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Karthikeyan G, Watkins D, Bukhman G, Cunningham MW, Haller J, Masterson M, Mensah GA, Mocumbi A, Muhamed B, Okello E, Sotoodehnia N, Machipisa T, Ralph A, Wyber R, Beaton A. Research priorities for the secondary prevention and management of acute rheumatic fever and rheumatic heart disease: a National Heart, Lung, and Blood Institute workshop report. BMJ Glob Health 2023; 8:e012468. [PMID: 37914183 PMCID: PMC10618973 DOI: 10.1136/bmjgh-2023-012468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/14/2023] [Indexed: 11/03/2023] Open
Abstract
Secondary prevention of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) involves continuous antimicrobial prophylaxis among affected individuals and is recognised as a cornerstone of public health programmes that address these conditions. However, several important scientific issues around the secondary prevention paradigm remain unresolved. This report details research priorities for secondary prevention that were developed as part of a workshop convened by the US National Heart, Lung, and Blood Institute in November 2021. These span basic, translational, clinical and population science research disciplines and are built on four pillars. First, we need a better understanding of RHD epidemiology to guide programmes, policies, and clinical and public health practice. Second, we need better strategies to find and diagnose people affected by ARF and RHD. Third, we urgently need better tools to manage acute RF and slow the progression of RHD. Fourth, new and existing technologies for these conditions need to be better integrated into healthcare systems. We intend for this document to be a reference point for research organisations and research sponsors interested in contributing to the growing scientific community focused on RHD prevention and control.
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Affiliation(s)
| | - David Watkins
- Division of General Internal Medicine, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Gene Bukhman
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Program in Global Noncommunicable Diseases and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | | | - John Haller
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Mary Masterson
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - George A Mensah
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Ana Mocumbi
- Non-Communicable Diseases Division, Instituto Nacional de Saúde, Marracuene, Mozambique
- Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Babu Muhamed
- The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Emmy Okello
- Cardiology, Uganda Heart Institute Ltd, Kampala, Uganda
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, USA
| | - Tafadzwa Machipisa
- Cape Heart Institute (CHI), Department of Medicine, University of Cape Town, Rondebosch, South Africa
- Clinical Research Laboratory & Biobank-Genetic & Molecular Epidemiology Laboratory (CRLB-GMEL), Population Health Research Institute, Hamilton, Ontario, Canada
| | - Anna Ralph
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Rosemary Wyber
- END RHD Program, Telethon Kids Institute, Perth, Western Australia, Australia
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, Canberra, Australian Capital Territory, Australia
| | - Andrea Beaton
- Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Salie MT, Muhamed B, Engel K, Rampersadh K, Daniels R, Mhlanti L, Penfound TA, Sable CA, Zühlke LJ, Dale JB, Engel ME. Serum Immune Responses to Group A Streptococcal Antigens following Pharyngeal Acquisitions among Children in Cape Town, South Africa. mSphere 2023:e0011323. [PMID: 37154726 DOI: 10.1128/msphere.00113-23] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
There is limited information on the human immune response following infection with group A Streptococcus (Strep A). Animal studies have shown, in addition to the M protein, that shared Strep A antigens elicit protective immunity. This study aimed to investigate the kinetics of antibody responses against a panel of Strep A antigens in a cohort of school-aged children in Cape Town, South Africa. Participants provided serial throat cultures and serum samples at two-monthly follow-up visits. Strep A recovered were emm-typed, and serum samples were analyzed by enzyme-linked immunosorbent assay (ELISA) to assess immune responses to thirty-five Strep A antigens (10-shared and 25-M peptides). Serologic evaluations were performed on serial serum samples from 42 selected participants (from 256 enrolled) based on the number of follow-up visits, the frequency of visits, and throat culture results. Among these, there were 44 Strep A acquisitions, 36 of which were successfully emm-typed. Participants were grouped into three clinical event groups based on culture results and immune responses. A preceding infection was most convincingly represented by a Strep A-positive culture with an immune response to at least one shared antigen and M peptide (11 events) or a Strep A-negative culture with antibody responses to shared antigens and M peptides (9 events). More than a third of participants demonstrated no immune response despite a positive culture. This study provided important information regarding the complexity and variability of human immune responses following pharyngeal acquisition of Strep A, as well as demonstrating the immunogenicity of Strep A antigens currently under consideration as potential vaccine candidates. IMPORTANCE There is currently limited information regarding the human immune response to group A streptococcal throat infection. An understanding of the kinetics and specificity of antibody responses against a panel of Group A Streptococcus (GAS) antigens will serve to refine diagnostic approaches and contribute to vaccine efforts, which together will serve to reduce the burden of rheumatic heart disease, a major source of morbidity and mortality especially in the developing world. This study, utilizing an antibody-specific assay, uncovered three patterns of response profiles following GAS infection, among 256 children presenting with sore throat to local clinics. Overall, the response profiles were complex and variable. Of note, a preceding infection was most convincingly represented by a GAS-positive culture with an immune response to at least one shared antigen and M peptide. Also, more than a third of participants demonstrated no immune response despite a positive culture. All antigens tested were immunogenic, providing guidance for future vaccine development.
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Affiliation(s)
- M Taariq Salie
- Department of Medicine (AFROStrep Research Initiative) and Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Babu Muhamed
- Department of Medicine (AFROStrep Research Initiative) and Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kélin Engel
- Department of Medicine (AFROStrep Research Initiative) and Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kimona Rampersadh
- Department of Medicine (AFROStrep Research Initiative) and Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Rezeen Daniels
- Department of Medicine (AFROStrep Research Initiative) and Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Lwazi Mhlanti
- Department of Medicine (AFROStrep Research Initiative) and Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Thomas A Penfound
- Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Craig A Sable
- Children's National Health System, Washington, DC, USA
| | - Liesl J Zühlke
- South African Medical Research Council, Cape Town, South Africa
- Division of Paediatric Cardiology, Department of Paediatrics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - James B Dale
- Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Mark E Engel
- Department of Medicine (AFROStrep Research Initiative) and Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Machipisa T, Chishala C, Shaboodien G, Zühlke LJ, Muhamed B, Pandie S, de Vries J, Laing N, Joachim A, Daniels R, Ntsekhe M, Hugo-Hamman CT, Gitura B, Ogendo S, Lwabi P, Okello E, Damasceno A, Novela C, Mocumbi AO, Madeira G, Musuku J, Mtaja A, ElSayed A, Alhassan HH, Bode-Thomas F, Yilgwan C, Amusa G, Nkereuwem E, Mulder N, Ramesar R, Lesosky M, Cordell HJ, Chong M, Keavney B, Paré G, Engel ME. Rationale, Design, and the Baseline Characteristics of the RHDGen (The Genetics of Rheumatic Heart Disease) Network Study†. Circ Genom Precis Med 2022; 16:e003641. [PMID: 36548480 PMCID: PMC9946164 DOI: 10.1161/circgen.121.003641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The genetics of rheumatic heart disease (RHDGen) Network was developed to assist the discovery and validation of genetic variations and biomarkers of risk for rheumatic heart disease (RHD) in continental Africans, as a part of the global fight to control and eradicate rheumatic fever/RHD. Thus, we describe the rationale and design of the RHDGen study, comprising participants from 8 African countries. METHODS RHDGen screened potential participants using echocardiography, thereafter enrolling RHD cases and ethnically-matched controls for whom case characteristics were documented. Biological samples were collected for conducting genetic analyses, including a discovery case-control genome-wide association study (GWAS) and a replication trio family study. Additional biological samples were also collected, and processed, for the measurement of biomarker analytes and the biomarker analyses are underway. RESULTS Participants were enrolled into RHDGen between December 2012 and March 2018. For GWAS, 2548 RHD cases and 2261 controls (3301 women [69%]; mean age [SD], 37 [16.3] years) were available. RHD cases were predominantly Black (66%), Admixed (24%), and other ethnicities (10%). Among RHD cases, 34% were asymptomatic, 26% had prior valve surgery, and 23% had atrial fibrillation. The trio family replication arm included 116 RHD trio probands and 232 parents. CONCLUSIONS RHDGen presents a rare opportunity to identify relevant patterns of genetic factors and biomarkers in Africans that may be associated with differential RHD risk. Furthermore, the RHDGen Network provides a platform for further work on fully elucidating the causes and mechanisms associated with RHD susceptibility and development.
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Affiliation(s)
- Tafadzwa Machipisa
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (T.M., C.C., G.S., L.J.Z., B.M., S.P.; J.d.V., N.L., A.J., R.D., M.N., M.E.E.).,Department of Medicine, Cape Heart Institute, University of Cape Town, Cape Town, South Africa (T.M., G.S., L.J.Z., B.M., M.E.E.).,Population Health Research Institute, Hamilton, ON, Canada (T.M., B.M., M.C., G.P.).,Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, ON, Canada (T.M., B.M., M.C., G.P.).,Department of Pathology and Molecular Medicine, Michael G. DeGroote School of Medicine, Hamilton, ON, Canada (T.M., B.M., M.C., G.P.)
| | - Chishala Chishala
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (T.M., C.C., G.S., L.J.Z., B.M., S.P.; J.d.V., N.L., A.J., R.D., M.N., M.E.E.).,Division of Cardiology, University of KwaZulu-Natal, Msunduzi, KwaZulu-Natal (C.C.)
| | - Gasnat Shaboodien
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (T.M., C.C., G.S., L.J.Z., B.M., S.P.; J.d.V., N.L., A.J., R.D., M.N., M.E.E.).,Department of Medicine, Cape Heart Institute, University of Cape Town, Cape Town, South Africa (T.M., G.S., L.J.Z., B.M., M.E.E.)
| | - Liesl J. Zühlke
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (T.M., C.C., G.S., L.J.Z., B.M., S.P.; J.d.V., N.L., A.J., R.D., M.N., M.E.E.).,Department of Medicine, Cape Heart Institute, University of Cape Town, Cape Town, South Africa (T.M., G.S., L.J.Z., B.M., M.E.E.).,Division of Pediatric Cardiology, Department of Pediatrics and Child Health, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa (L.J.Z.).,South African Medical Research Council, Extramural Research and Internal Portfolio, Cape Town, South Africa (L.J.Z.)
| | - Babu Muhamed
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (T.M., C.C., G.S., L.J.Z., B.M., S.P.; J.d.V., N.L., A.J., R.D., M.N., M.E.E.).,Department of Medicine, Cape Heart Institute, University of Cape Town, Cape Town, South Africa (T.M., G.S., L.J.Z., B.M., M.E.E.).,Population Health Research Institute, Hamilton, ON, Canada (T.M., B.M., M.C., G.P.).,Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, ON, Canada (T.M., B.M., M.C., G.P.).,Department of Pathology and Molecular Medicine, Michael G. DeGroote School of Medicine, Hamilton, ON, Canada (T.M., B.M., M.C., G.P.)
| | - Shahiemah Pandie
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (T.M., C.C., G.S., L.J.Z., B.M., S.P.; J.d.V., N.L., A.J., R.D., M.N., M.E.E.)
| | - Jantina de Vries
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (T.M., C.C., G.S., L.J.Z., B.M., S.P.; J.d.V., N.L., A.J., R.D., M.N., M.E.E.)
| | - Nakita Laing
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (T.M., C.C., G.S., L.J.Z., B.M., S.P.; J.d.V., N.L., A.J., R.D., M.N., M.E.E.)
| | - Alexia Joachim
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (T.M., C.C., G.S., L.J.Z., B.M., S.P.; J.d.V., N.L., A.J., R.D., M.N., M.E.E.)
| | - Rezeen Daniels
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (T.M., C.C., G.S., L.J.Z., B.M., S.P.; J.d.V., N.L., A.J., R.D., M.N., M.E.E.)
| | - Mpiko Ntsekhe
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (T.M., C.C., G.S., L.J.Z., B.M., S.P.; J.d.V., N.L., A.J., R.D., M.N., M.E.E.)
| | - Christopher T. Hugo-Hamman
- Rheumatic Heart Disease Clinic, Windhoek Central Hospital, Ministry of Health and Social Services, Windhoek, Republic of Namibia (C.T.H.-H.)
| | - Bernard Gitura
- Cardiology Department of Medicine, Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya (B.G.)
| | - Stephen Ogendo
- Uganda Heart Inst, Departments of Adult and Pediatric Cardiology, Kampala, Uganda (S.O.)
| | - Peter Lwabi
- School of Medicine, Maseno Univ, Kenya (P.L., E.O.)
| | - Emmy Okello
- School of Medicine, Maseno Univ, Kenya (P.L., E.O.)
| | - Albertino Damasceno
- Faculty of Medicine, Eduardo Mondlane Univ/Nucleo de Investigaçao, Departamento de Medicina, Hospital Central de Maputo, Maputo, Mozambique (A.D., C.N.)
| | - Celia Novela
- Faculty of Medicine, Eduardo Mondlane Univ/Nucleo de Investigaçao, Departamento de Medicina, Hospital Central de Maputo, Maputo, Mozambique (A.D., C.N.)
| | - Ana O. Mocumbi
- Instituto Nacional de Saúde Ministério da Saúde, Mozambique (A.O.M.)
| | | | - John Musuku
- University Teaching Hospital, Children’s Hospital, University of Zambia, Lusaka, Zambia (J.M., A.M.)
| | - Agnes Mtaja
- University Teaching Hospital, Children’s Hospital, University of Zambia, Lusaka, Zambia (J.M., A.M.)
| | - Ahmed ElSayed
- Department of Cardiothoracic Surgery, Alshaab Teaching Hospital, Alazhari Health Research Centre, Alzaiem Alazhari University, Khartoum, Sudan (A.E., H.H.M.A.)
| | - Huda H.M. Alhassan
- Department of Cardiothoracic Surgery, Alshaab Teaching Hospital, Alazhari Health Research Centre, Alzaiem Alazhari University, Khartoum, Sudan (A.E., H.H.M.A.)
| | - Fidelia Bode-Thomas
- Deptartments of Pediatrics and Medicine, Jos University Teaching Hospital and University of Jos, Jos, Plateau State, Nigeria (F.B.-T., C.Y., G.A., E.N.)
| | - Christopher Yilgwan
- Deptartments of Pediatrics and Medicine, Jos University Teaching Hospital and University of Jos, Jos, Plateau State, Nigeria (F.B.-T., C.Y., G.A., E.N.)
| | - Ganiyu Amusa
- Deptartments of Pediatrics and Medicine, Jos University Teaching Hospital and University of Jos, Jos, Plateau State, Nigeria (F.B.-T., C.Y., G.A., E.N.)
| | - Esin Nkereuwem
- Deptartments of Pediatrics and Medicine, Jos University Teaching Hospital and University of Jos, Jos, Plateau State, Nigeria (F.B.-T., C.Y., G.A., E.N.)
| | - Nicola Mulder
- Computational Biology Division, Department of Integrative Biomedical Sciences, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences (N.M.), University of Cape Town, Cape Town, South Africa
| | - Raj Ramesar
- Department of Pathology (R.R.), University of Cape Town, Cape Town, South Africa
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine (M.L.), University of Cape Town, Cape Town, South Africa
| | - Heather J. Cordell
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Newcastle upon Tyne, UK (H.J.C.)
| | - Michael Chong
- Population Health Research Institute, Hamilton, ON, Canada (T.M., B.M., M.C., G.P.).,Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, ON, Canada (T.M., B.M., M.C., G.P.).,Department of Pathology and Molecular Medicine, Michael G. DeGroote School of Medicine, Hamilton, ON, Canada (T.M., B.M., M.C., G.P.)
| | - Bernard Keavney
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, UK (B.K.).,Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK (B.K.)
| | - Guillaume Paré
- Population Health Research Institute, Hamilton, ON, Canada (T.M., B.M., M.C., G.P.).,Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, ON, Canada (T.M., B.M., M.C., G.P.).,Department of Pathology and Molecular Medicine, Michael G. DeGroote School of Medicine, Hamilton, ON, Canada (T.M., B.M., M.C., G.P.).,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada (G.P.)
| | - Mark E. Engel
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (T.M., C.C., G.S., L.J.Z., B.M., S.P.; J.d.V., N.L., A.J., R.D., M.N., M.E.E.).,Department of Medicine, Cape Heart Institute, University of Cape Town, Cape Town, South Africa (T.M., G.S., L.J.Z., B.M., M.E.E.)
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Mabhida SE, Sharma JR, Apalata T, Masilela C, Nomatshila S, Mabasa L, Fokkens H, Benjeddou M, Muhamed B, Shabalala S, Johnson R. The association of MTHFR (rs1801133) with hypertension in an indigenous south African population. Front Genet 2022; 13:937639. [PMID: 35938016 PMCID: PMC9353403 DOI: 10.3389/fgene.2022.937639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
Aims: The current study sought to investigate the association between the methylenetetrahydrofolate reductase (MTHFR) variant (rs1801133) and the risk of developing hypertension (HTN) in an indigenous South African population. Methods: A total of 442 participants (hypertensive, n = 279 and non-hypertensive, n = 163) from the indigenous tribe residing in Mthatha, Eastern Cape (South Africa) were recruited. HTN was defined as a systolic (SBP) and diastolic blood pressure (DBP) of ≥130/80 mmHg following American Heart Association guidelines. The genotyping of MTHFR (rs1801133) was assessed using MassARRAY® System. Thereafter, the association between rs1801133 in various genetic models and HTN was determined by logistic regression model analysis. Furthermore, the interaction between rs1801133 and selected risk factors on HTN was performed using the open-source multifactor dimensionality reduction (MDR). Results: The low frequency of the T allele (5%) was also observed when compared with the C allele (95%) in both cases and controls. After adjusting for confounding factors (gender, smoking status, BMI, and blood glucose levels), there were no significant associations were observed between rs1801133 and the risk of HTN in all genetic models: genotypic (OR 0.75, 95% CI 0.29–1.95, p = 0.56), dominant (OR 0.86, 95% CI 0.35–2.16, p = 0.75), co-dominant (OR 1.33, 95% CI 0.51–3.48, p = 0.55) and allelic (OR 0.80, 95% CI 0.49–1.62, p = 0.70) in logistic regression analysis. However, a significant interaction was reported among rs1801133, age, and gender (p < 0.0001) with the risk of HTN. Conclusion: The present study reports on the lack of association between MTHFR (rs1801133) and the risk of HTN in an indigenous South African tribe. However, an interaction between gender, age, and rs1801133 was observed. Thus, future studies with a large sample size are required to further validate these findings.
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Affiliation(s)
- Sihle E. Mabhida
- Biomedical Research and Innovation Platform, SAMRC, Tygerberg, South Africa
- Department of Biotechnology, Faculty of Natural Science, University of the Western Cape, Cape Town, South Africa
| | - Jyoti R. Sharma
- Biomedical Research and Innovation Platform, SAMRC, Tygerberg, South Africa
| | - Teke Apalata
- Division of Medical Microbiology, Department of Laboratory-Medicine and Pathology, Faculty of Health Sciences, Walter Sisulu University and National Health Laboratory Services, Mthatha, South Africa
| | - Charity Masilela
- Department of Biochemistry, North-West University, Mmabatho, South Africa
| | - Sibusiso Nomatshila
- Division of Preventive Medicine and Health Behavior, Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Lawrence Mabasa
- Biomedical Research and Innovation Platform, SAMRC, Tygerberg, South Africa
| | - Hannah Fokkens
- Biomedical Research and Innovation Platform, SAMRC, Tygerberg, South Africa
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Mongi Benjeddou
- Department of Biotechnology, Faculty of Natural Science, University of the Western Cape, Cape Town, South Africa
| | - Babu Muhamed
- Division of Infections Disease - University of Tennessee Health Sciences Center (UTHSC), Memphis, TN, United States
| | | | - Rabia Johnson
- Biomedical Research and Innovation Platform, SAMRC, Tygerberg, South Africa
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- *Correspondence: Rabia Johnson,
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Mabhida SE, Muhamed B, Sharma JR, Apalata T, Nomatshila S, Mabasa L, Benjeddou M, Masilela C, Ziqubu K, Shabalala S, Johnson R. Methylenetetrahydrofolate Reductase Polymorphism (rs1801133) and the Risk of Hypertension among African Populations: A Narrative Synthesis of Literature. Genes (Basel) 2022; 13:genes13040631. [PMID: 35456437 PMCID: PMC9027465 DOI: 10.3390/genes13040631] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 02/07/2023] Open
Abstract
In this review, we have gathered and analyzed the available genetic evidence on the association between the methylenetetrahydrofolate reductase gene (MTHFR), rs1801133 and the risk of Hypertension (HTN) in African populations, which was further compared to the global data evidence. This review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol and Human Genome Epidemiology Network (HuGENet) guidelines. Literature was retrieved through major search databases, including PubMed, Scopus, Web of Science, and African Journal Online. We identified 64 potential studies, of which 4 studies were from the African continent and 60 studies were reported globally. Among the studies conducted in Africa, only two (n = 2) reported a significant association between the MTHFR (rs1801133) and the risk of developing HTN. Only one (n = 1) study population was purely composed of black Africans, while others were of other ethnicities. Among studies conducted in other continents (n = 60), forty-seven (n = 47) studies reported a positive association between MTHFR (rs1801133) and the risk of developing HTN, whereas the remaining studies (n = 14) did not show a significant association. Available literature suggests an apparent association between rs1801133 and HTN in global regions; however, such information is still scarce in Africa, especially in the black African population.
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Affiliation(s)
- Sihle E. Mabhida
- Biomedical Research and Innovation Platform, South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa; (S.E.M.); (J.R.S.); (L.M.); (S.S.)
- Department of Biotechnology, Faculty of Natural Science, University of the Western Cape, Private Bag X17, Bellville, Cape Town 7535, South Africa;
| | - Babu Muhamed
- Division of Infections Disease, University of Tennessee Health Sciences Center (UTHSC), Memphis, TN 38163, USA;
| | - Jyoti R. Sharma
- Biomedical Research and Innovation Platform, South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa; (S.E.M.); (J.R.S.); (L.M.); (S.S.)
| | - Teke Apalata
- Division of Medical Microbiology, Department of Laboratory-Medicine and Pathology, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa;
- National Health Laboratory Services, Mthatha 5100, South Africa
| | - Sibusiso Nomatshila
- Division of Preventive Medicine and Health Behavior, Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa;
| | - Lawrence Mabasa
- Biomedical Research and Innovation Platform, South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa; (S.E.M.); (J.R.S.); (L.M.); (S.S.)
| | - Mongi Benjeddou
- Department of Biotechnology, Faculty of Natural Science, University of the Western Cape, Private Bag X17, Bellville, Cape Town 7535, South Africa;
| | - Charity Masilela
- Department of Biochemistry, North-West University, Mafikeng Campus, Mmabatho 2735, South Africa; (C.M.); (K.Z.)
| | - Khanyisani Ziqubu
- Department of Biochemistry, North-West University, Mafikeng Campus, Mmabatho 2735, South Africa; (C.M.); (K.Z.)
| | - Samukelisiwe Shabalala
- Biomedical Research and Innovation Platform, South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa; (S.E.M.); (J.R.S.); (L.M.); (S.S.)
- Division of Medical Microbiology, Department of Laboratory-Medicine and Pathology, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa;
- National Health Laboratory Services, Mthatha 5100, South Africa
| | - Rabia Johnson
- Biomedical Research and Innovation Platform, South African Medical Research Council (SAMRC), Tygerberg 7505, South Africa; (S.E.M.); (J.R.S.); (L.M.); (S.S.)
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa
- Correspondence: ; Tel.: +27-21-938-0866
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6
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Machipisa T, Chong M, Muhamed B, Chishala C, Shaboodien G, Pandie S, de Vries J, Laing N, Joachim A, Daniels R, Ntsekhe M, Hugo-Hamman CT, Gitura B, Ogendo S, Lwabi P, Okello E, Damasceno A, Novela C, Mocumbi AO, Madeira G, Musuku J, Mtaja A, ElSayed A, Elhassan HHM, Bode-Thomas F, Okeahialam BN, Zühlke LJ, Mulder N, Ramesar R, Lesosky M, Parks T, Cordell HJ, Keavney B, Engel ME, Paré G. Association of Novel Locus With Rheumatic Heart Disease in Black African Individuals: Findings From the RHDGen Study. JAMA Cardiol 2021; 6:1000-1011. [PMID: 34106200 PMCID: PMC8190704 DOI: 10.1001/jamacardio.2021.1627] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/25/2021] [Indexed: 01/02/2023]
Abstract
Importance Rheumatic heart disease (RHD), a sequela of rheumatic fever characterized by permanent heart valve damage, is the leading cause of cardiac surgery in Africa. However, its pathophysiologic characteristics and genetics are poorly understood. Understanding genetic susceptibility may aid in prevention, control, and interventions to eliminate RHD. Objective To identify common genetic loci associated with RHD susceptibility in Black African individuals. Design, Setting, and Participants This multicenter case-control genome-wide association study (GWAS), the Genetics of Rheumatic Heart Disease, examined more than 7 million genotyped and imputed single-nucleotide variations. The 4809 GWAS participants and 116 independent trio families were enrolled from 8 African countries between December 31, 2012, and March 31, 2018. All GWAS participants and trio probands were screened by use of echocardiography. Data analyses took place from May 15, 2017, until March 14, 2021. Main Outcomes and Measures Genetic associations with RHD. Results This study included 4809 African participants (2548 RHD cases and 2261 controls; 3301 women [69%]; mean [SD] age, 36.5 [16.3] years). The GWAS identified a single RHD risk locus, 11q24.1 (rs1219406 [odds ratio, 1.65; 95% CI, 1.48-1.82; P = 4.36 × 10-8]), which reached genome-wide significance in Black African individuals. Our meta-analysis of Black (n = 3179) and admixed (n = 1055) African individuals revealed several suggestive loci. The study also replicated a previously reported association in Pacific Islander individuals (rs11846409) at the immunoglobulin heavy chain locus, in the meta-analysis of Black and admixed African individuals (odds ratio, 1.16; 95% CI, 1.06-1.27; P = 1.19 × 10-3). The HLA (rs9272622) associations reported in Aboriginal Australian individuals could not be replicated. In support of the known polygenic architecture for RHD, overtransmission of a polygenic risk score from unaffected parents to affected probands was observed (polygenic transmission disequilibrium testing mean [SE], 0.27 [0.16] SDs; P = .04996), and the chip-based heritability was estimated to be high at 0.49 (SE = 0.12; P = 3.28 × 10-5) in Black African individuals. Conclusions and Relevance This study revealed a novel candidate susceptibility locus exclusive to Black African individuals and an important heritable component to RHD susceptibility in African individuals.
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Affiliation(s)
- Tafadzwa Machipisa
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Hatter Institute for Cardiovascular Diseases Research in Africa and Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
- Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Michael Chong
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
- Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Babu Muhamed
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Hatter Institute for Cardiovascular Diseases Research in Africa and Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
- Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Chishala Chishala
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Hatter Institute for Cardiovascular Diseases Research in Africa and Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Gasnat Shaboodien
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Hatter Institute for Cardiovascular Diseases Research in Africa and Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Shahiemah Pandie
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Jantina de Vries
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Nakita Laing
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Alexia Joachim
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Rezeen Daniels
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Mpiko Ntsekhe
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Christopher T. Hugo-Hamman
- Rheumatic Heart Disease Clinic, Windhoek Central Hospital, Ministry of Health and Social Services, Windhoek, Republic of Namibia
| | - Bernard Gitura
- Cardiology Department of Medicine, Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Stephen Ogendo
- Cardiology Department of Medicine, Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | | | | | - Albertino Damasceno
- Faculty of Medicine, Eduardo Mondlane University/Nucleo de Investigaçao, Departamento de Medicina, Hospital Central de Maputo, Maputo, Mozambique
| | - Celia Novela
- Faculty of Medicine, Eduardo Mondlane University/Nucleo de Investigaçao, Departamento de Medicina, Hospital Central de Maputo, Maputo, Mozambique
| | - Ana O. Mocumbi
- Instituto Nacional de Saúde Ministério da Saúde, Maputo, Moçambique
| | - Goeffrey Madeira
- Emergency Department, World Health Organization Mozambique, Maputo, Mozambique
| | - John Musuku
- Department of Paediatrics and Child Health, University Teaching Hospital–Children’s Hospital, University of Zambia, Lusaka, Zambia
| | - Agnes Mtaja
- Department of Paediatrics and Child Health, University Teaching Hospital–Children’s Hospital, University of Zambia, Lusaka, Zambia
| | - Ahmed ElSayed
- Department of Cardiothoracic Surgery, Alshaab Teaching Hospital, Alazhari Health Research Center, Alzaiem Alazhari University, Khartoum, Sudan
| | - Huda H. M. Elhassan
- Department of Cardiothoracic Surgery, Alshaab Teaching Hospital, Alazhari Health Research Center, Alzaiem Alazhari University, Khartoum, Sudan
| | - Fidelia Bode-Thomas
- Department of Paediatrics, Jos University Teaching Hospital and University of Jos, Jos, Plateau State Nigeria
| | - Basil N. Okeahialam
- Department of Paediatrics, Jos University Teaching Hospital and University of Jos, Jos, Plateau State Nigeria
| | - Liesl J. Zühlke
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa
| | - Nicola Mulder
- Computational Biology Division, Department of Integrative Biomedical Sciences, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Raj Ramesar
- Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Maia Lesosky
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Tom Parks
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Heather J. Cordell
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Newcastle upon Tyne, United Kingdom
| | - Bernard Keavney
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, United Kingdom
- Manchester University National Health Service Foundation Trust, Manchester Academic Health Science CentreManchester, United Kingdom
| | - Mark E. Engel
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Guillaume Paré
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
- Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton Ontario, Canada
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7
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Okello E, Ndagire E, Muhamed B, Sarnacki R, Murali M, Pulle J, Atala J, Bowen AC, DiFazio MP, Nakitto MG, Harik NS, Kansiime R, Longenecker CT, Lwabi P, Agaba C, Norton SA, Omara IO, Oyella LM, Parks T, Rwebembera J, Spurney CF, Stein E, Tochen L, Watkins D, Zimmerman M, Carapetis JR, Sable CA, Beaton A. Incidence of acute rheumatic fever in northern and western Uganda: a prospective, population-based study. Lancet Glob Health 2021; 9:e1423-e1430. [PMID: 34419237 DOI: 10.1016/s2214-109x(21)00288-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/24/2021] [Accepted: 06/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Acute rheumatic fever is infrequently diagnosed in sub-Saharan African countries despite the high prevalence of rheumatic heart disease. We aimed to determine the incidence of acute rheumatic fever in northern and western Uganda. METHODS For our prospective epidemiological study, we established acute rheumatic fever clinics at two regional hospitals in the north (Lira district) and west (Mbarara district) of Uganda and instituted a comprehensive acute rheumatic fever health messaging campaign. Communities and health-care workers were encouraged to refer children aged 3-17 years, with suspected acute rheumatic fever, for a definitive diagnosis using the Jones Criteria. Children were referred if they presented with any of the following: (1) history of fever within the past 48 h in combination with any joint complaint, (2) suspicion of acute rheumatic carditis, or (3) suspicion of chorea. We excluded children with a confirmed alternative diagnosis. We estimated incidence rates among children aged 5-14 years and characterised clinical features of definite and possible acute rheumatic fever cases. FINDINGS Data were collected between Jan 17, 2018, and Dec 30, 2018, in Lira district and between June 5, 2019, and Feb 28, 2020, in Mbarara district. Of 1075 children referred for evaluation, 410 (38%) met the inclusion criteria; of these, 90 (22%) had definite acute rheumatic fever, 82 (20·0%) had possible acute rheumatic fever, and 24 (6%) had rheumatic heart disease without evidence of acute rheumatic fever. Additionally, 108 (26%) children had confirmed alternative diagnoses and 106 (26%) had an unknown alternative diagnosis. We estimated the incidence of definite acute rheumatic fever among children aged 5-14 years as 25 cases (95% CI 13·7-30·3) per 100 000 person-years in Lira district (north) and 13 cases (7·1-21·0) per 100 000 person-years in Mbarara district (west). INTERPRETATION To the best of our knowledge, this is the first population-based study to estimate the incidence of acute rheumatic fever in sub-Saharan Africa. Given the known rheumatic heart disease burden, it is likely that only a proportion of children with acute rheumatic fever were diagnosed. These data dispel the long-held hypothesis that the condition does not exist in sub-Saharan Africa and compel investment in improving prevention, recognition, and diagnosis of acute rheumatic fever. FUNDING American Heart Association Children's Strategically Focused Research Network Grant, THRiVE-2, General Electric, and Cincinnati Children's Heart Institute Research Core.
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Affiliation(s)
- Emmy Okello
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda; Department of Medicine, Makerere University, Kampala, Uganda
| | - Emma Ndagire
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Babu Muhamed
- Makerere School of Health Sciences, Children's National Hospital, Washington DC, USA
| | - Rachel Sarnacki
- Makerere School of Health Sciences, Children's National Hospital, Washington DC, USA
| | - Meghna Murali
- Makerere School of Health Sciences, Children's National Hospital, Washington DC, USA
| | - Jafesi Pulle
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Jenifer Atala
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Asha C Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, and Department of Infectious Diseases, Perth Children's Hospital, Nedlands, WA, Australia
| | - Marc P DiFazio
- Makerere School of Health Sciences, Children's National Hospital, Washington DC, USA
| | - M G Nakitto
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Nada S Harik
- Makerere School of Health Sciences, Children's National Hospital, Washington DC, USA
| | - Rosemary Kansiime
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Chris T Longenecker
- Case Western Reserve University, Health Education Campus, Cleveland, OH, USA
| | - Peter Lwabi
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Collins Agaba
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Scott A Norton
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Isaac Otim Omara
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Linda Mary Oyella
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Tom Parks
- Wellcome Center for Human Genetics, The London School of Tropical Medicine and Hygiene, London, UK
| | | | - Christopher F Spurney
- Makerere School of Health Sciences, Children's National Hospital, Washington DC, USA
| | - Elizabeth Stein
- University of Washington School of Medicine, Seattle, WA, USA
| | - Laura Tochen
- Makerere School of Health Sciences, Children's National Hospital, Washington DC, USA
| | - David Watkins
- Department of Medicine and Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Jonathan R Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, and Department of Infectious Diseases, Perth Children's Hospital, Nedlands, WA, Australia
| | - Craig A Sable
- Makerere School of Health Sciences, Children's National Hospital, Washington DC, USA
| | - Andrea Beaton
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; The University of Cincinnati School of Medicine, Cincinnati, OH, USA.
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8
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de Loizaga SR, Arthur L, Arya B, Beckman B, Belay W, Brokamp C, Hyun Choi N, Connolly S, Dasgupta S, Dibert T, Dryer MM, Gokanapudy Hahn LR, Greene EA, Kernizan D, Khalid O, Klein J, Kobayashi R, Lahiri S, Lorenzoni RP, Otero Luna A, Marshall J, Millette T, Moore L, Muhamed B, Murali M, Parikh K, Sanyahumbi A, Shakti D, Stein E, Shah S, Wilkins H, Windom M, Wirth S, Zimmerman M, Beck AF, Ollberding N, Sable C, Beaton A. Rheumatic Heart Disease in the United States: Forgotten But Not Gone: Results of a 10 Year Multicenter Review. J Am Heart Assoc 2021; 10:e020992. [PMID: 34348475 PMCID: PMC8475057 DOI: 10.1161/jaha.120.020992] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Recent evaluation of rheumatic heart disease (RHD) mortality demonstrates disproportionate disease burden within the United States. However, there are few contemporary data on US children living with acute rheumatic fever (ARF) and RHD. Methods and Results Twenty‐two US pediatric institutions participated in a 10‐year review (2008–2018) of electronic medical records and echocardiographic databases of children 4 to 17 years diagnosed with ARF/RHD to determine demographics, diagnosis, and management. Geocoding was used to determine a census tract‐based socioeconomic deprivation index. Descriptive statistics of patient characteristics and regression analysis of RHD classification, disease severity, and initial antibiotic prescription according to community deprivation were obtained. Data for 947 cases showed median age at diagnosis of 9 years; 51% and 56% identified as male and non‐White, respectively. Most (89%) had health insurance and were first diagnosed in the United States (82%). Only 13% reported travel to an endemic region before diagnosis. Although 96% of patients were prescribed secondary prophylaxis, only 58% were prescribed intramuscular benzathine penicillin G. Higher deprivation was associated with increasing disease severity (odds ratio, 1.25; 95% CI, 1.08–1.46). Conclusions The majority of recent US cases of ARF and RHD are endemic rather than the result of foreign exposure. Children who live in more deprived communities are at risk for more severe disease. This study demonstrates a need to improve guideline‐based treatment for ARF/RHD with respect to secondary prophylaxis and to increase research efforts to better understand ARF and RHD in the United States.
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Affiliation(s)
| | - Lindsay Arthur
- University of Arkansas for Medical Sciences/Arkansas Children's Hospital Little Rock AR
| | - Bhawna Arya
- Seattle Children's Hospital/University of Washington School of Medicine Seattle WA
| | | | - Wubishet Belay
- Monroe Carell Jr Children's Hospital at Vanderbilt Nashville TN
| | - Cole Brokamp
- Cincinnati Children's Hospital Medical Center Cincinnati OH.,University of Cincinnati Cincinnati OH
| | - Nak Hyun Choi
- Morgan Stanley Children's Hospital of New York PresbyterianColumbia University Medical Center New York NY
| | - Sean Connolly
- Ann & Robert H. Lurie Children's Hospital of Chicago Chicago IL
| | - Soham Dasgupta
- Children's Healthcare of AtlantaEmory University Atlanta GA
| | - Tavenner Dibert
- University of Florida Health, Shands Children's Hospital Gainesville FL
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Elizabeth Stein
- Seattle Children's Hospital/University of Washington School of Medicine Seattle WA
| | | | - Hannah Wilkins
- University of Arkansas for Medical Sciences/Arkansas Children's Hospital Little Rock AR
| | | | - Scott Wirth
- Cincinnati Children's Hospital Medical Center Cincinnati OH
| | | | - Andrew F Beck
- Cincinnati Children's Hospital Medical Center Cincinnati OH.,University of Cincinnati Cincinnati OH
| | - Nicholas Ollberding
- Cincinnati Children's Hospital Medical Center Cincinnati OH.,University of Cincinnati Cincinnati OH
| | | | - Andrea Beaton
- Cincinnati Children's Hospital Medical Center Cincinnati OH.,University of Cincinnati Cincinnati OH
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9
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Mabhida SE, Mashatola L, Kaur M, Sharma JR, Apalata T, Muhamed B, Benjeddou M, Johnson R. Hypertension in African Populations: Review and Computational Insights. Genes (Basel) 2021; 12:genes12040532. [PMID: 33917487 PMCID: PMC8067483 DOI: 10.3390/genes12040532] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 01/11/2023] Open
Abstract
Hypertension (HTN) is a persistent public health problem affecting approximately 1.3 billion individuals globally. Treatment-resistant hypertension (TRH) is defined as high blood pressure (BP) in a hypertensive patient that remains above goal despite use of ≥3 antihypertensive agents of different classes including a diuretic. Despite a plethora of treatment options available, only 31.0% of individuals have their HTN controlled. Interindividual genetic variability to drug response might explain this disappointing outcome because of genetic polymorphisms. Additionally, the poor knowledge of pathophysiological mechanisms underlying hypertensive disease and the long-term interaction of antihypertensive drugs with blood pressure control mechanisms further aggravates the problem. Furthermore, in Africa, there is a paucity of pharmacogenomic data on the treatment of resistant hypertension. Therefore, identification of genetic signals having the potential to predict the response of a drug for a given individual in an African population has been the subject of intensive investigation. In this review, we aim to systematically extract and discuss African evidence on the genetic variation, and pharmacogenomics towards the treatment of HTN. Furthermore, in silico methods are utilized to elucidate biological processes that will aid in identifying novel drug targets for the treatment of resistant hypertension in an African population. To provide an expanded view of genetic variants associated with the development of HTN, this study was performed using publicly available databases such as PubMed, Scopus, Web of Science, African Journal Online, PharmGKB searching for relevant papers between 1984 and 2020. A total of 2784 articles were reviewed, and only 42 studies were included following the inclusion criteria. Twenty studies reported associations with HTN and genes such as AGT (rs699), ACE (rs1799752), NOS3 (rs1799983), MTHFR (rs1801133), AGTR1 (rs5186), while twenty-two studies did not show any association within the African population. Thereafter, an in silico predictive approach was utilized to identify several genes including CLCNKB, CYPB11B2, SH2B2, STK9, and TBX5 which may act as potential drug targets because they are involved in pathways known to influence blood pressure. Next, co-expressed genes were identified as they are controlled by the same transcriptional regulatory program and may potentially be more effective as multiple drug targets in the treatment regimens for HTN. Genes belonging to the co-expressed gene cluster, ACE, AGT, AGTR1, AGTR2, and NOS3 as well as CSK and ADRG1 showed enrichment of G-protein-coupled receptor activity, the classical targets of drug discovery, which mediate cellular signaling processes. The latter is of importance, as the targeting of co-regulatory gene clusters will allow for the development of more effective HTN drug targets that could decrease the prevalence of both controlled and TRH.
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Affiliation(s)
- Sihle E. Mabhida
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg 7505, South Africa; (S.E.M.); (J.R.S.)
- Department of Biotechnology, Faculty of Natural Science, University of the Western Cape, Private Bag X17, Bellville, Cape Town 7535, South Africa;
| | - Lebohang Mashatola
- School of Molecular and Cell Biology, University of the Witwatersrand, Private Bag 3, Johannesburg 2050, South Africa; (L.M.); (M.K.)
| | - Mandeep Kaur
- School of Molecular and Cell Biology, University of the Witwatersrand, Private Bag 3, Johannesburg 2050, South Africa; (L.M.); (M.K.)
| | - Jyoti R. Sharma
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg 7505, South Africa; (S.E.M.); (J.R.S.)
| | - Teke Apalata
- Division of Medical Microbiology, Department of Laboratory-Medicine and Pathology, Faculty of Health Sciences, Walter Sisulu University and National Health Laboratory Services, Mthatha 5100, South Africa;
| | - Babu Muhamed
- Hatter Institute for Cardiovascular Diseases Research in Africa, Department of Medicine, University of Cape Town, Cape Town 7535, South Africa;
- Children’s National Health System, Division of Cardiology, Washington, DC 20010, USA
| | - Mongi Benjeddou
- Department of Biotechnology, Faculty of Natural Science, University of the Western Cape, Private Bag X17, Bellville, Cape Town 7535, South Africa;
| | - Rabia Johnson
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg 7505, South Africa; (S.E.M.); (J.R.S.)
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa
- Correspondence: ; Tel.: +27-21-938-0866
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10
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Salie MT, Rampersadh K, Muhamed B, Engel KC, Zühlke LJ, Dale JB, Engel ME. Utility of Human Immune Responses to GAS Antigens as a Diagnostic Indicator for ARF: A Systematic Review. Front Cardiovasc Med 2021; 8:691646. [PMID: 34355030 PMCID: PMC8329041 DOI: 10.3389/fcvm.2021.691646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Previous studies have established that streptococcal antibody titer is correlated with a diagnosis of acute rheumatic fever (ARF). However, results vary in the usefulness of GAS antibodies, particularly anti-streptolysin-O (ASO) and anti-DNase B, in confirming a recent GAS infection. Therefore, we sought to provide, from published studies, an evidence-based synthesis of the correlation of streptococcal serology to establish the usefulness of immunological data in aiding the diagnosis of ARF. These findings are anticipated to have implications where echocardiography is not freely available, especially where ARF is rampant. Methods: We conducted a comprehensive search across a number of databases. Applying a priori criteria, we selected articles reporting on studies, regardless of study design, that evaluate the levels of antibodies against GAS-specific antigens in ARF subjects against control values or a published standard. Data were extracted onto data extraction forms, captured electronically, and analyzed using Stata software. Risk of bias was assessed in included studies using the Newcastle-Ottawa Scale (NOS). Results and Conclusion: The search strategy yielded 534 studies, from which 24 met the inclusion criteria, reporting on evaluation of titers for SLO (n = 10), DNase B (n = 9), anti-streptokinase (ASK) (n = 3) amongst others. Elevation in titers was determined by comparison with controls and upper limit of normal (ULN) antibody values as determined in healthy individuals. Meta-analysis of case-controlled studies revealed moderate odds ratio (OR) correlations between ARF diagnosis and elevated titers for SLO (OR = 10.57; 95% CI, 3.36-33.29; 10 studies) and DNAse B (OR = 6.97; 95% CI, 2.99-16.27; 7 studies). While providing support for incorporating SLO and DNase B in the diagnosis of ARF, we present the following reflections: an elevation in SLO and DNase B levels are not consistently associated with an ARF diagnosis; increasing the number of GAS proteins in the test is warranted to improve sensitivity; paired (acute and convalescent) samples could provide a more accurate indication of a rising titer. Use of community-based controls as a standard is not a reliable marker by which to gauge recent GAS infection.
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Affiliation(s)
- M Taariq Salie
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kimona Rampersadh
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Babu Muhamed
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Division of Cardiology, Children's National Health System, Washington, DC, United States
| | - Kélin C Engel
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Liesl J Zühlke
- Children's Heart Disease Research Unit, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - James B Dale
- Division of Infectious Diseases, University of Tennessee Health Science Center (UTHSC), Memphis, TN, United States
| | - Mark E Engel
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Muhamed B, Shaboodien G, Engel ME. Genetic variants in rheumatic fever and rheumatic heart disease. Am J Med Genet C Semin Med Genet 2020; 184:159-177. [PMID: 32083395 DOI: 10.1002/ajmg.c.31773] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 12/16/2022]
Abstract
Genetic association studies in rheumatic heart disease (RHD) have the potential to contribute toward our understanding of the pathogenetic mechanism, and may shed light on controversies about RHD etiology. Furthermore, genetic association studies may uncover biomarkers that can be used to identify susceptible individuals, and contribute toward developing vaccine and novel therapeutic targets. Genetic predisposition to rheumatic fever and RHD has been hypothesized by findings from familial studies and observed associations between genes located in the human leukocyte antigens on chromosome 6p21.3 and elsewhere in the genome. We sought to summarize, from published Genetic association studies in RHD, evidence on genetic variants implicated in RHD susceptibility. Using HuGENet™ systematic review methods, we evaluated 66 studies reporting on 42 genes. Existing meta-analyses of candidate gene studies suggest that TGF-β1 [rs1800469], and IL-1β [rs2853550] single nucleotide polymorphisms (SNPs) contribute to susceptibility to RHD, whereas the TNF-α [rs1800629 and rs361525], TGF-β1 [rs1800470 and rs4803457], IL-6 [rs1800795], IL-10 [rs1800896] were not associated with RHD. However, candidate gene studies in RF/RHD are relatively small, thus lacking statistical power to identify reliable and reproducible findings, emphasizing the need for large-scale multicenter studies with different populations.
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Affiliation(s)
- Babu Muhamed
- Department of Medicine, University of Cape Town, Cape Town, South Africa.,Hatter Institute for Cardiovascular Diseases Research in Africa, Observatory, South Africa.,Division of Cardiology, Children's National Health System, Washington, District of Columbia
| | - Gasnat Shaboodien
- Department of Medicine, University of Cape Town, Cape Town, South Africa.,Hatter Institute for Cardiovascular Diseases Research in Africa, Observatory, South Africa
| | - Mark E Engel
- Department of Medicine, University of Cape Town, Cape Town, South Africa
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Abstract
Rheumatic heart disease (RHD) is a complication of group A streptococcal infection that results from a complex interaction between the genetic make-up of the host, the infection itself and several other environmental factors, largely reflecting poverty. RHD is estimated to affect 33.4 million people and results in 10.5 million disability-adjusted life-years lost globally. The disease has long been considered heritable but still little is known about the host genetic factors that increase or reduce the risk of developing RHD. In the 1980s and 1990s, several reports linked the disease to the human leukocyte antigen (HLA) locus on chromosome 6, followed in the 2000s by reports implicating additional candidate regions elsewhere in the genome. Subsequently, the search for susceptibility loci has been reinvigorated by the use of genome-wide association studies (GWAS) through which millions of variants can be tested for association in thousands of individuals. Early findings implicate not only HLA, particularly the HLA-DQA1 to HLA-DQB1 region, but also the immunoglobulin heavy chain locus, including the IGHV4-61 gene segment, on chromosome 14. In this Review, we assess the emerging role of GWAS in assessing RHD, outlining both the advantages and disadvantages of this approach. We also highlight the potential use of large-scale, publicly available data and the value of international collaboration to facilitate comprehensive studies that produce findings that have implications for clinical practice.
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Affiliation(s)
- Babu Muhamed
- Hatter Institute for Cardiovascular Diseases Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Tom Parks
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Diseases Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa.
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Adebamowo SN, Francis V, Tambo E, Diallo SH, Landouré G, Nembaware V, Dareng E, Muhamed B, Odutola M, Akeredolu T, Nerima B, Ozumba PJ, Mbhele S, Ghanash A, Wachinou AP, Ngomi N. Implementation of genomics research in Africa: challenges and recommendations. Glob Health Action 2018; 11:1419033. [PMID: 29336236 PMCID: PMC5769805 DOI: 10.1080/16549716.2017.1419033] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 12/08/2017] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND There is exponential growth in the interest and implementation of genomics research in Africa. This growth has been facilitated by the Human Hereditary and Health in Africa (H3Africa) initiative, which aims to promote a contemporary research approach to the study of genomics and environmental determinants of common diseases in African populations. OBJECTIVE The purpose of this article is to describe important challenges affecting genomics research implementation in Africa. METHODS The observations, challenges and recommendations presented in this article were obtained through discussions by African scientists at teleconferences and face-to-face meetings, seminars at consortium conferences and in-depth individual discussions. RESULTS Challenges affecting genomics research implementation in Africa, which are related to limited resources include ill-equipped facilities, poor accessibility to research centers, lack of expertise and an enabling environment for research activities in local hospitals. Challenges related to the research study include delayed funding, extensive procedures and interventions requiring multiple visits, delays setting up research teams and insufficient staff training, language barriers and an underappreciation of cultural norms. While many African countries are struggling to initiate genomics projects, others have set up genomics research facilities that meet international standards. CONCLUSIONS The lessons learned in implementing successful genomics projects in Africa are recommended as strategies to overcome these challenges. These recommendations may guide the development and application of new research programs in low-resource settings.
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Affiliation(s)
- Sally N. Adebamowo
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Center for Bioethics and Research, Ibadan, Nigeria
| | - Veronica Francis
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Ernest Tambo
- Sydney Brenner Institute of Molecular Bioscience, University of Witwatersrand, Johannesburg, South Africa
| | - Seybou H. Diallo
- Faculté de Médecine et d’Odonstomatologie, Université des Sciences, des Techniques, et des Technologies de Bamako, Bamako, Mali
| | - Guida Landouré
- Faculté de Médecine et d’Odonstomatologie, Université des Sciences, des Techniques, et des Technologies de Bamako, Bamako, Mali
| | - Victoria Nembaware
- Department of Integrative Biomedical Sciences, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Eileen Dareng
- Office of Strategic Information and Research, Institute of Human Virology Nigeria, Abuja, Nigeria
- Department of Primary Care and Public Health, University of Cambridge, Cambridge, UK
| | - Babu Muhamed
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Cardiovascular Genetics, Hatter Institute for Cardiovascular Diseases Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Michael Odutola
- Office of Strategic Information and Research, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Teniola Akeredolu
- Office of Strategic Information and Research, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Barbara Nerima
- National Livestock Resources Research Institute, Tororo, Uganda
| | - Petronilla J. Ozumba
- Clinical Lab Molecular Virology Unit, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Slee Mbhele
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Anita Ghanash
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Ablo P. Wachinou
- National Hospital for Tuberculosis and Pulmonary Diseases, Cotonou, Benin Republic
| | - Nicholas Ngomi
- Health Challenges and Systems program, African Population and Health Research Center, Nairobi, Kenya
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