Genetic preservation of SLC22A3 in the Admixed and Xhosa populations living in the Western Cape

BACKGROUND

Amphiphilic solute facilitator organic cation transporters mediate the movement of various endogenous and exogenous organic cations, including crucial drugs like metformin, oxaliplatin, and lamivudine. These transporters are now seen as a potential explanation for inter-individual differences in drug effectiveness, contributing to 15-30% of such variability due to genetic factors.The aim of this study was to determine the baseline minor allele frequency distribution of 18 known coding SNPs in the SLC22A3 gene of 278 Cape Admixed (130) and Xhosa (148) individuals residing in Cape Town, South Africa.

METHODS

A convenience sampling method was used for sample collection. DNA extraction and subsequent amplification of target sites was carried out according to standard established methodologies. All genotyping was performed using the SNaPshot™ mini-seuqencing platform.

RESULTS

This study found no genetic polymorphisms in the coding region of the SLC22A3 gene of both the Xhosa and Cape Admixed individuals investigated.

CONCLUSION

This study has shown that SLC22A3 coding SNPs observed in other populations are absent in the sample of both Cape Admixed and Xhosa individuals studied. The lack of protein sequence variation was consistent with other studies and may reflect the significant physiological role of human organic cation transporter 3 in maintaining cellular and organismal homeostasis.

Lessons learned from the translation of the Internalised Stigma of Mental Illness (ISMI) scale into isiXhosa for use with South African Xhosa people with schizophrenia

Internalised stigma is highly prevalent among people with mental illness. This is concerning because internalised stigma is often associated with negative consequences affecting individuals' personal, familial, social, and overall wellbeing, employment opportunities and recovery. Currently, there is no psychometrically validated instrument to measure internalised stigma among Xhosa people in their home language. Our study aimed to translate the Internalised Stigma of Mental Illness (ISMI) scale into isiXhosa. Following WHO guidelines, the ISMI scale was translated using a five-stage translation design which included (i) forward-translation, (ii) back-translation, (iii) committee approach, (iv) quantitative piloting, and (v) qualitative piloting using cognitive interviews. The ISMI isiXhosa version (ISMI-X) underwent psychometric testing to establish utility, within-scale validity, convergent, divergent, and content validity (assessed using frequency of endorsements and cognitive interviewing) with n = 65 Xhosa people with schizophrenia. The resultant ISMI-X scale demonstrated good psychometric utility, internal consistency for the overall scale (α = .90) and most subscales (α > .70, except the Stigma Resistance subscale where α = .57), convergent validity between the ISMI Discrimination Experiences subscale and the Discrimination and Stigma (DISC) scale's Treated Unfairly subscale (r = .34, p = .03) and divergent validity between the ISMI Stigma Resistance and DISC Treated Unfairly subscales (r = .13, p = .49). But more importantly the study provides valuable insights into strengths and limitations of the present translation design. Specifically, validation methods such as assessing frequency of endorsements of scale items and using cognitive interviewing to establish conceptual clarity and relevance of items may be useful in small piloting sample sizes.

Description of the cross-cultural process adopted in the STRiDE (STrengthening Responses to dementia in DEveloping countries) program: A methodological overview

Cross-cultural adaptation is an important part of using validated questionnaires across countries and settings. Here we describe the cross-cultural process adopted in the STRiDE (STrengthening Responses to dementia in DEveloping countries) program. We adopted a cross-cultural adaptation process including forward translation, back translations, and cognitive interviews of the STRiDE toolkit. In total, 50 older adults and 41 carers across sites in Indonesia and South Africa participated in cognitive interviews; field notes and verbatim quotes are reported. We describe the cross-cultural adaptation process of the STRiDE toolkit. During the process, issues were identified with the translated toolkit, including aspects related to cultural appropriateness, terminology equivalence, and timings. The data demonstrate that a rigorous, yet pragmatic, cross-cultural adaptation process can be achieved even with limited resources. Our process should help the design and conduct of future dementia research in various contexts.

Self-identification, mode of diagnosis and treatment, and perceptions of relationships with medical providers of South African Xhosa-speaking traditional healers

There is widespread use of traditional medicine in treating common mental disorders in South Africa. We aimed to (i) explore the self-identification of traditional healers (THs; how they refer to themselves, e.g., as healer, spiritualist, sangoma, etc.); (ii) determine if different types of THs treat different conditions (physical/psychological) or use different modes of diagnosis and treatment; (iii) identify factors that influence the willingness of THs to refer patients to biomedical hospitals; and (iv) compare TH practices between two provinces. Participants included Xhosa-speaking THs (mean age = 54.10, SD = 13.57 years) from the Western (n = 50) and Eastern (n = 68) Cape provinces. Participants completed a questionnaire regarding self-identification, mode of diagnosis/treatment, relationship with biomedical hospitals, type of condition(s) treated, and a Patient Health Questionnaire. There were significant associations between the type of TH (as self-identified) and (i) mode of diagnosis, (ii) mode of treatment, and (iii) type of condition(s) treated. Spiritualists, male THs, and THs who had previously been hospitalised for a mental disorder were more likely to treat mental disorders. THs who had previously been hospitalised for mental disorders were more likely to report a willingness to refer patients to biomedical hospitals. Findings highlight the complex practices of Xhosa-speaking THs. Collaboration between THs and mental health care professionals could be facilitated by focusing on male THs, spiritualists, and THs who have previously been hospitalised for mental illness. Future research should provide clearer operational definitions of the type of TH included.

Becoming a Xhosa traditional healer: The calling, illness, conflict and belonging

Background

Traditional healers (THs) are an important part of the healthcare system in sub-Saharan Africa. Understanding their training, experiences of becoming healers and their perceived roles in society is critical.

Aim

This study aimed to explore the experience of becoming a TH, including accepting the calling, and sheds light on how the experience is conceptualised within the cultural and communitarian context of THs.

Setting

This study was conducted amongst Xhosa THs in the Western Cape, South Africa.

Methods

In-depth phenomenological interviews (n = 4) were conducted with Xhosa THs and analysed using Giorgi's descriptive pre-transcendental Husserlian phenomenological analysis.

Results

The experience of becoming a TH can be summarised in the context of three units of significance: (1) the gift of healing as an illness; (2) the experience of conflict (including with their families, the church and self-conflict); and (3) the experience of belonging. Familial conflict, specifically, was fuelled by the financial burden of becoming a TH and a lack of understanding of the process.

Conclusion

To develop a workable model of collaboration in the future, it is crucial that mental healthcare providers develop a better understanding of the experiences of THs in becoming care providers. The findings highlight an appreciation of the challenging process of becoming a TH. Finally, further research and culturally appropriate psychoeducation can provide trainee THs and their family members with the skills and knowledge to support each other through a difficult process.

Exploring values among three cultures from a global bioethics perspective

The United Nations Educational, Scientific and Cultural Organisation's (UNESCO) Declaration on Bioethics and Human Rights refers to the importance of cultural diversity and pluralism in ethical discourse and care of humanity. The aim of this meta-narrative review is to identify indigenous ethical values pertaining to the Ojibway (Canada), Xhosa (South Africa), and Mayan (Mexico and Central American) cultures from peer-reviewed sources and cultural review, and to ascertain if there are shared commonalities. Three main themes were identified, namely illness, healing, and health care choices. Illness was described with a more complex and dynamic picture than from the western view, as illness is not considered to be one dimensional. Healing needs to take place on various levels in order to restore a state of equilibrium between the different spheres. Health care choices were also considered from a multi-level perspective. In all three of the indigenous cultures explored, good decision-making is seen to have occurred when choices are informed by commitments to one's moral and ethical responsibilities towards the community, nature, and the spirit world.

Translation of the Adult Attention-Deficit/Hyperactivity Disorder Self-Report Scale into an African Language: An Exploratory Study

BACKGROUND

Attention-Deficit/Hyperactivity Disorder (ADHD) is commonly perceived as a cultural construct due to its disproportionate global representation, however limited data is available from Africa. Standardisation of screening tools in epidemiological studies is essential for global prevalence comparison, but tools such as the Adult ADHD Self-Report Scale (ASRS) have not been translated into African languages.

OBJECTIVE

To assess the translation process followed in attempting to adapt the ASRS into an indigenous African language widely spoken within South Africa for cross-cultural research.

METHOD

Xhosa was selected as an appropriate target language for translation. An exploratory approach was used to assess linguistic considerations for adaptation of the ASRS. Blind translation was applied by two independent bilingual translators. A translational studies expert translated the ASRS into Xhosa. The translated document was back-translated into English by a bilingual pharmacist.

KEY FINDINGS

Side-by-side comparison of the original and back-translated English versions revealed 13 content queries. Each query was discussed with the back translator, revealing common themes which complicated the effective Xhosa ASRS translation. Appropriate contextualisation of questions and removal or explanation of idiomatic terms were identified as key requirements to improve properties for Xhosa translation.

CONCLUSION

Suitability of the original instrument for Xhosa translation was problematic and further investigation into appropriate cross-cultural translation techniques is needed to improve ASRS translation properties and assess its Xhosa translation. Development of a suitable Xhosa version of the ASRS is considered to be an important step towards broadening the scope of ADHD research in South Africa.

Are plants used in the Eastern Cape province for cosmetics fully commercialized?

Plants have been used for years for various cosmetic purposes. In the Eastern Cape province of South Africa, a large proportion of the population reliant (to some extent) on botanical resources for beauty and health. Despite the use of these botanical resources for various cosmetic purposes, only a few have been fully commercialized or used as ingredients in cosmetic formulation. The present study aimed to review plant species that are fully explored commercially for cosmetic products in the Eastern Cape province. A survey of cosmetic products with plant-based ingredients was done covering the major supermarkets (SPAR, Shoprite, and Pick n Pay), cosmetic shops (Clicks), and pharmacies in the Eastern Cape province, and electronic databases including Embase, Google Scholar, Medline, PubMed, Scopus, SciFinder^®, Springer, Science Direct, and Web of Science were used as data sources for ethnobotanical information. Surprisingly, out of 150 plant species used by both Xhosa men and women for various cosmeceutical purposes, only six plant species have been used commercially with regard to cosmeceutical application. These plants species belong to five major plant families, namely Lamiaceae (two species), Asphodelaceae (one species) Cucurbitaceae (one species), Oleaceae (one species), and Verbenaceae (one species). The findings revealed that the use of Eastern Cape plants for cosmetic purposes has not been fully explored commercially. Thus, there is a need for cosmeceutical industries to explore these species commercially in order to develop new possible cosmetic products for local and international markets.

Predictors of consent to cell line creation and immortalisation in a South African schizophrenia genomics study

Background

Cell line immortalisation is a growing component of African genomics research and biobanking. However, little is known about the factors influencing consent to cell line creation and immortalisation in African research settings. We contribute to addressing this gap by exploring three questions in a sample of Xhosa participants recruited for a South African psychiatric genomics study: First, what proportion of participants consented to cell line storage? Second, what were predictors of this consent? Third, what questions were raised by participants during this consent process?

Methods

760 Xhose people with schizophrenia and 760 controls were matched to sex, age, level of education and recruitment region. We used descriptive statistics to determine the proportion of participants who consented to cell line creation and immortalization. Logistic regression methods were used to examine the predictors of consent. Reflections from study recruiters were elicited and discussed to identify key questions raised by participants about consent.

Results

Approximately 40% of participants consented to cell line storage. The recruiter who sought consent was a strong predictor of participant’s consent. Participants recruited from the South African Eastern Cape (as opposed to the Western Cape), and older participants (aged between 40 and 59 years), were more likely to consent; both these groups were more likely to hold traditional Xhosa values. Neither illness (schizophrenia vs control) nor education (primary vs secondary school) were significant predictors of consent. Key questions raised by participants included two broad themes: clarification of what cell immortalisation means, and issues around individual and community benefit.

Conclusions

These findings provide guidance on the proportion of participants likely to consent to cell line immortalisation in genomics research in Africa, and reinforce the important and influential role that study recruiters play during seeking of this consent. Our results reinforce the cultural and contextual factors underpinning consent choices, particularly around sharing and reciprocity. Finally, these results provide support for the growing literature challenging the stigmatizing perception that people with severe mental illness are overly vulnerable as a target group for heath research and specifically genomics studies.

Electronic supplementary material

The online version of this article (10.1186/s12910-018-0313-2) contains supplementary material, which is available to authorized users.

Effect of the African-specific promoter polymorphisms on the SLC22A2 gene expression levels

BACKGROUND

Single nucleotide polymorphisms in promoter regions have been shown to alter the transcription of genes. Thus, SNPs in SLC22A2 can result in inter-individual variable response to medication.

METHODS

The objective of the study was to investigate the effect of the African-specific promoter polymorphisms on the SLC22A2 gene expression levels in vitro. These included rs572296424 and rs150063153, which have been previously identified in the Xhosa population of South Africa. The promoter region (300 bp) for the two haplotypes was cloned into the pGLOW promoterless GFP reporter vector. The GFP expression levels of each haplotype was determined in the HEK293 cells using a GlowMax Multi-Detection E7031 luminometer in the form of light emission.

RESULTS

The relative promoter activity suggests that no significant variation exists between the expression levels of the WT and -95 haplotypes and the -95 and -156 haplotypes (p=0.498). However, the relative promoter activity of the WT haplotype in comparison to the -156 haplotype displayed a significant difference in expression level (p=0.016).

CONCLUSIONS

The data presented here show that the African-specific promoter polymorphisms can cause a decrease in the SLC22A2 gene expression levels in vitro, which in turn, may influence the pharmacokinetic profiles of cationic drugs.

Association between pro-inflammatory alleles and allergic phenotypes in Xhosa adolescents

BACKGROUND

Significant differences exist in the prevalence, spectrum, and severity of allergic diseases between developing and developed countries and between subpopulations within single countries. These discrepancies likely result from a complex interaction between genetic and environmental factors. However, the precise nature of the contribution of ethnicity to genetic differences in the predisposition to allergic disease is not yet fully understood. In particular, there is a paucity of literature regarding the genetic determinants of allergic disease in people of black African origin with little or no genetic admixture.

OBJECTIVE

We aimed to analyze associations between 27 single nucleotide polymorphisms (SNPs) and allergy phenotypes in the local Xhosa population.

METHODS

A convenience sample of 213 Xhosa teenagers was enrolled at a local high school. Phenotypic data were collected in the form of a symptom questionnaire, skin prick tests for common food and aeroallergens, total serum IgE, and IgE to Ascaris lumbricoides. In addition, genotyping was performed to establish the prevalence of putative pro-inflammatory alleles.

RESULTS

We demonstrated several significant associations between polymorphisms and allergy phenotypes. In particular, 2 polymorphisms in the IL-10 gene (IL10 -592A>C and IL10 -1082A>G) and 1 in the IL-4 gene (IL4 -589C>T) showed multiple associations with allergic sensitization and asthma phenotypes. Other polymorphisms, across a multitude of genes with discrepant functions, showed less consistent associations.

CONCLUSION

This study represents an important first step in genotype/phenotype association in this population. Further research is required to confirm or refute our findings.

A Xhosa language translation of the CORE-OM using South African university student samples

The translation of well established psychometric tools from English into Xhosa may assist in improving access to psychological services for Xhosa speakers. The aim of this study was to translate the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), a measure of general distress and dysfunction developed in the UK, into Xhosa for use at South African university student counselling centres. The CORE-OM and embedded CORE-10 were translated into Xhosa using a five-stage translation design. This design included (a) forward-translation, (b) back-translation, (c) committee approach, (d) qualitative piloting, and (e) quantitative piloting on South African university students. Clinical and general samples were drawn from English-medium South African universities. Clinical samples were generated from university student counselling centres. General student samples were generated through random stratified cluster sampling of full-time university students. Qualitative feedback from the translation process and results from quantitative piloting of the 34-item CORE-OM English and Xhosa versions supported the reduction of the scale to 10 items. This reduced scale is referred to as the South African CORE-10 (SA CORE-10). A measurement and structural model of the SA CORE-10 English version was developed and cross-validated using an English-speaking university student sample. Equivalence of this model with the SA CORE-10 Xhosa version was investigated using a first-language Xhosa-speaking university sample. Partial measurement equivalence was achieved at the metric level. The resultant SA CORE-10 Xhosa and English versions provide core measures of distress and dysfunction. Additional, culture- and language-specific domains could be added to increase sensitivity and specificity.

Ethnobotanical survey of medicinal plants used in the management of skin disorders among the Xhosa communities of the Amathole District, Eastern Cape, South Africa

ETHNOPHARMACOLOGICAL RELEVANCE

Skin diseases have been of major concern recently due to the association of skin opportunistic infections and HIV/AIDS, are usually the first sign of HIV infection and conversion to AIDS. More than 90% of HIV-infected individuals develop skin and mucosal complications at some stage during the disease. Although classical medicine is undoubtedly addressing these diseases, the people of the Eastern Cape, South Africa still depend, to a large extent on traditional herbal medicine for the treatment of various diseases. The current study was undertaken to investigate the local peoples characterisation of skin diseases/disorders and to document the medicinal plants used for various skin disorders among the Xhosa-speaking communities of the Amathole District, Eastern Cape.

MATERIALS AND METHODS

Information was obtained by interviewing 54 respondents in 7 locations. Collection of the reported medicinal plants from the wild was assisted by the informants and identification of the collected plants specimens was done with the help of floristic works of South Africa. Quantitative methods including the use-value and the informant consensus factor (ICF) were computed for determining the relative importance of species known locally and the homogeneity of the informants׳ knowledge respectively.

RESULTS

Twenty five skin disorders, classified under 5 categories are being treated with the listed medicinal plants in the study area. The highest ICF (0.45) was linked to bacteria-related skin disorders. This category comprised of 57 use citations, 3 skin disorders; with sore throat being the most frequently mentioned (4.2%). In this study, 106 plant species distributed in 61 families and 107 genera were identified as being used to treat one or more of the skin disorders. The species with the highest use-value was Aloe ferox Mill. (Xanthorrhoeaceae) known locally as Umhlaba. The most representative families were Solanaceae and Asteraceae with 6 species each, followed by Fabaceae, Poaceae and Rutaceae (5 species each). The leaves were the most frequently used plant part, followed by the bark (10%) and fruits (7%). Administration of the different plant parts was mostly topical (77%) on the affected area.

CONCLUSION

A total of twenty five skin disorders/conditions, classified under 5 categories are being treated with the listed medicinal plants in the study area. 106 plant species distributed in 61 families and 107 genera were identified as being used to treat one or more of the skin disorders. The species with the highest use-value was Aloe ferox Mill. (Xanthorrhoeaceae) known locally as Umhlaba. The most representative families were Solanaceae, Asteraceae, Fabaceae, Poaceae, Rutaceae and Euphorbiaceae. Majority of the plant species were herbs and the leaves were the most frequently used, mostly applied topically as a paste, powder or sap on the affected skin area.

Characterization of the genetic variation present in CYP3A4 in three South African populations

The CYP3A4 enzyme is the most abundant human cytochrome P450 (CYP) and is regarded as the most important enzyme involved in drug metabolism. Inter-individual and inter-population variability in gene expression and enzyme activity are thought to be influenced, in part, by genetic variation. Although Southern African individuals have been shown to exhibit the highest levels of genetic diversity, they have been under-represented in pharmacogenetic research to date. Therefore, the aim of this study was to identify genetic variation within CYP3A4 in three South African population groups comprising of 29 Khoisan, 65 Xhosa and 65 Mixed Ancestry (MA) individuals. To identify known and novel CYP3A4 variants, 15 individuals were randomly selected from each of the population groups for bi-directional Sanger sequencing of ~600 bp of the 5′-upstream region and all thirteen exons including flanking intronic regions. Genetic variants detected were genotyped in the rest of the cohort. In total, 24 SNPs were detected, including CYP3A4^*12, CYP3A4^*15, and the reportedly functional CYP3A4^*1B promoter polymorphism, as well as two novel non-synonymous variants. These putatively functional variants, p.R162W and p.Q200H, were present in two of the three populations and all three populations, respectively, and in silico analysis predicted that the former would damage the protein product. Furthermore, the three populations were shown to exhibit distinct genetic profiles. These results confirm that South African populations show unique patterns of variation in the genes encoding xenobiotic metabolizing enzymes. This research suggests that population-specific genetic profiles for CYP3A4 and other drug metabolizing genes would be essential to make full use of pharmacogenetics in Southern Africa. Further investigation is needed to determine if the identified genetic variants influence CYP3A4 metabolism phenotype in these populations.