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The emergence of genotypic divergence and future precision medicine applications. HANDBOOK OF CLINICAL NEUROLOGY 2023; 192:87-99. [PMID: 36796950 DOI: 10.1016/b978-0-323-85538-9.00013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Genotypic divergence is a term adapted from population genetics and intimately linked to evolution. We use divergence here to emphasize the differences that set individuals apart in any cohort. The history of genetics is filled with descriptions of genotypic differences, but causal inference of interindividual biological variation has been scarce. We suggest that the practice of precision medicine requires a divergent approach, an approach dependent on the causal interpretation of previous convergent (and preliminary) knowledge in the field. This knowledge has relied on convergent descriptive syndromology (lumping), which has overemphasized a reductionistic gene determinism on the quest of seeking associations without causal understanding. Regulatory variants with small effect and somatic mutations are some of the modifying factors that lead to incomplete penetrance and intrafamilial variable expressivity often observed in apparently monogenic clinical disorders. A truly divergent approach to precision medicine requires splitting, that is, the consideration of different layers of genetic phenomena that interact causally in a nonlinear fashion. This chapter reviews convergences and divergences in genetics and genomics, aiming to discuss what can be causally understood to approximate the as-yet utopian lands of Precision Medicine for patients with neurodegenerative disorders.
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Andreychuk N, Llop D, Moreno-Vedia J, Girona J, Ibarretxe D, Rodríguez-Borjabad C, Plana N, Masana L. Glycoprotein Serum Concentrations Assessed By 1H-NMR are Increased in Patients With High Blood Pressure. Hypertension 2023; 80:460-469. [PMID: 36384288 DOI: 10.1161/hypertensionaha.122.20137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with hypertension present a permanent state of low-grade inflammation, as the disease activates several pro-inflammatory cells and inflammatory pathways. Glycoproteins A, B, and F, determined by proton nuclear magnetic resonance, provide a highly sensitive method for determining a group of liver-derived pro-inflammatory proteins, and their role has not yet been explored in patients with hypertension. In this study, we evaluated the impact of plasma concentrations of these glycoproteins in patients with hypertension. METHODS This cross-sectional study involved 340 patients attending our vascular and metabolism medicine unit. Of them, 129 were normotensive and 211 were hypertensive. Standard biochemistry and carotid ultrasound measures were performed. Serum concentrations of glycoproteins A, B, and F were determined by proton nuclear magnetic resonance. RESULTS Hypertensive patients presented a higher prevalence of obesity, metabolic syndrome, and diabetes and higher glycoprotein A, B, and F concentrations. Glycoproteins A, B, and F were positively correlated with systolic and diastolic blood pressure. Multivariate logistic models showed that glycoproteins A, B, and F were associated with higher odds of being hypertensive. Machine learning methods corroborated the relationship between glycoproteins and high blood pressure. The higher prevalence of carotid plaques in patients with high blood pressure was partially mediated by glycoproteins A and F. CONCLUSIONS Patients with hypertension present systemic, subclinical inflammation as assessed by liver-derived glycoprotein A, B, and F serum levels. These results support the effect of hypertension on the mechanisms of systemic inflammation. Hypertension-associated systemic inflammation plays a role in hypertension-associated vascular injury and probably in hypertension-induced damage to other organs.
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Affiliation(s)
- Natalia Andreychuk
- Unitat de Medicina Vascular i Metabolisme (UVASMET), Unitat de Recerca en Lípids i Arteriosclerosis, Hospital Universitari Sant Joan, Universitat Rovira i Virgili, CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, IISPV, Reus, Spain
| | - Dídac Llop
- Unitat de Medicina Vascular i Metabolisme (UVASMET), Unitat de Recerca en Lípids i Arteriosclerosis, Hospital Universitari Sant Joan, Universitat Rovira i Virgili, CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, IISPV, Reus, Spain
| | - Juan Moreno-Vedia
- Unitat de Medicina Vascular i Metabolisme (UVASMET), Unitat de Recerca en Lípids i Arteriosclerosis, Hospital Universitari Sant Joan, Universitat Rovira i Virgili, CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, IISPV, Reus, Spain
| | - Josefa Girona
- Unitat de Medicina Vascular i Metabolisme (UVASMET), Unitat de Recerca en Lípids i Arteriosclerosis, Hospital Universitari Sant Joan, Universitat Rovira i Virgili, CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, IISPV, Reus, Spain
| | - Daiana Ibarretxe
- Unitat de Medicina Vascular i Metabolisme (UVASMET), Unitat de Recerca en Lípids i Arteriosclerosis, Hospital Universitari Sant Joan, Universitat Rovira i Virgili, CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, IISPV, Reus, Spain
| | - Cèlia Rodríguez-Borjabad
- Unitat de Medicina Vascular i Metabolisme (UVASMET), Unitat de Recerca en Lípids i Arteriosclerosis, Hospital Universitari Sant Joan, Universitat Rovira i Virgili, CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, IISPV, Reus, Spain
| | - Núria Plana
- Unitat de Medicina Vascular i Metabolisme (UVASMET), Unitat de Recerca en Lípids i Arteriosclerosis, Hospital Universitari Sant Joan, Universitat Rovira i Virgili, CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, IISPV, Reus, Spain
| | - Lluís Masana
- Unitat de Medicina Vascular i Metabolisme (UVASMET), Unitat de Recerca en Lípids i Arteriosclerosis, Hospital Universitari Sant Joan, Universitat Rovira i Virgili, CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, IISPV, Reus, Spain
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Elkomy MH, Khallaf RA, Mahmoud MO, Hussein RRS, El-Kalaawy AM, Abdel-Razik ARH, Aboud HM. Intratracheally Inhalable Nifedipine-Loaded Chitosan-PLGA Nanocomposites as a Promising Nanoplatform for Lung Targeting: Snowballed Protection via Regulation of TGF-β/β-Catenin Pathway in Bleomycin-Induced Pulmonary Fibrosis. Pharmaceuticals (Basel) 2021; 14:ph14121225. [PMID: 34959627 PMCID: PMC8707652 DOI: 10.3390/ph14121225] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 12/16/2022] Open
Abstract
Pulmonary fibrosis is a serious ailment that may progress to lung remodeling and demolition, where the key participants in its incidence are fibroblasts responding to growth factors and cellular calcium swinging. Calcium channel blockers, like nifedipine (NFD), may represent auspicious agents in pulmonary fibrosis treatment. Unfortunately, NFD bears complicated pharmacodynamics and a diminished systemic bioavailability. Thus, the current study aimed to develop a novel, non-invasive nanoplatform for NFD for direct/effective pulmonary targeting via intratracheal instillation. A modified solvent emulsification–evaporation method was adopted for the fabrication of NFD-nanocomposites, integrating poly(D,L-lactide-co-glycolide) (PLGA), chitosan (CTS), and polyvinyl alcohol, and optimized for different physiochemical properties according to the 32 full factorial design. Additionally, the aerodynamic behavior of the nanocomposites was scrutinized through cascade impaction. Moreover, the pharmacokinetic investigations were conducted in rats. Furthermore, the optimum formulation was tested in bleomycin-induced pulmonary fibrosis in rats, wherein fibrotic and oxidative stress parameters were measured. The optimum nanocomposites disclosed a nanosized spherical morphology (226.46 nm), a high entrapment efficiency (61.81%) and a sustained release profile over 24 h (50.4%). As well, it displayed a boosted in vitro lung deposition performance with a mass median aerodynamic diameter of 1.12 µm. Pharmacokinetic studies manifested snowballed bioavailability of the optimal nanocomposites by 3.68- and 2.36-fold compared to both the oral and intratracheal suspensions, respectively. The intratracheal nanocomposites revealed a significant reduction in lung fibrotic and oxidative stress markers notably analogous to normal control besides repairing abnormality in TGF-β/β-catenin pathway. Our results conferred a compelling proof-of-principle that NFD-CTS-PLGA nanocomposites can function as a promising nanoparadigm for pulmonary fibrosis management.
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Affiliation(s)
- Mohammed H. Elkomy
- Department of Pharmaceutics, College of Pharmacy, Jouf University, Sakaka 72388, Saudi Arabia
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62514, Egypt; (R.A.K.); (H.M.A.)
- Correspondence: ; Tel.: +966-56-096-7705
| | - Rasha A. Khallaf
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62514, Egypt; (R.A.K.); (H.M.A.)
| | - Mohamed O. Mahmoud
- Department of Biochemistry, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62514, Egypt;
| | - Raghda R. S. Hussein
- Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62514, Egypt;
- Department of Clinical Pharmacy, Faculty of Pharmacy, Modern University for Technology and Information, Cairo 12055, Egypt
| | - Asmaa M. El-Kalaawy
- Department of Pharmacology, Faculty of Medicine, Beni-Suef University, Beni-Suef 62511, Egypt;
| | | | - Heba M. Aboud
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62514, Egypt; (R.A.K.); (H.M.A.)
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