1
|
Lutz MW, Burns DK, Alexander R, Culp M, Yarnall D, Haneline S, Chiang C, Lai E, Metz C, Sundseth S, Guennel T, Marshall S, Andruss BF, Latham GJ, Hall B, Statt SN, Swanson T, Ratti E, Saunders AM. A genetic enrichment strategy for delay of onset of Alzheimer’s disease clinical trials. Alzheimers Dement 2020. [DOI: 10.1002/alz.044920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | | | | | - Meredith Culp
- Takeda Development Center Americas, Inc. Cambridge MA USA
| | | | | | - Carl Chiang
- Zinfandel Pharmaceuticals, Inc. Chapel Hill NC USA
| | - Eric Lai
- Takeda Development Center Americas, Inc. Cambridge MA USA
| | - Craig Metz
- Zinfandel Pharmaceuticals, Inc. Chapel Hill NC USA
| | | | - Tobi Guennel
- QuartzBio, part of Precision for Medicine Frederick MD USA
| | - Scott Marshall
- QuartzBio, part of Precision for Medicine Frederick MD USA
| | | | | | | | | | - Tom Swanson
- Zinfandel Pharmaceuticals, Inc. Chapel Hill NC USA
| | | | | |
Collapse
|
2
|
Burns DK, Chiang C, Welsh-Bohmer KA, Brannan SK, Culp M, O'Neil J, Runyan G, Harrigan P, Plassman BL, Lutz M, Lai E, Haneline S, Yarnall D, Yarbrough D, Metz C, Ponduru S, Sundseth S, Saunders AM. The TOMMORROW study: Design of an Alzheimer's disease delay-of-onset clinical trial. Alzheimers Dement (N Y) 2019; 5:661-670. [PMID: 31720367 PMCID: PMC6838537 DOI: 10.1016/j.trci.2019.09.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction Alzheimer's disease (AD) is a continuum with neuropathologies manifesting years before clinical symptoms; thus, AD research is attempting to identify more disease-modifying approaches to test treatments administered before full disease expression. Designing such trials in cognitively normal elderly individuals poses unique challenges. Methods The TOMMORROW study was a phase 3 double-blind, parallel-group study designed to support qualification of a novel genetic biomarker risk assignment algorithm (BRAA) and to assess efficacy and safety of low-dose pioglitazone to delay onset of mild cognitive impairment due to AD. Eligible participants were stratified based on the BRAA (using TOMM40 rs 10524523 genotype, Apolipoprotein E genotype, and age), with high-risk individuals receiving low-dose pioglitazone or placebo and low-risk individuals receiving placebo. The primary endpoint was time to the event of mild cognitive impairment due to AD. The primary objectives were to compare the primary endpoint between high- and low-risk placebo groups (for BRAA qualification) and between high-risk pioglitazone and high-risk placebo groups (for pioglitazone efficacy). Approximately 300 individuals were also asked to participate in a volumetric magnetic resonance imaging substudy at selected sites. Results The focus of this paper is on the design of the study; study results will be presented in a separate paper. Discussion The design of the TOMMORROW study addressed many key challenges to conducting a dual-objective phase 3 pivotal AD clinical trial in presymptomatic individuals. Experiences from planning and executing the TOMMORROW study may benefit future AD prevention/delay-of-onset trials.
Collapse
Affiliation(s)
| | - Carl Chiang
- Zinfandel Pharmaceuticals, Inc., Durham, NC, USA
| | - Kathleen A Welsh-Bohmer
- Department of Neurology, Bryan Alzheimer's Disease Research Center, Duke University School of Medicine, Durham, NC, USA
| | | | - Meredith Culp
- Takeda Development Center Americas, Inc., Deerfield, IL, USA
| | - Janet O'Neil
- Takeda Development Center Americas, Inc., Deerfield, IL, USA
| | - Grant Runyan
- Takeda Development Center Americas, Inc., Deerfield, IL, USA
| | | | - Brenda L Plassman
- Department of Neurology, Bryan Alzheimer's Disease Research Center, Duke University School of Medicine, Durham, NC, USA
| | - Michael Lutz
- Department of Neurology, Bryan Alzheimer's Disease Research Center, Duke University School of Medicine, Durham, NC, USA
| | - Eric Lai
- Takeda Development Center Americas, Inc., Deerfield, IL, USA
| | | | | | | | - Craig Metz
- Zinfandel Pharmaceuticals, Inc., Durham, NC, USA
| | - Sridevi Ponduru
- Takeda Development Center Americas, Inc., Cambridge, MA, USA
| | | | | |
Collapse
|
3
|
Bergmeijer T, Tantry U, ten Berg J, Angiolillo D, James S, Lindahl T, Svensson P, Jakubowski J, Brown P, Duvvuru S, Sundseth S, Walker J, Small D, Moser B, Winters K, Erlinge D, Gurbel P. The effect of CYP2C19 gene polymorphisms on the pharmacokinetics and pharmacodynamics of prasugrel 5-mg, prasugrel 10-mg and clopidogrel 75-mg in patients with coronary artery disease. Thromb Haemost 2017; 112:589-97. [DOI: 10.1160/th13-10-0891] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 03/14/2014] [Indexed: 01/22/2023]
Abstract
Summary
CYP2C19 genotype has been shown to impact response to clopidogrel 75-mg but not prasugrel 10-mg. Here, we assessed effects of CYP2C19 metaboliser status on pharmacokinetics (PK) and pharmacodynamic (PD) responses to prasugrel 5-mg and 10-mg and clopidogrel 75-mg using data from two PK/PD studies in stable coronary artery disease (CAD) patients (GENERATIONS and FEATHER). Active metabolite concentrations (area under the curve, AUC[0-tlast]), maximum platelet aggregation (MPA) measured by light transmission aggregometry, vasodilator- stimulated phosphoprotein platelet reactivity index, and VerifyNow P2Y12-platelet reaction units (VN-PRU) were analysed by CYP2C19-predicted phenotype (extensive metaboliser [EM; N=154], *2-*8 non-carriers, vs reduced metaboliser [RM; N=41],*2-*8 carriers/* 17 non-carriers). AUC(0-tlast) was unaffected by metaboliser status for prasugrel 5-mg and 10-mg (geometric mean EM/RM ratios 1.00, 95% confidence interval [CI]: 0.86,1.17, p>0.99; and 0.97, 95% CI:0.85,1.12, p=0.71, respectively), but was lower among RMs receiving clopidogrel 75-mg (1.37, 95% CI:1.14,1.65, p<0.001). Platelet reactivity was not significantly affected by CYP2C19 metaboliser status for prasugrel 5-mg, or for prasugrel 10-mg by MPA and VNPRU, but for clopidogrel 75-mg was significantly higher in reduced metabolisers (all measures p<0.01). Prasugrel 10-mg showed greater antiplatelet effects vs clopidogrel 75-mg (all comparisons p<0.001). Prasugrel 5-mg showed greater antiplatelet effects vs clopidogrel 75-mg in RMs (all p<0.001), and comparable effects in EMs (all p≥0.37). In contrast to clopidogrel, prasugrel active metabolite PK was not influenced by CYP2C19 genotype. Antiplatelet effect for prasugrel 10-mg was greater irrespective of metaboliser status and for prasugrel 5-mg was greater for RMs and comparable for EMs as compared to clopidogrel 75-mg.
Collapse
|
4
|
Roses A, Sundseth S, Saunders A, Gottschalk W, Burns D, Lutz M. Understanding the genetics of APOE and TOMM40 and role of mitochondrial structure and function in clinical pharmacology of Alzheimer's disease. Alzheimers Dement 2016; 12:687-94. [PMID: 27154058 DOI: 10.1016/j.jalz.2016.03.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/05/2016] [Indexed: 01/08/2023]
Abstract
The methodology of Genome-Wide Association Screening (GWAS) has been applied for more than a decade. Translation to clinical utility has been limited, especially in Alzheimer's Disease (AD). It has become standard practice in the analyses of more than two dozen AD GWAS studies to exclude the apolipoprotein E (APOE) region because of its extraordinary statistical support, unique thus far in complex human diseases. New genes associated with AD are proposed frequently based on SNPs associated with odds ratio (OR) < 1.2. Most of these SNPs are not located within the associated gene exons or introns but are located variable distances away. Often pathologic hypotheses for these genes are presented, with little or no experimental support. By eliminating the analyses of the APOE-TOMM40 linkage disequilibrium region, the relationship and data of several genes that are co-located in that LD region have been largely ignored. Early negative interpretations limited the interest of understanding the genetic data derived from GWAS, particularly regarding the TOMM40 gene. This commentary describes the history and problem(s) in interpretation of the genetic interrogation of the "APOE" region and provides insight into a metabolic mitochondrial basis for the etiology of AD using both APOE and TOMM40 genetics.
Collapse
Affiliation(s)
- Allen Roses
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA; Semillon Pharmaceuticals, Inc., Chapel Hill, NC, USA.
| | - Scott Sundseth
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA; Semillon Pharmaceuticals, Inc., Chapel Hill, NC, USA
| | - Ann Saunders
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA; Semillon Pharmaceuticals, Inc., Chapel Hill, NC, USA
| | - William Gottschalk
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA; Semillon Pharmaceuticals, Inc., Chapel Hill, NC, USA
| | - Dan Burns
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA; Semillon Pharmaceuticals, Inc., Chapel Hill, NC, USA
| | - Michael Lutz
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA; Semillon Pharmaceuticals, Inc., Chapel Hill, NC, USA
| |
Collapse
|
5
|
Roses AD, Akkari PA, Chiba-Falek O, Lutz MW, Gottschalk WK, Saunders AM, Saul B, Sundseth S, Burns D. Structural variants can be more informative for disease diagnostics, prognostics and translation than current SNP mapping and exon sequencing. Expert Opin Drug Metab Toxicol 2016; 12:135-47. [PMID: 26727306 DOI: 10.1517/17425255.2016.1133586] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION In this article we discuss several human neurological diseases and their relationship to specific highly polymorphic small structural variants (SVs). Unlike genome-wide association analysis (GWAS), this methodology is not a genome screen to define new possibly associated genes, requiring statistical corrections for a million association tests. SVs provide local mapping information at a specific locus. Used with phylogenetic analysis, the specific association of length variants can be mapped and recognized. AREAS COVERED This experimental strategy provides identification of DNA variants, particularly variable length Simple Sequence Repeats (SSRs or STRs or microsatellites) that provide specific local association data at the SV locus. Phylogenetic analysis that includes the specific appearance of different length SV variations can differentiate specific phenotypic risks in a population such as age of onset related to variable length polymorphisms and risk of phenotypic variations associated with several adjacent structural variations (SVs). We focus on data for three recent examples associated with Alzheimer's disease, Levy Bodies, and Parkinson's disease. EXPERT OPINION SVs are understudied, but have led directly to mechanism of pathogenesis studies involving the regulation of gene expression. The identification of specific length polymorphisms associated with clinical disease has led to translational advances and new drug discovery.
Collapse
Affiliation(s)
- Allen D Roses
- a Department of Neurology and Neurosciences , Duke University , Durham , NC , USA.,b Zinfandel Pharmaceuticals , Chapel Hill , NC , USA
| | | | | | - Michael W Lutz
- d Department of Neurology , Duke University , Durham , NC , USA
| | | | | | - Bob Saul
- e Polymorphic DNA , Alameda , CA , USA
| | - Scott Sundseth
- f Caberner Pharmaceuticals, Inc , Chapel Hill , NC , USA
| | - Daniel Burns
- g Zinfandel Pharmaceuticals, Inc , Raleigh-Durham , NC , USA
| |
Collapse
|
6
|
Bishop JP, Halburnt SB, Akkari PA, Sundseth S, Grossman I. Roadmap to Drug Development Enabled by Pharmacogenetics. Advances in Predictive, Preventive and Personalised Medicine 2015. [DOI: 10.1007/978-3-319-15344-5_3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
7
|
Erlinge D, James S, Duvvuru S, Jakubowski J, Wanger H, Varenhorst C, Tantry U, Brown P, Small D, Moser B, Sundseth S, Walker J, Winters K, Gurbel P. TCT-725 Point-of-Care Genetic Testing of Eleven CYP2C19 Single Nucleotide Polymorphisms Identifies Extensive and Reduced Metabolizers of Clopidogrel With High Accuracy in Patients With Coronary Artery Disease. J Am Coll Cardiol 2012. [DOI: 10.1016/j.jacc.2012.08.766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
8
|
Akkari P, Swanson T, Crenshaw D, Grossman I, Sundseth S, Burns D, Roses A. Pipeline Pharmacogenetics: A Novel Approach to Integrating Pharmacogenetics into Drug Development. Curr Pharm Des 2009; 15:3754-63. [DOI: 10.2174/138161209789649538] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
9
|
Kraus VB, Jordan JM, Doherty M, Wilson AG, Moskowitz R, Hochberg M, Loeser R, Hooper M, Renner JB, Crane MM, Hastie P, Sundseth S, Atif U. The Genetics of Generalized Osteoarthritis (GOGO) study: study design and evaluation of osteoarthritis phenotypes. Osteoarthritis Cartilage 2007; 15:120-7. [PMID: 17113325 DOI: 10.1016/j.joca.2006.10.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Accepted: 10/04/2006] [Indexed: 02/02/2023]
Abstract
PURPOSE The primary goal of the Genetics of Generalized Osteoarthritis (GOGO) study is to identify chromosomal regions associated with increased susceptibility to generalized osteoarthritis (OA). Here we describe the study design and phenotype of the 2728 participants from the 1145 families recruited for this study. METHODS GOGO is an investigator-initiated collaboration involving seven clinical academic sites and sponsored by GlaxoSmithKline. Family ascertainment was carried out between 1999 and 2002. A qualifying family required self-reported Caucasian ethnicity and at least two affected siblings with clinical hand OA. We hypothesized that this clinical phenotype would facilitate identification of participants with multijoint radiographic OA (rOA) in and beyond the hand. The "gold standard" case definition, however, was based on rOA (Kellgren-Lawrence grade > or =2) involving > or =3 hand joints distributed bilaterally and including at least one distal interphalangeal joint, with two of the three involved joints within a joint group (distal interphalangeal, proximal interphalangeal, or carpometacarpal). Radiographs of hips, knees and spine were also obtained. Additional siblings and living parents from qualifying families, both affected and unaffected, were invited to participate. RESULTS A total of 2706 participants had complete clinical and radiological examination data. Of these, 2569 participants met clinical examination criteria for affected status; while 1963 (73%) participants met the prespecified radiographic criteria for affected status. This corresponded to a total of 707 families with at least two affected siblings that met the hand rOA criteria. Of those individuals with rOA of the hand, the frequency of rOA at other sites was highest for the knee (51%) and spine (54%), and less common for the hip (25%). Concordance rates among hand affected siblings were greatest for spine (36%) followed by knee (31%) and hip (9%); a total of 53% of the affected sib pairs were concordant for specific patterns of generalized rOA involving the hand and large joints (knees, hips or spine). CONCLUSIONS GOGO represents a large multicenter collection of families with multiple joint OA that have been characterized both clinically and radiographically. The GOGO study will employ a comprehensive strategy for genetic screening based upon both qualitative and quantitative radiographic trait analyses, circulating biomarkers in a quantitative trait-based analysis, fine mapping, and candidate gene analysis. This sample should provide sufficient power to detect linkage to OA associated genes.
Collapse
Affiliation(s)
- V B Kraus
- Division of Rheumatology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Hauser ER, Crossman DC, Granger CB, Haines JL, Jones CJH, Mooser V, McAdam B, Winkelmann BR, Wiseman AH, Muhlestein JB, Bartel AG, Dennis CA, Dowdy E, Estabrooks S, Eggleston K, Francis S, Roche K, Clevenger PW, Huang L, Pedersen B, Shah S, Schmidt S, Haynes C, West S, Asper D, Booze M, Sharma S, Sundseth S, Middleton L, Roses AD, Hauser MA, Vance JM, Pericak-Vance MA, Kraus WE. A genomewide scan for early-onset coronary artery disease in 438 families: the GENECARD Study. Am J Hum Genet 2004; 75:436-47. [PMID: 15272420 PMCID: PMC1182022 DOI: 10.1086/423900] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2004] [Accepted: 06/25/2004] [Indexed: 12/16/2022] Open
Abstract
A family history of coronary artery disease (CAD), especially when the disease occurs at a young age, is a potent risk factor for CAD. DNA collection in families in which two or more siblings are affected at an early age allows identification of genetic factors for CAD by linkage analysis. We performed a genomewide scan in 1,168 individuals from 438 families, including 493 affected sibling pairs with documented onset of CAD before 51 years of age in men and before 56 years of age in women. We prospectively defined three phenotypic subsets of families: (1) acute coronary syndrome in two or more siblings; (2) absence of type 2 diabetes in all affected siblings; and (3) atherogenic dyslipidemia in any one sibling. Genotypes were analyzed for 395 microsatellite markers. Regions were defined as providing evidence for linkage if they provided parametric two-point LOD scores >1.5, together with nonparametric multipoint LOD scores >1.0. Regions on chromosomes 3q13 (multipoint LOD = 3.3; empirical P value <.001) and 5q31 (multipoint LOD = 1.4; empirical P value <.081) met these criteria in the entire data set, and regions on chromosomes 1q25, 3q13, 7p14, and 19p13 met these criteria in one or more of the subsets. Two regions, 3q13 and 1q25, met the criteria for genomewide significance. We have identified a region on chromosome 3q13 that is linked to early-onset CAD, as well as additional regions of interest that will require further analysis. These data provide initial areas of the human genome where further investigation may reveal susceptibility genes for early-onset CAD.
Collapse
Affiliation(s)
- Elizabeth R Hauser
- Center for Human Genetics, Duke University Medical Center, Durham, NC 27710, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Kraus VB, Li YJ, Martin ER, Jordan JM, Renner JB, Doherty M, Wilson AG, Moskowitz R, Hochberg M, Loeser R, Hooper M, Sundseth S. Articular hypermobility is a protective factor for hand osteoarthritis. ACTA ACUST UNITED AC 2004; 50:2178-83. [PMID: 15248215 DOI: 10.1002/art.20354] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Very few studies have evaluated the association of articular hypermobility and radiographic osteoarthritis (OA) in humans. We assessed hypermobility and its relationship to radiographic hand OA in a family-based study. METHODS A total of 1,043 individuals were enrolled in the multicenter Genetics of Generalized Osteoarthritis study, in which families were required to have 2 siblings with radiographic OA involving >/=3 joints (distributed bilaterally) of the distal interphalangeal (DIP), proximal interphalangeal (PIP), or carpometacarpal (CMC) joint groups, and OA in at least one DIP joint. Radiographic OA was defined as a score of >/=2 on the Kellgren/Lawrence scale in one or more joints within the group. The Beighton criteria for assessment of hypermobility were recorded on a 0-9-point scale. Hypermobility was defined as a Beighton score of >/=4, a threshold generally used to establish a clinical diagnosis of joint laxity. A threshold of >/=2 was also evaluated to assess lesser degrees of hypermobility. The Beighton score for the present was calculated based on clinical examination, and that for the past was based on recall of childhood hypermobility in the first 2 decades of life. The association of hypermobility and radiographic OA of the PIP, CMC, and metacarpophalangeal joints was evaluated in all participants and in men and women separately. Multiple logistic regression was used to examine the relationship of hypermobility with radiographic OA in each joint group, after adjusting for age and sex. The association of hypermobility and DIP OA was not evaluated, because evidence of DIP OA was required for study inclusion. RESULTS Using a threshold Beighton score of 4, 3.7% of individuals were classified as hypermobile based on the present examination, and 7.4% were classified as hypermobile based on the past assessment. A significant negative association between present hypermobility and age was observed. In persons with hypermobility, the odds of OA in PIP joints was lower (for present, odds ratio [OR] 0.34, 95% confidence interval [95% CI] 0.16-0.71; for past, OR 0.43, 95% CI 0.24-0.78). Similar results were obtained using a threshold Beighton score of 2. The lower odds of PIP OA with hypermobility were significant after adjusting for sex and age (for present, OR 0.44, 95% CI 0.20-0.94; for past, OR 0.48, 95% CI 0.26-0.87). CONCLUSION This study demonstrated a joint-protective effect of hypermobility for radiographic OA of PIP joints. In contrast to previous studies showing an association of hypermobility and CMC OA, in this cohort there was no evidence for increased odds of OA in any joint group of the hand in association with articular hypermobility.
Collapse
Affiliation(s)
- V B Kraus
- Duke University Medical Center, Durham, North Carolina 27710, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|