The Hungarian Twin Registry Update: Turning From a Voluntary to a Population-Based Registry

Morphometric Analysis of Neocortical and Infratentorial Structures: Genetic and Environmental Insights from a Twin Neuroanatomical Study

Background and Objective: Brain morphometry is shaped by a complex interplay of genetic and environmental factors, including physiological and neuropsychiatric conditions. These influences can vary across distinct brain regions, yet the precise contributions of genetics and environment to regional variation in healthy brains remain poorly understood. This study examines the heritability of specific brain structures to provide deeper insights into their development. Materials and Methods: We studied 118 healthy adult twins from the Hungarian Twin Registry using T1-weighted magnetic resonance imaging (T1W MRI) and the volBrain pipeline for structural measurements. Results: In all regions, monozygotic (MZ) twins showed a higher resemblance than dizygotic (DZ) twins in total brainstem and cerebellar volumes, with significant heritability (A: 90.5-92.6%) and minimal unique environmental effects (E: <1%). For supratentorial regions, regarding the total gray matter volume, all regions exhibited high heritability (A: 74.5-92.4%) and minimal environmental influence (E: <1.5%). In average cortical thickness analysis, the frontal lobe, temporal lobe, and pre-central gyrus were influenced by shared and unique environmental factors (C: 63-66.5%; E: 33.4-37%), whereas genetics were more prominent in the parietal lobe, occipital lobe, and post-central gyrus (A: 67.7-85%; E: 15-32.3%). Conclusions: Genetics strongly influence cortical gray matter volume in supratentorial regions (both total and regional), as well as the total brainstem volume and the total and cortical gray matter volumes of the cerebellum in infratentorial regions. This genetic influence extends to the average cortical thickness of the parietal lobe, post-central gyrus, and occipital lobe, while the frontal lobe, temporal lobe, and pre-central gyrus are more affected by environmental factors. These findings emphasize the importance of understanding region-specific genetic and environmental contributions to brain structure, which could guide personalized therapeutic and preventive strategies for neurological conditions.

The interplay of genetic and environmental factors on the morphology of the limbic cortex and hippocampal subfields: Insights from an MRI twin study

INTRODUCTION

The limbic system and the hippocampus are complex brain structures with key roles in memory, emotions, sexual stimulation and learning, with subregion abnormalities associated with a range of disorders and psychopathologies. Our study aimed to explore the heritability of specific subfield structures within the limbic system and hippocampus first in a Caucasian twin sample with volBrain pipeline.

MATERIALS AND METHODS

59 healthy adult Caucasian twin pairs from the Hungarian Twin Registry without any history of previous neurodegenerative or cerebrovascular diseases underwent brain MRI on a 3.0 T scanner (43 monozygotic, MZ and 16 dizygotic, DZ pairs, with a median age of 50±+27 years). The volBrain automated volumetry pipeline was used to calculate the subcortical and general brain volumes from three-dimensional T1-weighted images. Based on age- and sex-adjusted MZ and DZ intra-pair correlations, the univariate ACE model was applied to calculate additive genetic, shared and unshared environmental influences.

RESULTS

Adjusting for age and sex, moderate to strong heritability (A: 59.7 to 73.1 %) was found for most limbic cortex volumes, except for the volumes of entorhinal area and posterior cingulate gyrus where common environmental contribution was detected (C: 56.6 % and 65.0 %, respectively). A substantial heritability (A: 67.0 to 79.4 %) was estimated for the overall hippocampus and most subfield volumes, except for the CA2-CA3 region which was determinated by common environmental factors (C: 45.7 %). Unique environmental variance was a minor to moderate contributor across all variables (E: 20.6 to 54.3 %).

CONCLUSIONS

Albeit most limbic cortex, overall hippocampus and most subfield volumes are under substantial genetic influence in healthy adult twins, the volumes of entorhinal area, posterior cingulate gyrus and the CA2-CA3 region of the hippocampus are influenced common environmental factors. The findings underline the importance of unique environmental factors which may play a role in the prevention of disorders related to limbic cortex and hippocampus.

The Role of Sibling Patterns in the Educational Attainment of Hungarian Twins

Studies concerning twins with a sociological focus are scarce in Hungary as well as international research, although the number of twin births has increased dramatically worldwide. The raising and education of twins are tasks demanding special attention from both the family and institutions. In our study we examine these aspects, looking back from adulthood, using the narrow scope of the available data from research based on the 'Hungarostudy 2021' database (N total: 7000; n twins: 106). Our results, corresponding to the hypotheses of educational sociology, demonstrate how the relationships between family size and school career and increasing number of siblings reduces the chances of high educational attainment. A regression analysis confirmed that both the number of siblings and a later position in the birth order reduces the chance of obtaining a higher education. For the second child in a family, the chance of earning a university degree is reduced to to 0.743. The role of a large family concerning higher education showed a stronger relationship in the case of twins compared to nontwins. For twins, the sibling pattern has a decisive effect in educational attainment. Twins themselves have a 1.449 times higher chance of obtaining a higher education compared to nontwins (p = 0.101), and fraternal twins have half (0.517) the chance of obtaining a higher education compared to identical twins; but both results are not significant (p = 0.156).

The Population-Based Hungarian Twin Registry: An Update

Between 2006 and 2021, the Hungarian Twin Registry (HTR) operated a volunteer twin registry of all age groups (50% monozygotic [MZ], 50% dizygotic [DZ], 70% female, average age 34 ± 22 years), including 1044 twin pairs, 24 triplets and one quadruplet set. In 2021, the HTR transformed from a volunteer registry into a population-based one, and it was established in the Medical Imaging Centre of Semmelweis University in Budapest. Semmelweis University's innovation fund supported the development of information technology, a phone bank and voicemail infrastructure, administrative materials, and a new website was established where twins and their relatives (parent, foster parent or caregiver) can register. The HTR's biobank was also established: 157,751 individuals with a likely twin-sibling living in Hungary (77,042 twins, 1194 triplets, 20 quadruplets, and one quintuplet) were contacted between February and March of 2021 via sealed letters. Until November 20, 2022, 12,001 twin individuals and their parents or guardians (6724 adult twins, 3009 parents/guardians and 5277 minor twins) registered, mostly online. Based on simple self-reports, 37.6% of the registered adults were MZ twins and 56.8% were DZ; 1.12% were triplets and 4.5% were unidentified. Of the registered children, 22.3% were MZ, 72.7% were DZ, 1.93% were triplets, and 3.05% were unidentified. Of the registered twins, 59.9% were female (including both the adult and minor twins). The registration questionnaire consists of eight parts, including socio-demographic and anthropometric data, smoking habits and medical questions (diseases, operations, therapies). Hungary's twin registry has become the sole and largest population-based twin registry in Central Eastern Europe. This new resource will facilitate performing world-class modern genetic research.

Analysis of Genetic and MRI Changes, Blood Markers, and Risk Factors in a Twin Pair Discordant of Progressive Supranuclear Palsy

Background and Objectives: Progressive supranuclear palsy (PSP) is a neurodegenerative disease, a tauopathy, which results in a wide clinical spectrum of neurological symptoms. The diagnosis is mostly based on clinical signs and neuroimaging; however, possible biomarkers for screening have been under investigation, and the role of the gut microbiome is unknown. The aim of our study was to identify potential blood biomarkers and observe variations in the gut microbiome within a PSP discordant monozygotic twin pair. Materials and Methods: Anthropometric measurements, neuropsychological tests, and the neurological state were evaluated. Blood was collected for metabolic profiling and for the detection of neurodegenerative and vascular biomarkers. Both the gut microbiome and brain MRI results were thoroughly examined. Results: We found a relevant difference between alpha-synuclein levels and moderate difference in the levels of MMP-2, MB, Apo-A1, Apo-CIII, and Apo-H. With respect to the ratios, a small difference was observed for ApoA1/SAA and ApoB/ApoA1. Using a microbiome analysis, we also discovered a relative dysbiosis, and the MRI results revealed midbrain and frontoparietal cortical atrophy along with a reduction in overall brain volumes and an increase in white matter lesions in the affected twin. Conclusions: We observed significant differences between the unaffected and affected twins in some risk factors and blood biomarkers, along with disparities in the gut microbiome. Additionally, we detected abnormalities in brain MRI results and alterations in cognitive functions.

Palatal asymmetry assessed by intraoral scans: effects of sex, orthodontic treatment, and twinning. A retrospective cohort study

BACKGROUND

Symmetry is critical in perceived attractiveness, especially in female faces. The palate determines the teeth' alignment and supports facial soft tissues. Therefore, the study aimed to assess the effects of sex, orthodontic treatment, age, and heritability on the directional, anti-, and fluctuational asymmetry in the digital palatal model.

METHODS

The palate of 113 twins, 86 female and 27 male subjects, with and without previous orthodontic treatment, were scanned by the Emerald (Planmeca) intraoral scanner. Three lines were constructed horizontally in the digital model, one between the right and left first upper molars and two between the first molars and incisive papilla. Two observers calculated the left and right angles between the mid-sagittal plane and molar-papilla lines. The intraclass correlation coefficient was used to assess the inter-observer absolute agreement. The directional symmetry was determined by comparing the mean left and right angles. The antisymmetry was estimated from the distribution curve of the signed side difference. The fluctuating asymmetry was approximated from the magnitude of the absolute side difference. Finally, the genetic background was assessed by correlating the absolute side difference between monozygotic twin siblings.

RESULTS

The right angle (31.1 degrees) was not significantly different from the left one (31.6 degrees). The signed side difference followed a normal distribution with a mean of -0.48 degrees. The absolute side difference (2.29 degrees, p < 0.001) was significantly different from zero and negatively correlated (r=-0.46, p < 0.05) between siblings. None of the asymmetries was affected by sex, orthodontic treatment or age.

CONCLUSIONS

The palate illustrates neither directional asymmetry nor antisymmetry, indicating that most people's palates are symmetric. However, the significant fluctuating asymmetry suggests that some subject has considerable asymmetry but is not influenced by sex, orthodontic treatment, age, and genetics. The proposed digital method is a reliable and non-invasive tool that could facilitate achieving a more symmetrical structure during orthodontic and aesthetic rehabilitation.

TRIAL REGISTRATION

The Clinicatrial.gov registration number is NCT05349942 (27/04/2022).

Heritability of Subcortical Grey Matter Structures

Background and Objectives: Subcortical grey matter structures play essential roles in cognitive, affective, social, and motoric functions in humans. Their volume changes with age, and decreased volumes have been linked with many neuropsychiatric disorders. The aim of our study was to examine the heritability of six subcortical brain volumes (the amygdala, caudate nucleus, pallidum, putamen, thalamus, and nucleus accumbens) and four general brain volumes (the total intra-cranial volume and the grey matter, white matter, and cerebrospinal fluid (CSF) volume) in twins. Materials and Methods: A total of 118 healthy adult twins from the Hungarian Twin Registry (86 monozygotic and 32 dizygotic; median age 50 ± 27 years) underwent brain magnetic resonance imaging. Two automated volumetry pipelines, Computational Anatomy Toolbox 12 (CAT12) and volBrain, were used to calculate the subcortical and general brain volumes from three-dimensional T1-weighted images. Age- and sex-adjusted monozygotic and dizygotic intra-pair correlations were calculated, and the univariate ACE model was applied. Pearson's correlation test was used to compare the results obtained by the two pipelines. Results: The age- and sex-adjusted heritability estimates, using CAT12 for the amygdala, caudate nucleus, pallidum, putamen, and nucleus accumbens, were between 0.75 and 0.95. The thalamus volume was more strongly influenced by common environmental factors (C = 0.45-0.73). The heritability estimates, using volBrain, were between 0.69 and 0.92 for the nucleus accumbens, pallidum, putamen, right amygdala, and caudate nucleus. The left amygdala and thalamus were more strongly influenced by common environmental factors (C = 0.72-0.85). A strong correlation between CAT12 and volBrain (r = 0.74-0.94) was obtained for all volumes. Conclusions: The majority of examined subcortical volumes appeared to be strongly heritable. The thalamus was more strongly influenced by common environmental factors when investigated with both segmentation methods. Our results underline the importance of identifying the relevant genes responsible for variations in the subcortical structure volume and associated diseases.

The discriminative potential of palatal geometric analysis for sex discrimination and human identification

Previous 3D superimposition studies of digital scans of the human palate, using geometric and surface morphology comparisons, have shown its usefulness in assisting in the identification process, including its ability to distinguish identical twins. This study aimed to evaluate the discriminative potential when only simple geometric analysis is used. Its aim is not only to determine if geometric comparison alone is sufficient not only to assist in identification but if it supports the hypothesis of assisting in sex discrimination when no other comparative data is available. The palates of 64 monozygotic (M.Z.T.) and 39 dizygotic (D.Z.T.) twins were digitized three times using a scanner. Digital smoothing was used to remove the rugae, and palatal height, depth, and width were measured. The study confirmed that the smoothing function had little effect on the discriminatory function since the Mean Absolute Distance (MAD) between M.Z.T. (0.430 ± 0.018 mm versus 0.425 ± 0.022 mm p = 0.061) or D.Z.T. (0.621 ± 0.058 mm versus 0.586 ± 0.053 mm, p = 0.284) scans show little change. By combining the height, depth, and width into a discriminative function, the sex correctly correlated 83.9% of the time, identity by 91.2% sensitivity, and twining by 68.5%. The difference in the 3D palatal model between twin siblings is primarily due to palate geometrics. Since geometric comparison requires far less computation time, geometric comparison alone can be used as an adjunct metric for limiting the possible matches in a dental 3D database in determining both sex and identity, especially if no other evidence is available.

Genetic and Environmental Effects on the Development of White Matter Hyperintensities in a Middle Age Twin Population

Introduction: White matter hyperintensities (WMH) indicate white matter brain lesions in magnetic resonance imaging (MRI), which can be used as a marker for brain aging and cerebrovascular and neurodegenerative disorders. Twin studies revealed substantial but not uniform WMH heritability in elderly twins. The objective of our study was to investigate the genetic and environmental components of WMH, as well as their importance in a healthy twin population, utilizing 3T MRI scanners in a middle-aged twin population. Methods: Brain MRI was performed on 120 healthy adult twins from the Hungarian Twin Registry on a 3T scanner (86 monozygotic, MZ and 34 dizygotic, DZ twins; median age 50 ± 26.5 years, 72.5% female and 27.5% male). The count of WMH on FLAIR images was calculated using an automated volumetry pipeline (volBrain) and human processing. The age- and sex-adjusted MZ and DZ intra-pair correlations were determined and the total variance was decomposed into genetic, shared and unique environmental components using structural equation modeling. Results: Age and sex-adjusted MZ intrapair correlations were higher than DZ correlations, indicating moderate genetic influence in each lesion (rMZ = 0.466, rDZ = −0.025 for total count; rMZ = 0.482, rDZ = 0.093 for deep white matter count; rMZ = 0.739, rDZ = 0.39 for infratentorial count; rMZ = 0.573, rDZ = 0.372 for cerebellar count and rMZ = 0.473, rDZ = 0.19 for periventricular count), indicating a moderate heritability (A = 40.3%, A = 45%, A = 72.7% and A = 55.5%and 47.2%, respectively). The rest of the variance was influenced by unique environmental effects (E between 27.3% and 59.7%, respectively). Conclusions: The number of WMH lesions is moderately influenced by genetic effects, particularly in the infratentorial region in middle-aged twins. These results suggest that the distribution of WMH in various brain regions is heterogeneous.

The Heritability of Upper Airway Dimensions Using MRI Scans in Twins

Introduction: Obstructive sleep apnea (OSA) is a common disorder characterized by the repetitive collapse of the upper airways during sleep, most likely in the oropharyngeal region. Anatomical factors significantly contribute to the disease development; however, the heritability of the upper airway dimensions, which lead to the collapsibility of the upper airways, is less known. In the current study, we aimed to quantify the impact of heritable and environmental factors on the upper airway dimensions in twins using magnetic resonance imaging (MRI). Methods: We completed head and neck MRI imaging on 110 (66 monozygotic and 44 dizygotic, age median and Q1–Q3: 53 (44–63.75) years) adult twins from the Hungarian Twin Registry. We completed cephalometric, soft tissue and fatty tissue space measurements on T1- and T2-weighted images in sagittal, coronal and axial planes. For the analysis of the genetic and environmental, the determination of the measured parameters was performed with an ACE twin statistical model. Results: We found a strong genetic determination in the anteroposterior diameter of the tongue and the thickness of the submental fatty tissue of the neck. Other parameters of the tongue, soft palate and uvula have shown moderate heritability, while we found strong environmental determination in the thickness of the parapharyngeal fatty tissue, the thickness of the pharyngeal wall, and the smallest diameter of the posterior upper airways. Conclusion: Our twin study can help better understand the genetic and environmental background of anatomical structures involved in the development of sleep apnea.

Gut Microbiome in Patients with Obstructive Sleep Apnoea

Background: Obstructive sleep apnoea (OSA) is a risk factor for cardiovascular disease. Alterations in the gut microbiome have been implicated in the development of cardiovascular disease and may potentially link OSA to its cardiovascular consequences. However, only one study to date has investigated gut microbiomes in adult patients with OSA. Methods: 19 patients with OSA and 20 non-OSA controls participated in the study. Following a diagnostic sleep study, blood was collected for metabolic profiling, and the subjects provided a stool sample for microbiome analysis. The gut microbiome was investigated using the 16S ribosomal RNA method. Results: Patients with OSA had a higher relative abundance of the Proteobacteria phylum (p = 0.03), Gammaproteobacteria class (p = 0.01), Lactobacillae family (p = 0.02), Lactobacillus (p = 0.03), and Roseburia genus (p = 0.03), and a lower abundance of the Actinobacteria phylum (p = 0.03). The abundance of Proteobacteria, Gammaproteobacteria, Lactobacillae, and Lactobacillus were related to disease severity and dyslipidaemia (all p < 0.05), whilst the abundance of Proteobacteria and Gammaproteobacteria was also related to hypertension and cardiovascular disease (all p < 0.05). However, following adjustment for relevant confounders only the association between OSA and Actinobacteria remained significant (p = 0.04). Conclusions: Obstructive sleep apnoea is associated with only subtle changes in gut microbiome. Further studies should investigate gut dysbiosis in OSA.

Heritability analysis of liver stiffness detected by ultrasound shear wave elastography: a twin study

OBJECTIVES OF THE STUDY

Nonalcoholic fatty liver disease (NAFLD) is a common condition with a subset of individuals developing liver fibrosis as a major risk factor for advanced liver disease. The contribution of genetic factors to this progression remains incompletely understood. Our aim was to analyze heritability in the development of liver fibrosis estimated by ultrasound shear wave elastography (SWE) in an asymptomatic adult twin cohort.

METHODS

In total 172 adult Hungarian twins (51 monozygotic and 36 dizygotic pairs; 63% women; mean age 54.9 ± 15.1 years) underwent B-mode ultrasonography to assess steatosis and SWE to determine Young's modulus as a noninvasive marker or liver fibrosis.

RESULTS

We identified 99 subjects with steatosis, which was mild in 46 subjects (46%), moderate in 52 subjects (52%) and severe in a single subject (1%). Mean Young's modulus was 7.58 ± 3.53 kPa in this slightly overweight study cohort (BMI: 25.7 ± 4.6 kg/m2). Univariate analysis adjusted for age, sex and BMI indicated no discernible role for genetic components in the presence of liver stiffness, whereas shared and unshared environmental effects accounted for 38.3% (95% confidence interval (CI), 17-56.1%) and 61.7% (95% CI, 43.9-83%).

CONCLUSIONS

Our findings do not support the heritability of liver stiffness in an asymptomatic, twin cohort with slight overweight and variable degree of steatosis, underscoring the importance of environmental factors in the development of NAFLD and liver fibrosis.

An information-based framework for development national twin registry: Scoping review and focus group discussion

BACKGROUND

Registries in various clinical domains have been established in the last decades. The specific genetic structure of twins has enabled researchers to find answers to the role of genetics and the environment in medical sciences. Thus, twin registries were developed across the world to support twin studies. Our main objective was to devise a conceptual model for developing the national twin registry to ensure the success of this registry.

METHODS

In this descriptive and qualitative study, the combination of literature review and focus group discussions was applied to achieve suitable models for developing a national twin registry based on lessons learned from founded registries. The qualitative synthesis and reporting results were conducted based on the COREQ checklist.

RESULTS

According to a systematic literature review, the characteristics and employed strategies employed by established twin registries were recognized. Moreover, based on our objectives, suitable models for registry development were defined. The source of information, the different levels of data, and the information flow were determined based on this model.

CONCLUSION

Suggesting a conceptual framework for twin registry development at the national level based on the experiences of other countries could contribute to a greater understanding of twin registry implementation efficiently.

Lumbar spine abnormalities in patients with obstructive sleep apnoea

Previous studies suggested cervical spondylosis as a risk factor for development of obstructive sleep apnoea (OSA). We aimed to assess lumbar disc degeneration in patients with OSA and correlate the findings with symptoms and disease severity. Twenty-seven patients with OSA and 29 non-OSA controls underwent sleep studies and lumbar magnetic resonance imaging (MRI), and completed the Epworth Sleepiness Scale and the 24-item Roland-Morris Disability Questionnaire (RMDQ) questionnaires. Plasma klotho was determined with enzyme-linked immunosorbent assay. Patients with OSA had higher number of disc bulges (4.6 ± 3.7 vs. 1.7 ± 2.5, p < 0.01) and anterior spondylophytes (2.7 ± 4.2 vs. 0.8 ± 2.1, p < 0.01), increased disc degeneration (total Pfirrmann score 16.7 ± 4.7 vs. 13.2 ± 4.1, p < 0.01) and vertebral fatty degeneration (7.8 ± 4.7 vs. 3.8 ± 3.7, p < 0.01). There was no difference in the RMDQ score (0/0-3.5/ vs. 0/0-1/, p > 0.05). Markers of OSA severity, including the oxygen desaturation index and percentage of total sleep time spent with saturation < 90% as well as plasma levels of klotho were correlated with the number of disc bulges and anterior spondylophytes (all p < 0.05). OSA is associated with lumbar spondylosis. Our study highlights the importance of lumbar imaging in patients with OSA reporting lower back pain.

The Iranian Newborn Multiples Registry (IRNMR): a registry protocol

Purpose: Over the last decades, several twin/multiples registries have been developed worldwide, mostly concentrated in Europe and high-income countries (HICs). In Iran, we lack accurate nationwide epidemiological and biobank data on twins. We established the Iranian Newborn Multiples Registry (IRNMR) to evaluate the role of genetics and environmental factors in the variation of phenotypes among newborn monozygotic (MZ) and dizygotic (DZ) twin pairs. IRNMR is a multicenter hospital-based registry. Materials and methods: In the pilot phase, we collected epidemiological data from multiples born in Imam Khomeini Hospital complex and Aban Hospital located in Tehran, the capital of Iran, with a population exceeding 8 million, Allameh Bohlool Gonabadi Hospital, Gonabad, Razavi Khorasan, and Shahid Sadoughi Hospital, Yazd, Iran. Results: The IRNMR has recruited 457 sets of newborn twins and multiples so far. We hold follow-up sessions by mother and child health professionals to monitor multiples' growth, development, diseases, and mortality. Conclusions: We successfully developed a newborn multiples registry in Iran. This registry will create an invaluable database to study the relative influence of genes and environmental factors on various chronic diseases, growth, development, and behavioral disorders. We intend to collaborate with other centers to develop a large multicenter nationwide multiple birth registry and biobank in Iran.

Overlapping Genetic Background of Coronary Artery and Carotid/Femoral Atherosclerotic Calcification

Background and objectives: Multivessel atherosclerosis and its genetic background are under-investigated, although atherosclerosis is seldom local and still causes high mortality. Alternative methods to assess coronary calcification (CAC) might incorporate genetic links between different arteries’ atherosclerotic involvement, however, co-occurrences of coronary calcification have not been investigated in twins yet. Materials and Methods: We assessed the heritability of radio morphologically distinct atherosclerotic plaque types in coronary (non-enhanced CT, Agatston score), carotid, and femoral arteries (B-mode ultrasound) in 190 twin subjects (60 monozygotic, 35 dizygotic pairs). Four-segment scores were derived in order to assess the dissemination of the distinct plaque types in the carotid and femoral arteries taking bilaterality into account. We calculated the genetic correlation between phenotypically correlating plaque types in these arteries. Results: CAC and dissemination of calcified plaques in the carotid and femoral arteries (4S_hyper) were moderately heritable (0.67 [95% CI: 0.37–1] and 0.69 [95% CI: 0.38–1], respectively) when adjusted for age and sex. Hypoechoic plaques in the carotid and femoral arteries showed no heritability, while mixed plaques showed intermediate heritability (0.50 [95% CI: 0–0.76]). Age and sex-adjusted phenotypic correlation between CAC and 4segm_hyper was 0.48 [95% CI: 0.30–0.63] and the underlying genetic correlation was 0.86 [95% CI: 0.42–1]. Conclusions: Calcification of atherosclerotic plaques is moderately heritable in all investigated arteries and significant overlapping genetic factors can be attributed to the phenotypical resemblance of coronary and carotid or femoral atherosclerotic calcification. Our findings support the idea of screening extracoronary arteries in asymptomatic individuals. We also propose a hypothesis about primarily carotid-coronary and femoral-coronary atherosclerosis as two distinct genetic predispositions to co-localization.

Association between Gut Microbial Diversity and Carotid Intima-Media Thickness

Background and Objectives: There is an increasing focus on the effect of the gut microbiome on developing atherosclerosis, but there is still no unified standpoint. We aimed to find associations between intestinal microbiome diversity and a marker of subclinical atherosclerosis, the carotid intima-media thickness (IMT). Materials and Methods: Recruited from the Hungarian Twin Registry, 108 monozygotic (MZ) twins (mean age 52.4 ± 14.1 years, 58% female) underwent a comprehensive carotid ultrasound examination (Samsung RS85). Of the 108 MZ twins, 14 pairs (mean age 65 ± 6.4 years, 71% female) discordant for carotid IMT were selected to undergo a stool sample collection. A special stool sampling container was mailed and received from each participant. After DNA extraction, library construction was performed specifically for the V3–V4 hypervariable region of microbial 16S rRNA. Next, the microbiome composition of the samples was determined using Kraken software. Two hypotheses were tested with the exact permutation test: (1) in the group with normal IMT, the Shannon index of the phyla is higher; and (2) the Firmicutes/Bacteroidetes ratio is greater in the group with high IMT values. Furthermore, the abundance of different bacterial strains present at higher and normal IMT was also explored. Statistical analysis was carried out using R software. Results: Increased Firmicutes/Bacteroidetes ratio was associated with increased IMT (mean Firmicutes/Bacteroidetes ratio of IMT > 0.9 and IMT < 0.9 groups: 2.299 and 1.436, respectively; p = 0.031). In the group with normal IMT values, a substantially higher fraction of Prevotellaceae was observed in contrast with subjects having subclinical atherosclerosis. However, there was no significant difference in the alpha diversity between the two groups. Conclusions: The determining role of individual genera and their proportions in the development and progression of atherosclerosis can be assumed. Further studies are needed to clarify if these findings can be used as potential therapeutic targets.

Are the Morphological Indices of the Vertebrobasilar System Heritable? A Twin Study Based on 3D Reconstructed Models

Background and Objectives: The asymmetrical vertebral artery (VA) flow and diameter are common findings, which can result in an asymmetrical blood flow in the basilar artery (BA), leading to bending of the artery over time. This study investigated whether the variation of the different vertebrobasilar morphological indices that influence flow characteristics might be inherited. Materials and Methods: We analyzed 200 cerebral magnetic resonance imaging (MRI) scans of healthy Caucasian twins (100 pairs) who underwent time-of-flight MRI. From the scans, we reconstructed the 3D mesh of the posterior circulation from the start of the V4 segment to the basilar tip and subsequently analyzed the morphology of the vertebrobasilar system. The phenotypic covariances of the different morphological parameters were decomposed into heritability (A), shared (C), and unshared (E) environmental effects. Results: 39% of the twins had left dominant VA, while 32.5% had right dominant. In addition, 28.5% were classified as equal. The vertebral artery V4 segment diameter, curvature, and tortuosity were mainly influenced by shared (C) and unshared (E) environmental factors. A moderate heritability was found for the BA length (A: 63%; 95% CI: 45.7–75.2%; E: 37%; 95% CI: 24.8–54.3%) and volume (A: 60.1%; 95% CI: 42.4–73.2%; E: 39.9%; 95% CI: 26.8–57.6%), while the torsion of both arteries showed no heritability and were only influenced by the unshared environment. Conclusions: The length and volume of the BA show a moderate genetical influence. However, most of the measured morphological indices were influenced by shared and unshared factors, which highlight the role of the ever-changing hemodynamic influences shaping the geometry of the vertebrobasilar system.

Application of intraoral scanner to identify monozygotic twins

BACKGROUND

DNA base identification is a proper and high specificity method. However, identification could be challenged in a situation where there is no database or the DNA sequence is almost identical, as in the case of monozygotic (MZ) twins. The aim of this study was to introduce a novel forensic method for distinguishing between almost identical MZ twins by means of an intraoral scanner using the 3D digital pattern of the human palate.

METHODS

The palatal area of 64 MZ twins and 33 same-sex dizygotic (DZ) twins (DZSS) and seven opposite-sex dizygotic twins (DZOS) were scanned three times with an intraoral scanner. From the scanned data, an STL file was created and exported into the GOM Inspect® inspection software. All scans within a twin pair were superimposed on each other. The average deviation between scans of the same subject (intra-subject deviation, ISD) and between scans of the two siblings within a twin pair (intra-twin deviation, ITD) was measured. One-sided tolerance interval covering 99% of the population with 99% confidence was calculated for the ISD (upper limit) and the ITD (lower limit).

RESULTS

The mean ISD of the palatal scan was 35.3 μm ± 0.78 μm. The calculated upper tolerance limit was 95 μm. The mean ITD of MZ twins (406 μm ± 15 μm) was significantly (p < 0.001) higher than the ISD, and it was significantly lower than the ITD of DZSS twins (594 μm ± 53 μm, p < 0.01) and the ITD of DZOS twins (853 μm ± 202 μm, p < 0.05).

CONCLUSION

The reproducibility of palatal intraoral scans proved to be excellent. The morphology of the palate shows differences between members of MZ twins despite their almost identical DNA, indicating that this method could be useful in forensic odontology.