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Ekkert A, Šliachtenko A, Utkus A, Jatužis D. Intracerebral Hemorrhage Genetics. Genes (Basel) 2022; 13:genes13071250. [PMID: 35886033 PMCID: PMC9322856 DOI: 10.3390/genes13071250] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/04/2022] [Accepted: 07/11/2022] [Indexed: 02/01/2023] Open
Abstract
Intracerebral hemorrhage (ICH) is a devastating type of stroke, frequently resulting in unfavorable functional outcomes. Up to 15% of stroke patients experience ICH and approximately half of those have a lethal outcome within a year. Considering the huge burden of ICH, timely prevention and optimized treatment strategies are particularly relevant. Nevertheless, ICH management options are quite limited, despite thorough research. More and more trials highlight the importance of the genetic component in the pathogenesis of ICH. Apart from distinct monogenic disorders of familial character, mostly occurring in younger subjects, there are numerous polygenic risk factors, such as hypertension, neurovascular inflammation, disorders of lipid metabolism and coagulation cascade, and small vessel disease. In this paper we describe gene-related ICH types and underlying mechanisms. We also briefly discuss the emerging treatment options and possible clinical relevance of the genetic findings in ICH management. Although existing data seems of more theoretical and scientific value so far, a growing body of evidence, combined with rapidly evolving experimental research, will probably serve clinicians in the future.
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Affiliation(s)
- Aleksandra Ekkert
- Center of Neurology, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania;
- Correspondence:
| | | | - Algirdas Utkus
- Center for Medical Genetics, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania;
| | - Dalius Jatužis
- Center of Neurology, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania;
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Nath M, Misra S, Talwar P, Vibha D, Srivastava AK, Prasad K, Kumar P. Association between Angiotensin Converting Enzyme Insertion/Deletion gene polymorphism with the risk of Hemorrhagic Stroke: A systematic review and Meta-Analysis of 53 studies. Gene 2021; 790:145696. [PMID: 33964377 DOI: 10.1016/j.gene.2021.145696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/19/2021] [Accepted: 04/30/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS Hemorrhagic stroke (HS) results in significant mortality and disability worldwide. Angiotensin Converting Enzyme (ACE) is responsible for blood pressure regulation and vascular homeostasis. Our objective was to conduct a comprehensive meta-analysis for ascertaining the association of ACE I/D polymorphism with HS since a number of studies depicted inconclusive evidence. METHODS Literature search was performed till July 10, 2020 in PubMed, EMBASE, Cochrane, Chinese National Knowledge Information and Google Scholar databases with keywords: ('Angiotensin Converting Enzyme' OR 'ACE') AND ('Single Nucleotide polymorphisms' OR 'SNP') AND ('Hemorrhagic stroke or 'HS'). Pooled Odds Ratio (OR) and 95% Confidence Interval (CI) were determined for gene-disease association using either fixed (when I2 < 50%) or random effect (when I2 > 50%) models. Risk of bias in studies was assessed using funnel plots and sensitivity analyses. Statistical analysis was performed using STATA version 13.0 software. RESULTS A total of 53 studies having 5186 HS and 7347 healthy control subjects were included in our meta-analysis. Pooled analyses showed that ACE I/D gene polymorphism had significant association with risk of HS in overall study population [(dominant model: OR = 1.29, 95% CI = 1.12-1.50 & recessive model: OR = 1.79, 95% CI = 1.46-2.20)]. Population subgroup analyses further revealed significant relationship of ACE I/D polymorphism with ICH in Asians (recessive: OR 1.97, 95% CI = 1.57-2.47) but not in Caucasians (recessive: OR 1.02, 95% CI = 0.76-1.36). CONCLUSION This meta-analysis suggests that ACE I/D polymorphism may lead to risk of HS and can be a potential biomarker for HS susceptibility especially in Asian population.
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Affiliation(s)
- Manabesh Nath
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Shubham Misra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Pumanshi Talwar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Deepti Vibha
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Achal Kumar Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Kameshwar Prasad
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Pradeep Kumar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India.
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Li Z, Wang S, Jiao X, Wei G. Genetic Association of Angiotensin-Converting Enzyme I/D Polymorphism with Intracranial Hemorrhage: An Updated Meta-analysis of 39 Case-Control Studies. World Neurosurg 2020; 134:e1-e7. [DOI: 10.1016/j.wneu.2019.06.104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 01/11/2023]
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Genetic risk of Spontaneous intracerebral hemorrhage: Systematic review and future directions. J Neurol Sci 2019; 407:116526. [PMID: 31669726 DOI: 10.1016/j.jns.2019.116526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/18/2019] [Accepted: 10/07/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although highly heritable, few genes have been linked to spontaneous intracerebral hemorrhage (SICH), which does not currently have any evidence-based disease-modifying therapy. Individuals of African ancestry are especially susceptible to SICH, even more so for indigenous Africans. We systematically reviewed the genetic variants associated with SICH and examined opportunities for rapidly advancing SICH genomic research for precision medicine. METHOD We searched the National Human Genome Research Institute-European Bioinformatics Institute (NHGRI-EBI) Genome Wide Association Study (GWAS) catalog and PubMed for original research articles on genetic variants associated with SICH as of 15 June 2019 using the PRISMA guideline. RESULTS Eight hundred and sixty-four articles were identified using pre-specified search criteria, of which 64 met the study inclusion criteria. Among eligible articles, only 9 utilized GWAS approach while the rest were candidate gene studies. Thirty-eight genetic loci were found to be variously associated with the risk of SICH, hematoma volume, functional outcome and mortality, out of which 8 were from GWAS including APOE, CR1, KCNK17, 1q22, CETP, STYK1, COL4A2 and 17p12. None of the studies included indigenous Africans. CONCLUSION Given this limited information on the genetic contributors to SICH, more genomic studies are needed to provide additional insights into the pathophysiology of SICH, and develop targeted preventive and therapeutic strategies. This call for additional investigation of the pathogenesis of SICH is likely to yield more discoveries in the unexplored indigenous African populations which also have a greater predilection.
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Chen YC, Chang KH, Chen CM. Genetic Polymorphisms Associated with Spontaneous Intracerebral Hemorrhage. Int J Mol Sci 2018; 19:ijms19123879. [PMID: 30518145 PMCID: PMC6321144 DOI: 10.3390/ijms19123879] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 12/01/2018] [Accepted: 12/03/2018] [Indexed: 01/14/2023] Open
Abstract
Differences in the incidence of spontaneous intracerebral hemorrhage (ICH) between ethnicities exist, with an estimated 42% of the variance explained by ethnicity itself. Caucasians have a higher proportion of lobar ICH (LICH, 15.4% of all ICH) than do Asians (3.4%). Alterations in the causal factor exposure between countries justify part of the ethnic variance in ICH incidence. One third of ICH risk can be explained by genetic variation; therefore, genetic differences between populations can partly explain the difference in ICH incidence. In this paper, we review the current knowledge of genetic variants associated with ICH in multiple ethnicities. Candidate gene variants reportedly associated with ICH were involved in the potential pathways of hypertension, vessel wall integrity, lipid metabolism, endothelial dysfunction, inflammation, platelet function, and coagulopathy. Furthermore, variations in APOE (in multiple ethnicities), PMF1/SLC25A44 (in European), ACE (in Asian), MTHFR (in multiple ethnicities), TRHDE (in European), and COL4A2 (in European) were the most convincingly associated with ICH. The majority of the associated genes provide small contributions to ICH risk, with few of them being replicated in multiple ethnicities.
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Affiliation(s)
- Yi-Chun Chen
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, No.5, Fuxing St., Guishan Township, Taoyuan County 333, Taiwan.
| | - Kuo-Hsuan Chang
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, No.5, Fuxing St., Guishan Township, Taoyuan County 333, Taiwan.
| | - Chiung-Mei Chen
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, No.5, Fuxing St., Guishan Township, Taoyuan County 333, Taiwan.
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Kase CS, Shoamanesh A, Greenberg SM, Caplan LR. Intracerebral Hemorrhage. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Carpenter AM, Singh IP, Gandhi CD, Prestigiacomo CJ. Genetic risk factors for spontaneous intracerebral haemorrhage. Nat Rev Neurol 2015; 12:40-9. [PMID: 26670299 DOI: 10.1038/nrneurol.2015.226] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Intracerebral haemorrhage (ICH) is associated with the greatest morbidity and mortality of all stroke subtypes. Established risk factors for ICH include hypertension, alcohol use, current cigarette smoking, and use of oral anticoagulants and/or antiplatelet agents. Familial aggregation of ICH has been observed, and the heritability of ICH risk has been estimated at 44%. Few genes have been found to be associated with ICH at the population level, and much of the evidence for genetic risk factors for ICH comes from single studies conducted in relatively small and homogenous populations. In this Review, we summarize the current knowledge of genetic variants associated with primary spontaneous ICH. Two variants of the gene encoding apolipoprotein E (APOE) - which also contributes to the pathogenesis of cerebral amyloid angiopathy - are the most likely candidates for variants that increase the risk of ICH. Other promising candidates for risk alleles in ICH include variants of the genes ACE, PMF1/SLC25A44, COL4A2, and MTHFR. Other genetic variants, related to haemostasis, lipid metabolism, inflammation, and the CNS microenvironment, have been linked to ICH in single candidate gene studies. Although evidence for genetic contributions to the risk of ICH exists, we do not yet fully understand how and to what extent this information can be utilized to prevent and treat ICH.
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Affiliation(s)
- Amanda M Carpenter
- St. George's University, 3500 Sunrise Highway, Great River, NY 11739, USA
| | - Inder P Singh
- Department of Neurological Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, 90 Bergen Street Suite 8100, Newark, New Jersey 07103, USA
| | - Chirag D Gandhi
- Department of Neurological Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, 90 Bergen Street Suite 8100, Newark, New Jersey 07103, USA
| | - Charles J Prestigiacomo
- Department of Neurological Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, 90 Bergen Street Suite 8100, Newark, New Jersey 07103, USA
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Polymorphisms in the Promoters of the MMP-2 and TIMP-2 Genes Are Associated with Spontaneous Deep Intracerebral Hemorrhage in the Taiwan Population. PLoS One 2015; 10:e0142482. [PMID: 26551785 PMCID: PMC4638341 DOI: 10.1371/journal.pone.0142482] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 10/22/2015] [Indexed: 01/18/2023] Open
Abstract
Background Spontaneous intracerebral hemorrhage (ICH) is a devastating stroke subtype. Matrix metalloproteinases (MMPs) function in the degradation of extracellular matrix and the activities of MMPs are modulated by their endogenous inhibitors, tissue inhibitors of metalloproteinases (TIMPs). This study aimed to discuss relationship of MMP-2 and TIMP-2 to spontaneous deep ICH (SDICH) susceptibility and hematoma size. Methods Associations were tested by logistic regression and general linear models (GLM) where appropriate, adjusting with covariables of age, sex, hypertension, diabetes mellitus, smoking, and alcohol consumption. Association analyses were performed first by stratification of genders and then by the age of 65 years old (y/o). Elder population was defined as subjects who were older than 65 y/o. Results There were 396 SDICH patients and 376 control subjects in this study. In the elder group, rs7503607 C>A variant in TIMP-2 was associated with SDICH in male and overall patients (OR = 3.49, 95% CI 1.45 to 8.40, P = 0.005 and OR = 2.45, 95% CI 1.37 to 4.38, P = 0.003, respectively) in additive genetic model. In recessive genetic model, rs2285053 TT genotype in MMP-2 was correlated to SDICH in male patients and overall elder group (OR = 7.30, 95% CI 1.3 to 40, P = 0.02 and OR = 2.91, 95% CI 1.02 to 8.31, P = 0.046, respectively), and rs7503726 AA genotype in TIMP-2 was associated with SDICH in female patients (OR = 0.29, 95% CI 0.1 to 0.84, P = 0.02). In younger male and overall younger patients, SDICH patients who had supratentorial hemorrhage had significantly lower frequency of AA genotypes in rs7503726 than those with infratentorial hemorrhage (OR = 0.36, 95% CI 0.17 to 0.75, P = 0.006 and OR = 0.43, 95% CI 0.22 to 0.84, P = 0.014, respectively). Hemorrhage size increased by 9.7 (95% CI 2.1 to 43, P = 0.004) cm3 per minor allele (A) of the rs7503607 variant in the elder female patients and increased by 4.3 (95% CI 1.4 to 12.9, P = 0.009) cm3 per minor allele (A) in all elder patients. In younger patients, the hemorrhage size decreased by 3.3 (95% CI 1.2 to 9.5, P = 0.03) cm3 per minor allele of the s7503726 variant in the female patients. Conclusions This study showed a significant association between the variants of MMP-2 and TIMP-2 promoters and SDICH susceptibility with significant age and gender differences. Hemorrhage location and size might be affected by TIMP-2 promoter variants in the SDICH patients.
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Kumar A, Prasad K, Vivekanandhan S, Srivastava A, Goswami S, Srivastava MVP, Tripathi M. Association between angiotensin converting enzyme gene insertion/deletion polymorphism and intracerebral haemorrhage in North Indian population: a case control study and meta-analysis. Neurol Sci 2014; 35:1983-90. [PMID: 25016961 DOI: 10.1007/s10072-014-1877-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 06/30/2014] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to determine the relationship between Angiotensin converting enzyme (ACE) insertion/deletion polymorphism and ICH with an ACE level in a North Indian population. Patient with ICH and age- and sex- matched control subjects were recruited. Case control study design was used. Genotyping was performed by using Polymerase chain reaction. Serum ACE levels were measured by colorimetric method. Our results were integrated with other reported studies across different countries in a meta-analysis. One hundred and six patients with ICH and 106 age- and sex- matched control subjects were recruited. Mean age of cases and control subjects were 53.4 ± 1 and 52.9 ± 13.4, respectively. The DD genotypes were more frequency distributed in cases compared with controls (OR 2; 95 % CI, 1.02-3.8, P = 0.04) under a recessive model of inheritance. Meta-analysis suggests significant association between ACE I/D polymorphism and risk of ICH (OR 1.98; 95 % CI, 1.53-2.57) under the recessive model of inheritance and under the dominant model of inheritance (OR 1.31; 95 % CI, 1.18-1.45). The findings of the present study show a significant association between ACE insertion/deletion polymorphism and ICH. Meta-analysis indicate that ACE I/D polymorphism may be a susceptible marker for risk factor of ICH in Asian population.
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Affiliation(s)
- A Kumar
- Department of Neurology, Neurosciences Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India,
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Association of ACE gene I/D polymorphism and ACE levels with hemorrhagic stroke: comparison with ischemic stroke. Neurol Sci 2014; 36:137-42. [DOI: 10.1007/s10072-014-1880-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 07/04/2014] [Indexed: 01/05/2023]
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