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Farooq N, Ali N, Ullah S. Evaluation of Hematological Parameters in the Genetic Prospective in Epileptic Patients of Khyber Pakhtunkhwa. Pharmgenomics Pers Med 2019; 12:377-385. [PMID: 31920364 PMCID: PMC6934119 DOI: 10.2147/pgpm.s223572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/05/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Epilepsy is a treatable disease, but unfortunately a treatment gap exists in epileptic patients, especially in developing countries, due to adverse effects of antiepileptic drugs and polymorphisms in genes. Carbamazepine is the most commonly used medication in epilepsy, but is related to some serious and rare adverse effects. The aim of the study was to investigate the effect of folate metabolizing genes (MTHFR and DHFR) polymorphisms on different parameters of complete blood count in patients who were treated with carbamazepine and valproic acid. MATERIALS AND METHODS Blood samples from 267 epileptic patients were collected on consent and surrogate consent forms. The blood was analyzed for changes in different parameters in complete blood count through a blood analyzer. The MTHFR gene was genotyped using the RFLP method. The data were analyzed using GraphPad Prism 6. RESULTS The homozygous mutant genotype (677CT) of the methylenetetrahydrofolate reductase enzyme (MTHFR C677T) gene significantly affects the level of hemoglobin (P=0.12), hematocrit (P=0.008) and mean corpuscular hemoglobin (P=0.01) compared to the homozygous wild genotype (677CC) and heterozygous mutant genotype (677CT) of the MTHFR (C677T) gene. However, the heterozygous genotype (1298AC) of MTHFR (A1298C) gene affect the total leukocyte count (P=0.037) level significantly. CONCLUSION Changes in different parameters of complete blood count were statistically significant but clinically insubstantial decreases in different parameters of complete blood count indexes.
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Affiliation(s)
- Nazish Farooq
- Department of Hematology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
- Department of Pathology, Khyber Medical College, Peshawar, Pakistan
| | - Niaz Ali
- Department of Pharmacology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Shakir Ullah
- Department of Pharmacology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
- Department of Pharmacy, University of Malakand, Chakdara, Pakistan
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Abd-Elmawla MA, Rizk SM, Youssry I, Shaheen AA. Impact of Genetic Polymorphism of methylenetetrahydrofolate reductase C677T on Development of Hyperhomocysteinemia and Related Oxidative Changes in Egyptian β-Thalassemia Major Patients. PLoS One 2016; 11:e0155070. [PMID: 27187171 PMCID: PMC4871363 DOI: 10.1371/journal.pone.0155070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 04/24/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND β-thalasemia major (β-TM) patients often suffer from various vascular complications together with increased oxidative stress. Hyperhomocysteinemia (Hhcy) has been defined as a risk factor for these complications. Genetic polymorphism of methylenetetrahydrofolate reductase (MTHFR) C677T has been shown to cause Hhcy particularly in individuals with low B-vitamins. However, the status of homocysteine (hcy) in β-TM has not yet been adequately defined. AIM To evaluate the genetic polymorphism of MTHFR C677T among β-TM patients and its prospective contribution to Hhcy and related oxidative changes. SUBJECTS AND METHODS Genotyping for MTHFR C677T was done by PCR-RFLP technique. Plasma hcy, vitamin B12, folate, malondialdehyde (MDA), total antioxidant capacity (TAC), oxidized low density lipoprotein (oxLDL), total nitric oxide (NOx) and lipid profile were determined in 66 β-TM patients and 66 control subjects of matched age and sex. RESULTS The prevalence of MTHFR 677TT genotype was significant among β-TM patients (12%) compared to (3%) controls (OR = 4.9, 95%CI:1.2-24.2,P = 0.03). A strong association between Hhcy and MTHFR TT genotype was observed (OR = 7.7, 95%CI:2.8-20.9) where all β-TM patients with TT genotype were hyperhomocystienemic (≥ 15 μmol/l) and having sub-optimal folate level than those with CT or CC genotypes. Hyperhomocystienemic patients have suffered from increased oxidative stress characterized by significant increase in plasma MDA and oxLDL, and a significant reduction of plasma TAC and total NOx. Lipid profile of those patients was severely affected indicated by reduction in HDL and HDL/LDL and elevation in atherogenic index as compared with CC genotype. Other measured parameters were not significantly different among β-TM patients with different MTHFR genotypes. CONCLUSION This study suggests that Egyptian β-TM patients with MTHFR 677TT genotype could be at increasing risk of developing Hhcy particularly with folate deficiency. This state of Hhcy may account potentially for most oxidative changes and atherogenic vascular complications frequently reported in β-TM patients.
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Affiliation(s)
- Mai A. Abd-Elmawla
- Department of Biochemistry, Faculty of Pharmacy, Cairo University, Cairo, Egypt
- * E-mail:
| | - Sherine M. Rizk
- Department of Biochemistry, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Ilham Youssry
- Department of Pediatric Hematology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amira A. Shaheen
- Department of Biochemistry, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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Raina JK, Sharma M, Panjaliya RK, Bhagat M, Sharma R, Bakaya A, Kumar P. Methylenetetrahydrofolate reductase C677T and methionine synthase A2756G gene polymorphisms and associated risk of cardiovascular diseases: A study from Jammu region. Indian Heart J 2016; 68:421-30. [PMID: 27316508 PMCID: PMC4912384 DOI: 10.1016/j.ihj.2016.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 01/12/2016] [Accepted: 02/07/2016] [Indexed: 02/07/2023] Open
Abstract
Aim Potent risk factors at both genetic and non-genetic levels are accountable for susceptibility and instigation of different cardiovascular phenotypes. Recently, homocysteine is being identified as an important predictor for cardiovascular diseases. Homocysteine remethylation plays a key role in the synthesis of methionine and S-adenosine methionine. Methylenetetrahydrofolate reductase (MTHFR) and methionine synthase (MTR) genes are known to regulate the homocysteine remethylation reaction and higher homocysteine level is significantly associated with diverse cardiovascular phenotypes. In this context, we aimed to carry out a study on the association of MTHFR (C677T) and MTR (A2756G) gene polymorphism with CVD in population of Jammu region of J&K state. Materials and methods A total of 435 individuals were enrolled (195 CVD patients and 240 controls) for the case–control study. Genotyping of MTHFR C677T and MTR A2756G gene polymorphism was done by PCR-RFLP technique. Biochemical parameters were estimated by biochemical analyser. Results Metabolic variables such as serum LDL-C, TC and TG were significantly higher in patients (p < 0.0001), whereas serum HDL-C was higher in controls. Majority of the patients were having history of hypertension (57.44%; p < 0.0001) as a concomitant condition. The evaluation of genetic association showed that, MTHFR C6877T (OR: 8.89, 95% CI: 2.01–39.40) and MTR A2756G (OR: 1.48, 95% CI: 1.09–2.00) polymorphisms associated with higher risk of CVD. Conclusion The present study reveals significant differences in nongenetic variables among patients and control as well as association of gene polymorphisms with CVD risk.
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Affiliation(s)
- Jyotdeep K Raina
- Human Genetics Research cum Counselling Centre, University of Jammu, 180006, India
| | - Minakashee Sharma
- Human Genetics Research cum Counselling Centre, University of Jammu, 180006, India
| | - Rakesh K Panjaliya
- Human Genetics Research cum Counselling Centre, University of Jammu, 180006, India
| | | | - Ravi Sharma
- Human Genetics Research cum Counselling Centre, University of Jammu, 180006, India; Department of Zoology, University of Jammu, India
| | - Ashok Bakaya
- Department of Cardiology, Acharaya Shri Chander College of Medical Sciences and Hospital (ASCOMS), Sidhra, Jammu, India
| | - Parvinder Kumar
- Principal Investigator, Human Genetics Research cum Counselling Centre, University of Jammu, 180006, India; Assistant Professor, Department of Zoology, University of Jammu, India.
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Simone B, De Stefano V, Leoncini E, Zacho J, Martinelli I, Emmerich J, Rossi E, Folsom AR, Almawi WY, Scarabin PY, den Heijer M, Cushman M, Penco S, Vaya A, Angchaisuksiri P, Okumus G, Gemmati D, Cima S, Akar N, Oguzulgen KI, Ducros V, Lichy C, Fernandez-Miranda C, Szczeklik A, Nieto JA, Torres JD, Le Cam-Duchez V, Ivanov P, Cantu C, Shmeleva VM, Stegnar M, Ogunyemi D, Eid SS, Nicolotti N, De Feo E, Ricciardi W, Boccia S. Risk of venous thromboembolism associated with single and combined effects of Factor V Leiden, Prothrombin 20210A and Methylenetethraydrofolate reductase C677T: a meta-analysis involving over 11,000 cases and 21,000 controls. Eur J Epidemiol 2013; 28:621-47. [PMID: 23900608 PMCID: PMC3935237 DOI: 10.1007/s10654-013-9825-8] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 07/02/2013] [Indexed: 12/16/2022]
Abstract
Genetic and environmental factors interact in determining the risk of venous thromboembolism (VTE). The risk associated with the polymorphic variants G1691A of factor V (Factor V Leiden, FVL), G20210A of prothrombin (PT20210A) and C677T of methylentetrahydrofolate reductase (C677T MTHFR) genes has been investigated in many studies. We performed a pooled analysis of case-control and cohort studies investigating in adults the association between each variant and VTE, published on Pubmed, Embase or Google through January 2010. Authors of eligible papers, were invited to provide all available individual data for the pooling. The Odds Ratio (OR) for first VTE associated with each variant, individually and combined with the others, were calculated with a random effect model, in heterozygotes and homozygotes (dominant model for FVL and PT20210A; recessive for C677T MTHFR). We analysed 31 databases, including 11,239 cases and 21,521 controls. No significant association with VTE was found for homozygous C677T MTHFR (OR: 1.38; 95 % confidence intervals [CI]: 0.98-1.93), whereas the risk was increased in carriers of either heterozygous FVL or PT20210 (OR = 4.22; 95 % CI: 3.35-5.32; and OR = 2.79;95 % CI: 2.25-3.46, respectively), in double heterozygotes (OR = 3.42; 95 %CI 1.64-7.13), and in homozygous FVL or PT20210A (OR = 11.45; 95 %CI: 6.79-19.29; and OR: 6.74 (CI 95 % 2.19-20.72), respectively). The stratified analyses showed a stronger effect of FVL on individuals ≤ 45 years (p value for interaction = 0.036) and of PT20210A in women using oral contraceptives (p-value for interaction = 0.045). In this large pooled analysis, inclusive of large studies like MEGA, no effect was found for C677T MTHFR on VTE; FVL and PT20210A were confirmed to be moderate risk factors. Notably, double carriers of the two genetic variants produced an impact on VTE risk significantly increased but weaker than previously thought.
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Affiliation(s)
- B Simone
- Institute of Hygiene, Università Cattolica del
Sacro Cuore, Rome, Italy
| | - V De Stefano
- Institute of Haematology, Università Cattolica del
Sacro Cuore, Rome, Italy
| | - E Leoncini
- Institute of Hygiene, Università Cattolica del
Sacro Cuore, Rome, Italy
| | - J Zacho
- Department of Clinical Biochemistry, Herlev Hospital,
Copenhagen University Hospital, Herlev, Denmark
| | - I Martinelli
- A. Bianchi Bonomi Hemophilia and Thrombosis Center,
Department of Internal Medicine and Medical Specialties, Fondazione IRCCS Ca' Granda
- Ospedale Maggiore Policlinico, Milan, Italy
| | - J Emmerich
- Hôpital Européen Georges Pompidou, Service
de Médecine Vasculaire, Centre Claude Bernard et Laboratoire
d'Hémostase, Paris, France
| | - E Rossi
- Institute of Haematology, Università Cattolica del
Sacro Cuore, Rome, Italy
| | - AR Folsom
- Division of Epidemiology and Community Health, University
of Minnesota, Minneapolis, MN, USA
| | - WY Almawi
- Department of Medical Biochemistry, Arabian Gulf
University, Manama, Bahrain
| | | | - M den Heijer
- Department of Internal Medicine, VU Medical Center, PO-box
7057 1007 MB, Amsterdam, the Netherlands
| | - M Cushman
- Department of Medicine, University of Vermont,
Burlington 05446, USA
| | - S Penco
- Medical Genetics, Clinical Chemistry and Clinical
Pathology Laboratory, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3,
20100 Milan, Italy
| | - A Vaya
- Thrombosis and Hemostasis Unit, Department of Clinical
Pathology, La Fe University Hospital, Valencia, Spain
| | - P Angchaisuksiri
- Department of Medicine, Ramathibodi Hospital, Mahidol
University, Bangkok, Thailand
| | - G Okumus
- Department of Pulmonary Diseases, Istanbul Medical
Faculty, Istanbul University, Capa-Istanbul, Turkey
| | - D Gemmati
- Centre for the Study of Haemostasis and Thrombosis
Institute of Human Anatomy, the University of Ferrara, Ferrara, Italy
| | - S Cima
- Centre for the Study of Haemostasis and Thrombosis
Institute of Human Anatomy, the University of Ferrara, Ferrara, Italy
| | - N Akar
- Ankara University Department of Pediatric Molecular
Genetics, Ankara, Turkey
| | - KI Oguzulgen
- Department of Pulmonary Medicine, Gazi University School
of Medicine, Ankara, Turkey
| | - V Ducros
- Département de Biochimie, Toxicologie et
Pharmacologie, Centre Hospitalier Universitaire, BP 217, 38043 Grenoble,
France
| | - C Lichy
- Department of Neurology, Klinikum Memmingen,
Bismarckstrasse 23, 87700 Memmingen, Germany
| | - C Fernandez-Miranda
- Servicio de Medicina Interna, Hospital Universitario 12
de Octubre, Madrid, Spain
| | - A Szczeklik
- Dept of Medicine, Jagiellonian University School of
Medicine, Cracow, Poland
| | - JA Nieto
- Departments of Internal Medicine, Virgen de la Luz
Hospital, Cuenca, Spain
| | - JD Torres
- Grupo de Investigación en Trombosis, Universidad
de Antioquia–Hospital Universitario San Vicente de Paúl,
Medellín, Colombia
| | | | - P Ivanov
- Department of Biochemistry, University of Medicine,
Pleven, Bulgaria
| | - C Cantu
- Stroke Clinic, Instituto Nacional de Neurología y
Neurocirugía Manuel Velasco Suárez, Mexico
| | - VM Shmeleva
- Russian Institute of Haematology and Transfusion, St.
Petersburg, 2-nd Sovietskaya 16, Russia
| | - M Stegnar
- Department of Vascular Diseases, University Medical
Centre Ljubljana, Ljubljana, Slovenia
| | - D Ogunyemi
- Perinatology Unit, Morristown Memorial Hospital, New
Jersey, USA
| | - SS Eid
- King Hussein Medical Center, Princess Iman Research
Center for Laboratory Sciences, Amman, Jordan
| | - N Nicolotti
- Institute of Hygiene, Università Cattolica del
Sacro Cuore, Rome, Italy
| | - E De Feo
- Institute of Hygiene, Università Cattolica del
Sacro Cuore, Rome, Italy
| | - W Ricciardi
- Institute of Hygiene, Università Cattolica del
Sacro Cuore, Rome, Italy
| | - S Boccia
- Institute of Hygiene, Università Cattolica del
Sacro Cuore, Rome, Italy
- IRCCS S. Raffaele Pisana, Rome, Italy
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Prevalence of MTHFR C677T and MS A2756G polymorphisms in major depressive disorder, and their impact on response to fluoxetine treatment. CNS Spectr 2012; 17:76-86. [PMID: 22789065 PMCID: PMC4117348 DOI: 10.1017/s1092852912000430] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the prevalence of the C677T polymorphism of the methylene tetrahydrofolate reductase (MTHFR) gene and the A2756G polymorphism of methionine synthase (MS), and their impact on antidepressant response. METHODS We screened 224 subjects (52% female, mean age 39 ± 11 years) with SCID-diagnosed major depressive disorder (MDD), and obtained 194 genetic samples. 49 subjects (49% female, mean age 36 ± 11 years) participated in a 12-week open clinical trial of fluoxetine 20-60 mg/day. Association between clinical response and C677T and A2756G polymorphisms, folate, B12, and homocysteine was examined. RESULTS Prevalence of the C677T and A2756G polymorphisms was consistent with previous reports (C/C = 41%, C/T = 47%, T/T = 11%, A/A = 66%, A/G = 29%, G/G = 4%). In the fluoxetine-treated subsample (n = 49), intent-to-treat (ITT) response rates were 47% for C/C subjects and 46% for pooled C/T and T/T subjects (nonsignificant). ITT response rates were 38% for A/A subjects and 60% for A/G subjects (nonsignificant), with no subjects exhibiting the G/G homozygote. Mean baseline plasma B12 was significantly lower in A/G subjects compared to A/A, but folate and homocysteine levels were not affected by genetic status. Plasma folate was negatively associated with treatment response. CONCLUSION The C677T and A2756G polymorphisms did not significantly affect antidepressant response. These preliminary findings require replication in larger samples.
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Ringwald J, Berger A, Adler W, Kraus C, Pitto RP. Genetic polymorphisms in venous thrombosis and pulmonary embolism after total hip arthroplasty: a pilot study. Clin Orthop Relat Res 2009; 467:1507-15. [PMID: 18800213 PMCID: PMC2674155 DOI: 10.1007/s11999-008-0498-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 08/22/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED Deep venous thrombosis (DVT) after major orthopaedic surgery is a substantial concern. We asked whether the single or combined presence of thrombophilic genetic polymorphisms might further increase the already high risk for venous thrombosis and pulmonary embolism (PE) after THA. We therefore compared the prevalence of factor V Leiden, prothrombin G20210A, methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C, and plasminogen activator inhibitor 4G/5G polymorphisms between 50 patients with symptomatic DVT within 3 weeks after elective THA and an asymptomatic control group of 85 patients. We found no major difference for the presence of a single mutation between the groups. Factor V Leiden and homozygous MTHFR C667T mutations were of borderline significance with odds ratios (95% confidence intervals) of 3.73 (0.89-15.63) and 2.93 (0.92-9.29), respectively. Patients with homozygous or combined heterozygous status of MTHFR C677T and A1298C mutation had a higher frequency of DVT after elective THA (odds ratio, 2.86; 95% confidence interval, 1.32-6.35) than those with wild-type. The presence of a single mutation may not further increase the already high risk for symptomatic DVT after THA, whereas combinations of mutations of distinct polymorphisms might be important. However, prospective studies with a larger number of patients are needed before we would recommend preoperative screening. LEVEL OF EVIDENCE Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Juergen Ringwald
- Department of Transfusion Medicine and Haemostaseology, University Hospital of Erlangen, Krankenhausstraße 12, 91054 Erlangen, Germany
| | - Annika Berger
- Center for Neurological Imaging, Brigham and Women’s Hospital, Harvard University, Boston, MA USA
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Cornelia Kraus
- Institute of Human Genetics, University Hospital of Erlangen, Erlangen, Germany
| | - Rocco P. Pitto
- Department of Orthopaedic Surgery, Middlemore Hospital, University of Auckland, Auckland, New Zealand
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Hyperhomocysteinemia: no longer a consideration in the management of venous thromboembolism. Curr Opin Pulm Med 2008; 14:369-73. [DOI: 10.1097/mcp.0b013e328307ee38] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Naushad SM, Jain Jamal MN, Prasad CK, Rama Devi AR. Relationship between methionine synthase, methionine synthase reductase genetic polymorphisms and deep vein thrombosis among South Indians. Clin Chem Lab Med 2008; 46:73-9. [PMID: 18034637 DOI: 10.1515/cclm.2008.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The rationale behind this study was to examine the relationship between polymorphisms in genes that regulate remethylation of homocysteine to methionine, i.e., methionine synthase (MTR A2756G) and methionine synthase reductase (MTRR A66G), and risk of deep vein thrombosis (DVT) in a South Indian cohort (163 DVT cases and 163 controls), as elevated homocysteine has been documented as an independent risk factor for DVT in the same cohort. METHODS Plasma homocysteine analysis was carried out by reverse phase HPLC. The MTR A2756G and MTRR A66G genetic polymorphisms were detected using PCR-restriction fragment length polymorphism method. For statistical analyses, Fisher's exact test was used for categorical variables and Student's t-test and analysis of variance were used for continuous variables. RESULTS The MTRR 66GG genotype was associated with a 2.74-fold [95% confidence interval (CI): 1.73, 4.34] risk of DVT. The MTR A2756G polymorphism was not a risk factor. MTRR GG/MTR AG and MTRR GG/MTR GG genotypes cumulatively were found to increase the risk of DVT by 2.38-fold (95% CI: 1.43, 3.96). A positive association was observed between plasma homocysteine and the MTRR G allele, and the MTR G allele was shown to have an additive effect. The risk associated with the MTRR 66GG genotype was further increased in subjects compound heterozygous for methylene tetrahydrofolate reductase (MTHFR) [odds ratio (OR): 3.46, 95% CI: 1.38, 8.63]. CONCLUSIONS The MTRR 66GG genotype is a risk factor for DVT among South Indians. This risk is increased further in the presence of the MTHFR 677CT/1298AC genotype.
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Affiliation(s)
- Shaik Mohammad Naushad
- Diagnostic Division, Center for DNA Fingerprinting and Diagnostics, Hyderabad, Andhra Pradesh, India
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González-Porras JR, García-Sanz R, Alberca I, López ML, Balanzategui A, Gutierrez O, Lozano F, San Miguel J. Risk of recurrent venous thrombosis in patients with G20210A mutation in the prothrombin gene or factor V Leiden mutation. Blood Coagul Fibrinolysis 2006; 17:23-8. [PMID: 16607075 DOI: 10.1097/01.mbc.0000201488.33143.09] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The impact of the G20210A prothrombin mutation, factor V Leiden and 677T mutation of methylene tetrahydrofalate reductase (MTHFR) in recurrent deep venous thrombosis (DVT) is not so clear. We have prospectively monitored 259 patients following a first episode of DVT in order to determine which factors influence the development of a recurrent event. Several clinical and biological factors together with the genetic polymorphisms of factor V Leiden, G20210A prothrombin and 677T MTHFR were assessed. During a median follow-up of 786 patient-years, 27 patients (14%) developed one objective episode of recurrent venous thrombosis. The carriers of a double defect, homozygous or double heterozygous for factor V Leiden and G20210A, had an increased risk after a first episode of DVT, while patients who were isolated heterozygous for factor V Leiden or G20210 had a risk of recurrent DVT similar to patients who had neither mutation (annual incidence of 12.1, 3.1, 2.9 and 2.8%). The 677T MTHFR mutation alone or combined with hyperhomocysteinemia was not associated with an increased risk of recurrent events. The development of proximal DVT (P=0.01) and the presence of a double defect (P=0.01) were the only two risk factors independently associated with a high recurrence ratio in the multivariate analysis. Thus, the annual incidence of DVT recurrence in patients without any of these two risk factors was only 0.6% (95% confidence interval, 0.2-0.9). We have identified a group of patients with DVT but at very low risk of re-thrombosis in whom an extended secondary thromboprophylaxis should be carefully considered.
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Gross M, Friedman G, Eliashar R, Koren-Morag N, Goldschmidt N, Atta IA, Ben-Yehuda A. Impact of methionine synthase gene and methylenetetrahydrofolate reductase gene polymorphisms on the risk of sudden sensorineural hearing loss. Audiol Neurootol 2006; 11:287-93. [PMID: 16778415 DOI: 10.1159/000093957] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Accepted: 04/07/2006] [Indexed: 01/23/2023] Open
Abstract
Idiopathic sudden sensorineural hearing loss (SSNHL) represents a frequently encountered otological disease of unknown etiology. In recent years, several inherited risk factors have been found in the pathogenesis of vascular diseases. In the present study, we determined whether specific polymorphism or the combination of polymorphisms in folate-dependent homocysteine metabolism genes can act as predisposing inherited vascular risk factors in the development of SSNHL. We conducted a prospective case-control study using DNA samples extracted from 81 patients diagnosed as suffering from SSNHL and 264 healthy control subjects. Three functional polymorphisms were analyzed by polymerase chain reaction amplification, restriction enzyme digestion, and DNA fragment separation by electrophoresis: methylenetetrahydrofolate reductase (MTHFR) C677T, MTHFR A1298C, and methionine synthase (MTR) A2756G polymorphisms. The prevalence of the homozygous genotype of MTR 2756GG in the SSNHL patients (9%) was significantly higher than in the control group (4%) (p = 0.011). The allelic frequency of the G allele of the MTR A2756G polymorphism among SSNHL patients (12.5%) was also significantly higher than in the control group (5%) (p = 0.033). The prevalence of patients possessing two polymorphisms (31%) and three polymorphisms (17%) in the SSNHL group was significantly higher than in the control group (23 and 9%, respectively; p = 0.019). The frequency of patients with a very high rank risk (double homozygous) was significantly higher in the SSNHL group, MTHFR 677TT/MTR 2675GG--7%, than the frequency of patients in the control group, MTHFR 677TT/MTR 2675GG--3% (p = 0.030). Certain polymorphisms in genes encoding enzymes in the folate-dependent homocysteine metabolism are associated with SSNHL. In our case-control study, a significant association between MTR 2756GG genotype and SSNHL was found which may represent an inherited vascular risk factor in the pathogenesis of SSNHL.
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Affiliation(s)
- Menachem Gross
- Department of Otolaryngology/Head and Neck Surgery, Hadassah Hebrew University Hospital, Jerusalem, Israel.
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Den Heijer M, Lewington S, Clarke R. Homocysteine, MTHFR and risk of venous thrombosis: a meta-analysis of published epidemiological studies. J Thromb Haemost 2005; 3:292-9. [PMID: 15670035 DOI: 10.1111/j.1538-7836.2005.01141.x] [Citation(s) in RCA: 266] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT It has been suggested that elevated total plasma homocysteine levels are associated with the risk of venous thrombosis. OBJECTIVE To assess the relationship of homocysteine and the MTHFR 677TT genotype and the risk of venous thrombosis by conducting a meta-analysis of all relevant studies. DATA SOURCES AND SELECTION Studies (case-control or nested case-control) were identified by searches of electronic literature for relevant reports published before July 2003 on homocysteine and the MTHFR 677TT genotype and venous thrombosis as an end-point, by hand-searching reference lists of original articles (including meta-analyses) on this topic and by contact with investigators in the field. DATA EXTRACTION A meta-analysis of 24 retrospective (n = 3289 cases) and three prospective studies (n = 476 cases) was carried out to examine the association of homocysteine with venous thrombosis. A meta-analysis of 53 studies (n = 8364 cases) of the MTHFR 677TT genotype (that increases homocysteine) was carried out to assess if this association is causal. DATA SYNTHESIS A 5 micromol L(-1) higher measured homocysteine level was associated with a 27% (95% CI: 1-59) higher risk of venous thrombosis in prospective studies and a 60% (95% CI: 10-134) higher risk in retrospective studies. The 677TT genotype was associated with a 20% (95% CI: 8-32) higher risk of venous thrombosis compared with the 677CC genotype. In contrast with non-American studies, the 677TT genotype had no effect on venous thrombosis in North America, due probably to the higher intake of folate and riboflavin in North America. CONCLUSION This meta-analysis of prospective and retrospective studies demonstrates a modest association of homocysteine with venous thrombosis. The elevated risk associated with the MTHFR 677TT genotype provides some support for causality.
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Affiliation(s)
- M Den Heijer
- Department of Endocrinology (531), Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, the Netherlands.
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