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Delisle BP, George AL, Nerbonne JM, Bass JT, Ripplinger CM, Jain MK, Hermanstyne TO, Young ME, Kannankeril PJ, Duffy JF, Goldhaber JI, Hall MH, Somers VK, Smolensky MH, Garnett CE, Anafi RC, Scheer FAJL, Shivkumar K, Shea SA, Balijepalli RC. Understanding Circadian Mechanisms of Sudden Cardiac Death: A Report From the National Heart, Lung, and Blood Institute Workshop, Part 2: Population and Clinical Considerations. Circ Arrhythm Electrophysiol 2021; 14:e010190. [PMID: 34719257 DOI: 10.1161/circep.121.010190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Sudden cardiac death (SCD) is the sudden, unexpected death due to abrupt loss of heart function secondary to cardiovascular disease. In certain populations living with cardiovascular disease, SCD follows a distinct 24-hour pattern in occurrence, suggesting day/night rhythms in behavior, the environment, and endogenous circadian rhythms result in daily spans of increased vulnerability. The National Heart, Lung, and Blood Institute convened a workshop, Understanding Circadian Mechanisms of Sudden Cardiac Death to identify fundamental questions regarding the role of the circadian rhythms in SCD. Part 2 summarizes research gaps and opportunities in the areas of population and clinical research identified in the workshop. Established research supports a complex interaction between circadian rhythms and physiological responses that increase the risk for SCD. Moreover, these physiological responses themselves are influenced by several biological variables, including the type of cardiovascular disease, sex, age, and genetics, as well as environmental factors. The emergence of new noninvasive biotechnological tools that continuously measure key cardiovascular variables, as well as the identification of biomarkers to assess circadian rhythms, hold promise for generating large-scale human data sets that will delineate which subsets of individuals are most vulnerable to SCD. Additionally, these data will improve our understanding of how people who suffer from circadian disruptions develop cardiovascular diseases that increase the risk for SCD. Emerging strategies to identify new biomarkers that can quantify circadian health (eg, environmental, behavioral, and internal misalignment) may lead to new interventions and therapeutic targets to prevent the progression of cardiovascular diseases that cause SCD.
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Affiliation(s)
- Brian P Delisle
- Department of Physiology, University of Kentucky, Lexington (B.P.D.)
| | - Alfred L George
- Department of Pharmacology (A.L.G.), Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Jeanne M Nerbonne
- Cardiovascular Division, and Developmental Biology, Departments of Medicine (J.M.N.), Washington University School of Medicine, St Louis, MO
| | - Joseph T Bass
- Department of Medicine (J.T.B.), Northwestern University, Feinberg School of Medicine, Chicago, IL
| | | | - Mukesh K Jain
- Department of Medicine, Case Western Reserve University, Cleveland, OH (M.K.J.)
| | - Tracey O Hermanstyne
- Department of Developmental Biology (T.O.H.), Washington University School of Medicine, St Louis, MO
| | - Martin E Young
- Department of Medicine, University of Alabama, Birmingham (M.E.Y.)
| | - Prince J Kannankeril
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN (P.J.K.)
| | - Jeanne F Duffy
- Department of Medicine (J.F.D.), Harvard Medical School, Boston, MA
| | - Joshua I Goldhaber
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA (J.I.G.)
| | - Martica H Hall
- Department of Psychiatry, University of Pittsburgh, PA (M.H.H.)
| | | | | | | | - Ron C Anafi
- Department of Medicine and Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (R.C.A.)
| | - Frank A J L Scheer
- Division of Sleep Medicine (F.A.J.L.S.), Harvard Medical School, Boston, MA
| | - Kalyanam Shivkumar
- Departement of Medicine, David Greffen School of Medicine, University of California, Los Angeles (K.S.)
| | - Steven A Shea
- Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland (S.A.S.)
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Delisle BP, George AL, Nerbonne JM, Bass JT, Ripplinger CM, Jain MK, Hermanstyne TO, Young ME, Kannankeril PJ, Duffy JF, Goldhaber JI, Hall MH, Somers VK, Smolensky MH, Garnett CE, Anafi RC, Scheer FA, Shivkumar K, Shea SA, Balijepalli RC. Understanding Circadian Mechanisms of Sudden Cardiac Death: A Report From the National Heart, Lung, and Blood Institute Workshop, Part 1: Basic and Translational Aspects. Circ Arrhythm Electrophysiol 2021; 14:e010181. [PMID: 34719240 PMCID: PMC8815462 DOI: 10.1161/circep.121.010181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Sudden cardiac death (SCD), the unexpected death due to acquired or genetic cardiovascular disease, follows distinct 24-hour patterns in occurrence. These 24-hour patterns likely reflect daily changes in arrhythmogenic triggers and the myocardial substrate caused by day/night rhythms in behavior, the environment, and endogenous circadian mechanisms. To better address fundamental questions regarding the circadian mechanisms, the National Heart, Lung, and Blood Institute convened a workshop, Understanding Circadian Mechanisms of Sudden Cardiac Death. We present a 2-part report of findings from this workshop. Part 1 summarizes the workshop and serves to identify research gaps and opportunities in the areas of basic and translational research. Among the gaps was the lack of standardization in animal studies for reporting environmental conditions (eg, timing of experiments relative to the light dark cycle or animal housing temperatures) that can impair rigor and reproducibility. Workshop participants also pointed to uncertainty regarding the importance of maintaining normal circadian rhythmic synchrony and the potential pathological impact of desynchrony on SCD risk. One related question raised was whether circadian mechanisms can be targeted to reduce SCD risk. Finally, the experts underscored the need for studies aimed at determining the physiological importance of circadian clocks in the many different cell types important to normal heart function and SCD. Addressing these gaps could lead to new therapeutic approaches/molecular targets that can mitigate the risk of SCD not only at certain times but over the entire 24-hour period.
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Affiliation(s)
| | - Alfred L. George
- Department of Pharmacology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Jeanne M. Nerbonne
- Departments of Medicine, Cardiovascular Division, and Developmental Biology, Washington University School of Medicine, St. Louis, MO
| | - Joseph T. Bass
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | | | - Mukesh K. Jain
- Department of Medicine, Case Western Reserve University, Cleveland, OH
| | - Tracey O. Hermanstyne
- Department of Developmental Biology, Washington University School of Medicine, St. Louis, MO
| | - Martin E. Young
- Department of Medicine, University of Alabama, Birmingham, AL
| | | | | | | | - Martica H. Hall
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | | | | | | | - Ron C. Anafi
- Department of Medicine and Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | - Kalyanam Shivkumar
- Departement of Medicine, David Greffen School of Medicine at UCLA, Los Angeles, CA
| | - Steven A. Shea
- Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, OR
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Goff DC, Buxton DB, Pearson GD, Wei GS, Gosselin TE, Addou EA, Stoney CM, Desvigne-Nickens P, Srinivas PR, Galis ZS, Pratt C, Kit KBK, Maric-Bilkan C, Nicastro HL, Wong RP, Sachdev V, Chen J, Fine L. Implementing the National Heart, Lung, and Blood Institute's Strategic Vision in the Division of Cardiovascular Sciences. Circ Res 2019; 124:491-497. [PMID: 31031412 DOI: 10.1161/circresaha.118.314338] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
As we commemorate the 70th Anniversary of the National Heart, Lung, and Blood Institute (NHLBI) and celebrate important milestones that have been achieved by the Division of Cardiovascular Sciences (DCVS), it is imperative that DCVS and the Extramural Research community at-large continue to address critical public health challenges that persist within the area of Cardiovascular Diseases (CVD). The NHLBI's Strategic Vision, developed with extensive input from the extramural research community and published in 2016, included overarching goals and strategic objectives that serve to provide a general blueprint for sustaining the legacy of the Institute by leveraging opportunities in emerging scientific areas (e.g., regenerative medicine, omics technology, data science, precision medicine, and mobile health), finding new ways to address enduring challenges (e.g., social determinants of health, health inequities, prevention, and health promotion), and training the next generation of heart, lung, blood, and sleep researchers. DCVS has developed a strategic vision implementation plan to provide a cardiovascular framing for the pursuit of the Institute's overarching goals and strategic objectives garnered from the input of the broader NHLBI community. This plan highlights six scientific focus areas that demonstrate a cross-cutting and multifaceted approach to addressing cardiovascular sciences, including 1) addressing social determinants of cardiovascular health (CVH) and health inequities, 2) enhancing resilience, 3) promoting CVH and preventing CVD Across the lifespan, 4) eliminating hypertension-related CVD, 5) reducing the burden of heart failure, and 6) preventing vascular dementia. These priorities will guide our efforts in Institute-driven activities in the coming years but will not exclude development of other novel ideas or the support of investigator-initiated grant awards. The DCVS Strategic Vision implementation plan is a living document that will evolve with iterative dialogue with the NHLBI community and adapt as the dynamic scientific landscape changes to seize emerging opportunities.
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Affiliation(s)
| | - David C Goff
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Denis B Buxton
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Gail D Pearson
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Gina S Wei
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Teri E Gosselin
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Ebyan A Addou
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Catherine M Stoney
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Patrice Desvigne-Nickens
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Pothur R Srinivas
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Zorina S Galis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Charlotte Pratt
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Kit Brian K Kit
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Christine Maric-Bilkan
- Currently with the Division of Urology, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 6707 Democracy Boulevard, Bethesda MD 20892
| | - Holly L Nicastro
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Renee P Wong
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Vandana Sachdev
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Jue Chen
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
| | - Lawrence Fine
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), 6701 Rockledge Drive, Bethesda, MD 20892
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4
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Wang EA, Redmond N, Dennison Himmelfarb CR, Pettit B, Stern M, Chen J, Shero S, Iturriaga E, Sorlie P, Diez Roux AV. Cardiovascular Disease in Incarcerated Populations. J Am Coll Cardiol 2017; 69:2967-2976. [PMID: 28619198 DOI: 10.1016/j.jacc.2017.04.040] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 03/23/2017] [Accepted: 04/18/2017] [Indexed: 02/05/2023]
Abstract
Currently, 2.2 million individuals are incarcerated, and more than 11 million have been released from U.S. correctional facilities. Individuals with a history of incarceration are more likely to be of racial and ethnic minority populations, poor, and have higher rates of cardiovascular risk factors, especially smoking and hypertension. Cardiovascular disease is a leading cause of death among incarcerated individuals, and those recently released have a higher risk of being hospitalized and dying of cardiovascular disease compared with the general population, even after accounting for differences in racial identity and socioeconomic status. In this review, the authors: 1) present information on the cardiovascular health of justice-involved populations, and unique prevention and care conditions in correctional facilities; 2) identify knowledge gaps; and 3) propose promising areas for research to improve the cardiovascular health of this population. An Executive Summary of a National Heart, Lung, and Blood Institute workshop on this topic is available.
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Affiliation(s)
- Emily A Wang
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.
| | - Nicole Redmond
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Becky Pettit
- Department of Sociology, the University of Texas at Austin, Austin, Texas
| | - Marc Stern
- School of Public Health, University of Washington, Seattle, Washington
| | - Jue Chen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Susan Shero
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Erin Iturriaga
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Paul Sorlie
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Ana V Diez Roux
- School of Public Health, Drexel University, Philadelphia, Pennsylvania
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5
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Affiliation(s)
- Michael S Lauer
- From the Office of the Director, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD
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6
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Postow L, Punturieri A, Croxton TL, Weinmann GG, Kiley JP. A Decade of National Heart, Lung, and Blood Institute Programs Supporting COPD Research and Education . Chronic Obstr Pulm Dis 2014; 1:64-72. [PMID: 28848812 PMCID: PMC5559142 DOI: 10.15326/jcopdf.1.1.2014.0123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/10/2014] [Indexed: 12/23/2022]
Abstract
The past decade of research in chronic obstructive pulmonary disease (COPD) has seen a new age of understanding both pathogenic mechanisms and clinical manifestations of the disease. The National Heart, Lung, and Blood Institute (NHLBI) has helped guide this progress with a series of initiatives to stimulate COPD research in various ways. These initiatives were designed to promote a precision medicine approach to treating COPD, one that takes advantage of targeting particular molecular pathways and the individual pathobiologies of the diversity of COPD patients. This review describes the strategic objectives of these initiatives, as well as some of their observed and anticipated outcomes. In addition, we address parallel steps NHLBI has taken to promote COPD awareness among the public. As we look toward the immediate future of COPD research and education, we see a time of great progress in terms of understanding and treatment. Furthermore, while this remains a debilitating and disturbingly prevalent disease, as NHLBI looks even farther ahead, we envision emerging efforts toward COPD prevention.
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Affiliation(s)
- Lisa Postow
- Division of Lung Diseases. National Heart, Lung, and Blood Institute. National Institutes of Health. Bethesda, MD 20892-7952
| | - Antonella Punturieri
- Division of Lung Diseases. National Heart, Lung, and Blood Institute. National Institutes of Health. Bethesda, MD 20892-7952
| | - Thomas L. Croxton
- Division of Lung Diseases. National Heart, Lung, and Blood Institute. National Institutes of Health. Bethesda, MD 20892-7952
| | - Gail G. Weinmann
- Division of Lung Diseases. National Heart, Lung, and Blood Institute. National Institutes of Health. Bethesda, MD 20892-7952
| | - James P. Kiley
- Division of Lung Diseases. National Heart, Lung, and Blood Institute. National Institutes of Health. Bethesda, MD 20892-7952
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Sutherland ER, Busse WW. Designing clinical trials to address the needs of childhood and adult asthma: the National Heart, Lung, and Blood Institute's AsthmaNet. J Allergy Clin Immunol 2014; 133:34-8.e1. [PMID: 24369797 DOI: 10.1016/j.jaci.2013.10.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 10/09/2013] [Accepted: 10/14/2013] [Indexed: 10/25/2022]
Abstract
In 2008, the National Heart, Lung, and Blood Institute announced its intent to support a new asthma network known as AsthmaNet. This clinical trials consortium, now in its fifth year, has been charged with developing and executing clinical trials to address the most important asthma management questions and identify new treatment approaches in pediatric and adult patients. This review will discuss the organization of AsthmaNet and the scientific context in which the network was developed and began its work, report the results of an internal priority-setting exercise designed to guide the network's scientific strategy, and highlight the portfolio of clinical trials, proof-of-concept studies, and mechanistic studies planned for the 7-year period of the network to update the global asthma community regarding the progress and processes of the network.
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Affiliation(s)
- E Rand Sutherland
- Department of Medicine, National Jewish Health, the University of Colorado School of Medicine, Denver, Colo.
| | - William W Busse
- Department of Medicine, University of Wisconsin, Madison, Wis
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Ortega VE, Meyers DA. Pharmacogenetics: implications of race and ethnicity on defining genetic profiles for personalized medicine. J Allergy Clin Immunol 2014; 133:16-26. [PMID: 24369795 DOI: 10.1016/j.jaci.2013.10.040] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 10/22/2013] [Accepted: 10/23/2013] [Indexed: 01/06/2023]
Abstract
Pharmacogenetics is being used to develop personalized therapies specific to subjects from different ethnic or racial groups. To date, pharmacogenetic studies have been primarily performed in trial cohorts consisting of non-Hispanic white subjects of European descent. A "bottleneck" or collapse of genetic diversity associated with the first human colonization of Europe during the Upper Paleolithic period, followed by the recent mixing of African, European, and Native American ancestries, has resulted in different ethnic groups with varying degrees of genetic diversity. Differences in genetic ancestry might introduce genetic variation, which has the potential to alter the therapeutic efficacy of commonly used asthma therapies, such as β2-adrenergic receptor agonists (β-agonists). Pharmacogenetic studies of admixed ethnic groups have been limited to small candidate gene association studies, of which the best example is the gene coding for the receptor target of β-agonist therapy, the β2-adrenergic receptor (ADRB2). Large consortium-based sequencing studies are using next-generation whole-genome sequencing to provide a diverse genome map of different admixed populations, which can be used for future pharmacogenetic studies. These studies will include candidate gene studies, genome-wide association studies, and whole-genome admixture-based approaches that account for ancestral genetic structure, complex haplotypes, gene-gene interactions, and rare variants to detect and replicate novel pharmacogenetic loci.
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Affiliation(s)
- Victor E Ortega
- Center for Genomics and Personalized Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Deborah A Meyers
- Center for Genomics and Personalized Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
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Kirwin SM, Manolakos A, Barnett SS, Gonzalez IL. Tafazzin splice variants and mutations in Barth syndrome. Mol Genet Metab 2014; 111:26-32. [PMID: 24342716 DOI: 10.1016/j.ymgme.2013.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 11/12/2013] [Accepted: 11/12/2013] [Indexed: 11/23/2022]
Abstract
Barth syndrome is caused by mutations in the TAZ (tafazzin) gene on human chromosome Xq28. The human tafazzin gene produces four major mRNA splice variants; two of which have been shown to be functional (TAZ lacking exon 5 and full-length) in complementation studies with yeast and Drosophila. This study characterizes the multiple alternative splice variants of TAZ mRNA and their proportions in blood samples from a cohort of individuals with Barth syndrome (BTHS). Because it has been reported that collection and processing methods can affect the expression of various genes, we tested and chose a stabilizing medium for collecting, shipping and processing of the blood samples of these individuals. In both healthy controls and in BTHS individuals, we found a greater variety of alternatively spliced forms than previously described, with a sizeable proportion of minor splice variants besides the four dominant isoforms. Individuals with certain exonic and intronic splice mutations produce additional mutant mRNAs that could be translated into two or more proteins with different amino acid substitutions in a single individual. A fraction of the minor splice variants is predicted to be non-productive.
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Affiliation(s)
- Susan M Kirwin
- Molecular Diagnostics Laboratory, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
| | - Athena Manolakos
- Molecular Diagnostics Laboratory, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Sarah Swain Barnett
- Molecular Diagnostics Laboratory, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Iris L Gonzalez
- Molecular Diagnostics Laboratory, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
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Cabana MD, Kunselman SJ, Nyenhuis SM, Wechsler ME. Researching asthma across the ages: insights from the National Heart, Lung, and Blood Institute's Asthma Network. J Allergy Clin Immunol 2014; 133:27-33. [PMID: 24369796 PMCID: PMC3901784 DOI: 10.1016/j.jaci.2013.10.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 09/09/2013] [Revised: 10/14/2013] [Accepted: 10/15/2013] [Indexed: 11/24/2022]
Abstract
Clinical asthma studies across different age groups (ie, cross-age studies) can potentially offer insight into the similarities, differences, and relationships between childhood and adult asthma. The National Institutes of Health's Asthma Research Network (AsthmaNet) is unique and innovative in that it has merged pediatric and adult asthma research into a single clinical research network. This combination enhances scientific exchange between pediatric and adult asthma investigators and encourages the application of cross-age studies that involve participants from multiple age groups who are generally not studied together. The experience from AsthmaNet in the development of cross-age protocols highlights some of the issues in the evaluation of cross-age research in asthma. The aim of this review is to summarize these challenges, including the selection of parallel cross-age clinical interventions, identification of appropriate controls, measurement of meaningful clinical outcomes, and various ethical and logistic issues.
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Affiliation(s)
- Michael D Cabana
- Departments of Pediatrics, Epidemiology, and Biostatistics and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, Calif.
| | | | - Sharmilee M Nyenhuis
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois Hospital and Health Sciences System, Chicago, Ill
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Peters SP, Bleecker ER, Kunselman SJ, Icitovic N, Moore WC, Pascual R, Ameredes BT, Boushey HA, Calhoun WJ, Castro M, Cherniack RM, Craig T, Denlinger LC, Engle LL, Dimango EA, Israel E, Kraft M, Lazarus SC, Lemanske RF, Lugogo N, Martin RJ, Meyers DA, Ramsdell J, Sorkness CA, Sutherland ER, Wasserman SI, Walter MJ, Wechsler ME, Chinchilli VM, Szefler SJ. Predictors of response to tiotropium versus salmeterol in asthmatic adults. J Allergy Clin Immunol 2013; 132:1068-1074.e1. [PMID: 24084072 DOI: 10.1016/j.jaci.2013.08.003] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 08/09/2013] [Accepted: 08/12/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Tiotropium has activity as an asthma controller. However, predictors of a positive response to tiotropium have not been described. OBJECTIVE We sought to describe individual and differential responses of asthmatic patients to salmeterol and tiotropium when added to an inhaled corticosteroid, as well as predictors of a positive clinical response. METHODS Data from the double-blind, 3-way, crossover National Heart, Lung, and Blood Institute's Asthma Clinical Research Network's Tiotropium Bromide as an Alternative to Increased Inhaled Glucocorticoid in Patients Inadequately Controlled on a Lower Dose of Inhaled Corticosteroid (ClinicalTrials.gov number, NCT00565266) trial were analyzed for individual and differential treatment responses to salmeterol and tiotropium and predictors of a positive response to the end points FEV1, morning peak expiratory flow (PEF), and asthma control days (ACDs). RESULTS Although approximately equal numbers of patients showed a differential response to salmeterol and tiotropium in terms of morning PEF (n = 90 and 78, respectively) and ACDs (n = 49 and 53, respectively), more showed a differential response to tiotropium for FEV1 (n = 104) than salmeterol (n = 62). An acute response to a short-acting bronchodilator, especially albuterol, predicted a positive clinical response to tiotropium for FEV1 (odds ratio, 4.08; 95% CI, 2.00-8.31; P < .001) and morning PEF (odds ratio, 2.12; 95% CI, 1.12-4.01; P = 0.021), as did a decreased FEV1/forced vital capacity ratio (FEV1 response increased 0.39% of baseline for every 1% decrease in FEV1/forced vital capacity ratio). Higher cholinergic tone was also a predictor, whereas ethnicity, sex, atopy, IgE level, sputum eosinophil count, fraction of exhaled nitric oxide, asthma duration, and body mass index were not. CONCLUSION Although these results require confirmation, predictors of a positive clinical response to tiotropium include a positive response to albuterol and airway obstruction, factors that could help identify appropriate patients for this therapy.
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Abstract
This paper describes ongoing National, Heart, Lung, and Blood Institute (NHLBI)-initiated childhood obesity research. It calls on clinicians, researchers, and cardiologists to work with other healthcare providers, community agencies, schools and caregivers to foster better cardiovascular health in children by intervening on multiple levels of influence on childhood obesity.
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Affiliation(s)
- Charlotte A Pratt
- Clinical Applications and Prevention Branch, Prevention and Population Sciences Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
| | - Sonia Arteaga
- Clinical Applications and Prevention Branch, Prevention and Population Sciences Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Catherine Loria
- Clinical Applications and Prevention Branch, Prevention and Population Sciences Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
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Li X, Hawkins GA, Ampleford EJ, Moore WC, Li H, Hastie AT, Howard TD, Boushey HA, Busse WW, Calhoun WJ, Castro M, Erzurum SC, Israel E, Lemanske RF, Szefler SJ, Wasserman SI, Wenzel SE, Peters SP, Meyers DA, Bleecker ER. Genome-wide association study identifies TH1 pathway genes associated with lung function in asthmatic patients. J Allergy Clin Immunol 2013; 132:313-20.e15. [PMID: 23541324 DOI: 10.1016/j.jaci.2013.01.051] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [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: 09/24/2012] [Revised: 12/18/2012] [Accepted: 01/18/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recent meta-analyses of genome-wide association studies in general populations of European descent have identified 28 loci for lung function. OBJECTIVE We sought to identify novel lung function loci specifically for asthma and to confirm lung function loci identified in general populations. METHODS Genome-wide association studies of lung function (percent predicted FEV1 [ppFEV1], percent predicted forced vital capacity, and FEV1/forced vital capacity ratio) were performed in 4 white populations of European descent (n = 1544), followed by meta-analyses. RESULTS Seven of 28 previously identified lung function loci (HHIP, FAM13A, THSD4, GSTCD, NOTCH4-AGER, RARB, and ZNF323) identified in general populations were confirmed at single nucleotide polymorphism (SNP) levels (P < .05). Four of 32 loci (IL12A, IL12RB1, STAT4, and IRF2) associated with ppFEV1 (P < 10(-4)) belong to the TH1 or IL-12 cytokine family pathway. By using a linear additive model, these 4 TH1 pathway SNPs cumulatively explained 2.9% to 7.8% of the variance in ppFEV1 values in 4 populations (P = 3 × 10(-11)). Genetic scores of these 4 SNPs were associated with ppFEV1 values (P = 2 × 10(-7)) and the American Thoracic Society severe asthma classification (P = .005) in the Severe Asthma Research Program population. TH2 pathway genes (IL13, TSLP, IL33, and IL1RL1) conferring asthma susceptibility were not associated with lung function. CONCLUSION Genes involved in airway structure/remodeling are associated with lung function in both general populations and asthmatic subjects. TH1 pathway genes involved in anti-virus/bacterial infection and inflammation modify lung function in asthmatic subjects. Genes associated with lung function that might affect asthma severity are distinct from those genes associated with asthma susceptibility.
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Affiliation(s)
- Xingnan Li
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
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McCarron DA. NHLBI's conflict of interest: why we need the Data Quality Act. Am J Hypertens 2003; 16:789-91. [PMID: 12944040 DOI: 10.1016/s0895-7061(03)00964-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Affiliation(s)
- C C Seltzer
- Harvard University, Cambridge, Massachusetts 02138, USA
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Cohen S. Tangled lifeline. Washington Post 1996:10-15, 26-32. [PMID: 11647686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Nelson HL. Hope in our hearts. Hastings Cent Rep 1994; 24:2-3. [PMID: 8045763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Tangrea JA, Adrianza ME, Helsel WE. Patients' perceptions on participation in a cancer chemoprevention trial. Cancer Epidemiol Biomarkers Prev 1992; 1:325-30. [PMID: 11656233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
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21
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Affiliation(s)
- H Buchwald
- Department of Surgery, University of Minnesota Medical School, Minneapolis 55455
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The process of evaluating the artificial heart. Hastings Cent Rep 1986; 16:27-8. [PMID: 3804726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Jonsen AR. The artificial heart's threat to others. Hastings Cent Rep 1986; 16:9-11. [PMID: 3082803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A member of the two federal advisory panels on artificial hearts reflects that the nuclear-powered artificial heart, had it been developed, would have posed a physical threat to others. Today's artificial heart poses a different threat. Because of the high costs, many people may be deprived of access to other forms of medical care and other social goods.
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Augustin GC. Ethical issues related to the artificial heart. J Relig Health 1986; 25:177-87. [PMID: 16127860 DOI: 10.1007/bf01534013] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This paper is a general survey of ethical issues related to the artificial heart. It begins by looking at the history of funding of the artificial heart program through the National Institute of Health in 1965. Attention is paid to the problem of the lack of planning related to social, ethical, economic, and legal implications. The paper then deals with three areas of ethical concerns. They are those issues relating to the experimental versus therapeutic benefits, the cost, and public involvement with a private interest.
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The beta-blocker heart attack trial. beta-Blocker Heart Attack Study Group. JAMA 1981; 246:2073-4. [PMID: 7026815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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