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Tan AH, Cornejo‐Olivas M, Okubadejo N, Pal PK, Saranza G, Saffie‐Awad P, Ahmad‐Annuar A, Schumacher‐Schuh AF, Okeng'o K, Mata IF, Gatto EM, Lim S. Genetic Testing for Parkinson's Disease and Movement Disorders in Less Privileged Areas: Barriers and Opportunities. Mov Disord Clin Pract 2024; 11:14-20. [PMID: 38291851 PMCID: PMC10828609 DOI: 10.1002/mdc3.13903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/14/2023] [Accepted: 07/30/2023] [Indexed: 02/01/2024] Open
Affiliation(s)
- Ai Huey Tan
- Division of Neurology, Department of Medicine, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Mario Cornejo‐Olivas
- Neurogenetics Working GroupUniversidad Científica del SurLimaPeru
- Neurogenetics Research Center, Instituto Nacional de Ciencias NeurológicasLimaPeru
| | - Njideka Okubadejo
- Department of Medicine, College of MedicineUniversity of LagosLagosNigeria
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS)BengaluruIndia
| | - Gerard Saranza
- Movement Disorders Service, Section of Neurology, Department of Internal Medicine, Chong Hua Hospital and Vicente Sotto Memorial Medical CenterCebuPhilippines
| | - Paula Saffie‐Awad
- CETRAM‐Centro de Estudios de Transtornos del Movimiento, Clínica Santa MaríaSantiagoChile
| | - Azlina Ahmad‐Annuar
- Department of Biomedical Science, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Artur F. Schumacher‐Schuh
- Departamento de FarmacologiaUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
- Serviço de Neurologia, Hospital de Clínicas de Porto AlegrePorto AlegreBrazil
| | | | - Ignacio F. Mata
- Genomic Medicine Institute, Lerner Research Institute, Genomic Medicine, Cleveland Clinic FoundationClevelandOhioUSA
| | - Emilia M. Gatto
- Department of Neurology, Hospital Sanatorio de la Trinidad Mitre, Instituto de Neurociencias Buenos Aires, School of MedicineBuenos Aires UniversityBuenos AiresArgentina
| | - Shen‐Yang Lim
- Division of Neurology, Department of Medicine, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia
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Besharati S, Akinyemi R. Accelerating African neuroscience to provide an equitable framework using perspectives from West and Southern Africa. Nat Commun 2023; 14:8107. [PMID: 38062039 PMCID: PMC10703764 DOI: 10.1038/s41467-023-43943-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Affiliation(s)
- Sahba Besharati
- Department of Psychology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa.
- CIFAR Azrieli Global Scholars Program, CIFAR, Toronto, Canada.
| | - Rufus Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
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3
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Amoakoh-Coleman M, Vieira D, Abugri J. Ethical considerations for biobanking and use of genomics data in Africa: a narrative review. BMC Med Ethics 2023; 24:108. [PMID: 38053109 PMCID: PMC10699036 DOI: 10.1186/s12910-023-00985-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Biobanking and genomic research requires collection and storage of human tissue from study participants. From participants' perspectives within the African context, this can be associated with fears and misgivings due to a myriad of factors including myths and mistrust of researchers. From the researchers angle ethical dilemmas may arise especially with consenting and sample reuse during storage. The aim of this paper was to explore these ethical considerations in the establishment and conduct of biobanking and genomic studies in Africa. METHODS We conducted a narrative synthesis following a comprehensive search of nine (9) databases and grey literature. All primary research study designs were eligible for inclusion as well as both quantitative and qualitative evidence from peer reviewed journals, spanning a maximum of 20 years (2000-2020). It focused on research work conducted in Africa, even if data was stored or analysed outside the region. RESULTS Of 2,663 title and abstracts screened, 94 full texts were retrieved and reviewed for eligibility. We included 12 studies (7 qualitative; 4 quantitative and one mixed methods). Ethical issues described in these papers related to community knowledge and understanding of biobanking and genomic research, regulation, and governance of same by research ethics committees, enrolment of participants, types of informed consents, data collection, storage, usage and sharing as well as material transfer, returning results and benefit sharing. ca. Biospecimen collection and storage is given in trust and participants expect confidentially of data and results generated. Most participants are comfortable with broad consent due to trust in researchers, though a few would like to be contacted for reconsenting in future studies, and this would depend on whether the new research is for good cause. Sharing data with external partners is welcome in some contexts but some research participants did not trust foreign researchers. CONCLUSION Biobanking and genomic studies are a real need in Africa. Linked to this are ethical considerations related to setting up and participation in biobanks as well as data storage, export, use and sharing. There is emerging or pre-existing consensus around the acceptability of broad consent as a suitable model of consent, the need for Africans to take the lead in international collaborative studies, with deliberate efforts to build capacity in local storage and analysis of samples and employ processes of sample collection and use that build trust of communities and potential study participants. Research ethics committees, researchers and communities need to work together to work together to adapt and use clearly defined ethical frameworks, guidelines, and policy documents to harmonize the establishment and running of biobanking and genomic research in Africa.
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Affiliation(s)
- Mary Amoakoh-Coleman
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana.
| | - Dorice Vieira
- 2Health Sciences Library, Grossman School of Medicine, New York University, New York, USA
| | - James Abugri
- School of Chemical and Biochemical Sciences, C.K. Tedam University. of Technology & Applied Sciences, Navrongo, Ghana
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Kapapa MM, Bearden DR, Somwe SW, Birbeck GL, Ramdharry G, Kvalsund M. Genetic Neuromuscular Disorders and Health Services Access, Utilization, and Needs in Zambia. Pediatr Neurol 2023; 148:173-177. [PMID: 37738885 PMCID: PMC10642628 DOI: 10.1016/j.pediatrneurol.2023.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/26/2023] [Accepted: 08/28/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Medical and rehabilitative advances increasingly transform management of rare genetic neuromuscular diseases (GNMDs) for children in the global north. Lack of information about GNMDs and related health care needs in sub-Saharan Africa threatens to widen pre-existing health disparities. METHODS This is a cross-sectional study of probands enrolling in a study of GNMDs at the University Teaching Hospital in Lusaka, Zambia, a member of the International Consortium for Genomic Medicine in Neuromuscular Disease. Probands/caregivers were interviewed about utilization of medical, rehabilitative, and other support services by a research assistant. A neuromuscular neurologist and/or physiotherapist examined each case and completed an independent questionnaire regarding health service utilization for each proband. Diagnoses were made on available clinical and electrophysiologic data. Molecular findings were unavailable at the time of this analysis. RESULTS Among 50 probands, 52% were male with median age 12 (absolute range 2 months to 54 years). Motor neuron diseases (n = 16; 32%), muscle disorders (n = 20; 40%), and inherited polyneuropathies (n = 5; 10%) were most common. Six (15%) cases had insufficient clinical data to classify the GNMDs. Outside of primary care, patient/caregiver-reported access to recommended health services (n = 34; 69%) was challenging. Large disparities in current utilization of health care services versus clinician-recommended services are reported. CONCLUSIONS Paradigms to improve access to diagnostics and therapeutic interventions are needed for GNMDs in Zambia. Multidisciplinary clinics may improve access and utilization of needed health services. Qualitative and other research focused on improving referrals, access, and quality of available health services are greatly needed.
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Affiliation(s)
- Musambo M Kapapa
- University Teaching Hospital Neurology Research Office, Lusaka, Zambia
| | - David R Bearden
- University Teaching Hospital Neurology Research Office, Lusaka, Zambia; Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Somwe Wa Somwe
- University Teaching Hospital Neurology Research Office, Lusaka, Zambia
| | - Gretchen L Birbeck
- University Teaching Hospital Neurology Research Office, Lusaka, Zambia; Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | | | - Michelle Kvalsund
- University Teaching Hospital Neurology Research Office, Lusaka, Zambia; Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia.
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Aborode AT, Idowu NJ, Tundealao S, Jaiyeola J, Ogunware AE. Strengthening Brain Research in Africa. J Alzheimers Dis Rep 2023; 7:989-992. [PMID: 37849624 PMCID: PMC10578320 DOI: 10.3233/adr-230062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/14/2023] [Indexed: 10/19/2023] Open
Abstract
This paper explores the emerging field of neuroscience in Africa, considering the unique genetic diversity, socio-cultural determinants, and health inequalities in the continent. It presents numerous brain research initiatives, such as ABDRN, AMARI, APCDR, and H3Africa, aimed at understanding genetic and environmental factors influencing brain disorders in Africa. Despite numerous challenges like the brain drain phenomenon, inadequate infrastructure, and scarce research expertise, significant progress has been achieved. The paper proposes solutions, including international collaboration, capacity-building efforts, and policies to promote neuroscience research, to enhance the understanding of brain function and address brain-related health issues within the African context.
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Affiliation(s)
| | | | - Samuel Tundealao
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Joseph Jaiyeola
- Department of Demography, College for Health, Community and Policy, University of Texas at San Antonio, San Antonio, TX, USA
| | - Adedayo Emmanuel Ogunware
- Department of Neuroscience, Developmental, and Regenerative Biology, University of Texas at San Antonio, San Antonio, TX, USA
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Tunde Aborode A, Jesutofunmi Idowu N, Tundealao S, Jaiyeola J, Constance Chinyere E, Charles Ogunleye S, Olorunshola M, Adedayo Emmanuel O. Integrative Precision Medicine for Dementia and Alzheimer's Diseases in Africa. AGING BRAIN 2023; 4:100095. [PMID: 38098965 PMCID: PMC10719563 DOI: 10.1016/j.nbas.2023.100095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 12/17/2023] Open
Affiliation(s)
| | | | - Samuel Tundealao
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Joseph Jaiyeola
- Department of Demography, College for Health, Community and Policy, University of Texas at San Antonio
| | | | - Seto Charles Ogunleye
- Comparative Biomedical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, 39760, MS, USA
| | - Mercy Olorunshola
- Department of Biological Sciences, State University of New York at Binghamton, NewYork, USA
| | - Ogunware Adedayo Emmanuel
- Department of Neuroscience, Developmental, and Regenerative Biology, University of Texas at San Antonio, USA
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Mohamed W. Leveraging genetic diversity to understand monogenic Parkinson's disease's landscape in AfrAbia. AMERICAN JOURNAL OF NEURODEGENERATIVE DISEASE 2023; 12:108-122. [PMID: 37736165 PMCID: PMC10509492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023]
Abstract
Parkinson's disease may be caused by a single highly deleterious and penetrant pathogenic variant in 5-10% of cases (monogenic). Research into these mutational disorders yields important pathophysiological insights. This article examines the phenotype, genotype, pathophysiology, and geographic and ethnic distribution of genetic forms of disease. Well established Parkinson's disease (PD) causal variants can follow an autosomal dominant (SNCA, LRRK2, and VPS35) and autosomal recessive pattern of inheritance (PRKN, PINK1, and DJ). Parkinson's disease is a worldwide condition, yet the AfrAbia population is understudied in this regard. No prevalence or incidence investigations have been conducted yet. Few studies on genetic risk factors for PD in AfrAbia communities have been reported which supported the notion that the prevalence and incidence rates of PD in AfrAbia are generally lower than those reported for European and North American populations. There have been only a handful of documented genetic studies of PD in AfrAbia and very limited cohort and case-control research studies on PD have been documented. In this article, we provide a summary of prior conducted research on monogenic PD in Africa and highlight data gaps and promising new research directions. We emphasize that monogenic Parkinson's disease is influenced by distinctions in ethnicity and geography, thereby reinforcing the need for global initiatives to aggregate large numbers of patients and identify novel candidate genes. The current article increases our knowledge of the genetics of Parkinson's disease (PD) and helps to further our knowledge on the genetic factors that contribute to PD, such as the lower penetrance and varying clinical expressivity of known genetic variants, particularly in AfrAbian PD patients.
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Affiliation(s)
- Wael Mohamed
- Basic Medical Science Department, Kulliyah of Medicine, International Islamic University Malaysia Kuantan, Pahang, Malaysia
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8
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Amoakoh-Coleman M, Vieira D, Abugri J. Ethical considerations for Biobanking and Use of Genomics Data in Africa: A narrative review. RESEARCH SQUARE 2023:rs.3.rs-3173909. [PMID: 37546977 PMCID: PMC10402194 DOI: 10.21203/rs.3.rs-3173909/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Background Biobanking and genomic research requires collection and storage of human tissue from study participants. From participants' perspectives within the African context, this can be associated with fears and misgivings due to a myriad of factors including myths and mistrust of researchers. From the researchers angle ethical dilemmas may arise especially with consenting and sample reuse during storage. The aim of this paper was to explore these ethical considerations in the establishment and conduct of biobanking and biogenomic studies in Africa. Methods We conducted a narrative synthesis following a comprehensive search of nine (9) databases and grey literature. Ethical issues studied related to community knowledge and understanding of biobanking and genomic research, regulation, and governance of same by research ethics committees, enrolment of participants, types of informed consents, data collection, storage, usage and sharing as well as material transfer, returning results and benefit sharing. Results Of 2,663 title and abstracts screened, 94 full texts were retrieved and reviewed for eligibility. We included 12 studies (7 qualitative; 4 quantitative and one mixed methods). More education of study participants is needed, as well as appropriate community engagement processes that allow community confidence in enrolment into such studies. Competence of review and ethics committees (RECs) should be enhanced to adequately review and govern biobanking and genomic research in Africa. Biospecimen collection and storage is given in trust and participants expect confidentially of data and results generated. Most participants are comfortable with broad consent due to trust in researchers, though a few would like to be contacted for reconsenting in future studies, and this would depend on whether the new research is for good cause. Sharing data with external partners is welcome in some contexts but some research participants did not trust foreign researchers. Conclusion With these varying ethical considerations, we recommend that stakeholders, including research ethics committees, work together to adapt and use clearly defined ethical frameworks, guidelines, and policy documents to harmonize the establishment and running of biobanking and genomic research in Africa.
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Affiliation(s)
| | - Dorice Vieira
- Health Sciences Library, Grossman School of Medicine, New York University
| | - James Abugri
- School of Chemical and Biochemical Sciences, C.K. Tedam University. of Technology & Applied Sciences
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9
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Kong C, Campbell M, Kpobi L, Swartz L, Atuire C. The hermeneutics of recovery: Facilitating dialogue between African and Western mental health frameworks. Transcult Psychiatry 2023; 60:428-442. [PMID: 33761813 DOI: 10.1177/13634615211000549] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The widespread use of faith-based and traditional healing for mental disorders within African contexts is well known. However, normative responses tend to fall within two camps: on one hand, those oriented towards the biomedical model of psychiatry stress the abuses and superstition of such healing, whilst critics adopting a more 'local' perspective have fundamentally challenged the universalist claims of biomedical diagnostic categories and psychiatric treatments. What seemingly emerges is a dichotomy between those who endorse more 'universalist' or 'relativist' approaches as an analytical lens to the challenges of the diverse healing strands within African contexts. In this article, we draw upon the resources of philosophy and existing empirical work to challenge the notion that constructive dialogue cannot be had between seemingly incommensurable healing practices in global mental health. First, we suggest the need for much-needed conceptual clarity to explore the hermeneutics of meaning, practice, and understanding, in order to forge constructive normative pathways of dialogue between seemingly incommensurable values and conceptual schemas around mental disorder and healing. Second, we contextualise the complex motives to emphasise difference amongst health practitioners within a competitive healing economy. Finally, we appeal to the notion of recovery as discovery as a fruitful conceptual framework which incorporates dialogue, comparative evaluation, and cross-cultural enrichment across divergent conceptualisations of mental health.
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Soo CC, Brandenburg JT, Nebel A, Tollman S, Berkman L, Ramsay M, Choudhury A. Genome-wide association study of population-standardised cognitive performance phenotypes in a rural South African community. Commun Biol 2023; 6:328. [PMID: 36973338 PMCID: PMC10043003 DOI: 10.1038/s42003-023-04636-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/28/2023] [Indexed: 03/29/2023] Open
Abstract
Cognitive function is an indicator for global physical and mental health, and cognitive impairment has been associated with poorer life outcomes and earlier mortality. A standard cognition test, adapted to a rural-dwelling African community, and the Oxford Cognition Screen-Plus were used to capture cognitive performance as five continuous traits (total cognition score, verbal episodic memory, executive function, language, and visuospatial ability) for 2,246 adults in this population of South Africans. A novel common variant, rs73485231, reached genome-wide significance for association with episodic memory using data for ~14 million markers imputed from the H3Africa genotyping array data. Window-based replication of previously implicated variants and regions of interest support the discovery of African-specific associated variants despite the small population size and low allele frequency. This African genome-wide association study identifies suggestive associations with general cognition and domain-specific cognitive pathways and lays the groundwork for further genomic studies on cognition in Africa.
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Affiliation(s)
- Cassandra C Soo
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Division of Human Genetics, National Health Laboratory Service and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Jean-Tristan Brandenburg
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Almut Nebel
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Institute of Clinical Molecular Biology, Kiel University, 24105, Kiel, Germany
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa Berkman
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
| | - Michèle Ramsay
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ananyo Choudhury
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Neurogenomics in Africa: current state, challenges, opportunities, and recommendation. Ann Med Surg (Lond) 2023; 85:351-354. [PMID: 36845781 PMCID: PMC9949868 DOI: 10.1097/ms9.0000000000000158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/25/2022] [Indexed: 02/28/2023] Open
Abstract
Neurological diseases are becoming more common in Africa. Current estimates indicate that Africa has a significant burden of neurological illnesses, though it is unclear what fraction of the burden may be linked to genetic transmission. In recent years, there has been a significant expansion in the knowledge of the genetic basis of neurological illnesses. This has been made possible mainly by the positional cloning research paradigm, which uses linkage studies to pinpoint specific genes on chromosomes and targeted screening of Mendelian neurological illnesses to identify the causative genes. However, there is currently very little and unequal geographic knowledge about neurogenetics in African people. The lack of collaboration between academics studying neurogenomics and bioinformatics contributes to the scarcity of large-scale neurogenomic investigations in Africa. The primary cause is a shortage of funding from the African government for clinical researchers; this has resulted in heterogeneity in research collaboration in the region as African researchers work more closely with researchers outside the region due to pulling factors of standardized laboratory resources and adequate funding. Therefore, adequate funding is required to elevate researchers' morale and give them the resources they need for their neurogenomic and bioinformatics studies. For Africa to fully benefit from this significant research area, substantial and sustainable financial investments in the training of scientists and clinicians will be required.
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12
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Azeez IA, Awogbindin IO, Olayinka JN, Folarin RO, Adamu AS, Ior LD, Shehu AM, Mukhtar AI, Ajeigbe OF, Emokpae AO, Usende IL, Babatunde BR, Yusha'u Y, Olateju OI, Kamoga R, Benson AIO, Oparaji KC, Owemidu IO, Iliyasu MO, Imam MI, Olopade JO. Neural stem cell research in Africa: current realities and future prospects. Biol Open 2022; 11:280534. [PMID: 36326097 PMCID: PMC9641530 DOI: 10.1242/bio.059574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Neural stem cells (NSCs) are immature progenitor cells that are found in developing and adult brains that have the potential of dividing actively and renewing themselves, with a complex form of gene expression. The generation of new brain cells in adult individuals was initially considered impossible, however, the landmark discovery of human neural stem cells in the hippocampus has been followed by further discoveries in other discreet regions of the brain. Investigation into the current state in Africa of the research and use of NSCs shows relatively limited activities on the continent. Information on the African application of NSCs for modelling disease mechanisms, drug discovery, and therapeutics is still limited. The International Brain Research Organization (IBRO)-African Regional Committee (ARC), with support from the Company of Biologists, and the Movement Disorder Society, sponsored the first African Basic School on NSC in Ibadan, Nigeria, with the vision of bringing together young neuroscientists and physicians across different fields in neuroscience to learn from leaders who have applied NSCs in stem cell research, the pathophysiology of neurodegenerative diseases, neuroanatomy, and neurotherapeutics. Twenty early-career researchers in academic institutions at junior and senior faculty cadres were selected from South Africa, Uganda and Nigeria. The students and organizer of the school, who wrote this review on the state of NSCs research in Africa, recommended the following: (1) other African countries can take a cue from South Africa and Nigeria in probing the phenomena of adult neurogenesis in unique animal species on the continent; (2) Africa should leverage the expertise and facilities of South African scientists and international collaborators in scaling up NSC research into these unique species and (3) Centers of Excellence should be established on the continent to serve as research hubs for training postgraduate students, and facilities for African scientists who trained overseas on NSCs.
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Affiliation(s)
- Idris A. Azeez
- Department of Veterinary Anatomy, University of Jos 1 , Jos, 930001 Nigeria
| | | | - Juliet N. Olayinka
- Department of Pharmacology and Therapeutics, Afe Babalola University 3 , Ado-Ekiti, 360001 Nigeria
| | - Royhaan O. Folarin
- Department of Anatomy, Olabisi Onabanjo University 4 , Ago-Iwoye, 120107 Nigeria
| | - Abubakar S. Adamu
- Department of Human Anatomy, Ahmadu Bello University 5 , Zaria, 810107 , Nigeria
| | - Lydia D. Ior
- Department of Pharmacology, University of Jos 6 , Jos, 930001 , Nigeria
| | - Asmau M. Shehu
- Department of Human Anatomy, Federal University Dutse 7 , Dutse, 720223 , Nigeria
- School of Anatomical Sciences, University of the Witwatersrand 8 , Johannesburg, Wits 2050 , South Africa
| | - Abubakar I. Mukhtar
- Department of Human Anatomy, Ahmadu Bello University 5 , Zaria, 810107 , Nigeria
| | - Olufunke F. Ajeigbe
- Elizade University, Ilara-Mokin, 340112 9 Department of Physical and Chemical Sciences, Biochemistry Programme , , Nigeria
| | | | - Ifukibot L. Usende
- Department of Veterinary Anatomy, University of Abuja 11 , Abuja, 900105 , Nigeria
| | | | - Yusuf Yusha'u
- Department of Human Physiology, Ahmadu Bello University 12 , Zaria, 810107 , Nigeria
| | - Oladiran I. Olateju
- School of Anatomical Sciences, University of the Witwatersrand 8 , Johannesburg, Wits 2050 , South Africa
| | - Ronald Kamoga
- Department of Pharmacology and Therapeutics, Mbarara University of Science and Technology 13 , Mbarara P.O. Box 1410 , Uganda
| | - Ayoola I. O. Benson
- Department of Human Anatomy, Elizade University, Ilara-Mokin 14 , Abakaliki, 482131 Nigeria
| | - Kenneth C. Oparaji
- Department of Physiology, Alex Ekwueme Federal University Ndufu-Alike 15 , Abakaliki, 482131 , Nigeria
| | - Idowu O. Owemidu
- Department of Physiology, Kogi State University 16 , Anyigba, 272102 , Nigeria
| | - Musa O. Iliyasu
- Department of Anatomy, Kogi State University 17 , Anyigba, 272102 , Nigeria
| | - Maryam I. Imam
- Department of Human Physiology, Ahmadu Bello University 12 , Zaria, 810107 , Nigeria
| | - James O. Olopade
- Department of Veterinary Anatomy, University of Ibadan 18 , Ibadan, 200005 , Nigeria
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Akinyemi RO, Yaria J, Ojagbemi A, Guerchet M, Okubadejo N, Njamnshi AK, Sarfo FS, Akpalu A, Ogbole G, Ayantayo T, Adokonou T, Paddick SM, Ndetei D, Bosche J, Ayele B, Damas A, Coker M, Mbakile-Mahlanza L, Ranchod K, Bobrow K, Anazodo U, Damasceno A, Seshadri S, Pericak-Vance M, Lawlor B, Miller BL, Owolabi M, Baiyewu O, Walker R, Gureje O, Kalaria RN, Ogunniyi A. Dementia in Africa: Current evidence, knowledge gaps, and future directions. Alzheimers Dement 2022; 18:790-809. [PMID: 34569714 PMCID: PMC8957626 DOI: 10.1002/alz.12432] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/21/2021] [Accepted: 06/11/2021] [Indexed: 12/19/2022]
Abstract
In tandem with the ever-increasing aging population in low and middle-income countries, the burden of dementia is rising on the African continent. Dementia prevalence varies from 2.3% to 20.0% and incidence rates are 13.3 per 1000 person-years with increasing mortality in parts of rapidly transforming Africa. Differences in nutrition, cardiovascular factors, comorbidities, infections, mortality, and detection likely contribute to lower incidence. Alzheimer's disease, vascular dementia, and human immunodeficiency virus/acquired immunodeficiency syndrome-associated neurocognitive disorders are the most common dementia subtypes. Comprehensive longitudinal studies with robust methodology and regional coverage would provide more reliable information. The apolipoprotein E (APOE) ε4 allele is most studied but has shown differential effects within African ancestry compared to Caucasian. More candidate gene and genome-wide association studies are needed to relate to dementia phenotypes. Validated culture-sensitive cognitive tools not influenced by education and language differences are critically needed for implementation across multidisciplinary groupings such as the proposed African Dementia Consortium.
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Affiliation(s)
- Rufus O Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - Joseph Yaria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - Akin Ojagbemi
- Department of Psychiatry University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Maëlenn Guerchet
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Njideka Okubadejo
- Neurology Unit, Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi Araba, Lagos, Nigeria
| | - Alfred K Njamnshi
- Department of Neurology, Yaoundé Central Hospital/Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
- Brain Research Africa Initiative (BRAIN), Geneva, Switzerland/Yaoundé, Cameroon
| | - Fred S Sarfo
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School/Korle Bu Teaching Hospital, Accra, Ghana
| | - Godwin Ogbole
- Department of Radiology, University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Temitayo Ayantayo
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Thierry Adokonou
- Department of Neurology, University Teaching Hospital, Parakou, Benin
| | - Stella-Maria Paddick
- Translational and Clinical Research Institute, Newcastle University, UK/Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - David Ndetei
- Department of Psychiatry, University of Nairobi and African Meatal Health and Training Foundation, Nairobi, Kenya
| | - Judith Bosche
- Kilimanjaro Christian Medical College, Moshi, Tanzania
| | - Biniyam Ayele
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Andrea Damas
- Mirembe Mental Health Hospital, Dodoma, Tanzania
| | - Motunrayo Coker
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Lingani Mbakile-Mahlanza
- Department of Psychology, Faculty of Social Sciences, University of Botswana, Gaborone, Botswana
| | - Kirti Ranchod
- Lufuno Neuropsychiatry Centre, Johannesburg, South Africa
| | - Kirsten Bobrow
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Udunna Anazodo
- Lawson Health Research Institute / Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Albertino Damasceno
- Department of Cardiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, Texas, USA
| | - Margaret Pericak-Vance
- John T. Hussman Institute for Human Genomics and the Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Brian Lawlor
- Global Brain Health Institute, Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Bruce L Miller
- Global Brain Health Institute, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Mayowa Owolabi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - Olusegun Baiyewu
- Department of Psychiatry University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Richard Walker
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, North Tyneside General Hospital, North Shields, UK
| | - Oye Gureje
- Department of Psychiatry University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rajesh N Kalaria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Adesola Ogunniyi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
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14
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Mahungu AC, Monnakgotla N, Nel M, Heckmann JM. A review of the genetic spectrum of hereditary spastic paraplegias, inherited neuropathies and spinal muscular atrophies in Africans. Orphanet J Rare Dis 2022; 17:133. [PMID: 35331287 PMCID: PMC8944057 DOI: 10.1186/s13023-022-02280-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background Genetic investigations of inherited neuromuscular disorders in Africans, have been neglected. We aimed to summarise the published data and comment on the genetic evidence related to inherited neuropathies (Charcot-Marie-Tooth disease (CMT)), hereditary spastic paraplegias (HSP) and spinal muscular atrophy (SMA) in Africans. Methods PubMed was searched for relevant articles and manual checking of references and review publications were performed for African-ancestry participants with relevant phenotypes and identified genetic variants. For each case report we extracted phenotype information, inheritance pattern, variant segregation and variant frequency in population controls (including up to date frequencies from the gnomAD database). Results For HSP, 23 reports were found spanning the years 2000–2019 of which 19 related to North Africans, with high consanguinity, and six included sub-Saharan Africans. For CMT, 19 reports spanning years 2002–2021, of which 16 related to North Africans and 3 to sub-Saharan Africans. Most genetic variants had not been previously reported. There were 12 reports spanning years 1999–2020 related to SMN1-SMA caused by homozygous exon 7 ± 8 deletion. Interestingly, the population frequency of heterozygous SMN1-exon 7 deletion mutations appeared 2 × lower in Africans compared to Europeans, in addition to differences in the architecture of the SMN2 locus which may impact SMN1-SMA prognosis. Conclusions Overall, genetic data on inherited neuromuscular diseases in sub-Saharan Africa, are sparse. If African patients with rare neuromuscular diseases are to benefit from the expansion in genomics capabilities and therapeutic advancements, then it is critical to document the mutational spectrum of inherited neuromuscular disease in Africa. Highlights Review of genetic variants reported in hereditary spastic paraplegia in Africans Review of genetic variants reported in genetic neuropathies in Africans Review of genetic underpinnings of spinal muscular atrophies in Africans Assessment of pathogenic evidence for candidate variants
Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02280-2.
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Affiliation(s)
- Amokelani C Mahungu
- Neurology Research Group, University of Cape Town Neuroscience Institute, Cape Town, South Africa
| | | | - Melissa Nel
- Neurology Research Group, University of Cape Town Neuroscience Institute, Cape Town, South Africa
| | - Jeannine M Heckmann
- E8-74 Neurology, Department of Medicine, Groote Schuur Hospital and the University of Cape Town Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
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15
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Howlett WP. Rapidly progressive dementia: limitations in Africa. Pract Neurol 2022; 22:342-343. [DOI: 10.1136/practneurol-2022-003385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2022] [Indexed: 11/04/2022]
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16
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Maina MB, Ahmad U, Ibrahim HA, Hamidu SK, Nasr FE, Salihu AT, Abushouk AI, Abdurrazak M, Awadelkareem MA, Amin A, Imam A, Akinrinade ID, Yakubu AH, Azeez IA, Mohammed YG, Adamu AA, Ibrahim HB, Bukar AM, Yaro AU, Goni BW, Prieto-Godino LL, Baden T. Two decades of neuroscience publication trends in Africa. Nat Commun 2021; 12:3429. [PMID: 34103514 PMCID: PMC8187719 DOI: 10.1038/s41467-021-23784-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 05/11/2021] [Indexed: 12/12/2022] Open
Abstract
Neuroscience research in Africa remains sparse. Devising new policies to boost Africa's neuroscience landscape is imperative, but these must be based on accurate data on research outputs which is largely lacking. Such data must reflect the heterogeneity of research environments across the continent's 54 countries. Here, we analyse neuroscience publications affiliated with African institutions between 1996 and 2017. Of 12,326 PubMed indexed publications, 5,219 show clear evidence that the work was performed in Africa and led by African-based researchers - on average ~5 per country and year. From here, we extract information on journals and citations, funding, international coauthorships and techniques used. For reference, we also extract the same metrics from 220 randomly selected publications each from the UK, USA, Australia, Japan and Brazil. Our dataset provides insights into the current state of African neuroscience research in a global context.
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Affiliation(s)
- M B Maina
- School of Life Sciences, University of Sussex, Brighton, UK.
- Biomedical Science Research and Training Centre, College of Medical Sciences, Yobe State University, Damaturu, Nigeria.
- TReND in Africa (www.TReNDinAfrica.org), Brighton, UK.
| | - U Ahmad
- Medical Genetics Laboratory, Genetics and Regenerative Medicine Research Centre, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia
- Department of Anatomy, Faculty of Basic Medical Sciences, Bauchi State University, PMB 65, Gadau, Nigeria
| | - H A Ibrahim
- College of Medicine, Misr University for Science and Technology, Giza, Egypt
| | - S K Hamidu
- TReND in Africa (www.TReNDinAfrica.org), Brighton, UK
- Department of Human Anatomy, Faculty of Basic Medical Sciences, Gombe State University, Gombe, Nigeria
| | - F E Nasr
- TReND in Africa (www.TReNDinAfrica.org), Brighton, UK
- Faculty of Science, Alexandria University, Alexandria, Egypt
| | - A T Salihu
- Non-invasive Brain Stimulation and Neuroplasticity Laboratory, Department of Physiotherapy, School of Primary and Allied Healthcare, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Physiotherapy, Hasiya Bayero Paediatric Hospital, Kano, Nigeria
| | - A I Abushouk
- Harvard Medical School, Harvard University, Boston, MA, USA
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - M Abdurrazak
- Sheka Primary Health Care Kumbotso, Kano, Nigeria
| | - M A Awadelkareem
- TReND in Africa (www.TReNDinAfrica.org), Brighton, UK
- Faculty of Medical Laboratory Sciences, Al-Neelain University, Khartoum, Sudan
- UK Dementia Research Institute and Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Department of Neuroscience Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - A Amin
- TReND in Africa (www.TReNDinAfrica.org), Brighton, UK
- Instituto Gulbenkian de Ciência, Oeiras, Portugal
- Department of Physiology, Faculty of Basic Medical Sciences, University of Ilorin, Ilorin, Nigeria
| | - A Imam
- Department of Anatomy, Faculty of Basic Medical Sciences, University of Ilorin, Ilorin, Nigeria
- School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - I D Akinrinade
- TReND in Africa (www.TReNDinAfrica.org), Brighton, UK
- Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - A H Yakubu
- TReND in Africa (www.TReNDinAfrica.org), Brighton, UK
- Faculty of Pharmacy, University of Maiduguri, Maiduguri, Nigeria
| | - I A Azeez
- Department of Neuroscience Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Department of Veterinary Anatomy, Faculty of Veterinary Medicine, University of Jos, Jos, Nigeria
| | - Y G Mohammed
- TReND in Africa (www.TReNDinAfrica.org), Brighton, UK
- Department of Human Anatomy, Faculty of Basic Medical Sciences, Gombe State University, Gombe, Nigeria
- Department of Biology, Neurobiology group, University of Konstanz, Baden Wurttemberg, Germany
| | - A A Adamu
- Department of Physiotherapy, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - H B Ibrahim
- Department of Pharmacy, Federal Medical Centre, Katsina, Nigeria
| | - A M Bukar
- Centre for Visual Computing, University of Bradford, Bradford, UK
| | - A U Yaro
- College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - B W Goni
- Department of Medicine, Yobe State University Teaching Hospital Damaturu PMB 1072, Damaturu, Yobe State, Nigeria
| | - L L Prieto-Godino
- TReND in Africa (www.TReNDinAfrica.org), Brighton, UK.
- Francis Crick Institute, London, UK.
| | - T Baden
- School of Life Sciences, University of Sussex, Brighton, UK.
- TReND in Africa (www.TReNDinAfrica.org), Brighton, UK.
- Institute of Ophthalmic Research, University of Tübingen, Tübingen, Germany.
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Abstract
Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2-3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa.
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18
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Dekker MCJ, Coulibaly T, Bardien S, Ross OA, Carr J, Komolafe M. Parkinson's Disease Research on the African Continent: Obstacles and Opportunities. Front Neurol 2020; 11:512. [PMID: 32636796 PMCID: PMC7317302 DOI: 10.3389/fneur.2020.00512] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/08/2020] [Indexed: 12/11/2022] Open
Abstract
The burden of Parkinson's disease (PD) is becoming increasingly important in the context of an aging African population. Although PD has been extensively investigated with respect to its environmental and genetic etiology in various populations across the globe, studies on the African continent remain limited. In this Perspective article, we review some of the obstacles that are limiting research and creating barriers for future studies. We summarize what research is being done in four sub-Saharan countries and what the key elements are that are needed to take research to the next level. We note that there is large variation in neurological and genetic research capacity across the continent, and many opportunities for unexplored areas in African PD research. Only a handful of countries possess appropriate infrastructure and personnel, whereas the majority have yet to develop such capacity. Resource-constrained environments strongly determines the possibilities of performing research locally, and unidirectional export of biological samples and genetic data remains a concern. Local-regional partnerships, in collaboration with global PD consortia, should form an ethically appropriate solution, which will lead to a reduction in inequality and promote capacity building on the African continent.
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Affiliation(s)
- Marieke C J Dekker
- Department of Medicine and Pediatrics, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Toumany Coulibaly
- Service de Neurologie, Centre Hospitalier Universitaire du Point "G", Bamako, Mali
| | - Soraya Bardien
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Owen A Ross
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, United States.,Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL, United States
| | - Jonathan Carr
- Division of Neurology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Morenikeji Komolafe
- Department of Medicine, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
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19
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Akinyemi RO, Jenkins C, Nichols M, Singh A, Wahab K, Akpalu A, Sarfo FS, Owolabi LF, Obiako R, Akinyemi J, Ojebuyi B, Adigun M, Musbahu R, Bello A, Titiloye M, Calys-Tagoe B, Ogunronbi M, Uvere E, Laryea R, Fakunle A, Adeleye O, Olorunsogbon O, Ojo A, Adesina D, Mensah N, Oguike W, Coleman N, Mande A, Uthman M, Kalaria RN, Jegede A, Owolabi M, Ovbiagele B, Arulogun O. Unraveling the Ethical, Legal, and Social Implications of Neurobiobanking and Stroke Genomic Research in Africa: A Study Protocol of the African Neurobiobank for Precision Stroke Medicine ELSI Project. INTERNATIONAL JOURNAL OF QUALITATIVE METHODS 2020; 19:10.1177/1609406920923194. [PMID: 34276269 PMCID: PMC8284747 DOI: 10.1177/1609406920923194] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The ethical, legal, and social implications (ELSI) of emerging neurobiobanks and data resources are unclear in an African scientific landscape with unique cultural, linguistic, and belief systems. The overarching goal of the African Neurobiobank for Precision Stroke Medicine-ELSI Project is to identify, examine, and develop novel approaches to address ELSI issues of biobanking and stroke genomic research in sub-Saharan Africa (SSA). To accomplish the goal we will (1) explore knowledge, attitude, perceptions, barriers, and facilitators influencing ELSI issues related to biobanking and stroke genomic research; (2) use information obtained to craft a community intervention program focused on ELSI issues; and (3) build capacity and careers related to genomics and biobanking for effective client/community engagement while enhancing regulatory, governance, and implementation competences in biobanking science in SSA. A community-based participatory research and mixed-methodological approach, focused on various levels of the social ecological model, will be used to identify and examine relevant ELSI issues. Contextual intervention tools, platforms, and practices will be developed to enhance community understanding and participation in stroke biobanking and genomics research activities while facilitating enduring trust, and equitable and fair utilization of biobanking resources for genetic and trans-omics research. A concurrent capacity building program related to genetic counseling and biobanking will be implemented for early career researchers. The huge potential for neurobiobanking and genomics research in Africa to advance precision medicine applicable to stroke and other neurological disorders requires addressing ELSI challenges while building sustainable research, career, and regulatory capacities in trans-omics and biobanking science.
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Affiliation(s)
- Rufus O. Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Carolyn Jenkins
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Michelle Nichols
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Arti Singh
- KNUST Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kolawole Wahab
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, University of Ilorin, Nigeria
| | - Albert Akpalu
- University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Fred S. Sarfo
- Neurology Unit, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lukman F. Owolabi
- Neurology Unit, Department of Medicine, Aminu Kano Teaching Hospital, Bayero University, Nigeria
| | - Reginald Obiako
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | - Babatunde Ojebuyi
- Department of Communication and Language Arts, Faculty of Arts, University of Ibadan, Nigeria
| | | | - Rabiu Musbahu
- Neurology Unit, Department of Medicine, Aminu Kano Teaching Hospital, Bayero University, Nigeria
- Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Abiodun Bello
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, University of Ilorin, Nigeria
| | - Musibau Titiloye
- Department of Health Promotion and Education, Faculty of Public Health, University of Ibadan, Nigeria
| | | | - Mayowa Ogunronbi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
- Neurology Unit, Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Ezinne Uvere
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Ruth Laryea
- University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Adekunle Fakunle
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Osi Adeleye
- Neurology Unit, Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Olorunyomi Olorunsogbon
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
| | - Adebayo Ojo
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
| | - Deborah Adesina
- Neurology Unit, Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Nathaniel Mensah
- Neurology Unit, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Wisdom Oguike
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria
| | - Nathaniel Coleman
- University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Aliyu Mande
- Neurology Unit, Department of Medicine, Aminu Kano Teaching Hospital, Bayero University, Nigeria
| | - Muhammed Uthman
- Department of Epidemiology and Community Health, Faculty of Clinical Sciences, University of Ilorin, Nigeria
| | - Rajesh N. Kalaria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
- Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ayodele Jegede
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Nigeria
| | - Mayowa Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Bruce Ovbiagele
- School of Medicine, University of California, San Francisco, CA, USA
| | - Oyedunni Arulogun
- Department of Health Promotion and Education, Faculty of Public Health, University of Ibadan, Nigeria
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20
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Amin M, Elsayed L, Ahmed AE. Clinical and Genetic Characteristics of Leukodystrophies in Africa. J Neurosci Rural Pract 2019; 8:S89-S93. [PMID: 28936078 PMCID: PMC5602269 DOI: 10.4103/jnrp.jnrp_511_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Recent understanding of the genetic basis of neurological disorders in Africa has grown rapidly in the last two decades. Africa harbors the largest genetic repertoire in the world which gives unique opportunity to discover novel variant, genes, and molecular pathways associated with various neurological diseases. Despite that, large-scale genomic and exome studies are severely lacking especially for neglected diseases such as leukodystrophies. This review aims to shed light on the currently developed research in leukodystrophies in Africa. We reviewed all research articles related to “Leukodystrophy in Africa” published in Medline/PubMed and Google Scholar databases up to date. We found very few studies in leukodystrophy from Africa, especially from the Sub-Saharan regions. Metachromatic leukodystrophy was the most studied type of leukodystrophy. Published studies from North Africa (Tunisia, Morocco, and Egypt) were very limited in either sample size (case studies or single/few family studies) or molecular methods (targeted sequencing or polymerase chain reaction-restriction fragment length polymorphisms). More studies (GWAS or large family studies) with advanced techniques such as exome or whole genome sequencing are needed to unveil the genetic basis of leukodystrophy in Africa. Unmasking novel genes and molecular pathways of leukodystrophies invariably lead to better detection and treatment for both Africans and worldwide populations.
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Affiliation(s)
- Mutaz Amin
- Department of Biochemistry, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Liena Elsayed
- Department of Biochemistry, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Ammar Eltahir Ahmed
- Department of Physiology, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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Akinyemi RO, Sarfo FS, Akinyemi J, Singh A, Onoja Akpa M, Akpalu A, Owolabi L, Adeoye AM, Obiako R, Wahab K, Sanya E, Komolafe M, Ogbole G, Fawale M, Adebayo P, Osaigbovo G, Sunmonu T, Olowoyo P, Chukwuonye I, Obiabo Y, Adeniji O, Fakunle G, Melikam E, Saulson R, Yaria J, Uwanruochi K, Ibinaiye P, Adeniyi Amusa G, Suleiman Yahaya I, Hamisu Dambatta A, Faniyan M, Olowoniyi P, Bock-Oruma A, Chidi Joseph O, Oguntade A, Kolo P, Laryea R, Lakoh S, Uvere E, Farombi T, Akpalu J, Oyinloye O, Appiah L, Calys-Tagoe B, Shidali V, Abdulkadir Tabari N, Adebayo O, Efidi R, Adeleye O, Owusu D, Ogunjimi L, Aridegbe O, Lucius Imoh C, Sanni T, Gebreziabher M, Hemant T, Arulogun O, Ogunniyi A, Jenkins C, Owolabi M, Ovbiagele B. Knowledge, attitudes and practices of West Africans on genetic studies of stroke: Evidence from the SIREN Study. Int J Stroke 2019; 14:69-79. [PMID: 30040054 PMCID: PMC8325169 DOI: 10.1177/1747493018790059] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND It is crucial to assess genomic literacy related to stroke among Africans in preparation for the ethical, legal and societal implications of the genetic revolution which has begun in Africa. OBJECTIVE To assess the knowledge, attitudes and practices (KAP) of West Africans about stroke genetic studies. METHODS A comparative cross-sectional study was conducted among stroke patients and stroke-free controls recruited across 15 sites in Ghana and Nigeria. Participants' knowledge of heritability of stroke, willingness to undergo genetic testing and perception of the potential benefits of stroke genetic research were assessed using interviewer-administered questionnaire. Descriptive, frequency distribution and multiple regression analyses were performed. RESULTS Only 49% of 2029 stroke patients and 57% of 2603 stroke-free individuals knew that stroke was a heritable disorder. Among those who knew, 90% were willing to undergo genetic testing. Knowledge of stroke heritability was associated with having at least post-secondary education (OR 1.51, 1.25-1.81) and a family history of stroke (OR 1.20, 1.03-1.39) while Islamic religion (OR=0.82, CI: 0.72-0.94), being currently unmarried (OR = 0.81, CI: 0.70-0.92), and alcohol use (OR = 0.78, CI: 0.67-0.91) were associated with lower odds of awareness of stroke as a heritable disorder. Willingness to undergo genetic testing for stroke was associated with having a family history of stroke (OR 1.34, 1.03-1.74) but inversely associated with a medical history of high blood pressure (OR = 0.79, 0.65-0.96). CONCLUSION To further improve knowledge of stroke heritability and willingness to embrace genetic testing for stroke, individuals with less formal education, history of high blood pressure and no family history of stroke require targeted interventions.
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Affiliation(s)
- Rufus O Akinyemi
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria,Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria,Federal Medical Centre, Abeokuta, Nigeria
| | - Fred S Sarfo
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Arti Singh
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Matthew Onoja Akpa
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Albert Akpalu
- Department of Medicine, University of Ghana, Accra, Ghana
| | - Lukman Owolabi
- Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
| | - Abiodun M. Adeoye
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria,Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Emmanuel Sanya
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Morenikeji Komolafe
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Godwin Ogbole
- Department of Radiology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Michael Fawale
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Philip Adebayo
- Department of Medicine, Ladoke Akintola University Teaching Hospital, Ogbomoso, Nigeria
| | - Godwin Osaigbovo
- Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Taofiki Sunmonu
- Department of Medicine, Federal Medical Centre, Owo, Nigeria
| | - Paul Olowoyo
- Department of Medicine, Federal University Teaching Hospital, Ido-Ekiti, Nigeria
| | | | - Yahaya Obiabo
- Department of Medicine, Delta State University Teaching Hospital, Igharra, Nigeria
| | | | - Gregory Fakunle
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ezinne Melikam
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Raelle Saulson
- Department of Neurosciences, Medical University of South Carolina, Charleston, USA
| | - Joseph Yaria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | - Phillip Ibinaiye
- Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | | | | | | | - Mercy Faniyan
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Peter Olowoniyi
- Department of Medicine, Federal Medical Centre, Umuahia, Nigeria
| | - Andrew Bock-Oruma
- Department of Medicine, Delta State University Teaching Hospital, Igharra, Nigeria
| | - Odo Chidi Joseph
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | - Philip Kolo
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Ruth Laryea
- Department of Medicine, University of Ghana, Accra, Ghana
| | - Sulaiman Lakoh
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Ezinne Uvere
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Temitope Farombi
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | - Olalekan Oyinloye
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Lambert Appiah
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | | | - Vincent Shidali
- Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | | | - Oladimeji Adebayo
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Richard Efidi
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | - Dorcas Owusu
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Luqman Ogunjimi
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | | | | | - Taofeeq Sanni
- Department of Medicine, Federal University Teaching Hospital, Ido-Ekiti, Nigeria
| | | | - Tiwari Hemant
- Department of Epidemiology, University of Alabama at Birmingham, Alabama, USA
| | - Oyedunni Arulogun
- Department of Health Promotion and Education, University of Ibadan, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Carolyn Jenkins
- Department of Neurosciences, Medical University of South Carolina, Charleston, USA
| | - Mayowa Owolabi
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria,Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bruce Ovbiagele
- Department of Neurosciences, Medical University of South Carolina, Charleston, USA
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22
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Akinyemi RO, Akinwande K, Diala S, Adeleye O, Ajose A, Issa K, Owusu D, Boamah I, Yahaya IS, Jimoh AO, Imoh L, Fakunle G, Akpalu A, Sarfo F, Wahab K, Sanya E, Owolabi L, Obiako R, Osaigbovo G, Komolafe M, Fawale M, Adebayo P, Olowoyo P, Obiabo Y, Sunmonu T, Chukwuonye I, Balogun O, Adeoye B, Oladele F, Olowoniyi P, Adeyemi F, Lezzi A, Falayi AT, Fasanya M, Ogunwale K, Adeola O, Olomu O, Aridegbe O, Laryea R, Uvere E, Faniyan M, Melikam E, Tagge R, Akpa O, Akinyemi J, Arulogun O, Tiwari HK, Ovbiagele B, Owolabi MO. Biobanking in a Challenging African Environment: Unique Experience from the SIREN Project. Biopreserv Biobank 2018; 16:217-232. [PMID: 29733683 PMCID: PMC5995267 DOI: 10.1089/bio.2017.0113] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Africa was previously insufficiently represented in the emerging discipline of biobanking despite commendable early efforts. However, with the Human, Heredity, and Health in Africa (H3Africa) initiative, biorepository science has been bolstered, regional biobanks are springing up, and awareness about biobanks is growing on the continent. The Stroke Investigative Research and Educational Network (SIREN) project is a transnational, multicenter, hospital and community-based study involving over 3000 cases and 3000 controls recruited from 16 sites in Ghana and Nigeria. SIREN aims to explore and unravel the genetic and environmental factors that interact to produce the peculiar phenotypic and clinical characteristics of stroke as seen in people of African ancestry and facilitate the development of new diagnostics, therapeutics, and preventative strategies. The aim of this article is to describe our experience with the development of the procedure for collection, processing, storage, and shipment of biological samples (blood, serum, plasma, buffy coat, red cell concentrates, and DNA) and brain imaging across coordinating and participating sites within the SIREN Project. The SIREN network was initiated in 2014 with support and funding from the H3Africa Initiative. The SIREN Biobank currently has 3015 brain images, 92,950 blood fractions (serum, plasma, red cell concentrates, and buffy coat) accrued from 8450 recruited subjects, and quantified and aliquoted good-quality DNA extracts from 6150 study subjects. This represents an invaluable resource for future research with expanding genomic and trans-omic technologies. This will facilitate the involvement of indigenous African samples in cutting-edge stroke genomics and trans-omics research. It is, however, critical to effectively engage African stroke patients and community members who have contributed precious biological materials to the SIREN Biobank to generate appropriate evidence base for dealing with ethical, legal, and social issues of privacy, autonomy, identifiability, biorights, governance issues, and public understanding of stroke biobanking in the context of unique African culture, language, and belief systems.
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Affiliation(s)
- Rufus O. Akinyemi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Pathology Department, Federal Medical Centre, Abeokuta, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | | | - Samuel Diala
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Osi Adeleye
- Pathology Department, Federal Medical Centre, Abeokuta, Nigeria
| | - Abiodun Ajose
- Neurology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Kehinde Issa
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Dorcas Owusu
- Neurology Unit, Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Isaac Boamah
- Neurology Unit, Department of Medicine, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | | | | | - Lucius Imoh
- Neurology Unit, Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Gregory Fakunle
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Albert Akpalu
- Neurology Unit, Department of Medicine, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Fred Sarfo
- Neurology Unit, Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Kolawole Wahab
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Emmanuel Sanya
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Lukman Owolabi
- Neurology Unit, Department of Medicine, Bayero University, Kano, Nigeria
| | - Reginald Obiako
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Godwin Osaigbovo
- Neurology Unit, Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Morenikeji Komolafe
- Neurology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Michael Fawale
- Neurology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Philip Adebayo
- Neurology Unit, Department of Medicine, Ladoke Akintola University Teaching Hospital, Ogbomoso, Nigeria
| | - Paul Olowoyo
- Neurology Unit, Department of Medicine, Federal University Teaching Hospital, Ido Ekiti, Nigeria
| | - Yahaya Obiabo
- Neurology Unit, Department of Medicine, Delta State University Teaching Hospital, Igharra, Nigeria
| | - Taofiki Sunmonu
- Neurology Unit, Department of Medicine, Federal Medical Center, Owo, Nigeria
| | - Ijezie Chukwuonye
- Neurology Unit, Department of Medicine, Federal Medical Center, Umuahia, Nigeria
| | - Olayemi Balogun
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Basirat Adeoye
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Florence Oladele
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Peter Olowoniyi
- Neurology Unit, Department of Medicine, Federal Medical Center, Umuahia, Nigeria
| | - Frederick Adeyemi
- Neurology Unit, Department of Medicine, Federal Medical Center, Owo, Nigeria
| | - Arthur Lezzi
- Neurology Unit, Department of Medicine, Delta State University Teaching Hospital, Igharra, Nigeria
| | - Ajibola Tunde Falayi
- Neurology Unit, Department of Medicine, Federal University Teaching Hospital, Ido Ekiti, Nigeria
| | - Michael Fasanya
- Neurology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Kolawole Ogunwale
- Neurology Unit, Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Olabisi Adeola
- Pathology Department, Federal Medical Centre, Abeokuta, Nigeria
| | - Omolara Olomu
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | | | - Ruth Laryea
- Neurology Unit, Department of Medicine, School of Medicine & Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ezinne Uvere
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Moyinoluwalogo Faniyan
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Ezinne Melikam
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Raelle Tagge
- Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina
| | - Onoja Akpa
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Joshua Akinyemi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oyedunni Arulogun
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Hemant K. Tiwari
- School of Public Health, University of Alabama, Birmingham, Alabama
| | - Bruce Ovbiagele
- Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina
| | - Mayowa O. Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Nigeria
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23
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Akinyemi RO, Owolabi MO, Ihara M, Damasceno A, Ogunniyi A, Dotchin C, Paddick SM, Ogeng'o J, Walker R, Kalaria RN. Stroke, cerebrovascular diseases and vascular cognitive impairment in Africa. Brain Res Bull 2018; 145:97-108. [PMID: 29807146 DOI: 10.1016/j.brainresbull.2018.05.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/20/2018] [Accepted: 05/22/2018] [Indexed: 12/30/2022]
Abstract
With increased numbers of older people a higher burden of neurological disorders worldwide is predicted. Stroke and other cerebrovascular diseases do not necessarily present with different phenotypes in Africa but their incidence is rising in tandem with the demographic change in the population. Age remains the strongest irreversible risk factor for stroke and cognitive impairment. Modifiable factors relating to vascular disease risk, diet, lifestyle, physical activity and psychosocial status play a key role in shaping the current spate of stroke related diseases in Africa. Hypertension is the strongest modifiable risk factor for stroke but is also likely associated with co-inheritance of genetic traits among Africans. Somewhat different from high-income countries, strokes attributed to cerebral small vessel disease (SVD) are higher >30% among sub-Saharan Africans. Raised blood pressure may explain most of the incidence of SVD-related strokes but there are likely other contributing factors including dyslipidaemia and diabetes in some sectors of Africa. However, atherosclerotic and cardioembolic diseases combined also appear to be common subtypes as causes of strokes. Significant proportions of cerebrovascular diseases are ascribed to various forms of infectious disease including complications of human immunodeficiency virus. Cerebral SVD leads to several clinical manifestations including gait disturbance, autonomic dysfunction and depression. Pathological processes are characterized by arteriolosclerosis, lacunar infarcts, perivascular spaces, microinfarcts and diffuse white matter changes, which can now all be detected on neuroimaging. Except for isolated cases of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy or CADASIL, hereditary arteriopathies have so far not been reported in Africa. Prevalence estimates of vascular dementia (2-3%), delayed dementia after stroke (10-20%) and vascular cognitive impairment (30-40%) do not appear to be vastly different from those in other parts of the world. However, given the current demographic transition in both urban and rural settings these figures will likely rise. Wider application of neuroimaging modalities and implementation of stroke care in Africa will enable better estimates of SVD and other subtypes of stroke. Stroke survivors with SVD type pathology are likely to have low mortality and therefore portend increased incidence of dementia.
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Affiliation(s)
- Rufus O Akinyemi
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria; Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Mayowa O Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | | | - Adesola Ogunniyi
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Catherine Dotchin
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, United Kingdom
| | - Stella-Maria Paddick
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Julius Ogeng'o
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Richard Walker
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, United Kingdom
| | - Raj N Kalaria
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom.
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24
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Russell VA. Notes on the Recent History of Neuroscience in Africa. Front Neuroanat 2017; 11:96. [PMID: 29163069 PMCID: PMC5681988 DOI: 10.3389/fnana.2017.00096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 10/16/2017] [Indexed: 01/16/2023] Open
Abstract
Neuroscience began with neuroanatomy and neurosurgery in Egypt more than 5000 years ago. Knowledge grew over time and specialized neurosurgery centers were established in north Africa in the eleventh century. However, it was not until the twentieth century that neuroscience research became established in sub-Saharan Africa. In most African countries, clinical research focused on understanding the rationale and improving treatment of epilepsy, infections, nutritional neuropathies, stroke and tumors. Significant advances were made. In the twenty-first century, African knowledge expanded to include all branches of neuroscience, contributing to genetic, biochemical and inflammatory determinants of brain disorders. A major focus of basic neuroscience research has been, and is, investigation of plant extracts, drugs and stress in animal models, providing insight and identifying potential novel therapies. A significant event in the history of African neuroscience was the founding of the Society of Neuroscientists of Africa (SONA) in 1993. The International Brain Research Organization (IBRO) supported SONA conferences, as well as workshops and neuroscience training schools in Africa. Thanks to their investment, as well as that of funding agencies, such as the National Institutes of Health (NIH), International Society for Neurochemistry (ISN), World Federation of Neurosurgical Societies (WFNS), World Federation of Neurology (WFN) and the International League Against Epilepsy (ILAE), neuroscience research is well-established in Africa today. However, in order to continue to develop, African neuroscience needs continued international support and African neuroscientists need to engage in policy and decision-making to persuade governments to fund studies that address the unique regional needs in Africa.
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Affiliation(s)
- Vivienne A Russell
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, South Africa.,School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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25
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Owolabi M, Peprah E, Xu H, Akinyemi R, Tiwari HK, Irvin MR, Wahab KW, Arnett DK, Ovbiagele B. Advancing stroke genomic research in the age of Trans-Omics big data science: Emerging priorities and opportunities. J Neurol Sci 2017; 382:18-28. [PMID: 29111012 DOI: 10.1016/j.jns.2017.09.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/19/2017] [Accepted: 09/15/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND We systematically reviewed the genetic variants associated with stroke in genome-wide association studies (GWAS) and examined the emerging priorities and opportunities for rapidly advancing stroke research in the era of Trans-Omics science. METHODS Using the PRISMA guideline, we searched PubMed and NHGRI- EBI GWAS catalog for stroke studies from 2007 till May 2017. RESULTS We included 31 studies. The major challenge is that the few validated variants could not account for the full genetic risk of stroke and have not been translated for clinical use. None of the studies included continental Africans. Genomic study of stroke among Africans presents a unique opportunity for the discovery, validation, functional annotation, Trans-Omics study and translation of genomic determinants of stroke with implications for global populations. This is because all humans originated from Africa, a continent with a unique genomic architecture and a distinctive epidemiology of stroke; as well as substantially higher heritability and resolution of fine mapping of stroke genes. CONCLUSION Understanding the genomic determinants of stroke and the corresponding molecular mechanisms will revolutionize the development of a new set of precise biomarkers for stroke prediction, diagnosis and prognostic estimates as well as personalized interventions for reducing the global burden of stroke.
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Affiliation(s)
- Mayowa Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Emmanuel Peprah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Huichun Xu
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rufus Akinyemi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Hemant K Tiwari
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, USA
| | - Marguerite R Irvin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, USA
| | - Kolawole Wasiu Wahab
- Department of Medicine, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - Donna K Arnett
- College of Public Health, University of Kentucky at Lexington, USA
| | - Bruce Ovbiagele
- Department of Neurology, Medical University of South Carolina, Charleston, USA
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Quansah E, McGregor NW. Towards diversity in genomics: The emergence of neurogenomics in Africa? Genomics 2017; 110:1-9. [PMID: 28774809 DOI: 10.1016/j.ygeno.2017.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/24/2017] [Accepted: 07/30/2017] [Indexed: 12/11/2022]
Abstract
There is a high burden of mental and neurological disorders in Africa. Nevertheless, there appears to be an under-representation of African ancestry populations in large-scale genomic studies. Here, we evaluated the extent of under-representation of Africans in neurogenomic studies in the GWAS Catalog. We found 569 neurogenomic studies, of which 88.9% were exclusively focused on people with European ancestry and the remaining 11.1% having African ancestry cases included. In terms of population, only 1.2% of the total populations involved in these 569 GWAS studies were of African descent. Further, most of the individuals in the African ancestry category were identified to be African-Americans/Afro-Caribbeans, highlighting the huge under-representation of homogenous African populations in large-scale neurogenomic studies. Efforts geared at establishing strong collaborative ties with European/American researchers, maintaining freely accessible biobanks and establishing comprehensive African genome data repositories to track African genome variations are critical for propelling neurogenomics/precision medicine in Africa.
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Affiliation(s)
- Emmanuel Quansah
- Pharmacology, Faculty of Health and Life Sciences, De Montfort University, Leicester LE1 9BH, UK.
| | - Nathaniel W McGregor
- Department of Genetics, Stellenbosch University, Stellenbosch, South Africa; Department of Psychiatry, Stellenbosch University, Tygerberg Medical Campus, Tygerberg, South Africa.
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Akinyemi R, Arnett DK, Tiwari HK, Ovbiagele B, Sarfo F, Srinivasasainagendra V, Irvin MR, Adeoye A, Perry RT, Akpalu A, Jenkins C, Owolabi L, Obiako R, Wahab K, Sanya E, Komolafe M, Fawale M, Adebayo P, Osaigbovo G, Sunmonu T, Olowoyo P, Chukwuonye I, Obiabo Y, Akpa O, Melikam S, Saulson R, Kalaria R, Ogunniyi A, Owolabi M. Interleukin-6 (IL-6) rs1800796 and cyclin dependent kinase inhibitor (CDKN2A/CDKN2B) rs2383207 are associated with ischemic stroke in indigenous West African Men. J Neurol Sci 2017; 379:229-235. [PMID: 28716248 DOI: 10.1016/j.jns.2017.05.046] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 05/09/2017] [Accepted: 05/22/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Inherited genetic variations offer a possible explanation for the observed peculiarities of stroke in sub - Saharan African populations. Interleukin-6 polymorphisms have been previously associated with ischemic stroke in some non-African populations. AIM Herein we investigated, for the first time, the association of genetic polymorphisms of IL-6, CDKN2A- CDKN2B and other genes with ischemic stroke among indigenous West African participants in the Stroke Investigative Research and Education Network (SIREN) Study. METHODS Twenty-three previously identified single nucleotide polymorphisms (SNPs) in 14 genes of relevance to the neurobiology of ischemic stroke were investigated. Logistic regression models adjusting for known cardiovascular disease risk factors were constructed to assess the associations of the 23 SNPs in rigorously phenotyped cases (N=429) of ischemic stroke (Men=198; Women=231) and stroke- free (N=483) controls (Men=236; Women=247). RESULTS Interleukin-6 (IL6) rs1800796 (C minor allele; frequency: West Africans=8.6%) was significantly associated with ischemic stroke in men (OR=2.006, 95% CI=[1.065, 3.777], p=0.031) with hypertension in the model but not in women. In addition, rs2383207 in CDKN2A/CDKN2B (minor allele A with frequency: West Africans=1.7%) was also associated with ischemic stroke in men (OR=2.550, 95% CI=[1.027, 6.331], p=0.044) with primary covariates in the model, but not in women. Polymorphisms in other genes did not show significant association with ischemic stroke. CONCLUSION Polymorphisms rs1800796 in IL6 gene and rs2383207 in CDKN2A/CDKN2B gene have significant associations with ischemic stroke in indigenous West African men. CDKN2A/CDKN2B SNP rs2383207 is independently associated with ischemic stroke in indigenous West African men. Further research should focus on the contributions of inflammatory genes and other genetic polymorphisms, as well as the influence of sex on the neurobiology of stroke in people of African ancestry.
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Affiliation(s)
- Rufus Akinyemi
- University of Ibadan, Ibadan, Nigeria; Federal Medical Centre Abeokuta, Nigeria
| | | | | | | | - Fred Sarfo
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | | | | | | | | | | | | | | | | | | | - Michael Fawale
- Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Philip Adebayo
- Ladoke Akintola University Teaching Hospital, Ogbomosho, Nigeria
| | | | | | - Paul Olowoyo
- Federal University Teaching Hospital Ido-Ekiti, Nigeria
| | | | - Yahaya Obiabo
- Delta State University Teaching Hospital, Oghara, Nigeria
| | | | | | | | - Raj Kalaria
- Newcastle University, Newcastle upon Tyne, UK
| | | | - Mayowa Owolabi
- University of Ibadan, Ibadan, Nigeria; WFNR-Blossom Specialist Medical Center Ibadan, Nigeria
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Adeoye AM, Ovbiagele B, Kolo P, Appiah L, Aje A, Adebayo O, Sarfo F, Akinyemi J, Adekunle G, Agyekum F, Shidali V, Ogah O, Lackland D, Gebregziabher M, Arnett D, Tiwari HK, Akinyemi R, Olagoke OO, Oguntade AS, Olunuga T, Uwanruochi K, Jenkins C, Adadey P, Iheonye H, Owolabi L, Obiako R, Akinjopo S, Armstrong K, Akpalu A, Fakunle A, Saulson R, Aridegbe M, Olowoyo P, Osaigbovo G, Akpalu J, Fawale B, Adebayo P, Arulogun O, Ibinaiye P, Agunloye A, Ishaq N, Wahab K, Akpa O, Adeleye O, Bock-Oruma A, Ogbole G, Melikam S, Yaria J, Ogunjimi L, Salaam A, Sunmonu T, Makanjuola A, Farombi T, Laryea R, Uvere E, Kehinde S, Chukwuonye I, Azuh P, Komolafe M, Akintunde A, Obiabo O, Areo O, Kehinde I, Amusa AG, Owolabi M. Exploring Overlaps Between the Genomic and Environmental Determinants of LVH and Stroke: A Multicenter Study in West Africa. Glob Heart 2017; 12:107-113.e5. [PMID: 28302552 DOI: 10.1016/j.gheart.2017.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Whether left ventricular hypertrophy (LVH) is determined by similar genomic and environmental risk factors with stroke, or is simply an intermediate stroke marker, is unknown. OBJECTIVES We present a research plan and preliminary findings to explore the overlap in the genomic and environmental determinants of LVH and stroke among Africans participating in the SIREN (Stroke Investigative Research and Education Network) study. METHODS SIREN is a transnational, multicenter study involving acute stroke patients and age-, ethnicity-, and sex-matched control subjects recruited from 9 sites in Ghana and Nigeria. Genomic and environmental risk factors and other relevant phenotypes for stroke and LVH are being collected and compared using standard techniques. RESULTS This preliminary analysis included only 725 stroke patients (mean age 59.1 ± 13.2 years; 54.3% male). Fifty-five percent of the stroke subjects had LVH with greater proportion among women (51.6% vs. 48.4%; p < 0.001). Those with LVH were younger (57.9 ± 12.8 vs. 60.6 ± 13.4; p = 0.006) and had higher mean systolic and diastolic blood pressure (167.1/99.5 mm Hg vs 151.7/90.6 mm Hg; p < 0.001). Uncontrolled blood pressure at presentation was prevalent in subjects with LVH (76.2% vs. 57.7%; p < 0.001). Significant independent predictors of LVH were age <45 years (adjusted odds ratio [AOR]: 1.91; 95% confidence interval [CI]: 1.14 to 3.19), female sex (AOR: 2.01; 95% CI: 1.44 to 2.81), and diastolic blood pressure > 90 mm Hg (AOR: 2.10; 95% CI: 1.39 to 3.19; p < 0.001). CONCLUSIONS The prevalence of LVH was high among stroke patients especially the younger ones, suggesting a genetic component to LVH. Hypertension was a major modifiable risk factor for stroke as well as LVH. It is envisaged that the SIREN project will elucidate polygenic overlap (if present) between LVH and stroke among Africans, thereby defining the role of LVH as a putative intermediate cardiovascular phenotype and therapeutic target to inform interventions to reduce stroke risk in populations of African ancestry.
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Affiliation(s)
| | | | - Philip Kolo
- University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | | | | | - Fred Sarfo
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | | | | | | | | | - Dan Lackland
- Medical University of South Carolina, Charleston, SC, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Raelle Saulson
- Medical University of South Carolina, Charleston, SC, USA
| | | | - Paul Olowoyo
- Federal University Teaching Hospital, Ido-Ekiti, Nigeria
| | | | | | - Bimbo Fawale
- Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Philip Adebayo
- Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | | | | | | | | | | | | | - Omisore Adeleye
- Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | | | | | | | | | | | | | | | | | | | - Ruth Laryea
- University of Ghana Medical School, Accra, Ghana
| | | | | | | | | | | | | | - Olugbo Obiabo
- Delta State University Teaching Hospital, Ogara, Nigeria
| | - Olusegun Areo
- Federal University Teaching Hospital, Ido-Ekiti, Nigeria
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