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Gallego-Fabrega C, Temprano-Sagrera G, Cárcel-Márquez J, Muiño E, Cullell N, Lledós M, Llucià-Carol L, Martin-Campos JM, Sobrino T, Castillo J, Millán M, Muñoz-Narbona L, López-Cancio E, Ribó M, Alvarez-Sabin J, Jiménez-Conde J, Roquer J, Tur S, Obach V, Arenillas JF, Segura T, Serrano-Heras G, Marti-Fabregas J, Freijo-Guerrero M, Moniche F, Castellanos MDM, Morrison AC, Smith NL, de Vries PS, Fernández-Cadenas I, Sabater-Lleal M. A multitrait genetic study of hemostatic factors and hemorrhagic transformation after stroke treatment. J Thromb Haemost 2024; 22:936-950. [PMID: 38103737 DOI: 10.1016/j.jtha.2023.11.027] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/08/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Thrombolytic recombinant tissue plasminogen activator (r-tPA) treatment is the only pharmacologic intervention available in the ischemic stroke acute phase. This treatment is associated with an increased risk of intracerebral hemorrhages, known as hemorrhagic transformations (HTs), which worsen the patient's prognosis. OBJECTIVES To investigate the association between genetically determined natural hemostatic factors' levels and increased risk of HT after r-tPA treatment. METHODS Using data from genome-wide association studies on the risk of HT after r-tPA treatment and data on 7 hemostatic factors (factor [F]VII, FVIII, von Willebrand factor [VWF], FXI, fibrinogen, plasminogen activator inhibitor-1, and tissue plasminogen activator), we performed local and global genetic correlation estimation multitrait analyses and colocalization and 2-sample Mendelian randomization analyses between hemostatic factors and HT. RESULTS Local correlations identified a genomic region on chromosome 16 with shared covariance: fibrinogen-HT, P = 2.45 × 10-11. Multitrait analysis between fibrinogen-HT revealed 3 loci that simultaneously regulate circulating levels of fibrinogen and risk of HT: rs56026866 (PLXND1), P = 8.80 × 10-10; rs1421067 (CHD9), P = 1.81 × 10-14; and rs34780449, near ROBO1 gene, P = 1.64 × 10-8. Multitrait analysis between VWF-HT showed a novel common association regulating VWF and risk of HT after r-tPA at rs10942300 (ZNF366), P = 1.81 × 10-14. Mendelian randomization analysis did not find significant causal associations, although a nominal association was observed for FXI-HT (inverse-variance weighted estimate [SE], 0.07 [-0.29 to 0.00]; odds ratio, 0.87; 95% CI, 0.75-1.00; raw P = .05). CONCLUSION We identified 4 shared loci between hemostatic factors and HT after r-tPA treatment, suggesting common regulatory mechanisms between fibrinogen and VWF levels and HT. Further research to determine a possible mediating effect of fibrinogen on HT risk is needed.
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Affiliation(s)
- Cristina Gallego-Fabrega
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain. https://twitter.com/FabregaGallego
| | - Gerard Temprano-Sagrera
- Genomics of Complex Disease Group, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | - Jara Cárcel-Márquez
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | - Elena Muiño
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | - Natalia Cullell
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain; Neurology Unit, Hospital Universitari MútuaTerrassa, Terrassa, Spain
| | - Miquel Lledós
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | - Laia Llucià-Carol
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | - Jesús M Martin-Campos
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratories, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - José Castillo
- Department of Neurology, Hospital Clínico Universitario de Santiago (CHUS), Santiago de Compostela, Spain
| | - Mònica Millán
- Department of Neuroscience, Hospital Universitario Hermanos Trias y Pujol (HUGTP), Badalona, Spain
| | - Lucía Muñoz-Narbona
- Department of Neuroscience, Hospital Universitario Hermanos Trias y Pujol (HUGTP), Badalona, Spain
| | - Elena López-Cancio
- Stroke Unit, Neurology Department, Hospital Universitario Central de Asturias (HUCA), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Marc Ribó
- Stroke Unit, Hospital Universitario Valle de Hebrón (HUVH), Barcelona, Spain
| | - Jose Alvarez-Sabin
- Department of Neurology, Hospital Universitario Valle de Hebrón (HUVH), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Jordi Jiménez-Conde
- Department of Neurology, Neurovascular Research Group, Instituto de investigaciones médicas Hospital del Mar (IMIM) Hospital del Mar, Barcelona, Spain
| | - Jaume Roquer
- Department of Neurology, Neurovascular Research Group, Instituto de investigaciones médicas Hospital del Mar (IMIM) Hospital del Mar, Barcelona, Spain
| | - Silvia Tur
- Department of Neurology, Hospital Universitario Son Espases (HUSE), Mallorca, Spain
| | - Victor Obach
- Department of Neurology, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | - Juan F Arenillas
- Department of Neurology, Hospital Clínico Universitario, University of Valladolid, Valladolid, Spain
| | - Tomas Segura
- Department of Neurology, Complejo Hospitalario Universitario de Albacete (CHUA), Universidad de Castilla-La Mancha (UCLM), Albacete, Spain
| | - Gemma Serrano-Heras
- Research Unit, Complejo Hospital Universitario de Albacete (CHUA), Albacete, Spain
| | - Joan Marti-Fabregas
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | | | - Francisco Moniche
- Department of Neurology, Hospital Universitario Virgen del Rocio, Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - Maria Del Mar Castellanos
- Department of Neurology, Hospital Universitario de A Coruña (CHUAC), Biomedical Research Institute, A Coruña, Spain
| | - Alanna C Morrison
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Nicholas L Smith
- Department of Epidemiology, University of Washington, Seattle, Washington, USA; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA; Department of Veterans Affairs Office of Research and Development, Seattle Epidemiologic Research and Information Center, Seattle, Washington, USA
| | - Paul S de Vries
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Israel Fernández-Cadenas
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain.
| | - Maria Sabater-Lleal
- Genomics of Complex Disease Group, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain; Cardiovascular Medicine Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
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Medina-Dols A, Cañellas G, Capó T, Solé M, Mola-Caminal M, Cullell N, Jaume M, Nadal-Salas L, Llinàs J, Gómez L, Tur S, Jiménez C, Díaz RM, Carrera C, Muiño E, Gallego-Fabrega C, Soriano-Tárraga C, Ruiz-Guerra L, Pol-Fuster J, Asensio V, Muncunill J, Fleischer A, Iglesias A, Giralt-Steinhauer E, Lazcano U, Fernández-Pérez I, Jiménez-Balado J, Gabriel-Salazar M, Garcia-Gabilondo M, Lei T, Torres-Aguila NP, Cárcel-Márquez J, Lladó J, Olmos G, Rosell A, Montaner J, Planas AM, Rabionet R, Hernández-Guillamon M, Jiménez-Conde J, Fernández-Cadenas I, Vives-Bauzá C. Role of PATJ in stroke prognosis by modulating endothelial to mesenchymal transition through the Hippo/Notch/PI3K axis. Cell Death Discov 2024; 10:85. [PMID: 38368420 PMCID: PMC10874379 DOI: 10.1038/s41420-024-01857-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 02/19/2024] Open
Abstract
Through GWAS studies we identified PATJ associated with functional outcome after ischemic stroke (IS). The aim of this study was to determine PATJ role in brain endothelial cells (ECs) in the context of stroke outcome. PATJ expression analyses in patient's blood revealed that: (i) the risk allele of rs76221407 induces higher expression of PATJ, (ii) PATJ is downregulated 24 h after IS, and (iii) its expression is significantly lower in those patients with functional independence, measured at 3 months with the modified Rankin scale ((mRS) ≤2), compared to those patients with marked disability (mRS = 4-5). In mice brains, PATJ was also downregulated in the injured hemisphere at 48 h after ischemia. Oxygen-glucose deprivation and hypoxia-dependent of Hypoxia Inducible Factor-1α also caused PATJ depletion in ECs. To study the effects of PATJ downregulation, we generated PATJ-knockdown human microvascular ECs. Their transcriptomic profile evidenced a complex cell reprogramming involving Notch, TGF-ß, PI3K/Akt, and Hippo signaling that translates in morphological and functional changes compatible with endothelial to mesenchymal transition (EndMT). PATJ depletion caused loss of cell-cell adhesion, upregulation of metalloproteases, actin cytoskeleton remodeling, cytoplasmic accumulation of the signal transducer C-terminal transmembrane Mucin 1 (MUC1-C) and downregulation of Notch and Hippo signaling. The EndMT phenotype of PATJ-depleted cells was associated with the nuclear recruitment of MUC1-C, YAP/TAZ, β-catenin, and ZEB1. Our results suggest that PATJ downregulation 24 h after IS promotes EndMT, an initial step prior to secondary activation of a pro-angiogenic program. This effect is associated with functional independence suggesting that activation of EndMT shortly after stroke onset is beneficial for stroke recovery.
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Affiliation(s)
- Aina Medina-Dols
- Neurobiology Laboratory, Research Unit, Hospital Universitari Son Espases, Health Research Institute of Balearic Islands (IdISBa), Palma, Spain
| | - Guillem Cañellas
- Neurobiology Laboratory, Research Unit, Hospital Universitari Son Espases, Health Research Institute of Balearic Islands (IdISBa), Palma, Spain
- Department of Biology, University of Balearic Islands (UIB), Institut Universitari d'Investigacions en Ciències de la Salut (IUNICS), Palma, Spain
| | - Toni Capó
- Neurobiology Laboratory, Research Unit, Hospital Universitari Son Espases, Health Research Institute of Balearic Islands (IdISBa), Palma, Spain
- Department of Biology, University of Balearic Islands (UIB), Institut Universitari d'Investigacions en Ciències de la Salut (IUNICS), Palma, Spain
| | - Montse Solé
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marina Mola-Caminal
- Neurology, Hospital del Mar Medical Research Institute, Barcelona, Spain
- Unit of Medical Epidemiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Natalia Cullell
- Neurology, Hospital Universitari Mútua de Terrassa/Fundacio Docència i Recerca Mútua Terrassa, Terrassa, Spain
- Stroke Pharmacogenomics and Genetics, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | - Marina Jaume
- Neurobiology Laboratory, Research Unit, Hospital Universitari Son Espases, Health Research Institute of Balearic Islands (IdISBa), Palma, Spain
- Department of Biology, University of Balearic Islands (UIB), Institut Universitari d'Investigacions en Ciències de la Salut (IUNICS), Palma, Spain
| | - Laura Nadal-Salas
- Neurobiology Laboratory, Research Unit, Hospital Universitari Son Espases, Health Research Institute of Balearic Islands (IdISBa), Palma, Spain
- Department of Biology, University of Balearic Islands (UIB), Institut Universitari d'Investigacions en Ciències de la Salut (IUNICS), Palma, Spain
| | - Jaume Llinàs
- Neurobiology Laboratory, Research Unit, Hospital Universitari Son Espases, Health Research Institute of Balearic Islands (IdISBa), Palma, Spain
- Department of Biology, University of Balearic Islands (UIB), Institut Universitari d'Investigacions en Ciències de la Salut (IUNICS), Palma, Spain
| | - Lluis Gómez
- Neurobiology Laboratory, Research Unit, Hospital Universitari Son Espases, Health Research Institute of Balearic Islands (IdISBa), Palma, Spain
- Department of Biology, University of Balearic Islands (UIB), Institut Universitari d'Investigacions en Ciències de la Salut (IUNICS), Palma, Spain
| | - Silvia Tur
- Neurobiology Laboratory, Research Unit, Hospital Universitari Son Espases, Health Research Institute of Balearic Islands (IdISBa), Palma, Spain
- Department of Neurology, Hospital Universitari Son Espases (HUSE), Palma, Spain
| | - Carmen Jiménez
- Neurobiology Laboratory, Research Unit, Hospital Universitari Son Espases, Health Research Institute of Balearic Islands (IdISBa), Palma, Spain
- Department of Neurology, Hospital Universitari Son Espases (HUSE), Palma, Spain
| | - Rosa M Díaz
- Neurobiology Laboratory, Research Unit, Hospital Universitari Son Espases, Health Research Institute of Balearic Islands (IdISBa), Palma, Spain
- Department of Neurology, Hospital Universitari Son Espases (HUSE), Palma, Spain
| | - Caty Carrera
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Stroke Pharmacogenomics and Genetics, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | - Elena Muiño
- Stroke Pharmacogenomics and Genetics, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | - Cristina Gallego-Fabrega
- Stroke Pharmacogenomics and Genetics, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | | | - Laura Ruiz-Guerra
- Neurobiology Laboratory, Research Unit, Hospital Universitari Son Espases, Health Research Institute of Balearic Islands (IdISBa), Palma, Spain
| | - Josep Pol-Fuster
- Neurobiology Laboratory, Research Unit, Hospital Universitari Son Espases, Health Research Institute of Balearic Islands (IdISBa), Palma, Spain
- Department of Biology, University of Balearic Islands (UIB), Institut Universitari d'Investigacions en Ciències de la Salut (IUNICS), Palma, Spain
| | - Víctor Asensio
- Department of Genetics (GEN-IB), HUSE, IdISBa, Palma, Spain
| | | | | | - Amanda Iglesias
- Department of Respiratory Medicine,, Hospital Universitari Son Espases-IdISBa Palma, Spain; CIBERES, Instituto de Salud Carlos III, Madrid, Spain
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
| | | | - Uxue Lazcano
- Neurology, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | | | | | - Marina Gabriel-Salazar
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miguel Garcia-Gabilondo
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ting Lei
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuria-Paz Torres-Aguila
- Stroke Pharmacogenomics and Genetics, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | - Jara Cárcel-Márquez
- Stroke Pharmacogenomics and Genetics, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | - Jerònia Lladó
- Neurobiology Laboratory, Research Unit, Hospital Universitari Son Espases, Health Research Institute of Balearic Islands (IdISBa), Palma, Spain
- Department of Biology, University of Balearic Islands (UIB), Institut Universitari d'Investigacions en Ciències de la Salut (IUNICS), Palma, Spain
| | - Gabriel Olmos
- Neurobiology Laboratory, Research Unit, Hospital Universitari Son Espases, Health Research Institute of Balearic Islands (IdISBa), Palma, Spain
- Department of Biology, University of Balearic Islands (UIB), Institut Universitari d'Investigacions en Ciències de la Salut (IUNICS), Palma, Spain
| | - Anna Rosell
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Institute of Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville & Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Anna M Planas
- Department of Neuroscience and Experimental Therapeutics, Institut d'Investigacions Biomèdiques de Barcelona (IIBB)-Consejo Superior de Investigaciones Científicas (CSIC), Barcelona, Spain
- Area of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Raquel Rabionet
- Department of Genetics, Microbiology & Statistics, IBUB, University of Barcelona (UB), Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Mar Hernández-Guillamon
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Israel Fernández-Cadenas
- Stroke Pharmacogenomics and Genetics, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | - Cristòfol Vives-Bauzá
- Neurobiology Laboratory, Research Unit, Hospital Universitari Son Espases, Health Research Institute of Balearic Islands (IdISBa), Palma, Spain.
- Department of Biology, University of Balearic Islands (UIB), Institut Universitari d'Investigacions en Ciències de la Salut (IUNICS), Palma, Spain.
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Martín-Campos JM, Cárcel-Márquez J, Llucià-Carol L, Lledós M, Cullell N, Muiño E, Gallego-Fabrega C, Fernández-Cadenas I. Causal role of lipid metabolome on the risk of ischemic stroke, its etiological subtypes, and long-term outcome: A Mendelian randomization study. Atherosclerosis 2023; 386:117382. [PMID: 38006695 DOI: 10.1016/j.atherosclerosis.2023.117382] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 09/09/2023] [Accepted: 11/07/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND AND AIMS The lipid profile is consistently associated with coronary artery disease (CAD) and ischemic stroke (IS). However, the lipoprotein subfractions have not been deeply explored in stroke subtypes, especially in IS outcome. METHODS We performed two-sample Mendelian randomization (MR) analysis using 92 lipid traits measured by nuclear magnetic resonance in 115,000 subjects from the UK Biobank. Data for genetic associations with IS, its subtypes, and long-term outcome (LTO) were obtained from three cohorts of European ancestry: GIGASTROKE (73,652 cases, 1,234,808 controls), GODS (n = 1791) and GISCOME (n = 6165). Results obtained using CARDIoGRAMPlusC4D were used to identify differences with CAD. RESULTS Genetically determined low concentration of medium high-density lipoprotein (HDL) particles (odds ratio (OR) = 0.92, 95% CI 0.88-0.96; p = 3.6 × 10-4) and its cholesterol content (OR = 0.92, 95% CI 0.88-0.96; p = 1.9 × 10-4) showed causal associations with an increased risk of stroke. Genetic predisposition to high apolipoprotein (apo)B to apoA-I ratio was causally associated with an increased risk of IS (OR = 1.12, 95% CI 1.06-1.18, p = 1.1 × 10-4), and a highly suggestive association was found between non-esterified cholesterol in low-density lipoprotein (LDL) and increased risk of atherothrombotic stroke (LAS) (OR = 1.35, 95% CI 1.10-1.66; p = 4.0 × 10-3). Low cholesterol in small and medium LDL was suggestively associated with poor LTO. CONCLUSIONS Our results support that low medium HDL concentration was causally associated with an increased stroke risk, while high levels of non-esterified cholesterol in LDL were suggestively associated with an increased risk of LAS and with a better LTO.
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Affiliation(s)
- Jesús M Martín-Campos
- Stroke Pharmacogenomic and Genetics, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, (Cerdanyola del Vallès), Spain.
| | - Jara Cárcel-Márquez
- Stroke Pharmacogenomic and Genetics, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Laia Llucià-Carol
- Stroke Pharmacogenomic and Genetics, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain; Institute for Biomedical Research of Barcelona (IIBB), National Spanish Research Council (CSIC), Barcelona, Spain
| | - Miquel Lledós
- Stroke Pharmacogenomic and Genetics, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Natàlia Cullell
- Stroke Pharmacogenomic and Genetics, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain; Neurology, Hospital Universitari Mútua de Terrassa/Fundació Docència I Recerca, Mútua Terrassa, Terrassa, Spain; Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Elena Muiño
- Stroke Pharmacogenomic and Genetics, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Cristina Gallego-Fabrega
- Stroke Pharmacogenomic and Genetics, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Israel Fernández-Cadenas
- Stroke Pharmacogenomic and Genetics, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
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4
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Lledós M, Prats-Sánchez L, Llucià-Carol L, Cárcel-Márquez J, Muiño E, Cullell N, Gallego-Fabrega C, Martín-Campos JM, Aguilera-Simón A, Guasch-Jiménez M, Guisado-Alonso D, Ramos-Pachón A, Martínez-Domeño A, Izquierdo A, Marín R, Camps-Renom P, Martí-Fàbregas J, Fernández-Cadenas I. Ischaemic stroke patients present sex differences in gut microbiota. Eur J Neurol 2023; 30:3497-3506. [PMID: 37329328 DOI: 10.1111/ene.15931] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Gut microbiota plays a role in the pathophysiology of ischaemic stroke (IS) through the bidirectional gut-brain axis. Nevertheless, little is known about sex-specific microbiota signatures in IS occurrence. METHODS A total of 89 IS patients and 12 healthy controls were enrolled. We studied the taxonomic differences of the gut microbiota between men and women with IS by shotgun metagenomic sequencing. To evaluate the causal effect of several bacteria on IS risk, we performed a two-sample Mendelian randomisation (MR) with inverse-variance weighting (IVW) using genome-wide association analysis (GWAS) summary statistics from two cohorts of 5959 subjects with genetic and microbiota data and 1,296,908 subjects with genetic and IS data, respectively. RESULTS α-Diversity analysis measured using Observed Species (p = 0.017), Chao1 (p = 0.009) and Abundance-based Coverage Estimator (p = 0.012) indexes revealed that IS men have a higher species richness compared with IS women. Moreover, we found sex-differences in IS patients in relation to the phylum Fusobacteria, class Fusobacteriia, order Fusobacteriales and family Fusobacteriaceae (all Bonferroni-corrected p < 0.001). MR confirmed that increased Fusobacteriaceae levels in the gut are causally associated with an increased risk of IS (IVW p = 0.02, β = 0.32). CONCLUSIONS Our study is the first to indicate that there are gut microbiome differences between men and women with IS, identifying high levels of Fusobacteriaceae in women as a specific risk factor for IS. Incorporating sex stratification analysis is important in the design, analysis and interpretation of studies on stroke and the gut microbiota.
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Affiliation(s)
- Miquel Lledós
- Stroke Pharmacogenomics and Genetics Laboratory, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Department of Genetics, Microbiology and Statistics, Universitat de Barcelona, Barcelona, Spain
| | - Luís Prats-Sánchez
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laia Llucià-Carol
- Stroke Pharmacogenomics and Genetics Laboratory, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Jara Cárcel-Márquez
- Stroke Pharmacogenomics and Genetics Laboratory, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Elena Muiño
- Stroke Pharmacogenomics and Genetics Laboratory, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Natalia Cullell
- Stroke Pharmacogenomics and Genetics Laboratory, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Stroke Pharmacogenomics and Genetics Laboratory, Fundación Docència i Recerca MútuaTerrassa, Hospital Mútua de Terrassa, Terrassa, Spain
| | - Cristina Gallego-Fabrega
- Stroke Pharmacogenomics and Genetics Laboratory, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jesús M Martín-Campos
- Stroke Pharmacogenomics and Genetics Laboratory, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Ana Aguilera-Simón
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Marina Guasch-Jiménez
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Daniel Guisado-Alonso
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Anna Ramos-Pachón
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Artur Izquierdo
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Rebeca Marín
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Pol Camps-Renom
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Joan Martí-Fàbregas
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Israel Fernández-Cadenas
- Stroke Pharmacogenomics and Genetics Laboratory, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
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Llucià-Carol L, Muiño E, Cullell N, Cárcel-Márquez J, Lledós M, Gallego-Fabrega C, Martin-Campos J, Martí-Fàbregas J, Aguilera-Simón A, Planas AM, DeDiego ML, de Felipe Mimbrera A, Masjuan J, García-Madrona S, Segura T, González-Villar E, Serrano-Heras G, Domínguez Mayoral A, Menéndez-Valladares P, Montaner J, Migeotte I, Rahmouni S, Darcis G, Bernardo D, Rojo S, Schulte EC, Protzer U, Fricke L, Winter C, Niemi MEK, Cordioli M, Delgado P, Fernández-Cadenas I. Genetic Architecture of Ischaemic Strokes after COVID-19 Shows Similarities with Large Vessel Strokes. Int J Mol Sci 2023; 24:13452. [PMID: 37686257 PMCID: PMC10487930 DOI: 10.3390/ijms241713452] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/04/2023] [Revised: 08/03/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
We aimed to analyse whether patients with ischaemic stroke (IS) occurring within eight days after the onset of COVID-19 (IS-COV) are associated with a specific aetiology of IS. We used SUPERGNOVA to identify genome regions that correlate between the IS-COV cohort (73 IS-COV cases vs. 701 population controls) and different aetiological subtypes. Polygenic risk scores (PRSs) for each subtype were generated and tested in the IS-COV cohort using PRSice-2 and PLINK to find genetic associations. Both analyses used the IS-COV cohort and GWAS from MEGASTROKE (67,162 stroke patients vs. 454,450 population controls), GIGASTROKE (110,182 vs. 1,503,898), and the NINDS Stroke Genetics Network (16,851 vs. 32,473). Three genomic regions were associated (p-value < 0.05) with large artery atherosclerosis (LAA) and cardioembolic stroke (CES). We found four loci targeting the genes PITX2 (rs10033464, IS-COV beta = 0.04, p-value = 2.3 × 10-2, se = 0.02), previously associated with CES, HS6ST1 (rs4662630, IS-COV beta = -0.04, p-value = 1.3 × 10-3, se = 0.01), TMEM132E (rs12941838 IS-COV beta = 0.05, p-value = 3.6 × 10-4, se = 0.01), and RFFL (rs797989 IS-COV beta = 0.03, p-value = 1.0 × 10-2, se = 0.01). A statistically significant PRS was observed for LAA. Our results suggest that IS-COV cases are genetically similar to LAA and CES subtypes. Larger cohorts are needed to assess if the genetic factors in IS-COV cases are shared with the general population or specific to viral infection.
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Affiliation(s)
- Laia Llucià-Carol
- Stroke Pharmacogenomics and Genetics, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain; (L.L.-C.); (M.L.)
- Departament de Genètica i de Microbiologia, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Elena Muiño
- Stroke Pharmacogenomics and Genetics, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain; (L.L.-C.); (M.L.)
| | - Natalia Cullell
- Stroke Pharmacogenomics and Genetics, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain; (L.L.-C.); (M.L.)
- Department of Neurology, Hospital Universitari MútuaTerrassa, Fundació Docència i Recerca MútuaTerrassa, 08221 Terrassa, Spain
| | - Jara Cárcel-Márquez
- Stroke Pharmacogenomics and Genetics, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain; (L.L.-C.); (M.L.)
| | - Miquel Lledós
- Stroke Pharmacogenomics and Genetics, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain; (L.L.-C.); (M.L.)
| | - Cristina Gallego-Fabrega
- Stroke Pharmacogenomics and Genetics, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain; (L.L.-C.); (M.L.)
| | - Jesús Martin-Campos
- Stroke Pharmacogenomics and Genetics, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain; (L.L.-C.); (M.L.)
| | - Joan Martí-Fàbregas
- Department of Neurology, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | - Ana Aguilera-Simón
- Department of Neurology, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | - Anna M. Planas
- Institute for Biomedical Research of Barcelona (IIBB), Spanish National Research Council (CSIC), 08036 Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Marta L. DeDiego
- Department of Molecular and Cell Biology, Centro Nacional de Biotecnología (CNB-CSIC), Campus Universidad Autónoma de Madrid, 28049 Madrid, Spain;
| | - Alicia de Felipe Mimbrera
- Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Universitario Ramón Y Cajal, 28034 Madrid, Spain
| | - Jaime Masjuan
- Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Universitario Ramón Y Cajal, 28034 Madrid, Spain
| | - Sebastián García-Madrona
- Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Universitario Ramón Y Cajal, 28034 Madrid, Spain
| | - Tomás Segura
- Department of Neurology, University Hospital of Albacete, 02006 Albacete, Spain
| | | | - Gemma Serrano-Heras
- Department of Neurology, University Hospital of Albacete, 02006 Albacete, Spain
| | - Ana Domínguez Mayoral
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, 410113 Seville, Spain
- Department of Neurology, Hospital Universitario Virgen Macarena, 41009 Seville, Spain
| | - Paloma Menéndez-Valladares
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, 410113 Seville, Spain
- Department of Neurology, Hospital Universitario Virgen Macarena, 41009 Seville, Spain
| | - Joan Montaner
- Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, 410113 Seville, Spain
- Department of Neurology, Hospital Universitario Virgen Macarena, 41009 Seville, Spain
| | - Isabelle Migeotte
- Fonds de la Recherche Scientifique (FNRS), 1000 Brussels, Belgium
- Centre de Génétique Humaine, Hopital Erasme, Université Libre de Bruxelles, 1050 Brussels, Belgium
| | - Souad Rahmouni
- Fonds de la Recherche Scientifique (FNRS), 1000 Brussels, Belgium
- Department of Biomedical and Preclinical Sciences, Faculty of Medicine, GIGA-Insitute, University of Liege, 4000 Liège, Belgium
| | - Gilles Darcis
- Fonds de la Recherche Scientifique (FNRS), 1000 Brussels, Belgium
- CHU of Liege, 4000 Liège, Belgium
| | - David Bernardo
- Mucosal Immunology Lab, Unidad de Excelencia del Instituto de Biomedicina y Genética Molecular (IBGM), Universidad de Valladolid-CSIC, 47005 Valladolid, Spain
| | - Silvia Rojo
- Department of Microbiology, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), 47003 Valladolid, Spain
| | - Eva C. Schulte
- Institute of Virology, Technical University Munich/Helmholtz Zentrum München, 81377 Munich, Germany
- Institute of Psychiatric Phenomics and Genomics, University Hospital, LMU Munich University, 80336 Munich, Germany
- Department of Psychiatry, University Hospital, LMU Munich University, 80336 Munich, Germany
- Institute of Human Genetics, University Hospital Bonn, Medical Faculty, University of Bonn, 53127 Bonn, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Medical Faculty, University of Bonn, 53127 Bonn, Germany
| | - Ulrike Protzer
- Institute of Virology, Technical University Munich/Helmholtz Zentrum München, 81377 Munich, Germany
| | - Lisa Fricke
- Department of Internal Medicine II, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich (TUM), 81675 Munich, Germany;
| | - Christof Winter
- Institute of Clinical Chemistry and Pathobiochemistry, School of Medicine, Technische Universität München (TUM), 81675 Munich, Germany
- TranslaTUM, Center for Translational Cancer Research, Technische Universität München, 81675 Munich, Germany
| | - Mari E. K. Niemi
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, 00014 Helsinki, Finland; (M.E.K.N.)
| | - Mattia Cordioli
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, 00014 Helsinki, Finland; (M.E.K.N.)
| | - Pilar Delgado
- Department of Neurology, Hospital Universitari de la Vall d’Hebrón, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Israel Fernández-Cadenas
- Stroke Pharmacogenomics and Genetics, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain; (L.L.-C.); (M.L.)
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6
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Cárcel-Márquez J, Muiño E, Gallego-Fabrega C, Cullell N, Lledós M, Llucià-Carol L, Sobrino T, Campos F, Castillo J, Freijo M, Arenillas JF, Obach V, Álvarez-Sabín J, Molina CA, Ribó M, Jiménez-Conde J, Roquer J, Muñoz-Narbona L, Lopez-Cancio E, Millán M, Diaz-Navarro R, Vives-Bauza C, Serrano-Heras G, Segura T, Ibañez L, Heitsch L, Delgado P, Dhar R, Krupinski J, Delgado-Mederos R, Prats-Sánchez L, Camps-Renom P, Blay N, Sumoy L, de Cid R, Montaner J, Cruchaga C, Lee JM, Martí-Fàbregas J, Férnandez-Cadenas I. A Polygenic Risk Score Based on a Cardioembolic Stroke Multitrait Analysis Improves a Clinical Prediction Model for This Stroke Subtype. Front Cardiovasc Med 2022; 9:940696. [PMID: 35872910 PMCID: PMC9304625 DOI: 10.3389/fcvm.2022.940696] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 05/10/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background Occult atrial fibrillation (AF) is one of the major causes of embolic stroke of undetermined source (ESUS). Knowing the underlying etiology of an ESUS will reduce stroke recurrence and/or unnecessary use of anticoagulants. Understanding cardioembolic strokes (CES), whose main cause is AF, will provide tools to select patients who would benefit from anticoagulants among those with ESUS or AF. We aimed to discover novel loci associated with CES and create a polygenetic risk score (PRS) for a more efficient CES risk stratification. Methods Multitrait analysis of GWAS (MTAG) was performed with MEGASTROKE-CES cohort (n = 362,661) and AF cohort (n = 1,030,836). We considered significant variants and replicated those variants with MTAG p-value < 5 × 10−8 influencing both traits (GWAS-pairwise) with a p-value < 0.05 in the original GWAS and in an independent cohort (n = 9,105). The PRS was created with PRSice-2 and evaluated in the independent cohort. Results We found and replicated eleven loci associated with CES. Eight were novel loci. Seven of them had been previously associated with AF, namely, CAV1, ESR2, GORAB, IGF1R, NEURL1, WIPF1, and ZEB2. KIAA1755 locus had never been associated with CES/AF, leading its index variant to a missense change (R1045W). The PRS generated has been significantly associated with CES improving discrimination and patient reclassification of a model with age, sex, and hypertension. Conclusion The loci found significantly associated with CES in the MTAG, together with the creation of a PRS that improves the predictive clinical models of CES, might help guide future clinical trials of anticoagulant therapy in patients with ESUS or AF.
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Affiliation(s)
- Jara Cárcel-Márquez
- Stroke Pharmacogenomics and Genetics Group, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Muiño
- Stroke Pharmacogenomics and Genetics Group, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Cristina Gallego-Fabrega
- Stroke Pharmacogenomics and Genetics Group, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Natalia Cullell
- Stroke Pharmacogenomics and Genetics Group, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Stroke Pharmacogenomics and Genetics Laboratory, Fundación Docència i Recerca Mútua Terrassa, Hospital Mútua Terrassa, Terrassa, Spain
| | - Miquel Lledós
- Stroke Pharmacogenomics and Genetics Group, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Laia Llucià-Carol
- Stroke Pharmacogenomics and Genetics Group, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Department de Genética i de Microbiologia, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario de Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Francisco Campos
- Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario de Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - José Castillo
- Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario de Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Marimar Freijo
- Department of Neurology, Biocruces-Bizkaia Health Research Institute, Bilbao, Spain
| | | | - Victor Obach
- Department of Neurology, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain
| | - José Álvarez-Sabín
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carlos A. Molina
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Marc Ribó
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Jiménez-Conde
- Department of Neurology, IMIM-Hospital del Mar; Neurovascular Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona, Spain
| | - Jaume Roquer
- Department of Neurology, IMIM-Hospital del Mar; Neurovascular Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona, Spain
| | - Lucia Muñoz-Narbona
- Department of Neurosciences, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Lopez-Cancio
- Department of Neurology, University Hospital Central de Asturias (HUCA).Oviedo, Spain
| | - Mònica Millán
- Department of Neurosciences, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rosa Diaz-Navarro
- Department of Neurology, Son Espases University Hospital, Illes Balears Health Research Institute (IdISBa), Palma, Spain
| | - Cristòfol Vives-Bauza
- Department of Neurology, Son Espases University Hospital, Illes Balears Health Research Institute (IdISBa), Palma, Spain
| | | | - Tomás Segura
- Department of Neurology, University Hospital of Albacete, Albacete, Spain
| | - Laura Ibañez
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, United States
| | - Laura Heitsch
- Department of Emergency Medicine, Washington University School of Medicine, Saint Louis, MO, United States
- Department of Neurology, Washington University School of Medicine, Saint Louis, MO, United States
| | - Pilar Delgado
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rajat Dhar
- Department of Neurology, Washington University School of Medicine, Saint Louis, MO, United States
| | - Jerzy Krupinski
- Neurology Service, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Raquel Delgado-Mederos
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Luis Prats-Sánchez
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Pol Camps-Renom
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Natalia Blay
- GenomesForLife-GCAT Lab, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Lauro Sumoy
- High Content Genomics and Bioinformatics Unit, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Rafael de Cid
- GenomesForLife-GCAT Lab, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Joan Montaner
- Institute de Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville and Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Carlos Cruchaga
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, United States
- Neurogenomics and Informatics Center at Washington University in St. Louis, Saint Louis, MO, United States
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, Saint Louis, MO, United States
| | - Joan Martí-Fàbregas
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Israel Férnandez-Cadenas
- Stroke Pharmacogenomics and Genetics Group, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- *Correspondence: Israel Férnandez-Cadenas
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7
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Gallego-Fabrega C, Muiño E, Cullell N, Cárcel-Márquez J, Lazcano U, Soriano-Tárraga C, Lledós M, Llucià-Carol L, Aguilera-Simón A, Marín R, Prats-Sánchez L, Camps-Renom P, Delgado-Mederos R, Martín-Campos JM, Delgado P, Martí-Fàbregas J, Montaner J, Krupinski J, Jiménez-Conde J, Roquer J, Fernández-Cadenas I. Biological Age Acceleration Is Lower in Women With Ischemic Stroke Compared to Men. Stroke 2022; 53:2320-2330. [PMID: 35209739 DOI: 10.1161/strokeaha.121.037419] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND Stroke onset in women occurs later in life compared with men. The underlying mechanisms of these differences have not been established. Epigenetic clocks, based on DNA methylation (DNAm) profiles, are the most accurate biological age estimate. Epigenetic age acceleration (EAA) measures indicate whether an individual is biologically younger or older than expected. Our aim was to analyze whether sexual dichotomy at age of stroke onset is conditioned by EAA. METHODS We used 2 DNAm datasets from whole blood samples of case-control genetic studies of ischemic stroke (IS), a discovery cohort of 374 IS patients (N women=163, N men=211), from GRECOS (Genotyping Recurrence Risk of Stroke) and SEDMAN (Dabigatran Study in the Early Phase of Stroke, New Neuroimaging Markers and Biomarkers) studies and a replication cohort of 981 IS patients (N women=411, N men=570) from BASICMAR register. We compared chronological age, 2 DNAm-based biomarkers of aging and intrinsic and extrinsic epigenetic age acceleration EAA (IEAA and extrinsic EAA, respectively), in IS as well as in individual IS etiologic subtypes. Horvath and Hannum epigenetic clocks were used to assess the aging rate. A proteomic study using the SOMAScan multiplex assay was performed on 26 samples analyzing 1305 proteins. RESULTS Women present lower Hannum-extrinsic EAA values, whereas men have higher Hannum-extrinsic EAA values (women=-0.64, men=1.24, P=1.34×10-2); the same tendency was observed in the second cohort (women=-0.57, men=0.79, P=0.02). These differences seemed to be specific to cardioembolic and undetermined stroke subtypes. Additionally, 42 blood protein levels were associated with Hannum-extrinsic EAA (P<0.05), belonging to the immune effector process (P=1.54×10-6) and platelet degranulation (P<8.74×10-6) pathways. CONCLUSIONS This study shows that sex-specific underlying biological mechanisms associated with stroke onset could be due to differences in biological age acceleration between men and women.
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Affiliation(s)
- Cristina Gallego-Fabrega
- Stroke Unit, Department of Neurology Santa Creu i Sant Pau, Barcelona, Spain (C.G.-F., A.A.-S., R.M., L.P.-S., P.C.-R., R.D.-M., J.M.-F.)
- Stroke Pharmacogenomics and Genetics, Biomedical Research Institute Sant Pau, Sant Pau Hospital, Barcelona, Spain (C.G.-F., E.M., N.C., J.C.-M., M.L., L.L.-C., J.M.M.-C., I.F.-C.)
| | - Elena Muiño
- Stroke Pharmacogenomics and Genetics, Biomedical Research Institute Sant Pau, Sant Pau Hospital, Barcelona, Spain (C.G.-F., E.M., N.C., J.C.-M., M.L., L.L.-C., J.M.M.-C., I.F.-C.)
| | - Natalia Cullell
- Stroke Pharmacogenomics and Genetics, Biomedical Research Institute Sant Pau, Sant Pau Hospital, Barcelona, Spain (C.G.-F., E.M., N.C., J.C.-M., M.L., L.L.-C., J.M.M.-C., I.F.-C.)
- Department of Neurology, Hospital Universitari MútuaTerrassa/Fundació Docència i Recerca MútuaTerrassa, Spain (N.C., J.K.)
| | - Jara Cárcel-Márquez
- Stroke Pharmacogenomics and Genetics, Biomedical Research Institute Sant Pau, Sant Pau Hospital, Barcelona, Spain (C.G.-F., E.M., N.C., J.C.-M., M.L., L.L.-C., J.M.M.-C., I.F.-C.)
| | - Uxue Lazcano
- Stroke Pharmacogenomics and Genetics, Biomedical Research Institute Sant Pau, Sant Pau Hospital, Barcelona, Spain (C.G.-F., E.M., N.C., J.C.-M., M.L., L.L.-C., J.M.M.-C., I.F.-C.)
- Department of Neurology, Hospital del Mar; Neurovascular Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain (U.L., C.S.-T., J.J., J.R.)
| | - Carolina Soriano-Tárraga
- Department of Neurology, Hospital del Mar; Neurovascular Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain (U.L., C.S.-T., J.J., J.R.)
- Department of Psychiatry, Washington University School of Medicine, Saint-Louis, MO (C.S.-T.)
| | - Miquel Lledós
- Stroke Pharmacogenomics and Genetics, Biomedical Research Institute Sant Pau, Sant Pau Hospital, Barcelona, Spain (C.G.-F., E.M., N.C., J.C.-M., M.L., L.L.-C., J.M.M.-C., I.F.-C.)
| | - Laia Llucià-Carol
- Stroke Pharmacogenomics and Genetics, Biomedical Research Institute Sant Pau, Sant Pau Hospital, Barcelona, Spain (C.G.-F., E.M., N.C., J.C.-M., M.L., L.L.-C., J.M.M.-C., I.F.-C.)
- Institute for Biomedical Research of Barcelona (IIBB), National Spanish Research Council (CSIC) (L.L.-C.)
| | - Ana Aguilera-Simón
- Stroke Unit, Department of Neurology Santa Creu i Sant Pau, Barcelona, Spain (C.G.-F., A.A.-S., R.M., L.P.-S., P.C.-R., R.D.-M., J.M.-F.)
| | - Rebeca Marín
- Stroke Unit, Department of Neurology Santa Creu i Sant Pau, Barcelona, Spain (C.G.-F., A.A.-S., R.M., L.P.-S., P.C.-R., R.D.-M., J.M.-F.)
| | - Luis Prats-Sánchez
- Stroke Unit, Department of Neurology Santa Creu i Sant Pau, Barcelona, Spain (C.G.-F., A.A.-S., R.M., L.P.-S., P.C.-R., R.D.-M., J.M.-F.)
| | - Pol Camps-Renom
- Stroke Unit, Department of Neurology Santa Creu i Sant Pau, Barcelona, Spain (C.G.-F., A.A.-S., R.M., L.P.-S., P.C.-R., R.D.-M., J.M.-F.)
| | - Raquel Delgado-Mederos
- Stroke Unit, Department of Neurology Santa Creu i Sant Pau, Barcelona, Spain (C.G.-F., A.A.-S., R.M., L.P.-S., P.C.-R., R.D.-M., J.M.-F.)
| | - Jesús M Martín-Campos
- Stroke Unit, Department of Neurology Santa Creu i Sant Pau, Barcelona, Spain (C.G.-F., A.A.-S., R.M., L.P.-S., P.C.-R., R.D.-M., J.M.-F.)
- Stroke Pharmacogenomics and Genetics, Biomedical Research Institute Sant Pau, Sant Pau Hospital, Barcelona, Spain (C.G.-F., E.M., N.C., J.C.-M., M.L., L.L.-C., J.M.M.-C., I.F.-C.)
| | - Pilar Delgado
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Spain (P.D.)
| | | | - Joan Montaner
- Department of Neurology, Virgen del Rocío and Macarena Hospitals, Institute of Biomedicine of Seville (IBiS), Seville, Spain (J.M.)
| | - Jerzy Krupinski
- Department of Neurology, Hospital Universitari MútuaTerrassa/Fundació Docència i Recerca MútuaTerrassa, Spain (N.C., J.K.)
- Centre for Biomedicine, Manchester Metropolitan University, United Kingdom (J.K.)
| | - J Jiménez-Conde
- Department of Neurology, Hospital del Mar; Neurovascular Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain (U.L., C.S.-T., J.J., J.R.)
| | - Jaume Roquer
- Department of Neurology, Hospital del Mar; Neurovascular Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain (U.L., C.S.-T., J.J., J.R.)
| | - Israel Fernández-Cadenas
- Stroke Pharmacogenomics and Genetics, Biomedical Research Institute Sant Pau, Sant Pau Hospital, Barcelona, Spain (C.G.-F., E.M., N.C., J.C.-M., M.L., L.L.-C., J.M.M.-C., I.F.-C.)
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8
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Llucià-Carol L, Muiño E, Gallego-Fabrega C, Cárcel-Márquez J, Martín-Campos J, Lledós M, Cullell N, Fernández-Cadenas I. Pharmacogenetics studies in stroke patients treated with rtPA: a review of the most interesting findings. Pharmacogenomics 2021; 22:1091-1097. [PMID: 34698533 DOI: 10.2217/pgs-2021-0100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/01/2023] Open
Abstract
Recombinant tissue-plasminogen activator (rtPA) is the only drug used during the acute phase of stroke. Despite its important benefits, a percentage of patients suffer symptomatic hemorrhagic transformations or a lack of early recanalization rates. These undesirable effects are associated with acute neurological and long-term functional deterioration. For the past 20 years, pharmacogenetic studies have tried to find the genetic risk factors associated with rtPA response. Most of these studies have used a gene-candidate strategy; however, recent genome-wide association studies have emerged indicating that genetic predisposition could modulate rtPA response. This review summarizes the most interesting findings in this field, including which genes and genetic variations are associated with hemorrhagic transformations and recanalization rates after thrombolytic therapy.
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Affiliation(s)
- Laia Llucià-Carol
- Institute for Biomedical Research of Barcelona (IIBB), National Spanish Research Council (CSIC), Barcelona, Spain.,Stroke Pharmacogenomics & Genetics, Biomedical Research Institute Sant Pau, Sant Pau Hospital, Barcelona, Spain
| | - Elena Muiño
- Stroke Pharmacogenomics & Genetics, Biomedical Research Institute Sant Pau, Sant Pau Hospital, Barcelona, Spain
| | - Cristina Gallego-Fabrega
- Stroke Pharmacogenomics & Genetics, Biomedical Research Institute Sant Pau, Sant Pau Hospital, Barcelona, Spain
| | - Jara Cárcel-Márquez
- Stroke Pharmacogenomics & Genetics, Biomedical Research Institute Sant Pau, Sant Pau Hospital, Barcelona, Spain
| | - Jesus Martín-Campos
- Stroke Pharmacogenomics & Genetics, Biomedical Research Institute Sant Pau, Sant Pau Hospital, Barcelona, Spain
| | - Miquel Lledós
- Stroke Pharmacogenomics & Genetics, Biomedical Research Institute Sant Pau, Sant Pau Hospital, Barcelona, Spain
| | - Natalia Cullell
- Stroke Pharmacogenomics & Genetics, Biomedical Research Institute Sant Pau, Sant Pau Hospital, Barcelona, Spain.,Neurology Unit, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Israel Fernández-Cadenas
- Stroke Pharmacogenomics & Genetics, Biomedical Research Institute Sant Pau, Sant Pau Hospital, Barcelona, Spain
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9
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Carrera C, Cárcel-Márquez J, Cullell N, Torres-Águila N, Muiño E, Castillo J, Sobrino T, Campos F, Rodríguez-Castro E, Llucià-Carol L, Millán M, Muñoz-Narbona L, López-Cancio E, Bustamante A, Ribó M, Álvarez-Sabín J, Jiménez-Conde J, Roquer J, Giralt-Steinhauer E, Soriano-Tárraga C, Mola-Caminal M, Vives-Bauza C, Navarro RD, Tur S, Obach V, Arenillas JF, Segura T, Serrano-Heras G, Martí-Fàbregas J, Delgado-Mederos R, Freijo-Guerrero MM, Moniche F, Cabezas JA, Castellanos M, Gallego-Fabrega C, González-Sanchez J, Krupinsky J, Strbian D, Tatlisumak T, Thijs V, Lemmens R, Slowik A, Pera J, Kittner S, Cole J, Heitsch L, Ibañez L, Cruchaga C, Lee JM, Montaner J, Fernández-Cadenas I. Single nucleotide variations in ZBTB46 are associated with post-thrombolytic parenchymal haematoma. Brain 2021; 144:2416-2426. [PMID: 33723576 PMCID: PMC8418348 DOI: 10.1093/brain/awab090] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 02/12/2021] [Accepted: 02/25/2021] [Indexed: 12/13/2022] Open
Abstract
Haemorrhagic transformation is a complication of recombinant tissue-plasminogen activator treatment. The most severe form, parenchymal haematoma, can result in neurological deterioration, disability, and death. Our objective was to identify single nucleotide variations associated with a risk of parenchymal haematoma following thrombolytic therapy in patients with acute ischaemic stroke. A fixed-effect genome-wide meta-analysis was performed combining two-stage genome-wide association studies (n = 1904). The discovery stage (three cohorts) comprised 1324 ischaemic stroke individuals, 5.4% of whom had a parenchymal haematoma. Genetic variants yielding a P-value < 0.05 1 × 10-5 were analysed in the validation stage (six cohorts), formed by 580 ischaemic stroke patients with 12.1% haemorrhagic events. All participants received recombinant tissue-plasminogen activator; cases were parenchymal haematoma type 1 or 2 as defined by the European Cooperative Acute Stroke Study (ECASS) criteria. Genome-wide significant findings (P < 5 × 10-8) were characterized by in silico functional annotation, gene expression, and DNA regulatory elements. We analysed 7 989 272 single nucleotide polymorphisms and identified a genome-wide association locus on chromosome 20 in the discovery cohort; functional annotation indicated that the ZBTB46 gene was driving the association for chromosome 20. The top single nucleotide polymorphism was rs76484331 in the ZBTB46 gene [P = 2.49 × 10-8; odds ratio (OR): 11.21; 95% confidence interval (CI): 4.82-26.55]. In the replication cohort (n = 580), the rs76484331 polymorphism was associated with parenchymal haematoma (P = 0.01), and the overall association after meta-analysis increased (P = 1.61 × 10-8; OR: 5.84; 95% CI: 3.16-10.76). ZBTB46 codes the zinc finger and BTB domain-containing protein 46 that acts as a transcription factor. In silico studies indicated that ZBTB46 is expressed in brain tissue by neurons and endothelial cells. Moreover, rs76484331 interacts with the promoter sites located at 20q13. In conclusion, we identified single nucleotide variants in the ZBTB46 gene associated with a higher risk of parenchymal haematoma following recombinant tissue-plasminogen activator treatment.
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Affiliation(s)
- Caty Carrera
- Neurovascular Research Laboratory, VHIR, Universitat Autònoma de Barcelona, Barcelona 08035, Spain
- Stroke Pharmacogenomics and Genetics, IIB-Sant Pau, Barcelona 08025, Spain
| | | | - Natalia Cullell
- Stroke Pharmacogenomics and Genetics, IIB-Sant Pau, Barcelona 08025, Spain
- Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mútua Terrassa, Terrassa 08221, Spain
| | - Nuria Torres-Águila
- Stroke Pharmacogenomics and Genetics, IIB-Sant Pau, Barcelona 08025, Spain
- Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mútua Terrassa, Terrassa 08221, Spain
| | - Elena Muiño
- Stroke Pharmacogenomics and Genetics, IIB-Sant Pau, Barcelona 08025, Spain
| | - José Castillo
- Clinical Neurosciences Research Laboratory, IDIS, Santiago de Compostela, 15706, Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratory, IDIS, Santiago de Compostela, 15706, Spain
| | - Francisco Campos
- Clinical Neurosciences Research Laboratory, IDIS, Santiago de Compostela, 15706, Spain
| | | | - Laia Llucià-Carol
- Stroke Pharmacogenomics and Genetics, IIB-Sant Pau, Barcelona 08025, Spain
| | - Mònica Millán
- Department of Neuroscience, HUGTP, Badalona 08916, Spain
| | | | | | - Alejandro Bustamante
- Neurovascular Research Laboratory, VHIR, Universitat Autònoma de Barcelona, Barcelona 08035, Spain
| | - Marc Ribó
- Stroke Unit, HUVH, Barcelona 08035, Spain
| | | | - Jordi Jiménez-Conde
- Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Barcelona 08003, Spain
| | - Jaume Roquer
- Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Barcelona 08003, Spain
| | - Eva Giralt-Steinhauer
- Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Barcelona 08003, Spain
| | - Carolina Soriano-Tárraga
- Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Barcelona 08003, Spain
| | - Marina Mola-Caminal
- Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar, Barcelona 08003, Spain
| | | | | | - Silvia Tur
- Department of Neurology, HUSE, Mallorca 07120, Spain
| | - Victor Obach
- Department of Neurology, Hospital Clínic i Provincial de Barcelona, Barcelona 08036, Spain
| | - Juan Francisco Arenillas
- Department of Neurology, Hospital Clínico Universitario, University of Valladolid, Valladolid 47003, Spain
| | - Tomás Segura
- Department of Neurology, CHUA, Albacete 02006, Spain
| | | | - Joan Martí-Fàbregas
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona 08025, Spain
| | - Raquel Delgado-Mederos
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona 08025, Spain
| | - M Mar Freijo-Guerrero
- Neurovascular Unit, Biocruces Bizkaia Health Research Institute, Bilbao 48903, Spain
| | - Francisco Moniche
- Department of Neurology, Virgen del Rocío, IBIS, Seville 41023, Spain
| | | | | | - Cristina Gallego-Fabrega
- Stroke Pharmacogenomics and Genetics, IIB-Sant Pau, Barcelona 08025, Spain
- Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mútua Terrassa, Terrassa 08221, Spain
| | - Jonathan González-Sanchez
- Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mútua Terrassa, Terrassa 08221, Spain
- School of Healthcare Science, Manchester Metropolitan University, Manchester M15 6BH, UK
| | - Jurek Krupinsky
- School of Healthcare Science, Manchester Metropolitan University, Manchester M15 6BH, UK
- Neurology Unit, Hospital Universitari Mútua Terrassa, Terrassa 08221, Spain
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital, Helsinki FI-00029, Finland
| | - Turgut Tatlisumak
- Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg 41345, Sweden
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC 3072, Australia
- Department of Neurology, Austin Health, Heidelberg, VIC 3072, Australia
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Campus Gasthuisberg, Leuven 3000, Belgium
| | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University Medical College, Kraków 31-007, Poland
| | - Johanna Pera
- Department of Neurology, Jagiellonian University Medical College, Kraków 31-007, Poland
| | - Steven Kittner
- Department of Neurology, University of Maryland School of Medicine and Baltimore, Baltimore, MD 21201-1559, USA
| | - John Cole
- Department of Neurology, University of Maryland School of Medicine and Baltimore, Baltimore, MD 21201-1559, USA
| | - Laura Heitsch
- Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO 63110-1010, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110-1010, USA
| | - Laura Ibañez
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110-1010, USA
| | - Carlos Cruchaga
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110-1010, USA
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110-1010, USA
| | - Joan Montaner
- Neurovascular Research Laboratory, VHIR, Universitat Autònoma de Barcelona, Barcelona 08035, Spain
- Department of Neurology, Virgen del Rocío, IBIS, Seville 41023, Spain
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10
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Muiño E, Cárcel-Márquez J, Carrera C, Llucià-Carol L, Gallego-Fabrega C, Cullell N, Lledós M, Castillo J, Sobrino T, Campos F, Rodríguez-Castro E, Millán M, Muñoz-Narbona L, Bustamante A, López-Cancio E, Ribó M, Álvarez-Sabín J, Jiménez-Conde J, Roquer J, Giralt-Steinhauer E, Soriano-Tárraga C, Vives-Bauza C, Navarro RD, Tur S, Obach V, Arenillas JF, Segura T, Serrano-Heras G, Martí-Fàbregas J, Delgado-Mederos R, Camps-Renom P, Prats-Sánchez L, Guisado D, Guasch M, Marin R, Martínez-Domeño A, Freijo-Guerrero MDM, Moniche F, Cabezas JA, Castellanos M, Krupinsky J, Strbian D, Tatlisumak T, Thijs V, Lemmens R, Slowik A, Pera J, Heitsch L, Ibañez L, Cruchaga C, Dhar R, Lee JM, Montaner J, Fernández-Cadenas I. RP11-362K2.2:RP11-767I20.1 Genetic Variation Is Associated with Post-Reperfusion Therapy Parenchymal Hematoma. A GWAS Meta-Analysis. J Clin Med 2021; 10:jcm10143137. [PMID: 34300314 PMCID: PMC8305811 DOI: 10.3390/jcm10143137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/07/2021] [Revised: 07/05/2021] [Accepted: 07/14/2021] [Indexed: 12/12/2022] Open
Abstract
Stroke is one of the most common causes of death and disability. Reperfusion therapies are the only treatment available during the acute phase of stroke. Due to recent clinical trials, these therapies may increase their frequency of use by extending the time-window administration, which may lead to an increase in complications such as hemorrhagic transformation, with parenchymal hematoma (PH) being the more severe subtype, associated with higher mortality and disability rates. Our aim was to find genetic risk factors associated with PH, as that could provide molecular targets/pathways for their prevention/treatment and study its genetic correlations to find traits sharing genetic background. We performed a GWAS and meta-analysis, following standard quality controls and association analysis (fastGWAS), adjusting age, NIHSS, and principal components. FUMA was used to annotate, prioritize, visualize, and interpret the meta-analysis results. The total number of patients in the meta-analysis was 2034 (216 cases and 1818 controls). We found rs79770152 having a genome-wide significant association (beta 0.09, p-value 3.90 × 10−8) located in the RP11-362K2.2:RP11-767I20.1 gene and a suggestive variant (rs13297983: beta 0.07, p-value 6.10 × 10−8) located in PCSK5 associated with PH occurrence. The genetic correlation showed a shared genetic background of PH with Alzheimer’s disease and white matter hyperintensities. In addition, genes containing the ten most significant associations have been related to aggregated amyloid-β, tau protein, white matter microstructure, inflammation, and matrix metalloproteinases.
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Affiliation(s)
- Elena Muiño
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (E.M.); (J.C.-M.); (L.L.-C.); (C.G.-F.); (N.C.); (M.L.)
| | - Jara Cárcel-Márquez
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (E.M.); (J.C.-M.); (L.L.-C.); (C.G.-F.); (N.C.); (M.L.)
| | - Caty Carrera
- Neurovascular Research Laboratory, Vall d’Hebron Institut de Recerca, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain;
| | - Laia Llucià-Carol
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (E.M.); (J.C.-M.); (L.L.-C.); (C.G.-F.); (N.C.); (M.L.)
| | - Cristina Gallego-Fabrega
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (E.M.); (J.C.-M.); (L.L.-C.); (C.G.-F.); (N.C.); (M.L.)
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, 08025 Barcelona, Spain; (J.M.-F.); (R.D.-M.); (P.C.-R.); (L.P.-S.); (D.G.); (M.G.); (R.M.); (A.M.-D.)
| | - Natalia Cullell
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (E.M.); (J.C.-M.); (L.L.-C.); (C.G.-F.); (N.C.); (M.L.)
- Stroke Pharmacogenomics and Genetics, Fundació MútuaTerrassa per la Docència i la Recerca, 08221 Terrassa, Spain
| | - Miquel Lledós
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (E.M.); (J.C.-M.); (L.L.-C.); (C.G.-F.); (N.C.); (M.L.)
| | - José Castillo
- Clinical Neurosciences Research Laboratories, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (J.C.); (T.S.); (F.C.)
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratories, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (J.C.); (T.S.); (F.C.)
| | - Francisco Campos
- Clinical Neurosciences Research Laboratories, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; (J.C.); (T.S.); (F.C.)
| | - Emilio Rodríguez-Castro
- Department of Neurology, Hospital Clínico Universitario de Santiago, 15706 Santiago de Compostela, Spain;
| | - Mònica Millán
- Department of Neuroscience, Hospital Germans Trias i Pujol, 08025 Badalona, Spain; (M.M.); (L.M.-N.); (A.B.)
| | - Lucía Muñoz-Narbona
- Department of Neuroscience, Hospital Germans Trias i Pujol, 08025 Badalona, Spain; (M.M.); (L.M.-N.); (A.B.)
| | - Alejandro Bustamante
- Department of Neuroscience, Hospital Germans Trias i Pujol, 08025 Badalona, Spain; (M.M.); (L.M.-N.); (A.B.)
| | - Elena López-Cancio
- Stroke Unit, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain;
| | - Marc Ribó
- Stroke Unit, Hospital Universitario Valle de Hebrón, 08025 Barcelona, Spain;
| | - José Álvarez-Sabín
- Department of Neurology, Hospital Universitario Valle de Hebrón, Universidad Autónoma de Barcelona, 08025 Barcelona, Spain;
| | - Jordi Jiménez-Conde
- Department of Neurology, Neurovascular Research Group, Instituto de Investigaciones Médicas Hospital del Mar-Hospital del Mar, 08025 Barcelona, Spain; (J.J.-C.); (J.R.); (E.G.-S.); (C.S.-T.)
| | - Jaume Roquer
- Department of Neurology, Neurovascular Research Group, Instituto de Investigaciones Médicas Hospital del Mar-Hospital del Mar, 08025 Barcelona, Spain; (J.J.-C.); (J.R.); (E.G.-S.); (C.S.-T.)
| | - Eva Giralt-Steinhauer
- Department of Neurology, Neurovascular Research Group, Instituto de Investigaciones Médicas Hospital del Mar-Hospital del Mar, 08025 Barcelona, Spain; (J.J.-C.); (J.R.); (E.G.-S.); (C.S.-T.)
| | - Carolina Soriano-Tárraga
- Department of Neurology, Neurovascular Research Group, Instituto de Investigaciones Médicas Hospital del Mar-Hospital del Mar, 08025 Barcelona, Spain; (J.J.-C.); (J.R.); (E.G.-S.); (C.S.-T.)
| | - Cristófol Vives-Bauza
- Neurobiology Laboratory, Instituto de Investigación Sanitaria de Palma, 07120 Mallorca, Spain;
| | - Rosa Díaz Navarro
- Department of Neurology, Hospital Universitari Son Espases, 07120 Mallorca, Spain; (R.D.N.); (S.T.)
| | - Silvia Tur
- Department of Neurology, Hospital Universitari Son Espases, 07120 Mallorca, Spain; (R.D.N.); (S.T.)
| | - Victor Obach
- Department of Neurology, Hospital Clínic i Provincial de Barcelona, 08025 Barcelona, Spain;
| | - Juan F. Arenillas
- Department of Neurology, Hospital Clínico Universitario, University of Valladolid, 47003 Valladolid, Spain;
| | - Tomás Segura
- Department of Neurology, Complejo Hospitalario Universitario de Albacete, 02006 Albacete, Spain;
| | - Gemma Serrano-Heras
- Experimental Research Unit, Complejo Hospitalario Universitario de Albacete, 02006 Albacete, Spain;
| | - Joan Martí-Fàbregas
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, 08025 Barcelona, Spain; (J.M.-F.); (R.D.-M.); (P.C.-R.); (L.P.-S.); (D.G.); (M.G.); (R.M.); (A.M.-D.)
| | - Raquel Delgado-Mederos
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, 08025 Barcelona, Spain; (J.M.-F.); (R.D.-M.); (P.C.-R.); (L.P.-S.); (D.G.); (M.G.); (R.M.); (A.M.-D.)
| | - Pol Camps-Renom
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, 08025 Barcelona, Spain; (J.M.-F.); (R.D.-M.); (P.C.-R.); (L.P.-S.); (D.G.); (M.G.); (R.M.); (A.M.-D.)
| | - Luis Prats-Sánchez
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, 08025 Barcelona, Spain; (J.M.-F.); (R.D.-M.); (P.C.-R.); (L.P.-S.); (D.G.); (M.G.); (R.M.); (A.M.-D.)
| | - Daniel Guisado
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, 08025 Barcelona, Spain; (J.M.-F.); (R.D.-M.); (P.C.-R.); (L.P.-S.); (D.G.); (M.G.); (R.M.); (A.M.-D.)
| | - Marina Guasch
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, 08025 Barcelona, Spain; (J.M.-F.); (R.D.-M.); (P.C.-R.); (L.P.-S.); (D.G.); (M.G.); (R.M.); (A.M.-D.)
| | - Rebeca Marin
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, 08025 Barcelona, Spain; (J.M.-F.); (R.D.-M.); (P.C.-R.); (L.P.-S.); (D.G.); (M.G.); (R.M.); (A.M.-D.)
| | - Alejandro Martínez-Domeño
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, 08025 Barcelona, Spain; (J.M.-F.); (R.D.-M.); (P.C.-R.); (L.P.-S.); (D.G.); (M.G.); (R.M.); (A.M.-D.)
| | | | - Francisco Moniche
- Department of Neurology, Virgen del Rocío, Instituto de Biomedicina de Sevilla, 41013 Seville, Spain; (F.M.); (J.A.C.); (J.M.)
| | - Juan Antonio Cabezas
- Department of Neurology, Virgen del Rocío, Instituto de Biomedicina de Sevilla, 41013 Seville, Spain; (F.M.); (J.A.C.); (J.M.)
| | - Mar Castellanos
- Department of Neurology, Complejo Hospitalario Universitario A Coruña, 15006 A Coruña, Spain;
| | - Jerzy Krupinsky
- School of Healthcare Science, Manchester Metropolitan University, Manchester M15 6BH, UK;
- Neurology Unit, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital, FI-00029 Helsinki, Finland;
| | - Turgut Tatlisumak
- Department of Clinical Neuroscience, Institute of Neurosciences and Physiology, Sahlgrenska Academy at University of Gothenburg, 41345 Gothenburg, Sweden;
- Department of Neurology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg VIC 3072, Australia;
- Department of Neurology, Austin Health, Heidelberg VIC 3072, Australia
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Campus Gasthuisberg, 3000 Leuven, Belgium;
| | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University Medical College, 31-007 Kraków, Poland; (A.S.); (J.P.)
| | - Joanna Pera
- Department of Neurology, Jagiellonian University Medical College, 31-007 Kraków, Poland; (A.S.); (J.P.)
| | - Laura Heitsch
- Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO 63110-1010, USA;
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110-1010, USA; (R.D.); (J.-M.L.)
| | - Laura Ibañez
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110-1010, USA; (L.I.); (C.C.)
| | - Carlos Cruchaga
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110-1010, USA; (L.I.); (C.C.)
| | - Rajat Dhar
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110-1010, USA; (R.D.); (J.-M.L.)
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110-1010, USA; (R.D.); (J.-M.L.)
| | - Joan Montaner
- Department of Neurology, Virgen del Rocío, Instituto de Biomedicina de Sevilla, 41013 Seville, Spain; (F.M.); (J.A.C.); (J.M.)
| | - Israel Fernández-Cadenas
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (E.M.); (J.C.-M.); (L.L.-C.); (C.G.-F.); (N.C.); (M.L.)
- Correspondence:
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Cárcel-Márquez J, Cullell N, Muiño E, Gallego-Fabrega C, Lledós M, Ibañez L, Krupinski J, Montaner J, Cruchaga C, Lee JM, Gill D, Paré G, Mola-Caminal M, Roquer J, Jimenez-Conde J, Martí-Fàbregas J, Fernandez-Cadenas I. Causal Effect of MMP-1 (Matrix Metalloproteinase-1), MMP-8, and MMP-12 Levels on Ischemic Stroke: A Mendelian Randomization Study. Stroke 2021; 52:e316-e320. [PMID: 33902302 DOI: 10.1161/strokeaha.120.033041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Jara Cárcel-Márquez
- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain (J.C.-M., N.C., E.M., C.G.-F., M.L., I.F.-C.).,Department of Medicine, Universitat Autònoma de Barcelona, Spain (J.C.-M.)
| | - Natalia Cullell
- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain (J.C.-M., N.C., E.M., C.G.-F., M.L., I.F.-C.).,Stroke Pharmacogenomics and Genetics Laboratory, Fundación Docència I Recerca Mútua Terrassa, Hospital Mútua de Terrassa, Spain (N.C., C.G.-F., J.K., I.F.-C.)
| | - Elena Muiño
- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain (J.C.-M., N.C., E.M., C.G.-F., M.L., I.F.-C.)
| | - Cristina Gallego-Fabrega
- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain (J.C.-M., N.C., E.M., C.G.-F., M.L., I.F.-C.).,Stroke Pharmacogenomics and Genetics Laboratory, Fundación Docència I Recerca Mútua Terrassa, Hospital Mútua de Terrassa, Spain (N.C., C.G.-F., J.K., I.F.-C.)
| | - Miquel Lledós
- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain (J.C.-M., N.C., E.M., C.G.-F., M.L., I.F.-C.)
| | - Laura Ibañez
- Department of Psychiatry (L.I., C.C.), Washington University School of Medicine, Saint Louis, MO
| | - Jerzy Krupinski
- Stroke Pharmacogenomics and Genetics Laboratory, Fundación Docència I Recerca Mútua Terrassa, Hospital Mútua de Terrassa, Spain (N.C., C.G.-F., J.K., I.F.-C.)
| | - Joan Montaner
- Institute de Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Department of Neurology, Hospital Universitario Virgen Macarena, Spain (J.M.)
| | - Carlos Cruchaga
- Department of Psychiatry (L.I., C.C.), Washington University School of Medicine, Saint Louis, MO
| | - Jin-Moo Lee
- Department of Neurology (J.-M.L.), Washington University School of Medicine, Saint Louis, MO
| | - Dipender Gill
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom (D.G.)
| | | | - Marina Mola-Caminal
- Department of Neurology, IMIM-Hospital del Mar, Neurovascular Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (M.M.-C., J.R., J.J.-C.)
| | - Jaume Roquer
- Department of Neurology, IMIM-Hospital del Mar, Neurovascular Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (M.M.-C., J.R., J.J.-C.)
| | - Jordi Jimenez-Conde
- Department of Neurology, IMIM-Hospital del Mar, Neurovascular Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (M.M.-C., J.R., J.J.-C.)
| | - Joan Martí-Fàbregas
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (J.M.-F.)
| | - Israel Fernandez-Cadenas
- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain (J.C.-M., N.C., E.M., C.G.-F., M.L., I.F.-C.).,Stroke Pharmacogenomics and Genetics Laboratory, Fundación Docència I Recerca Mútua Terrassa, Hospital Mútua de Terrassa, Spain (N.C., C.G.-F., J.K., I.F.-C.)
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12
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Cole JW, Adigun T, Akinyemi R, Akpa OM, Bell S, Chen B, Jimenez Conde J, Lazcano Dobao U, Fernandez I, Fornage M, Gallego-Fabrega C, Jern C, Krawczak M, Lindgren A, Markus HS, Melander O, Owolabi M, Schlicht K, Söderholm M, Srinivasasainagendra V, Soriano Tárraga C, Stenman M, Tiwari H, Corasaniti M, Fecteau N, Guizzardi B, Lopez H, Nguyen K, Gaynor B, O’Connor T, Stine OC, Kittner SJ, McArdle P, Mitchell BD, Xu H, Grond-Ginsbach C. The copy number variation and stroke (CaNVAS) risk and outcome study. PLoS One 2021; 16:e0248791. [PMID: 33872305 PMCID: PMC8055008 DOI: 10.1371/journal.pone.0248791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/04/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE The role of copy number variation (CNV) variation in stroke susceptibility and outcome has yet to be explored. The Copy Number Variation and Stroke (CaNVAS) Risk and Outcome study addresses this knowledge gap. METHODS Over 24,500 well-phenotyped IS cases, including IS subtypes, and over 43,500 controls have been identified, all with readily available genotyping on GWAS and exome arrays, with case measures of stroke outcome. To evaluate CNV-associated stroke risk and stroke outcome it is planned to: 1) perform Risk Discovery using several analytic approaches to identify CNVs that are associated with the risk of IS and its subtypes, across the age-, sex- and ethnicity-spectrums; 2) perform Risk Replication and Extension to determine whether the identified stroke-associated CNVs replicate in other ethnically diverse datasets and use biomarker data (e.g. methylation, proteomic, RNA, miRNA, etc.) to evaluate how the identified CNVs exert their effects on stroke risk, and lastly; 3) perform outcome-based Replication and Extension analyses of recent findings demonstrating an inverse relationship between CNV burden and stroke outcome at 3 months (mRS), and then determine the key CNV drivers responsible for these associations using existing biomarker data. RESULTS The results of an initial CNV evaluation of 50 samples from each participating dataset are presented demonstrating that the existing GWAS and exome chip data are excellent for the planned CNV analyses. Further, some samples will require additional considerations for analysis, however such samples can readily be identified, as demonstrated by a sample demonstrating clonal mosaicism. CONCLUSION The CaNVAS study will cost-effectively leverage the numerous advantages of using existing case-control data sets, exploring the relationships between CNV and IS and its subtypes, and outcome at 3 months, in both men and women, in those of African and European-Caucasian descent, this, across the entire adult-age spectrum.
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Affiliation(s)
- John W. Cole
- Veterans Affairs Maryland Health Care System, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | | | | | | | - Steven Bell
- Unversity of Cambridge, Cambridge, England, United Kingdom
| | - Bowang Chen
- National Center for Cardiovascular Diseases, Beijing, China
| | | | - Uxue Lazcano Dobao
- IMIM-Hospital del Mar; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Israel Fernandez
- Institute of Research Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Myriam Fornage
- University of Texas Health Science at Houston, Institute of Molecular Medicine & School of Public Health, Houston, TX, United States of America
| | | | | | - Michael Krawczak
- Institute of Medical Statistics and Informatics, University of Kiel, Kiel, Germany
| | | | - Hugh S. Markus
- Unversity of Cambridge, Cambridge, England, United Kingdom
| | | | | | - Kristina Schlicht
- Institute of Medical Statistics and Informatics, University of Kiel, Kiel, Germany
| | - Martin Söderholm
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital Malmö and Lund, Lund, Sweden
| | | | | | | | - Hemant Tiwari
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Margaret Corasaniti
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Natalie Fecteau
- Veterans Affairs Maryland Health Care System, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Beth Guizzardi
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Haley Lopez
- Veterans Affairs Maryland Health Care System, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Kevin Nguyen
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Brady Gaynor
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Timothy O’Connor
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - O. Colin Stine
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Steven J. Kittner
- Veterans Affairs Maryland Health Care System, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Patrick McArdle
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Braxton D. Mitchell
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Huichun Xu
- University of Maryland School of Medicine, Baltimore, MD, United States of America
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13
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Muiño E, Maisterra O, Jiménez-Balado J, Cullell N, Carrera C, Torres-Aguila NP, Cárcel-Márquez J, Gallego-Fabrega C, Lledós M, González-Sánchez J, Olmos-Alpiste F, Espejo E, March Á, Pujol R, Rodríguez-Campello A, Romeral G, Krupinski J, Martí-Fàbregas J, Montaner J, Roquer J, Fernández-Cadenas I. Genome-wide transcriptome study in skin biopsies reveals an association of E2F4 with cadasil and cognitive impairment. Sci Rep 2021; 11:6846. [PMID: 33767277 PMCID: PMC7994794 DOI: 10.1038/s41598-021-86349-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 03/11/2021] [Indexed: 01/31/2023] Open
Abstract
CADASIL is a small vessel disease caused by mutations in NOTCH3 that lead to an odd number of cysteines in the EGF-like repeat domain, causing protein misfolding and aggregation. The main symptoms are migraine, psychiatric disturbances, recurrent strokes and dementia, being executive function characteristically impaired. The molecular pathways altered by this receptor aggregation need to be studied further. A genome-wide transcriptome study (four cases paired with three healthy siblings) was carried out, in addition to a qRT-PCR for validation purposes (ten new cases and eight new controls). To study the expression profile by cell type of the significant mRNAs found, we performed an in situ hybridization (ISH) (nine cases and eight controls) and a research in the Single-nuclei Brain RNA-seq expression browser (SNBREB). Pathway analysis enrichment was carried out with Gene Ontology and Reactome. Neuropsychological tests were performed in five of the qRT-PCR cases. The two most significant differentially expressed mRNAs (BANP, p-value = 7.23 × 10-4 and PDCD6IP, p-value = 8.36 × 10-4) were selected for the validation study by qRT-PCR. Additionally, we selected two more mRNAs (CAMK2G, p-value = 4.52 × 10-3 and E2F4, p-value = 4.77 × 10-3) due to their association with ischemic neuronal death. E2F4 showed differential expression in the genome-wide transcriptome study and in the qRT-PCR (p = 1.23 × 10-3), and it was upregulated in CADASIL cases. Furthermore, higher E2F4 expression was associated with worse executive function (p = 2.04 × 10-2) and attention and information processing speed (IPS) (p = 8.73 × 10-2). In situ hibridization showed E2F4 expression in endothelial and vascular smooth vessel cells. In silico studies indicated that E2F4 is also expressed in brain endothelial cells. Among the most significant pathways analyzed, there was an enrichment of vascular development, cell adhesion and vesicular machinery terms and autophagy process. E2F4 is more highly expressed in the skin biopsy of CADASIL patients compared to controls, and its expression is present in endothelial cells and VSMCs. Further studies are needed to understand whether E2F4 could be useful as a biomarker, to monitor the disease or be used as a therapeutic target.
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Affiliation(s)
- Elena Muiño
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca de l`Hospital de la Santa Creu i Sant Pau, C/Sant Antoni María Claret 167, Barcelona, Spain
| | - Olga Maisterra
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Jiménez-Balado
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Natalia Cullell
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca de l`Hospital de la Santa Creu i Sant Pau, C/Sant Antoni María Claret 167, Barcelona, Spain
- Stroke Pharmacogenomics and Genetics, Fundació MútuaTerrassa per la Docència i la Recerca, Terrassa, Spain
| | - Caty Carrera
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca de l`Hospital de la Santa Creu i Sant Pau, C/Sant Antoni María Claret 167, Barcelona, Spain
| | - Nuria P Torres-Aguila
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca de l`Hospital de la Santa Creu i Sant Pau, C/Sant Antoni María Claret 167, Barcelona, Spain
| | - Jara Cárcel-Márquez
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca de l`Hospital de la Santa Creu i Sant Pau, C/Sant Antoni María Claret 167, Barcelona, Spain
| | - Cristina Gallego-Fabrega
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca de l`Hospital de la Santa Creu i Sant Pau, C/Sant Antoni María Claret 167, Barcelona, Spain
- Stroke Pharmacogenomics and Genetics, Fundació MútuaTerrassa per la Docència i la Recerca, Terrassa, Spain
| | - Miquel Lledós
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca de l`Hospital de la Santa Creu i Sant Pau, C/Sant Antoni María Claret 167, Barcelona, Spain
| | - Jonathan González-Sánchez
- Stroke Pharmacogenomics and Genetics, Fundació MútuaTerrassa per la Docència i la Recerca, Terrassa, Spain
- The Manchester Metropolitan University of All Saints, Manchester, UK
| | | | - Eva Espejo
- Dermatology Department, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | - Álvaro March
- Dermatology Department, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | - Ramón Pujol
- Dermatology Department, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | | | - Gemma Romeral
- Neurology Department, IMIM-Hospital del Mar, Barcelona, Spain
| | - Jurek Krupinski
- Neurology Department, Hospital Mútua Terrassa, Terrassa, Spain
| | - Joan Martí-Fàbregas
- Neurology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Joan Montaner
- The Manchester Metropolitan University of All Saints, Manchester, UK
- Biomedicine Institute of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Seville, Spain
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Jaume Roquer
- Neurology Department, IMIM-Hospital del Mar, Barcelona, Spain
| | - Israel Fernández-Cadenas
- Stroke Pharmacogenomics and Genetics Group, Institut de Recerca de l`Hospital de la Santa Creu i Sant Pau, C/Sant Antoni María Claret 167, Barcelona, Spain.
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14
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Arranz MJ, Gallego-Fabrega C, Martín-Blanco A, Soler J, Elices M, Dominguez-Clavé E, Salazar J, Vega D, Briones-Buixassa L, Pascual JC. A genome-wide methylation study reveals X chromosome and childhood trauma methylation alterations associated with borderline personality disorder. Transl Psychiatry 2021; 11:5. [PMID: 33414392 PMCID: PMC7791113 DOI: 10.1038/s41398-020-01139-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Received: 03/18/2020] [Revised: 12/02/2020] [Accepted: 12/07/2020] [Indexed: 02/06/2023] Open
Abstract
Borderline personality disorder (BPD) is a severe and highly prevalent psychiatric disorder, more common in females than in males and with notable differences in presentation between genders. Recent studies have shown that epigenetic modifications such as DNA methylation may modulate gene × environment interactions and impact on neurodevelopment. We conducted an epigenome wide study (Illumina Infinium HumanMethylation450k beadchip) in a group of BPD patients with (N = 49) and without (N = 47) childhood traumas and in a control group (N = 44). Results were confirmed in a replication cohort (N = 293 BPD patients and N = 114 controls) using EpiTYPER assays. Differentially methylated CpG sites were observed in several genes and intragenic regions in the X chromosome (PQBP1, ZNF41, RPL10, cg07810091 and cg24395855) and in chromosome 6 (TAP2). BPD patients showed significantly lower methylation levels in these CpG sites than healthy controls. These differences seemed to be increased by the existence of childhood trauma. Comparisons between BPD patients with childhood trauma and patients and controls without revealed significant differences in four genes (POU5F1, GGT6, TNFRSF13C and FAM113B), none of them in the X chromosome. Gene set enrichment analyses revealed that epigenetic alterations were more frequently found in genes controlling oestrogen regulation, neurogenesis and cell differentiation. These results suggest that epigenetic alterations in the X chromosome and oestrogen-regulation genes may contribute to the development of BPD and explain the differences in presentation between genders. Furthermore, childhood trauma events may modulate the magnitude of the epigenetic alterations contributing to BPD.
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Affiliation(s)
- María J. Arranz
- grid.414875.b0000 0004 1794 4956Fundació Docència i Recerca Mutua Terrassa, Terrassa, Spain ,grid.7722.00000 0001 1811 6966Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut de Recerca Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Cristina Gallego-Fabrega
- grid.414875.b0000 0004 1794 4956Fundació Docència i Recerca Mutua Terrassa, Terrassa, Spain ,grid.7722.00000 0001 1811 6966Stroke Pharmacogenomics and Genetics Group, Institut de Recerca Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Ana Martín-Blanco
- grid.7722.00000 0001 1811 6966Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut de Recerca Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain ,grid.413396.a0000 0004 1768 8905Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain ,grid.7080.fDepartment of Psychiatry and Forensic Medicine & Institute of Neurosciences, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Joaquim Soler
- grid.7722.00000 0001 1811 6966Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut de Recerca Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain ,grid.413396.a0000 0004 1768 8905Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain ,grid.7080.fDepartment of Psychiatry and Forensic Medicine & Institute of Neurosciences, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Matilde Elices
- grid.7722.00000 0001 1811 6966Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut de Recerca Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain ,grid.413396.a0000 0004 1768 8905Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain ,grid.7080.fDepartment of Psychiatry and Forensic Medicine & Institute of Neurosciences, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Elisabet Dominguez-Clavé
- grid.413396.a0000 0004 1768 8905Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Juliana Salazar
- grid.7722.00000 0001 1811 6966Translational Medical Oncology Laboratory, Institut de Recerca Biomèdica Sant Pau (IIB-Sant Pau), Bellaterra, Spain
| | - Daniel Vega
- grid.7080.fDepartment of Psychiatry and Forensic Medicine & Institute of Neurosciences, Universitat Autònoma de Barcelona, Bellaterra, Spain ,Psychiatry and Mental Health Department, Hospital of Igualada, Consorci Sanitari de l’Anoia & Fundació Sanitària d’Igualada, Igualada, Spain
| | - Laia Briones-Buixassa
- Psychiatry and Mental Health Department, Hospital of Igualada, Consorci Sanitari de l’Anoia & Fundació Sanitària d’Igualada, Igualada, Spain
| | - Juan Carlos Pascual
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut de Recerca Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain. .,Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. .,Department of Psychiatry and Forensic Medicine & Institute of Neurosciences, Universitat Autònoma de Barcelona, Bellaterra, Spain.
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15
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Muiño E, Bustamante A, Rodriguez-Campello A, Gallego-Fabrega C, Ois A, Carrera C, Cullell N, Torres-Aguila N, Cárcel-Márquez J, Rubiera M, Molina CA, Cuadrado-Godia E, Giralt-Steinhauer E, Jiménez-Conde J, Montaner J, Fernández-Cadenas I, Roquer J. A parsimonious score with a free web tool for predicting disability after an ischemic stroke: the Parsifal Score. J Neurol 2020; 267:2871-2880. [PMID: 32458199 DOI: 10.1007/s00415-020-09914-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Most of the models to predict prognosis after an ischemic stroke include complex mathematical equations or too many variables, making them difficult to use in the daily clinic. We want to predict disability 3 months after an ischemic stroke in an independent patient not receiving recanalization treatment within the first 24 h, using a minimum set of variables and an easy tool to facilitate its implementation. As a secondary aim, we calculated the capacity of the score to predict an excellent/devastating outcome and mortality. METHODS Eight hundred and forty-four patients were evaluated. A multivariable ordinal logistic regression was used to obtain the score. The Modified Rankin Scale (mRS) was used to estimate disability at the third month. The results were replicated in another independent cohort (378 patients). The "polr" function of R was used to perform the regression, stratifying the sample into seven groups with different cutoffs (from mRS 0 to 6). RESULTS The Parsifal score was generated with: age, previous mRS, initial NIHSS, glycemia on admission, and dyslipidemia. This score predicts disability with an accuracy of 80-76% (discovery-replication cohorts). It has an AUC of 0.86 in the discovery and replication cohort. The specificity was 90-80% (discovery-replication cohorts); while, the sensitivity was 64-74% (discovery-replication cohorts). The prediction of an excellent or devastating outcome, as well as mortality, obtained good discrimination with AUC > 0.80. CONCLUSIONS The Parsifal Score is a model that predicts disability at the third month, with only five variables, with good discrimination and calibration, and being replicated in an independent cohort.
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Affiliation(s)
- E Muiño
- Stroke Pharmacogenomics and Genetics, Fundació Mutua Terrassa per la Docència i la Recerca Biomèdica i Social FPC, Barcelona, Spain.,Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Departamento de Medicina de la UAB, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - A Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Hospital Vall d'Hebron-UAB, Barcelona, Spain
| | | | - C Gallego-Fabrega
- Stroke Pharmacogenomics and Genetics, Fundació Mutua Terrassa per la Docència i la Recerca Biomèdica i Social FPC, Barcelona, Spain.,Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A Ois
- Neurology Service, IMIM-Hospital del Mar, Barcelona, Spain
| | - C Carrera
- Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Hospital Vall d'Hebron-UAB, Barcelona, Spain
| | - N Cullell
- Stroke Pharmacogenomics and Genetics, Fundació Mutua Terrassa per la Docència i la Recerca Biomèdica i Social FPC, Barcelona, Spain.,Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - N Torres-Aguila
- Stroke Pharmacogenomics and Genetics, Fundació Mutua Terrassa per la Docència i la Recerca Biomèdica i Social FPC, Barcelona, Spain.,Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J Cárcel-Márquez
- Stroke Pharmacogenomics and Genetics, Fundació Mutua Terrassa per la Docència i la Recerca Biomèdica i Social FPC, Barcelona, Spain.,Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M Rubiera
- Neurology Service, Hospital Vall D'Hebron, Barcelona, Spain
| | - C A Molina
- Neurology Service, Hospital Vall D'Hebron, Barcelona, Spain
| | | | | | | | - J Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Hospital Vall d'Hebron-UAB, Barcelona, Spain.,Biomedicine Institute of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC, University of Seville, Seville, Spain.,Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - I Fernández-Cadenas
- Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - J Roquer
- Neurology Service, IMIM-Hospital del Mar, Barcelona, Spain
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16
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Gallego-Fabrega C, Cullell N, Soriano-Tárraga C, Carrera C, Torres-Aguila NP, Muiño E, Cárcel-Márquez J, de Moura MC, Fernández-Sanlés A, Esteller M, Elosua R, Jiménez-Conde J, Roquer J, Montaner J, Krupinski J, Fernandez-Cadenas I. DNA methylation of MMPs and TIMPs in atherothrombosis process in carotid plaques and blood tissues. Oncotarget 2020; 11:905-912. [PMID: 32206187 PMCID: PMC7075467 DOI: 10.18632/oncotarget.27469] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 10/09/2019] [Accepted: 01/13/2020] [Indexed: 12/20/2022] Open
Abstract
Background and Purpose: Polymorphisms and serum levels of Matrix Metalloproteinases (MMP) and Tissue Inhibitor of Metalloproteinases (TIMP) have been studied with regard to atheromatous plaques and ischemic stroke, while no studies of DNA methylation (DNAm) patterns of MMP or TIMP have been performed to that end. Here, we evaluate DNAm levels of the MMP and TIMP gene families in human carotid plaques and blood samples of atherothrombotic stroke patients. Methods: We profiled the DNAm status of stable and ulcerated atherosclerotic plaques obtained as pair sets from three patients who underwent carotid endarterectomy surgery. We selected 415 CpG sites, mapping into MMPs and TIMPs genes for further study. Secondly, the statistically associated CpG sites were analyzed in blood samples from two separate atherothrombotic stroke cohorts (total sample size = 307), ischemic stroke-cohort 1 (ISC-1): 37 atherothrombotic patients and 6 controls, ischemic stroke-cohort 2 (ISC-2): 80 atherothrombotic patients and 184 controls. DNAm levels from plaque tissue and blood samples were evaluated using a high-density microarray Infinium, HumanMethylation450 BeadChip and Infinium MethylationEPIC BeadChip. Results: Three CpG sites were statistically significantly associated with unstable plaque portions; cg02969624, q-value = 0.035 (TIMP2), and cg04316754, q-value = 0.037 (MMP24) were hypermethylated, while cg24211657 q-value = 0.035 (TIMP2) was hypomethylated. Association of cg04316754 (MMP24) methylation levels with atherothrombotic risk was also observed in blood tissue: ISC-1 p-values = 0.03, ISC-2 p-value = 1.9 × 10-04. Conclusions: The results suggest different DNAm status of MMP24 between stable and unstable atherothrombotic carotid plaques, and between atherothrombotic stroke and controls in blood samples.
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Affiliation(s)
- Cristina Gallego-Fabrega
- Neurology, Hospital Universitari Mútua de Terrassa/Fundacio Docència i Recerca MutuaTerrassa, Terrassa, Spain.,Stroke Pharmacogenomics and Genetics, Sant Pau Research Institute, Barcelona, Spain
| | - Natalia Cullell
- Neurology, Hospital Universitari Mútua de Terrassa/Fundacio Docència i Recerca MutuaTerrassa, Terrassa, Spain.,Stroke Pharmacogenomics and Genetics, Sant Pau Research Institute, Barcelona, Spain.,Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Carolina Soriano-Tárraga
- Department of Neurology, Hospital del Mar, Neurovascular Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona, Spain
| | - Caty Carrera
- Stroke Pharmacogenomics and Genetics, Sant Pau Research Institute, Barcelona, Spain.,Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Elena Muiño
- Stroke Pharmacogenomics and Genetics, Sant Pau Research Institute, Barcelona, Spain
| | - Jara Cárcel-Márquez
- Stroke Pharmacogenomics and Genetics, Sant Pau Research Institute, Barcelona, Spain
| | | | - Alba Fernández-Sanlés
- Cardiovascular Epidemiology and Genetics Research Group, Hospital del Mar Medical Research Institute, Universitat Pompeu Fabra, Barcelona, Spain
| | - Manel Esteller
- Josep Carreras Leukaemia Research Institute (IJC), Badalona, Barcelona, Spain.,Department of Physiological Sciences II, School of Medicine, University of Barcelona, Barcelona, Spain.,Institucio Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Roberto Elosua
- Cardiovascular Epidemiology and Genetics Research Group, Hospital del Mar Medical Research Institute, Universitat Pompeu Fabra, Barcelona, Spain
| | - Jordi Jiménez-Conde
- Department of Neurology, Hospital del Mar, Neurovascular Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona, Spain
| | - Jaume Roquer
- Department of Neurology, Hospital del Mar, Neurovascular Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jerzy Krupinski
- Neurology, Hospital Universitari Mútua de Terrassa/Fundacio Docència i Recerca MutuaTerrassa, Terrassa, Spain.,Centre for Biomedicine, Manchester Metropolitan University, Manchester, UK.,These authors contributed equally to this work
| | - Israel Fernandez-Cadenas
- Stroke Pharmacogenomics and Genetics, Sant Pau Research Institute, Barcelona, Spain.,These authors contributed equally to this work
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17
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Draganov M, Arranz MJ, Salazar J, de Diego-Adeliño J, Gallego-Fabrega C, Jubero M, Carceller-Sindreu M, Portella MJ. Association study of polymorphisms within inflammatory genes and methylation status in treatment response in major depression. Eur Psychiatry 2020; 60:7-13. [DOI: 10.1016/j.eurpsy.2019.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/03/2019] [Accepted: 05/05/2019] [Indexed: 12/28/2022] Open
Abstract
AbstractBackground:Although pharmacogenetics for major depressive disorder (MDD) is gaining momentum, the role of genetics in differences in response to antidepressant treatment is controversial, as they depend on multifactorial and polygenic phenotypes. Previous studies focused on the genes of the serotonergic system, leaving apart other pathological factors such as the inflammatory pathway. The main objective of the study was to assess whether treatment response might be associated with specific inflammation-related genetic variants or their methylation status.Methods:41 SNPs in 8 inflammatory genes: interleukin (IL) 1-β, IL2, IL6, IL6R, IL10, IL18, tumor necrosis factor (TNF)-α and interferon (IFN)-γ were genotyped in 153 patients with MDD, who were evaluated with the Mausdley Staging Method to determine treatment response profiles. Pyrosequencing reactions and methylation quantification were performed in a PyroMark Q24 in 5 selected CpG islands of IL1- β, IL6 and IL6R. Linear and logistic regression analyses were conducted, including age and gender as covariates using PLINK 1.07.Results:Allelic distribution of IL1- β rs1143643 was significantly associated with MSM scores (FDR corrected p = 0.04). Allelic distribution of IL6R rs57569414 showed a trend towards significance with MSM scores (p = 0.002; FDR corrected p = 0.07). Haplotype analyses showed associations between allelic combinations of IL1-β and IL10 with treatment response (FDR corrected p < 0.01). Methylation percentage of treatment responders was only higher in an IL6R CpG island (p < 0.05).Conclusions:These exploratory findings suggest that IL1-β and, marginally, IL6R polymorphisms may affect treatment response in major depression. If confirmed, these results may account for the heterogeneous phenotypes of major depression that underlie differences in treatment response.
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18
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Mola-Caminal M, Carrera C, Soriano-Tárraga C, Giralt-Steinhauer E, Díaz-Navarro RM, Tur S, Jiménez C, Medina-Dols A, Cullell N, Torres-Aguila NP, Muiño E, Rodríguez-Campello A, Ois A, Cuadrado-Godia E, Vivanco-Hidalgo RM, Hernandez-Guillamon M, Solé M, Delgado P, Bustamante A, García-Berrocoso T, Mendióroz M, Castellanos M, Serena J, Martí-Fàbregas J, Segura T, Serrano-Heras G, Obach V, Ribó M, Molina CA, Alvarez-Sabín J, Palomeras E, Freijo M, Font MA, Rosand J, Rost NS, Gallego-Fabrega C, Lee JM, Heitsch L, Ibanez L, Cruchaga C, Phuah CL, Lemmens R, Thijs V, Lindgren A, Maguire J, Rannikmae K, Sudlow CL, Jern C, Stanne TM, Lorentzen E, Muñoz-Narbona L, Dávalos A, López-Cancio E, Worrall BB, Woo D, Kittner SJ, Mitchell BD, Montaner J, Roquer J, Krupinski J, Estivill X, Rabionet R, Vives-Bauzá C, Fernández-Cadenas I, Jiménez-Conde J. PATJ Low Frequency Variants Are Associated With Worse Ischemic Stroke Functional Outcome. Circ Res 2019; 124:114-120. [PMID: 30582445 DOI: 10.1161/circresaha.118.313533] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
RATIONALE Ischemic stroke is among the leading causes of adult disability. Part of the variability in functional outcome after stroke has been attributed to genetic factors but no locus has been consistently associated with stroke outcome. OBJECTIVE Our aim was to identify genetic loci influencing the recovery process using accurate phenotyping to produce the largest GWAS (genome-wide association study) in ischemic stroke recovery to date. METHODS AND RESULTS A 12-cohort, 2-phase (discovery-replication and joint) meta-analysis of GWAS included anterior-territory and previously independent ischemic stroke cases. Functional outcome was recorded using 3-month modified Rankin Scale. Analyses were adjusted for confounders such as discharge National Institutes of Health Stroke Scale. A gene-based burden test was performed. The discovery phase (n=1225) was followed by open (n=2482) and stringent joint-analyses (n=1791). Those cohorts with modified Rankin Scale recorded at time points other than 3-month or incomplete data on previous functional status were excluded in the stringent analyses. Novel variants in PATJ (Pals1-associated tight junction) gene were associated with worse functional outcome at 3-month after stroke. The top variant was rs76221407 (G allele, β=0.40, P=1.70×10-9). CONCLUSIONS Our results identify a set of common variants in PATJ gene associated with 3-month functional outcome at genome-wide significance level. Future studies should examine the role of PATJ in stroke recovery and consider stringent phenotyping to enrich the information captured to unveil additional stroke outcome loci.
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Affiliation(s)
- Marina Mola-Caminal
- From the Department of Neurology, Neurovascular Research Group, Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra (M.M.-C., C.S.-T., E.G.-S., A.R.-C., A.O., E.C.-G., R.M.V.-H., J.R., J.J.-C.).,Department of Genetics, Universitat de Barcelona (M.M.-C.)
| | - Caty Carrera
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (C.C., M.H.-G., M.S., P.D., A.B., T.G.-B., M.M., J.M., I.F.-C.), Universitat Autònoma de Barcelona
| | - Carolina Soriano-Tárraga
- From the Department of Neurology, Neurovascular Research Group, Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra (M.M.-C., C.S.-T., E.G.-S., A.R.-C., A.O., E.C.-G., R.M.V.-H., J.R., J.J.-C.)
| | - Eva Giralt-Steinhauer
- From the Department of Neurology, Neurovascular Research Group, Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra (M.M.-C., C.S.-T., E.G.-S., A.R.-C., A.O., E.C.-G., R.M.V.-H., J.R., J.J.-C.)
| | - Rosa M Díaz-Navarro
- Department of Neurology (R.M.D.-N., S.T., C.J.), Son Espases University Hospital, Institut d'Investigació Sanitària de Les Illes Balears, Palma de Mallorca
| | - Sílvia Tur
- Department of Neurology (R.M.D.-N., S.T., C.J.), Son Espases University Hospital, Institut d'Investigació Sanitària de Les Illes Balears, Palma de Mallorca
| | - Carmen Jiménez
- Department of Neurology (R.M.D.-N., S.T., C.J.), Son Espases University Hospital, Institut d'Investigació Sanitària de Les Illes Balears, Palma de Mallorca
| | - Aina Medina-Dols
- Research Unit (A.M.-D., C.V.-B.), Son Espases University Hospital, Institut d'Investigació Sanitària de Les Illes Balears, Palma de Mallorca
| | - Natàlia Cullell
- Stroke Pharmacogenomics and Genetics Group, Fundació Docència i Recerca Mútua Terrassa (N.C., N.P.T.-A., E.M., I.F.-C.)
| | - Nuria P Torres-Aguila
- Stroke Pharmacogenomics and Genetics Group, Fundació Docència i Recerca Mútua Terrassa (N.C., N.P.T.-A., E.M., I.F.-C.)
| | - Elena Muiño
- Stroke Pharmacogenomics and Genetics Group, Fundació Docència i Recerca Mútua Terrassa (N.C., N.P.T.-A., E.M., I.F.-C.)
| | - Ana Rodríguez-Campello
- From the Department of Neurology, Neurovascular Research Group, Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra (M.M.-C., C.S.-T., E.G.-S., A.R.-C., A.O., E.C.-G., R.M.V.-H., J.R., J.J.-C.)
| | - Angel Ois
- From the Department of Neurology, Neurovascular Research Group, Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra (M.M.-C., C.S.-T., E.G.-S., A.R.-C., A.O., E.C.-G., R.M.V.-H., J.R., J.J.-C.)
| | - Elisa Cuadrado-Godia
- From the Department of Neurology, Neurovascular Research Group, Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra (M.M.-C., C.S.-T., E.G.-S., A.R.-C., A.O., E.C.-G., R.M.V.-H., J.R., J.J.-C.)
| | - Rosa M Vivanco-Hidalgo
- From the Department of Neurology, Neurovascular Research Group, Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra (M.M.-C., C.S.-T., E.G.-S., A.R.-C., A.O., E.C.-G., R.M.V.-H., J.R., J.J.-C.)
| | - Mar Hernandez-Guillamon
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (C.C., M.H.-G., M.S., P.D., A.B., T.G.-B., M.M., J.M., I.F.-C.), Universitat Autònoma de Barcelona
| | - Montse Solé
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (C.C., M.H.-G., M.S., P.D., A.B., T.G.-B., M.M., J.M., I.F.-C.), Universitat Autònoma de Barcelona
| | - Pilar Delgado
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (C.C., M.H.-G., M.S., P.D., A.B., T.G.-B., M.M., J.M., I.F.-C.), Universitat Autònoma de Barcelona
| | - Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (C.C., M.H.-G., M.S., P.D., A.B., T.G.-B., M.M., J.M., I.F.-C.), Universitat Autònoma de Barcelona
| | - Teresa García-Berrocoso
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (C.C., M.H.-G., M.S., P.D., A.B., T.G.-B., M.M., J.M., I.F.-C.), Universitat Autònoma de Barcelona
| | - Maite Mendióroz
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (C.C., M.H.-G., M.S., P.D., A.B., T.G.-B., M.M., J.M., I.F.-C.), Universitat Autònoma de Barcelona
| | - Mar Castellanos
- Neurology Service, A Coruña University Hospital and Biomedical Research Institute, La Coruña (M.C.)
| | - Joaquín Serena
- Department of Neurology, Doctor Josep Trueta University Hospital, Girona Institute of Biomedical Investigation (J.S.)
| | - Joan Martí-Fàbregas
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona (J.M.-F.S.)
| | - Tomás Segura
- Department of Neurology (T.S.), Complejo Hospitalario Universitario de Albacete
| | | | - Victor Obach
- Department of Neurology, Hospital Clínic i Provincial de Barcelona (V.O.)
| | - Marc Ribó
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (M.R., C.A.M., J.A.-S.)
| | - Carlos A Molina
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (M.R., C.A.M., J.A.-S.)
| | - José Alvarez-Sabín
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona (M.R., C.A.M., J.A.-S.)
| | | | - Mar Freijo
- Department of Neurology, Hospital de Basurto, Bilbao (M.F.)
| | - Maria A Font
- Department of Neurology, Hospital de Bellvitge, Hospitalet de Llobregat (M.A.F.)
| | - Jonathan Rosand
- From the Department of Neurology, Neurovascular Research Group, Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra (M.M.-C., C.S.-T., E.G.-S., A.R.-C., A.O., E.C.-G., R.M.V.-H., J.R., J.J.-C.)
| | - Natalia S Rost
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., N.S.R.)
| | - Cristina Gallego-Fabrega
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA (J.R., C.G.-F.).,Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R., C.G.F.)
| | - Jin-Moo Lee
- Department of Neurology (J.-M.L., L.H., L.I., C.C., C.-L.P.), Washington University School of Medicine, St. Louis, MO
| | - Laura Heitsch
- Department of Neurology (J.-M.L., L.H., L.I., C.C., C.-L.P.), Washington University School of Medicine, St. Louis, MO.,The Division of Emergency Medicine (L.H.), Washington University School of Medicine, St. Louis, MO
| | - Laura Ibanez
- Department of Neurology (J.-M.L., L.H., L.I., C.C., C.-L.P.), Washington University School of Medicine, St. Louis, MO
| | - Carlos Cruchaga
- Department of Neurology (J.-M.L., L.H., L.I., C.C., C.-L.P.), Washington University School of Medicine, St. Louis, MO
| | - Chia-Ling Phuah
- Department of Neurology (J.-M.L., L.H., L.I., C.C., C.-L.P.), Washington University School of Medicine, St. Louis, MO
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (R.L.).,Laboratory of Neurobiology, VIB, Center for Brain & Disease Research, Leuven (R.L.).,Department of Neurology, University Hospitals Leuven (R.L.)
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia (V.T.).,Department of Neurology, Austin Health, Heidelberg, Australia (V.T.)
| | - Arne Lindgren
- Clinical Sciences Lund, Neurology, Lund University, Sweden (A.L.).,Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.)
| | - Jane Maguire
- Faculty of Health, University of Technology, Sidney (J. Maguire).,Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, University of Newcastle, Australia (J. Maguire)
| | - Kristiina Rannikmae
- Division of Clinical Brain Sciences, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (K.R., C.L.S.)
| | - Catherine L Sudlow
- Division of Clinical Brain Sciences, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (K.R., C.L.S.)
| | - Christina Jern
- Institute of Biomedicine, the Sahlgrenska Academy at University of Gothenburg (C.J., T.M.S.)
| | - Tara M Stanne
- Institute of Biomedicine, the Sahlgrenska Academy at University of Gothenburg (C.J., T.M.S.)
| | - Erik Lorentzen
- Bioinformatics Core Facility, University of Gothenburg (E.L.)
| | - Lucía Muñoz-Narbona
- Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol (L.M.-N., A.D.), Universitat Autònoma de Barcelona
| | - Antonio Dávalos
- Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol (L.M.-N., A.D.), Universitat Autònoma de Barcelona
| | - Elena López-Cancio
- Stroke Unit, Hospital Universitario Central de Asturias (HUCA), Oviedo (E.L.-C.)
| | - Bradford B Worrall
- Neurology and Department of Public Health Sciences, University of Virginia, Charlottesville (B.B.W.)
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, OH (D.W.)
| | - Steven J Kittner
- Department of Neurology, University of Maryland School of Medicine and Baltimore VAMC, MD (S.J.K.)
| | - Braxton D Mitchell
- Geriatrics Research and Education Clinical Center, Baltimore Veterans Administration Medical Center, MD (B.D.M.).,Department of Medicine, University of Maryland School of Medicine, Baltimore, MD (B.D.M.)
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (C.C., M.H.-G., M.S., P.D., A.B., T.G.-B., M.M., J.M., I.F.-C.), Universitat Autònoma de Barcelona.,Neurovascular Research Laboratory, Institute of Biomedicine of Seville, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla (J. Montaner).,Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla (J. Montaner)
| | - Jaume Roquer
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., N.S.R.).,Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA (J.R., C.G.-F.).,Center for Genomic Medicine, Massachusetts General Hospital, Boston (J.R., C.G.F.)
| | - Jurek Krupinski
- Neurology Unit, Neuroscience Department, Mútua de Terrassa Hospital (J.K.)
| | - Xavier Estivill
- Research Department, Sidra Medicine, Doha, Qatar (X.E.).,Genomics Unit, Dexeus Woman's Health, Barcelona (X.E.)
| | | | - Cristòfol Vives-Bauzá
- Research Unit (A.M.-D., C.V.-B.), Son Espases University Hospital, Institut d'Investigació Sanitària de Les Illes Balears, Palma de Mallorca
| | - Israel Fernández-Cadenas
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (C.C., M.H.-G., M.S., P.D., A.B., T.G.-B., M.M., J.M., I.F.-C.), Universitat Autònoma de Barcelona.,Stroke Pharmacogenomics and Genetics Group, Fundació Docència i Recerca Mútua Terrassa (N.C., N.P.T.-A., E.M., I.F.-C.).,Stroke Pharmacogenomics and Genetics Group, Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona (I.F.-C.)
| | - Jordi Jiménez-Conde
- From the Department of Neurology, Neurovascular Research Group, Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra (M.M.-C., C.S.-T., E.G.-S., A.R.-C., A.O., E.C.-G., R.M.V.-H., J.R., J.J.-C.)
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19
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Torres-Aguila NP, Carrera C, Giese AK, Cullell N, Muiño E, Cárcel-Márquez J, Gallego-Fabrega C, González-Sánchez J, Del Mar Freijo M, Álvarez-Sabín J, Molina C, Ribó M, Jimenez-Conde J, Roquer J, Sobrino T, Campos F, Castillo J, Muñoz-Narbona L, Lopez-Cancio E, Dàvalos A, Diaz-Navarro R, Tur S, Vives-Bauza C, Serrano-Heras G, Segura T, Krupinski J, Delgado-Mederos R, Martí-Fàbregas J, Heitsch L, Ibañez L, Cruchaga C, Rost NS, Montaner J, Lee JM, Fernandez-Cadenas I. Genome-Wide Association Study of White Blood Cell Counts in Patients With Ischemic Stroke. Stroke 2019; 50:3618-3621. [PMID: 31587654 DOI: 10.1161/strokeaha.119.026593] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 12/11/2022]
Abstract
Background and Purpose- Immune cells play a key role in the first 24h poststroke (acute phase), being associated with stroke outcome. We aimed to find genetic risk factors associated with leukocyte counts during the acute phase of stroke. Methods- Ischemic stroke patients with leukocyte counts data during the first 24h were included. Genome-wide association study and gene expression studies were performed. Results- Our genome-wide association study, which included 2064 (Discovery) and 407 (Replication) patients, revealed a new locus (14q24.3) associated with leukocyte counts. After Joint analysis (n=2471) 5 more polymorphisms reached genome-wide significance (P<5×10-8). The 14q24.3 locus was associated with acute stroke outcome (rs112809786, P=0.036) and with ACOT1 and PTGR2 gene expression. Previous polymorphisms associated with leukocyte counts in general-population did not show any significance in our study. Conclusions- We have found the first locus associated with leukocyte counts in ischemic stroke, also associated with acute outcome. Genetic analysis of acute endophenotypes could be useful to find the genetic factors associated with stroke outcome. Our findings suggested a different modulation of immune cells in stroke compared with healthy conditions.
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Affiliation(s)
- Nuria P Torres-Aguila
- From the Stroke Pharmacogenomics and Genetics Laboratory, Hospital de la Santa Creu i Sant Pau Research Institute, Barcelona Spain (N.P.T.-A., E.M., J.C.-M., C.G.-F., J.G.-S., I.F.-C.).,Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Barcelona, Spain (N.P.T.-A., C.C., J.M.)
| | - Caty Carrera
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Barcelona, Spain (N.P.T.-A., C.C., J.M.)
| | - Anne-Katrine Giese
- Neurology Department, Massachusetts General Hospital, Boston (A.-K.G., N.S.R.)
| | - Natalia Cullell
- Stroke Pharmacogenomics and Genetics Laboratory, Fundació Mútua Terrasa, Hospital Universitari Mútua Terrassa, Spain (N.C., C.G.-F., J.G.-S.)
| | - Elena Muiño
- From the Stroke Pharmacogenomics and Genetics Laboratory, Hospital de la Santa Creu i Sant Pau Research Institute, Barcelona Spain (N.P.T.-A., E.M., J.C.-M., C.G.-F., J.G.-S., I.F.-C.)
| | - Jara Cárcel-Márquez
- From the Stroke Pharmacogenomics and Genetics Laboratory, Hospital de la Santa Creu i Sant Pau Research Institute, Barcelona Spain (N.P.T.-A., E.M., J.C.-M., C.G.-F., J.G.-S., I.F.-C.)
| | - Cristina Gallego-Fabrega
- From the Stroke Pharmacogenomics and Genetics Laboratory, Hospital de la Santa Creu i Sant Pau Research Institute, Barcelona Spain (N.P.T.-A., E.M., J.C.-M., C.G.-F., J.G.-S., I.F.-C.).,Stroke Pharmacogenomics and Genetics Laboratory, Fundació Mútua Terrasa, Hospital Universitari Mútua Terrassa, Spain (N.C., C.G.-F., J.G.-S.)
| | - Jonathan González-Sánchez
- From the Stroke Pharmacogenomics and Genetics Laboratory, Hospital de la Santa Creu i Sant Pau Research Institute, Barcelona Spain (N.P.T.-A., E.M., J.C.-M., C.G.-F., J.G.-S., I.F.-C.).,Stroke Pharmacogenomics and Genetics Laboratory, Fundació Mútua Terrasa, Hospital Universitari Mútua Terrassa, Spain (N.C., C.G.-F., J.G.-S.).,School of Healthcare Science, Manchester Metropolitan University, Manchester, United Kingdom (J.G.-S., J.K.)
| | | | - José Álvarez-Sabín
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (J.Á.-S., C.M., M.R.)
| | - Carlos Molina
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (J.Á.-S., C.M., M.R.)
| | - Marc Ribó
- Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain (J.Á.-S., C.M., M.R.)
| | - Jordi Jimenez-Conde
- Neurology Department, Institut Hospital del Mar d'Investigacions Mèdiques-Hospital del Mar Barcelona, Spain (J.J.-C., J.R.).,Neurovascular Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (J.J.-C., J.R.).,Universitat Autónoma de Barcelona/Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.)
| | - Jaume Roquer
- Neurology Department, Institut Hospital del Mar d'Investigacions Mèdiques-Hospital del Mar Barcelona, Spain (J.J.-C., J.R.).,Neurovascular Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (J.J.-C., J.R.).,Universitat Autónoma de Barcelona/Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.)
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratory, Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain (T.S., F.C., J.C.)
| | - Francisco Campos
- Clinical Neurosciences Research Laboratory, Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain (T.S., F.C., J.C.)
| | - José Castillo
- Clinical Neurosciences Research Laboratory, Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain (T.S., F.C., J.C.)
| | - Lucia Muñoz-Narbona
- Neurosciences Department, Hospital Germans Trias I Pujol-Universitat Autónoma de Barcelona, Barcelona, Spain (L.M.-N., A.D.)
| | - Elena Lopez-Cancio
- Stroke Unit, Hospital Universitario Central de Asturias, Oviedo, Spain (E.L.-C.)
| | - Antoni Dàvalos
- Neurosciences Department, Hospital Germans Trias I Pujol-Universitat Autónoma de Barcelona, Barcelona, Spain (L.M.-N., A.D.)
| | - Rosa Diaz-Navarro
- Neuroscience Laboratory, Fundació Institut d'Investigació Sanitària Illes Balears, Mallorca, Spain (R.D.-N., S.T., C.V.-B.)
| | - Silvia Tur
- Neuroscience Laboratory, Fundació Institut d'Investigació Sanitària Illes Balears, Mallorca, Spain (R.D.-N., S.T., C.V.-B.)
| | - Cristòfol Vives-Bauza
- Neuroscience Laboratory, Fundació Institut d'Investigació Sanitària Illes Balears, Mallorca, Spain (R.D.-N., S.T., C.V.-B.)
| | - Gemma Serrano-Heras
- Neurology Department, University Hospital of Albacete, Spain (G.S.-H., T.S.)
| | - Tomás Segura
- Neurology Department, University Hospital of Albacete, Spain (G.S.-H., T.S.)
| | - Jerzy Krupinski
- School of Healthcare Science, Manchester Metropolitan University, Manchester, United Kingdom (J.G.-S., J.K.).,Neurology Service, Hospital Universitari Mútua Terrassa, Spain (J.K.)
| | - Raquel Delgado-Mederos
- Stroke Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (R.D.-M., J.M.-F.)
| | - Joan Martí-Fàbregas
- Stroke Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (R.D.-M., J.M.-F.)
| | - Laura Heitsch
- Emergency Medicine (L.H.), Washington University School of Medicine, Saint Louis, MO.,Neurology Department (L.H., J.-M.L.), Washington University School of Medicine, Saint Louis, MO
| | - Laura Ibañez
- Psychiatry Department (L.I., C.C.), Washington University School of Medicine, Saint Louis, MO
| | - Carlos Cruchaga
- Psychiatry Department (L.I., C.C.), Washington University School of Medicine, Saint Louis, MO
| | - Natalia S Rost
- Neurology Department, Massachusetts General Hospital, Boston (A.-K.G., N.S.R.)
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Barcelona, Spain (N.P.T.-A., C.C., J.M.).,Stroke Research Program, Instituto de Biomedicina de Sevilla/Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/University of Seville (J.M.).,Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain (J.M.)
| | - Jin-Moo Lee
- Neurology Department (L.H., J.-M.L.), Washington University School of Medicine, Saint Louis, MO
| | - Israel Fernandez-Cadenas
- From the Stroke Pharmacogenomics and Genetics Laboratory, Hospital de la Santa Creu i Sant Pau Research Institute, Barcelona Spain (N.P.T.-A., E.M., J.C.-M., C.G.-F., J.G.-S., I.F.-C.)
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20
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Torres-Aguila NP, Carrera C, Muiño E, Cullell N, Cárcel-Márquez J, Gallego-Fabrega C, González-Sánchez J, Bustamante A, Delgado P, Ibañez L, Heitsch L, Krupinski J, Montaner J, Martí-Fàbregas J, Cruchaga C, Lee JM, Fernandez-Cadenas I. Clinical Variables and Genetic Risk Factors Associated with the Acute Outcome of Ischemic Stroke: A Systematic Review. J Stroke 2019; 21:276-289. [PMID: 31590472 PMCID: PMC6780022 DOI: 10.5853/jos.2019.01522] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 06/12/2019] [Accepted: 08/28/2019] [Indexed: 12/19/2022] Open
Abstract
Stroke is a complex disease and one of the main causes of morbidity and mortality among the adult population. A huge variety of factors is known to influence patient outcome, including demographic variables, comorbidities or genetics. In this review, we expound what is known about the influence of clinical variables and related genetic risk factors on ischemic stroke outcome, focusing on acute and subacute outcome (within 24 to 48 hours after stroke and until day 10, respectively), as they are the first indicators of stroke damage. We searched the PubMed data base for articles that investigated the interaction between clinical variables or genetic factors and acute or subacute stroke outcome. A total of 61 studies were finally included in this review. Regarding the data collected, the variables consistently associated with acute stroke outcome are: glucose levels, blood pressure, presence of atrial fibrillation, prior statin treatment, stroke severity, type of acute treatment performed, severe neurological complications, leukocyte levels, and genetic risk factors. Further research and international efforts are required in this field, which should include genome-wide association studies.
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Affiliation(s)
- Nuria P Torres-Aguila
- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain.,Neurovascular Research Laboratory, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - Caty Carrera
- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain.,Neurovascular Research Laboratory, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - Elena Muiño
- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain
| | - Natalia Cullell
- Stroke Pharmacogenomics and Genetics Laboratory, Mutua Terrasa Foundation of Teaching and Research, Mutua Terrassa Hospital, Terrassa, Spain
| | - Jara Cárcel-Márquez
- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain
| | - Cristina Gallego-Fabrega
- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain.,Stroke Pharmacogenomics and Genetics Laboratory, Mutua Terrasa Foundation of Teaching and Research, Mutua Terrassa Hospital, Terrassa, Spain
| | - Jonathan González-Sánchez
- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain.,Stroke Pharmacogenomics and Genetics Laboratory, Mutua Terrasa Foundation of Teaching and Research, Mutua Terrassa Hospital, Terrassa, Spain.,Health Care Science Department, The Manchester Metropolitan University of All Saints, Manchester, UK
| | - Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - Pilar Delgado
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - Laura Ibañez
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Laura Heitsch
- Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jerzy Krupinski
- Stroke Pharmacogenomics and Genetics Laboratory, Mutua Terrasa Foundation of Teaching and Research, Mutua Terrassa Hospital, Terrassa, Spain.,Health Care Science Department, The Manchester Metropolitan University of All Saints, Manchester, UK
| | - Joan Montaner
- Department of Neurology, Virgin Rocío and Macarena Hospitals, Institute of Biomedicine of Seville (IBiS), Seville, Spain
| | - Joan Martí-Fàbregas
- Stroke Unit, Department of Neurology, Saint Cross and Saint Pau Hospital, Barcelona, Spain
| | - Carlos Cruchaga
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
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- Stroke Pharmacogenomics and Genetics Laboratory, Sant Pau Research Institute, Barcelona, Spain
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21
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Carrera C, Jiménez-Conde J, Derdak S, Rabionet K, Vives-Bauzá C, Soriano-Tárrega C, Giralt-Steinhauer E, Mola-Caminal M, Diaz-Navarro RM, Tur S, Muiño E, Gallego-Fabrega C, Beltran S, Roquer J, Ruiz A, Sotolongo-Grau O, Krupinski J, Lee JM, Cruchaga C, Delgado P, Malik R, Worrall BB, Seshadri S, Montaner J, Fernández-Cadenas I. Whole exome sequencing analysis reveals TRPV3 as a risk factor for cardioembolic stroke/subtitle. Thromb Haemost 2018; 116:1165-1171. [DOI: 10.1160/th16-02-0113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 08/15/2016] [Indexed: 12/12/2022]
Abstract
SummaryGenetic studies suggest that hundreds of genes associated with stroke remain unidentified. Exome sequencing proves useful for finding new genes associated with stroke. We aimed to find new genetic risk factors for cardioembolic stroke by analysing exome sequence data using new strategies. For discovery, we analysed 42 cardioembolic stroke cases and controls with extreme phenotypes (cohort 1), and for replication, 32 cardioembolic stroke cases and controls (cohort 2) using the SeqCapExome capture kit. We then analysed the replicated genes in two new cohorts that comprised 834 cardioembolic strokes and controls (cohort 3) and 64,373 cardioembolic strokes and controls (cohort 4). Transcriptomic in-silico functional analyses were also performed. We found 26 coding regions with a higher frequency of mutations in cardioembolic strokes after correcting for the number of mutations found in the whole exome of every patient. The TRPV3 gene was associated with cardioembolic stroke after replication of exome sequencing analysis (p-value-discovery: 0.018, p-value-replication: 0.014). The analysis of the TRPV3 gene using polymorphisms in cohort 3 and 4 revealed two polymorphisms associated with cardioembolic stroke in both cohorts, the most significant polymorphism being rs151091899 (p-value: 3.1 × 10−05; odds ratio: 5.4) in cohort 3. The genotype of one polymorphism of TRPV3 was associated with a differential expression of genes linked to cardiac malformations. In conclusion, new strategies using exome sequence data have revealed TRPV3 as a new gene associated with cardioembolic stroke. This strategy among others might be useful in finding new genes associated with complex genetic diseases.
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22
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Crawford KM, Gallego-Fabrega C, Kourkoulis C, Miyares L, Marini S, Flannick J, Burtt NP, von Grotthuss M, Alexander B, Costanzo MC, Vaishnav NH, Malik R, Hall JL, Chong M, Rosand J, Falcone GJ. Cerebrovascular Disease Knowledge Portal: An Open-Access Data Resource to Accelerate Genomic Discoveries in Stroke. Stroke 2018; 49:470-475. [PMID: 29335331 DOI: 10.1161/strokeaha.117.018922] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/16/2017] [Accepted: 12/06/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Katherine M Crawford
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Cristina Gallego-Fabrega
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Christina Kourkoulis
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Laura Miyares
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Sandro Marini
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Jason Flannick
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Noel P Burtt
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Marcin von Grotthuss
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Benjamin Alexander
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Maria C Costanzo
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Neil H Vaishnav
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Rainer Malik
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Jennifer L Hall
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Michael Chong
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
| | - Jonathan Rosand
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.).
| | - Guido J Falcone
- From the Center for Genomic Medicine (K.C., C.G.-F., C.K., S.M., N.V., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (J.R.), and J. Philip Kistler Stroke Research Center (J.R.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (K.C., C.G.-F., C.K., S.M., J.F., N.B., M.v.G., B.A., M.C., N.V., J.R., G.J.F.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (L.M., G.J.F.); Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany (R.M.); Institute for Precision Cardiovascular Medicine, American Heart Association National Center, Dallas, TX (J.L.H.); Department of Medicine, Lillehei Heart Institute, University of Minnesota, Minneapolis (J.L.H.); and McMaster University, Hamilton, Ontario, Canada (M.C.)
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Muiño E, Gallego-Fabrega C, Cullell N, Carrera C, Torres N, Krupinski J, Roquer J, Montaner J, Fernández-Cadenas I. Systematic Review of Cysteine-Sparing NOTCH3 Missense Mutations in Patients with Clinical Suspicion of CADASIL. Int J Mol Sci 2017; 18:E1964. [PMID: 28902129 PMCID: PMC5618613 DOI: 10.3390/ijms18091964] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [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: 07/27/2017] [Revised: 09/07/2017] [Accepted: 09/10/2017] [Indexed: 11/25/2022] Open
Abstract
CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is caused by mutations in the NOTCH3 gene, affecting the number of cysteines in the extracellular domain of the receptor, causing protein misfolding and receptor aggregation. The pathogenic role of cysteine-sparing NOTCH3 missense mutations in patients with typical clinical CADASIL syndrome is unknown. The aim of this article is to describe these mutations to clarify if any could be potentially pathogenic. Articles on cysteine-sparing NOTCH3 missense mutations in patients with clinical suspicion of CADASIL were reviewed. Mutations were considered potentially pathogenic if patients had: (a) typical clinical CADASIL syndrome; (b) diffuse white matter hyperintensities; (c) the 33 NOTCH3 exons analyzed; (d) mutations that were not polymorphisms; and (e) Granular osmiophilic material (GOM) deposits in the skin biopsy. Twenty-five different mutations were listed. Four fulfill the above criteria: p.R61W; p.R75P; p.D80G; and p.R213K. Patients carrying these mutations had typical clinical CADASIL syndrome and diffuse white matter hyperintensities, mostly without anterior temporal pole involvement. Cysteine-sparing NOTCH3 missense mutations are associated with typical clinical CADASIL syndrome and typical magnetic resonance imaging (MRI) findings, although with less involvement of the anterior temporal lobe. Hence, these mutations should be further studied to confirm their pathological role in CADASIL.
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Affiliation(s)
- Elena Muiño
- Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mútua Terrassa, Hospital Mútua de Terrassa, 08221 Terrassa, Spain.
| | - Cristina Gallego-Fabrega
- Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mútua Terrassa, Hospital Mútua de Terrassa, 08221 Terrassa, Spain.
| | - Natalia Cullell
- Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mútua Terrassa, Hospital Mútua de Terrassa, 08221 Terrassa, Spain.
| | - Caty Carrera
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Hospital Vall d'Hebron, 08035 Barcelona, Spain; (C.C.).
| | - Nuria Torres
- Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mútua Terrassa, Hospital Mútua de Terrassa, 08221 Terrassa, Spain.
| | - Jurek Krupinski
- Neurology Service, Hospital Mútua de Terrassa, 08221 Terrassa, Spain.
| | - Jaume Roquer
- Neurology Service, Institut Hospital del Mar d'investigacions Mèdiques, IMIM-Hospital del Mar, 08003 Barcelona, Spain.
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Hospital Vall d'Hebron, 08035 Barcelona, Spain; (C.C.).
| | - Israel Fernández-Cadenas
- Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mútua Terrassa, Hospital Mútua de Terrassa, 08221 Terrassa, Spain.
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Fernández-Cadenas I, Mendióroz M, Giralt D, Nafria C, Garcia E, Carrera C, Gallego-Fabrega C, Domingues-Montanari S, Delgado P, Ribó M, Castellanos M, Martínez S, Freijo M, Jiménez-Conde J, Rubiera M, Alvarez-Sabín J, Molina CA, Font MA, Grau Olivares M, Palomeras E, Perez de la Ossa N, Martinez-Zabaleta M, Masjuan J, Moniche F, Canovas D, Piñana C, Purroy F, Cocho D, Navas I, Tejero C, Aymerich N, Cullell N, Muiño E, Serena J, Rubio F, Davalos A, Roquer J, Arenillas JF, Martí-Fábregas J, Keene K, Chen WM, Worrall B, Sale M, Arboix A, Krupinski J, Montaner J. GRECOS Project (Genotyping Recurrence Risk of Stroke): The Use of Genetics to Predict the Vascular Recurrence After Stroke. Stroke 2017; 48:1147-1153. [PMID: 28411264 DOI: 10.1161/strokeaha.116.014322] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 01/26/2017] [Accepted: 02/07/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Vascular recurrence occurs in 11% of patients during the first year after ischemic stroke (IS) or transient ischemic attack. Clinical scores do not predict the whole vascular recurrence risk; therefore, we aimed to find genetic variants associated with recurrence that might improve the clinical predictive models in IS. METHODS We analyzed 256 polymorphisms from 115 candidate genes in 3 patient cohorts comprising 4482 IS or transient ischemic attack patients. The discovery cohort was prospectively recruited and included 1494 patients, 6.2% of them developed a new IS during the first year of follow-up. Replication analysis was performed in 2988 patients using SNPlex or HumanOmni1-Quad technology. We generated a predictive model using Cox regression (GRECOS score [Genotyping Reurrence Risk of Stroke]) and generated risk groups using a classification tree method. RESULTS The analyses revealed that rs1800801 in the MGP gene (hazard ratio, 1.33; P=9×10-03), a gene related to artery calcification, was associated with new IS during the first year of follow-up. This polymorphism was replicated in a Spanish cohort (n=1.305); however, it was not significantly associated in a North American cohort (n=1.683). The GRECOS score predicted new IS (P=3.2×10-09) and could classify patients, from low risk of stroke recurrence (1.9%) to high risk (12.6%). Moreover, the addition of genetic risk factors to the GRECOS score improves the prediction compared with previous Stroke Prognosis Instrument-II score (P=0.03). CONCLUSIONS The use of genetics could be useful to estimate vascular recurrence risk after IS. Genetic variability in the MGP gene was associated with vascular recurrence in the Spanish population.
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Affiliation(s)
- Israel Fernández-Cadenas
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville.
| | - Maite Mendióroz
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Dolors Giralt
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Cristina Nafria
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Elena Garcia
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Caty Carrera
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Cristina Gallego-Fabrega
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Sophie Domingues-Montanari
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Pilar Delgado
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Marc Ribó
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Mar Castellanos
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Sergi Martínez
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Marimar Freijo
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Jordi Jiménez-Conde
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Marta Rubiera
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - José Alvarez-Sabín
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Carlos A Molina
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Maria Angels Font
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Marta Grau Olivares
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Ernest Palomeras
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Natalia Perez de la Ossa
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Maite Martinez-Zabaleta
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Jaime Masjuan
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Francisco Moniche
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - David Canovas
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Carlos Piñana
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Francisco Purroy
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Dolores Cocho
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Inma Navas
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Carlos Tejero
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Nuria Aymerich
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Natalia Cullell
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Elena Muiño
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Joaquín Serena
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Francisco Rubio
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Antoni Davalos
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Jaume Roquer
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Juan Francisco Arenillas
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Joan Martí-Fábregas
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Keith Keene
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Wei-Min Chen
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Bradford Worrall
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Michele Sale
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Adrià Arboix
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Jerzy Krupinski
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
| | - Joan Montaner
- From the Stroke Pharmacogenomics and Genetics, Fundacio Docència i Recerca MutuaTerrassa, Spain (I.F.-C., E.G., C.G.-F., N.C., E.M.); Neurovascular Research Laboratory and Neurovascular Unit, Neurology and Medicine Departments-Universitat Autònoma de Barcelona (I.F.-C., M.M., D.G., C.N., C.C., S.D.-M., P.D., J.M.) and Neurology Department (M.Ribó, M.Rubiera, J.A.-S., C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; Neuroepigenetics Research Group, Navarrabiomed, Pamplona, Spain (M.M.); Department of Neurology, Hospital Universitari Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona, Spain (M.C., J.S.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (S.M., J.M.-F.); Department of Neurology, Hospital de Basurto, Bilbao, Spain (M.F.); Department of Neurology, Hospital del Mar and Centre de Regulació Genòmica, Universitat Pompeu Fabra, Barcelona, Spain (J.J.-C., J.R.); Department of Neurology, Hospital de Bellvitge, Hospitalet del Llobregat, Spain (M.A.F., F.R.); Department of Neurology, Hospital Universitari Sagrat Cor, Barcelona, Spain (M.G.O., A.A.); Department of Neurology, Hospital de Mataró, Spain (E.P.); Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain (N.P.d.l.O., A.D.); Department of Neurology, Hospital Donostia, San Sebastián, Spain (M.M.-Z.); Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain (J.M.); Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain (F.M.); Department of Neurology, Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Department of Neurology, Hospital Universitario Virgen de las Nieves, Granada, Spain (C.P.); Department of Neurology, Hospital Universitario Arnau De Vilanova, Lleida, Spain (F.P.); Department of Neurology, Hospital de Granollers, Spain (D.C.); Department of Neurology, Hospital Mútua de Terrassa, Spain (I.N., J.K.); Department of Neurology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain (C.T.); Department of Neurology, Hospital De Navarra, Pamplona, Spain (N.A.); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (J.F.A.); Department of Biology, Center for Health Disparities, East Carolina University, Greenville, North Carolina (K.K.); Department of Public Health Sciences, Center for Public Health Genomics (W.-M.C.); Departments of Neurology (B.W.), Public Health Sciences (B.W., M.S.), and Biochemistry and Molecular Genetics (M.S.), and Center for Public Health Genomics (M.S.), University of Virginia, Charlottesville
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Gallego-Fabrega C, Carrera C, Reny JL, Fontana P, Slowik A, Pera J, Pezzini A, Serrano-Heras G, Segura T, Bin Dukhyil AAA, Martí-Fàbregas J, Muiño E, Cullell N, Montaner J, Krupinski J, Fernandez-Cadenas I. PPM1A Methylation Is Associated With Vascular Recurrence in Aspirin-Treated Patients. Stroke 2016; 47:1926-9. [PMID: 27301936 DOI: 10.1161/strokeaha.116.013340] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/17/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Despite great efforts by pharmacogenetic studies, the causes of aspirin failure to prevent the recurrence of ischemic events remain unclear. Our aim was to study whether epigenetics could be associated with the risk of vascular recurrence in aspirin-treated stroke patients. METHODS We performed an epigenetic joint analysis study in 327 patients treated with aspirin. In the discovery stage, we performed a nested case-control study in 38 matched ischemic stroke patients in whom 450 000 methylation sites were analyzed. Nineteen patients presented vascular recurrence after stroke, and 19 matched patients did not present vascular recurrence during the first year of follow-up. In a second stage, 289 new patients were analyzed by EpiTYPER. RESULTS The following 3 differentially methylated candidate CpG sites, were identified in the discovery stage and analyzed in the second stage: cg26039762 (P=9.69×10(-06), RAF1), cg04985020 (P=3.47×10(-03), PPM1A), and cg08419850 (P=3.47×10(-03), KCNQ1). Joint analysis identified an epigenome-wide association for cg04985020 (PPM1A; P=1.78×10(-07)), with vascular recurrence in patients treated with aspirin. CONCLUSIONS The pattern of differential methylation in PPM1A is associated with vascular recurrence in aspirin-treated stroke patients.
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Affiliation(s)
- Cristina Gallego-Fabrega
- From the Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca MutuaTerrassa, Hospital Mútua de Terrassa, Terrassa, Spain (C.G.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Barcelona, Spain (C.C., J.M.); Division of Internal Medicine and Rehabilitation (J.-L.R.) and Division of Angiology and Haemostasis (P.F.), Geneva University Hospitals, Switzerland; Geneva Platelet Group, Faculty of Medicine, Geneva, Switzerland (J.-L.R., P.F.); Department of Neurology, Jagiellonian University Medical College, Krakow, Poland (A.S., J.P.); Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy (A.P.); Neurology Department, Albacete Hospital, Albacete, Spain (G.S.-H., T.S.); College of Applied Medical Sciences, Majmaah University, Saudi Arabia (A.-A.A.B.D.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain (J.M.-F.); Neurology Service, Hospital Universitari Mútua Terrassa, Terrasa, Spain (J.K.); and School of Healthcare Science, Manchester Metropolitan University, Manchester, UK (J.K.)
| | - Caty Carrera
- From the Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca MutuaTerrassa, Hospital Mútua de Terrassa, Terrassa, Spain (C.G.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Barcelona, Spain (C.C., J.M.); Division of Internal Medicine and Rehabilitation (J.-L.R.) and Division of Angiology and Haemostasis (P.F.), Geneva University Hospitals, Switzerland; Geneva Platelet Group, Faculty of Medicine, Geneva, Switzerland (J.-L.R., P.F.); Department of Neurology, Jagiellonian University Medical College, Krakow, Poland (A.S., J.P.); Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy (A.P.); Neurology Department, Albacete Hospital, Albacete, Spain (G.S.-H., T.S.); College of Applied Medical Sciences, Majmaah University, Saudi Arabia (A.-A.A.B.D.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain (J.M.-F.); Neurology Service, Hospital Universitari Mútua Terrassa, Terrasa, Spain (J.K.); and School of Healthcare Science, Manchester Metropolitan University, Manchester, UK (J.K.)
| | - Jean-Luc Reny
- From the Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca MutuaTerrassa, Hospital Mútua de Terrassa, Terrassa, Spain (C.G.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Barcelona, Spain (C.C., J.M.); Division of Internal Medicine and Rehabilitation (J.-L.R.) and Division of Angiology and Haemostasis (P.F.), Geneva University Hospitals, Switzerland; Geneva Platelet Group, Faculty of Medicine, Geneva, Switzerland (J.-L.R., P.F.); Department of Neurology, Jagiellonian University Medical College, Krakow, Poland (A.S., J.P.); Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy (A.P.); Neurology Department, Albacete Hospital, Albacete, Spain (G.S.-H., T.S.); College of Applied Medical Sciences, Majmaah University, Saudi Arabia (A.-A.A.B.D.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain (J.M.-F.); Neurology Service, Hospital Universitari Mútua Terrassa, Terrasa, Spain (J.K.); and School of Healthcare Science, Manchester Metropolitan University, Manchester, UK (J.K.)
| | - Pierre Fontana
- From the Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca MutuaTerrassa, Hospital Mútua de Terrassa, Terrassa, Spain (C.G.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Barcelona, Spain (C.C., J.M.); Division of Internal Medicine and Rehabilitation (J.-L.R.) and Division of Angiology and Haemostasis (P.F.), Geneva University Hospitals, Switzerland; Geneva Platelet Group, Faculty of Medicine, Geneva, Switzerland (J.-L.R., P.F.); Department of Neurology, Jagiellonian University Medical College, Krakow, Poland (A.S., J.P.); Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy (A.P.); Neurology Department, Albacete Hospital, Albacete, Spain (G.S.-H., T.S.); College of Applied Medical Sciences, Majmaah University, Saudi Arabia (A.-A.A.B.D.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain (J.M.-F.); Neurology Service, Hospital Universitari Mútua Terrassa, Terrasa, Spain (J.K.); and School of Healthcare Science, Manchester Metropolitan University, Manchester, UK (J.K.)
| | - Agnieszka Slowik
- From the Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca MutuaTerrassa, Hospital Mútua de Terrassa, Terrassa, Spain (C.G.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Barcelona, Spain (C.C., J.M.); Division of Internal Medicine and Rehabilitation (J.-L.R.) and Division of Angiology and Haemostasis (P.F.), Geneva University Hospitals, Switzerland; Geneva Platelet Group, Faculty of Medicine, Geneva, Switzerland (J.-L.R., P.F.); Department of Neurology, Jagiellonian University Medical College, Krakow, Poland (A.S., J.P.); Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy (A.P.); Neurology Department, Albacete Hospital, Albacete, Spain (G.S.-H., T.S.); College of Applied Medical Sciences, Majmaah University, Saudi Arabia (A.-A.A.B.D.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain (J.M.-F.); Neurology Service, Hospital Universitari Mútua Terrassa, Terrasa, Spain (J.K.); and School of Healthcare Science, Manchester Metropolitan University, Manchester, UK (J.K.)
| | - Joanna Pera
- From the Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca MutuaTerrassa, Hospital Mútua de Terrassa, Terrassa, Spain (C.G.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Barcelona, Spain (C.C., J.M.); Division of Internal Medicine and Rehabilitation (J.-L.R.) and Division of Angiology and Haemostasis (P.F.), Geneva University Hospitals, Switzerland; Geneva Platelet Group, Faculty of Medicine, Geneva, Switzerland (J.-L.R., P.F.); Department of Neurology, Jagiellonian University Medical College, Krakow, Poland (A.S., J.P.); Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy (A.P.); Neurology Department, Albacete Hospital, Albacete, Spain (G.S.-H., T.S.); College of Applied Medical Sciences, Majmaah University, Saudi Arabia (A.-A.A.B.D.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain (J.M.-F.); Neurology Service, Hospital Universitari Mútua Terrassa, Terrasa, Spain (J.K.); and School of Healthcare Science, Manchester Metropolitan University, Manchester, UK (J.K.)
| | - Alessandro Pezzini
- From the Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca MutuaTerrassa, Hospital Mútua de Terrassa, Terrassa, Spain (C.G.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Barcelona, Spain (C.C., J.M.); Division of Internal Medicine and Rehabilitation (J.-L.R.) and Division of Angiology and Haemostasis (P.F.), Geneva University Hospitals, Switzerland; Geneva Platelet Group, Faculty of Medicine, Geneva, Switzerland (J.-L.R., P.F.); Department of Neurology, Jagiellonian University Medical College, Krakow, Poland (A.S., J.P.); Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy (A.P.); Neurology Department, Albacete Hospital, Albacete, Spain (G.S.-H., T.S.); College of Applied Medical Sciences, Majmaah University, Saudi Arabia (A.-A.A.B.D.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain (J.M.-F.); Neurology Service, Hospital Universitari Mútua Terrassa, Terrasa, Spain (J.K.); and School of Healthcare Science, Manchester Metropolitan University, Manchester, UK (J.K.)
| | - Gemma Serrano-Heras
- From the Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca MutuaTerrassa, Hospital Mútua de Terrassa, Terrassa, Spain (C.G.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Barcelona, Spain (C.C., J.M.); Division of Internal Medicine and Rehabilitation (J.-L.R.) and Division of Angiology and Haemostasis (P.F.), Geneva University Hospitals, Switzerland; Geneva Platelet Group, Faculty of Medicine, Geneva, Switzerland (J.-L.R., P.F.); Department of Neurology, Jagiellonian University Medical College, Krakow, Poland (A.S., J.P.); Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy (A.P.); Neurology Department, Albacete Hospital, Albacete, Spain (G.S.-H., T.S.); College of Applied Medical Sciences, Majmaah University, Saudi Arabia (A.-A.A.B.D.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain (J.M.-F.); Neurology Service, Hospital Universitari Mútua Terrassa, Terrasa, Spain (J.K.); and School of Healthcare Science, Manchester Metropolitan University, Manchester, UK (J.K.)
| | - Tomás Segura
- From the Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca MutuaTerrassa, Hospital Mútua de Terrassa, Terrassa, Spain (C.G.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Barcelona, Spain (C.C., J.M.); Division of Internal Medicine and Rehabilitation (J.-L.R.) and Division of Angiology and Haemostasis (P.F.), Geneva University Hospitals, Switzerland; Geneva Platelet Group, Faculty of Medicine, Geneva, Switzerland (J.-L.R., P.F.); Department of Neurology, Jagiellonian University Medical College, Krakow, Poland (A.S., J.P.); Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy (A.P.); Neurology Department, Albacete Hospital, Albacete, Spain (G.S.-H., T.S.); College of Applied Medical Sciences, Majmaah University, Saudi Arabia (A.-A.A.B.D.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain (J.M.-F.); Neurology Service, Hospital Universitari Mútua Terrassa, Terrasa, Spain (J.K.); and School of Healthcare Science, Manchester Metropolitan University, Manchester, UK (J.K.)
| | - Abdul-Aziz A Bin Dukhyil
- From the Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca MutuaTerrassa, Hospital Mútua de Terrassa, Terrassa, Spain (C.G.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Barcelona, Spain (C.C., J.M.); Division of Internal Medicine and Rehabilitation (J.-L.R.) and Division of Angiology and Haemostasis (P.F.), Geneva University Hospitals, Switzerland; Geneva Platelet Group, Faculty of Medicine, Geneva, Switzerland (J.-L.R., P.F.); Department of Neurology, Jagiellonian University Medical College, Krakow, Poland (A.S., J.P.); Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy (A.P.); Neurology Department, Albacete Hospital, Albacete, Spain (G.S.-H., T.S.); College of Applied Medical Sciences, Majmaah University, Saudi Arabia (A.-A.A.B.D.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain (J.M.-F.); Neurology Service, Hospital Universitari Mútua Terrassa, Terrasa, Spain (J.K.); and School of Healthcare Science, Manchester Metropolitan University, Manchester, UK (J.K.)
| | - Joan Martí-Fàbregas
- From the Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca MutuaTerrassa, Hospital Mútua de Terrassa, Terrassa, Spain (C.G.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Barcelona, Spain (C.C., J.M.); Division of Internal Medicine and Rehabilitation (J.-L.R.) and Division of Angiology and Haemostasis (P.F.), Geneva University Hospitals, Switzerland; Geneva Platelet Group, Faculty of Medicine, Geneva, Switzerland (J.-L.R., P.F.); Department of Neurology, Jagiellonian University Medical College, Krakow, Poland (A.S., J.P.); Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy (A.P.); Neurology Department, Albacete Hospital, Albacete, Spain (G.S.-H., T.S.); College of Applied Medical Sciences, Majmaah University, Saudi Arabia (A.-A.A.B.D.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain (J.M.-F.); Neurology Service, Hospital Universitari Mútua Terrassa, Terrasa, Spain (J.K.); and School of Healthcare Science, Manchester Metropolitan University, Manchester, UK (J.K.)
| | - Elena Muiño
- From the Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca MutuaTerrassa, Hospital Mútua de Terrassa, Terrassa, Spain (C.G.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Barcelona, Spain (C.C., J.M.); Division of Internal Medicine and Rehabilitation (J.-L.R.) and Division of Angiology and Haemostasis (P.F.), Geneva University Hospitals, Switzerland; Geneva Platelet Group, Faculty of Medicine, Geneva, Switzerland (J.-L.R., P.F.); Department of Neurology, Jagiellonian University Medical College, Krakow, Poland (A.S., J.P.); Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy (A.P.); Neurology Department, Albacete Hospital, Albacete, Spain (G.S.-H., T.S.); College of Applied Medical Sciences, Majmaah University, Saudi Arabia (A.-A.A.B.D.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain (J.M.-F.); Neurology Service, Hospital Universitari Mútua Terrassa, Terrasa, Spain (J.K.); and School of Healthcare Science, Manchester Metropolitan University, Manchester, UK (J.K.)
| | - Natalia Cullell
- From the Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca MutuaTerrassa, Hospital Mútua de Terrassa, Terrassa, Spain (C.G.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Barcelona, Spain (C.C., J.M.); Division of Internal Medicine and Rehabilitation (J.-L.R.) and Division of Angiology and Haemostasis (P.F.), Geneva University Hospitals, Switzerland; Geneva Platelet Group, Faculty of Medicine, Geneva, Switzerland (J.-L.R., P.F.); Department of Neurology, Jagiellonian University Medical College, Krakow, Poland (A.S., J.P.); Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy (A.P.); Neurology Department, Albacete Hospital, Albacete, Spain (G.S.-H., T.S.); College of Applied Medical Sciences, Majmaah University, Saudi Arabia (A.-A.A.B.D.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain (J.M.-F.); Neurology Service, Hospital Universitari Mútua Terrassa, Terrasa, Spain (J.K.); and School of Healthcare Science, Manchester Metropolitan University, Manchester, UK (J.K.)
| | - Joan Montaner
- From the Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca MutuaTerrassa, Hospital Mútua de Terrassa, Terrassa, Spain (C.G.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Barcelona, Spain (C.C., J.M.); Division of Internal Medicine and Rehabilitation (J.-L.R.) and Division of Angiology and Haemostasis (P.F.), Geneva University Hospitals, Switzerland; Geneva Platelet Group, Faculty of Medicine, Geneva, Switzerland (J.-L.R., P.F.); Department of Neurology, Jagiellonian University Medical College, Krakow, Poland (A.S., J.P.); Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy (A.P.); Neurology Department, Albacete Hospital, Albacete, Spain (G.S.-H., T.S.); College of Applied Medical Sciences, Majmaah University, Saudi Arabia (A.-A.A.B.D.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain (J.M.-F.); Neurology Service, Hospital Universitari Mútua Terrassa, Terrasa, Spain (J.K.); and School of Healthcare Science, Manchester Metropolitan University, Manchester, UK (J.K.)
| | - Jerzy Krupinski
- From the Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca MutuaTerrassa, Hospital Mútua de Terrassa, Terrassa, Spain (C.G.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Barcelona, Spain (C.C., J.M.); Division of Internal Medicine and Rehabilitation (J.-L.R.) and Division of Angiology and Haemostasis (P.F.), Geneva University Hospitals, Switzerland; Geneva Platelet Group, Faculty of Medicine, Geneva, Switzerland (J.-L.R., P.F.); Department of Neurology, Jagiellonian University Medical College, Krakow, Poland (A.S., J.P.); Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy (A.P.); Neurology Department, Albacete Hospital, Albacete, Spain (G.S.-H., T.S.); College of Applied Medical Sciences, Majmaah University, Saudi Arabia (A.-A.A.B.D.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain (J.M.-F.); Neurology Service, Hospital Universitari Mútua Terrassa, Terrasa, Spain (J.K.); and School of Healthcare Science, Manchester Metropolitan University, Manchester, UK (J.K.)
| | - Israel Fernandez-Cadenas
- From the Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca MutuaTerrassa, Hospital Mútua de Terrassa, Terrassa, Spain (C.G.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurovascular Research Laboratory, Vall d'Hebron Institute of Research, Universitat Autonoma de Barcelona, Barcelona, Spain (C.C., J.M.); Division of Internal Medicine and Rehabilitation (J.-L.R.) and Division of Angiology and Haemostasis (P.F.), Geneva University Hospitals, Switzerland; Geneva Platelet Group, Faculty of Medicine, Geneva, Switzerland (J.-L.R., P.F.); Department of Neurology, Jagiellonian University Medical College, Krakow, Poland (A.S., J.P.); Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy (A.P.); Neurology Department, Albacete Hospital, Albacete, Spain (G.S.-H., T.S.); College of Applied Medical Sciences, Majmaah University, Saudi Arabia (A.-A.A.B.D.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain (J.M.-F.); Neurology Service, Hospital Universitari Mútua Terrassa, Terrasa, Spain (J.K.); and School of Healthcare Science, Manchester Metropolitan University, Manchester, UK (J.K.).
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Gallego-Fabrega C, Carrera C, Reny JL, Fontana P, Slowik A, Pera J, Pezzini A, Serrano-Heras G, Segura T, Martí-Fàbregas J, Muiño E, Cullell N, Montaner J, Krupinski J, Fernandez-Cadenas I. TRAF3
Epigenetic Regulation Is Associated With Vascular Recurrence in Patients With Ischemic Stroke. Stroke 2016; 47:1180-6. [DOI: 10.1161/strokeaha.115.012237] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 03/01/2016] [Indexed: 01/25/2023]
Abstract
Background and Purpose—
Clopidogrel is one of the most used antiplatelet drugs in patients with cardiovascular disease. However, 16% to 50% of patients have a high on-clopidogrel platelet reactivity and an increased risk of ischemic events. The pathogenesis of high on-treatment platelet reactivity in patients with stroke is only partially explained by genetic variations. This study aims to find differentially methylated sites across the genome associated with vascular recurrence in ischemic stroke patients treated with clopidogrel.
Methods—
From a cohort of 1900 patients with ischemic stroke, we selected 42 patients treated with clopidogrel, including 21 with a recurrent vascular event and 21 without vascular recurrence during the first year of follow-up. Over 480 000 DNA methylation sites were analyzed across the genome. Differentially methylated CpG sites were identified by nonparametric testing using R. Replication analysis was performed in a new cohort of 191 subjects and results were correlated with platelet reactivity in a subset of 90 subjects using light transmission aggregometry.
Results—
A total of 73 differentially methylated CpG sites (
P
<1×10
−05
) were identified; 3 of them were selected for further replication: cg03548645 (
P
=1.42×10
−05
,
TRAF3
), cg09533145 (
P
=7.81×10
−06
,
ADAMTS2
), and cg15107336 (
P
=1.89×10
−05
,
XRCC1
). The cg03548645 CpG remained significant in the replication study (
P
=0.034), a deep analysis of this region revealed another methylation site associated with vascular recurrence,
P
=0.037. Lower cg03548645 (
TRAF3
) DNA methylation levels were correlated with an increased platelet aggregation (ρ=−0.29,
P
=0.0075).
Conclusions—
This study suggests for the first time that epigenetics may significantly contribute to the variability of clopidogrel response and recurrence of ischemic events in patients with stroke.
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Affiliation(s)
- Cristina Gallego-Fabrega
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Caty Carrera
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Jean-Luc Reny
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Pierre Fontana
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Agnieszka Slowik
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Joanna Pera
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Alessandro Pezzini
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Gemma Serrano-Heras
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Tomás Segura
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Joan Martí-Fàbregas
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Elena Muiño
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Natalia Cullell
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Joan Montaner
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Jerzy Krupinski
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
| | - Israel Fernandez-Cadenas
- From the Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Hospital Universitari Mútua de Terrassa, Terrassa (Barcelona), Spain (C.G.-F., J.M.-F., E.M., N.C., I.F.-C.); School of Medicine, University of Barcelona, Barcelona, Spain (C.G.-F.); Neurology Department, Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Hospital Vall d’Hebron, Barcelona, Spain (C.C., J.M.); Division of
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Gallego-Fabrega C, Krupinski J, Fernandez-Cadenas I. La resistencia en el tratamiento secundario del ictus isquémico, el componente genético en la respuesta a ácido acetilsalicílico y clopidogrel. Neurologia 2015; 30:566-73. [DOI: 10.1016/j.nrl.2013.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 11/20/2013] [Accepted: 11/28/2013] [Indexed: 02/08/2023] Open
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