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Kahlon T, Carlisle S, Otero Mostacero D, Williams N, Trainor P, DeFilippis AP. Angiotensinogen: More Than its Downstream Products: Evidence From Population Studies and Novel Therapeutics. JACC. HEART FAILURE 2022; 10:699-713. [PMID: 35963818 DOI: 10.1016/j.jchf.2022.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 06/08/2022] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
The renin-angiotensin-aldosterone system (RAAS) is a well-defined pathway playing a key role in maintaining circulatory homeostasis. Abnormal activation of RAAS contributes to development of cardiovascular disease, including heart failure, cardiac hypertrophy, hypertension, and atherosclerosis. Although several key RAAS enzymes and peptide hormones have been thoroughly investigated, the role of angiotensinogen-the precursor substrate of the RAAS pathway-remains less understood. The study of angiotensinogen single-nucleotide polymorphisms (SNPs) has provided insight into associations between angiotensinogen and hypertension, congestive heart failure, and atherosclerotic cardiovascular disease. Targeted drug therapy of RAAS has dramatically improved clinical outcomes for patients with heart failure, myocardial infarction, and hypertension. However, all such therapeutics block RAAS components downstream of angiotensinogen and elicit compensatory pathways that limit their therapeutic efficacy as monotherapy. Upstream RAAS targeting by an angiotensinogen inhibitor has the potential to be more efficacious in patients with suboptimal RAAS inhibition and has a better safety profile than multiagent RAAS blockade. Newly developed therapeutics that target angiotensinogen through antisense oligonucleotides or silencer RNA technologies are providing a novel perspective into the pathobiology of angiotensinogen and show promise as the next frontier in the treatment of cardiovascular disease.
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Affiliation(s)
- Tanvir Kahlon
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Samantha Carlisle
- Department of Chemistry and Biochemistry, New Mexico State University, Las Cruces, New Mexico, USA
| | - Diana Otero Mostacero
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Nina Williams
- Warren Clinic Cardiology of Tulsa, St Francis Hospital, Tulsa, Oklahoma, USA
| | - Patrick Trainor
- Department of Chemistry and Biochemistry, New Mexico State University, Las Cruces, New Mexico, USA
| | - Andrew P DeFilippis
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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2
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Mocan O, Rădulescu D, Buzdugan E, Cozma A, Leucuta DC, Bogdan SA, Procopciuc LM. Association between polymorphisms of genes involved in the Renin-Angiotensin-Aldosterone System and the adaptive morphological and functional responses to essential hypertension. Biomed Rep 2021; 15:80. [PMID: 34429966 PMCID: PMC8372125 DOI: 10.3892/br.2021.1456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/13/2021] [Indexed: 12/26/2022] Open
Abstract
Hypertensive cardiac remodeling is illustrated by increased left ventricular (LV) mass index values and/or relative wall thickness (RWT) values >0.42, and functionally by isolated alteration of LV diastole (abnormal relaxation). The aim of the present study was to establish differentiated models of anatomical and functional adaptation to essential hypertension (EHT), in relation to the genetic variants of genes involved in the Renin-Angiotensin-Aldosterone System (RAAS). The M235T-AGT, I/D-ACE, A1166C-R1AngII, A3123C-R2AngII and G83A-REN genotypes were determined using PCR-Restriction Fragment Length Polymorphism in 139 hypertensive subjects. The relationship between the studied RAAS gene polymorphisms with morphological and functional cardiac remodeling was assessed by multiple logistic regression analysis. Patients carrying the C/C, A/C genotypes (A3123C-R2AngII polymorphism) had a 2.72-fold (P=0.033) increased risk of exhibiting an RWT value <0.42; in the multivariate model the risk was 4.02-fold higher (P=0.008). Analysis of LV diastolic dysfunction (LVDD) revealed that hypertensive patients carrying the T/T, M/T genotypes (M235T-AGT polymorphism) had a 2.24-fold (P=0.037) increased risk of developing LVDD and a 2.42-fold increased risk (P=0.039) after adjustment for confounders. Similarly, carriers of the G/G, A/G genotypes (G83A-REN) had a 2.32-fold (P=0.021) increased risk of developing LVDD, and this remained an independent risk factor based on the multivariate model (P=0.033). The results of the present study showed that no particular gene was associated with increased LV mass, but the A3123C-R2AngII polymorphism was associated with a non-concentric type of cardiac response in hypertensive patients. Conversely, the M235T-AGT and G83A-REN polymorphisms were found to be statistically significantly associated with LVDD when assessing abnormal relaxation.
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Affiliation(s)
- Oana Mocan
- Department of Internal Medicine, 5th Medical Clinic, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Dan Rădulescu
- Department of Internal Medicine, 5th Medical Clinic, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Elena Buzdugan
- Department of Internal Medicine, 5th Medical Clinic, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Angela Cozma
- Department of Internal Medicine, 4th Medical Clinic, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Daniel Corneliu Leucuta
- Department of Medical Informatics and Biostatistics, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Sidonia Alina Bogdan
- Department of Surgery, Faculty of Veterinary Medicine, University of Agricultural Science and Veterinary Medicine, 400372 Cluj-Napoca, Romania
| | - Lucia Maria Procopciuc
- Department of Medical Biochemistry, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
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Li PKT, Chow KM. The Clinical and Epidemiological Aspects of Vascular Mortality in Chronic Peritoneal Dialysis Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080502503s20] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This article reviews the clinical aspects of and epidemiological links between vascular mortality and the dialysis population, and emphasizes areas that warrant further clarification. In particular, we highlight potential pitfalls in interpretation of published observational and clinical studies, notably some of the issues related to reverse epidemiology of risk factors for cardiovascular disease. Recent published data from our own center in the Prince of Wales Hospital relating to the significance of residual renal function, inflammation, valvular calcification, as well as left ventricular hypertrophy were highlighted. Actions are needed to tackle both the traditional and the nontraditional factors for cardiovascular disease in order to treat this problem causing the highest mortality in peritoneal dialysis patients.
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Affiliation(s)
- Philip Kam-Tao Li
- Division of Nephrology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kai Ming Chow
- Division of Nephrology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
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4
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Affiliation(s)
- Soner Duman
- Department of Nephrology Ege University Izmir, Turkey
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Cruz-Topete D, Oakley RH, Carroll NG, He B, Myers PH, Xu X, Watts MN, Trosclair K, Glasscock E, Dominic P, Cidlowski JA. Deletion of the Cardiomyocyte Glucocorticoid Receptor Leads to Sexually Dimorphic Changes in Cardiac Gene Expression and Progression to Heart Failure. J Am Heart Assoc 2019; 8:e011012. [PMID: 31311395 PMCID: PMC6761632 DOI: 10.1161/jaha.118.011012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The contribution of glucocorticoids to sexual dimorphism in the heart is essentially unknown. Therefore, we sought to determine the sexually dimorphic actions of glucocorticoid signaling in cardiac function and gene expression. To accomplish this goal, we conducted studies on mice lacking glucocorticoid receptors (GR) in cardiomyocytes (cardioGRKO mouse model). Methods and Results Deletion of cardiomyocyte GR leads to an increase in mortality because of the development of spontaneous cardiac pathology in both male and female mice; however, females are more resistant to GR signaling inactivation in the heart. Male cardioGRKO mice had a median survival age of 6 months. In contrast, females had a median survival age of 10 months. Transthoracic echocardiography data showed phenotypic differences between male and female cardioGRKO hearts. By 3 months of age, male cardioGRKO mice exhibited left ventricular systolic dysfunction. Conversely, no significant functional deficits were observed in female cardioGRKO mice at the same time point. Functional sensitivity of male hearts to the loss of cardiomyocyte GR was reversed following gonadectomy. RNA‐Seq analysis showed that deleting GR in the male hearts leads to a more profound dysregulation in the expression of genes implicated in heart rate regulation (calcium handling). In agreement with these gene expression data, cardiomyocytes isolated from male cardioGRKO hearts displayed altered intracellular calcium responses. In contrast, female GR‐deficient cardiomyocytes presented a response comparable with controls. Conclusions These data suggest that GR regulates calcium responses in a sex‐biased manner, leading to sexually distinct responses to stress in male and female mice hearts, which may contribute to sex differences in heart disease, including the development of ventricular arrhythmias that contribute to heart failure and sudden death.
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Affiliation(s)
- Diana Cruz-Topete
- Department of Molecular and Cellular Physiology LSU Health Sciences Center Shreveport LA.,Center for Cardiovascular Diseases and Sciences LSU Health Sciences Center Shreveport LA
| | - Robert H Oakley
- Signal Transduction Laboratory National Institute of Environmental Health Sciences National Institutes of Health Department of Health and Human Services Research Triangle Park NC
| | - Natalie G Carroll
- Department of Molecular and Cellular Physiology LSU Health Sciences Center Shreveport LA
| | - Bo He
- Signal Transduction Laboratory National Institute of Environmental Health Sciences National Institutes of Health Department of Health and Human Services Research Triangle Park NC
| | - Page H Myers
- Comparative Medicine Branch National Institute of Environmental Health Sciences National Institutes of Health Department of Health and Human Services Research Triangle Park NC
| | - Xiaojiang Xu
- Laboratory of Integrative Bioinformatics National Institute of Environmental Health Sciences National Institutes of Health Department of Health and Human Services Research Triangle Park NC
| | - Megan N Watts
- Department of Cardiology LSU Health Sciences Center Shreveport LA
| | - Krystle Trosclair
- Department of Cellular Biology and Anatomy LSU Health Sciences Center Shreveport LA
| | - Edward Glasscock
- Department of Cellular Biology and Anatomy LSU Health Sciences Center Shreveport LA.,Center for Cardiovascular Diseases and Sciences LSU Health Sciences Center Shreveport LA
| | - Paari Dominic
- Department of Cardiology LSU Health Sciences Center Shreveport LA.,Center for Cardiovascular Diseases and Sciences LSU Health Sciences Center Shreveport LA
| | - John A Cidlowski
- Signal Transduction Laboratory National Institute of Environmental Health Sciences National Institutes of Health Department of Health and Human Services Research Triangle Park NC
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The sirtuin1 gene associates with left ventricular myocardial hypertrophy and remodeling in two chronic kidney disease cohorts: a longitudinal study. J Hypertens 2019; 36:1705-1711. [PMID: 29702498 DOI: 10.1097/hjh.0000000000001746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Oxidative stress and inflammation are major drivers of myocardial hypertrophy in chronic kidney disease (CKD). The silent information regulator gene 1 (Sirt1) is a fundamental mediator of the response to oxidative stress and inflammation and promotes myocardial growth under stress conditions; therefore, it may contribute to myocardial hypertrophy and concentric remodeling of the left ventricle (LV) in CKD. METHODS We investigated the cross-sectional and longitudinal relationship between three candidate polymorphisms in the Sirt1 gene and LV parameters in two cohorts of CKD patients including 235 stage G5D patients and 179 stages G1-5 patients, respectively. RESULTS In both cohorts, the C allele of the Sirt1 rs7069102 polymorphism associated with the posterior wall thickness in separate and combined analyses (beta = 0.15, P = 2 × 10) but was unrelated with the LV volume and the LV mass index indicating a peculiar association of this allele with LV concentric remodeling. Accordingly, the same allele was linked with the LV mass-to-volume ratio in separate and combined (beta = 0.14, P = 2 × 10) analyses in the same cohorts. Furthermore, in longitudinal analyses patients harboring the C allele showed a more pronounced increase in LV mass-to-volume ratio over time than patients without such an allele (regression coefficient = 0.14, 95% confidence interval: 0.05-0.23; P = 3 × 10 in the combined analysis). CONCLUSION The rs7069102 polymorphism in the Sirt1 gene is associated with LV concentric remodeling in two independent cohorts of stages G5D and G1-5 CKD patients. These results offer a genetic basis to the hypothesis that the Sirt1 gene plays a causal role in myocardial hypertrophy and LV concentric remodeling in these patients.
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7
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Yu J, Seldin MM, Fu K, Li S, Lam L, Wang P, Wang Y, Huang D, Nguyen TL, Wei B, Kulkarni RP, Di Carlo D, Teitell M, Pellegrini M, Lusis AJ, Deb A. Topological Arrangement of Cardiac Fibroblasts Regulates Cellular Plasticity. Circ Res 2018; 123:73-85. [PMID: 29691232 DOI: 10.1161/circresaha.118.312589] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/17/2018] [Accepted: 04/22/2018] [Indexed: 01/03/2023]
Abstract
RATIONALE Cardiac fibroblasts do not form a syncytium but reside in the interstitium between myocytes. This topological relationship between fibroblasts and myocytes is maintained throughout postnatal life until an acute myocardial injury occurs, when fibroblasts are recruited to, proliferate and aggregate in the region of myocyte necrosis. The accumulation or aggregation of fibroblasts in the area of injury thus represents a unique event in the life cycle of the fibroblast, but little is known about how changes in the topological arrangement of fibroblasts after cardiac injury affect fibroblast function. OBJECTIVE The objective of the study was to investigate how changes in topological states of cardiac fibroblasts (such as after cardiac injury) affect cellular phenotype. METHODS AND RESULTS Using 2 and 3-dimensional (2D versus 3D) culture conditions, we show that simple aggregation of cardiac fibroblasts is sufficient by itself to induce genome-wide changes in gene expression and chromatin remodeling. Remarkably, gene expression changes are reversible after the transition from a 3D back to 2D state demonstrating a topological regulation of cellular plasticity. Genes induced by fibroblast aggregation are strongly associated and predictive of adverse cardiac outcomes and remodeling in mouse models of cardiac hypertrophy and failure. Using solvent-based tissue clearing techniques to create optically transparent cardiac scar tissue, we show that fibroblasts in the region of dense scar tissue express markers that are induced by fibroblasts in the 3D conformation. Finally, using live cell interferometry, a quantitative phase microscopy technique to detect absolute changes in single cell biomass, we demonstrate that conditioned medium collected from fibroblasts in 3D conformation compared with that from a 2D state significantly increases cardiomyocyte cell hypertrophy. CONCLUSIONS Taken together, these findings demonstrate that simple topological changes in cardiac fibroblast organization are sufficient to induce chromatin remodeling and global changes in gene expression with potential functional consequences for the healing heart.
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Affiliation(s)
- Jingyi Yu
- From the Division of Cardiology, Department of Medicine (J.Y., M.M.S., S.L., P.W., Y.W., A.J.L., A.D.).,Cardiovascular Research Laboratory (J.Y., M.M.S., S.L., P.W., Y.W., A.J.L., A.D.).,Department of Molecular, Cell, and Developmental Biology (J.Y., K.F., S.L., L.L., P.W., Y.W., M.P., A.D.).,Eli & Edythe Broad Center of Regenerative Medicine and Stem Cell Research (J.Y., K.F., S.L., L.L., P.W., Y.W., M.P., A.D.).,Molecular Biology Institute (J.Y., K.F., S.L., L.L., P.W., Y.W., M.T., M.P., A.D.).,Jonsson Comprehensive Cancer Center (J.Y., K.F., S.L., L.L., P.W., Y.W., R.P.K., D.D.C., M.T., M.P., A.D.)
| | - Marcus M Seldin
- From the Division of Cardiology, Department of Medicine (J.Y., M.M.S., S.L., P.W., Y.W., A.J.L., A.D.).,Cardiovascular Research Laboratory (J.Y., M.M.S., S.L., P.W., Y.W., A.J.L., A.D.).,Departments of Human Genetics and Microbiology, Immunology and Molecular Genetics (M.M.S., A.J.L.)
| | - Kai Fu
- Department of Molecular, Cell, and Developmental Biology (J.Y., K.F., S.L., L.L., P.W., Y.W., M.P., A.D.).,Eli & Edythe Broad Center of Regenerative Medicine and Stem Cell Research (J.Y., K.F., S.L., L.L., P.W., Y.W., M.P., A.D.).,Molecular Biology Institute (J.Y., K.F., S.L., L.L., P.W., Y.W., M.T., M.P., A.D.).,Jonsson Comprehensive Cancer Center (J.Y., K.F., S.L., L.L., P.W., Y.W., R.P.K., D.D.C., M.T., M.P., A.D.)
| | - Shen Li
- From the Division of Cardiology, Department of Medicine (J.Y., M.M.S., S.L., P.W., Y.W., A.J.L., A.D.).,Cardiovascular Research Laboratory (J.Y., M.M.S., S.L., P.W., Y.W., A.J.L., A.D.).,Department of Molecular, Cell, and Developmental Biology (J.Y., K.F., S.L., L.L., P.W., Y.W., M.P., A.D.).,Eli & Edythe Broad Center of Regenerative Medicine and Stem Cell Research (J.Y., K.F., S.L., L.L., P.W., Y.W., M.P., A.D.).,Molecular Biology Institute (J.Y., K.F., S.L., L.L., P.W., Y.W., M.T., M.P., A.D.).,Jonsson Comprehensive Cancer Center (J.Y., K.F., S.L., L.L., P.W., Y.W., R.P.K., D.D.C., M.T., M.P., A.D.)
| | - Larry Lam
- Department of Molecular, Cell, and Developmental Biology (J.Y., K.F., S.L., L.L., P.W., Y.W., M.P., A.D.).,Eli & Edythe Broad Center of Regenerative Medicine and Stem Cell Research (J.Y., K.F., S.L., L.L., P.W., Y.W., M.P., A.D.).,Jonsson Comprehensive Cancer Center (J.Y., K.F., S.L., L.L., P.W., Y.W., R.P.K., D.D.C., M.T., M.P., A.D.)
| | - Ping Wang
- From the Division of Cardiology, Department of Medicine (J.Y., M.M.S., S.L., P.W., Y.W., A.J.L., A.D.).,Cardiovascular Research Laboratory (J.Y., M.M.S., S.L., P.W., Y.W., A.J.L., A.D.).,Department of Molecular, Cell, and Developmental Biology (J.Y., K.F., S.L., L.L., P.W., Y.W., M.P., A.D.).,Eli & Edythe Broad Center of Regenerative Medicine and Stem Cell Research (J.Y., K.F., S.L., L.L., P.W., Y.W., M.P., A.D.).,Molecular Biology Institute (J.Y., K.F., S.L., L.L., P.W., Y.W., M.T., M.P., A.D.).,Jonsson Comprehensive Cancer Center (J.Y., K.F., S.L., L.L., P.W., Y.W., R.P.K., D.D.C., M.T., M.P., A.D.)
| | - Yijie Wang
- From the Division of Cardiology, Department of Medicine (J.Y., M.M.S., S.L., P.W., Y.W., A.J.L., A.D.).,Cardiovascular Research Laboratory (J.Y., M.M.S., S.L., P.W., Y.W., A.J.L., A.D.).,Department of Molecular, Cell, and Developmental Biology (J.Y., K.F., S.L., L.L., P.W., Y.W., M.P., A.D.).,Eli & Edythe Broad Center of Regenerative Medicine and Stem Cell Research (J.Y., K.F., S.L., L.L., P.W., Y.W., M.P., A.D.).,Molecular Biology Institute (J.Y., K.F., S.L., L.L., P.W., Y.W., M.T., M.P., A.D.).,Jonsson Comprehensive Cancer Center (J.Y., K.F., S.L., L.L., P.W., Y.W., R.P.K., D.D.C., M.T., M.P., A.D.)
| | - Dian Huang
- Department of Bioengineering (D.H., T.L.N., D.D.C.)
| | | | - Bowen Wei
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine (B.W., R.P.K.)
| | - Rajan P Kulkarni
- Jonsson Comprehensive Cancer Center (J.Y., K.F., S.L., L.L., P.W., Y.W., R.P.K., D.D.C., M.T., M.P., A.D.).,Division of Dermatology, Department of Medicine, David Geffen School of Medicine (B.W., R.P.K.)
| | - Dino Di Carlo
- Jonsson Comprehensive Cancer Center (J.Y., K.F., S.L., L.L., P.W., Y.W., R.P.K., D.D.C., M.T., M.P., A.D.).,Department of Bioengineering (D.H., T.L.N., D.D.C.)
| | - Michael Teitell
- Molecular Biology Institute (J.Y., K.F., S.L., L.L., P.W., Y.W., M.T., M.P., A.D.).,Jonsson Comprehensive Cancer Center (J.Y., K.F., S.L., L.L., P.W., Y.W., R.P.K., D.D.C., M.T., M.P., A.D.).,Department of Pathology and Laboratory Medicine, David Geffen School of Medicine (M.T.), University of California, Los Angeles
| | - Matteo Pellegrini
- Department of Molecular, Cell, and Developmental Biology (J.Y., K.F., S.L., L.L., P.W., Y.W., M.P., A.D.).,Eli & Edythe Broad Center of Regenerative Medicine and Stem Cell Research (J.Y., K.F., S.L., L.L., P.W., Y.W., M.P., A.D.).,Molecular Biology Institute (J.Y., K.F., S.L., L.L., P.W., Y.W., M.T., M.P., A.D.).,Jonsson Comprehensive Cancer Center (J.Y., K.F., S.L., L.L., P.W., Y.W., R.P.K., D.D.C., M.T., M.P., A.D.)
| | - Aldons J Lusis
- From the Division of Cardiology, Department of Medicine (J.Y., M.M.S., S.L., P.W., Y.W., A.J.L., A.D.).,Cardiovascular Research Laboratory (J.Y., M.M.S., S.L., P.W., Y.W., A.J.L., A.D.).,Departments of Human Genetics and Microbiology, Immunology and Molecular Genetics (M.M.S., A.J.L.)
| | - Arjun Deb
- From the Division of Cardiology, Department of Medicine (J.Y., M.M.S., S.L., P.W., Y.W., A.J.L., A.D.) .,Cardiovascular Research Laboratory (J.Y., M.M.S., S.L., P.W., Y.W., A.J.L., A.D.).,Department of Molecular, Cell, and Developmental Biology (J.Y., K.F., S.L., L.L., P.W., Y.W., M.P., A.D.).,Eli & Edythe Broad Center of Regenerative Medicine and Stem Cell Research (J.Y., K.F., S.L., L.L., P.W., Y.W., M.P., A.D.).,Molecular Biology Institute (J.Y., K.F., S.L., L.L., P.W., Y.W., M.T., M.P., A.D.).,Jonsson Comprehensive Cancer Center (J.Y., K.F., S.L., L.L., P.W., Y.W., R.P.K., D.D.C., M.T., M.P., A.D.)
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Personalized Medicine: New Perspectives for the Diagnosis and the Treatment of Renal Diseases. Int J Mol Sci 2017; 18:ijms18061248. [PMID: 28604601 PMCID: PMC5486071 DOI: 10.3390/ijms18061248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/19/2017] [Accepted: 05/27/2017] [Indexed: 12/29/2022] Open
Abstract
The prevalence of renal diseases is rising and reaching 5-15% of the adult population. Renal damage is associated with disturbances of body homeostasis and the loss of equilibrium between exogenous and endogenous elements including drugs and metabolites. Studies indicate that renal diseases are influenced not only by environmental but also by genetic factors. In some cases the disease is caused by mutation in a single gene and at that time severity depends on the presence of one or two mutated alleles. In other cases, renal disease is associated with the presence of alteration within a gene or genes, but environmental factors are also necessary for the development of disease. Therefore, it seems that the analysis of genetic aspects should be a natural component of clinical and experimental studies. The goal of personalized medicine is to determine the right drug, for the right patient, at the right time. Whole-genome examinations may help to change the approach to the disease and the patient resulting in the creation of "personalized medicine" with new diagnostic and treatment strategies designed on the basis of genetic background of each individual. The identification of high-risk patients in pharmacogenomics analyses will help to avoid many unwarranted side effects while optimizing treatment efficacy for individual patients. Personalized therapies for kidney diseases are still at the preliminary stage mainly due to high costs of such analyses and the complex nature of human genome. This review will focus on several areas of interest: renal disease pathogenesis, diagnosis, treatment, rate of progression and the prediction of prognosis.
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Harshman LA, Zepeda-Orozco D. Genetic Considerations in Pediatric Chronic Kidney Disease. J Pediatr Genet 2016; 5:43-50. [PMID: 27617141 PMCID: PMC4918706 DOI: 10.1055/s-0035-1557111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 02/27/2015] [Indexed: 02/07/2023]
Abstract
Chronic kidney disease (CKD) in children is an irreversible process that, in some cases, may lead to end-stage renal disease. The majority of children with CKD have a congenital disorder of the kidney or urological tract arising from birth. There is strong evidence for both a genetic and epigenetic component to progression of CKD. Utilization of gene-mapping strategies, ranging from genome-wide association studies to single-nucleotide polymorphism analysis, serves to identify potential genetic variants that may lend to disease variation. Genome-wide association studies evaluating population-based data have identified different loci associated with CKD progression. Analysis of single-nucleotide polymorphisms on an individual level suggests that secondary systemic sequelae of CKD are closely related to dysfunction of the cardiovascular-inflammatory axis and may lead to advanced cardiovascular disease through abnormal vascular calcification and activation of the renin-angiotensin system. Similarly, genetic variants affecting cytokine control, fibrosis, and parenchymal development may modulate CKD through development and acceleration of renal interstitial fibrosis. Epigenetic studies evaluate modification of the genome through DNA methylation, histone modification, or RNA interference, which may be directly influenced by external or environmental factors directing genomic expression. Lastly, improved understanding of the genetic and epigenetic contribution to CKD progression may allow providers to identify a population at accelerated risk for disease progression and apply novel therapies targeted at the genetic mechanism of disease.
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Affiliation(s)
- Lyndsay A. Harshman
- Division of Pediatric Nephrology, Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa, United States
| | - Diana Zepeda-Orozco
- Division of Pediatric Nephrology, Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa, United States
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Abstract
Numerous clinical trials are currently evaluating new strategies to halt the progression of renal damage in patients with chronic kidney diseases (CKDs). Unfortunately, none of them have considered that the lack of response to new therapies may be due to the pharmacogenetics/pharmacogenomics profile of the patient. The recent impact of high-throughput technologies used in genomics, proteomics and metabolomics may open a new way for discovering biomarkers that can provide us information about the mechanisms on the progression of renal damage. However, they can also be used for diagnosis and for selecting drugs, leading to personalized tailored therapy. The uses of classifiers formed by a list of genes, proteins and metabolites have been introduced into oncology and organ transplantation. These new approaches have recently also been used in the care of human glomerulonephritis. Integrating the large omic data sets with drug and disease databases could give the prediction of drug efficacy and side effects in CKDs.
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Affiliation(s)
- Francesco Paolo Schena
- University of Bari and CARSO Consortium , Policlinico, Piazza G. Cesare 11, 70124 Bari , Italy +39 080 5478869 ; +39 080 5575710 ;
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Lin C, Yang HY, Wu CC, Lee HS, Lin YF, Lu KC, Chu CM, Lin FH, Kao SY, Su SL. Angiotensin-converting enzyme insertion/deletion polymorphism contributes high risk for chronic kidney disease in Asian male with hypertension--a meta-regression analysis of 98 observational studies. PLoS One 2014; 9:e87604. [PMID: 24498151 PMCID: PMC3909221 DOI: 10.1371/journal.pone.0087604] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 12/24/2013] [Indexed: 12/22/2022] Open
Abstract
Background Associations between angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphisms and chronic kidney disease (CKD) have been extensively studied, with most studies reporting that individuals with the D allele have a higher risk. Although some factors, such as ethnicity, may moderate the association between ACE I/D polymorphisms and CKD risk, gender-dependent effects on the CKD risk remain controversial. Objectives This study investigated the gender-dependent effects of ACE I/D polymorphisms on CKD risk. Data sources PubMed, the Cochrane library, and EMBASE were searched for studies published before January 2013. Study eligibility criteria, participants, and interventions Cross-sectional surveys and case–control studies analyzing ACE I/D polymorphisms and CKD were included. They were required to match the following criteria: age >18 years, absence of rare diseases, and Asian or Caucasian ethnicity. Study appraisal and synthesis methods The effect of carrying the D allele on CKD risk was assessed by meta-analysis and meta-regression using random-effects models. Results Ethnicity [odds ratio (OR): 1.24; 95% confidence interval (CI): 1.08–1.42] and hypertension (OR: 1.55; 95% CI: 1.04–2.32) had significant moderate effects on the association between ACE I/D polymorphisms and CKD risk, but they were not significant in the diabetic nephropathy subgroup. Males had higher OR for the association between ACE I/D polymorphisms and CKD risk than females in Asians but not Caucasians, regardless of adjustment for hypertension (p<0.05). In subgroup analyses, this result was significant in the nondiabetic nephropathy group. Compared with the I allele, the D allele had the highest risk (OR: 3.75; 95% CI: 1.84–7.65) for CKD in hypertensive Asian males. Conclusions and implications of key findings The ACE I/D polymorphisms may incur the highest risk for increasing CKD in hypertensive Asian males.
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Affiliation(s)
- Chin Lin
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hsin-Yi Yang
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chia-Chao Wu
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Herng-Sheng Lee
- Division of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yuh-Feng Lin
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
- Division of Nephrology, Department of Medicine, Shuang Ho Hospital, Graduate Institute of Clinical Medicine, Taipei Medical University, New Taipei City, Taiwan, ROC
| | - Kuo-Cheng Lu
- Division of Nephrology, Department of Medicine, Cardinal Tien Hospital, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, ROC
| | - Chi-Ming Chu
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Fu-Huang Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Sen-Yeong Kao
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Sui-Lung Su
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
- * E-mail:
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Zaliaduonyte-Peksiene D, Simonyte S, Lesauskaite V, Vaskelyte J, Gustiene O, Mizariene V, Jurkevicius R, Jariene G, Tamosiunas A, Zaliunas R. Left ventricular remodelling after acute myocardial infarction: Impact of clinical, echocardiographic parameters and polymorphism of angiotensinogen gene. J Renin Angiotensin Aldosterone Syst 2013; 15:286-93. [DOI: 10.1177/1470320312471228] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Sandrita Simonyte
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
| | - Vaiva Lesauskaite
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
| | - Jolanta Vaskelyte
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
| | - Olivija Gustiene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
| | - Vaida Mizariene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
| | - Renaldas Jurkevicius
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
| | - Giedre Jariene
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
| | - Abdonas Tamosiunas
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
| | - Remigijus Zaliunas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Lithuania
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Zhou TB, Yin SS, Qin YH. Association between angiotensin-converting enzyme insertion/deletion gene polymorphism and end-stage renal disease susceptibility. J Renin Angiotensin Aldosterone Syst 2012; 15:22-31. [PMID: 23077080 DOI: 10.1177/1470320312460898] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Tian-Biao Zhou
- Department of Pediatric Nephrology, The First Affiliated Hospital of GuangXi Medical University, China
| | - Sheng-Sheng Yin
- Department of Pediatric Nephrology, The First Affiliated Hospital of GuangXi Medical University, China
| | - Yuan-Han Qin
- Department of Pediatric Nephrology, The First Affiliated Hospital of GuangXi Medical University, China
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14
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Orenes-Piñero E, Hernández-Romero D, Jover E, Valdés M, Lip GYH, Marín F. Impact of polymorphisms in the renin–angiotensin–aldosterone system on hypertrophic cardiomyopathy. J Renin Angiotensin Aldosterone Syst 2011; 12:521-30. [DOI: 10.1177/1470320311405247] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a clinically heterogeneous autosomal dominant heart disease characterised by left ventricular hypertrophy in the absence of another cardiac or systemic disease that is capable of producing significant wall thickening. Microscopically it is characterised by cardiomyocyte hypertrophy, myofibrillar disarray and fibrosis. The phenotypic expression of HCM is multifactorial, with the majority of cases occurring secondary to mutations in genes encoding the sarcomere proteins. In conjunction with the genetic heterogeneity of HCM, phenotypic expression also exhibits a high level of variability even within families with the same aetiological mutation, and may be influenced by additional genetic factors. Polymorphisms of the renin–angiotensin–aldosterone system (RAAS) represent an attractive hypothesis as potential disease modifiers, as these genetic variants alter the ‘activation status’ of the RAAS, which leads to more left ventricular hypertrophy through different pathways. The main objective of this review is to provide an overview of the role of different polymorphisms identified in the RAAS, in patients with HCM.
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Affiliation(s)
- Esteban Orenes-Piñero
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | - Eva Jover
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Mariano Valdés
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Gregory YH Lip
- Haemostasis, Thrombosis and Vascular Biology Unit, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Francisco Marín
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
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Abstract
OBJECTIVES To identify genes contributing to variation in echocardiographic left ventricular mass and related traits using linkage and linkage disequilibrium analysis in sibships ascertained on hypertension. METHODS The Hypertension Genetic Epidemiology Network (HyperGEN) Study of left ventricular hypertrophy characterized left ventricular mass, relative wall thickness (RWT), and aortic root diameter (ARD) with echocardiograms collected using a standardized protocol at four HyperGEN field centers. A high-throughput scanning fluorescence detector system genotyped 387 polymorphisms distributed throughout the genome. Linkage analyses were conducted once genotyping results became available for 885 siblings from 382 sibships. RESULTS Although single logarithm of the odds (LOD) score peaks of 1.2 or more were found on chromosomes 1, 4, 5, 6, 7, 8, 9, 10, 12, 14, 17, and 21, we observed a broad band of peaks in both ethnic groups (white and black) on chromosome 4 and selected candidate genes (NPY1R, NPY2R, NPY5R, SFRP2, CPE, IL15, and EDNRA) from this region. Using cases and controls from extremes of the left ventricular mass index, RWT, and ARD distributions, we assessed associations with these phenotypes and haplotype-tagging single-nucleotide polymorphisms (SNPs) in the candidates. Among blacks, SNPs in IL15, NPY2R, and NPY5R showed strong evidence for association (P < 0.005); all candidates except EDNRA showed suggestive association (P < 0.05). In whites, NPY2R, NPY5R, and SFRP2 SNPs offered suggestive evidence of association with one or more traits (P < 0.05). CONCLUSION Genetic variation in NPY1R, NPY2R, NPY5R, CPE, IL15, and SFRP2, detected using linkage analysis in hypertensive siblings, was associated with left ventricular phenotypes in blacks and/or whites.
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Luttropp K, Lindholm B, Carrero JJ, Glorieux G, Schepers E, Vanholder R, Schalling M, Stenvinkel P, Nordfors L. Genetics/Genomics in Chronic Kidney Disease-Towards Personalized Medicine? Semin Dial 2009; 22:417-22. [DOI: 10.1111/j.1525-139x.2009.00592.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Understanding the role of genetic polymorphisms in chronic kidney disease. Pediatr Nephrol 2008; 23:1941-9. [PMID: 18368429 DOI: 10.1007/s00467-008-0788-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Revised: 01/31/2008] [Accepted: 02/04/2008] [Indexed: 01/24/2023]
Abstract
Although no valid studies clearly indicate increasing or decreasing numbers of incident paediatric patients, the prevalence of chronic kidney disease (CKD) and end-stage renal disease (ESRD) is growing worldwide. This is mainly due to improved access to renal replacement therapy (RRT), increased survival after dialysis and kidney transplantation and an increase in diagnosis and referral of these patients. Although the increase in CKD prevalence is mainly caused by environmental factors, genetic factors may also influence the incidence and/or the progression of CKD and its complications. As CKD patients might be more sensitive to genetic effects due to the exposure to a uraemic milieu, this makes studies of genetic factors especially interesting in this population. The goal of identifying genetic factors that contribute to the outcome of CKD is to gain further understanding of the disease pathogenesis and underlying causes and, possibly, to use this knowledge to predict disease or its complications and to identify a risk population. Therefore, genetic screening of paediatric CKD patients may enhance the impact of preventive measures that could have a positive effect on outcome. Furthermore, by identifying patients' genetic backgrounds, it is possible that a more individualised therapy could be designed.
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Zakrzewski-Jakubiak M, de Denus S, Dubé MP, Bélanger F, White M, Turgeon J. Ten renin-angiotensin system-related gene polymorphisms in maximally treated Canadian Caucasian patients with heart failure. Br J Clin Pharmacol 2008; 65:742-51. [PMID: 18279468 PMCID: PMC2432486 DOI: 10.1111/j.1365-2125.2007.03091.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Accepted: 10/10/2007] [Indexed: 02/03/2023] Open
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT The progression and pharmacological response of heart failure-affected patients are subject to interindividual variability. It is also acknowledged that the genotype frequency of certain gene polymorphisms varies across different ethnic groups and that a difference in gene polymorphism frequencies between healthy and heart failure patients seems to exist. WHAT THIS STUDY ADDS This study investigated associations between 10 gene polymorphisms of RAAS-related genes with an individual's susceptibility to heart failure. Our data suggest that the angiotensinogen (AGT) 235 single nucleotide polymorphism (SNP) may be associated with heart failure in our population and that the AGT(M174)-AGT(T235) haplotype, as well as the AGT/angiotensin-converting enzyme (ACE) gene combination, may play an important role in disease predisposition. AIMS Racial differences in survival outcomes point towards a genetic role in the pathophysiology of heart failure. Furthermore, contemporary evidence links genetics to heart failure (HF) predisposition. We tested for a difference in prevalence of 10 renin-angiotensin-aldosterone system (RAAS)-related gene polymorphisms between a homogenous population of HF patients and healthy controls. METHODS One hundred and eleven healthy volunteers and 58 HF patients were included in this study. The healthy control group consisted of males aged between 18 and 35 years old. The HF group consisted of patients (89.7% male) who were 63.8 +/- 7.9 years old, were in New York Heart Association (NYHA) class II-III and had a documented left ventricular ejection fraction (LVEF) CONCLUSIONS This study demonstrates that the SNPs of AGT may be associated with HF in our population and that the AGT/ACE gene combination may play an important role in disease predisposition.
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Affiliation(s)
| | - Simon de Denus
- Université de MontréalMontréal, Canada
- Montreal Heart InstituteMontréal, Canada
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Lin TH, Chiu HC, Lee YT, Su HM, Voon WC, Liu HW, Lai WT, Sheu SH. Association Between Functional Polymorphisms of Renin-Angiotensin System, Left Ventricular Mass, and Geometry Over 4 Years in a Healthy Chinese Population Aged 60 Years and Older. J Gerontol A Biol Sci Med Sci 2007; 62:1157-63. [DOI: 10.1093/gerona/62.10.1157] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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20
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Lin TH, Chiu HC, Su HM, Juo SHH, Lee YT, Voon WC, Lai WT, Sheu SH. D-Allele of ACE Polymorphism is Associated With Increased Magnitude of QT Dispersion Prolongation in Elderly Chinese 4-Year Follow-up Study. Circ J 2007; 71:39-45. [PMID: 17186976 DOI: 10.1253/circj.71.39] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There has not been a longitudinal investigation of the influence of angiotensin-converting enzyme (ACE) insertion/deletion and angiotensinogen (AGT) M235T gene polymorphisms on repolarization parameters, such as QT dispersion (QTd) and the peak and the end of the T-wave interval (Tpe). METHODS AND RESULTS Electrocardiographys were recorded from 106 elderly Chinese at baseline, and 2nd and 4th year follow-up. The corrected QT (QTc), QTd, QTc dispersion (QTcd) and Tpe were manually calculated. Average age was 72.7+/-4.1 years (range 62-81). QTd, QTcd and Tpe were significantly prolonged (all p<0.001 at the 2nd and 4th year). At the 4th year the magnitude of the QTd prolongation, but not Tpe, was significantly higher in subjects carrying the ACE D allele than non-D-allele carriers (p=0.001), as was QTcd (p=0.002). This association was still significant in the multivariate analyses (p<0.001 and p=0.001 for QTc and QTcd, respectively). No significant correlation was found between repolarization parameters and AGT genotype. CONCLUSIONS This longitudinal study shows that the ageing process is associated with prolongation of QTd, QTcd and Tpe after 4 years follow-up. The elderly Chinese subjects with the ACE D-allele had greater prolongation QTd and QTcd.
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Affiliation(s)
- Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Chung-Ho Memorial Hospital, Taiwan
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21
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22
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van der Sman-de Beer F, Verhagen C, Rombach SM, Boorsma P, van Manen JG, Korevaar JC, van den Bogaard R, Boeschoten EW, Krediet RT, Navis GJ, Vandenbroucke JP, Dekker FW. ACE I/D polymorphism is associated with mortality in a cohort study of patients starting with dialysis. Kidney Int 2006; 68:2237-43. [PMID: 16221224 DOI: 10.1111/j.1523-1755.2005.00681.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In dialysis patients, only a few follow-up studies have addressed the relationship between the insertion/deletion (I/D) polymorphism in the angiotensin-converting enzyme (ACE) gene and mortality, but the available data are contradictory. METHODS A cohort of 453 consecutive patients starting dialysis between January 1999 and January 2002 and participating in a Dutch multicenter prospective study was examined. Patients who died within 3 months after the start of dialysis were excluded. Patients were followed until date of death or censoring in November 2003. RESULTS The ACE II, ID, and DD genotype frequencies were 24.3% (N = 110), 50.1% (N = 227), and 25.6% (N = 116). Besides a slightly higher number of Caucasians in the DD group, all other patient characteristics of the 3 ACE groups were similar at the start of dialysis. After adjustment for age, comorbidity, and ethnic background, patients with the ID and DD genotype showed an increased hazard ratio (HR) for all-cause mortality of 1.55 (95% CI 1.00-2.42) and 2.30 (95% CI 1.41-3.75), compared to patients with the II genotype. Slightly lower HRs were found for cardiovascular mortality. All groups of primary kidney disease showed a 2- to 3-fold increased adjusted HR for DD. CONCLUSION The DD genotype identifies dialysis patients at an increased risk for mortality.
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Abstract
Cardiovascular disease (CVD) is the most important cause of morbidity and mortality in dialysis patients. The high prevalence of CVD is due to the cumulative effects of multiple risk factors from the early stages of chronic kidney disease (CKD). Familial predispositions to CVD, CKD, and their respective risk factors are well known, and it is likely that genetic factors determine the interindividual variability in risks for disease. Advances in genomic technology have facilitated the study of genetic variation--most commonly single nucleotide polymorphisms (SNPs) in candidate genes--and their associations with disease. This review examines CVD in dialysis patients as a model of a complex disease, discusses the approach to gene polymorphism association studies, including the roles of gene-environment and gene-gene interactions and provides an overview of available studies.
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Affiliation(s)
- Madhumathi Rao
- Division of Nephrology, Department of Medicine, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA
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Nordfors L, Lindholm B, Stenvinkel P. End-stage renal disease--not an equal opportunity disease: the role of genetic polymorphisms. J Intern Med 2005; 258:1-12. [PMID: 15953127 DOI: 10.1111/j.1365-2796.2005.01516.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Despite several decades of development in renal replacement therapy, end-stage renal disease (ESRD) patients continue to have markedly increased morbidity and mortality especially caused by cardiovascular disease (CVD). This shows that current strategies, e.g. the focus on dialysis adequacy, to improve the clinical outcome in ESRD patients have to be complemented by novel approaches. Although traditional risk factors are common in dialysis patients they cannot alone explain the unacceptably high prevalence of CVD in this patient group. Much recent interest has therefore focused on the role of various nontraditional cardiovascular risk factors, such as inflammation, vascular calcification and oxidative stress. Recent studies show that genetic factors, such as DNA single nucleotide polymorphisms, may significantly influence the immune response, the levels of inflammatory markers, as well as the prevalence of atherosclerosis in this patient group. To elucidate the respective roles of DNA polymorphisms in genes that encode inflammatory markers (such as IL-10, IL-6 and TNF-alpha) and other factors that may affect the development of atherosclerosis (such as apolipoprotein E, transforming growth factor and fetuin-A), sufficiently powered studies are needed in which genotype, the protein product and the specific phenotype all are analysed in relation to outcome. The recent developments in the field of genetics have opened up entirely new possibilities to understand the impact of genotype on disease development and progress and thus offer new options and strategies for treatment. It seems conceivable that in the near future, prognostic or predictive multigene DNA assays will provide the nephrological community with a more precise approach for the identification of "high-risk" ESRD patients and the development of accurate individual treatment strategies. For this purpose, integrative studies on genotype-phenotype associations and impact on clinical outcome are needed.
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Affiliation(s)
- L Nordfors
- Neurogenetics Unit, Department of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
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Bleumink GS, Schut AFC, Sturkenboom MCJM, Deckers JW, van Duijn CM, Stricker BHC. Genetic polymorphisms and heart failure. Genet Med 2005; 6:465-74. [PMID: 15545741 DOI: 10.1097/01.gim.0000144061.70494.95] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Heart failure is a complex clinical syndrome. There is evidence for a genetic contribution to the pathophysiology of heart failure. Considering the fundamental role of neurohormonal factors in the pathophysiology and progression of cardiac dysfunction and hypertrophy, variants of genes involved in this system are logical candidate genes in heart failure. In this report, genetic polymorphisms of the major neurohormonal systems in heart failure will be discussed. Studies on polymorphisms of the renin-angiotensin-aldosterone system (RAAS), adrenergic receptor polymorphisms, endothelin (receptor) polymorphisms, and a group of miscellaneous polymorphisms that may be involved in the development or phenotypic expression of heart failure will be reviewed. Research on left ventricular hypertrophy is also included. The majority of genetic association studies focused on the ACE I/D polymorphism. Initial genetic associations have often been difficult to replicate, mainly due to problems in study design and lack of power. Promising results have been obtained with genetic polymorphisms of the RAAS and sympathetic system. Considering the evidence so far, a modifying role for these polymorphisms seems more likely than a role of these variants as susceptibility genes. Besides the need for larger studies to examine the effects of single nucleotide polymorphisms and haplotypes, future studies also need to focus on the complexity of these systems and study gene-gene interactions and gene-environment interactions.
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Affiliation(s)
- Gysèle S Bleumink
- Department of Epidemiology and Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
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Liangos O, Balakrishnan VS, Jaber BL. Model for gene-environment interaction: the case for dialysis. Semin Dial 2005; 18:41-6. [PMID: 15663764 DOI: 10.1111/j.1525-139x.2005.18103.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Organ complications in end-stage renal disease (ESRD) such as cardiovascular disease, anemia, bone disease, malnutrition, inflammation, and infections occur in many organ systems and are caused by a multitude of underlying disease-, uremia-, and therapy-related factors, and with a wide range of manifestations and severity. Interindividual variability in the pathophysiologic response of the uremic host to environmental factors, including renal replacement therapy, may be governed to a significant degree by genetic susceptibility factors. Specific genes regulate the pathophysiologic responses of organ systems affected by ESRD and can serve as candidate genes for the host-environment interaction. This review summarizes emerging clinical and translational research work in the field of genetic polymorphism of candidate genes and their effects on the development of organ complications in ESRD. Methodologic limitations of the existing published data, the need for large prospective cohort studies, and potential future risks for the use of genomic information in resource allocation are also highlighted.
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Affiliation(s)
- Orfeas Liangos
- Division of Nephrology, Department of Medicine, Tufts-New England Medical Center, Boston, MA, USA
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Wang AYM, Li PKT, Lui SF, Sanderson JE. Angiotensin converting enzyme inhibition for cardiac hypertrophy in patients with end-stage renal disease: what is the evidence? Nephrology (Carlton) 2004; 9:190-7. [PMID: 15363049 DOI: 10.1111/j.1440-1797.2004.00260.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Dialysis patients show a high prevalence of cardiovascular complications among which left ventricular hypertrophy is one of the most frequent and is independently predictive of mortality. A recent study indicates that partial regression of left ventricular hypertrophy improves mortality and reduces cardiovascular events in end-stage renal disease (ESRD) patients, suggesting the importance of targeting therapeutic strategies to reduce cardiac hypertrophy and improve the outcome in these patients. The pathogenesis of left ventricular hypertrophy in ESRD patients is multifactorial and includes hypertension, activation of the renin-angiotensin system, increased sympathetic activity, chronic volume overload, chronic anaemia and hyperparathyroidism. In this paper, we review the available experimental and clinical evidence showing the important contribution of the renin-angiotensin system as well as its interaction with the sympathetic nervous system in the pathogenesis of left ventricular hypertrophy in ESRD patients. Furthermore, we summarize the results of currently available clinical studies that examined the effects of angiotensin-converting enzyme inhibition or angiotensin receptor antagonism on left ventricular hypertrophy in ESRD patients, and review evidences that support the use of angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists in the ESRD population.
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Affiliation(s)
- Angela Yee-Moon Wang
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin New Territories, Hong Kong.
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de Simone G. Left Ventricular Geometry and Hypotension in End-Stage Renal Disease: A Mechanical Perspective. J Am Soc Nephrol 2003; 14:2421-7. [PMID: 14514719 DOI: 10.1097/01.asn.0000088724.66957.fc] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
ABSTRACT. Hemodynamic and nonhemodynamic factors are implicated in the maintenance and aggravation of left ventricular (LV) hypertrophy in ESRD. Functional consequences of LV geometry are of substantial importance in patients who undergo dialysis and may contribute to explain the negative outcome related to LV hypertrophy, also in patients without overt coronary heart disease (CHD). Whereas most patients with eccentric LV hypertrophy have systolic dysfunction and the underlying CHD imposes progression of their disease, when overt CHD does not occur to remodel left ventricle, concentric LV geometry is more prevalent in ESRD and functional consequences are different. Concentric LV geometry is very sensitive to abrupt changes of cardiac loading conditions because of increased LV stiffness. Dialysis-related decrease in LV filling pressure reduces Starling forces recruitment and causes a fall in stroke volume as a result of reduced preload. This fall cannot be compensated by increased contractility, as myocardial mechanics is impaired in concentric LV geometry and no functional reserve can be used. When adequate increase in heart rate is not achieved to compensate reduced stroke volume, cardiac output substantially decreases and hypotension occurs. Occurrence of hypotension in the context of concentric LV geometry might contribute to reduce repeatedly coronary blood flow supply in the stiff and thick myocardium and might accelerate myocardial structural deterioration seen in ESRD. E-mail: simogi@unina.it
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Affiliation(s)
- Giovanni de Simone
- Laboratory of Echocardiography, Department of Clinical and Experimental Medicine, Federico II University Hospital, School of Medicine, Naples, Italy.
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