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Ames PR, D'Andrea G, Arcaro A, Marottoli V, Iannaccone L, Margaglione M, Gentile F. Homozygous MTHFR C677T carriers develop idiopathic portal vein thrombosis 20 years earlier than wild type. Blood Coagul Fibrinolysis 2024; 35:180-186. [PMID: 38526965 DOI: 10.1097/mbc.0000000000001299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
The aim of this study was to evaluate the impact of methylene tetrahydrofolate reductase (MTHFR) rs1801133 (C→T667 transition) on age at first idiopathic portal vein thrombosis (PVT) and to identify clinical and/or laboratory variables influencing age at first PVT, including plasma homocysteine and the prothrombin rs1799963 PT (G→A transition at position 20210) (PT) mutation. A retrospective cross-sectional cohort, including 15 MTHFR TT, 32 MTHFR TC and 22 MTHFR CC idiopathic PVT participants contributing demographics, age at PVT, plasma concentrations of homocysteine and of natural anticoagulants. MTHFR TT carriers presented with a lower age at PVT than heterozygous or wild-type genotypes (31 ± 8 vs. 48 ± 15 vs. 52 ± 13 years, P = 0.001) and were more likely to have a plasma HC concentration above the cut-off (73.3 vs. 32 vs. 50%, P = 0.04). MTHFR TT and protein C predicted age at PVT ( P < 0.0001 and P = 0.06); MTHFR TT predicted plasma homocysteine ( P = 0.05). In the MTHFR TT group, plasma homocysteine inversely related to protein C ( P = 0.03). Plasma homocysteine predicted the extent of PVT ( P = 0.03). Compound MTHFR TT + PT GA did not lower age at first PVT compared to MTHFR TT alone (35 ± 9 vs. 30 ± 8 years). MTHFR TT is associated with a 20-year earlier PVT presentation than heterozygous and wild-type MTHFR genotypes. The inverse relation between plasma homocysteine and protein C contributes to the prematurity of PVT in the MTHFR TT group, whereas plasma homocysteine contributes to the extent of PVT. The recent exclusion of MTHFR genotyping from the thrombophilia screen needs revisiting in this setting.
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Affiliation(s)
- Paul Rj Ames
- Immune Response & Vascular Disease Unit, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Giovanna D'Andrea
- Dumfries & Galloway Royal Infirmary, Dumfries, UK
- Medical Genetics, Department of Clinical and Experimental Medicine, University of Foggia, Foggia
| | - Alessia Arcaro
- Department of Medicine and Health Sciences 'V. Tiberio', University of Molise, Campobasso, Italy
| | | | | | - Maurizio Margaglione
- Dumfries & Galloway Royal Infirmary, Dumfries, UK
- Medical Genetics, Department of Clinical and Experimental Medicine, University of Foggia, Foggia
| | - Fabrizio Gentile
- Department of Medicine and Health Sciences 'V. Tiberio', University of Molise, Campobasso, Italy
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Stanwyck LK, Anozie CC, Laylani NA, Charoenkijkajorn C, Pakravan M, Ishihara R, Lee AG. The Controversial Role of Homocysteine and Methylenetetrahydrofolate Reductase Mutations in Nonarteritic Anterior Ischemic Optic Neuropathy. J Neuroophthalmol 2024:00041327-990000000-00576. [PMID: 38363636 DOI: 10.1097/wno.0000000000002095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Affiliation(s)
- Lynn K Stanwyck
- Virginia Tech Carilion School of Medicine (LKS), Roanoke, Virginia; John Sealy School of Medicine at the University of Texas Medical Branch (CCA), Galveston, Texas; Department of Ophthalmology (NAL, CC, MP, AGL), Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; Department of Ophthalmology (RI, AGL), University of Texas Medical Branch, Galveston, Texas; Departments of Ophthalmology, Neurology, and Neurosurgery (AGL), Weill Cornell Medicine, New York, New York; University of Texas Maryland Anderson Cancer Center (AGL), Houston, Texas; Texas A and M College of Medicine (AGL), Bryan, Texas; and Department of Ophthalmology (AGL), The University of Iowa Hospitals and Clinics, Iowa City, Iowa
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3
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Kramarz C, Murphy E, Reilly MM, Rossor AM. Nutritional peripheral neuropathies. J Neurol Neurosurg Psychiatry 2023; 95:61-72. [PMID: 37536924 DOI: 10.1136/jnnp-2022-329849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/30/2023] [Indexed: 08/05/2023]
Abstract
Nutritional peripheral neuropathies are a global problem, heavily influenced by geopolitical, cultural and socioeconomic factors. Peripheral neuropathy occurs most frequently secondary to B-vitamin deficiencies, which is suspected to increase in years to come due to the popularity of vegan and vegetarian diets and increased use of bariatric surgery.This review will focus on the common B-vitamins for which a causal link to peripheral neuropathy is more established (vitamins B1, B2, B6, B9 and B12). We will review the historical human and animal data on which much of the clinical descriptions of vitamin deficiencies are based and summarise current available tools for accurately diagnosing a nutritional deficiency. We will also review recently described genetic diseases due to pathogenic variants in genes involved in B-vitamin metabolism that have helped to inform the phenotypes and potential causality of certain B-vitamins in peripheral neuropathy (B2 and B9).Endemic outbreaks of peripheral neuropathy over the last two centuries have been linked to food shortages and nutritional deficiency. These include outbreaks in Jamaican sugar plantation workers in the nineteenth century (Strachan's syndrome), World War two prisoners of war, Cuban endemic neuropathy and also Tanzanian endemic optic neuropathy, which remains a significant public health burden today. An improved understanding of lack of which vitamins cause peripheral neuropathy and how to identify specific deficiencies may lead to prevention of significant and irreversible disability in vulnerable populations.
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Affiliation(s)
- Caroline Kramarz
- Department of Neuromuscular Diseases, Queen Square UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Elaine Murphy
- Charles Dent Metabolic Unit, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Mary M Reilly
- Department of Neuromuscular Diseases, Queen Square UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Alexander M Rossor
- Department of Neuromuscular Diseases, Queen Square UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
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Abstract
In this guideline, recurrent miscarriage has been defined as three or more first trimester miscarriages. However, clinicians are encouraged to use their clinical discretion to recommend extensive evaluation after two first trimester miscarriages, if there is a suspicion that the miscarriages are of pathological and not of sporadic nature. Women with recurrent miscarriage should be offered testing for acquired thrombophilia, particularly for lupus anticoagulant and anticardiolipin antibodies, prior to pregnancy. [Grade C] Women with second trimester miscarriage may be offered testing for Factor V Leiden, prothrombin gene mutation and protein S deficiency, ideally within a research context. [Grade C] Inherited thrombophilias have a weak association with recurrent miscarriage. Routine testing for protein C, antithrombin deficiency and methylenetetrahydrofolate reductase mutation is not recommended. [Grade C] Cytogenetic analysis should be offered on pregnancy tissue of the third and subsequent miscarriage(s) and in any second trimester miscarriage. [Grade D] Parental peripheral blood karyotyping should be offered for couples in whom testing of pregnancy tissue reports an unbalanced structural chromosomal abnormality [Grade D] or there is unsuccessful or no pregnancy tissue available for testing. [GPP] Women with recurrent miscarriage should be offered assessment for congenital uterine anomalies, ideally with 3D ultrasound. [Grade B] Women with recurrent miscarriage should be offered thyroid function tests and assessment for thyroid peroxidase (TPO) antibodies. [Grade C] Women with recurrent miscarriage should not be routinely offered immunological screening (such as HLA, cytokine and natural killer cell tests), infection screening or sperm DNA testing outside a research context. [Grade C] Women with recurrent miscarriage should be advised to maintain a BMI between 19 and 25 kg/m2 , smoking cessation, limit alcohol consumption and limit caffeine to less than 200 mg/day. [Grade D] For women diagnosed with antiphospholipid syndrome, aspirin and heparin should be offered from a positive test until at least 34 weeks of gestation, following discussion of potential benefits versus risks. [Grade B] Aspirin and/or heparin should not be given to women with unexplained recurrent miscarriage. [Grade B] There are currently insufficient data to support the routine use of PGT-A for couples with unexplained recurrent miscarriage, while the treatment may carry a significant cost and potential risk. [Grade C] Resection of a uterine septum should be considered for women with recurrent first or second trimester miscarriage, ideally within an appropriate audit or research context. [Grade C] Thyroxine supplementation is not routinely recommended for euthyroid women with TPO who have a history of miscarriage. [Grade A] Progestogen supplementation should be considered in women with recurrent miscarriage who present with bleeding in early pregnancy (for example 400 mg micronised vaginal progesterone twice daily at the time of bleeding until 16 weeks of gestation). [Grade B] Women with unexplained recurrent miscarriage should be offered supportive care, ideally in the setting of a dedicated recurrent miscarriage clinic. [Grade C].
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Mendes-de-Almeida DP, Kehdy FSG, Martins-Gonçalves R, Bokel J, Grinsztejn E, Mouta Nunes de Oliveira P, Maia MDLDS, Hoagland B, Wagner Cardoso S, Grinsztejn B, Siqueira MM, Kurtz P, Bozza PT, Garcia CC. A case report of vaccine-induced immune thrombotic thrombocytopenia (VITT) with genetic analysis. Front Cardiovasc Med 2023; 10:1189320. [PMID: 37351283 PMCID: PMC10284151 DOI: 10.3389/fcvm.2023.1189320] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 04/24/2023] [Indexed: 06/24/2023] Open
Abstract
The emergence of the rare syndrome called vaccine-induced immune thrombocytopenia and thrombosis (VITT) after adenoviral vector vaccines, including ChAdOx1 nCov-19, raises concern about one's predisposing risk factors. Here we report the case of a 56-year-old white man who developed VITT leading to death within 9 days of symptom onset. He presented with superior sagittal sinus thrombosis, right frontal intraparenchymal hematoma, frontoparietal subarachnoid and massive ventricular hemorrhage, and right lower extremity arterial and venous thrombosis. His laboratory results showed elevated D-dimer, C-reactive protein, tissue factor, P-selectin (CD62p), and positive anti-platelet factor 4. The patient's plasma promoted higher CD62p expression in healthy donors' platelets than the controls. Genetic investigation on coagulation, thrombophilia, inflammation, and type I interferon-related genes was performed. From rare variants in European or African genomic databases, 68 single-nucleotide polymorphisms (SNPs) in one allele and 11 in two alleles from common SNPs were found in the patient genome. This report highlights the possible relationship between VITT and genetic variants. Additional investigations regarding the genetic predisposition of VITT are needed.
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Affiliation(s)
- Daniela P. Mendes-de-Almeida
- Department of Hematology, Evandro Chagas National Institute of Infectious Diseases, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
- Department of Medical Affairs, Clinical Studies, and Post-Registration Surveillance (DEAME), Institute of Technology in Immunobiologicals/Bio-Manguinhos, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
- Research Center, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
| | - Fernanda S. G. Kehdy
- Laboratório de Hanseníase, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Remy Martins-Gonçalves
- Laboratory of Immunopharmacology, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Joanna Bokel
- Department of Hematology, Evandro Chagas National Institute of Infectious Diseases, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
- Onco-Hematology Unit, Clínica São Vicente, Rio de Janeiro, Brazil
| | - Eduarda Grinsztejn
- Department of Medicine, Hematology and Oncology Division, University Hospitals, Case Western University, Cleveland, OH, United States
| | - Patrícia Mouta Nunes de Oliveira
- Department of Medical Affairs, Clinical Studies, and Post-Registration Surveillance (DEAME), Institute of Technology in Immunobiologicals/Bio-Manguinhos, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Maria de Lourdes de Sousa Maia
- Department of Medical Affairs, Clinical Studies, and Post-Registration Surveillance (DEAME), Institute of Technology in Immunobiologicals/Bio-Manguinhos, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Brenda Hoagland
- Laboratory of Clinical Research on STD/AIDS, Evandro Chagas National Institute of Infectious Diseases Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Sandra Wagner Cardoso
- Laboratory of Clinical Research on STD/AIDS, Evandro Chagas National Institute of Infectious Diseases Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Laboratory of Clinical Research on STD/AIDS, Evandro Chagas National Institute of Infectious Diseases Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Marilda M. Siqueira
- Laboratório de Vírus Respiratórios, Exantemáticos, Enterovírus e Emergências Virais, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Pedro Kurtz
- Intensive Care Department, Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, Brazil
| | - Patricia T. Bozza
- Laboratory of Immunopharmacology, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Cristiana C. Garcia
- Laboratório de Vírus Respiratórios, Exantemáticos, Enterovírus e Emergências Virais, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
- Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ-Minas), Belo Horizonte, Brazil
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Maher K, Persa L, Barry D, Lee-Eng J, Dichek H, Joshi S, Amlie-Lefond C. Thrombophilia screening in the routine clinical care of children with arterial ischemic stroke. Pediatr Blood Cancer 2023:e30381. [PMID: 37114761 DOI: 10.1002/pbc.30381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/09/2023] [Accepted: 04/02/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Current guidelines recommend thrombophilia evaluation in childhood arterial ischemic stroke, but the impact of screening on management is unknown. The objective of the current study is to report the incidence of thrombophilia identified as part of routine clinical care in the context of available literature reports, and to describe the impact of a diagnosis of thrombophilia on patient management. METHODS We conducted a single-institution retrospective chart review for all children with arterial ischemic stroke occurring between January 1, 2009 and January 1, 2021. We collected thrombophilia screening results, stroke etiology, and management. We also reviewed the literature of thrombophilia testing in childhood arterial ischemic stroke published prior to June 30, 2022. Meta-analysis methods were used to assess prevalence rates. RESULTS Among children with thrombophilia testing performed, 5% (six of 122 patients) were factor V Leiden heterozygous, 1% (one of 102 patients) were prothrombin gene mutation heterozygous, 1% (one of 122) had protein S deficiency, 20% (23/116 patients) had elevated lipoprotein(a), 3% (three of 110 patients) had elevated homocysteine levels, and 9% (10/112) had elevated antiphospholipid antibodies, only two of whom had persistently elevated levels. There was no change in stroke therapy due to these results. Literature review revealed a wide range of prevalence for most thrombophilia traits, with high cross-study heterogeneity in most cases. CONCLUSIONS The rates of thrombophilia in our cohort were consistent with that expected in the general population. The identification of thrombophilia did not alter stroke care. However, some of the results were actionable, prompting evaluation for lipid disorders and patient-specific counseling on cardiovascular risk and risk for venous thrombosis.
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Affiliation(s)
- Kristin Maher
- Division of Hematology-Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Laurel Persa
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Dwight Barry
- Clinical Analytics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jacqueline Lee-Eng
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Helen Dichek
- Division of Endocrinology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Sarita Joshi
- Division of Hematology-Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Catherine Amlie-Lefond
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
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Abdulaziz-Opiela G, Sobieraj A, Sibrecht G, Bajdor J, Mroziński B, Kozłowska Z, Iciek R, Wróblewska-Seniuk K, Wender-Ożegowska E, Szczapa T. Prenatal and Neonatal Pulmonary Thrombosis as a Potential Complication of SARS-CoV-2 Infection in Late Pregnancy. Int J Mol Sci 2023; 24:ijms24087629. [PMID: 37108791 PMCID: PMC10146603 DOI: 10.3390/ijms24087629] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
Neonatal venous thrombosis is a rare condition that can be iatrogenic or occur due to viral infections or genetic mutations. Thromboembolic complications are also commonly observed as a result of SARS-CoV-2 infections. They can affect pediatric patients, especially the ones suffering from multisystem inflammatory syndrome in children (MIS-C) or multisystem inflammatory syndrome in neonates (MIS-N). The question remains whether the maternal SARS-CoV-2 infection during pregnancy can lead to thromboembolic complications in fetuses and neonates. We report on a patient born with an embolism in the arterial duct, left pulmonary artery, and pulmonary trunk, who presented several characteristic features of MIS-N, suspecting that the cause might have been the maternal SARS-CoV2 infection in late pregnancy. Multiple genetic and laboratory tests were performed. The neonate presented only with a positive result of IgG antibodies against SARS-CoV-2. He was treated with low molecular weight heparin. Subsequent echocardiographic tests showed that the embolism dissolved. More research is necessary to evaluate the possible neonatal complications of maternal SARS-CoV-2 infection.
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Affiliation(s)
| | - Anna Sobieraj
- Faculty of Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Greta Sibrecht
- II Department of Neonatology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Julia Bajdor
- Department of Radiology, Nicolaus Copernicus Hospital, 80-803 Gdansk, Poland
| | - Bartłomiej Mroziński
- Department of Pediatric Cardiology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Zuzanna Kozłowska
- II Department of Neonatology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Rafał Iciek
- Department of Reproduction, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | | | - Ewa Wender-Ożegowska
- Department of Reproduction, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Tomasz Szczapa
- II Department of Neonatology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
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Gonzalez A, Smith GH, Gambello MJ, Sokolová J, Kožich V, Li H. Elevated homocysteine levels: What inborn errors of metabolism might we be missing? Am J Med Genet A 2023; 191:130-134. [PMID: 36271828 DOI: 10.1002/ajmg.a.63001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/14/2022] [Accepted: 08/24/2022] [Indexed: 12/14/2022]
Abstract
Elevated total plasma homocysteine (hyperhomocysteinemia) is a marker of cardiovascular, thrombotic, and neuropsychological disease. It has multiple causes, including the common nutritional vitamin B12 or folate deficiency. However, some rare but treatable, inborn errors of metabolism (IEM) characterized by hyperhomocysteinemia can be missed due to variable presentations and the lack of awareness. The aim of this study is to identify undiagnosed IEM in adults with significantly elevated homocysteine using key existing clinical data points, then IEM specific treatment can be offered to improve outcome. We conducted a retrospective study with data mining and chart review of patients with plasma total homocysteine >30 μmol/L over a two-year period. We offer biochemical and genetic testing to patients with significant hyperhomocysteinemia without a clear explanation to diagnose IEM. We identified 22 subjects with significant hyperhomocysteinemia but no clear explanation. Subsequently, we offered genetic testing to seven patients and diagnosed one patient with classic homocystinuria due to cystathionine beta-synthase deficiency. With treatment, she lowered her plasma homocysteine and improved her health. This study stresses the importance of a thorough investigation of hyperhomocysteinemia in adults to identify rare but treatable IEM. We propose a metabolic evaluation algorithm for elevated homocysteine levels.
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Affiliation(s)
- Aixa Gonzalez
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Pediatrics, Genetics Section, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Geoffrey Hughes Smith
- Department of Pathology, Emory University, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael J Gambello
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jitka Sokolová
- Department of Pediatrics and Inherited Metabolic Disorders, Charles University-First Faculty of Medicine and General University Hospital in Prague, Prague, Czechia
| | - Viktor Kožich
- Department of Pediatrics and Inherited Metabolic Disorders, Charles University-First Faculty of Medicine and General University Hospital in Prague, Prague, Czechia
| | - Hong Li
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
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Hoefer CC, Hollon LK, Campbell JA. The Role of the Human Gutome on Chronic Disease: A Review of the Microbiome and Nutrigenomics. Clin Lab Med 2022; 42:627-643. [PMID: 36368787 DOI: 10.1016/j.cll.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Carrie C Hoefer
- James L. Winkle College of Pharmacy, University of Cincinnati, 231 Albert Sabin Way, MSB 3005, Cincinnati, OH 45267, USA.
| | - Leah K Hollon
- Richmond Natural Medicine, National University of Natural Medicine Residency, 9211 Forest Hill Avenue, Richmond, VA 23235, USA
| | - Jennifer A Campbell
- Manchester University, College of Pharmacy, Natural, and Health Sciences, 10627 Diebold Road, Fort Wayne, IN 46845, USA
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Intrauterine Limb Ischemia in Patient Heterozygous for the 677C>T) RS1801133 (Polymorphism of Methylenetetrahydrofolate Reductase MTHR Gene. Case Rep Pediatr 2022; 2022:2701548. [PMID: 36313901 PMCID: PMC9616673 DOI: 10.1155/2022/2701548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 10/07/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background Intrauterine arterial thrombosis is extremely rare. Multiple inherited coagulopathies were found to be associated with thrombophilia and an increased risk of intrauterine arterial thrombosis. Methylenetetrahydrofolate reductase MTHFR (C667T) polymorphism was found to be associated with mild hyper-homocysteinemia, which, in turn, can promote thrombotic complications. Materials and Methods We reported a case of intrauterine upper limb ischemia in a neonate who was found to be heterozygous for the 677C > T polymorphism of the MTHFR gene despite the dispute regarding its clinical significance as a risk of arterial thrombosis. We also reviewed the literature and summarized the clinical features, treatment, and prognosis of similar cases. Case Presentation. We reported a full-term female, born by normal spontaneous vaginal delivery who was found to have a swollen, blue left upper limb in the delivery room. Left upper limb computed tomography angiography (CTA) revealed left subclavian artery thrombosis. Investigations for the risk revealed heterozygosity for the MTHFR (C667T) polymorphism. Left upper limb amputation was done after the failure of medical management. Conclusion Despite the conflict about whether heterozygosity for MTHFR (C667T) polymorphism increases the risk of arterial thrombosis or not, there are few cases in the literature presented with intrauterine upper limb ischemia and were found to be heterozygous for the mutation. We recommend investigating neonates and their parents for complete thrombophilia mutations when they present with unusual vascular occlusion sites as newborns.
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Wang LQ, Fernandez-Boyano I, Robinson WP. Genetic variation in placental insufficiency: What have we learned over time? Front Cell Dev Biol 2022; 10:1038358. [PMID: 36313546 PMCID: PMC9613937 DOI: 10.3389/fcell.2022.1038358] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/03/2022] [Indexed: 11/28/2022] Open
Abstract
Genetic variation shapes placental development and function, which has long been known to impact fetal growth and pregnancy outcomes such as miscarriage or maternal pre-eclampsia. Early epidemiology studies provided evidence of a strong heritable component to these conditions with both maternal and fetal-placental genetic factors contributing. Subsequently, cytogenetic studies of the placenta and the advent of prenatal diagnosis to detect chromosomal abnormalities provided direct evidence of the importance of spontaneously arising genetic variation in the placenta, such as trisomy and uniparental disomy, drawing inferences that remain relevant to this day. Candidate gene approaches highlighted the role of genetic variation in genes influencing immune interactions at the maternal-fetal interface and angiogenic factors. More recently, the emergence of molecular techniques and in particular high-throughput technologies such as Single-Nucleotide Polymorphism (SNP) arrays, has facilitated the discovery of copy number variation and study of SNP associations with conditions related to placental insufficiency. This review integrates past and more recent knowledge to provide important insights into the role of placental function on fetal and perinatal health, as well as into the mechanisms leading to genetic variation during development.
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Affiliation(s)
- Li Qing Wang
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Icíar Fernandez-Boyano
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Wendy P. Robinson
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
- *Correspondence: Wendy P. Robinson,
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Liver Cirrhosis Patients Homozygous for MTHFR C677T Develop Portal Vein Thrombosis 8 Years Earlier Than Wild Type. Dig Dis Sci 2022; 68:1332-1338. [PMID: 35999432 DOI: 10.1007/s10620-022-07666-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/09/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Age at portal vein thrombosis (PVT) in liver cirrhosis (LC) carriers of the methylene tetrahydrofolate reductase (MTHFR) rs1801133 (C → T667 transition) polymorphism has never been addressed; we compared age at PVT in LC patients genotyped for the MTHFR and explored the interrelated clinical and laboratory factors predicting age at PVT. APPROACH AND RESULTS Retrospective cross-sectional cohort study. PVT participants: MTHFR CC n = 36, MTHFR CT n = 53, MTHFR TT n = 19; age, sex, age at PVT, Child-Pugh score, rs1799963 PT polymorphisms (G → A 20,210 transition), plasma HC and natural anticoagulants available for all participants. Age at PVT was lower in MTHFR TT than CT and CC (56 ± 13 vs. 57 ± 13 vs. 64 ± 9 years, p = 0.001); median (IQR) plasma HC was higher in MTHFR TT than in the other groups [(17 (9.4, 23.3) vs 13 (8,14.7) vs 11 (8.9, 12.7) μmol/l, p = 0.03)]. MTHFR TT, male gender and protein C predicted age at PVT (p = 0.02, p = 0.04 and p = 0.08); MTHFR TT and Child-Pugh score predicted plasma HC (p = 0.005 and p = 0.01) as well as low plasma protein C (p < 0.0001 and p = 0.0002). Plasma HC inversely related to protein C in the MTHFR TT group (p < 0.0001). Compound MTHFR TT with PT GA had lower age at PVT compared to MTHFR TT alone (49 ± 18 vs 58 ± 12 years). CONCLUSIONS MTHFR TT anticipates PVT associated with LC by an average of 8 years; MTHFR TT associates with severity of liver disease and to high plasma HC; the latter may contribute to the prematurity of PVT by interfering with the anticoagulant activity of protein C.
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Deloughery TG, Hunt BJ, Barnes GD, Connors JM, Ay C, Barco S, Castellucci L, Cesarman‐Maus G, Paula EVD, Dumantepe M, Esposito MCG, Fedele F, Lee LH, McLintock C, Morishita E, Samama CM, Okoye H, Robertson T. A call to action: MTHFR polymorphisms should not be a part of inherited thrombophilia testing. Res Pract Thromb Haemost 2022; 6:e12739. [PMID: 35702587 PMCID: PMC9175241 DOI: 10.1002/rth2.12739] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/04/2022] [Accepted: 05/08/2022] [Indexed: 12/31/2022] Open
Abstract
Testing for polymorphisms in the methylenetetrahydrofolate reductase (MTHFR) gene is still a standard part of thrombophilia testing in many laboratories. However, it is clear that these polymorphisms are not risk factors for arterial or venous thrombosis and therefore should not be part of thrombophilia testing. Eliminating MTHFR from thrombophilia testing will reduce patient concerns and health care costs.
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Affiliation(s)
- Thomas G. Deloughery
- Division of Hematology/Medical Oncology Knight Cancer Center Oregon Health & Science University Portland Oregon USA
| | | | - Geoffrey D. Barnes
- Frankel Cardiovascular Center Department of Internal Medicine University of Michigan Ann Arbor Michigan USA
| | - Jean M. Connors
- Hematology Division Brigham and Women’s Hospital Harvard Medical School Boston Massachusetts USA
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14
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Moukalled NM, Hashash JG, Taher AT. Inflammatory Bowel Disease: An Indication to Screen for Thrombophilia? Diseases 2022; 10:diseases10010014. [PMID: 35323181 PMCID: PMC8947449 DOI: 10.3390/diseases10010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 11/30/2022] Open
Abstract
Inflammatory bowel diseases (IBD) are systemic conditions characterized by multiple intestinal and extra-intestinal manifestations related to the associated chronic inflammatory state. Among their diverse extra-intestinal complications, venous thromboembolism (VTE) remains one of the most under recognized causes of morbidity and mortality in these patients, highlighting the need for a better understanding of the underlying mechanism of hypercoagulability, in addition to the role of acquired and inherited risk factors that further increase the risk of thrombosis with its impact on patients’ outcomes. We hereby present a review of the data regarding thrombosis in the setting of IBD, elucidating the possible role for screening in this high-risk category of patients and specifically in areas where inherited thrombophilia is expected to be highly prevalent, reporting two patients with IBD, one who developed a cerebrovascular event and another one who had recurrent VTE events; nevertheless, both of them had inherited thrombophilic mutations. The identification of specific genetic abnormalities in those patients reintroduces the controversy related to the need to screen a specific category of patients with IBD for hereditary thrombophilia, especially in regions characterized by a higher prevalence of such thrombophilic alterations.
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Affiliation(s)
- Nour M. Moukalled
- Division of Hematology and Oncology, Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon;
- Correspondence:
| | - Jana G. Hashash
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Ali T. Taher
- Division of Hematology and Oncology, Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon;
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15
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Elkattawy S, Alyacoub R, Singh KS, Fichadiya H, Kessler W. Prothrombin G20210A Gene Mutation-Induced Recurrent Deep Vein Thrombosis and Pulmonary Embolism: Case Report and Literature Review. J Investig Med High Impact Case Rep 2022; 10:23247096211058486. [PMID: 35426321 PMCID: PMC9016586 DOI: 10.1177/23247096211058486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Inherited thrombophilia is an important cause of venous thrombosis. The Factor V
Leiden (FVL) is the most commonly encountered mutation, followed by the
prothrombin G20210A gene mutation (PTM). The typical venous thrombotic events
(VTEs) associated with PTM mutations are deep vein thrombosis (DVT) and
pulmonary embolisms (PE). The PTM is inherited in an autosomal dominant pattern
with variable penetrance. While heterozygous PTM mutations are more frequent and
well documented in the literature, rare cases of homozygous PTM mutations are
also reported. In this report, we discuss a 56-year-old male with a past medical
history of homozygous prothrombin gene mutation (G20210A) who presented with an
unprovoked DVT of the right lower extremity involving both the proximal and
distal veins associated with multiple bilateral PEs. This case is unique in
terms of the homozygous PTM inheritance, the age at which the patient presented
(usually presentation is earlier in life), and the fact that he had a recurrence
of both DVT and PE simultaneously.
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Affiliation(s)
- Sherif Elkattawy
- Rutgers New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - Ramez Alyacoub
- Rutgers New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | | | - Hardik Fichadiya
- Rutgers New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
| | - William Kessler
- Rutgers New Jersey Medical School/Trinitas Regional Medical Center, Elizabeth, USA
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16
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Keathley J, Garneau V, Zavala-Mora D, Heister RR, Gauthier E, Morin-Bernier J, Green R, Vohl MC. A Systematic Review and Recommendations Around Frameworks for Evaluating Scientific Validity in Nutritional Genomics. Front Nutr 2021; 8:789215. [PMID: 35004815 PMCID: PMC8728558 DOI: 10.3389/fnut.2021.789215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/26/2021] [Indexed: 12/18/2022] Open
Abstract
Background: There is a significant lack of consistency used to determine the scientific validity of nutrigenetic research. The aims of this study were to examine existing frameworks used for determining scientific validity in nutrition and/or genetics and to determine which framework would be most appropriate to evaluate scientific validity in nutrigenetics in the future.Methods: A systematic review (PROSPERO registration: CRD42021261948) was conducted up until July 2021 using Medline, Embase, and Web of Science, with articles screened in duplicate. Gray literature searches were also conducted (June-July 2021), and reference lists of two relevant review articles were screened. Included articles provided the complete methods for a framework that has been used to evaluate scientific validity in nutrition and/or genetics. Articles were excluded if they provided a framework for evaluating health services/systems more broadly. Citing articles of the included articles were then screened in Google Scholar to determine if the framework had been used in nutrition or genetics, or both; frameworks that had not were excluded. Summary tables were piloted in duplicate and revised accordingly prior to synthesizing all included articles. Frameworks were critically appraised for their applicability to nutrigenetic scientific validity assessment using a predetermined categorization matrix, which included key factors deemed important by an expert panel for assessing scientific validity in nutrigenetics.Results: Upon screening 3,931 articles, a total of 49 articles representing 41 total frameworks, were included in the final analysis (19 used in genetics, 9 used in nutrition, and 13 used in both). Factors deemed important for evaluating nutrigenetic evidence related to study design and quality, generalizability, directness, consistency, precision, confounding, effect size, biological plausibility, publication/funding bias, allele and nutrient dose-response, and summary levels of evidence. Frameworks varied in the components of their scientific validity assessment, with most assessing study quality. Consideration of biological plausibility was more common in frameworks used in genetics. Dose-response effects were rarely considered. Two included frameworks incorporated all but one predetermined key factor important for nutrigenetic scientific validity assessment.Discussion/Conclusions: A single existing framework was highlighted as optimal for the rigorous evaluation of scientific validity in nutritional genomics, and minor modifications are proposed to strengthen it further.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=261948, PROSPERO [CRD42021261948].
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Affiliation(s)
- Justine Keathley
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, QC, Canada
- School of Nutrition, Université Laval, Québec City, QC, Canada
- Mass General Brigham, Boston, MA, United States
- Ariadne Labs, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- The Broad Institute, Boston, MA, United States
| | - Véronique Garneau
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, QC, Canada
- School of Nutrition, Université Laval, Québec City, QC, Canada
| | | | | | - Ellie Gauthier
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, QC, Canada
- School of Nutrition, Université Laval, Québec City, QC, Canada
| | - Josiane Morin-Bernier
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, QC, Canada
- School of Nutrition, Université Laval, Québec City, QC, Canada
| | - Robert Green
- Mass General Brigham, Boston, MA, United States
- Ariadne Labs, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- The Broad Institute, Boston, MA, United States
| | - Marie-Claude Vohl
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, QC, Canada
- School of Nutrition, Université Laval, Québec City, QC, Canada
- *Correspondence: Marie-Claude Vohl
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17
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Nakano M, Nakamura Y, Urano T, Miyazaki A, Suzuki T, Watanabe K, Takahashi J, Shiraki M. Associations of Homocysteine Metabolism With the Risk of Spinal Osteoarthritis Progression in Postmenopausal Women. J Clin Endocrinol Metab 2021; 106:3428-3438. [PMID: 34375425 DOI: 10.1210/clinem/dgab591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Indexed: 02/07/2023]
Abstract
CONTEXT Although homocysteine accumulation is a reported risk factor for several age-related disorders, little is known about its relationship with osteoarthritis (OA). OBJECTIVE We investigated for associations of homocysteine and C677T polymorphism in methylenetetrahydrofolate reductase (MTHFR), which is involved in homocysteine clearance, with the development and progression of spinal OA through a combined cross-sectional and longitudinal cohort study. METHODS A total of 1306 Japanese postmenopausal outpatients participating in the Nagano Cohort Study were followed for a mean 9.7-year period. Cross-sectional multiple logistic regression for spinal OA prevalence at registration by serum homocysteine level was performed with adjustment for confounders. In addition to Kaplan-Meier analysis, multivariate Cox regression was employed to examine the independent risk of MTHFR C677T variant for spinal OA progression. RESULTS Multivariate regression analysis revealed a significant association between homocysteine and spinal OA prevalence (odds ratio 1.38; 95% CI 1.14-1.68). Kaplan-Meier curves showed a gene dosage effect of the T allele in MTHFR C677T polymorphism on the accelerated progression of spinal OA severity (P = 0.003). A statistically significant independent risk of the T allele for spinal OA advancement was validated by Cox regression analysis. Respective adjusted hazard ratios for the CT/TT and TT genotypes were 1.68 (95% CI, 1.16-2.42) and 1.67 (95% CI, 1.23-2.28). CONCLUSION Circulating homocysteine and C677T variant in MTHFR are associated with the prevalence rate and ensuing progression, respectively, of spinal OA. These factors may represent potential interventional targets to prevent OA development and improve clinical outcomes.
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Affiliation(s)
- Masaki Nakano
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Yukio Nakamura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Tomohiko Urano
- Department of Geriatric Medicine, International University of Health and Welfare School of Medicine, 4-3 Kozunomori, Narita, Chiba 286-8686, Japan
| | - Akiko Miyazaki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Takako Suzuki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
- Department of Human Nutrition, Faculty of Human Nutrition, Tokyo Kasei Gakuin University, 22 Sanban-cho, Chiyoda-ku, Tokyo 102-8341, Japan
| | - Kazuki Watanabe
- Department of Biology, College of Liberal Arts and Sciences, Tokyo Medical and Dental University, 2-8-30 Kohnodai, Ichikawa, Chiba 272-0827, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Masataka Shiraki
- Research Institute and Practice for Involutional Diseases, 1610-1 Meisei, Misato, Azumino, Nagano 399-8101, Japan
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18
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Ghumman GM, Ishtiaq R, Avasthi D. Portal Vein Thrombosis in a Patient With Methylenetetrahydrofolate Reductase Gene Mutation and Normal Homocysteine Levels. Cureus 2021; 13:e18225. [PMID: 34722031 PMCID: PMC8544635 DOI: 10.7759/cureus.18225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 01/21/2023] Open
Abstract
A 21-year-old male presented with chief complaints of abdominal pain, nausea, and vomiting and was found to have portal vein thrombosis (PVT) on computed tomography (CT) scan of the abdomen, which was redemonstrated on ultrasound. Thrombophilia workup was negative except that patient was heterozygous for methylenetetrahydrofolate reductase (MTHFR) gene mutation. Homocysteine levels were normal. The patient was started on enoxaparin and discharged on apixaban with the plan to continue anticoagulation for at least six months. Follow-up MRI after four months showed interval improvement of the main portal vein thrombus with the use of Eliquis.
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Affiliation(s)
| | - Rizwan Ishtiaq
- Internal Medicine, St. Vincent Mercy Medical Center, Toledo, USA
| | - Deepti Avasthi
- Internal Medicine, St. Vincent Mercy Medical Center, Toledo, USA
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19
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Assaf N, Chamseddine F, Taher A, Mahfouz R. Prevalence of thrombophilia-associated mutations and their clinical significance in a large cohort of Lebanese patients. Meta Gene 2021. [DOI: 10.1016/j.mgene.2021.100936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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20
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Chart NA, Kisor DF, Farrell CL. Defining the role of pharmacists in medication-related genetic counseling. Per Med 2021; 18:509-522. [PMID: 34402307 DOI: 10.2217/pme-2021-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is little question that precision medicine will eventually be the standard of care in treatment with algorithms designed for therapy selection and is already being used in some specialties such as cystic fibrosis and multiple cancer treatments. Genetic counselors are the heart of the treatment team in relation to counseling regarding genetic risk factors and disease states. A framework for treatment within the interdisciplinary team with more defined roles and areas of specialty will need to be in place as this practice approach expands with new data and treatments. Pharmacists are poised to be of great assistance in this matrix as many of these roles are merely an extension of current tasks and responsibilities of pharmacy practice.
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Affiliation(s)
- Nova A Chart
- Pharmacy & Pharmacogenomics Programs, Manchester University, Fort Wayne, IN 46845, USA
| | - David F Kisor
- Pharmacy & Pharmacogenomics Programs, Manchester University, Fort Wayne, IN 46845, USA
| | - Christopher L Farrell
- Department of Pharmaceutical & Administrative Sciences, School of Pharmacy, Presbyterian College, 307 N Broad St, Clinton, SC 29325, USA
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21
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Roy B, Walker K, Morgan C, Finch-Edmondson M, Galea C, Epi M, Badawi N, Novak I. Epidemiology and pathogenesis of stroke in preterm infants: A systematic review. J Neonatal Perinatal Med 2021; 15:11-18. [PMID: 34219672 PMCID: PMC8842753 DOI: 10.3233/npm-200597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Perinatal stroke is one of the principal causes of cerebral palsy (CP) in preterm infants. Stroke in preterm infants is different from stroke in term infants, given the differences in brain maturation and the mechanisms of injury exclusive to the immature brain. We conducted a systematic review to explore the epidemiology and pathogenesis of periventricular hemorrhagic infarction (PVHI), perinatal arterial ischemic stroke (PAIS) and cerebral sinovenous thrombosis (CSVT) in preterm infants. METHODS: Studies were identified based on predefined study criteria from MEDLINE, EMBASE, SCOPUS and WEB OF SCIENCE electronic databases from 2000 –2019. Results were combined using descriptive statistics. RESULTS: Fourteen studies encompassed 546 stroke cases in preterm infants between 23 –36 weeks gestational ages and birth weights between 450 –3500 grams. Eighty percent (436/546) of the stroke cases were PVHI, 17%(93/546) were PAIS and 3%(17/546) were CSVT. Parietal PVHI was more common than temporal and frontal lobe PVHI. For PAIS, left middle cerebral artery (MCA) was more common than right MCA or cerebellar stroke. For CSVT partial or complete thrombosis in the transverse sinus was universal. All cases included multiple possible risk factors, but the data were discordant precluding aggregation within a meta-analysis. CONCLUSION: This systematic review confirms paucity of data regarding the etiology and the precise causal pathway of stroke in preterm infants. Moreover, the preterm infants unlike the term infants do not typically present with seizures. Hence high index of clinical suspicion and routine cUS will assist in the timely diagnosis and understanding of stroke in this population.
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Affiliation(s)
- B Roy
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Australia.,School of Medicine, The University of Notre Dame Australia, Sydney, Australia.,The Mater Hospital, Sydney, Australia
| | - K Walker
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Australia.,The George Institute for Global Health, Sydney, Australia.,Newborn Care, Royal Prince Alfred Hospital, Sydney, Australia
| | - C Morgan
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Australia.,Cerebral Palsy Alliance Research Institute, Sydney, Australia
| | - M Finch-Edmondson
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Australia.,Cerebral Palsy Alliance Research Institute, Sydney, Australia
| | - C Galea
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Australia.,Cerebral Palsy Alliance Research Institute, Sydney, Australia
| | | | - N Badawi
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Australia.,Cerebral Palsy Alliance Research Institute, Sydney, Australia.,Grace Centre for Newborn Intensive Care, Sydney Children's Hospital Network, Westmead, Australia
| | - I Novak
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Australia.,Cerebral Palsy Alliance Research Institute, Sydney, Australia
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22
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Çetin İD, Eraslan C, Şimşek E, Kanmaz S, Serin HM, Karapınar DY, Yılmaz SK, Aktan G, Tekgül H, Gökben S. Cerebral sinovenous thrombosis in children: A single-center experience. Turk Arch Pediatr 2021; 56:236-244. [PMID: 34104915 DOI: 10.5152/turkarchpediatr.2021.20073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 10/23/2020] [Indexed: 02/02/2023]
Abstract
Objective The study aimed to evaluate the patients with a diagnosis of cerebral sinovenous thrombosis in terms of clinical findings, etiology and underlying risk factors, imaging findings, treatment, and prognosis in the long term. Materials and Methods Medical records of 19 patients whose ages ranged between 0 days and 17 years with clinical and radiological cerebral sinovenous thrombosis in Ege University Department of Child Neurology were retrospectively evaluated. Results Nine of nineteen cases were female (47.3%). The median age was 84 months (0-201 months). The most common complaint at the presentation was headache (n=12) and the most common physical examination finding was papilledema (n=11). In etiology, otitis/mastoiditis in three cases, iron deficiency anemia in three cases, sinusitis in two cases, catheter use in four cases, Behçet's disease in three cases were determined. The most common observed genetic factors causing thrombosis was methylenetetrahydrofolate reductase mutation. The transverse sinus (68.4%) is the sinus where thrombosis is most frequently observed. As a result of an average follow-up of 12 months (2-72 months), hemiparesis (n=3/19, 15.7%) and epilepsy (n=5/19, 26.3%) were recorded as sequelae findings, and no mortality was observed. Conclusion In cases presenting with headache, evaluation of papilledema on funduscopic examination should not be skipped. Neurological imaging should be performed in the change of consciousness of poor feeding infants and children with infections in the head and neck area or underlying chronic diseases. When cerebral sinovenous thrombosis is detected, anticoagulant therapy should be started immediately.
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Affiliation(s)
- İpek Dokurel Çetin
- Department of Child Health and Diseases, Department of Child Neurology, Ege University School of Medicine, İzmir, Turkey
| | - Cenk Eraslan
- Department of Radiology, Ege University School of Medicine, İzmir, Turkey
| | - Erdem Şimşek
- Department of Child Health and Diseases, Department of Child Neurology, Ege University School of Medicine, İzmir, Turkey
| | - Seda Kanmaz
- Department of Child Health and Diseases, Department of Child Neurology, Ege University School of Medicine, İzmir, Turkey
| | - Hepsen Mine Serin
- Department of Child Health and Diseases, Department of Child Neurology, Ege University School of Medicine, İzmir, Turkey
| | - Deniz Yılmaz Karapınar
- Department of Child Health and Diseases, Department of Pediatric Hematology and Oncology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Sanem Keskin Yılmaz
- Department of Child Health and Diseases, Department of Child Neurology, Ege University School of Medicine, İzmir, Turkey
| | - Gül Aktan
- Department of Child Health and Diseases, Department of Child Neurology, Ege University School of Medicine, İzmir, Turkey
| | - Hasan Tekgül
- Department of Child Health and Diseases, Department of Child Neurology, Ege University School of Medicine, İzmir, Turkey
| | - Sarenur Gökben
- Department of Child Health and Diseases, Department of Child Neurology, Ege University School of Medicine, İzmir, Turkey
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23
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Petrone I, Bernardo PS, dos Santos EC, Abdelhay E. MTHFR C677T and A1298C Polymorphisms in Breast Cancer, Gliomas and Gastric Cancer: A Review. Genes (Basel) 2021; 12:587. [PMID: 33920562 PMCID: PMC8073588 DOI: 10.3390/genes12040587] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/08/2021] [Accepted: 04/15/2021] [Indexed: 02/07/2023] Open
Abstract
Folate (vitamin B9) is found in some water-soluble foods or as a synthetic form of folic acid and is involved in many essential biochemical processes. Dietary folate is converted into tetrahydrofolate, a vital methyl donor for most methylation reactions, including DNA methylation. 5,10-methylene tetrahydrofolate reductase (MTHFR) is a critical enzyme in the folate metabolism pathway that converts 5,10-methylenetetrahydrofolate into 5-methyltetrahydrofolate, which produces a methyl donor for the remethylation of homocysteine to methionine. MTHFR polymorphisms result in reduced enzyme activity and altered levels of DNA methylation and synthesis. MTHFR polymorphisms have been linked to increased risks of several pathologies, including cancer. Breast cancer, gliomas and gastric cancer are highly heterogeneous and aggressive diseases associated with high mortality rates. The impact of MTHFR polymorphisms on these tumors remains controversial in the literature. This review discusses the relationship between the MTHFR C677T and A1298C polymorphisms and the increased risk of breast cancer, gliomas, and gastric cancer. Additionally, we highlight the relevance of ethnic and dietary aspects of population-based studies and histological stratification of highly heterogeneous tumors. Finally, this review discusses these aspects as potential factors responsible for the controversial literature concerning MTHFR polymorphisms.
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Affiliation(s)
- Igor Petrone
- Stem Cell Laboratory, Center for Bone Marrow Transplants, Brazilian National Cancer Institute—INCA, Rio de Janeiro 20230-240, Brazil; (E.C.d.S.); (E.A.)
- Stricto Sensu Graduate Program in Oncology, INCA, Rio de Janeiro 20230-240, Brazil;
| | - Paula Sabbo Bernardo
- Stricto Sensu Graduate Program in Oncology, INCA, Rio de Janeiro 20230-240, Brazil;
- Laboratory of Cellular and Molecular Hemato-Oncology, Molecular Hemato-Oncology Program, Brazilian National Cancer Institute—INCA, Rio de Janeiro 20230-240, Brazil
| | - Everton Cruz dos Santos
- Stem Cell Laboratory, Center for Bone Marrow Transplants, Brazilian National Cancer Institute—INCA, Rio de Janeiro 20230-240, Brazil; (E.C.d.S.); (E.A.)
- Stricto Sensu Graduate Program in Oncology, INCA, Rio de Janeiro 20230-240, Brazil;
| | - Eliana Abdelhay
- Stem Cell Laboratory, Center for Bone Marrow Transplants, Brazilian National Cancer Institute—INCA, Rio de Janeiro 20230-240, Brazil; (E.C.d.S.); (E.A.)
- Stricto Sensu Graduate Program in Oncology, INCA, Rio de Janeiro 20230-240, Brazil;
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Methylenetetrahydrofolate reductase gene polymorphisms in the risk of polycystic ovary syndrome and ovarian cancer. Biosci Rep 2021; 40:225735. [PMID: 32639550 PMCID: PMC7369393 DOI: 10.1042/bsr20200995] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/23/2020] [Accepted: 07/08/2020] [Indexed: 12/15/2022] Open
Abstract
Polymorphisms of methylenetetrahydrofolate reductase (MTHFR) in hormone metabolism pathways might cause metabolic disturbances and contribute to the development of polycystic ovary syndrome (PCOS) and ovarian cancer, but the published studies were inconsistent. The aim of the present study was to evaluate the MTHFR C677T (rs1801133) and A1298C (rs1801131) gene polymorphisms in the risk of PCOS and ovarian cancer by meta-analysis. A comprehensive electronic search was conducted in databases for studies published from 1995 to 2020. The pooled ORs were calculated by Revman 5.2 software. Twenty-nine articles including 45 case–control studies were included. We found that MTHFR C677T polymorphisms were correlated with elevated PCOS risk (TT vs. CT+CC: OR = 1.41, 95%CI = 1.20–1.67; TT+CT vs. CC: OR = 1.54, 95%CI = 1.07–2.22; CT vs. CC+TT: OR = 1.18, 95%CI 1.04–1.33; TT vs. CC: OR = 1.47, 95%CI = 1.03–2.11; T vs. C: OR = 1.25, 95%CI = 1.06–1.47), which were more obvious in Middle Eastern subgroup. MTHFR A1298C polymorphisms were also associated with overall PCOS susceptibility (CC vs. AC+AA: OR = 2.55, 95% CI = 1.61–4.03; CC+AC vs. AA: OR = 1.84, 95%CI = 1.04–3.28; CC vs. AA: OR = 2.66, 95%CI = 1.68–4.22; C vs. A: OR = 1.67, 95%CI = 1.03–2.71), which were mainly reflected in Asian subjects. For ovarian cancer, MTHFR C677T polymorphisms were only related with elevated ovarian cancer risk in Asian population, while no significant association was found for A1298C polymorphisms. This meta-analysis suggested that MTHFR C677T and MTHFR A1298C polymorphisms were correlated with elevated PCOS risk. MTHFR C667T only posed a higher risk for ovarian cancer in Asians instead of other populations, while MTHFR A1298C polymorphisms were not related to ovarian cancer risk. Further studies are needed to validate the conclusion.
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Tutty E, Hickerton C, Terrill B, McClaren B, Tytherleigh R, Stackpoole E, Savard J, Newson A, Middleton A, Nisselle A, Cusack M, Adamski M, Gaff C, Metcalfe S. The expectations and realities of nutrigenomic testing in australia: A qualitative study. Health Expect 2021; 24:670-686. [PMID: 33635607 PMCID: PMC8077070 DOI: 10.1111/hex.13216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/12/2021] [Accepted: 02/02/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Consumer genomic testing for nutrition and wellness, (nutritional genomics), is becoming increasingly popular. Concurrently, health-care practitioners (HPs) working in private practice (including doctors interested in integrative medicine, private genetic counsellors, pharmacists, dieticians, naturopaths and nutritionists) are involved as test facilitators or interpreters. OBJECTIVE To explore Australian consumers' and HPs' experiences with nutrigenomic testing. METHOD Semi-structured in-depth interviews were conducted using predominantly purposive sampling. The two data sets were analysed individually, then combined, using a constant comparative, thematic approach. RESULTS Overall, 45 interviews were conducted with consumers (n = 18) and HPs (n = 27). Many of the consumer interviewees experienced chronic ill-health. Nutrigenomic testing was perceived as empowering and a source of hope for answers. While most made changes to their diet/supplements post-test, self-reported health improvements were small. A positive relationship with their HP appeared to minimize disappointment. HPs' adoption and views of nutrigenomic testing varied. Those enthusiastic about testing saw the possibilities it could offer. However, many felt nutrigenomic testing was not the only 'tool' to utilize when offering health care. DISCUSSION This research highlights the important role HPs play in consumers' experiences of nutrigenomics. The varied practice suggests relevant HPs require upskilling in this area to at least support their patients/clients, even if nutrigenomic testing is not part of their practice. PATIENT OR PUBLIC CONTRIBUTION Advisory group included patient/public group representatives who informed study design; focus group participants gave feedback on the survey from which consumer interviewees were sourced. This informed the HP data set design. Interviewees from HP data set assisted with snowball sampling.
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Affiliation(s)
- Erin Tutty
- Murdoch Children’s Research InstituteMelbourneVictoriaAustralia
- Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia
| | - Chriselle Hickerton
- Murdoch Children’s Research InstituteMelbourneVictoriaAustralia
- Australian Genomics Health AllianceVictoriaAustralia
| | - Bronwyn Terrill
- Australian Genomics Health AllianceVictoriaAustralia
- Kinghorn Centre for Clinical GenomicsGarvan Institute of Medical ResearchSydneyNSWAustralia
- St. Vincent’s Clinical SchoolUNSWSydneyNSWAustralia
| | - Belinda McClaren
- Murdoch Children’s Research InstituteMelbourneVictoriaAustralia
- Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia
- Australian Genomics Health AllianceVictoriaAustralia
| | - Rigan Tytherleigh
- Murdoch Children’s Research InstituteMelbourneVictoriaAustralia
- Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia
| | - Elaine Stackpoole
- Murdoch Children’s Research InstituteMelbourneVictoriaAustralia
- Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia
- Present address:
Genetic Services of Western AustraliaSubiacoWAAustralia
| | - Jaqueline Savard
- Kinghorn Centre for Clinical GenomicsGarvan Institute of Medical ResearchSydneyNSWAustralia
- Sydney Health Ethicsthe University of SydneySydneyNSWAustralia
- Present address:
School of MedicineFaculty of HealthDeakin UniversityGeelongVictoriaAustralia
| | - Ainsley Newson
- Kinghorn Centre for Clinical GenomicsGarvan Institute of Medical ResearchSydneyNSWAustralia
- Sydney Health Ethicsthe University of SydneySydneyNSWAustralia
| | - Anna Middleton
- Society and Ethics ResearchConnecting ScienceWellcome Genome CampusCambridgeUK
- Faculty of EducationUniversity of CambridgeCambridgeUK
| | - Amy Nisselle
- Murdoch Children’s Research InstituteMelbourneVictoriaAustralia
- Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia
- Australian Genomics Health AllianceVictoriaAustralia
| | - Marie Cusack
- Australian Genomics Health AllianceVictoriaAustralia
- Centre for Genetics EducationNSW HealthSydneyNSWAustralia
| | - Melissa Adamski
- Department of Nutrition, Dietetics and FoodMonash UniversityMelbourneVictoriaAustralia
| | - Clara Gaff
- Murdoch Children’s Research InstituteMelbourneVictoriaAustralia
- Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia
- Australian Genomics Health AllianceVictoriaAustralia
- The Walter and Eliza Hall Institute of Medical ResearchMelbourneVictoriaAustralia
| | - Sylvia Metcalfe
- Murdoch Children’s Research InstituteMelbourneVictoriaAustralia
- Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia
- Australian Genomics Health AllianceVictoriaAustralia
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26
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Beriault DR, Gilmour JA, Hicks LK. Overutilization in laboratory medicine: tackling the problem with quality improvement science. Crit Rev Clin Lab Sci 2021; 58:430-446. [PMID: 33691585 DOI: 10.1080/10408363.2021.1893642] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Overutilization of tests and treatments is a widespread problem in contemporary heath care, and laboratory medicine is no exception. It is estimated that 10-70% of laboratory tests may be unnecessary, with estimates in the literature varying depending on the situation and the laboratory test. Inappropriate use of laboratory tests can lead to further unnecessary testing, adverse events, inaccurate diagnoses, and inappropriate treatments. Altogether, this increases the risk of harm to a patient, which can be physical, psychological, or financial in nature. Overutilization in healthcare is driven by complex factors including care delivery models, litigious practice environments, and medical and patient culture. Quality improvement (QI) methods can help to tackle overutilization. In this review, we outline the global healthcare problem of laboratory overutilization, particularly in the developed world, and describe how an understanding of and application of quality improvement principles can help to address this challenge.
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Affiliation(s)
- Daniel R Beriault
- Department of Laboratory Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Julie A Gilmour
- Division of Endocrinology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lisa K Hicks
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Hematology and Oncology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
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Hennessy M, Dennehy R, Meaney S, Linehan L, Devane D, Rice R, O'Donoghue K. Clinical practice guidelines for recurrent miscarriage in high-income countries: a systematic review. Reprod Biomed Online 2021; 42:1146-1171. [PMID: 33895080 DOI: 10.1016/j.rbmo.2021.02.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
Recurrent miscarriage affects 1-2% of women of reproductive age, depending on the definition used. A systematic review was conducted to identify, appraise and describe clinical practice guidelines (CPG) published since 2000 for the investigation, management, and/or follow-up of recurrent miscarriage within high-income countries. Six major databases, eight guideline repositories and the websites of 11 professional organizations were searched to identify potentially eligible studies. The quality of eligible CPG was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE II) Tool. A narrative synthesis was conducted to describe, compare and contrast the CPG and recommendations therein. Thirty-two CPG were included, from which 373 recommendations concerning first-trimester recurrent miscarriage were identified across four sub-categories: structure of care (42 recommendations, nine CPG), investigations (134 recommendations, 23 CPG), treatment (153 recommendations, 24 CPG), and counselling and supportive care (46 recommendations, nine CPG). Most CPG scored 'poor' on applicability (84%) and editorial independence (69%); and to a lesser extent stakeholder involvement (38%) and rigour of development (31%). Varying levels of consensus were found across CPG, with some conflicting recommendations. Greater efforts are required to improve the quality of evidence underpinning CPG, the rigour of their development and the inclusion of multi-disciplinary perspectives, including those with lived experience of recurrent miscarriage.
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Affiliation(s)
- Marita Hennessy
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork T12 DC4A, Ireland; The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork T12 DC4A, Ireland; College of Medicine and Health, University College Cork Cork T12 EKDO, Ireland.
| | - Rebecca Dennehy
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork T12 DC4A, Ireland; The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork T12 DC4A, Ireland; College of Medicine and Health, University College Cork Cork T12 EKDO, Ireland
| | - Sarah Meaney
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork T12 DC4A, Ireland; The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork T12 DC4A, Ireland; College of Medicine and Health, University College Cork Cork T12 EKDO, Ireland; National Perinatal Epidemiology Centre, University College Cork, Cork University Maternity Hospital Cork T12 DC4A, Ireland
| | - Laura Linehan
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork T12 DC4A, Ireland; The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork T12 DC4A, Ireland; College of Medicine and Health, University College Cork Cork T12 EKDO, Ireland
| | - Declan Devane
- The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork T12 DC4A, Ireland; School of Nursing and Midwifery, National University of Ireland, Galway, Galway H91 E3YV, Ireland; Evidence Synthesis Ireland, National University of Ireland, Galway, Galway H91 E3YV, Ireland
| | - Rachel Rice
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork T12 DC4A, Ireland; School of Applied Social Studies, University College Cork, Cork T12 D726, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork T12 DC4A, Ireland; The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork T12 DC4A, Ireland; College of Medicine and Health, University College Cork Cork T12 EKDO, Ireland
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28
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Gomez K. Genomic Analysis for the Detection of Bleeding and Thrombotic Disorders. Semin Thromb Hemost 2021; 47:174-182. [PMID: 33636748 DOI: 10.1055/s-0041-1722865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The development of high-throughput sequencing technologies has ushered in a new era of genomic testing in clinical medicine. This has greatly enhanced our diagnostic repertoire for hemostatic diseases particularly for milder or rarer bleeding disorders. New genetic causes for heritable platelet disorders have been discovered along with the recognition of clinical manifestations outside hemostasis, such as the association of leukemia with RUNX1 variation. Genome-wide association studies in heritable thrombophilia have demonstrated that some of the genetic variants that are commonly included in thrombophilia testing are of no clinical relevance, while uncovering new variants that should potentially be included. The implementation of new technology has necessitated far-reaching changes in clinical practice to deal with incidental findings, variants of uncertain significance, and genetic disease modifiers. Mild bleeding disorders that were previously considered to have a monogenic basis now appear to have an oligogenic etiology. To harness these advances in knowledge large databases have been developed to capture the new genomic information with phenotypic features on a population-wide scale. The use of this so-called "big data" requires new bioinformatics tools with the promise of delivering precision medicine in the foreseeable future. This review discusses the use of these technologies in clinical practice, the benefits of genomic testing, and some of the challenges associated with implementation.
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Affiliation(s)
- Keith Gomez
- Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London, United Kingdom
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29
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Cao Y, Su N, Zhang D, Zhou L, Yao M, Zhang S, Cui L, Zhu Y, Ni J. Correlation between total homocysteine and cerebral small vessel disease: A Mendelian randomization study. Eur J Neurol 2021; 28:1931-1938. [PMID: 33377242 DOI: 10.1111/ene.14708] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/12/2020] [Accepted: 12/13/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral small vessel disease (CSVD) is a clinical imaging syndrome with diverse etiology. Total homocysteine (HCY) level might increase the risk of myocardial and cerebral infarction by damaging the vascular endothelium. We aimed to explore the correlation between total HCY and CSVD imaging burden, based on Mendelian randomization methods. METHODS A total of 1,023 participants of the Shunyi study, a population-based cohort study, were included. Vascular risk factors, total HCY levels and methylenetetrahydrofolate reductase (MTHFR) gene mutations (C677T and A1298C) were examined. CSVD imaging markers, including lacunes, cerebral microbleeds, white matter hyperintensity, enlarged perivascular space and brain parenchymal fraction (BPF) were also assessed. RESULTS Mutations of C677T were significantly correlated with increased total HCY levels (CC→TT: β = 0.28, p < 0.0001), while mutations of A1298C were correlated with decreased total HCY levels (AA→AC: β = -0.13, p < 0.0001; AA→CC: β = -0.25, p = 0.004). In the Mendelian randomization study, the C677T genotype was significantly associated with lacunes (CC→CT: odds ratio [OR] 2.76, p = 0.008; CC→TT: OR 2.50, p = 0.018), and the A1298C genotype was significantly correlated with BPF (AA→CC: β = 1.32, p = 0.015). Similarly, in multivariate regression analysis, total HCY levels were significantly correlated with lacunes (OR 2.14, p < 0.0001) and negatively correlated with BPF (β = -0.55, p = 0.004). Age, sex and vascular risk factors were adjusted for. CONCLUSIONS Total HCY level was correlated with imaging burden of CSVD, especially with lacunes and brain volume loss. For individuals with risk genetic predisposition, enhanced homocysteine-lowering strategies might be necessary to reduce the risk and progress of CSVD.
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Affiliation(s)
- Yuze Cao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Su
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dingding Zhang
- Central Research Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lixin Zhou
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming Yao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yicheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Ni
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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30
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Abdulla R, Kudkuli J, Kapoor S, Prabhu V, Shetty P, Aziz NZ. Single-nucleotide polymorphisms of methylenetetrahydrofolate reductase gene in a South Indian cohort with nonsyndromic cleft lip with or without palate. J Oral Maxillofac Pathol 2021; 24:453-458. [PMID: 33967480 PMCID: PMC8083445 DOI: 10.4103/jomfp.jomfp_329_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 06/03/2020] [Accepted: 07/30/2020] [Indexed: 12/04/2022] Open
Abstract
Objective: Clefts of the lip, with or without cleft palate and cleft palate only, collectively called as orofacial clefts (OFCs) are one of the most common congenital malformations with varying degrees of penetrance and phenotype expressions. The aim of this study was to investigate the association between methylenetetrahydrofolate reductase (MTHFR) cytosine-to-thymine (c. 677 C>T), adenine-to-cytosine (c.1298 A>C) single- nucleotide polymorphisms (SNPs) and South Indian patients with the nonsyndromic cleft lip with or without palate (NSCL ± P). Methods: A cohort consisting of 25 cases of NSCL ± P and 18 controls from a South Indian cohort were included in this case–control study. Genetic analysis of c.677C>T and c.1298A C polymorphisms in the MTHFR gene was carried out using Sanger sequencing and analyzed from chromatogram profiles. Data interpretation was done using statistical software MedCalc Statistical Software version 16.2 and the Statistical Package for the Social Sciences (SPSS version 22.0). Results: DNA sequence analysis of the MTHFR gene revealed c. 677C>T and c. 1298A>C polymorphisms in 16% and 76% of NSCL ± P cases, respectively. Heterozygous variant in MTHFR c. 1298A>C polymorphism was found to be a significant risk factor (P = 0.0164) for NSCL ± P in South Indian ethnic population. c.677C>T polymorphism, in particular, was apparently dormant overall in the study population. These results offer certain novelty in terms of the distinctive pattern in SNPs of genotypes observed in the study. Conclusion: NSCL ± P is one of the most common and challenging congenital malformations with complex etiological basis. Common risk factors such as MTHFR SNPs, namely c.677C>T and c.1298A>C, are subjected to variations in terms of ethnic group, geographic region and micro/macro-environmental factors. Overall, our study has explored part of South Indian ethnic population and revealed a different and unique distribution of mutations in this sample population.
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Affiliation(s)
- Riaz Abdulla
- Department of Oral Pathology and Microbiology, Yenepoya Dental College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India.,Department of Biomaterials and Research Centre, Yenepoya Dental College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - Jagadish Kudkuli
- Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - Saketh Kapoor
- Stem Cells and Regenerative Medicine Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - Vishnudas Prabhu
- Department of Oral Pathology and Microbiology, Yenepoya Dental College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - Pushparaja Shetty
- Department of Oral Pathology, A B Shetty Memorial Institute of Dental Sciences, NITTE (Deemed to be University), Mangalore, Karnataka, India
| | - Niloufa Z Aziz
- Department of Oral Pathology, Century International Institute of Dental Sciences, Poinachi, Kerala, India
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31
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Schupmann W, Jamal L, Berkman BE. Re-examining the Ethics of Genetic Counselling in the Genomic Era. JOURNAL OF BIOETHICAL INQUIRY 2020; 17:325-335. [PMID: 32557217 PMCID: PMC10084396 DOI: 10.1007/s11673-020-09983-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 05/17/2020] [Indexed: 05/06/2023]
Abstract
Respect for patient autonomy has served as the dominant ethical principle of genetic counselling, but as we move into a genomic era, it is time to actively re-examine the role that this principle plays in genetic counselling practice. In this paper, we argue that the field of genetic counselling should move away from its emphasis on patient autonomy and toward the incorporation of a more balanced set of principles that allows counsellors to offer clear guidance about how best to obtain or use genetic information. We begin with a brief history of how respect for patient autonomy gained such emphasis in the field and how it has taken on various manifestations over time, including the problematic concept of nondirectiveness. After acknowledging the field's preliminary move away from nondirectiveness, we turn to a series of arguments about why the continued dominance of patient autonomy has become untenable given the arrival of the genomic era. To conclude, we describe how a more complete set of bioethical principles can be adapted and used by genetic counsellors to strengthen their practice without undermining patient autonomy.
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Affiliation(s)
- Will Schupmann
- Department of Bioethics, Clinical Center, National Institutes of Health, 10 Center Dr., Bldg. 10/Room 1C118, Bethesda, MD, 20892, USA.
| | - Leila Jamal
- Department of Bioethics, Clinical Center, National Institutes of Health; National Institute of Allergy and Infectious Diseases, NIH, 10 Center Dr., Bldg. 10/Room 1C118, Bethesda, MD, 20892, USA
| | - Benjamin E Berkman
- Department of Bioethics, Clinical Center, National Institutes of Health; Bioethics Core, National Human Genome Research Institute, NIH, 10 Center Dr., Bldg. 10/Room 1C118, Bethesda, MD, 20892, USA
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32
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Parkhurst E, Calonico E, Noh G. Medical Decision Support to Reduce Unwarranted Methylene Tetrahydrofolate Reductase (MTHFR) Genetic Testing. J Med Syst 2020; 44:152. [PMID: 32737598 DOI: 10.1007/s10916-020-01615-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/15/2020] [Indexed: 11/26/2022]
Abstract
Most major national medical associations have advised against routine MTHFR testing since at least 2013. However, many providers continue to order this unwarranted genetic test. This study assessed the efficacy of an electronic best practice alert to aid ordering providers. We tracked the rate of MTHFR tests ordered per 1 million patients in the twelve months before and after the implementation of an alert that suggested an alternative test. Associated factors including the ordering department, diagnosis, patient sex, and patient age were also analyzed. Chi square analysis was used to compare the difference between pre- and post-alert test ordering rates. A total of 997 MTHFR analysis were ordered in Southern California Kaiser Permanente from January 2017 through December 2018. Overall, the average MTHFR monthly test ordering rates dropped significantly from 12.93 per million patients in 2017 to 7.08 per million patients in 2018 (p = 0.0056). However, testing rates in children were unchanged and, in some associated diagnoses, such as psychiatric illnesses and neurodevelopmental conditions, the testing rates increased. Recommending an alternate test in lieu of the unwarranted one significantly reduced the overall rate of MTHFR testing. The alert was most effective for specialties and diagnoses where MTHFR was historically medically indicated. This suggests such alerts are an effective intervention that health care systems can implement to serve as an educational update and to reduce unwarranted genetic testing.
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Affiliation(s)
- Emily Parkhurst
- Genetics Department, Southern California Kaiser Permanente, 6041 Cadillac Ave, Los Angeles, CA, 90034, USA.
| | - Elise Calonico
- Genetics Department, Southern California Kaiser Permanente, 6041 Cadillac Ave, Los Angeles, CA, 90034, USA
| | - Grace Noh
- Genetics Department, Southern California Kaiser Permanente, 9985 Sierra Ave, MOB2, 2nd floor, Fontana, CA, 92335, USA
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MTHFR Gene Polymorphisms Prevalence and Cardiovascular Risk Factors Involved in Cardioembolic Stroke Type and Severity. Brain Sci 2020; 10:brainsci10080476. [PMID: 32722170 PMCID: PMC7463445 DOI: 10.3390/brainsci10080476] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/07/2020] [Accepted: 07/20/2020] [Indexed: 01/28/2023] Open
Abstract
Background: Cardioembolic stroke (CES), generally known as the most severe subtype of ischemic stroke, is related to many factors, including diabetes mellitus (DM), hypertension (HTN), smoking, hyperlipidemia and atrial fibrillation (AF). Genetic mutations of the methylenetetrahydrofolate reductase (MTHFR) gene C677T and A1298C have been recently associated with ischemic stroke. The purpose of this study was to analyze the prevalence of MTHFR gene polymorphisms correlated with cardiovascular risk factors in a selected population of patients with CES due to non-valvular AF (NVAF). Methods: This cross-sectional study was performed on 67 consecutive patients with acute cardioembolic stroke admitted to our hospital. The protocol included general physical examination, neurological clinical status and stroke severity evaluation, imagistic evaluation and genetic testing of MTHFRC677T and A1298C polymorphisms. Results: The prevalence of MTHFR polymorphisms in the study population was 38.2% for C677T and 40.3% for A1298C. The C677T mutation was significantly correlated with increased diastolic blood pressure (DBP) values (p = 0.007), higher total cholesterol (TC) (p = 0.003), low-density lipoprotein cholesterol (LDLc) (p = 0.003) and triglycerides (TGL) (p = 0.001), increased high-sensitive C-reactive protein (hsCRP) values (p = 0.015), HbA1c (p = 0.004) and left ventricle ejection fraction (LVEF) (p = 0.047) and lower high-density lipoprotein cholesterol (HDLc) (p < 0.001) compared to patients without this genetic variant. This genetic profile also included significantly higher CHA2DS2VASC (p = 0.029) and HASBLED (Hypertension, Abnormal liver/renal function, Stroke, Bleeding, Labile INR, Elderly age(>65 years), Drug/Alcohol usage history/Medication usage with bleeding predisposition) (p = 0.025) scores. Stroke severity in patients with MTHFRA1298C mutation was significantly increased when applying National Institutes of Health Stroke Scale (NIHSS) (p = 0.006) and modified Rankin scale (mRS) (p = 0.020) scores. The presence of A1298C mutation as a dependent variable was associated with significantly higher TGL values (odds ratio (OR) = 2.983, 95%CI = (1.972, 7.994)). Conclusions: The results obtained in this study demonstrate that MTHFR gene polymorphisms have a high prevalence in an NVAF cardioembolic stroke population. Moreover, an association between C677T mutation and stroke severity was highlighted. The C677T mutation in patients with NVAF was correlated with a higher incidence of cardiovascular comorbidities (hypertension HTN, heart failure (HF), dyslipidemia, type II diabetes mellitus (T2DM) with high HbA1c and increased inflammatory state). The A1298CMTHFR gene mutation was associated with a higher incidence of previous lacunar stroke and stroke recurrence rate, while dyslipidemia was the main cardiovascular comorbidity in this category.
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When the Path to Parenthood Does Not Go as Planned: Genetic Counseling for Infertility and Miscarriage. CURRENT GENETIC MEDICINE REPORTS 2020. [DOI: 10.1007/s40142-020-00189-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Osadnik T, Pawlas N, Lejawa M, Lisik M, Osadnik K, Fronczek M, Bujak K, Gąsior M. Genetic and environmental factors associated with homocysteine concentrations in a population of healthy young adults. Analysis of the MAGNETIC study. Nutr Metab Cardiovasc Dis 2020; 30:939-947. [PMID: 32404292 DOI: 10.1016/j.numecd.2020.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 01/25/2020] [Accepted: 01/27/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIMS Elevated homocysteine concentration is associated with a higher risk of cardiovascular disease. The aim of our study was to determine the environmental and genetic factors associated with serum homocysteine concentration in healthy young adults. Moreover, we aimed to determine the cutoff value of homocysteine concentration for predicting unfavorable MTHFR genotype and to investigate whether this association is modified by dietary patterns and serum folate status. METHODS AND RESULTS A total of 744 healthy individuals, aged 18-35 years, were included in the study. Diet quality was assessed by establishing diet quality scores and adherence to the pro-Healthy Diet Index (pHDI) and non-Healthy Diet Index (nHDI). Genotyping was performed using the TaqMan method. Multivariate analysis showed that pHDI, creatinine, folate concentrations, and the T/T genotype of the C677T polymorphism in MTHFR, as well as the interaction between the T/T genotype of MTHFR (C677T polymorphism) and folate level, were most strongly related to homocysteine concentrations. The specificity of a homocysteine >13.1 μmol/l in predicting T/T homozygous status was 76% (area under the curve 0.68). CONCLUSION Healthy dietary patterns, folate, and creatinine levels, as well as the C677T polymorphism, proved to be the strongest predictors of homocysteine concentrations. T/T genotype of MTHFR modifies the relationship between folate and homocysteine.
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Affiliation(s)
- Tadeusz Osadnik
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland; 2nd Department of Cardiology and Angiology, Silesian Centre for Heart Diseases, Zabrze, Poland.
| | - Natalia Pawlas
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland; Institute of Occupational Medicine and Environmental Health, Sosnowiec, Poland
| | - Mateusz Lejawa
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland; Kardio-Med Silesia, Zabrze, Poland
| | - Małgorzata Lisik
- Genetic Outpatient Maria Skłodowska-Curie Memorial Cancer Center, Institute of Oncology Gliwice Branch, Poland
| | - Kamila Osadnik
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Martyna Fronczek
- Department of Medical and Molecular Biology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland; Kardio-Med Silesia, Zabrze, Poland
| | - Kamil Bujak
- 3rd Department of Cardiology, Silesian Center for Heart Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Mariusz Gąsior
- 3rd Department of Cardiology, Silesian Center for Heart Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
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Vieira D, Florindo C, Tavares de Almeida I, Macário MC. Adult-onset methylenetetrahydrofolate reductase deficiency. BMJ Case Rep 2020; 13:13/3/e232241. [PMID: 32161077 DOI: 10.1136/bcr-2019-232241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Severe hyperhomocysteinemia (>100 µmol/L) is often associated with inborn errors of homocysteine metabolism. It manifests typically in neonatal period with developmental delay, hypotonia, feeding problems or failure to thrive. Adult-onset forms are rare and include less severe manifestations. Early diagnosis is crucial because effective treatment is available. A 23-year-old man presented with a 3-week history of speech and gait impairment, and numbness in lower limbs. Neurological examination revealed dysarthria, decreased vibratory sensation in both legs and appendicular and gait ataxia. Brain MRI revealed T2-hyperintense symmetric white matter lesions and cortical atrophy. He had folate and vitamin B12 deficiency, a markedly elevated serum homocysteine and low methionine. Despite vitamin supplementation homocysteine levels remained elevated. Molecular studies of 5,10-methylenetetrahydrofolate reductase (MTHFR) gene revealed a new pathogenic mutation (c.1003C>T (p.Arg335Cys)) and a polymorphism (C677T (p.Ala222Val)) associated with hyperhomocysteinemia, both in homozygosity. The patient started betaine with clinical and biochemical improvement.
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Affiliation(s)
- Daniela Vieira
- Serviço de Neurologia, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Cristina Florindo
- Lab. Met&Gen, iMed, Faculdade de Farmácia da Universidade de Lisboa, Lisboa, Portugal
| | | | - Maria Carmo Macário
- Serviço de Neurologia, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
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Unim B, De Vito C, Hagan J, Villari P, Knoppers BM, Zawati M. The Provision of Genetic Testing and Related Services in Quebec, Canada. Front Genet 2020; 11:127. [PMID: 32194621 PMCID: PMC7064617 DOI: 10.3389/fgene.2020.00127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/03/2020] [Indexed: 11/19/2022] Open
Abstract
Background Research in the field of genomics and genetics has evolved in recent years and so has the demand of consumers who are increasingly interested in genomic prediction of diseases and various traits. The aim of this study is to identify genetic service delivery models, policies governing the use of genomics medicine, and measures to evaluate genetic services in the province of Quebec, Canada. Methods An ad hoc questionnaire was designed and administered online in 2017 to healthcare workers with good knowledge or experience in the provision of BReast CAncer genes 1 and 2 (BRCA1/2), Lynch syndrome, familial hypercholesterolemia, inherited thrombophilia genetic tests, engaged in policy planning or evaluation of genetic services. A quali-quantitative analysis of the survey results was performed. Results Thirty professionals participated in the study. The delivery models are classified in five categories according to the leading role of healthcare professionals in patient care pathways: i) the geneticist model; ii) the primary care model; iii) the medical specialist model; iv) the population screening program model; and v) the direct-to-consumer model. Barriers to genetic services are the coverage of genetic tests by the publicly funded healthcare system, the availability of qualified personnel, and the number of genetic centers. Regulatory oversight concerning the provision of genetic services appears to be insufficient. Conclusions Integration between genetics and the overall healthcare system in Quebec is in an early phase. Current models of genetic services require good level of genetic knowledge by all medical specialists, collaboration among different healthcare personnel, and work redistribution. The proper implementation of genomics into healthcare can be achieved through education and training, proper regulatory oversight, genomic policies, and public awareness.
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Affiliation(s)
- Brigid Unim
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Julie Hagan
- Centre of Genomics and Policy, McGill University, Montreal, QC, Canada
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Ma'n Zawati
- Centre of Genomics and Policy, McGill University, Montreal, QC, Canada
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Griesman J, Karahalios D, Prendergast C. Hematologic changes in cyanotic congenital heart disease: a review. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2020.101193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Combined presence of coagulation factor XIII V34L and plasminogen activator inhibitor 1 4G/5G gene polymorphisms significantly contribute to recurrent pregnancy loss in Serbian population. J Med Biochem 2020; 39:199-207. [PMID: 33033453 DOI: 10.2478/jomb-2019-0028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/06/2019] [Indexed: 11/20/2022] Open
Abstract
Background Recurrent pregnancy loss (RPL) is a heterogeneous condition affecting up to 5% of women of reproductive age. Inherited thrombophilia have been postulated as one of the causes of RPL. Here we examined the prevalence of nine thrombophilic gene polymorphisms among women with history of recurrent miscarriages and fertile controls. Methods The study included 70 women with history of at least three early pregnancy losses and 31 fertile controls with no miscarriages. We investigated mutations in genes responsible for clotting and fibrinolysis, including factor V (FV) Leiden, FV H1299R, factor II (FII) G20210A, methylene tetrahydrofolate reductase (MTHFR) C677T and A1298C, factor XIII (FXIII) V34L, plasminogen activator inhibitor-1 (PAI-1) 4G/5G and endothelial protein C receptor (EPCR) H1 and H3 haplotypes using reverse polymerase chain reaction ViennaLab cardiovascular disease StrippAssays. Results Our results showed no significant increase in prevalence of tested polymorphisms in women with RPL. However, relative risk for PRL among women heterozygous for FXIII V34L was 2.81 times increased (OR 2.81, 95% CI 1.15-6.87, P=0.023). Haplotype analysis showed that combined presence of high-risk genotypes for FXIII and PAI-1 significantly increases risk for RPL (OR 13.98, CI 95% 1.11-17.46, P=0.044). Conclusions This is the first study in Serbian population that investigated prevalence of FVR2, A1298C, FXIII V34L and EPCR gene variants. Compound heterozygosity for FXIII V34L and PAI-1 4G is significant risk factor for recurrent miscarriage. Our results should be viewed in context of small case-control study, so further large prospective studies are need for confirmation of our findings.
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Hyman SL, Levy SE, Myers SM. Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics 2020; 145:peds.2019-3447. [PMID: 31843864 DOI: 10.1542/peds.2019-3447] [Citation(s) in RCA: 449] [Impact Index Per Article: 112.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Autism spectrum disorder (ASD) is a common neurodevelopmental disorder with reported prevalence in the United States of 1 in 59 children (approximately 1.7%). Core deficits are identified in 2 domains: social communication/interaction and restrictive, repetitive patterns of behavior. Children and youth with ASD have service needs in behavioral, educational, health, leisure, family support, and other areas. Standardized screening for ASD at 18 and 24 months of age with ongoing developmental surveillance continues to be recommended in primary care (although it may be performed in other settings), because ASD is common, can be diagnosed as young as 18 months of age, and has evidenced-based interventions that may improve function. More accurate and culturally sensitive screening approaches are needed. Primary care providers should be familiar with the diagnostic criteria for ASD, appropriate etiologic evaluation, and co-occurring medical and behavioral conditions (such as disorders of sleep and feeding, gastrointestinal tract symptoms, obesity, seizures, attention-deficit/hyperactivity disorder, anxiety, and wandering) that affect the child's function and quality of life. There is an increasing evidence base to support behavioral and other interventions to address specific skills and symptoms. Shared decision making calls for collaboration with families in evaluation and choice of interventions. This single clinical report updates the 2007 American Academy of Pediatrics clinical reports on the evaluation and treatment of ASD in one publication with an online table of contents and section view available through the American Academy of Pediatrics Gateway to help the reader identify topic areas within the report.
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Affiliation(s)
- Susan L Hyman
- Golisano Children's Hospital, University of Rochester, Rochester, New York;
| | - Susan E Levy
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Scott M Myers
- Geisinger Autism & Developmental Medicine Institute, Danville, Pennsylvania
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Abstract
: The role of genetic thrombophilia screening for identifying a hypercoagulable state in the management of venous thromboembolism. We searched MEDLINE and EMBASE from 1995 to 2017, the websites of the professional bodies including American Society of Hematology, British Society of Hematology, International Society of Thrombosis and Hemostasis, College of American Pathologists, American College of Medical Genetics, and American Society of obstetrics and gynecology for their clinical practice guidelines. We used search strategy terms - venous thromboembolism, inherited, thrombophilia, and hypercoagulable state. Thrombophilia screening does not alter management in pregnancy, infertility, recurrent miscarriages, in primary occlusive arterial syndromes, and for primary prevention in relatives of venous thromboembolism patients considering hormonal manipulation including oral contraceptives. Routine thrombophilia screening for identifying a hypercoagulable state is not indicated in venous thromboembolism, as it is only useful in a select group of patients. There is no difference in the treatment of venous thromboembolism in patients with or without an inherited hypercoagulable state.
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Abstract
The aim is to study risk factors for retinal vein occlusion (RVO), such as thrombophilic and cardiovascular risk factors (CRF). A retrospective consecutive case series of 60 patients with RVO was made, tested for CRF, hyperhomocysteinemia, lupic anticoagulant, antiphospholipid antibody and 5 gene variants: factor V (FV) Leiden (G1691A), factor II (PT G20210A), 5,1-methylenetetra-hydrofolate reductase (MTHFR; 677 C > T and 1298 A > C), plasminogen activator inhibitor 1 (PAI-1; 4 G/5 G). More than 1 CRF were present in 36 patients (60%), which had a significantly higher mean age at diagnosis (66.7 ± 12.9 versus 59.5 ± 13.7 with ≤1 CRF, [t(57) = −2.05, p = 0.045, d = 0.54). Patients with thermolabile MTHFR forms with decreased enzyme activity (T677T or C677T/A1298C) had a significant lower mean age [57.6 ± 15.1; t (58) = 3.32; p = 0.002; d = 0.846] than patients with normal MTHFR enzyme activity (68.5 ± 10.2). Regarding CRF and thermolabile forms of MTHFR, the mean age at diagnosis could be significantly predicted [F(2,56) = 7.18; p = 0.002] by the equation: 64.8 − 10.3 × (thermolabile MTHFR) − 5.31 × ( ≤ 1CRF). Screening of MTHFR polymorphisms may be useful in younger RVO patients, particularly when multiple CRF are absent.
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Paradkar MU, Padate B, Shah SAV, Vora H, Ashavaid TF. Association of Genetic Variants with Hyperhomocysteinemia in Indian Patients with Thrombosis. Indian J Clin Biochem 2019; 35:465-473. [PMID: 33013017 DOI: 10.1007/s12291-019-00846-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 08/20/2019] [Indexed: 11/24/2022]
Abstract
Hyperhomocysteinemia known to be associated with increased thrombotic tendency has been considered as a risk factor for coronary artery disease, atherosclerosis, venous thrombosis, and stroke. There are three main genes MTHFR, cystathionine beta-synthase (CBS) and methionine synthase (MS) and it's genetic variant that are known to influence the homocysteine metabolism leading to hyperhomocysteinemia. There is scarcity of Indian data on hyperhomocysteinemia and genetics variants in patients with thrombosis. Hence the objective of present study was to determine MTHFR, CBS, and MS genetic variants in thrombosis patients from Indian population. Genetic variant analysis was performed on thrombosis patients to detect MTHFR C677T (rs1801133), MTHFR A1298C (rs1801131), MS A2756G (rs1805087) and CBS T833C (rs5742905) mutations. The mutant allele frequencies of MTHFR 677T, MTHFR 1298C, MS2756G and CBS 833C were observed to be 16.1%, 37.5%, 34.1% and 5.8% respectively. MTHFR 677TT genotype was observed to be significantly associated with elevated homocysteine (Hcy) levels (64.65 μmol/L) alleles as compared to CC alleles (32.43 μmol/L) and CT alleles (30.54 μmol/L). MTHFR A1298C, MS A2756G and CBS T833C genotypes did not showed significant association with higher Hcy levels. Thus, in Indian patients with thrombosis only MTHFR T677T genotype was observed to be significantly associated with hyperhomocysteinemia.
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Affiliation(s)
- Minal Umesh Paradkar
- Research Laboratories, P. D. Hinduja Hospital & Medical Research Centre, Lalita Girdhar Bldg (S1), Veer Savarkar Marg, Mahim, Mumbai 400016, India
| | - Balkrishna Padate
- Department of Hemato-Oncology and Bone Marrow Transplant, P. D. Hinduja Hospital & Medical Research Centre, Veer Savrkar Marg, Mumbai 400016, India
| | - Swarup A V Shah
- Research Laboratories, P. D. Hinduja Hospital & Medical Research Centre, Lalita Girdhar Bldg (S1), Veer Savarkar Marg, Mahim, Mumbai 400016, India
| | - Hiral Vora
- Research Laboratories, P. D. Hinduja Hospital & Medical Research Centre, Lalita Girdhar Bldg (S1), Veer Savarkar Marg, Mahim, Mumbai 400016, India
| | - Tester F Ashavaid
- Department of Laboratory Medicine, Biochemistry Laboratory, P. D. Hinduja Hospital & Medical Research Center, Lalita Girdhar Bldg (S1), Veer Savarkar Marg, Mahim, Mumbai, 400 016 India
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Ašić A, Salazar R, Storm N, Doğan S, Höppner W, Marjanović D, Primorac D. Population study of thrombophilic markers and pharmacogenetic markers of warfarin prevalence in Bosnia and Herzegovina. Croat Med J 2019; 60:212-220. [PMID: 31187948 PMCID: PMC6563168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 05/03/2019] [Indexed: 10/13/2023] Open
Abstract
AIM To investigate the prevalence of common genetic variants that can serve as markers of thrombophilia and warfarin pharmacogenetics in Bosnia and Herzegovina. METHODS The study was performed between August and October 2017 on 130 healthy unrelated adult volunteers from Bosnian-Herzegovinian population sample. The prevalence of the following genetic variants was determined: F5 c.1601G>A (factor V Leiden), F2 c.*97G>A (factor II or prothrombin mutation), F13A1 (factor XIII) c.103G>T, MTHFR (methylenetetrahydrofolate reductase) c.665C>T and c.1286A>C, as well as PAI-1 (plasminogen activator inhibitor 1) c.-816A>G and c.-844G>A as markers of thrombophilia risk, and *2 and *3 alleles of CYP2C9 (cytochrome P450 2C9) and five variants of VKORC1 (vitamin K epoxide reductase complex subunit 1) as markers of warfarin pharmacogenetics. DNA was isolated from buccal swabs using salting out method, while genotyping was performed using matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry. RESULTS Minor allele frequencies for two main thrombophilia risk factors, F5 c.1601G>A and F2 c.*97G>A were 0.023 and 0.008, respectively. Combined data for the markers of warfarin pharmacogenetics imply that 57.4% study participants can be expected to metabolize warfarin at an extensive, 40.3% at intermediate, and 2.3% at a poor rate. CONCLUSION This study reports the first extensive population genetic data for thrombophilia and warfarin pharmacogenetic markers in Bosnia and Herzegovina. Allele frequencies of genetic variants are within the general average for European populations, and their presence implies the necessity of introduction of personalized medicine in warfarin-mediated antithrombotic therapy.
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Affiliation(s)
- Adna Ašić
- Adna Ašić, Department of Genetics and Bioengineering, International Burch University, Francuske revolucije bb, 71210 Ilidža, Sarajevo, Bosnia and Herzegovina,
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Graydon JS, Claudio K, Baker S, Kocherla M, Ferreira M, Roche-Lima A, Rodríguez-Maldonado J, Duconge J, Ruaño G. Ethnogeographic prevalence and implications of the 677C>T and 1298A>C MTHFR polymorphisms in US primary care populations. Biomark Med 2019; 13:649-661. [PMID: 31157538 PMCID: PMC6630484 DOI: 10.2217/bmm-2018-0392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/25/2019] [Indexed: 02/04/2023] Open
Abstract
Aim: Variants of the MTHFR gene have been associated with a wide range of diseases. Materials & methods: The present study analyzed data from clinical genotyping of MTHFR 677C>T and 1298A>C in 1405 patients in urban primary care settings. Results: Striking differences in ethnogeographic frequencies of MTHFR polymorphisms were observed. African-Americans appear to be protected from MTHFR deficiency. Hispanics and Caucasians may be at elevated risk due to increased frequencies of 677C>T and 1298A>C, respectively. Conclusion: Individuals carrying mutations for both genes were rare and doubly homozygous mutants were absent, suggesting the TTcc is extremely rare in the greater population. The results suggest multilocus MTHFR genotyping may yield deeper insight into the ethnogeographic association between MTHFR variants and disease.
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Affiliation(s)
- James S Graydon
- Laboratory of Personalized Health, Genomas, Inc., Hartford, CT 06102, USA
| | - Karla Claudio
- Pharmaceutical Sciences department, University of Puerto Rico School of Pharmacy, San Juan, PR 00936, USA
| | - Seth Baker
- Clinical Laboratory Partners, Hartford Healthcare, Hartford, CT 06102, USA
| | - Mohan Kocherla
- Laboratory of Personalized Health, Genomas, Inc., Hartford, CT 06102, USA
| | - Mark Ferreira
- Laboratory of Personalized Health, Genomas, Inc., Hartford, CT 06102, USA
| | - Abiel Roche-Lima
- Center for Collaborative Research in Health Disparities, University of Puerto Rico School of Medicine, San Juan, PR 00936, USA
| | - Jovaniel Rodríguez-Maldonado
- Center for Collaborative Research in Health Disparities, University of Puerto Rico School of Medicine, San Juan, PR 00936, USA
| | - Jorge Duconge
- Pharmaceutical Sciences department, University of Puerto Rico School of Pharmacy, San Juan, PR 00936, USA
| | - Gualberto Ruaño
- Laboratory of Personalized Health, Genomas, Inc., Hartford, CT 06102, USA
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Stricker S, Balmer C, Guzman R, Soleman J. Dizygotic opposite-sex twins with surgically repaired concordant myelomeningocele conceived by in vitro fertilization using intracytoplasmic sperm injection: a case report and review of the literature. Childs Nerv Syst 2019; 35:725-728. [PMID: 30349985 DOI: 10.1007/s00381-018-3990-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/10/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Myelomeningocele (MMC) is a common subtype of congenital neural tube defects (NTD). Although congenital malformations including NTD are more common in twins, concordance, especially in dizygotic twins, is extremely rare and is found mostly in same-sex twins. The role of genetic and environmental factors in the etiology of MMC is unclear. CASE REPORT Dizygotic twins of opposite sex were born at term to a 35-year-old woman conceived with in vitro fertilization (IVF) using intracytoplasmic sperm injection (ICSI). Prenatal ultrasonography (US) revealed concordant lumbosacral MMC at 18 weeks of gestation as well as ventriculomegaly and Arnold-Chiari malformation type II at 28 weeks. Both twins underwent surgical repair of the MMC within 48 h after birth and required a ventriculoperitoneal shunt in the second week of life. DISCUSSION The case presented raises questions concerning the etiology of MMC, since in twins, it is compelling to attribute the etiology to genetic factors. In the literature, 22 pairs of twins with concordant MMC have been reported, and of the 10 dizygotic twins described, four were of opposite sex. However, in monozygotic twins, most of the cases are non-concordant; therefore, the role of genetics remains unclear. In addition, environmental factors such as nutrition, metabolic folic acid deficiency, and assisted conception with IVF and ICSI might play a role as well. CONCLUSION The appearance of concordant MMC in opposite-sex dizygotic twins, conceived by IVF using ICSI, intrigues questions concerning the etiology of MMC. In such cases, genetic counseling and evaluation should be considered.
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Affiliation(s)
- Sarah Stricker
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University Hospital and Children's Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Cécile Balmer
- Department of Pediatric Surgery, University Children's Hospital of Basel, Basel, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University Hospital and Children's Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Jehuda Soleman
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University Hospital and Children's Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
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Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2019; 50:e51-e96. [DOI: 10.1161/str.0000000000000183] [Citation(s) in RCA: 240] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Capelli I, Cianciolo G, Gasperoni L, Zappulo F, Tondolo F, Cappuccilli M, La Manna G. Folic Acid and Vitamin B12 Administration in CKD, Why Not? Nutrients 2019; 11:nu11020383. [PMID: 30781775 PMCID: PMC6413093 DOI: 10.3390/nu11020383] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/09/2019] [Accepted: 02/11/2019] [Indexed: 12/13/2022] Open
Abstract
Patients affected by chronic kidney disease (CKD) or end-stage renal disease (ESRD) experience a huge cardiovascular risk and cardiovascular events represent the leading causes of death. Since traditional risk factors cannot fully explain such increased cardiovascular risk, interest in non-traditional risk factors, such as hyperhomocysteinemia and folic acid and vitamin B12 metabolism impairment, is growing. Although elevated homocysteine blood levels are often seen in patients with CKD and ESRD, whether hyperhomocysteinemia represents a reliable cardiovascular and mortality risk marker or a therapeutic target in this population is still unclear. In addition, folic acid and vitamin B12 could not only be mere cofactors in the homocysteine metabolism; they may have a direct action in determining tissue damage and cardiovascular risk. The purpose of this review was to highlight homocysteine, folic acid and vitamin B12 metabolism impairment in CKD and ESRD and to summarize available evidences on hyperhomocysteinemia, folic acid and vitamin B12 as cardiovascular risk markers, therapeutic target and risk factors for CKD progression.
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Affiliation(s)
- Irene Capelli
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy.
| | - Giuseppe Cianciolo
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy.
| | - Lorenzo Gasperoni
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy.
| | - Fulvia Zappulo
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy.
| | - Francesco Tondolo
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy.
| | - Maria Cappuccilli
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy.
| | - Gaetano La Manna
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy.
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Nashef L, Singh R, Moran N, Murphy E. Investigating adults with early-onset epilepsy and intellectual or physical disability. Pract Neurol 2019; 19:115-130. [PMID: 30679263 DOI: 10.1136/practneurol-2018-001965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
This article focuses on investigating adults with early-onset epilepsy and intellectual or physical disability within adult neurology services. We aim to guide general neurologists in the diagnostic reassessment of people with epilepsy and complex neurological problems of unknown cause. Following an overview, we address imaging, electroencephalography, genetic studies and metabolic testing, and give examples where diagnosis directly influences treatment. Aetiological diagnosis serves to inform prognosis, guide treatment and provide a framework for genetic counselling.
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Affiliation(s)
- Lina Nashef
- Neurology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Rinki Singh
- Neurophysiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Nicholas Moran
- Neurology Department, East Kent Hospitals University Foundation Trust, Canterbury, UK
| | - Elaine Murphy
- Metabolic Disease (Adult Inherited), Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
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Abstract
BACKGROUND Genetic data have the potential to impact patient care significantly. In primary care and in the ICU, patients are undergoing genetic testing. Genetics is also transforming cancer care and undiagnosed diseases. Optimal personalized medicine relies on the understanding of disease penetrance. In this article, I examine the complexity of penetrance. METHODS In this article, I assess how variable penetrance can be seen with many diseases, including those of different modes of inheritance, and how genomic testing is being applied effectively for many diseases. In this article, I also identify challenges in the field, including the interpretation of gene variants. RESULTS Using advancing bioinformatics and detailed phenotypic assessment, we can increase the yield of genomic testing, particularly for highly penetrant conditions. The technologies are useful and applicable to different medical situations. CONCLUSIONS There are now effective genome diagnostics for many diseases. However, the best personalized application of these data still requires skilled interpretation.
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Affiliation(s)
- Joseph T.C. Shieh
- Division of Medical Genetics, Department of Pediatrics, Institute for Human Genetics, University of California, San Francisco, San Francisco, California
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