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Yugavathy N, Abdullah BM, Lim SK, Abdul Gafor AHB, Wong MG, Bavanandan S, Wong HS, Huri HZ. Precision Medicine in Erythropoietin Deficiency and Treatment Resistance: A Novel Approach to Management of Anaemia in Chronic Kidney Disease. Curr Issues Mol Biol 2023; 45:6550-6563. [PMID: 37623232 PMCID: PMC10453742 DOI: 10.3390/cimb45080413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/26/2023] Open
Abstract
The study of anaemia is a well-developed discipline where the concepts of precision medicine have, in part, been researched extensively. This review discusses the treatment of erythropoietin (EPO) deficiency anaemia and resistance in cases of chronic kidney disease (CKD). Traditionally, erythropoietin-stimulating agents (ESAs) and iron supplementation have been used to manage anaemia in cases of CKD. However, these treatments pose potential risks, including cardiovascular and thromboembolic events. Newer treatments have emerged to address these risks, such as slow-release and low-dosage intravenous iron, oral iron supplementation, and erythropoietin-iron combination therapy. Another novel approach is the use of hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs). This review highlights the need for precision medicine targeting the genetic components of EPO deficiency anaemia in CKD and discusses individual variability in genes such as the erythropoietin gene (EPO), the interleukin-β gene (IL-β), and the hypoxia-inducible factor gene (HIF). Pharmacogenetic testing aims to provide targeted therapies and interventions that are tailored to the specific characteristics of an individual, thus optimising treatment outcomes and minimising resistance and adverse effects. This article concludes by suggesting that receptor modification has the potential to revolutionise the treatment outcomes of patients with erythropoietin deficiency anaemia through the integration of the mentioned approach.
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Affiliation(s)
- Nava Yugavathy
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur 50603, Malaysia;
| | | | - Soo Kun Lim
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia;
| | | | - Muh Geot Wong
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, NSW 2065, Australia;
- The George Institute for Global Health, University of New South Wales, Kensington, NSW 2052, Australia
| | - Sunita Bavanandan
- Department of Nephrology, Hospital Kuala Lumpur, Kuala Lumpur 50586, Malaysia;
| | - Hin Seng Wong
- Department of Nephrology, Hospital Selayang, Batu Caves 68100, Malaysia;
| | - Hasniza Zaman Huri
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur 50603, Malaysia;
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The resistance to methoxy polyethylene glycol-epoetin beta in anemic patients of end-stage renal disease. Heliyon 2023; 9:e13747. [PMID: 36865462 PMCID: PMC9971169 DOI: 10.1016/j.heliyon.2023.e13747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/04/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Background Chronic kidney disease (CKD) is a global disease, and the number of people affected is increasing due to driving factors such as diabetes, obesity, and hypertension, as well as increased life expectancy. Many patients with CKD suffer anemia throughout the period of their disease. Aim This research aimed to investigate the relation between resistance to the methoxy polyethylene glycol-epoetin beta (ME-β) and angiotensin-converting enzyme (ACE) gene polymorphism. Methods Seventy Iraqi patients with CKD on hemodialysis treatment for at least six months and receiving a subcutaneous injection of ME-β were selected to enroll in this current study. In addition to these patients, the control group of 20 healthy subjects. Baseline samples (Three blood samples) were obtained and withdrawn from each participant, then 3 and 6 months following the starting sample. In addition, a unique blood sample was taken from each participant in the control group in the early morning hours following 8 h of fasting and before dialysis (for the patients' group). Results ACE polymorphism did not demonstrate a significant (p ˃ 0.05) relation with changing the dose of ME-β. Furthermore, there was a negative relationship between ME-β dose and hemoglobin (Hb) in CKD patients. Comparing ACE polymorphism between good and hypo-response groups shows no significant effect (p ˃ 0.05) on ME-β therapy. Moreover, the erythropoietin resistance index (ERI) was significantly (p < 0.001) lower in good responders to ME-β therapy compared to the hypo-response group. Finally, comparing the ERI of the patient, the good response group to the hypo-response group showed no significant association (p ˃ 0.05) with ACE gene polymorphism in response to ME-β therapy. Conclusion No relation was determined between the polymorphism ACE gene and the resistance to the ME-β administration in CKD Iraqi patients.
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Strong Association of Angiotensin Converting Enzyme-2 Gene Insertion/Deletion Polymorphism with Susceptibility to SARS-CoV-2, Hypertension, Coronary Artery Disease and COVID-19 Disease Mortality. J Pers Med 2021; 11:jpm11111098. [PMID: 34834450 PMCID: PMC8621157 DOI: 10.3390/jpm11111098] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/11/2021] [Accepted: 10/22/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The ongoing outbreak of SARS-CoV-2 represents a significant challenge to international health. Several reports have highlighted the importance of ACE2 on the pathogenesis of COVID-19. The spike protein of SARS-CoV-2 efficiently binds to the angiotensin-converting enzyme 2 (ACE2) receptors and facilitates virus entry into the host cell. In the present study, we hypothesize that a functional insertion/deletion polymorphism-rs4646994 I/D and rs4240157 T > C in the ACE gene could be associated with SARS-CoV-2 infection and mortality. METHODOLOGY This study included 117 consecutive COVID-19 patients and 150 age matched healthy controls (ACE2-rs4646994 I/D) and 100 age matched healthy controls with ACE2 rs4240157 T > C. We used Mutation specific PCR (MSP) for ACE2-rs4646994 I/D genotyping and amplification refractory mutation system (ARMS-PCR) for ACE2 rs4240157 T > C genotyping. RESULTS Results indicated that there were significant differences in the genotype distributions of ACE2-rs4646994 I/D polymorphisms (p < 0.030) and ACE2 rs4240157 T > C between COVID-19 patients and controls (p-values < 0.05). Higher frequency of DD genotype (48.71%) and D allele (0.67) was reported in COVID-19 patients than controls. Our results showed that the ACE2-DD genotype was strongly associated with increased COVID-19 severity (OR 2.37 (95%) CI = (1.19-4.70), RR = 1.39 (1.09-1.77), p < 0.013) and also a strong association was seen with ACE2-ID genotype with COVID-19 severity (OR 2.20 (95%) CI = (1.08-4.46), p < 0.020) in the codominant model. In allelic comparison, the D allele was strongly associated with COVID-19 severity (OR 1.58 (95% CI) (1.11-2.27), RR 1.21 (1.05-1.41) p < 0.010). A significant correlation of ACE2-I/D genotypes was reported with Age (p < 0.035), T2D (p < 0.0013), hypertension (p < 0.0031) and coronary artery disease (p < 0.0001). Our results indicated ACE2-DD genotype was strongly associated with increased COVID-19 mortality (OR 8.25 (95%) CI = (2.40 to 28.34), p < 0.008) and also ACE2-DD + DI genotype was strongly associated with increased COVID-19 mortality with OR 4.74 (95%) CI = (1.5214 to 14.7915), p < 0.007. A significant correlation was reported between COVID-19 patients and age matched controls (p < 0.0007). Higher frequency of heterozygosity TC (40%) followed by ACE2-CC genotype (24.78%) was reported among COVID-19 patients. Using multivariate analysis, ACE2-CT genotype was strong associated with SARS-CoV-2 severity with an OR 2.18 (95% CI) (1.92-3.99), p < 0.010 and also ACE2-CC genotype was linked with COVID-19 severity with an OR 2.66 (95% CI) (1.53-4.62), p < 0.005. A significant correlation of ACE2-T > C genotypes was reported with gender (p < 0.04), T2D (p < 0.035). ACE2-CC genotype was strongly associated with increased COVID-19 mortality OR 3.66 (95%) CI = (1.34 to 9.97), p < 0.011 and also ACE2-C allele was associated with COVID-19 mortality OR 2, 01 (1.1761-3.45), p < 0.010. CONCLUSIONS It is concluded that ACE-DD genotype and D allele was strongly associated with increased COVID-19 patient severity. In addition, ACE I/D polymorphism were strongly associated with advanced age, diabetes and ischemic heart disease in COVID-19 patients whereas ACE-II genotype was a protective factor against the development of severe COVID-19. ACE2-DD genotype was strongly associated with increased COVID-19 mortality. Additionally, ACE2-CC and CT genotypes were strongly associated with COVID-19 severity. Therefore, our study might be useful for identifying the susceptible population groups for targeted interventions and for making relevant public health policy decisions.
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Hamdan Almaeen A, Mostafa-Hedeab G. Haematological Indicators of Response to Erythropoietin Therapy in Chronic Renal Failure Patients on Haemodialysis: Impact of Angiotensin-Converting Enzyme rs4343 Gene Polymorphism. Pharmgenomics Pers Med 2021; 14:1055-1068. [PMID: 34483678 PMCID: PMC8408344 DOI: 10.2147/pgpm.s311181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/09/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE This is the first cross-sectional study studying the changes in haematological indicators of the response to recombinant human erythropoietin (rHuEPO) therapy in chronic renal failure (CRF) patients on haemodialysis (HD) stratified according to ACE G2350A (rs4343) gene polymorphism. DESIGN An observational cross-sectional study. SETTING Nephrology department and Biochemistry and molecular biology department, faculty of medicine, Cairo University. PATIENTS A total of 256 CRF patients on HD for at least six months (162 male and 103 female) and 160 healthy subjects (122 male and 38 female) were recruited in the current study after signing a consent form. ACE G2350A (rs4343) Insertion/Deletion (I/D) was tested, the association between ACE G2350A (RS4343) gene polymorphisms and patients response to rHuEpo was evaluated. RESULTS ACE G2350A (rs4343) I/D was the most prevalent genotype, while I/I genotype was the lowest prevalent among patient or control subjects included in the study. D allele is the most prevalent allele, either among patients or the control group. Hemoglobin (Hb) level in patients with I/I and Deletion/Deletion (D/D) genotype was significantly higher compared to those with I/D genotype (P = 0.012 and P = 0.005, respectively). Serum iron in the I/D genotype was significantly higher than those with either I/I or D/D genotype (P = 0.045 and P = 0.018, respectively). Angiotensin-converting enzyme (ACE) content, total leukocytic count (TLC), and soluble erythropoietin receptor (sEpoR) were independent predictors of Hb level. The ACE gene, TLC, and serum iron were the independent factors that may affect the Haematocrit (Hct) level. ACE G2350A (rs4343) gene polymorphisms may affect the HD patient's responses to rHuEPOs. CONCLUSION In HD patients, screening for ACE G2350A (rs4343) gene polymorphisms before rHuEpo administration may help predict patient response.
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Affiliation(s)
| | - Gomaa Mostafa-Hedeab
- Pharmacology Department, Health Sciences Research Unit, Medical College, Jouf University, Sakaka, Kingdom of Saudi Arabia
- Pharmacology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
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Kao CC, Wong HSC, Wang YJ, Chou WH, Perwitasari DA, Wu MS, Chang WC. The role of genetic polymorphisms in STIM1 and ORAI1 for erythropoietin resistance in patients with renal failure. Medicine (Baltimore) 2021; 100:e25243. [PMID: 33907089 PMCID: PMC8083997 DOI: 10.1097/md.0000000000025243] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT Anemia is a common complication in patients with renal failure. While erythropoietin is commonly used to treat anemia, some patients exhibit a poor response to erythropoietin. Since store-operated calcium channel (SOC) signaling is one of the erythropoietin activated pathways, we aimed to investigate the association between the genetic polymorphisms of SOC signaling pathway and erythropoietin resistance in patients with renal failure.Four tagging single nucleotide polymorphisms in STIM1 and five in ORAI1 were selected in this study. Genotyping was performed with the TaqMan Allelic Discrimination assay and the association of individual tagging single nucleotide polymorphisms with erythropoietin resistance was analyzed by multivariable adjusted random intercepts model.194 patients were enrolled in this study. The mean age of participants is 68 years, and 56% were men. The mean erythropoietin resistance index was 9.04 ± 4.51 U/Kg/week/g/dL. We found that patients with the AA genotype of rs1561876 in STIM1, and the CC or CT genotypes of rs6486795 in ORAI1, were associated with increased risk of erythropoietin resistance. Functional annotation of expression quantitative trait loci revealed that the AA genotype of rs1561876 in STIM1 has a relatively lower expression of ribonucleotide reductase catalytic subunit M1 in skeletal muscle, while the CC genotype of rs6486795 in ORAI1 has a relatively higher expression of ORAI1 in the whole blood and thyroid.Overall, we demonstrate a significant association between erythropoietin resistance and genetic polymorphisms of STIM1 and ORAI1. Annotation prediction revealed the importance of SOC-mediated calcium signaling for erythropoietin resistance.
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Affiliation(s)
- Chih-Chin Kao
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University
- TMU Research Center of Urology and Kidney (TMU-RCUK)
| | - Henry Sung-Ching Wong
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University
- Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy, Taipei Medical University
| | - Yu-Jia Wang
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University
- Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University and National Health Research Institutes, Taipei, Taiwan
| | - Wan-Hsuan Chou
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University
| | | | - Mai-Szu Wu
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University
- TMU Research Center of Urology and Kidney (TMU-RCUK)
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City
| | - Wei-Chiao Chang
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University
- Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy, Taipei Medical University
- Integrative Research Center for Critical Care, Wan Fang Hospital, Taipei Medical University, Taipei
- Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
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Pati A, Mahto H, Padhi S, Panda AK. ACE deletion allele is associated with susceptibility to SARS-CoV-2 infection and mortality rate: An epidemiological study in the Asian population. Clin Chim Acta 2020; 510:455-458. [PMID: 32791137 PMCID: PMC7416133 DOI: 10.1016/j.cca.2020.08.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 02/07/2023]
Abstract
Differential distribution of ACE I/D polymorphism observed in Asian countries. Allele D of ACE I/D polymorphism was associated with susceptibility to SARS-CoV-2 infection. The minor allele of ACE I/D was linked with COVID-19 mortality in the Asian population.
Background Severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) is believed to have emerged from Wuhan, China, and spreads over 215 countries worldwide. The spike protein of SARS-CoV-2 binds to angiotensin-converting enzyme-2 (ACE-2) receptors and enter the host cells. Several reports have been highlighted the importance of ACE-2 on the pathogenesis of COVID-19. In the present study, we hypothesize that a functional insertion/deletion polymorphism in the ACE gene could be associated with SARS-CoV-2 infection and mortality. Materials and methods PubMed and Google scholar search engines were used to obtained data on the prevalence of ACE I/D polymorphism in different countries of the Asia continent. Data on COVID-19 infection rate (per million), mortality/million, and percentage of recovery were acquired form worldometer website. The Spearman rank correlation test performed to investigate the correlation of allele ‘D’ with SARS-CoV-2 infection, mortality rate, and recovery percentage. Results Epidemiological investigation revealed a significant positive correlation of D allele of ACE polymorphism with SARS-CoV-2 infection (r = 0.502, p = 0.008, n = 26) and mortality rate (r = 0.620, p = 0.002, n = 22) in Asian population. However, no significant role of ACE I/D polymorphism was observed with recovery rate of patients from SARS-CoV-2 infection (r = −0.208, p = 0.352, n = 22). Conclusions Allele D of ACE insertion/deletion polymorphism is associated with the rate of infection and mortality in the Asian population.
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Affiliation(s)
- Abhijit Pati
- Department of Bioscience and Bioinformatics, Khallikote University, Transit Campus: GMax Building, Konisi, Berhampur, Odisha 761008, India
| | - Harishankar Mahto
- Department of Botany, Ranchi University, Ranchi, Jharkhand 834008, India
| | - Sunali Padhi
- Department of Bioscience and Bioinformatics, Khallikote University, Transit Campus: GMax Building, Konisi, Berhampur, Odisha 761008, India
| | - Aditya K Panda
- Department of Bioscience and Bioinformatics, Khallikote University, Transit Campus: GMax Building, Konisi, Berhampur, Odisha 761008, India.
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Yugavathy N, Huri HZ, Kun LS, Bin Abdul Gafor AH, Geot WM, Bavanandan S, Seng WH. Clinical and genetic markers of erythropoietin deficiency anemia in chronic kidney disease (predialysis) patients. Biomark Med 2020; 14:1099-1108. [PMID: 32969247 DOI: 10.2217/bmm-2020-0205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aim: To determine the clinical and genetic markers associated with erythropoietin deficiency anemia in predialysis individuals. Materials & methods: Patients were categorized into cases and control group. Demographic characteristics and clinical parameters were obtained from medical record review and serum EPO and ferritin were obtained with ELISA. HIF-1α (rs2057482), IL-1β (rs1143627) and EPO (rs1617640) gene polymorphism were genotyped. Results: Female gender, glomerular filtration rate, treatment with hematinics, anticoagulant and diuretic were strong predictors of EPO-deficient anemia in predialysis chronic kidney disease patients. Genetic polymorphism in the HIF-1α recessive model was associated with non-EPO-deficiency, followed by EPO recessive allele associated with low-serum erythropoietin and IL-1β recessive model with low hemoglobin level. Conclusion: EPO-deficiency anemia can be diagnosed more conveniently in the presence of biomarkers.
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Affiliation(s)
- Nava Yugavathy
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Hasniza Zaman Huri
- Department of Pharmacy, Faculty of Pharmacy, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Lim Soo Kun
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | | | - Wong Muh Geot
- Department of Renal Medicine, Royal North Shore Hospital, NSW, Australia.,Department of Renal and Metabolic, The George Institute for Global Health, University of New South Wales, NSW, Australia
| | - Sunita Bavanandan
- Department of Nephrology, Hospital Kuala Lumpur, Kuala Lumpur 50586, Malaysia
| | - Wong Hing Seng
- Deparment of Nephrology, Hospital Selayang, Selangor 68100, Malaysia
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Al-Radeef MY, Fawzi HA, Allawi AA. ACE gene polymorphism and its association with serum erythropoietin and hemoglobin in Iraqi hemodialysis patients. Appl Clin Genet 2019; 12:107-112. [PMID: 31303780 PMCID: PMC6611710 DOI: 10.2147/tacg.s198992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/10/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose To evaluate the frequencies of angiotensin-converting enzyme gene polymorphism in Iraqi hemodialysis patients and to examine the association between this polymorphism and serum erythropoietin and hemoglobin levels.. Methods In this study, 70 chronic renal failure Iraqi patients on maintenance hemodialysis (patient group) and 20 healthy subjects (control group) were genotyped for angiotensin-converting enzyme gene polymorphism. The distribution of genotype and allele frequencies of this polymorphism in these subjects were also evaluated.. Results The distribution of angiotensin-converting enzyme genotypes between groups was similar, and the ID genotype was the most frequent, followed by DD and II genotypes (50%, 37%, and 13%). The control group had a nonsignificant difference in serum erythropoietin levels among different angiotensin-converting enzyme genotypes, while patients with ID and DD genotypes displayed significant elevation in serum erythropoietin with time. No significant differences in hemoglobin levels were observed in patient and control groups. A significant positive correlation was observed between serum erythropoietin and hemoglobin in the control group with different angiotensin-converting enzyme genotypes, while a nonsignificant negative correlation was observed in the patient group throughout the study. . Conclusions Chronic kidney disease did not significantly alter angiotensin-converting enzyme genotypes, and angiotensin-converting enzyme gene polymorphism had a significant effect on serum erythropoietin levels and a nonsignificant effect on hemoglobin levels. .
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Affiliation(s)
| | - Hayder Adnan Fawzi
- Department of Clinical Pharmacy, Baghdad Medical City Hospital, Baghdad, Iraq
| | - Ali Abdulmajid Allawi
- Department of Internal Medicine, College of Medicine, Baghdad University, Baghdad, Iraq
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Kalatharan V, Lemaire M, Lanktree MB. Opportunities and Challenges for Genetic Studies of End-Stage Renal Disease in Canada. Can J Kidney Health Dis 2018; 5:2054358118789368. [PMID: 30046452 PMCID: PMC6056781 DOI: 10.1177/2054358118789368] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/14/2018] [Indexed: 11/23/2022] Open
Abstract
Purpose of review: Genetic testing can improve diagnostic precision in some patients with
end-stage renal disease (ESRD) providing the potential for targeted therapy
and improved patient outcomes. We sought to describe the genetic
architecture of ESRD and Canadian data sources available for further genetic
investigation into ESRD. Sources of information: We performed PubMed searches of English, peer-reviewed articles using
keywords “chronic kidney disease,” “ESRD,” “genetics,” “sequencing,” and
“administrative databases,” and searched for nephrology-related Mendelian
diseases on the Online Mendelian Inheritance in Man database. Methods: In this narrative review, we discuss our evolving understanding of the
genetic architecture of kidney disease and ESRD, the risks and benefits of
using genetic data to help diagnose and manage patients with ESRD, existing
public Canadian biobanks and databases, and a vision for future genetic
studies of ESRD in Canada. Key findings: ESRD has a polygenic architecture including rare Mendelian mutations and
common small effect genetic polymorphism contributors. Genetic testing will
improve diagnostic accuracy and contribute to a precision medicine approach
in nephrology. However, the risk and benefits of genetic testing needs to be
considered from an individual and societal perspective, and further research
is required. Merging existing health data, linking biobanks and
administrative databases, and forming Canadian collaborations hold great
potential for genetic research into ESRD. Large sample sizes are necessary
to perform the suitably powered investigations required to bring this vision
to reality. Limitations: This is a narrative review of the literature discussing future directions and
opportunities. It reflects the views and academic biases of the authors. Implications: National collaborations will be required to obtain sample sizes required for
impactful, robust research. Merging established datasets may be one approach
to obtain adequate samples. Patient education and engagement will improve
the value of knowledge gained.
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Affiliation(s)
- Vinusha Kalatharan
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada
| | - Mathieu Lemaire
- Division of Nephrology, The Hospital for Sick Children, University of Toronto, ON, Canada.,Cell Biology Program, SickKids Research Institute, Toronto, ON, Canada
| | - Matthew B Lanktree
- Division of Nephrology, University Health Network, Toronto, ON, Canada.,University of Toronto, ON, Canada.,Division of Nephrology, McMaster University, Hamilton, ON, Canada
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Tumor necrosis factor-α and interleukin-1β gene polymorphisms and risk of brain abscess in North Indian population. Cytokine 2015; 75:159-64. [DOI: 10.1016/j.cyto.2015.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 07/07/2015] [Accepted: 07/08/2015] [Indexed: 12/30/2022]
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11
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Alves MT, Vilaça SS, Carvalho MDG, Fernandes AP, Dusse LMS, Gomes KB. Resistance of dialyzed patients to erythropoietin. Rev Bras Hematol Hemoter 2015; 37:190-7. [PMID: 26041422 PMCID: PMC4459468 DOI: 10.1016/j.bjhh.2015.02.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 11/24/2014] [Indexed: 02/07/2023] Open
Abstract
Resistance to recombinant human erythropoietin is a common condition in dialyzed patients with chronic kidney disease and is associated with more hospitalizations, increased mortality and frequent blood transfusions. The main cause of hyporesponsiveness to recombinant human erythropoietin in these patients is iron deficiency. However, a high proportion of patients does not respond to treatment, even to the use of intravenous iron, which indicates the presence of other important causes of resistance. In addition to the iron deficiency, the most common causes of resistance include inflammation, infection, malnutrition, inadequate dialysis, and hyperparathyroidism, although other factors may be associated. In the presence of adequate iron stores, other causes should be investigated and treated appropriately.
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Affiliation(s)
| | | | | | | | | | - Karina Braga Gomes
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
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12
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Zhang C, Li Z, Cao Q, Qin C, Cai H, Zhou H, Qian J, Tao L, Ju X, Yin C. Association of erythropoietin gene rs576236 polymorphism and risk of adrenal tumors in a Chinese population. J Biomed Res 2014; 28:456-61. [PMID: 25469114 PMCID: PMC4250524 DOI: 10.7555/jbr.28.20130126] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 09/29/2013] [Accepted: 07/03/2014] [Indexed: 12/22/2022] Open
Abstract
Erythropoietin (EPO) is a circulating glycosylated protein hormone and has been implicated in the development and progression of non-hematopoietic tissue tumors. The objective of the present study was to determine if the EPO rs576236 polymorphism was associated with the risk of adrenal tumors. We genotyped the EPO rs576236 polymorphism in a case-control study of 288 adrenal tumor patients and 456 cancer-free controls by using the TaqMan method, and assessed the association between the polymorphism and the adrenal tumor risk by logistic regression. Furthermore, 95% confidence interval (CI) was used to assess the genetic association between the polymorphism and the risk of adrenal tumor. Compared with the TT genotype, the TC genotype had a significantly increased risk of adrenal tumor [adjusted odds ratio (OR) = 1.24, 95% CI = 1.12–2.22]. Furthermore a significantly increased risk of adrenal tumor was found in the combined variant genotypes TC+CC compared with the TT genotype (adjusted OR = 1.17, 95% CI = 1.12–2.21). Our present study suggests that the rs576236 polymorphism of EPO confers susceptibility to adrenal tumor in the Chinese population.
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Affiliation(s)
- Chao Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Zhongxing Li
- Department of Urology, Zhenjiang Second People's Hospital, Zhenjiang, Jiangsu 212000, China
| | - Qiang Cao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Chao Qin
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Hongzhou Cai
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Hai Zhou
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jian Qian
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Liangjun Tao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Xiaobing Ju
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Changjun Yin
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
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Kiss Z, Ambrus C, Kulcsár I, Szegedi J, Kiss I. Effect of angiotensin-converting enzyme gene insertion/deletion polymorphism and angiotensin-converting enzyme inhibition on erythropoiesis in patients on haemodialysis. J Renin Angiotensin Aldosterone Syst 2014; 16:1021-7. [PMID: 25002133 DOI: 10.1177/1470320314535276] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Angiotensin-converting enzyme inhibitors (ACEis) improve survival; however, their effect on erythropoiesis remains a matter of debate in this population. Since insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene largely influences serum ACE activity, its effect on erythropoiesis is also anticipated. METHOD In this multicentre, cross-sectional study of 660 patients on maintenance haemodialysis, we analysed the effect of ACEi use and ACE gene I/D polymorphism on haemoglobin levels and erythropoietin resistance. Patients were allocated in groups based on genotype and ACEi therapy. We identified 128 matched pairs with I/I and D/D genotypes. RESULT There was no difference in haemoglobin levels between genotype groups. Haemoglobin levels were lower in patients on ACEi therapy in the entire cohort (95.5±12.1 g/l vs 97.4±13.4 g/l, p=0.02) and patients with I/D (95.2±11 g/l vs 98.2±11.9 g/l, p=0.04) and D/D (93.3±13.2 g/l vs 97.4±14.2 g/l, p=0.02) genotypes. In patient pairs treated with ACEi therapy, subjects with D/D genotype had lower Haemoglobin level (93.0±12.8 g/l vs 98.2±11.9 g/l, p=0.006) and higher erythropoietin resistance index (ERI) (199.1 vs 175.0, p=0.046) than individuals with I/I genotype. CONCLUSION These results indicate that ACEi therapy may increase erythropoietin resistance and worsen erythropoiesis in haemodialysis patients with the D allele.
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Affiliation(s)
- Zoltán Kiss
- School for Ph.D. Candidates of Aesculap Academy, Hungary
| | - Csaba Ambrus
- B. Braun Avitum Hungary CPLC Dialysis Network, Hungary Department of Nephrology-Hypertension, St Imre University Teaching Hospital, Hungary
| | - Imre Kulcsár
- B. Braun Avitum Hungary CPLC Dialysis Network, Hungary
| | - János Szegedi
- B. Braun Avitum Hungary CPLC Dialysis Network, Hungary
| | - István Kiss
- School for Ph.D. Candidates of Aesculap Academy, Hungary Division Section of Geriatrics, 2nd Department of Internal Medicine, Semmelweis University, Hungary
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Pesce M, Felaco P, Franceschelli S, Speranza L, Grilli A, De Lutiis MA, Ferrone A, Sirolli V, Bonomini M, Felaco M, Patruno A. Effect of erythropoietin on primed leucocyte expression profile. Open Biol 2014; 4:140026. [PMID: 24920275 PMCID: PMC4077059 DOI: 10.1098/rsob.140026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 05/20/2014] [Indexed: 02/04/2023] Open
Abstract
Resistance to erythropoietin (EPO) affects a significant number of anaemic patients with end-stage renal disease. Previous reports suggest that inflammation is one of the major independent predictors of EPO resistance, and the effects of EPO treatment on inflammatory mediators are not well established. The aim of this study was to investigate EPO-induced modification to gene expression in primary cultured leucocytes. Microarray experiments were performed on primed ex vivo peripheral blood mononuclear cells (PBMCs) and treated with human EPO-α. Data suggested that EPO-α modulated genes involved in cell movement and interaction in primed PBMCs. Of note, EPO-α exerts anti-inflammatory effects inhibiting the expression of pro-inflammatory cytokine IL-8 and its receptor CXCR2; by contrast, EPO-α increases expression of genes relating to promotion of inflammation encoding for IL-1β and CCL8, and induces de novo synthesis of IL-1α, CXCL1 and CXCL5 in primed cells. The reduction in MAPK p38-α activity is involved in modulating both IL-1β and IL-8 expression. Unlike the induction of MAPK, Erk1/2 activity leads to upregulation of IL-1β, but does not affect IL-8 expression and release. Furthermore, EPO-α treatment of primed cells induces the activation of caspase-1 upstream higher secretion of IL-1β, and this process is not dependent on caspase-8 activation. In conclusion, our findings highlight new potential molecules involved in EPO resistance and confirm the anti-inflammatory role for EPO, but also suggest a plausible in vivo scenario in which the positive correlation found between EPO resistance and elevated levels of some pro-inflammatory mediators is due to treatment with EPO itself.
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Affiliation(s)
- Mirko Pesce
- Department of Psychological, Humanistic and Territorial Sciences, University 'G. D'Annunzio', Chieti, Italy
| | - Paolo Felaco
- Department of Medicine and Science of Aging, University 'G. D'Annunzio', Chieti, Italy
| | - Sara Franceschelli
- Department of Medicine and Science of Aging, University 'G. D'Annunzio', Chieti, Italy
| | - Lorenza Speranza
- Department of Medicine and Science of Aging, University 'G. D'Annunzio', Chieti, Italy
| | - Alfredo Grilli
- Department of Medicine and Science of Aging, University 'G. D'Annunzio', Chieti, Italy
| | - Maria Anna De Lutiis
- Department of Medicine and Science of Aging, University 'G. D'Annunzio', Chieti, Italy
| | - Alessio Ferrone
- Department of Medicine and Science of Aging, University 'G. D'Annunzio', Chieti, Italy
| | - Vittorio Sirolli
- Department of Medicine and Science of Aging, University 'G. D'Annunzio', Chieti, Italy
| | - Mario Bonomini
- Department of Medicine and Science of Aging, University 'G. D'Annunzio', Chieti, Italy
| | - Mario Felaco
- Department of Medicine and Science of Aging, University 'G. D'Annunzio', Chieti, Italy
| | - Antonia Patruno
- Department of Medicine and Science of Aging, University 'G. D'Annunzio', Chieti, Italy
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15
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Bamgbola OF. Pattern of resistance to erythropoietin-stimulating agents in chronic kidney disease. Kidney Int 2011; 80:464-74. [DOI: 10.1038/ki.2011.179] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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16
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An alternative method for genotyping of the ACE I/D polymorphism. Mol Biol Rep 2008; 36:1305-10. [PMID: 18622756 DOI: 10.1007/s11033-008-9313-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Accepted: 07/01/2008] [Indexed: 10/21/2022]
Abstract
The mistyping of the angiotensin I-converting enzyme insertion/deletion (ACE I/D) has been well documented, and new methods have been suggested here to improve the genotyping efficiency. Buccal cell samples were collected from 157 young Caucasians, and genotyped using previously known and newly developed PCR amplification genotyping techniques, as well as PCR-RFLP tests for three single nucleotide polymorphisms (rs4327, rs4341 and rs4343). Inconsistent genotyping results were found when using only the PCR amplification genotyping techniques across repeated attempts (8% to 45%), however, individual SNP genotyping was highly consistent (100%). Two SNPs (rs4341 and rs4343) were in complete LD and SNP rs4327 was in high LD with the ACE I/D. The ACE I/D was in HW equilibrium in the portion of the population with consistent genotyping results, whereas the three SNPs were not in HW equilibrium. The mistyping of ACE I/D by only PCR amplification can be improved using alternative methods.
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