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Watson AW, Houghton D, Avery PJ, Stewart C, Vaughan EE, Meyer PD, de Bos Kuil MJ, Weijs PJ, Brandt K. Changes in stool frequency following chicory inulin consumption, and effects on stool consistency, quality of life and composition of gut microbiota. Food Hydrocoll 2019; 96:688-698. [PMID: 31680713 PMCID: PMC6686634 DOI: 10.1016/j.foodhyd.2019.06.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/15/2019] [Accepted: 06/03/2019] [Indexed: 02/07/2023]
Abstract
Inulin is a soluble dietary fibre, also classified as a prebiotic, extracted from chicory roots. The present study aimed to determine the effect of consumption of native chicory inulin on the stool frequency of middle-aged to older adults (40-75 years old) with uncomfortably but not clinically relevant low stool frequency, specified as two to four days without bowel movements per week. Two randomised, double blind, placebo-controlled crossover trials were conducted using similar protocols in differing populations. Trial A was conducted in Amsterdam, The Netherlands and subsequently Trial B was conducted in Newcastle, United Kingdom. Both trials involved supplementation for 5 weeks with 10 g per day of inulin or placebo, a washout period of 2 weeks, and then crossed over to receive the other treatment. In Trial B, faecal gut microbiota composition was assessed using 16S rRNA gene sequencing. In Trial A, which 10 volunteers completed, the stool frequency was significantly increased to an average 4.9 ± 0.23 (SEM) times per week during inulin periods versus 3.6 ± 0.25 in the periods with placebo (p = 0.01). In contrast, in Trial B which 20 volunteers completed, there was no significant effect of the inulin on stool frequency (7.5 ± 2.1 times per week with inulin, 8.1 ± 3.0 with placebo, p = 0.35). However, many subjects in Trial B had a stool frequency >5 per week also for the placebo period, in breach of the inclusion criteria. Combining the data of 16 low stool frequency subjects from Trials A and B showed a significant effect of inulin to increase stool frequency from 4.1 to 5.0 per week (p = 0.032). Regarding secondary outcomes, stool consistency was significantly softer with inulin treatment compared to placebo periods, it increased 0.29 on the Bristol stool scale (p = 0.008) when data from all subjects of Trials A and B were combined. No other differences in bowel habit parameters due to inulin consumption were significant. None of the differences in specific bacterial abundance, alpha or beta diversity were significant, however the trends were in directions consistent with published studies on other types of inulin. We conclude that 10 g per day of native chicory inulin can increase stool frequency in subjects with low stool frequency.
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Affiliation(s)
- Anthony W. Watson
- NU-Food Research Facility, Human Nutrition Research Centre, Newcastle University, NE1 7RU, Newcastle upon Tyne, UK
- Institute of Cellular Medicine, Newcastle University, NE2 4HH, Newcastle upon Tyne, UK
| | - David Houghton
- Wellcome Trust Centre for Mitochondrial Research, Institute for Cell and Molecular Biosciences and Institute of Neuroscience, Newcastle University, NE2 4HH, Newcastle upon Tyne, UK
| | - Peter J. Avery
- School of Mathematics & Statistics, Newcastle University, NE1 7RU, Newcastle upon Tyne, UK
| | - Christopher Stewart
- Institute of Cellular Medicine, Newcastle University, NE2 4HH, Newcastle upon Tyne, UK
| | - Elaine E. Vaughan
- Sensus (Royal Cosun), Borchwerf 3, 4704 RG Roosendaal, the Netherlands
| | | | - Minse J.J. de Bos Kuil
- Department of Nutrition and Dietetics, Amsterdam University of Applied Sciences, Postbus 2165, 1000 CD Amsterdam, the Netherlands
| | - Peter J.M. Weijs
- Department of Nutrition and Dietetics, Amsterdam University of Applied Sciences, Postbus 2165, 1000 CD Amsterdam, the Netherlands
| | - Kirsten Brandt
- NU-Food Research Facility, Human Nutrition Research Centre, Newcastle University, NE1 7RU, Newcastle upon Tyne, UK
- Institute of Cellular Medicine, Newcastle University, NE2 4HH, Newcastle upon Tyne, UK
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Kampouraki E, Avery PJ, Biss T, Kamali F. Association between CYP4F2 genotype and circulating plasma vitamin K concentration in children on chronic warfarin therapy: Possible long-term implications for bone development and vascular health. Pediatr Blood Cancer 2017; 64. [PMID: 28521079 DOI: 10.1002/pbc.26653] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/31/2017] [Accepted: 05/03/2017] [Indexed: 11/11/2022]
Abstract
Vitamin K is essential, for the activation of clotting proteins, as well as the biosynthesis of osteocalcin in bones and the activation of matrix-Gla protein needed in maintaining vasculature health. Cytochrome p450 4F2 (CYP4F2) enzyme is involved in vitamin K catabolism. Genetic polymorphism in CYP4F2 is thus likely to affect vitamin K systemic availability. We show that children on chronic warfarin therapy have low levels of vitamin K and vitamin K levels are linked to CYP4F2 genotype. Long-term low levels of vitamin K, influenced by CYP4F2 genotype, might affect bone development and vascular health in children on chronic warfarin therapy.
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Affiliation(s)
- Emmanouela Kampouraki
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Peter J Avery
- School of Mathematics & Statistics, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Tina Biss
- Department of Haematology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Farhad Kamali
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
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Kampouraki E, Avery PJ, Wynne H, Biss T, Hanley J, Talks K, Kamali F. Assessment of the efficacy of a novel tailored vitamin K dosing regimen in lowering the International Normalised Ratio in over-anticoagulated patients: a randomised clinical trial. Br J Haematol 2017; 178:800-809. [PMID: 28771671 DOI: 10.1111/bjh.14777] [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: 01/18/2017] [Accepted: 03/29/2017] [Indexed: 11/28/2022]
Abstract
Current guidelines advocate using fixed-doses of oral vitamin K to reverse excessive anticoagulation in warfarinised patients who are either asymptomatic or have minor bleeds. Over-anticoagulated patients present with a wide range of International Normalised Ratio (INR) values and response to fixed doses of vitamin K varies. Consequently a significant proportion of patients remain outside their target INR after vitamin K administration, making them prone to either haemorrhage or thromboembolism. We compared the performance of a novel tailored vitamin K dosing regimen to that of a fixed-dose regimen with the primary measure being the proportion of over-anticoagulated patients returning to their target INR within 24 h. One hundred and eighty-one patients with an index INR > 6·0 (asymptomatic or with minor bleeding) were randomly allocated to receive oral administration of either a tailored dose (based upon index INR and body surface area) or a fixed-dose (1 or 2 mg) of vitamin K. A greater proportion of patients treated with the tailored dose returned to within target INR range compared to the fixed-dose regimen (68·9% vs. 52·8%; P = 0·026), whilst a smaller proportion of patients remained above target INR range (12·2% vs. 34·0%; P < 0·001). Individualised vitamin K dosing is more accurate than fixed-dose regimen in lowering INR to within target range in excessively anticoagulated patients.
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Affiliation(s)
| | - Peter J Avery
- School of Mathematics & Statistics, Newcastle University, Newcastle upon Tyne, UK
| | - Hilary Wynne
- Older People's Medicine, Freeman Hospital, Newcastle upon Tyne, UK
| | - Tina Biss
- Department of Haematology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - John Hanley
- Department of Haematology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Kate Talks
- Department of Haematology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Farhad Kamali
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
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Steel DHW, Dinah C, White K, Avery PJ. The relationship between a dissociated optic nerve fibre layer appearance after macular hole surgery and Muller cell debris on peeled internal limiting membrane. Acta Ophthalmol 2017; 95:153-157. [PMID: 27572851 DOI: 10.1111/aos.13195] [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: 12/08/2015] [Accepted: 06/18/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE A dissociated optic nerve fibre layer (DONFL) is a characteristic change noted in inner retinal morphology after internal limiting membrane (ILM) peeling. It is thought to be due to trauma to Muller cells as the ILM is peeled from their attached end plates. In this study, we aimed to determine the extent and size of Muller cell debris on the retinal side of excised ILM and assess whether this correlated with the extent of DONFL observed postoperatively. METHOD Prospective single centre study of a consecutive series of patients undergoing macular hole surgery. Transmission electron microscopy of the ILM was used to assess Muller cell debris and postoperative spectral domain optical coherence tomography (SD-OCT) to assess the extent of DONFL. A variety of other pre- and postoperative features was also included. RESULTS Thirty-nine patients were analysed. There were retinal dimples characteristic of DONFL detected on SD-OCT in all 39 eyes. The portion of the retinal side of the ILM specimen covered by cellular debris ranged from 12% to 49%, with a median of 28%. Using linear regression, the percentage of retinal debris, the size of the debris and the postoperative visual acuity were significantly positively associated with the DONFL score. The total R squared for the model was 63.9%. CONCLUSION The extent of DONFL observed postoperatively can be partly explained by the amount of retinal side cellular debris on the retinal side of the peeled ILM. Surgical strategies which minimize this material could reduce the extent of DONFL.
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Affiliation(s)
- David H. W. Steel
- Sunderland Eye Infirmary; Sunderland UK
- Institute of Genetic Medicine; Newcastle University; Newcastle Upon Tyne UK
| | | | - Kathryn White
- EM Research Services; Newcastle University; Newcastle Upon Tyne UK
| | - Peter J. Avery
- School of Mathematics and Statistics; Newcastle University; Newcastle Upon Tyne UK
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Sidaginamale RP, Joyce TJ, Bowsher JG, Lord JK, Avery PJ, Natu S, Nargol AVF, Langton DJ. The clinical implications of metal debris release from the taper junctions and bearing surfaces of metal-on-metal hip arthroplasty: joint fluid and blood metal ion concentrations. Bone Joint J 2017; 98-B:925-33. [PMID: 27365470 DOI: 10.1302/0301-620x.98b7.37029] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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] [Received: 08/05/2015] [Accepted: 03/17/2016] [Indexed: 11/05/2022]
Abstract
AIMS We wished to investigate the influence of metal debris exposure on the subsequent immune response and resulting soft-tissue injury following metal-on-metal (MoM) hip arthroplasty. Some reports have suggested that debris generated from the head-neck taper junction is more destructive than equivalent doses from metal bearing surfaces. PATIENTS AND METHODS We investigated the influence of the source and volume of metal debris on chromium (Cr) and cobalt (Co) concentrations in corresponding blood and hip synovial fluid samples and the observed agglomerated particle sizes in excised tissues using multiple regression analysis of prospectively collected data. A total of 199 explanted MoM hips (177 patients; 132 hips female) were analysed to determine rates of volumetric wear at the bearing surfaces and taper junctions. RESULTS The statistical modelling suggested that a greater source contribution of metal debris from the taper junction was associated with smaller aggregated particle sizes in the local tissues and a relative reduction of Cr ion concentrations in the corresponding synovial fluid and blood samples. Metal debris generated from taper junctions appears to be of a different morphology, composition and therefore, potentially, immunogenicity to that generated from bearing surfaces. CONCLUSION The differences in debris arising from the taper and the articulating surfaces may provide some understanding of the increased incidence of soft-tissue reactions reported in patients implanted with MoM total hip arthroplasties compared with patients with hip resurfacings. Cite this article: Bone Joint J 2016;98-B:925-33.
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Affiliation(s)
| | - T J Joyce
- Newcastle University, Stephenson Building, NE1 7RU, UK
| | - J G Bowsher
- Food and Drugs Administration, 0903 New Hampshire Avenue, Silver Spring, Maryland 20993-0002, USA
| | - J K Lord
- Virginia Tech, Blacksburg, VA 24061, USA
| | - P J Avery
- Newcastle University, Stephenson Building, NE1 7RU, UK
| | - S Natu
- University Hospital of North Tees, TS19 8PE, UK
| | - A V F Nargol
- University Hospital of North Tees, Farndale House, TS19 8PE, UK
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Abstract
Purpose: A variety of retinal topographical changes occur after internal limiting membrane (ILM) peeling for macular holes including a movement of the fovea toward the optic nerve. This study was carried out to assess the effect of the extent of ILM-peeled area on these changes and postoperative visual acuity. Methods: Prospective single-center study of a consecutive series of patients undergoing macular hole surgery. Preoperative and postoperative optical coherence tomography images were used to assess a variety of measures of retinal morphology. Transmission electron microscopy of the peeled ILM was used to assess residual retinal and vitreous side debris. The area of the ILM peeled was calculated from intraoperative images. Results: Fifty-six eyes of 56 patients were included. The mean area of ILM peeled was 9.5 mm2 (2.4-28.3 mm2). The mean disc-to-fovea distance (DFD) preoperatively was 3703 μm with a mean reduction of 52 μm postoperatively, representing a change of −1.29% with a wide range of −7.04% to 1.36%. Using stepwise linear regression, ILM-peeled area was significantly associated with a change in DFD ( P < .001), extent of a dissociated optic nerve fiber layer appearance ( P < .001), and postoperative visual acuity ( P = .025). Nasotemporal retinal thickness asymmetry was associated with the minimum linear diameter ( P < .001). Conclusion: The ILM-peeled area has a significant effect on changes in retinal topography and postoperative visual acuity separate from macular hole size. Further study is needed to assess the effect of ILM peeled size on visual function and to guide clinical practice.
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Affiliation(s)
- David H. W. Steel
- Sunderland Eye Infirmary, Sunderland, United Kingdom
- Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Yunzi Chen
- Sunderland Eye Infirmary, Sunderland, United Kingdom
| | - James Latimer
- Sunderland Eye Infirmary, Sunderland, United Kingdom
| | - Kathryn White
- EM Research Services, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Peter J. Avery
- School of Mathematics and Statistics, Newcastle University, Newcastle Upon Tyne, United Kingdom
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Musgrave KM, van Delft FW, Avery PJ, Clack RM, Chalmers EA, Qureshi A, Vora AJ, Biss TT. Cerebral sinovenous thrombosis in children and young adults with acute lymphoblastic leukaemia - a cohort study from the United Kingdom. Br J Haematol 2016; 179:667-669. [PMID: 27392277 DOI: 10.1111/bjh.14231] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kathryn M Musgrave
- Department of Haematology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Frederik W van Delft
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Peter J Avery
- School of Mathematics and Statistics, Newcastle University, Newcastle upon Tyne, UK
| | - Rachel M Clack
- Clinical Trial Service Unit, University of Oxford, Oxford, UK
| | | | - Amrana Qureshi
- Oxford Children's Hospital, Oxford University NHS Foundation Trust, Oxford, UK
| | - Ajay J Vora
- Sheffield Children's Hospital, Sheffield, UK
| | - Tina T Biss
- Department of Haematology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Baker PN, Petheram T, Dowen D, Jameson SS, Avery PJ, Reed MR, Deehan DJ. Early PROMs following total knee arthroplasty--functional outcome dependent on patella resurfacing. J Arthroplasty 2014; 29:314-9. [PMID: 23769662 DOI: 10.1016/j.arth.2013.05.001] [Citation(s) in RCA: 10] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 04/27/2013] [Accepted: 05/01/2013] [Indexed: 02/01/2023] Open
Abstract
Patella resurfacing during primary total knee arthroplasty (TKA) remains controversial. Variation in published results for patella resurfacing may potentially be explained by differences in design between TKA brands. We interrogated NJR-PROMs data to ascertain whether there is an early functional benefit to resurfacing the patella, both overall and for each of the five most popular primary knee designs through use of the Oxford Knee Score. A total of 8103 resurfaced TKAs and 15,290 nonresurfaced TKAs were studied. There was a large variation in the proportion of knees undergoing patella resurfacing by brand (Nexgen=16% versus Triathlon=52%). Patellar resurfacing did not significantly influence the magnitude of improvement in overall knee function or anterior knee-specific function irrespective of TKA brand or for cruciate retaining versus sacrificing designs.
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Affiliation(s)
- Paul N Baker
- The National Joint Registry for England and Wales, London, UK; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; Northern Deanery Training Programme, Newcastle upon Tyne, UK
| | | | - Daniel Dowen
- Northern Deanery Training Programme, Newcastle upon Tyne, UK
| | - Simon S Jameson
- The National Joint Registry for England and Wales, London, UK; Northern Deanery Training Programme, Newcastle upon Tyne, UK
| | - Peter J Avery
- School of Mathematics and Statistics, Newcastle University, Newcastle upon Tyne, UK
| | - Mike R Reed
- South Tees Hospitals NHS Foundation Trust, The James Cook University Hospital, Marton Road, Middlesbrough, UK
| | - David J Deehan
- Newcastle upon Tyne NHS Trust, Freeman Hospital, Freeman Road, Newcastle upon Tyne, UK
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Biss TT, Avery PJ, Williams MD, Brandão LR, Grainger JD, Kamali F. The VKORC1 and CYP2C9 genotypes are associated with over-anticoagulation during initiation of warfarin therapy in children. J Thromb Haemost 2013; 11:373-5. [PMID: 23279643 DOI: 10.1111/jth.12072] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 11/08/2012] [Indexed: 11/30/2022]
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Harper AR, Mayosi BM, Rodriguez A, Rahman T, Hall D, Mamasoula C, Avery PJ, Keavney BD. Common variation neighbouring micro-RNA 22 is associated with increased left ventricular mass. PLoS One 2013; 8:e55061. [PMID: 23372812 PMCID: PMC3555935 DOI: 10.1371/journal.pone.0055061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 08/02/2012] [Accepted: 12/22/2012] [Indexed: 01/18/2023] Open
Abstract
Aims Previous genome-wide linkage analysis has suggested that chromosomal region 17p13.3 may harbour genes influencing left ventricular mass (LVM) in man. To date, the genetic factors accounting for LVM variability remain largely unknown but a non-coding RNA gene within this region, micro-RNA 22 (miR-22), has been implicated in cardiac hypertrophy and heart failure in animal models. We thus investigated the relationship between common genetic polymorphisms surrounding miR-22 and left ventricular mass in a family-based association study. Methods and Results We studied a cohort of 255 families comprising 1,425 individuals ascertained via a hypertensive proband. Ten single nucleotide polymorphisms which together tagged common genetic variation surrounding the miR-22 gene were genotyped. There was evidence of association between the rs7223247 polymorphism, which lies within the 3′UTR of a gene of unknown function, TLCD2, immediately downstream from miR-22, and left ventricular mass determined by Sokolow-Lyon voltage (Bonferroni corrected p-value = 0.038). The T allele at rs7223247 was associated with an 0.272 standard deviation higher Sokolow-Lyon voltage. Genotype was responsible for ∼1% of the population variability in LVM. Conclusions Genotype at the rs7223247 polymorphism affects left ventricular mass determined by Sokolow-Lyon voltage. The neighbouring genes miR-22 and TLCD2 are strong candidates to account for this observation.
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Affiliation(s)
- Andrew R. Harper
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Bongani M. Mayosi
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Antony Rodriguez
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, Texas, United States of America
| | - Thahira Rahman
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Darroch Hall
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Peter J. Avery
- School of Mathematics & Statistics, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Bernard D. Keavney
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
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Baker PN, Deehan DJ, Lees D, Jameson S, Avery PJ, Gregg PJ, Reed MR. The effect of surgical factors on early patient-reported outcome measures (PROMS) following total knee replacement. ACTA ACUST UNITED AC 2012; 94:1058-66. [PMID: 22844046 DOI: 10.1302/0301-620x.94b8.28786] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Patient-reported outcome measures (PROMs) are increasingly being used to assess functional outcome and patient satisfaction. They provide a framework for comparisons between surgical units, and individual surgeons for benchmarking and financial remuneration. Better performance may bring the reward of more customers as patients and commissioners seek out high performers for their elective procedures. Using National Joint Registry (NJR) data linked to PROMs we identified 22,691 primary total knee replacements (TKRs) undertaken for osteoarthritis in England and Wales between August 2008 and February 2011, and identified the surgical factors that influenced the improvements in the Oxford knee score (OKS) and EuroQol-5D (EQ-5D) assessment using multiple regression analysis. After correction for patient factors the only surgical factors that influenced PROMs were implant brand and hospital type (both p < 0.001). However, the effects of surgical factors upon the PROMs were modest compared with patient factors. For both the OKS and the EQ-5D the most important factors influencing the improvement in PROMs were the corresponding pre-operative score and the patient's general health status. Despite having only a small effect on PROMs, this study has shown that both implant brand and hospital type do influence reported subjective functional scores following TKR. In the current climate of financial austerity, proposed performance-based remuneration and wider patient choice, it would seem unwise to ignore these effects and the influence of a range of additional patient factors.
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Affiliation(s)
- P N Baker
- Institute of Cellular Medicine, Medical school, Newcastle University, Framlington place, Newcastle upon Tyne NE1 7RU, UK.
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Baker PN, Petheram T, Jameson SS, Avery PJ, Reed MR, Gregg PJ, Deehan DJ. Comparison of patient-reported outcome measures following total and unicondylar knee replacement. ACTA ACUST UNITED AC 2012; 94:919-27. [PMID: 22733946 DOI: 10.1302/0301-620x.94b7.28436] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Following arthroplasty of the knee, the patient's perception of improvement in symptoms is fundamental to the assessment of outcome. Better clinical outcome may offset the inferior survival observed for some types of implant. By examining linked National Joint Registry (NJR) and patient-reported outcome measures (PROMs) data, we aimed to compare PROMs collected at a minimum of six months post-operatively for total (TKR: n = 23,393) and unicondylar knee replacements (UKR: n = 505). Improvements in knee-specific (Oxford knee score, OKS) and generic (EuroQol, EQ-5D) scores were compared and adjusted for case-mix differences using multiple regression. Whereas the improvements in the OKS and EQ-5D were significantly greater for TKR than for UKR, once adjustments were made for case-mix differences and pre-operative score, the improvements in the two scores were not significantly different. The adjusted mean differences in the improvement of OKS and EQ-5D were 0.0 (95% confidence interval (CI) -0.9 to 0.9; p = 0.96) and 0.009 (95% CI -0.034 to 0.015; p = 0.37), respectively. We found no difference in the improvement of either knee-specific or general health outcomes between TKR and UKR in a large cohort of registry patients. With concerns about significantly higher revision rates for UKR observed in worldwide registries, we question the widespread use of an arthroplasty that does not confer a significant benefit in clinical outcome.
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Affiliation(s)
- P N Baker
- Institute of Cellular Medicine, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK.
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13
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Abstract
BACKGROUND Unicompartmental knee arthroplasty has been associated with consistently worse implant survival rates than total knee arthroplasty in worldwide arthroplasty registers. The rate of revision and the proportion of revisions performed for unexplained knee pain after either a unicompartmental or total knee arthroplasty were studied to assess if there is evidence to support the hypothesis that the numbers of revisions performed for unexplained knee pain differ between these two implant types. METHODS Using data from the National Joint Registry (NJR) of England and Wales, we identified 402,714 primary knee arthroplasties (366,965 total knee arthroplasties and 35,749 unicompartmental knee arthroplasties) that were consecutively entered from April 2003 to December 2010. The status of all implants was assessed as of December 2010, at which time 6075 implants (4503 total knee implants and 1572 unicompartmental knee implants) had been revised at a maximum of eight years. Survival analysis and Cox regression analysis with adjustment of differences in age, sex, American Society of Anesthesiologists (ASA) grade, and indication for arthroplasty were performed with use of the end points of revision for any reason, revision for unexplained pain, and revision for other reasons. RESULTS Revision for unexplained pain was more common after unicompartmental knee arthroplasty than after total knee arthroplasty (representing 23% of revisions as compared with 9% of revisions; p < 0.001). The five-year rate of revision for unexplained pain was 1.6% for the unicompartmental knee arthroplasty group and 0.2% for the total knee arthroplasty group. With use of Cox regression, the hazard ratio (HR) for unicompartmental knee arthroplasty relative to total knee arthroplasty with the end points of revision for any reason, revision for unexplained pain, and revision for all other reasons were 2.82 (95% confidence interval [CI], 2.66 to 2.99; p < 0.001), 6.76 (95% CI, 5.84 to 7.83; p < 0.001), and 2.39 (95% CI, 2.24 to 2.56; p < 0.001), respectively. The mean time from primary implantation to revision was similar for both implant types. CONCLUSIONS While more unicompartmental knee implants than total knee implants were revised for unexplained pain, when these revisions for unexplained pain were discounted, unicompartmental knee arthroplasty still had a significantly greater risk of revision from other reasons than did total knee arthroplasty. The revision rate in isolation may not be a reliable way to compare different implant designs and should instead be considered in the context of the reason for failure.
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Affiliation(s)
- Paul N Baker
- Institute of Cellular Medicine, University of Newcastle upon Tyne, Newcastle, NE1 7RU, England.
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Biss TT, Avery PJ, Walsh PM, Kamali F. Comparison of time within therapeutic INR range with percentage INR within therapeutic range for assessing long-term anticoagulation control in children: reply to a rebuttal. J Thromb Haemost 2011; 9:2332-3. [PMID: 21899719 DOI: 10.1111/j.1538-7836.2011.04500.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Abstract
This study addresses the epidemiology of knee injuries in adolescent males. Data were collected prospectively from 41 Premiership soccer academies over a 5 year period from July 2000 to June 2005. A total of 12,306 player seasons were registered in the U9 to the U16 age categories with a total of 1750 recordable injuries specific to the knee joint. There was a mean incidence of 0.71 (95% confidence interval ± 0.05) knee injuries per player per year, and a median of 17 (inter-quartile range 9-38) training days and 2 (inter-quartile range 1-4) matches missed per knee injury. Knee injuries were found to be most common in the 14-16 year age group. Six hundred and nine (35% of total) injuries were classed as severe resulting in more than 28 days' absence. Injuries were more likely to be sustained in a competitive or match-play environment (862 or 52%) than in training (796 or 48%), and a non-contact mechanism was implicated in 823 (55%) of recorded cases. Peaks in injury numbers were seen in early season and subsequent to the winter break. Sprain was the most common diagnosis recorded, with the medial collateral ligament affected in 23% of all knee injuries. Knee injuries are common in elite youth footballers. In this uninsured age group, it could be argued that earlier medical intervention may reduce long-term damage to the immature skeleton.
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Affiliation(s)
- Oliver Moore
- Newcastle Medical School, Newcastle-upon-Tyne, UK
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Rahman TJ, Walker EA, Mayosi BM, Hall DH, Avery PJ, Connell JMC, Watkins H, Stewart PM, Keavney B. Genotype at the P554L variant of the hexose-6 phosphate dehydrogenase gene is associated with carotid intima-medial thickness. PLoS One 2011; 6:e23248. [PMID: 21858044 PMCID: PMC3155541 DOI: 10.1371/journal.pone.0023248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 05/12/2011] [Accepted: 07/11/2011] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The combined thickness of the intima and media of the carotid artery (carotid intima-medial thickness, CIMT) is associated with cardiovascular disease and stroke. Previous studies indicate that carotid intima-medial thickness is a significantly heritable phenotype, but the responsible genes are largely unknown. Hexose-6 phosphate dehydrogenase (H6PDH) is a microsomal enzyme whose activity regulates corticosteroid metabolism in the liver and adipose tissue; variability in measures of corticosteroid metabolism within the normal range have been associated with risk factors for cardiovascular disease. We performed a genetic association study in 854 members of 224 families to assess the relationship between polymorphisms in the gene coding for hexose-6 phosphate dehydrogenase (H6PD) and carotid intima-medial thickness. METHODS Families were ascertained via a hypertensive proband. CIMT was measured using B-mode ultrasound. Single nucleotide polymorphisms (SNPs) tagging common variation in the H6PD gene were genotyped. Association was assessed following adjustment for significant covariates including "classical" cardiovascular risk factors. Functional studies to determine the effect of particular SNPs on H6PDH were performed. RESULTS There was evidence of association between the single nucleotide polymorphism rs17368528 in exon five of the H6PD gene, which encodes an amino-acid change from proline to leucine in the H6PDH protein, and mean carotid intima-medial thickness (p = 0.00065). Genotype was associated with a 5% (or 0.04 mm) higher mean carotid intima-medial thickness measurement per allele, and determined 2% of the population variability in the phenotype. CONCLUSIONS Our results suggest a novel role for the H6PD gene in atherosclerosis susceptibility.
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Affiliation(s)
- Thahira J. Rahman
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Elizabeth A. Walker
- Department of Medicine, University of Birmingham, Birmingham, United Kingdom
| | - Bongani M. Mayosi
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Darroch H. Hall
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Peter J. Avery
- School of Mathematics and Statistics, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Hugh Watkins
- Department of Cardiovascular Medicine, Oxford University, Oxford, United Kingdom
| | - Paul M. Stewart
- Department of Medicine, University of Birmingham, Birmingham, United Kingdom
| | - Bernard Keavney
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail:
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17
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Biss TT, Avery PJ, Walsh PM, Kamali F. Comparison of 'time within therapeutic INR range' with 'percentage INR within therapeutic range' for assessing long-term anticoagulation control in children. J Thromb Haemost 2011; 9:1090-2. [PMID: 21362125 DOI: 10.1111/j.1538-7836.2011.04248.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Rahman TJ, Mayosi BM, Hall D, Avery PJ, Stewart PM, Connell JM, Watkins H, Keavney B. Common Variation at the 11-β Hydroxysteroid Dehydrogenase Type 1 Gene Is Associated With Left Ventricular Mass. ACTA ACUST UNITED AC 2011; 4:156-62. [DOI: 10.1161/circgenetics.110.958496] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background—
Polymorphisms in 11-β hydroxysteroid dehydrogenase type 1 (11β-HSD1, encoded by
HSD11B1
) have been reported to be associated with obesity-related cardiovascular risk factors, such as type II diabetes and hypertension. Left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular death associated with these factors but has significant additional heritability, the cause of which is undetermined. The 11β-HSD1 is believed to maintain tonic inhibition of the mineralocorticoid receptor in cardiomyocytes, and mineralocorticoid receptor activation is involved in the pathophysiology of LVH. We assessed the association between polymorphisms in the
HSD11B1
gene and left ventricular mass (LVM) in 248 families ascertained through a proband with hypertension.
Methods and Results—
LVM was measured by electrocardiography and echocardiography in 868 and 829 participants, respectively. Single-nucleotide polymorphisms (SNPs) tagging common variation in the
HSD11B1
gene were genotyped by mass spectrometry. The rs846910 SNP, which lies in the flanking region 5′ to exon 1B of
HSD11B1
, was associated with LVM both by electrocardiography (≈5% lower LVM per copy of the rare allele,
P
=0.02) and by echocardiography (≈10% lower LVM per copy of the rare allele,
P
=0.003). Genotype explained 1% to 2% of the population variability in LVM, or approximately 5% of the heritable fraction. There were no significant associations between any
HSD11B1
SNP and blood pressure or body mass index that could have confounded the association with LVM.
Conclusions—
Genotype at
HSD11B1
has a small, but significant effect on LVM, apparently independently of any effect on obesity-related traits. These findings suggest a novel action of 11β-HSD1 in the human cardiomyocyte, which may be of therapeutic importance.
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Affiliation(s)
- Thahira J. Rahman
- From the Institute of Human Genetics (T.J.R., D.H., P.J.A., B.K.), Newcastle University, Newcastle upon Tyne, UK; Department of Medicine (B.M.M.), University of Cape Town, Cape Town, South Africa; Department of Medicine (P.M.S.), University of Birmingham, Birmingham, UK; Department of Medicine (J.M.C.C.), University of Dundee, Dundee, UK; Department of Cardiovascular Medicine (H.W.), Oxford University, Oxford, UK
| | - Bongani M. Mayosi
- From the Institute of Human Genetics (T.J.R., D.H., P.J.A., B.K.), Newcastle University, Newcastle upon Tyne, UK; Department of Medicine (B.M.M.), University of Cape Town, Cape Town, South Africa; Department of Medicine (P.M.S.), University of Birmingham, Birmingham, UK; Department of Medicine (J.M.C.C.), University of Dundee, Dundee, UK; Department of Cardiovascular Medicine (H.W.), Oxford University, Oxford, UK
| | - Darroch Hall
- From the Institute of Human Genetics (T.J.R., D.H., P.J.A., B.K.), Newcastle University, Newcastle upon Tyne, UK; Department of Medicine (B.M.M.), University of Cape Town, Cape Town, South Africa; Department of Medicine (P.M.S.), University of Birmingham, Birmingham, UK; Department of Medicine (J.M.C.C.), University of Dundee, Dundee, UK; Department of Cardiovascular Medicine (H.W.), Oxford University, Oxford, UK
| | - Peter J. Avery
- From the Institute of Human Genetics (T.J.R., D.H., P.J.A., B.K.), Newcastle University, Newcastle upon Tyne, UK; Department of Medicine (B.M.M.), University of Cape Town, Cape Town, South Africa; Department of Medicine (P.M.S.), University of Birmingham, Birmingham, UK; Department of Medicine (J.M.C.C.), University of Dundee, Dundee, UK; Department of Cardiovascular Medicine (H.W.), Oxford University, Oxford, UK
| | - Paul M. Stewart
- From the Institute of Human Genetics (T.J.R., D.H., P.J.A., B.K.), Newcastle University, Newcastle upon Tyne, UK; Department of Medicine (B.M.M.), University of Cape Town, Cape Town, South Africa; Department of Medicine (P.M.S.), University of Birmingham, Birmingham, UK; Department of Medicine (J.M.C.C.), University of Dundee, Dundee, UK; Department of Cardiovascular Medicine (H.W.), Oxford University, Oxford, UK
| | - John M.C. Connell
- From the Institute of Human Genetics (T.J.R., D.H., P.J.A., B.K.), Newcastle University, Newcastle upon Tyne, UK; Department of Medicine (B.M.M.), University of Cape Town, Cape Town, South Africa; Department of Medicine (P.M.S.), University of Birmingham, Birmingham, UK; Department of Medicine (J.M.C.C.), University of Dundee, Dundee, UK; Department of Cardiovascular Medicine (H.W.), Oxford University, Oxford, UK
| | - Hugh Watkins
- From the Institute of Human Genetics (T.J.R., D.H., P.J.A., B.K.), Newcastle University, Newcastle upon Tyne, UK; Department of Medicine (B.M.M.), University of Cape Town, Cape Town, South Africa; Department of Medicine (P.M.S.), University of Birmingham, Birmingham, UK; Department of Medicine (J.M.C.C.), University of Dundee, Dundee, UK; Department of Cardiovascular Medicine (H.W.), Oxford University, Oxford, UK
| | - Bernard Keavney
- From the Institute of Human Genetics (T.J.R., D.H., P.J.A., B.K.), Newcastle University, Newcastle upon Tyne, UK; Department of Medicine (B.M.M.), University of Cape Town, Cape Town, South Africa; Department of Medicine (P.M.S.), University of Birmingham, Birmingham, UK; Department of Medicine (J.M.C.C.), University of Dundee, Dundee, UK; Department of Cardiovascular Medicine (H.W.), Oxford University, Oxford, UK
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Biss T, Avery PJ, Walsh PM, Kamali F. Warfarin treatment outcomes in children monitored at home with a point-of-care device. Thromb Haemost 2011; 105:1103-5. [PMID: 21437355 DOI: 10.1160/th10-09-0608] [Citation(s) in RCA: 3] [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] [Received: 09/24/2010] [Accepted: 02/14/2011] [Indexed: 11/05/2022]
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20
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Cunnington MS, Kay C, Avery PJ, Mayosi BM, Koref MS, Keavney B. STK39 polymorphisms and blood pressure: an association study in British Caucasians and assessment of cis-acting influences on gene expression. BMC Med Genet 2009; 10:135. [PMID: 20003416 PMCID: PMC2803166 DOI: 10.1186/1471-2350-10-135] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Accepted: 12/14/2009] [Indexed: 01/06/2023]
Abstract
Background Blood pressure (BP) has significant heritability, but the genes responsible remain largely unknown. Single nucleotide polymorphisms (SNPs) at the STK39 locus were recently associated with hypertension by genome-wide association in an Amish population; in vitro data from transient transfection experiments using reporter constructs suggested that altered STK39 expression might mediate the effect. However, other large studies have not implicated STK39 in hypertension. We determined whether reported SNPs influenced STK39 expression in vivo, or were associated with BP in a large British Caucasian cohort. Methods 1372 members of 247 Caucasian families ascertained through a hypertensive proband were genotyped for reported risk variants in STK39 (rs6749447, rs3754777, rs35929607) using Sequenom technology. MERLIN software was used for family-based association testing. Cis-acting influences on expression were assessed in vivo using allelic expression ratios in cDNA from peripheral blood cells in 35 South African individuals heterozygous for a transcribed SNP in STK39 (rs1061471) and quantified by mass spectrometry (Sequenom). Results No significant association was seen between the SNPs tested and systolic or diastolic BP in clinic or ambulatory measurements (all p > 0.05). The tested SNPs were all associated with allelic expression differences in peripheral blood cells (p < 0.05), with the most significant association for the intronic SNP rs6749447 (P = 9.9 × 10-4). In individuals who were heterozygous for this SNP, on average the G allele showed 13% overexpression compared to the T allele. Conclusions STK39 expression is modified by polymorphisms acting in cis and the typed SNPs are associated with allelic expression of this gene, but there is no evidence for an association with BP in a British Caucasian cohort.
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Affiliation(s)
- Michael S Cunnington
- Institute of Human Genetics, Newcastle University, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK.
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21
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Thomas HE, Avery PJ, Ahmed JM, Edwards R, Purcell I, Zaman AG, Arthur HM, Keavney BD. Local vessel injury following percutaneous coronary intervention does not promote early mobilisation of endothelial progenitor cells in the absence of myocardial necrosis. Heart 2008; 95:555-8. [DOI: 10.1136/hrt.2008.146662] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Palomino-Doza J, Rahman TJ, Avery PJ, Mayosi BM, Farrall M, Watkins H, Edwards CRW, Keavney B. Ambulatory blood pressure is associated with polymorphic variation in P2X receptor genes. Hypertension 2008; 52:980-5. [PMID: 18852390 DOI: 10.1161/hypertensionaha.108.113282] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The P2X receptor gene family encodes a series of proteins that function as ATP-gated nonselective ion channels. P2X receptor channels are involved in transducing aldosterone-mediated signaling in the distal renal tubule and are potential candidate genes for blood pressure regulation. We performed a family based quantitative genetic association study in 248 families ascertained through a proband with hypertension to investigate the relationship between common genetic variation in the P2X4, P2X6, and P2X7 genes and ambulatory blood pressure. We genotyped 28 single nucleotide polymorphisms, which together captured the common genetic variability in the 3 genes. We corrected our results for multiple comparisons specifying a false discovery rate of 5%. We found significant evidence of association between the single nucleotide polymorphism rs591874 in the first intron of the P2X7 gene and blood pressure. The strongest association was found for nighttime diastolic blood pressure (P=0.0032), although association was present for both systolic and diastolic blood pressures measured by an observer during the day and at night. Genotypes were associated with a 0.2 SD ( approximately 2.5 mm Hg) difference in night diastolic blood pressure per allele and accounted for approximately 1% of the total variability in this measurement. Other suggestive associations were found, but these were nonsignificant after correction for multiple testing. These genetic data suggest that drugs affecting P2X receptor signaling may have promise as clinical antihypertensive agents.
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Affiliation(s)
- Julian Palomino-Doza
- Institute of Human Genetics, Newcastle University, Newcastle upon Tyne, United Kingdom
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23
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Mayosi BM, Avery PJ, Farrall M, Keavney B, Watkins H. Genome-wide linkage analysis of electrocardiographic and echocardiographic left ventricular hypertrophy in families with hypertension. Eur Heart J 2008; 29:525-30. [PMID: 18276622 DOI: 10.1093/eurheartj/ehn028] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [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] [Indexed: 11/14/2022] Open
Abstract
AIMS To localize chromosomal regions (or quantitative trait loci) that harbour genetic variants influencing the variability of electrocardiographic (ECG) and echocardiographic left ventricular hypertrophy (LVH). METHODS AND RESULTS We evaluated genetic linkage to ECG Sokolow-Lyon voltage, ECG Cornell voltage product, ECG left ventricular (LV) mass, and to echocardiographic septal wall thickness, LV cavity size, and LV mass in 868 members of 224 white British families. A genome-wide scan was performed with microsatellite markers that covered the genome at 10-cM intervals and linkage was assessed by variance components analysis. We identified chromosomal regions suggestive of linkage for Sokolow-Lyon voltage on chromosome 10q23.1 [log(10) of the odds (LOD = 2.21, P = 0.0007)], for ECG Cornell voltage product on chromosome 17p13.3 (LOD = 2.67; P = 0.0002), and for ECG LV mass on chromosome 12q14.1 (LOD = 2.19; P = 0.0007). There was a single region of possible linkage for echocardiographic LV mass on chromosome 5p14.1 (LOD = 1.6; P = 0.003). CONCLUSION Stronger genetic signals for LVH were found using electrocardiographic than echocardiographic measurements, and the genetic determinants of each of these appear to be distinct. Chromosomes 10, 12, and 17 are likely to harbour genetic loci that exert a major influence on electrocardiographic LVH.
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Affiliation(s)
- Bongani M Mayosi
- Department of Medicine, University of Cape Town, J Floor Old Main Building, Groote Schuur Hospital, Anzio Road Observatory, Cape Town 7925, W Cape, South Africa
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Cunnington MS, Mayosi BM, Hall DH, Avery PJ, Farrall M, Vickers MA, Watkins H, Keavney B. Novel genetic variants linked to coronary artery disease by genome-wide association are not associated with carotid artery intima-media thickness or intermediate risk phenotypes. Atherosclerosis 2008; 203:41-4. [PMID: 18675980 PMCID: PMC2654912 DOI: 10.1016/j.atherosclerosis.2008.06.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 06/18/2008] [Accepted: 06/21/2008] [Indexed: 11/17/2022]
Abstract
Background It is uncertain whether the novel single nucleotide polymorphisms (SNPs) that have recently been associated with coronary artery disease (CAD) in genome-wide studies also influence carotid atheroma and stroke risk. The mechanisms of their association with CAD are unknown; relationships to other cardiovascular phenotypes may give mechanistic clues. Carotid artery intima-media thickness (CIMT) is a subclinical marker of atherosclerosis associated with stroke. We investigated association of reported CAD risk variants with CIMT, and with other intermediate phenotypes that may implicate causative pathways. Methods We studied 1425 members of 248 British Caucasian families ascertained through a hypertensive proband. We genotyped CAD risk SNPs on chromosomes 9 (rs1333049, rs7044859, rs496892, rs7865618), 6 (rs6922269) and 2 (rs2943634) using TaqMan. Merlin software was used for family-based association testing. Results No significant association was found between genotype at any SNP and CIMT in 846 individuals with acceptable measurements. Nor were SNPs significantly associated with blood pressure, obesity, cholesterol, CRP, interleukin-6, TNF-α, or leptin. Conclusions These novel CAD variants are not associated with CIMT and do not appear to mediate the risk of atherothrombosis through known risk factors.
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25
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Sconce EA, Avery PJ, Wynne HA, Kamali F. Vitamin K epoxide reductase complex subunit 1 (VKORC1 ) polymorphism influences the anticoagulation response subsequent to vitamin K intake: a pilot study. J Thromb Haemost 2008; 6:1226-8. [PMID: 18466315 DOI: 10.1111/j.1538-7836.2008.03003.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Gaukrodger N, Avery PJ, Keavney B. Plasma potassium level is associated with common genetic variation in the beta-subunit of the epithelial sodium channel. Am J Physiol Regul Integr Comp Physiol 2008; 294:R1068-72. [PMID: 18184758 DOI: 10.1152/ajpregu.00732.2007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Plasma potassium is a moderately heritable phenotype, but no robust associations between common single nucleotide polymorphisms (SNPs) and plasma potassium have previously been described. Genetic influences on renal potassium handling could be important in the etiology of hypertension. We have tested whether common genetic variation in the gene encoding the beta-subunit of the epithelial sodium channel (SCNN1B) affects plasma potassium and blood pressure level in a study of 1,425 members of 248 families ascertained on a proband with hypertension. We characterized family members for blood pressure using ambulatory monitoring, measured plasma potassium in venous blood samples, and genotyped four SNPs that spanned the SCNN1B gene. We found highly significant association between genotype at the SCNN1B rs889299 SNP situated in intron 4 of the gene and plasma potassium. Homozygotes for the rarer T allele had on average a 0.15 mM lower plasma potassium than homozygotes for the common C allele, with an intermediate value for heterozygotes (trend, P = 0.0003). Genotype at rs889299 accounted for approximately 1% of the total variability in plasma potassium, or around 3% of the total heritable fraction. There was no association between genotype at any SCNN1B SNP and blood pressure considered as a quantitative trait, or with hypertension affection status. We have shown a modest sized but highly significant effect of common genetic variation in the SCNN1B gene on plasma potassium. Interaction between the rs889299 SNP and functional SNPs in other genes influencing aldosterone-responsive distal tubular electrolyte transport may be important in the etiology of essential hypertension.
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27
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Rahman T, Baker M, Hall DH, Avery PJ, Keavney B. Common genetic variation in the type A endothelin-1 receptor is associated with ambulatory blood pressure: a family study. J Hum Hypertens 2008; 22:282-8. [DOI: 10.1038/sj.jhh.1002322] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [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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28
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Patel S, Flyvbjerg A, Kozàkovà M, Frystyk J, Ibrahim IM, Petrie JR, Avery PJ, Ferrannini E, Walker M. Variation in the ADIPOQ gene promoter is associated with carotid intima media thickness independent of plasma adiponectin levels in healthy subjects. Eur Heart J 2007; 29:386-93. [PMID: 18084018 DOI: 10.1093/eurheartj/ehm526] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [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] [Indexed: 11/14/2022] Open
Abstract
AIMS The ADIPOQ gene encodes the protein adiponectin, and decreased circulating adiponectin levels have been observed in cardiovascular disease. We investigated the role of the ADIPOQ gene single-nucleotide polymorphisms (SNPs) A-11426G, G-11391A, C-11377G, and T45G with plasma adiponectin levels and common carotid artery intima media thickness (IMT) in a cohort of healthy subjects participating in the RISC (Relationship between Insulin Sensitivity and Cardiovascular disease) study. METHODS AND RESULTS Anthropometric and metabolic assessment and B-mode ultrasound of the carotid IMT were measured in 1306 subjects [589 men; 717 women, mean +/- SD age 43.8 +/- 8.3 years, BMI 25.5 +/- 4.0 kg/m(2)] recruited from 19 centres in 14 European countries. Carriers of the -11426G allele and homozygous carriers of the -11391G allele had significantly lower plasma adiponectin levels. These relationships remained significant after adjusting for age, sex, recruitment centre, and BMI. Carriers of SNP -11377G allele had significantly greater IMT values compared with C allele homozygotes [geometric mean (interquartile range) 601 (543-665) vs. 590 (537-647) mum, P = 0.021]. This relationship became stronger after correcting for key covariates, including plasma adiponectin levels (P = 0.011). CONCLUSION Variation within the ADIPOQ gene promoter is directly associated with carotid IMT in healthy subjects and is independent of circulating adiponectin levels.
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Affiliation(s)
- Sheila Patel
- Department of Medicine, University of Melbourne, Austin Health, Heidelberg Repatriation Hospital, Victoria, Australia
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29
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Baker M, Rahman T, Hall D, Avery PJ, Mayosi BM, Connell JMC, Farrall M, Watkins H, Keavney B. The C-532T polymorphism of the angiotensinogen gene is associated with pulse pressure: a possible explanation for heterogeneity in genetic association studies of AGT and hypertension. Int J Epidemiol 2007; 36:1356-62. [PMID: 17998241 DOI: 10.1093/ije/dym213] [Citation(s) in RCA: 17] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Many previous studies have investigated whether there is an association between genotypes at the angiotensinogen (AGT) gene and hypertensive status, but few have incorporated quantitative data. Although meta-analyses support a possible effect of AGT variants on blood pressure (BP), substantial unexplained between-study heterogeneity has been observed. We hypothesized that a primary effect of AGT variants on arterial stiffness (and thus pulse pressure) might explain such heterogeneity, and tested for such an effect in a family study. METHODS We studied 1425 individuals from 248 families ascertained through a proband with essential hypertension. BP was measured using 24 h ambulatory monitoring, and polymorphisms of the AGT gene that had been previously associated with hypertension and/or plasma angiotensinogen levels were typed. Pulse pressure was used as a measurement of arterial stiffness. RESULTS We observed a highly significant association between genotypes at the AGT C-532T polymorphism and pulse pressure (p = 0.00006). Each T allele was associated with a 5% lower pulse pressure (that is, an additive effect). This resulted from opposing genotypic effects to (slightly) lower systolic BP and (slightly) elevate DBP. CONCLUSIONS These results suggest that genetic variation at the angiotensinogen locus may primarily affect arterial stiffness, and therefore pulse pressure. The heterogeneity between previous genetic studies of AGT and hypertension status could in part be explained by this finding, since case selection criteria based on systolic BP, diastolic BP, or both would result in different levels of selection for the -532T allele.
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Affiliation(s)
- Michelle Baker
- The Institute of Human Genetics, Newcastle University, UK
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30
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Imrie H, Freel M, Mayosi BM, Davies E, Fraser R, Ingram M, Cordell HJ, Farrall M, Avery PJ, Watkins H, Keavney B, Connell JMC. Association between aldosterone production and variation in the 11beta-hydroxylase (CYP11B1) gene. J Clin Endocrinol Metab 2006; 91:5051-6. [PMID: 16984984 DOI: 10.1210/jc.2006-1481] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT Variation in the region of chromosome 8 including the genes steroid 11beta-hydroxylase (CYP11B1) and aldosterone synthase (CYP11B2) influences mineralocorticoid and glucocorticoid metabolism. However, the relative importance of polymorphisms in CYP11B1 and CYP11B2 in determining these phenotypes is unknown. OBJECTIVE Our objective was to investigate genetic influences of the CYP11B1 and CYP11B2 genes on mineralocorticoid metabolism. DESIGN We measured 24-h urinary excretion of the key metabolites of the principal mineralocorticoids, glucocorticoids and androgens secreted by the adrenal cortex. We genotyped polymorphisms spanning the CYP11B1 and CYP11B2 genes, which together capture all common variations at the locus. PARTICIPANTS Participants included 573 members of 105 British Caucasian families ascertained on a hypertensive proband. MAIN OUTCOME MEASURES We assessed heritability of urinary tetrahydroaldosterone (THAldo) excretion and association of THAldo excretion with genotype. RESULTS The heritability of THAldo excretion was 52% (P < 10(-6)). There was significant association between THAldo and genotype at several of the CYP11B1/B2 polymorphisms. The strongest association was observed at the rs6387 (2803A/G) polymorphism in intron 3 of CYP11B1 (P = 0.0004). Association followed a codominant model with a 21% higher THAldo excretion per G allele. Genotype at rs6387 accounted for 2.1% of the total population variability of THAldo. We found significant association between THAldo excretion and urinary total androgen excretion, urinary tetrahydrodeoxycortisol level, and urinary cortisol metabolites (all P < 0.001). CONCLUSIONS Aldosterone synthesis is highly heritable and is affected by genotype at CYP11B1. Our findings support the hypothesis that genetically determined differences in 11-hydroxylation efficiency can have downstream effects on mineralocorticoid synthesis. Such effects may be of relevance to the development of low-renin essential hypertension.
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Affiliation(s)
- Helen Imrie
- Institute of Human Genetics, Central Parkway, Newcastle NE1 3BZ, United Kingdom
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Hall DH, Rahman T, Avery PJ, Keavney B. INSIG-2 promoter polymorphism and obesity related phenotypes: association study in 1428 members of 248 families. BMC Med Genet 2006; 7:83. [PMID: 17137505 PMCID: PMC1698479 DOI: 10.1186/1471-2350-7-83] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Accepted: 11/30/2006] [Indexed: 11/10/2022]
Abstract
Background Obesity is a major public health problem. Body mass index (BMI) is a highly heritable phenotype but robust associations of genetic polymorphisms to BMI or other obesity-related phenotypes have been difficult to establish. Recently a large genetic association study showed evidence for association of the single nucleotide polymorphism (SNP) rs7566605, which lies 10 Kb 5' to the first exon of the insulin-induced gene 2 (INSIG-2), with obesity in several cohorts. We tested this polymorphism for association with body mass related phenotypes in a large family study whose mean BMI was consistent with moderate overweight. Methods We studied 1428 members of 248 British Caucasian families who had been ascertained through a proband with hypertension. We measured BMI, waist and hip circumference, and plasma levels of leptin. We genotyped the rs7566605 SNP using a restriction fragment length polymorphism assay, and carried out a family-based association test for quantitative traits related to obesity using the statistical programs MERLIN and QTDT. Results We observed no significant association between genotype at rs7566605 and covariate-adjusted (for age, sex, alcohol consumption, smoking and exercise habit) log-transformed BMI, waist measurement, hip measurement, waist-to-hip ratio, or plasma levels of leptin. Conclusion There was no association between genotype at rs7566605 and obesity-related phenotypes in this British Caucasian population. These families were in general moderately overweight, few members being severely obese. Our result indicates that this polymorphism has little if any effect on BMI within the normal to moderately overweight range. The effects of this polymorphism on body mass may be restricted to those already predisposed to at least moderate obesity as a result of environmental factors and other predisposing genotypes.
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Affiliation(s)
- Darroch H Hall
- Institute of Human Genetics (DH, TR, BK), and School of Mathematics and Statistics (PJA), Newcastle University, UK
| | - Thahira Rahman
- Institute of Human Genetics (DH, TR, BK), and School of Mathematics and Statistics (PJA), Newcastle University, UK
| | - Peter J Avery
- Institute of Human Genetics (DH, TR, BK), and School of Mathematics and Statistics (PJA), Newcastle University, UK
| | - Bernard Keavney
- Institute of Human Genetics (DH, TR, BK), and School of Mathematics and Statistics (PJA), Newcastle University, UK
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Singh R, Pearson E, Avery PJ, McCarthy MI, Levy JC, Hitman GA, Sampson M, Walker M, Hattersley AT. Reduced beta cell function in offspring of mothers with young-onset type 2 diabetes. Diabetologia 2006; 49:1876-80. [PMID: 16703328 DOI: 10.1007/s00125-006-0285-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [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] [Received: 11/11/2005] [Accepted: 03/16/2006] [Indexed: 10/24/2022]
Abstract
AIMS/HYPOTHESIS Animal models indicate that even exposure to mild maternal hyperglycaemia in utero is detrimental to the beta cell function of the offspring, but evidence of this in humans is limited. In Europids who are diagnosed with type 2 diabetes before the age of 50 years, the risk of diabetes in the offspring of the diabetic mothers is greatly increased compared with the risk in those born to diabetic fathers. We hypothesised that offspring born to mothers with young-onset type 2 diabetes would have been exposed to mild hyperglycaemia in utero, so we studied the impact of this on their beta cell function. SUBJECTS AND METHODS We measured beta cell function using early insulin response (EIR) after oral glucose; insulin resistance using HOMA; and HbA(1c) in 568 non-diabetic adult offspring born to parents with type 2 diabetes (mean age 55.8 years), split according to which parent was affected (in 327 it was the mother) and parental age of diagnosis: <50 years (n=117) or > or =50 years. To reduce the impact of genetic susceptibility, the offspring of affected fathers were used as control subjects. RESULTS Offspring of mothers with young-onset type 2 diabetes had lower EIR (log EIR 4.32, 95% CI [4.14-4.51] vs 4.63 [4.43-4.83] p=0.02) and higher HbA(1c) (4.89% [4.79-4.99] vs 4.68% [4.57-4.79] p=0.02) than the offspring of fathers with young-onset type 2 diabetes. Insulin sensitivity was similar in the two groups. There were no differences in EIR or HbA(1c) between the offspring born to mothers and fathers who were diagnosed after the age of 50 years. CONCLUSIONS/INTERPRETATION We conclude that the offspring of mothers with young-onset type 2 diabetes have a reduction in beta cell function. This is consistent with exposure to mild maternal hyperglycaemia programming beta cell function.
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Affiliation(s)
- R Singh
- Institute of Biomedical Sciences, Peninsula Medical School, Barrack Road, Exeter EX2 5AX, UK
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Mayosi BM, Avery PJ, Baker M, Gaukrodger N, Imrie H, Green FR, Farrall M, Watkins H, Keavney B. Genotype at the −174G/C Polymorphism of the Interleukin-6 Gene Is Associated With Common Carotid Artery Intimal-Medial Thickness. Stroke 2005; 36:2215-9. [PMID: 16179573 DOI: 10.1161/01.str.0000182254.47941.96] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [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: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Studies in unrelated individuals have produced conflicting findings concerning the putative association between the interleukin-6 (IL-6) -174G/C polymorphism and carotid intimal-medial thickness (IMT). We have used a family-based genetic association design to assess the heritability of carotid IMT and to investigate the hypothesized association of carotid IMT with the IL-6 to -174G/C polymorphism. METHODS We studied 854 members of 224 white British families. The heritability of carotid IMT was determined using Multipoint Engine for Rapid Likelihood Inference. Genetic association analyses were carried out using ANOVA and family-based tests of association implemented in Quantitative Transmission Disequilibrium Test. A meta-analysis of previous studies of the association was conducted to place our result in context. RESULTS The heritability of carotid IMT was 24%. Under a recessive model (GG+GC versus CC), there was significant evidence of association between IL-6 to the -174G/C genotype and adjusted log(e) maximal carotid IMT (F=5.469; P=0.02). Family-based analyses using Quantitative Transmission Disequilibrium Test showed no evidence of population stratification as a cause of the observed association (chi2(1)=0.469; P=0.4934). The CC genotype was associated with a 4.8% increase in maximal carotid IMT and accounted for 0.6% of the observed variation in the trait, which is equivalent to 2.5% of the heritable component. A meta-analysis of the present and 2 previous large studies, which enrolled a total of 2930 subjects, confirmed the recessive effect of the C allele on carotid IMT (P=0.0014). CONCLUSIONS The genotype at the IL-6 to -174G/C polymorphism is associated with common carotid artery IMT, although the size of the genetic effect is small.
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Affiliation(s)
- Bongani M Mayosi
- Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom.
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Baker M, Gaukrodger N, Mayosi BM, Imrie H, Farrall M, Watkins H, Connell JMC, Avery PJ, Keavney B. Association between common polymorphisms of the proopiomelanocortin gene and body fat distribution: a family study. Diabetes 2005; 54:2492-6. [PMID: 16046320 DOI: 10.2337/diabetes.54.8.2492] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [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: 02/02/2023]
Abstract
Rare mutations in the proopiomelanocortin (POMC) gene cause severe early-onset childhood obesity. However, it is unknown whether common variants in POMC are responsible for variation in body weight or fat distribution within the commonly observed range in the population. We tested for association between three polymorphisms spanning the POMC gene and obesity phenotypes in 1,428 members of 248 families. There was significant association between genotypes at the C8246T (P < 0.0001) and C1032G (P = 0.003) polymorphisms and waist-to-hip ratio (WHR) corrected for age, sex, smoking, exercise, and alcohol consumption. Each T allele at C8246T (or G allele at C1032G) was associated with a 0.2-SD-higher WHR in a codominant fashion. When WHR was additionally corrected for BMI, thus providing a measure of body fat distribution throughout the range of BMI, there remained significant evidence for association with both markers that was of similar magnitude and statistical significance. There was no association between genotype at any polymorphism and BMI or plasma leptin level. These data show that genetic variants at the POMC locus influence body fat distribution within the normal range, suggesting a novel role for POMC in metabolic regulation.
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Affiliation(s)
- Michelle Baker
- Institute of Human Genetics, Central Parkway, Newcastle NE1 3BZ, UK
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35
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Mills GW, Avery PJ, McCarthy MI, Hattersley AT, Levy JC, Hitman GA, Sampson M, Walker M. Heritability estimates for beta cell function and features of the insulin resistance syndrome in UK families with an increased susceptibility to type 2 diabetes. Diabetologia 2004; 47:732-8. [PMID: 15298351 DOI: 10.1007/s00125-004-1338-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [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: 11/25/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to measure the heritability estimates for metabolic traits and the features of the insulin resistance syndrome in families with an increased genetic susceptibility to Type 2 diabetes. METHODS A total of 811 non-diabetic relatives from 278 pedigrees of northern European extraction in which there was a sib-pair with Type 2 diabetes were recruited and studied at the six Diabetes UK Warren Type 2 diabetes centres. Heritability estimates were calculated, allowing for key covariates (age, sex, BMI and recruitment centre). Values greater than 0.10 were considered statistically significant in comparison to zero. RESULTS Fasting glucose concentration and homeostasis model assessment of pancreatic beta cell function (HOMA %B) had the highest heritability estimates of 0.72 and 0.78 respectively. Heritability estimates for the features of the insulin resistance syndrome (BMI, WHR, systolic and diastolic blood pressure, serum lipids and homeostasis model assessment of insulin sensitivity [HOMA %S]) were also high. The heritability estimate for fasting glucose was markedly higher in the present study (0.77 vs 0.21 adjusted for age and sex; p<0.001) than in a comparable study of families from the same background population but with no increased susceptibility to diabetes. However, the estimates for the features of the insulin resistance syndrome were similar in the two studies. CONCLUSIONS/INTERPRETATION In families with a high risk of Type 2 diabetes, the heritability estimates for fasting glucose, pancreatic beta cell function and the features of the insulin resistance syndrome were all high. The higher heritability estimate for pancreatic beta cell function suggests that this resource may be most effective when investigating genetic susceptibility to beta cell dysfunction.
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Affiliation(s)
- G W Mills
- School of Clinical Medical Sciences, 4th Floor William Leech Block, The Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
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Van de Weerd HA, Docking CM, Day JE, Avery PJ, Edwards SA. A systematic approach towards developing environmental enrichment for pigs. Appl Anim Behav Sci 2003. [DOI: 10.1016/s0168-1591(03)00150-3] [Citation(s) in RCA: 175] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Insulin resistance is a feature of non-diabetic relatives of non-insulin-dependent diabetic (NIDDM) families. Tumour necrosis factor-alpha (TNF alpha) expression is linked with insulin resistance, and is under strong genetic control. We examined the relationship between insulin resistance and two polymorphisms of the TNF alpha promoter region (positions -238 and -308). Non-diabetic relatives (n = 123) of NIDDM families and control subjects (n = 126) with no family history of diabetes were studied. Insulin resistance was determined by homeostasis model assessment (HOMA) and short insulin tolerance test (ITT), and genotyping was by restriction digest. The -238 polymorphism (TNFA-A allele) was carried by 14 relatives and 11 control subjects, and all were heterozygotes. To examine the relationship between the -238 polymorphism and insulin resistance independent of potentially confounding factors, the relatives with the TNFA-A allele were individually pair-matched for age, sex, waist-hip ratio, body mass index, and glucose tolerance with relatives homozygous for the wild-type allele. Relatives with the TNFA-A allele had decreased insulin resistance (HOMA index: 2.0, 3.6 +/- 2.1 [means +/- SD of differences], p = 0.03), and this was true for comparable pair-matched control subjects (HOMA index: 1.1, 1.9 +/- 0.8, p = 0.01). Combining relative (n = 7) and control (n = 4) pairs that had undergone an ITT, subjects with the TNFA-A allele had an increased K(ITT) (3.8, 3.0 +/- 1.0%/min, p = 0.04) similarly indicating decreased insulin resistance. There was no significant relationship between the -308 polymorphism and insulin resistance. We conclude that the TNFA-A allele is associated with decreased insulin resistance as assessed by two independent methods, and may protect against the future development of NIDDM in susceptible individuals.
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Affiliation(s)
- C P Day
- Department of Medicine, University of Newcastle upon Tyne, UK
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Humphriss DB, Stewart MW, Berrish TS, Barriocanal LA, Trajano LR, Ashworth LA, Brown MD, Miller M, Avery PJ, Alberti KG, Walker M. Multiple metabolic abnormalities in normal glucose tolerant relatives of NIDDM families. Diabetologia 1997; 40:1185-90. [PMID: 9349600 DOI: 10.1007/s001250050805] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.6] [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: 02/05/2023]
Abstract
Non-diabetic first degree relatives of non-insulin-dependent diabetic (NIDDM) families are at increased risk of developing diabetes mellitus, and have been studied to identify early metabolic abnormalities. Hormone concentrations measured by specific enzyme immunoassays were assessed in non-diabetic relatives of North European extraction, and control subjects with no family history of diabetes were matched for age, sex and ethnicity. A 75-g oral glucose tolerance test was conducted and those with newly diagnosed NIDDM were excluded. Basal insulin resistance was determined by homeostasis model assessment (HOMA), and hepatic insulin clearance by C-peptide:insulin molar ratio. Relatives (n = 150) were heavier (BMI: p < 0.0001) than the control subjects (n = 152), and had an increased prevalence of impaired glucose tolerance (15 vs 3%, p < 0.01). The relatives had increased fasting proinsulin levels and decreased C-peptide levels following the glucose load, while insulin levels were increased at all time points. To examine whether the differences in hormone levels were secondary to the differences in glucose tolerance and adiposity, we studied 100 normal glucose tolerant relatives and control subjects pair-matched for age, sex, waist-hip ratio and BMI. The differences in proinsulin levels were no longer apparent. However, the relatives remained more insulin resistant, and had decreased C-peptide levels and C-peptide:insulin ratios at all time points. In conclusion, we have identified several metabolic abnormalities in the normal glucose tolerant relatives, and propose that the decreased hepatic insulin clearance helps to maintain normoglycaemia in the face of combined insulin resistance and decreased insulin secretion.
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Affiliation(s)
- D B Humphriss
- Human Diabetes and Metabolism Research Centre and Department of Medicine, University of Newcastle upon Tyne, UK
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Armstrong M, Haldane F, Avery PJ, Mitcheson J, Stewart MW, Turnbull DM, Walker M. Relationship between insulin sensitivity and insulin receptor substrate-1 mutations in non-diabetic relatives of NIDDM families. Diabet Med 1996; 13:341-5. [PMID: 9162610 DOI: 10.1002/(sici)1096-9136(199604)13:4<341::aid-dia80>3.0.co;2-f] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [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: 02/04/2023]
Abstract
Insulin receptor substrate-1 (IRS-1) occupies a key position in the insulin-signalling pathway. Two mutations of the IRS-1 gene (Gly(972)Arg and Ala(513)Pro) have been described, although their roles in the development of insulin resistance and non-insulin-dependent diabetes mellitus (NIDDM) remain controversial. Insulin resistance has been described in non-diabetic relatives of NIDDM families, suggesting that it may be due to an inherited defect of insulin action. We therefore examined the relationships between the two mutations and insulin sensitivity in 93 non-diabetic first degree relatives from North European families with 2 or more living NIDDM subjects. Anthropometric measurements, an oral glucose tolerance test, and an insulin tolerance test to assess insulin sensitivity (K(ITT)) were performed. Basal insulin sensitivity was assessed by homeostasis model assessment (HOMA). Comparisons were made between the following relative subgroups: with (n = 9) and without (n = 84) the 972 mutation; with (n = 5) and without (n = 88) the 513 mutation; and with either one or both mutations (n = 13) or without either (n = 80). General linear model analysis was used to compare K(ITT) and HOMA between the subgroups with the anthropometric variables known to influence insulin sensitivity as covariates. There were no significant differences between the subgroups for K(ITT) and HOMA. In conclusion, the 513 and 972 mutations, alone and in combination, are not associated with decreased insulin sensitivity in non-diabetic relatives of NIDDM families.
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Affiliation(s)
- M Armstrong
- Department of Medicine, University of Newcastle upon Tyne, UK
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Seal CJ, Parker DS, Avery PJ. The effect of forage and forage-concentrate diets on rumen fermentation and metabolism of nutrients by the mesenteric- and portal-drained viscera in growing steers. Br J Nutr 1992; 67:355-70. [PMID: 1622976 DOI: 10.1079/bjn19920041] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.4] [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: 12/27/2022]
Abstract
Growing Friesian steers chronically catheterized in the anterior mesenteric and portal veins were used to study the influence of feeding with either a forage or forage-concentrate diet on nutrient utilization by mucosal tissue. When animals were consuming the forage-concentrate diet the molar proportion of propionate in rumen fluid was significantly increased, although production rate as measured by isotope dilution was not altered. Net rates of absorption of VFA into portal blood when compared with rumen production rates underlined the extent to which metabolism within mucosal tissue modifies the propionate supply to the liver. Net glucose utilization by splanchnic tissue was shown to be significantly lower on the forage-concentrate diet. There were no effects of diet on whole-body glucose turnover or on the proportion of glucose derived from propionate. Animals fed on the forage-concentrate diet had significantly lower concentrations of circulating essential amino acids, due mainly to a reduction in branched-chain amino acid levels. There was net absorption of all amino acids by animals on both diets except for glutamate, glutamine and taurine in forage-fed animals.
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Affiliation(s)
- C J Seal
- Department of Biological and Nutritional Sciences, Faculty of Agriculture and Biological Sciences, University of Newcastle upon Tyne
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Abstract
In order to examine whether certain short DNA sequences (putative splice signals) occurred in a certain region of an intron more often than would be expected by chance, intron data were examined to see what structure they took. There were significant departures from equal nucleotide frequency, and successive nucleotides clearly did not occur independently in the rat and mouse introns examined. The nonindependence was mainly due to a CG shortage and a less marked TA shortage. However the pairwise frequencies explained almost all the variability in triplet frequencies in the data and so the data could be approximately modeled by using nucleotide frequencies conditional on what the previous nucleotide was. Some coding DNA was also examined and the pairs in second and third positions, and third and first positions in a codon, showed similar departures from independence to those of the intron data. Using the probability model derived for intron data, expected frequencies of putative signals were derived and compared with the observed frequencies.
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Affiliation(s)
- P J Avery
- Department of Statistics, University of Newcastle upon Tyne, England
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Abstract
ABSTRACT
The influence of small population size (N) on the genetic variance within and between randomly bred unselected lines, with selfing permitted, is investigated for a model of a quantitative trait determined by linked genes that show dominance within loci but are additive over loci. Formulae for within-line variance include terms in linkage disequilibrum, which occurs by chance in the lines and these are evaluated in terms of N, map length and gene number. —The expected variance within lines is increased by this disequilibrium, quite substantially if there are many loci, with most of the increase being between or within full-sib families and almost no change expected between half-sib families or in the covariance of offspring and parent. If all loci are unlinked, there is no increase in variance within full-sib families. The variance between lines is little affected by disequilibrum generated by chance.— Expressions for the variance between individuals in heterozygosity over the whole genome are special cases of those for the variance due to linked dominated genes, and formulae are given and evaluated. The coefficient of variation of heterozygosity is at least 1/√3N and can be much higher for species with few chromosomes.
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Affiliation(s)
- P J Avery
- Institute of Animal Genetics, West Mains Road, Edinburgh EH9 3JN, Scotland
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Abstract
The method of genotype assay, proposed by Jinks and Towey (1976) for estimating the number of effective factors in a polygenic system, assumes independent segregation if applied to number of genes. Their results are extended to include the case of linked genes, and the ratio of expected number of effective factors to number of genes is computed for a range of models. Unless all genes are on different chromosomes or many generations of inbreeding are used, the estimate of gene number is biased downwards.
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Abstract
SUMMARYFor a model in which quantitative traits are assumed to be determined solely by additive genes at many loci, formulae are developed for the variance among replicated small populations of sizeN, maintained without selection, of the additive genetic variance, heritability, genetic correlations and similar parameters. The base population is assumed to be in linkage equilibrium, but it is argued that most of the variation in the within-line additive variance (VAtat generationt) is due to linkage disequilibrium caused by sampling. Ifis the squared correlation of gene frequencies averaged over all pairs of loci at timet, the coefficient of variation (CV) ofVAtequals, with similar formulae for other parameters.The formulae are evaluated for models of loci distributed uniformly along the chromosome but much of the disequilibrium is due to loci on different chromosomes. For unlinked loci CV(VAt) reaches √4/(3(N)), and for mammalian models, this value is not greatly exceeded. The variance in successive generations has a correlation of at least one-half due to the maintenance of linkage disequilibrium. The magnitude of this variance in parameters and their autocorrelation with time shows that accurate predictions cannot be made about genetic parameters in the base population from single replicate results.
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Abstract
SUMMARYThe model of random selection coefficients is considered in the context of a finite population of diploids. The selection coefficients of the homozygotes are allowed to vary with equal variance while the fitness of the heterozygote is kept fixed. Steady-state solutions are found in the case of equal two-way mutation rates with particular reference to the expected heterozygosity. Increasing the variance of the selection coefficients of the homozygotes is found to uniformly increase the heterozygosity for all values of the average selection coefficients and its effect is largest when the selection coefficients of the homozygotes are fully correlated. The fate of mutant genes is also considered in the case of random selection coefficients by looking at the probability of ultimate fixation and the mean times to fixation and extinction. The errors in previous calculations (e.g. Kimura, 1954; Ohta, 1972) are pointed out. It is found that a small average heterozygote advantage together with a reasonable degree of variance in the coefficients can cause an unexpectedly large amount of heterozygosity to be maintained. It is also seen that probabilities of fixation and mean times to boundaries are usually increased by increasing the variance showing that it in fact helps to keep the population heterozygous for much longer than the non-random case. This is in contradiction to some conclusions of Karlin & Levikson (1974) because their haploid results are not easily extendable to the consideration of this sort of diploid model.
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Abstract
SUMMARYThe model, suggested by Ohta & Kimura, of an infinite number of selectively neutral alleles, in which alleles can only mutate to neighbouring alleles, has been extended to include a migratory pattern. The stepping-stone and island models of migration have been considered. In the latter case, it has been found that as the number of colonies becomes large, the expected number of alleles,ne, becomes approximately equal towheremis the migration rate,vis the mutation rate andNeis the effective size of each population. This solution tends to that of Ohta & Kimura asm→ 0 but one can see that for any appreciable value ofNem, a large increase inneis obtained. In order to check the validity of iterative results, models with a finite number of alleles have been considered, and their solutions have been found to converge quickly to those of the infinite case. The results exemplify the great power of migratory structure and neutral alleles to maintain a large amount of heterozygosity. Double step mutation and the finite time solution have also been considered.
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