Genetic Testing in Familial Hypercholesterolemia: Is It for Everyone?

PURPOSE OF REVIEW

Lipid measurements and genetic testing are the main diagnostic tools for FH screening that are available in many countries. A lipid profile is widely accessible, and genetic testing, although available worldwide, in some countries is only performed in a research context. Still FH is diagnosed late, showing lack of early screening programs worldwide.

RECENT FINDINGS

Pediatric screening of FH was recently recognized by the European Commission Public Health Best Practice Portal as one on the best practices in non-communicable disease prevention. The early diagnosis of FH and the lowering of LDL-C values over lifespan can reduce the risk of coronary artery disease and offer health and socioeconomic gains. Current knowledge about FH shows that early detection through appropriate screening needs to become a priority in healthcare systems worldwide. Governmental programs for FH identification should be implemented to unify the diagnosis and increase patient identification.

Sexual dimorphism in Kinosternon scorpioides (Linnaeus, 1766) from the Brazilian Amazon

The sexual dimorphism of the Kinosternon scorpioides was evaluated using two different techniques (linear and geometric morphometry) from images and linear measurements of the carapace and plastron of adults (male and female). Linear morphometry indicated that the height and width of carapace and plastron are statistically different between sexes, with females being wider and taller. In the evaluation of geometric morphometry, ANOVA demonstrated variation in the size of the plastron and the shape of the carapace and plastron, expressing a tendency in shape for each sex. Sexual dimorphism, therefore, is verified for this species, notably by the plastron. This study indicates an additional tool for the phenotypic knowledge of animals, contributing to the study of threatened populations.

Factors associated with extubation failure in very low birth weight infants: a cohort study in the northeast Brazil

OBJECTIVES

Identifying and understanding the main risk factors associated with extubation failure of very low birthweight (VLBW) infants in different populations can subsequently help in establishing better criteria while taking decision of extubation. The aim of the study was to identify factors associated with extubation failure in VLBW infants.

METHODS

A cohort study of VLBW infants who underwent their first extubation between April 2018 and December 2019 in a Neonatal Intensive Care Unit, Alagoas, Brazil, were included in this study. Extubation failure was defined as reintubation within seven days of extubation. Relative risks of predictive variables different between the extubation success group (ES) and extubation failure group (EF) were estimated with a robust Poisson regression model.

RESULTS

Out of the 112 infants included, 26 (23%) cases exhibited extubation failure. Extremely low birth weight (RR 2.55, 95% CI 1.07, 6.06), mechanical ventilation duration for first extubation greater than seven days (RR 2.66, 95% CI 1.10, 6.45), vaginal delivery (RR 2.07, 95% CI 1.03, 4.18) and maternal chorioamnionitis (RR 4.89, 95% CI 1.26-18.98) remained independently associated with extubation failure. EF had a significant greater need for respiratory support, longer oxygen therapy duration, more bronchopulmonary dysplasia (BPD) and longer length of hospital stay, even when adjusted for confounding variables.

CONCLUSIONS

Extremely low birth weight infants needing mechanical ventilation, wherein the duration for first extubation was longer than seven days, with vaginal delivery and maternal chorioamnionitis failed more frequently at the first attempt of extubation. And this failure increased the risk of BPD and the length of hospital stay.

Genotype x environment interaction on experimental hybrids of chili pepper

In Brazil, cultivation of hybrid plants comprise near 40% of the area grown with vegetables. For Capsicum, hybrids of bell and chili peppers have already exceeded 50% and over 25% of all are commercialized seeds. This study aimed to evaluate new pepper hybrids in two environments, Cáceres, MT, and Campos dos Goytacazes, RJ, Brazil. Nine experimental hybrids of C. baccatum var. pendulum were tested and trials were performed in a randomized block design, with three replications and eight plants per plot. In each environment, plants were assessed for canopy diameter, plant height, number of fruit per plant, mean fruit mass per plant, fruit length and diameter, pulp thickness, and content of soluble solids. Seven of the eight traits have differed significantly due to environment variation. Furthermore, genotype and environment interaction was highly significant for number of fruit per plant, mean fruit mass per plant, fruit length, and fruit diameter. Choosing a hybrid to be grown in one of the studied locations must be in accordance with the sought characteristics since there is a complex interaction for some studied traits.

Molecular and agronomic analysis of intraspecific variability in Capsicum baccatum var. pendulum accessions

Capsicum baccatum is one of the most important chili peppers in South America, since this region is considered to be the center of origin and diversity of this species. In Brazil, C. baccatum has been widely explored by family farmers and there are different local names for each fruit phenotype, such as cambuci and dedo-de-moça (lady's finger). Although very popular among farmers and consumers, C. baccatum has been less extensively studied than other Capsicum species. This study describes the phenotypic and genotypic variability in C. baccatum var. pendulum accessions. Twenty-nine accessions from the Universidade Estadual do Norte Fluminense Darcy Ribeiro gene bank, and one commercial genotype ('BRS-Mari') were evaluated for 53 morphoagronomic descriptors (31 qualitative and 22 quantitative traits). In addition, accessions were genotyped using 30 microsatellite primers. Three accessions from the C. annuum complex were included in the molecular characterization. Nine of 31 qualitative descriptors were monomorphic, while all quantitative descriptors were highly significant different between accessions (P < 0.01). Using the unweighted pair group method using arithmetic averages, four groups were obtained based on multicategoric variables and five groups were obtained based on quantitative variables. In the genotyping analysis, 12 polymorphic simple sequence repeat primers amplified in C. baccatum with dissimilarity between accessions ranging from 0.13 to 0.91, permitting the formation of two distinct groups for Bayesian analysis. These results indicate wide variability among the accessions comparing phenotypic and genotypic data and revealed distinct patterns of dissimilarity between matrices, indicating that both steps are valuable for the characterization of C. baccatum var. pendulum accessions.

Occurrence and use of an estuarine habitat by giant manta ray Manta birostris

Based on the knowledge of local artisanal fishermen and on direct observations, this study presents evidence that the giant manta ray Manta birostris uses the Paranaguá estuarine complex in south Brazil, south-western Atlantic Ocean, in a predictable seasonal pattern. Behavioural observations suggest that the estuary can act as a nursery ground for M. birostris during the summer.

Genetic divergence among African cowpea lines based on morphoagronomic traits

The aim of this study was to estimate the genetic divergence between African cowpea lines from the Cowpea Germplasm Bank of Embrapa Meio-Norte, Brazil. The morphoagronomic diversity of 57 cowpea lines was assessed using multivariate analysis. The germplasm was evaluated in August 2009 using a randomized block design with three replications based on the following traits: number of pods per peduncle, pod length (PL), number of grains per pod (NGP), grain length (GRL), grain width, 100-grain weight (W100G), and yield. The heritability values of the traits PL, NGP, GRL, and W100G were all higher than 70%, indicating the possibility of genetic progress with selection. The crosses between the lines IT82D-889 and IT89KD-245, IT85F-1380 and IT89KD-245, and IT89KD-245 and IT98K-1092-1 could result in promising genetic combinations. The characteristics that contributed most to genetic divergence were W100G (49.7%), PL (16.7%), GRL (12.0%), and NGP (9.7%).

Update of the Portuguese Familial Hypercholesterolaemia Study

The main aim of the Portuguese Familial Hypercholesterolaemia Study is to identify the genetic cause of hypercholesterolaemia in individuals with a clinical diagnosis of Familial Hypercholesterolaemia (FH). A total of 1340 blood samples were collected from 482 index patients and 858 relatives with the collaboration of clinicians from several hospitals all over the country. The genetic diagnosis of FH in this study is based on the analyses of three genes: LDLR, APOB and PCSK9. In the last 10 years, the Portuguese FH Study identified a genetic defect in a total of 171 index patients, corresponding to an overall of 48% of the total received cases with clinical diagnosis of FH. Although the Simon Broome FH register criteria have been adapted to our study, 59 patients that did not fulfil all criteria were included in the study and a mutation causing disease was identified in 8 of these patients. In the LDLR gene were found 80 different mutations in 165 unrelated index patients: 159 heterozygous, 3 compounds heterozygous and 3 true homozygous. The APOB p.Arg3527Gln and the PCSK9 p.Asp374His mutation were not found in any of our patients since our last report, but a novel mutation in the APOB gene, predicted to cause a single amino acid substitution p.Tyr3560Cys, was found in one patient. The cascade screening in relatives of these 171 index patients allowed the identification and genetic characterization of a total of 404 FH patients in Portugal.

Molecular diagnosis of familial hypercholesterolemia: an important tool for cardiovascular risk stratification

Familial hypercholesterolemia (FH) is associated with an increased risk of premature coronary heart disease. Molecular identification of these patients can reduce the burden of mortality from cardiovascular disorders simply by the correct identification of the disease early in life, followed by counseling and appropriate lifestyle modifications, and therapeutic measures when required. Recent studies show that, in Portugal, this disease is severely under-diagnosed. After more than 10 years of research through the Portuguese FH Study, it is now possible to translate the original research results into clinical application.

AIMS

The main aims of the present work were to determine whether clinical characterization is sufficient to identify these individuals at high risk of developing CHD and to evaluate the clinical applicability of molecular diagnosis for FH.

METHODS

All patients described in this study were recruited for the Portuguese FH Study. The diagnostic criteria used to select the index patients were adapted from the Simon Broome Heart Research Trust. To analyze the usefulness of the molecular diagnosis, graphs of total and LDL cholesterol values by age were constructed for 622 possible FH patients. The lipid profile of patients genetically identified as having FH, before and under medication, were analyzed to assess whether these patients were receiving appropriate treatment. The data are shown separately for children and adults and for female and male propositi (index cases and hypercholesterolemic relatives), both with and without a detectable mutation in the LDLR gene.

RESULTS

The Portuguese FH Study has already genetically identified 404 individuals (171 index patients and 233 relatives) among more than one thousand individuals sent for study. A total of 78 different mutations in the LDLR gene were found in 171 index patients, 2 different mutations were found in the apoB gene of 4 patients and 2 patients had a unique PCSK9 mutation. Statistical analysis revealed that there are significant differences between total cholesterol (p < 0.001) and apoB (p = 0.026) values in the group of children (male and female) with and without a mutation in LDLR. For female children LDL values were also significantly different (p < 0.001) between subgroups but for male children this difference did not reach statistical significance. In adult women there is a statistically significant difference for total cholesterol (p = 0.049), LDL cholesterol (p = 0.031) and apoB (p = 0.003) values in the subgroups with and without a LDLR mutation. In adult males there is a statistical difference for total cholesterol (p = 0.002). LDL cholesterol (p = 0.003) and apoB (p = 0.0023) in subgroups with and without an LDLR mutation. Nevertheless there was considerable dispersion of values and individually it is not possible to distinguish between patients with and without a mutation in the LDLR gene, based only on lipid profile.

CONCLUSIONS

By analysis of the clinical data of 696 possible FH patients, the present report shows evidence that clinical characterization is not sufficient to distinguish between patients with genetic or environmental dyslipidemia, and so molecular diagnosis is useful in clinical practice, allowing correct identification of FH patients and their relatives, and the early implementation of therapeutic measures to reduce the elevated cardiovascular risk of these patients. In general, molecular diagnosis of FH is feasible and could be obtained in 1-2 months if the technology is available. In Portugal the test will be offered to the population by our Institute at a cost of about 500 euros, like many other genetic tests or exams such as nuclear magnetic resonance.

Familial hypercholesterolaemia in Portugal

Familial hypercholesterolaemia (FH) is characterised clinically by an increased level of circulating LDL cholesterol that leads to lipid accumulation in tendons and arteries, premature atherosclerosis and increased risk of coronary heart disease (CHD). Although Portugal should have about 20,000 cases, this disease is severely under-diagnosed in our country, this being the first presentation of Portuguese data on FH. A total of 602 blood samples were collected from 184 index patients and 418 relatives from several centres throughout Portugal. Fifty-three different mutations were found in 83 index patients, 79 heterozygous and 4 with two defective LDLR alleles. Additionally, 4 putative alterations were found in 8 patients but were not considered mutations causing disease, mainly because they did not co-segregate with hypercholesterolaemia in the families. Three unrelated patients were found to be heterozygous for the APOB(3500) mutation and two unrelated patients were found to be heterozygous for a novel mutation in PCSK9, predicted to cause a single amino acid substitution, D374H. Cascade screening increased the number of FH patients identified genetically to 204. The newly identified FH patients are now receiving counselling and treatment based on the genetic diagnosis. The early identification of FH patients can increase their life expectancy and quality of life by preventing the development of premature CHD if patients receive appropriate pharmacological treatment.

Evaluation of skin sensitization response of dialkyl (C6-C13) phthalate esters

Isolated case reports suggest that dermal contact with some phthalate esters may result in skin sensitization. This issue was investigated in guinea pig sensitization tests, but the results were inconclusive. Consequently, 7 dialkyl phthalate esters, (diisohexyl, diisoheptyl, di(2-ethylhexyl), diisononyl, diisodecyl, diundecyl and ditridecyl phthalates), ranging in carbon number from C6 to C13, were tested in a 104-person panel human repeated insult patch test (HRIPT) using the modified Draize procedure. Test concentrations of 100% were selected for the induction and challenge phases of the HRIPT based upon a 24-h occluded irritation test on 15 panelists. Under the conditions of this HRIPT, no evidence of dermal irritation or sensitization for any of the 7 phthalate esters was observed in the 104-person panel. These HRIPT data provide evidence for the lack of experimental skin sensitization potential for the phthalate esters tested.

Potential biomarkers of benzene exposure

Biological markers or biomarkers of exposure are indicators for the evaluation of the internal dose of a xenobiotic. Biomarkers integrate exposure from all routes and sources. This review presents a short overview of potential biomarkers of benzene exposure currently under investigation, the methodology used for their determination, and experimental findings and their usefulness and specificity in assessing exposure to benzene. Potential biomarkers of benzene exposure are benzene, benzene metabolites, and adducts formed by reactive benzene metabolites with cellular constituents. The potential biomarkers of benzene exposure described in this review are: (1) benzene, the parent hydrocarbon; (2) ring-hydroxylated urinary metabolites, phenol, catechol, hydroquinone, and 1,2,4-trihydroxybenzene; (3) trans,trans-muconic acid, a urinary ring-opened metabolite; (4) N-acetyl-S-(2,5-dihydroxyphenyl)-L-cysteine, a urinary metabolite of benzene, phenol, and hydroquinone; (5) S-phenylmercapturic acid, a glutathione-derived adduct; (6) N7-phenylguanine, a DNA adduct; and (7) S-phenylcysteine and N-phenyl-valine, hemoglobin/protein-derived adducts.

DNA bioprints: simple nonisotopic DNA fingerprints with biotinylated probes

The discovery of multilocal DNA fingerprinting represented a revolution in criminal identification and paternity testing. However, for routine use in clinical laboratories, the standard DNA fingerprint methodology is too complex. We have been successful in the development of a simplified DNA nonisotopic fingerprinting system using biotin-labeled probes which we have called DNA bioprints. To achieve this we explored three main technical features: utilization of biotinylated nonradioactive probes as a simpler substitute for 32P-labeled probes, utilization of oligonucleotide probes as a simpler substitute for recombinant probes, and direct hybridization in the dried agarose gel as a simpler substitute for Southern blots. In this article we review our results in the development of DNA bioprints.