a nonsynonymous IL6R SNP were genotyped in 700 Mexican and Puerto Rican asthma families and in 443 African-American asthma cases and controls. Both family-based association tests and linear regression models were used to assess the association between individual SNPs and haplotypes with bronchodilator response. Gene-gene interactions were tested by using multiple linear regression analyses. RESULTS No single SNP was consistently associated with drug response in all the three populations. However, on the gene level, we found a consistent IL6 and IL6R pharmacogenetic interaction in the three populations. This pharmacogenetic gene-gene interaction was contextual and dependent upon ancestry (racial background). This interaction resulted in higher drug response to albuterol in Latinos, but lower drug response in African-Americans. Herein, we show that there is an effect modification by ancestry on bronchodilator responsiveness to albuterol. CONCLUSION Genetic variants in the IL6 and IL6R genes act synergistically to modify the bronchodilator drug responsiveness in asthma and this pharmacogenetic interaction is modified by the genetic ancestry.
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Sleiman PM, Hakonarson H. Pharmacogenetics and functional genomics in asthma. Per Med 2009; 6:409-416. [PMID: 29783539 DOI: 10.2217/pme.09.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Asthma is a complex phenotype caused by a combination of genetic and environmental factors that remain poorly understood. The common variants involved in the pathogenesis of asthma have proved difficult to identify by candidate gene association studies. As a result, few genetic variants influencing clinical response to asthma and allergy medications have been uncovered. Recently, genome-wide association, which is more robust in identifying common predisposition variants, has been applied to disorders such as asthma. As genome-wide associations are hypothesis-free, they raise the possibility of identifying novel biological pathways that could be translated to the future benefit of patients through improved diagnostic and therapeutic measures in the form of personalized medicine. This review addresses both recent advances in the genetics of asthma and their potential in transforming the treatment of the disorder into more individualized care in the near future.
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Affiliation(s)
- Patrick Ma Sleiman
- Center for Applied Genomics, 1216E Abramson Research Center, 3615 Civic Center Blvd., Philadelphia, PA 19104-4318, USA.
| | - Hakon Hakonarson
- Center for Applied Genomics, 1216E Abramson Research Center, 3615 Civic Center Blvd., Philadelphia, PA 19104-4318, USA.
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Moore PE, Ryckman KK, Williams SM, Patel N, Summar ML, Sheller JR. Genetic variants of GSNOR and ADRB2 influence response to albuterol in African-American children with severe asthma. Pediatr Pulmonol 2009; 44:649-54. [PMID: 19514054 DOI: 10.1002/ppul.21033] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
African Americans are disproportionately affected by asthma. Social and economic factors play a role in this disparity, but there is evidence that genetic factors may also influence the development of asthma and response to therapy in African American children. Our hypothesis is that variations in asthma related genes contribute to the observed asthma disparities by influencing the response to asthma-specific therapy. In order to test this hypothesis, we characterized the clinical response to asthma-specific therapy in 107 African American children who presented to the emergency room in status asthmaticus, with a primary outcome indicator of length of time on continuous albuterol. Single locus analysis indicated that genotype variation in glutathione-dependent S-nitrosoglutathione reductase (GSNOR) is associated with a decreased response to asthma treatment in African American children. A post hoc multi-locus analysis revealed that a combination of four single nucleotide polymorphisms (SNPs) within GSNOR, adrenergic receptor beta 2, and carbamoyl phosphate synthetase-1 give a 70% predictive value for lack of response to therapy. This predictive model needs replication in other cohorts of patients with asthma, but suggests gene-gene interactions may have greater significance than that identified with single variants. Our findings also suggest that genetic variants may contribute to the observed population disparities in asthma.
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Affiliation(s)
- Paul E Moore
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-9500, USA
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44
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Abstract
PURPOSE OF REVIEW We aim to discuss current insights into our understanding of the mechanisms by which socioeconomic status influences the prevalence and severity of asthma in ethnic minorities. In addition, we review potential risk factors for ethnic disparities in asthma that are not mediated by socioeconomic status. RECENT FINDINGS Exposures and factors correlated with ethnicity through socioeconomic status (e.g. indoor and outdoor air quality, smoke exposure, and access to healthcare) are likely to explain a significant proportion of the observed ethnic differences in asthma morbidity. However, other factors correlated with ethnicity (e.g. genetic variation) can impact ethnic disparities in asthma independently of and/or interacting with socioeconomic status-related factors. SUMMARY Socioeconomic status is a rough marker of a variety of environmental/behavioral exposures and a very important determinant of differences in asthma prevalence and severity among ethnic minorities in the United States. However, socioeconomic status is unlikely to be the sole explanation for ethnic disparities in asthma, which may also be due to differences in genetic variation and gene-by-environment interactions among ethnic groups.
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Affiliation(s)
- Erick Forno
- Channing Laboratory, Dept. of Medicine, Brigham and Women’s Hospital, Boston, MA
- Division of Respiratory Diseases, Dept. of Pediatrics, Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Juan C. Celedón
- Channing Laboratory, Dept. of Medicine, Brigham and Women’s Hospital, Boston, MA
- Division of Pulmonary/Critical Care Medicine, Dept. of Medicine, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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Abstract
beta2-Agonist medications, such as albuterol and salmeterol, are widely used to treat asthma. However, there are a significant number of poor responders. Poor response may present as decreased lung function, and in extreme cases (a small percentage), patients who have asthma are at increased risk for mortality. A common single nucleotide polymorphism (SNP) in the beta2-adrenergic receptor gene (ADRB2) results in an arginine substitution for glycine at amino acid 16 (Arg16-->Gly) of the beta2-adrenergic receptor protein. Although this SNP has been associated with increased responsiveness at therapy initiation, it has also been associated with decreased lung function and increased asthma exacerbations with long-term use of beta2-agonists with or without corticosteroids in Caucasians. This pharmacogenetic relationship is less well studied in other ethnic groups. Experts have proposed that regular use of albuterol or salmeterol may be inappropriate for Caucasian asthmatics who have the homozygous ADRB2 Arg16 genotype.
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Affiliation(s)
- I-Wen Yu
- Department of Pharmacy, School of Pharmacy, Virginia Commonwealth University, 410N 12th Street, P.O. Box 980533, Richmond, VA 23298-0533, USA
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Fejerman L, John EM, Huntsman S, Beckman K, Choudhry S, Perez-Stable E, Burchard EG, Ziv E. Genetic ancestry and risk of breast cancer among U.S. Latinas. Cancer Res 2009; 68:9723-8. [PMID: 19047150 DOI: 10.1158/0008-5472.can-08-2039] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
U.S. Latinas have a lower incidence of breast cancer compared with non-Latina White women. This difference is partially explained by differences in the prevalence of known risk factors. Genetic factors may also contribute to this difference in incidence. Latinas are an admixed population with most of their genetic ancestry from Europeans and Indigenous Americans. We used genetic markers to estimate the ancestry of Latina breast cancer cases and controls and assessed the association with genetic ancestry, adjusting for reproductive and other risk factors. We typed a set of 106 ancestry informative markers in 440 Latina women with breast cancer and 597 Latina controls from the San Francisco Bay area and estimated genetic ancestry using a maximum likelihood method. Odds ratios (OR) and 95% confidence intervals (95% CI) for ancestry modeled as a continuous variable were estimated using logistic regression with known risk factors included as covariates. Higher European ancestry was associated with increased breast cancer risk. The OR for a 25% increase in European ancestry was 1.79 (95% CI, 1.28-2.79; P<0.001). When known risk factors and place of birth were adjusted for, the association with European ancestry was attenuated but remained statistically significant (OR, 1.39; 95% CI, 1.06-2.11; P=0.013). Further work is needed to determine if the association is due to genetic differences between populations or possibly due to environmental factors not measured.
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Affiliation(s)
- Laura Fejerman
- Division of General Internal Medicine and Lung Biology Center, Department of Medicine, University of California, San Francisco, CA 94143-1732, USA.
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Abstract
PURPOSE OF REVIEW Patient response to the asthma drug classes, bronchodilators, inhaled corticosteroids and leukotriene modifiers, are characterized by a large degree of heterogeneity, which is attributable in part to genetic variation. Herein, we review and update the pharmacogenetics and pharmaogenomics of common asthma drugs. RECENT FINDINGS Early studies suggest that bronchodilator reversibility and asthma worsening in patients on continuous short-acting and long-acting beta-agonists are related to the Gly16Arg genotype for the ADRB2. More recent studies including genome-wide association studies implicate variants in other genes contribute to bronchodilator response heterogeneity and fail to replicate asthma worsening associated with continuous beta-agonist use. Genetic determinants of the safety of long-acting beta-agonist require further study. Variants in CRHR1, TBX21, and FCER2 contribute to variability in response for lung function, airways responsiveness, and exacerbations in patients taking inhaled corticosteroids. Variants in ALOX5, LTA4H, LTC4S, ABCC1, CYSLTR2, and SLCO2B1 contribute to variability in response to leukotriene modifiers. SUMMARY Identification of novel variants that contribute to response heterogeneity supports future studies of single nucleotide polymorphism discovery and include gene expression and genome-wide association studies. Statistical models that predict the genomics of response to asthma drugs will complement single nucleotide polymorphism discovery in moving toward personalized medicine.
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Affiliation(s)
- John J Lima
- Centers for Pediatric Clinical Pharmacology and Pharmacogenetics, Nemours Children's Clinic, Jacksonville, Florida 32207, USA.
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Carroll CL, Stoltz P, Schramm CM, Zucker AR. Beta2-adrenergic receptor polymorphisms affect response to treatment in children with severe asthma exacerbations. Chest 2008; 135:1186-1192. [PMID: 19029431 DOI: 10.1378/chest.08-2041] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND beta(2)-adrenergic receptor (AR) agonists are the mainstay of treatment for severe asthma exacerbations, one of the most common causes of critical illness in children. Genotypic differences in the beta(2)-AR gene, particularly at amino acid positions 16 and 27, have been shown to affect the response to beta(2)-AR agonist therapy. Our hypothesis is that genotypic differences contribute to patient response to beta(2)-AR agonist treatment during severe asthma exacerbations in children. METHODS Children admitted to the hospital ICU for a severe asthma exacerbation between 2002 and 2005 were located, and genetic samples were obtained from saliva. Children hospitalized during this period were treated with a protocol that titrated beta(2)-AR therapy (first nebulized, then IV) according to a validated clinical asthma score. RESULTS Thirty-seven children hospitalized during the study period were enrolled into the study. At amino acid position 16 in the beta(2)-AR gene, 13 children were homozygous for the glycine (Gly) allele (Gly/Gly), 8 were homozygous for the arginine (Arg) allele (Arg/Arg), and 16 were heterozygous (Arg/Gly). Despite similar clinical asthma scores on hospital admission, the children with the Gly/Gly genotype had significantly shorter hospital ICU length of stay and duration of continuously nebulized albuterol therapy and were significantly less likely to require IV beta(2)-AR therapy than those with Arg/Arg or Arg/Gly genotypes. No association existed among polymorphisms at amino acid position 27 and response to beta(2)-AR therapy. CONCLUSIONS In this cohort of children with severe asthma exacerbations, children whose genotypes were homozygous for Gly at amino acid position 16 of the beta(2)-AR gene had a more rapid response to beta(2)-AR agonist treatment. The beta(2)-AR genotype appears to influence the response to therapy in this population.
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Affiliation(s)
| | - Petronella Stoltz
- Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT
| | - Craig M Schramm
- Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT
| | - Aaron R Zucker
- Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT
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Aldrich MC, Selvin S, Hansen HM, Barcellos LF, Wrensch MR, Sison JD, Quesenberry CP, Kittles RA, Silva G, Buffler PA, Seldin MF, Wiencke JK. Comparison of statistical methods for estimating genetic admixture in a lung cancer study of African Americans and Latinos. Am J Epidemiol 2008; 168:1035-46. [PMID: 18791191 DOI: 10.1093/aje/kwn224] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A variety of methods are available for estimating genetic admixture proportions in populations; however, few investigators have conducted detailed comparisons using empirical data. The authors characterized admixture proportions among self-identified African Americans (n = 535) and Latinos (n = 412) living in the San Francisco Bay Area who participated in a lung cancer case-control study (1998-2003). Individual estimates of genetic ancestry based on 184 informative markers were obtained from a Bayesian approach and 2 maximum likelihood approaches and were compared using descriptive statistics, Pearson correlation coefficients, and Bland-Altman plots. Case-control differences in individual admixture proportions were assessed using 2-sample t tests and logistic regression analysis. Results indicated that Bayesian and frequentist approaches to estimating admixture provide similar estimates and inferences. No difference was observed in admixture proportions between African-American cases and controls, but Latino cases and controls significantly differed according to Amerindian and European genetic ancestry. Differences in admixture proportions between Latino cases and controls were not unexpected, since cases were more likely to have been born in the United States. Genetic admixture proportions provide a quantitative measure of ancestry differences among Latinos that can be used in analyses of genetic risk factors.
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Affiliation(s)
- Melinda C Aldrich
- University of California, San Francisco, Box 2911 Rock Hall, Mission Bay 582, 1550 4th Street, San Francisco, CA 94143-2911, USA.
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Corvol H, Burchard EG. Pharmacogenetic response to albuterol among asthmatics. Pharmacogenomics 2008; 9:505-10. [PMID: 18466098 DOI: 10.2217/14622416.9.5.505] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pharmacogenetics offers to individualize asthma treatment by identifying genetic variants associated with drug efficacy or adverse events. Several studies have focused on pharmacogenetic associations with albuterol, the most commonly prescribed medication for asthma worldwide. However, pharmacogenetic associations have varied within and between studies and across populations. Herein, we focus on pharmacogenetic associations between genetic variants in the beta(2)-adrenergic receptor gene and bronchodilator response to albuterol among subjects with asthma.
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Affiliation(s)
- Harriet Corvol
- UCSF/Lung Biology Center, University of California, San Francisco, CA 94143-2911, USA.
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