Group-based exercice training programs for military members presenting musculoskeletal disorders - protocol for a pragmatic randomized controlled trial

BACKGROUND

Musculoskeletal disorders are a leading cause of morbidity and the most prevalent source of disability among soldiers. Their high prevalence in armed forces and limited ressources have led to problems related to access to physical rehabilitation care. To increase access, supervised group-based exercise programs for the most prevalent musculoskeletal disorders (low back pain, patellofemoral pain, rotator cuff-related shoulder pain or lateral ankle sprain) have been developed at a Canadian Armed forces (CAF) base, but their effectiveness has not been evaluated. The primary objective of this randomized controlled trial is to evaluate the mid- and long-term effects of these group-based training programs on pain severity and functional limitations, in comparison with usual individual physiotherapy care. Secondary objectives include comparing both interventions in terms of health-related quality of life, pain-related fear, and patients' satisfaction.

METHODS

One hundred and twenty soldiers with a new medical referral for physiotherapy services for one of the four targeted musculoskeletal disorders will be consecutively recruited. They will be randomly assigned to either group-based training program or usual individual physiotherapy care, and will take part in the assigned 12-week intervention. There will be four evaluation sessions over 26 weeks (baseline, week 6, 12 and 26). At each follow-up, functional limitations, pain severity, health-related quality of life and pain-related fears will be assessed. Patients satisfaction with treatment will also be evaluated at the end of the intervention period. Either two-way repeated measures ANOVA will be used to analyse and compare the effects of the interventions.

DISCUSSION

This RCT will determine the effectiveness of group-based training programs compared to usual individual physiotherapy care. This new intervention model could represent an efficient, and more pro-active approach to manage a higher number of soldiers with musculoskeletal disorders. It could improve access to physical rehabilitation care and improve the health of soldiers.

TRIAL REGISTRATION

ClinicalTrials.gov ( NCT05235152 ), February 11th 2022.

Prodrugs of a 1'-CN-4-Aza-7,9-dideazaadenosine C-Nucleoside Leading to the Discovery of Remdesivir (GS-5734) as a Potent Inhibitor of Respiratory Syncytial Virus with Efficacy in the African Green Monkey Model of RSV

A discovery program targeting respiratory syncytial virus (RSV) identified C-nucleoside 4 (RSV A2 EC50 = 530 nM) as a phenotypic screening lead targeting the RSV RNA-dependent RNA polymerase (RdRp). Prodrug exploration resulted in the discovery of remdesivir (1, GS-5734) that is >30-fold more potent than 4 against RSV in HEp-2 and NHBE cells. Metabolism studies in vitro confirmed the rapid formation of the active triphosphate metabolite, 1-NTP, and in vivo studies in cynomolgus and African Green monkeys demonstrated a >10-fold higher lung tissue concentration of 1-NTP following molar normalized IV dosing of 1 compared to that of 4. A once daily 10 mg/kg IV administration of 1 in an African Green monkey RSV model demonstrated a >2-log10 reduction in the peak lung viral load. These early data following the discovery of 1 supported its potential as a novel treatment for RSV prior to its development for Ebola and approval for COVID-19 treatment.

Drug Resistance Assessment Following Administration of Respiratory Syncytial Virus (RSV) Fusion Inhibitor Presatovir to Participants Experimentally Infected With RSV

BACKGROUND

Presatovir is an oral respiratory syncytial virus (RSV) fusion inhibitor targeting RSV F protein. In a double-blind, placebo-controlled study in healthy adults experimentally infected with RSV (Memphis-37b), presatovir significantly reduced viral load and clinical disease severity in a dose-dependent manner.

METHODS

Viral RNA from nasal wash samples was amplified and the F gene sequenced to monitor presatovir resistance. Effects of identified amino acid substitutions on in vitro susceptibility to presatovir, viral fitness, and clinical outcome were assessed.

RESULTS

Twenty-eight treatment-emergent F substitutions were identified. Of these, 26 were tested in vitro; 2 were not due to lack of recombinant virus recovery. Ten substitutions did not affect presatovir susceptibility, and 16 substitutions reduced RSV susceptibility to presatovir (2.9- to 410-fold). No substitutions altered RSV susceptibility to palivizumab or ribavirin. Frequency of phenotypically resistant substitutions was higher with regimens containing lower presatovir dose and shorter treatment duration. Participants with phenotypic presatovir resistance had significantly higher nasal viral load area under the curve relative to those without, but substitutions did not significantly affect peak viral load or clinical manifestations of RSV disease.

CONCLUSIONS

Emergence of presatovir-resistant RSV occurred during therapy but did not significantly affect clinical efficacy in participants with experimental RSV infection.

Cell-Specific Gene-Expression Profiles and Cortical Thickness in the Human Brain

Neurobiological underpinnings of cortical thickness in the human brain are largely unknown. Here we use cell-type-specific gene markers to evaluate the contribution of 9 neural cell-types in explaining inter-regional variations in cortical thickness and age-related cortical thinning in the adolescent brain. Gene-expression data were derived from the Allen Human Brain Atlas (and validated using the BrainSpan Atlas). Values of cortical thickness/thinning were obtained with magnetic resonance imaging in a sample of 987 adolescents. We show that inter-regional profiles in cortical thickness relate to those in the expression of genes marking CA1 pyramidal cells, astrocytes, and microglia; taken together, the 3 cell types explain 70% of regional variation in cortical thickness. We also show that inter-regional profiles in cortical thinning relate to those in the expression of genes marking CA1 and S1 pyramidal cells, astrocytes and microglia. Using Gene Ontology analysis, we demonstrate that the difference in the contribution of CA1 and S1 pyramidal cells may relate to biological processes such as neuronal plasticity and potassium channel activity, respectively. This "virtual histology" approach (scripts provided) can be used to examine neurobiological underpinnings of cortical profiles associated with development, aging, and various disorders.

Inter-Regional Variations in Gene Expression and Age-Related Cortical Thinning in the Adolescent Brain

Age-related decreases in cortical thickness observed during adolescence may be related to fluctuations in sex and stress hormones. We examine this possibility by relating inter-regional variations in age-related cortical thinning (data from the Saguenay Youth Study) to inter-regional variations in expression levels of relevant genes (data from the Allen Human Brain Atlas); we focus on genes coding for glucocorticoid receptor (NR3C1), androgen receptor (AR), progesterone receptor (PGR), and estrogen receptors (ESR1 and ESR2). Across 34 cortical regions (Desikan-Killiany parcellation), age-related cortical thinning varied as a function of mRNA expression levels of NR3C1 in males (R2 = 0.46) and females (R2 = 0.30) and AR in males only (R2 = 0.25). Cortical thinning did not vary as a function of expression levels of PGR, ESR1, or ESR2 in either sex; this might be due to the observed low consistency of expression profiles of these 3 genes across donors. Inter-regional levels of the NR3C1 and AR expression interacted with each other vis-à-vis cortical thinning: age-related cortical thinning varied as a function of NR3C1 mRNA expression in brain regions with low (males: R2 = 0.64; females: R2 = 0.58) but not high (males: R2 = 0.0045; females: R2 = 0.15) levels of AR mRNA expression. These results suggest that glucocorticoid and androgen receptors contribute to cortical maturation during adolescence.

Efficacy and safety of the nucleoside analog GS-441524 for treatment of cats with naturally occurring feline infectious peritonitis

Objectives

The aim of this study was to determine the safety and efficacy of the nucleoside analog GS-441524 for cats suffering from various forms of naturally acquired feline infectious peritonitis (FIP).

Methods

Cats ranged from 3.4–73 months of age (mean 13.6 months); 26 had effusive or dry-to-effusive FIP and five had non-effusive disease. Cats with severe neurological and ocular FIP were not recruited. The group was started on GS-441524 at a dosage of 2.0 mg/kg SC q24h for at least 12 weeks and increased when indicated to 4.0 mg/kg SC q24h.

Results

Four of the 31 cats that presented with severe disease died or were euthanized within 2–5 days and a fifth cat after 26 days. The 26 remaining cats completed the planned 12 weeks or more of treatment. Eighteen of these 26 cats remain healthy at the time of publication (OnlineFirst, February 2019) after one round of treatment, while eight others suffered disease relapses within 3–84 days. Six of the relapses were non-neurological and two neurological. Three of the eight relapsing cats were treated again at the same dosage, while five cats had the dosage increased from 2.0 to 4.0 mg/kg q24h. The five cats treated a second time at the higher dosage, including one with neurological disease, responded well and also remain healthy at the time of publication. However, one of the three cats re-treated at the original lower dosage relapsed with neurological disease and was euthanized, while the two remaining cats responded favorably but relapsed a second time. These two cats were successfully treated a third time at the higher dosage, producing 25 long-time survivors. One of the 25 successfully treated cats was subsequently euthanized due to presumably unrelated heart disease, while 24 remain healthy.

Conclusions and relevance

GS-441524 was shown to be a safe and effective treatment for FIP. The optimum dosage was found to be 4.0 mg/kg SC q24h for at least 12 weeks.

Considerations for upscaling individual effects of wind energy development towards population-level impacts on wildlife

The expansion of wind energy poses challenges to policy- and decision-makers to address conflicts with wildlife. Conflicts are associated with impacts of existing and planned projects on wildlife, and associated difficulties of prediction where impacts are subject to considerable uncertainty. Many post-construction studies have demonstrated adverse effects on individuals of various bird and bat species. These effects may come in the form of collision-induced mortality or behavioral or physiological changes reducing the fitness of individuals exposed to wind energy facilities. Upscaling these individual effects to population impacts provides information on the true value of interest from a conservation point of view. This paper identifies methodological issues associated when moving from individual effects to population impacts in the context of wind energy. Distinct methodological approaches to predict population impacts are described using published case studies. The various choices of study design and metrics available to detect significant changes at the population level are further assessed based on these. Ways to derive impact thresholds relevant for decision-making are discussed in detail. Robust monitoring schemes and sophisticated modelling techniques may inevitably be unable to describe the whole complexity of wind and wildlife interactions and the natural variability of animal populations. Still, they will provide an improved understanding of the response of wildlife to wind energy and better-informed policies to support risk-based decision-making. Policies that support the use of adaptive management will promote assessments at the population level. Providing information to adequately balance the development of wind energy with the persistence of wildlife populations.

The nucleoside analog GS-441524 strongly inhibits feline infectious peritonitis (FIP) virus in tissue culture and experimental cat infection studies

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GS-441524 inhibited replication of serotype II FIP virus (FIPV) in CRFK cell cultures at an EC50 of approximately 1 uM and no toxicity at 100 uM.

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GS-441524 inhibited wildtype FIPV replication in macrophage cultures from ascitic fluid of two cats with naturally occurring FIP.

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GS-441525 is triphosphorylated by CRFK cells in vitro and PBMC in vivo.

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Pharmacokinetic studies in laboratory cats demonstrated effective blood levels over 24 h after a single dose of 5 mg/kg SC or IV.

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Severe experimental effusive FIP was successfully treated with 2 or 5 mg/kg GS-441524 SC q24 h for two weeks.

Feline infectious peritonitis (FIP) is a common and highly lethal coronavirus disease of domestic cats. Recent studies of diseases caused by several RNA viruses in people and other species indicate that antiviral therapy may be effective against FIP in cats. The small molecule nucleoside analog GS-441524 is a molecular precursor to a pharmacologically active nucleoside triphosphate molecule. These analogs act as an alternative substrate and RNA-chain terminator of viral RNA dependent RNA polymerase. We determined that GS-441524 was non-toxic in feline cells at concentrations as high as 100 uM and effectively inhibited FIPV replication in cultured CRFK cells and in naturally infected feline peritoneal macrophages at concentrations as low as 1 uM. We determined the pharmacokinetics of GS-441524 in cats in vivo and established a dosage that would sustain effective blood levels for 24 h. In an experimental FIPV infection of cats, GS-441524 treatment caused a rapid reversal of disease signs and return to normality with as little as two weeks of treatment in 10/10 cats and with no apparent toxicity.

Abstract 044: Sex Differences in Relative Contributions of Hemodynamic Parameters to Blood Pressure: A Population-based Study of Adolescents and Middle-aged Adults

Hypertension is a leading cause of death. Sex differences in blood pressure (BP) and hypertension prevalence emerge during adolescence and remain throughout reproductive age. Sex differences in BP-underlying hemodynamics, i.e., in the relative contributions of stroke volume (SV), total peripheral resistance (TPR) and heart rate (HR) to BP, have not been investigated in these age categories in a population-based setting. We studied a cohort of 1,347 individuals, including 911 adolescents (12-18 years, 52 % female) and 426 young to middle-aged adults (36-65 years, 56 % female). Beat-by-beat systolic BP (SBP) and diastolic BP (DBP), together with HR, SV, and TPR, were measured with a Finometer throughout a 52-min protocol; the protocol was intended to “mimic” daily-life activities, such as changes in posture and mental stress. It is well established that BP during regular daily activities (ambulatory BP monitoring) is a better predictor of target-organ damage than standard office BP. The relative contributions of HR, SV and TPR to SBP and DBP were determined by decomposing the model-explained variance into non-negative contributions. The relative contributions of SV, TPR and HR to SBP and DBP showed marked sex differences in young and middle-aged adults. The main determinant of higher SBP was SV in females (55 [50-60] % in females vs. only 35 [30-40] % in males), whereas it was TPR in males (47 [41-52] % in males vs. only 30 [26-34] % in females). The main determinant of higher DBP was TPR in both sexes, but its contribution was higher in males than females (58 [52-63] % vs. 41 [36-45] %, respectively). These sex differences were seen across most of the 52-min protocol, being most prominent during standing and least evident during mental stress. Similar sex differences were observed in adolescents, but they were less pronounced, being significant only during standing. The present population-based study of adolescents and young to middle-aged adults, suggest that marked sex differences exist in BP-underlying hemodynamics, with BP being driven mainly by SV in females and by TPR in males. These results underscore the need for sex-specific treatments of hypertension (not recommended currently), which affects 3-5 % of adolescents and 23-58% of young to middle-aged adults.

Income inequality, gene expression, and brain maturation during adolescence

Income inequality is associated with poor health and social outcomes. Negative social comparisons and competition may involve the hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-gonadal (HPG) axes in underlying some of these complex inter-relationships. Here we investigate brain maturation, indexed by age-related decreases in cortical thickness, in adolescents living in neighborhoods with differing levels of income inequality and household income. We examine whether inter-regional variations relate to those in glucocorticoid receptor (HPA) and androgen receptor (HPG) gene expression. For each sex, we used a median split of income inequality and household income (income-to-needs ratio) to create four subgroups. In female adolescents, the high-inequality low-income group displayed the greatest age-related decreases in cortical thickness. In this group, expression of glucocorticoid and androgen receptor genes explained the most variance in these age-related decreases in thickness across the cortex. We speculate that female adolescents living in high-inequality neighborhoods and low-income households may experience greater HPA and HPG activity, leading to steeper decreases in cortical thickness with age.

Discovery and Synthesis of a Phosphoramidate Prodrug of a Pyrrolo[2,1-f][triazin-4-amino] Adenine C-Nucleoside (GS-5734) for the Treatment of Ebola and Emerging Viruses

The recent Ebola virus (EBOV) outbreak in West Africa was the largest recorded in history with over 28,000 cases, resulting in >11,000 deaths including >500 healthcare workers. A focused screening and lead optimization effort identified 4b (GS-5734) with anti-EBOV EC50 = 86 nM in macrophages as the clinical candidate. Structure activity relationships established that the 1'-CN group and C-linked nucleobase were critical for optimal anti-EBOV potency and selectivity against host polymerases. A robust diastereoselective synthesis provided sufficient quantities of 4b to enable preclinical efficacy in a non-human-primate EBOV challenge model. Once-daily 10 mg/kg iv treatment on days 3-14 postinfection had a significant effect on viremia and mortality, resulting in 100% survival of infected treated animals [ Nature 2016 , 531 , 381 - 385 ]. A phase 2 study (PREVAIL IV) is currently enrolling and will evaluate the effect of 4b on viral shedding from sanctuary sites in EBOV survivors.

Tenofovir alafenamide (TAF) does not deplete mitochondrial DNA in human T-cell lines at intracellular concentrations exceeding clinically relevant drug exposures

HIV-infected patients treated with certain nucleoside reverse transcriptase inhibitors (NRTIs) have experienced adverse effects due to drug-related mitochondrial toxicity. Tenofovir alafenamide (TAF) is a novel prodrug of the NRTI tenofovir (TFV) with an improved safety profile compared to tenofovir disoproxil fumarate (TDF). Prior in vitro studies have demonstrated that the parent nucleotide TFV has no significant effects on mtDNA synthesis. This study investigated whether clinically relevant TAF and TDF exposures affect mtDNA content in human lymphocytes. First, activated or resting peripheral blood mononuclear cells (PBMCs), as well as MT-2 and Jurkat T-cell lines, were continuously treated with ddC for 10 days to establish their susceptibility to mtDNA depletion. PBMCs had low sensitivity to NRTI-mediated mtDNA depletion in vitro. In contrast, ddC treatment of rapidly dividing MT-2 and Jurkat cells resulted in a dose-dependent decrease in mtDNA. Therefore, these two T-cell lines were selected for evaluating TAF and TDF treatment effects. MT-2 and Jurkat cells were pulse-treated with TAF or TDF every 24 h for 10 days to mimic pharmacologically relevant drug exposures. Pulse treatment of cells with 3.3 μM TAF or 1.1 μM TDF for 10 days resulted in 2- to 7-fold greater steady-state intracellular TFV-diphosphate (TFV-DP) levels than those observed clinically in TAF- or TDF-treated patients. At these concentrations, no significant TAF- (106.7% and 84.1% of control; p = 0.77 and 0.12 for MT-2 and Jurkat, respectively) or TDF- (100.6% and 91.0% of control; p = 0.91 and 0.37, respectively) associated reduction in mtDNA content was observed compared with untreated control cells. This study demonstrates that, despite delivering higher intracellular levels of TFV-DP than TDF, TAF does not inhibit mtDNA synthesis in vitro at concentrations exceeding the clinically relevant intracellular drug exposures. Thus, TAF has a low potential for mitochondrial toxicity in T-cells of HIV-infected patients.

Glycerophosphocholine Metabolites and Cardiovascular Disease Risk Factors in Adolescents: A Cohort Study

BACKGROUND

Glycerophosphocholine (GPC) metabolites modulate atherosclerosis and thus risk for cardiovascular disease (CVD). Preclinical CVD may start during adolescence. Here, we used targeted serum lipidomics to identify a new panel of GPCs, and tested whether any of these GPCs are associated, in adolescence, with classical risk factors of CVD, namely excess visceral fat (VF), elevated blood pressure, insulin resistance, and atherogenic dyslipidemia.

METHODS

We studied a population-based sample of 990 adolescents (12-18 years, 48% male), as part of the Saguenay Youth Study. Using liquid chromatography-electrospray ionization-mass spectrometry, we identified 69 serum GPCs within the 450 to 680 m/z range. We measured VF with MRI.

RESULTS

We identified several novel GPCs that were associated with multiple CVD risk factors. Most significantly, PC16:0/2:0 was negatively associated with VF (P=1.4×10^-19), blood pressure (P=7.7×10^-5), and fasting triacylglycerols (P=9.0×10^-5), and PC14:1/0:0 was positively associated with VF (P=3.0×10^-7), fasting insulin (P=5.4×10^-32), and triacylglycerols (P=1.4×10^-29). The Sobel test of mediation revealed that both GPCs mediated their respective relations between VF (as a potential primary exposure) and CVD risk factors (as outcomes, P values<1.3×10^-3). Furthermore, a GPC shown recently to predict incident coronary heart disease in older adults, PC18:2/0:0, was associated with several CVD risk factors in adolescents; these associations were less strong than those with the newly identified GPCs.

CONCLUSIONS

We identified novel GPCs strongly associated with multiple CVD risk factors in adolescents. These GPCs may be sensitive indicators of obesity-related risk for CVD outcomes in adults, and may improve biological understanding of CVD risk.

Age- and sex-related variations in vocal-tract morphology and voice acoustics during adolescence

Distinct differences in the human voice emerge during adolescence, with males producing deeper and more resonant voices than females by the end of sexual maturation. Using magnetic resonance images of heads and voice recordings obtained in 532 typically developing adolescents, we investigate what might be the drivers of this change in voice, and the subjective judgment of the voice "maleness" and "femaleness". We show clear sex differences in the morphology of voice-related structures during adolescence, with males displaying strong associations between age (and puberty) and both vocal-fold and vocal-tract length; this was not the case in female adolescents. At the same time, males (compared with females) display stronger associations between age (and puberty) with both fundamental frequency and formant position. In males, vocal morphology was a mediator in the relationship between bioavailable testosterone and acoustic indices. Subjective judgment of the voice sex could be predicted by the morphological and acoustic parameters in males only: the length of vocal folds and its acoustic counterpart, fundamental frequency, is a larger predictor of subjective "maleness" of a voice than vocal-tract length and formant position.

Chronotype, Light Exposure, Sleep, and Daytime Functioning in High School Students Attending Morning or Afternoon School Shifts

Adolescent maturation is associated with delays of the endogenous circadian phase. Consequently, early school schedules may lead to a mismatch between internal and external time, which can be detrimental to adolescent sleep and health. In parallel, chronotype is known to play a role in adolescent health; evening chronotype adolescents are at higher risk for sleep problems and lower academic achievement. In the summer of 2008, Kénogami High School (Saguenay, Canada) was destroyed by fire. Kénogami students were subsequently relocated to Arvida High School (situated 5.3 km away) for the 2008-2009 academic year. A dual school schedule was implemented, with Arvida students attending a morning schedule (0740-1305 h) and Kénogami students an afternoon schedule (1325-1845 h). This study aimed to investigate the effects of such school schedules and chronotype on sleep, light exposure, and daytime functioning. Twenty-four morning and 33 afternoon schedule students wore an actigraph during 7 days to measure sleep and light exposure. Academic achievement was obtained from school. Subjects completed validated questionnaires on daytime sleepiness, psychological distress, social rhythms, school satisfaction, alcohol, and chronotype. Overall, afternoon schedule students had longer sleep duration, lower sleepiness, and lower light exposure than morning schedule students. Evening chronotypes (E-types) reported higher levels of sleepiness than morning chronotypes (M-types) in both morning and afternoon schedules. Furthermore, M-types attending the morning schedule reported higher sleepiness than M-types attending the afternoon schedule. No difference was found between morning and afternoon schedule students with regard to academic achievement, psychological distress, social rhythms, school satisfaction, and alcohol consumption. However, in both schedules, M-type had more regular social rhythms and lower alcohol consumption. In summary, this study emphasizes that an early school schedule is associated with detrimental effects in terms of sleep deprivation and daytime sleepiness, even for M-types. Furthermore, irrespective of school schedule, E-type adolescents face an increased risk for poor daytime functioning.

Dietary Vitamin A and Visceral Adiposity: A Modulating Role of the Retinol-Binding Protein 4 Gene

BACKGROUND/AIMS

Visceral fat (VF) compared with subcutaneous fat (SF) is more closely associated with cardiometabolic disease. Dietary vitamin A (retinol) may reduce adiposity through its effects on adipogenesis differentially in VF and SF, and this effect may be modulated by retinol-binding protein-4 (RBP4). We investigated whether intake of vitamin A is associated with either VF or SF, and whether this association is moderated by the RBP4 genotype (rs10882272, C/T) previously associated with circulating retinol levels.

METHODS

This was a cross-sectional association study in a sample of 947 adolescents from a French-Canadian founder population. VF and SF were quantified with magnetic resonance imaging, and vitamin A intake was assessed with a 24-hour food recall. All participants were genotyped to determine their RBP4 variant.

RESULTS

Dietary intake of vitamin A was negatively associated with VF; however, it was not associated with SF. These relationships were independent of age, sex, height and energy intake, and were modulated by the RBP4 variant. The T allele promoted adiposity-reducing effects of vitamin A in VF and adiposity-enhancing effects in SF, while the C allele had adiposity-reducing effects in both VF and SF.

CONCLUSIONS

Dietary vitamin A may reduce abdominal adiposity and promote visceral to subcutaneous body fat redistribution during adolescence in an RBP4-dependent manner. These observational findings provide the basis for future interventional studies, which together with genetic information may inject further causality in the association between dietary vitamin A intake and abdominal adiposity.

Early Cannabis Use, Polygenic Risk Score for Schizophrenia and Brain Maturation in Adolescence

IMPORTANCE

Cannabis use during adolescence is known to increase the risk for schizophrenia in men. Sex differences in the dynamics of brain maturation during adolescence may be of particular importance with regard to vulnerability of the male brain to cannabis exposure.

OBJECTIVE

To evaluate whether the association between cannabis use and cortical maturation in adolescents is moderated by a polygenic risk score for schizophrenia.

DESIGN, SETTING, AND PARTICIPANTS

Observation of 3 population-based samples included initial analysis in 1024 adolescents of both sexes from the Canadian Saguenay Youth Study (SYS) and follow-up in 426 adolescents of both sexes from the IMAGEN Study from 8 European cities and 504 male youth from the Avon Longitudinal Study of Parents and Children (ALSPAC) based in England. A total of 1577 participants (aged 12-21 years; 899 [57.0%] male) had (1) information about cannabis use; (2) imaging studies of the brain; and (3) a polygenic risk score for schizophrenia across 108 genetic loci identified by the Psychiatric Genomics Consortium. Data analysis was performed from March 1 through December 31, 2014.

MAIN OUTCOMES AND MEASURES

Cortical thickness derived from T1-weighted magnetic resonance images. Linear regression tests were used to assess the relationships between cannabis use, cortical thickness, and risk score.

RESULTS

Across the 3 samples of 1574 participants, a negative association was observed between cannabis use in early adolescence and cortical thickness in male participants with a high polygenic risk score. This observation was not the case for low-risk male participants or for the low- or high-risk female participants. Thus, in SYS male participants, cannabis use interacted with risk score vis-à-vis cortical thickness (P = .009); higher scores were associated with lower thickness only in males who used cannabis. Similarly, in the IMAGEN male participants, cannabis use interacted with increased risk score vis-à-vis a change in decreasing cortical thickness from 14.5 to 18.5 years of age (t137 = -2.36; P = .02). Finally, in the ALSPAC high-risk group of male participants, those who used cannabis most frequently (≥61 occasions) had lower cortical thickness than those who never used cannabis (difference in cortical thickness, 0.07 [95% CI, 0.01-0.12]; P = .02) and those with light use (<5 occasions) (difference in cortical thickness, 0.11 [95% CI, 0.03-0.18]; P = .004).

CONCLUSIONS AND RELEVANCE

Cannabis use in early adolescence moderates the association between the genetic risk for schizophrenia and cortical maturation among male individuals. This finding implicates processes underlying cortical maturation in mediating the link between cannabis use and liability to schizophrenia.

Visceral fat enhances blood pressure reactivity to physical but not mental challenges in male adolescents

BACKGROUND

Excess visceral fat is a major risk factor for hypertension. Enhanced blood pressure (BP) reactivity and delayed BP recovery from physical and mental challenges predict future hypertension.

OBJECTIVES

Determine whether visceral fat is associated with higher BP reactivity and delayed BP recovery from physical and mental challenges during adolescence.

METHODS

In a community-based sample of 283 male and 308 female adolescents, we measured visceral fat with magnetic resonance imaging, total body fat with bioimpedance, and beat-by-beat BP with a Finometer at rest and during physical (10-min standing) and mental (2-min math stress) challenges.

RESULTS

Males vs. females showed greater BP reactivity and no differences in BP recovery from either type of challenges. Visceral fat was positively associated with BP reactivity to standing up only and in males only (+8.4 ± 3.6 mmHg per 1 log cm(3) of visceral fat, P = 0.008), and this association was independent of total body fat. No association was seen between visceral fat and BP recovery from either type of challenge in either sex. All these associations were independent of age, puberty stage, height and initial BP.

CONCLUSIONS

Adolescent males vs. females demonstrate greater BP reactivity but similar BP recovery from physical and mental challenges. Excess visceral fat enhances BP reactivity to physical but not mental challenges in males only.

Abstract P075: Stroke Volume and Visceral Fat Drive Differences in Blood Pressure Between Two Generations: A Population-Based Study of Adolescents and Their Parents

Excess total body fat (TBF) and visceral fat (VF) are major risk factors of hypertension. Blood pressure (BP) increases with age, as do TBF and VF. Here we investigated whether TBF and VF contribute to BP differences between adolescents and adults. A population-based sample of adolescents (n=933, 12-18 years) and their parents (n=429, 38-65 years) was studied as part of the Saguenay Youth Study. In all participants, beat-by-beat values of SBP, DBP and underlying hemodynamic parameters (heart rate, stroke volume [SV] and total peripheral resistance) were obtained with a Finometer during a 52-minute protocol mimicking daily life activities and including posture and math-stress tests. TBF was assessed by bioelectrical impedance and VF was examined by magnetic resonance imaging. SBP was higher in parents than adolescents by an average of 10.2±0.3 mmHg in males and 9.1±0.3 mmHg in females (p<0.0001 for both sexes). DBP differed minimally throughout the protocol (p=0.3 and 0.1, respectively). In males and females, respectively, the ‘generation’ differences in SBP were reduced to 6.0±0.1 and 4.3±0.1 mmHg when adjusted for height and TBF (p<0.0001 for both), and were further reduced to 1.9±0.1 and 2.5±0.2 mmHg when additionally adjusted for VF (p=0.1 and 0.02). Of the underlying hemodynamic parameters, only SV was higher in parents than adolescents (by 46±2 ml in males and 39±2 ml in females, p<0.0001 for both). Again, the ‘generation’ differences in SV were reduced to 23±1 (males) and 20±1 ml (females) when adjusted for height and TBF (p<0.0001 for both sexes), and were further reduced to 11.8±0.6 and 15.7±0.8 ml when additionally adjusted for VF (p<0.0001 for both sexes). These results suggest that the transition from adolescence to middle-aged adulthood is associated with an increase in SBP (but not DBP), which is driven mainly by SV augmentation. They also suggest that VF contributes to the generational differences in both SBP and SV above and beyond the contribution of TBF, despite VF being a relatively small fraction of TBF. The co-occurrence of these differences in VF, SV and SBP may be related to sympathoactivation and renal handling of sodium and water reabsorption; further research is required to confirm this possibility.

Abstract P181: Circulating Second-messenger Glycerophosphocholines and Cardiovascular Risk Factors in a Population-based Sample of Adolescents

Circulating second-messenger glycerophosphocholines (smGPCs), including lysophosphatidylcholines and platelet-activating factors, are low-abundance plasma phospholipids that modulate atherosclerosis and inflammation and, in turn, the risk for cardiovascular disease (CVD). Although CVD is a slow-progressing disease culminating in middle-to-late adulthood, its initial stages may be seen already in adolescence. Here, we investigated whether circulating smGPCs are associated with classical CVD risk factors - excess body fat, elevated BP, insulin resistance and low-grade inflammation - during adolescence. We studied a population-based sample of 1029 adolescents (52% females, 12-18 years), as part of the Saguenay Youth Study. We used targeted serum lipidomics (LC-ESI-MS) to identify and quantify circulating smGPCs within the 440-640 Da range. In all participants, we also measured: (i) visceral fat with MRI and total body fat with bioimpedance; (ii) blood pressure (BP) beat-by-beat for five minutes under standard clinical conditions; and (iii and iv) fasting serum insulin (as an index of insulin resistance) and CRP (as an index of low-grade inflammation). We identified a total of 81 smGPCs that varied by the length and saturation of their fatty acyl residues and the type of linkage these residues are attached to the glycerol backbone. Over 30 of them were associated with multiple CVD risk factors (p<6x10 -4 ). Most of these associations were inverse and involved ‘medium’ mass smGPCs. Positive associations were also seen and these involved ‘low’ or ‘high’ mass smGPCs. Most strongly inversely associated smGPCs were: (i) PC(20:6/0:0) and PC(O-18:6/2:0), which were associated with total body fat (p<3x10 -14 ) and CRP (p<8x10 -36 ); and (ii) PC(16:0/2:0), which was associated with visceral fat (p=2x10 -18 ) and BP (p<1x10 -5 ). The most strongly positively associated smGPC was PC(14:1/0:0), which was associated with visceral fat (p=8x10 -8 ) and fasting insulin (p=2x10 -24 ). Thus, specific circulating smGPCs are strongly associated with multiple CVD risk factors in adolescence; some of these associations may be ‘protective’ whereas others ‘adverse’. Circulating smGPCs may serve as novel biomarkers of early risk for CVD.

Discovery of β-D-2'-deoxy-2'-α-fluoro-4'-α-cyano-5-aza-7,9-dideaza adenosine as a potent nucleoside inhibitor of respiratory syncytial virus with excellent selectivity over mitochondrial RNA and DNA polymerases

Novel 4'-substituted β-d-2'-deoxy-2'-α-fluoro (2'd2'F) nucleoside inhibitors of respiratory syncytial virus (RSV) are reported. The introduction of 4'-substitution onto 2'd2'F nucleoside analogs resulted in compounds demonstrating potent cell based RSV inhibition, improved inhibition of the RSV polymerase by the nucleoside triphosphate metabolites, and enhanced selectivity over incorporation by mitochondrial RNA and DNA polymerases. Selectivity over the mitochondrial polymerases was found to be extremely sensitive to the specific 4'-substitution and not readily predictable. Combining the most potent and selective 4'-groups from N-nucleoside analogs onto a 2'd2'F C-nucleoside analog resulted in the identification of β-D-2'-deoxy-2'-α-fluoro-4'-α-cyano-5-aza-7,9-dideaza adenosine as a promising nucleoside lead for RSV.

Development and aetiology of body dissatisfaction in adolescent boys and girls

This longitudinal study aims to describe the development of body dissatisfaction (BD), measured with the Contour Drawing Rating Scale, between the ages of 14 and 18, and to identify factors associated with BD at age 18, among 413 adolescents. Between the ages of 14 and 18, the proportion of girls wanting to be thinner increased, although it remained unchanged among boys. A ratio of 1:2 girls and 1:5 boys reported having seriously tried to lose weight. Factors associated with BD in girls at age 18 were (1) wanting to be thinner, (2) body mass index (BMI), (3) weight control behaviours and (4) negative comments about weight. Factors associated with BD in boys at age 18 were (1) wanting to be thinner or bigger, (2) BMI, (3) having experienced sexual intercourse and (4) negative comments about weight. The high prevalence of BD and weight-related concerns suggest a need for early interventions.

Discovery of an oral respiratory syncytial virus (RSV) fusion inhibitor (GS-5806) and clinical proof of concept in a human RSV challenge study

GS-5806 is a novel, orally bioavailable RSV fusion inhibitor discovered following a lead optimization campaign on a screening hit. The oral absorption properties were optimized by converting to the pyrazolo[1,5-a]-pyrimidine heterocycle, while potency, metabolic, and physicochemical properties were optimized by introducing the para-chloro and aminopyrrolidine groups. A mean EC50 = 0.43 nM was found toward a panel of 75 RSV A and B clinical isolates and dose-dependent antiviral efficacy in the cotton rat model of RSV infection. Oral bioavailability in preclinical species ranged from 46 to 100%, with evidence of efficient penetration into lung tissue. In healthy human volunteers experimentally infected with RSV, a potent antiviral effect was observed with a mean 4.2 log10 reduction in peak viral load and a significant reduction in disease severity compared to placebo. In conclusion, a potent, once daily, oral RSV fusion inhibitor with the potential to treat RSV infection in infants and adults is reported.

Prenatal exposure to cigarette smoke interacts with OPRM1 to modulate dietary preference for fat

BACKGROUND

Preference for fatty foods is a risk factor for obesity. It is a complex behaviour that involves the brain reward system and is regulated by genetic and environmental factors, such as the opioid receptor mu-1 gene (OPRM1) and prenatal exposure to maternal cigarette smoking (PEMCS). We examined whether OPRM1 and PEMCS interact in influencing fat intake and whether exposure-associated epigenetic modifications of OPRM1 may mediate this gene-environment interaction.

METHODS

We studied adolescents from a French Canadian genetic founder population, half of whom were exposed prenatally to maternal cigarette smoking. Fat intake was assessed with a 24-hour food recall in the form of a structured interview conducted by a trained nutritionist. The OPRM1 variant rs2281617 was genotyped for the whole sample with the Illumina Human610-Quad and HumanOmniExpress BeadChips. Methylation of blood DNA was assessed at 21 CpGs across OPRM1 in a subset of the sample using the Illumina HumanMethylation450 BeadChip.

RESULTS

We included 956 adolescents in our study. In the whole sample, OPRM1 (T carrier in rs2281617) was associated with lower fat intake (-1.6%, p = 0.017), and PEMCS was associated with higher fat intake (+1.6%, p = 0.005). OPRM1 and PEMCS interacted with each other (p = 0.003); the "protective" (fat intake-lowering) allele of OPRM1 was associated with lower fat intake in nonexposed (-3.2%, p < 0.001) but not in exposed individuals (+0.8%, p = 0.42). Further, PEMCS was associated with lower DNA methylation across multiple CpGs across OPRM1 in exposed versus nonexposed individuals (p = 0.031).

LIMITATIONS

A limitation of our study was its cross-sectional design.

CONCLUSION

Our study suggests that PEMCS may interact with OPRM1 in increasing fat preference. Silencing of the protective OPRM1 allele in exposed adolescents might be related to epigenetic modification of this gene.

Puberty and testosterone shape the corticospinal tract during male adolescence

Some of the known sex differences in white matter emerge during adolescence. Here, we replicate and extend our previous findings of sex differences in the structure of the corticospinal tract (Perrin et al. 2009; Hervé et al. 2009). In a large normative sample of adolescents, we observed age × sex interactions in the signal intensity of T1-weighted (T1W) images (n = 941) and in magnetization transfer ratio (MTR; n = 761); both features were inversely associated with age in males but not in females. Moreover, we hypothesized that the age-related differences in CST structure exhibited by males would be mediated by differences in puberty stage and levels of bioavailable testosterone. We confirmed this prediction using mediation analysis with bootstrapping. These findings suggest that sex differences in the CST structure observed during male adolescence may be due to multiple processes associated with puberty, including (but not limited to) the rising levels of testosterone.

Maternal cigarette smoking during pregnancy predicts drug use via externalizing behavior in two community-based samples of adolescents

BACKGROUND AND AIMS

Prenatal exposure to maternal cigarette smoking (PEMCS) is associated with a higher probability of substance use in adolescence. We explore if externalizing behavior mediates this relationship, while controlling for a number of potential covariates of this mediation process.

METHODS

We used data obtained in two geographically distinct community samples of adolescents. The first (cross-sectional) sample consisted of 996 adolescents (12-18 years of age) recruited from the Saguenay Youth Study (SYS) in Canada (47% with PEMCS). The second (longitudinal) sample consisted of 1141 adolescents (49% with PEMCS) from the Northern Finland Birth Cohort (NFBC1986). In both samples, externalizing behavior and substance use were assessed during adolescence. In the NFBC1986 cohort, externalizing behavior was also assessed in childhood.

RESULTS

In both populations, PEMCS is associated with a higher likelihood of adolescent drug experimentation. In the NFBC1986 cohort, exposed (versus non-exposed) adolescents experiment with an extra 1.27 [B = 0.24, 95% confidence intervals (CI) = 0.15, 0.33 P < 0.001] drugs. In the SYS cohort, a clear protective effect of not being exposed is shown: non-exposed (versus exposed) adolescents are 1.5 times [B = -0.42, 95% CI = -0.75, -0.09, P = 0.013] less likely to take drugs. These associations between PEMCS and drug experimentation remain in the multivariate and mediational analyses.

CONCLUSIONS

Prenatal exposure to maternal cigarette smoking appears to be associated with a higher probability of experimenting with drugs during adolescence, both directly and indirectly via externalizing behavior and the number of peers reported as using drugs.

Adiposity is associated with structural properties of the adolescent brain

Obesity, a major risk factor for cardiometabolic disease, is associated with variations in a number of structural properties in the adult brain, as assessed with magnetic resonance imaging (MRI). In this study, we investigated the cross-sectional relationship between visceral fat (VF), total body fat (TBF) and three MRI parameters in the brains of typically developing adolescents: (i) T1-weighted (T1W) signal intensity; (ii) T1W signal contrast between white matter (WM) and gray matter (GM); and (iii) magnetization transfer ratio (MTR). In a community-based sample of 970 adolescents (12-18 years old, 466 males), VF was quantified using MRI, and total body fat was measured using a multifrequency bioimpedance. T1W images of the brain were used to determine signal intensity in lobar GM and WM, as well as WM:GM signal contrast. A magnetization transfer (MT) sequence of MT(ON) and MT(OFF) was used to obtain MTR in GM and WM. We found that both larger volumes of VF and more TBF were independently associated with higher signal intensity in WM and higher WM:GM signal contrast, as well as higher MTR in both GM and WM. These relationships were independent of a number of potential confounders, including age, sex, puberty stage, household income and height. Our results suggest that both visceral fat and fat deposited elsewhere in the body are associated independently with structural properties of the adolescent brain. We speculate that these relationships suggest the presence of adiposity-related variations in phospholipid composition of brain lipids.

Clustering of the metabolic syndrome components in adolescence: role of visceral fat

Visceral fat (VF) promotes the development of metabolic syndrome (MetS), which emerges as early as in adolescence. The clustering of MetS components suggests shared etiologies, but these are largely unknown and may vary between males and females. Here, we investigated the latent structure of pre-clinical MetS in a community-based sample of 286 male and 312 female adolescents, assessing their abdominal adiposity (VF) directly with magnetic resonance imaging. Principal component analysis of the five MetS-defining variables (VF, blood pressure [BP], fasting serum triglycerides, HDL-cholesterol and glucose) identified two independent components in both males and females. The first component was sex-similar; it explained >30% of variance and was loaded by all but BP variables. The second component explained >20% of variance; it was loaded by BP similarly in both sexes but additional loading by metabolic variables was sex-specific. This sex-specificity was not detected in analyses that used waist circumference instead of VF. In adolescence, MetS-defining variables cluster into at least two sub-syndromes: (1) sex-similar metabolic abnormalities of obesity-induced insulin resistance and (2) sex-specific metabolic abnormalities associated with BP elevation. These results suggest that the etiology of MetS may involve more than one pathway and that some of the pathways may differ between males and females. Further, the sex-specific metabolic abnormalities associated with BP elevation suggest the need for sex-specific prevention and treatment strategies of MetS.

Height-based Indices of Pubertal Timing in Male Adolescents

It is important to account for timing of puberty when studying the adolescent brain and cognition. The use of classical methods for assessing pubertal status may not be feasible in some studies, especially in male adolescents. Using data from a sample of 478 males from a longitudinal birth cohort, we describe the calculations of three independent height-based markers of pubertal timing: Age at Peak Height Velocity (APHV), Height Difference in Standard Deviations (HDSDS), and Percent Achieved of Adult Stature (PAAS). These markers correlate well with each other. In a separate cross-sectional study, we show that the PAAS marker correlates well with testosterone levels and self-reported pubertal-stage scores. We conclude by discussing key considerations for investigators when drawing upon these methods of assessing pubertal timing.

Prenatal exposure to maternal cigarette smoking, amygdala volume, and fat intake in adolescence

CONTEXT

Prenatal exposure to maternal cigarette smoking is a well-established risk factor for obesity, but the underlying mechanisms are not known. Preference for fatty foods, regulated in part by the brain reward system, may contribute to the development of obesity.

OBJECTIVE

To examine whether prenatal exposure to maternal cigarette smoking is associated with enhanced fat intake and risk for obesity, and whether these associations may be related to subtle structural variations in brain regions involved in reward processing.

DESIGN

Cross-sectional study of a population-based cohort.

SETTING

The Saguenay Youth Study, Quebec, Canada.

PARTICIPANTS

A total of 378 adolescents (aged 13 to 19 years; Tanner stage 4 and 5 of sexual maturation), half of whom were exposed prenatally to maternal cigarette smoking (mean [SD], 11.1 [6.8] cigarettes/d).

MAIN OUTCOME MEASURES

Fat intake was assessed with a 24-hour food recall (percentage of energy intake consumed as fat). Body adiposity was measured with anthropometry and multifrequency bioimpedance. Volumes of key brain structures involved in reward processing, namely the amygdala, nucleus accumbens, and orbitofrontal cortex, were measured with magnetic resonance imaging.

RESULTS

Exposed vs nonexposed subjects exhibited a higher total body fat (by approximately 1.7 kg; P = .009) and fat intake (by 2.7%; P = .001). They also exhibited a lower volume of the amygdala (by 95 mm3; P < .001) but not of the other 2 brain structures. Consistent with its possible role in limiting fat intake, amygdala volume correlated inversely with fat intake (r = -0.15; P = .006).

CONCLUSIONS

Prenatal exposure to maternal cigarette smoking may promote obesity by enhancing dietary preference for fat, and this effect may be mediated in part through subtle structural variations in the amygdala.

FTO, obesity and the adolescent brain

Genetic variations in fat mass- and obesity (FTO)-associated gene, a well-replicated gene locus of obesity, appear to be associated also with reduced regional brain volumes in elderly. Here, we examined whether FTO is associated with total brain volume in adolescence, thus exploring possible developmental effects of FTO. We studied a population-based sample of 598 adolescents recruited from the French Canadian founder population in whom we measured brain volume by magnetic resonance imaging. Total fat mass was assessed with bioimpedance and body mass index was determined with anthropometry. Genotype-phenotype associations were tested with Merlin under an additive model. We found that the G allele of FTO (rs9930333) was associated with higher total body fat [TBF (P = 0.002) and lower brain volume (P = 0.005)]. The same allele was also associated with higher lean body mass (P = 0.03) and no difference in height (P = 0.99). Principal component analysis identified a shared inverse variance between the brain volume and TBF, which was associated with FTO at P = 5.5 × 10(-6). These results were replicated in two independent samples of 413 and 718 adolescents, and in a meta-analysis of all three samples (n = 1729 adolescents), FTO was associated with this shared inverse variance at P = 1.3 × 10(-9). Co-expression networks analysis supported the possibility that the underlying FTO effects may occur during embryogenesis. In conclusion, FTO is associated with shared inverse variance between body adiposity and brain volume, suggesting that this gene may exert inverse effects on adipose and brain tissues. Given the completion of the overall brain growth in early childhood, these effects may have their origins during early development.

Abstract 157: The Sex-Specific Influence of Adiposity on Blood Pressure During Physical and Mental Challenges in Adolescence

Greater blood pressure (BP) reactivity and slower BP recovery from physical and mental challenges predict future hypertension. Males exhibit higher BP than females throughout their reproductive age and, as such, have a higher prevalence of hypertension. Excess body-fat is a major risk factor for hypertension in both males and females. We investigated whether BP reactivity and recovery from physical and mental challenges differ between adolescent males and females, and whether these hemodynamic parameters are associated with resting BP and are influenced by excess body-fat in a sex-specific manner. In 285 male and 311 female adolescents (age 12-18 years), we quantified visceral fat (VF) with magnetic resonance imaging and total body fat (TBF) with bioimpedance and measured systolic BP (SBP) beat-by-beat at rest and during physical (10-min standing) and mental (2-min math test) challenges. Our results showed that in both sexes, BP reactivity and BP recovery for both challenges (adjusted for age, height and initial BP) correlated closely with resting BP (0.03 ≤ r2 ≤ 0.34). In addition, for both physical and mental challenges, males versus females showed greater BP reactivity (by 3.5 mm Hg, p<0.0001 and by 2.6 mmHg, p=0.02, respectively) and no difference in BP recovery. VF correlated positively with BP reactivity to the physical challenge only and in males only (r=0.18, p=0.007), and this correlation was independent of TBF (r=0.21, p=0.002). Consistent with these results, additional adjustment for VF diminished the sex difference in BP reactivity to the physical but not mental challenge (from 3.5 to 2.7 mm Hg, p=0.01). No relationship was observed between VF and BP recovery from either challenge and in either sex. This is the first study to show sex differences exist not only in BP adaptation to daily activities, but also in the way VF influences this adaptation. Overall, our findings suggest the need for sex-specific prevention and treatment of hypertension.

Abstract 164: CYP17A1 Variant is Associated with Blood Pressure Reactivity to a Mental but not a Physical Challenge in Male Adolescents and May Be an Early Marker of Hypertension Risk

Individuals who exhibit exaggerated blood pressure (BP) reactivity to physical and mental challenges at a young age are at increased risk of developing hypertension in adulthood. Hypertension is a complex genetic trait that is more prevalent in men than women during reproductive age. CYP17A1 is one of the best-established gene loci of hypertension. It encodes a key enzyme in the steroidogenic pathway that produces mineralocorticoids, glucocorticoids, androgens, and estrogens; as such, it may influence BP reactivity in a sex-specific manner. Here, we investigated whether CYP17A1 is associated with BP reactivity to physical and mental challenges in adolescence. In 285 male and 311 female adolescents (age 12-18 years), we measured systolic BP (SBP) and diastolic BP (DBP) beat-by-beat during a 52-minute protocol, which included a physical (10-min standing) and mental (2-min math test) challenge and we genotyped 8 tagging single nucleotide polymorphisms (SNPs) that covered the entire region of CYP17A1. Genotype-phenotype association tests were performed separately in males and females, while adjusting for age, height and initial BP. Our results showed that 6 SNPs were associated with higher SBP and DBP reactivity (p=0.003-0.0001), but only in response to mental stress and only in boys. At rs619824 , minor allele homozygotes differed from major allele homozygotes by 8.7 mm Hg of SBP (p=3x10-4) and 4.8 mm Hg of DBP (p=1x10-4) in boys, and the two groups varied only by 2.0 mm Hg of SBP (p=0.31) and 0.9 mm Hg of DBP (p=0.42) in girls. These results suggest that CYP17A1 may contribute to the development of hypertension through the regulation of the stress response and that, at least in adolescence, this effect appears to be present in males but not in females.

Sex differences in the contributions of visceral and total body fat to blood pressure in adolescence

Excess body fat deposited viscerally rather than elsewhere in the body is associated with higher risk for hypertension; this relationship is stronger in men than in women. Here we investigated whether similar sex dimorphism exists already in adolescence. A population-based sample of adolescent boys (n=237) and girls (n=262), age 12 to 18 years, was studied. Total body fat (TBF) was assessed with multifrequency bioelectrical impedance, and visceral fat (VF) was quantified with MRI. Blood pressure (BP) was measured beat by beat during an hour-long protocol, including supine, standing, sitting, mental stress, and poststress sections. Multivariate mixed-model analysis was used to assess the relative contributions of TBF and VF to BP during these sections. In boys, BP was strongly positively associated with VF (P<0.0001), whereas it was less strongly and negatively associated with TBF (P=0.004); these relationships did not substantially vary during the protocol. In contrast, in girls, BP was strongly positively associated with TBF (P=0.0006), whereas it was not associated with VF (P=0.08); the relationship with TBF varied during the protocol and was most apparent during mental stress (TBF*section interaction: P=0.002). Furthermore, when waist circumference was included in multivariate models instead of VF, it was not associated with BP in either sex; this indicates that waist circumference may not be an appropriate surrogate for VF. Thus, in adolescence, adiposity-related BP elevation is driven mainly by visceral fat in males and by fat deposited elsewhere in females. This dimorphism suggests sex-specific mechanisms of obesity-induced hypertension and the need for sex-specific criteria of its prevention.

Genome-wide scan for loci of adolescent obesity and their relationship with blood pressure

CONTEXT

Hypertension, typically considered a disorder of adulthood, is now emerging in adolescence. This is mainly due to the growing prevalence of obesity and the fact that excess body fat increases blood pressure (BP).

OBJECTIVE

The objective of the study was to investigate whether genome-wide identified gene loci of obesity are associated with elevated BP in adolescence.

DESIGN

This was a genotype-phenotype association study.

SETTING

The study was conducted in a French-Canadian founder population.

PARTICIPANTS

Participants included 598 adolescents, aged 12-18 yr.

INTERVENTION

Testing associations between 530,011 single-nucleotide polymorphisms (SNP; Human610W-Quad BeadChip) and obesity measures and between identified SNP and BP.

PRIMARY OUTCOME MEASURES

Total fat mass (TFM) was assessed with bioelectrical impedance, and body mass index (BMI) was determined with anthropometry. BP was measured beat by beat during an hour-long protocol.

RESULTS

The genome-wide association studies of TFM and BMI revealed two novel and several previously identified loci of obesity. The former were PAX5 (rs16933812, TFM: P = 9.3 × 10(-9)) and MRPS22 (rs7638110, BMI: P = 4.6 × 10(-8)), and the top ones among the latter (P < 5 × 10(-4)) were MC4R (rs17773430, BMI: P = 5.8 × 10(-6)), FTO (rs9930333, BMI: P = 1.9 × 10(-4)), and MTCH2 (rs7120548, BMI: P = 1.9 × 10(-4)). From these five, only the PAX5, MRPS22, and FTO were also associated with BP; their minor allele homozygotes vs. major allele homozygotes showed greater TFM by 2.9-8.0 kg and higher BP by 3.3-6.7 mm Hg.

CONCLUSIONS

Genome-wide association studies conducted in an adolescent founder population revealed two new and a number of previously identified loci of obesity and demonstrated that several but not all of these loci are also associated with elevated BP. These results begin to reveal the genetic architecture of obesity-induced hypertension.

KCTD8 gene and brain growth in adverse intrauterine environment: a genome-wide association study

The most dramatic growth of the human brain occurs in utero and during the first 2 years of postnatal life. Genesis of the cerebral cortex involves cell proliferation, migration, and apoptosis, all of which may be influenced by prenatal environment. Here, we show that variation in KCTD8 (potassium channel tetramerization domain 8) is associated with brain size in female adolescents (rs716890, P = 5.40 × 10(-09)). Furthermore, we found that the KCTD8 locus interacts with prenatal exposure to maternal cigarette smoking vis-à-vis cortical area and cortical folding: In exposed girls only, the KCTD8 locus explains up to 21% of variance. Using head circumference as a proxy of brain size at 7 years of age, we have replicated this gene-environment interaction in an independent sample. We speculate that KCTD8 might modulate adverse effects of smoking during pregnancy on brain development via apoptosis triggered by low intracellular levels of potassium, possibly reducing the number of progenitor cells.

Testosterone-mediated sex differences in the face shape during adolescence: subjective impressions and objective features

Sex identification of a face is essential for social cognition. Still, perceptual cues indicating the sex of a face, and mechanisms underlying their development, remain poorly understood. Previously, our group described objective age- and sex-related differences in faces of healthy male and female adolescents (12-18 years of age), as derived from magnetic resonance images (MRIs) of the adolescents' heads. In this study, we presented these adolescent faces to 60 female raters to determine which facial features most reliably predicted subjective sex identification. Identification accuracy correlated highly with specific MRI-derived facial features (e.g. broader forehead, chin, jaw, and nose). Facial features that most reliably cued male identity were associated with plasma levels of testosterone (above and beyond age). Perceptible sex differences in face shape are thus associated with specific facial features whose emergence may be, in part, driven by testosterone.

Risk factors for work-related fatigue in students with school-year employment

PURPOSE

To explore potential risk factors for acute and chronic work-related fatigue in students working at a paid job while pursuing school studies. Although work-related fatigue was identified as a potential hazard for youth health, academic achievement, and occupational safety, very few studies have specifically addressed its correlates and possible predictors.

METHODS

Cross-sectional data from an ongoing prospective cohort study of health risk behaviors in adolescents was used to identify factors associated with increased levels of acute and chronic fatigue in 209 students aged 17-18 years working during the school year. Multiple stepwise regression analyses were performed with acute and chronic fatigue levels as dependent variables, and demographic, work, and health factors as potential explanatory variables.

RESULTS

Average hours worked per week by students was 14.7 hours. It was observed that higher psychological distress, poorer health perception, greater sleep debt, and higher exposure to physical work factors were associated with higher levels of acute fatigue. Also, it was observed that higher psychological distress, poorer health perception, higher exposure to physical work factors, and holding multiple jobs were associated with higher levels of chronic fatigue. The number of hours worked weekly was associated with neither acute nor chronic work-related fatigue.

CONCLUSIONS

Findings suggest that prevention strategies devised to minimize work-related fatigue in students should consider exposure to physical work factors. Results also re-emphasize the importance of obtaining sufficient sleep so as to prevent high levels of acute work-related fatigue.