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Hassan R, Cano J, Fronterre C, Bakhiet S, Fahal A, Deribe K, Newport M. Estimating the burden of mycetoma in Sudan for the period 1991-2018 using a model-based geostatistical approach. PLoS Negl Trop Dis 2022; 16:e0010795. [PMID: 36240229 PMCID: PMC9604875 DOI: 10.1371/journal.pntd.0010795] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 10/26/2022] [Accepted: 09/06/2022] [Indexed: 11/26/2022] Open
Abstract
Mycetoma is widespread in tropical and subtropical regions favouring arid areas with low humidity and a short rainy season. Sudan is one of the highly endemic countries for mycetoma. Estimating the population at risk and the number of cases is critical for delivering targeted and equitable prevention and treatment services. In this study, we have combined a large dataset of mycetoma cases recorded by the Mycetoma Research Centre (MRC) in Sudan over 28 years (1991-2018) with a collection of environmental and water and hygiene-related datasets in a geostatistical framework to produce estimates of the disease burden across the country. We developed geostatistical models to predict the number of cases of actinomycetoma and eumycetoma in areas considered environmentally suitable for the two mycetoma forms. Then used the raster dataset (gridded map) with the population estimates for 2020 to compute the potentially affected population since 1991. The geostatistical models confirmed this heterogeneous and distinct distribution of the estimated cases of eumycetoma and actinomycetoma across Sudan. For eumycetoma, these higher-risk areas were smaller and scattered across Al Jazirah, Khartoum, White Nile and Sennar states, while for actinomycetoma a higher risk for infection is shown across the rural districts of North and West Kurdufan. Nationally, we estimated 63,825 people (95%CI: 13,693 to 197,369) to have been suffering from mycetoma since 1991 in Sudan,51,541 people (95%CI: 9,893-166,073) with eumycetoma and 12,284 people (95%CI: 3,800-31,296) with actinomycetoma. In conclusion, the risk of mycetoma in Sudan is particularly high in certain restricted areas, but cases are ubiquitous across all states. Both prevention and treatment services are required to address the burden. Such work provides a guide for future control and prevention programs for mycetoma, highly endemic areas are clearly targeted, and resources are directed to areas with high demand.
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Affiliation(s)
- Rowa Hassan
- Mycetoma Research Centre, Soba University Hospital, University of Khartoum, Khartoum, Sudan
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, United Kingdom
- * E-mail: ,
| | - Jorge Cano
- Expanded Special Project for Elimination of Neglected Tropical Diseases, WHO Regional Office for Africa, Brazzaville, Democratic Republic of the Congo
| | - Claudio Fronterre
- Centre for health informatics, computing, and statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Sahar Bakhiet
- Mycetoma Research Centre, Soba University Hospital, University of Khartoum, Khartoum, Sudan
| | - Ahmed Fahal
- Mycetoma Research Centre, Soba University Hospital, University of Khartoum, Khartoum, Sudan
| | - Kebede Deribe
- Children’s Investment Fund Foundation, Addis Ababa, Ethiopia
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Melanie Newport
- Centre for health informatics, computing, and statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
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Hassan R, Deribe K, Simpson H, Bremner S, Elhadi O, Alnour M, Fahal AH, Newport M, Bakhiet S. Individual Risk Factors of Mycetoma Occurrence in Eastern Sennar Locality, Sennar State, Sudan: A Case-Control Study. Trop Med Infect Dis 2022; 7:tropicalmed7080174. [PMID: 36006266 PMCID: PMC9412883 DOI: 10.3390/tropicalmed7080174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
Mycetoma is a serious chronic subcutaneous granulomatous inflammatory disease that is endemic in tropical and subtropical regions, where it impacts profoundly on patients, families, and communities. Individual-level risk factors for the disease are poorly understood. To address this, a case-control study was conducted based on data collected from 60 villages in Eastern Sennar Locality, Sennar State, Sudan. Based on the presence of swelling in any part of the body, or sinus formation with or without grain discharge evident from the lesion by ultrasound examination, we diagnosed 359 cases of mycetoma. For each case, we included three healthy sex-matched persons, with no evidence of mycetoma, from the same village as the control group (n = 1077). The odds for mycetoma were almost three times higher in individuals in the age group 16–30 years (Adjusted Odds Ratio (AOR) = 2.804, 95% CI = 1.424–5.523) compared to those in age group ≤ 15 years. Other factors contributing to the odds of mycetoma were history of local trauma (AOR = 1.892, 95% CI = 1.425–2.513), being unmarried (AOR = 3.179, 95% CI = 2.339–4.20) and owning livestock (AOR = 3.941, 95% CI = 2.874–5.405). In conclusion, certain factors found to be associated with mycetoma in this study could inform a high index of suspicion for mycetoma diagnosis, which would improve early case detection. Other factors found to be associated could inform the development of an interventional program for mycetoma control in Sudan, including education on healthy farming practices and the risks of puncture wounds for individuals residing in endemic areas. However, this work was conducted in one endemic state, while mycetoma cases occur in all states of Sudan. Replicating this study over a wider area would give a fuller picture of the situation, providing the control program with more comprehensive information on the risk factors for the disease.
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Affiliation(s)
- Rowa Hassan
- Mycetoma Research Centre, Soba University Hospital, University of Khartoum, Khartoum 11111, Sudan
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton BN1 9PX, UK
- Correspondence:
| | - Kebede Deribe
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton BN1 9PX, UK
- Children’s Investment Fund Foundation, Addis Ababa P.O. Box 9086, Ethiopia
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia
| | - Hope Simpson
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Stephen Bremner
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton BN1 9PX, UK
| | - Osama Elhadi
- Mycetoma Research Centre, Soba University Hospital, University of Khartoum, Khartoum 11111, Sudan
| | - Mustafa Alnour
- Mycetoma Research Centre, Soba University Hospital, University of Khartoum, Khartoum 11111, Sudan
- Department of Radiography, Faculty of Medicine, University of Khartoum, Khartoum 11111, Sudan
| | - Ahmed Hassan Fahal
- Mycetoma Research Centre, Soba University Hospital, University of Khartoum, Khartoum 11111, Sudan
| | - Melanie Newport
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton BN1 9PX, UK
| | - Sahar Bakhiet
- Mycetoma Research Centre, Soba University Hospital, University of Khartoum, Khartoum 11111, Sudan
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Wonkam A, Bardien S, Diallo RN, Gaye A, Alimohamed MZ, Kya S, Makani J, Landoure G, Mutesa L, El-Kamah G, Mohamed A, Newport M, Williams SM, Ramsay M, Nembaware V. "Black Lives Matter and Black Research Matters": the African Society of Human Genetics' call to halt racism in science. Mol Biol Cell 2022; 33:vo2. [PMID: 35862495 DOI: 10.1091/mbc.e22-04-0122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The African Society of Human Genetics (AfSHG) was formed to provide a forum for human genetics and genomics scientists in Africa to interact, network, and collaborate. This is critical to facilitate development of solutions to the public health burden of many rare and common diseases across the continent. AfSHG fully supports the Black Lives Matter movement, which is dedicated to fighting racism and ensuring that society values the lives and humanity of Black people. The AfSHG would like to add its "voice" to the public outcry against racism sparked by George Floyd's death and to declare its commitment to ensuring that injustice and systematic racism, as well as abuse and exploitation of Africans and their biological material, are no longer tolerated. This is particularly relevant now as African genomic variation is poised to make significant contributions across several disciplines including ancestry, personalized medicine, and novel drug discovery. "Black Lives Matter and Black Research Matters" is AfSHG's call for the global community to support halting, and reversing, the perpetuation of exploitation of African people through neocolonial malpractices in genomic research. We also propose five key ways to curb racism in science, so that we can move forward together, with a common humanity, collectively embracing scientific endeavors.
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Affiliation(s)
- Ambroise Wonkam
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa.,McKusick-Nathans Institute and Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205
| | - Soraya Bardien
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa.,South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Cape Town 7505, South Africa
| | - Rokhaya Ndiaye Diallo
- Division of Human Genetics, Faculty of Medicine, Pharmacy and Odontology, University Cheikh Anta Diop, Dakar P. O. Box 5005, Senegal
| | - Amadou Gaye
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892
| | - Mohamed Zahir Alimohamed
- Department of Haematology and Blood Transfusion, School of Medicine, MUHAS, Dar es Saalam P. O. Box 65001, Tanzania.,Department of Research and Training, Shree Hindu Mandal Hospital, Dar es Salaam P. O. Box 581, Tanzania
| | - Siana Kya
- Department of Haematology and Blood Transfusion, School of Medicine, MUHAS, Dar es Saalam P. O. Box 65001, Tanzania
| | - Julie Makani
- Department of Haematology and Blood Transfusion, School of Medicine, MUHAS, Dar es Saalam P. O. Box 65001, Tanzania
| | - Guida Landoure
- Hopital du point G, University of Bamako, Bamako P. O. Box 333, Mali
| | - Leon Mutesa
- Center for Human Genetics, College of Medicine and Health Sciences, University of Rwanda, Kigali P. O. Box 4285, Rwanda
| | - Ghada El-Kamah
- Human Genetics and Genome Research Institute, National Research Centre, Cairo, Egypt
| | - Amal Mohamed
- Brighton & Sussex Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Sussex, BN1 9RH, UK
| | - Melanie Newport
- Brighton & Sussex Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Sussex, BN1 9RH, UK
| | - Scott M Williams
- Department of Population and Quantitative Health Sciences, Institute of Computational Biology, Case Western Reserve University, Cleveland, 44106 OH
| | - Michele Ramsay
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Private Bag 3, Wits 2050, South Africa
| | - Victoria Nembaware
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
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Hassan R, Deribe K, Fahal AH, Newport M, Bakhiet S. Clinical epidemiological characteristics of mycetoma in Eastern Sennar locality, Sennar State, Sudan. PLoS Negl Trop Dis 2021; 15:e0009847. [PMID: 34898611 PMCID: PMC8699598 DOI: 10.1371/journal.pntd.0009847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/22/2021] [Revised: 12/23/2021] [Accepted: 11/08/2021] [Indexed: 11/18/2022] Open
Abstract
Mycetoma epidemiological features remain uncharacterised. Few studies have been conducted in a community-based setting to explore the epidemiological features and risk factors for mycetoma in Sudan. To bridge this gap, this study was conducted in Eastern Sennar Locality, Sennar State, Sudan, to report the clinical, epidemiological characteristics of mycetoma patients and the disease burden in the state. We used cluster sampling; sixty villages were randomly selected across the locality's five administrative units, and a household-to-household survey was conducted. We collected data using pre-designed questionnaires at the community, household, and individual levels. We performed descriptive analyses of the data and produced prevalence maps using ArcGIS 10.5 ([ESRI] Inc., Redlands CA, USA). A total of 41,176 individuals were surveyed, and 359 mycetoma patients were identified. The overall prevalence of mycetoma was 0.87% (95%CI = 0.78-0.97%), the prevalence among males was 0.83% (95%CI = 0.71-0.96%), and females 0.92% (95% CI = 0.79-1.06%). Individuals in the age group 31-45 years had the highest prevalence among the different age groups (1.52%, 95% CI = 1.23-1.86%). The prevalence map showed patients clustered within the central and north-eastern part of the locality, while villages in the south-western part had few or no cases. In conclusion, this clinical epidemiological study is pioneering and shows that mycetoma is prevalent in certain parts of Sudan. This data obtained will support the design of measures to reduce the disease burden in the state. The survey procedures and protocols can be adopted for further studies in Sudan and beyond.
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Affiliation(s)
- Rowa Hassan
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Kebede Deribe
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, United Kingdom
- Children’s Investment Fund Foundation, Addis Ababa, Ethiopia
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Melanie Newport
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Sahar Bakhiet
- Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan
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Al-Hassan L, Roemer-Mahler A, Price J, Islam J, El-Mahallawy H, Higgins PG, Hussein AFA, Roca I, Newport M. The TACTIC experience: establishing an international, interdisciplinary network to tackle antimicrobial resistance. J Med Microbiol 2020; 69:1213-1220. [PMID: 32902373 DOI: 10.1099/jmm.0.001249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/18/2022] Open
Abstract
Antimicrobial resistance (AMR) is a major global health threat that requires an interdisciplinary international approach to address. In response to calls from policymakers and funders alike, a growing number of research networks on AMR have been created with this approach in mind. However, there are many challenges facing researchers in establishing such networks and research projects. In this article, we share our experience of establishing the network 'TACTIC: Tackling AMR Challenges through Translational Interdisciplinary Collaborations'. Although presented with many challenges both scientific and logistical, the network has underpinned productive interaction between biomedical and social scientists from several countries and fostered true collaboration in an educative, stimulating and sustainable way that forms a platform for important research on AMR.
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Affiliation(s)
- Leena Al-Hassan
- Brighton and Sussex Centre for Global Health Research, Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
| | - Anne Roemer-Mahler
- Department of International Relations, University of Sussex, Brighton, BN1 9SN, UK
| | - James Price
- Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Jasmin Islam
- Brighton and Sussex Centre for Global Health Research, Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
| | | | - Paul G Higgins
- German Centre for Infection Research (DZIF), partner site, Bonn-Cologne, Germany.,Institute of Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne 50935, Germany
| | - Amira F A Hussein
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ignasi Roca
- Barcelona Institute for Global Health, University of Barcelona, Barcelona, Spain
| | - Melanie Newport
- Brighton and Sussex Centre for Global Health Research, Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
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Gebresilase TT, Deresse Z, Tsegay G, Tessema TS, Aseffa A, Davey G, Newport M, Tekola-Ayele F, Addissie A. Rapid Ethical Appraisal: A tool to design a contextualized consent process for a genetic study of podoconiosis in Ethiopia. Wellcome Open Res 2017. [DOI: 10.12688/wellcomeopenres.12613.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Obtaining genuine informed consent from research participants in developing countries can be difficult, partly due to poor knowledge about research process and research ethics. The situation is complicated when conducting genomic research on a disease considered familial and a reason for stigmatisation. Methods: We used a Rapid Ethical Appraisal tool to assess local factors that were barriers to getting genuine informed consent prior to conducting a genetic study of podoconiosis (non-filarial elephantiasis) in two Zones of Ethiopia. The tool included in-depth interviews and focus group discussions with patients, healthy community members, field workers, researchers/Institutional Review Board (IRB) members, elders, religious leaders, and podoconiosis administrators who work closely with patients. Results: Most patients and healthy community members did not differentiate research from routine clinical diagnosis. Participants felt comfortable when approached in the presence of trusted community members. Field workers and podoconiosis administrators preferred verbal consent, whereas the majority of patients and healthy community members prefer both verbal and written consent. Participants better understood genetic susceptibility concepts when analogies drawn from their day-to-day experience were used. The type of biological sample sought and gender were the two most important factors affecting the recruitment process. Most researchers and IRB members indicated that reporting incidental findings to participants is not a priority in an Ethiopian context. Conclusions: Understanding the concerns of local people in areas where research is to be conducted facilitates the design of contextualized consent processes appropriate for all parties and will ultimately result in getting genuine consent.
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Addissie A, Abay S, Feleke Y, Newport M, Farsides B, Davey G. Cluster randomized trial assessing the effects of rapid ethical assessment on informed consent comprehension in a low-resource setting. BMC Med Ethics 2016; 17:40. [PMID: 27406063 PMCID: PMC4943010 DOI: 10.1186/s12910-016-0127-z] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 06/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maximizing comprehension is a major challenge for informed consent processes in low-literacy and resource-limited settings. Application of rapid qualitative assessments to improve the informed consent process is increasingly considered useful. This study assessed the effects of Rapid Ethical Assessment (REA) on comprehension, retention and quality of the informed consent process. METHODS A cluster randomized trial was conducted among participants of HPV sero-prevalence study in two districts of Northern Ethiopia, in 2013. A total of 300 study participants, 150 in the intervention and 150 in the control group, were included in the study. For the intervention group, the informed consent process was designed with further revisions based on REA findings. Informed consent comprehension levels and quality of the consent process were measured using the Modular Informed Consent Comprehension Assessment (MICCA) and Quality of Informed Consent (QuIC) process assessment tools, respectively. RESULT Study recruitment rates were 88.7 % and 80.7 % (p = 0.05), while study retention rates were 85.7 % and 70.3 % (p < 0.005) for the intervention and control groups respectively. Overall, the mean informed consent comprehension scores for the intervention and control groups were 73.1 % and 45.2 %, respectively, with a mean difference in comprehension score of 27.9 % (95 % CI 24.0 % - 33.4 %; p < 0.001,). Mean scores for quality of informed consent for the intervention and control groups were 89.1 % and 78.5 %, respectively, with a mean difference of 10.5 % (95 % CI 6.8 -14.2 %; p < 0.001). CONCLUSION Levels of informed consent comprehension, quality of the consent process, study recruitment and retention rates were significantly improved in the intervention group. We recommend REA as a potential modality to improve informed consent comprehension and quality of informed consent process in low resource settings.
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Affiliation(s)
- Adamu Addissie
- Brighton and Sussex Medical School, Brighton, UK. .,Addis Ababa University, Addis Ababa, Ethiopia.
| | - Serebe Abay
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | - Gail Davey
- Brighton and Sussex Medical School, Brighton, UK
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Newport M, Smith A. Implementation of evidence-based practice in anaesthesia. BJA Educ 2015. [DOI: 10.1093/bjaceaccp/mkv002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Iwuji CC, McGrath N, de Oliveira T, Porter K, Pillay D, Fisher M, Newport M, Newell ML. The Art of HIV Elimination: Past and Present Science. J AIDS Clin Res 2015; 6:525. [PMID: 27774350 PMCID: PMC5072486 DOI: 10.4172/2155-6113.1000525] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Remarkable strides have been made in controlling the HIV epidemic, although not enough to achieve epidemic control. More recently, interest in biomedical HIV control approaches has increased, but substantial challenges with the HIV cascade of care hinder successful implementation. We summarise all available HIV prevention methods and make recommendations on how to address current challenges. DISCUSSION In the early days of the epidemic, behavioural approaches to control the HIV dominated, and the few available evidence-based interventions demonstrated to reduce HIV transmission were applied independently from one another. More recently, it has become clear that combination prevention strategies targeted to high transmission geographies and people at most risk of infections are required to achieve epidemic control. Biomedical strategies such as male medical circumcision and antiretroviral therapy for treatment in HIV-positive individuals and as pre-exposure prophylaxis in HIV-negative individuals provide immense promise for the future of HIV control. In resource-rich settings, the threat of HIV treatment optimism resulting in increased sexual risk taking has been observed and there are concerns that as ART roll-out matures in resource-poor settings and the benefits of ART become clearly visible, behavioural disinhibition may also become a challenge in those settings. Unfortunately, an efficacious vaccine, a strategy which could potentially halt the HIV epidemic, remains elusive. CONCLUSION Combination HIV prevention offers a logical approach to HIV control, although what and how the available options should be combined is contextual. Therefore, knowledge of the local or national drivers of HIV infection is paramount. Problems with the HIV care continuum remain of concern, hindering progress towards the UNAIDS target of 90-90-90 by 2020. Research is needed on combination interventions that address all the steps of the cascade as the steps are not independent of each other. Until these issues are addressed, HIV elimination may remain an unattainable goal.
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Affiliation(s)
- Collins C. Iwuji
- Africa Centre for Health and Population Studies, University of KwaZulu Natal, South Africa
- Research Department of Infection and Population Health, University College London, UK
| | - Nuala McGrath
- Africa Centre for Health and Population Studies, University of KwaZulu Natal, South Africa
- Academic Unit of Primary Care and Population Sciences, and Department of Social statistics and Demography, University of Southampton, UK
| | - Tulio de Oliveira
- Africa Centre for Health and Population Studies, University of KwaZulu Natal, South Africa
| | | | - Deenan Pillay
- Africa Centre for Health and Population Studies, University of KwaZulu Natal, South Africa
- Research Department of Infection and Immunity, University College London, UK
| | - Martin Fisher
- Division of Medicine, Brighton and Sussex Medical School, UK
| | - Melanie Newport
- Department of Infectious Diseases and Global Health, Brighton and Sussex Medical School, UK
| | - Marie-Louise Newell
- Faculty of Medicine and Faculty of Social and Human Sciences, University of Southampton, UK
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Suleiman SH, Koko ME, Nasir WH, Elfateh O, Elgizouli UK, Abdallah MOE, Alfarouk KO, Hussain A, Faisal S, Ibrahim FMA, Romano M, Sultan A, Banks L, Newport M, Baralle F, Elhassan AM, Mohamed HS, Ibrahim ME. Exome sequencing of a colorectal cancer family reveals shared mutation pattern and predisposition circuitry along tumor pathways. Front Genet 2015; 6:288. [PMID: 26442106 PMCID: PMC4584935 DOI: 10.3389/fgene.2015.00288] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 06/14/2015] [Accepted: 08/28/2015] [Indexed: 01/04/2023] Open
Abstract
The molecular basis of cancer and cancer multiple phenotypes are not yet fully understood. Next Generation Sequencing promises new insight into the role of genetic interactions in shaping the complexity of cancer. Aiming to outline the differences in mutation patterns between familial colorectal cancer cases and controls we analyzed whole exomes of cancer tissues and control samples from an extended colorectal cancer pedigree, providing one of the first data sets of exome sequencing of cancer in an African population against a background of large effective size typically with excess of variants. Tumors showed hMSH2 loss of function SNV consistent with Lynch syndrome. Sets of genes harboring insertions-deletions in tumor tissues revealed, however, significant GO enrichment, a feature that was not seen in control samples, suggesting that ordered insertions-deletions are central to tumorigenesis in this type of cancer. Network analysis identified multiple hub genes of centrality. ELAVL1/HuR showed remarkable centrality, interacting specially with genes harboring non-synonymous SNVs thus reinforcing the proposition of targeted mutagenesis in cancer pathways. A likely explanation to such mutation pattern is DNA/RNA editing, suggested here by nucleotide transition-to-transversion ratio that significantly departed from expected values (p-value 5e-6). NFKB1 also showed significant centrality along with ELAVL1, raising the suspicion of viral etiology given the known interaction between oncogenic viruses and these proteins.
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Affiliation(s)
| | - Mahmoud E Koko
- Department of Molecular Biology, Institute of Endemic Diseases, University of Khartoum Khartoum, Sudan
| | - Wafaa H Nasir
- Department of Molecular Biology, Institute of Endemic Diseases, University of Khartoum Khartoum, Sudan
| | - Ommnyiah Elfateh
- Department of Molecular Biology, Institute of Endemic Diseases, University of Khartoum Khartoum, Sudan
| | - Ubai K Elgizouli
- Department of Molecular Biology, Institute of Endemic Diseases, University of Khartoum Khartoum, Sudan
| | - Mohammed O E Abdallah
- Department of Molecular Biology, Institute of Endemic Diseases, University of Khartoum Khartoum, Sudan
| | - Khalid O Alfarouk
- Department of Molecular Biology, Institute of Endemic Diseases, University of Khartoum Khartoum, Sudan
| | - Ayman Hussain
- Department of Molecular Biology, Institute of Endemic Diseases, University of Khartoum Khartoum, Sudan
| | - Shima Faisal
- Department of Molecular Biology, Institute of Endemic Diseases, University of Khartoum Khartoum, Sudan
| | - Fathelrahamn M A Ibrahim
- Department of Molecular Biology, Institute of Endemic Diseases, University of Khartoum Khartoum, Sudan
| | - Maurizio Romano
- International Centre for Genetic Engineering and Biotechnology Trieste, Italy
| | - Ali Sultan
- Weill Cornell Medical College Doha, Qatar
| | - Lawrence Banks
- International Centre for Genetic Engineering and Biotechnology Trieste, Italy
| | | | - Francesco Baralle
- International Centre for Genetic Engineering and Biotechnology Trieste, Italy
| | | | - Hiba S Mohamed
- Faculty of Medicine, University of Khartoum Khartoum, Sudan
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11
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Woolf K, Elton C, Newport M. The specialty choices of graduates from Brighton and Sussex Medical School: a longitudinal cohort study. BMC Med Educ 2015; 15:46. [PMID: 25889968 PMCID: PMC4365809 DOI: 10.1186/s12909-015-0328-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 02/25/2015] [Indexed: 05/25/2023]
Abstract
BACKGROUND Since 2007 junior doctors in the UK have had to make major career decisions at a point when previously many had not yet chosen a specialty. This study examined when doctors in this new system make specialty choices, which factors influence choices, and whether doctors who choose a specialty they were interested in at medical school are more confident in their choice than those doctors whose interests change post-graduation. METHODS Two cohorts of students in their penultimate year at one medical school (n = 227/239) were asked which specialty interested them as a career. Two years later, 210/227 were sent a questionnaire measuring actual specialty chosen, confidence, influence of perceptions of the specialty and experiences on choice, satisfaction with medicine, personality, self-efficacy, and demographics. Medical school and post-graduation choices in the same category were deemed 'stable'. Predictors of stability, and of not having chosen a specialty, were calculated using bootstrapped logistic regression. Differences between specialties on questionnaire factors were analysed. RESULTS 50% responded (n = 105/277; 44% of the 239 Year 4 students). 65% specialty choices were 'stable'. Factors univariately associated with stability were specialty chosen, having enjoyed the specialty at medical school or since starting work, having first considered the specialty earlier. A regression found doctors who chose psychiatry were more likely to have changed choice than those who chose general practice. Confidence in the choice was not associated with stability. Those who chose general practice valued lifestyle factors. A psychiatry choice was associated with needing a job and using one's intellect to help others. The decision to choose surgical training tended to be made early. Not having applied for specialty training was associated with being lower on agreeableness and conscientiousness. CONCLUSION Medical school experiences are important in specialty choice but experiences post-graduation remain significant, particularly in some specialties (psychiatry in our sample). Career guidance is important at medical school and should be continued post-graduation, with senior clinicians supported in advising juniors. Careers advice in the first year post-graduation may be particularly important, especially for specialties which have difficulty recruiting or are poorly represented at medical school.
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Affiliation(s)
- Katherine Woolf
- University College London Medical School (UCLMS), Room GF/664, Royal Free Hospital, London, NW3 2PF, UK.
| | - Caroline Elton
- London Deanery, The Careers Unit, Room ST201, Stewart House, 32 Russell Square, London, WC1B 5DN, UK.
| | - Melanie Newport
- Brighton & Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, East Sussex BN1 9PX, UK.
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Addissie A, Davey G, Newport M, Farsides B, Feleke Y. Feasibility of rapid ethical assessment for the Ethiopian health research ethics review system. Ethiop Med J 2015; 53 Suppl 1:25-33. [PMID: 25816498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
One of the challenges in the process of ethical medical research in developing countries, including Ethiopia, is translating universal principles of medical ethics into appropriate informed consent documents and their implementation. Rapid Ethical Assessment (REA) has been suggested as a feasible approach to meet this application gap. In the past few years REA has been employed in few research project in Ethiopia and have been found to be a useful and practical approach. Feasibility assessment of REA for the Ethiopian research setting was conducted between 2012-2013 in order to inform the subsequent introduction of REA into research ethics review and governance system in the country. REA was found to be an appropriate, relevant and feasible venture. We argue that REA can be integrated as part of the ethics review and governance system in Ethiopia. REA tools and techniques are considered relevant and acceptable to the Ethiopian research community, with few practical challenges anticipated in their implementation. REA are considered feasible for integration in the Ethiopian ethics review system.
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Jallad S, Thomas P, Newport M, Kern F. P58. Can T-cells predict response to intravesical BCG immunotherapy in high-risk non-invasive bladder cancer. J Immunother Cancer 2014. [PMCID: PMC4072435 DOI: 10.1186/2051-1426-2-s2-p32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Seddon P, Fidler K, Raman S, Wyatt H, Ruiz G, Elston C, Perrin F, Gyi K, Bilton D, Drobniewski F, Newport M. Prevalence of nontuberculous mycobacteria in cystic fibrosis clinics, United Kingdom, 2009. Emerg Infect Dis 2014; 19:1128-30. [PMID: 23764198 DOI: 10.3201/eid/1907.120615] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 11/19/2022] Open
Abstract
Incidence of pulmonary infection with nontuberculous mycobacteria (NTM) is increasing among persons with cystic fibrosis (CF). We assessed prevalence and management in CF centers in the United Kingdom and found 5.0% of 3,805 adults and 3.3% of 3,317 children had recently been diagnosed with NTM. Of those, 44% of adults and 47% of children received treatment.
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Affiliation(s)
- Paul Seddon
- Royal Alexandra Children’s Hospital, Brighton, UK.
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Seddon P, Fidler K, Raman S, Wyatt H, Ruiz G, Elston C, Perrin F, Gyi K, Bilton D, Drobniewski F, Newport M. Prevalence of nontuberculous mycobacteria in cystic fibrosis clinics, United Kingdom, 2009. Emerg Infect Dis 2014. [PMID: 23764198 PMCID: PMC3713964 DOI: 10.3201/eid1907.120615] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [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] [Indexed: 11/19/2022] Open
Abstract
Incidence of pulmonary infection with nontuberculous mycobacteria (NTM) is increasing among persons with cystic fibrosis (CF). We assessed prevalence and management in CF centers in the United Kingdom and found 5.0% of 3,805 adults and 3.3% of 3,317 children had recently been diagnosed with NTM. Of those, 44% of adults and 47% of children received treatment.
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Affiliation(s)
- Paul Seddon
- Royal Alexandra Children’s Hospital, Brighton, UK.
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Isa SE, Onyedibe KI, Okolo MO, Abiba AE, Mafuka JS, Simji GS, Nathan SY, Udoh UA, Awang SK, Egah DZ, Banwat EB, Newport M, Ahmed A. A 21-year-old student with fever and profound jaundice. PLoS Negl Trop Dis 2014; 8:e2534. [PMID: 24416459 PMCID: PMC3886912 DOI: 10.1371/journal.pntd.0002534] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Samson Ejiji Isa
- Infectious Diseases Unit, Department of Medicine, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
- Faculty of Medical Sciences, University of Jos, Jos, Plateau State, Nigeria
- * E-mail:
| | - Kenneth Ikenna Onyedibe
- Faculty of Medical Sciences, University of Jos, Jos, Plateau State, Nigeria
- Department of Medical Microbiology, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Mark Ojogba Okolo
- Faculty of Medical Sciences, University of Jos, Jos, Plateau State, Nigeria
- Department of Medical Microbiology, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Abiayi Elmina Abiba
- Leptospirosis Unit, Central Diagnostics Laboratories National Veterinary Research Institute, Vom, Plateau State, Nigeria
| | - Johnson Simon Mafuka
- Infectious Diseases Unit, Department of Medicine, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Gomerep Samuel Simji
- Infectious Diseases Unit, Department of Medicine, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
- Faculty of Medical Sciences, University of Jos, Jos, Plateau State, Nigeria
| | - Shehu Yakubu Nathan
- Infectious Diseases Unit, Department of Medicine, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Ubong Aniefok Udoh
- Department of Medical Microbiology, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Sati Klein Awang
- Infectious Diseases Unit, Department of Medicine, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Daniel Zanyu Egah
- Faculty of Medical Sciences, University of Jos, Jos, Plateau State, Nigeria
- Department of Medical Microbiology, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Edmond Banle Banwat
- Faculty of Medical Sciences, University of Jos, Jos, Plateau State, Nigeria
- Department of Medical Microbiology, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Melanie Newport
- Department of Infectious Diseases, Brighton and Sussex University Hospital, Brighton, Southeast England, United Kingdom
- Global Health Programme, Brighton and Sussex University, Brighton, Southeast England, United Kingdom
| | - Ahmed Ahmed
- Royal Tropical Institute, KIT Biomedical Research, WHO/FAO/OIE and National Collaborating Center for Reference and research on Leptospirosis, Meibergdreef, Amsterdam, The Netherlands
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Deribe K, Brooker SJ, Pullan RL, Hailu A, Enquselassie F, Reithinger R, Newport M, Davey G. Spatial distribution of podoconiosis in relation to environmental factors in Ethiopia: a historical review. PLoS One 2013; 8:e68330. [PMID: 23874587 PMCID: PMC3706425 DOI: 10.1371/journal.pone.0068330] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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: 01/23/2013] [Accepted: 05/28/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND An up-to-date and reliable map of podoconiosis is needed to design geographically targeted and cost-effective intervention in Ethiopia. Identifying the ecological correlates of the distribution of podoconiosis is the first step for distribution and risk maps. The objective of this study was to investigate the spatial distribution and ecological correlates of podoconiosis using historical and contemporary survey data. METHODS Data on the observed prevalence of podoconiosis were abstracted from published and unpublished literature into a standardized database, according to strict inclusion and exclusion criteria. In total, 10 studies conducted between 1969 and 2012 were included, and data were available for 401,674 individuals older than 15 years of age from 229 locations. A range of high resolution environmental factors were investigated to determine their association with podoconiosis prevalence, using logistic regression. RESULTS The prevalence of podoconiosis in Ethiopia was estimated at 3.4% (95% CI 3.3%-3.4%) with marked regional variation. We identified significant associations between mean annual Land Surface Temperature (LST), mean annual precipitation, topography of the land and fine soil texture and high prevalence of podoconiosis. The derived maps indicate both widespread occurrence of podoconiosis and a marked variability in prevalence of podoconiosis, with prevalence typically highest at altitudes >1500 m above sea level (masl), with >1500 mm annual rainfall and mean annual LST of 19-21°C. No (or very little) podoconiosis occurred at altitudes <1225 masl, with annual rainfall <900 mm, and mean annual LST of >24°C. CONCLUSION Podoconiosis remains a public health problem in Ethiopia over considerable areas of the country, but exhibits marked geographical variation associated in part with key environmental factors. This is work in progress and the results presented here will be refined in future work.
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Affiliation(s)
- Kebede Deribe
- Brighton and Sussex Medical School, Falmer, Brighton, United Kingdom.
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Lang T, Clarke M, Newport M, Enquoselassie F, van Loggerenberg F, Franzen S, Furtado T, Njuguna P, Fegan G, Davey G. A research methodology study to map the process of initiating and operating a randomised controlled trial of podoconiosis treatment in Northern Ethiopia. Trials 2013. [PMCID: PMC3981616 DOI: 10.1186/1745-6215-14-s1-o31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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De Silva S, Hassan-Ibrahim MO, Austin M, Newport M, Verma S. Hepatitis E infection is an under recognized cause of acute decompensation in patients with chronic liver disease. Dig Liver Dis 2012; 44:930-4. [PMID: 22592074 DOI: 10.1016/j.dld.2012.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 04/11/2012] [Accepted: 04/15/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIMS We aimed to assess characteristics of patients with a positive hepatitis E virus serology with emphasis on acute on chronic liver disease. METHODS This was a retrospective audit performed at a large teaching hospital. RESULTS Of the 164 patients tested, 15(9.1%) had a positive serology (hepatitis E virus IgG and or IgM) of whom two also had a positive hepatitis E virus RNA. Six (42.8%) had underlying chronic liver disease and presented with deteriorating liver tests±decompensation. In one patient (16%) acute hepatitis E virus infection was the aetiology for the decompensation and in three the positive hepatitis E virus IgG was a reflection of prior subclinical infection. However, in two of the six patients with unexplained decompensation there was delay (150-270 days) in obtaining a hepatitis E virus serology, which may have resulted in a negative hepatitis E virus IgM at time of testing. CONCLUSIONS 9.1% of patients presenting with abnormal liver tests at a large teaching hospital in south east England have a positive hepatitis E virus serology of whom 42.8% have acute on chronic liver disease. In 16% hepatitis E virus infection is the aetiology for the acute decompensation. This may be an under representation as in >30% of patients with unexplained decompensation there is considerable delay in requesting a hepatitis E virus serology.
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Affiliation(s)
- Sampath De Silva
- Department of Gastroenterology, Brighton and Sussex University Hospitals, Brighton, UK
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Davey G, Bockarie M, Wanji S, Addiss D, Fuller C, Fox L, Mycoskie M, Gruin M, Tsegaye A, Tekola Ayele F, Newport M. Launch of the international podoconiosis initiative. Lancet 2012; 379:1004. [PMID: 22423883 DOI: 10.1016/s0140-6736(12)60427-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Thye T, Owusu-Dabo E, Vannberg FO, van Crevel R, Curtis J, Sahiratmadja E, Balabanova Y, Ehmen C, Muntau B, Ruge G, Sievertsen J, Gyapong J, Nikolayevskyy V, Hill PC, Sirugo G, Drobniewski F, van de Vosse E, Newport M, Alisjahbana B, Nejentsev S, Ottenhoff THM, Hill AVS, Horstmann RD, Meyer CG. Common variants at 11p13 are associated with susceptibility to tuberculosis. Nat Genet 2012; 44:257-9. [PMID: 22306650 DOI: 10.1038/ng.1080] [Citation(s) in RCA: 161] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 12/15/2011] [Indexed: 01/09/2023]
Abstract
After imputation of data from the 1000 Genomes Project into a genome-wide dataset of Ghanaian individuals with tuberculosis and controls, we identified a resistance locus on chromosome 11p13 downstream of the WT1 gene (encoding Wilms tumor 1). The strongest signal was obtained at the rs2057178 SNP (P = 2.63 × 10(-9)). Replication in Gambian, Indonesian and Russian tuberculosis case-control study cohorts increased the significance level for the association with this SNP to P = 2.57 × 10(-11).
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Affiliation(s)
- Thorsten Thye
- Department of Molecular Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
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Thye T, Vannberg FO, Wong SH, Owusu-Dabo E, Osei I, Gyapong J, Sirugo G, Sisay-Joof F, Enimil A, Chinbuah MA, Floyd S, Warndorff DK, Sichali L, Malema S, Crampin AC, Ngwira B, Teo YY, Small K, Rockett K, Kwiatkowski D, Fine PE, Hill PC, Newport M, Lienhardt C, Adegbola RA, Corrah T, Ziegler A, Morris AP, Meyer CG, Horstmann RD, Hill AVS. Erratum: Genome-wide association analyses identifies a susceptibility locus for tuberculosis on chromosome 18q11.2. Nat Genet 2011. [DOI: 10.1038/ng1011-1040a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Thye T, Vannberg FO, Wong SH, Owusu-Dabo E, Osei I, Gyapong J, Sirugo G, Sisay-Joof F, Enimil A, Chinbuah MA, Floyd S, Warndorff DK, Sichali L, Malema S, Crampin AC, Ngwira B, Teo YY, Small K, Rockett K, Kwiatkowski D, Fine PE, Hill PC, Newport M, Lienhardt C, Adegbola RA, Corrah T, Ziegler A, Morris AP, Meyer CG, Horstmann RD, Hill AV. Genome-wide association analyses identifies a susceptibility locus for tuberculosis on chromosome 18q11.2. Nat Genet 2010; 42:739-741. [PMID: 20694014 PMCID: PMC4975513 DOI: 10.1038/ng.639] [Citation(s) in RCA: 272] [Impact Index Per Article: 19.4] [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: 02/23/2010] [Accepted: 07/08/2010] [Indexed: 11/28/2022]
Abstract
We combined two tuberculosis genome-wide association studies from Ghana and The Gambia with subsequent replication in a combined 11,425 individuals. rs4331426, located in a gene-poor region on chromosome 18q11.2, was associated with disease (combined P = 6.8 x 10(-9), odds ratio = 1.19, 95% CI = 1.13-1.27). Our study demonstrates that genome-wide association studies can identify new susceptibility loci for infectious diseases, even in African populations, in which levels of linkage disequilibrium are particularly low.
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Affiliation(s)
- Thorsten Thye
- Department of Molecular Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
- Institute of Medical Biometry and Statistics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Fredrik O. Vannberg
- Wellcome Trust Centre for Human Genetics, University of Oxford, United Kingdom
| | - Sunny H. Wong
- Wellcome Trust Centre for Human Genetics, University of Oxford, United Kingdom
| | - Ellis Owusu-Dabo
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
- Department of Community Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ivy Osei
- Health Research Unit, Ghana Health Service, Accra, Ghana
| | - John Gyapong
- Health Research Unit, Ghana Health Service, Accra, Ghana
| | | | | | - Anthony Enimil
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Sian Floyd
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Lifted Sichali
- Karonga Prevention Study, Chilumba, Karonga District, Malawi
| | - Simon Malema
- Karonga Prevention Study, Chilumba, Karonga District, Malawi
| | - Amelia C. Crampin
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bagrey Ngwira
- Karonga Prevention Study, Chilumba, Karonga District, Malawi
| | - Yik Y. Teo
- Wellcome Trust Centre for Human Genetics, University of Oxford, United Kingdom
| | - Kerrin Small
- Wellcome Trust Centre for Human Genetics, University of Oxford, United Kingdom
| | - Kirk Rockett
- Wellcome Trust Centre for Human Genetics, University of Oxford, United Kingdom
| | - Dominic Kwiatkowski
- Wellcome Trust Centre for Human Genetics, University of Oxford, United Kingdom
| | - Paul E. Fine
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Karonga Prevention Study, Chilumba, Karonga District, Malawi
| | | | | | | | | | | | - Andreas Ziegler
- Institute of Medical Biometry and Statistics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | | | - Andrew P. Morris
- Wellcome Trust Centre for Human Genetics, University of Oxford, United Kingdom
| | - Christian G. Meyer
- Department of Molecular Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Rolf D. Horstmann
- Department of Molecular Medicine, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Adrian V.S. Hill
- Wellcome Trust Centre for Human Genetics, University of Oxford, United Kingdom
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Abstract
The Tooke inquiry into Modernising Medical Careers highlighted the need for medical schools to become more actively involved in preparing their students for the critical career decisions that they will make during the foundation programme. Incorporating a reflective careers assignment into the elective module may be a useful way of encouraging students to become more highly skilled in self-assessment and career exploration.
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Affiliation(s)
- Gail Davey
- Faculty of Medicine, Addis Ababa, Ethiopia.
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Wilson JN, Rockett K, Keating B, Jallow M, Pinder M, Sisay-Joof F, Newport M, Kwiatkowski D. A hallmark of balancing selection is present at the promoter region of interleukin 10. Genes Immun 2006; 7:680-3. [PMID: 16943796 DOI: 10.1038/sj.gene.6364336] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
As an anti-inflammatory mediator IL10 is beneficial in certain contexts and deleterious in others. As increased production of IL10 favours protection against inflammatory disease, whereas low production promotes elimination of foreign pathogens by the host, we investigated the possible influence of balancing selection at this locus. We began by resequencing 48 European and 48 African chromosomes across 2.2 kb of the IL10 promoter region, and compared this with four neighbouring gene regions: MK2, IL19, IL20 and IL24. Analysis of nucleotide diversity showed a positive Tajima's D-test for IL10 in Europeans, of borderline statistical significance (1.89, P=0.05). Analysis of F(st) values showed significant population divergence at MK2, IL19, IL20 and IL24 (P<0.01) but not at IL10. Taken together, these findings are consistent with the hypothesis that balancing selection has played a role in the evolution of polymorphisms in the IL10 promoter region.
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Affiliation(s)
- J N Wilson
- Wellcome Trust Centre for Human Genetics, Oxford, UK.
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Davey G, Gebrehanna E, Adeyemo A, Rotimi C, Newport M, Desta K. Podoconiosis: a tropical model for gene-environment interactions? Trans R Soc Trop Med Hyg 2006; 101:91-6. [PMID: 16884751 DOI: 10.1016/j.trstmh.2006.05.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Revised: 05/19/2006] [Accepted: 05/19/2006] [Indexed: 10/24/2022] Open
Abstract
Podoconiosis (endemic non-filarial elephantiasis) is a geochemical disease occurring in individuals exposed to red clay soil derived from alkalic volcanic rock. It is a chronic, debilitating disorder and a considerable public health problem in at least 10 countries in tropical Africa, Central America and northern India. Only a small proportion of individuals exposed to red clay develop disease and familial clustering of cases occurs, so we tested the hypothesis that disease occurs in genetically susceptible individuals on exposure to an environmental element in soil. Using multiple statistical genetic techniques we estimated sibling recurrence risk ratio (lambda(s)) and heritability for podoconiosis, and conducted segregation analysis on 59 multigenerational affected families from Wolaitta Zone, southern Ethiopia. We estimated the lambda(s) to be 5.07. The heritability of podoconiosis was estimated to be 0.629 (SE 0.069, P=1x10(-7)). Segregation analysis showed that the most parsimonious model was that of an autosomal co-dominant major gene. Age and use of footwear were significant covariates in the final model. Host genetic factors are important determinants of susceptibility to podoconiosis. Identification of the gene(s) involved will lead to better understanding of the gene-environment interactions involved in the pathogenesis of podoconiosis and other complex multifactorial conditions.
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Affiliation(s)
- Gail Davey
- Department of Community Health, Addis Ababa University, Addis Ababa, Ethiopia.
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Wilson JN, Rockett K, Jallow M, Pinder M, Sisay-Joof F, Newport M, Newton J, Kwiatkowski D. Analysis of IL10 haplotypic associations with severe malaria. Genes Immun 2005; 6:462-6. [PMID: 15933743 DOI: 10.1038/sj.gene.6364227] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We investigated the association between severe malaria and genetic variation of IL10 in Gambian children, as several lines of evidence indicate that IL10 is protective against severe malaria and that IL10 production is genetically determined. We began by identifying five informative SNPs in the Gambian population that were genotyped in a combined case-control and intrafamilial study including 654 cases of severe malaria, 579 sets of parents and 459 ethnically matched controls. No significant associations were identified with individual SNPs. One haplotype of frequency 0.11 was strongly associated with protection against severe malaria in the case-control analysis (odds ratio 0.52, P=0.00002), but the transmission disequilibrium test in families showed no significant effect. These findings raise the question of whether IL10 associations with severe malaria might be confounded by foetal survival rates or other sources of transmission bias.
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Affiliation(s)
- J N Wilson
- Wellcome Trust Centre for Human Genetics, Oxford, UK.
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Stensballe LG, Nante E, Jensen IP, Kofoed PE, Poulsen A, Jensen H, Newport M, Marchant A, Aaby P. Acute lower respiratory tract infections and respiratory syncytial virus in infants in Guinea-Bissau: a beneficial effect of BCG vaccination for girls community based case-control study. Vaccine 2005; 23:1251-7. [PMID: 15652667 DOI: 10.1016/j.vaccine.2004.09.006] [Citation(s) in RCA: 175] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2004] [Accepted: 09/07/2004] [Indexed: 01/06/2023]
Abstract
Among measles unvaccinated infants in Guinea-Bissau, we tested whether case infants with acute lower respiratory tract infection (ALRI), especially ALRI caused by respiratory syncytial virus (RSV), were more likely to be Bacille Calmette Guerin (BCG)-unvaccinated and to have no scar after BCG vaccination than were control infants without symptoms of ALRI. Three hundred and eighty-six case infants with ALRI were identified at a paediatric clinic (N=84), a health centre (N=82), and in a community morbidity surveillance system (N=220). Control infants were matched on sex, age, and district and were also measles unvaccinated. In ALRI case infants, the adjusted OR of being BCG unvaccinated was 2.87 (1.31-6.32), 1.72 (0.48-6.19) in boys and 4.45 (1.48-13.4) in girls. Among BCG vaccinated ALRI case infants, the adjusted OR of having no BCG scar was 1.54 (0.86-2.75), 0.93 (0.45-1.91) in boys and 2.70 (1.21-6.02) in girls. In ALRI case infants with RSV infection, similar trends were observed. BCG vaccination may have a non-targeted protective effect against ALRI, the effect being most marked in girls.
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Affiliation(s)
- Lone Graff Stensballe
- Bandim Health Project, Apartado 861, Bissau, Guinea-Bissau; Danish Epidemiology Science Centre, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark.
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33
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Dorman SE, Picard C, Lammas D, Heyne K, van Dissel JT, Baretto R, Rosenzweig SD, Newport M, Levin M, Roesler J, Kumararatne D, Casanova JL, Holland SM. Clinical features of dominant and recessive interferon gamma receptor 1 deficiencies. Lancet 2004; 364:2113-21. [PMID: 15589309 DOI: 10.1016/s0140-6736(04)17552-1] [Citation(s) in RCA: 296] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Interferon gamma receptor 1 (IFNgammaR1) deficiency is a primary immunodeficiency with allelic dominant and recessive mutations characterised clinically by severe infections with mycobacteria. We aimed to compare the clinical features of recessive and dominant IFNgammaR1 deficiencies. METHODS We obtained data from a large cohort of patients worldwide. We assessed these people by medical histories, records, and genetic and immunological studies. Data were abstracted onto a standard form. FINDINGS We identified 22 patients with recessive complete IFNgammaR1 deficiency and 38 with dominant partial deficiency. BCG and environmental mycobacteria were the most frequent pathogens. In recessive patients, 17 (77%) had environmental mycobacterial disease and all nine BCG-vaccinated patients had BCG disease. In dominant patients, 30 (79%) had environmental mycobacterial disease and 11 (73%) of 15 BCG-vaccinated patients had BCG disease. Compared with dominant patients, those with recessive deficiency were younger at onset of first environmental mycobacterial disease (mean 3.1 years [SD 2.5] vs 13.4 years [14.3], p=0.001), had more mycobacterial disease episodes (19 vs 8 per 100 person-years of observation, p=0.0001), had more severe mycobacterial disease (mean number of organs infected by Mycobacterium avium complex 4.1 [SD 0.8] vs 2.0 [1.1], p=0.004), had shorter mean disease-free intervals (1.6 years [SD 1.4] vs 7.2 years [7.6], p<0.0001), and lower Kaplan-Meier survival probability (p<0.0001). M avium complex osteomyelitis was more frequent in dominant than in recessive patients (22/28 [79%] vs 1/8 [13%], p=0.002), and this disorder without other organ involvement arose only in dominant patients (9/28 [32%]). Disease caused by rapidly growing mycobacteria was present in more recessive than dominant patients (7/22 [32%] vs 1/38 [3%], p=0.002). INTERPRETATION Recessive complete and dominant partial IFNgammaR1 deficiencies have related clinical phenotypes, but are distinguishable by age at onset, dissemination, and clinical course of mycobacterial diseases. A strong correlation exists between IFNGR1 genotype, cellular responsiveness to interferon gamma, and clinical disease features.
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Affiliation(s)
- Susan E Dorman
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Building 10, CRC B3-419, 10 Center Drive, MSC 1684, Bethesda, MD 20892-1684, USA
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Goetghebuer T, Ota MOC, Kebbeh B, John M, Jackson-Sillah D, Vekemans J, Marchant A, Newport M, Weiss HA. Delay in Motor Development of Twins in Africa: A Prospective Cohort Study. ACTA ACUST UNITED AC 2003; 6:279-84. [PMID: 14511433 DOI: 10.1375/136905203322296629] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Twins are prone to developmental delay due to prematurity and low birthweight. However it is unknown if twinning is an independent risk factor for developmental delay. The objective of this study was to compare the attainment of a set of gross motor milestones in a cohort of twins and singletons in The Gambia. Eighty-four pairs of twins and 72 singletons were enrolled at birth and followed up until 18 months of age. The mean age at achieving milestones was higher in twins for each development outcome and the difference between twins and singletons was significant after adjustment for confounders for maintaining head, sitting without support and walking. In twins, we found a highly significant correlation within pairs for most milestones. When monozygotic and dizygotic twins were compared, a significant heritability was observed for crawling, sitting, standing and walking, with over 90% of population variance observed due to genetic factors rather than environmental factors. There was little evidence for a genetic contribution towards very early milestones. In conclusion, our data suggest that twinning is an independent risk factor for developmental delay in early life in The Gambia, and that genetic factors contribute strongly to certain motor development outcomes.
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Affiliation(s)
- Tessa Goetghebuer
- University Department of Paediatrics, John Radcliffe Hospital, Oxford, UK.
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35
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Abstract
The molecular aetiology of familial susceptibility to disseminated mycobacterial disease, usually involving weakly pathogenic strains of mycobacteria, has now been elucidated in more than 30 families. Mutations have been identified in five genes in the interleukin-12-dependent interferon-gamma pathway, highlighting the importance of this pathway in human mycobacterial immunity. Knowledge derived from the study of these rare patients contributes to our understanding of the immune response to common mycobacterial pathogens such as Mycobacterium tuberculosis and Mycobacterium leprae, which remain major public health problems globally. This knowledge can be applied to the rational development of novel therapies and vaccines for these important mycobacterial diseases.
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Affiliation(s)
- Melanie Newport
- Cambridge Institute for Medical Research, Addenbrookes Hospital, Hills Road, Cambridge, CB2 2XY, UK.
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Sabeti P, Usen S, Farhadian S, Jallow M, Doherty T, Newport M, Pinder M, Ward R, Kwiatkowski D. CD40L association with protection from severe malaria. Genes Immun 2002; 3:286-91. [PMID: 12140747 DOI: 10.1038/sj.gene.6363877] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2001] [Revised: 02/19/2002] [Accepted: 02/19/2002] [Indexed: 11/09/2022]
Abstract
CD40 ligand (CD40L), a glycoprotein involved in B cell proliferation, antigen presenting cell activation, and Ig class switching, is important in the immune response to infection. Rare coding mutations in CD40L can lead to life-threatening immunodeficiency but the potential for common variants to alter disease susceptibility remains to be explored. To identify polymorphisms in CD40L, we sequenced 2.3 kb of the 5' flanking region and the first exon of the gene in DNA samples from 36 Gambian females and one chimpanzee. Diversity was lower than the average reported for other areas of the X chromosome, and only two polymorphisms were identified. The polymorphisms were genotyped in DNA samples from 957 Gambian individuals, cases and controls from a study of severe malaria. A significant reduction in risk for severe malaria (OR = 0.52, P = 0.002) was associated with males hemizygous for the CD40L-726C. Analysis by transmission disequilibrium test of 371 cases, for whom DNA from both parents was also available, confirmed the result was not due to stratification (P = 0.04). A similar but non-significant trend was found in females. This preliminary association of a common variant in CD40L with a malaria resistance phenotype encourages further genetic characterization of the role of CD40L in infectious disease.
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Affiliation(s)
- P Sabeti
- Wellcome Trust Centre for Human Genetics, Oxford, UK
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37
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Bennett S, Lienhardt C, Bah-Sow O, Gustafson P, Manneh K, Del Prete G, Gomes V, Newport M, McAdam K, Hill A. Investigation of environmental and host-related risk factors for tuberculosis in Africa. II. Investigation of host genetic factors. Am J Epidemiol 2002; 155:1074-9. [PMID: 12034587 DOI: 10.1093/aje/155.11.1074] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In an accompanying paper (Am. J. Epidemiol. 2002;155:1066-73), the authors describe the design of a large multicenter study being carried out in three West African countries for investigation of the roles of environmental and host-related factors in the development of tuberculosis. In this paper, the authors review some evidence that host genetic factors play a role in susceptibility to tuberculosis. They describe the three components of the study that are designed to investigate the effect of host genetic factors on the development of tuberculosis: case-control and family-based association studies of candidate genes and analysis of affected relative pairs to screen the human genome for areas of linkage to the disease. The authors also address a number of methodological issues that arise, such as the effects of consanguinity, half-siblings, and nonpaternity. Lastly, they review opportunities to assess gene-environment interaction in the framework of the study, in light of current methodological knowledge. Consideration of these issues may be useful in the design of other studies of genetic susceptibility to infectious diseases, particularly those to be carried out in developing countries.
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Affiliation(s)
- S Bennett
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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38
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Lienhardt C, Bennett S, Del Prete G, Bah-Sow O, Newport M, Gustafson P, Manneh K, Gomes V, Hill A, McAdam K. Investigation of environmental and host-related risk factors for tuberculosis in Africa. I. Methodological aspects of a combined design. Am J Epidemiol 2002; 155:1066-73. [PMID: 12034586 DOI: 10.1093/aje/155.11.1066] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Host-related and environmental factors for tuberculosis have usually been investigated separately using different study designs. Joint investigation of the genetic, immunologic, and environmental factors at play in susceptibility to tuberculosis represents an innovative goal for obtaining a better understanding of the pathogenesis of the disease. In this paper, the authors describe methods being used to investigate these points in a West African study combining several designs. Patients with newly diagnosed smear-positive cases of tuberculosis are recruited. The effect of host-related factors is assessed by comparing each case with a healthy control from the case's household. The role of environmental factors is estimated by comparing cases with randomly selected community controls. The frequencies of candidate gene variants are compared between cases and community controls, and results are validated through family-based association studies. Members of the households of cases and community controls are being followed prospectively to determine the incidence of "secondary" tuberculosis and to evaluate the influence of geographic and genetic proximity to the index case. This type of design raises important methodological issues that may be useful to consider in studies investigating the natural history of infectious diseases and in attempts to disentangle the effects of environmental and genetic factors in response to infection.
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Koch O, Awomoyi A, Usen S, Jallow M, Richardson A, Hull J, Pinder M, Newport M, Kwiatkowski D. IFNGR1 gene promoter polymorphisms and susceptibility to cerebral malaria. J Infect Dis 2002; 185:1684-7. [PMID: 12023780 DOI: 10.1086/340516] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2001] [Revised: 01/24/2002] [Indexed: 11/03/2022] Open
Abstract
Interferon (IFN)-gamma is a critical mediator of immunity to malaria. This study explored the relationship between polymorphisms in the promoter region of the gene encoding IFN-gamma receptor 1 (IFNGR1) and susceptibility to malaria in African children. Four polymorphisms were found in the region between -1400 and +100 nt of the translational start site by sequencing, and analysis of 562 nuclear families revealed 6 haplotypes. Case-control analysis of 562 Gambian children with severe malaria and 569 umbilical cord blood samples (controls) showed that in Mandinka, the major Gambian ethnic group, heterozygotes for the IFNGR1-56 polymorphism were protected against cerebral malaria (odds ratio, 0.54; P=.016) and against death resulting from cerebral malaria (odds ratio, 0.22; P=.006). Analysis of a family study by transmission disequilibrium testing revealed a similar result. Further data are needed to validate this finding, but these results are reminiscent of those for other well-established heterozygote advantages, such as that associated with hemoglobin S.
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Affiliation(s)
- Oliver Koch
- Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, United Kingdom.
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40
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van der Sande MA, Milligan PJ, Walraven GE, Dolmans WM, Newport M, Nyan OA, Banya WA, Thien T, Ward R, McAdam KP. Geographical variation in prevalence of hypertension within The Gambia. J Hum Hypertens 2001; 15:733-9. [PMID: 11607805 DOI: 10.1038/sj.jhh.1001259] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2000] [Revised: 02/05/2001] [Accepted: 05/30/2001] [Indexed: 11/08/2022]
Abstract
Hypertension has become an important public health problem for sub-Sahara Africa. In a previous nationwide study, we observed a high degree of geographical variation in the prevalence of diastolic hypertension. Geographical variation provides essential background information for the development of community randomised trials could suggest aetiological mechanisms, inform control strategies and prompt further research questions. We designed a follow-up study from the nine high-prevalence communities, and from 18 communities where hypertension was found least prevalent (controls). In each community, 50 households were randomly selected. In each household, an (unrelated) man and woman were enrolled. The risk for hypertension (blood pressure > or =160/95 mm Hg) was higher in the high prevalence communities compared to the control villages (adjusted OR = 1.7, 95% CI 1.3-2.2). The observed coefficient of variation in hypertension prevalence, k, was 0.30. Thus we confirmed significant geographical variation in prevalence of hypertension over time, which has implications for planning of interventions.
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Abstract
Although one third of the world's population is estimated to be infected with Mycobacterium tuberculosis, only one tenth of infected individuals develop clinical disease. There is substantial epidemiological evidence that host genetic factors are important determinants of susceptibility to mycobacterial disease. This paper gives a historical context to the recent exciting advances in the field which have led to the identification of a number of human mycobacterial susceptibility genes.
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Affiliation(s)
- M Levin
- Department of Paediatrics, Imperial College School of Medicine, Norfolk Place, W2 1PG, London, UK.
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42
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Abstract
Newborns and young infants are at increased risk of severe or prolonged infections. Recent advances in our understanding of the host immune response in this age group, coupled with the development of molecular genetic tools, have paved the way for a new generation of preventive vaccines.
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Affiliation(s)
- Arnaud Marchant
- aMRC Laboratories, Banjul, The Gambia, West Africa, and bWellcome Trust Centre for the Study of Molecular Mechanisms in Disease, Cambridge Institute for Medical Research, Addenbrooke's Hospital, Hills Road, Cambridge, UK
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43
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Affiliation(s)
- M Newport
- Department of Medicine, Cambridge Institute for Medical Research, Addenbrooke's Hospital, UK
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44
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Abstract
Genetic factors have long been suspected of determining susceptibility and resistance to mycobacterial infection. The recent identification of families with a unique susceptibility to mycobacterial infection, and the identification of mutations in the genes for either the interferon-gamma (IFN-gamma) receptor or the interleukin (IL)-12 receptor as the cause of the defect, has provided an important clue to the pathways critical for resistance to mycobacterial infection in humans. Although the genetically determined absence of key cytokines or their receptors results in susceptibility to lethal mycobacterial infections in early childhood, it is likely that more subtle mutations that result in only partial dysfunction of macrophage upregulation pathways may play a role in susceptibility to tuberculosis (TB) and leprosy in the general population.
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Affiliation(s)
- M Levin
- Infectious Disease Unit, Department of Paediatrics, Imperial College School of Medicine at St Mary's Hospital, London, UK
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45
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Newport M. Genetics and tuberculosis. Novartis Foundation Symposium 217: D. J. Chadwick, G. Cardew (Editors) John Wiley and Sons (269 pages), ISBN 0-471-98261-X, £ 57.50, Hardcover. Hum Genet 1999. [DOI: 10.1007/s004390050983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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46
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Altare F, Jouanguy E, Newport M, Lamhamedi S, Fischer A, Levin M, Casanova JL. IFNgR1, a human mycobacterial susceptibility candidate gene. ACTA ACUST UNITED AC 1997. [DOI: 10.1016/s0020-2452(97)81368-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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47
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Affiliation(s)
- M Levin
- Department of Paediatrics, Imperial College School of Medicine, St Mary's Hospital, London, U.K
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48
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Jouanguy E, Altare F, Lamhamedi S, Revy P, Emile JF, Newport M, Levin M, Blanche S, Seboun E, Fischer A, Casanova JL. Interferon-gamma-receptor deficiency in an infant with fatal bacille Calmette-Guérin infection. N Engl J Med 1996; 335:1956-61. [PMID: 8960475 DOI: 10.1056/nejm199612263352604] [Citation(s) in RCA: 615] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- E Jouanguy
- INSERM Unité 429, Hôpital Necker-Enfants Malades, Paris, France
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49
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Newport M, Levin M, Blackwell J, Shaw MA, Williamson R, Huxley C. Evidence for exclusion of a mutation in NRAMP as the cause of familial disseminated atypical mycobacterial infection in a Maltese kindred. J Med Genet 1995; 32:904-6. [PMID: 8592339 PMCID: PMC1051747 DOI: 10.1136/jmg.32.11.904] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In mice, susceptibility to intracellular infections in inbred strains is controlled by a single locus, Lsh/Ity/Bcg, and the gene responsible has been cloned and designated Nramp (Natural resistance associated macrophage protein). We have identified a group of related children who appear to have a single gene defect, inherited recessively, which results in increased susceptibility to myocabacterial infection. The immunological defect observed in the affected children resembles that in mice homozygous for the Lsh/Ity/Bcg susceptible allele. To test the hypothesis that a mutation in NRAMP is responsible for the immunodeficiency observed in the affected children, we have typed eight markers in the region of human 2q34-q37 where NRAMP, the human homologue of Nramp, maps. We have shown discordance with the defect in one family and the chromosomes in the three affected children have different haplotypes making it unlikely that inheritance of an ancestral mutation in the NRAMP gene is the cause of increased mycobacterial susceptibility in this group of children.
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Affiliation(s)
- M Newport
- Department of Biochemistry and Molecular Genetics, St Mary's Hospital Medical School, Imperial College of Science, Technology and Medicine, London, UK
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50
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Abstract
Mycobacterial disease remains a major public health problem and there appears to be a genetic component underlying susceptibility. This paper describes a group of related children who appear to have a genetic predisposition to disseminated atypical mycobacterial infection. Identification of the defect in this group could lead to better understanding of the genetics of susceptibility to mycobacterial infection.
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Affiliation(s)
- M Newport
- Department of Paediatrics, St Mary's Hospital Medical School, Imperial College of Science, Technology and Medicine, London, UK
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