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Galal AA, Abd Elmajeed AA, Elbaz RA, Wafa AM, Elshazli RM. Association of Apolipoprotein E gene polymorphism with the risk of T2DM and obesity among Egyptian subjects. Gene 2020; 769:145223. [PMID: 33059023 DOI: 10.1016/j.gene.2020.145223] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/26/2020] [Accepted: 10/07/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Numerous reports investigated the involvement of apolipoprotein E (APOE) polymorphisms with elevated risk of type 2 diabetes mellitus (T2DM) and obesity. The principal objective of this study is to assess the contribution of APOE polymorphisms (rs429358 and rs7412) with the risk of T2DM and obesity. SUBJECTS AND METHODS This work was designed involving 400 participants [100 healthy controls, 100 T2DM patients, 100 obese patients, and 100 T2DM + obese patients]. Genomic deoxyribonucleic acid (DNA) of the APOE polymorphisms was characterized using the PCR-RFLP assay. RESULTS The common predominant genotype of the study population is the APOE Ɛ3/Ɛ3 [T2DM patients (46%), obese patients (52%), T2DM + obese patients (37%), and healthy controls (58%)]. The frequencies of the APOE Ɛ4/Ɛ4 genotype and the APOE*Ɛ4 allele were significantly elevated among T2DM patients (p-value < 0.05). Additionally, the frequencies of the APOE Ɛ2/Ɛ2 genotype and the APOE*Ɛ2 allele were significantly increased among obese patients (p-value < 0.05). Moreover, the frequencies of the APOE Ɛ2/Ɛ2 genotype, APOE*Ɛ2 allele, APOE Ɛ4/Ɛ4 genotype, and APOE*Ɛ4 allele were statistically significant among T2DM + obese patients (p-value < 0.05). CONCLUSIONS APOE*Ɛ2 and APOE*Ɛ4 alleles were considered as independent risk factor among T2DM + obese patients. Furthermore, the APOE*Ɛ2 allele was correlated with elevated risk of obesity, while the APOE*Ɛ4 allele was correlated with elevated risk of T2DM.
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Affiliation(s)
- Amr A Galal
- Biochemistry Section, Department of Chemistry, Faculty of Science, Menoufia University, Menoufia, Egypt
| | - Ahmed A Abd Elmajeed
- Department of Chemistry, Faculty of Science, Menoufia University, Menoufia, Egypt
| | - Rizk A Elbaz
- Genetic Unit, Children Hospital, Mansoura University, Mansoura, Egypt
| | - Alaa M Wafa
- Diabetes and Endocrine Unit, Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Rami M Elshazli
- Biochemistry and Molecular Genetics Unit, Department of Basic Sciences, Faculty of Physical Therapy, Horus University - Egypt, New Damietta 34518, Egypt.
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2
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Beyond the CNS: The many peripheral roles of APOE. Neurobiol Dis 2020; 138:104809. [PMID: 32087284 DOI: 10.1016/j.nbd.2020.104809] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/06/2020] [Accepted: 02/18/2020] [Indexed: 12/28/2022] Open
Abstract
Apolipoprotein E (APOE) is a multifunctional protein synthesized and secreted by multiple mammalian tissues. Although hepatocytes contribute about 75% of the peripheral pool, APOE can also be expressed in adipose tissue, the kidney, and the adrenal glands, among other tissues. High levels of APOE production also occur in the brain, where it is primarily synthesized by glia, and peripheral and brain APOE pools are thought to be distinct. In humans, APOE is polymorphic, with three major alleles (ε2, ε3, and ε4). These allelic forms dramatically alter APOE structure and function. Historically, the vast majority of research on APOE has centered on the important role it plays in modulating risk for cardiovascular disease and Alzheimer's disease. However, the established effects of this pleiotropic protein extend well beyond these two critical health challenges, with demonstrated roles across a wide spectrum of biological conditions, including adipose tissue function and obesity, metabolic syndrome and diabetes, fertility and longevity, and immune function. While the spectrum of biological systems in which APOE plays a role seems implausibly wide at first glance, there are some potential unifying mechanisms that could tie these seemingly disparate disorders together. In the current review, we aim to concisely summarize a wide breadth of APOE-associated pathologies and to analyze the influence of APOE in the development of several distinct disorders in order to provide insight into potential shared mechanisms implied in these various pathophysiological processes.
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Atti AR, Valente S, Iodice A, Caramella I, Ferrari B, Albert U, Mandelli L, De Ronchi D. Metabolic Syndrome, Mild Cognitive Impairment, and Dementia: A Meta-Analysis of Longitudinal Studies. Am J Geriatr Psychiatry 2019; 27:625-637. [PMID: 30917904 DOI: 10.1016/j.jagp.2019.01.214] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/11/2019] [Accepted: 01/30/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE A systematic review and a meta-analysis of both clinical and population-based studies was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to clarify whether Metabolic Syndrome (MetS) is a risk or a protective factor for incident dementia, Alzheimer disease (AD), and vascular dementia (VaD), and whether it's involved in progression to dementia in patients affected by mild cognitive impairment (MCI). METHODS Search terms included ("metabolic syndrome" OR "syndrome x" OR "plurimetabolic syndrome") AND ("dementia" OR "Alzheimer disease" OR "vascular dementia" OR "mild cognitive impairment" OR "MCI"). Research was restricted to articles published in English between January 1, 2000 and August 31, 2018. No age limit was set. RESULTS At the end of the selection procedure, nine longitudinal studies were selected for the meta-analysis: six studies enrolled cognitively well-functioning participants and three studies involved MCI patients. A total of 18,313 participants aged older than 40 years with mean MetS prevalence of 22.7% were followed on average for 9.41years. A fixed model was used to estimate pooled hazard ratios and 95% confidence intervals. CONCLUSION No statistically significant pooled association emerged between MetS and incident dementia and AD. MetS increased the incidence of pure VaD. MetS increased the risk of progression from MCI to dementia. Follow-up length might be a key factor in investigating these associations further. Because MetS is constituted by a set of potentially modifiable factors, further studies with longer follow-up and repeated assessment of both MetS and cognitive status are desirable to draw definite conclusions.
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Affiliation(s)
- Anna Rita Atti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.
| | - Stefano Valente
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Antonia Iodice
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Ilaria Caramella
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Barbara Ferrari
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Umberto Albert
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Laura Mandelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Diana De Ronchi
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
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4
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Arrifano GPF, Alvarez-Leite JI, Souza-Monteiro JR, Augusto-Oliveira M, Paraense R, Macchi BM, Pinto A, Oriá RB, do Nascimento JLM, Crespo-Lopez ME. In the Heart of the Amazon: Noncommunicable Diseases and Apolipoprotein E4 Genotype in the Riverine Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1957. [PMID: 30205523 PMCID: PMC6165059 DOI: 10.3390/ijerph15091957] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 07/31/2018] [Accepted: 08/07/2018] [Indexed: 02/07/2023]
Abstract
The Amazon River basin is the largest tropical forest in the world. Most of the Amazon belongs to Brazil, a developing country that currently faces huge challenges related to the consolidation of its universal healthcare system. Noncommunicable diseases (NCDs) are the leading cause of death in Brazil, accounting for 74% of all deaths, and NCDs are probably underestimated in Amazonian population because of their geographical isolation and the precariousness of riverine communities. Important risk factors, such as genetic susceptibility, remain undetermined in the riverine population. This study performed fasting blood sugar (FBS) and blood pressure measurements and investigated the presence of the ε4 allele of apolipoprotein E (APOE4) to determine the prevalence of diabetes, hypertension and the genetic risk of NCDs. FBS and APOE4 were measured in blood samples from 763 participants using spectrometry and real-time PCR; 67.5% showed altered measurements, and 57.9% had never been diagnosed or treated. Altered FBS was found in 28.3% of the participants, hypertension in 57.6% and APOE4 in 32.0%. The health profile of the riverine population appears to differ from that of urban population in the Amazon. Additional risk factors for NCDs, such as environmental contamination and nutritional transition, may contribute more than increased genetic susceptibility to the prevalence of altered FBS and hypertension. Our results will help guide the development of preventive strategies and governmental actions for more effective management of NCDs in the Amazon area.
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Affiliation(s)
- Gabriela P F Arrifano
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil.
| | - Jacqueline I Alvarez-Leite
- Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte 31270-90, Brazil.
| | - José Rogério Souza-Monteiro
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil.
| | - Marcus Augusto-Oliveira
- Laboratório de Investigações em Neurodegeneração e Infecção (Hospital Universitário João de Barros Barreto), Universidade Federal do Pará, Belém 66063-023, Brazil.
| | - Ricardo Paraense
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil.
| | - Barbarella M Macchi
- Laboratório de Neuroquímica e Biologia Celular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil.
| | - André Pinto
- Laboratório de Análises Clínicas, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil.
| | - Reinaldo B Oriá
- Laboratório da Biologia da Cicatrização, Ontogenia e Nutrição de Tecidos, Departamento de Morfologia e Instituto de Biomedicina, Escola de Medicina, Universidade Federal do Ceará, Fortaleza 60430-160, Brazil.
| | - José Luiz Martins do Nascimento
- Laboratório de Neuroquímica e Biologia Celular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil.
| | - Maria Elena Crespo-Lopez
- Laboratório de Farmacologia Molecular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, Brazil.
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Peng XD, Huang CQ, Chen L, Wei XM, Liu QX, Wang ZR. The polymorphism of CLOCK gene rs4864548 A>G is associated with susceptibility of Alzheimer’s disease in Chinese population. BIOL RHYTHM RES 2017. [DOI: 10.1080/09291016.2017.1371951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Xiao-Dong Peng
- Key Laboratory of Chronobiology of Health Ministry, West China School of Basic Science and Forensic Medicine, Sichuan University, Chengdu, China
| | - Chang-Quan Huang
- Departments of Geriatrics, the Third Hospital of Mianyang, Mianyang, China
| | - Ling Chen
- Departments of Geriatrics, the Third Hospital of Mianyang, Mianyang, China
| | - Xue-Mei Wei
- Departments of Geriatrics, the Third Hospital of Mianyang, Mianyang, China
| | - Qing-Xiu Liu
- Departments of Geriatrics, the Third Hospital of Mianyang, Mianyang, China
| | - Zheng-rong Wang
- Key Laboratory of Chronobiology of Health Ministry, West China School of Basic Science and Forensic Medicine, Sichuan University, Chengdu, China
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Fallaize R, Carvalho-Wells AL, Tierney AC, Marin C, Kieć-Wilk B, Dembińska-Kieć A, Drevon CA, DeFoort C, Lopez-Miranda J, Risérus U, Saris WH, Blaak EE, Roche HM, Lovegrove JA. APOE genotype influences insulin resistance, apolipoprotein CII and CIII according to plasma fatty acid profile in the Metabolic Syndrome. Sci Rep 2017; 7:6274. [PMID: 28740125 PMCID: PMC5524844 DOI: 10.1038/s41598-017-05802-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 06/05/2017] [Indexed: 01/03/2023] Open
Abstract
Metabolic markers associated with the Metabolic Syndrome (MetS) may be affected by interactions between the APOE genotype and plasma fatty acids (FA). In this study, we explored FA-gene interactions between the missense APOE polymorphisms and FA status on metabolic markers in MetS. Plasma FA, blood pressure, insulin sensitivity and lipid concentrations were determined at baseline and following a 12-week randomized, controlled, parallel, dietary FA intervention in 442 adults with MetS (LIPGENE study). FA-APOE gene interactions at baseline and following change in plasma FA were assessed using adjusted general linear models. At baseline E4 carriers had higher plasma concentrations of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and apolipoprotein B (apo B) compared with E2 carriers; and higher TC, LDL-C and apo B compared with E3/E3. Whilst elevated plasma n-3 polyunsaturated FA (PUFA) was associated with a beneficially lower concentration of apo CIII in E2 carriers, a high proportion of plasma C16:0 was associated with insulin resistance in E4 carriers. Following FA intervention, a reduction in plasma long-chain n-3 PUFA was associated with a reduction in apo CII concentration in E2 carriers. Our novel data suggest that individuals with MetS may benefit from personalized dietary interventions based on APOE genotype.
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Affiliation(s)
- Rosalind Fallaize
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, University of Reading, Whiteknights, Reading, RG6 6AP, UK
- School of Life and Medical Sciences, University of Hertfordshire, College Lane, Hatfield, AL10 9AB, UK
| | - Andrew L Carvalho-Wells
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, University of Reading, Whiteknights, Reading, RG6 6AP, UK
| | - Audrey C Tierney
- Nutrigenomics Research Group, University College Dublin Conway Institute, University College Dublin, Dublin, Ireland
| | - Carmen Marin
- Lipids and Atherosclerosis Unit. Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
| | - Beata Kieć-Wilk
- Department of Metabolic Diseases, University Medical College, Krakow, Poland
| | - Aldona Dembińska-Kieć
- Department of Clinical Biochemistry, Jagiellonian University Collegium Medicum, Kraków, Poland
| | - Christian A Drevon
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - José Lopez-Miranda
- Lipids and Atherosclerosis Unit. Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
| | - Ulf Risérus
- Department of Public Health and Caring Sciences/Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Wim H Saris
- Department of Human Biology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (MUMC+) Maastricht, Maastricht, The Netherlands
| | - Ellen E Blaak
- Department of Human Biology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (MUMC+) Maastricht, Maastricht, The Netherlands
| | - Helen M Roche
- Nutrigenomics Research Group, University College Dublin Conway Institute, University College Dublin, Dublin, Ireland
| | - Julie A Lovegrove
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, University of Reading, Whiteknights, Reading, RG6 6AP, UK.
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Resende CMM, Durso DF, Borges KBG, Pereira RM, Rodrigues GKD, Rodrigues KF, Silva JLP, Rodrigues EC, Franco GR, Alvarez-Leite JI. The polymorphism rs17782313 near MC4R gene is related with anthropometric changes in women submitted to bariatric surgery over 60 months. Clin Nutr 2017; 37:1286-1292. [PMID: 28579220 DOI: 10.1016/j.clnu.2017.05.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 04/20/2017] [Accepted: 05/15/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Evaluate whether the polymorphism rs17782313 near MC4R gene influences long-term outcomes after bariatric surgery. METHODS The rs16782313 polymorphism was genotyped in 217 individuals undergoing bariatric surgery and analyzed in detail in 141 women. Data for comorbidities, BMI, excess weight loss (EWL), and body composition were obtained before and during 60 months after surgery. RESULTS The risk allele was found in 65 (47%) of the 141 women. Pre-surgical body weight and BMI were higher in carriers of the rs17782313 polymorphism (CC + CT group) than in non-carriers (TT group) (p = 0.039 and 0.047, respectively). The number of women who acquired surgical success (EWL > 50%), was lower in CC + CT group compared to TT group (p = 0.015). The minimum BMI seen during the 60 months of follow-up was higher in CC + CT group compared to TT group (p = 0.028). The number of women who presented BMI < 30 kg/m2 (no longer classified as obesity) after 24 months of surgery was inferior in CC + CT group (6 out 35 patients - 17%) than in TT group (19 out 49 patients - 37%, p = 0.043). Moreover, the number of patients maintaining BMI > 35 kg/m2 were higher carriers (18 out 35 patients - 51%) compare to non-carriers (16 out 49 patients - 32%, p = 0.045). CONCLUSION Women with extreme obesity carrying rs17782313 MC4R polymorphism present a higher pre-surgical BMI, are more unlikely to reach non-obesity BMI (<30 kg/m2) and tend to maintain a BMI > 35 kg/m2 that characterize treatment failure.
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Affiliation(s)
| | - Danielle Fernandes Durso
- Departamento de Bioquimica e Imunologia - ICB, Universidade Federal de Minas, Belo Horizonte, MG, Brazil
| | - Karina Braga Gomes Borges
- Departamento de Análises Clínicas de Toxicológicas - FAFAR, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Rafaela Messias Pereira
- Departamento de Bioquimica e Imunologia - ICB, Universidade Federal de Minas, Belo Horizonte, MG, Brazil
| | | | - Kathryna Fontana Rodrigues
- Departamento de Análises Clínicas de Toxicológicas - FAFAR, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - José Luiz Padilha Silva
- Departamento de Estatística, ICEX, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Gloria Regina Franco
- Departamento de Bioquimica e Imunologia - ICB, Universidade Federal de Minas, Belo Horizonte, MG, Brazil
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Karmelić I, Lovrić J, Božina T, Merkler A, Božina N, Sertić J. Is there any association of apolipoprotein E gene polymorphisms with metabolic syndrome in a young population of Croatian origin? Ann Hum Biol 2016; 44:287-294. [DOI: 10.1080/03014460.2016.1210675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ivana Karmelić
- Department of Medical Chemistry, Biochemistry and Clinical Chemistry, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Jasna Lovrić
- Department of Medical Chemistry, Biochemistry and Clinical Chemistry, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Tamara Božina
- Department of Medical Chemistry, Biochemistry and Clinical Chemistry, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ana Merkler
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Nada Božina
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
- Department of Pharmacology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Jadranka Sertić
- Department of Medical Chemistry, Biochemistry and Clinical Chemistry, School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Laboratory Diagnostics, University Hospital Centre Zagreb, Zagreb, Croatia
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Sun Y, Wei R, Yan D, Xu F, Zhang X, Zhang B, Yimiti D, LI H, Sun H, Hu C, Luo L, Yao H. Association between APOE polymorphism and metabolic syndrome in Uyghur ethnic men. BMJ Open 2016; 6:e010049. [PMID: 26739741 PMCID: PMC4716259 DOI: 10.1136/bmjopen-2015-010049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES This study aimed to examine the association between apolipoprotein E (APOE) polymorphism and metabolic syndrome (MetS) among Uyghur ethnic men in Xinjiang, China. PARTICIPANTS A total of 482 patients with MetS and 510 healthy sex-matched and age-matched controls were recruited from the Xinjiang Uyghur Autonomous Region of China. The participants were subjected to routine physical and blood biochemical tests, and APOE genotyping was performed. RESULTS The APOE ε3/3 was the predominant type, with a frequency of 71.8%, while ε2/2 was less common than ε4/4 in Uyghur males. The frequencies of the APOE2, E3 and E4 alleles in Uyghur males were 8.5%, 80.0% and 11.5%, respectively. However, the distribution of APOE genotypes was significantly different between the MetS and control groups (p<0.001). In the MetS group, the frequencies of the ε2 and ε4 alleles and the frequencies of the ε2/2, ε2/3 and ε2/4 genotypes were significantly lower than those of the control group. Those individuals without the ε2 and ε4 alleles had higher MetS prevalence than the other gene carriers, and the ORs of these individuals developing MetS were 1.5 and 1.27 compared to the gene carriers. Triglyceride, serum total cholesterol and low-density lipoprotein cholesterol levels were lower and serum high-density lipoprotein was higher in the ε2 carriers than the ε3 carriers, and the prevalence of MetS, central obesity, high blood pressure, hypercholesterolaemia and hypertriglyceridaemia was lower in the APOE2 group than in the APOE4 group. The risks of these individuals with ε4 allele carriers getting these changes were 1.327, 1.780, 1.888, 1.428 and 2.571 times greater than those of ε2 allele carriers. CONCLUSIONS APOE4 is associated with many individual components of MetS, whereas APOE2 was associated with a reduced risk of MetS at the univariate level in Uyghur ethnic men.
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Affiliation(s)
- YuPing Sun
- College of Basic Medical Science, Xinjiang Medical University, Xinjiang, China
| | - Rong Wei
- The Fourth Affiliated Hospital, Xinjiang Medical University, Xinjiang, China
| | - DanDan Yan
- Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - FeiLi Xu
- The Fourth Affiliated Hospital, Xinjiang Medical University, Xinjiang, China
| | - XiaoJin Zhang
- The Key Laboratory of Metabolic Diseases, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
| | - Bei Zhang
- College of Basic Medical Science, Xinjiang Medical University, Xinjiang, China
| | - Delixiati Yimiti
- College of Basic Medical Science, Xinjiang Medical University, Xinjiang, China
| | - Hui LI
- The Second Affiliated Hospital, Xinjiang Medical University, Urumqi, China
| | - HongYan Sun
- Department of Science and Technology, Xinjiang Medical University, Urumqi, China
| | - Cheng Hu
- Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Li Luo
- The Key Laboratory of Metabolic Diseases, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
| | - Hua Yao
- The Key Laboratory of Metabolic Diseases, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
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Torres-Perez E, Ledesma M, Garcia-Sobreviela MP, Leon-Latre M, Arbones-Mainar JM. Apolipoprotein E4 association with metabolic syndrome depends on body fatness. Atherosclerosis 2015; 245:35-42. [PMID: 26691908 DOI: 10.1016/j.atherosclerosis.2015.11.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/05/2015] [Accepted: 11/24/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND AIMS The human Apolipoprotein E (APOE) gene is polymorphic. The APOE*4 allele is a risk factor for cardiovascular disease and could contribute to the development of the metabolic syndrome (MetS) as it may affect all MetS components. We hypothesize that the common APOE4 polymorphism differentially regulates MetS risk and that this association might be modulated by body fatness. METHODS & RESULTS We used body mass index (BMI) as surrogate of fatness and cross-sectionally studied the prevalence of MetS in 4408 middle-aged men of the Aragon Workers Health Study (AWHS). Our analysis revealed i) a gene dose-dependent association between APOE*4 allele and increased risk for MetS, ii) this association primarily derived from the overweight subjects. For these individuals, the MetS risk was higher in APOE*4 carriers than in non-carriers (Odds Ratio = 1.31; 95% CI, 1.03-1.67). Additionally, we examined 3908 healthy young individuals from the Coronary Artery Risk Development in Young Adults (CARDIA) cohort, followed-up for 25 years. Compared with APOE*4 non-carriers, APOE*4 presence significantly increased the risk of developing MetS (Hazard Ratio, 1.12; 95% CI, 1.00-1.26). Again, an interplay between APOE*4 and the longitudinal development of fatness towards the onset of MetS occurred throughout the study. For individuals with BMI gain below the median, the cumulative onset rate of MetS was significantly higher in APOE*4 carriers than in the non-carriers (HR, 1.29; 95% CI, 1.07-1.55). CONCLUSIONS Carrying APOE*4 alleles increases MetS in a dose-dependent manner, characterizing individual's APOE genotype might help identify at-risk subjects for preventive intervention.
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Affiliation(s)
- Elena Torres-Perez
- Adipocyte and Fat Biology Laboratory (AdipoFat), Unidad de Investigación Traslacional, Hospital Universitario Miguel Servet, Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain; Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain
| | - Marta Ledesma
- Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain; Unidad de Prevención Cardiovascular, Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain
| | - Maria Pilar Garcia-Sobreviela
- Adipocyte and Fat Biology Laboratory (AdipoFat), Unidad de Investigación Traslacional, Hospital Universitario Miguel Servet, Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain; Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain
| | - Montserrat Leon-Latre
- Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain; Unidad de Prevención Cardiovascular, Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain
| | - Jose M Arbones-Mainar
- Adipocyte and Fat Biology Laboratory (AdipoFat), Unidad de Investigación Traslacional, Hospital Universitario Miguel Servet, Instituto Aragonés de Ciencias de la Salud (IACS), Zaragoza, Spain; Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain.
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11
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Rodrigues GK, Resende CM, Durso DF, Rodrigues LA, Silva JLP, Reis RC, Pereira SS, Ferreira DC, Franco GR, Alvarez-Leite J. A single FTO gene variant rs9939609 is associated with body weight evolution in a multiethnic extremely obese population that underwent bariatric surgery. Nutrition 2015; 31:1344-50. [DOI: 10.1016/j.nut.2015.05.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 04/21/2015] [Accepted: 05/14/2015] [Indexed: 01/31/2023]
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12
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Lai LYH, Petrone AB, Pankow JS, Arnett DK, North KE, Ellison RC, Hunt SC, Rosenzweig JL, Djoussé L. Lack of association of apolipoprotein E (Apo E) polymorphism with the prevalence of metabolic syndrome: the National Heart, Lung and Blood Institute Family Heart Study. Diabetes Metab Res Rev 2015; 31:582-7. [PMID: 25656378 PMCID: PMC4720970 DOI: 10.1002/dmrr.2638] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 01/30/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Metabolic syndrome (MetS), characterized by abdominal obesity, atherogenic dyslipidaemia, elevated blood pressure and insulin resistance, is a major public health concern in the United States. The effects of apolipoprotein E (Apo E) polymorphism on MetS are not well established. METHODS We conducted a cross-sectional study consisting of 1551 participants from the National Heart, Lung and Blood Institute Family Heart Study to assess the relation of Apo E polymorphism with the prevalence of MetS. MetS was defined according to the American Heart Association-National Heart, Lung and Blood Institute-International Diabetes Federation-World Health Organization harmonized criteria. We used generalized estimating equations to estimate adjusted odds ratios (ORs) for prevalent MetS and the Bonferroni correction to account for multiple testing in the secondary analysis. RESULTS Our study population had a mean age (standard deviation) of 56.5 (11.0) years, and 49.7% had MetS. There was no association between the Apo E genotypes and the MetS. The multivariable adjusted ORs (95% confidence interval) were 1.00 (reference), 1.26 (0.31-5.21), 0.89 (0.62-1.29), 1.13 (0.61-2.10), 1.13 (0.88-1.47) and 1.87 (0.91-3.85) for the Ɛ3/Ɛ3, Ɛ2/Ɛ2, Ɛ2/Ɛ3, Ɛ2/Ɛ4, Ɛ3/Ɛ4 and Ɛ4/Ɛ4 genotypes, respectively. In a secondary analysis, Ɛ2/Ɛ3 genotype was associated with 41% lower prevalence odds of low high-density lipoprotein [multivariable adjusted ORs (95% confidence interval) = 0.59 (0.36-0.95)] compared with Ɛ3/Ɛ3 genotype. CONCLUSIONS Our findings do not support an association between Apo E polymorphism and MetS in a multicentre population-based study of predominantly White US men and women.
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Affiliation(s)
- Lana Y H Lai
- School of Medicine, Boston University, 72, East Concord St, Boston, MA, USA
- Clinical Research Center, Sarawak General Hospital, Kuching, Malaysia
| | - Andrew B Petrone
- Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
| | - James S Pankow
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Donna K Arnett
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kari E North
- Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - R Curtis Ellison
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA, USA
| | - Steven C Hunt
- Cardiovascular Genetics, University of Utah, Salt Lake City, Utah, USA
| | - James L Rosenzweig
- School of Medicine, Boston University, 72, East Concord St, Boston, MA, USA
- Department of Endocrinology, Diabetes and Nutrition, Boston Medical Center, Boston, MA, USA
| | - Luc Djoussé
- Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Boston Veterans Affairs Healthcare System, Boston, MA, USA
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13
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Jeenduang N, Porntadavity S, Nuinoon M, Horpet D, Thepkwan N, Thaworn P, Theanmontri S. Studies of the CETP TaqIB and ApoE Polymorphisms in Southern Thai Subjects with the Metabolic Syndrome. Biochem Genet 2015; 53:184-99. [DOI: 10.1007/s10528-015-9680-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 05/12/2015] [Indexed: 02/07/2023]
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14
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Teixeira AA, Marrocos MS, Quinto BMR, Dalboni MA, Rodrigues CJDO, de Melo Carmona S, Kuniyoshi M, Batista MC. Diversity of apolipoprotein E genetic polymorphism significance on cardiovascular risk is determined by the presence of metabolic syndrome among hypertensive patients. Lipids Health Dis 2014; 13:174. [PMID: 25413697 PMCID: PMC4258020 DOI: 10.1186/1476-511x-13-174] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 10/21/2014] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Hypertension has a significant relevance as a cardiovascular risk factor. A consistent increase on world's Metabolic Syndrome (MetS) incidence has been associated with an epidemic cardiovascular risk in different populations. Dislipidemia plays a major role determining the epidemic CV burden attributed to MetS. Apolipoprotein E (ApoE) is involved on cholesterol and triglycerides metabolism regulation. Once ApoE polymorphism may influence lipid metabolism, it is possible that it brings on individual susceptibility consequences for the development of MetS and cardiovascular risk. The objective of the study is to measure the discriminatory power of ApoE polymorphism in determining cardiovascular risk stratification based on the presence MetS in a cohort of hypertensive patients. METHODS It was enrolled 383 patients, divided in two groups, classified by MetS presence (IDF criteria): Group 1: 266 patients with MetS (MetS +) and Group 2: 117 patients without Mets (MetS -). Patient's data were collected by clinical evaluation, physical exam, file reviews and laboratory testing. Polymorphic ApoE analysis was performed by PCR amplification. Groups were compared on clinical and laboratory characteristics as well as allele and genotype distribution towards ApoE polymorphism. Mets CVD prevalence was analysed according to E4 allele prevalence. RESULTS The results evidenced 184 men (48%), 63,7% whites, 45,1% diabetics and 11,7% of patients were smokers. Mean age was 64,0 ± 12,0 years. When genotypic distribution was analyzed, E3/3 genotype and E3 allele frequencies were more prevalent. Among patients with MetS, we observed an independent association between CVD prevalence and E4 allele frequency (OR 2.42 (1.17- 5.0, p < 0,05)). On the opposite direction, in those without MetS, there was lesser CVD burden in E4 allele carriers (OR 0,14 (0,02-0,75)). These associations remained significant even after confounding factor corrections. CONCLUSIONS The results presented demonstrate that the association between ApoE gene and CVD may be modulated by the presence of MetS, with an increased CV burden observed among E4 allele carriers with the syndrome. On the opposite way, E4 allele carriers without visceral obesity had lesser prevalence of CVD.
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Affiliation(s)
- Andrei Alkmim Teixeira
- />Nephrology Division, R. Pedro de Toledo, Universidade Federal de São Paulo, 781 14o. andar, Vila Clementino, São Paulo, São Paulo CEP 04039-032 Brazil
| | - Mauro Sergio Marrocos
- />Nephrology Division, R. Pedro de Toledo, Universidade Federal de São Paulo, 781 14o. andar, Vila Clementino, São Paulo, São Paulo CEP 04039-032 Brazil
| | - Beata Marie Redublo Quinto
- />Nephrology Division, R. Pedro de Toledo, Universidade Federal de São Paulo, 781 14o. andar, Vila Clementino, São Paulo, São Paulo CEP 04039-032 Brazil
| | - Maria Aparecida Dalboni
- />Nephrology Division, R. Pedro de Toledo, Universidade Federal de São Paulo, 781 14o. andar, Vila Clementino, São Paulo, São Paulo CEP 04039-032 Brazil
| | - Cassio Jose de Oliveira Rodrigues
- />Nephrology Division, R. Pedro de Toledo, Universidade Federal de São Paulo, 781 14o. andar, Vila Clementino, São Paulo, São Paulo CEP 04039-032 Brazil
| | - Silmara de Melo Carmona
- />Nephrology Division, R. Pedro de Toledo, Universidade Federal de São Paulo, 781 14o. andar, Vila Clementino, São Paulo, São Paulo CEP 04039-032 Brazil
| | - Mariana Kuniyoshi
- />Nephrology Division, R. Pedro de Toledo, Universidade Federal de São Paulo, 781 14o. andar, Vila Clementino, São Paulo, São Paulo CEP 04039-032 Brazil
| | - Marcelo Costa Batista
- />Nephrology Division, R. Pedro de Toledo, Universidade Federal de São Paulo, 781 14o. andar, Vila Clementino, São Paulo, São Paulo CEP 04039-032 Brazil
- />Nephrology Division-New England Medical Center, Tufts University, Boston, Massachusetts USA
- />Research and Education Institute, Hospital Israelita Albert Einstein, São Paulo, São Paulo Brazil
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Novotny D, Karasek D, Vaverkova H, Slavik L. The influence of apolipoprotein A5 T-1131C and apolipoprotein E common genetic variants on the levels of hemostatic markers in dyslipidemic patients. Clin Chim Acta 2014; 436:11-7. [DOI: 10.1016/j.cca.2014.04.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 04/19/2014] [Accepted: 04/21/2014] [Indexed: 12/22/2022]
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16
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Wu CL, Zhao SP, Yu BL. Intracellular role of exchangeable apolipoproteins in energy homeostasis, obesity and non-alcoholic fatty liver disease. Biol Rev Camb Philos Soc 2014; 90:367-76. [PMID: 24834836 DOI: 10.1111/brv.12116] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 04/10/2014] [Accepted: 04/17/2014] [Indexed: 02/06/2023]
Affiliation(s)
- Chen-Lu Wu
- Department of Cardiology; The Second Xiangya Hospital, Central South University; Changsha Hunan 410011 China
| | - Shui-Ping Zhao
- Department of Cardiology; The Second Xiangya Hospital, Central South University; Changsha Hunan 410011 China
| | - Bi-Lian Yu
- Department of Cardiology; The Second Xiangya Hospital, Central South University; Changsha Hunan 410011 China
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Novotny D, Vaverkova H, Karasek D, Malina P. Genetic variants of apolipoprotein A5 T-1131C and apolipoprotein E common polymorphisms and their relationship to features of metabolic syndrome in adult dyslipidemic patients. Clin Biochem 2014; 47:1015-21. [PMID: 24709297 DOI: 10.1016/j.clinbiochem.2014.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 02/26/2014] [Accepted: 03/24/2014] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The aim was to evaluate the relationships of the T-1131C (rs662799) polymorphism variants of apolipoprotein A5 (Apo A5) gene and variants of apolipoprotein E (Apo E) gene common polymorphism (rs429358, rs7412) to signs of metabolic syndrome (MetS). DESIGN AND METHODS We examined 590 asymptomatic dyslipidemic patients divided into MetS+ (n=146) and MetS- (n=444) groups according to criteria of NCEP ATPIII Panel. We evaluated genotype frequencies and differences in MetS features between individual groups. Logistic regression analysis was used for the evaluation of Apo A5/Apo E variants as possible risk factors for MetS. RESULTS We found no statistical differences between genotype and allele frequencies for both Apo A5 and Apo E polymorphisms between MetS+ and MetS- groups. In all subjects and MetS- group, we confirmed well-known association of the -1131C Apo A5 minor allele with elevated triglycerides (TG, p<0.001). The Apo E gene E2 and E4 variants were associated with higher levels of TG (p<0.01) in comparison to E33 common variant. However, no statistical differences were observed in MetS+ subjects, regardless of significantly higher TG levels in this group. Apo A5/Apo E variant analysis in all dyslipidemic patients revealed significant increase of TG levels in all subgroups in comparison to common -1131T/E3 variant carriers, the most in -1131C/E4 variant subgroup. Logistic regression analysis models showed no association of Apo A5, Apo E and all Apo A5/Apo E variants with metabolic syndrome, even after adjustment for age and sex. CONCLUSION Our study refined the role of Apo A5 and Apo E genetic variants in the group of adult dyslipidemic patients. We demonstrate that except of TG, Apo A5 T-1131C (rs662799) and Apo E (rs429358, rs7412) polymorphisms have no remarkable effect on MetS characteristics.
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Affiliation(s)
- Dalibor Novotny
- Department of Clinical Biochemistry, University Hospital Olomouc, I. P. Pavlova 6, 775 20 Olomouc, Czech Republic.
| | - Helena Vaverkova
- 3rd Department of Internal Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, 775 20 Olomouc, Czech Republic
| | - David Karasek
- 3rd Department of Internal Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, 775 20 Olomouc, Czech Republic
| | - Pavel Malina
- Department of Clinical Biochemistry, Hospital Písek, Karla Čapka 589, 397 23 Písek, Czech Republic
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Silva F, Rodriguez-Revenga L, Madrigal I, Alvarez-Mora MI, Oliva R, Milà M. High apolipoprotein E4 allele frequency in FXTAS patients. Genet Med 2013; 15:639-42. [PMID: 23492875 DOI: 10.1038/gim.2013.12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 01/18/2013] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Fragile X-associated tremor/ataxia syndrome is a late-onset neurodegenerative disorder that occurs in FMR1 premutation carriers. It is well known that the apolipoprotein E ε4 allele is a risk factor for neurodegenerative disease. The main goal of this work was to evaluate the apolipoprotein E genotypes and allelic distribution among patients with fragile X-associated tremor/ataxia syndrome. METHODS A total of 44 unrelated FMR1 premutation carriers (22 presenting with fragile X-associated tremor/ataxia syndrome and 22 without fragile X-associated tremor/ataxia syndrome) were genotyped. RESULTS All the apolipoprotein E ε4/4 genotype carriers detected (100%), and six of the seven apolipoprotein E ε4/3 genotype carriers (85.7%) are patients presenting with fragile X-associated tremor/ataxia syndrome symptoms, whereas only 40% of the apolipoprotein E ε3/3 genotype carriers belong to the fragile X-associated tremor/ataxia syndrome group. The results showed that the presence of the apolipoprotein E ε4 allele increases the risk of developing fragile X-associated tremor/ataxia syndrome (odds ratio = 12.041; P = 0.034). CONCLUSION On the basis of these results, we conclude that the presence of at least one apolipoprotein E ε4 allele might act as a genetic factor predisposing individuals to develop fragile X-associated tremor/ataxia syndrome.
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Affiliation(s)
- Francisca Silva
- Department of Biochemistry and Molecular Genetics, Hospital Clinic, Barcelona, Spain
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Végh C, Langmár Z, Szerző M, Ágota A, Marosi K, Szabolcs Z, Nagy ZB. Connections between apolipoprotein E genotypes and the development of cardiovascular diseases. Orv Hetil 2012; 153:2070-6. [DOI: 10.1556/oh.2012.29508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Elevated plasma lipid level is one of the main risk factors for cardiovascular diseases, which are considered to be pimary causes of death. Apolipoprotein E plays a part in the lipid transport in the blood, thus polimophisms of that affect the lipid composition of the plasma. The three most common alleles of apolipoprotein E are e2, e3, e4. Out of the two non-wild type alleles, the e2 and e4, the latter was shown to play a role in the development of cardiovascular diseases and Alzheimer’s disease. Some studies mention the e2/e2 homozygote genotype as one of the causes of hyperlipoproteinemia type III. Besides lipid metabolism, apolipoprotein E also influences the manifestation of cardiovascular diseases through other biochemical pathways, therefore it is essential to explore the molecular background of these metabolic pathways. Orv. Hetil., 2012, 153, 2070–2076.
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Affiliation(s)
- Csaba Végh
- Genetikával Az Egészségért Egyesület Budapest
| | - Zoltán Langmár
- Zirc Városi Erzsébet Kórház-Rendelőintézet Zirc
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Szülészeti és Nőgyógyászati Klinika Budapest Üllői út 78/A 1082
| | | | | | | | - Zoltán Szabolcs
- Semmelweis Egyetem, Általános Orvostudományi Kar Szív- és Érgyógyászati Klinika Budapest
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