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Stage C, Dalhoff K, Rasmussen HB, Schow Guski L, Thomsen R, Bjerre D, Ferrero-Miliani L, Busk Madsen M, Jürgens G. The impact of human CES1 genetic variation on enzyme activity assessed by ritalinic acid/methylphenidate ratios. Basic Clin Pharmacol Toxicol 2019; 125:54-61. [PMID: 30801959 DOI: 10.1111/bcpt.13212] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/14/2018] [Accepted: 02/04/2019] [Indexed: 01/29/2023]
Abstract
The present clinical trial investigated the impact of selected SNPs in CES1 on the metabolic activity of the enzyme. For this purpose, we used methylphenidate (MPH) as a pharmacological probe and the d-RA/d-MPH (metabolite/parent drug) ratios as a measure of enzymatic activity. This metabolic ratio (MR) was validated against the AUC ratios (AUCd -RA /AUCd -MPH ). CES1 SNPs from 120 volunteers were identified, and 12 SNPs fulfilling predefined inclusion criteria were analysed separately, comparing the effect of each genotype on the metabolic ratios. The SNP criteria were as follows: presence of Hardy-Weinberg equilibrium, a minor allele frequency ≥ 0.01 and a clearly interpretable sequencing result in at least 30% of the individuals. Each participant ingested 10 mg of racemic methylphenidate, and blood samples were drawn prior to and 3 hours after drug administration. The SNP analysis confirmed the considerable impact of rs71647871 (G143E) in exon 4 on drug metabolism. In addition, three volunteers with markedly lower median MR, indicating decreased CES1 activity, harboured the same combination of three SNPs in intron 5. The median MR for these SNPs was 8.2 for the minor allele compared to 16.4 for the major alleles (P = 0.04). Hence, one of these or the combination of these SNPs could be of clinical significance considering that the median MR of the G143E group was 5.4. The precise genetic relationship of this finding is currently unknown, as is the clinical significance.
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Affiliation(s)
- Claus Stage
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Kim Dalhoff
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Henrik Berg Rasmussen
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | - Louise Schow Guski
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Ragnar Thomsen
- Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ditte Bjerre
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | - Laura Ferrero-Miliani
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | - Majbritt Busk Madsen
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | - Gesche Jürgens
- Clinical Pharmacological Unit, Zealand University Hospital, Roskilde, Denmark
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Ferrero-Miliani L, Bjerre D, Stage C, Madsen MB, Jűrgens G, Dalhoff KP, Rasmussen HB. Reappraisal of the genetic diversity and pharmacogenetic assessment of CES1. Pharmacogenomics 2017; 18:1241-1257. [DOI: 10.2217/pgs-2017-0052] [Citation(s) in RCA: 3] [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: 11/21/2022] Open
Abstract
The CES1 gene encodes a hydrolase that metabolizes important drugs. Variants generated by exchange of segments with CES1P1 complicate genotyping of CES1. Using a highly specific procedure we examined DNA samples from 200 Caucasians and identified 46 single nucleotide variants (SNVs) in CES1 and 21 SNVs in CES1A2, a hybrid composed of CES1 and CES1P1. Several of these SNVs were novel. The frequencies of SNVs with a potential functional impact were below 0.02 suggesting limited pharmacogenetic potential for CES1 genotyping. In silico PCR revealed that the majority of the primer pairs for amplification of CES1 or CES1A2 in three previous studies lacked specificity, which partially explains a limited overlap with our findings.
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Affiliation(s)
- Laura Ferrero-Miliani
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | - Ditte Bjerre
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | - Claus Stage
- Department of Clinical Pharmacology, Bispebjerg & Frederiksberg University Hospital, Copenhagen, Denmark
| | - Majbritt Busk Madsen
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | - Gesche Jűrgens
- Clinical Pharmacological Unit, Zealand University Hospital, Roskilde, Denmark
| | - Kim Peder Dalhoff
- Department of Clinical Pharmacology, Bispebjerg & Frederiksberg University Hospital, Copenhagen, Denmark
- Faculty of Health & Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Berg Rasmussen
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
- Department of Science & Environment, Roskilde University, Roskilde, Denmark
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3
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Stage C, Jürgens G, Guski LS, Thomsen R, Bjerre D, Ferrero-Miliani L, Lyauk YK, Rasmussen HB, Dalhoff K. The Pharmacokinetics of Enalapril in Relation to CES1
Genotype in Healthy Danish Volunteers. Basic Clin Pharmacol Toxicol 2017. [DOI: 10.1111/bcpt.12835] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Claus Stage
- Department of Clinical Pharmacology; Bispebjerg and Frederiksberg University Hospital; Copenhagen NV Denmark
| | - Gesche Jürgens
- Clinical Pharmacological Unit; Zealand University Hospital; Roskilde Denmark
| | - Louise Schow Guski
- Department of Clinical Pharmacology; Bispebjerg and Frederiksberg University Hospital; Copenhagen NV Denmark
| | - Ragnar Thomsen
- Department of Forensic Medicine; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - Ditte Bjerre
- Institute of Biological Psychiatry; Mental Health Centre Sct. Hans; Copenhagen University Hospital; Roskilde Denmark
| | - Laura Ferrero-Miliani
- Institute of Biological Psychiatry; Mental Health Centre Sct. Hans; Copenhagen University Hospital; Roskilde Denmark
| | - Yassine Kamal Lyauk
- Clinical Pharmacological Unit; Zealand University Hospital; Roskilde Denmark
| | - Henrik Berg Rasmussen
- Institute of Biological Psychiatry; Mental Health Centre Sct. Hans; Copenhagen University Hospital; Roskilde Denmark
| | - Kim Dalhoff
- Department of Clinical Pharmacology; Bispebjerg and Frederiksberg University Hospital; Copenhagen NV Denmark
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Stage C, Jürgens G, Guski LS, Thomsen R, Bjerre D, Ferrero-Miliani L, Lyauk YK, Rasmussen HB, Dalhoff K. The impact of CES1 genotypes on the pharmacokinetics of methylphenidate in healthy Danish subjects. Br J Clin Pharmacol 2017; 83:1506-1514. [PMID: 28087982 DOI: 10.1111/bcp.13237] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 01/03/2017] [Accepted: 01/05/2017] [Indexed: 01/01/2023] Open
Abstract
AIMS This study investigated the influence of CES1 variations, including the single nucleotide polymorphism (SNP) rs71647871 (G143E) and variation in copy number, on the pharmacokinetics of a single oral dose of 10 mg methylphenidate. METHODS CES1 genotype was obtained from 200 healthy Danish Caucasian volunteers. Based on the genotype, 44 (19 males and 25 females) were invited to participate in an open, prospective trial involving six predefined genotypes: three groups with two, three and four CES1 copies, respectively; a group of carriers of the CES1 143E allele; a group of individuals homozygous for CES1A1c (CES1VAR); and a group having three CES1 copies, in which the duplication, CES1A2, had increased transcriptional activity. Plasma concentrations of methylphenidate and its primary metabolites were determined at scheduled time points. RESULTS Median AUC of d-methylphenidate was significantly larger in the group carrying the 143E allele (53.3 ng ml-1 h-1 , range 38.6-93.9) than in the control group (21.4 ng ml-1 h-1 , range 15.7-34.9) (P < 0.0001). Median AUC of d-methylphenidate was significantly larger in the group with four CES1 copies (34.5 ng ml-1 h-1 , range 21.3-62.8) than in the control group (P = 0.01) and the group with three CES1 copies (23.8 ng ml-1 h-1 , range 15.3-32.0, P = 0.03). There was no difference between the groups with two and three copies of CES1. CONCLUSIONS The 143E allele resulted in an increased AUC, suggesting a significantly decreased CES1 enzyme activity. Surprisingly, this was also the case in subjects with homozygous duplication of CES1, perhaps reflecting an undiscovered mutation affecting the activity of the enzyme.
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Affiliation(s)
- Claus Stage
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Gesche Jürgens
- Clinical Pharmacological Unit, Zealand University Hospital, Roskilde, Denmark
| | - Louise Schow Guski
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Ragnar Thomsen
- Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ditte Bjerre
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Copenhagen, Denmark
| | - Laura Ferrero-Miliani
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Copenhagen, Denmark
| | - Yassine Kamal Lyauk
- Clinical Pharmacological Unit, Zealand University Hospital, Roskilde, Denmark
| | - Henrik Berg Rasmussen
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kim Dalhoff
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
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Nilsson LL, Djurisic S, Andersen AMN, Melbye M, Bjerre D, Ferrero-Miliani L, Hackmon R, Geraghty DE, Hviid TVF. Distribution of HLA-G extended haplotypes and one HLA-E polymorphism in a large-scale study of mother-child dyads with and without severe preeclampsia and eclampsia. HLA 2016; 88:172-86. [PMID: 27596021 DOI: 10.1111/tan.12871] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 07/29/2016] [Accepted: 08/10/2016] [Indexed: 01/01/2023]
Abstract
The etiological pathways and pathogenesis of preeclampsia have rendered difficult to disentangle. Accumulating evidence points toward a maladapted maternal immune system, which may involve aberrant placental expression of immunomodulatory human leukocyte antigen (HLA) class Ib molecules during pregnancy. Several studies have shown aberrant or reduced expression of HLA-G in the placenta and in maternal blood in cases of preeclampsia compared with controls. Unlike classical HLA class Ia loci, the nonclassical HLA-G has limited polymorphic variants. Most nucleotide variations are clustered in the 5'-upstream regulatory region (5'URR) and 3'-untranslated regulatory region (3'UTR) of HLA-G and reflect a stringent expressional control. Based on genotyping and full gene sequencing of HLA-G in a large number of cases and controls (n > 900), the present study, which to our knowledge is the largest and most comprehensive performed, investigated the association between the HLA-G 14-bp ins/del (rs66554220) and HLA-E polymorphisms in mother and newborn dyads from pregnancies complicated by severe preeclampsia/eclampsia and from uncomplicated pregnancies. Furthermore, results from extended HLA-G haplotyping in the newborns are presented in order to assess whether a combined contribution of nucleotide variations spanning the 5'URR, coding region, and 3'UTR of HLA-G describes the genetic association with severe preeclampsia more closely. In contrast to earlier findings, the HLA-G 14-bp ins/del polymorphism was not associated with severe preeclampsia. Furthermore, the polymorphism (rs1264457) defining the two nonsynonymous HLA-E alleles, HLA-E*01:01:xx:xx and HLA-E*01:03:xx:xx, were not associated with severe preeclampsia. Finally, no specific HLA-G haplotypes were significantly associated with increased risk of developing severe preeclampsia/eclampsia.
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Affiliation(s)
- L L Nilsson
- Department of Clinical Biochemistry, Centre for Immune Regulation and Reproductive Immunology (CIRRI), Zealand University Hospital (Roskilde), Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - S Djurisic
- Department of Clinical Biochemistry, Centre for Immune Regulation and Reproductive Immunology (CIRRI), Zealand University Hospital (Roskilde), Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - A-M N Andersen
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - M Melbye
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - D Bjerre
- Research Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | - L Ferrero-Miliani
- Research Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | - R Hackmon
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - D E Geraghty
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - T V F Hviid
- Department of Clinical Biochemistry, Centre for Immune Regulation and Reproductive Immunology (CIRRI), Zealand University Hospital (Roskilde), Roskilde, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Christiansen SL, Hertz CL, Ferrero-Miliani L, Dahl M, Weeke PE, LuCamp, Ottesen GL, Frank-Hansen R, Bundgaard H, Morling N. Genetic investigation of 100 heart genes in sudden unexplained death victims in a forensic setting. Eur J Hum Genet 2016; 24:1797-1802. [PMID: 27650965 DOI: 10.1038/ejhg.2016.118] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 07/12/2016] [Accepted: 08/05/2016] [Indexed: 11/09/2022] Open
Abstract
In forensic medicine, one-third of the sudden deaths remain unexplained after medico-legal autopsy. A major proportion of these sudden unexplained deaths (SUD) are considered to be caused by inherited cardiac diseases. Sudden cardiac death (SCD) may be the first manifestation of these diseases. The purpose of this study was to explore the yield of next-generation sequencing of genes associated with SCD in a cohort of SUD victims. We investigated 100 genes associated with cardiac diseases in 61 young (1-50 years) SUD cases. DNA was captured with the Haloplex target enrichment system and sequenced using an Illumina MiSeq. The identified genetic variants were evaluated and classified as likely, unknown or unlikely to have a functional effect. The criteria for this classification were based on the literature, databases, conservation and prediction of the effect of the variant. We found that 21 (34%) individuals carried variants with a likely functional effect. Ten (40%) of these variants were located in genes associated with cardiomyopathies and 15 (60%) of the variants in genes associated with cardiac channelopathies. Nineteen individuals carried variants with unknown functional effect. Our findings indicate that broad genetic investigation of SUD victims increases the diagnostic outcome, and the investigation should comprise genes involved in both cardiomyopathies and cardiac channelopathies.
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Affiliation(s)
- Sofie Lindgren Christiansen
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christin Løth Hertz
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Laura Ferrero-Miliani
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten Dahl
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter Ejvin Weeke
- The Department of Cardiology, Laboratory of Molecular Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - LuCamp
- LuCamp, The Lundbeck Foundation Centre for Applied Medical Genomics in Personalized Disease Prediction, Prevention and Care, Copenhagen, Denmark
| | - Gyda Lolk Ottesen
- Section of Forensic Pathology, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rune Frank-Hansen
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- The Unit for Inherited Cardiac Diseases, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels Morling
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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7
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Nunn LM, Lopes LR, Syrris P, Murphy C, Plagnol V, Firman E, Dalageorgou C, Zorio E, Domingo D, Murday V, Findlay I, Duncan A, Carr-White G, Robert L, Bueser T, Langman C, Fynn SP, Goddard M, White A, Bundgaard H, Ferrero-Miliani L, Wheeldon N, Suvarna SK, O'Beirne A, Lowe MD, McKenna WJ, Elliott PM, Lambiase PD. Diagnostic yield of molecular autopsy in patients with sudden arrhythmic death syndrome using targeted exome sequencing. Europace 2015; 18:888-96. [PMID: 26498160 DOI: 10.1093/europace/euv285] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [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: 05/03/2015] [Accepted: 07/20/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS The targeted genetic screening of Sudden Arrhythmic Death Syndrome (SADS) probands in a molecular autopsy has a diagnostic yield of up to 35%. Exome sequencing has the potential to improve this yield. The primary aim of this study is to examine the feasibility and diagnostic utility of targeted exome screening in SADS victims, utilizing familial clinical screening whenever possible. METHODS AND RESULTS To determine the feasibility and diagnostic yield of targeted exome sequencing deoxyribonucleic acid (DNA) was isolated from 59 SADS victims (mean age 25 years, range 1-51 years). Targeted exome sequencing of 135 genes associated with cardiomyopathies and ion channelopathies was performed on the Illumina HiSeq2000 platform. Non-synonymous, loss-of-function, and splice-site variants with a minor allele frequency <0.02% in the NHLBI exome sequencing project and an internal set of control exomes were prioritized for analysis followed by <0.5% frequency threshold secondary analysis. First-degree relatives were offered clinical screening for inherited cardiac conditions. Seven probands (12%) carried very rare (<0.02%) or novel non-sense candidate mutations and 10 probands (17%) had previously published rare (0.02-0.5%) candidate mutations-a total yield of 29%. Co-segregation fully confirmed two private SCN5A Na channel mutations. Variants of unknown significance were detected in a further 34% of probands. CONCLUSION Molecular autopsy using targeted exome sequencing has a relatively low diagnostic yield of very rare potentially disease causing mutations. Candidate pathogenic variants with a higher frequency in control populations are relatively common and should be interpreted with caution.
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Affiliation(s)
- Laurence M Nunn
- Institute of Cardiovascular Sciences, Barts Heart Centre, St Bartholomews Hospital and Institute of Cardiovascular Sciences, UCL, West Smithfield, London EC1A 7BE, UK
| | - Luis R Lopes
- Institute of Cardiovascular Sciences, Barts Heart Centre, St Bartholomews Hospital and Institute of Cardiovascular Sciences, UCL, West Smithfield, London EC1A 7BE, UK
| | - Petros Syrris
- Institute of Cardiovascular Sciences, Barts Heart Centre, St Bartholomews Hospital and Institute of Cardiovascular Sciences, UCL, West Smithfield, London EC1A 7BE, UK
| | - Cian Murphy
- Institute of Cardiovascular Sciences, Barts Heart Centre, St Bartholomews Hospital and Institute of Cardiovascular Sciences, UCL, West Smithfield, London EC1A 7BE, UK
| | - Vincent Plagnol
- Institute of Cardiovascular Sciences, Barts Heart Centre, St Bartholomews Hospital and Institute of Cardiovascular Sciences, UCL, West Smithfield, London EC1A 7BE, UK
| | - Eileen Firman
- Institute of Cardiovascular Sciences, Barts Heart Centre, St Bartholomews Hospital and Institute of Cardiovascular Sciences, UCL, West Smithfield, London EC1A 7BE, UK
| | - Chrysoula Dalageorgou
- Institute of Cardiovascular Sciences, Barts Heart Centre, St Bartholomews Hospital and Institute of Cardiovascular Sciences, UCL, West Smithfield, London EC1A 7BE, UK
| | - Esther Zorio
- Unit for Inherited Heart Diseases and Sudden Cardiac Death, Cardiology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Diana Domingo
- Unit for Inherited Heart Diseases and Sudden Cardiac Death, Cardiology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Victoria Murday
- West of Scotland Clinical Genetics, Laboratory Medicine, Southern General Hospital, Edinburgh, UK
| | - Iain Findlay
- West of Scotland Clinical Genetics, Laboratory Medicine, Southern General Hospital, Edinburgh, UK
| | - Alexis Duncan
- West of Scotland Clinical Genetics, Laboratory Medicine, Southern General Hospital, Edinburgh, UK
| | | | | | | | | | | | | | | | - Henning Bundgaard
- Unit for Inherited Heart Diseases, The Heart Centre, National University Hospital, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Laura Ferrero-Miliani
- Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nigel Wheeldon
- South Yorkshire Regional Inherited Cardiac Conditions Service, South Yorkshire Cardiothoracic Centre, Sheffield, UK
| | - Simon K Suvarna
- South Yorkshire Regional Inherited Cardiac Conditions Service, South Yorkshire Cardiothoracic Centre, Sheffield, UK
| | - Aliceson O'Beirne
- South Yorkshire Regional Inherited Cardiac Conditions Service, South Yorkshire Cardiothoracic Centre, Sheffield, UK
| | - Martin D Lowe
- Institute of Cardiovascular Sciences, Barts Heart Centre, St Bartholomews Hospital and Institute of Cardiovascular Sciences, UCL, West Smithfield, London EC1A 7BE, UK
| | - William J McKenna
- Institute of Cardiovascular Sciences, Barts Heart Centre, St Bartholomews Hospital and Institute of Cardiovascular Sciences, UCL, West Smithfield, London EC1A 7BE, UK
| | - Perry M Elliott
- Institute of Cardiovascular Sciences, Barts Heart Centre, St Bartholomews Hospital and Institute of Cardiovascular Sciences, UCL, West Smithfield, London EC1A 7BE, UK
| | - Pier D Lambiase
- Institute of Cardiovascular Sciences, Barts Heart Centre, St Bartholomews Hospital and Institute of Cardiovascular Sciences, UCL, West Smithfield, London EC1A 7BE, UK
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8
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Hertz CL, Christiansen SL, Ferrero-Miliani L, Dahl M, Weeke PE, Ottesen GL, Frank-Hansen R, Bundgaard H, Morling N. Next-generation sequencing of 100 candidate genes in young victims of suspected sudden cardiac death with structural abnormalities of the heart. Int J Legal Med 2015; 130:91-102. [PMID: 26383259 DOI: 10.1007/s00414-015-1261-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND In sudden, unexpected, non-traumatic death in young individuals, structural abnormalities of the heart are frequently identified at autopsy. However, the findings may be unspecific and cause of death may remain unclear. A significant proportion of these cases are most likely caused by inherited cardiac diseases, and the cases are categorized as sudden cardiac death (SCD). The purpose of this study was to explore the added diagnostic value of genetic testing by next-generation sequencing (NGS) of a broad gene panel, as a supplement to the traditional forensic investigation in cases with non-diagnostic structural abnormalities of the heart. METHODS AND RESULTS We screened 72 suspected SCD cases (<50 years) using the HaloPlex Target Enrichment System (Agilent) and NGS (Illumina MiSeq) for 100 genes previously associated with inherited cardiomyopathies and channelopathies. Fifty-two cases had non-diagnostic structural cardiac abnormalities and 20 cases, diagnosed with a cardiomyopathy post-mortem (ARVC = 14, HCM = 6), served as comparators. Fifteen (29%) of the deceased individuals with non-diagnostic findings had variants with likely functional effects based on conservation, computational prediction, allele-frequency and supportive literature. The corresponding frequency in deceased individuals with cardiomyopathies was 35% (p = 0.8). CONCLUSION The broad genetic screening revealed variants with likely functional effects at similar high rates, i.e. in 29 and 35% of the suspected SCD cases with non-diagnostic and diagnostic cardiac abnormalities, respectively. Although the interpretation of broad NGS screening is challenging, it can support the forensic investigation and help the cardiologist's decision to offer counselling and clinical evaluation to relatives of young SCD victims.
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Affiliation(s)
- C L Hertz
- The Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 11 Frederik V's Vej, 2100, Copenhagen, Denmark.
| | - S L Christiansen
- The Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 11 Frederik V's Vej, 2100, Copenhagen, Denmark
| | - L Ferrero-Miliani
- The Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 11 Frederik V's Vej, 2100, Copenhagen, Denmark
| | - M Dahl
- The Department of Clinical Biochemistry, Køge University Hospital, Køge, Denmark
| | - P E Weeke
- The Department of Cardiology, Laboratory of Molecular Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - G L Ottesen
- The Section of Forensic Pathology, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - R Frank-Hansen
- The Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 11 Frederik V's Vej, 2100, Copenhagen, Denmark
| | - H Bundgaard
- The Unit for Inherited Cardiac Diseases, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - N Morling
- The Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 11 Frederik V's Vej, 2100, Copenhagen, Denmark
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9
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Hertz CL, Christiansen SL, Larsen MK, Dahl M, Ferrero-Miliani L, Weeke PE, Pedersen O, Hansen T, Grarup N, Ottesen GL, Frank-Hansen R, Banner J, Morling N. Genetic investigations of sudden unexpected deaths in infancy using next-generation sequencing of 100 genes associated with cardiac diseases. Eur J Hum Genet 2015; 24:817-22. [PMID: 26350513 DOI: 10.1038/ejhg.2015.198] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/08/2015] [Accepted: 08/24/2015] [Indexed: 02/07/2023] Open
Abstract
Sudden infant death syndrome (SIDS) is the most frequent manner of post-perinatal death among infants. One of the suggested causes of the syndrome is inherited cardiac diseases, mainly channelopathies, that can trigger arrhythmias and sudden death. The purpose of this study was to investigate cases of sudden unexpected death in infancy (SUDI) for potential causative variants in 100 cardiac-associated genes. We investigated 47 SUDI cases of which 38 had previously been screened for variants in RYR2, KCNQ1, KCNH2 and SCN5A. Using the Haloplex Target Enrichment System (Agilent) and next-generation sequencing (NGS), the coding regions of 100 genes associated with inherited channelopathies and cardiomyopathies were captured and sequenced on the Illumina MiSeq platform. Sixteen (34%) of the SUDI cases had variants with likely functional effects, based on conservation, computational prediction and allele frequency, in one or more of the genes screened. The possible effects of the variants were not verified with family or functional studies. Eight (17%) of the SUDI cases had variants in genes affecting ion channel functions. The remaining eight cases had variants in genes associated with cardiomyopathies. In total, one third of the SUDI victims in a forensic setting had variants with likely functional effect that presumably contributed to the cause of death. The results support the assumption that channelopathies are important causes of SUDI. Thus, analysis of genes associated with cardiac diseases in SUDI victims is important in the forensic setting and a valuable supplement to the clinical investigation in all cases of sudden death.
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Affiliation(s)
- Christin Loeth Hertz
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sofie Lindgren Christiansen
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maiken Kudahl Larsen
- Department of Forensic Medicine, Faculty of Health Sciences, University of Aarhus, Aarhus, Denmark
| | - Morten Dahl
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Biochemistry, Køge, Copenhagen University Hospital, Copenhagen, Denmark
| | - Laura Ferrero-Miliani
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Ejvin Weeke
- Department of Cardiology, Laboratory of Molecular Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Oluf Pedersen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Torben Hansen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Niels Grarup
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gyda Lolk Ottesen
- Section of Forensic Pathology, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rune Frank-Hansen
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jytte Banner
- Section of Forensic Pathology, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Morling
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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10
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Hertz CL, Christiansen SL, Ferrero-Miliani L, Fordyce SL, Dahl M, Holst AG, Ottesen GL, Frank-Hansen R, Bundgaard H, Morling N. Next-generation sequencing of 34 genes in sudden unexplained death victims in forensics and in patients with channelopathic cardiac diseases. Int J Legal Med 2014; 129:793-800. [PMID: 25467552 DOI: 10.1007/s00414-014-1105-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 10/30/2014] [Indexed: 01/11/2023]
Abstract
Sudden cardiac death (SCD) is responsible for a large proportion of sudden deaths in young individuals. In forensic medicine, many cases remain unexplained after routine postmortem autopsy and conventional investigations. These cases are called sudden unexplained deaths (SUD). Genetic testing has been suggested useful in forensic medicine, although in general with a significantly lower success rate compared to the clinical setting. The purpose of the study was to estimate the frequency of pathogenic variants in the genes most frequently associated with SCD in SUD cases and compare the frequency to that in patients with inherited cardiac channelopathies. Fifteen forensic SUD cases and 29 patients with channelopathies were investigated. DNA from 34 of the genes most frequently associated with SCD were captured using NimbleGen SeqCap EZ library build and were sequenced with next-generation sequencing (NGS) on an Illumina MiSeq. Likely pathogenic variants were identified in three out of 15 (20%) forensic SUD cases compared to 12 out of 29 (41%) patients with channelopathies. The difference was not statistically significant (p = 0.1). Additionally, two larger deletions of entire exons were identified in two of the patients (7%). The frequency of likely pathogenic variants was >2-fold higher in the clinical setting as compared to SUD cases. However, the demonstration of likely pathogenic variants in three out of 15 forensic SUD cases indicates that NGS investigations will contribute to the clinical investigations. Hence, this has the potential to increase the diagnostic rate significantly in the forensic as well as in the clinical setting.
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Affiliation(s)
- C L Hertz
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 11 Frederik V's Vej, 2100, Copenhagen, Denmark,
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11
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Hertz CL, Ferrero-Miliani L, Frank-Hansen R, Morling N, Bundgaard H. A comparison of genetic findings in sudden cardiac death victims and cardiac patients: the importance of phenotypic classification. Europace 2014; 17:350-7. [PMID: 25345827 DOI: 10.1093/europace/euu210] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Sudden cardiac death (SCD) is responsible for a large proportion of non-traumatic, sudden and unexpected deaths in young individuals. Sudden cardiac death is a known manifestation of several inherited cardiac diseases. In post-mortem examinations, about two-thirds of the SCD cases show structural abnormalities at autopsy. The remaining cases stay unexplained after thorough investigations and are referred to as sudden unexplained deaths. A routine forensic investigation of the SCD victims in combination with genetic testing makes it possible to establish a likely diagnosis in some of the deaths previously characterized as unexplained. Additionally, a genetic diagnose in a SCD victim with a structural disease may not only add to the differential diagnosis, but also be of importance for pre-symptomatic family screening. In the case of SCD, the optimal establishment of the cause of death and management of the family call for standardized post-mortem procedures, genetic screening, and family screening. Studies of genetic testing in patients with primary arrhythmia disorders or cardiomyopathies and of victims of SCD presumed to be due to primary arrhythmia disorders or cardiomyopathies, were systematically identified and reviewed. The frequencies of disease-causing mutation were on average between 16 and 48% in the cardiac patient studies, compared with ∼10% in the post-mortem studies. The frequency of pathogenic mutations in heart genes in cardiac patients is up to four-fold higher than that in SCD victims in a forensic setting. Still, genetic investigation of SCD victims is important for the diagnosis and the possible investigation of relatives at risk.
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Affiliation(s)
- Christin L Hertz
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 11 Frederik V's Vej, 2100 Copenhagen, Denmark
| | - Laura Ferrero-Miliani
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 11 Frederik V's Vej, 2100 Copenhagen, Denmark
| | - Rune Frank-Hansen
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 11 Frederik V's Vej, 2100 Copenhagen, Denmark
| | - Niels Morling
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 11 Frederik V's Vej, 2100 Copenhagen, Denmark
| | - Henning Bundgaard
- Rigshospitalets Unit for Inherited Heart Diseases, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark
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12
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Phan TT, Khan S, Dewhurst M, Lee D, James S, de Belder M, Linker NJ, Thornley A, Turley AJ, Ahmed FZ, Arumugam P, Allen S, Daniels K, Clarke B, Mamas M, James J, Zaidi AM, Ullah W, Hunter R, Lovell M, Dhinoja M, Earley M, Sporton S, Schilling R, Raju H, Hedley P, Arno G, Ware J, Jeffery S, Cook S, Christiansen M, Behr ER, Sohal M, Chen Z, Sammut E, Jackson T, Child N, Wright M, O'Neill M, Cooklin M, Gill J, Carr-White G, Razavi R, Rinaldi CA, Nunn LM, Lopes L, Syrris P, Plagnol V, Firman E, Dalageorgou C, Domingo D, Zorio E, Murday V, Findlay I, Duncan A, Fynn S, White A, Goddard M, Carr-White G, Robert L, Bueser T, Langman C, Bundgaard H, Ferrero-Miliani L, Wheeldon N, O'Beirne A, Suvarna SK, Lowe MD, McKenna WJ, Elliott PM, Lambiase PD. YOUNG INVESTIGATORS COMPETITION, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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13
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Stangegaard M, Børsting C, Ferrero-Miliani L, Frank-Hansen R, Poulsen L, Hansen AJ, Morling N. Evaluation of Four Automated Protocols for Extraction of DNA from FTA Cards. ACTA ACUST UNITED AC 2013; 18:404-10. [DOI: 10.1177/2211068213484472] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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14
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Stangegaard M, Ferrero-Miliani L, Børsting C, Frank-Hansen R, Hansen AJ, Morling N. Repeated extraction of DNA from FTA cards. Forensic Science International: Genetics Supplement Series 2011. [DOI: 10.1016/j.fsigss.2011.09.035] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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15
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Ferrero-Miliani L, Holst AG, Pehrson S, Morling N, Bundgaard H. Strategy for clinical evaluation and screening of sudden cardiac death relatives. Fundam Clin Pharmacol 2011; 24:619-35. [PMID: 20698891 DOI: 10.1111/j.1472-8206.2010.00864.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Sudden cardiac death (SCD) may be the first and final manifestation of several heart diseases. In the young, SCD is often caused by a hereditary cardiac disease. As the most frequently seen inherited cardiac diseases have an autosomal-dominant pattern of inheritance, half of the first-degree relatives are at risk of having or developing the same disease. Therefore, screening of these high-risk relatives is a rational approach to reduce the incidence of SCD. To offer family screening and counseling, the cause of death should be carefully established. Autopsy is only performed in a limited number of cases. We advocate for systematic autopsies in SCD, because positive findings are crucial for choosing the optimal screening program for the relatives. A negative autopsy makes identification of at-risk population difficult. However, this finding also provides clues to the cardiologist, because a limited number of inherited cardiac diseases associated with SCD are without any structural changes. In other cases, the autopsy may reveal noncardiac causes of death, which is also important for reassuring the relatives. However, in cases with no autopsy or negative findings, thorough clinical examinations and selective genetic screening of relatives may identify a likely diagnosis in more than 50% of affected families. There is a need for consensus regarding routine evaluation of SCD cases and the ethical and legal framework related to postmortem testing. We propose an algorithm that narrows the diagnostic possibilities in apparently healthy relatives of young SCD victims. Molecular autopsy may play an important role.
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Affiliation(s)
- Laura Ferrero-Miliani
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health Sciences, University of Copenhagen, Frederik V's Vej 11, DK-2100 Copenhagen, Denmark.
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Abstract
Inflammation is part of the non-specific immune response that occurs in reaction to any type of bodily injury. In some disorders, the inflammatory process - which under normal conditions is self-limiting - becomes continuous and chronic inflammatory diseases might develop subsequently. Pattern recognition molecules (PRMs) represent a diverse collection of molecules responsible for sensing danger signals, and together with other immune components they are involved in the first line of defence. NALP3 and NOD2, which belong to a cytosolic subgroup of PRMs, dubbed Nod-like-receptors (NLRs), have been associated recently with inflammatory diseases, specifically Crohn's disease and Blau syndrome (NOD2) and familial cold autoinflammatory syndrome, Muckle-Wells syndrome and chronic infantile neurological cutaneous and articular syndrome (NALP3). The exact effects of the defective proteins are not fully understood, but activation of nuclear factor (NF)-kappaB, transcription, production and secretion of interleukin (IL)-1beta and activation of the inflammasome are some of the processes that might hold clues, and the present review will provide a thorough update in this area.
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Affiliation(s)
- L Ferrero-Miliani
- Department of Gastroenterology, Herlev Hospital, University of Copenhagen, Denmark.
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Ferrero-Miliani L, Seidelin JB, Nielsen OH. [Regulation of cytokine production in inflammatory bowel disease]. Ugeskr Laeger 2006; 168:1847-50. [PMID: 16756799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Interleukin-1beta (IL-1beta) is a pivotal mediator in the inflammatory immune response that is characteristic of a number of chronic disorders. The etiology and pathophysiology of inflammatory bowel disease (IBD) have for many years been an enigma. The recent identification of the inflammasome, a multiprotein complex responsible for interleukin-1beta converting enzyme (ICE, caspase-1) activation, has generated new possibilities for the elucidation of the etiology and pathophysiology of IBD and as a consequence also for the identification of new treatment targets.
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