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Itoku A, Isaac J, Wilson S, Reidy K, Kaskel F. APOL1 Nephropathy Risk Variants Through the Life Course: A Review. Am J Kidney Dis 2024; 84:102-110. [PMID: 38341125 DOI: 10.1053/j.ajkd.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/26/2023] [Accepted: 12/05/2023] [Indexed: 02/12/2024]
Abstract
Two variant alleles of the gene apolipoprotein L1 (APOL1), known as risk variants (RVs), are a major contributor to kidney disease burden in those of African descent. The APOL1 protein contributes to innate immunity and may protect against Trypanosoma, HIV, Salmonella, and leishmaniasis. However, the effects of carrying 1 or more RVs contribute to a variety of disease processes starting as early as in utero and can be exacerbated by other factors (or "second hits"). Indeed, these genetic variations interact with environmental exposures, infections, and systemic disease to modify health outcomes across the life span. This review focuses on APOL1-associated diseases through the life-course perspective and discusses how early exposure to second hits can impact long-term outcomes. APOL1-related kidney disease typically presents in adolescents to young adults, and individuals harboring RVs are more likely to progress to kidney failure than are those with kidney disease who lack APOL-1 RVs. Ongoing research is aimed at elucidating the association of APOL1 RV effects with adverse donor and recipient kidney transplant outcomes. Unfortunately, there is currently no established treatment for APOL1-associated nephropathy. Long-term research is needed to evaluate the risk and protective factors associated with APOL1 RVs at different stages of life.
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Affiliation(s)
- Ai Itoku
- Division of Pediatric Nephrology, Children's Hospital at Montefiore, Bronx, New York
| | - Jaya Isaac
- Division of Pediatric Nephrology, Children's Hospital at Montefiore, Bronx, New York
| | - Scott Wilson
- Albert Einstein College of Medicine, Bronx, New York.
| | - Kimberly Reidy
- Division of Pediatric Nephrology, Children's Hospital at Montefiore, Bronx, New York
| | - Frederick Kaskel
- Division of Pediatric Nephrology, Children's Hospital at Montefiore, Bronx, New York
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Bhale AS, Meilhac O, d'Hellencourt CL, Vijayalakshmi MA, Venkataraman K. Cholesterol transport and beyond: Illuminating the versatile functions of HDL apolipoproteins through structural insights and functional implications. Biofactors 2024. [PMID: 38661230 DOI: 10.1002/biof.2057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
High-density lipoproteins (HDLs) play a vital role in lipid metabolism and cardiovascular health, as they are intricately involved in cholesterol transport and inflammation modulation. The proteome of HDL particles is indeed complex and distinct from other components in the bloodstream. Proteomics studies have identified nearly 285 different proteins associated with HDL; however, this review focuses more on the 15 or so traditionally named "apo" lipoproteins. Important lipid metabolizing enzymes closely working with the apolipoproteins are also discussed. Apolipoproteins stand out for their integral role in HDL stability, structure, function, and metabolism. The unique structure and functions of each apolipoprotein influence important processes such as inflammation regulation and lipid metabolism. These interactions also shape the stability and performance of HDL particles. HDLs apolipoproteins have multifaceted roles beyond cardiovascular diseases (CVDs) and are involved in various physiological processes and disease states. Therefore, a detailed exploration of these apolipoproteins can offer valuable insights into potential diagnostic markers and therapeutic targets. This comprehensive review article aims to provide an in-depth understanding of HDL apolipoproteins, highlighting their distinct structures, functions, and contributions to various physiological processes. Exploiting this knowledge holds great potential for improving HDL function, enhancing cholesterol efflux, and modulating inflammatory processes, ultimately benefiting individuals by limiting the risks associated with CVDs and other inflammation-based pathologies. Understanding the nature of all 15 apolipoproteins expands our knowledge of HDL metabolism, sheds light on their pathological implications, and paves the way for advancements in the diagnosis, prevention, and treatment of lipid and inflammatory-related disorders.
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Affiliation(s)
- Aishwarya Sudam Bhale
- Centre for Bio-Separation Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Olivier Meilhac
- Inserm, UMR 1188 Diabète Athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, Saint-Pierre, France
| | - Christian Lefebvre d'Hellencourt
- Inserm, UMR 1188 Diabète Athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, Saint-Pierre, France
| | | | - Krishnan Venkataraman
- Centre for Bio-Separation Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, India
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Adeva-Andany MM, Domínguez-Montero A, Adeva-Contreras L, Fernández-Fernández C, Carneiro-Freire N, González-Lucán M. Body Fat Distribution Contributes to Defining the Relationship between Insulin Resistance and Obesity in Human Diseases. Curr Diabetes Rev 2024; 20:e160823219824. [PMID: 37587805 DOI: 10.2174/1573399820666230816111624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/28/2023] [Accepted: 05/31/2023] [Indexed: 08/18/2023]
Abstract
The risk for metabolic and cardiovascular complications of obesity is defined by body fat distribution rather than global adiposity. Unlike subcutaneous fat, visceral fat (including hepatic steatosis) reflects insulin resistance and predicts type 2 diabetes and cardiovascular disease. In humans, available evidence indicates that the ability to store triglycerides in the subcutaneous adipose tissue reflects enhanced insulin sensitivity. Prospective studies document an association between larger subcutaneous fat mass at baseline and reduced incidence of impaired glucose tolerance. Case-control studies reveal an association between genetic predisposition to insulin resistance and a lower amount of subcutaneous adipose tissue. Human peroxisome proliferator-activated receptorgamma (PPAR-γ) promotes subcutaneous adipocyte differentiation and subcutaneous fat deposition, improving insulin resistance and reducing visceral fat. Thiazolidinediones reproduce the effects of PPAR-γ activation and therefore increase the amount of subcutaneous fat while enhancing insulin sensitivity and reducing visceral fat. Partial or virtually complete lack of adipose tissue (lipodystrophy) is associated with insulin resistance and its clinical manifestations, including essential hypertension, hypertriglyceridemia, reduced HDL-c, type 2 diabetes, cardiovascular disease, and kidney disease. Patients with Prader Willi syndrome manifest severe subcutaneous obesity without insulin resistance. The impaired ability to accumulate fat in the subcutaneous adipose tissue may be due to deficient triglyceride synthesis, inadequate formation of lipid droplets, or defective adipocyte differentiation. Lean and obese humans develop insulin resistance when the capacity to store fat in the subcutaneous adipose tissue is exhausted and deposition of triglycerides is no longer attainable at that location. Existing adipocytes become large and reflect the presence of insulin resistance.
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Affiliation(s)
- María M Adeva-Andany
- Nephrology Division, Department of Internal Medicine, Hospital General Juan Cardona, c/ Pardo Bazán s/n, 15406 Ferrol, Spain
| | - Alberto Domínguez-Montero
- Nephrology Division, Department of Internal Medicine, Hospital General Juan Cardona, c/ Pardo Bazán s/n, 15406 Ferrol, Spain
| | | | - Carlos Fernández-Fernández
- Nephrology Division, Department of Internal Medicine, Hospital General Juan Cardona, c/ Pardo Bazán s/n, 15406 Ferrol, Spain
| | - Natalia Carneiro-Freire
- Nephrology Division, Department of Internal Medicine, Hospital General Juan Cardona, c/ Pardo Bazán s/n, 15406 Ferrol, Spain
| | - Manuel González-Lucán
- Nephrology Division, Department of Internal Medicine, Hospital General Juan Cardona, c/ Pardo Bazán s/n, 15406 Ferrol, Spain
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Hung AM, Assimon VA, Chen HC, Yu Z, Vlasschaert C, Triozzi JL, Chan H, Wheless L, Wilson O, Shah SC, Mack T, Thompson T, Matheny ME, Chandrasekar S, Mozaffari SV, Chung CP, Tsao P, Susztak K, Siew ED, Estrada K, Gaziano JM, Graham RR, Tao R, Hoek M, Robinson-Cohen C, Green EM, Bick AG. Genetic Inhibition of APOL1 Pore-Forming Function Prevents APOL1-Mediated Kidney Disease. J Am Soc Nephrol 2023; 34:1889-1899. [PMID: 37798822 PMCID: PMC10631602 DOI: 10.1681/asn.0000000000000219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/17/2023] [Indexed: 10/07/2023] Open
Abstract
SIGNIFICANCE STATEMENT African Americans are at increased risk of CKD in part due to high-risk (HR) variants in the apolipoprotein L1 ( APOL1 ) gene, termed G1/G2. A different APOL1 variant, p.N264K , reduced the risk of CKD and ESKD among carriers of APOL1 HR variants to levels comparable with individuals with APOL1 low-risk variants in an analysis of 121,492 participants of African ancestry from the Million Veteran Program (MVP). Functional genetic studies in cell models showed that APOL1 p.N264K blocked APOL1 pore-forming function and ion channel conduction and reduced toxicity of APOL1 HR mutations. Pharmacologic inhibitors that mimic this mutation blocking APOL1 -mediated pore formation may be able to prevent and/or treat APOL1 -associated kidney disease. BACKGROUND African Americans are at increased risk for nondiabetic CKD in part due to HR variants in the APOL1 gene. METHODS We tested whether a different APOL1 variant, p.N264K , modified the association between APOL1 HR genotypes (two copies of G1/G2) and CKD in a cross-sectional analysis of 121,492 participants of African ancestry from the MVP. We replicated our findings in the Vanderbilt University Biobank ( n =14,386) and National Institutes of Health All of Us ( n =14,704). Primary outcome was CKD and secondary outcome was ESKD among nondiabetic patients. Primary analysis compared APOL1 HR genotypes with and without p.N264K . Secondary analyses included APOL1 low-risk genotypes and tested for interaction. In MVP, we performed sequential logistic regression models adjusting for demographics, comorbidities, medications, and ten principal components of ancestry. Functional genomic studies expressed APOL1 HR variants with and without APOL1 p.N264K in cell models. RESULTS In the MVP cohort, 15,604 (12.8%) had two APOL1 HR variants, of which 582 (0.5%) also had APOL1 p.N264K . In MVP, 18,831 (15%) had CKD, 4177 (3%) had ESKD, and 34% had diabetes. MVP APOL1 HR, without p.N264K , was associated with increased odds of CKD (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.60 to 1.85) and ESKD (OR, 3.94; 95% CI, 3.52 to 4.41). In MVP, APOL1 p.N264K mitigated the renal risk of APOL1 HR, in CKD (OR, 0.43; 95% CI, 0.28 to 0.65) and ESKD (OR, 0.19; CI 0.07 to 0.51). In the replication cohorts meta-analysis, APOL1 p.N264K mitigated the renal risk of APOL1 HR in CKD (OR, 0.40; 95% CI, 0.18 to 0.92) and ESKD (OR, 0.19; 95% CI, 0.05 to 0.79). In the mechanistic studies, APOL1 p.N264K blocked APOL1 pore-forming function and ion channel conduction and reduced toxicity of APOL1 HR variants. CONCLUSIONS APOL1 p.N264K is associated with reduced risk of CKD and ESKD among carriers of APOL1 HR to levels comparable with individuals with APOL1 low-risk genotypes.
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Affiliation(s)
- Adriana M. Hung
- Nashville VA Medical Center, VA Tennessee Valley Healthcare System, Nashville, Tennessee
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Hua-Chang Chen
- Nashville VA Medical Center, VA Tennessee Valley Healthcare System, Nashville, Tennessee
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Zhihong Yu
- Nashville VA Medical Center, VA Tennessee Valley Healthcare System, Nashville, Tennessee
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Jefferson L. Triozzi
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Helen Chan
- Maze Therapeutics, South San Francisco, California
| | - Lee Wheless
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Otis Wilson
- Nashville VA Medical Center, VA Tennessee Valley Healthcare System, Nashville, Tennessee
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shailja C. Shah
- VA San Diego Healthcare System and UC San Diego Health, La Jolla, California
| | - Taralynn Mack
- Nashville VA Medical Center, VA Tennessee Valley Healthcare System, Nashville, Tennessee
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Trevor Thompson
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael E. Matheny
- Nashville VA Medical Center, VA Tennessee Valley Healthcare System, Nashville, Tennessee
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Cecilia P. Chung
- Department of Rheumatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Philip Tsao
- VA Palo Alto Health Care System, Palo Alto, California
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Katalin Susztak
- Renal, Electrolyte, and Hypertension Division, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Edward D. Siew
- Nashville VA Medical Center, VA Tennessee Valley Healthcare System, Nashville, Tennessee
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - J. Michael Gaziano
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, Massachusetts
- Department of Medicine, Brigham and Women's Hospital and Harvard School of Medicine, Boston, Massachusetts
| | | | - Ran Tao
- Nashville VA Medical Center, VA Tennessee Valley Healthcare System, Nashville, Tennessee
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Maarten Hoek
- Maze Therapeutics, South San Francisco, California
| | - Cassianne Robinson-Cohen
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Alexander G. Bick
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, Massachusetts
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Miller DV, Watson KE, Wang H, Fyfe-Kirschner B, Heide RSV. Racially Related Risk Factors for Cardiovascular Disease: Society for Cardiovascular Pathology Symposium 2022. Cardiovasc Pathol 2022; 61:107470. [PMID: 36029934 DOI: 10.1016/j.carpath.2022.107470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Dylan V Miller
- Department of Pathology, University of Utah and Intermountain Central Laboratory, Salt Lake City, UT, USA
| | - Karol E Watson
- Department of Medicine (Cardiology), UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - He Wang
- Department of Pathology, Yale University, New Haven, CT, USA
| | - Billie Fyfe-Kirschner
- Department of Pathology and Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Richard S Vander Heide
- Department of Pathology and Laboratory Medicine, Marshfield Clinic Health System, Marshfield, WI, USA
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Hung AM, Shah SC, Bick AG, Yu Z, Chen HC, Hunt CM, Wendt F, Wilson O, Greevy RA, Chung CP, Suzuki A, Ho YL, Akwo E, Polimanti R, Zhou J, Reaven P, Tsao PS, Gaziano JM, Huffman JE, Joseph J, Luoh SW, Iyengar S, Chang KM, Casas JP, Matheny ME, O’Donnell CJ, Cho K, Tao R, Susztak K, Robinson-Cohen C, Tuteja S, Siew ED. APOL1 Risk Variants, Acute Kidney Injury, and Death in Participants With African Ancestry Hospitalized With COVID-19 From the Million Veteran Program. JAMA Intern Med 2022; 182:386-395. [PMID: 35089317 PMCID: PMC8980930 DOI: 10.1001/jamainternmed.2021.8538] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/25/2021] [Indexed: 01/30/2023]
Abstract
IMPORTANCE Coronavirus disease 2019 (COVID-19) confers significant risk of acute kidney injury (AKI). Patients with COVID-19 with AKI have high mortality rates. OBJECTIVE Individuals with African ancestry with 2 copies of apolipoprotein L1 (APOL1) variants G1 or G2 (high-risk group) have significantly increased rates of kidney disease. We tested the hypothesis that the APOL1 high-risk group is associated with a higher-risk of COVID-19-associated AKI and death. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included 990 participants with African ancestry enrolled in the Million Veteran Program who were hospitalized with COVID-19 between March 2020 and January 2021 with available genetic information. EXPOSURES The primary exposure was having 2 APOL1 risk variants (RV) (APOL1 high-risk group), compared with having 1 or 0 risk variants (APOL1 low-risk group). MAIN OUTCOMES AND MEASURES The primary outcome was AKI. The secondary outcomes were stages of AKI severity and death. Multivariable logistic regression analyses adjusted for preexisting comorbidities, medications, and inpatient AKI risk factors; 10 principal components of ancestry were performed to study these associations. We performed a subgroup analysis in individuals with normal kidney function prior to hospitalization (estimated glomerular filtration rate ≥60 mL/min/1.73 m2). RESULTS Of the 990 participants with African ancestry, 905 (91.4%) were male with a median (IQR) age of 68 (60-73) years. Overall, 392 (39.6%) patients developed AKI, 141 (14%) developed stages 2 or 3 AKI, 28 (3%) required dialysis, and 122 (12.3%) died. One hundred twenty-five (12.6%) of the participants were in the APOL1 high-risk group. Patients categorized as APOL1 high-risk group had significantly higher odds of AKI (adjusted odds ratio [OR], 1.95; 95% CI, 1.27-3.02; P = .002), higher AKI severity stages (OR, 2.03; 95% CI, 1.37-2.99; P < .001), and death (OR, 2.15; 95% CI, 1.22-3.72; P = .007). The association with AKI persisted in the subgroup with normal kidney function (OR, 1.93; 95% CI, 1.15-3.26; P = .01). Data analysis was conducted between February 2021 and April 2021. CONCLUSIONS AND RELEVANCE In this cohort study of veterans with African ancestry hospitalized with COVID-19 infection, APOL1 kidney risk variants were associated with higher odds of AKI, AKI severity, and death, even among individuals with prior normal kidney function.
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Affiliation(s)
- Adriana M. Hung
- Tennessee Valley Healthcare System, Nashville Campus, Nashville
- Division of Nephrology & Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shailja C. Shah
- GI Section, VA San Diego Healthcare System, San Diego, California
- Division of Gastroenterology, University of California, San Diego, San Diego
| | - Alexander G. Bick
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Zhihong Yu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hua-Chang Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christine M. Hunt
- Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina
- VA Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina
| | - Frank Wendt
- Department of Psychiatry, Yale University School of Medicine, West Haven, Connecticut
- VA CT Healthcare Center, West Haven, Connecticut
| | - Otis Wilson
- Division of Nephrology & Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert A. Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cecilia P. Chung
- Division of Rheumatology and Division of Clinical Pharmacology, Vanderbilt University Medical Center, Rheumatology Section, Veterans Affairs, Nashville, Tennessee
| | - Ayako Suzuki
- Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina
- VA Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina
| | - Yuk-Lam Ho
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston
| | - Elvis Akwo
- Division of Nephrology & Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Renato Polimanti
- Department of Psychiatry, Yale University School of Medicine, West Haven, Connecticut
- VA CT Healthcare Center, West Haven, Connecticut
| | - Jin Zhou
- Department of Epidemiology and Biostatistics, University of Arizona, Phoenix
- Phoenix VA Health Care System, Phoenix, Arizona
| | - Peter Reaven
- Phoenix VA Health Care System, Phoenix, Arizona
- Division of Endocrinology, Department of Medicine, University of Arizona, Phoenix
| | - Philip S. Tsao
- Epidemiology Research and Information Center (ERIC), VA Palo Alto Health Care System, Palo Alto, California
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - J. Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston
- Division of Aging, Brigham & Women’s Hospital, Boston, Massachusetts
| | - Jennifer E. Huffman
- Center for Population Genomics, Massachusetts Veterans Epidemiology Research & Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts
| | - Jacob Joseph
- Cardiology Section, Veterans Affairs Boston, Boston, Massachusetts
- Division of Cardiovascular Medicine, Brigham & Women’s Hospital, Boston, Massachusetts
| | - Shiuh-Wen Luoh
- VA Portland Health Care System, Portland, Oregon
- Knight Cancer Institute, Oregon Health & Science University, Portland
| | - Sudha Iyengar
- Department of Population and Quantitative Health Sciences, Case Western Reserve University and Louis Stoke, Cleveland VA, Cleveland, Ohio
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Kyong-Mi Chang
- The Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Juan P. Casas
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston
- Department of Medicine, Brigham & Women’s Hospital, Boston, Massachusetts
| | - Michael E. Matheny
- Departments of Biomedical Informatics, Biostatistics, and Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- GREEC, TVHS VA, Nashville, Tennessee
| | - Christopher J. O’Donnell
- Cardiology, VA Boston Healthcare System, Boston, Massachusetts
- Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Novartis
| | - Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston
- Department of Medicine, Brigham & Women’s Hospital, Boston, Massachusetts
| | - Ran Tao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katalin Susztak
- Renal, Electrolyte, and Hypertension Division, Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Cassianne Robinson-Cohen
- Division of Nephrology & Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sony Tuteja
- The Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Edward D. Siew
- Division of Nephrology & Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Tennessee Valley Healthcare System, Nashville VA Medical Center, Nashville, Tennessee
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Daneshpajouhnejad P, Kopp JB, Winkler CA, Rosenberg AZ. The evolving story of apolipoprotein L1 nephropathy: the end of the beginning. Nat Rev Nephrol 2022; 18:307-320. [PMID: 35217848 PMCID: PMC8877744 DOI: 10.1038/s41581-022-00538-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 01/13/2023]
Abstract
Genetic coding variants in APOL1, which encodes apolipoprotein L1 (APOL1), were identified in 2010 and are relatively common among individuals of sub-Saharan African ancestry. Approximately 13% of African Americans carry two APOL1 risk alleles. These variants, termed G1 and G2, are a frequent cause of kidney disease — termed APOL1 nephropathy — that typically manifests as focal segmental glomerulosclerosis and the clinical syndrome of hypertension and arterionephrosclerosis. Cell culture studies suggest that APOL1 variants cause cell dysfunction through several processes, including alterations in cation channel activity, inflammasome activation, increased endoplasmic reticulum stress, activation of protein kinase R, mitochondrial dysfunction and disruption of APOL1 ubiquitinylation. Risk of APOL1 nephropathy is mostly confined to individuals with two APOL1 risk variants. However, only a minority of individuals with two APOL1 risk alleles develop kidney disease, suggesting the need for a ‘second hit’. The best recognized factor responsible for this ‘second hit’ is a chronic viral infection, particularly HIV-1, resulting in interferon-mediated activation of the APOL1 promoter, although most individuals with APOL1 nephropathy do not have an obvious cofactor. Current therapies for APOL1 nephropathies are not adequate to halt progression of chronic kidney disease, and new targeted molecular therapies are in clinical trials. This Review summarizes current understanding of the role of APOL1 variants in kidney disease. The authors discuss the genetics, protein structure and biological functions of APOL1 variants and provide an overview of promising therapeutic strategies. In contrast to other APOL family members, which are primarily intracellular, APOL1 contains a unique secretory signal peptide, resulting in its secretion into plasma. APOL1 renal risk alleles provide protection from African human trypanosomiasis but are a risk factor for progressive kidney disease in those carrying two risk alleles. APOL1 risk allele frequency is ~35% in the African American population in the United States, with ~13% of individuals having two risk alleles; the highest allele frequencies are found in West African populations and their descendants. Cell and mouse models implicate endolysosomal and mitochondrial dysfunction, altered ion channel activity, altered autophagy, and activation of protein kinase R in the pathogenesis of APOL1-associated kidney disease; however, the relevance of these injury pathways to human disease has not been resolved. APOL1 kidney disease tends to be progressive, and current standard therapies are generally ineffective; targeted therapeutic strategies hold the most promise.
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Affiliation(s)
- Parnaz Daneshpajouhnejad
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Pathology, University of Pennsylvania Hospital, Philadelphia, PA, USA
| | | | - Cheryl A Winkler
- Basic Research Program, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Avi Z Rosenberg
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Chen TK, Fitzpatrick J, Winkler CA, Binns-Roemer EA, Corona-Villalobos CP, Jaar BG, Sozio SM, Parekh RS, Estrella MM. APOL1 Risk Variants and Subclinical Cardiovascular Disease in Incident Hemodialysis Patients. Kidney Int Rep 2020; 6:333-341. [PMID: 33615058 PMCID: PMC7879092 DOI: 10.1016/j.ekir.2020.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/23/2020] [Accepted: 11/10/2020] [Indexed: 01/13/2023] Open
Abstract
Introduction To better understand the impact of APOL1 risk variants in end-stage renal disease (ESRD) we evaluated associations of APOL1 risk variants with subclinical cardiovascular disease (CVD) and mortality among African Americans initiating hemodialysis and enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in ESRD cohort study. Methods We modeled associations of APOL1 risk status (high = 2; low = 0/1 risk alleles) with baseline subclinical CVD (left ventricular [LV] hypertrophy; LV mass; ejection fraction; coronary artery calcification [CAC]; pulse wave velocity [PWV]) using logistic and linear regression and all-cause or cardiovascular mortality using Cox models, adjusting for age, sex, and ancestry. In sensitivity analyses, we further adjusted for systolic blood pressure and Charlson Comorbidity Index. Results Of 267 African American participants successfully genotyped for APOL1, 27% were high-risk carriers, 41% were women, and mean age was 53 years. At baseline, APOL1 high- versus low-risk status was independently associated with 50% and 53% lower odds of LV hypertrophy and CAC, respectively, and 10.7% lower LV mass. These associations were robust to further adjustment for comorbidities but not systolic blood pressure. APOL1 risk status was not associated with all-cause or cardiovascular mortality (mean follow-up 2.5 years). Conclusion Among African American patients with incident hemodialysis, APOL1 high-risk status was associated with better subclinical measures of CVD but not mortality.
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Affiliation(s)
- Teresa K. Chen
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Correspondence: Teresa K. Chen, Division of Nephrology, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 416, Baltimore, Maryland 21287, USA.
| | - Jessica Fitzpatrick
- Departments of Pediatrics and Medicine, Hospital for Sick Children, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Cheryl A. Winkler
- Basic Research Program, Frederick National Laboratory, Frederick, Maryland, USA
| | | | - Celia P. Corona-Villalobos
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bernard G. Jaar
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Nephrology Center of Maryland, Baltimore, Maryland, USA
| | - Stephen M. Sozio
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rulan S. Parekh
- Departments of Pediatrics and Medicine, Hospital for Sick Children, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Michelle M. Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- San Francisco VA Health Care System, San Francisco, California, USA
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9
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Chen TK, Katz R, Estrella MM, Post WS, Kramer H, Rotter JI, Tayo B, Mychaleckyj JC, Wassel CL, Peralta CA. Association of APOL1 Genotypes With Measures of Microvascular and Endothelial Function, and Blood Pressure in MESA. J Am Heart Assoc 2020; 9:e017039. [PMID: 32851884 PMCID: PMC7660790 DOI: 10.1161/jaha.120.017039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background APOL1 high‐risk genotypes are associated with increased risk for hypertension‐attributed kidney disease among Black adults in the United States. Biopsy studies show differences in kidney vasculature by APOL1 status; less is known about the variants' associations with systemic vascular and endothelial function. Whether APOL1 risk variants are associated with blood pressure (BP) is also uncertain. Methods and Results Using linear regression, we examined cross‐sectional associations of APOL1 risk genotypes (high=2 risk alleles, low=0 or 1 risk allele) with subclinical measures of vascular function (small arterial elasticity, n=1586; large arterial elasticity, n=1586; ascending aortic distensibility, n=985) and endothelial function (flow‐mediated dilation, n=777). Using linear mixed‐effects models, we studied longitudinal associations of APOL1 risk genotypes with BP (n=1619), adjusting for age, sex, and African ancestry. Among 1619 (12% APOL1 high‐risk) Black participants in MESA (Multi‐Ethnic Study of Atherosclerosis), mean age was 62 years old, 58% had hypertension, and mean systolic BP was 131 mm Hg at baseline. At examination 1 (2000–2002), there was no significant difference in small arterial elasticity, large arterial elasticity, ascending aortic distensibility, or flow‐mediated dilation in participants with APOL1 high‐ versus low‐risk genotypes (P>0.05 for all). Over a mean follow‐up of 7.8 years, relative annual changes in systolic and diastolic BP and pulse pressure did not differ significantly by APOL1 risk status (between‐group differences of −0.20, −0.14, and −0.25, respectively; P>0.05 for all). Conclusions Among Black participants in MESA, APOL1 high‐risk genotypes were not associated with subclinical vascular and endothelial function or BP trajectories. The relationship of APOL1 with kidney disease may be intrinsic to the kidney rather than through peripheral effects on systemic vasculature or BP.
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Affiliation(s)
- Teresa K Chen
- Division of Nephrology Department of Medicine Johns Hopkins University School of Medicine Baltimore MD.,Welch Center for Prevention, Epidemiology, and Clinical Research Johns Hopkins Medical Institutions Baltimore MD
| | - Ronit Katz
- Department of Medicine Kidney Research Institute University of Washington Seattle WA
| | - Michelle M Estrella
- Kidney Health Research Collaborative Department of Medicine University of California San Francisco CA.,San Francisco VA Health Care System San Francisco CA
| | - Wendy S Post
- Division of Cardiology Department of Medicine Johns Hopkins University School of Medicine Baltimore MD
| | - Holly Kramer
- Division of Nephrology Departments of Medicine and Public Health Sciences Loyola University Maywood IL
| | - Jerome I Rotter
- Department of Pediatrics The Institute for Translational Genomics and Population Sciences The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center Torrance CA
| | - Bamidele Tayo
- Department of Public Health Sciences Loyola University Maywood IL
| | - Josyf C Mychaleckyj
- Department of Public Health Sciences University of Virginia School of Medicine Charlottesville VA
| | | | - Carmen A Peralta
- Kidney Health Research Collaborative Department of Medicine University of California San Francisco CA.,San Francisco VA Health Care System San Francisco CA
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10
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Franceschini N, Kopp JB, Barac A, Martin LW, Li Y, Qian H, Reiner AP, Pollak M, Wallace RB, Rosamond WD, Winkler CA. Association of APOL1 With Heart Failure With Preserved Ejection Fraction in Postmenopausal African American Women. JAMA Cardiol 2019; 3:712-720. [PMID: 29971324 DOI: 10.1001/jamacardio.2018.1827] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance APOL1 genotypes are associated with kidney diseases in African American individuals and may influence cardiovascular disease and mortality risk, but findings have been inconsistent. Objective To discern whether high-risk APOL1 genotypes are associated with cardiovascular disease and stroke in postmenopausal African American women, who are at high risk for these outcomes. Design, Setting, and Participants The Women's Health Initiative is a prospective cohort that enrolled 161 838 postmenopausal women into clinical trials and an observational study between 1993 and 1998. This study includes 11 137 African American women participants who had a clinical event from enrollment to June 2014. Data analyses were completed from January 2017 to August 2017. Exposures The variants of APOL1 were genotyped or imputed from whole-exome sequencing. Main Outcomes and Measures Incident coronary heart disease, stroke and heart failure subtypes, and overall and cause-specific mortality were adjudicated from hospital records and death certificates. Estimated incidence rates were determined for each outcome and hazard ratios (HR) and 95% CIs for the associations of APOL1 groups with outcomes. Results The mean (SD) age of participants was 61.7 (7.1) years. Carriers of high-risk APOL1 variants (n = 1370; 12.3%) had higher prevalence of hypertension, use of cholesterol-lowering medications, and reduced estimated glomerular filtration rate (eGFR). After a mean (SD) of 11.0 (3.6) years, carriers of high-risk APOL1 variants had a higher incidence rate of hospitalized heart failure with preserved ejection fraction (HFpEF) than low-risk carriers did but showed no differences for other outcomes. In adjusted models, there was a significant 58% increased hazard of hospitalized HFpEF (HR, 1.58 [95% CI, 1.03-2.41]) among carriers of high-risk APOL1 variants compared with carriers of low-risk APOL1 variants. The association with HFpEF was attenuated (HR = 1.50 [95% CI, 0.98-2.30]) and no longer significant when adjusting for baseline eGFR. Conclusions and Relevance Status as a carrier of a high-risk APOL1 genotype was associated with HFpEF hospitalization among postmenopausal women, which is partly accounted for by baseline kidney function. These findings do not support an association of high-risk APOL1 genotypes with coronary heart disease, stroke, or mortality in postmenopausal African American women.
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Affiliation(s)
- Nora Franceschini
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Jeffrey B Kopp
- Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Ana Barac
- MedStar Heart and Vascular Institute, Washington, DC
| | - Lisa W Martin
- Cardiology Division, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Yun Li
- Department of Statistics and Operations Research, University of North Carolina, Chapel Hill
| | - Huijun Qian
- Department of Statistics and Operations Research, University of North Carolina, Chapel Hill
| | - Alex P Reiner
- University of Washington School of Public Health, Seattle
| | - Martin Pollak
- Division of Nephrology, Harvard Medical School, Boston, Massachusetts
| | - Robert B Wallace
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City
| | - Wayne D Rosamond
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Cheryl A Winkler
- Molecular Genetic Epidemiology Section, Basic Research Laboratory, Basic Science Program, National Cancer Institute Leidos Biomedical Research, Frederick National Laboratory, Frederick, Maryland
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11
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Grams ME, Surapaneni A, Ballew SH, Appel LJ, Boerwinkle E, Boulware LE, Chen TK, Coresh J, Cushman M, Divers J, Gutiérrez OM, Irvin MR, Ix JH, Kopp JB, Kuller LH, Langefeld CD, Lipkowitz MS, Mukamal KJ, Musani SK, Naik RP, Pajewski NM, Peralta CA, Tin A, Wassel CL, Wilson JG, Winkler CA, Young BA, Zakai NA, Freedman BI. APOL1 Kidney Risk Variants and Cardiovascular Disease: An Individual Participant Data Meta-Analysis. J Am Soc Nephrol 2019; 30:2027-2036. [PMID: 31383730 DOI: 10.1681/asn.2019030240] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/17/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Two coding variants in the apo L1 gene (APOL1) are strongly associated with kidney disease in blacks. Kidney disease itself increases the risk of cardiovascular disease, but whether these variants have an independent direct effect on the risk of cardiovascular disease is unclear. Previous studies have had inconsistent results. METHODS We conducted a two-stage individual participant data meta-analysis to assess the association of APOL1 kidney-risk variants with adjudicated cardiovascular disease events and death, independent of kidney measures. The analysis included 21,305 blacks from eight large cohorts. RESULTS Over 8.9±5.0 years of follow-up, 2076 incident cardiovascular disease events occurred in the 16,216 participants who did not have cardiovascular disease at study enrollment. In fully-adjusted analyses, individuals possessing two APOL1 kidney-risk variants had similar risk of incident cardiovascular disease (coronary heart disease, myocardial infarction, stroke and heart failure; hazard ratio 1.11, 95% confidence interval, 0.96 to 1.28) compared to individuals with zero or one kidney-risk variant. The risk of coronary heart disease, myocardial infarction, stroke and heart failure considered individually was also comparable by APOL1 genotype. APOL1 genotype was also not associated with death. There was no difference in adjusted associations by level of kidney function, age, diabetes status, or body-mass index. CONCLUSIONS In this large, two-stage individual participant data meta-analysis, APOL1 kidney-risk variants were not associated with incident cardiovascular disease or death independent of kidney measures.
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Affiliation(s)
- Morgan E Grams
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; .,Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Aditya Surapaneni
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Shoshana H Ballew
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Eric Boerwinkle
- Human Genetics Center, The University of Texas Health Science Center at Houston, Houston, Texas
| | - L Ebony Boulware
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Teresa K Chen
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Josef Coresh
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Mary Cushman
- Departments of Medicine and.,Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Colchester, Vermont
| | - Jasmin Divers
- Department of Biostatistics and Data Science, Division of Public Health Sciences and
| | - Orlando M Gutiérrez
- Departments of Medicine and.,Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Marguerite R Irvin
- Departments of Medicine and.,Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Joachim H Ix
- Division of Nephrology-Hypertension, Department of Medicine, University of California, San Diego, California.,Nephrology Section, Veterans Affairs San Diego Healthcare System, La Jolla, California
| | - Jeffrey B Kopp
- Kidney Diseases Branch, Intramural Research Program, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Lewis H Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Carl D Langefeld
- Department of Biostatistics and Data Science, Division of Public Health Sciences and
| | - Michael S Lipkowitz
- Division of Nephrology and Hypertension, Georgetown University Medical Center, Washington, DC
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Rakhi P Naik
- Department of Medicine, Division of Hematology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Nicholas M Pajewski
- Department of Biostatistics and Data Science, Division of Public Health Sciences and
| | - Carmen A Peralta
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, California.,Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California.,Cricket Health Inc, San Francisco, California
| | - Adrienne Tin
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | - James G Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Cheryl A Winkler
- Molecular Genetic Epidemiology Section, Basic Research Laboratory, Basic Science Program, National Cancer Institute Leidos Biomedical Research, Frederick National Laboratory, Frederick, Maryland
| | - Bessie A Young
- Division of Nephrology, Veterans Affairs Puget Sound Health Care Center, Seattle, Washington; and.,Kidney Research Institute, University of Washington, Seattle, Washington
| | - Neil A Zakai
- Departments of Medicine and.,Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Colchester, Vermont
| | - Barry I Freedman
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
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12
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Bick AG, Akwo E, Robinson-Cohen C, Lee K, Lynch J, Assimes TL, DuVall S, Edwards T, Fang H, Freiberg SM, Giri A, Huffman JE, Huang J, Hull L, Kember RL, Klarin D, Lee JS, Levin M, Miller DR, Natarajan P, Saleheen D, Shao Q, Sun YV, Tang H, Wilson O, Chang KM, Cho K, Concato J, Gaziano JM, Kathiresan S, O'Donnell CJ, Rader DJ, Tsao PS, Wilson PW, Hung AM, Damrauer SM. Association of APOL1 Risk Alleles With Cardiovascular Disease in Blacks in the Million Veteran Program. Circulation 2019; 140:1031-1040. [PMID: 31337231 DOI: 10.1161/circulationaha.118.036589] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Approximately 13% of black individuals carry 2 copies of the apolipoprotein L1 (APOL1) risk alleles G1 or G2, which are associated with 1.5- to 2.5-fold increased risk of chronic kidney disease. There have been conflicting reports as to whether an association exists between APOL1 risk alleles and cardiovascular disease (CVD) that is independent of the effects of APOL1 on kidney disease. We sought to test the association of APOL1 G1/G2 alleles with coronary artery disease, peripheral artery disease, and stroke among black individuals in the Million Veteran Program. METHODS We performed a time-to-event analysis of retrospective electronic health record data using Cox proportional hazard and competing-risks Fine and Gray subdistribution hazard models. The primary exposure was APOL1 risk allele status. The primary outcome was incident coronary artery disease among individuals without chronic kidney disease during the 12.5-year follow-up period. We separately analyzed the cross-sectional association of APOL1 risk allele status with lipid traits and 115 cardiovascular diseases using phenome-wide association. RESULTS Among 30 903 black Million Veteran Program participants, 3941 (13%) carried the 2 APOL1 risk allele high-risk genotype. Individuals with normal kidney function at baseline with 2 risk alleles had slightly higher risk of developing coronary artery disease compared with those with no risk alleles (hazard ratio, 1.11 [95% CI, 1.01-1.21]; P=0.039). Similarly, modest associations were identified with incident stroke (hazard ratio, 1.20 [95% CI, 1.05-1.36; P=0.007) and peripheral artery disease (hazard ratio, 1.15 [95% CI, 1.01-1.29l; P=0.031). When both cardiovascular and renal outcomes were modeled, APOL1 was strongly associated with incident renal disease, whereas no significant association with the CVD end points could be detected. Cardiovascular phenome-wide association analyses did not identify additional significant associations with CVD subsets. CONCLUSIONS APOL1 risk variants display a modest association with CVD, and this association is likely mediated by the known APOL1 association with chronic kidney disease.
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Affiliation(s)
- Alexander G Bick
- Boston VA Healthcare System, MA (A.G.B., J.E.H., J.H., L.H., D.K., K.C., J.M.G., C.J.O.).,Massachusetts General Hospital, Boston (A.G.B., D.K., P.N., S.K.).,Broad Institute of MIT and Harvard, Cambridge, MA (A.G.B., D.K., P.N., S.K.)
| | - Elvis Akwo
- Nashville VA Medical Center, TN (E.A., C.R.-C., T.E., S.M.F., A.G., O.W., A.M.H.).,Vanderbilt University Medical Center, Nashville, TN (E.A., C.R.-C., T.E., S.M.F., A.G., A.M.H.)
| | - Cassianne Robinson-Cohen
- Nashville VA Medical Center, TN (E.A., C.R.-C., T.E., S.M.F., A.G., O.W., A.M.H.).,Vanderbilt University Medical Center, Nashville, TN (E.A., C.R.-C., T.E., S.M.F., A.G., A.M.H.)
| | - Kyung Lee
- Edith Norse Rogers Memorial VA Medical Center, Bedford, MA (K.L., J.L., L.H., D.R.M., Q.S.)
| | - Julie Lynch
- Edith Norse Rogers Memorial VA Medical Center, Bedford, MA (K.L., J.L., L.H., D.R.M., Q.S.).,University of Massachusetts College of Nursing & Health Sciences, Boston (J.L.).,VA Informatics and Computing Infrastructure, Salt Lake City, UT (J.L., S.D.)
| | - Themistocles L Assimes
- Palo Alto VA Health Care, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.).,Stanford University School of Medicine, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.)
| | - Scott DuVall
- VA Informatics and Computing Infrastructure, Salt Lake City, UT (J.L., S.D.)
| | - Todd Edwards
- Nashville VA Medical Center, TN (E.A., C.R.-C., T.E., S.M.F., A.G., O.W., A.M.H.).,Vanderbilt University Medical Center, Nashville, TN (E.A., C.R.-C., T.E., S.M.F., A.G., A.M.H.)
| | - Huaying Fang
- Palo Alto VA Health Care, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.).,Stanford University School of Medicine, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.)
| | - S Matthew Freiberg
- Nashville VA Medical Center, TN (E.A., C.R.-C., T.E., S.M.F., A.G., O.W., A.M.H.).,Vanderbilt University Medical Center, Nashville, TN (E.A., C.R.-C., T.E., S.M.F., A.G., A.M.H.)
| | - Ayush Giri
- Nashville VA Medical Center, TN (E.A., C.R.-C., T.E., S.M.F., A.G., O.W., A.M.H.).,Vanderbilt University Medical Center, Nashville, TN (E.A., C.R.-C., T.E., S.M.F., A.G., A.M.H.)
| | - Jennifer E Huffman
- Boston VA Healthcare System, MA (A.G.B., J.E.H., J.H., L.H., D.K., K.C., J.M.G., C.J.O.)
| | - Jie Huang
- Boston VA Healthcare System, MA (A.G.B., J.E.H., J.H., L.H., D.K., K.C., J.M.G., C.J.O.)
| | - Leland Hull
- Boston VA Healthcare System, MA (A.G.B., J.E.H., J.H., L.H., D.K., K.C., J.M.G., C.J.O.).,Edith Norse Rogers Memorial VA Medical Center, Bedford, MA (K.L., J.L., L.H., D.R.M., Q.S.)
| | - Rachel L Kember
- Corporal Michael Crescenz VA Medical Center, Philadelphia, PA (R.L.K., M.L., D.S., K.-M.C., D.J.R., S.M.D.).,Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.L.K., M.L., D.S., K.-M.C., S.M.D.)
| | - Derek Klarin
- Boston VA Healthcare System, MA (A.G.B., J.E.H., J.H., L.H., D.K., K.C., J.M.G., C.J.O.).,Massachusetts General Hospital, Boston (A.G.B., D.K., P.N., S.K.).,Broad Institute of MIT and Harvard, Cambridge, MA (A.G.B., D.K., P.N., S.K.)
| | - Jennifer S Lee
- Palo Alto VA Health Care, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.).,Stanford University School of Medicine, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.)
| | - Michael Levin
- Corporal Michael Crescenz VA Medical Center, Philadelphia, PA (R.L.K., M.L., D.S., K.-M.C., D.J.R., S.M.D.).,Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.L.K., M.L., D.S., K.-M.C., S.M.D.)
| | - Donald R Miller
- Edith Norse Rogers Memorial VA Medical Center, Bedford, MA (K.L., J.L., L.H., D.R.M., Q.S.).,Boston University, MA (D.R.M.)
| | - Pradeep Natarajan
- Massachusetts General Hospital, Boston (A.G.B., D.K., P.N., S.K.).,Broad Institute of MIT and Harvard, Cambridge, MA (A.G.B., D.K., P.N., S.K.)
| | - Danish Saleheen
- Corporal Michael Crescenz VA Medical Center, Philadelphia, PA (R.L.K., M.L., D.S., K.-M.C., D.J.R., S.M.D.).,Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.L.K., M.L., D.S., K.-M.C., S.M.D.)
| | - Qing Shao
- Edith Norse Rogers Memorial VA Medical Center, Bedford, MA (K.L., J.L., L.H., D.R.M., Q.S.)
| | - Yan V Sun
- Atlanta VA Medical Center, GA (Y.V.S., P.W.W.).,Emory University, Atlanta, GA (Y.V.S., P.W.W.)
| | - Hua Tang
- Palo Alto VA Health Care, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.).,Stanford University School of Medicine, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.)
| | - Otis Wilson
- Nashville VA Medical Center, TN (E.A., C.R.-C., T.E., S.M.F., A.G., O.W., A.M.H.)
| | - Kyong-Mi Chang
- Corporal Michael Crescenz VA Medical Center, Philadelphia, PA (R.L.K., M.L., D.S., K.-M.C., D.J.R., S.M.D.).,Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.L.K., M.L., D.S., K.-M.C., S.M.D.)
| | - Kelly Cho
- Boston VA Healthcare System, MA (A.G.B., J.E.H., J.H., L.H., D.K., K.C., J.M.G., C.J.O.)
| | - John Concato
- VA Connecticut HealthCare System, New Haven (J.C.)
| | - J Michael Gaziano
- Boston VA Healthcare System, MA (A.G.B., J.E.H., J.H., L.H., D.K., K.C., J.M.G., C.J.O.).,Harvard Medical School, Boston, MA (J.M.G., S.K., C.J.O.)
| | - Sekar Kathiresan
- Massachusetts General Hospital, Boston (A.G.B., D.K., P.N., S.K.).,Broad Institute of MIT and Harvard, Cambridge, MA (A.G.B., D.K., P.N., S.K.).,Harvard Medical School, Boston, MA (J.M.G., S.K., C.J.O.)
| | - Christopher J O'Donnell
- Boston VA Healthcare System, MA (A.G.B., J.E.H., J.H., L.H., D.K., K.C., J.M.G., C.J.O.).,Harvard Medical School, Boston, MA (J.M.G., S.K., C.J.O.)
| | - Daniel J Rader
- Corporal Michael Crescenz VA Medical Center, Philadelphia, PA (R.L.K., M.L., D.S., K.-M.C., D.J.R., S.M.D.)
| | - Philip S Tsao
- Palo Alto VA Health Care, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.).,Stanford University School of Medicine, CA (T.L.A., H.F., J.S.L., H.T., P.S.T.)
| | - Peter W Wilson
- Atlanta VA Medical Center, GA (Y.V.S., P.W.W.).,Emory University, Atlanta, GA (Y.V.S., P.W.W.)
| | - Adriana M Hung
- Nashville VA Medical Center, TN (E.A., C.R.-C., T.E., S.M.F., A.G., O.W., A.M.H.).,Vanderbilt University Medical Center, Nashville, TN (E.A., C.R.-C., T.E., S.M.F., A.G., A.M.H.)
| | - Scott M Damrauer
- Corporal Michael Crescenz VA Medical Center, Philadelphia, PA (R.L.K., M.L., D.S., K.-M.C., D.J.R., S.M.D.).,Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.L.K., M.L., D.S., K.-M.C., S.M.D.)
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13
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RNA sequencing of isolated cell populations expressing human APOL1 G2 risk variant reveals molecular correlates of sickle cell nephropathy in zebrafish podocytes. PLoS One 2019; 14:e0217042. [PMID: 31158233 PMCID: PMC6546218 DOI: 10.1371/journal.pone.0217042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 05/05/2019] [Indexed: 12/04/2022] Open
Abstract
Kidney failure occurs in 5–13% of individuals with sickle cell disease and is associated with early mortality. Two APOL1 alleles (G1 and G2) have been identified as risk factors for sickle cell disease nephropathy. Both risk alleles are prevalent in individuals with recent African ancestry and have been associated with nephropathic complications in other diseases. Despite the association of G1 and G2 with kidney dysfunction, the mechanisms by which these variants contribute to increased risk remain poorly understood. Previous work in zebrafish models suggest that the G2 risk allele functions as a dominant negative, whereas the G1 allele is a functional null. To understand better the cellular pathology attributed to APOL1 G2, we investigated the in vivo effects of the G2 risk variant on distinct cell types using RNA sequencing. We surveyed APOL1 G2 associated transcriptomic alterations in podocytes and vascular endothelial cells isolated from zebrafish larvae expressing cell-type specific reporters. Our analysis identified many transcripts (n = 7,523) showing differential expression between APOL1 G0 (human wild-type) and APOL1 G2 exposed podocytes. Conversely, relatively few transcripts (n = 107) were differentially expressed when comparing APOL1 G0 and APOL1 G2 exposed endothelial cells. Pathway analysis of differentially expressed transcripts in podocytes showed enrichment for autophagy associated terms such as “Lysosome” and “Phagosome”, implicating these pathways in APOL1 G2 associated kidney dysfunction. This work provides insight into the molecular pathology of APOL1 G2 nephropathy which may offer new therapeutic strategies for multiple disease contexts such as sickle cell nephropathy.
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Abstract
PURPOSE OF REVIEW APOL1 nephropathy risk variants drive most of the excess risk of chronic kidney disease (CKD) seen in African Americans, but whether the same risk variants account for excess cardiovascular risk remains unclear. This mini-review highlights the controversies in the APOL1 cardiovascular field. RECENT FINDINGS In the past 10 years, our understanding of how APOL1 risk variants contribute to renal cytotoxicity has increased. Some of the proposed mechanisms for kidney disease are biologically plausible for cells and tissues relevant to cardiovascular disease (CVD), but cardiovascular studies published since 2014 have reported conflicting results regarding APOL1 risk variant association with cardiovascular outcomes. In the past year, several studies have also contributed conflicting results from different types of study populations. SUMMARY Heterogeneity in study population and study design has led to differing reports on the role of APOL1 nephropathy risk variants in CVD. Without consistently validated associations between these risk variants and CVD, mechanistic studies for APOL1's role in cardiovascular biology lag behind.
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Robinson TW, Freedman BI. The Impact of APOL1 on Chronic Kidney Disease and Hypertension. Adv Chronic Kidney Dis 2019; 26:131-136. [PMID: 31023447 PMCID: PMC6601639 DOI: 10.1053/j.ackd.2019.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/21/2018] [Accepted: 01/09/2019] [Indexed: 12/13/2022]
Abstract
Essential hypertension is a clinical diagnosis based on the presence of an elevated systemic blood pressure on physical examination without a clear inciting cause. It has multiple etiologies and is not a homogeneous disorder. Hypertension contributes to the development and progression of atherosclerotic cardiovascular diseases, and antihypertensive treatment reduces the risk of fatal and nonfatal myocardial infarction, stroke, and congestive heart failure. Although hypertension is frequently present in nondiabetic individuals with low levels of proteinuria and chronic kidney disease, reducing blood pressures in this population does not reliably slow nephropathy progression. Many of these patients with recent African ancestry have the primary kidney disease "solidified glomerulosclerosis" that is strongly associated with renal-risk variants in the apolipoprotein L1 gene (APOL1). This kidney disease contributes to secondarily elevated blood pressures. The APOL1-associated spectrum of nondiabetic nephropathy also includes proteinuric kidney diseases, idiopathic focal segmental glomerulosclerosis, collapsing glomerulopathy, severe lupus nephritis, and sickle cell nephropathy. This article reviews relationships between mild to moderate essential hypertension and chronic kidney disease with a focus on the role of APOL1 in development of hypertension. Available evidence strongly supports that APOL1 renal-risk variants associate with glomerulosclerosis in African Americans, which then causes secondary hypertension, not with essential hypertension per se.
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Affiliation(s)
- Todd W Robinson
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Barry I Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC.
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Meng LB, Shan MJ, Yu ZM, Lv J, Qi RM, Guo P, Zhang YM, Gong T. Chronic stress: a crucial promoter of cell apoptosis in atherosclerosis. J Int Med Res 2019; 48:300060518814606. [PMID: 30700193 PMCID: PMC7140195 DOI: 10.1177/0300060518814606] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective Chronic stress may lead to augmented incidence rates of coronary and
cerebrovascular diseases associated with atherosclerosis. However, few
studies have focused on the effect of chronic stress on atherosclerosis
plaque formation. Therefore, this study was designed to directly evaluate
how chronic stress affects atherosclerosis. Methods Thirty rabbits were divided into three groups: the control group,
balloon-injury operation + high-fat diet model group, and chronic
stress + balloon-injury operation + high-fat diet model group. Physical and
social stress were induced, and proteomic methods were applied to identify
specific markers. Results After protein determination, the chronic stress + balloon-injury
operation + high-fat diet model group exhibited significant upregulation of
the following apoptosis-related proteins: UBE2K, caspase 3, caspase 9, BAX,
P53, and FAS. In particular, real-time polymerase chain reaction showed that
the protein expression of caspase 9 was significantly downregulated in the
stress group compared with the non-stress groups. However, the other
proteins showed significantly increased expression in the stress group. Conclusion Chronic stress may promote cell apoptosis in the physiopathologic process of
atherosclerosis.
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Affiliation(s)
- Ling-Bing Meng
- Neurology Department, Beijing Hospital, National Center of Gerontology, Dong Dan, Beijing, China
| | - Meng-Jie Shan
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ze-Mou Yu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Jian Lv
- Second Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Ruo-Mei Qi
- The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, Dong Dan, Beijing, China
| | - Peng Guo
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Yuan-Meng Zhang
- Internal Medicine Department, Jinzhou Medical University, Liaoning, China
| | - Tao Gong
- Neurology Department, Beijing Hospital, National Center of Gerontology, Dong Dan, Beijing, China
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17
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Waitzman JS, Wilkins JT, Lin J. APOL1 Sends Its REGARDS to Cardiovascular Disease. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2018; 11:e002212. [PMID: 29899046 DOI: 10.1161/circgen.118.002212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Joshua S Waitzman
- Division of Nephrology and Hypertension (J.S.W., J.L.).,Feinberg School of Medicine (J.S.W., J.T.W., J.L.), Northwestern University, Chicago, IL
| | - John T Wilkins
- Division of Cardiology (J.T.W.).,Feinberg School of Medicine (J.S.W., J.T.W., J.L.), Northwestern University, Chicago, IL
| | - Jennie Lin
- Feinberg Cardiovascular and Renal Research Institute (J.L.) .,Feinberg School of Medicine (J.S.W., J.T.W., J.L.), Northwestern University, Chicago, IL
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