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Wagner LE, Bridges KM, Hinman JM, He J, Buckles D, Dunn W, Drisko J, Sullivan DK, Carlson SE. Treatment of functional bowel disorders in an integrative medicine clinic resulting in improved digestive tract symptoms. JGH Open 2024; 8:e13022. [PMID: 38268959 PMCID: PMC10805498 DOI: 10.1002/jgh3.13022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/17/2023] [Accepted: 12/11/2023] [Indexed: 01/26/2024]
Abstract
Background and Aim Functional bowel disorders (FBDs), including irritable bowel syndrome (IBS) and others, are conditions without a physically identifiable etiology that, as a result, are difficult to treat. Alternatives to traditional medical interventions are needed because IBS patients require more of physician time and higher healthcare spending. The goal of this study was to determine the efficacy of alternative lifestyle interventions for patients with FBDs seen in an integrative medicine (IM) clinic at an academic medical center. Methods We performed a retrospective chart review to determine whether patients with FBDs had improvement in symptoms following predominantly nutrition-based IM interventions that included recommendations for dietary supplements and elimination diets. We measured symptoms before and after intervention (average time between measurements 8.75 months) using a medical symptoms questionnaire (MSQ) commonly used to quantify symptom change in IM clinics. Results Digestive tract symptoms, as measured by the MSQ, improved significantly in patients (n = 57) with FBDs following IM intervention. The MSQ Digestive Tract subtotal for FBD patients decreased from 10.2 (SD, 5.4) to 7.2 (SD, 5.2) (P < 0.001) after IM intervention. Conclusions Patients in an IM clinic had improved digestive tract symptoms scores following IM intervention. Because nutrition-based interventions were the primary intervention recommended by IM providers, primary care physicians and gastroenterologists may wish to consider referring FBD patients to registered dietitian-nutritionists (RDNs) skilled in implementing elimination diets.
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Affiliation(s)
- Leigh E Wagner
- Department of Dietetics and NutritionUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Kristina M Bridges
- Department of Family Medicine and Community HealthUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Jill M Hinman
- Department of Dietetics and NutritionUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Jianghua He
- Department of Biostatistics and Data ScienceUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Daniel Buckles
- Division of Gastroenterology, Hepatology and Motility, Department of Internal MedicineUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Winnie Dunn
- Department of Occupational TherapyUniversity of MissouriColumbiaMissouriUSA
| | - Jeanne Drisko
- Department of Internal MedicineUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Debra K Sullivan
- Department of Dietetics and NutritionUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Susan E Carlson
- Department of Dietetics and NutritionUniversity of Kansas Medical CenterKansas CityKansasUSA
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Wetherill MS, Bridges KM, Talavera GE, Harvey SP, Skidmore B, Burger ES. Planting Seeds for Food Is Medicine: Pre-Implementation Planning Methods and Formative Evaluation Findings From a Multi-Clinic Initiative in the Midwest. J Prim Care Community Health 2024; 15:21501319241241465. [PMID: 38523426 PMCID: PMC10962037 DOI: 10.1177/21501319241241465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024] Open
Abstract
Food is medicine (FIM) initiatives are an emerging strategy for addressing nutrition-related health disparities increasingly endorsed by providers, payers, and policymakers. However, food insecurity screening protocols and oversight of medically-tailored food assistance programs are novel for many healthcare settings. Here, we describe the pre-implementation planning processes used to successfully engage federally-qualified health centers (FQHCs) across Kansas to develop new FIM initiatives. A Kansas-based philanthropic foundation facilitated pre-implementation planning for FQHCs over 17 months across 3 stages: 1) Community inquiry, 2) FIM learning event with invitation for FQHC attendees to request pre-implementation funding, and 3) Pre-implementation planning workshops and application assignments for FQHC grantees to develop a FIM implementation grant proposal. We evaluated satisfaction and perceived utility of these pre-implementation planning activities via post-workshop surveys and qualitative comparisons of FIM design components from pre-implementation and implementation grant applications. All 7 FQHCs attending the learning event applied for and were awarded pre-implementation planning grants; 6 submitted an implementation grant application following workshop completion. FQHCs rated pre-implementation support activities favorably; however, most clinics cited limited staff as a barrier to effective planning. As compared to pre-implementation planning grant proposals, all FQHCs elected to narrow their priority population to people with pre-diabetes or diabetes with better articulation of evidence-based nutrition prescriptions and intervention models in their final program designs. In the midst of a nationwide FIM groundswell, we recommend that funders, clinic stakeholders, and evaluators work together to devise and financially support appropriate pre-implementation planning activities prior to launching new FIM initiatives.
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Bridges KM, Rampon K, Mabachi N, Born W, Kost A, Parente DJ, Witt LB. More Than Half of Family Medicine Clerkships Do Not Address Systemic Racism: A CERA Study. Fam Med 2023; 55:217-224. [PMID: 37043181 PMCID: PMC10622030 DOI: 10.22454/fammed.2023.581155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND AND OBJECTIVES The influence of racism in medicine is increasingly acknowledged, and the negative effect of systemic racism on individual and population health is well established. Yet, little is known about how or whether medical students are being educated on this topic. This study investigated the presence and features of curricula related to systemic racism in North American family medicine clerkships. METHODS We conducted a survey of North American family medicine clerkship directors as part of the 2021 Council of Academic Family Medicine's Educational Research Alliance (CERA) survey. RESULTS The survey response rate was 49% (78/160). Almost all clerkship directors agreed (n=68; 97.1%) that teaching about racism at all levels of medical education was appropriate. Yet, 60% (n=42) of family medicine clerkship directors reported no formalized curriculum for teaching about racism or bias. Teaching about systemic racism was more likely to be present in the family medicine clerkship at institutions where clerkship directors reported that faculty receive 5 or more hours of training in racism and bias, as compared to institutions where faculty receive 4 or fewer hours of training in racism/bias (odds ratio 2.82, 95% CI 1.05-8.04, P=.045). Programs reported using racism in medicine curricula based in cultural competency (20%); structural competency (10%); both cultural and structural competency (31%); and neither or uncertain (40%). Clerkship directors reported high faculty, student, and institutional engagement in addressing systemic racism. We did not find an association between underrepresented in medicine director identity and racism curricula. CONCLUSIONS In more than half of family medicine clerkships, systemic racism is not addressed, despite interest from students and institutional support. A higher number of hours of faculty training time on the topic of racism was associated with having a systemic racism module in the clerkship curriculum, but we lacked data to identify a causal relationship. Investments in faculty development to teach systemic racism, including discussion of structural competency, are needed.
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Affiliation(s)
- Kristina M. Bridges
- Department of Family Medicine and Community Health, University of Kansas Medical CenterKansas City, KS
| | - Kathryn Rampon
- Department of Family Medicine and Community Health, University of Kansas Medical CenterKansas City, KS
| | - Natabhona Mabachi
- Department of Family Medicine and Community Health, University of Kansas Medical CenterKansas City, KS
| | - Wendi Born
- Department of Family Medicine and Community Health, University of Kansas Medical CenterKansas City, KS
| | - Amanda Kost
- Department of Family Medicine, University of WashingtonSeattle, WA
| | - Daniel J. Parente
- Department of Family Medicine and Community Health, University of Kansas Medical CenterKansas City, KS
| | - Laurel B. Witt
- Department of Family Medicine and Community Health, University of Kansas Medical CenterKansas City, KS
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Bridges KM, LeMaster JW, Parente DJ, Pacheco CM, Schultz C, Morrow E, Corriveau E, Miras Neira T, Greiner KA, Woodward J, Anders- Rumsey J, Cirotski D, Finocchario-Kessler S, Ellerbeck EF. Assessing Social Needs and Engaging Community Health Workers in Underserved Kansas Counties: Insights From Primary Care Providers and Clinic Managers. J Prim Care Community Health 2023; 14:21501319231214513. [PMID: 38041409 PMCID: PMC10693805 DOI: 10.1177/21501319231214513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/17/2023] [Accepted: 10/30/2023] [Indexed: 12/03/2023] Open
Abstract
INTRODUCTION Rural and under-resourced urban communities face unique challenges in addressing patients' social determinants of health needs (SDoH). Community health workers (CHWs) can support patients experiencing social needs, yet little is known about how rural and under-resourced primary care clinics are screening for SDoH or utilizing CHWs. METHODS Interviews were conducted with primary care clinic providers and managers across a geographically large and predominately rural state to assess screening practices for SDoH and related community resources, and perspectives on using CHWs to address SDoH. Interviews were conducted by phone, recorded, and transcribed. Data were analyzed using thematic analysis. We completed interviews with 27 respondents (12 providers and 15 clinic managers) at 26 clinics. RESULTS Twelve (46.1%) clinics had a standardized process for capturing SDoH, but this was primarily limited to Medicare wellness visits. Staffing and time were identified as barriers to proper SDoH screening. Lack of transportation and affordable medication were the most cited SDoH. While respondents were all aware of CHWs, only 8 (30.8%) included a CHW on their care team. Perceived barriers to engaging CHWs included cost, space, and availability of qualified CHWs. Perceived benefits of engaging CHWs in their practice were: assisting patients with navigating resources and programs, relieving clinical staff of non-medical tasks, and bridging language barriers. CONCLUSIONS Rural and under-resourced primary care clinics need help in identifying and addressing SDoH. CHWs could play an important part in addressing social needs and promoting preventive care if financial constraints could be addressed and local CHWs could be trained.
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Affiliation(s)
| | | | | | | | | | - Emily Morrow
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Erin Corriveau
- University of Kansas Medical Center, Kansas City, KS, USA
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Bridges KM, Woodward J, Murray M, Mumm E, Greiner KA. Pandemic Food Response in Primary Care to Minimize Exposure for Elderly Food Insecure Population. Kans J Med 2022; 15:148-154. [PMID: 35646247 PMCID: PMC9126864 DOI: 10.17161/kjm.vol15.15913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/01/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Stay-at-home orders during the first wave of the COVID-19 pandemic encouraged individuals, especially the elderly, to stock up on food and supplies and remain home to limit exposure to the SARS-CoV-2 virus. However, individuals with food insecurity may be able only to afford a few days of food at a time, causing frequent outings to obtain food. An emergency food delivery system decreases the need for frequent outings. This study investigated: (1) whether elderly family medicine patients with previously reported food insecurity were making frequent trips to obtain food during the lockdown, and (2) if social determinants of health screening data could be used successfully to identify patients in need of emergency food delivery during the pandemic. Methods Primary care patients 65 years and older with previously reported food insecurity were screened for referral to a community food delivery program. A cross-sectional secondary analysis of screening and referral data were conducted. Results Clinic staff called 52 patients and completed screening of 30. For 23/30 respondents (76.7%), reported monthly outings to obtain food exceeded the recommended stay-at-home guidelines. In our sample, 22/30 (73.3%) reported current food need, 14/30 (46.7%) reported two or fewer days of food, 28/30 (93.3%) reported receiving home food delivery would keep them from going out, 24/30 (80.0%) agreed to food delivery, and 17 patients received a food delivery. Conclusions Targeted screening and referral for food delivery may reduce the need for patients experiencing food insecurity to leave home during a pandemic or other disaster, potentially decreasing community exposure for a high-risk population. Primary care practices can utilize previously collected food insecurity and other social determinants of health data to identify and assist high-risk patients in a pandemic.
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Affiliation(s)
- Kristina M Bridges
- Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS
| | - Jennifer Woodward
- Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS
| | - Megan Murray
- Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS
| | - Emma Mumm
- Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS
| | - K Allen Greiner
- Department of Family Medicine and Community Health, University of Kansas Medical Center, Kansas City, KS
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Darche JP, Murray MJ, Bridges KM, Noland J, Greiner KA. Assessing the utility of yearly pre-season laboratory screening for athletes on a major professional sports team. J Sci Med Sport 2018; 22:484-487. [PMID: 30442547 DOI: 10.1016/j.jsams.2018.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/12/2018] [Accepted: 10/18/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Professional athletes undergo annual pre-season laboratory screening, although clinical evidence supporting the practice is limited and no uniform set of guidelines on pre-season laboratory screening exists. The aim of this study was to assess the clinical value of annual pre-season laboratory screening tests for a major professional sports team over multiple years. DESIGN Retrospective chart review. METHODS A retrospective analysis was performed of all laboratory results as well as screening ECGs for a single major professional sports team over a 9-year timeframe (2009-2017). RESULTS The data show that 10.01% of initial screening test results were abnormal and 40.32% of abnormal tests resulted in additional testing. Overall, only 0.35% of initial tests resulted in a clinically significant outcome. Non-US born players showed a significantly higher average rate of abnormal tests/year compared to US-born players (p-value 0.006), but there was no difference in clinically significant outcomes. There was no relationship between athlete age and laboratory screening outcomes. CONCLUSIONS In our study population, yearly pre-season laboratory screening of professional athletes did not yield substantial clinically significant outcomes and would not be warranted under normal clinical standards. Future best practice guidelines should combine research concerning effects of family medical history, race, gender, country of origin, and type of sport on athlete health when creating recommendations for which pre-season laboratory screenings may be pertinent even with evidence of little utility.
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Affiliation(s)
- J P Darche
- Department of Family Medicine, University of Kansas Medical Center, USA
| | - Megan J Murray
- Department of Family Medicine Research Division, University of Kansas Medical Center, USA.
| | - Kristina M Bridges
- Department of Family Medicine Research Division, University of Kansas Medical Center, USA
| | - Joe Noland
- Department of Family Medicine, University of Kansas Medical Center, USA
| | - K Allen Greiner
- Department of Family Medicine, University of Kansas Medical Center, USA; Department of Family Medicine Research Division, University of Kansas Medical Center, USA
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Hidaka BH, Hester CM, Bridges KM, Daley CM, Greiner KA. Fast food consumption is associated with higher education in women, but not men, among older adults in urban safety-net clinics: A cross-sectional survey. Prev Med Rep 2018; 12:148-151. [PMID: 30258763 PMCID: PMC6152808 DOI: 10.1016/j.pmedr.2018.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/22/2018] [Accepted: 09/08/2018] [Indexed: 11/04/2022] Open
Abstract
Fast food consumption is linked to poor health, yet many older adults regularly consume fast food. Understanding factors contributing to fast food consumption is useful in the development of targeted interventions. The aim of this study was to characterize how fast food consumption relates to socio-demographic characteristics in a low-income sample of older adults. This study used cross-sectional survey data of 50 to79-year-olds (N-236) in urban safety-net clinics in 2010 in Kansas City, KS. Self-reported frequency of fast food consumption was modeled using ordinal logistic regression with socio-demographics as predictor variables. Participants were 56.8 ± 6.0 (mean ± SD) years old, 64% female, 45% non-Hispanic African American, and 26% Hispanic. Thirty-nine percent denied eating fast food in the past week, 36% ate once, and 25% ate fast food at least twice. Age was negatively correlated with fast food intake (r = −0.20, P = 0.003). After adjusting for age, race-ethnicity, employment, and marital status, the association between education and fast food consumption differed by sex (Pinteraction = 0.017). Among women, higher education was associated with greater fast food intake (Spearman's correlation; r = 0.28, P = 0.0005); the association was not significant in men (r = −0.14, P = 0.21). In this diverse, low-income population, high educational attainment (college graduate or higher) related to greater fast food intake among women but not men. Exploration of the factors contributing to this difference could inform interventions to curb fast food consumption or encourage healthy fast food choices among low-income, older adults.
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Affiliation(s)
- Brandon H Hidaka
- Department of Family Medicine Research Division, University of Kansas Medical Center, Kansas City, KS 66160, USA.,Department of Family Medicine, Kaiser Permanente Washington, Seattle, WA 98112, USA
| | - Christina M Hester
- Department of Family Medicine Research Division, University of Kansas Medical Center, Kansas City, KS 66160, USA.,University of Kansas Cancer Center, Kansas City, KS 66160, USA.,American Academy of Family Physicians, Leawood, KS 66211, USA
| | - Kristina M Bridges
- Department of Family Medicine Research Division, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Christine M Daley
- Department of Family Medicine Research Division, University of Kansas Medical Center, Kansas City, KS 66160, USA.,University of Kansas Cancer Center, Kansas City, KS 66160, USA.,Center for American Indian Community Health, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - K Allen Greiner
- Department of Family Medicine Research Division, University of Kansas Medical Center, Kansas City, KS 66160, USA.,University of Kansas Cancer Center, Kansas City, KS 66160, USA
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Bridges KM, Diaz FJ, Wang Z, Ahmed I, Sullivan DK, Umar S, Buckles DC, Greiner KA, Hester CM. Relating Stool Microbial Metabolite Levels, Inflammatory Markers and Dietary Behaviors to Screening Colonoscopy Findings in a Racially/Ethnically Diverse Patient Population. Genes (Basel) 2018; 9:genes9030119. [PMID: 29495356 PMCID: PMC5867840 DOI: 10.3390/genes9030119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 02/09/2018] [Accepted: 02/20/2018] [Indexed: 12/11/2022] Open
Abstract
Colorectal cancer (CRC) is the third leading cause of cancer death for both men and women in the United States, yet it is treatable and preventable. African Americans have higher incidence of CRC than other racial/ethnic groups, however, it is unclear whether this disparity is primarily due to environmental or biological factors. Short chain fatty acids (SCFAs) are metabolites produced by bacteria in the colon and are known to be inversely related to CRC progression. The aim of this study is to investigate how stool SCFA levels, markers of inflammation in stool and dietary intake relate to colonoscopy findings in a diverse patient population. Stool samples from forty-eight participants were analyzed for SCFA levels and inflammatory markers (lysozyme, secretory IgA, lactoferrin). Additionally, participants completed the National Cancer Institute's Diet History Questionnaire II (DHQ II) to report dietary intake over the past year. Subsequently, the majority of participants underwent screening colonoscopy. Our results showed that African Americans had higher total levels of SCFAs in stool than other racial/ethnic groups, significantly lower intake of non-starchy vegetables and similar inflammatory marker expression and colonoscopy outcomes, compared to others. This work is an initial exploration into the biological and clinical factors that may ultimately inform personalized screening approaches and clinical decision-making to improve colorectal cancer disparities for African Americans.
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Affiliation(s)
- Kristina M Bridges
- Department of Family Medicine Research Division, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Francisco J Diaz
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Zhiwen Wang
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Ishfaq Ahmed
- Department of Surgery, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS 66160, USA.
- University of Kansas Cancer Center, Kansas City, KS 66160, USA.
| | - Shahid Umar
- Department of Surgery, University of Kansas Medical Center, Kansas City, KS 66160, USA.
- University of Kansas Cancer Center, Kansas City, KS 66160, USA.
| | - Daniel C Buckles
- Department of Internal Medicine, Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - K Allen Greiner
- Department of Family Medicine Research Division, University of Kansas Medical Center, Kansas City, KS 66160, USA.
- University of Kansas Cancer Center, Kansas City, KS 66160, USA.
| | - Christina M Hester
- Department of Family Medicine Research Division, University of Kansas Medical Center, Kansas City, KS 66160, USA.
- University of Kansas Cancer Center, Kansas City, KS 66160, USA.
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Small KM, Forbes SL, Rahman FF, Bridges KM, Liggett SB. A four amino acid deletion polymorphism in the third intracellular loop of the human alpha 2C-adrenergic receptor confers impaired coupling to multiple effectors. J Biol Chem 2000; 275:23059-64. [PMID: 10801795 DOI: 10.1074/jbc.m000796200] [Citation(s) in RCA: 149] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The alpha(2)-adrenergic receptors (alpha(2)ARs) play a critical role in modulating neurotransmitter release in the central and peripheral sympathetic nervous systems. A polymorphism of the alpha(2)AR subtype localized to human chromosome 4 (the pharmacologic alpha(2C)AR subtype) within an intracellular domain has been identified in normal individuals. The polymorphism (denoted Del322-325) is because of an in-frame 12-nucleic acid deletion encoding a receptor lacking Gly-Ala-Gly-Pro in the third intracellular loop. To delineate the functional consequences of this structural alteration, Chinese hamster ovary cells were permanently transfected with constructs encoding wild-type human alpha(2C)AR and the polymorphic receptor. The Del322-325 variant had decreased high affinity agonist binding (K(H) = 7.3 +/- 0.95 versus 3.7 +/- 0.43 nm; %R(H) = 31 +/- 4 versus 49 +/- 4) compared with wild-type indicating impaired formation of the agonist-receptor-G protein complex. The polymorphic receptor displayed markedly depressed epinephrine-promoted coupling to G(i), inhibiting adenylyl cyclase by 10 +/- 4.3% compared with 73 +/- 2.4% for wild-type alpha(2C)AR. This also was so for the endogenous ligand norepinephrine and full and partial synthetic agonists. Depressed agonist-promoted coupling to the stimulation of MAP kinase ( approximately 71% impaired) and inositol phosphate production ( approximately 60% impaired) was also found with the polymorphic receptor. The Del322-325 receptor was approximately 10 times more frequent in African-Americans compared with Caucasians (allele frequencies 0.381 versus 0.040). Given this significant loss of function phenotype in several signal transduction cascades and the skewed ethnic prevalence, Del322-325 represents a pharmacoethnogenetic locus and may also be the basis for interindividual variation in cardiovascular or central nervous system pathophysiology.
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Affiliation(s)
- K M Small
- Departments of Medicine and Molecular Genetics, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267, USA
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