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Huang Y, Hui Q, Gwinn M, Hu YJ, Quyyumi AA, Vaccarino V, Sun YV. Interaction between genetics and smoking in determining risk of coronary artery diseases. Genet Epidemiol 2022; 46:199-212. [PMID: 35170807 PMCID: PMC9086149 DOI: 10.1002/gepi.22446] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/18/2021] [Accepted: 01/20/2022] [Indexed: 12/15/2022]
Abstract
Coronary artery disease (CAD) is a preeminent cause of death, and smoking is a strong risk factor for CAD. Genetic factors contribute to the development of CAD, but the interplay between genetic predisposition and smoking history in CAD remains unclear. Using data from the UK Biobank, we constructed several genetic risk scores (GRSs) based on known CAD loci and assessed their interactions with smoking for the development of incident CAD in 307,147 participants of European ancestry who were free of CAD. We fitted Cox proportional hazard models and assessed gene-smoking interaction on both multiplicative and additive scales. Overall, we found no multiplicative interactions, but observed a synergistic additive interaction of GRS with both smoking status and pack-years of smoking, finding that the absolute CAD risk due to smoking was higher for those with high genetic risk. Trait-based sub-GRSs suggested smoking status and smoking intensity measured by pack-years might confer gene-smoking interaction effects with different intermediate risk factors for CAD. Our study results suggest that genetics could modify the effects of smoking on CAD and highlight the value of addressing gene-lifestyle interactions on both additive and multiplicative scales.
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Affiliation(s)
- Yunfeng Huang
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Qin Hui
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Marta Gwinn
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Yi-Juan Hu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Arshed A Quyyumi
- Division of Cardiology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Yan V Sun
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA,Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, USA
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Gordon-Larsen P, French JE, Moustaid-Moussa N, Voruganti VS, Mayer-Davis EJ, Bizon CA, Cheng Z, Stewart DA, Easterbrook JW, Shaikh SR. Synergizing Mouse and Human Studies to Understand the Heterogeneity of Obesity. Adv Nutr 2021; 12:2023-2034. [PMID: 33885739 PMCID: PMC8483969 DOI: 10.1093/advances/nmab040] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/17/2021] [Accepted: 03/13/2021] [Indexed: 12/12/2022] Open
Abstract
Obesity is routinely considered as a single disease state, which drives a "one-size-fits-all" approach to treatment. We recently convened the first annual University of North Carolina Interdisciplinary Nutrition Sciences Symposium to discuss the heterogeneity of obesity and the need for translational science to advance understanding of this heterogeneity. The symposium aimed to advance scientific rigor in translational studies from animal to human models with the goal of identifying underlying mechanisms and treatments. In this review, we discuss fundamental gaps in knowledge of the heterogeneity of obesity ranging from cellular to population perspectives. We also advocate approaches to overcoming limitations in the field. Examples include the use of contemporary mouse genetic reference population models such as the Collaborative Cross and Diversity Outbred mice that effectively model human genetic diversity and the use of translational models that integrate -omics and computational approaches from pre-clinical to clinical models of obesity. Finally, we suggest best scientific practices to ensure strong rigor that will allow investigators to delineate the sources of heterogeneity in the population with obesity. Collectively, we propose that it is critical to think of obesity as a heterogeneous disease with complex mechanisms and etiologies, requiring unique prevention and treatment strategies tailored to the individual.
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Affiliation(s)
| | - John E French
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC, USA
| | - Naima Moustaid-Moussa
- Obesity Research Institute and Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA
| | - Venkata S Voruganti
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC, USA
| | - Elizabeth J Mayer-Davis
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christopher A Bizon
- Renaissance Computing Institute, University of North Carolina at Chapel Hill, NC, USA
| | - Zhiyong Cheng
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL, USA
| | - Delisha A Stewart
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, NC, USA
| | - John W Easterbrook
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Guevara-Cruz M, Medina-Vera I, Flores-López A, Aguilar-López M, Smith CE, Parnell LD, Lee YC, Lai CQ, Tovar AR, Ordovás JM, Torres N. Development of a Genetic Score to Predict an Increase in HDL Cholesterol Concentration After a Dietary Intervention in Adults with Metabolic Syndrome. J Nutr 2019; 149:1116-1121. [PMID: 31070756 DOI: 10.1093/jn/nxz060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/28/2018] [Accepted: 03/11/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dietary intervention (DI) is a primary strategy to attenuate some of the metabolic abnormalities associated with metabolic syndrome (MetS), including low HDL cholesterol. There is no biomarker that can identify individuals who respond to DI by increasing HDL cholesterol. OBJECTIVE The aim of this study was to assess the predictive power of a genetic predisposition score (GPS) in Mexican adults with MetS to identify HDL cholesterol responders to DI. METHODS This study followed a prospective cohort design. Sixty-seven Mexican adults aged 20-60 y (21% men) with BMI ≥25 and ≤39.9 kg/m², who had at least 3 of 5 positive criteria for MetS, were included. Participants consumed a low saturated fat diet for 2.5 mo (<7% energy as saturated fat, <200 mg of cholesterol/d) and reduced their usual diet by ∼440 kcal/d, a reduction in total energy intake of about 25%. Anthropometry and serum biochemical markers, including HDL cholesterol, were measured before and after DI. A multilocus GPS was constructed using previously reported genetic variants associated with response to diet in subjects with MetS. GPS values, designed to predict the response of HDL cholesterol to the DI, were computed for each individual as the sum of the number of effect alleles across 14 SNPs. RESULTS Individuals were dichotomized as high and low GPS according to median GPS (-2.12) and we observed a difference in HDL cholesterol changes on DI of +3 mg/dL (6.3%) in subjects with low GPS, whereas those with high GPS had HDL cholesterol decreases of -3 mg/dL (-7.9%) (P = 0.04). CONCLUSIONS Individuals with low GPS showed greater increases in their HDL cholesterol than those with high GPS. Therefore, the GPS can be useful for predicting the HDL cholesterol response to diet.
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Affiliation(s)
- Martha Guevara-Cruz
- Department of Physiology of Nutrition, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Isabel Medina-Vera
- Department of Physiology of Nutrition, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Adriana Flores-López
- Department of Physiology of Nutrition, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Miriam Aguilar-López
- Department of Physiology of Nutrition, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Caren E Smith
- Nutrition and Genomics' Laboratory, Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Laurence D Parnell
- Nutrition and Genomics' Laboratory, Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Yu-Chi Lee
- Nutrition and Genomics' Laboratory, Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Chao-Qiang Lai
- Nutrition and Genomics' Laboratory, Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Armando R Tovar
- Department of Physiology of Nutrition, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Jose M Ordovás
- Nutrition and Genomics' Laboratory, Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Nimbe Torres
- Department of Physiology of Nutrition, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
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Lai CQ, Smith CE, Parnell LD, Lee YC, Corella D, Hopkins P, Hidalgo BA, Aslibekyan S, Province MA, Absher D, Arnett DK, Tucker KL, Ordovas JM. Epigenomics and metabolomics reveal the mechanism of the APOA2-saturated fat intake interaction affecting obesity. Am J Clin Nutr 2018; 108:188-200. [PMID: 29901700 PMCID: PMC6454512 DOI: 10.1093/ajcn/nqy081] [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: 11/27/2017] [Accepted: 03/28/2018] [Indexed: 12/13/2022] Open
Abstract
Background The putative functional variant -265T>C (rs5082) within the APOA2 promoter has shown consistent interactions with saturated fatty acid (SFA) intake to influence the risk of obesity. Objective The aim of this study was to implement an integrative approach to characterize the molecular basis of this interaction. Design We conducted an epigenome-wide scan on 80 participants carrying either the rs5082 CC or TT genotypes and consuming either a low-SFA (<22 g/d) or high-SFA diet (≥22 g/d), matched for age, sex, BMI, and diabetes status in the Boston Puerto Rican Health Study (BPRHS). We then validated the findings in selected participants in the Genetics of Lipid Lowering Drugs and Diet Network (GOLDN) Study (n = 379) and the Framingham Heart Study (FHS) (n = 243). Transcription and metabolomics analyses were conducted to determine the relation between epigenetic status, APOA2 mRNA expression, and blood metabolites. Results In the BPRHS, we identified methylation site cg04436964 as exhibiting significant differences between CC and TT participants consuming a high-SFA diet, but not among those consuming low-SFA. Similar results were observed in the GOLDN Study and the FHS. Additionally, in the FHS, cg04436964 methylation was negatively correlated with APOA2 expression in the blood of participants consuming a high-SFA diet. Furthermore, when consuming a high-SFA diet, CC carriers had lower APOA2 expression than those with the TT genotype. Lastly, metabolomic analysis identified 4 pathways as overrepresented by metabolite differences between CC and TT genotypes with high-SFA intake, including tryptophan and branched-chain amino acid (BCAA) pathways. Interestingly, these pathways were linked to rs5082-specific cg04436964 methylation differences in high-SFA consumers. Conclusions The epigenetic status of the APOA2 regulatory region is associated with SFA intake and APOA2 -265T>C genotype, promoting an APOA2 expression difference between APOA2 genotypes on a high-SFA diet, and modulating BCAA and tryptophan metabolic pathways. These findings identify potential mechanisms by which this highly reproducible gene-diet interaction influences obesity risk, and contribute new insights to ongoing investigations of the relation between SFA and human health. This study was registered at clinicaltrials.gov as NCT03452787.
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Affiliation(s)
- Chao-Qiang Lai
- USDA Agricultural Research Service,Address correspondence to C-QL (e-mail )
| | - Caren E Smith
- Nutrition and Genomics Laboratory, JM-USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | | | - Yu-Chi Lee
- Nutrition and Genomics Laboratory, JM-USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Dolores Corella
- Department of Preventive Medicine, University of Valencia and CIBER Physiopathology of Obesity and Nutrition, Valencia, Spain
| | - Paul Hopkins
- Department of Cardiovascular Genetics, University of Utah, Salt Lake City, UT
| | - Bertha A Hidalgo
- Department of Epidemiology, School of Public Health, University of Alabama, Birmingham, AL
| | - Stella Aslibekyan
- Department of Epidemiology, School of Public Health, University of Alabama, Birmingham, AL
| | - Michael A Province
- Department of Genetics, Washington University School of Medicine, St. Louis, MO
| | - Devin Absher
- Hudson Alpha Institute for Biotechnology, Huntsville, AL
| | - Donna K Arnett
- College of Public Health, University of Kentucky, Lexington, KY
| | - Katherine L Tucker
- Department of Biomedical & Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA
| | - Jose M Ordovas
- Nutrition and Genomics Laboratory, JM-USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA,IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
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Mehramiz M, Ghasemi F, Esmaily H, Tayefi M, Hassanian SM, Sadeghzade M, Sadabadi F, Moohebati M, Azarpazhooh MR, Parizadeh SMR, Heidari-Bakavoli A, Safarian M, Nematy M, Ebrahimi M, Ryzhikov M, Ferns GA, Ghayour-Mobarhan M, Avan A. Interaction between a variant of CDKN2A/B-gene with lifestyle factors in determining dyslipidemia and estimated cardiovascular risk: A step toward personalized nutrition. Clin Nutr 2018; 37:254-261. [DOI: 10.1016/j.clnu.2016.12.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 12/12/2016] [Accepted: 12/22/2016] [Indexed: 01/12/2023]
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6
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Mirzababaei A, Mollahosseini M, Rahimi MH, Yekaninejad MS, Maghbooli Z, Sobhani R, Mirzaei K. Interaction between a variant of chromosome 9p21.3 locus and diet antioxidant capacity on metabolic syndrome in Tehrani adults. Diabetol Metab Syndr 2018; 10:76. [PMID: 30364300 PMCID: PMC6194558 DOI: 10.1186/s13098-018-0372-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 09/14/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Genome-wide association studies have shown that risk alleles on chromosome 9p21.3 locus, are associated with increasing the risk of cardiovascular diseases (CVDs). Several epidemiological studies have found that metabolic syndrome (MetS) is associated with CVDs. Dietary antioxidants also have shown to have potential favorable effects on MetS prevention. This study examined the interactions between rs1333048 genotypes on 9p21 genetic region and Total antioxidant capacity (TAC) on odds of MetS. METHODS 263 Tehrani adults were enrolled in this cross-sectional study. The MetS was defined according to the ATPIII. Dietary intake was assessed daily using a FFQ with 147 items. Dietary TAC was assessed according to United States Department of Agriculture database for oxygen radical absorbance capacity (ORAC). Bioelectrical impedance analysis method was used for body analysis and rs1333048 were genotyped by restriction fragment length polymorphism method. Participants were categorized into three groups based on rs1333048 genotypes. RESULTS The results demonstrate that, prevalence of C allele was 52.85% and A allele was 47.15%. After adjustment for confunder variable, this study demonstrated an interaction between AA genotype and high Lyophilic oxygen radical absorbance capacity (L-ORAC) and high Hydrophilic oxygen radical absorbance capacity (H-ORAC) intake on low odds of MetS (OR = 0.24, 95% CI = 0.06-0.94, P for interaction = 0.04, OR = 0.26, 95% CI = 0.06-0.99, P for interaction = 0.04). Also, our result indicated, there was no interaction between AA genotype and high total oxygen radical absorbance capacity (T-ORAC) and total phenolic intakes on reduce odds of MetS (OR = 0.07, 95% CI = 0.07-1.10, P for interaction = 0.07, OR = 0.58, 95% CI = 0.16-2.07, P for interaction = 0.40) respectively. CONCLUSION The results of the present study indicate that high L-ORAC and high H-ORAC intake may modify the elevated odds of MetS in AA genotype of rs1333048 on the 9p21 genetic locus.
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Affiliation(s)
- Atieh Mirzababaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box: 14155-6117, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mehdi Mollahosseini
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box: 14155-6117, Tehran, Iran
| | - Mohammad Hossein Rahimi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box: 14155-6117, Tehran, Iran
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Zhila Maghbooli
- Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Reza Sobhani
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box: 14155-6117, Tehran, Iran
| | - Khadijeh Mirzaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O. Box: 14155-6117, Tehran, Iran
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7
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Shaw SD, Bagozzi RP. The neuropsychology of consumer behavior and marketing. ACTA ACUST UNITED AC 2017. [DOI: 10.1002/arcp.1006] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Steven D. Shaw
- Stephen M. Ross School of Business; University of Michigan; Ann Arbor MI USA
| | - Richard P. Bagozzi
- Stephen M. Ross School of Business; University of Michigan; Ann Arbor MI USA
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Pitha J, Králová Lesná I, Hubáček JA, Sekerková A, Lánská V, Adámková V, Dorobantu M, Nicolescu R, Steiner R, Ivić V, Borbely A, Papp Z, Vari SG. Smoking impairs and circulating stem cells favour the protective effect of the T allele of the connexin37 gene in ischemic heart disease--A multinational study. Atherosclerosis 2016; 244:73-8. [PMID: 26588185 DOI: 10.1016/j.atherosclerosis.2015.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/04/2015] [Accepted: 11/04/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND The connexin 37 (Cx37) gene is considered to be a candidate gene for ischemic heart disease (IHD). We analyzed the association between the C1019 > T (Pro319 > Ser) variant of the Cx37 gene and IHD in patients in the Czech Republic, Croatia, Hungary and Romania with regard to the presence/absence of selected cardiovascular risk factors (RF). In a complementary study, we analyzed the association between the Cx37 gene and circulating stem and endothelial progenitor cells in healthy women. METHODS The study population comprised 2396 patients (663 women) with IHD. The control population comprised 2476 subjects (1, 337 women). Additionally, in 662 healthy women, the association between the Cx37 gene and circulating stem and endothelial progenitor cells was analyzed. RESULTS The strongest protective effect of the Cx37 T allele was detected in non-smoking patients without diabetes mellitus and hypertension (OR 0.610, 95% CI 0.377-0.990); a similar effect was found in non-smoking men (OR 0.781, 95% CI 0.628-0.971); weaker effect was found in non-smoking women (OR 0.768, 95% CI 0.560-1.050). In non-smoking healthy women, stem cells were significantly higher in TT than in CT and CC carriers (p for trend 0.011). Additionally, non-smoking TT carriers had significantly higher number of stem cells than past and current smoking TT carriers (p for trend = 0.006); no such trend was found in CT and CC carriers. CONCLUSIONS The protective effect of the T allele of the Cx37 gene might be strongly modified by smoking; in women, this effect could be mediated through stem cells.
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Affiliation(s)
- Jan Pitha
- Center for Experimental Medicine, Laboratory for Atherosclerosis Research, Institute for Clinical & Experimental Medicine, Prague, Czech Republic.
| | - Ivana Králová Lesná
- Center for Experimental Medicine, Laboratory for Atherosclerosis Research, Institute for Clinical & Experimental Medicine, Prague, Czech Republic
| | - Jaroslav A Hubáček
- Center for Experimental Medicine, Laboratory for Atherosclerosis Research, Institute for Clinical & Experimental Medicine, Prague, Czech Republic
| | - Alena Sekerková
- Department of Clinical and Transplant Immunology, Institute of Clinical & Experimental Medicine, Prague, Czech Republic
| | - Věra Lánská
- Medicine Statistic Unit, Institute of Clinical & Experimental Medicine, Prague, Czech Republic
| | - Věra Adámková
- Department of Preventive Cardiology, Institute of Clinical & Experimental Medicine, Prague, Czech Republic
| | - Maria Dorobantu
- University of Medicine and Pharmacy "Carol Davila" Bucharest, Romania Emergency Clinical Hospital of Bucharest, Cardiology Dept., Romania
| | - Rodica Nicolescu
- Emergency Clinical Hospital of Bucharest, Cardiology Dept., Romania
| | - Robert Steiner
- Department of Cardiovascular Disease and Intensive Care, Osijek University Hospital, Osijek, Croatia
| | - Vedrana Ivić
- Department of Medical Biology and Genetics, Faculty of Medicine, University of Osijek, Osijek, Croatia
| | - Attila Borbely
- Regional Cooperation for Health, Science and Technology (RECOOP HST) Association, Debrecen, Hungary
| | - Zoltan Papp
- Regional Cooperation for Health, Science and Technology (RECOOP HST) Association, Debrecen, Hungary
| | - Sandor G Vari
- Regional Cooperation for Health, Science and Technology (RECOOP HST) Association, Debrecen, Hungary; International Research and Innovation Management Program, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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Yamasaki M, Mutombo PBWB, Iwamoto M, Nogi A, Hashimoto M, Nabika T, Shiwaku K. The interaction of Apolipoprotein A5 gene promoter region T-1131C polymorphism (rs12286037) and lifestyle modification on plasma triglyceride levels in Japanese. Nutr Res Pract 2015; 9:379-84. [PMID: 26244076 PMCID: PMC4523481 DOI: 10.4162/nrp.2015.9.4.379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/19/2014] [Accepted: 12/14/2014] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND/OBJECTIVE Apolipoprotein A5 gene promoter region T-1131C polymorphism (APOA5 T-1131C) is known to be associated with elevated plasma TG levels, although little is known of the influence of the interaction between APOA5 T-1131C and lifestyle modification on TG levels. To investigate this matter, we studied APOA5 T-1131C and plasma TG levels of subjects participating in a three-month lifestyle modification program. SUBJECTS/METHODS A three-month lifestyle modification program was conducted with 297 participants (Age: 57 ± 8 years) in Izumo City, Japan, from 2001-2007. Changes in energy balance (the difference between energy intake and energy expenditure) and BMI were used to evaluate the participants' responses to the lifestyle modification. RESULTS Even after adjusting for confounding factors, plasma TG levels were significantly different at baseline among three genotype subgroups: TT, 126 ± 68 mg/dl; TC, 134 ± 74 mg/dl; and CC, 172 ± 101 mg/dl. Lifestyle modification resulted in significant reductions in plasma TG levels in the TT, TC, and CC genotype subgroups: -21.9 ± 61.0 mg/dl, -20.9 ± 51.0 mg/dl, and -42.6 ± 78.5 mg/dl, respectively, with no significant differences between them. In a stepwise regression analysis, age, APOA5 T-1131C, body mass index (BMI), homeostasis model assessment-insulin resistance (HOMA-IR), and the 18:1/18:0 ratio showed independent association with plasma TG levels at baseline. In a general linear model analysis, APOA5 T-1131C C-allele carriers showed significantly greater TG reduction with decreased energy balance than wild type carriers after adjustment for age, gender, and baseline plasma TG levels. CONCLUSIONS The genetic effects of APOA5 T-1131C independently affected plasma TG levels. However, lifestyle modification was effective in significantly reducing plasma TG levels despite the APOA5 T-1131C genotype background.
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Affiliation(s)
- Masayuki Yamasaki
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Paulin Beya Wa Bitadi Mutombo
- Department of Nutrition, School of Public Health, Faculty of Medicine, University of Kinshasa, B.P. 127 Kinshasa XI, Democratic Republic of Congo
| | - Mamiko Iwamoto
- Department of Environmental and Preventive Medicine, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Akiko Nogi
- Department of Human Nutrition, Faculty of Nursing and Human Nutrition, Yamaguchi Prefectural University, Yamaguchi 753-8502, Japan
| | - Michio Hashimoto
- Department of Environmental Physiology, Faculty of Medicine, Shimane University, Shimane 693-8501, Japan
| | - Toru Nabika
- Department of Functional Pathology, Faculty of Medicine, Shimane University, Shimane 693-8501, Japan
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Bookman EB, McAllister K, Gillanders E, Wanke K, Balshaw D, Rutter J, Reedy J, Shaughnessy D, Agurs-Collins T, Paltoo D, Atienza A, Bierut L, Kraft P, Fallin MD, Perera F, Turkheimer E, Boardman J, Marazita ML, Rappaport SM, Boerwinkle E, Suomi SJ, Caporaso NE, Hertz-Picciotto I, Jacobson KC, Lowe WL, Goldman LR, Duggal P, Gunnar MR, Manolio TA, Green ED, Olster DH, Birnbaum LS. Gene-environment interplay in common complex diseases: forging an integrative model—recommendations from an NIH workshop. Genet Epidemiol 2015; 35:217-25. [PMID: 21308768 DOI: 10.1002/gepi.20571] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 01/03/2011] [Accepted: 01/10/2011] [Indexed: 11/07/2022]
Abstract
Although it is recognized that many common complex diseases are a result of multiple genetic and environmental risk factors, studies of gene-environment interaction remain a challenge and have had limited success to date. Given the current state-of-the-science, NIH sought input on ways to accelerate investigations of gene-environment interplay in health and disease by inviting experts from a variety of disciplines to give advice about the future direction of gene-environment interaction studies. Participants of the NIH Gene-Environment Interplay Workshop agreed that there is a need for continued emphasis on studies of the interplay between genetic and environmental factors in disease and that studies need to be designed around a multifaceted approach to reflect differences in diseases, exposure attributes, and pertinent stages of human development. The participants indicated that both targeted and agnostic approaches have strengths and weaknesses for evaluating main effects of genetic and environmental factors and their interactions. The unique perspectives represented at the workshop allowed the exploration of diverse study designs and analytical strategies, and conveyed the need for an interdisciplinary approach including data sharing, and data harmonization to fully explore gene-environment interactions. Further, participants also emphasized the continued need for high-quality measures of environmental exposures and new genomic technologies in ongoing and new studies.
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Affiliation(s)
- Ebony B Bookman
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA.
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12
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Zheng Y, Qi L. Diet and lifestyle interventions on lipids: combination with genomics and metabolomics. ACTA ACUST UNITED AC 2014. [DOI: 10.2217/clp.14.30] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Sela DA, Mills DA. The marriage of nutrigenomics with the microbiome: the case of infant-associated bifidobacteria and milk. Am J Clin Nutr 2014; 99:697S-703S. [PMID: 24452239 PMCID: PMC3927697 DOI: 10.3945/ajcn.113.071795] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Broadly, nutrigenomics examines the association of exogenous nutrients and molecular responses to maintain homeostasis in an individual. Phenotypic expression profiling, often transcriptomics, has been applied to identify markers and metabolic consequences of suboptimal diet, lifestyle, or both. The decade after the Human Genome Project has been marked with advances in high-throughput analysis of biological polymers and metabolites, prompting a rapid increase in characterization of the profound nature by which our symbiotic microbiota influences human physiology. Although the technology is widely accessible to assess microbiome composition, genetic potential, and global function, nutrigenomics studies often exclude the microbial contribution to host responses to ingested nutritive molecules. Perhaps a hallmark of coevolution, milk provides a dramatic example of a diet that promotes a particular microbial community structure, because the lower infant gastrointestinal tract is often dominated by bifidobacteria that flourish on milk glycans. Systems-level approaches should continue to be applied to examine the microbial communities in the context of their host's dietary habits and metabolic status. In addition, studies of isolated microbiota species should be encouraged to inform clinical studies and interventions as well as community studies. Whereas nutrigenomics research is beginning to account for resident microbiota, the need remains to consistently consider our microscopic partners in the human holobiont.
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Affiliation(s)
- David A Sela
- Foods for Health Institute, Departments of Food Science and Technology and Viticulture and Enology, University of California, Davis, Davis, CA
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Yiannakouris N, Katsoulis M, Trichopoulou A, Ordovas JM, Trichopoulos D. Additive influence of genetic predisposition and conventional risk factors in the incidence of coronary heart disease: a population-based study in Greece. BMJ Open 2014; 4:e004387. [PMID: 24500614 PMCID: PMC3918976 DOI: 10.1136/bmjopen-2013-004387] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES An additive genetic risk score (GRS) for coronary heart disease (CHD) has previously been associated with incident CHD in the population-based Greek European Prospective Investigation into Cancer and nutrition (EPIC) cohort. In this study, we explore GRS-'environment' joint actions on CHD for several conventional cardiovascular risk factors (ConvRFs), including smoking, hypertension, type-2 diabetes mellitus (T2DM), body mass index (BMI), physical activity and adherence to the Mediterranean diet. DESIGN A case-control study. SETTING The general Greek population of the EPIC study. PARTICIPANTS AND OUTCOME MEASURES 477 patients with medically confirmed incident CHD and 1271 controls participated in this study. We estimated the ORs for CHD by dividing participants at higher or lower GRS and, alternatively, at higher or lower ConvRF, and calculated the relative excess risk due to interaction (RERI) as a measure of deviation from additivity. RESULTS The joint presence of higher GRS and higher risk ConvRF was in all instances associated with an increased risk of CHD, compared with the joint presence of lower GRS and lower risk ConvRF. The OR (95% CI) was 1.7 (1.2 to 2.4) for smoking, 2.7 (1.9 to 3.8) for hypertension, 4.1 (2.8 to 6.1) for T2DM, 1.9 (1.4 to 2.5) for lower physical activity, 2.0 (1.3 to 3.2) for high BMI and 1.5 (1.1 to 2.1) for poor adherence to the Mediterranean diet. In all instances, RERI values were fairly small and not statistically significant, suggesting that the GRS and the ConvRFs do not have effects beyond additivity. CONCLUSIONS Genetic predisposition to CHD, operationalised through a multilocus GRS, and ConvRFs have essentially additive effects on CHD risk.
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Affiliation(s)
- Nikos Yiannakouris
- Hellenic Health Foundation, Athens, Greece
- Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
| | | | - Antonia Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School, Athens, Greece
| | - Jose M Ordovas
- Nutrition and Genomics Laboratory, Jean Mayer—US Department of Agriculture, Human Nutrition Research Center on Aging (HNRCA) at Tufts University, Boston, Massachusetts, USA
- Department of Cardiovascular Epidemiology and Population Genetics, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Instituto Madrileño de Estudios Avanzados (IMDEA) Alimentacion, Madrid, Spain
| | - Dimitrios Trichopoulos
- Hellenic Health Foundation, Athens, Greece
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
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Hamrefors V, Hedblad B, Hindy G, Smith JG, Almgren P, Engström G, Sjögren M, Gränsbo K, Orho-Melander M, Melander O. Smoking modifies the associated increased risk of future cardiovascular disease by genetic variation on chromosome 9p21. PLoS One 2014; 9:e85893. [PMID: 24465769 PMCID: PMC3899088 DOI: 10.1371/journal.pone.0085893] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 12/03/2013] [Indexed: 12/31/2022] Open
Abstract
AIMS Genetic predisposition for cardiovascular disease (CVD) is likely to be modified by environmental exposures. We tested if the associated risk of CVD and CVD-mortality by the single nucleotide polymorphism rs4977574 on chromosome 9p21 is modified by life-style factors. METHODS AND RESULTS A total of 24,944 middle-aged subjects (62% females) from the population-based Malmö-Diet-and-Cancer-Cohort were genotyped. Smoking, education and physical activity-levels were recorded. Subjects were followed for 15 years for incidence of coronary artery disease (CAD; N = 2309), ischemic stroke (N = 1253) and CVD-mortality (N = 1156). Multiplicative interactions between rs4977574 and life-style factors on endpoints were tested in Cox-regression-models. We observed an interaction between rs4977574 and smoking on incident CAD (P = 0.035) and CVD-mortality (P = 0.012). The hazard ratios (HR) per risk allele of rs4977574 were highest in never smokers (N = 9642) for CAD (HR = 1.26; 95% CI 1.13-1.40; P<0.001) and for CVD-mortality (HR = 1.40; 95% CI 1.20-1.63; P<0.001), whereas the risk increase by rs4977574 was attenuated in current smokers (N = 7000) for both CAD (HR = 1.05; 95%CI 0.95-1.16; P = 0.326) and CVD-mortality (HR = 1.08; 95%CI 0.94-1.23; P = 0.270). A meta-analysis supported the finding that the associated increased risk of CAD by the risk-allele was attenuated in smokers. Neither education nor physical activity-levels modified the associated risk of CAD, ischemic stroke and CVD mortality conferred by rs4977574. CONCLUSION Smoking may modify the associated risk of CAD and CVD-mortality conferred by genetic variation on chromosome 9p21. Whether the observed attenuation of the genetic risk reflects a pathophysiological mechanism or is a result of smoking being such a strong risk-factor that it may eliminate the associated genetic effect, requires further investigation.
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Affiliation(s)
- Viktor Hamrefors
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden ; Clinical Physiology and Nuclear Medicine Unit, Skåne University Hospital, Malmö, Sweden
| | - Bo Hedblad
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - George Hindy
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - J Gustav Smith
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden ; Department of Cardiology, Faculty of Medicine, Lund University, Lund, Sweden ; Department of Cardiology, Skåne University Hospital, Lund, Sweden ; Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, United States of America
| | - Peter Almgren
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Marketa Sjögren
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Klas Gränsbo
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden ; Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Marju Orho-Melander
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Olle Melander
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden ; Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
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Lamina C, Forer L, Schönherr S, Kollerits B, Ried JS, Gieger C, Peters A, Wichmann HE, Kronenberg F. Evaluation of gene–obesity interaction effects on cholesterol levels: A genetic predisposition score on HDL-cholesterol is modified by obesity. Atherosclerosis 2012; 225:363-9. [DOI: 10.1016/j.atherosclerosis.2012.09.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 09/14/2012] [Accepted: 09/14/2012] [Indexed: 01/19/2023]
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Cornelis MC, Hu FB. Gene-environment interactions in the development of type 2 diabetes: recent progress and continuing challenges. Annu Rev Nutr 2012; 32:245-59. [PMID: 22540253 DOI: 10.1146/annurev-nutr-071811-150648] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Type 2 diabetes (T2D) is thought to arise from the complex interplay of both genetic and environmental factors. Since the advent of genome-wide association studies (GWAS), we have seen considerable progress in our understanding of the role that genetics and gene-environment interactions play in the development of T2D. Recent work suggests that the adverse effect of several T2D loci may be abolished or at least attenuated by higher physical activity levels or healthy lifestyle, whereas low physical activity and dietary factors characterizing a Western dietary pattern may augment it. However, there still remain inconsistencies warranting further investigation. Lack of statistical power and measurement errors for the environmental factors continue to challenge our efforts for characterizing interactions. Although our recent focus on established T2D loci is reasonable, we may be overlooking many other potential loci not captured by recent T2D GWAS. Agnostic approaches to the discovery of gene and environment interactions may address this possibility, but their application to the field is currently limited and still faces conceptual challenges. Nonetheless, continued investment in gene-environment interaction studies through large collaborative efforts holds promise in furthering our understanding of the interplay between genetic and environmental factors.
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Affiliation(s)
- Marilyn C Cornelis
- Department of Nutrition, Harvard School of Public Health, Harvard University, Boston, Massachusetts 02115, USA
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18
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Do R, Xie C, Zhang X, Männistö S, Harald K, Islam S, Bailey SD, Rangarajan S, McQueen MJ, Diaz R, Lisheng L, Wang X, Silander K, Peltonen L, Yusuf S, Salomaa V, Engert JC, Anand SS. The effect of chromosome 9p21 variants on cardiovascular disease may be modified by dietary intake: evidence from a case/control and a prospective study. PLoS Med 2011; 8:e1001106. [PMID: 22022235 PMCID: PMC3191151 DOI: 10.1371/journal.pmed.1001106] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 08/30/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND One of the most robust genetic associations for cardiovascular disease (CVD) is the Chromosome 9p21 region. However, the interaction of this locus with environmental factors has not been extensively explored. We investigated the association of 9p21 with myocardial infarction (MI) in individuals of different ethnicities, and tested for an interaction with environmental factors. METHODS AND FINDINGS We genotyped four 9p21 SNPs in 8,114 individuals from the global INTERHEART study. All four variants were associated with MI, with odds ratios (ORs) of 1.18 to 1.20 (1.85×10(-8)≤p≤5.21×10(-7)). A significant interaction (p = 4.0×10(-4)) was observed between rs2383206 and a factor-analysis-derived "prudent" diet pattern score, for which a major component was raw vegetables. An effect of 9p21 on MI was observed in the group with a low prudent diet score (OR = 1.32, p = 6.82×10(-7)), but the effect was diminished in a step-wise fashion in the medium (OR = 1.17, p = 4.9×10(-3)) and high prudent diet scoring groups (OR = 1.02, p = 0.68) (p = 0.014 for difference). We also analyzed data from 19,129 individuals (including 1,014 incident cases of CVD) from the prospective FINRISK study, which used a closely related dietary variable. In this analysis, the 9p21 risk allele demonstrated a larger effect on CVD risk in the groups with diets low or average for fresh vegetables, fruits, and berries (hazard ratio [HR] = 1.22, p = 3.0×10(-4), and HR = 1.35, p = 4.1×10(-3), respectively) compared to the group with high consumption of these foods (HR = 0.96, p = 0.73) (p = 0.0011 for difference). The combination of the least prudent diet and two copies of the risk allele was associated with a 2-fold increase in risk for MI (OR = 1.98, p = 2.11×10(-9)) in the INTERHEART study and a 1.66-fold increase in risk for CVD in the FINRISK study (HR = 1.66, p = 0.0026). CONCLUSIONS The risk of MI and CVD conferred by Chromosome 9p21 SNPs appears to be modified by a prudent diet high in raw vegetables and fruits. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Ron Do
- Department of Human Genetics, McGill University, Montréal, Quebec, Canada
| | - Changchun Xie
- Population Health Research Institute, Hamilton Health Sciences, and McMaster University, Hamilton, Ontario, Canada
- Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Xiaohe Zhang
- Population Health Research Institute, Hamilton Health Sciences, and McMaster University, Hamilton, Ontario, Canada
| | - Satu Männistö
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Kennet Harald
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Shofiqul Islam
- Population Health Research Institute, Hamilton Health Sciences, and McMaster University, Hamilton, Ontario, Canada
- Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Swneke D. Bailey
- Department of Human Genetics, McGill University, Montréal, Quebec, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences, and McMaster University, Hamilton, Ontario, Canada
| | - Matthew J. McQueen
- Population Health Research Institute, Hamilton Health Sciences, and McMaster University, Hamilton, Ontario, Canada
| | - Rafael Diaz
- Estudios Cardiologicos Latinoamerica, Rosario, Argentina
| | - Liu Lisheng
- Cardiovascular Institute and Fu Wai Hospital, Chinese Hypertension League Institute, Beijing, China
| | - Xingyu Wang
- Laboratory of Human Genetics, Beijing Hypertension League Institute, Beijing, China
| | - Kaisa Silander
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
- Human Genomics Unit, Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Leena Peltonen
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
- Human Genomics Unit, Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, and McMaster University, Hamilton, Ontario, Canada
| | - Veikko Salomaa
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - James C. Engert
- Department of Human Genetics, McGill University, Montréal, Quebec, Canada
- Department of Medicine, McGill University, Montréal, Quebec, Canada
- The Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
- * E-mail: (JCE); (SSA)
| | - Sonia S. Anand
- Population Health Research Institute, Hamilton Health Sciences, and McMaster University, Hamilton, Ontario, Canada
- Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- * E-mail: (JCE); (SSA)
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Kaput J, Evelo CT, Perozzi G, van Ommen B, Cotton R. Connecting the Human Variome Project to nutrigenomics. GENES & NUTRITION 2010; 5:275-283. [PMID: 28300226 PMCID: PMC2989367 DOI: 10.1007/s12263-010-0186-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 09/24/2010] [Indexed: 10/19/2022]
Abstract
Nutrigenomics is the science of analyzing and understanding gene-nutrient interactions, which because of the genetic heterogeneity, varying degrees of interaction among gene products, and the environmental diversity is a complex science. Although much knowledge of human diversity has been accumulated, estimates suggest that ~90% of genetic variation has not yet been characterized. Identification of the DNA sequence variants that contribute to nutrition-related disease risk is essential for developing a better understanding of the complex causes of disease in humans, including nutrition-related disease. The Human Variome Project (HVP; http://www.humanvariomeproject.org/) is an international effort to systematically identify genes, their mutations, and their variants associated with phenotypic variability and indications of human disease or phenotype. Since nutrigenomic research uses genetic information in the design and analysis of experiments, the HVP is an essential collaborator for ongoing studies of gene-nutrient interactions. With the advent of next generation sequencing methodologies and the understanding of the undiscovered variation in human genomes, the nutrigenomic community will be generating novel sequence data and results. The guidelines and practices of the HVP can guide and harmonize these efforts.
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Affiliation(s)
- Jim Kaput
- Division of Personalised Nutrition and Medicine, FDA/National Center for Toxicological Research, 3900 NCTR Road, Jefferson, AR 72079 USA
| | - Chris T. Evelo
- Department of Bioinformatics (BiGCaT), Maastricht University, Maastricht, The Netherlands
| | - Giuditta Perozzi
- INRAN—National Research Institute on Food & Nutrition, Via Ardeatina 546, 00178 Rome, Italy
| | - Ben van Ommen
- TNO Quality of Life, P.O. box 360, 3700 AJ Zeist, The Netherlands
| | - Richard Cotton
- Genomic Disorders Research Centre, Level 2, Alan Gilbert Building, 161 Barry Street, Melbourne, VIC 3053 Australia
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Caspi A, Hariri AR, Holmes A, Uher R, Moffitt TE. Genetic sensitivity to the environment: the case of the serotonin transporter gene and its implications for studying complex diseases and traits. Am J Psychiatry 2010; 167:509-27. [PMID: 20231323 PMCID: PMC2943341 DOI: 10.1176/appi.ajp.2010.09101452] [Citation(s) in RCA: 866] [Impact Index Per Article: 61.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Evidence of marked variability in response among people exposed to the same environmental risk implies that individual differences in genetic susceptibility might be at work. The study of such Gene-by-Environment (GxE) interactions has gained momentum. In this article, the authors review research about one of the most extensive areas of inquiry: variation in the promoter region of the serotonin transporter gene (SLC6A4; also known as 5-HTT) and its contribution to stress sensitivity. Research in this area has both advanced basic science and generated broader lessons for studying complex diseases and traits. The authors evaluate four lines of evidence about the 5-HTT stress-sensitivity hypothesis: 1) observational studies about the serotonin transporter linked polymorphic region (5-HTTLPR), stress sensitivity, and depression in humans; 2) experimental neuroscience studies about the 5-HTTLPR and biological phenotypes relevant to the human stress response; 3) studies of 5-HTT variation and stress sensitivity in nonhuman primates; and 4) studies of stress sensitivity and genetically engineered 5-HTT mutations in rodents. The authors then dispel some misconceptions and offer recommendations for GxE research. The authors discuss how GxE interaction hypotheses can be tested with large and small samples, how GxE research can be carried out before as well as after replicated gene discovery, the uses of GxE research as a tool for gene discovery, the importance of construct validation in evaluating GxE research, and the contribution of GxE research to the public understanding of genetic science.
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Affiliation(s)
- Avshalom Caspi
- Department of Psychology, and Institute for Genome Sciences and Policy, Duke University, Durham, NC 27708, USA.
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22
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Ariza MJ, Sánchez-Chaparro MA, Barón FJ, Hornos AM, Calvo-Bonacho E, Rioja J, Valdivielso P, Gelpi JA, González-Santos P. Additive effects of LPL, APOA5 and APOE variant combinations on triglyceride levels and hypertriglyceridemia: results of the ICARIA genetic sub-study. BMC MEDICAL GENETICS 2010; 11:66. [PMID: 20429872 PMCID: PMC2877669 DOI: 10.1186/1471-2350-11-66] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 04/29/2010] [Indexed: 12/19/2022]
Abstract
Background Hypertriglyceridemia (HTG) is a well-established independent risk factor for cardiovascular disease and the influence of several genetic variants in genes related with triglyceride (TG) metabolism has been described, including LPL, APOA5 and APOE. The combined analysis of these polymorphisms could produce clinically meaningful complementary information. Methods A subgroup of the ICARIA study comprising 1825 Spanish subjects (80% men, mean age 36 years) was genotyped for the LPL-HindIII (rs320), S447X (rs328), D9N (rs1801177) and N291S (rs268) polymorphisms, the APOA5-S19W (rs3135506) and -1131T/C (rs662799) variants, and the APOE polymorphism (rs429358; rs7412) using PCR and restriction analysis and TaqMan assays. We used regression analyses to examine their combined effects on TG levels (with the log-transformed variable) and the association of variant combinations with TG levels and hypertriglyceridemia (TG ≥ 1.69 mmol/L), including the covariates: gender, age, waist circumference, blood glucose, blood pressure, smoking and alcohol consumption. Results We found a significant lowering effect of the LPL-HindIII and S447X polymorphisms (p < 0.0001). In addition, the D9N, N291S, S19W and -1131T/C variants and the APOE-ε4 allele were significantly associated with an independent additive TG-raising effect (p < 0.05, p < 0.01, p < 0.001, p < 0.0001 and p < 0.001, respectively). Grouping individuals according to the presence of TG-lowering or TG-raising polymorphisms showed significant differences in TG levels (p < 0.0001), with the lowest levels exhibited by carriers of two lowering variants (10.2% reduction in TG geometric mean with respect to individuals who were homozygous for the frequent alleles of all the variants), and the highest levels in carriers of raising combinations (25.1% mean TG increase). Thus, carrying two lowering variants was protective against HTG (OR = 0.62; 95% CI, 0.39-0.98; p = 0.042) and having one single raising polymorphism (OR = 1.20; 95% CI, 1.39-2.87; p < 0.001) or more (2 or 3 raising variants; OR = 2.90; 95% CI, 1.56-5.41; p < 0.001) were associated with HTG. Conclusion Our results showed a significant independent additive effect on TG levels of the LPL polymorphisms HindIII, S447X, D9N and N291S; the S19W and -1131T/C variants of APOA5, and the ε4 allele of APOE in our study population. Moreover, some of the variant combinations studied were significantly associated with the absence or the presence of hypertriglyceridemia.
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Affiliation(s)
- María-José Ariza
- Departamento de Medicina y Dermatología, Facultad de Medicina, Laboratorio de Lípidos y Arteriosclerosis, Centro de Investigaciones Médico-Sanitarias (CIMES), Universidad de Málaga, Campus de Teatinos, 29010 Málaga, Spain.
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Solà R, Bruckert E, Valls RM, Narejos S, Luque X, Castro-Cabezas M, Doménech G, Torres F, Heras M, Farrés X, Vaquer JV, Martínez JM, Almaraz MC, Anguera A. Soluble fibre (Plantago ovata husk) reduces plasma low-density lipoprotein (LDL) cholesterol, triglycerides, insulin, oxidised LDL and systolic blood pressure in hypercholesterolaemic patients: A randomised trial. Atherosclerosis 2010; 211:630-7. [PMID: 20413122 DOI: 10.1016/j.atherosclerosis.2010.03.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Revised: 03/05/2010] [Accepted: 03/07/2010] [Indexed: 11/25/2022]
Abstract
UNLABELLED The objective was to evaluate whether the soluble fibre Plantago ovata (Po)-husk improves cardiovascular disease (CVD) risk biomarkers including low-density lipoprotein cholesterol (LDL-C). METHODS In a multi-centred, double-blind, placebo-controlled, parallel, randomised trial conducted in primary care-clinics in Spain, France and Holland, mild-moderate hypercholesterolaemic patients (age range: 43-67 years) received 14 g/d of Po-husk (n=126) or placebo (microcrystalline-cellulose 14 g/d; n=128) in a low saturated fat diet for 8 weeks. Subsequently, if LDL-C remained > or = 3.35 mmol/L [130 mg/dL], participants proceeded with the fibre plus simvastatin (20mg/d) for further 8 weeks. Lipid profile, blood pressure (BP), insulin, oxidised LDL and some gene polymorphisms involved in CVD risk were measured. RESULTS Relative to placebo, Po-husk reduced plasma LDL-C by -6% (P<0.0002), total cholesterol (TC) by -6%, triglycerides (TG) by -21.6%, apolipoprotein (Apo) B-100 by -6.7%, oxidised LDL by a mean of -6.82 U/L (95%CI: 3.15-10.48), insulin by -4.68 pmol/L (95%CI: 0.68-8.67) and systolic BP by -4.0mm Hg (95%CI; 1.2-6.7) (P<0.05). The TG-lowering effect in the Po-husk group was magnified by variants in plasminogen-activator-inhibitor (PAI-1; rs1799768) and fatty acid-binding protein (FABP-2; rs1799883) genes. At 16 weeks, the intra-group action of simvastatin (20mg/d) added to Po-husk or placebo was a similar LDL-C reduction. CONCLUSIONS Po-husk, apart from lowering LDL-C, also reduced TG, TG related to certain gene variants, TC, Apo B-100, oxLDL, insulin-resistance and systolic BP in mild-moderate hypercholesterolaemic individuals. Thus, the target patients to receive Po-husk would be those who present a cluster of various CVD risk factors, such as metabolic syndrome.
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Affiliation(s)
- Rosa Solà
- Unitat de Recerca en Lípids i Arteriosclerosi, CIBERDEM, Hospital Universitari Sant Joan, IISPV, Universitat ROVIRA i VIRGILI, Reus, Spain.
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Decreased apolipoprotein A5 is implicated in insulin resistance-related hypertriglyceridemia in obesity. Atherosclerosis 2009; 210:563-8. [PMID: 20047745 DOI: 10.1016/j.atherosclerosis.2009.12.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 12/01/2009] [Accepted: 12/03/2009] [Indexed: 11/21/2022]
Abstract
Hypertriglyceridemia is associated insulin resistance in obese people. Recently identified apolipoprotein A5 (apoA5) is involved in triglyceride (TG) metabolism. This study was to investigate the role of apoA5 in insulin resistance-related hypertriglyceridemia in obesity. 682 participants including 340 non-obese individuals and 342 obese individuals were recruited in this study. Plasma apoA5 levels were measured. The insulin resistance in participants was assessed by homeostasis model assessment of insulin resistance (HOMA-IR). An insulin resistant and hypertriglyceridemic rat model was established by high-fructose diet with obese Zucker rats as positive controls. Besides, two insulin resistant models in vitro were induced by insulin and tumor necrosis factor-alpha (TNFalpha) in HepG2 cells. Obese participants had lower plasma apoA5 levels. Plasma apoA5 levels were inversely correlated with TG, body mass index and HOMA-IR in humans. Furthermore, hepatic and plasma apoA5 reduced in fructose-fed rats whereas no significant changes of apoA5 were observed in obese Zucker rats. In addition, treatment of HepG2 cells with insulin and TNFalpha decreased apoA5 expression and increased TG content. Thus, decreased apolipoprotein A5 is implicated in insulin resistance-related hypertriglyceridemia in obesity.
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Diez D, Wheelock AM, Goto S, Haeggström JZ, Paulsson-Berne G, Hansson GK, Hedin U, Gabrielsen A, Wheelock CE. The use of network analyses for elucidating mechanisms in cardiovascular disease. MOLECULAR BIOSYSTEMS 2009; 6:289-304. [PMID: 20094647 DOI: 10.1039/b912078e] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Systems biology offers the potential to provide new insights into our understanding of the pathogenesis of complex diseases such as atherosclerosis. It seeks to comprehend the system properties of the non-linear interactions of the multiple biomolecular components that characterize a living organism. An important component of this research approach is identifying the biological networks that connect the differing elements of a system and in the process describe the characteristics that define a shift in equilibrium from a healthy to a diseased state. The utility of this method becomes clear when applied to multifactorial diseases with complex etiologies such as inflammatory-related diseases, herein exemplified by cardiovascular disease. In this study, the application of network theory to systems biology is described in detail and an example is provided using data from a clinical biobank database of carotid endarterectomies from the Karolinska University Hospital (Biobank of Karolinska Endarterectomies, BiKE). Data from 47 microarrays were examined using a combination of Bioconductor modules and the Cytoscape resource with several associated plugins to analyze the transcriptomics data and create a combined gene association and correlation network of atherosclerosis. The methodology and workflow are described in detail, with a total of 43 genes found to be differentially expressed on a gender-specific basis, of which 15 were not directly linked to the sex chromosomes. In particular, the APOC1 gene was 2.1-fold down-regulated in plaques in women relative to men and was selected for further analysis based upon a purported role in cardiovascular disease. The resulting network was identified as a scale-free network that contained specific sub-networks related to immune function and lipid biosynthesis. These sub-networks link atherosclerotic-related genes to other genes that may not have previously known roles in disease etiology and only evidence small alterations, which are challenging to find by statistical and comparison-based methods. A number of Gene Ontology (GO), BioCarta and KEGG pathways involved in the atherosclerotic process were identified in the constructed sub-network, with 19 GO pathways related to APOC1 of which 'phospholipid efflux' evidenced the strongest association. The utility and functionality of network analysis and the different Cytoscape plugins employed are discussed. Lastly, the applications of these methods to cardiovascular disease are discussed with focus on the current limitations and future visions of this emerging field.
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Affiliation(s)
- Diego Diez
- Bioinformatics Center, Institute for Chemical Research, Kyoto University, Uji, Kyoto 611-0011, Japan
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Pérez-Cueto FJA, Verbeke W, de Barcellos MD, Kehagia O, Chryssochoidis G, Scholderer J, Grunert KG. Food-related lifestyles and their association to obesity in five European countries. Appetite 2009; 54:156-62. [PMID: 19835922 DOI: 10.1016/j.appet.2009.10.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 10/07/2009] [Accepted: 10/08/2009] [Indexed: 01/28/2023]
Abstract
This paper's objective is to investigate the associations between obesity and Food-Related Lifestyles (FRL) in five European countries. A cross-sectional web-based survey was carried out in Belgium, Denmark, Germany, Greece and Poland, January 2008, with quota samples on gender (male, female), age categories (20-44 and 45-70 years), and locality of residence (urban, rural). A total of 2437 respondents (51% women, 49% men; mean age 41.4 years, SD 13.1) participated. Obtained data included socio-demographic information, measure of the food-related lifestyle scale and self-reported weights and heights. Body Mass Index (in kg/m(2)) was calculated as weight (in kg) divided by the squared height (in m(2)). Individuals were classified as obese if BMI > or = 30. Logistic regressions were fitted for the aggregated sample and then by country with obese as dependent and socio-demographics and FRL were included as independents. The prevalence of obesity in the five countries is 22%. Europeans giving more importance to 'self-fulfilment' (odds = 1.18), 'planning of meals' (odds = 1.15), and preferring 'snacks vs. meals' (odds = 1.24) are more likely to be obese. Respondents were less likely to be obese if they attached lower levels of importance to the use of 'shopping lists' (odds = 0.87). The overall picture is that a stronger interest in health, organic products and freshness, within the FLR domain of quality aspects, is associated with 'not being obese'. This study has identified specific FRL dimensions as potential predictors of obesity. The resulting consumers' profiling can be used for targeted interventions for weight management in Europe.
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Affiliation(s)
- Federico J A Pérez-Cueto
- Ghent University, Department of Agricultural Economics, Coupure Links 653, B-9000 Ghent, Belgium.
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Abstract
Type 2 diabetes mellitus (T2DM), like all chronic diseases, results from interactions between multiple genes and multiple environmental factors. Nevertheless, many research studies focus on either nutrition or genetic factors independently of each other. The challenges of analyzing gene-nutrient interactions in T2DM are the (i) genetic heterogeneity in humans, (ii) complexity of environmental factors, particularly dietary chemicals, and (iii) diverse physiologies that produce the same apparent disease. Many of these variables are not accounted for in the design or study of T2DM or, indeed, most chronic diseases, although exceptions are noteworthy. Establishing experimental paradigms to analyze the complexity of these interactions and physiologies is challenging, but possible. This article provides a strategy to extend nutrigenomic experimental strategies to include early environmental influences that may promote adult-onset disease.
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Affiliation(s)
- Carolyn Wise
- Division of Personalized Nutrition and Medicine, Food and Drug Administration/National Center for Toxicological Research, Jefferson, Arkansas 72079, USA.
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28
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Marteau JB, Samara A, Dedoussis G, Pfister M, Visvikis-Siest S. Candidate gene microarray analysis in peripheral blood cells for studying hypertension/obesity. Per Med 2009; 6:269-291. [PMID: 29783504 DOI: 10.2217/pme.09.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIMS The gene expression of 182 cardiovascular candidate genes was measured in high quality groups of individuals (n = 20) by microarrays to determine whether a subset of genes would discriminate obese and hypertensive individuals, in spite of the existence of a close link between these two cardiovascular risk factors. MATERIALS & METHODS The results were validated on the 20 subjects used for microarray analysis and on 62 additional individuals by real-time PCR. RESULTS The first analysis, where patient groups were compared with healthy subjects, revealed 15 out of 182 genes that differed in hypertensive, obese or obesity-related hypertensive individuals. These genes were ALOX5, APOA2, SELL, RGS2, CD14, FPR1, CAMP, DEFA3, DEFA4, CBS, CHRM1, ICAM1, NR1H2, SCNN1B and TGFB1. A second analysis was carried out in which patient groups were compared with each other, demonstrating FPR1 and DEFA3 as being significant genes discriminating patient groups. Furthermore, an analysis stratified by sex revealed that, with the exception of DEFA3, there are no other common genes between men and women. DISCUSSION We were able to indentify a number of interesting genes that distinguish patient and healthy subject groups as well as patient groups between them. CONCLUSION In addition, it seems that gender plays an important role, at least for some of the genes we tested. These findings may have important implications in the screening and etiology of hypertension or obesity, and could further help to focus on these specific mRNAs as antisense therapy targets.
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Affiliation(s)
- Jean-Brice Marteau
- Nancy Université Henri Poincaré, Faculté de Pharmacie, Unité de recherche Génétique Cardiovasculaire, 30 rue Lionnois, 54000 Nancy, France.
| | - Anastasia Samara
- Nancy Université Henri Poincaré, Faculté de Pharmacie, Unité de recherche Génétique Cardiovasculaire, 30 rue Lionnois, 54000 Nancy, France.
| | | | - Michèle Pfister
- Nancy Université Henri Poincaré, Faculté de Pharmacie, Unité de recherche Génétique Cardiovasculaire, 30 rue Lionnois, 54000 Nancy, France.
| | - Sophie Visvikis-Siest
- Nancy Université Henri Poincaré, Faculté de Pharmacie, Unité de recherche Génétique Cardiovasculaire, 30 rue Lionnois, 54000 Nancy, France.
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29
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Abstract
The metabolic syndrome comprises a set of metabolic and physiological risk factors associated with elevated cardiovascular disease risk. The expression of each one of its major factors (hypertriglyceridemia, low high-density lipoprotein cholesterol levels, hypertension, abdominal obesity, and insulin resistance) has been found to be the result of complex interactions between genetic and environmental factors. Moreover, one of them, obesity, may play a major role in triggering the metabolic syndrome by interacting with genetic variants at candidate genes for dyslipidemia, hypertension, and insulin resistance. In support of this hypothesis, several studies at several candidate genes, mainly adipokines and perilipin, have already demonstrated the significance of these interactions; however, the information and its solidity are still very limited and in many cases, replication studies are still lacking in the literature. Therefore, more studies with better epidemiological design and standardized adiposity measures are needed to estimate the contribution of body weight and fat distribution to the genetic predisposition to the metabolic syndrome, the most common CVD risk factor in industrialized societies.
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Affiliation(s)
- Jose M Ordovas
- Jean Mayer-US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, USA.
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30
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Nutrigenetics and personalised nutrition: how far have we progressed and are we likely to get there? Proc Nutr Soc 2009; 68:162-72. [DOI: 10.1017/s0029665109001116] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Nutrigenetics and personalised nutrition are components of the concept that in the future genotyping will be used as a means of defining dietary recommendations to suit the individual. Over the last two decades there has been an explosion of research in this area, with often conflicting findings reported in the literature. Reviews of the literature in the area of apoE genotype and cardiovascular health, apoA5 genotype and postprandial lipaemia and perilipin and adiposity are used to demonstrate the complexities of genotype–phenotype associations and the aetiology of apparent between-study inconsistencies in the significance and size of effects. Furthermore, genetic research currently often takes a very reductionist approach, examining the interactions between individual genotypes and individual disease biomarkers and how they are modified by isolated dietary components or foods. Each individual possesses potentially hundreds of ‘at-risk’ gene variants and consumes a highly-complex diet. In order for nutrigenetics to become a useful public health tool, there is a great need to use mathematical and bioinformatic tools to develop strategies to examine the combined impact of multiple gene variants on a range of health outcomes and establish how these associations can be modified using combined dietary strategies.
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Agurs-Collins T, Khoury MJ, Simon-Morton D, Olster DH, Harris JR, Milner JA. Public health genomics: translating obesity genomics research into population health benefits. Obesity (Silver Spring) 2008; 16 Suppl 3:S85-94. [PMID: 19037221 PMCID: PMC2736102 DOI: 10.1038/oby.2008.517] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We examine how a public health genomics framework can be used to move genomic discoveries into clinical and public health practice for obesity prevention and treatment. There are four phases of translational research: T1: discovery to candidate health application; T2: health application to evidence-based practice guidelines; T3: practice guidelines to health practice; and T4: practice to population health impact. Types of multidisciplinary research and knowledge synthesis needed for each phase, as well as the importance of developing and disseminating evidence-based guidelines, are discussed. Because obesity genomics research is mostly in the discovery phase or in the very early phases of translation (T1), the authors present this framework to illustrate the range of translation activities needed to move genomic discoveries in obesity to actual applications that reduce the burden of obesity at the population level.
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Affiliation(s)
- Tanya Agurs-Collins
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
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