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Butnariu LI, Gorduza EV, Țarcă E, Pânzaru MC, Popa S, Stoleriu S, Lupu VV, Lupu A, Cojocaru E, Trandafir LM, Moisă ȘM, Florea A, Stătescu L, Bădescu MC. Current Data and New Insights into the Genetic Factors of Atherogenic Dyslipidemia Associated with Metabolic Syndrome. Diagnostics (Basel) 2023; 13:2348. [PMID: 37510094 PMCID: PMC10378477 DOI: 10.3390/diagnostics13142348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Atherogenic dyslipidemia plays a critical role in the development of metabolic syndrome (MetS), being one of its major components, along with central obesity, insulin resistance, and hypertension. In recent years, the development of molecular genetics techniques and extended analysis at the genome or exome level has led to important progress in the identification of genetic factors (heritability) involved in lipid metabolism disorders associated with MetS. In this review, we have proposed to present the current knowledge related to the genetic etiology of atherogenic dyslipidemia, but also possible challenges for future studies. Data from the literature provided by candidate gene-based association studies or extended studies, such as genome-wide association studies (GWAS) and whole exome sequencing (WES,) have revealed that atherogenic dyslipidemia presents a marked genetic heterogeneity (monogenic or complex, multifactorial). Despite sustained efforts, many of the genetic factors still remain unidentified (missing heritability). In the future, the identification of new genes and the molecular mechanisms by which they intervene in lipid disorders will allow the development of innovative therapies that act on specific targets. In addition, the use of polygenic risk scores (PRS) or specific biomarkers to identify individuals at increased risk of atherogenic dyslipidemia and/or other components of MetS will allow effective preventive measures and personalized therapy.
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Affiliation(s)
- Lăcramioara Ionela Butnariu
- Department of Medical Genetics, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Eusebiu Vlad Gorduza
- Department of Medical Genetics, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Elena Țarcă
- Department of Surgery II-Pediatric Surgery, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Monica-Cristina Pânzaru
- Department of Medical Genetics, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Setalia Popa
- Department of Medical Genetics, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Simona Stoleriu
- Odontology-Periodontology, Fixed Prosthesis Department, Faculty of Dental Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Vasile Valeriu Lupu
- Department of Pediatrics, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ancuta Lupu
- Department of Pediatrics, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Elena Cojocaru
- Department of Morphofunctional Sciences I, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Laura Mihaela Trandafir
- Department of Pediatrics, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ștefana Maria Moisă
- Department of Pediatrics, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Andreea Florea
- Department of Medical Genetics, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Laura Stătescu
- Medical III Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Minerva Codruța Bădescu
- III Internal Medicine Clinic, "St. Spiridon" County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
- Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
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Rivera-Íñiguez I, González-Becerra K, Ramos-Lopez O, Peréz-Beltrán YE, Chagüén-Hernández MS, Martínez-López E, Mendivil EJ. Lipid-Related Genetic Variants for Personalized Dietary Interventions: A Systematic Review. Mol Nutr Food Res 2023; 67:e2200675. [PMID: 37186438 DOI: 10.1002/mnfr.202200675] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/26/2023] [Indexed: 05/17/2023]
Abstract
Dyslipidemias are known risk factors for chronic diseases. Precision nutrition interventions are designed according to characteristics, such as diet, phenotype, and genotype. This systematic review aims to define a panel of genetic variants associated with lipid abnormalities that could be later used in nutrigenetic intervention studies. A systematic review is conducted following the PRISMA-P. Studies published from January 2010 to December 2020 in English language and humans are included from PubMed and ScienceDirect databases. Articles that demonstrate a strong association between polymorphisms (single nucleotide variation) of genes involved in lipid metabolism and increased risk for dyslipidemia are included. A total of 3031 articles are screened, but only 51 articles fulfill the inclusion criteria. The genes included are FABP2, MTTP related to CM synthesis and secretion; LPL, LIPC involved in triglyceride hydrolysis; CETP, APOA1, LCAT, ABCA1, and APOA5 related to lipoprotein metabolism, and APOE, LDLR, SCARB1, APOC3 involved in lipid clearance. In this systematic review, genetic variants related to chylomicron synthesis, triglyceride hydrolysis, lipoprotein metabolism, and lipid clearance demonstrate a strong association with lipid abnormalities, which can be used to design precision nutrition interventions that may help to prevent and treat dyslipidemia effectively.
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Affiliation(s)
- Ingrid Rivera-Íñiguez
- Grupo de Investigación en Nutrición y Ciencias de los Alimentos, Departamento de Psicología, Educación y Salud, ITESO, Universidad Jesuita de Guadalajara, Guadalajara, 45604, México
- Departamento de Reproducción Humana, Crecimiento y Desarrollo Infantil, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, 44340, México
| | - Karina González-Becerra
- Departamento de Ciencias Médicas y de la Vida, Centro Universitario de la Ciénega, Instituto de Investigación en Genética Molecular, Universidad de Guadalajara, Ocotlán, Jalisco, 47820, México
| | - Omar Ramos-Lopez
- Facultad de Medicina y Psicología, Universidad Autónoma de Baja California, Tijuana, Baja California, 22390, México
| | - Yolanda E Peréz-Beltrán
- Laboratorio Integral de Investigación en Alimentos, Instituto Tecnológico de Tepic/Instituto Nacional de México, Tepic, Nayarit, 63175, México
| | - Marian S Chagüén-Hernández
- Grupo de Investigación en Nutrición y Ciencias de los Alimentos, Departamento de Psicología, Educación y Salud, ITESO, Universidad Jesuita de Guadalajara, Guadalajara, 45604, México
| | - Erika Martínez-López
- Instituto de Nutrigenética y Nutrigenómica Traslacional, Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, 44340, México
| | - Edgar J Mendivil
- Grupo de Investigación en Nutrición y Ciencias de los Alimentos, Departamento de Psicología, Educación y Salud, ITESO, Universidad Jesuita de Guadalajara, Guadalajara, 45604, México
- Departamento de Salud, Universidad Iberoamericana, Ciudad de México, 01219, México
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3
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Wang YE, Kirschke CP, Woodhouse LR, Bonnel EL, Stephensen CB, Bennett BJ, Newman JW, Keim NL, Huang L. SNPs in apolipoproteins contribute to sex-dependent differences in blood lipids before and after a high-fat dietary challenge in healthy U.S. adults. BMC Nutr 2022; 8:95. [PMID: 36050800 PMCID: PMC9438272 DOI: 10.1186/s40795-022-00592-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 08/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background The effect of genetic polymorphisms on fasting blood lipid levels have been widely studied but the effects of these within the context of a high-fat meal challenge remain less characterized. The current study aimed to investigate the association of SNPs in lipoprotein-related genes with blood lipid profiles in healthy adults in the U.S. Methods Subjects (n = 393) between 18–66 years of age with BMIs ranging from 18.5–45 kg/m2 were enrolled the cross-sectional Nutritional Phenotyping Study. Among them, 349 subjects (men: 48%; women: 52%) gave consent for genotyping. SNPs in APOA5, APOB, APOC3, APOE, and LDLR were assessed. The association between lipid markers and genotypes was tested separately for each SNP with analysis of variance (ANOVA), adjusted for sex, age, and BMI. We also examined two-factor interactions between SNPs and sex, age, or BMI. Results Women carrying the C allele of rs3135506 in APOA5 or men carrying the C allele of rs429358 in APOE had reduced HDL-cholesterol levels during fasting and postprandially. The C allele in APOE was also correlated to increased LDL-C levels. The TT genotype of rs2854116 in APOC3 was associated with elevated total cholesterol. Additive effect of the risk alleles of APOA5 and APOE or APOC3 and APOE was detected. Nevertheless, the tested SNPs had little impact on the postprandial triglyceride responses to the high-fat challenge meal. We found no significant effects of SNPs in APOB (rs1042034) or LDLR (rs2228671) on triglycerides, cholesterol, or free fatty acid levels. Conclusions In healthy adults, fasting and postprandial cholesterol levels are strongly correlated with the tested APOA5, APOE, and APOC3 genotypes. Sex contributes to the genetic impact of the tested SNPs on lipid profiles. Trial registration ClinicalTrials.gov, NCT02367287. Registered February 20, 2015, https://clinicaltrials.gov/ct2/show/NCT02367287. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-022-00592-x.
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Affiliation(s)
- Yining E Wang
- Integrative Genetics and Genomics, University of California at Davis, One Shields Ave, Davis, CA, 95616, USA
| | - Catherine P Kirschke
- USDA/ARS/Western Human Nutrition Research Center, 430 West Health Sciences Drive, Davis, CA, 95616, USA
| | - Leslie R Woodhouse
- USDA/ARS/Western Human Nutrition Research Center, 430 West Health Sciences Drive, Davis, CA, 95616, USA
| | - Ellen L Bonnel
- USDA/ARS/Western Human Nutrition Research Center, 430 West Health Sciences Drive, Davis, CA, 95616, USA
| | - Charles B Stephensen
- USDA/ARS/Western Human Nutrition Research Center, 430 West Health Sciences Drive, Davis, CA, 95616, USA.,Department of Nutrition, University of California at Davis, One Shields Ave, Davis, CA, 95616, USA
| | - Brian J Bennett
- Integrative Genetics and Genomics, University of California at Davis, One Shields Ave, Davis, CA, 95616, USA.,USDA/ARS/Western Human Nutrition Research Center, 430 West Health Sciences Drive, Davis, CA, 95616, USA.,Department of Nutrition, University of California at Davis, One Shields Ave, Davis, CA, 95616, USA
| | - John W Newman
- USDA/ARS/Western Human Nutrition Research Center, 430 West Health Sciences Drive, Davis, CA, 95616, USA.,Department of Nutrition, University of California at Davis, One Shields Ave, Davis, CA, 95616, USA
| | - Nancy L Keim
- USDA/ARS/Western Human Nutrition Research Center, 430 West Health Sciences Drive, Davis, CA, 95616, USA.,Department of Nutrition, University of California at Davis, One Shields Ave, Davis, CA, 95616, USA
| | - Liping Huang
- Integrative Genetics and Genomics, University of California at Davis, One Shields Ave, Davis, CA, 95616, USA. .,USDA/ARS/Western Human Nutrition Research Center, 430 West Health Sciences Drive, Davis, CA, 95616, USA. .,Department of Nutrition, University of California at Davis, One Shields Ave, Davis, CA, 95616, USA.
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Wuni R, Adela Nathania E, Ayyappa AK, Lakshmipriya N, Ramya K, Gayathri R, Geetha G, Anjana RM, Kuhnle GGC, Radha V, Mohan V, Sudha V, Vimaleswaran KS. Impact of Lipid Genetic Risk Score and Saturated Fatty Acid Intake on Central Obesity in an Asian Indian Population. Nutrients 2022; 14:2713. [PMID: 35807893 PMCID: PMC9269337 DOI: 10.3390/nu14132713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/22/2022] Open
Abstract
Abnormalities in lipid metabolism have been linked to the development of obesity. We used a nutrigenetic approach to establish a link between lipids and obesity in Asian Indians, who are known to have a high prevalence of central obesity and dyslipidaemia. A sample of 497 Asian Indian individuals (260 with type 2 diabetes and 237 with normal glucose tolerance) (mean age: 44 ± 10 years) were randomly chosen from the Chennai Urban Rural Epidemiological Study (CURES). Dietary intake was assessed using a previously validated questionnaire. A genetic risk score (GRS) was constructed based on cholesteryl ester transfer protein (CETP) and lipoprotein lipase (LPL) genetic variants. There was a significant interaction between GRS and saturated fatty acid (SFA) intake on waist circumference (WC) (Pinteraction = 0.006). Individuals with a low SFA intake (≤23.2 g/day), despite carrying ≥2 risk alleles, had a smaller WC compared to individuals carrying <2 risk alleles (Beta = −0.01 cm; p = 0.03). For those individuals carrying ≥2 risk alleles, a high SFA intake (>23.2 g/day) was significantly associated with a larger WC than a low SFA intake (≤23.2 g/day) (Beta = 0.02 cm, p = 0.02). There were no significant interactions between GRS and other dietary factors on any of the measured outcomes. We conclude that a diet low in SFA might help reduce the genetic risk of central obesity confirmed by CETP and LPL genetic variants. Conversely, a high SFA diet increases the genetic risk of central obesity in Asian Indians.
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Affiliation(s)
- Ramatu Wuni
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Reading RG6 6DZ, UK; (R.W.); (G.G.C.K.)
| | - Evelyn Adela Nathania
- Indonesia International Institute for Life Sciences, JI. Pulomas Barat Kav. 88, Jakarta Timur 13210, Indonesia;
| | - Ashok K. Ayyappa
- Department of Molecular Genetics, Madras Diabetes Research Foundation, ICMR Centre for Advanced Research on Diabetes, Chennai 603103, India; (A.K.A.); (K.R.); (R.M.A.); (V.R.); (V.M.)
| | - Nagarajan Lakshmipriya
- Department of Food, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai 600086, India; (N.L.); (R.G.); (G.G.); (V.S.)
| | - Kandaswamy Ramya
- Department of Molecular Genetics, Madras Diabetes Research Foundation, ICMR Centre for Advanced Research on Diabetes, Chennai 603103, India; (A.K.A.); (K.R.); (R.M.A.); (V.R.); (V.M.)
| | - Rajagopal Gayathri
- Department of Food, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai 600086, India; (N.L.); (R.G.); (G.G.); (V.S.)
| | - Gunasekaran Geetha
- Department of Food, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai 600086, India; (N.L.); (R.G.); (G.G.); (V.S.)
| | - Ranjit Mohan Anjana
- Department of Molecular Genetics, Madras Diabetes Research Foundation, ICMR Centre for Advanced Research on Diabetes, Chennai 603103, India; (A.K.A.); (K.R.); (R.M.A.); (V.R.); (V.M.)
- Department of Food, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai 600086, India; (N.L.); (R.G.); (G.G.); (V.S.)
- Dr. Mohan’s Diabetes Specialties Centre, IDF Centre of Excellence in Diabetes Care, Gopalapuram, Chennai 600086, India
| | - Gunter G. C. Kuhnle
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Reading RG6 6DZ, UK; (R.W.); (G.G.C.K.)
| | - Venkatesan Radha
- Department of Molecular Genetics, Madras Diabetes Research Foundation, ICMR Centre for Advanced Research on Diabetes, Chennai 603103, India; (A.K.A.); (K.R.); (R.M.A.); (V.R.); (V.M.)
| | - Viswanathan Mohan
- Department of Molecular Genetics, Madras Diabetes Research Foundation, ICMR Centre for Advanced Research on Diabetes, Chennai 603103, India; (A.K.A.); (K.R.); (R.M.A.); (V.R.); (V.M.)
- Department of Food, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai 600086, India; (N.L.); (R.G.); (G.G.); (V.S.)
- Dr. Mohan’s Diabetes Specialties Centre, IDF Centre of Excellence in Diabetes Care, Gopalapuram, Chennai 600086, India
| | - Vasudevan Sudha
- Department of Food, Nutrition and Dietetics Research, Madras Diabetes Research Foundation, Chennai 600086, India; (N.L.); (R.G.); (G.G.); (V.S.)
| | - Karani Santhanakrishnan Vimaleswaran
- Hugh Sinclair Unit of Human Nutrition, Department of Food and Nutritional Sciences, University of Reading, Reading RG6 6DZ, UK; (R.W.); (G.G.C.K.)
- The Institute for Food, Nutrition, and Health (IFNH), University of Reading, Reading RG6 6AP, UK
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Hosseinzadeh N, Mehrabi Y, Daneshpour MS, Zayeri F, Guity K, Azizi F. Identifying new associated pleiotropic SNPs with lipids by simultaneous test of multiple longitudinal traits: An Iranian family-based study. Gene 2019; 692:156-169. [DOI: 10.1016/j.gene.2019.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/05/2019] [Accepted: 01/11/2019] [Indexed: 02/08/2023]
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Griffin BA, Walker CG, Jebb SA, Moore C, Frost GS, Goff L, Sanders TAB, Lewis F, Griffin M, Gitau R, Lovegrove JA. APOE4 Genotype Exerts Greater Benefit in Lowering Plasma Cholesterol and Apolipoprotein B than Wild Type (E3/E3), after Replacement of Dietary Saturated Fats with Low Glycaemic Index Carbohydrates. Nutrients 2018; 10:nu10101524. [PMID: 30336580 PMCID: PMC6213759 DOI: 10.3390/nu10101524] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 09/27/2018] [Accepted: 10/12/2018] [Indexed: 12/19/2022] Open
Abstract
We examined the impact of APOE genotype on plasma lipids and glucose in a secondary analysis of data from a five-arm, randomised controlled, parallel dietary intervention trial ('RISCK' study), to investigate the impact of replacing saturated fatty acids (SFA) with either monounsaturated fat (MUFA) or carbohydrate of high or low glycaemic index (GI) on CVD risk factors and insulin sensitivity. We tested the impact of APOE genotype (carriage of E2 and E4 alleles versus E3/E3), determined retrospectively, on plasma lipids, lipoproteins and glucose homeostasis at baseline (n = 469), and on the change in these variables after 24 weeks of dietary intervention (n = 389). At baseline, carriers of E2 (n = 70), E4 (n = 125) and E3/E3 (n = 274) expressed marked differences in total plasma cholesterol (TC, p = 0.001), low density lipoprotein cholesterol (LDL-C, p < 0.0001), apolipoprotein B (apo B, p < 0.0001) and total to high density lipoprotein cholesterol ratio (TC:HDL-C, p = 0.002), with plasma concentrations decreasing in the order E4 > E3/E3 > E2. Following intervention, there was evidence of a significant diet x genotype interaction with significantly greater decreases in TC (p = 0.02) and apo B (p = 0.006) among carriers of E4 when SFA was replaced with low GI carbohydrate on a lower fat diet (TC -0.28 mmol/L p = 0.03; apo B -0.1 g/L p = 0.02), and a relative increase in TC (in comparison to E3/E3) when SFA was replaced with MUFA and high GI carbohydrates (TC 0.3 mmol/L, p = 0.03). Among carriers of E2 (compared with E3/E3) there was an increase in triacylglycerol (TAG) when SFA was replaced with MUFA and low GI carbohydrates 0.46 mmol/L p = 0.001). There were no significant interactions between APOE genotype and diet for changes in indices of glucose homeostasis. In conclusion, variations in APOE genotype led to differential effects on the lipid response to the replacement of SFA with MUFA and low GI carbohydrates.
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Affiliation(s)
- Bruce A Griffin
- Department of Nutritional Sciences, University of Surrey, Guildford GU2 7WG, UK.
| | - Celia G Walker
- Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge CB1 9NL, UK.
| | - Susan A Jebb
- Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge CB1 9NL, UK.
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK.
| | - Carmel Moore
- Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge CB1 9NL, UK.
| | - Gary S Frost
- Nutrition and Dietetic Research Group, Imperial College London, London W12 OHS, UK.
| | - Louise Goff
- Nutrition and Dietetic Research Group, Imperial College London, London W12 OHS, UK.
- Nutritional Sciences Division, Kings College London, London WC2R 2LS, UK.
| | - Tom A B Sanders
- Nutritional Sciences Division, Kings College London, London WC2R 2LS, UK.
| | - Fiona Lewis
- Nutritional Sciences Division, Kings College London, London WC2R 2LS, UK.
| | - Margaret Griffin
- Department of Nutritional Sciences, University of Surrey, Guildford GU2 7WG, UK.
| | - Rachel Gitau
- Hugh Sinclair Unit of Human Nutrition, University of Reading, Reading RG6 6AP, UK.
| | - Julie A Lovegrove
- Hugh Sinclair Unit of Human Nutrition, University of Reading, Reading RG6 6AP, UK.
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Fallaize R, Carvalho-Wells AL, Tierney AC, Marin C, Kieć-Wilk B, Dembińska-Kieć A, Drevon CA, DeFoort C, Lopez-Miranda J, Risérus U, Saris WH, Blaak EE, Roche HM, Lovegrove JA. APOE genotype influences insulin resistance, apolipoprotein CII and CIII according to plasma fatty acid profile in the Metabolic Syndrome. Sci Rep 2017; 7:6274. [PMID: 28740125 PMCID: PMC5524844 DOI: 10.1038/s41598-017-05802-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 06/05/2017] [Indexed: 01/03/2023] Open
Abstract
Metabolic markers associated with the Metabolic Syndrome (MetS) may be affected by interactions between the APOE genotype and plasma fatty acids (FA). In this study, we explored FA-gene interactions between the missense APOE polymorphisms and FA status on metabolic markers in MetS. Plasma FA, blood pressure, insulin sensitivity and lipid concentrations were determined at baseline and following a 12-week randomized, controlled, parallel, dietary FA intervention in 442 adults with MetS (LIPGENE study). FA-APOE gene interactions at baseline and following change in plasma FA were assessed using adjusted general linear models. At baseline E4 carriers had higher plasma concentrations of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and apolipoprotein B (apo B) compared with E2 carriers; and higher TC, LDL-C and apo B compared with E3/E3. Whilst elevated plasma n-3 polyunsaturated FA (PUFA) was associated with a beneficially lower concentration of apo CIII in E2 carriers, a high proportion of plasma C16:0 was associated with insulin resistance in E4 carriers. Following FA intervention, a reduction in plasma long-chain n-3 PUFA was associated with a reduction in apo CII concentration in E2 carriers. Our novel data suggest that individuals with MetS may benefit from personalized dietary interventions based on APOE genotype.
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Affiliation(s)
- Rosalind Fallaize
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, University of Reading, Whiteknights, Reading, RG6 6AP, UK
- School of Life and Medical Sciences, University of Hertfordshire, College Lane, Hatfield, AL10 9AB, UK
| | - Andrew L Carvalho-Wells
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, University of Reading, Whiteknights, Reading, RG6 6AP, UK
| | - Audrey C Tierney
- Nutrigenomics Research Group, University College Dublin Conway Institute, University College Dublin, Dublin, Ireland
| | - Carmen Marin
- Lipids and Atherosclerosis Unit. Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
| | - Beata Kieć-Wilk
- Department of Metabolic Diseases, University Medical College, Krakow, Poland
| | - Aldona Dembińska-Kieć
- Department of Clinical Biochemistry, Jagiellonian University Collegium Medicum, Kraków, Poland
| | - Christian A Drevon
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - José Lopez-Miranda
- Lipids and Atherosclerosis Unit. Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
| | - Ulf Risérus
- Department of Public Health and Caring Sciences/Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Wim H Saris
- Department of Human Biology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (MUMC+) Maastricht, Maastricht, The Netherlands
| | - Ellen E Blaak
- Department of Human Biology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (MUMC+) Maastricht, Maastricht, The Netherlands
| | - Helen M Roche
- Nutrigenomics Research Group, University College Dublin Conway Institute, University College Dublin, Dublin, Ireland
| | - Julie A Lovegrove
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, University of Reading, Whiteknights, Reading, RG6 6AP, UK.
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8
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Fallaize R, Celis-Morales C, Macready AL, Marsaux CF, Forster H, O'Donovan C, Woolhead C, San-Cristobal R, Kolossa S, Hallmann J, Mavrogianni C, Surwillo A, Livingstone KM, Moschonis G, Navas-Carretero S, Walsh MC, Gibney ER, Brennan L, Bouwman J, Grimaldi K, Manios Y, Traczyk I, Drevon CA, Martinez JA, Daniel H, Saris WH, Gibney MJ, Mathers JC, Lovegrove JA. The effect of the apolipoprotein E genotype on response to personalized dietary advice intervention: findings from the Food4Me randomized controlled trial. Am J Clin Nutr 2016; 104:827-36. [PMID: 27510539 DOI: 10.3945/ajcn.116.135012] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 06/29/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The apolipoprotein E (APOE) risk allele (ɛ4) is associated with higher total cholesterol (TC), amplified response to saturated fatty acid (SFA) reduction, and increased cardiovascular disease. Although knowledge of gene risk may enhance dietary change, it is unclear whether ɛ4 carriers would benefit from gene-based personalized nutrition (PN). OBJECTIVES The aims of this study were to 1) investigate interactions between APOE genotype and habitual dietary fat intake and modulations of fat intake on metabolic outcomes; 2) determine whether gene-based PN results in greater dietary change than do standard dietary advice (level 0) and nongene-based PN (levels 1-2); and 3) assess the impact of knowledge of APOE risk (risk: E4+, nonrisk: E4-) on dietary change after gene-based PN (level 3). DESIGN Individuals (n = 1466) recruited into the Food4Me pan-European PN dietary intervention study were randomly assigned to 4 treatment arms and genotyped for APOE (rs429358 and rs7412). Diet and dried blood spot TC and ω-3 (n-3) index were determined at baseline and after a 6-mo intervention. Data were analyzed with the use of adjusted general linear models. RESULTS Significantly higher TC concentrations were observed in E4+ participants than in E4- (P < 0.05). Although there were no significant differences in APOE response to gene-based PN (E4+ compared with E4-), both groups had a greater reduction in SFA (percentage of total energy) intake than at level 0 (mean ± SD: E4+, -0.72% ± 0.35% compared with -1.95% ± 0.45%, P = 0.035; E4-, -0.31% ± 0.20% compared with -1.68% ± 0.35%, P = 0.029). Gene-based PN was associated with a smaller reduction in SFA intake than in nongene-based PN (level 2) for E4- participants (-1.68% ± 0.35% compared with -2.56% ± 0.27%, P = 0.025). CONCLUSIONS The APOE ɛ4 allele was associated with higher TC. Although gene-based PN targeted to APOE was more effective in reducing SFA intake than standard dietary advice, there was no difference between APOE "risk" and "nonrisk" groups. Furthermore, disclosure of APOE nonrisk may have weakened dietary response to PN. This trial was registered at clinicaltrials.gov as NCT01530139.
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Affiliation(s)
- Rosalind Fallaize
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, University of Reading, Reading, United Kingdom
| | - Carlos Celis-Morales
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Anna L Macready
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, University of Reading, Reading, United Kingdom
| | - Cyril Fm Marsaux
- Department of Human Biology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center, Maastricht, Netherlands
| | - Hannah Forster
- UCD Institute of Food and Health, University College Dublin, Belfield, Dublin, Ireland
| | - Clare O'Donovan
- UCD Institute of Food and Health, University College Dublin, Belfield, Dublin, Ireland
| | - Clara Woolhead
- UCD Institute of Food and Health, University College Dublin, Belfield, Dublin, Ireland
| | - Rodrigo San-Cristobal
- Center for Nutrition Research, University of Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; and Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Silvia Kolossa
- ZIEL Research Center of Nutrition and Food Sciences, Biochemistry Unit, Technische Universität München, Munich, Germany
| | - Jacqueline Hallmann
- ZIEL Research Center of Nutrition and Food Sciences, Biochemistry Unit, Technische Universität München, Munich, Germany
| | | | | | - Katherine M Livingstone
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - George Moschonis
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Santiago Navas-Carretero
- Center for Nutrition Research, University of Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; and Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Marianne C Walsh
- UCD Institute of Food and Health, University College Dublin, Belfield, Dublin, Ireland
| | - Eileen R Gibney
- UCD Institute of Food and Health, University College Dublin, Belfield, Dublin, Ireland
| | - Lorraine Brennan
- UCD Institute of Food and Health, University College Dublin, Belfield, Dublin, Ireland
| | - Jildau Bouwman
- Microbiology and Systems Biology Group, TNO, Zeist, Netherlands
| | | | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Iwona Traczyk
- National Food and Nutrition Institute (IZZ), Warsaw, Poland
| | - Christian A Drevon
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - J Alfredo Martinez
- Center for Nutrition Research, University of Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; and Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Hannelore Daniel
- ZIEL Research Center of Nutrition and Food Sciences, Biochemistry Unit, Technische Universität München, Munich, Germany
| | - Wim Hm Saris
- Department of Human Biology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center, Maastricht, Netherlands
| | - Michael J Gibney
- UCD Institute of Food and Health, University College Dublin, Belfield, Dublin, Ireland
| | - John C Mathers
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Julie A Lovegrove
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, University of Reading, Reading, United Kingdom.
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Panizzon M, Hauger RL, Sailors M, Lyons MJ, Jacobson KC, Murray RE, Rana B, Vasilopoulos T, Vuoksimaa E, Xian H, Kremen WS, Franz CE. A new look at the genetic and environmental coherence of metabolic syndrome components. Obesity (Silver Spring) 2015; 23:2499-507. [PMID: 26524476 PMCID: PMC4701648 DOI: 10.1002/oby.21257] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/29/2015] [Accepted: 07/16/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Metabolic syndrome, a clustering of risk factors including insulin resistance, dyslipidemia, central obesity, and hypertension, increases risk for cardiovascular disease and cognitive decline. The etiology of the risk factors' cohesion remains unclear. How genetic and environmental influences explained co-occurrence of metabolic syndrome components was examined. METHODS Continuous measures of body mass index (BMI), waist circumference, blood pressure (BP), fasting insulin and glucose, high-density lipoprotein cholesterol (HDL), and triglycerides from 1,193 middle-aged twin men participating in the Vietnam Era Twin Study of Aging at average age 62 (range 56-67) were analyzed using multivariate biometrical modeling. RESULTS Four heritable factors were found: adiposity (BMI, waist circumference), insulin resistance (glucose, insulin), lipids (HDL, triglycerides), and BP (systolic, diastolic). Heritabilities were 0.42-0.68. In the best-fitting model, insulin resistance, lipids, and adiposity comprised a higher-order latent genetic factor. Adiposity and BP shared genetic influences independent of the latent genetic factor. All factors aggregated on a latent unique environmental factor. CONCLUSIONS Metabolic syndrome components form the equivalent of two genetic factors. BP was genetically unrelated to insulin resistance and lipids. Adiposity was the only characteristic genetically and environmentally related to all other factors. These results inform strategies for gene discovery and prediction of health outcomes.
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Affiliation(s)
- Matthew Panizzon
- Department of Psychiatry, University of California San Diego, La Jolla CA, USA
| | - Richard L. Hauger
- Department of Psychiatry, University of California San Diego, La Jolla CA, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, USA
| | - Megan Sailors
- Department of Psychiatry, University of California San Diego, La Jolla CA, USA
| | - Michael J. Lyons
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Kristen C. Jacobson
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Ruth E. Murray
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Brinda Rana
- Department of Psychiatry, University of California San Diego, La Jolla CA, USA
| | - Terrie Vasilopoulos
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Eero Vuoksimaa
- Department of Psychiatry, University of California San Diego, La Jolla CA, USA
- University of Helsinki, Finland
| | - Hong Xian
- Department of Public Health, St. Louis University, St. Louis, MO, USA
| | - William S. Kremen
- Department of Psychiatry, University of California San Diego, La Jolla CA, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, USA
| | - Carol E. Franz
- Department of Psychiatry, University of California San Diego, La Jolla CA, USA
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Hirobe-Jahn S, Harsch S, Renner O, Richter D, Müller O, Stange EF. Association of FXR gene variants with cholelithiasis. Clin Res Hepatol Gastroenterol 2015; 39:68-79. [PMID: 25242139 DOI: 10.1016/j.clinre.2014.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/23/2014] [Accepted: 07/04/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Impairment of bile acid homeostasis is the most important risk factor of gallstone disease. Thereby the bile acid sensor farnesoid X receptor (FXR) plays a pivotal role in hepatic and intestinal bile acid metabolism. In this explorative study, the FXR gene was investigated to identify gene variants, associated with gallstone formation in a Caucasian population. METHODS Sequencing of the FXR gene was conducted in a randomly selected cohort of gallstone carriers (n=30) and control subjects (n=16) from Stuttgart, Germany. Genomic DNA was obtained from blood leukocytes. Genotype frequencies were established in the total cohort (controls: n=133, gallstone carriers: n=74). For expression analysis, total RNA and protein were isolated from ileal biopsies. RESULTS The sequencing showed the sole appearance of 10 SNPs in gallstone carriers. Further genotype analysis revealed significant gender- and weight-dependent frequency differences of 3 SNPs between gallstone carriers and controls in males (rs35724: OR=4.73, P=0.022) and normal weight subjects (rs11110385: OR=3.67, P=0.027; rs11110386: OR=3.67, P=0.027) applying the 11+12<>22 allele model. Furthermore, rs11110385 carriers showed a significantly decreased FXR protein expression (11+12<>22: P=0.003). Significant mRNA expression differences between lean rs11110385 carriers and non-carriers were observed in FXR target genes (decrease: ILBP: P=0.042, OSTalpha: P=0.071, FGF19: P=0.011. Increase: LRH1: P=0.044). CONCLUSIONS Three FXR gene variants (rs35724, rs11110385, rs11110386) were identified as potential susceptibility factors for cholelithiasis in a German cohort in gender- and weight-dependent manners. Thereby the tag SNP rs11110385 seemed to influence the activation of the FXR gene.
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Affiliation(s)
- Satoko Hirobe-Jahn
- Dr. Margarete Fischer-Bosch Institute for Clinical Pharmacology and University of Tuebingen, Stuttgart, Germany.
| | - Simone Harsch
- Dr. Margarete Fischer-Bosch Institute for Clinical Pharmacology and University of Tuebingen, Stuttgart, Germany.
| | - Olga Renner
- Dr. Margarete Fischer-Bosch Institute for Clinical Pharmacology and University of Tuebingen, Stuttgart, Germany.
| | - Dominique Richter
- Dr. Margarete Fischer-Bosch Institute for Clinical Pharmacology and University of Tuebingen, Stuttgart, Germany.
| | - Oliver Müller
- Department of Internal Medicine I, Robert Bosch Hospital, Stuttgart, Germany.
| | - Eduard F Stange
- Department of Internal Medicine I, Robert Bosch Hospital, Stuttgart, Germany.
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Daneshpour MS. Strategy planning for shortening the list of the metabolic syndrome candidate genes. ACTA MEDICA INTERNATIONAL 2015. [DOI: 10.5530/ami.2015.4.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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12
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Li W, Wang Y, Han Z, Luo C, Zhang C, Xiong J. Apolipoprotein e mutation and double filtration plasmapheresis therapy on a new Chinese patient with lipoprotein glomerulopathy. Kidney Blood Press Res 2014; 39:330-9. [PMID: 25300642 DOI: 10.1159/000355810] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Lipoprotein glomerulopathy (LPG) is a rare hereditary disease. In this study, we investigated the apoE mutation and the role of double filtration plasmapheresis therapy (DFPP) on a new Chinese patient with LPG. METHODS Renal biopsy was performed on this patient to allow a definitive diagnosis. The mutations in the coding sequence of apoE and the hereditary pedigree of this patient were investigated by DNA sequencing. The patient was treated with DFPP, and clinical parameters before and after DFPP were compared. RESULTS Two missense mutations were found in this patient: Cys112Arg and Arg25Cys. Arg25Cys was previously designated as APOE Kyoto. Family genotyping showed that Cys112Arg and Arg25Cys mutation were transmitted through his father and his mother, respectively. The patient's parents are healthy so far to date. Possibly there was a dose effect on apoE mutation induced LPG. Furthermore, DFPP treatment was first used on this patient and led to dramatic changes: Proteinuria and apo E values declined, and hemoglobin level increased significantly. CONCLUSION APOE Kyoto mutation was found in a new Chinese patient with LPG, accompanied by Cys112Arg. More cases and further functional experiments are needed to investigate the role of these two mutations together in LPG. DFPP is an effective therapeutic modality for improving NS in patients with LPG.
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Affiliation(s)
- Wencheng Li
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
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13
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Vučinić N, Djan I, Stokić E, Božin B, Obreht D, Stankov K, Djan M. Different associations of apoE gene polymorphism with metabolic syndrome in the Vojvodina Province (Serbia). Mol Biol Rep 2014; 41:5221-7. [DOI: 10.1007/s11033-014-3390-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 05/02/2014] [Indexed: 11/28/2022]
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Novotny D, Vaverkova H, Karasek D, Malina P. Genetic variants of apolipoprotein A5 T-1131C and apolipoprotein E common polymorphisms and their relationship to features of metabolic syndrome in adult dyslipidemic patients. Clin Biochem 2014; 47:1015-21. [PMID: 24709297 DOI: 10.1016/j.clinbiochem.2014.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 02/26/2014] [Accepted: 03/24/2014] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The aim was to evaluate the relationships of the T-1131C (rs662799) polymorphism variants of apolipoprotein A5 (Apo A5) gene and variants of apolipoprotein E (Apo E) gene common polymorphism (rs429358, rs7412) to signs of metabolic syndrome (MetS). DESIGN AND METHODS We examined 590 asymptomatic dyslipidemic patients divided into MetS+ (n=146) and MetS- (n=444) groups according to criteria of NCEP ATPIII Panel. We evaluated genotype frequencies and differences in MetS features between individual groups. Logistic regression analysis was used for the evaluation of Apo A5/Apo E variants as possible risk factors for MetS. RESULTS We found no statistical differences between genotype and allele frequencies for both Apo A5 and Apo E polymorphisms between MetS+ and MetS- groups. In all subjects and MetS- group, we confirmed well-known association of the -1131C Apo A5 minor allele with elevated triglycerides (TG, p<0.001). The Apo E gene E2 and E4 variants were associated with higher levels of TG (p<0.01) in comparison to E33 common variant. However, no statistical differences were observed in MetS+ subjects, regardless of significantly higher TG levels in this group. Apo A5/Apo E variant analysis in all dyslipidemic patients revealed significant increase of TG levels in all subgroups in comparison to common -1131T/E3 variant carriers, the most in -1131C/E4 variant subgroup. Logistic regression analysis models showed no association of Apo A5, Apo E and all Apo A5/Apo E variants with metabolic syndrome, even after adjustment for age and sex. CONCLUSION Our study refined the role of Apo A5 and Apo E genetic variants in the group of adult dyslipidemic patients. We demonstrate that except of TG, Apo A5 T-1131C (rs662799) and Apo E (rs429358, rs7412) polymorphisms have no remarkable effect on MetS characteristics.
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Affiliation(s)
- Dalibor Novotny
- Department of Clinical Biochemistry, University Hospital Olomouc, I. P. Pavlova 6, 775 20 Olomouc, Czech Republic.
| | - Helena Vaverkova
- 3rd Department of Internal Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, 775 20 Olomouc, Czech Republic
| | - David Karasek
- 3rd Department of Internal Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, 775 20 Olomouc, Czech Republic
| | - Pavel Malina
- Department of Clinical Biochemistry, Hospital Písek, Karla Čapka 589, 397 23 Písek, Czech Republic
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