Causal relationship between obesity and vitamin D status: bi-directional Mendelian randomization analysis of multiple cohorts.

BACKGROUND: Obesity is associated with vitamin D deficiency, and both are areas of active public health concern. We explored the causality and direction of the relationship between body mass index (BMI) and 25-hydroxyvitamin D [25(OH)D] using genetic markers as instrumental variables (IVs) in bi-directional Mendelian randomization (MR) analysis. METHODS AND FINDINGS: We used information from 21 adult cohorts (up to 42,024 participants) with 12 BMI-related SNPs (combined in an allelic score) to produce an instrument for BMI and four SNPs associated with 25(OH)D (combined in two allelic scores, separately for genes encoding its synthesis or metabolism) as an instrument for vitamin D. Regression estimates for the IVs (allele scores) were generated within-study and pooled by meta-analysis to generate summary effects. Associations between vitamin D scores and BMI were confirmed in the Genetic Investigation of Anthropometric Traits (GIANT) consortium (n = 123,864). Each 1 kg/m(2) higher BMI was associated with 1.15% lower 25(OH)D (p = 6.52×10⁻²⁷). The BMI allele score was associated both with BMI (p = 6.30×10⁻⁶²) and 25(OH)D (-0.06% [95% CI -0.10 to -0.02], p = 0.004) in the cohorts that underwent meta-analysis. The two vitamin D allele scores were strongly associated with 25(OH)D (p≤8.07×10⁻⁵⁷ for both scores) but not with BMI (synthesis score, p = 0.88; metabolism score, p = 0.08) in the meta-analysis. A 10% higher genetically instrumented BMI was associated with 4.2% lower 25(OH)D concentrations (IV ratio: -4.2 [95% CI -7.1 to -1.3], p = 0.005). No association was seen for genetically instrumented 25(OH)D with BMI, a finding that was confirmed using data from the GIANT consortium (p≥0.57 for both vitamin D scores). CONCLUSIONS: On the basis of a bi-directional genetic approach that limits confounding, our study suggests that a higher BMI leads to lower 25(OH)D, while any effects of lower 25(OH)D increasing BMI are likely to be small. Population level interventions to reduce BMI are expected to decrease the prevalence of vitamin D deficiency.

Association of genetic variation with systolic and diastolic blood pressure among African Americans: the Candidate Gene Association Resource study.

The prevalence of hypertension in African Americans (AAs) is higher than in other US groups; yet, few have performed genome-wide association studies (GWASs) in AA. Among people of European descent, GWASs have identified genetic variants at 13 loci that are associated with blood pressure. It is unknown if these variants confer susceptibility in people of African ancestry. Here, we examined genome-wide and candidate gene associations with systolic blood pressure (SBP) and diastolic blood pressure (DBP) using the Candidate Gene Association Resource (CARe) consortium consisting of 8591 AAs. Genotypes included genome-wide single-nucleotide polymorphism (SNP) data utilizing the Affymetrix 6.0 array with imputation to 2.5 million HapMap SNPs and candidate gene SNP data utilizing a 50K cardiovascular gene-centric array (ITMAT-Broad-CARe [IBC] array). For Affymetrix data, the strongest signal for DBP was rs10474346 (P= 3.6 × 10(-8)) located near GPR98 and ARRDC3. For SBP, the strongest signal was rs2258119 in C21orf91 (P= 4.7 × 10(-8)). The top IBC association for SBP was rs2012318 (P= 6.4 × 10(-6)) near SLC25A42 and for DBP was rs2523586 (P= 1.3 × 10(-6)) near HLA-B. None of the top variants replicated in additional AA (n = 11 882) or European-American (n = 69 899) cohorts. We replicated previously reported European-American blood pressure SNPs in our AA samples (SH2B3, P= 0.009; TBX3-TBX5, P= 0.03; and CSK-ULK3, P= 0.0004). These genetic loci represent the best evidence of genetic influences on SBP and DBP in AAs to date. More broadly, this work supports that notion that blood pressure among AAs is a trait with genetic underpinnings but also with significant complexity.

Interactions of dietary whole-grain intake with fasting glucose- and insulin-related genetic loci in individuals of European descent: a meta-analysis of 14 cohort studies.

Whole-grain foods are touted for multiple health benefits, including enhancing insulin sensitivity and reducing type 2 diabetes risk. Recent genome-wide association studies (GWAS) have identified several single nucleotide polymorphisms (SNPs) associated with fasting glucose and insulin concentrations in individuals free of diabetes. We tested the hypothesis that whole-grain food intake and genetic variation interact to influence concentrations of fasting glucose and insulin. Via meta-analysis of data from 14 cohorts comprising ∼ 48,000 participants of European descent, we studied interactions of whole-grain intake with loci previously associated in GWAS with fasting glucose (16 loci) and/or insulin (2 loci) concentrations. For tests of interaction, we considered a P value <0.0028 (0.05 of 18 tests) as statistically significant. Greater whole-grain food intake was associated with lower fasting glucose and insulin concentrations independent of demographics, other dietary and lifestyle factors, and BMI (β [95% CI] per 1-serving-greater whole-grain intake: -0.009 mmol/l glucose [-0.013 to -0.005], P < 0.0001 and -0.011 pmol/l [ln] insulin [-0.015 to -0.007], P = 0.0003). No interactions met our multiple testing-adjusted statistical significance threshold. The strongest SNP interaction with whole-grain intake was rs780094 (GCKR) for fasting insulin (P = 0.006), where greater whole-grain intake was associated with a smaller reduction in fasting insulin concentrations in those with the insulin-raising allele. Our results support the favorable association of whole-grain intake with fasting glucose and insulin and suggest a potential interaction between variation in GCKR and whole-grain intake in influencing fasting insulin concentrations.

Surface assembly of poly(I:C) on PEGylated microspheres to shield from adverse interactions with fibroblasts.

By expressing an array of pattern recognition receptors (PRRs), fibroblasts play an important role in stimulating and modulating the response of the innate immune system. The TLR3 ligand polyriboinosinic acid-polyribocytidylic acid, poly(I:C), a mimic of viral dsRNA, is a vaccine adjuvant candidate to activate professional antigen presenting cells (APCs). However, owing to its ligation with extracellular TLR3 on fibroblasts, subcutaneously administered poly(I:C) bears danger towards autoimmunity. It is thus in the interest of its clinical safety to deliver poly(I:C) in such a way that its activation of professional APCs is as efficacious as possible, whereas its interference with non-immune cells such as fibroblasts is controlled or even avoided. Complementary to our previous work with monocyte-derived dendritic cells (MoDCs), here we sought to control the delivery of poly(I:C) surface-assembled on microspheres to human foreskin fibroblasts (HFFs). Negatively charged polystyrene (PS) microspheres were equipped with a poly(ethylene glycol) (PEG) corona through electrostatically driven coatings with a series of polycationic poly(L-lysine)-graft-poly(ethylene glycol) copolymers, PLL-g-PEG, of varying grafting ratios g from 2.2 up to 22.7. Stable surface assembly of poly(I:C) was achieved by incubation of polymer-coated microspheres with aqueous poly(I:C) solutions. Notably, recognition of both surface-assembled and free poly(I:C) by extracellular TLR3 on HFFs halted their phagocytic activity. Ligation of surface-assembled poly(I:C) with extracellular TLR3 on HFFs could be controlled by tuning the grafting ratio g and thus the chain density of the PEG corona. When assembled on PLL-5.7-PEG-coated microspheres, poly(I:C) was blocked from triggering class I MHC molecule expression on HFFs. Secretion of interleukin (IL)-6 by HFFs after exposure to surface-assembled poly(I:C) was distinctly lower as compared to free poly(I:C). Overall, surface assembly of poly(I:C) may have potential to contribute to the clinical safety of this vaccine adjuvant candidate.

Meta-analysis identifies multiple loci associated with kidney function-related traits in east Asian populations.

Chronic kidney disease (CKD), impairment of kidney function, is a serious public health problem, and the assessment of genetic factors influencing kidney function has substantial clinical relevance. Here, we report a meta-analysis of genome-wide association studies for kidney function-related traits, including 71,149 east Asian individuals from 18 studies in 11 population-, hospital- or family-based cohorts, conducted as part of the Asian Genetic Epidemiology Network (AGEN). Our meta-analysis identified 17 loci newly associated with kidney function-related traits, including the concentrations of blood urea nitrogen, uric acid and serum creatinine and estimated glomerular filtration rate based on serum creatinine levels (eGFRcrea) (P < 5.0 × 10(-8)). We further examined these loci with in silico replication in individuals of European ancestry from the KidneyGen, CKDGen and GUGC consortia, including a combined total of ∼110,347 individuals. We identify pleiotropic associations among these loci with kidney function-related traits and risk of CKD. These findings provide new insights into the genetics of kidney function.

Validation de la version française du score de hanche d'Oxford-12

Fondement L'appréciation objective du résultat des actes chirurgicaux fait partie de la démarche d'évaluation des pratiques professionnelles, notamment en chirurgie orthopédique pour le résultat des prothèses articulaires. Dans cette optique, les questionnaires « auto-administrés » par les patients offrent une solution séduisante, mais peu utilisée en France. Le questionnaire anglais Oxford Hip Score en 12 questions (OHS-12) a été sélectionné pour cette étude en raison de sa facilité d'utilisation. Hypothèse Le but de ce travail était de valider la traduction française du score d'autoévaluation Oxford-12 et d'en confronter les résultats à ceux des scores fonctionnels de références, de Harris (HHS) et de Merle d'Aubigné (PMA). Matériel et méthode À partir d'une série clinique de 242 patients candidats à une arthroplastie de hanche, une validation de la traduction en langue française de ce questionnaire a été réalisée, ainsi qu'une évaluation de sa cohérence par confrontation des données obtenues en préopératoire avec celles provenant des deux scores cliniques de référence. Résultats La traduction a été validée selon le processus de traduction inverse du français à l'anglais avec correction de toute déviation ou contresens après comparaison systématisée avec le questionnaire original anglais. La moyenne du score global OHS-12 était de 43,8 points (22 à 60 points) avec une bonne distribution de la valeur globale des trois scores comparés. La corrélation était excellente entre OHS et HHS, mais une corrélation de niveau identique entre OHS et PMA n'a été obtenue que pour l'association des paramètres douleur et fonction, après exclusion du critère mobilité relativement surreprésenté dans le score PMA. Discussion et conclusion Le recours à des questionnaires subjectifs qui apportent une appréciation personnelle du résultat de l'arthroplastie par le patient est facilement applicable à grande échelle. Ce travail permet de mettre à la disposition des chirurgiens orthopédistes français une version traduite et validée d'un score d'autoévaluation fiable et internationalement reconnu. Les résultats obtenus nous incitent à privilégier l'utilisation de ce questionnaire en complément des scores et méthodes d'évaluation classiques.

Hepatitis C virus RNA replication requires a conserved structural motif within the transmembrane domain of the NS5B RNA-dependent RNA polymerase.

Hepatitis C virus (HCV) nonstructural protein 5B (NS5B), the viral RNA-dependent RNA polymerase (RdRp), is a tail-anchored protein with a highly conserved C-terminal transmembrane domain (TMD) that is required for the assembly of a functional replication complex. Here, we report that the TMD of the HCV RdRp can be functionally replaced by a newly identified analogous membrane anchor of the GB virus B (GBV-B) NS5B RdRp. Replicons with a chimeric RdRp consisting of the HCV catalytic domain and the GBV-B membrane anchor replicated with reduced efficiency. Compensatory amino acid changes at defined positions within the TMD improved the replication efficiency of these chimeras. These observations highlight a conserved structural motif within the TMD of the HCV NS5B RdRp that is required for RNA replication.

Quinupristin-dalfopristin combined with beta-lactams for treatment of experimental endocarditis due to Staphylococcus aureus constitutively resistant to macrolide-lincosamide-streptogramin B antibiotics.

Quinupristin-dalfopristin (Q-D) is an injectable streptogramin active against most gram-positive pathogens, including methicillin-resistant Staphylococcus aureus (MRSA). In experimental endocarditis, however, Q-D was less efficacious against MRSA isolates constitutively resistant to macrolide-lincosamide-streptogram B (C-MLS(B)) than against MLS(B)-susceptible isolates. To circumvent this problem, we used the checkerboard method to screen drug combinations that would increase the efficacy of Q-D against such bacteria. beta-Lactams consistently exhibited additive or synergistic activity with Q-D. Glycopeptides, quinolones, and aminoglycosides were indifferent. No drugs were antagonistic. The positive Q-D-beta-lactam interaction was independent of MLS(B) or beta-lactam resistance. Moreover, addition of Q-D at one-fourth the MIC to flucloxacillin-containing plates decreased the flucloxacillin MIC for MRSA from 500 to 1,000 mg/liter to 30 to 60 mg/liter. Yet, Q-D-beta-lactam combinations were not synergistic in bactericidal tests. Rats with aortic vegetations were infected with two C-MLS(B)-resistant MRSA isolates (isolates AW7 and P8) and were treated for 3 or 5 days with drug dosages simulating the following treatments in humans: (i) Q-D at 7 mg/kg two times a day (b.i.d.) (a relatively low dosage purposely used to help detect positive drug interactions), (ii) cefamandole at constant levels in serum of 30 mg/liter, (iii) cefepime at 2 g b.i.d., (iv) Q-D combined with either cefamandole or cefepime. Any of the drugs used alone resulted in treatment failure. In contrast, Q-D plus either cefamandole or cefepime significantly decreased valve infection compared to the levels of infection for both untreated controls and those that received monotherapy (P &lt; 0.05). Importantly, Q-D prevented the growth of highly beta-lactam-resistant MRSA in vivo. The mechanism of this beneficial drug interaction is unknown. However, Q-D-beta-lactam combinations might be useful for the treatment of complicated infections caused by multiple organisms, including MRSA.

Génération d'une souris dépourvue du gène VIT32 de manière conditionnelle: étude du phénotype rénal chez les souris dépourvues de RGS2

Résumé Dans le rein, la vasopressine possède un rôle essentiel dans la régulation fine du transport d'eau et participe au contrôle de la réabsorption du sodium. Cette action est conduite par l'activation du récepteur à la vasopressine V2R situé dans l'anse de Henle, dans le tubule connecteur et dans le canal collecteur du néphron des rongeurs et conduit à la formation d'AMPc entraînant un mécanisme d'action caractérisé par deux phases distinctes. Le premier effet de la vasopressine est non génomique et a lieu rapidement après l'activation du récepteur, la deuxième phase est plus tardive et possède la caractéristique de moduler la transcription d'un réseau de gènes. Parmi ces gènes, plusieurs sont directement impliqués dans le transport d'eau et de sodium, comme l'Aqp2 et 3, ENaC et la Na,K-ATPase. L'identification des effets de la voie de signalisation de la vasopressine représente un point crucial pour la compréhension des mécanismes moléculaires de la réabsorption de l'eau et du sodium dans le néphron. L'analyse en série de l'expression de gènes (SAGE) réalisée en 2001 dans notre laboratoire a permis de caractériser le transcriptome dépendant de la vasopressine dans la lignée cellulaire mpkCCDc14,a dérivée du canal collecteur cortical (CCD) de souris. Deux des transcrits induits par la vasopressine (VIT) ont fait l'objet des études de ce travail de thèse. Le premier est VIT32 (Vasopressin induced transcript 32) qui code pour une protéine ne possédant aucune homologie avec des domaines protéiques dont la fonction est connue. Dans le système d'expression de l'ovocyte de Xenopus laevis, VIT32 induit la maturation des ovocytes et diminue le courant sensible à l'amiloride de manière dépendante de la voie des MAPK. Dans les mpkCCDc14, l'inhibition de la voie des MAPK diminue le courant sodique en diminuant l'activité de la Na,K-ATPase, mais sans modifier le courant d'ENaC. Ainsi la voie de signalisation des MAPK peut avoir des cibles différentes suivant le système dans lequel elle est étudiée. C'est pourquoi nous avons décidé de poursuivre l'étude de VIT32 dans un contexte physiologique en créant une souris dépourvue du gène codant pour VIT32 de manière conditionnelle (conditional knockout). La première partie de cette thèse a donc consisté à générer cette souris. Le deuxième transcrit induit par la vasopressine qui a été étudié dans cette thèse est RGS2 (Regulator of G protein Signaling 2). In vitro, il a été montré que RGS2 inhibe des voies de signalisation dépendantes de récepteurs couplés à des protéines Gq et Gs. Dans notre étude, nous avons montré que dans le néphron de rein de souris, RGS2 est colocalisé avec V2R. In vivo, la vasopressine sécrétée lors d'une restriction en eau imposée à des souris augmente l'expression de RGS2. De plus, l'accumulation d'AMPc engendrée par l'action de la vasopressine sur les canaux collecteurs est significativement plus grande chez les souris dépourvues de RGS2 (rgs2 -/-). Cette induction de la signalisation de la vasopressine est corrélée à une augmentation de la réabsorption d'eau chez les souris rgs2 -/-. Ainsi RGS2 serait impliqué dans le rétrocontrôle négatif de la voie de signalisation de la vasopressine. Abstract In the kidney, vasopressin plays a key role in the control of water balance and participates in salt reabsorption. These actions are induced by the activation of V2 vasopressin receptor (V2R) located in the loop of Henle, in the connecting tubule and in the collecting duct leading to an increase in intracellular cAMP levels. The V2R-mediated vasopressin action elicits a rapid, non-genomic effect, during which water and salt reabsorption is rapidly increased and a late or genomic effect characterised by the long-term regulation of water and salt reabsorption through the transcriptional activation of a gene network that includes Aqp2, Aqp3, ENaC and Na,K-ATPase. Serial analysis of gene expression (SAGE) performed in 2001 in our laboratory characterised the vasopressin induced transcripts (VIT) in the mpkCCDc14 cell line. Two of them are studied in this thesis. The first one is VIT32 (Vasopressin induced transcript 32) that encodes a protein that has no homology with any protein domain of known function. In the Xenopus laevis oocyte, VIT32 induces oocyte maturation and downregulates the ENaC amiloride sensitive current via the activation of the MAPK pathway. In mpkCCDc14 cell line, the MAPK pathway inhibition leads to a decrease of Na,K-ATPase activity without affecting ENaC current. Therefore, the MAPK pathway can act on different targets depending on the cellular context. Thus, we decided to investigate the function of VIT32 in its physiological environment by performing a conditional knockout mouse of VIT32. The first part of this thesis consisted in generating this mouse. The second studied vasopressin induced transcript is RGS2 (Regulator of G protein Signaling 2). In vitro, RGS2 has been shown to inhibit Gq and Gs protein-coupled receptor pathway. In our study we show that RGS2 is co-localized with V2R in the mouse nephron. In vivo, vasopressin secreted during water restriction up-regulates RGS2 expression. Moreover, vasopressin-dependant accumulation of CAMP is significantly increased in the cortical collecting duct of RGS2 knockout mice. This increase is correlated with an increase in water reabsorption. RGS2 could be involved in the negative feedback regulation of V2R signalling. Résumé tout public Le corps humain est composé d'environ 60% d'eau répartie à l'intérieur et à l'extérieur des cellules de notre organisme. Les cellules, unités fondamentales du vivant, puisent l'oxygène et les nutriments indispensables à leur fonctionnement dans le liquide extracellulaire. La composition du milieu doit être constante, car les variations peuvent perturber considérablement et parfois fatalement la fonction des cellules. Ainsi les organismes pluricellulaires ont développé des mécanismes permettant de contrôler la constance du milieu extracellulaire afin de maintenir l'état d'équilibre nommé homéostasie. Le rein joue un rôle majeur dans cette homéostasie grâce à sa capacité de réabsorber l'eau et les solutés en fonction des besoins de l'organisme. Cette fonction du rein est régulée par différentes hormones comme la vasopressine, qui permet de contrôler la réabsorption fine de l'eau et des solutés. Dans leurs membranes, les cellules possèdent des récepteurs leur permettant de répondre aux signaux extracellulaires comme le sont entre autres les hormones. Ainsi les cellules sensibles à la vasopressine possèdent un récepteur nommé V2R qui permet d'intégrer les signaux de la vasopressine en déclenchant tout une cascade d'événements conduisant à une modification de l'expression de certaines protéines impliquées directement ou non dans la réabsorption de l'eau et des solutés. Une étude précédente élaborée au sein de notre laboratoire a permis de répertorier les protéines dont l'expression est augmentée par de la vasopressine. Deux de ces protéines ont fait l'objet des études de cette thèse. La première protéine induite par la vasopressine est VIT32 (Vasopressin induced transcript 32). Cette protéine est entre autres impliquée dans la réabsorption du sodium, mais la fonction précise de VIT32 dans ce transport n'a pas pu être déterminée. Une des approches possibles pour l'étude de la fonction d'une protéine est de supprimer son expression chez la souris et d'étudier les conséquences de son absence. Ces souris sont appelées des souris knockout, puisque la protéine en question ne peut plus agir. La première partie de cette thèse a donc consisté à générer une souris dépourvue du gène de VIT32. La deuxième protéine étudiée est RGS2 (Regulator of G protein Signaling 2). Cette protéine inhibe certaines voies de signalisation activées par différentes hormones. Dans cette partie du travail de thèse, nous avons pu mettre en évidence que RGS2 agit comme un inhibiteur de la voie de signalisation de la vasopressine. En modifiant cette signalisation, RGS2 serait donc un médiateur du contrôle de la réabsorption d'eau dans les cellules du rein sensibles à la vasopressine.

Incident Hepatitis C Virus Infections in the Swiss HIV Cohort Study : changes in treatment uptake and outcomes between 1991 and 2013

Background: The hepatitis C virus (HCV) epidemic is evolving rapidly in patients infected with human immunodeficiency virus (HIV). We aimed to describe changes in treatment uptake and outcomes of incident HCV infections before and after 2006, the time-point at which major changes in HCV epidemic became apparent. Methods.  We included all adults with an incident HCV infection before June 2012 in the Swiss HIV Cohort Study, a prospective nationwide representative cohort of individuals infected with HIV. We assessed the following outcomes by time period: the proportion of patients starting an HCV therapy, the proportion of treated patients achieving a sustained virological response (SVR), and the proportion of patients with persistent HCV infection during follow-up. Results.  Of 193 patients with an HCV seroconversion, 106 were diagnosed before and 87 after January 2006. The proportion of men who have sex with men increased from 24% before to 85% after 2006 (P < .001). Hepatitis C virus treatment uptake increased from 33% before 2006 to 77% after 2006 (P < .001). Treatment was started during early infection in 22% of patients before and 91% after 2006 (P < .001). An SVR was achieved in 78% and 29% (P = .01) of patients treated during early and chronic HCV infection. The probability of having a detectable viral load 5 years after diagnosis was 0.67 (95% confidence interval [CI], 0.58-0.77) in the group diagnosed before 2006 and 0.24 (95% CI, 0.16-0.35) in the other group (P < .001). Conclusions. In recent years, increased uptake and earlier initiation of HCV therapy among patients with incident infections significantly reduced the proportion of patients with replicating HCV.