Alpha(1)-antichymotrypsin gene polymorphism in patients with stroke

Is Alpha-1 Antichymotrypsin Gene Polymorphism a Risk Factor for Primary Intracerebral Hemorrhage? A Case-Control Study and Meta-Analysis

Background

Alpha-1 antichymotrypsin (ACT) signal peptide A/T polymorphism has been suggested to play a role in various brain diseases with arterial wall pathology. We conducted a case-control study and a meta-analysis to evaluate the association between this polymorphism and risk of primary intracerebral hemorrhage.

Material/Methods

A total of 188 patients and 200 age- and sex-matched healthy controls were enrolled in our case-control study. The ACT polymorphism was genotyped by PCR-LDR. Further meta-analysis was conducted by searching literature from PUBMED, EMBASE, and Chinese National Knowledge Infrastructure databases until December 2014, then combining data using STATA10.0.

Results

Similar genotype distribution was detected between PICH patients and healthy controls (p=0.523). Further analysis based on hypertension and location of hemorrhage did not observe significant association. Multiple logistic regression analysis also failed to identify ACT polymorphism as an independent risk factor for PICH. With regard to meta-analysis, a total of 6 case-control studies including 932 PICH patients and 1140 controls were enrolled. Pooled ORs failed to detect a significant association of ACT signal peptide A/T polymorphism with PICH (dominant model: OR=1.03, 95%CI=0.72–1.46; recessive model: OR=1.08, 95%CI=0.88–1.32). Subgroup analysis based on hypertension revealed no association in hypertensive PICH or in normotensive PICH.

Conclusions

Our case-control study in a Chinese population did not detect a significant association between ACT signal peptide A/T polymorphism and PICH. Moreover, meta-analysis combining data from relevant studies failed to provide evidence for the association. Further well-designed studies with larger sample sizes are warranted to verify our findings.

Recurrent intracerebral hemorrhage in patients with hypertension is associated with APOE gene polymorphism: a preliminary study

BACKGROUND

Recurrent intracerebral hemorrhage (ICH) in patients with hypertension has been reported in Asia and is attributed to poor control of blood pressure, but there may be a genetic basis. This study evaluates the roles of apolipoprotein E (APOE) and α-1 antichymotrypsin (ACT) genes in patients with recurrent hypertensive ICH and compares patients with nonrecurring hypertensive ICH and normal controls.

METHODS

Thirty-three recurrent and 101 nonrecurrent patients with hypertension and ICH were included. The demographic, stroke risk factors, and computed tomographic or magnetic resonance imaging findings were recorded. Magnetic resonance angiography or digital subtraction angiography and vasculitic profile were done in recurrent group to exclude secondary causes of ICH. APOE and ACT gene polymorphisms were assessed with polymerase chain reaction studies in patients with ICH and 188 healthy controls.

RESULTS

The demographic and clinical variables were similar in patients with recurrent and nonrecurrent ICH, but patients with recurrent ICH were older (61.1 vs 57.2 years). In the recurrent ICH group, only 7 (10%) out of 69 episodes were lobar; the remaining were deep-seated hematomas. In the nonrecurrent group, 7 (6.9%) patients had lobar ICH. The E2 (odds ratio 4.32; 95% confidence interval 1.65-11.28; P = .003) and E4 alleles of APOE (odds ratio 11.33; 95% confidence interval 5.37-23.02; P < .0001) were significantly related to recurrent ICH compared to healthy controls. The E4 allele was also independently related to recurrent compared to nonrecurrent ICH, even after adjustment for stroke risk factors (odds ratio 25.99; 95% confidence interval 11.65-57.97; P < .0001). ACT gene polymorphism, however, was not related to recurrent ICH compared to controls and nonrecurrent ICH.

CONCLUSIONS

APOE polymorphism may contribute to the recurrence of hypertensive ICH.

A study of alpha1 antichymotrypsin gene polymorphism in Indian stroke patients

OBJECTIVE

To evaluate the role of ACT gene polymorphism in primary spontaneous intracerebral hemorrhage (PSICH) and ischemic stroke (IS).

METHODS

193 PSICH, 272 IS and 188 controls were included from the same geographical area. The demographic and clinical stroke risk factors were noted. PSICH was confirmed by CT and IS by MRI. The location of stroke and size were noted. ACT gene polymorphism was analyzed by polymerase chain reaction. The ACT genotype and allele frequency in PSICH, IS and controls were compared.

RESULTS

The age of the PSICH was 56.9+/-13 years, IS 54+/-16.7 years and controls 54.8+/-10 years. 134 females were in study and 65 in control groups. In the controls the AA genotype was 30%, AT 51.1% and TT in 16% whereas these were 39.3%, 53% and 7.7% in PSICH and 34.6%, 53.3% and 12.1% in IS. The frequency of T allele in controls was 41.5%, PSICH 34.2% and IS 38.6%. There was no significant difference in genotype and allele frequency in PSICH, IS and controls as well as location and etiology of stroke.

INTERPRETATION

The ACT genotype and allele frequency are not different in Indian PSICH and IS compared to controls.

The genetics of primary haemorrhagic stroke, subarachnoid haemorrhage and ruptured intracranial aneurysms in adults

Background

The genetic basis of haemorrhagic stroke has proved difficult to unravel, partly hampered by the small numbers of subjects in any single study. A meta-analysis of all candidate gene association studies of haemorrhagic stroke (including ruptured subarachnoid haemorrhage and amyloid angiopathy-related haemorrhage) was performed, allowing more reliable estimates of risk.

Methods

A systematic review and meta-analysis of all genetic studies in haemorrhagic stroke was conducted. Electronic databases were searched until and including March 2007 for any candidate gene in haemorrhagic stroke. Odds ratio (OR) and 95% confidence intervals (CI) were determined for each gene disease association using fixed and random effect models.

Results

Our meta-analyses included 6,359 cases and 13,805 controls derived from 55 case-control studies, which included 12 genes (13 polymorphisms). Statistically significant associations with haemorrhagic stroke were identified for those homozygous for the ACE/I allele (OR, 1.48; 95% CI, 1.20–1.83; p = 0.0003) and for the 5G allele in the SERPINE1 4G/5G polymorphism (OR, 1.42; 95% CI, 1.03–1.96; p = 0.03). In addition, both &b.epsi;2 and &b.epsi;4 alleles of APOE were significantly associated with lobar haemorrhage (OR, 1.81; 95% CI, 1.26–2.62; p = 0.002 and OR, 1.49; 95% 1.08–2.05; p = 0.01 respectively). Furthermore, a significant protective association against haemorrhagic stroke was found for the factor V Leiden mutation (OR, 0.30; 95% CI, 0.10–0.87; p = 0.03).

Conclusion

Our data suggests a genetic contribution to some types of haemorrhagic stroke, with no overall responsible single gene but rather supporting a polygenic aetiology . However, the evidence base is smaller compared to ischaemic stroke. Importantly, for several alleles previously found to be associated with protection from ischaemic stroke, there was a trend towards an increased risk of haemorrhagic stroke.

The alanine/threonine polymorphism of the alpha-1-antichymotrypsin (SERPINA3) gene and ruptured intracranial aneurysms in the Japanese population

BACKGROUND

Serine protease inhibitor member 3 of clade A (SERPINA3), also known as alpha-1-antichymotrypsin, inhibits the activity of cathepsin G. The release of neutrophil cathepsin G (proteolytic enzyme) can destroy the vascular matrix through degradation, platelet aggregation and coagulation disorders. In a previous report there was evidence that an alanine/threonine polymorphism was associated with the risk factor for aneurysmal subarachnoid hemorrhage (SAH) in a Polish population. We performed this study to determine whether this A15T polymorphism shows the same association in a Japanese population.

METHODS

A total of 437 patients with an aneurysmal SAH and 405 control cases of Japanese origin were genotyped for the A15T polymorphism and 2 further intronic single nucleotide polymorphisms by using polymerase chain reaction and direct sequencing.

RESULTS

In the patients with intracranial aneurysms the SERPINA3 A15T allele and genotype distribution did not differ significantly from the controls.

CONCLUSION

In the Japanese population the A15T polymorphism of the SERPINA3 gene is not associated with aneurysmal SAH.

Post-stroke dementia is associated with alpha(1)-antichymotrypsin polymorphism

BACKGROUND AND PURPOSE

Alpha-1-antichymotrypsin (ACT) is an acute phase protein involved in inflammatory reaction, promoting the assembly of beta amyloid protein into filaments and contributing to its resistance to proteolytic digestion. The aim of our study was to determine ACT signal peptide polymorphism (A/T) as a possible risk factor for post-stroke dementia (PSD).

METHODS

142 consecutive ischemic stroke patients and 188 controls were included in this study. Pre-stroke dementia (PRESD) was evaluated using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). The diagnosis of the post-stroke dementia (PSD) was established according to DSM-IV criteria. The ACT gene (A/T) polymorphism was determined by PCR-RFLR.

RESULTS

Both ACT-TT genotype and T-allele were significantly more prevalent in patients with PSD than in non-demented stroke patients, controls or patients with PRESD. After adjustment for age, gender, and vascular risk factors, both the ACT-TT genotype and T-allele remained independently associated with PSD.

CONCLUSION

Our findings suggest that ACT polymorphism (A/T) is a risk factor for PSD.

Subtyping in ischemic stroke genetic research

Discovery of genes that influence stroke risk might be facilitated if phenotypic heterogeneity of the population studied were reduced by studying individual subtypes of stroke. Standardized systems for classifying stroke are generally mechanistic or syndromic. Mechanistic systems (eg, Trial of ORG10172 in Acute Stroke Treatment) are based on presumed pathophysiologic basis of occlusion. Syndromic systems (eg, Oxfordshire Community Stroke Project) are based on signs and symptoms of neurologic dysfunction. Linkage and candidate gene studies should use such standardized systems in the search for subtype-specific genetic risk factors to increase the validity of interstudy comparisons.