Predictive genetic testing -- new possibilities in determination of risk of complex diseases

Predictive genetic testing offers the possibility to statistically determine the risk of inheriting a complex phenotype by establishing an individual s genotype for metabolic polymorphisms. Here we discuss the conditions under which a predictive test may be offered to a patient and the problems connected with it. Examples of predictive genetic testing for multifactorial diseases and drug responses are given. We describe in detail the association of the C677T polymorphism of methylentetrahydrofolate reductase gene with hyperhomocystinemia and folate levels, as an independent risk factor for cardiovascular disease, and the association of a polymorphism of the promoter of the 5-lipoxygenase gene and the response to leukotriene inhibitors in asthma. Prospective development of genomic medicine and its use in the study of complex traits will hopefully bring significant benefit to the population and enhance the prevention and therapy of common diseases.     

Polymorphisms in the myosin light chain kinase gene that confer risk of severe sepsis are associated with a lower risk of asthma

BACKGROUND: Myosin light chain kinase (MYLK) is a multifunctional protein involved in regulation of airway hyperreactivity and other activities relevant to asthma. OBJECTIVE: To determine the role of MYLK gene variants in asthma among African Caribbean and African American populations. METHODS: We performed association tests between single nucleotide polymorphisms (SNPs) in the MYLK gene and asthma susceptibility and total serum IgE concentrations in 2 independent, family-based populations of African descent. Previously we identified variants/haplotypes in MYLK that confer risk for sepsis and acute lung injury; we compared findings from our asthma populations to findings in the African American sepsis and acute lung injury groups. RESULTS: Significant associations between MYLK SNPs and asthma and total serum IgE concentrations were observed in the African Caribbean families: a promoter SNP (rs936170) in the smooth muscle form gave the strongest association (P = .009). A haplotype including rs936170 corresponding to the actin-binding activity of the nonmuscle and smooth muscle forms was negatively associated with asthma (eg, decreased risk) in both the American (P = .005) and Caribbean families (P = .004), and was the same haplotype that conferred risk for severe sepsis (P = .002). RNA expression studies on PBMCs and rs936170 suggested a significant decrease in MYLK expression among patients with asthma with this variant (P = .025). CONCLUSION: MYLK polymorphisms may function as a common genetic factor in clinically distinct diseases involving bronchial smooth muscle contraction and inflammation. CLINICAL IMPLICATIONS: Genetic variants in MYLK are significantly associated with both asthma and sepsis in populations of African ancestry.     

Pharmacogenetics of anti-leukotriene drugs

Cysteinyl leukotrienes, a group of compounds with potent bioactivity to constrict bronchial smooth muscle cells and recruit eosinophils and other inflammatory cells into the airways, act as key modulators of the pathophysiology of allergic rhinitis and asthma. Drugs targeting leukotriene-related molecules such as leukotriene synthase inhibitors and CysLT₁-receptor antagonists are widely used as safe and effective agents for the treatment of these diseases. The main limitation of anti-leukotriene drugs, however, is that there is a substantial proportion of patients who do not respond to these drugs. Therefore, identification of genetic and non-genetic factors that determine the pharmacologic response should further increase the usefulness of anti-leukotriene drugs. We undertook a multidirectional approach based on the assumption that the pharmacologic response to anti-leukotriene drugs is determined by factors related to pharmacokinetics such as drug metabolism, and pharmacodynamics such as the expression and function of leukotriene synthases and receptors. Among patients with asthma, we identified two genetic variations (polymorphisms) in the promoter of arachidonate 5-lipoxygenase and leukotriene C₄ synthase as possible factors to distinguish responders from non-responders to anti-leukotriene drugs. This pharmacogenetic approach might be useful to establish the basis of individualized treatment for patients with asthma as well as those with allergic rhinitis.     

Associations of microRNA single nucleotide polymorphisms and disease risk and pathophysiology

Single nucleotide polymorphisms (SNPs) are genetic variations that contribute to human phenotypes associated with various diseases. SNPs are involved in the regulation of a broad range of physiological and pathological processes, such as cellular senescence, apoptosis, inflammation, and immune response, by upregulating the expression of classical inflammation markers. Recent studies have suggested that SNPs located in gene‐encoding microRNAs (miRNAs) affect various aspects of diseases by regulating the expression or activity of miRNAs. In the last few years, miRNA polymorphisms that increase and/or reduce the risk of developing many diseases, such as cancers, autoimmune diseases, and cardiovascular diseases, have attracted increasing attention not only because of their involvement in the pathophysiology of diseases but also because they can be used as prognostic biomarkers for a variety of diseases. In this review, we summarize the relationships between miRNA SNPs and the pathophysiology and risk of diseases.     

心肌素与心血管疾病的研究进展

 心肌素（myocardin）是2001年发现的在心血管组织特异表达的转录辅助因子,心肌素与血清效应因子（SRF）共同控制着心肌和平滑肌细胞特异基因的表达,其活性的改变与人类主要心血管疾病如动脉粥样硬化、心肌肥大、高血压的发生发展关系非常密切。本文就心肌素分子结构、表达调控以及与心血管疾病关系的研究进展作一综述。     

Genetic architecture of the F7 gene in a Spanish population: implication for mapping complex diseases and for functional assays

Delineating the genetic variability of loci coding for complex diseases helps to understand the individual variation in disease susceptibility and drug response. We present the allelic architecture of the F7 gene. This gene is the major determinant of FVII plasma levels, and these plasma levels constitute an important intermediate risk factor for cardiovascular disease. As part of the Genetic Analysis of Idiopathic Thrombophila Project, we completely re-sequenced the F7 locus (promoter, exons, introns, and 3'-untranslated region) in 40 unrelated individuals. We found 49 polymorphisms with only two amino acid changes suggesting that regulatory non-coding and intronic variants are responsible for the FVII variability. These results are important for mapping susceptibility alleles of complex diseases, because differences in pair-wise linkage disequilibrium patterns between DNA variants and haplotype frequency distributions may help to detect disease-associated alleles. In addition, we present the results of an in silico search that established genomic comparisons among different species. In conclusion, our study of the F7 DNA sequence variations is an example of a strategy for analyzing the genetic architecture of a quantitative trait locus. Furthermore, it provides a model for future analyses of genetic factors that contribute to the susceptibility of complex diseases in humans.     

Microvascular mural cell functionality of human embryonic stem cell-derived mesenchymal cells

Microvascular mural or perivascular cells are required for the stabilization and maturation of the remodeling vasculature. However, much less is known about their biology and function compared to large vessel smooth muscle cells. We have developed lines of multipotent mesenchymal cells from human embryonic stem cells (hES-MC); we hypothesize that these can function as perivascular mural cells. Here we show that the derived cells do not form teratomas in SCID mice and independently derived lines show similar patterns of gene expression by microarray analysis. When exposed to platelet-derived growth factor-BB, the platelet-derived growth factor receptor β is activated and hES-MC migrate in response to a gradient. We also show that in a serum-free medium, transforming growth factor β1 (TGFβ1) induces robust expression of multiple contractile proteins (α smooth muscle actin, smooth muscle myosin heavy chain, smooth muscle 22α, and calponin). TGFβ1 signaling is mediated through the TGFβR1/Alk5 pathway as demonstrated by inhibition of α smooth muscle actin expression by treatment of the Alk5-specific inhibitor SB525334 and stable retroviral expression of the Alk5 dominant negative (K232R). Coculture of human umbilical vein endothelial cell (HUVEC) with hES-MC maintains network integrity compared to HUVEC alone in three-dimensional collagen I-fibronectin by paracrine signaling. Using high-resolution laser confocal microscopy, we show that hES-MC also make direct contact with HUVEC. This demonstrates that hESC-derived mesenchymal cells possess the molecular machinery expected in a perivascular progenitor cells and can play a functional role in stabilizing EC networks in in vitro three-dimensional culture.     

Redox control of growth factor signaling: recent advances in cardiovascular medicine

Growth factors play vital roles in the regulation of various biologic processes, including those in cardiovascular and respiratory systems. Accumulating evidence suggests that reactive oxygen species mediate growth factor signal transduction. The discovery of reactive oxygen species production by angiotensin II in vascular smooth muscle cells via the activation of NAD(P)H oxidase promoted studies of redox control of growth factor signaling. In the past few years, there have been further advances in this field. In addition to established roles of reactive oxygen species in vascular smooth muscle growth, these species have been demonstrated to serve as second messengers for cardiac hypertrophy induced by angiotensin II. NAD(P)H oxidase also produces reactive oxygen species in response to endothelin-1 in vascular smooth muscle and cardiac muscle cells. These results suggest that inhibiting NAD(P)H oxidase might be a useful therapeutic strategy. In fact, adenovirus-mediated gene transfer appears to be an effective approach to prevent vascular hypertrophy in rodent models. Growth factors also induce survival signaling in cardiac and smooth muscle cells, and redox control may play a role in such events. It is likely that studies reporting the mechanisms of redox control of growth factor signaling will rapidly emerge in the next several years, and understanding of such regulation should help in the development of therapeutic strategies against heart and lung diseases.     

Variation in immunoregulatory genes determines the clinical phenotype of common variable immunodeficiency

Variation in clinical phenotype is a hallmark of many complex diseases. The cause of this clinical heterogeneity is unknown, but it may be determined by genetic factors distinct from those conferring disease susceptibility. Common variable immunodeficiency (CVID) is a complex disease of unknown aetiology and diverse clinical manifestations. We have developed a unified polymerase chain reaction and sequence-specific primer (PCR-SSP) method to simultaneously genotype multiple polymorphisms under identical conditions, and have used this method to test the hypothesis that the clinical phenotype of CVID is determined by immunoregulatory gene polymorphism. Twenty-three polymorphisms in 13 genes were studied in 163 CVID patients. Vitamin D receptor and IL-6 alleles were associated with immunophenotypic abnormalities characteristic of more severe disease; and tumour necrosis factor and IL-10 alleles conferred susceptibility to the granulomatous form of CVID in an interacting fashion. These findings demonstrate that different clinical features of a disease may have unique pathogenetic abnormalities, determined by multiple interacting genetic factors. The ease of application of this efficient, robust genotyping technique to polymorphisms throughout the genome will make it a powerful tool in the investigation of the genetic basis of phenotypic variability in a wide variety of diseases.     

New techniques and laboratory examinations in the detection and evaluation of hypertension

Monitoring of 24-hour ambulatory blood pressure(ABPM), measurements of circulating vasoactive substances and microalbuminuria, and assessment of gene polymorphisms as genetic markers are introduced to detect and evaluate hypertension. Classifications of ABPM based on impact on risks of cardiovascular diseases have been currently available. Plasma level of brain natriuretic peptide(BNP), a cardiac hormone, increases markedly in congestive heart failure, in proportion to its severity, and is evaluated as a potential index of severity of heart failure. In addition, serum level of hepatocyte growth factor(HGF), a member of endothelium specific growth factors, in hypertension might be useful for evaluating the presence of complications and degree of endothelial dysfunction. In diabetes mellitus, onset of microalbuminuria appeared as an important sign of early nephropathy. There is growing evidence that microalbuminuria is an independent predictor of atherosclerosis and premature death in the general population. Current studies have shown that gene polymorphisms including components of the renin-angiotensin-aldosterone system may be possible genetic markers for hypertension and its associated cardiovascular diseases. Our data suggest positive linkages between hypertension and 4 gene polymorphisms including angiotensinogen Met235Thr, angiotensin converting enzyme I/D, aldosterone synthase CYP11B2 T-344C, and endothelial nitric oxide synthase Glu298Asp in the Aomori population.     

KLF4: a novel target for the treatment of atherosclerosis

Atherosclerosis is an inflammatory disease characterized by a large amount of hyperproliferation and poorly differentiated or undifferentiated smooth muscle cells in atherosclerotic plaque. Cancer cells differ from normal cells in many aspects, including hyperproliferation and loss of differentiation. So the research on tumor may shed light on the treatment of atherosclerosis. Given that Kruppel-like factor 4 (KLF4) has an important function in tumor development and progression, it may be associated with the formation and development of atherosclerosis. Recently, KLF4 expression has been documented in vascular endothelial cells. KLF4, which is normally not expressed in differentiated SMC in vivo, was rapidly up-regulated in response to vascular injury. In addition, KLF4 is a critical regulator in macrophage activation. Endothelial dysfunction, macrophage activation and VSMC phenotype switching are critical component elements in development of atherosclerosis. Herein we hypothesize that KLF4 is an important regulator in different phase of atherosclerosis and may be a novel target of prevention and cure of atherosclerosis. Further investigation is needed to approach the concrete signaling pathways about KLF4.     

Neurotrophin and Neurotrophin Receptors in Vascular Smooth Muscle Cells: Regulation of Expression in Response to Injury

The neurotrophins, a family of related polypeptide growth factors including nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF) and neurotrophin (NT)-3 and NT-4/5 promote the survival and differentiation of distinctive sets of embryonic neurons. Here we define a new functional role for neurotrophins, as autocrine or local paracrine mediators of vascular smooth muscle cell migration. We have identified neurotrophins, and their cognate receptors, the trk tyrosine kinases, in human and rat vascular smooth muscle cells in vivo. In vitro, cultured human smooth muscle cells express BDNF; NT-3; and trk A, B, and C Similarly, rat smooth muscle cells expressed all three trk receptors as well as all four neurotrophins. Moreover, NGF induces cultured human smooth muscle cell migration at subnanomolar concentrations. In the rat aortic balloon deendothelialization model of vascular injury, the expression of NGF, BDNF, and their receptors trk A and trk B increased dramatically in the area of injury within 3 days and persisted during the formation of the neointima. In human coronary atherosclerotic lesions, BDNF, NT-3, and NT-4/5, and the trk B and trk C receptors could be demonstrated in smooth muscle cells. These findings suggest that neurotrophins play an important role in regulating the response of vascular smooth muscle cells to injury.     

PDGF-BB对血管平滑肌细胞表型标志物表达的影响

目的:观察血小板源性生长因子BB(PDGF-BB)对血管平滑肌细胞(VSMCs)增殖及分化相关基因表达的影响,探讨其可能的机制。方法:分离体外培养的SD大鼠胸腹主动脉VSMCs,分为空白对照组和不同浓度PDGF-BB处理组。分别采用MTT法、流式细胞术和伤口愈合实验检测PDGF-BB对VSMCs增殖、细胞周期和迁移活性的影响;用W estern b lotting分析检测VSMCs表型标志物的表达;用免疫沉淀和免疫共沉淀分析检测Krüppel样因子4(KLF4)磷酸化及与其它转录因子的相互作用。结果:PDGF-BB促进VSMCs增殖和迁移;上调增殖相关蛋白PCNA的表达,下调增殖抑制蛋白p27、分化相关蛋白SM22α的表达。PDGF-BB诱导KLF4的表达和磷酸化,促进KLF4与NF-κB的相互作用,抑制KLF4与Sm ad3、HDAC2的结合。结论:PDGF-BB可能通过影响KLF4磷酸化及其与不同转录调节因子的相互作用而诱导VSMCs表型转化。