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Lens fluorescence in relation to glucose tolerance and genetic predisposition to type 2 diabetes mellitus in a population-based study.

PURPOSE: The fluorescence of the lens has the characteristics of a life-long cumulative index of glycemia, and it is elevated in patients with diabetes in proportion to the duration of diabetes and the level of glycemia. Consequently, lens fluorometry should be capable of providing an estimate of prediagnostic disease duration when patients are diagnosed with type 2 diabetes. Among euglycemic subjects, first-degree relatives of patients with type 2 diabetes tend to have higher glycemia levels than subjects who are unrelated to diabetes patients. They should therefore also have the higher lens fluorescence values. METHODS: The study comprised 218 Caucasian subjects in self-reported good health aged 30-88 years who were recruited from population-based studies to represent approximately equal proportions of different type 2 diabetes family history characteristics: no diabetic relative, first-degree offspring, second-degree offspring, not first-degree offspring but possibly second-degree offspring, or uncertain family history. Characterization of subjects included oral glucose tolerance testing and lens fluorometry. RESULTS: Type 2 diabetes was diagnosed in 10 subjects (4.6% of the population) and impaired glucose tolerance in 12 subjects (5.5%). Regression analysis indicated a prediagnostic duration of type 2 diabetes of 2.7 years versus 0.1 years for impaired glucose tolerance. Neither group demonstrated significantly increased lens fluorescence compared with euglycemic subjects. Being a first-degree relative of a patient with type 2 diabetes was associated with higher lens fluorescence than having no relative with diabetes (p = 0.02). CONCLUSIONS: Population screening by fasting blood glucose measurement can advance the diagnosis and initiation of treatment of type 2 diabetes mellitus by nearly a decade, compared with previous studies of patients diagnosed in routine clinical practice. In addition to higher than normal glycemia, euglycemic subjects who are offspring of patients with type 2 diabetes also have both elevated lens fluorescence and elevated glycemia. Fasting blood glucose measurement remains the method of choice for type 2 diabetes screening.

Adult↗

Association of Genetic Predisposition to Inflammation With Cancer-Related Cognitive Impairment and Fatigue in Women Who Received Chemotherapy for Nonmetastatic Breast Cancer.

PURPOSE: Cancer-related cognitive impairment (CRCI) and cancer-related fatigue (CRF) are reported by approximately 75% of patients receiving chemotherapy for breast cancer and both have been linked to inflammation. We sought to test whether an inflammation polygenic risk score (iPRS) might be associated with CRCI and/or CRF. METHODS: Using data from the UK Biobank, we developed an iPRS for the INFLA-Score, a composite measure of C-reactive protein, white cell count, platelet count, and neutrophil-lymphocyte ratio. The iPRS was evaluated for association with CRCI and CRF among women with nonmetastatic breast cancer enrolled in two completed multisite clinical trials: URCC08106 and URCC10055. CRCI and CRF were measured before and after standard-of-care chemotherapy using the FACT-Cog and Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF), respectively. Linear regression evaluated the change in FACT-Cog and MFSI scores; logistic regression evaluated binary outcomes of any versus no worsening of scores. Analyses were adjusted for patient and treatment factors. We also performed exploratory genome-wide analyses. RESULTS: The cohort included 802 women who received chemotherapy (anthracycline-based = 51.8%; previous surgery = 85.0%) at a median age of 55 years (range = 22-81). The iPRS was associated with a significant decrease in MFSI-SF score (β = -3.29 [95% CI, -6.25 to -0.34]; P = .029) and lower odds of decreased MFSI-SF score (odds ratio, 0.66 [95% CI, 0.47 to 0.93]; P = .016) following chemotherapy. This negative relationship was partially explained by a positive correlation of the iPRS with prechemotherapy MFSI-SF score (β = 4.33 [95% CI, 0.23 to 8.43]; P = .038). The iPRS was not associated with a change in FACT-Cog score (β = -1.12; P = .627), but single nucleotide polymorphism rs9365961 was (β = -10.05; P = 1.46 × 10-8). CONCLUSION: If validated, the iPRS could identify patients in need of supportive care interventions to reduce CRF.

Humans↗

Pediatric and adult forms of type I autoimmune hepatitis in Argentina: evidence for differential genetic predisposition.

The aim of this study was to compare major histocompatibility complex (MHC) class II susceptibility to type 1 autoimmune hepatitis (AH) between children and adults of the same ethnic group. HLA-DRB1, HLA-DRB3, HLA-DQA1, and HLA-DQB1 gene subtypes were examined by high resolution oligonucleotide typing in 122 pediatric (PAH) and 84 adult (AAH) patients and in 208 controls. In children, HLA-DRB1*1301 was the primary susceptibility allele (66.4% patients vs. 10.6% controls, relative risk [RR] = 16.3, Pc < 10(-24)) whereas HLA-DRB1*1302, which differs from HLA-DRB1*1301 by only 1 amino acid, appeared to be protective. The exclusion of individuals with HLA-DRB1*1301 from control and pediatric patients allowed us to find a secondary association of PAH with HLA-DRB1*0301. Possession of HLA-DRB1*1301, however, was associated with a lower therapeutic response rate. Analysis of peptide binding pocket residues indicated that Tyr 10, Ser 11, Ser 13, and Val 86 in the class II beta chain were present in 85% of patients compared with 37% of controls, suggesting that a high proportion of AH susceptibility is attributable to these residues (etiologic fraction [EF] = 76%). In contrast to the class II associations in children, AAH was associated with HLA-DRB1*0405 (RR = 10.4, Pc <.005) but not with HLA-DRB1*1301 or HLA-DRB1*0301. In addition, HLA-DR4 with the class I gene, HLA-A11, appeared synergistic in predisposing AAH patients to develop extra-hepatic autoimmune (AI) manifestations (odds ratio [OR] = 104.9, Pc < 10(-4)). Concomitant differences in autoantibody profiles were also observed in PAH versus AAH: smooth muscle antibodies (SMA) were most prevalent in PAH but antinuclear antibodies were most prevalent in AAH (P =.003). This study therefore reveals that different HLA-DRB1 allotypes confer susceptibility to AH in children and adults and raises the possibility that PAH and AAH may be triggered by different factors.

Adult↗

Fetal pyelectasis in consecutive pregnancies: a possible genetic predisposition.

Mild fetal pyelectasis is a relatively common finding. The objective of this study was to assess its recurrence rate in subsequent pregnancies. The study comprised 420 women with two consecutive normal uncomplicated pregnancies screened at 15-24 weeks' gestation by ultrasound. Pyelectasis was defined as a fetal pelvis of 4 mm or more in its anterior-posterior dimensions. Of 64 fetuses with pyelectasis, 43 (67%) had a recurrence of this finding in their subsequent pregnancy. Compared with normal fetuses, those with pyelectasis had a relative risk of 6.1 to have a recurrence of this finding in their next pregnancy (95% confidence interval, 4.3-7.5, p < 0.001). These results suggest a predisposition for pyelectusis that may be influenced by genetic and/or environmental factors. More data are needed before an accurate adjustment based on previous results can be made.

Adult↗

[Gliomas: the role of environmental risk factors and genetic predisposition].

Exposure to ionising radiation is the only established risk factor for glioma. Although gliomas are looked upon as a non-heritable disease, physicians regularly see patients with affected relatives in practice. A few monogenetic tumour syndromes explain < 5% of all gliomas: neurofibromatosis type 1 and 2, Li-Fraumeni syndrome, tuberous sclerosis, Turcot syndrome, Gorlin syndrome, and the melanomaastrocytoma syndrome. Aggregation ofgliomas in families without these tumour syndromes also occurs. The overall familial pattern is generally atypical for hereditary cancers. Relatives are estimated to have a 2- to 9-fold increased risk. The occurrence ofgliomas in families can probably best be explained by a multifactorial model: environmental risk factors with a genetically determined susceptibility for these risk factors. The identity of the genetic variants leading to this predisposition remains to be determined. When there are indications of a hereditary tumour syndrome, additional diagnostic investigation is indicated.

Central Nervous System Neoplasms↗

The basis of autoimmunity: Part II. Genetic predisposition.

In Part II of his review of the basis of autoimmunity, Argyrios N. Theofilopoulos summarizes current knowledge on the genetic factors that contribute to autoimmune disease predisposition. The findings indicate that multiple genes contribute to the induction of pathogenic autoimmunity, and that no single genetic abnormality is sufficient in itself to induce disease. The definition of these genetically complex diseases is about to be revolutionized by the development of genome scanning approaches, such as dense chromosomal maps based on polymorphic microsatellite DNA and other informative markers. These will allow the loci and genes that predispose to these diseases to be identified broadly.

Animals↗

Genetic predisposition to breast cancer.

Breast cancer is the most common cancer among American women. Because metastatic breast cancer is an incurable disease, efforts to decrease breast cancer mortality have focused on early detection and improved treatment. Identification and analysis of a specific genetic susceptibility could permit detection of susceptible women and greatly increase the understanding of the initial step that eventually leads to cancer. Because susceptibility loci have been recognized as sites that often are altered during tumor progression, the identification and cloning of such loci could be important in developing cancer therapies. In this article, the progress being made in segregation analysis, linkage analysis, and cloning of breast cancer susceptibility loci is reviewed. The evidence for genetic inheritance is most consistent with dominant inheritance for at least three major susceptibility loci. Proliferative breast disease has been hypothesized to be an inherited lesion in breast cancer kindreds with both premenopausal and postmenopausal probands. Currently, there are many genetic markers for mapping the human genome. Technologic advances have progressed from restriction fragment length polymorphisms to highly polymorphic markers. Using this technology, breast cancer susceptibility in some kindreds with an early onset has been shown to be linked to chromosome 17q. Gene isolation eventually will follow with an increased understanding of the percentage of breast cancer cases that are a result of this genetic locus. Li-Fraumeni syndrome, which often is expressed as breast cancer, is due to mutations in the p53 gene. Characterization of the syndrome and its relationship to the altered gene should proceed rapidly. There is also a group of families exhibiting a genetic susceptibility that is not due to either of these loci. Together, these findings indicate that there are at least three separate major loci segregating for breast cancer susceptibility. With the current initiative to map and sequence the entire human genome and the advances that recently have been reported, a detailed molecular understanding of breast cancer predisposition can be envisaged.

Age Factors↗

Angular bundle kindling is accelerated in rats with a genetic predisposition to acoustic stimulus-induced seizures.

Limbic kindling was examined in genetically epilepsy-prone (GEPR) and non-epileptic control rats. The early stage of kindling development was accelerated in both groups of GEPR rats compared to controls. Later stages of kindling were accelerated in GEPR-9 but not GEPR-3 rats. These results indicate that GEPR rats have an enhanced susceptibility to limbic kindling and suggest that limbic brain alterations may contribute to acceleration of the early stage kindling development in GEPR rats.

Acoustic Stimulation↗

Genetic predisposition to cancer and familial cancer syndromes.

Approximately 10% to 15% of childhood cancers are hereditary or familial in nature. For several genetic disorders, the development of cancer is a secondary manifestation of the clinical phenotype, whereas cancer predisposition syndromes are generally recognized by the manifestation of characteristic malignancies. The study of pediatric cancer and rare hereditary cancer syndromes and associations has led to the identification of numerous cancer genes that are known to play critical roles in both normal and abnormal cellular growth, differentiation, and proliferation. The potential to identify such genetic markers of cancer predisposition poses difficult social, legal, and ethical questions in their application to clinical practice.

Beckwith-Wiedemann Syndrome↗

Genetic predisposition to cancer with special reference to mutagen sensitivity.

From studies on cancer genetics, available information suggests the following tentative conclusions: 1. Cancer starts with a genetic change (or changes) from a normal somatic cell, but the changes (mutational events) must be specific in a target tissue cell. In a number of cases, genetic changes can be detected at the chromosome level. 2. Hereditary cancers usually have one genetic lesion already existing prezygotically; therefore only one additional mutational event is required in the homologous gene to complete the process of neoplastic transformation. In nonhereditary neoplasms, both mutations must occur postzygotically. 3. Individuals with high spontaneous mutation rates (monitored by chromosome breakage rates) are more liable to acquire specific genetic lesions than those with low mutation rates; therefore they are at higher risk to develop neoplasms. 4. Individuals with genetic defects in response to damage induced by mutagens (carcinogens) are more liable to accumulate genetic lesions than those who are more resistant; therefore, they are more liable to develop cancers. Mutagen sensitivity or resistance is probably genetic expression of DNA repair capabilities. 5. An effective assay method for sensitivity or resistance to mutagens can be developed to analyze the human population to identify the at-risk fraction.

Chromosome Aberrations↗

[Analysis of the genetic predisposition to cancer in families of patients with multiple primary malignant neoplasms].

Clinical-genetic examination of 305 patients with multiple primary tumors aimed at determining the rate of genetic burden to their development and community of joint accumulation of tumors in families of these patients has revealed a significant genetic community of inheritance of breast cancer, carcinomas of colon, endometrium, ovaries and stomach in the families of patients with multiple primary tumors. Comparative analysis of genetic correlations has shown the greatest genetic burden in families of patients with multiple primary tumours as against the families of patients with solitary cancer.

Breast Neoplasms↗

Lung cancer detection and prevention: evidence for an interaction between smoking and genetic predisposition.

The initiation and promotion of cancer is thought to result from a series of genetic mutations, some of which may be inherited. Our analysis of 337 lung cancer families suggested that, after allowing for an individual's pack-years of tobacco use, the pattern of disease was best explained by Mendelian codominant inheritance of an allele that produced earlier age of onset. Since lung cancer rarely occurs in the absence of exposure to tobacco, differences in the prevalence of smoking across generations could have a profound influence on the fit of genetic models. In the present study, families were partitioned into two groups, based on the birth cohort of the proband, i.e., born before World War I (age at death, greater than or equal to 60 years) or born after World War I (age at death, less than 60 years). This partition was chosen because the year 1915 signaled the start of the dramatic rise in tobacco use in the United States. In younger proband families, in which parents were more likely to smoke, Mendelian codominant inheritance provided the best fit to the data. In older proband families, for whom smoking among parents was less prevalent, the "no major gene" and "environmental" hypotheses were rejected; however, no Mendelian models could be distinguished. If the results on the families with the most homogeneous exposure to tobacco across generations (born after World War I) reflect the true underlying biology, then the influence of genetic factors in the pathogenesis of lung has been underestimated; the cumulative probability of lung cancer at age 80 for a noncarrier of the gene, at the average level of tobacco consumption, is close to zero, implying that virtually all lung cancer occurs among gene carriers. Identification of this putative genetic factor has profound implications for the detection and prevention of lung cancer.

Aged↗

Genetic predisposition to phaeochromocytoma: analysis of candidate genes GDNF, RET and VHL.

Inherited predisposition to phaeochromocytoma (MIM No 171300) occurs in multiple endocrine neoplasia type 2 (MEN 2) (MIM No 171400), von Hippel-Lindau (VHL) disease (MIM No 199300), and neurofibromatosis type 1 (NF1) (MIM No 162200). In addition, familial phaeochromocytoma alone has also been reported and we and others have identified germline VHL mutations in five of six kindreds analysed previously. Germline mutations in the RET proto-oncogene, which encodes a receptor tyrosine kinase, and in the VHL tumour suppressor gene cause MEN 2 and VHL disease, respectively. To further investigate the genetics of phaeochromocytoma predisposition, we analysed three groups of patients with no evidence of VHL disease, MEN 2 or NF1: Group A, eight kindreds with familial phaeochromocytoma; Group B, two patients with isolated bilateral phaeochromocytoma; and Group C, six cases of multiple extra-adrenal phaeochromocytoma or adrenal phaeochromocytoma with a family history of neuroectodermal tumours. Germline missense VHL mutations were identified in three of eight kindreds with familial phaeochromocytoma. A germline VHL mutation was also characterised in one of the two patients with bilateral phaeochromocytoma. No VHL or RET mutations were detected in the final group of patients with multiple extra-adrenal phaeochromocytoma or adrenal phaeochromocytoma with a family history of neuroectodermal tumours. The absence of germline VHL and RET gene mutations in many of these families suggested that other phaeochromoeytoma susceptibility loci may exist. Glial cell line-derived neurotrophic factor (GDNF) has been recently identified as a natural ligand for RET. Thus, it seems plausible that GDNF is a good candidate gene to play a role in phaeochromocytoma susceptibility. We searched for germline mutations in GDNF in 16 cases of familial phaeochromocytoma (groups A, B and C) and looked for evidence of somatic change in GDNF in 28 sporadic phaeochromocytomas, 12 MEN 2 phaeochromocytomas and five VHL phaeochromocytomas. No GDNF mutations were identified in patients with familial phaeochromocytoma disease, but a c277C-->T (R93W) sequence variant was identified in one of 28 sporadic tumours. This candidate mutation was identified in the germline and tumour tissue but was not present in 104 control GDNF alleles. GDNF sequence variants including R93W have been suggested previously to represent low penetrance susceptibility mutations for Hirschsprung disease and the R93W was not identified in 376 control alleles studied by others. These findings suggest that although GDNF mutations do not appear to have a major role in the pathogenesis of familial or sporadic phaeochromocytomas, allelic variation at the GDNF locus may modify phaeochromocytoma susceptibility.

Adrenal Gland Neoplasms↗

Influence of the endogenous opioid system on high alcohol consumption and genetic predisposition to alcoholism.

There is increasing evidence supporting a link between the endogenous opioid system and excessive alcohol consumption. Acute or light alcohol consumption stimulates the release of opioid peptides in brain regions that are associated with reward and reinforcement and that mediate, at least in part, the reinforcing effects of ethanol. However, chronic heavy alcohol consumption induces a central opioid deficiency, which may be perceived as opioid withdrawal and may promote alcohol consumption through the mechanisms of negative reinforcement. The role of genetic factors in alcohol dependency is well recognized, and there is evidence that the activity of the endogenous opioid system under basal conditions and in response to ethanol may play a role in determining an individual's predisposition to alcoholism. The effectiveness of opioid receptor antagonists in decreasing alcohol consumption in people with an alcohol dependency and in animal models lends further support to the view that the opioid system may regulate, either directly or through interactions with other neurotransmitters, alcohol consumption. A better understanding of the complex interactions between ethanol, the endogenous opioids and other neurotransmitter systems will help to delineate the neurochemical mechanisms leading to alcoholism and may lead to the development of novel treatments.

Alcohol Drinking↗