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Figueroa MAC, Lujambio IM, Gutiérrez TA, Hernández MFP, Ramírez EYE, Guzmán DJ, Sánchez MFL, Morales HFG, Samudio HJG, Sánchez FS, Flores MD, Zamarripa CAJ, Mendoza CCC, Hernández MEO, Velázquez CMO, Flores MS, Orozco DVH, Moreno GYC, Cruz M, de Jesús Peralta Romero J. Association of the rs5186 polymorphism of the AGTR1 gene with decreased eGFR in patients with type 2 diabetes from Mexico City. Nefrologia 2023; 43:546-561. [PMID: 37996337 DOI: 10.1016/j.nefroe.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 06/10/2022] [Accepted: 06/29/2022] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Early biomarkers search for Diabetic Kidney Disease (DKD) in patients with Type 2 Diabetes Mellitus (T2DM), as genetic markers to identify vulnerable carriers of the disease even before Glomerular Filtration Rate (GFR) decline or microalbuminuria development, has been relevant during the last few years. The rs5186 (A116C) polymorphism of the Angiotensin II Receptor Type I gene (AGTR1), has been associated to multiple effects of renal injury risk, commonly detected in patients with Diabetes Mellitus (DM). It has been described that rs5186 could have an effect in stability proteins that assemble Angiotensin II Receptor Type I (AT1), modifying its action, which is why it should be considered as a risk factor for Chronic Kidney Disease (CKD), characterized by a GFR progressive reduction. Even though, the association between rs5186 AGTR1 gene polymorphism and DKD in patients with T2DM has been controversial, inconclusive, and even absent. This disputable issue might be as a result of association studies in which many and varied clinical phenotypes included are contemplated as CKD inductors and enhancers. Although, the sample sizes studied in patients with T2DM are undersized and did not have a strict inclusion criteria, lacking of biochemical markers or KDOQI classification, which have hindered its examination. OBJECTIVE The aim of our study was to establish an association between rs5186 AGTR1 gene polymorphism and GFR depletion, assessed as a risk factor to DKD development in patients with T2DM. METHODS We analyzed 297 not related patients with T2DM, divided into 221 controls (KDOQI 1) and 76 cases (KDOQI 2). Arterial pressure, anthropometric and biochemical parameters were measured. rs5186 of AGTR1 genotyping was performed by TaqMan assay real-time PCR method. Allele and genotype frequencies, and Hardy-Weinberg equilibrium were measured. Normality test for data distribution was analyzed by Shapiro-Wilk test, variable comparison by Student's t-test for continuous variables, and Chi-squared test for categorical variables; ANOVA test was used for mean comparison of more than two groups. Effect of rs5186 to DKD was estimated by multiple heritability adjustment models for risk variables of DKD. Statistical significance was indicated by p<0.05. Data was analyzed using Statistical Package STATA v11 software. RESULTS Dominant and Over-dominant models showed a likelihood ratio to GFR depletion of 1.89 (1.05-3.39, p=0.031) and 2.01 (1.08-3.73, p=0.023) in patients with T2DM. Risk factor increased to 2.54 (1.10-5.89) in women in Over-dominant model. CONCLUSION In clinical practice, most of nephropathies progress at a slow pace into a total breakdown of renal function, even asymptomatic. This is the first study, reporting that rs5186 polymorphism of AGTR1 gene contribution to GFR depletion, and this could be evaluated as a predisposing factor for DKD in patients with T2DM.
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Affiliation(s)
- Manuel Alejandro Contreras Figueroa
- Unidad de Investigación Médica en Bioquímica, Unidad Médica de Alta Especialidad "Dr. Bernardo Sepúlveda", Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México, México; Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina del Instituto Politécnico Nacional, Ciudad de México, México
| | - Irene Mendoza Lujambio
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina del Instituto Politécnico Nacional, Ciudad de México, México
| | - Teresa Alvarado Gutiérrez
- Coordinación Clínica de Educación e Investigación en Salud de la Unidad de Medicina Familiar 31, Instituto Mexicano del Seguro Social, Delegación sur, Ciudad de México, México
| | - María Fernanda Pérez Hernández
- Unidad de Investigación Médica en Bioquímica, Unidad Médica de Alta Especialidad "Dr. Bernardo Sepúlveda", Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México, México; Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina del Instituto Politécnico Nacional, Ciudad de México, México; Red de Medicina Para la Educación, el Desarrollo y la Investigación Científica de Iztacala. MEDICI, Facultad de Estudios Superiores Iztacala, UNAM, Estado de México, México
| | - Evelyn Yazmín Estrada Ramírez
- Unidad de Investigación Médica en Bioquímica, Unidad Médica de Alta Especialidad "Dr. Bernardo Sepúlveda", Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México, México; Departamento de Nefrología del Hospital de Especialidades "Dr. Antonio Fraga Mouret", CMN La Raza, IMSS, Ciudad de México, México
| | - Dominga Jiménez Guzmán
- Departamento de Nefrología del Hospital de Especialidades "Dr. Bernardo Sepúlveda" CMN Siglo XXI, IMSS, Ciudad de México, México; Jefatura de la Unidad de Consulta Externa de la UMAE, Hospital de Alta Especialidad Médica "Dr. Bernardo Sepúlveda", Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México, México
| | - María Fernanda Lucas Sánchez
- Secretaría de Enseñanza Clínica, Internado y Servicio Social. Facultad de Medicina UNAM, Ciudad de México, México; Becaria de la Dirección General de Calidad y Educación en Salud, Secretaría de Salud, México
| | - Hannia Fernanda González Morales
- Unidad de Investigación Médica en Bioquímica, Unidad Médica de Alta Especialidad "Dr. Bernardo Sepúlveda", Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México, México; Red de Medicina Para la Educación, el Desarrollo y la Investigación Científica de Iztacala. MEDICI, Facultad de Estudios Superiores Iztacala, UNAM, Estado de México, México
| | - Héctor Jaime Gómez Samudio
- Unidad de Investigación Médica en Bioquímica, Unidad Médica de Alta Especialidad "Dr. Bernardo Sepúlveda", Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México, México
| | - Fernando Suarez Sánchez
- Unidad de Investigación Médica en Bioquímica, Unidad Médica de Alta Especialidad "Dr. Bernardo Sepúlveda", Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México, México
| | - Margarita Díaz Flores
- Unidad de Investigación Médica en Bioquímica, Unidad Médica de Alta Especialidad "Dr. Bernardo Sepúlveda", Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México, México
| | - Carlos Alberto Jiménez Zamarripa
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina del Instituto Politécnico Nacional, Ciudad de México, México
| | - Claudia Camelia Calzada Mendoza
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina del Instituto Politécnico Nacional, Ciudad de México, México
| | - María Esther Ocharán Hernández
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina del Instituto Politécnico Nacional, Ciudad de México, México
| | - Cora Mariana Orozco Velázquez
- Unidad de Investigación Médica en Bioquímica, Unidad Médica de Alta Especialidad "Dr. Bernardo Sepúlveda", Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México, México; Secretaría de Enseñanza Clínica, Internado y Servicio Social. Facultad de Medicina UNAM, Ciudad de México, México
| | - Mariana Soto Flores
- Unidad de Investigación Médica en Bioquímica, Unidad Médica de Alta Especialidad "Dr. Bernardo Sepúlveda", Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México, México; Departamento de Formación Integral e Institucional, Escuela Nacional de Medicina y Homeopatía, Instituto Politécnico Nacional, Ciudad de México, México
| | - Daniela Vicenta Hernández Orozco
- Unidad de Investigación Médica en Bioquímica, Unidad Médica de Alta Especialidad "Dr. Bernardo Sepúlveda", Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México, México; Departamento de Formación Integral e Institucional, Escuela Nacional de Medicina y Homeopatía, Instituto Politécnico Nacional, Ciudad de México, México
| | - Gabriela Yanet Cortés Moreno
- Coordinación Nacional de Investigación, Subdirección de Servicios de salud de Petróleos Mexicanos, PEMEX, Ciudad de México, México
| | - Miguel Cruz
- Unidad de Investigación Médica en Bioquímica, Unidad Médica de Alta Especialidad "Dr. Bernardo Sepúlveda", Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México, México
| | - José de Jesús Peralta Romero
- Unidad de Investigación Médica en Bioquímica, Unidad Médica de Alta Especialidad "Dr. Bernardo Sepúlveda", Centro Médico Nacional Siglo XXI, IMSS, Ciudad de México, México.
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Asociación del polimorfismo rs5186 del gen AGTR1 con disminución de la TFGe en pacientes con diabetes tipo 2 de la Ciudad de México. Nefrologia 2022. [DOI: 10.1016/j.nefro.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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A Genome-Wide Association Study of a Korean Population Identifies Genetic Susceptibility to Hypertension Based on Sex-Specific Differences. Genes (Basel) 2021; 12:genes12111804. [PMID: 34828409 PMCID: PMC8622776 DOI: 10.3390/genes12111804] [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: 10/18/2021] [Revised: 11/13/2021] [Accepted: 11/13/2021] [Indexed: 12/24/2022] Open
Abstract
Genome-wide association studies have expanded our understanding of the genetic variation of hypertension. Hypertension and blood pressure are influenced by sex-specific differences; therefore, genetic variants may have sex-specific effects on phenotype. To identify the genetic factors influencing the sex-specific differences concerning hypertension, we conducted a heterogeneity analysis of a genome-wide association study (GWAS) on 13,926 samples from a Korean population. Using the Illumina exome chip data of the population, we performed GWASs of the male and female population independently and applied a statistical test that identified heterogeneous effects of the variants between the two groups. To gain information about the biological implication of the genetic heterogeneity, we used gene set enrichment analysis with GWAS catalog and pathway gene sets. The heterogeneity analysis revealed that the rs11066015 of ACAD10 was a significant locus that had sex-specific genetic effects on the development of hypertension. The rs2074356 of HECTD4 also showed significant genetic heterogeneity in systolic blood pressure. The enrichment analysis showed significant results that are consistent with the pathophysiology of hypertension. These results indicate a sex-specific genetic susceptibility to hypertension that should be considered in future genetic studies of hypertension.
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Cantone M, Lanza G, Puglisi V, Vinciguerra L, Mandelli J, Fisicaro F, Pennisi M, Bella R, Ciurleo R, Bramanti A. Hypertensive Crisis in Acute Cerebrovascular Diseases Presenting at the Emergency Department: A Narrative Review. Brain Sci 2021; 11:70. [PMID: 33430236 PMCID: PMC7825668 DOI: 10.3390/brainsci11010070] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 02/07/2023] Open
Abstract
Hypertensive crisis, defined as an increase in systolic blood pressure >179 mmHg or diastolic blood pressure >109 mmHg, typically causes end-organ damage; the brain is an elective and early target, among others. The strong relationship between arterial hypertension and cerebrovascular diseases is supported by extensive evidence, with hypertension being the main modifiable risk factor for both ischemic and hemorrhagic stroke, especially when it is uncontrolled or rapidly increasing. However, despite the large amount of data on the preventive strategies and therapeutic measures that can be adopted, the management of high BP in patients with acute cerebrovascular diseases presenting at the emergency department is still an area of debate. Overall, the outcome of stroke patients with high blood pressure values basically depends on the occurrence of hypertensive emergency or hypertensive urgency, the treatment regimen adopted, the drug dosages and their timing, and certain stroke features. In this narrative review, we provide a timely update on the current treatment, debated issues, and future directions related to hypertensive crisis in patients referred to the emergency department because of an acute cerebrovascular event. This will also focus greater attention on the management of certain stroke-related, time-dependent interventions, such as intravenous thrombolysis and mechanic thrombectomy.
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Affiliation(s)
- Mariagiovanna Cantone
- Department of Neurology, Sant’Elia Hospital, ASP Caltanissetta, Via Luigi Russo, 6, 93100 Caltanissetta, Italy;
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia, 78, 95123 Catania, Italy
- Department of Neurology IC, Oasi Research Institute—IRCCS, Via Conte Ruggero, 73, 94018 Troina, Italy
| | - Valentina Puglisi
- Department of Neurology and Stroke Unit, ASST Cremona, Viale Concordia, 1, 26100 Cremona, Italy; (V.P.); (L.V.)
| | - Luisa Vinciguerra
- Department of Neurology and Stroke Unit, ASST Cremona, Viale Concordia, 1, 26100 Cremona, Italy; (V.P.); (L.V.)
| | - Jaime Mandelli
- Department of Neurosurgery, Sant’Elia Hospital, ASP Caltanissetta, Via Luigi Russo, 6, 93100 Caltanissetta, Italy;
| | - Francesco Fisicaro
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia, 89, 95123 Catania, Italy; (F.F.); (M.P.)
| | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia, 89, 95123 Catania, Italy; (F.F.); (M.P.)
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Via Santa Sofia, 78, 95123 Catania, Italy;
| | - Rosella Ciurleo
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113, Via Palermo C/da Casazza, 98123 Messina, Italy; (R.C.); (A.B.)
| | - Alessia Bramanti
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113, Via Palermo C/da Casazza, 98123 Messina, Italy; (R.C.); (A.B.)
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Hypertensive Crisis in Acute Cerebrovascular Diseases Presenting at the Emergency Department: A Narrative Review. Brain Sci 2021. [PMID: 33430236 DOI: 10.3390/brainsci11010070.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hypertensive crisis, defined as an increase in systolic blood pressure >179 mmHg or diastolic blood pressure >109 mmHg, typically causes end-organ damage; the brain is an elective and early target, among others. The strong relationship between arterial hypertension and cerebrovascular diseases is supported by extensive evidence, with hypertension being the main modifiable risk factor for both ischemic and hemorrhagic stroke, especially when it is uncontrolled or rapidly increasing. However, despite the large amount of data on the preventive strategies and therapeutic measures that can be adopted, the management of high BP in patients with acute cerebrovascular diseases presenting at the emergency department is still an area of debate. Overall, the outcome of stroke patients with high blood pressure values basically depends on the occurrence of hypertensive emergency or hypertensive urgency, the treatment regimen adopted, the drug dosages and their timing, and certain stroke features. In this narrative review, we provide a timely update on the current treatment, debated issues, and future directions related to hypertensive crisis in patients referred to the emergency department because of an acute cerebrovascular event. This will also focus greater attention on the management of certain stroke-related, time-dependent interventions, such as intravenous thrombolysis and mechanic thrombectomy.
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Corbacho-Alonso N, Rodríguez-Sánchez E, Martin-Rojas T, Mouriño-Alvarez L, Sastre-Oliva T, Hernandez-Fernandez G, Padial LR, Ruilope LM, Ruiz-Hurtado G, Barderas MG. Proteomic investigations into hypertension: what's new and how might it affect clinical practice? Expert Rev Proteomics 2019; 16:583-591. [PMID: 31195841 DOI: 10.1080/14789450.2019.1632197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction: Hypertension is a multifactorial disease that has, thus far, proven to be a difficult target for pharmacological intervention. The application of proteomic strategies may help to identify new biomarkers for the early diagnosis and prompt treatment of hypertension, in order to control blood pressure and prevent organ damage. Areas covered: Advances in proteomics have led to the discovery of new biomarkers to help track the pathophysiological processes implicated in hypertension. These findings not only help to better understand the nature of the disease, but will also contribute to the clinical needs for a timely diagnosis and more precise treatment. In this review, we provide an overview of new biomarkers identified in hypertension through the application of proteomic techniques, and we also discuss the difficulties and challenges in identifying biomarkers in this clinical setting. We performed a literature search in PubMed with the key words 'hypertension' and 'proteomics', and focused specifically on the most recent literature on the utility of proteomics in hypertension research. Expert opinion: There have been several promising biomarkers of hypertension identified by proteomics, but too few have been introduced to the clinic. Thus, further investigations in larger cohorts are necessary to test the feasibility of this strategy for patients. Also, this emerging field would profit from more collaboration between clinicians and researchers.
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Affiliation(s)
- N Corbacho-Alonso
- a Department of Vascular Physiopathology , Hospital Nacional de Paraplejicos (HNP), SESCAM , Toledo , Spain
| | - E Rodríguez-Sánchez
- b Cardiorenal Translational Laboratory , Instituto de Investigación i+12, Hospital Universitario 12 de Octubre , Madrid , Spain
| | - T Martin-Rojas
- a Department of Vascular Physiopathology , Hospital Nacional de Paraplejicos (HNP), SESCAM , Toledo , Spain
| | - L Mouriño-Alvarez
- a Department of Vascular Physiopathology , Hospital Nacional de Paraplejicos (HNP), SESCAM , Toledo , Spain
| | - T Sastre-Oliva
- a Department of Vascular Physiopathology , Hospital Nacional de Paraplejicos (HNP), SESCAM , Toledo , Spain
| | - G Hernandez-Fernandez
- a Department of Vascular Physiopathology , Hospital Nacional de Paraplejicos (HNP), SESCAM , Toledo , Spain
| | - L R Padial
- c Department of Cardiology , Hospital Virgen de la Salud, SESCAM , Toledo , Spain
| | - L M Ruilope
- b Cardiorenal Translational Laboratory , Instituto de Investigación i+12, Hospital Universitario 12 de Octubre , Madrid , Spain.,d Department of Preventive Medicine and Public Health, School of Medicine , Universidad Autónoma de Madrid/IdiPAZ and CIBER in Epidemiology and Public Health (CIBERESP) , Madrid , Spain.,e School of Doctoral Studies and Research , Universidad Europea de Madrid , Madrid , Spain
| | - G Ruiz-Hurtado
- b Cardiorenal Translational Laboratory , Instituto de Investigación i+12, Hospital Universitario 12 de Octubre , Madrid , Spain
| | - M G Barderas
- a Department of Vascular Physiopathology , Hospital Nacional de Paraplejicos (HNP), SESCAM , Toledo , Spain
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Ferrario CM, Mullick AE. Renin angiotensin aldosterone inhibition in the treatment of cardiovascular disease. Pharmacol Res 2017; 125:57-71. [PMID: 28571891 PMCID: PMC5648016 DOI: 10.1016/j.phrs.2017.05.020] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 02/07/2023]
Abstract
A collective century of discoveries establishes the importance of the renin angiotensin aldosterone system in maintaining blood pressure, fluid volume and electrolyte homeostasis via autocrine, paracrine and endocrine signaling. While research continues to yield new functions of angiotensin II and angiotensin-(1-7), the gap between basic research and clinical application of these new findings is widening. As data accumulates on the efficacy of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers as drugs of fundamental importance in the treatment of cardiovascular and renal disorders, it is becoming apparent that the achieved clinical benefits is suboptimal and surprisingly no different than what can be achieved with other therapeutic interventions. We discuss this issue and summarize new pathways and mechanisms effecting the synthesis and actions of angiotensin II. The presence of renin-independent non-canonical pathways for angiotensin II production are largely unaffected by agents inhibiting renin angiotensin system activity. Hence, new efforts should be directed to develop drugs that can effectively block the synthesis and/or action of intracellular angiotensin II. Improved drug penetration into cardiac or renal sites of disease, inhibiting chymase the primary angiotensin II forming enzyme in the human heart, and/or inhibiting angiotensinogen synthesis would all be more effective strategies to inhibit the system. Additionally, given the role of angiotensin II in the maintenance of renal homeostatic mechanisms, any new inhibitor should possess greater selectivity of targeting pathogenic angiotensin II signaling processes and thereby limit inappropriate inhibition.
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Affiliation(s)
- Carlos M Ferrario
- Department of Surgery, Wake Forest University Health Science, Medical Center Blvd., Winston Salem, NC 27157, United States.
| | - Adam E Mullick
- Cardiovascular Antisense Drug Discovery, Ionis Pharmaceuticals, Inc., Carlsbad, CA 92010, United States
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The influence of proximity to city parks on blood pressure in early pregnancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:2958-72. [PMID: 24619158 PMCID: PMC3987015 DOI: 10.3390/ijerph110302958] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 02/18/2014] [Accepted: 03/03/2014] [Indexed: 11/17/2022]
Abstract
This study investigated the effect of proximity to city parks on blood pressure categories during the first trimester of pregnancy. This cross-sectional study included 3,416 female residents of the city of Kaunas, Lithuania, who were enrolled in the FP7 PHENOTYPE project study. The women were classified into four blood pressure categories: optimal, normal, high-normal blood pressure, and hypertension. Multinomial regression models were used to investigate the association between three women's groups with respect to the residence distances from city parks (300, >300-1,000, and >1,000 m) and four blood pressure categories. When using the optimal blood pressure as the reference group, the crude and adjusted odds ratios (OR) for normal blood pressure and for high-normal blood pressure proved to be statistically significantly higher after the inclusion of the selected covariates into the regression analysis. The probability of normal blood pressure increased by 9%, and that of high-normal blood pressure-by 14% for every 300 m increase in the distance to green spaces. The findings of this study suggest a beneficial impact of nearby city parks on blood pressure amongst 20- to 45-year-old women. This relationship has important implications for the prevention of hypertension and the reduction of hypertension-related morbidity.
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Kobori H, Mori H, Masaki T, Nishiyama A. Angiotensin II blockade and renal protection. Curr Pharm Des 2013; 19:3033-42. [PMID: 23176216 DOI: 10.2174/1381612811319170009] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 11/20/2012] [Indexed: 12/15/2022]
Abstract
Current national guidelines have recommended the use of renin-angiotensin system inhibitors, including angiotensin II type 1 receptor blockers (ARBs), in preference to other antihypertensive agents for treating hypertensive patients with chronic kidney disease. However, the mechanisms underlying the renoprotective effects of ARBs are multiple and complex. Blood pressure reduction by systemic vasodilation with an ARB contributes to its beneficial effects in treating kidney disease. Furthermore, ARB-induced renal vasodilation results in an increase in renal blood flow, leading to improvement of renal ischemia and hypoxia. ARBs are also effective in reducing urinary albumin excretion through a reduction in intraglomerular pressure and the protection of glomerular endothelium and/or podocyte injuries. In addition to blocking angiotensin II-induced renal cell and tissue injuries, ARBs can decrease intrarenal angiotensin II levels by reducing proximal tubular angiotensinogen and production of collecting duct renin, as well as angiotensin II accumulation in the kidney. In this review, we will briefly summarize our current understanding of the pharmacological effects of an ARB in the kidney. We will also discuss the possible mechanisms responsible for the renoprotective effects of ARBs on type 2 diabetic nephropathy.
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Affiliation(s)
- Hiroyuki Kobori
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Ikenobe 1750-1, Miki, Kita, Kagawa 761-0793, Japan
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Michel FS, Norton GR, Majane OH, Badenhorst M, Vengethasamy L, Paiker J, Maseko MJ, Sareli P, Woodiwiss AJ. Contribution of Circulating Angiotensinogen Concentrations to Variations in Aldosterone and Blood Pressure in a Group of African Ancestry Depends on Salt Intake. Hypertension 2012; 59:62-9. [DOI: 10.1161/hypertensionaha.111.181230] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Frederic S. Michel
- From the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology (F.S.M., G.R.N., O.H.I.M., M.B., L.V., M.J.M., P.S., A.J.W.), and the School of Pathology (J.P.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gavin R. Norton
- From the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology (F.S.M., G.R.N., O.H.I.M., M.B., L.V., M.J.M., P.S., A.J.W.), and the School of Pathology (J.P.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Olebogeng H.I. Majane
- From the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology (F.S.M., G.R.N., O.H.I.M., M.B., L.V., M.J.M., P.S., A.J.W.), and the School of Pathology (J.P.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Margaret Badenhorst
- From the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology (F.S.M., G.R.N., O.H.I.M., M.B., L.V., M.J.M., P.S., A.J.W.), and the School of Pathology (J.P.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Leanda Vengethasamy
- From the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology (F.S.M., G.R.N., O.H.I.M., M.B., L.V., M.J.M., P.S., A.J.W.), and the School of Pathology (J.P.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Janice Paiker
- From the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology (F.S.M., G.R.N., O.H.I.M., M.B., L.V., M.J.M., P.S., A.J.W.), and the School of Pathology (J.P.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Muzi J. Maseko
- From the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology (F.S.M., G.R.N., O.H.I.M., M.B., L.V., M.J.M., P.S., A.J.W.), and the School of Pathology (J.P.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pinhas Sareli
- From the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology (F.S.M., G.R.N., O.H.I.M., M.B., L.V., M.J.M., P.S., A.J.W.), and the School of Pathology (J.P.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Angela J. Woodiwiss
- From the Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology (F.S.M., G.R.N., O.H.I.M., M.B., L.V., M.J.M., P.S., A.J.W.), and the School of Pathology (J.P.), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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12
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Navar LG, Kobori H, Prieto MC, Gonzalez-Villalobos RA. Intratubular renin-angiotensin system in hypertension. Hypertension 2011; 57:355-62. [PMID: 21282552 PMCID: PMC3073668 DOI: 10.1161/hypertensionaha.110.163519] [Citation(s) in RCA: 177] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- L Gabriel Navar
- Department of Physiology, SL39, Tulane University Health Science Center, 1430 Tulane Ave, New Orleans, LA 70112, USA.
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Navar LG, Prieto MC, Satou R, Kobori H. Intrarenal angiotensin II and its contribution to the genesis of chronic hypertension. Curr Opin Pharmacol 2011; 11:180-6. [PMID: 21339086 DOI: 10.1016/j.coph.2011.01.009] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 01/27/2011] [Accepted: 01/28/2011] [Indexed: 12/20/2022]
Abstract
The increased activity of intrarenal renin-angiotensin system (RAS) in a setting of elevated arterial pressure elicits renal vasoconstriction, increased sodium reabsorption, proliferation, fibrosis and renal injury. Increases in intrarenal and interstitial angiotensin (Ang) II levels are due to increased AT(1) receptor mediated Ang II uptake and stimulation of renal angiotensinogen (AGT) mRNA and protein expression. Augmented proximal tubule AGT production increases tubular AGT secretion and spillover of AGT into the distal nephron and urine. Increased renin formation by principal cells of the collecting ducts forms Ang I from AGT thus increasing Ang II. The catalytic actions of renin and prorenin are enhanced by prorenin receptors (PRRs) on the intercalated cells. The resultant increased intrarenal Ang II levels contribute to the genesis of chronic hypertension.
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Affiliation(s)
- L Gabriel Navar
- Department of Physiology and the Hypertension and Renal Center of Excellence, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, USA.
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Acres OW, Satou R, Navar LG, Kobori H. Contribution of a nuclear factor-kappaB binding site to human angiotensinogen promoter activity in renal proximal tubular cells. Hypertension 2011; 57:608-13. [PMID: 21282554 DOI: 10.1161/hypertensionaha.110.165464] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Intrarenal angiotensinogen (AGT) is expressed highly in renal proximal tubular cells (RPTCs) and contributes to the regulation of intrarenal angiotensin II levels. Inhibition of nuclear factor (NF)-κB suppressed human (h)AGT expression in human RPTCs. However, the presence and localization of an NF-κB binding site in the hAGT promoter region have not been determined. Therefore, this study was performed to demonstrate that an NF-κB binding site in the hAGT promoter region contributes to hAGT promoter activity in human RPTCs. The hAGT promoter region was cloned from -4358 to +122 and deletion analysis was performed. A possible NF-κB binding site was removed from the hAGT promoter region (M1) and mutated (M2). Human RPTCs were transfected, and hAGT promoter activity was determined by luciferase assay. The identity of DNA binding proteins from binding assays were determined by Western blot. Progressive 5'-end deletions demonstrated removal of a distal promoter element in hAGT_-2414/+122 reduced promoter activity (0.61 ± 0.12, ratio to hAGT_-4358/+122). Inhibition of NF-κB suppressed promoter activity in hAGT_-4358/+122 (0.51 ± 0.14, ratio to control) and hAGT_-3681/+122 (0.48 ± 0.06, ratio to control) but not in the construct without the NF-κB binding site. Promoter activity was reduced in the domain mutants M1 (0.57 ± 0.08, ratio to hAGT_-4358/+122) and M2 (0.61 ± 0.16, ratio to hAGT_-4358/+122). DNA binding levels of NF-κB protein were reduced in M1. These data demonstrate the functional importance of an NF-κB binding site in the hAGT promoter region, which contributes to hAGT promoter activity in human RPTCs.
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Affiliation(s)
- Omar W Acres
- Department of Medicine and Physiology, Tulane University Health Sciences Center, New Orleans, LA 70112-2699, USA
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Abstract
Blood pressure and hypertension have significant genetic underpinnings that may be age-dependent. The age-dependency, significant contributions from environmental factors such as diet and exercise, and inherent moment-to-moment variability complicate the identification of the genes contributing to the development of hypertension. Although genetic abnormalities may have moderate effects, the physiologic pathways involving these genes have redundant compensating mechanisms to bring the system back into equilibrium. This has the effect of reducing or completely masking the initial genetic defects, one of the hypothesized reasons for the small genetic effects found by the recent genome-wide association studies. This review article discusses the concept of initiators versus compensators in the context of finding genes related to hypertension development. A brief review is provided of some key genes found to be associated with hypertension, including the genes identified from the nine genome-wide association studies published to date.
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Affiliation(s)
- Steven C Hunt
- Cardiovascular Genetics Division, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84108, USA.
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16
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Genotype-phenotype analysis of angiotensinogen polymorphisms and essential hypertension: the importance of haplotypes. J Hypertens 2010; 28:65-75. [PMID: 19770777 DOI: 10.1097/hjh.0b013e328332031a] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To better understand the relationship between angiotensinogen (AGT) genetic variation and essential hypertension, AGT genotypes and haplotypes were tested for association with hypertensive endophenotypes and essential hypertension. METHODS Two hundred and fifty-six Hypertensive Pathotype (HyperPATH)/Specialized Center of Research (SCOR) cases and 126 controls were genotyped for 24 single-nucleotide polymorphisms (SNPs) in the AGT gene. SNPs and AGT haplotypes were tested for association with plasma AGT, renal plasma flow (RPF), and essential hypertension. RESULTS New associations between essential hypertension, plasma AGT, and RPF are reported for alleles -1178G, 6066A, 6152A, 6233C, and 12822C. The maximum odds ratio for association of hypertension and AGT genetic variation was 2.3 [95% confidence interval (CI) 1.5-3.8; P < 0.0003] for allele 6233C. Previous associations for -1074T, -532T, -217A, -6A, and 4072C are confirmed (P < 0.05). Sodium depletion enhances associations between AGT SNPs and plasma AGT. Most individually associated SNPs, including -6A and 4072C, are found on a common complete AGT haplotype, H4 (frequency = 0.09). Individuals with haplotype H4 have significantly higher plasma AGT and reduced RPF (P < 0.003 and P < 0.0002, respectively). Other common haplotypes are not associated with increased plasma AGT levels in this data set despite the presence of the -6A and 4072C alleles, suggesting that AGT haplotype H4 is more predictive of elevated plasma AGT than is -6A or 4072C. CONCLUSION This study demonstrates the importance of analyzing haplotypes in addition to single genotypes in association studies. By demonstrating the dependence of AGT associations on sodium depletion status, it helps to explain previous conflicting association results.
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Rosivall L. Intrarenal renin-angiotensin system. Mol Cell Endocrinol 2009; 302:185-92. [PMID: 18977408 DOI: 10.1016/j.mce.2008.09.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Revised: 09/21/2008] [Accepted: 09/22/2008] [Indexed: 12/29/2022]
Abstract
Phylogenetically the renin-angiotensin system (RAS) is an ancient regulatory system which has attracted the attention of researchers for about a century. As a result of their efforts, different types of RAS inhibitors are now widely used as therapeutic medicines. The scientific enthusiasm toward RAS remains undiminished and new findings and discoveries are to be expected. Early investigators described the role of RAS in the local control of renal hemodynamics. This correlated well with the morphology of juxtaglomerular apparatus (JGA). Recently developed imaging techniques has allowed for in vivo visualization of cellular functions and the use of molecular biological tools have shed new light on the morphology and physiology of renal RAS, especially in connection with the tubular system. RAS has gained recognition to be more than just an endocrine regulatory system for regulating hemodynamics and water/salt metabolism. RAS is a local tissue and/or cellular regulator with a wide range of effects exerted via various receptors. Local RAS is crucially involved in basic physiological processes like ontogenesis and cell proliferation as well as pathophysiological conditions such as inflammation and tissue fibrosis. These findings may open new frontiers for novel therapeutic approaches. This review focuses only on some specific - less discussed and recently described or hypothesized - morphological and functional aspects of intrarenal RAS, including in vivo imaging of RAS, its effects on juxtaglomerular apparatus and possible cooperative mechanisms among various local renal RAS systems.
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Affiliation(s)
- László Rosivall
- Institute of Pathophysiology, Faculty of Medicine, Semmelweis University, Hungarian Academy of Sciences, Budapest, Hungary.
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Conlin PR. Genes and environment in blood pressure control--salt intake again shows its importance. Am J Clin Nutr 2008; 88:255-6. [PMID: 18689358 DOI: 10.1093/ajcn/88.2.255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Response to genetic manipulations of liver angiotensinogen in the physiological range. J Hum Genet 2008; 53:775-788. [PMID: 18600297 DOI: 10.1007/s10038-008-0311-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Accepted: 06/03/2008] [Indexed: 10/21/2022]
Abstract
Genetic variation in the human angiotensinogen gene (AGT) influences plasma AGT concentration and susceptibility to essential hypertension by a mechanism that remains to be clarified. When one or two additional copies of the gene were inserted by gene titration (by homologous recombination with gap-repair at the AGT locus), both plasma AGT and arterial pressure were elevated in the physiological range in the mouse. The causal dependency between plasma AGT and blood pressure and the relative contribution of the various tissues that express AGT to these two phenotypic parameters remained to be determined. To address these issues, we generated a transgenic mouse with overexpression of the mouse AGT gene restricted to the liver. The transgene was examined in two contrasted genetic backgrounds, the sodium-sensitive C57BL/6J and the sodium-resistant A/J. Transgenic and control male animals underwent continuous cardiovascular monitoring by telemetry for 14 days while under a standard sodium diet (0.2%). Moderate but significant increases in plasma AGT (40%, p = 0.01) and systolic blood pressure (4-6 mmHg, p ranging from 0.01 to <0.001) were observed in the sodium-sensitive background, but not in the sodium-resistant animals. Statistical analysis of a large number of consecutive, repeated measurements of blood pressure afforded power to detect small effects in the physiological range by use of advanced mixed models of analysis of variances and covariances. Although plasma renin activity was increased in the sodium-sensitive background, it did not reach statistical significance. These observations underline a potential contribution of systemic AGT to the mechanism of AGT-mediated hypertension, but the significance of sodium sensitivity in the genetic background suggests participation of the kidney in expression of the elevated blood pressure phenotype, a matter that will warrant further studies. They also highlight the challenge of identifying the contribution of individual genes in complex inheritance, as their effects are modulated by other genetic and environmental determinants.
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Wang JJ, Rochtchina E, Liew G, Tan AG, Wong TY, Leeder SR, Smith W, Shankar A, Mitchell P. The long-term relation among retinal arteriolar narrowing, blood pressure, and incident severe hypertension. Am J Epidemiol 2008; 168:80-8. [PMID: 18469315 DOI: 10.1093/aje/kwn100] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The authors assessed associations between retinal vascular signs and incident severe hypertension in an older population-based cohort. At baseline (1992-1994), 3,654 residents aged 49-97 years living in the Blue Mountains area west of Sydney, Australia, were examined; respectively, 2,335 (75.1%) and 1,952 (76%) survivors were reexamined 5 and 10 years later. Retinal arteriolar and venular calibers were measured, and average central retinal artery and central retinal vein equivalents for that eye were estimated. Severe hypertension was defined by previous diagnosis of hypertension plus antihypertensive medication use or by systolic blood pressure > or =160 mmHg and/or diastolic blood pressure > or =100 mmHg at examinations. Of the 1,424 participants at risk, 618 developed severe hypertension over 10 years (cumulative incidence = 47.7%, 95% confidence interval: 44.9, 50.5). Participants who subsequently developed severe hypertension had significantly narrower mean central retinal artery equivalents than those who did not (187.0 vs. 191.9 mum, p < 0.0001). After adjusting for age, sex, body mass index, smoking, mean arterial blood pressure, and plasma glucose and triglyceride levels, baseline narrowing central retinal artery equivalent was associated with increased risk of severe hypertension (per standard deviation reduction, odds ratio = 1.1, 95% confidence interval: 1.1, 1.2; narrowest vs. widest quintile, odds ratio = 1.6, 95% confidence interval: 1.2, 2.1). These findings support structural narrowing in small arteries and arterioles antecedent to clinical onset of severe hypertension.
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Affiliation(s)
- Jie Jin Wang
- Centre for Vision Research, Department of Ophthalmology and the Westmead Millennium Institute, University of Sydney, Sydney, Australia.
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Rohrwasser A, Lott P, Weiss RB, Lalouel JM. From genetics to mechanism of disease liability. ADVANCES IN GENETICS 2008; 60:701-26. [PMID: 18358337 DOI: 10.1016/s0065-2660(07)00424-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
With each advance in genomic technology, new statistical methods have regularly emerged to test genetic hypotheses in complex inheritance, as evidenced throughout this book. Notwithstanding the approach used, the greatest challenge in the genetics of complex traits remains the identification of the gene(s) and the molecular variant(s) accounting for a genetic inference based on statistical testing. We take the example of quantitative trait locus (QTL) mapping for blood pressure (BP) and related phenotypes in rodents to review the current landscape. Traditional approaches to refined mapping are typically hampered by the small effect and the small proportion of the variance attached to individual QTLs. The alternative of functional screens in intact animals, whether by chemical mutagenesis or gene targeting, remains a daunting undertaking. Such limitations account for the slow progress to date of inferences from QTL to gene(s). We select a QTL for differential sodium sensitivity between two mouse inbred lines to propose an approach that can be used in relatively large genomic regions (1) by optimizing the selection of candidate genes and (2) by subjecting such genes to high-throughput functional screens. While this is still work in progress, we think it abundantly illustrates what is ahead of us in delineating genetic variation that underlie complex disease.
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Affiliation(s)
- Andreas Rohrwasser
- Department of Human Genetics, The University of Utah School of Medicine, Salt Lake City, Utah, USA
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