WO2010001358A2 - Diagnostic polymorphisms for cardiac disease - Google Patents
Diagnostic polymorphisms for cardiac disease Download PDFInfo
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- WO2010001358A2 WO2010001358A2 PCT/IB2009/052892 IB2009052892W WO2010001358A2 WO 2010001358 A2 WO2010001358 A2 WO 2010001358A2 IB 2009052892 W IB2009052892 W IB 2009052892W WO 2010001358 A2 WO2010001358 A2 WO 2010001358A2
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Definitions
- the present invention relates to diagnostic markers, and more specifically to the use of a polymorphism, including a single nucleotide polymorphism (SNP), or a combination of such markers, for diagnosis of cardiac disease, such as heart failure and atrial fibrillation.
- a polymorphism including a single nucleotide polymorphism (SNP), or a combination of such markers, for diagnosis of cardiac disease, such as heart failure and atrial fibrillation.
- SNP single nucleotide polymorphism
- Heart failure is a condition in which the heart is unable to pump sufficient blood throughout the body. Recently, evidence has accumulated that genetic factors may have a potential role in the pathogenesis of AF in HF patients [1,2].
- Atrial fibrillation which is an arrhythmia defined by the absence of coordinated atrial systole, is a common complication in heart failure patients, and is usually associated with advanced disease and aggravated symptoms [3].
- renin-angiotensin-aldosterone system is a hormone system which plays an important role in regulating blood volume and systemic vascular resistance, which together influence cardiac output and arterial pressure. Renin, which is primarily released by the kidneys, stimulates the formation of angiotensin in blood and tissues, which in turn stimulates the release of aldosterone from the adrenal cortex.
- the RAAS appears to be a relevant contributing cause in the pathogenesis of heart failure [4], and AF [1,3,5] including myocardial remodeling [4], regulation of blood pressure, and vascular smooth muscle growth and proliferation [6].
- Angiotensin II is the predominant neurohormone in the RAAS, and regulates a number of physiologic responses, including fluid homeostasis, aldosterone production, renal function, vascular smooth muscle contraction, sympathetic nervous activity and salt retention [6] .
- Angiotensin II plays a key role in the pathophysiology of HF, and treatment with angiotensin (AT)-II receptor antagonists has been suggested in the management of AF patients [9]. Most of the known effects of angiotensin II are mediated through the angiotensin II type 1 receptor (ATlR).
- ATlR angiotensin II type 1 receptor
- ATlR 3 '-untranslated region
- IO 3 '-untranslated region
- this polymorphism has been linked to enhanced physiological responses to Ang II resulting in increased vasoconstrictor activity [H].
- ATlR polymorphism was associated with left ventricular hypertrophy [12,13], autonomic modulation of heart rate [2], vascular manifestations of atherosclerosis [14], coronary artery disease[15-18], and for development/progression of renal failure [19-21].
- Worsening renal functions and ischemic etiology have both been shown to be associated with a more advanced HF disease and an increased mortality [22,23].
- angiotensin II is produced from angiotensin I by the angiotensin-converting enzyme (ACE) and the heart chymase (CMA) pathways.
- Human heart chymase is a chymotrypsin-like serine protease that is the most catalytically efficient enzyme described, thus far, for the cleavage of angiotensin I to angiotensin II [33].
- Angiotensin II is primarily (80%) generated via the chymase pathway [34].
- Heart chymase has been implicated in the process of acute inflammation [35], apoptosis of cardiac myocytes, proliferation of fibroblasts ⁇ and tissue remodeling [37-39].
- a functional polymorphism of the human ACE gene (GenBank accession no.
- Aldosterone an important peptide produced following RAAS activation, plays an important role in growth promotion and cardiac fibrosis, which contributes to ventricular remodeling and was suggested to have an impact on the pathogenesis of HF and AF [45,46].
- the final step in the aldosterone synthetic pathway is via an enzymatic reaction catalyzed by aldosterone synthase.
- the aldosterone synthase (CYP 11B2) gene (a 9-exon gene localized to chromosome 8q22; GenBank accession no. AC073385) [2] contains a common T-344C polymorphism (a thymidine to cytosine substitution) within its promoter region (rsl799998) [47].
- the C allele has been associated with increased binding to the steroidogenic transcription factor 1 (SF- 1) [48] as well as with increased aldosterone synthase activity [49,50].
- Aldosterone synthase promoter -344C allele linked to higher aldosterone levels has been associated with poorer event- free survival in blacks with HF [53].
- the present invention provides one or more polymorphisms, including single nucleotide polymorphisms (SNPs), or combinations thereof, for diagnosis of cardiac disease, such as heart failure and atrial fibrillation.
- SNPs single nucleotide polymorphisms
- a nucleotide position in genome at which more than one sequence is possible in a population, is referred to herein as a "polymorphic site” or “polymorphism”. Where a polymorphic site is a single nucleotide in length, the site is referred to as a SNP.
- polymorphic site For example, if at a particular chromosomal location, one member of a population has an adenine and another member of the population has a thymine at the same position, then this position is a polymorphic site, and, more specifically, the polymorphic site is a SNP.
- Polymorphic sites may be several nucleotides in length due to insertions, deletions, conversions or translocations. As described herein, although reference may be made to an "SNP", it is understood to include any type of polymorphism. Each version of the sequence with respect to the polymorphic site is referred to herein as an "allele" of the polymorphic site.
- the SNP allows for both an adenine allele and a thymine allele.
- a reference nucleotide sequence is referred to for a particular gene e.g. in NCBI databases (www.ncbi.nlm.nih.gov). Alleles that differ from the reference are referred to as “variant” alleles.
- the polypeptide encoded by the reference nucleotide sequence is the "reference" polypeptide with a particular reference amino acid sequence, and polypeptides encoded by variant alleles are referred to as "variant" polypeptides with variant amino acid sequences. Nucleotide sequence variants can result in changes affecting properties of a polypeptide.
- sequence differences when compared to a reference nucleotide sequence, include insertions, deletions, conversions and substitutions: e.g. an insertion, a deletion or a conversion may result in a frame shift generating an altered polypeptide; a substitution of at least one nucleotide may result in a premature stop codon, amino acid change or abnormal mRNA splicing; the deletion of several nucleotides, resulting in a deletion of one or more amino acids encoded by the nucleotides; the insertion of several nucleotides, such as by unequal recombination or gene conversion, resulting in an interruption of the coding sequence of a reading frame; duplication of all or a part of a sequence; transposition; or a rearrangement of a nucleotide sequence, as described in detail above.
- sequence changes may alter the polypeptide encoded by a gene which in turn may alter the functionality and/or other properties of the polypeptide.
- a nucleotide change resulting in a change in polypeptide sequence can alter the physiological properties of a polypeptide dramatically by resulting in altered activity, distribution and stability or otherwise affect on properties of a polypeptide.
- nucleotide sequence variants can result in changes affecting transcription of a gene or translation of its mRNA, without affecting the polypeptide itself (of course a combination of both types of effects is also possible).
- a polymorphic site located in a regulatory region of a gene may result in altered transcription of a gene e.g. due to altered tissue specificity, altered transcription rate or altered response to transcription factors.
- a polymorphic site located in a region corresponding to the mRNA of a gene may result in altered translation of the mRNA e.g. by inducing stable secondary structures to the mRNA and affecting the stability of the mRNA. Such sequence changes may alter the expression of a gene and hence may have physiological effects.
- the present invention is not limited to polymorphisms in which there is a direct effect on the expression of the gene and/or on the resultant polypeptide.
- gene refers to an entirety containing entire transcribed region and all regulatory regions of a gene.
- the transcribed region of a gene including all exon and intron sequences of a gene including alternatively spliced exons and introns so the transcribed region of a gene contains in addition to polypeptide encoding region of a gene also regulatory and 5' and 3' untranslated regions present in transcribed RNA.
- Each gene described herein has been assigned a specific and unique nucleotide sequence by the scientific community.
- diagnostic means identifying the presence or nature of a pathologic condition. Diagnostic methods differ in their sensitivity and specificity.
- the "sensitivity” of a diagnostic assay is the percentage of diseased individuals who test positive (percent of "true positives”). Diseased individuals not detected by the assay are “false negatives.” Subjects who are not diseased and who test negative in the assay are termed “true negatives.”
- the "specificity” of a diagnostic assay is 1 minus the false positive rate, where the "false positive” rate is defined as the proportion of those without the disease who test positive. While a particular diagnostic method may not provide a definitive diagnosis of a condition, it suffices if the method provides a positive indication that aids in diagnosis.
- diagnosis refers to classifying a disease or a symptom, determining a severity of the disease, monitoring disease progression, forecasting an outcome of a disease and/or prospects of recovery.
- detecting may also optionally encompass any of the above.
- FIG. 1 shows ATlR A1166C genotyping in ischemic and non-ischemic HF patients
- FIG. 2 is a Kaplan-Meier plot of survival in HF patients according to ATlR Al 166C genotype
- FIG. 4A shows Kaplan-Meier survival curves according to circulating TNF- alpha levels (below and above median); and FIG 4B shows Cox proportional hazard ratio curves according to combined circulating TNF-alpha and IL-10 levels (both below and above median).
- SNP SNP
- cardiac disease particularly heart failure and atrial fibrillation.
- SNP single nucleotide polymorphism
- the single nucleotide polymorphism occurs in a gene selected from the group consisting of a renin angiotensin aldosterone system gene, an adrenergic receptor gene, an inflammatory path gene, a metabolic pathway gene, a cell proliferation gene, a natriuretic peptide receptor gene, a plasminogen activator inhibitor gene and a platelet- activating factor gene.
- Examples of such polymorphisms are presented in Appendix I.
- Examples of single nucleotide polymorphisms of the renin angiotensin gene include ATlR (such as A1166C polymorphism), CYPl 1B2 (such as a T-344C promoter polymorphism), CMAl (such as G- 1903 A polymorphism) and BDKRB2 polymorphisms.
- polymorphisms of the adrenergic receptor gene examples include polymorphisms of ADRB2 (such as Arg (A)16, A46, GIn (Q)27, C79] or He (1)164, T491), ADRBl (such as GIy (G)49, G145 or GIy (G)389, Gl 165), ADRAlA (such as
- Cys (Q347, T1039), and ADRA2B (such as ADRA2B 894+ AGAGGAGGA insertion/deletion) .
- polymorphisms of inflammatory pathway genes include polymorphisms of interleukin (IL)-IO (such as A-592 or G-1082), IL-6 (such as C (G- reverse)- 174), tumor necrosis factor (TNF) (such as A-318), IL-IB (such as T315), IL-IRN (such as 86-bp tandem repeat), and C-reactive protein (CRP) (such as C552).
- IL interleukin
- IL-6 such as C (G- reverse)- 174
- TNF tumor necrosis factor
- IL-IB such as T31
- IL-IRN such as 86-bp tandem repeat
- CRP C-reactive protein
- Examples of polymorphisms of metabolic pathway genes include perixosome proliferator-activated receptor genes (such as PPARA, PPARG and PPARGClA), nuclear respiratory genes (such as NRFl and GABPBl), NOS3 and GNB3.
- An example of a cell proliferation gene is FGF2; examples of natriuretic peptide genes include NPRl and NPR3; an example of a plasminogen activator inhibitor gene is SERPINE 1; and an example of a platelet-activating factor gene is PLA2G7.
- genetic analysis that identifies patients with one or more polymorphisms will enable the detection of patients with a predisposition for potentially suffering significant side effects due to the anti-RAAS therapy.
- genetic analysis is also expected to assist in detecting patients who would benefit from the aggressive "Anti-RAAS Therapy", such as combination of three /four anti RAAS therapy medications, for blocking the high activity of this system without such significant side effects.
- one or more polymorphisms such as SNPs, which are believed to affect RAAS (renin-angiotensin-aldosterone system) activity or at least to predict patients who may suffer from altered RAAS activity.
- RAAS renin-angiotensin-aldosterone system
- Such polymorphisms are expected to have prognostic and/or diagnostic importance, in terms of clinical manifestations and long-term survival of patients with heart disease, such as chronic systolic HF, and preferably also for determining which patients may potentially be predisposed to side effects from anti-RAAS therapy as opposed to patients who may be potentially predisposed to benefit from such therapy.
- SNPs in the following genes may have such prognostic and/or diagnostic importance: ATlR, CYPl 1B2, CMAl, ACE and BDKRB2.
- the present inventors examined ATlR polymorphism in patients with systolic HF and its relation to clinical manifestations and patient outcome. As described in detail in Example 1 below, 134 patients with HF and reduced systolic function were genotyped for the ATlR A1166C genotype, using polymerase chain reaction and restriction fragment length polymorphism. The relationship between ATlR A1166C polymorphism and clinical, electrocardiographic, echocardiographic and laboratory parameters in patients with ischemic and non-ischemic etiology was studied, and the relation between ATlR genotype and long-term (30 months) patient survival was examined.
- ATlR CC homozygous genotype was significantly associated with ischemic etiology and poorer renal function.
- the mechanism by which ATlR Al 166C may affect HF is in unknown. Given the potent characteristics of angiotensin II in the cardiac remodeling process and in cell growth regulation, ATlR polymorphism may be expected to alter RAAS activation, with consequent clinical effects.
- this polymorphism in the 3'UTR region of the gene implies it may influence ATlR transcriptional activity. Indeed, it has been recently reported that this polymorphism is mapped to microRNAs (miRNA) target sites and therefore can affect gene expression via miRNA regulation [55]. In this regard, the 1166 C allele rather than the A allele has been associated with increased ATlR expression. It is therefore, reasonable to believe that any effects attributed to ATlR genotype, would become overt mainly in patients homozygous for the 1166C allele compared to patients carrying the +1166A (AA+AC) genotypes.
- AA+AC +1166A
- the population frequency of the ATlR A1166C in the present study by the present inventors was found to be 74 and 26% for A and C alleles, respectively.
- This allele distribution showed a similarity to the respective frequencies reported in dbSNP using different European Caucasian populations or CEPH samples (65-75 and 25-35% for the A and C alleles, respectively).
- Considerable interethnic variation in the frequencies of this polymorphism has been demonstrated with the -1166C allele being rarer in Afro-American, and Asian populations (94-97 and 3-6% for the A and C alleles, respectively, dbSNP) compared with European Caucasian groups [29, 57], which is consistent with the present findings.
- ATlR A1166C polymorphism is a major determinant of late outcome in patients with ischemic cardiomyopathy.
- Patients homozygous for a gene variation associated with increased ATlR expression and enhanced receptor activity are more likely to have poor prognosis and higher mortality.
- These findings imply not necessarily a causal relation, but presumably (without wishing to be limited by a single hypothesis) a diminished adaptive capability for the ATlR 1166CC genotype group.
- the observed significant clinical deterioration is possible attributed to exaggerated neurohormonal activation of RAAS, again without wishing to be limited by a single hypothesis.
- the present inventors also analyzed the possible association between aldosterone synthase (CYP 11B2) T-344C polymorphism, which is associated with increased aldosterone activity, and the prevalence of AF in 191 consecutive patients who had symptomatic systolic HF (left ventricular ejection fraction ⁇ 40%) for at least 3 months prior to recruitment.
- CYP 11B2 aldosterone synthase
- T-344C polymorphism which is associated with increased aldosterone activity
- CYP11B2 T-344C promoter polymorphism is associated with predisposition to clinical AF in patients with HF.
- polymorphism of the aldosterone synthase, CYP11B2 CC genotype may serve as a significant marker for the presence of AF and emphasizes genetic predilection for differences in the clinical course of HF patients.
- genomic DNA was extracted from peripheral blood leukocytes using a standard protocol. Subjects were genotyped for the CYP11B2 polymorphism, using the polymerase chain reaction- restriction fragment length polymorphism approach.
- Atrial fibrillation was found to be present in 57 (32%) of HF patients.
- CYP11B2 T-344 C promoter polymorphism associated with aldosterone synthase expression is related to a 2-3 fold increased prevalence of AF in HF patients.
- the -344 CC genotype was shown to be a strong independent marker for AF, and almost half the patients with this genotype were found to suffer from AF, compared to a quarter of those with the -344 TT and TC genotypes.
- LA size is related to cardiac remodeling, and an increased LA dimension contributes to the development of AF in HF.
- the pathogenesis of AF is mediated through both mechanical and electrical remodeling via sympathetic activation and inflammation [61,62].
- the RAS -aldosterone axis plays a crucial part in these processes [63,64].
- aldosterone expression In the failing heart, there is a significant increase in aldosterone expression [65]. This occurs as the activity of aldosterone synthase (CYPl 1B2), the key enzyme in the aldosterone production, is increased in HF patients [66].
- CYP11B2 CC genotype was a significant predictor of AF but had no direct correlation with LA size. Although the present inventors did not examine direct inflammatory mediators, it is believed (without wishing to be limited by a single hypothesis) that CYP11B2 CC genotype may have contributed to AF pathogenesis through neurohormonal, inflammatory and autonomic system activation [61,62,64,69]. The genetic predisposition of HF patients to AF may have important practical implications. Beta blocker therapy, with known RAS antagonistic characteristics, has been suggested to reduce AF prevalence in systolic HF patients [59]. More specific therapy with direct aldosterone antagonists may offer stronger anti-remodeling properties. This concept, especially in the CYPl 1B2 CC genotype subpopulation, was also implied recently by others [63,70] and may potentially decrease AF prevalence in these patients.
- the present inventors further studied ACE and CMA polymorphisms and their relationship to HF.
- LV dysfunction ejection fraction ⁇ 40%) for ACE insertion (I)/deletion (D) and CMAl (-1903G/A) polymorphisms were genotyped. HF etiology and patients' clinical manifestations were analyzed in relation to genotype subtypes.
- the odds ratio of CMAl GG genotype having a non-ischemic etiology was 2.48 (95% C.I.1.23-5.00).
- the ACE D allele had no detectable impact on systolic HF phenotype. It was therefore concluded that in patients with chronic systolic HF, the CMAl polymorphism was related to non-ischemic etiology of HF. Patients homozygous for the G allele had a significantly greater reduction in systolic LV function.
- CMAl polymorphism may be mediated through an acceleration of the remodeling process in patients with HF, and mainly in patients with non-ischemic cardiomyopathy (without wishing to be limited by a single hypothesis).
- Chymase is produced from mast cells and is not inhibited by angiotensin-converting enzyme inhibitors [74].
- mast cells increase in number in the failing myocardium [75], and may be implicated in ventricular dilatation and cardiac decompensation [76].
- Chymase may be responsible for the vast majority of production of local angiotensin II in the myocardium [34] .
- chymase is associated with apoptosis; TGF- ⁇ mediated fibrosis [79], collagen formation [80] and fibroblast differentiation to myofibroblasts [36,76,81].
- mast cell chymase produced in the myocardium can directly induce acute inflammation and affect tissue remodeling through activation of matrix metalloproteinases [38] and IL- l ⁇ precursors [37], and stimulation of IL-8 release resulting in recruitment of granulocytes [39]. All of these are important features of the cardiac remodeling process, which may explain the present finding of lower LV ejection fraction in patients with the CMAl GG genotype (without wishing to be limited by a single hypothesis).
- all study patients had systolic heart failure (EF ⁇ 40%), with a mean LVEF of 24+6.5%.
- EF systolic heart failure
- CMAl polymorphism is associated with cardiomyopathy of non-ischemic etiology. It may be related to the long term impact of the remodeling process in systolic HF. In patients with ischemic etiology, it is not uncommon that HF symptoms start after initial extensive myocardial damage while the remodeling process contributes little to the progression of HF. On the other hand, in non-ischemic cardiomyopathy, the remodeling process may have greater importance and be linked more closely to the inflammatory process.
- the present inventors did not find a clinical association with the ACE VD genotype in HF patients. Although an association between ACE VD polymorphism and cardiomyopathy has previously been reported [82,83], other studies did not confirm such relationship and in those which did, the study cohorts deviated from the Hardy- Weinberg equilibrium [42,84]. Some authors have suggested that although there was no causative relation between the ACE VD polymorphism and cardiomyopathy, HF patients with the ACE DD genotype have poor outcome and increased mortality [43]. The present inventors, as others [85] did not find such a correlation. The vast majority of the patients of the present study were treated with pharmacotherapy involving modulation of the RAAS, including beta blocker, ACEI and/or ARB.
- CMAl promoter polymorphism was associated with patients (particularly with non-ischemic etiology for HF) who had greater reduction in measured systolic LV function.
- ACE VD polymorphism had no relation to the level of cardiac function.
- the present invention in at least some embodiments as described in greater detail below, comprises test kits and diagnostic methods for detecting one or more
- RAAS-related polymorphisms optionally and preferably for prognostic and diagnostic uses in relation to heart disease, more preferably for HF (heart failure) and optionally and most preferably for determining which patients have a predisposition toward potential significant side effects with anti- RAAS therapy and which patients may be expected to potentially benefit from such therapy.
- Enhanced sympathetic activation has a central role in the development of heart failure. Increased sympathetic activity is known for its deleterious effects on the myocardium and the coronary system, either alone or in concert with other systems such as with the RAAS system for facilitating fibrosis, apoptosis, necrosis and fatal gene activation, leading to morbidity and mortality.
- RAAS RAAS-associated fibrosis
- Clearly genetic analysis of genes related to such enhanced sympathetic activity would be useful as a diagnostic and prognostic tool
- one or more polymorphisms of the sympathetic nerve system receptors on the myocardium itself specifically the beta (l/2)-adrenoceptor and the alpha- 1 and 2 and its subtypes such as alpha- 2C-adrenoceptor. Each of them may alter the sympathetic influence and consequently may cause enhance sympathetic tone manifest as a trigger for myocardial damage, coronary events, cardiac remodeling and higher arrhythmia and mortality rates.
- polymorphisms related to the sympathetic system, and also relating to differential activity therein, including but are not limited to polymorphisms of the adrenergic receptor gene include polymorphisms of ADRB2 (such as Arg (A)16, A46, GIn (Q)27, C79] or He (1)164, T491), ADRBl (such as GIy (G)49, G145 or GIy (G)389, Gl 165), ADRAlA (such as Cys (Q347, T1039), and ADRA2B (such as ADRA2B 894+ AGAGGAGGA insertion/deletion).
- ADRB2 such as Arg (A)16, A46, GIn (Q)27, C79] or He (1)164, T49
- ADRBl such as GIy (G)49, G145 or GIy (G)389, Gl 165
- ADRAlA such as Cys (Q347, T1039)
- ADRA2B such as ADRA2
- the present invention in at least some embodiments as described in greater detail below, comprises test kits and diagnostic methods for detecting one or more sympathetic system-related polymorphisms, optionally and preferably for prognostic and diagnostic uses in relation to heart disease, more preferably for HF (heart failure) and optionally and most preferably for determining which patients have a predisposition to benefit from sympathetic system related therapies such as beta blocker therapies for example.
- sympathetic system related therapies such as beta blocker therapies for example.
- IL-10 plays a major role in patients with HF.
- IL-10 was proposed in the past to have a protective effect as a non- inflammatory cytokine.
- the present inventors found that the mortality in patients with combined elevation of both IL-10 and TNF-alpha was the highest, suggesting that IL-10 may have a counter- productive effect.
- cytokines Since the production of such cytokines is regulated through various genetic factors, according to at least some embodiments of the present invention, there is provided one or more polymorphisms for the above mentioned cytokines as being important factors in the pathogenesis, predisposition and prognosis of HF which may have treatment implications, for example in terms of selecting one or more therapies for patients having such polymorphisms. Furthermore, according to at least some embodiments of the present invention, there is provided one or more inflammatory activity related polymorphisms, which may optionally not be polymorphisms for the above mentioned cytokines.
- polymorphisms related to inflammatory activity include but are not limited to polymorphisms of inflammatory pathway genes, including but not limited to polymorphisms of interleukin (IL)-IO (such as A-592 or G-1082), IL-6 (such as C
- TNF tumor necrosis factor
- A-318 tumor necrosis factor
- IL-IB IL-IB
- IL-IRN such as 86-bp tandem repeat
- CRP C-reactive protein
- the present invention in at least some embodiments as described in greater detail below, comprises test kits and diagnostic methods for detecting one or more inflammatory activity-related polymorphisms, optionally and preferably for prognostic and diagnostic uses in relation to heart disease, more preferably for HF (heart failure) and optionally and most preferably for determining which patients have a predisposition to benefit from inflammatory activity related therapies.
- BNP B-type natriuretic peptide
- GRACE global registry of acute coronary events
- NRPl is a membrane -bound coreceptor to a tyrosine kinase receptor for both vascular endothelial growth factor (VEGF; MIM 192240) and semaphorin (see SEMA3A; MIM 603961) family members. NRPl plays versatile roles in angiogenesis.
- the neuropilins-1 and -2 function as receptors vascular endothelial growth factor and have been implicated in angiogenesis. Hypoxia and nutrient deprivation stimulate the rapid loss of NRPl expression in endothelial. NRP2 expression, in contrast, is maintained under these conditions.
- B-type natriuretic peptide is a peptide hormone of myocardial origin with significant cardioprotective properties. It was shown by the present inventors that in heart failure patients referred to an outpatient specialized heart failure center, an upper tertile NT-proBNP level identified patients at high risk for mortality. A single high > 550 pg/ml NT-proBNP measurement appears to be useful for selecting patients for care in a heart failure center, and a level > 2000 pg/ml for assigning patients to high priority management ⁇ Amir O, Paz H, Ammar R, Yaniv N, Schliamser JE, Lewis BS.Isr Med Assoc J. 2008:152-3. Usefulness and predictive value of circulating NT- proBNP levels to stratify patients for referral and priority treatment in a specialized outpatient heart failure center. Isr Med Assoc J. 2008;10(2):109-12 ⁇ .
- hypoxia inducible factor 1 HIF-I
- one or more polymorphisms for the above mentioned natriuretic peptides as being important factors in the pathogenesis, predisposition and prognosis of HF which may have treatment implications, for example in terms of selecting one or more therapies for patients having such polymorphisms.
- one or more cell proliferation related polymorphisms which may optionally not be polymorphisms for the above mentioned natriuretic peptides.
- polymorphisms related to cell proliferation include but are not limited to polymorphisms of cell proliferation genes, including but not limited to FGF2; and/or polymorphisms of natriuretic peptide genes, including but not limited to NPRl and NPR3.
- the present invention in at least some embodiments as described in greater detail below, comprises test kits and diagnostic methods for detecting one or more cell proliferation-related polymorphisms, including but not limited to polymorphisms associated with natriuretic peptides, optionally and preferably for prognostic and diagnostic uses in relation to heart disease, more preferably for HF (heart failure).
- Polymorphisms related to metabolic pathway genes include but are not limited to polymorphisms of cell proliferation genes, including but not limited to FGF2; and/or polymorphisms of natriuretic peptide genes, including but not limited to NPRl and NPR3.
- the present invention in at least some embodiments as described in greater detail below, comprises test kits and diagnostic methods for
- Cellular energy production is tightly linked to metabolic demand.
- the capacity for cellular ATP production is controlled, in part, by the expression levels of nuclear genes involved in mitochondrial oxidative metabolism. Accordingly, cellular energy metabolism necessitates transduction of diverse signals related to cellular energy demands to the nucleus.
- the PPAR gene pathway consists of interrelated genes that encode transcription factors, enzymes, and downstream targets which coordinately act to regulate cellular processes central to glucose and lipid metabolism.
- the pathway includes the PPAR genes themselves, other class II nuclear hormone receptor transcription factors within the PPAR family, PPAR co-activators, PPAR co-repressors, and downstream metabolic gene targets.
- the PPARY coactivator-l ⁇ (PGC-IK), had been characterized as a broad regulator of cellular energy metabolism.
- PGC-I P, and the PGC-I -related protein a family of inducible transcriptional coactivators responsive to selective physiological stimuli, which are mediated between the extracellular events and the regulation of genes involved in energy metabolism.
- Diabetes mellitus is a known risk factor for coronary atherosclerosis, myocardial infarction, and ischemic cardiomyopathy. Insulin resistance is associated with left hypertrophy and hypertensive cardiomyopathy. The relationship between insulin resistance and cardiomyopathy is less well established. Systemic and myocardial glucose uptake is compromised in heart failure independent of etiology. These abnormalities are associated with cellular deficits of insulin signaling. Insulin resistance and fatty acid excess are potential therapeutic targets in heart failure.
- Nitric oxide synthase catalyzes the generation of NO (nitric oxide). All isoforms of NOS (C/I /E/N) exist in the heart, when in normal heart the e NOS is the dominant. NO in the heart decreases both oxygen consumption and glucose metabolism of the myocardium cells as well as possible lipid metabolism inhibition.
- one or more polymorphisms for the above mentioned metabolic pathway genes as being important factors in the pathogenesis, predisposition and prognosis of HF which may have treatment implications, for example in terms of selecting one or more therapies for patients having such polymorphisms.
- one or more metabolic pathway related polymorphisms include but are not limited to perixosome proliferator-activated receptor genes (including but not limited to PPARA, PPARG and PPARGClA), nuclear respiratory genes (including but not limited to NRFl and GABPBl), NOS3 and GNB3.
- the present invention in at least some embodiments as described in greater detail below, comprises test kits and diagnostic methods for detecting one or more metabolic pathway-related polymorphisms, including but not limited to polymorphisms associated with perixosome proliferator-activated receptor genes and/or nuclear respiratory genes, optionally and preferably for prognostic and diagnostic uses in relation to heart disease, more preferably for HF (heart failure).
- metabolic pathway-related polymorphisms including but not limited to polymorphisms associated with perixosome proliferator-activated receptor genes and/or nuclear respiratory genes, optionally and preferably for prognostic and diagnostic uses in relation to heart disease, more preferably for HF (heart failure).
- Serum oxidative stress level is a crucial element of the inflammatory process, owing to the accumulation of reactive oxygen/nitrogen species that might provoke and exacerbate the myocardial damage of the already failing heart.
- Several medications claim to have at least some beneficial effects through anti-oxidant potential.
- the present inventors recently reported serum oxidative stress level correlates with clinical parameters in chronic systolic heart failure patients ⁇ Amir O et al; Clin Cardiol. 2009 ⁇ .
- Plasma platelet-activating factor acetylhydrolase acts as a key defense against oxidative stress by hydrolyzing PAF and oxidized phospholipids.
- Deficiency of the activity of this enzyme may thus potentially result in predisposition to myocardial damage leading to ischemic and non-ischemic cardiomyopathy and be a potential target for HF/CAD treatnment.
- Fibrinolysis in blood is mainly reflected by the activities of tissue plasminogen activator (tPA) and of plasminogen activator inhibitor- 1 (PAI-I).
- Plasminogen activator inhibitor-1 is a serine protease inhibitor (serpin) protein (SERPINEl).
- PAI-I levels have been associated with atherosclerotic plaque formation and in a prothrombotic state, carrying an increased risk of arterial occlusion and consequently with myocardial infarction .
- the human PAI-I gene has been mapped on chromosome 7 (q21.3-q22) and contains 9 exons and 8 introns and a possible association with ischemic and non-ischemic cardiomyopathy will be tested. Changes in plasma fibrinolytic parameters were shown with acute ATI antagonism via suppression of angiotensin II in HF patients and were associated with a significant improvement in plasma fibrinolytic parameters.
- one or more polymorphisms for the above mentioned blood related genes as being important factors in the pathogenesis, predisposition and prognosis of HF which may have treatment implications, for example in terms of selecting one or more therapies for patients having such polymorphisms. Furthermore, according to at least some embodiments of the present invention, there is provided one or more blood related polymorphisms.
- polymorphisms of plasminogen activator inhibitor gene include but are not limited to SERPINE 1 ; and an example of a platelet- activating factor gene is PLA2G7.
- the present invention in at least some embodiments as described in greater detail below, comprises test kits and diagnostic methods for detecting one or more blood-related polymorphisms, including but not limited to polymorphisms associated with plasminogen activator inhibitor genes and/or platelet-activating factor genes, optionally and preferably for prognostic and diagnostic uses in relation to heart disease, more preferably for HF (heart failure). Diagnostic Methods and Test Kits
- the risk assessment methods and test kits of this invention can be applied to any healthy person as a screening or predisposition test, although the methods and test kits are preferably applied to high-risk individuals (who have e.g. family history of cardiac disease, one or more cardiac specific risk factors, one or more general risk factors such as obesity or any combination of these). Diagnostic tests that define genetic factors contributing to cardiac disease might be used together with or independent of the known clinical risk factors to define an individual's risk relative to the general population.
- a susceptibility to cardiac disease in a subject is made by detecting one or more polymorphisms, such as SNPs, as described herein in the subject's nucleic acid.
- cardiac disease associated alleles of the assessed polymorphisms in individual's genome indicates subject's increased risk for cardiac disease.
- sequences listed herein by SEQ ID NO it should be noted that all odd-numbered SEQ ID NOs relate to the WT (wild type) while all even-numbered SEQ ID NOs relate to the mutant SNP sequence.
- both types of sequences may optionally have diagnostic and/or prognostic uses as described herein.
- a polynucleotide comprising at least 10 contiguous nucleotides of a nucleotide sequence selected from the group consisting of the nucleotide sequences of even numbered SEQ ID NOs, or a complementary polynucleotide thereof.
- the polynucleotide comprises at least 10 contiguous nucleotides of a nucleotide sequence selected from the group consisting of nucleotide sequences of even numbered SEQ ID NOs and comprising a polymorphic site.
- the length of the polynucleotide is 10 to 400 nucleotides, and preferably 10 to 100 nucleotides, and more preferably 10 to 50 nucleotides.
- the polynucleotide may be DNA or RNA.
- an allele-specific polynucleotide for diagnosis of cardiovascular disease as described herein hybridized with the polynucleotide including at least 10 contiguous nucleotides of a nucleotide sequence selected from the group consisting of nucleotide sequences of even numbered SEQ ID NOs and comprising the nucleotide of a polymorphic site or a complementary polynucleotide thereof.
- the allele- specific polynucleotide refers to polynucleotide hybridized specifically with each allele.
- the allele-specific polynucleotide is hybridized such that a base of a polymorphic site in polymorphic sequences of even numbered SEQ ID NOs can be specifically distinguished.
- the hybridization can usually be carried out under a strict condition, for example, in a salt concentration of 1 M or less and at a temperature of 25 C or higher.
- 5xSSPE 750 mM NaCl, 50 mM Na phosphate, 5 mM EDTA, pH 7.4
- 25 to 30 C may optionally be suitable for the allele-specific probe hybridization, without wishing to be limited in any way.
- the allele- specific polynucleotide may optionally be a primer.
- the primer refers to a single- strand oligonucleotide capable of initiating a template-directed DNA synthesis in an appropriate buffer under an appropriate condition (for example, in the presence of four different nucleoside triphosphates and a polymerizing agent such as DNA, RNA polymerase or reverse transcriptase) at a proper temperature.
- the length of the primer may vary according to the purpose of use, but is usually 15 to 30 nucleotides. A short primer molecule generally requires lower temperatures to be stably hybridized with a template.
- the primer sequence does not necessarily need to be completely complementary with the template, but should be sufficiently complementary to be hybridized with the template.
- the primer has 3' end arranged so as to correspond to the polymorphic sites of the sequences of the even numbered SEQ ID NOs.
- the primer is hybridised with a target DNA including the polymorphic site and initiates amplification of allele having complete homology to the primer.
- the primer is used as a primer pair with the other primer hybridized at the opposite side. Amplification is performed from the two primers, indicating that there is a specific allele.
- the primer of the present embodiment optionally includes a polynucleotide fragment used in a ligase chain reaction (LCR).
- the allele- specific polynucleotide may be a probe.
- the probe refers to a hybridization probe, which is an oligonucleotide capable of binding sequence- specific ally to a complementary strand of a nucleic acid.
- a probe includes a peptide nucleic acid introduced by Nielsen, et al., Science 254, 1497-1500 (1991).
- the probe of the present invention is an allele- specific probe. When a polymorphic site is located in DNA fragments derived from two members of the same species, the allele- specific probe is hybridized with the DNA fragment derived from one member but is not hybridized with the DNA fragment derived from the other member.
- the hybridization condition should be sufficiently strict to be hybridized with only one allele by showing a significant difference in terms of the intensity of hybridization between alleles.
- the probe of the present invention is preferably arranged such that its central site (i.e., 7th position in a probe consisting of 15 nucleotides, or 8th or 9th position in a probe consisting of 16 nucleotides) has the polymorphic site of the above sequence. In this way, a hybridization difference between alleles can be caused.
- the probe of these embodiments of present invention can be used in a diagnosis method for detecting an allele, etc.
- the diagnosis method includes but is not limited to detection methods based on hybridization of nucleic acid such as southern blot. In a method using a DNA chip, the probe can previously be bound to a substrate of the DNA chip.
- microarray including the polynucleotide of even numbered SEQ ID NOs or a complementary polynucleotide thereof.
- the microarray may include a DNA or
- RNA polynucleotide The microarray has the same structure as a conventional microarray, except that it includes the polynucleotide of even numbered SEQ ID NOs.
- kits including the polynucleotide of even numbered SEQ ID NOs.
- the kit can include a reagent for polymerization, for example, dNTP, various polymerization enzymes, a colorizing agent, etc., in addition to the polynucleotide of even numbered SEQ ID NOs.
- the kit can be used in diagnosis of cardiovascular disease, such as heart failure.
- a method of diagnosing cardiovascular disease including: obtaining nucleic acid from a individual; and determining a nucleotide sequence of a polymorphic site of at least one polynucleotide selected from the group consisting of polynucleotides of even numbered SEQ ID NOs and their complementary polynucleotides.
- the method of diagnosing cardiovascular disease may further include deciding that the risk of cardiovascular disease is high when the nucleotide sequence of the polymorphic site is the same as at least one of risk alleles according to the sequences of the even numbered SEQ ID NOs.
- the obtaining of nucleic acid from an individual can be carried out by a conventional DNA isolation method.
- nucleic acid can be obtained by amplifying a target nucleic acid through polymerase chain reaction (PCR) and purifying the amplified product.
- PCR polymerase chain reaction
- LCR Long et al., Genomics 4, 560 (1989), Landegren et al., Science 241, 1077 (1988)
- transcription amplification Kwoh et al., Proc. Natl. Acad. Sci. USA 86, 1173 (1989)
- self-sustained sequence replication (Guatelli et al., Proc. Natl. Acad. Sci. USA 87, 1874 (1990)
- NASBA nucleic acid sequence based amplification
- Last two methods are associated with an isothermal reaction based on isothermal transcription and produce 30 or 100 times amplified single-strand RNA and double-strand DNA.
- the determining nucleotide sequence of the polymorphic site includes hybridizing the nucleic acid sample onto a microarray on which a polynucleotide for diagnosis or treatment of cardiovascular disease comprising at least 10 contiguous nucleotides selected from the group consisting of nucleotide sequences of even numbered SEQ ID NOs and comprising the nucleotide of the polymorphic site, or a complementary polynucleotide thereof, is immobilized; and detecting the hybridization result.
- the method of preparing a microarray by immobilizing a probe polynucleotide on a substrate is well known in the art.
- the immobilization of the probe polynucleotide associated with cardiovascular disease on a substrate can also be easily performed using a conventional technology.
- the hybridization of nucleic acid on the microarray and the detection of the hybridisation result are well known in the art.
- the nucleic acid sample is labelled with a fluorescent material, for example, a labelling material capable of generating detectable signals including Cy3 and Cy5, and then is hybridised on the microarray, followed by detecting signals generated from the labelling material.
- the method may further include determining that the individual belongs to a risk group having high probability of cardiovascular disease when the determined nucleotide sequence of the polymorphic site corresponds to the at least one polymorphic site selected from the group consisting of even numbered SEQ ID NOs in which nucleotides of the polymorphic sites are A, C, A, G and A, respectively. It can be determined that when many nucleic acid sequences having the risk allele are detected in an individual, the probability of belonging to a risk group is high.
- a susceptibility to cardiac disease in an individual comprising detection of a haplotype in a cardiac disease risk gene that is more frequently present in an individual having cardiac disease (affected), compared to the frequency of its presence in a healthy individual (control), wherein the presence of the haplotype is indicative of a susceptibility to cardiac disease.
- Another non-limiting, illustrative application of the current invention is diagnosis of a molecular subtype of cardiac disease in a subject.
- Molecular diagnosis methods and kits of this embodiment of the present invention can be applied to a person having cardiac disease and/or to family members.
- molecular subtype of cardiac disease in an individual is determined to provide information of the molecular etiology of cardiac disease.
- the molecular etiology is known, better diagnosis and prognosis of cardiac disease can be made and efficient and safe therapy for treating cardiac disease in an individual can be selected on the basis of this cardiac disease subtype. For example, the drug that is likely to be effective can be selected without (or with minimal) trial and error.
- biomarker information obtained from methods and kits for determining molecular subtype of cardiac disease in an individual is for monitoring the effectiveness of their treatment.
- methods and kits for determining molecular subtype of cardiac disease are used to select human subjects for clinical trials testing cardiac drugs.
- the kits provided for diagnosing a molecular subtype of cardiac disease in an individual comprise wholly or in part protocol and reagents for detecting one or more biomarkers and interpretation software for data analysis and cardiac disease molecular subtype assessment.
- the diagnostic assays and kits of the invention may further comprise a step of combining non-genetic information with the biomarker data to make risk assessment, diagnosis or prognosis of cardiac disease.
- Useful non-genetic information comprises age, gender, smoking status, physical activity, waist-to-hip circumference ratio (cm/cm), the subject family history of cardiac disease, obesity, hypertriglyceridemia, low HDL cholesterol, HT and elevated BP.
- the detection method of the invention may also further comprise a step determining total cholesterol, HDL cholesterol, LDL cholesterol, triglyceride, or C-reactive protein concentration.
- nucleotides present in one or more polymorphisms of this invention can be performed by any method or technique which can accurately determine nucleotides present in a polymorphic site.
- suitable methods include, but are not limited to, hybridization assays, ligation assays, primer extension assays, enzymatic cleavage assays, chemical cleavage assays and any combinations of these assays.
- the assays may or may not include PCR, solid phase step, a microarray, modified oligonucleotides, labeled probes or labeled nucleotides and the assay may be multiplex or singleplex.
- the nucleotides present in a polymorphic site can be determined from either nucleic acid strand or from both strands.
- a susceptibility to cardiac disease is assessed from transcription products of one or more cardiac disease associated genes.
- Qualitative or quantitative alterations in transcription products can be assessed by a variety of methods described in the art, including e.g. hybridization methods, enzymatic cleavage assays, RT-PCR assays and microarrays.
- a test sample from an individual is collected and the alterations in the transcription of cardiac disease associated genes are assessed from the RNA molecules present in the sample. Altered transcription is diagnostic for a susceptibility to cardiac disease.
- Probes or “primers” are oligonucleotides that hybridize in a base-specific manner to a complementary strand of nucleic acid molecules.
- base specific manner is meant that the two sequences must have a degree of nucleotide complementarity sufficient for the primer or probe to hybridize to its specific target. Accordingly, the primer or probe sequence is not required to be perfectly complementary to the sequence of the template. Non-complementary bases or modified bases can be interspersed into the primer or probe, provided that base substitutions do not inhibit hybridization.
- the nucleic acid template may also include "non-specific priming sequences" or “nonspecific sequences” to which the primer or probe has varying degrees of complementarity.
- Probes and primers may include modified bases as in polypeptide nucleic acids. Probes or primers typically comprise about 15, to 30 consecutive nucleotides present e.g. in human genome and they may further comprise a detectable label, e.g., radioisotope, fluorescent compound, enzyme, or enzyme co-factor.
- a detectable label e.g., radioisotope, fluorescent compound, enzyme, or enzyme co-factor.
- Probes and primers to a SNP described herein are described herein and/or can easily be designed using the flanking nucleotide sequences assigned to a SNP rs ID and standard probe and primer design tools. Primers and probes for other types of polymorphisms are also described herein and/or could easily be designed by one of ordinary skill in the art. Primers and probes for SNPs and/or other polymorphisms described herein can be used in risk assessment as well as molecular diagnostic methods and kits according to at least some embodiments of the present invention.
- Diagnostic test kits e.g. reagent kits
- reagents e.g. reagent kits
- reagents materials and protocols for assessing one or more biomarkers, and instructions and software for comparing the biomarker data from a subject to biomarker data from healthy and diseased people to make risk assessment, diagnosis or prognosis of cardiac disease.
- kits include, but are not limited to PCR primers, hybridization probes and primers as described herein (e.g., labeled probes or primers), allele- specific oligonucleotides, reagents for genotyping SNP markers, reagents for detection of labeled molecules, restriction enzymes (e.g., for RFLP analysis), DNA polymerases, RNA polymerases, DNA ligases, marker enzymes, antibodies which bind to altered or to non-altered (native) cardiac disease risk gene encoded polypeptide, means for amplification of nucleic acids fragments from one or more cardiac disease risk genes described herein, means for analyzing the nucleic acid sequence of one or more cardiac disease risk genes or fragments thereof, or means for analyzing the sequence of one or more amino acid residues of cardiac disease risk gene encoded polypeptides, etc.
- a kit for diagnosing susceptibility cardiac disease comprises primers and reagents for detecting the nucleotides
- Various types of biological samples may optionally be used with the polymorphisms of the present invention, for the diagnosis and/or prognosis of heart disease in a subject.
- Non-limiting examples of such sample types are described in greater detail below for the purpose of illustration only.
- suitable biological samples which may optionally be used with preferred embodiments of the present invention include but are not limited to blood, serum, plasma, blood cells, urine, sputum, saliva, stool, spinal fluid or CSF, lymph fluid, the external secretions of the skin, respiratory, intestinal, and genitourinary tracts, tears, milk, neuronal tissue, lung tissue, any human organ or tissue, including any tumor or normal tissue, any sample obtained by lavage (for example of the bronchial system or of the breast ductal system).
- Diagnosis of a disease can be effected by determining a polymorphism in a biological sample obtained from the subject, wherein such determination can be correlated with predisposition to, or presence or absence of the disease. It should be noted that a "biological sample obtained from the subject” may also optionally comprise a sample that has not been physically removed from the subject.
- tissue or fluid collection methods can be utilized to collect the biological sample from the subject in order to detect the polymorphism in the subject.
- Examples include, but are not limited to, fine needle biopsy, needle biopsy, core needle biopsy and surgical biopsy (e.g., brain biopsy), and lavage. Regardless of the procedure employed, once a biopsy/sample is obtained the level of the variant can be determined and a diagnosis can thus be made.
- HF patients had symptomatic systolic HF (echocardiographic LV ejection fraction ⁇ 45%) for at least 3 months prior to recruitment.
- Etiology of HF was classified as ischemic or non-ischemic, based on a history of myocardial infarction and/or coronary angiography which were in keeping with the findings of reduced LV systolic function.
- Clinical and laboratory data were recorded and blood samples were obtained for genotypic analysis. Patients were followed over a period of 30 months, or up to an end point of death.
- PCR-RFLP polymerase chain reaction-restriction fragment length polymorphism
- ATlR PCR fragments (404-bp length) encompassing the A1166C polymorphism were amplified from ⁇ 20 ng of each DNA sample used as template in 20 ⁇ l polymerase chain reactions (PCR) containing 0.2U Taq polymerase, lxconcentration of the supplied buffer, 0.2mmol/L concentration of each deoxynucleotide triphosphate, and 10 pmol of each of the following primers: AGAAGCCTGCACCATGTTTTGAG
- the SPSS statistical package version 13.0 was used to perform all statistical evaluation (SSPS Inc., Chicago, IL, USA).
- a Chi-squared test was used to examine observed genotype frequencies in terms of the Hardy- Weinberg equilibrium and to compare the genotype frequencies between patients and controls.
- Genotype subtype comparisons were made by ANOVA and the Kruskal-Wallis test (asymmetrical data distribution).
- Continuous variables were compared by genotypes group by linear analysis of variance (ANOVA). Stepwise multiple linear regression analysis was used to evaluate whether the different ATlR alleles carried by each patient had statistical influence on clinical and laboratory parameters. Event- free survival was compared by
- HF left ventricular
- EF ejection fraction
- Treatment included angiotensin converting enzyme inhibitor (ACEI) and/or 10 angiotensin II receptors blockers (ARB) in 125 (93%) patients, aldosterone antagonists in 35 (26%) patients, and beta blockers in 112 (84%) patients.
- ACEI angiotensin converting enzyme inhibitor
- ARB angiotensin II receptors blockers
- Figure 1 shows results of genotyping of ischemic (upper lanes, A) and non- 10 ischemic (lower lanes, B) HF patients for the A1166C polymorphism of the ATlR gene, using polymerase chain reaction (PCR).
- PCR polymerase chain reaction
- the 404-bp PCR product was cut into 2 fragments of 118 and 286 bp in length.
- Homozygosity for the 1166C allele was observed exclusively in ischemic patients (upper lanes 1-4).
- Each lane represents genotyping results of each individual patient.
- a multivariate linear regression model which included the following clinical parameters: age, sex, BMI, etiology of ischemic cardiomyopathy, NYHA class, blood pressure, serum sodium level and mean QRS duration, ATlR CC
- LV ejection fraction tended to be lower, but with overlap between the 2 groups (NS).
- the study population consisted of 191 HF patients, followed in a specialized tertiary referral HF center, and 200 ethnically matched healthy control subjects who had no history or evidence of heart disease. All the HF patients had symptomatic systolic HF (left ventricular ejection fraction, LVEF ⁇ 40%) for at least 3 months prior to recruitment. Etiology of HF was classified as ischemic or non-ischemic, based on a history or lack thereof of myocardial infarction and/or coronary angiography, which were in keeping with the findings of reduced LV systolic function. Clinical and laboratory data were recorded and blood samples were obtained for genotypic analysis.
- Echocardiographic measurements of LVEF, left ventricular end diastolic diameter and left atrial (LA) dimension were made. Atrial fibrillation was diagnosed in patients who had atrial fibrillation on at least 2 occasions on a standard 12 lead electrocardiographic recording. The study was approved by the Institution Review Board (Helsinki Committee) of the Lady Davis Carmel Medical Center, and all patients gave written informed consent.
- PCR- RFLP polymerase chain reaction-restriction fragment length polymorphism
- CYP11B2 PCR fragments (537-bp length) encompassing the T- 344C polymorphism were amplified from ⁇ 20 ng of each DNA sample used as template in 20 ⁇ l polymerase chain reactions (PCR) containing 0.2U Taq polymerase, lxconcentration of the supplied buffer (New England Biolabs, MA, USA), 0.2mmol/L concentration of each deoxynucleotide triphosphate, and 10 pmol of each of the following primers: CAGGAGGAGACCCCATGTGA (sense) and CCTCCACCCTGTTCAGCCC (antisense).
- PCR polymerase chain reactions
- the initial denaturation at 950C for 5 minutes was followed by 35 cycles of 940C for 30 seconds, 650C annealing for 30 seconds, and 650C elongation for 45 seconds.
- 5 ⁇ l of CYP11B2 reaction was digested with 5 U of restriction endonuclease Hae III in the supplied buffer for 2 hours at 370C.
- the -344T allele lacks a Hae III site present in the -344C allele, so - 344T alleles are detected as 273-bp fragments, while the -344C alleles are detected as Hae III fragments of 204 and 69-bp.
- the clinical characteristics of the patients are summarized in Table 4.
- Patients were aged 65+13 years. 145 (81%) patients were males.
- the etiology of HF was ischemic in 112 (63%) patients, 97 (55%) patients had a history of, or treatment for, systemic hypertension, and 69 (39%) patients had diabetes mellitus. Atrial fibrillation was present in 57 (32%) patients.
- Mean QRS on the surface electrocardiogram was 138+50 milliseconds.
- Mean echocardiographic left ventricular ejection fraction (LVEF) was 24+7%.
- Treatment included angiotensin converting enzyme inhibitors (ACEI) and/or angiotensin II receptor blockers (ARB) in 164 (92%) patients, aldosterone antagonists in 48 (27%) patients, and beta blockers in 151 (86%) patients. All patients were symptomatic and 97 (55%) patients were in functional class 3 or 4 (New York Heart Association, NYHA). Over a course of 22+7 months follow-up, there were 16 (9%) deaths.
- ACEI angiotensin converting enzyme inhibitors
- ARB angiotensin II receptor blockers
- CYP11B2 genotype subtypes were compared between CYP11B2 genotype subtypes.
- CYP11B2 polymorphism was not associated with the etiology of HF in these patients.
- the presence of AF was associated with CYPl 1B2 genotype (Table 4, Figure 3).
- Example 3 Association between Chymase and Angiotensin - Converting Enzyme Gene Polymorphisms in Chronic Systolic Heart Failure Patients
- a case-control design was used to study 195 consecutive HF patients in a specialized HF center, and 200 population control subjects. Controls [165 (82.5%) males and 35 (17.5%) females, age 26 + 4 years] were all healthy individuals who had no history of or treatment for coronary artery disease, diabetes mellitus, hypertension or hypercholesterolemia. The study and control groups were all Israeli residents with an equivalent ratio of Non-Ashkenazi and Ashkenazi descent (2:1). The HF patients had symptomatic systolic HF (echocardiographic LV ejection fraction ⁇ 40%) for at least 3 months prior to recruitment.
- Etiology of HF was classified as ischemic or non-ischemic, based on a history or not of myocardial infarction and/or coronary angiography which were in keeping with the findings of reduced LV systolic function.
- Clinical and laboratory data were recorded and blood samples were obtained for genotypic analysis. Patients were followed over a period of 30 months, or up to an end point of death. The study was approved by the Institution Review Board (Helsinki committee) of the Lady Davis Carmel Medical Center, and all patients gave written informed consent before inclusion in the study.
- Genomic DNA was extracted from peripheral blood leukocytes using a standard protocol [89]. Genotyping of the ACE VD polymorphism was performed using polymerase chain reaction (PCR) according to the method of Lindpaintner et al.[93]. Genotyping for the CMAl 1903G/A polymorphism was conducted using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) approach, as described by Pfeufer et al.[72].
- PCR-RFLP polymerase chain reaction-restriction fragment length polymorphism
- PCR fragments were amplified from ⁇ 20 ng of each DNA sample used as a template in 20 ⁇ l polymerase chain reactions (PCR) containing 0.2U Taq polymerase, Ix concentration PCR buffer, 0.2mmol/L of each dNTP, and 10 pmol of each of the following primers: GGAAATGTGAGCAGATAGTGCAGT (CM ⁇ i-sense) and
- ACE VO genotypes were designated as follows: VI, a single band of 597-bp; D/I, two bands of 319- and 597-bp; and D/D, a single band of 319-bp. Because the D allele in heterozygous samples is preferentially amplified, there is a tendency to misclassify the ACE VO genotype as the D/D genotype.
- a second PCR was performed using I-specific primers: TGGGACCACAGCGCCCGCCACTAC (I-specific -sense) and TCGCCAGCCCTCCCATGCCCATAA (I-specific -antisense).
- This PCR yields a 335-bp fragment only in the presence of the I allele, and no product in sample homozygous for the D allele.
- the CMAl PCR fragments (285-bp length) were digested with 10 U of restriction endonuclease Bst XI in the supplied buffer (New England Biolabs, MA, USA) for 2 hours at 550C.
- the SPSS statistical package version 13.0 was used for statistical evaluation (SPSS Inc, Chicago IL, USA).
- SPSS Inc Chicago IL, USA.
- a chi square test was used to confirm that observed genotype frequencies were in Hardy-Weinberg equilibrium and to compare the genotype frequencies between patients and controls.
- Genotype subtypes comparisons were made by ANOVA and the Kruskal-Wallis test (asymmetrical data distribution).
- Continuous variables were compared by genotypes group by linear analysis of variance (ANOVA). Stepwise multiple linear regression analysis was used to evaluate whether the number of ACE and CMAl alleles carried by each patient had statistical influence on clinical and laboratory parameters.
- Asymmetrically distributed variables were log transformed before regression analysis. Continuous data are presented as mean + SD. Square multiple correlation coefficients (r 2 ) were calculated. In order to adjust for multiple comparisons, P values were considered significant if ⁇ 0.01.
- HF left ventricular
- EF ejection fraction
- Treatment included angiotensin converting enzyme inhibitor (ACEI) and/or angiotensin II receptor blockers (ARB) in 181 (93%) patients, direct aldosterone antagonists in 56 (29%) patients, and beta blockers in 167 (87%) patients. Patients were all considerably disabled and 105 (54%) were in Functional Class 3 or 4 (New York Heart Association, NYHA). Over the course of follow-up, there were 17 (9%) deaths, 9 due to HF and 2 due to fatal arrhythmia.
- ACEI angiotensin converting enzyme inhibitor
- ARB angiotensin II receptor blockers
- the ACE D allele was not associated with the phenotypic expression of HF in our patients. It should be noted that no difference was found in clinical disability (NYHA class) and mortality in regard to either CMAl or ACE gene polymorphism.
- Interleukin-10 is an anti-inflammatory cytokine and consequently is considered by many to have a protective role in heart failure, as opposed to the "notorious" tumor necrosis factor-alpha (TNF-alpha).
- TNF-alpha tumor necrosis factor-alpha
- Figure 4A shows Kaplan-Meier survival curves according to circulating TNF- alpha levels (below and above median). Survival was reduced in patients with higher
- Stolarz K Staessen JA, Kawecka-Jaszcz K, Brand E, Bianchi G, Kuznetsova T, Tikhonoff V, Thijs L, Reineke T, Babeanu S, Casiglia E, Fagard R, Filipovsky J, Peleska J, Nikitin Y, Struijker-Boudier H, Grodzicki T: Genetic variation in
- CYPl 1B2 and ATlR influences heart rate variability conditional on sodium excretion. Hypertension 2004;44:156-162.
- Alvarez R Reguero JR, Batalla A, Iglesias-Cubero G, Cortina A, Alvarez V, Coto E: Angiotensin-converting enzyme and angiotensin II receptor 1 polymorphisms: association with early coronary disease. Cardiovasc Res 1998;40:375-379.
- Fatini C Abbate R, Pepe G, Battaglini B, Gensini F, Ruggiano G, Gensini GF, Guazzelli R: Searching for a better assessment of the individual coronary risk profile.
- IL-I beta interleukin 1 beta
- Wilson PA Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J 2005;26:215-225.
- Van Wagoner DR Recent insights into the pathophysiology of atrial fibrillation. Semin Thorac Cardiovasc Surg 2007; 19:9-15.
- SNP name and number (in NCBI SNP database): Not found The SNP is an insertion/deletion of 9 bp (nucleotides).
- Gene name and number (in NCBI nucleotide database): bradykinin receptor B2, NM_000623
- BAR Also known as: BAR; B2AR; ADRBR; ADRB2R; BETA2AR
- BAR Also known as: BAR; B2AR; ADRBR; ADRB2R; BETA2AR
- NM_000024 mRNA transcript from homo sapiens chromosome 5 genomic contig (NW_001838953 or NT_029289).
- BAR Also known as: BAR; B2AR; ADRBR; ADRB2R; BETA2AR
- RHR RHR; BlAR; ADRBlR; BETAlAR
- RHR RHR; BlAR; ADRBlR; BETAlAR
- Gene name and number (in NCBI nucleotide database): adrenergic, alpha-lA-, receptor, NM_000680, NM_033302, NM_033303, NM_033304 (4 different splice variants) Also known as: ADRAlC; ADRAlLl; ALPHAlAAR
- ILlO interleukin 10, NM-000572 (mRNA transcript) from Homo sapiens chromosome 1 genomic contig(NW_001838536, nucleotides372078-376969). Also known as: CSIF; TGIF; IL-10; ILlOA; MGC126450; MGC126451
- ILlO interleukin 10
- NM_000572 mRNA transcript
- ILlO interleukin 10
- NM_000572 mRNA transcript
- Genomic contig (NWJ)Ol 838536 nucleotides 372078-376969. Also known as: CSIF, TGIF, IL-10, ILlOA, MGC126450, MGC126451
- NM_173843 mRNA transcript variants 1-4 from Homo sapiens chromosome 2 genomic contig (NW_001838841) Also known as: IRAP; IL1F3; ILlRA; IL-lra3; ICIL-IRA; MGC10430
- Intron 2 short tandem repeat an 86-bp tandem repeat (highlighted), occurs 2/3/4/5/6 times:
- NCBI SNP database IL6 G-174C, rs56588968 (position 16492950 on NW_001839003)
- Gene name and number in NCBI nucleotide database: interleukin 6 (interferon, beta 2), NM_000600 (mRNA transcript) from Homo sapiens chromosome 7 genomic contig (NW_001839003).
- HGF HGF
- HSF HSF
- BSF2 IL-6
- IFNB2 31 IFNB2 31. Sequence of the WT allele (reversed): G (C-reverse)-174:
- TNF G-318A, rs361525 (nucleotide number 104675 on NT_113894)
- TNF superfamily tumor necrosis factor
- NM_000594 mRNA transcript
- C-reactive protein, pentraxin-related, NM_000567 (mRNA transcript) from Homo sapiens chromosome 1 genomic contig NW_001838531.
- NPRl -67+ GCTGAGCC insertion/deletion polymorphism
- [-67 nubering is according to the start codon (-1 is the first nucleotide upstream, -67 is nucleotide no.
- NCBI SNP database Gene name and number (in NCBI nucleotide database): natriuretic peptide receptor A/guanylate cyclase A (atrionatriuretic peptide receptor
- NM_000906 (mRNA transcript) from Homo sapiens chromosome 1 genomic contig
- NW_001838529 Also known as: ANPa; NPRA; ANPRA; GUC2A; GUCY2A
- NCBI SNP database NPR3 C-251A, rs9716700 (position 11318530 on NW_001838929)
- Gene name and number in NCBI nucleotide database: natriuretic peptide receptor C/guanylate cyclase C (atrionatriuretic peptide receptor C), NM-000908 (mRNA transcript) from Homo sapiens chromosome 5 genomic contig (NWJ)Ol 838529).
- NCBI SNP database NPR3 C-251A, rs9716700 (position 11318530 on NW_001838929)
- NCBI nucleotide database natriuretic peptide receptor C/guanylate cyclase C (atrionatriuretic peptide receptor C), NM-000908 (mRNA transcript) from Homo sapiens chromosome 5 genomic contig (NWJ)Ol 838529).
- CSIF NPRC ANPRC; GUCY2B
- NOS3 SNP name and number (in NCBI SNP database):
- nitric oxide synthase 3 endothelial cell
- NM_000603 mRNA transcript from homo sapiens chromosome 7 genomic contig
- plasminogen activator inhibitor- 1 plasminogen activator inhibitor, type I, serine (or cysteine) proteinase inhibitor, clade E (nexin, plasminogen activator inhibitor type 1), member 1, NM_000602 (mRNA transcript) fro Homo sapiens chromosome 7 genomic contig (NWJ)01839067).
- PAI PAI
- PAIl PAI-I
- PLANHl PLANHl
- PLA2G7 G824T (824 is nucleotide number according to mRNA transcript NM_005084, nucleotide numbering starts at the start codon, 25966 is the nucleotide number in NW_923073), no rs number in NCBI SNP database.
- Gene name and number (in NCBI nucleotide database): phospholipase A2, group VII (platelet-activating factor acetylhydrolase, plasma),
- NM_000504 mRNA transcript from homo sapiens chromosome 6 genomic contig
- FGF2 T-553A (nucleotide number 4320453 in NWJ)018389203), rs 308398
- fibroblast growth factor 2 basic
- NM_002006 mRNA transcript
- homo sapiens chromosome 4 genomic contig NW_0018389203
- CTTTCTCTCC TTTTGTTGGT AGACGACTTC AGCCTCTGTC CTTTAATTTT
- CTTTCTCTCC TTTTGTTGGT AGACGACTTC AGCCTCTGTC CTTTAATTTT
- G protein guanine nucleotide binding protein
- beta polypeptide NM_002075 (mRNA transcript) from homo sapiens chromosome 12 genomic contig (NW)
- GCTGTATAGT GCAGAGCGGG CGAGGGGCAT AGGGAAGTCA CTGGCACGTG GTATGTGTTG
- CTGCCCAGGT CTGATCCCTG
- ACCCACTTGC CACCCGTGCC
- NM_015869 nucleotide numbering starts at the start codon, position on NW_ 921654 is 12330520, or position on NT_022517 is 12333125 ], rsl801282
- NM_013261 nucleotide numbering starts at the start codon, position on NW_ 001838900 is 14439695, or position on NT_006316 is 14491020 ], rs8192678 Gene name and number (in NCBI nucleotide database): peroxisome proliferator- activated receptor gamma, coactivator 1 alpha, (mRNA transcript) from homo sapiens chromosome 4 genomic contig (NW_ 001838900 or NT_006316) Also known as: LEM6; PGCl; PGClA; PGC-Iv; PPARGCl; PGC-l(alpha)
- TAATATATCA CAGGAGCTCC AAGACTCTAG ACAACTAGAA AATAAAGATG TCTCCTCTGA
- PPARGClA T2842C (according to mRNA transcript: NM_013261, nucleotide numbering starts at the start codon, position on NW_ 001838900 is 14421049, or position on NT_006316 is 14472358 ], rs6821591 Gene name and number (in NCBI nucleotide database): peroxisome proliferator- activated receptor gamma, coactivator 1 alpha, (mRNA transcript) from homo sapiens chromosome 4 genomic contig (NW_ 001838900 or NT_006316) Also known as: LEM6; PGCl; PGClA; PGC-Iv; PPARGCl; PGC-l(alpha)
- CTCTTCAGCA GCTGTGTTCA TGTAAACCAT TGTTGTTATT GTTGTTGTTG TTCTTGTTGT
- CTCTTCAGCA GCTGTGTTCA TGTAAACCAT TGTTGTTATT GTTGTTGTTG
- NRFl A/G intron
- position on NW_ 001839071 is 2006402, or position on
- NT_007933 is 54470012]
- rs6949152 Gene name and number (in NCBI nucleotide database): nuclear respiratory factor 1, NM_005011 and NM_1040110 (mRNA transcript variants 1 and 2) from homo sapiens chromosome 4 genomic contig (NW_
- CTCCCTAGGC AAAACCTAAC AGGATACTGG CAGTAAAGTC TGGAAAACAT
- CTCCCTAGGC AAAACCTAAC AGGATACTGG CAGTAAAGTC TGGAAAACAT
- NRFl C/T intron
- position on NW_ 001839071 is 1913409
- position on NT_007933 is 54563377
- TCTTAGTACT TCTGGCACAT ATGCTTAGGG CCAGGGCCAG TGAGTCTTCA
- NCBI SNP database GABPB2 A/G (intron) (position on NW_ 001838218 is 23749281, or position on NT_010194 is 21401349), rs7181866 Gene name and number (in NCBI nucleotide database):
- a cccaaaatga tggtgaaggg agaccccaag acaacagctg tgacacagac ctagaaggca aacccagatg ggagccagag aacagagttc caggaaggag gtctccaagg aaaagacagg ctggtaagtc tcctaagaag agaatgaatg tcagtggaga gtttgggatg cgttaatgac ggatacaaga aaactaagaa aagaaaaaaac tagactattt ttcagaaggg agaaaaaaaac tataccataaaggtatacat gtctcttgta cagtttttcc tttacacacacacacaga
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Abstract
One or more polymorphisms, including single nucleotide polymorphisms (SNPs), or combinations thereof, for diagnosis of cardiac disease, such as heart failure and atrial fibrillation.
Description
DIAGNOSTIC POLYMORPHISMS FOR CARDIAC DISEASE
FIELD OF THE INVENTION
The present invention relates to diagnostic markers, and more specifically to the use of a polymorphism, including a single nucleotide polymorphism (SNP), or a combination of such markers, for diagnosis of cardiac disease, such as heart failure and atrial fibrillation.
BACKGROUND OF THE INVENTION Heart failure (HF) is a condition in which the heart is unable to pump sufficient blood throughout the body. Recently, evidence has accumulated that genetic factors may have a potential role in the pathogenesis of AF in HF patients [1,2].
Atrial fibrillation (AF), which is an arrhythmia defined by the absence of coordinated atrial systole, is a common complication in heart failure patients, and is usually associated with advanced disease and aggravated symptoms [3].
The renin-angiotensin-aldosterone system (RAAS) is a hormone system which plays an important role in regulating blood volume and systemic vascular resistance, which together influence cardiac output and arterial pressure. Renin, which is primarily released by the kidneys, stimulates the formation of angiotensin in blood and tissues, which in turn stimulates the release of aldosterone from the adrenal cortex.
The RAAS appears to be a relevant contributing cause in the pathogenesis of heart failure [4], and AF [1,3,5] including myocardial remodeling [4], regulation of blood pressure, and vascular smooth muscle growth and proliferation [6]. Angiotensin II is the predominant neurohormone in the RAAS, and regulates a number of physiologic responses, including fluid homeostasis, aldosterone production, renal function, vascular smooth muscle contraction, sympathetic nervous activity and salt retention [6] . Angiotensin II plays a key role in the pathophysiology of HF, and treatment with angiotensin (AT)-II receptor antagonists has been suggested in the management of AF patients [9]. Most of the known effects of angiotensin II are mediated through the angiotensin II type 1 receptor (ATlR).
The most extensively studied polymorphism in the ATlR gene is the A1166C variant. The functional significance of this gene variation is uncertain because of its location in the 3 '-untranslated region (UTR)[IO]. However, this polymorphism has
been linked to enhanced physiological responses to Ang II resulting in increased vasoconstrictor activity [H].
Previous clinical studies suggested that ATlR polymorphism was associated with left ventricular hypertrophy [12,13], autonomic modulation of heart rate [2], vascular manifestations of atherosclerosis [14], coronary artery disease[15-18], and for development/progression of renal failure [19-21]. Worsening renal functions and ischemic etiology have both been shown to be associated with a more advanced HF disease and an increased mortality [22,23].
However, most studies did not find a role for the ATlR polymorphism in the determination of LV size and performance, both in healthy individuals and in patients with coronary artery disease [24-29]. Hamon et al showed that subjects homozygous for the ATlR CC mutation did have a lower ejection fraction than those with at least a single A allele (AC+AA)[30]. Apart from the possible association of the ATlR polymorphism with a tendency towards systemic hypertension[19], there was no association between the ATlR CC genotype and either cardiac or vascular structural abnormalities [14,32].
In the human heart, angiotensin II is produced from angiotensin I by the angiotensin-converting enzyme (ACE) and the heart chymase (CMA) pathways. Human heart chymase is a chymotrypsin-like serine protease that is the most catalytically efficient enzyme described, thus far, for the cleavage of angiotensin I to angiotensin II [33]. Angiotensin II is primarily (80%) generated via the chymase pathway [34]. Heart chymase has been implicated in the process of acute inflammation [35], apoptosis of cardiac myocytes, proliferation of fibroblastsό and tissue remodeling [37-39]. A functional polymorphism of the human ACE gene (GenBank accession no.
AFl 18569) was described in which the presence (insertion: I allele), rather than the absence (deletion: D allele), of a 287-bp AIu repeat element in intron 16 (rs4646994) is associated with lower enzyme activity [40,41]. In a review of the literature, Bleumink et al recognized the debatable data in the literature regarding the significance of ACE VO polymorphism in heart failure [42]. In several different ethnic groups; Caucasians, Chinese, black South Africans and Japanese, there was no association with either ischemic or non-ischemic cardiomyopathy [42]. On the contrary, a very few studies did suggest an association between the DD genotype and transplant- free survival rates. Interestingly this poor outcome associated with the
genetic polymorphism was blunted with beta blocker treatment [43]. The adverse impact of the DD genotype was also demonstrated in a Swedish population study, but only in concert with several other polymorphisms and not by itself [44] .
Aldosterone, an important peptide produced following RAAS activation, plays an important role in growth promotion and cardiac fibrosis, which contributes to ventricular remodeling and was suggested to have an impact on the pathogenesis of HF and AF [45,46]. The final step in the aldosterone synthetic pathway is via an enzymatic reaction catalyzed by aldosterone synthase. The aldosterone synthase (CYP 11B2) gene (a 9-exon gene localized to chromosome 8q22; GenBank accession no. AC073385) [2] contains a common T-344C polymorphism (a thymidine to cytosine substitution) within its promoter region (rsl799998) [47]. The C allele has been associated with increased binding to the steroidogenic transcription factor 1 (SF- 1) [48] as well as with increased aldosterone synthase activity [49,50].
There is disagreement regarding the prevalence and clinical consequences of aldosterone synthase gene polymorphism in patients with systemic hypertension or HF [51,52]. Aldosterone synthase promoter -344C allele linked to higher aldosterone levels has been associated with poorer event- free survival in blacks with HF [53].
SUMMARY OF THE INVENTION There is a need for, and it would be useful to have sensitive and accurate markers for diagnosis of cardiac disease.
The present invention provides one or more polymorphisms, including single nucleotide polymorphisms (SNPs), or combinations thereof, for diagnosis of cardiac disease, such as heart failure and atrial fibrillation. A nucleotide position in genome at which more than one sequence is possible in a population, is referred to herein as a "polymorphic site" or "polymorphism". Where a polymorphic site is a single nucleotide in length, the site is referred to as a SNP. For example, if at a particular chromosomal location, one member of a population has an adenine and another member of the population has a thymine at the same position, then this position is a polymorphic site, and, more specifically, the polymorphic site is a SNP. Polymorphic sites may be several nucleotides in length due to insertions, deletions, conversions or translocations. As described herein, although reference may be made to an "SNP", it is understood to include any type of polymorphism.
Each version of the sequence with respect to the polymorphic site is referred to herein as an "allele" of the polymorphic site. Thus, in the previous example, the SNP allows for both an adenine allele and a thymine allele. Typically, a reference nucleotide sequence is referred to for a particular gene e.g. in NCBI databases (www.ncbi.nlm.nih.gov). Alleles that differ from the reference are referred to as "variant" alleles. The polypeptide encoded by the reference nucleotide sequence is the "reference" polypeptide with a particular reference amino acid sequence, and polypeptides encoded by variant alleles are referred to as "variant" polypeptides with variant amino acid sequences. Nucleotide sequence variants can result in changes affecting properties of a polypeptide. These sequence differences, when compared to a reference nucleotide sequence, include insertions, deletions, conversions and substitutions: e.g. an insertion, a deletion or a conversion may result in a frame shift generating an altered polypeptide; a substitution of at least one nucleotide may result in a premature stop codon, amino acid change or abnormal mRNA splicing; the deletion of several nucleotides, resulting in a deletion of one or more amino acids encoded by the nucleotides; the insertion of several nucleotides, such as by unequal recombination or gene conversion, resulting in an interruption of the coding sequence of a reading frame; duplication of all or a part of a sequence; transposition; or a rearrangement of a nucleotide sequence, as described in detail above. Such sequence changes may alter the polypeptide encoded by a gene which in turn may alter the functionality and/or other properties of the polypeptide. For example, a nucleotide change resulting in a change in polypeptide sequence can alter the physiological properties of a polypeptide dramatically by resulting in altered activity, distribution and stability or otherwise affect on properties of a polypeptide. Alternatively, nucleotide sequence variants can result in changes affecting transcription of a gene or translation of its mRNA, without affecting the polypeptide itself (of course a combination of both types of effects is also possible). A polymorphic site located in a regulatory region of a gene may result in altered transcription of a gene e.g. due to altered tissue specificity, altered transcription rate or altered response to transcription factors. A polymorphic site located in a region corresponding to the mRNA of a gene may result in altered translation of the mRNA e.g. by inducing stable secondary structures to the mRNA and affecting the stability of the mRNA. Such sequence changes may alter the expression of a gene and hence may have physiological effects. However, the present invention is not limited to
polymorphisms in which there is a direct effect on the expression of the gene and/or on the resultant polypeptide.
The term "gene," as used herein, refers to an entirety containing entire transcribed region and all regulatory regions of a gene. The transcribed region of a gene including all exon and intron sequences of a gene including alternatively spliced exons and introns so the transcribed region of a gene contains in addition to polypeptide encoding region of a gene also regulatory and 5' and 3' untranslated regions present in transcribed RNA. Each gene described herein has been assigned a specific and unique nucleotide sequence by the scientific community. By using the name of the gene as provided herein, those skilled in the art will readily find the nucleotide sequences of a gene and its encoded mRNAs as well as amino acid sequences of its encoded polypeptides, although some genes may have been known with other name(s) in the art.
As used herein the phrase "diagnostic" means identifying the presence or nature of a pathologic condition. Diagnostic methods differ in their sensitivity and specificity. The "sensitivity" of a diagnostic assay is the percentage of diseased individuals who test positive (percent of "true positives"). Diseased individuals not detected by the assay are "false negatives." Subjects who are not diseased and who test negative in the assay are termed "true negatives." The "specificity" of a diagnostic assay is 1 minus the false positive rate, where the "false positive" rate is defined as the proportion of those without the disease who test positive. While a particular diagnostic method may not provide a definitive diagnosis of a condition, it suffices if the method provides a positive indication that aids in diagnosis.
As used herein the phrase "diagnosing" refers to classifying a disease or a symptom, determining a severity of the disease, monitoring disease progression, forecasting an outcome of a disease and/or prospects of recovery. The term "detecting" may also optionally encompass any of the above.
As used herein, "about" means plus or minus approximately ten percent of the indicated value. Other features and advantages of the invention will be apparent from the following detailed description, and from the claims.
BRIEF DESCRIPTION OF THE DRAWINGS
The invention is herein described, by way of example only, with reference to the accompanying drawings. With specific reference now to the drawings in detail, it is stressed that the particulars shown are by way of example and for purposes of illustrative discussion of the preferred embodiments of the present invention only, and are presented in the cause of providing what is believed to be the most useful and readily understood description of the principles and conceptual aspects of the invention. In this regard, no attempt is made to show structural details of the invention in more detail than is necessary for a fundamental understanding of the invention, the description taken with the drawings making apparent to those skilled in the art how the several forms of the invention may be embodied in practice.
In the drawings:
FIG. 1 shows ATlR A1166C genotyping in ischemic and non-ischemic HF patients;
FIG. 2 is a Kaplan-Meier plot of survival in HF patients according to ATlR Al 166C genotype;
FIG. 3 shows prevalence of atrial fibrillation in chronic systolic heart failure patients by CYPl 1B2 T-344C genotype TT = homozygous for the -344T allele, TC = heterozygous; CC = homozygous for the -344C allele; and
FIG. 4A shows Kaplan-Meier survival curves according to circulating TNF- alpha levels (below and above median); and FIG 4B shows Cox proportional hazard ratio curves according to combined circulating TNF-alpha and IL-10 levels (both below and above median).
DESCRIPTION OF THE PREFERRED EMBODIMENTS The present invention provides the use of a single nucleotide polymorphism
(SNP), or a combination of such SNPs, for the diagnosis of cardiac disease, particularly heart failure and atrial fibrillation.
Although the association between gene polymorphisms and heart disease, especially coronary artery disease (CAD), has been investigated, the relationship to systolic HF is less understood. Surprisingly, the present inventors have found that a number of different SNPs may in fact be related to the pathogenesis, diagnosis and prognosis of systolic HF and/or other cardiac diseases.
According to some embodiments of the present invention, there is provided the use of a single nucleotide polymorphism (SNP) for diagnosis and/or prognosis of cardiac disease in a subject.
According to some embodiments, the single nucleotide polymorphism occurs in a gene selected from the group consisting of a renin angiotensin aldosterone system gene, an adrenergic receptor gene, an inflammatory path gene, a metabolic pathway gene, a cell proliferation gene, a natriuretic peptide receptor gene, a plasminogen activator inhibitor gene and a platelet- activating factor gene.
Examples of such polymorphisms are presented in Appendix I. Examples of single nucleotide polymorphisms of the renin angiotensin gene include ATlR (such as A1166C polymorphism), CYPl 1B2 (such as a T-344C promoter polymorphism), CMAl (such as G- 1903 A polymorphism) and BDKRB2 polymorphisms.
Examples of polymorphisms of the adrenergic receptor gene include polymorphisms of ADRB2 (such as Arg (A)16, A46, GIn (Q)27, C79] or He (1)164, T491), ADRBl (such as GIy (G)49, G145 or GIy (G)389, Gl 165), ADRAlA (such as
Cys (Q347, T1039), and ADRA2B (such as ADRA2B 894+ AGAGGAGGA insertion/deletion) .
Examples of polymorphisms of inflammatory pathway genes include polymorphisms of interleukin (IL)-IO (such as A-592 or G-1082), IL-6 (such as C (G- reverse)- 174), tumor necrosis factor (TNF) (such as A-318), IL-IB (such as T315), IL-IRN (such as 86-bp tandem repeat), and C-reactive protein (CRP) (such as C552).
Examples of polymorphisms of metabolic pathway genes include perixosome proliferator-activated receptor genes (such as PPARA, PPARG and PPARGClA), nuclear respiratory genes (such as NRFl and GABPBl), NOS3 and GNB3. An example of a cell proliferation gene is FGF2; examples of natriuretic peptide genes include NPRl and NPR3; an example of a plasminogen activator inhibitor gene is SERPINE 1; and an example of a platelet-activating factor gene is PLA2G7.
Polymorphisms Related to RAAS (renin-angiotensin-aldosterone system) Activity
The combination of one or more treatments which target the RAAS products is the cornerstone of HF (heart failure) therapy. However, the efficacy of such combined targeted "anti-RAAS therapy" is debatable as it may be too aggressive. Such
combined therapy may produce severe side effects including hypotension, hyperkalemia and renal deterioration.
Accordingly, without wishing to be limited by a single hypothesis, it is believed that specific genetic analysis that identifies patients with one or more polymorphisms will enable the detection of patients with a predisposition for potentially suffering significant side effects due to the anti-RAAS therapy. On the other hand, genetic analysis is also expected to assist in detecting patients who would benefit from the aggressive "Anti-RAAS Therapy", such as combination of three /four anti RAAS therapy medications, for blocking the high activity of this system without such significant side effects.
More specifically, according to some embodiments of the present invention, there is provided one or more polymorphisms, such as SNPs, which are believed to affect RAAS (renin-angiotensin-aldosterone system) activity or at least to predict patients who may suffer from altered RAAS activity. Such polymorphisms are expected to have prognostic and/or diagnostic importance, in terms of clinical manifestations and long-term survival of patients with heart disease, such as chronic systolic HF, and preferably also for determining which patients may potentially be predisposed to side effects from anti-RAAS therapy as opposed to patients who may be potentially predisposed to benefit from such therapy. Surprisingly, the present inventors found that SNPs in the following genes may have such prognostic and/or diagnostic importance: ATlR, CYPl 1B2, CMAl, ACE and BDKRB2.
The present inventors examined ATlR polymorphism in patients with systolic HF and its relation to clinical manifestations and patient outcome. As described in detail in Example 1 below, 134 patients with HF and reduced systolic function were genotyped for the ATlR A1166C genotype, using polymerase chain reaction and restriction fragment length polymorphism. The relationship between ATlR A1166C polymorphism and clinical, electrocardiographic, echocardiographic and laboratory parameters in patients with ischemic and non-ischemic etiology was studied, and the relation between ATlR genotype and long-term (30 months) patient survival was examined.
It was found that in HF patients, the frequency of the ATlR 1166C allele and especially the CC genotype was similar to that of the general population, but was associated with an ischemic and not a non-ischemic etiology (p=0.02). The CC genotype was associated with more advanced disease and more severe abnormalities
of renal function (p=0.008). Survival analysis showed that ATlR CC homozygous patients had significantly higher mortality (p=0.008) (adjusted OR for mortality 6.35, 95% confidence interval 1.49 - 11.21, p=0.01). The results imply that there is a decreased ability to adapt to myocardial damage and cardiovascular dysfunction in patients without the A allele of the ATI receptor. None of the 50 patients with nonischemic cardiomyopathy were homozygous for the C allele, possibly due to play of chance or to a different pathophysiologic effect in these circumstances.
The present study demonstrates that CC homozygous patients tend to have reduced LV function (relative difference of 12%). The lack of statistical significant in systolic and diastolic echocardio graphic parameters might be either because patients share homogenous phenotype of advanced systolic HF disease, which masks possible differences between the groups, or because other mechanisms are involved. In the present study, ATlR CC homozygous genotype was significantly associated with ischemic etiology and poorer renal function. The mechanism by which ATlR Al 166C may affect HF is in unknown. Given the potent characteristics of angiotensin II in the cardiac remodeling process and in cell growth regulation, ATlR polymorphism may be expected to alter RAAS activation, with consequent clinical effects. This may occur via several other mechanisms. Moreover, the position of this polymorphism in the 3'UTR region of the gene implies it may influence ATlR transcriptional activity. Indeed, it has been recently reported that this polymorphism is mapped to microRNAs (miRNA) target sites and therefore can affect gene expression via miRNA regulation [55]. In this regard, the 1166 C allele rather than the A allele has been associated with increased ATlR expression. It is therefore, reasonable to believe that any effects attributed to ATlR genotype, would become overt mainly in patients homozygous for the 1166C allele compared to patients carrying the +1166A (AA+AC) genotypes.
Alternatively, although it has been hypothesized that the A1166C polymorphism itself possesses bona fide effects on HF phenotype, there exists the possibility that other markers in linkage disequilibrium with this gene are causative, as was previously suggested by Tiret et al [56]. It should be noted that regardless of the reason for the diagnostic and/or prognostic efficacy of the polymorphism, it is encompassed within the present invention for its prognostic and/or diagnostic efficacy.
The population frequency of the ATlR A1166C in the present study by the present inventors was found to be 74 and 26% for A and C alleles, respectively. This
allele distribution showed a similarity to the respective frequencies reported in dbSNP using different European Caucasian populations or CEPH samples (65-75 and 25-35% for the A and C alleles, respectively). Considerable interethnic variation in the frequencies of this polymorphism has been demonstrated with the -1166C allele being rarer in Afro-American, and Asian populations (94-97 and 3-6% for the A and C alleles, respectively, dbSNP) compared with European Caucasian groups [29, 57], which is consistent with the present findings.
The present inventors have therefore determined that ATlR A1166C polymorphism is a major determinant of late outcome in patients with ischemic cardiomyopathy. Patients homozygous for a gene variation associated with increased ATlR expression and enhanced receptor activity are more likely to have poor prognosis and higher mortality. These findings imply not necessarily a causal relation, but presumably (without wishing to be limited by a single hypothesis) a diminished adaptive capability for the ATlR 1166CC genotype group. In patients homozygous for the C allele, the observed significant clinical deterioration is possible attributed to exaggerated neurohormonal activation of RAAS, again without wishing to be limited by a single hypothesis. These patients may benefit from intensified medical treatment including aggressive anti-RAAS therapy such as a combined "triad" regimen of ACEI, ARB and direct aldosterone antagonists. Future treatment may alter or blunt RAAS activity. The findings support the principle of genome-based therapies in the future treatment of HF patients.
The present inventors also analyzed the possible association between aldosterone synthase (CYP 11B2) T-344C polymorphism, which is associated with increased aldosterone activity, and the prevalence of AF in 191 consecutive patients who had symptomatic systolic HF (left ventricular ejection fraction <40%) for at least 3 months prior to recruitment.
It was found that CYP11B2 T-344C promoter polymorphism is associated with predisposition to clinical AF in patients with HF. Hence, in systolic HF patients, polymorphism of the aldosterone synthase, CYP11B2 CC genotype, may serve as a significant marker for the presence of AF and emphasizes genetic predilection for differences in the clinical course of HF patients.
As described in greater detail in Example 2 below, genomic DNA was extracted from peripheral blood leukocytes using a standard protocol. Subjects were
genotyped for the CYP11B2 polymorphism, using the polymerase chain reaction- restriction fragment length polymorphism approach.
Atrial fibrillation (AF) was found to be present in 57 (32%) of HF patients. The -344 CC genotype was found to be a strong independent marker for AF. Almost half (45%) patients with this genotype had AF, compared to a quarter (27%) with - 344 TT and TC genotypes (p=0.02). A multivariate stepwise logistic regression model which included age, sex, New York Heart Association (NYHA) class, CYP11B2 - 344CC genotype and echocardiographic measurements of left ventricular ejection fraction (LVEF), left atrial (LA) dimension, left ventricular end diastolic diameter and mitral regurgitation severity showed that the CYPl 1B2 CC genotype (adjusted for age and left atrial size) was an independent predictor of AF (adjusted odds ratio 2.59, 95% confidence interval 1.68 - 3.98, p=0.02).
It was determined that the CYP11B2 T-344 C promoter polymorphism associated with aldosterone synthase expression is related to a 2-3 fold increased prevalence of AF in HF patients. The -344 CC genotype was shown to be a strong independent marker for AF, and almost half the patients with this genotype were found to suffer from AF, compared to a quarter of those with the -344 TT and TC genotypes.
The prevalence of AF (32%) in the HF population was in the expected range [58,59]. Three parameters were associated with AF: LA size, age and CYP11B2 CC genotype. Age is a well known determinant of AF, in both the general population and in HF patients. The present inventors and others did not find LVEF to be a significant predictor of AF in these patients with severe HF [60]. Also, in contrast to previous reports 1, NYHA class was not a significant correlate of AF in the present population. It is possible that this association was obscured in the relatively ill homogenous population studied as described below, as 55% of the patients in NYHA Class 3-4. .
LA size is related to cardiac remodeling, and an increased LA dimension contributes to the development of AF in HF. The pathogenesis of AF is mediated through both mechanical and electrical remodeling via sympathetic activation and inflammation [61,62]. The RAS -aldosterone axis plays a crucial part in these processes [63,64]. In the failing heart, there is a significant increase in aldosterone expression [65]. This occurs as the activity of aldosterone synthase (CYPl 1B2), the key enzyme in the aldosterone production, is increased in HF patients [66]. Several reports, in different ethnic populations, suggested that patients who are homozygous
for the C allele of the CYP11B2 gene promoter polymorphism (T-344C) may have an adverse outcome. According to these reports, these individuals suffer from higher blood pressure and have elevated left ventricular mass and hypertrophy [67,68]. In patients with idiopathic dilated cardiomyopathy, the CYP11B2 CC genotype was associated with larger left ventricular volumes and significantly elevated plasma levels of aldosterone [51]. Moreover, in Afro-American HF patients, the CYP11B2 CC genotype was associated with higher mortality rates compared to the CYP11B2 TT genotype [53].
In the present study, by contrast, CYP11B2 CC genotype was a significant predictor of AF but had no direct correlation with LA size. Although the present inventors did not examine direct inflammatory mediators, it is believed (without wishing to be limited by a single hypothesis) that CYP11B2 CC genotype may have contributed to AF pathogenesis through neurohormonal, inflammatory and autonomic system activation [61,62,64,69]. The genetic predisposition of HF patients to AF may have important practical implications. Beta blocker therapy, with known RAS antagonistic characteristics, has been suggested to reduce AF prevalence in systolic HF patients [59]. More specific therapy with direct aldosterone antagonists may offer stronger anti-remodeling properties. This concept, especially in the CYPl 1B2 CC genotype subpopulation, was also implied recently by others [63,70] and may potentially decrease AF prevalence in these patients.
The present inventors further studied ACE and CMA polymorphisms and their relationship to HF.
Two candidate polymorphisms were studied in the genes encoding these two enzymes, a functional polymorphism of the human ACE gene (GenBank accession no. AFl 18569) involving the presence (insertion: I allele), rather than the absence (deletion: D allele), of a 287-bp AIu repeat element in intron 16 (rs4646994), and a novel single nucleotide polymorphism (SNP) (G/A transition at position -1903 of the 5' untranscribed region of the gene, rs 1800875) close to the regulatory region of the CMAl gene (GenBank accession no. M64269. There is an impressive shortage of data in the literature regarding the impact of this specific polymorphism on systolic HF. Based on the premise that ACE I/D and CMAl (-1903G/A) may affect RAAS activity, the present authors hypothesized that these polymorphisms may have clinical importance in patients with chronic systolic HF. The prevalence of these two
polymorphisms of the ACE /CMAl genes was evaluated among chronic systolic HF patients compared to healthy controls and their relation to the etiology (ischemic/nonischemic) of HF. The association of these gene polymorphisms with the clinical manifestations of HF patients was also examined. As described in detail in Example 3 below, 195 patients with HF and systolic
LV dysfunction (ejection fraction <40%) for ACE insertion (I)/deletion (D) and CMAl (-1903G/A) polymorphisms were genotyped. HF etiology and patients' clinical manifestations were analyzed in relation to genotype subtypes.
The CMAl -1903 GG genotype was found to be associated with a non- ischemic HF etiology (χ2=6.67, P=0.009). In the group of HF patients, the odds ratio of CMAl GG genotype having a non-ischemic etiology was 2.48 (95% C.I.1.23-5.00). The CMAl GG genotype was associated with lower ejection fraction (P=O.005). Conversely, the ACE D allele had no detectable impact on systolic HF phenotype. It was therefore concluded that in patients with chronic systolic HF, the CMAl polymorphism was related to non-ischemic etiology of HF. Patients homozygous for the G allele had a significantly greater reduction in systolic LV function.
The study showed that in patients with chronic systolic HF, the CMAl - 1903G/A polymorphism, and in particular homozygosity for the G allele, was more frequent in patients with a non-ischemic etiology of HF and was associated with a greater reduction in LV ejection fraction. The overall frequency of the GG genotype in HF patients was similar to that in the general population, implying then, not necessarily a causal relation, but presumably a differing adaptation to myocardial damage (without wishing to be limited by a single hypothesis).
The association between CMAl gene polymorphisms and heart disease, studied mainly in patients with hypertrophic cardiomyopathy [71-73] has not been clear. The present inventors believe the present study to be the first which demonstrates an association between CMAl -1903G/A polymorphism and LV systolic dysfunction. Proposed mechanisms include the possibility that the polymorphism, which is located in promoter of the CMAl gene, alters protein expression, or if not functional, may be in linkage disequilibrium with other causative alleles [42].
Effects of CMAl polymorphism may be mediated through an acceleration of the remodeling process in patients with HF, and mainly in patients with non-ischemic cardiomyopathy (without wishing to be limited by a single hypothesis). Chymase is produced from mast cells and is not inhibited by angiotensin-converting enzyme
inhibitors [74]. In HF patients, mast cells increase in number in the failing myocardium [75], and may be implicated in ventricular dilatation and cardiac decompensation [76].
Without wishing to be limited by a single hypothesis, these changes may be attributed to local angiotensin II activity, which induces hypertrophy of cardiac myocytes and myocardial fibrosis and therefore is the most important remodeling factor in the heart [77,78]. Chymase may be responsible for the vast majority of production of local angiotensin II in the myocardium [34] . In addition to the effects associated with direct angiotensin II production, chymase is associated with apoptosis; TGF-β mediated fibrosis [79], collagen formation [80] and fibroblast differentiation to myofibroblasts [36,76,81]. Moreover, mast cell chymase produced in the myocardium can directly induce acute inflammation and affect tissue remodeling through activation of matrix metalloproteinases [38] and IL- lβ precursors [37], and stimulation of IL-8 release resulting in recruitment of granulocytes [39]. All of these are important features of the cardiac remodeling process, which may explain the present finding of lower LV ejection fraction in patients with the CMAl GG genotype (without wishing to be limited by a single hypothesis). Of note, as per inclusion criteria, all study patients had systolic heart failure (EF<40%), with a mean LVEF of 24+6.5%. Thus, the absolute EF difference of 4 points in the CMAl GG sub-group (25% vs. 21%), actually reflects a 16% change when compared to the mean EF and is therefore statistically very significant (P = 0.005).
It is less clear why CMAl polymorphism is associated with cardiomyopathy of non-ischemic etiology. It may be related to the long term impact of the remodeling process in systolic HF. In patients with ischemic etiology, it is not uncommon that HF symptoms start after initial extensive myocardial damage while the remodeling process contributes little to the progression of HF. On the other hand, in non-ischemic cardiomyopathy, the remodeling process may have greater importance and be linked more closely to the inflammatory process. In an animal model of viral myocarditis, there was an increased density of myocardial mast cells with a simultaneous up regulation in gene expression of inflammatory cytokines and mouse mast cell protease-5 (which is the counterpart of the human chymase) [35], indicating that mast cell chymase both mediates and accelerates inflammatory pathways and is a crucial player in the remodeling process. Moreover, the myocardial remodeling phenomenon in HF progression may be the end point of several pathways, only some of which are
mediated through cardiac angiotensin II formation. In non-ischemic cardiomyopathy, the chymase-dependent remodeling process may be predominant, causing the observed reduced systolic function in the present CMAl GG patients (without wishing to be limited by a single hypothesis). The population frequency of the CMAl -1903G/A genotype was found to be
53% and 47% for A and G alleles, respectively. This allele distribution showed a similarity to the respective frequencies reported in dbSNP using a Caucasian group (58% and 42% for the A and G alleles, respectively). Considerable interethnic variation in the frequencies of this polymorphism has been demonstrated, with the - 1903G allele being rarer in Caucasian populations compared with Afro-American, Chinese and Japanese groups (18-20% and 80-82% for the A and G alleles, respectively, dbSNP), which is consistent with the present findings.
The present inventors did not find a clinical association with the ACE VD genotype in HF patients. Although an association between ACE VD polymorphism and cardiomyopathy has previously been reported [82,83], other studies did not confirm such relationship and in those which did, the study cohorts deviated from the Hardy- Weinberg equilibrium [42,84]. Some authors have suggested that although there was no causative relation between the ACE VD polymorphism and cardiomyopathy, HF patients with the ACE DD genotype have poor outcome and increased mortality [43]. The present inventors, as others [85] did not find such a correlation. The vast majority of the patients of the present study were treated with pharmacotherapy involving modulation of the RAAS, including beta blocker, ACEI and/or ARB. More than a quarter were treated in addition with direct aldosterone antagonists. The clinical impact of the ACE VD polymorphism may have been attenuated by these treatments, as demonstrated previously [43,86]. Another explanation may be that ACE VD genotype acts only in concert with other polymorphisms as a synergistic genetic polymorphism in order for its prognostic implications to become evident [44]. Polymorphism in the chymase gene, less blunted by medical therapy, did have clinical implications and a lower LV ejection fraction in the present patients.
It was concluded that CMAl promoter polymorphism was associated with patients (particularly with non-ischemic etiology for HF) who had greater reduction in measured systolic LV function. In contrast, ACE VD polymorphism had no relation to the level of cardiac function. Although a single center with relatively small patient
numbers was studied, the findings were fairly robust by statistical analysis. The findings may explain differences in response to therapies aimed at modulation of the RAAS in patients with apparently similar HF profiles and treatments.
The present invention, in at least some embodiments as described in greater detail below, comprises test kits and diagnostic methods for detecting one or more
RAAS-related polymorphisms, optionally and preferably for prognostic and diagnostic uses in relation to heart disease, more preferably for HF (heart failure) and optionally and most preferably for determining which patients have a predisposition toward potential significant side effects with anti- RAAS therapy and which patients may be expected to potentially benefit from such therapy.
Polymorphisms Related to Sympathetic Activity
Enhanced sympathetic activation has a central role in the development of heart failure. Increased sympathetic activity is known for its deleterious effects on the myocardium and the coronary system, either alone or in concert with other systems such as with the RAAS system for facilitating fibrosis, apoptosis, necrosis and fatal gene activation, leading to morbidity and mortality. Clearly genetic analysis of genes related to such enhanced sympathetic activity would be useful as a diagnostic and prognostic tool According to some embodiments of the present invention, there is provided one or more polymorphisms of the sympathetic nerve system receptors on the myocardium itself, specifically the beta (l/2)-adrenoceptor and the alpha- 1 and 2 and its subtypes such as alpha- 2C-adrenoceptor. Each of them may alter the sympathetic influence and consequently may cause enhance sympathetic tone manifest as a trigger for myocardial damage, coronary events, cardiac remodeling and higher arrhythmia and mortality rates.
It was previously demonstrated that different patients gave different responses to the same regimen therapy in beta blockers as seen in several trials, suggesting that the different sub-type populations may be an important factor in determining the patient response. These different populations may be a reflection of different beta/alpha adrenoceptor in these populations. Tracing the specific polymorphism in the individual patient may be crucial factor in matching the relevant anti- sympathetic therapy for him as well {Domanski MJ, Krause-Steinrauf H, Massie BM, Deedwania P, Follmann D, Kovar D, Murray D, Oren R, Rosenberg Y, Young J, ZiIe M,
Eichhorn E; BEST Investigators: A comparative analysis of the results from 4 trials of beta-blocker therapy for heart failure: BEST, CIBIS-II, MERIT-HF, and COPERNICUS J Card Fail. 2003 Oct;9(5):354-63}.
Some non-limiting examples of polymorphisms related to the sympathetic system, and also relating to differential activity therein, including but are not limited to polymorphisms of the adrenergic receptor gene include polymorphisms of ADRB2 (such as Arg (A)16, A46, GIn (Q)27, C79] or He (1)164, T491), ADRBl (such as GIy (G)49, G145 or GIy (G)389, Gl 165), ADRAlA (such as Cys (Q347, T1039), and ADRA2B (such as ADRA2B 894+ AGAGGAGGA insertion/deletion). The present invention, in at least some embodiments as described in greater detail below, comprises test kits and diagnostic methods for detecting one or more sympathetic system-related polymorphisms, optionally and preferably for prognostic and diagnostic uses in relation to heart disease, more preferably for HF (heart failure) and optionally and most preferably for determining which patients have a predisposition to benefit from sympathetic system related therapies such as beta blocker therapies for example.
Polymorphisms Related to Inflammatory Activity
As described in greater detail with regard to the Example below, different cytokines have different effects on heart failure (HF) patients. In particular, it was noted that IL-10 plays a major role in patients with HF. As opposed to known inflammatory cytokines such as TNF- alpha, IL-10 was proposed in the past to have a protective effect as a non- inflammatory cytokine. However, surprisingly, the present inventors found that the mortality in patients with combined elevation of both IL-10 and TNF-alpha was the highest, suggesting that IL-10 may have a counter- productive effect. The interaction between the different cytokines, such as IL-10/ TNF-alpha, was further elaborated as described in greater detail below.
Since the production of such cytokines is regulated through various genetic factors, according to at least some embodiments of the present invention, there is provided one or more polymorphisms for the above mentioned cytokines as being important factors in the pathogenesis, predisposition and prognosis of HF which may have treatment implications, for example in terms of selecting one or more therapies for patients having such polymorphisms. Furthermore, according to at least some embodiments of the present invention, there is provided one or more inflammatory
activity related polymorphisms, which may optionally not be polymorphisms for the above mentioned cytokines.
Some non-limiting examples of polymorphisms related to inflammatory activity, and also relating to differential levels of such activity, include but are not limited to polymorphisms of inflammatory pathway genes, including but not limited to polymorphisms of interleukin (IL)-IO (such as A-592 or G-1082), IL-6 (such as C
(G-reverse)-174), tumor necrosis factor (TNF) (such as A-318), IL-IB (such as T315),
IL-IRN (such as 86-bp tandem repeat), and C-reactive protein (CRP) (such as C552).
The present invention, in at least some embodiments as described in greater detail below, comprises test kits and diagnostic methods for detecting one or more inflammatory activity-related polymorphisms, optionally and preferably for prognostic and diagnostic uses in relation to heart disease, more preferably for HF (heart failure) and optionally and most preferably for determining which patients have a predisposition to benefit from inflammatory activity related therapies.
Polymorphisms Related to Cell Proliferation
Natriuretic peptides (BNP, NT-proBNP) have been widely used for the diagnosis and prognostic evaluation of HF (heart failure), as a non-limiting example of a diagnostic and prognostic cell proliferation system. The importance of B-type natriuretic peptide (BNP) as a diagnostic and therapeutic modality in cardiovascular disease and specifically in HF is well known { Ang DS, Wei L, Kao MP, Lang CC, Struthers AD.A comparison between B-type natriuretic peptide, global registry of acute coronary events (GRACE) score and their combination in ACS risk stratification. Heart. 2009 Apr 6; Hobbs RE. Using BNP to diagnose, manage, and treat heart failure.,cleve Clin J Med. 2003 Apr;70(4):333-6}. BNP levels correlate clinical, physiologic and prognosis in HF and acute coronary syndromes as well. Accordingly, analysis of the genetic variation of the cell proliferation genes, including those related to natriuretic peptides, may provide a diagnostic and/or prognostic tool for heart failure. NRPl is a membrane -bound coreceptor to a tyrosine kinase receptor for both vascular endothelial growth factor (VEGF; MIM 192240) and semaphorin (see SEMA3A; MIM 603961) family members. NRPl plays versatile roles in angiogenesis. The neuropilins-1 and -2 (NRPl and NRP2) function as receptors vascular endothelial growth factor and have been implicated in angiogenesis. Hypoxia and nutrient
deprivation stimulate the rapid loss of NRPl expression in endothelial. NRP2 expression, in contrast, is maintained under these conditions.
B-type natriuretic peptide (BNP) is a peptide hormone of myocardial origin with significant cardioprotective properties. It was shown by the present inventors that in heart failure patients referred to an outpatient specialized heart failure center, an upper tertile NT-proBNP level identified patients at high risk for mortality. A single high > 550 pg/ml NT-proBNP measurement appears to be useful for selecting patients for care in a heart failure center, and a level > 2000 pg/ml for assigning patients to high priority management {Amir O, Paz H, Ammar R, Yaniv N, Schliamser JE, Lewis BS.Isr Med Assoc J. 2008:152-3. Usefulness and predictive value of circulating NT- proBNP levels to stratify patients for referral and priority treatment in a specialized outpatient heart failure center. Isr Med Assoc J. 2008;10(2):109-12}.
Patients with either heart failure or myocardial ischemia present with high levels of BNP in plasma and elevated expression in the myocardium. It was shown that hypoxia via the induction of hypoxia inducible factor 1 (HIF-I) stimulated protein release of BNP and VEGF as manifested by an increased of mRNA levels of BNP.
According to at least some embodiments of the present invention, there is provided one or more polymorphisms for the above mentioned natriuretic peptides as being important factors in the pathogenesis, predisposition and prognosis of HF which may have treatment implications, for example in terms of selecting one or more therapies for patients having such polymorphisms. Furthermore, according to at least some embodiments of the present invention, there is provided one or more cell proliferation related polymorphisms, which may optionally not be polymorphisms for the above mentioned natriuretic peptides. Some non-limiting examples of polymorphisms related to cell proliferation, and also relating to differential levels of such activity, include but are not limited to polymorphisms of cell proliferation genes, including but not limited to FGF2; and/or polymorphisms of natriuretic peptide genes, including but not limited to NPRl and NPR3. The present invention, in at least some embodiments as described in greater detail below, comprises test kits and diagnostic methods for detecting one or more cell proliferation-related polymorphisms, including but not limited to polymorphisms associated with natriuretic peptides, optionally and preferably for prognostic and diagnostic uses in relation to heart disease, more preferably for HF (heart failure).
Polymorphisms related to metabolic pathway genes
Cellular energy production is tightly linked to metabolic demand. The capacity for cellular ATP production is controlled, in part, by the expression levels of nuclear genes involved in mitochondrial oxidative metabolism. Accordingly, cellular energy metabolism necessitates transduction of diverse signals related to cellular energy demands to the nucleus.
The PPAR gene pathway consists of interrelated genes that encode transcription factors, enzymes, and downstream targets which coordinately act to regulate cellular processes central to glucose and lipid metabolism. The pathway includes the PPAR genes themselves, other class II nuclear hormone receptor transcription factors within the PPAR family, PPAR co-activators, PPAR co-repressors, and downstream metabolic gene targets.
The PPARY coactivator-lκ (PGC-IK), had been characterized as a broad regulator of cellular energy metabolism. PGC-I P, and the PGC-I -related protein, a family of inducible transcriptional coactivators responsive to selective physiological stimuli, which are mediated between the extracellular events and the regulation of genes involved in energy metabolism.
These transcription factors have been implicated in the development of myocardial hypertrophy and dilated cardiomyopathy as well as response to myocardial ischemia/infarction and, by association, ischemic cardiomyopathy.
Diabetes mellitus is a known risk factor for coronary atherosclerosis, myocardial infarction, and ischemic cardiomyopathy. Insulin resistance is associated with left hypertrophy and hypertensive cardiomyopathy. The relationship between insulin resistance and cardiomyopathy is less well established. Systemic and myocardial glucose uptake is compromised in heart failure independent of etiology. These abnormalities are associated with cellular deficits of insulin signaling. Insulin resistance and fatty acid excess are potential therapeutic targets in heart failure. Indeed, that shifting the energy substrate preference away from fatty acid metabolism and toward glucose metabolism could be an effective adjunctive treatment in patients with heart failure, in terms of left ventricular function and glucose metabolism improvement including Peroxisome proliferator activator receptor gamma agonists which are used in diabetes mellitus as they have combined antilipemic and insulin-
sensitizing activity. Similarly, genetic testing and drug therapy may apply to patients with heart failure and/or coronary artery disease with or without diabetes mellitus.
The enzyme Nitric oxide synthase (NOS) catalyzes the generation of NO (nitric oxide). All isoforms of NOS (C/I /E/N) exist in the heart, when in normal heart the e NOS is the dominant. NO in the heart decreases both oxygen consumption and glucose metabolism of the myocardium cells as well as possible lipid metabolism inhibition.
According to at least some embodiments of the present invention, there is provided one or more polymorphisms for the above mentioned metabolic pathway genes as being important factors in the pathogenesis, predisposition and prognosis of HF which may have treatment implications, for example in terms of selecting one or more therapies for patients having such polymorphisms. Furthermore, according to at least some embodiments of the present invention, there is provided one or more metabolic pathway related polymorphisms. Some non-limiting examples of polymorphisms of metabolic pathway genes include but are not limited to perixosome proliferator-activated receptor genes (including but not limited to PPARA, PPARG and PPARGClA), nuclear respiratory genes (including but not limited to NRFl and GABPBl), NOS3 and GNB3.
The present invention, in at least some embodiments as described in greater detail below, comprises test kits and diagnostic methods for detecting one or more metabolic pathway-related polymorphisms, including but not limited to polymorphisms associated with perixosome proliferator-activated receptor genes and/or nuclear respiratory genes, optionally and preferably for prognostic and diagnostic uses in relation to heart disease, more preferably for HF (heart failure).
Polymorphisms related to blood related genes
Several studies suggested that inflammation has an important role in HF progression. Serum oxidative stress level is a crucial element of the inflammatory process, owing to the accumulation of reactive oxygen/nitrogen species that might provoke and exacerbate the myocardial damage of the already failing heart. Several medications claim to have at least some beneficial effects through anti-oxidant potential. The present inventors recently reported serum oxidative stress level correlates with clinical parameters in chronic systolic heart failure patients {Amir O et al; Clin Cardiol. 2009}. Plasma platelet-activating factor acetylhydrolase acts as a key
defense against oxidative stress by hydrolyzing PAF and oxidized phospholipids. Deficiency of the activity of this enzyme may thus potentially result in predisposition to myocardial damage leading to ischemic and non-ischemic cardiomyopathy and be a potential target for HF/CAD treatnment. Fibrinolysis in blood is mainly reflected by the activities of tissue plasminogen activator (tPA) and of plasminogen activator inhibitor- 1 (PAI-I). Plasminogen activator inhibitor-1 is a serine protease inhibitor (serpin) protein (SERPINEl). As the principal inhibitor of tissue plasminogen activator and urokinase, the activators of plasminogen and fibrinolysis .Accordingly, high PAI-I levels have been associated with atherosclerotic plaque formation and in a prothrombotic state, carrying an increased risk of arterial occlusion and consequently with myocardial infarction . The human PAI-I gene has been mapped on chromosome 7 (q21.3-q22) and contains 9 exons and 8 introns and a possible association with ischemic and non-ischemic cardiomyopathy will be tested. Changes in plasma fibrinolytic parameters were shown with acute ATI antagonism via suppression of angiotensin II in HF patients and were associated with a significant improvement in plasma fibrinolytic parameters.
According to at least some embodiments of the present invention, there is provided one or more polymorphisms for the above mentioned blood related genes as being important factors in the pathogenesis, predisposition and prognosis of HF which may have treatment implications, for example in terms of selecting one or more therapies for patients having such polymorphisms. Furthermore, according to at least some embodiments of the present invention, there is provided one or more blood related polymorphisms.
Some non-limiting examples of polymorphisms of plasminogen activator inhibitor gene include but are not limited to SERPINE 1 ; and an example of a platelet- activating factor gene is PLA2G7.
The present invention, in at least some embodiments as described in greater detail below, comprises test kits and diagnostic methods for detecting one or more blood-related polymorphisms, including but not limited to polymorphisms associated with plasminogen activator inhibitor genes and/or platelet-activating factor genes, optionally and preferably for prognostic and diagnostic uses in relation to heart disease, more preferably for HF (heart failure).
Diagnostic Methods and Test Kits
One major application of the current invention is diagnosing a susceptibility to a cardiac condition. The risk assessment methods and test kits of this invention can be applied to any healthy person as a screening or predisposition test, although the methods and test kits are preferably applied to high-risk individuals (who have e.g. family history of cardiac disease, one or more cardiac specific risk factors, one or more general risk factors such as obesity or any combination of these). Diagnostic tests that define genetic factors contributing to cardiac disease might be used together with or independent of the known clinical risk factors to define an individual's risk relative to the general population. Better means for identifying those individuals susceptible for cardiac disease should lead to better preventive and treatment regimens, including more aggressive management of the risk factors for cardiac disease such as obesity, lack of physical activity, hypercholesterolemia, elevated LDL cholesterol, low HDL cholesterol, elevated BP, cigarette smoking and inflammatory components as reflected by increased C-reactive protein levels or other inflammatory markers. Physicians may use the information on genetic risk factors to convince particular patients to adjust their life style e.g. to stop smoking, to reduce caloric intake or to increase exercise. In one embodiment of the invention, diagnosis of a susceptibility to cardiac disease in a subject is made by detecting one or more polymorphisms, such as SNPs, as described herein in the subject's nucleic acid. The presence of cardiac disease associated alleles of the assessed polymorphisms in individual's genome indicates subject's increased risk for cardiac disease. With regard the sequences listed herein by SEQ ID NO, it should be noted that all odd-numbered SEQ ID NOs relate to the WT (wild type) while all even-numbered SEQ ID NOs relate to the mutant SNP sequence. However, both types of sequences may optionally have diagnostic and/or prognostic uses as described herein.
Preferably according to at least some embodiments of the present invention, there is provided a polynucleotide comprising at least 10 contiguous nucleotides of a nucleotide sequence selected from the group consisting of the nucleotide sequences of even numbered SEQ ID NOs, or a complementary polynucleotide thereof. The polynucleotide comprises at least 10 contiguous nucleotides of a nucleotide sequence selected from the group consisting of nucleotide sequences of even numbered SEQ ID
NOs and comprising a polymorphic site. The length of the polynucleotide is 10 to 400 nucleotides, and preferably 10 to 100 nucleotides, and more preferably 10 to 50 nucleotides. The polynucleotide may be DNA or RNA.
Preferably according to at least some embodiments of the present invention, there is provided an allele- specific polynucleotide for diagnosis of cardiovascular disease as described herein, hybridized with the polynucleotide including at least 10 contiguous nucleotides of a nucleotide sequence selected from the group consisting of nucleotide sequences of even numbered SEQ ID NOs and comprising the nucleotide of a polymorphic site or a complementary polynucleotide thereof. The allele- specific polynucleotide refers to polynucleotide hybridized specifically with each allele. That is, the allele-specific polynucleotide is hybridized such that a base of a polymorphic site in polymorphic sequences of even numbered SEQ ID NOs can be specifically distinguished. The hybridization can usually be carried out under a strict condition, for example, in a salt concentration of 1 M or less and at a temperature of 25 C or higher. For example, 5xSSPE (750 mM NaCl, 50 mM Na phosphate, 5 mM EDTA, pH 7.4) and 25 to 30 C may optionally be suitable for the allele-specific probe hybridization, without wishing to be limited in any way.
According to at least some embodiments of the present invention, the allele- specific polynucleotide may optionally be a primer. The primer refers to a single- strand oligonucleotide capable of initiating a template-directed DNA synthesis in an appropriate buffer under an appropriate condition (for example, in the presence of four different nucleoside triphosphates and a polymerizing agent such as DNA, RNA polymerase or reverse transcriptase) at a proper temperature. The length of the primer may vary according to the purpose of use, but is usually 15 to 30 nucleotides. A short primer molecule generally requires lower temperatures to be stably hybridized with a template. The primer sequence does not necessarily need to be completely complementary with the template, but should be sufficiently complementary to be hybridized with the template. Preferably, the primer has 3' end arranged so as to correspond to the polymorphic sites of the sequences of the even numbered SEQ ID NOs. The primer is hybridised with a target DNA including the polymorphic site and initiates amplification of allele having complete homology to the primer. The primer is used as a primer pair with the other primer hybridized at the opposite side. Amplification is performed from the two primers, indicating that there is a specific
allele. The primer of the present embodiment optionally includes a polynucleotide fragment used in a ligase chain reaction (LCR).
According to at least some embodiments of the present invention, the allele- specific polynucleotide may be a probe. The probe refers to a hybridization probe, which is an oligonucleotide capable of binding sequence- specific ally to a complementary strand of a nucleic acid. Such a probe includes a peptide nucleic acid introduced by Nielsen, et al., Science 254, 1497-1500 (1991). The probe of the present invention is an allele- specific probe. When a polymorphic site is located in DNA fragments derived from two members of the same species, the allele- specific probe is hybridized with the DNA fragment derived from one member but is not hybridized with the DNA fragment derived from the other member. In this case, the hybridization condition should be sufficiently strict to be hybridized with only one allele by showing a significant difference in terms of the intensity of hybridization between alleles. The probe of the present invention is preferably arranged such that its central site (i.e., 7th position in a probe consisting of 15 nucleotides, or 8th or 9th position in a probe consisting of 16 nucleotides) has the polymorphic site of the above sequence. In this way, a hybridization difference between alleles can be caused. The probe of these embodiments of present invention can be used in a diagnosis method for detecting an allele, etc. The diagnosis method includes but is not limited to detection methods based on hybridization of nucleic acid such as southern blot. In a method using a DNA chip, the probe can previously be bound to a substrate of the DNA chip.
According to some embodiments of the present invention there is also provided a microarray including the polynucleotide of even numbered SEQ ID NOs or a complementary polynucleotide thereof. The microarray may include a DNA or
RNA polynucleotide. The microarray has the same structure as a conventional microarray, except that it includes the polynucleotide of even numbered SEQ ID NOs.
According to some embodiments of the present invention there is also provided a kit including the polynucleotide of even numbered SEQ ID NOs. The kit can include a reagent for polymerization, for example, dNTP, various polymerization enzymes, a colorizing agent, etc., in addition to the polynucleotide of even numbered SEQ ID NOs. The kit can be used in diagnosis of cardiovascular disease, such as heart failure.
According to some embodiments of the present invention there is also provided a method of diagnosing cardiovascular disease, the method including: obtaining nucleic acid from a individual; and determining a nucleotide sequence of a polymorphic site of at least one polynucleotide selected from the group consisting of polynucleotides of even numbered SEQ ID NOs and their complementary polynucleotides. The method of diagnosing cardiovascular disease may further include deciding that the risk of cardiovascular disease is high when the nucleotide sequence of the polymorphic site is the same as at least one of risk alleles according to the sequences of the even numbered SEQ ID NOs. The obtaining of nucleic acid from an individual can be carried out by a conventional DNA isolation method. For example, nucleic acid can be obtained by amplifying a target nucleic acid through polymerase chain reaction (PCR) and purifying the amplified product. In addition, LCR (Wu and Wallace, Genomics 4, 560 (1989), Landegren et al., Science 241, 1077 (1988)), transcription amplification (Kwoh et al., Proc. Natl. Acad. Sci. USA 86, 1173 (1989)), self-sustained sequence replication (Guatelli et al., Proc. Natl. Acad. Sci. USA 87, 1874 (1990)), and nucleic acid sequence based amplification (NASBA) can be used. Last two methods are associated with an isothermal reaction based on isothermal transcription and produce 30 or 100 times amplified single-strand RNA and double-strand DNA. In an embodiment of the method, the determining nucleotide sequence of the polymorphic site includes hybridizing the nucleic acid sample onto a microarray on which a polynucleotide for diagnosis or treatment of cardiovascular disease comprising at least 10 contiguous nucleotides selected from the group consisting of nucleotide sequences of even numbered SEQ ID NOs and comprising the nucleotide of the polymorphic site, or a complementary polynucleotide thereof, is immobilized; and detecting the hybridization result.
The method of preparing a microarray by immobilizing a probe polynucleotide on a substrate is well known in the art. The immobilization of the probe polynucleotide associated with cardiovascular disease on a substrate can also be easily performed using a conventional technology. Also, the hybridization of nucleic acid on the microarray and the detection of the hybridisation result are well known in the art. For example, the nucleic acid sample is labelled with a fluorescent material, for example, a labelling material capable of generating detectable signals including Cy3
and Cy5, and then is hybridised on the microarray, followed by detecting signals generated from the labelling material.
In another embodiment, the method may further include determining that the individual belongs to a risk group having high probability of cardiovascular disease when the determined nucleotide sequence of the polymorphic site corresponds to the at least one polymorphic site selected from the group consisting of even numbered SEQ ID NOs in which nucleotides of the polymorphic sites are A, C, A, G and A, respectively. It can be determined that when many nucleic acid sequences having the risk allele are detected in an individual, the probability of belonging to a risk group is high.
According to some embodiments of the present invention there are also provided methods of diagnosing a susceptibility to cardiac disease in an individual comprising detection of a haplotype in a cardiac disease risk gene that is more frequently present in an individual having cardiac disease (affected), compared to the frequency of its presence in a healthy individual (control), wherein the presence of the haplotype is indicative of a susceptibility to cardiac disease.
Another non-limiting, illustrative application of the current invention is diagnosis of a molecular subtype of cardiac disease in a subject. Molecular diagnosis methods and kits of this embodiment of the present invention can be applied to a person having cardiac disease and/or to family members. In one preferred embodiment, molecular subtype of cardiac disease in an individual is determined to provide information of the molecular etiology of cardiac disease. When the molecular etiology is known, better diagnosis and prognosis of cardiac disease can be made and efficient and safe therapy for treating cardiac disease in an individual can be selected on the basis of this cardiac disease subtype. For example, the drug that is likely to be effective can be selected without (or with minimal) trial and error. Physicians may use the information on genetic risk factors with or without known clinical risk factors to convince particular patients to adjust their life style and manage cardiac disease risk factors and select intensified preventive and curative interventions for them. In other embodiments, biomarker information obtained from methods and kits for determining molecular subtype of cardiac disease in an individual is for monitoring the effectiveness of their treatment. In one embodiment, methods and kits for determining molecular subtype of cardiac disease are used to select human subjects for clinical trials testing cardiac drugs. The kits provided for diagnosing a
molecular subtype of cardiac disease in an individual comprise wholly or in part protocol and reagents for detecting one or more biomarkers and interpretation software for data analysis and cardiac disease molecular subtype assessment.
The diagnostic assays and kits of the invention may further comprise a step of combining non-genetic information with the biomarker data to make risk assessment, diagnosis or prognosis of cardiac disease. Useful non-genetic information comprises age, gender, smoking status, physical activity, waist-to-hip circumference ratio (cm/cm), the subject family history of cardiac disease, obesity, hypertriglyceridemia, low HDL cholesterol, HT and elevated BP. The detection method of the invention may also further comprise a step determining total cholesterol, HDL cholesterol, LDL cholesterol, triglyceride, or C-reactive protein concentration.
In diagnostic assays determination of the nucleotides present in one or more polymorphisms of this invention, including SNPs, in an individual's nucleic acid can be performed by any method or technique which can accurately determine nucleotides present in a polymorphic site. Numerous suitable methods have been described in the art [see e.g. 87,88], these methods include, but are not limited to, hybridization assays, ligation assays, primer extension assays, enzymatic cleavage assays, chemical cleavage assays and any combinations of these assays. The assays may or may not include PCR, solid phase step, a microarray, modified oligonucleotides, labeled probes or labeled nucleotides and the assay may be multiplex or singleplex. As it is obvious in the art the nucleotides present in a polymorphic site can be determined from either nucleic acid strand or from both strands.
In another embodiment of the invention, a susceptibility to cardiac disease is assessed from transcription products of one or more cardiac disease associated genes. Qualitative or quantitative alterations in transcription products can be assessed by a variety of methods described in the art, including e.g. hybridization methods, enzymatic cleavage assays, RT-PCR assays and microarrays. A test sample from an individual is collected and the alterations in the transcription of cardiac disease associated genes are assessed from the RNA molecules present in the sample. Altered transcription is diagnostic for a susceptibility to cardiac disease.
"Probes" or "primers" are oligonucleotides that hybridize in a base-specific manner to a complementary strand of nucleic acid molecules. By "base specific manner" is meant that the two sequences must have a degree of nucleotide complementarity sufficient for the primer or probe to hybridize to its specific target.
Accordingly, the primer or probe sequence is not required to be perfectly complementary to the sequence of the template. Non-complementary bases or modified bases can be interspersed into the primer or probe, provided that base substitutions do not inhibit hybridization. The nucleic acid template may also include "non-specific priming sequences" or "nonspecific sequences" to which the primer or probe has varying degrees of complementarity. Probes and primers may include modified bases as in polypeptide nucleic acids. Probes or primers typically comprise about 15, to 30 consecutive nucleotides present e.g. in human genome and they may further comprise a detectable label, e.g., radioisotope, fluorescent compound, enzyme, or enzyme co-factor.
Probes and primers to a SNP described herein are described herein and/or can easily be designed using the flanking nucleotide sequences assigned to a SNP rs ID and standard probe and primer design tools. Primers and probes for other types of polymorphisms are also described herein and/or could easily be designed by one of ordinary skill in the art. Primers and probes for SNPs and/or other polymorphisms described herein can be used in risk assessment as well as molecular diagnostic methods and kits according to at least some embodiments of the present invention.
Diagnostic test kits (e.g. reagent kits) according to at least some embodiments of the present invention comprise reagents, materials and protocols for assessing one or more biomarkers, and instructions and software for comparing the biomarker data from a subject to biomarker data from healthy and diseased people to make risk assessment, diagnosis or prognosis of cardiac disease. Useful reagents and materials for kits include, but are not limited to PCR primers, hybridization probes and primers as described herein (e.g., labeled probes or primers), allele- specific oligonucleotides, reagents for genotyping SNP markers, reagents for detection of labeled molecules, restriction enzymes (e.g., for RFLP analysis), DNA polymerases, RNA polymerases, DNA ligases, marker enzymes, antibodies which bind to altered or to non-altered (native) cardiac disease risk gene encoded polypeptide, means for amplification of nucleic acids fragments from one or more cardiac disease risk genes described herein, means for analyzing the nucleic acid sequence of one or more cardiac disease risk genes or fragments thereof, or means for analyzing the sequence of one or more amino acid residues of cardiac disease risk gene encoded polypeptides, etc. In one embodiment, a kit for diagnosing susceptibility cardiac disease comprises primers and
reagents for detecting the nucleotides present in one or more polymorphisms described herein in an individual's nucleic acid.
Various types of biological samples may optionally be used with the polymorphisms of the present invention, for the diagnosis and/or prognosis of heart disease in a subject. Non-limiting examples of such sample types are described in greater detail below for the purpose of illustration only.
According to preferred embodiments of the present invention, examples of suitable biological samples which may optionally be used with preferred embodiments of the present invention include but are not limited to blood, serum, plasma, blood cells, urine, sputum, saliva, stool, spinal fluid or CSF, lymph fluid, the external secretions of the skin, respiratory, intestinal, and genitourinary tracts, tears, milk, neuronal tissue, lung tissue, any human organ or tissue, including any tumor or normal tissue, any sample obtained by lavage (for example of the bronchial system or of the breast ductal system). Diagnosis of a disease according to at least some embodiments of the present invention can be effected by determining a polymorphism in a biological sample obtained from the subject, wherein such determination can be correlated with predisposition to, or presence or absence of the disease. It should be noted that a "biological sample obtained from the subject" may also optionally comprise a sample that has not been physically removed from the subject.
Numerous well known tissue or fluid collection methods can be utilized to collect the biological sample from the subject in order to detect the polymorphism in the subject.
Examples include, but are not limited to, fine needle biopsy, needle biopsy, core needle biopsy and surgical biopsy (e.g., brain biopsy), and lavage. Regardless of the procedure employed, once a biopsy/sample is obtained the level of the variant can be determined and a diagnosis can thus be made.
EXAMPLES Reference is now made to the following examples, which together with the above description, illustrate the invention in a non limiting fashion.
Example 1: Association between ATlR polymorphism and heart failure
Methods
Study population
134 consecutive HF patients in a specialized HF center and 200 ethnically matched healthy control subjects who had no history or evidence of heart disease were studied. The HF patients had symptomatic systolic HF (echocardiographic LV ejection fraction <45%) for at least 3 months prior to recruitment. Etiology of HF was classified as ischemic or non-ischemic, based on a history of myocardial infarction and/or coronary angiography which were in keeping with the findings of reduced LV systolic function. Clinical and laboratory data were recorded and blood samples were obtained for genotypic analysis. Patients were followed over a period of 30 months, or up to an end point of death. Patients and controls were ethnically matched Israeli Caucasians, with an equivalent ratio of Ashkenazi and non-Ashkenazi descent. The study was approved by the Institution Review Board (Helsinki committee) of the Lady Davis Carmel Medical Center, and all patients gave written informed consent before inclusion in the study and the start of any study related procedures.
Genotyping for ATlR Polymorphism
Genomic DNA was extracted from peripheral blood leukocytes using a standard protocol [89]. Subjects were genotyped for the ATlR, using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) approach.
ATlR PCR fragments (404-bp length) encompassing the A1166C polymorphism were amplified from ~20 ng of each DNA sample used as template in 20μl polymerase chain reactions (PCR) containing 0.2U Taq polymerase, lxconcentration of the supplied buffer, 0.2mmol/L concentration of each deoxynucleotide triphosphate, and 10 pmol of each of the following primers: AGAAGCCTGCACCATGTTTTGAG
(sense) and CCTGTTGCTCCTCTAACGATTTA (antisense). The initial denaturation at 950C for 5 minutes was followed by 35 cycles of 940C for 30 seconds, 590C annealing for 30 seconds, and 650C elongation for 45 seconds. Then, 5μl of ATlR reaction was digested with 5 U of restriction endonuclease Dde I in the supplied (New
England Biolabs, MA, USA) for 2 hours at 370C. In the presence of the 1166C allele, the 404-bp PCR product was cut into 2 fragments of 118 and 286 bp in length.
Data analysis
The SPSS statistical package version 13.0 was used to perform all statistical evaluation (SSPS Inc., Chicago, IL, USA). A Chi-squared test was used to examine observed genotype frequencies in terms of the Hardy- Weinberg equilibrium and to compare the genotype frequencies between patients and controls. Genotype subtype comparisons were made by ANOVA and the Kruskal-Wallis test (asymmetrical data distribution). Continuous variables were compared by genotypes group by linear analysis of variance (ANOVA). Stepwise multiple linear regression analysis was used to evaluate whether the different ATlR alleles carried by each patient had statistical influence on clinical and laboratory parameters. Event- free survival was compared by
10 genotype class by Kaplan-Meier log rank analysis. Multivariate stepwise logistic regression model was used for assessment of the dominant variable effecting mortality. Asymmetrically distributed variables were log transformed before regression analysis. Continuous data are presented as mean + SD. Square multiple correlation coefficients (r2) were calculated.
15
Results Clinical features
Patients were aged 66+13 years. 109 (81%) were males. The etiology of HF was ischemic heart disease in 84 (63%) patients, 71 (53%) gave a history or were treated 5 for systemic hypertension, 51 (38%) for diabetes mellitus. Atrial fibrillation was present in 43 (32%) patients and mean QRS duration on the surface electrocardiogram was 137+49 milliseconds. Echocardiographic left ventricular (LV) end-diastolic dimension (6.0+0.7 cm) was increased and ejection fraction (EF) reduced (25+7%).
Treatment included angiotensin converting enzyme inhibitor (ACEI) and/or 10 angiotensin II receptors blockers (ARB) in 125 (93%) patients, aldosterone antagonists in 35 (26%) patients, and beta blockers in 112 (84%) patients.
Patients were all considerably disabled and 55% were in Functional Class 3 or
4 (New York Heart Association, NYHA). Over the course of follow-up, there were 11
(8%) deaths, 9 due to HF and 2 due to fatal arrhythmia. 15
Genotype distribution
There was no deviation from Hardy- Weinberg equilibrium, in either the HF patients group (allele frequency A/C = 0.74/0.26, expected genotype frequencies % 5 AA/AC/CC = 54%/39%/7%, X2=0.09, p = 0.95), or the control group (allele frequency A/C = 0.72/0.28, expected genotype frequencies % AA/AC/CC = 52%/40%/8%, X2=0.037, p = 0.98). Allele and genotype frequencies did not differ markedly between the groups (Table 2).
Figure 1 shows results of genotyping of ischemic (upper lanes, A) and non- 10 ischemic (lower lanes, B) HF patients for the A1166C polymorphism of the ATlR gene, using polymerase chain reaction (PCR). In the presence of the 1166C allele, the 404-bp PCR product was cut into 2 fragments of 118 and 286 bp in length. Homozygosity for the 1166C allele was observed exclusively in ischemic patients (upper lanes 1-4). Each lane represents genotyping results of each individual patient. 15 Comparison of HF etiology by ATlR genotype (Figure 1 and Table 3) revealed that all 10 patients who were homozygous for the C allele had ischemic cardiomyopathy (X2=4.82, p=0.02).
Haplotype analysis and clinical findings
To determine genotype-phenotype correlations, we compared clinical findings
5 in relation to ATlR genotype subtypes (Table 1). The ATlR CC genotype was associated with a higher serum creatinine level (p=0.008) and lower creatinine clearance. In a multivariate linear regression model which included the following clinical parameters: age, sex, BMI, etiology of ischemic cardiomyopathy, NYHA class, blood pressure, serum sodium level and mean QRS duration, ATlR CC
10 genotype was the second (after age) most powerful determinant of serum creatinine
(p=0.005). Most of the homozygous ATlR CC patients (80%) had a lower functional capacity, as manifested by an advanced NYHA class (NYHA>3). Echocardiographic
LV ejection fraction tended to be lower, but with overlap between the 2 groups (NS).
15 Mortality and survival analysis
Mortality was greater in patients with C allele (% deaths AA/AC/CC = 5%, 8%, 30%; X2=7.08, p = 0.02). The ATlR CC genotype was associated with poorer survival, while the best survival was among AA and AC patients (% survival at 15/20/30 months = 98%/91%/89%), and the poorest for CC homozygous (% survival 20 86%/69%/34%) (X2=11.71, p =0.002). Mortality in patients homozygous for the C allele was significantly higher compared to patients with AA and AC subtypes (% deaths CC/AC+AA = 30%, 6%; X2=4.04, p=0.04).
Survival analysis (Kaplan-Meier method) showed that patients with CC genotype had increased mortality and by 30 months a greater than two thirds 25 probability of death, compared to >80% survival in patients with AA or AC alleles (Figure 2).
Since it is already known that the ATlR 1166CC genotype is associated with ischemic heart disease and poor renal function, these parameters have been controlled
for in the multivariate analysis. Accordingly, a stepwise logistic regression ,model, adjusting for age, sex, BMI, ischemic/non-ischemic etiology, history of previous myocardial infarction, NYHA class, LVEF, blood pressure, baseline level of serum creatinine, serum sodium level and mean QRS duration, showed that ATlR CC genotype was the most powerful predictor of death (adjusted OR for mortality 6.35, 95% confidence interval 1.49 - 11.21, p =0.01).
Example 2: Association between aldosterone synthase (CYP11B2) T-344C polymorphism and atrial fibrillation
Methods
Study Population
The study population consisted of 191 HF patients, followed in a specialized tertiary referral HF center, and 200 ethnically matched healthy control subjects who had no history or evidence of heart disease. All the HF patients had symptomatic systolic HF (left ventricular ejection fraction, LVEF<40%) for at least 3 months prior to recruitment. Etiology of HF was classified as ischemic or non-ischemic, based on a history or lack thereof of myocardial infarction and/or coronary angiography, which were in keeping with the findings of reduced LV systolic function. Clinical and laboratory data were recorded and blood samples were obtained for genotypic analysis. Echocardiographic measurements of LVEF, left ventricular end diastolic diameter and left atrial (LA) dimension were made. Atrial fibrillation was diagnosed in patients who had atrial fibrillation on at least 2 occasions on a standard 12 lead electrocardiographic recording. The study was approved by the Institution Review Board (Helsinki Committee) of the Lady Davis Carmel Medical Center, and all patients gave written informed consent.
Genotyping for CYP11B2 polymorphism
Genomic DNA was extracted from peripheral blood leukocytes using a standard protocol [89]. Subjects were genotyped for the CYP11B2 polymorphism, using the polymerase chain reaction-restriction fragment length polymorphism (PCR- RFLP) approach. CYP11B2 PCR fragments (537-bp length) encompassing the T- 344C polymorphism were amplified from ~20 ng of each DNA sample used as template in 20μl polymerase chain reactions (PCR) containing 0.2U Taq polymerase,
lxconcentration of the supplied buffer (New England Biolabs, MA, USA), 0.2mmol/L concentration of each deoxynucleotide triphosphate, and 10 pmol of each of the following primers: CAGGAGGAGACCCCATGTGA (sense) and CCTCCACCCTGTTCAGCCC (antisense). The initial denaturation at 950C for 5 minutes was followed by 35 cycles of 940C for 30 seconds, 650C annealing for 30 seconds, and 650C elongation for 45 seconds. Then, 5μl of CYP11B2 reaction was digested with 5 U of restriction endonuclease Hae III in the supplied buffer for 2 hours at 370C. The -344T allele lacks a Hae III site present in the -344C allele, so - 344T alleles are detected as 273-bp fragments, while the -344C alleles are detected as Hae III fragments of 204 and 69-bp. Genotyping was performed by experienced staff. PCR scores by two independent investigators who were blind to subject data correlated well (r2=0.991).
Data analysis The SPSS statistical package version 13.0 was used for statistical analysis
(SSPS Inc., Chicago, IL, USA). A Chi-squared test was used to examine observed genotype frequencies in terms of the Hardy- Weinberg equilibrium, to compare the genotype frequencies between patients and controls, and for the analysis of gender ratios, presence of ischemic cardiomyopathy, hypertension, diabetes, and or atrial fibrillation. Genotype subtype comparisons were made by ANOVA and the Kruskal- Wallis test (asymmetrical data distribution). Continuous variables were compared by genotypes group by linear analysis of variance (ANOVA). Stepwise multiple linear regression analysis was used to evaluate whether the different CYP11B2 alleles carried by each patient had statistical influence on clinical and laboratory parameters. Multivariate stepwise logistic regression model was used for assessment of the dominant variable affecting AF. Asymmetrically distributed variables were log transformed before regression analysis. Continuous data are presented as mean + SD. Square multiple correlation coefficients (r2) were calculated.
Results
The clinical characteristics of the patients are summarized in Table 4. Patients were aged 65+13 years. 145 (81%) patients were males. The etiology of HF was ischemic in 112 (63%) patients, 97 (55%) patients had a history of, or treatment for, systemic hypertension, and 69 (39%) patients had diabetes mellitus. Atrial
fibrillation was present in 57 (32%) patients. Mean QRS on the surface electrocardiogram was 138+50 milliseconds. Mean echocardiographic left ventricular ejection fraction (LVEF) was 24+7%.
Treatment included angiotensin converting enzyme inhibitors (ACEI) and/or angiotensin II receptor blockers (ARB) in 164 (92%) patients, aldosterone antagonists in 48 (27%) patients, and beta blockers in 151 (86%) patients. All patients were symptomatic and 97 (55%) patients were in functional class 3 or 4 (New York Heart Association, NYHA). Over a course of 22+7 months follow-up, there were 16 (9%) deaths.
The data on allele and genotype frequencies in patients and controls are shown in Table 5. There was no deviation from Hardy- Weinberg equilibrium, in either the
HF patient group (allele frequency T/C = 0.48/0.52, expected genotype frequencies
%TT/TC/CC = 23%/50%/27%, X2=0.42, p = 0.81) or the control group (allele frequency T/C = 0.48/0.52, expected genotype frequencies %TT/TC/CC =
23%/50%/27%, X2=1.78, p = 0.40). Allele and genotype frequencies did not differ markedly between the groups (Table 5), and were similar to previously reported numbers in normal Caucasian populations [48,52,90-92]. Frequencies from dbSNP, using data for HAPMAP (CEPH samples), or a Caucasian group show similarities to the present data.
To determine genotype-phenotype correlations, patients' clinical characteristics were compared between CYP11B2 genotype subtypes. CYP11B2 polymorphism was not associated with the etiology of HF in these patients. There were no significant differences among the genotype subtypes in terms of gender distribution, history of hypertension or diabetes mellitus, medical therapy regimens, baseline systolic blood pressure levels, LVEF, LA size and the severity of mitral regurgitation (Table 4). However, the presence of AF was associated with CYPl 1B2 genotype (Table 4, Figure 3). Compared with the TT and TC genotype subgroup, a significant proportion of patients who were homozygous for the C allele had AF (X2=4.80, p = 0.02). The odds ratio for AF based on the CYPl 1B2 -344CC genotype was 2.24 (95% confidence interval 1.14-4.42).
To predict determinants of AF, relevant clinical measurements were included in a multivariate stepwise logistic regression model: age, sex, NYHA class, CYP11B2 -344CC genotype and echocardiographic measurements of LA size, LVEF and mitral regurgitation severity. The most powerful predictors of AF were LA size and age: odds ratio for AF 5.10 (95% confidence interval 3.23 - 8.05) per lcm increase in LA size (p=0.0004), and AF increasing 5.38% (95% confidence interval 3.48% - 7.31%) with each year of increasing age, for a 10 year age difference a 69% (95% confidence interval 41% - 102%) increase (p=0.0039). The CYP11B2 CC genotype remained an independent powerful predictor of AF (adjusted odds ratio 2.59, 95% confidence interval 1.68 - 3.98, p=0.02). There was no difference in clinical disability (NYHA class) or mortality in regard to CYP11B2 genotype.
Example 3: Association between Chymase and Angiotensin - Converting Enzyme Gene Polymorphisms in Chronic Systolic Heart Failure Patients
Methods
Study population
A case-control design was used to study 195 consecutive HF patients in a specialized HF center, and 200 population control subjects. Controls [165 (82.5%) males and 35 (17.5%) females, age 26 + 4 years] were all healthy individuals who had no history of or treatment for coronary artery disease, diabetes mellitus, hypertension or hypercholesterolemia.
The study and control groups were all Israeli residents with an equivalent ratio of Non-Ashkenazi and Ashkenazi descent (2:1). The HF patients had symptomatic systolic HF (echocardiographic LV ejection fraction <40%) for at least 3 months prior to recruitment. Etiology of HF was classified as ischemic or non-ischemic, based on a history or not of myocardial infarction and/or coronary angiography which were in keeping with the findings of reduced LV systolic function. Clinical and laboratory data were recorded and blood samples were obtained for genotypic analysis. Patients were followed over a period of 30 months, or up to an end point of death. The study was approved by the Institution Review Board (Helsinki committee) of the Lady Davis Carmel Medical Center, and all patients gave written informed consent before inclusion in the study.
Genotyping for ACE and CMAl polymorphisms
Genomic DNA was extracted from peripheral blood leukocytes using a standard protocol [89]. Genotyping of the ACE VD polymorphism was performed using polymerase chain reaction (PCR) according to the method of Lindpaintner et al.[93]. Genotyping for the CMAl 1903G/A polymorphism was conducted using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) approach, as described by Pfeufer et al.[72]. PCR fragments were amplified from ~20 ng of each DNA sample used as a template in 20μl polymerase chain reactions (PCR) containing 0.2U Taq polymerase, Ix concentration PCR buffer, 0.2mmol/L of each dNTP, and 10 pmol of each of the following primers: GGAAATGTGAGCAGATAGTGCAGT (CMΛi-sense) and
AATCCGGAGCTGGAGAACTCTTGTC (CMΛi-antisense), and GCCCTGCAGGTGTCTGCAGCATGT (AC£-sense) and
GGATGGCTCTCCCCGCCTTGTCTC (AC£-antisense).
The initial denaturation at 950C for 5 minutes was followed by 35 cycles of 940C for 30 seconds, 56-580C annealing for 30 seconds, and 650C elongation for 45 seconds. ACE VO genotypes were designated as follows: VI, a single band of 597-bp; D/I, two bands of 319- and 597-bp; and D/D, a single band of 319-bp. Because the D allele in heterozygous samples is preferentially amplified, there is a tendency to misclassify the ACE VO genotype as the D/D genotype. In order to avoid this misclassification, a second PCR was performed using I-specific primers: TGGGACCACAGCGCCCGCCACTAC (I-specific -sense) and
TCGCCAGCCCTCCCATGCCCATAA (I-specific -antisense). This PCR yields a 335-bp fragment only in the presence of the I allele, and no product in sample homozygous for the D allele. The CMAl PCR fragments (285-bp length) were digested with 10 U of restriction endonuclease Bst XI in the supplied buffer (New England Biolabs, MA, USA) for 2 hours at 550C. The -1903 A allele lacks a Bst XI site present in the -1903G allele, so -1903 A alleles are detected as uncut fragments of 285-bp while the -1903G alleles are detected as Bst XI fragments of 195 and 90-bp. Genotyping was performed by experienced staff. PCR scores by two independent investigators who were blind to subject data, correlated well (r2=0.991).
Data analysis
The SPSS statistical package version 13.0 was used for statistical evaluation (SPSS Inc, Chicago IL, USA). A chi square test was used to confirm that observed genotype frequencies were in Hardy-Weinberg equilibrium and to compare the genotype frequencies between patients and controls. Genotype subtypes comparisons were made by ANOVA and the Kruskal-Wallis test (asymmetrical data distribution). Continuous variables were compared by genotypes group by linear analysis of variance (ANOVA). Stepwise multiple linear regression analysis was used to evaluate whether the number of ACE and CMAl alleles carried by each patient had statistical influence on clinical and laboratory parameters. Asymmetrically distributed variables were log transformed before regression analysis. Continuous data are presented as mean + SD. Square multiple correlation coefficients (r2) were calculated. In order to adjust for multiple comparisons, P values were considered significant if <0.01.
Results
The clinical characteristics of the patients are summarized in Table 6.
Patients were aged 64+13 years, 162 (83%) were males. The etiology of HF was ischemic heart disease in 124 (64%) patients, 105 (54%) gave a history of or were treated for hypertension, 77 (39%) for diabetes mellitus. Atrial fibrillation was present in 63 (32%) patients and the mean QRS on the surface electrocardiogram was 137+45.5 milliseconds. Mean echocardiographic left ventricular (LV) end-diastolic dimension was 6.2+0.8 cm and ejection fraction (EF) 24+6.5%. Treatment included angiotensin converting enzyme inhibitor (ACEI) and/or angiotensin II receptor blockers (ARB) in 181 (93%) patients, direct aldosterone antagonists in 56 (29%) patients, and beta blockers in 167 (87%) patients. Patients were all considerably
disabled and 105 (54%) were in Functional Class 3 or 4 (New York Heart Association, NYHA). Over the course of follow-up, there were 17 (9%) deaths, 9 due to HF and 2 due to fatal arrhythmia.
The data on allele and genotype frequencies in patients and controls are shown in Table 7.
For both ACE VD and CMAl -1903G/A polymorphisms, there was no deviation from Hardy- Weinberg equilibrium in either the HF patients group (all) (allele frequency ACE VD = 0.38/0.62, expected genotype frequencies % IUIOfDO = 14%/47%/39%, χ2=0.60, P = 0.74; Allele frequency CMAl A/G = 0.53/0.47, expected genotype frequencies % AA/AG/GG = 28%/50%/22%, χ2=0.25, p=0.87), the ischemic HF patients group (allele frequency ACE IID = 0.36/0.64, expected genotype frequencies % II/ID/DD = 13%/46%/41%, χ2=0.20, P = 0.90; Allele frequency CMAl A/G = 0.57/0.43, expected genotype frequencies % AA/AG/GG = 32.5%/49%/18.5%, χ2=1.08, P=O.58), the non-ischemic HF patients group (allele frequency ACE HD = 0.42/0.58, expected genotype frequencies % II/ID/DD = 17%/49%/34%, χ2=0.47, P = 0.78; Allele frequency CMAl A/G = 0.46/0.54, expected genotype frequencies % AA/AG/GG = 21%/50%/29%, χ2=0.11, P=0.94), or the control group (allele frequency ACE I/O = 0.33/0.67, expected genotype frequencies % II/ID/DD =
ll%/44%/45%, χ2=0.38, P = 0.82; Allele frequency CMAl A/G = 0.48/0.52, expected genotype frequencies % AA/AG/GG = 23%/50%/27%, χ2=1.45, P = 0.48).
The subjects' age, gender distribution, and Ashkenazi/ non-Ashkenazi ancestry did not differ by either ACE VD or CMAl -1903G/A genotypes. For both ACE VD and CMAl -1903G/A polymorphisms, frequencies from dbSNP, using data for mixed European or Caucasian populations, show similarities to the present data. Allele (and genotype) frequencies of the whole cohort of HF patients were similar to that amongst healthy controls (Table 7). However, CMAl -1903G/A allele and genotype frequencies of the non-ischemic patients differed significantly from those of ischemic patients (Table 7). Moreover, comparison of HF etiology by CMAl genotype revealed that the CMAl -1903GG genotype was associated with non-ischemic HF etiology (Table 7 and Table 8, χ2=6.67, P = 0.009). The odds ratio for the CMAl GG genotype in non-ischemic patients was 2.48 (95% confidence interval 1.23-5.00). Importantly, ACE VD polymorphism was not associated with HF etiology in the patients of the present study.
To determine genotype-phenotype correlations, patients' clinical characteristics between genotype subtypes of each polymorphism were compared. Compared with the AA and AG genotype subgroup, homozygous CMAl GG patients had lower values of left ventricular ejection fraction (P = 0.005) (Table 8). Multivariate stepwise linear regression, adjusted for age, previous myocardial infarction, NYHA class, echocardiographic LV dimension and QRS duration on the surface electrocardiogram, showed that CMAl GG genotype (after echocardiographic LV dimension) was the most powerful independent predictor of reduced systolic
function (adjusted odds ratio 32.6, 95% confidence interval 11.9 - 89.3, P = 0.0007). The ACE D allele was not associated with the phenotypic expression of HF in our patients. It should be noted that no difference was found in clinical disability (NYHA class) and mortality in regard to either CMAl or ACE gene polymorphism.
Example 4: Impact of Different Cytokines in Heart Failure (HF) Patients
As described above, different cytokines were shown to have different effects in HF patients. Without wishing to be limited by a single hypothesis, it is believed that these results support the potential diagnostic and prognostic use of polymorphisms of inflammatory activity related genes, particularly (but not exclusively) with regard to polymorphisms of the cytokines themselves.
Interleukin-10 (IL-10) is an anti-inflammatory cytokine and consequently is considered by many to have a protective role in heart failure, as opposed to the "notorious" tumor necrosis factor-alpha (TNF-alpha). In the current study the hypothesis of the possible beneficial impact of IL-10 on mortality in systolic heart failure (HF) patients in relation to their circulating TNF-alpha levels was tested.
Methods: Circulating levels of IL-10 and TNF-alpha in 67 ambulatory systolic HF patients (aged 65+13) years were measured in the plasma via a blood test.
Results: Mortality was or tended higher in patients with higher levels (above median level) of circulating TNF-alpha (9/23, 39% vs 6/44, 14%, p=0.02) or IL-10 (10/34, 30% vs 5/33, 15%, p=0.10). However, mortality was highest in the sub-set of patients with elevation of both markers above median (7/16, 44% vs 8/51, 16%, p=0.019). Elevation of both markers was associated with more than a threefold hazard ratio for mortality (HR 3.67, 95% CI 1.14-11.78). Tables 9-11 show information about the patients and also the relationship between the levels of various cytokines and various other clinical parameters of the patients.
Figure 4A shows Kaplan-Meier survival curves according to circulating TNF- alpha levels (below and above median). Survival was reduced in patients with higher
TNF-alpha levels (p=0.02). Figure 4B shows Cox proportional hazard ratio curves according to combined circulating TNF-alpha and IL-10 levels (both below and above median). Survival was reduced in patients with higher TNF/IL-10 levels (p=0.03)
These results show that elevated circulating IL-10 levels in systolic HF patients do not have a protective counterbalance effect on mortality. Moreover, patients with elevated IL-10 and TNF-alpha had significantly higher mortality, suggesting that in fact such cytokines, and particularly polymorphisms of such cytokines, may have a significant biological effect which can be used for diagnostic and prognostic purposes.
It is appreciated that certain features of the invention, which are, for clarity, described in the context of separate embodiments, may also be provided in combination in a single embodiment. Conversely, various features of the invention, which are, for brevity, described in the context of a single embodiment, may also be provided separately or in any suitable subcombination.
Although the invention has been described in conjunction with specific embodiments thereof, it is evident that many alternatives, modifications and variations will be apparent to those skilled in the art. Accordingly, it is intended to embrace all such alternatives, modifications and variations that fall within the spirit and broad scope of the appended claims. All publications, patents and patent applications mentioned in this specification are herein incorporated in their entirety by reference into the specification, to the same extent as if each individual publication, patent or patent application was specifically and individually indicated to be incorporated herein by reference. In addition, citation or identification of any reference in this application shall not be construed as an admission that such reference is available as prior art to the present invention.
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APPENDIX I
ATlR
SNP name and number (in NCBI SNP database): ATlR A1166C rs5186
Gene name and number (in NCBI nucleotide database): ATlR angiotensin II receptor, type 1, NM_000685
1. Sequence of WT allele (A 1166) : CAGCTTCTAAAATATATTCCCCCAAAAGCCAAATCCCACTCAAACCTTTCA ACAAAAATGAGCACGCTTTCCTACCGCCCCTCAGATAATGTAAGCTCATC CACCAAGAAGCCTGCACCATGTTTTGAGGTTGAGTGACATGTTCGAAACC TGTCCATAAAGTAATTTTGTGAAAGAAGGAGCAAGAGAACATTCCTCTGC AGCACTTCACTACCAAATGAGCATTAGCTACTTTTCAGAATTGAAGGAGA AAATGCATTATGTGGACTGAACCGACTTTTCTAAAGCTCTGAACAAAAGC TTTTCTTTCCTTTTGCAACAAGACAAAGCAAAGCCACATTTTGCATTAGAC AGATGACGGCTGCTCGAAGAACAATGTCAGAAACTCGATGAATGTGTTGA TTTGAGAAATTTTACTGACAGAAATGCAATCTCCCTAGCCTGCTTTTGTCC TGTTATTTTTTATTTCCACATAAAGGTATTTAGAATA
2. Sequence of mutant (SNP bearing) allele (Cl 166):
CAGCTTCTAAAATATATTCCCCCAAAAGCCAAATCCCACTCAAACCTTTCA
ACAAAAATGAGCACGCTTTCCTACCGCCCCTCAGATAATGTAAGCTCATC
CACCAAGAAGCCTGCACCATGTTTTGAGGTTGAGTGACATGTTCGAAACC TGTCCATAAAGTAATTTTGTGAAAGAAGGAGCAAGAGAACATTCCTCTGC AGCACTTCACTACCAAATGAGCCTTAGCTACTTTTCAGAATTGAAGGAGA AAATGCATTATGTGGACTGAACCGACTTTTCTAAAGCTCTGAACAAAAGC TTTTCTTTCCTTTTGCAACAAGACAAAGCAAAGCCACATTTTGCATTAGAC AGATGACGGCTGCTCGAAGAACAATGTCAGAAACTCGATGAATGTGTTGA TTTGAGAAATTTTACTGACAGAAATGCAATCTCCCTAGCCTGCTTTTGTCC TGTTATTTTTTATTTCCACATAAAGGTATTTAGAATA
CYPl 1B2:
SNP name and SNP number (in NCBI SNP database): CYPl lB2 T-344C rs 1799998
Gene name and Genebank number (in NCBI nucleotide database): CYPl 1B2 aldosterone synthase, AC073385
3. Sequence of WT allele (-344T) (please note sequence is in reverse):
TCAAGGCTGGAGGCCCCCAGCCAAAGGTAGATGAAGGAGAAGTCAGGTG CCTAATTCCCCATTGCTGCAAGTCCTGCTGGTCTGAGGATGCTGAGAAAA GGCGTGGGGTCTGGACTGGGGGTCCATGCTGGTGGAAGGTGGTGGGACCT GGCCTCTCCTTTCTCCAGGGCTGAGAGGAGTAAAATGGATGGGGACTTTA TCTTATCGTGAGATGAGAGGGAGCCTTGGATTCTTTTAATAGACTTTATTT TTATACCACAGATTTAGTTCATTGCAAAATTGATCAAAAACTGCAGAAAA TGTCCACGTACCCCCTGCCCTGACACAGGTACACCCTCCACCACAGGAGC GCACTGGTTCCATGTGAGGAATCTCGATACGTTGTTATCAACCAGGGTCCT GGAGTCACATGGGGTCTCCTCCTGGTGGTCAACATGCTGTGGGTTTTGACA AATGTATGTAATTTGTATCCCTCCTTGCAGGATCCTAG
4. Sequence of mutant (SNP bearing) allele (-344C) (please note sequence is in reverse):
TCAAGGCTGGAGGCCCCCAGCCAAAGGTAGATGAAGGAGAAGTCAGGTG CCTAATTCCCCATTGCTGCAAGTCCTGCTGGTCTGAGGATGCTGAGAAAA GGCGTGGGGTCTGGACTGGGGGTCCATGCTGGTGGAAGGTGGTGGGACCT GGCCTCTCCTTTCTCCAGGGCTGAGAGGAGTAAAATGGATGGGGACTTTA TCTTATCGTGAGATGAGAGGGGGCCTTGGATTCTTTTAATAGACTTTATTT TTATACCACAGATTTAGTTCATTGCAAAATTGATCAAAAACTGCAGAAAA TGTCCACGTACCCCCTGCCCTGACACAGGTACACCCTCCACCACAGGAGC GCACTGGTTCCATGTGAGGAATCTCGATACGTTGTTATCAACCAGGGTCCT GGAGTCACATGGGGTCTCCTCCTGGTGGTCAACATGCTGTGGGTTTTGACA AATGTATGTAATTTGTATCCCTCCTTGCAGGATCCTAG
CMAl
SNP name and number (in NCBI SNP database): CMAl G- 1903 A rs 1800875
Gene name and number (in NCBI nucleotide database): chymase 1, mast cell, M64269
5. Sequence of WT allele (G- 1903) :
GTTCACTACCAACATGCTATATATAAAATAACCAAAGGGGGAAGAAGAA AGAGAAAAAGGAAATCTCTTAAAATACACAGGTATACATATGACAAAGC AAAGAAGGAAATGTGAGCAGATAGCGCAGTCCTCGTTTCTGAAATTGGTC CCCTGACTGGGGCTATACCTATTCCATTTCCTCACCCTCAGCCAGGCAGGT GGAGCAAAACTTAAGTCTTGGTGGATCTGAATCTTGATGCTGTGGAGCTG TCTTACTAGCCCCAGACTACCTGCCTCTCAATTTCTAATTATATCAGTGAA AGCAAACAGCTTTGATTTGTTTAAGCCTCTGATTTTTTGGTCTAACTGATG TAAGACCACAAGACAAGAGTTCTCCAGCTCCGGATTCTCTTCTGTTCTGTT AATGGTGAAATGCCCAGAG
6. Sequence of mutant (SNP bearing) allele (G-1903A):
GTTCACTACCAACATGCTATATATAAAATAACCAAAGGGGGAAGAAGAA AGAGAAAAAGGAAATCTCTTAAAATACACAGGTATACATATGACAAAGC AAAGAAGGAAATGTGAGCAGATAGCGCAGTCCTCGTTTCTGAAATTGGTC CCCTGACTGGGGCTATACCTATTCCATTTCCTCACCCTCAGCCAGGCAGGT GAAGCAAAACTTAAGTCTTGGTGGATCTGAATCTTGATGCTGTGGAGCTG TCTTACTAGCCCCAGACTACCTGCCTCTCAATTTCTAATTATATCAGTGAA AGCAAACAGCTTTGATTTGTTTAAGCCTCTGATTTTTTGGTCTAACTGATG TAAGACCACAAGACAAGAGTTCTCCAGCTCCGGATTCTCTTCTGTTCTGTT AATGGTGAAATGCCCAGAG
BDKRB2
SNP name and number (in NCBI SNP database): Not found The SNP is an insertion/deletion of 9 bp (nucleotides). Gene name and number (in NCBI nucleotide database): bradykinin receptor B2, NM_000623
7. Sequence of WT allele (insertion):
CTCCGAGGAGGGGTGGGGACGGTCCTGACGGTGGGGACATCAGGCTGCC CCGCAGTACCAGGGAGCGACTTGAAGTGCCCATGCCGCTTGCTCCGGGAG AAGCCCAGGTGTGGCCTCACTCACATCCCACTCTGAGTCCA
8. Sequence of mutant allele (deletion):
CTCCGAGGAGGGGTGGGGACGGTXXXXXXXXXGGGGACATCAGGCTGCC CCGCAGTACCAGGGAGCGACTTGAAGTGCCCATGCCGCTTGCTCCGGGAG AAGCCCAGGTGTGGCCTCACTCACATCCCACTCTGAGTCCA
ADRB2
SNP name and number (in NCBI SNP database):
ADRB2 GIy (G) 16 Arg (R) [G46A (according to mRNA NM_000024) nucleotide numbering starts at the start codon], rs 1042713
Gene name and number (in NCBI nucleotide database): adrenergic, beta-2-, receptor, surface, NM_000024
Also known as: BAR; B2AR; ADRBR; ADRB2R; BETA2AR
9. Sequence of WT allele [GIy (G) 16, G46]:
CGGCTTCTTCAGAGCACGGGCTGGAACTGGCAGGCACCGCGAGCCCCTAG CACCCGACAAGCTGAGTGTGCAGGACGAGTCCCCACCACACCCACACCAC AGCCGCTGAATGAGGCTTCCAGGCGTCCGCTCGCGGCCCGCAGAGCCCCG CCGTGGGTCCGCCCGCTGAGGCGCCCCCAGCCAGTGCGCTCACCTGCCAG
ACTGCGCGCCATGGGGCAACCCGGGAACGGCAGCGCCTTCTTGCTGGCAC CCAATGGAAGCCATGCGCCGGACCACGACGTCACGCAGGAAAGGGACGA GGTGTGGGTGGTGGGCATGGGCATCGTCATGTCTCTCATCGTCCTGGCCAT CGTGTTTGGCAATGTGCTGGTCATCACAGCCATTGCCAAGTTCGAGCGTCT GCAGACGGTCACCAACTACTTCATCACTTCACTGGCCTGTGCTGATCTGGT CATGGGCCTGGCAGTGGTGCCCTTTGGGGCCGCCCATATTCTTATGAAAAT GTGGACTT
10. Sequence of mutant (SNP bearing) allele [Arg (A)16, A46]: CGGCTTCTTCAGAGCACGGGCTGGAACTGGCAGGCACCGCGAGCCCCTAG CACCCGACAAGCTGAGTGTGCAGGACGAGTCCCCACCACACCCACACCAC AGCCGCTGAATGAGGCTTCCAGGCGTCCGCTCGCGGCCCGCAGAGCCCCG CCGTGGGTCCGCCCGCTGAGGCGCCCCCAGCCAGTGCGCTCACCTGCCAG ACTGCGCGCCATGGGGCAACCCGGGAACGGCAGCGCCTTCTTGCTGGCAC CCAATAGAAGCCATGCGCCGGACCACGACGTCACGCAGGAAAGGGACGA GGTGTGGGTGGTGGGCATGGGCATCGTCATGTCTCTCATCGTCCTGGCCAT CGTGTTTGGCAATGTGCTGGTCATCACAGCCATTGCCAAGTTCGAGCGTCT GCAGACGGTCACCAACTACTTCATCACTTCACTGGCCTGTGCTGATCTGGT CATGGGCCTGGCAGTGGTGCCCTTTGGGGCCGCCCATATTCTTATGAAAAT GTGGACTT
ADRB2
SNP name and number (in NCBI SNP database): ADRB2 GIu (E) 27 GIn (Q), [G79C (according to mRNA NM_000024), nucleotide numbering starts at the start codon], rs 1042714
Gene name and number (in NCBI nucleotide database): adrenergic, beta-2-, receptor, surface, NM_000024
Also known as: BAR; B2AR; ADRBR; ADRB2R; BETA2AR
11. Sequence of WT allele [GIu (E)27, G79]:
GCACCGCGAGCCCCTAGCACCCGACAAGCTGAGTGTGCAGGACGAGTCCC
CACCACACCCACACCACAGCCGCTGAATGAGGCTTCCAGGCGTCCGCTCG
CGGCCCGCAGAGCCCCGCCGTGGGTCCGCCCGCTGAGGCGCCCCCAGCCA GTGCGCTCACCTGCCAGACTGCGCGCCATGGGGCAACCCGGGAACGGCAG CGCCTTCTTGCTGGCACCCAATGGAAGCCATGCGCCGGACCACGACGTCA CGCAGGAAAGGGACGAGGTGTGGGTGGTGGGCATGGGCATCGTCATGTC TCTCATCGTCCTGGCCATCGTGTTTGGCAATGTGCTGGTCATCACAGCCAT TGCCAAGTTCGAGCGTCTGCAGACGGTCACCAACTACTTCATCACTTCACT GGCCTGTGCTGATCTGGTCATGGGCCTGGCAGTGGTGCCCTTTGGGGCCG CCCATATTCTTATGAAAATGTGGACTTTTGGCAACTTCTGGTGCGAGTTTT GGACTTCCA
12. Sequence of mutant (SNP bearing) allele [GIn (Q)27, C79]:
GCACCGCGAGCCCCTAGCACCCGACAAGCTGAGTGTGCAGGACGAGTCCC CACCACACCCACACCACAGCCGCTGAATGAGGCTTCCAGGCGTCCGCTCG CGGCCCGCAGAGCCCCGCCGTGGGTCCGCCCGCTGAGGCGCCCCCAGCCA GTGCGCTCACCTGCCAGACTGCGCGCCATGGGGCAACCCGGGAACGGCAG CGCCTTCTTGCTGGCACCCAATGGAAGCCATGCGCCGGACCACGACGTCA CGCAGCAAAGGGACGAGGTGTGGGTGGTGGGCATGGGCATCGTCATGTCT CTCATCGTCCTGGCCATCGTGTTTGGCAATGTGCTGGTCATCACAGCCATT GCCAAGTTCGAGCGTCTGCAGACGGTCACCAACTACTTCATCACTTCACTG GCCTGTGCTGATCTGGTCATGGGCCTGGCAGTGGTGCCCTTTGGGGCCGCC CATATTCTTATGAAAATGTGGACTTTTGGCAACTTCTGGTGCGAGTTTTGG ACTTCCA
ADRB2
SNP name and number (in NCBI SNP database): ADRB2 Thr(T) 164 He (I), [C491T (according to mRNA NM_000024), nucleotide numbering starts at the start codon, position on NW_001838953 is 6928765 and position on NT_029289 is 9369821], rsl8OO888.
Gene name and number (in NCBI nucleotide database): adrenergic, beta-2-, receptor, surface, NM_000024 (mRNA transcript) from homo sapiens chromosome 5 genomic contig (NW_001838953 or NT_029289).
Also known as: BAR; B2AR; ADRBR; ADRB2R; BETA2AR
13. Sequence of WT allele [Thr (T) 164, C491 ] :
ATCTGGTCATGGGCCTGGCAGTGGTGCCCTTTGGGGCCGCCCATATTCTTA TGAAAATGTGGACTTTTGGCAACTTCTGGTGCGAGTTTTGGACTTCCATTG ATGTGCTGTGCGTCACGGCCAGCATTGAGACCCTGTGCGTGATCGCAGTG GATCGCTACTTTGCCATTACTTCACCTTTCAAGTACCAGAGCCTGCTGACC AAGAATAAGGCCCGGGTGATCATTCTGATGGTGTGGATTGTGTCAGGCCT TACCTCCTTCTTGCCCATTCAGATGCACTGGTACCGGGCCACCCACCAGGA AGCCATCAACTGCTATGCCAATGAGACCTGCTGTGACTTCTTCACGAACC AAGCCTATGCCATTGCCTCTTCCATCGTGTCCTTCTACGTTCCCCTGGTGAT CATGGTCTTCGTCTACTCCAGGGTCTTTCAGGAGGCCAAAAGGCAGCTCC AGAAGATTGACAAATCTGAGGGCCGCTTCCATGTCCAGAACCTTAGCCAG GTGGA
14. Sequence of mutant (SNP bearing) allele [He (1)164, T491]:
ATCTGGTCATGGGCCTGGCAGTGGTGCCCTTTGGGGCCGCCCATATTCTTA TGAAAATGTGGACTTTTGGCAACTTCTGGTGCGAGTTTTGGACTTCCATTG ATGTGCTGTGCGTCACGGCCAGCATTGAGACCCTGTGCGTGATCGCAGTG GATCGCTACTTTGCCATTACTTCACCTTTCAAGTACCAGAGCCTGCTGACC AAGAATAAGGCCCGGGTGATCATTCTGATGGTGTGGATTGTGTCAGGCCT
TATCTCCTTCTTGCCCATTCAGATGCACTGGTACCGGGCCACCCACCAGGA AGCCATCAACTGCTATGCCAATGAGACCTGCTGTGACTTCTTCACGAACC AAGCCTATGCCATTGCCTCTTCCATCGTGTCCTTCTACGTTCCCCTGGTGAT CATGGTCTTCGTCTACTCCAGGGTCTTTCAGGAGGCCAAAAGGCAGCTCC AGAAGATTGACAAATCTGAGGGCCGCTTCCATGTCCAGAACCTTAGCCAG GTGGA
ADRBl
SNP name and number (in NCBI SNP database): ADRBl Ser (S) 49 GIy (G), [A145G (according to mRNA NM_000684), nucleotide numbering starts at the start codon], rs 1801252
Gene name and number (in NCBI nucleotide database): adrenergic, beta-1-, receptor, NM_000684
Also known as: RHR; BlAR; ADRBlR; BETAlAR
15. Sequence of WT allele [Ser (S)49; A145]:
TGACCCGGCCGCGACCTCCCTCTGCGCACCACGCCGCCCGGGCTTCTGGG
GTGTTCCCCAACCACGGCCCAGCCCTGCCACACCCCCCGCCCCCGGCCTCC
GCAGCTCGGCATGGGCGCGGGGGTGCTCGTCCTGGGCGCCTCCGAGCCCG GTAACCTGTCGTCGGCCGCACCGCTCCCCGACGGCGCGGCCACCGCGGCG CGGCTGCTGGTGCCCGCGTCGCCGCCCGCCTCGTTGCTGCCTCCCGCCAGC GAAAGCCCCGAGCCGCTGTCTCAGCAGTGGACAGCGGGCATGGGTCTGCT GATGGCGCTCATCGTGCTGCTCATCGTGGCGGGCAATGTGCTGGTGATCG TGGCCATCGCCAAGACGCCGCGGCTGCAGACGCTCACCAACCTCTTCATC ATGTCCCTGGCCAGCGCCGACCTGGTCATGGGGCTGCTGGTGGTGCCGTT CGGGGCCACCATCGTGGTGTGGGGCCGCTGGGAGTACGGCTCCTTCTTCT GCGAGCTGT
16. Sequence of mutant (SNP bearing) allele [GIy (G)49, G145]: TGACCCGGCCGCGACCTCCCTCTGCGCACCACGCCGCCCGGGCTTCTGGG GTGTTCCCCAACCACGGCCCAGCCCTGCCACACCCCCCGCCCCCGGCCTCC GCAGCTCGGCATGGGCGCGGGGGTGCTCGTCCTGGGCGCCTCCGAGCCCG GTAACCTGTCGTCGGCCGCACCGCTCCCCGACGGCGCGGCCACCGCGGCG CGGCTGCTGGTGCCCGCGTCGCCGCCCGCCTCGTTGCTGCCTCCCGCCAGC GAAGGCCCCGAGCCGCTGTCTCAGCAGTGGACAGCGGGCATGGGTCTGCT GATGGCGCTCATCGTGCTGCTCATCGTGGCGGGCAATGTGCTGGTGATCG TGGCCATCGCCAAGACGCCGCGGCTGCAGACGCTCACCAACCTCTTCATC ATGTCCCTGGCCAGCGCCGACCTGGTCATGGGGCTGCTGGTGGTGCCGTT CGGGGCCACCATCGTGGTGTGGGGCCGCTGGGAGTACGGCTCCTTCTTCT GCGAGCTGT
ADRBl
SNP name and number (in NCBI SNP database):
ADRBl Arg (R) 389 GIy (G), [C1165G (according to mRNA NM_000684), nucleotide numbering starts at the start codon,], rsl801253 Gene name and number (in NCBI nucleotide database): adrenergic, beta-1-, receptor, NM_000684
Also known as: RHR; BlAR; ADRBlR; BETAlAR
17. Sequence of WT allele [Arg (R)389; Cl 165]:
CCCCGCGCCCCGCCGCCGCCGCCGCCACCGCCCCGCTGGCCAACGGGCGT GCGGGTAAGCGGCGGGCCCTCGCGCCTCGTGGCCCTGCGCGAGCAGAAG GCGCTCAGGACGCTGGGCATCATCATGGGCGTCTTCACGCTCTGCTGGCT GCCCTTCTTCCTGGCCAACGTGGTGAAGGCCTTCCACCGCGAGCTGGTGCC CGACCGCCTCTTCGTCTTCTTCAACTGGCTGGGCTACGCCAACTCGGCCTT CAACCCCATCATCTACTGCCGCAGCCCCGACTTCCGCAAGGCCTTCCAGC GACTGCTCTGCTGCGCGCGCAGGGCTGCCCGCCGGCGCCACGCGACCCAC GGAGACCGGCCGCGCGCCTCGGGCTGTCTGGCCCGGCCCGGACCCCCGCC ATCGCCCGGGGCCGCCTCGGACGACGACGACGACGATGTCGTCGGGGCCA CGCCGCCCGCGCGCCTGCTGGAGCCCTGGGCCGGCTGCAACGGCGGGGCG GCGGCGGACAGCGACTCGAGCCTGGACGAGCCGTGCCGCCCCGGCTTCGC CTCGGAATCCAAGGTGTAGGGCCCGGCGCGGGGCGCGGACTCCGGGCAC G
18. Sequence of mutant (SNP bearing) allele [GIy (G)389, G1165]:
CCCCGCGCCCCGCCGCCGCCGCCGCCACCGCCCCGCTGGCCAACGGGCGT GCGGGTAAGCGGCGGGCCCTCGCGCCTCGTGGCCCTGCGCGAGCAGAAG GCGCTCAGGACGCTGGGCATCATCATGGGCGTCTTCACGCTCTGCTGGCT GCCCTTCTTCCTGGCCAACGTGGTGAAGGCCTTCCACCGCGAGCTGGTGCC CGACCGCCTCTTCGTCTTCTTCAACTGGCTGGGCTACGCCAACTCGGCCTT CAACCCCATCATCTACTGCCGCAGCCCCGACTTCCGCAAGGCCTTCCAGG GACTGCTCTGCTGCGCGCGCAGGGCTGCCCGCCGGCGCCACGCGACCCAC GGAGACCGGCCGCGCGCCTCGGGCTGTCTGGCCCGGCCCGGACCCCCGCC ATCGCCCGGGGCCGCCTCGGACGACGACGACGACGATGTCGTCGGGGCCA CGCCGCCCGCGCGCCTGCTGGAGCCCTGGGCCGGCTGCAACGGCGGGGCG GCGGCGGACAGCGACTCGAGCCTGGACGAGCCGTGCCGCCCCGGCTTCGC CTCGGAATCCAAGGTGTAGGGCCCGGCGCGGGGCGCGGACTCCGGGCAC G
ADRAlA
SNP name and number (in NCBI SNP database):
ADRAlA Arg (R)347 Cys (C), [C1039T according to mRNA variants (NM_000680, NM_033302, NM_033303, NM_033304), nucleotide numbering starts at the start codon,], rs 1048101
Gene name and number (in NCBI nucleotide database): adrenergic, alpha-lA-, receptor, NM_000680, NM_033302, NM_033303, NM_033304 (4 different splice variants) Also known as: ADRAlC; ADRAlLl; ALPHAlAAR
19. Sequence of WT allele [Arg (R)347; C1039]: GTCAGTCAAATGTGAGAAACTCATATGTGTTTGGGATCATTTTAACCGTTT AAAAATACAGAAAGATGTCTGTTTGATTGTTTTCCTAGCCAATTGGCTTGC TGGCTTTCAAATAATATGTATAAATCTGTGTGTTTTCTTCCAGGGTCTTTCT TCCCTGATTTCAAGCCCTCTGAAACAGTTTTTAAAATAGTATTTTGGCTCG GATATCTAAACAGCTGCATCAACCCCATCATATACCCATGCTCCAGCCAA GAGTTCAAAAAGGCCTTTCAGAATGTCTTGAGAATCCAGTGTCTCCGCAG AAAGCAGTCTTCCAAACATGCCCTGGGCTACACCCTGCACCCGCCCAGCC AGGCCGTGGAAGGGCAACACAAGGACATGGTGCGCATCCCCGTGGGATC AAGAGAGACCTTCTACAGGATCTCCAAGACGGATGGCGTTTGTGAATGGA AATTTTTCTCTTCCATGCCCCGTGGATCTGCCAGGATTACAGTGTCCAAAG ACCAATCCTCCTGTACCACAGCCCGGGTGAGAAGTAAAAGCTTTTTGCAG GTCTGCTGCTGTGTAGGGCCCTCAACCCCCAGCCTT
20. Sequence of mutant (SNP bearing) allele [Cys (Q347, T1039]:
GTCAGTCAAATGTGAGAAACTCATATGTGTTTGGGATCATTTTAACCGTTT AAAAATACAGAAAGATGTCTGTTTGATTGTTTTCCTAGCCAATTGGCTTGC TGGCTTTCAAATAATATGTATAAATCTGTGTGTTTTCTTCCAGGGTCTTTCT TCCCTGATTTCAAGCCCTCTGAAACAGTTTTTAAAATAGTATTTTGGCTCG GATATCTAAACAGCTGCATCAACCCCATCATATACCCATGCTCCAGCCAA GAGTTCAAAAAGGCCTTTCAGAATGTCTTGAGAATCCAGTGTCTCTGCAG AAAGCAGTCTTCCAAACATGCCCTGGGCTACACCCTGCACCCGCCCAGCC AGGCCGTGGAAGGGCAACACAAGGACATGGTGCGCATCCCCGTGGGATC AAGAGAGACCTTCTACAGGATCTCCAAGACGGATGGCGTTTGTGAATGGA AATTTTTCTCTTCCATGCCCCGTGGATCTGCCAGGATTACAGTGTCCAAAG ACCAATCCTCCTGTACCACAGCCCGGGTGAGAAGTAAAAGCTTTTTGCAG GTCTGCTGCTGTGTAGGGCCCTCAACCCCCAGCCTT
ADRA2B
SNP name and number (in NCBI SNP database):
ADRA2B 894+ AGAGGAGGA (insertion/deletion polymorphism), rs29000568 Gene name and number (in NCBI nucleotide database): adrenergic, alpha- 2B-, receptor, NM_000682
Also known as: ADRA2L1; ADRARLl; ADRA2RL1; ALPHA2BAR 21. Sequence of WT allele
AGAGGAGGAiTGGGCAGGGTGAGTCCAAGCAGCCCCGACCCGACCATGGT GGGGCTTTGGCCTCAGCCAAACTGCCAGCCCTGGCCTCTGTGGCTTCTGCC AGAGAGGTCAACGGACACTCGAAGTCCACTGGGGAGAAGGAGGAGGGGG AGACCCCTGAAGATACTGGGACCCGGGCCTTGCCACCCAGTTGGGCTGCC CTTCCCAACTCAGGCCAGGGCCAGAAGGAGGGTGTTTGTGGGGCATCTCC AGAGGATGAAGCTGAAGAGGAGGAGGAGGAGGAGGAAGAGTGTGAACC CCAGGCAGTGCCAGTGTCTCCGGCCTCAGCTTGCAGCCCCCCGCTGCAGC AGCCACAGGGCTCCCGGGTGCTGGCCACCCTACGTGGCCAGGTGCTCCTG GGCAGGGGCGTGGGTGCTATAGGTGGGCAGTGGTGGCGTCGACGGGCGC AGCTGACCCGGGAGAAGCGCTTCACCTTCGTGCTGGCTGTGGTCATTGGC GTTTTTGTGCTCTGCTGGTTCCC
22. Sequence of mutant allele (deletion) -
AGAGGAGGATGGGCAGGGTGAGTCCAAGCAGCCCCGACCCGACCATGGT GGGGCTTTGGCCTCAGCCAAACTGCCAGCCCTGGCCTCTGTGGCTTCTGCC AGAGAGGTCAACGGACACTCGAAGTCCACTGGGGAGAAGGAGGAGGGGG AGACCCCTGAAGATACTGGGACCCGGGCCTTGCCACCCAGTTGGGCTGCC CTTCCCAACTCAGGCCAGGGCCAGAAGGAGGGTGTTTGTGGGGCATCTCC AGAGGATGAAGCTGAXXXXXXXXXGGAGGAGGAGGAAGAGTGTGAACC CCAGGCAGTGCCAGTGTCTCCGGCCTCAGCTTGCAGCCCCCCGCTGCAGC AGCCACAGGGCTCCCGGGTGCTGGCCACCCTACGTGGCCAGGTGCTCCTG GGCAGGGGCGTGGGTGCTATAGGTGGGCAGTGGTGGCGTCGACGGGCGC AGCTGACCCGGGAGAAGCGCTTCACCTTCGTGCTGGCTGTGGTCATTGGC GTTTTTGTGCTCTGCTGGTTCCC
ILlO
SNP name and number (in NCBI SNP database): ILlO C-592A, rs 1800872 (position 377537 on NWJ)Ol 838536)
Gene name and number (in NCBI nucleotide database):
ILlO, interleukin 10, NM-000572 (mRNA transcript) from Homo sapiens chromosome 1 genomic contig(NW_001838536, nucleotides372078-376969). Also known as: CSIF; TGIF; IL-10; ILlOA; MGC126450; MGC126451
23. Sequence of the WT allele: C-592:
GAGATGGTGTACAGTAGGGTGAGGAAACCAAATTCTCAGTTGGCACTGGT GTACCCTTGTACAGGTGATGTAACATCTCTGTGCCTCAGTTTGCTCACTAT AAAATAGAGACGGTAGGGGTCATGGTGAGCACTACCTGACTAGCATATAA
GAAGCTTTCAGCAAGTGCAGACTACTCTTACCCACTTCCCCCAAGCACAG TTGGGGTGGGGGACAGCTGAAGAGGTGGAAACATGTGCCTGAGAATCCT AATGAAATCGGGGTAAAGGAGCCTGGAACACATCCTGTGACCCCGCCTGT CCTGTAGGAAGCCAGTCTCTGGAAAGTAAAATGGAAGGGCTGCTTGGGA ACTTTGAGGATATTTAGCCCACCCCCTCATTTTTACTTGGGGAAACTAAGG CCCAGAGACCTAAGGTGACTGCCTAAGTTAGCAAGGAGAAGTCTTGGGTA TTCATCCCAGGTTGGGGGGACCCAATTATTTCTCAATCCCATTGTATTCTG GAATGGGCAATTTGTCCACGTCACTGTGACCTAGGAACACGCGAATGAGA ACCCACAGCTGAGGGCCTCTGCGCACAGAACAGCTGTTCTCCCCAGGAAA
24. Sequence of the mutant (SNP bearing) allele: A-592:
GAGATGGTGTACAGTAGGGTGAGGAAACCAAATTCTCAGTTGGCACTGGT GTACCCTTGTACAGGTGATGTAACATCTCTGTGCCTCAGTTTGCTCACTAT AAAATAGAGACGGTAGGGGTCATGGTGAGCACTACCTGACTAGCATATAA GAAGCTTTCAGCAAGTGCAGACTACTCTTACCCACTTCCCCCAAGCACAG TTGGGGTGGGGGACAGCTGAAGAGGTGGAAACATGTGCCTGAGAATCCT AATGAAATCGGGGTAAAGGAGCCTGGAACACATCCTGTGACCCCGCCTGT ACTGTAGGAAGCCAGTCTCTGGAAAGTAAAATGGAAGGGCTGCTTGGGA ACTTTGAGGATATTTAGCCCACCCCCTCATTTTTACTTGGGGAAACTAAGG CCCAGAGACCTAAGGTGACTGCCTAAGTTAGCAAGGAGAAGTCTTGGGTA TTCATCCCAGGTTGGGGGGACCCAATTATTTCTCAATCCCATTGTATTCTG GAATGGGCAATTTGTCCACGTCACTGTGACCTAGGAACACGCGAATGAGA ACCCACAGCTGAGGGCCTCTGCGCACAGAACAGCTGTTCTCCCCAGGAAA
ILlO SNP name and number (in NCBI SNP database) :
ILlO A-1082G, rsl800896 (position 378027 on NW_001838536)
Gene name and number (in NCBI nucleotide database):
ILlO, interleukin 10, NM_000572 (mRNA transcript) from Homo sapiens chromosome 1 genomic contig (NWJ)Ol 838536, nucleotides372078-376969).
Also known as: CSIF; TGIF; IL-10; ILlOA; MGC126450; MGC126451
25. Sequence of the WT allele: A-1082:
TCAATGCTCCCTGGCAGGCAGGAGGACAGGTGCTATTGCCCTGTTGGGAC AGATGAAAAACAGACACAGGGAGGATGAGTGATTTGCCCTGACTATAGA GTGGCAGGGCCAAGGCAGAGCCCAGGCCTCCTGCACCTAGGTCAGTGTTC CTCCCAGTTACAGTCTAAACTGGAATGGCAGGCAAAGCCCCTGTGGAAGG GGAAGGTGAAGCTCAAATCAAAGCTCNNCCAGAGACTTTCCAGATATCTG AAGAAGTCCTGATGTCACTGCCCCGGTCCTTCCCCAGGTAGAGCAACACT CCTCGCCGCAACCCAACTGGCTCTCCTTACTTTCTACACACACACACACAC
ACACACACACACACACACACACACACACAAATCCAAGACAACACTACTA AGGCTTCTTTGGGAAGGGGAAGTAGGGATAGGTAAGAGGAAAGTAAGGG ACCTCCTATCCAGCCTCCATGGAATCCTGACTTCTTTTCCTTGTTATTTCAA CTTCTTCCACCCCATCTTTTAAACTTTAGACTCCAGCCACAGAAGCTTACA ACTAAAAGAAACTCTAAGGCCAATTTAATCCAAGGTTTCATTCTATGTGCT GGAGATGGTGTACAGTAGGGTGAGGAAACCAAATTCTCAGTTGGCACTGG TG
26. Sequence of the mutant (SNP bearing) allele: G-1082:
TCAATGCTCCCTGGCAGGCAGGAGGACAGGTGCTATTGCCCTGTTGGGAC AGATGAAAAACAGACACAGGGAGGATGAGTGATTTGCCCTGACTATAGA GTGGCAGGGCCAAGGCAGAGCCCAGGCCTCCTGCACCTAGGTCAGTGTTC CTCCCAGTTACAGTCTAAACTGGAATGGCAGGCAAAGCCCCTGTGGAAGG GGAAGGTGAAGCTCAAATCAAAGCTCNNCCAGAGACTTTCCAGATATCTG AAGAAGTCCTGATGTCACTGCCCCGGTCCTTCCCCAGGTAGAGCAACACT CCTCGCCGCAACCCAACTGGCTCTCCTTACTTTCTACACACACACACACAC ACACACACACACACACACACACACACACAAATCCAAGACAACACTACTA AGGCTTCTTTGGGAGGGGGAAGTAGGGATAGGTAAGAGGAAAGTAAGGG ACCTCCTATCCAGCCTCCATGGAATCCTGACTTCTTTTCCTTGTTATTTCAA CTTCTTCCACCCCATCTTTTAAACTTTAGACTCCAGCCACAGAAGCTTACA ACTAAAAGAAACTCTAAGGCCAATTTAATCCAAGGTTTCATTCTATGTGCT GGAGATGGTGTACAGTAGGGTGAGGAAACCAAATTCTCAGTTGGCACTGG TG
ILlO
SNP name and number (in ncbi database):
ILlO T-819C (position 377764 on NWJ)Ol 838536), no rs number in ncbi SNP database.
Gene name and number (in ncbi database):
ILlO, interleukin 10, NM_000572 (mRNA transcript) from Homo sapiens chromosome 1
Genomic contig (NWJ)Ol 838536, nucleotides 372078-376969). Also known as: CSIF, TGIF, IL-10, ILlOA, MGC126450, MGC126451
27. Sequence of the WT T allele:
TATGTGCTGGAGATGGTGTACAGTAGGGTGAGGAAACCAAATTCTCAGT TAGCACTGGTGTACCCTTGTACAGGTGATGIAACATCTCTGTGCCTCAGT TTGCTCACTATAAAATAGAGACGGTAGGGGTCATGGTGAGCACTACCTG AC
28. Sequence of the mutant C allele:
TATGTGCTGGAGATGGTGTACAGTAGGGTGAGGAAACCAAATTCTCAGT TAGCACTGGTGTACCCTTGTACAGGTGATGCAACATCTCTGTGCCTCAGT TTGCTCACTATAAAATAGAGACGGTAGGGGTCATGGTGAGCACTACCTG AC
ILlRN
SNP name and number (in ncbi database):
ILlRN 86-bp tandem repeat [short tandem repeat (STR); micro satellite) polymorphism, (position 329879 on NW_001838841), rs2234663.
Gene name and number (in ncbi database): interleukin 1 receptor antagonist, NM_173842, NM_173841, NM_000577 and
NM_173843 (mRNA transcript variants 1-4) from Homo sapiens chromosome 2 genomic contig (NW_001838841) Also known as: IRAP; IL1F3; ILlRA; IL-lra3; ICIL-IRA; MGC10430
29. Instead of the normal WT sequence, for reasons given below, a protein sequence is provided instead:
1 maladlyeeg gggggegedn adsketicrp sgrksskmqa fπwdvnqkt fylrnnqlva 61 gylqgpnvnl eekidvvpie phalflgihg gkmclscvks gdetrlqlea vmtdlsenr 121 kqdkrfafir sdsgpttsfe saacpgwflc tameadqpvs ltnmpdegvm vtkfyfqede
No WT nucleotide sequence is provided because the below sequence which is bold and underlined font is repeated 2/3/4/5/6 times although of course the present invention is not limited to such a number of repeats.
Intron 2 short tandem repeat (an 86-bp tandem repeat (highlighted), occurs 2/3/4/5/6 times:
30. ACTCCTATTGACCTGGAGCACAGGTr(ATCCTGGGGAAAGTGAGG GAAATATGGACATCACATGGAACAACATCCAGGAGACTCAGGC CTCTAGGAGTAACTGGGTAGTGTGOX2/3/4/5/61TTGGTTTAATCT
TCTATTTACCTGC
IL6
SNP name and number (in NCBI SNP database): IL6 G-174C, rs56588968 (position 16492950 on NW_001839003) Gene name and number (in NCBI nucleotide database): interleukin 6 (interferon, beta 2), NM_000600 (mRNA transcript) from Homo sapiens chromosome 7 genomic contig (NW_001839003). Also known as: HGF; HSF; BSF2; IL-6; IFNB2
31. Sequence of the WT allele (reversed): G (C-reverse)-174:
GGAAAATCCCACATTTGATAAATCTTTGTTGGAGGGTGAGGGTGGGGCCA GAGCGGGTGGGGCTGATTGGAAACCTTATTAAGATTGTGCAATGTGACGT CCTTTAGCATCGCAAGACACAACTAGGGGGAAAAGTGCAGCTTAGGTCGT CATTGAGGCTAGCGCTAAGAAGCAGAACCACTCTTCCTTTACTTTCTTTTT TTCTTTTATTAGTGACTCAGCACTTTGGCATGTCTT 32. Sequence of the mutant (SNP bearing) allele: C (G-reverse)-174:
GGAAAATCCCACATTTGATAAATCTTTGTTGGAGGGTGAGGGTGGGGCCA GAGCGGGTGGGGCTGATTGGAAACCTTATTAAGATTGTGCAATGTGACGT CCTTTAGCATGGCAAGACACAACTAGGGGGAAAAGTGCAGCTTAGGTCGT CATTGAGGCTAGCGCTAAGAAGCAGAACCACTCTTCCTTTACTTTCTTTTT TTCTTTTATTAGTGACTCAGCACTTTGGCATGTCTT
TNF
SNP name and number (in NCBI SNP database):
TNF G-318A, rs361525 (nucleotide number 104675 on NT_113894)
Gene name and number (in NCBI nucleotide database): tumor necrosis factor (TNF superfamily, member 2), NM_000594 (mRNA transcript) from
Homo sapiens chromosome 6 genomic contig (NT_113894, nucleotides 104924—
107688).
Also known as: DIF; TNFA; TNFSF2; TNF-alpha
33. Sequence of the WT allele: G-318
CAGTGGGGTCTGTGAATTCCCGGGGGTGATTTCACTCCCCGGGGCTGTCCC
AGGCTTGTCCCTGCTACCCCCACCCAGCCTTTCCTGAGGCCTCAAGCCTGC
CACCAAGCCCCCAGCTCCTTCTCCCCGCAGGGACCCAAACACAGGCCTCA GGACTCAACACAGCTTTTCCCTCCAACCCCGTTTTCTCTCCCTCAAGGACT CAGCTTTCTGAAGCCCCTCCCAGTTCTAGTTCTATCTTTTTCCTGCATCCTG TCTGGAAGTTAGAAGGAAACAGACCACAGACCTGGTCCCCAAAAGAAAT GGAGGCAATAGGTTTTGAGGGGCATGGGGACGGGGTTCAGCCTCCAGGGT CCTACACACAAATCAGTCAGTGGCCCAGAAGACCCCCCTCGGAATCGGAG CAGGGAGGATGGGGAGTGTGAGGGGTATCCTTGATGCTTGTGTGTCCCCA ACTTTCCAAATCCCCGCCCCCGCGATGGAGAAGAAACCGAGACAGAAGGT GCAGGGCCCACTACCGCTTCCTCCAGATGAGCTCATGGGTTTCTCCACCAA GGAAGTTTTCCGCTGGTTGAATGATTCTTTCCCCGCCCTCCTCTCGCCCCA GGGACATATAAAGGCAGTTGTTGGCACACCCAGCCAGCAGACGCTCCCTC AGCAAGGACAGCAGAGGACCAGCTAAGAGGGAGAGAAGCAACTACAGA
CCCCCCCTGAAAACAACCCTCAGACGCCACATCCCCTGACAAGCTGCCAG GCAGGTTCTCTTCCTCTCACATACTGACCCACGGCTCCACCCTCTCT
34. Sequence of the mutant (SNP bearing) allele: A-318:
CAGTGGGGTCTGTGAATTCCCGGGGGTGATTTCACTCCCCGGGGCTGTCCC AGGCTTGTCCCTGCTACCCCCACCCAGCCTTTCCTGAGGCCTCAAGCCTGC CACCAAGCCCCCAGCTCCTTCTCCCCGCAGGGACCCAAACACAGGCCTCA GGACTCAACACAGCTTTTCCCTCCAACCCCGTTTTCTCTCCCTCAAGGACT CAGCTTTCTGAAGCCCCTCCCAGTTCTAGTTCTATCTTTTTCCTGCATCCTG TCTGGAAGTTAGAAGGAAACAGACCACAGACCTGGTCCCCAAAAGAAAT GGAGGCAATAGGTTTTGAGGGGCATGGGGACGGGGTTCAGCCTCCAGGGT CCTACACACAAATCAGTCAGTGGCCCAGAAGACCCCCCTCGGAATCAGAG CAGGGAGGATGGGGAGTGTGAGGGGTATCCTTGATGCTTGTGTGTCCCCA ACTTTCCAAATCCCCGCCCCCGCGATGGAGAAGAAACCGAGACAGAAGGT GCAGGGCCCACTACCGCTTCCTCCAGATGAGCTCATGGGTTTCTCCACCAA GGAAGTTTTCCGCTGGTTGAATGATTCTTTCCCCGCCCTCCTCTCGCCCCA GGGACATATAAAGGCAGTTGTTGGCACACCCAGCCAGCAGACGCTCCCTC AGCAAGGACAGCAGAGGACCAGCTAAGAGGGAGAGAAGCAACTACAGA CCCCCCCTGAAAACAACCCTCAGACGCCACATCCCCTGACAAGCTGCCAG GCAGGTTCTCTTCCTCTCACATACTGACCCACGGCTCCACCCTCTCT
ILlB
SNP name and number (in NCBI SNP database):
ILlB Phe (F) 105 Phe (F), [C315T according to mRNA transcript(NM_000576), nucleotide numbering starts at the start codon, rs 1143634 Gene name and number (in NCBI nucleotide database): interleukin 1, beta, NM_000576 (mRNA transcript) Also known as: IL-I; IL1F2; ILl-BETA
35. Sequence of the WT allele: C315
TAGTGGAAACTATTCTTAAAGAAGATCTTGATGGCTACTGACATTTGCAAC TCCCTCACTCTTTCTCAGGGGCCTTTCACTTACATTGTCACCAGAGGTTCG TAACCTCCCTGTGGGCTAGTGTTATGACCATCACCATTTTACCTAAGTAGC TCTGTTGCTCGGCCACAGTGAGCAGTAATAGACCTGAAGCTGGAACCCAT GTCTAATAGTGTCAGGTCCAGTGTTCTTAGCCACCCCACTCCCAGCTTCAT CCCTACTGGTGTTGTCATCAGACTTTGACCGTATATGCTCAGGTGTCCTCC AAGAAATCAAATTTTGCCGCCTCGCCTCACGAGGCCTGCCCTTCTGATTTT ATACCTAAACAACATGTGCTCCACATTTCAGAACCTATCTTCTTCGACACA TGGGATAACGAGGCTTATGTGCACGATGCACCTGTACGATCACTGAACTG CACGCTCCGGGACTCACAGCAAAAAAGCTTGGTGATGTCTGGTCCATATG AACTGAAAGCTCTCCACCTCCAGGGACAGGATATGGAGCAACAAGGTAA ATGGAAACATCCTGGTTTCCCTGCCTGGCCTCCTGGCAGCTTGCTAATTCT
CCATGTTTTAAACAAAGTAGAAAGTTAATTTAAGGCAAATGATCAACACA AGTGAAAAAAAATATTAAAAAGGAATATACAAACTTTGGTCCTAGAAATG GCACATTTGATTGCACTGGCCAGTGCATTTGTTAACAGGAGTGTGACCCTG AGA
36. Sequence of the mutant allele:T315:
TAGTGGAAACTATTCTTAAAGAAGATCTTGATGGCTACTGACATTT GCAACTCCCTCACTCTTTCTCAGGGGCCTTTCACTTACATTGTCACC AGAGGTTCGTAACCTCCCTGTGGGCTAGTGTTATGACCATCACCAT TTTACCTAAGTAGCTCTGTTGCTCGGCCACAGTGAGCAGTAATAGA
CCTGAAGCTGGAACCCATGTCTAATAGTGTCAGGTCCAGTGTTCTT AGCCACCCCACTCCCAGCTTCATCCCTACTGGTGTTGTCATCAGACT TTGACCGTATATGCTCAGGTGTCCTCCAAGAAATCAAATTTTGCCG CCTCGCCTCACGAGGCCTGCCCTTCTGATTTTATACCTAAACAACAT GTGCTCCACATTTCAGAACCTATCTTCTTTGACACATGGGATAACG
AGGCTTATGTGCACGATGCACCTGTACGATCACTGAACTGCACGCT CCGGGACTCACAGCAAAAAAGCTTGGTGATGTCTGGTCCATATGAA CTGAAAGCTCTCCACCTCCAGGGACAGGATATGGAGCAACAAGGT AAATGGAAACATCCTGGTTTCCCTGCCTGGCCTCCTGGCAGCTTGC TAATTCTCCATGTTTTAAACAAAGTAGAAAGTTAATTTAAGGCAAA
TGATCAACACAAGTGAAAAAAAATATTAAAAAGGAATATACAAAC TTTGGTCCTAGAAATGGCACATTTGATTGCACTGGCCAGTGCATTT GTTAACAGGAGTGTGACCCTGAGA
CRP
SNP name and number (in NCBI SNP database):
CRP Leu (L) 184 Leu (L), [G552C according to mRNA transcript (NM_000567), nucleotide numbering starts at the start codon, position 1726559 on NW_001838531], rs 1800947
Gene name and number (in NCBI nucleotide database):
C-reactive protein, pentraxin-related, NM_000567 (mRNA transcript) from Homo sapiens chromosome 1 genomic contig (NW_001838531).
Also known as: PTXl; MGC88244; MGC149895 PTXl; MGC88244; MGC149895
37. Sequence of the WT allele: G552: TTGGTCTAAGGATATAGGATACAGTTTTACAGTGGGTGGGTCTGAAATATT ATTCGAGGTTCCTGAAGTCACAGTAGCTCCAGTACACATTTGTACAAGCT GGGAGTCCGCCTCAGGGATCGTGGAGTTCTGGGTAGATGGGAAGCCCAGG GTGAGGAAGAGTCTGAAGAAGGGATACACTGTGGGGGCAGAAGCAAGCA TCATCTTGGGGCAGGAGCAGGATTCCTTCGGTGGGAACTTTGAAGGAAGC CAGTCCCTGGTGGGAGACATTGGAAATGTGAACATGTGGGACTTTGTGCT
GTCACCAGATGAGATTAACACCATCTATCTTGGCGGGCCCTTCAGTCCTA ATGTCCTGAACTGGCGGGCACTGAAGTATGAAGTGCAAGGCGAAGTGTTC ACCAAACCCCAGCTGTGGCCCTGAGGCCCAGCTGTGGGTCCTGAAGGTAC CTCCCGGTTTTTTACACCGCATGGGCCCCACGTCTCTGTCTCTGGTACCTC CCGCTTTTTTACACTGCATGGTTCCCACGTCTCTGTCTCTGGGCCTTTGTTC CCCTATATGCATTGCAGGCCTGCTCCACCCTCCTCAGCGCCTGAGAAT
38. Sequence of the mutant (SNP bearing) allele: C552: TTGGTCTAAGGATATAGGATACAGTTTTACAGTGGGTGGGTCTGAAATATT ATTCGAGGTTCCTGAAGTCACAGTAGCTCCAGTACACATTTGTACAAGCT GGGAGTCCGCCTCAGGGATCGTGGAGTTCTGGGTAGATGGGAAGCCCAGG GTGAGGAAGAGTCTGAAGAAGGGATACACTGTGGGGGCAGAAGCAAGCA TCATCTTGGGGCAGGAGCAGGATTCCTTCGGTGGGAACTTTGAAGGAAGC CAGTCCCTGGTGGGAGACATTGGAAATGTGAACATGTGGGACTTTGTGCT CTCACCAGATGAGATTAACACCATCTATCTTGGCGGGCCCTTCAGTCCTAA TGTCCTGAACTGGCGGGCACTGAAGTATGAAGTGCAAGGCGAAGTGTTCA CCAAACCCCAGCTGTGGCCCTGAGGCCCAGCTGTGGGTCCTGAAGGTACC TCCCGGTTTTTTACACCGCATGGGCCCCACGTCTCTGTCTCTGGTACCTCC CGCTTTTTTACACTGCATGGTTCCCACGTCTCTGTCTCTGGGCCTTTGTTCC CCTATATGCATTGCAGGCCTGCTCCACCCTCCTCAGCGCCTGAGAAT
NPRl SNP name and number (in NCBI SNP database):
NPRl -67+ GCTGAGCC (insertion/deletion polymorphism), [-67 nubering is according to the start codon (-1 is the first nucleotide upstream, -67 is nucleotide no.
356 according to mRNA transcript NM_000906), no rs number in NCBI SNP database. Gene name and number (in NCBI nucleotide database): natriuretic peptide receptor A/guanylate cyclase A (atrionatriuretic peptide receptor
A),
NM_000906) (mRNA transcript) from Homo sapiens chromosome 1 genomic contig
(NW_001838529). Also known as: ANPa; NPRA; ANPRA; GUC2A; GUCY2A
39. Sequence of WT allele + GCTGAGCC:
CTCACGCACGCTACAAACACACACTCCTCTTTCCTCCCTCGCGCGCCCTCTCTCATC CTTCTTCACGAAGCGCTCACTCGCACCCTTTCTCTCTCTCTCTCTCTCTCTCTAACA CGCACGCACACTCCCAGTTGTTCACACTCGGGTCCTCTCCAGCCCGACGTTCTCCTG GCACCCACCTGCTCCGCGGCGCCCTGCGCGCCCCCCTCGGTCGCGCCCCTTGCGCTC TCGGCCCAGACCGTCGCAGCTACAGGGGGCCTCGAGCCCCGGGGTGAGCGTCCCCGT
CCCGCTCCTGCTCCTTCCCATAGGGACGCGCCTGATGCCTGGGACCGGCCGCTGAGC CCAAGGGGACCGAGGAGGCCATGGTAGGAGCGCTCGCCTGCTGCGGTGCCCGCTGAG GCCATGCCGGGGCCCCGGCGCCCCGCTGGCTCCCGCCTGCGCCTGCTCCTGCTCCTG CTGCTGCCGCCGCTGCTGCTGCTGCTCCGGGGCAGCCACGCGGGCAACCTGACGGTA GCCGTGGTACTGCCGCTGGCCAATACCTCGTACCCCTGGTCGTGGGC
40. Sequence of the mutant (polymorphism bearing) allele -GCTGAGCC:
CTCACGCACGCTACAAACACACACTCCTCTTTCCTCCCTCGCGCGCCCTCTCTCATC CTTCTTCACGAAGCGCTCACTCGCACCCTTTCTCTCTCTCTCTCTCTCTCTCTAACA CGCACGCACACTCCCAGTTGTTCACACTCGGGTCCTCTCCAGCCCGACGTTCTCCTG GCACCCACCTGCTCCGCGGCGCCCTGCGCGCCCCCCTCGGTCGCGCCCCTTGCGCTC TCGGCCCAGACCGTCGCAGCTACAGGGGGCCTCGAGCCCCGGGGTGAGCGTCCCCGT CCCGCTCCTGCTCCTTCCCATAGGGACGCGCCTGATGCCTGGGACCGGCCXXXXXXX XCAAGGGGACCGAGGAGGCCATGGTAGGAGCGCTCGCCTGCTGCGGTGCCCGCTGAG GCCATGCCGGGGCCCCGGCGCCCCGCTGGCTCCCGCCTGCGCCTGCTCCTGCTCCTG CTGCTGCCGCCGCTGCTGCTGCTGCTCCGGGGCAGCCACGCGGGCAACCTGACGGTA GCCGTGGTACTGCCGCTGGCCAATACCTCGTACCCCTGGTCGTGGGC
NPR3
SNP name and number (in NCBI SNP database): NPR3 C-251A, rs9716700 (position 11318530 on NW_001838929) Gene name and number (in NCBI nucleotide database): natriuretic peptide receptor C/guanylate cyclase C (atrionatriuretic peptide receptor C), NM-000908 (mRNA transcript) from Homo sapiens chromosome 5 genomic contig (NWJ)Ol 838529). Also known as: CSIF NPRC; ANPRC; GUCY2B
41. Sequence of the WT allele C-251 :
AATCAATGAGATCAAATGCGAGGGAGATGCACCGTCAATTACAAACACTTGGACAAG TCTAACTTTTTTTTTCTTCTACAAAAACGCTTTCAAAAGCAACCTTAGCAACGCCCA AATAAGAAGCCACCTCTAAGCAAAATAGTATATGTATAAACGGAGGGCGAATATATA CAAGTATATATATATGTATATTACAGACGCACAGGTTTACACCCGGTGAACTTTTTC TTTTTCTTTTTCTTTTTTTTTTAAGAAAAACTATGACATTGCAGAGAAGGACGCTTC CTCTCTATCTTTTGGCGCATTAGTGAAGGGGGTATTCTATTTTGTTAAAGCGCCCAA GGGGGCGCAGGGACCTTGGAGAGAAGAGTGGGGAGGAAAGAGGAAGGGTGGGTGGGG GGCAGAGGGCGAGTCGGCGGCGGCGAGGG
42. Sequence of the mutant allele A-251 :
AATCAATGAGATCAAATGCGAGGGAGATGCACCGTCAATTACAAACACTTGGACAAG TCT
AACTTTTTTTTTCTTCTACAAAAACGCTTTCAAAAGCAACCTTAGCAACGCCCAAAT AAG
AAGCCACCTCTAAGCAAAATAGTATATGTATAAACGGAGGGCGAATATATACAAGTA TAT ATATATGTATATTACAGACGAACAGGTTTACACCCGGTGAACTTTTTCTTTTTCTTT TTCTTTTTTTTTTAAGAAAAACTATGACATTGCAGAGAAGGACGCTTCCTCTCTATC TTTTGGCGCATTAGTGAAGGGGGTATTCTATTTTGTTAAAGCGCCCAAGGGGGCGCA GGGACCTTGGAGAGAAGAGTGGGGAGGAA
AGAGGAAGGGTGGGTGGGGGGCAGAGGGCGAGTCGGCGGCGGCGAGGG
NOS3 SNP name and number (in NCBI SNP database):
NOS3 GIu (E)298Asp (D), [G894T (according to mRNA transcript NM_000603, nucleotide numbering starts at the start codon, position on NW 001839088 is
1803394 ], rs57135373
Gene name and number (in NCBI nucleotide database): nitric oxide synthase 3 (endothelial cell), NM_000603 (mRNA transcript) from homo sapiens chromosome 7 genomic contig (NW 001839088)
Also known as: eNOS; ECNOS; NOS III
43. Sequence of WT allele [GIu (E)298;
G894]:
GTGGTCACGGAGACCCAGCCAATGAGGGACCCTGGAGATGAAGGCAGGAGACAGTGG ATGGAGGGGTCCCTGAGGAGGGCATGAGGCTCAGCCCCAGAACCCCCTCTGGCCCAC TCCCCACAGCTCTGCATTCAGCACGGCTGGACCCCAGGAAACGGTCGCTTCGACGTG CTGCCCCTGCTGCTGCAGGCCCCAGATGAGCCCCCAGAACTCTTCCTTCTGCCCCCC GAGCTGGTCCTTGAGGTGCCCCTGGAGCACCCCACGTGAGCACCAAAGGGATTGACT GGGTGGGATGGAGGGGGCCATCCCTGAGCCTCTCAAGAAGGGCCTGCAAGGGGGTGC TGATCCCACACCCCAACACCCCCAGGCTGGAGTGGTTTGCAGCCCTGGGCCTGCGCT GG 44. Sequence of mutant allele [Asp (D)298;
T894]:
GTGGTCACGGAGACCCAGCCAATGAGGGACCCTGGAGATGAAGGCAGGAGACAGTGG
ATGGAGGGGTCCCTGAGGAGGGCATGAGGCTCAGCCCCAGAACCCCCTCTGGCCCAC
TCCCCACAGCTCTGCATTCAGCACGGCTGGACCCCAGGAAACGGTCGCTTCGACGTG CTGCCCCTGCTGCTGCAGGCCCCAGATGATCCCCCAGAACTCTTCCTTCTGCCCCCC
GAGCTGGTCCTTGAGGTGCCCCTGGAGCACCCCACGTGAGCACCAAAGGGATTGACT GGGTGGGATGGAGGGGGCCATCCCTGAGCCTCTCAAGAAGGGCCTGCAAGGGGGTGC TGATCCCACACCCCAACACCCCCAGGCTGGAGTGGTTTGCAGCCCTGGGCCTGCGCT GG
SERPINEl
SNP name and number (in NCBI SNP database): PAIl -A/G (nucleotide deleted between nucleotides 1343159:1343160 from
NWJ)Ol 839067), rsl799889.
Gene name and number (in NCBI nucleotide database): plasminogen activator inhibitor- 1, plasminogen activator inhibitor, type I, serine (or cysteine) proteinase inhibitor, clade E (nexin, plasminogen activator inhibitor type 1), member 1, NM_000602 (mRNA transcript) fro Homo sapiens chromosome 7 genomic contig (NWJ)01839067).
Also known as: PAI; PAIl; PAI-I; PLANHl
45. Sequence of the WT allele +G: CCCTAAAAGC ACACCCTGCA AACCTGCCAT GAATTGACAC TCTGTTTCTA
TCCCTTTTCC
CCTTGTGTCT GTGTCTGGAG GAAGAGGATA AAGGACAAGC TGCCCCAAGT
CCTAGCGGGC
AGCTCGAGGA AGTGAAACTT ACACGTTGGT CTCCTGTTTC CTTACCAAGC TTTTACCATG
GTAACCCCTG GTCCCGTTCA GCCACCACCA CCCCACCCAG CACACCTCCA
ACCTCAGCCA
GACAAGGTTG TTGACACAAG AGAGCCCTCA GGGGCACAGA GAGAGTCTGG
ACACGTGGGG G
AGTCAGCCGT GTATCATCGG AGGCGGCCGG GCACATGGCA GGGATGAGGG
AAAGACCAAG
AGTCCTCTGT TGGGCCCAAG TCCTAGACAG ACAAAACCTA GACAATCACG
TGGCTGGCTG CATGCCCTGT GGCTGTTGGG CTGGGCCCAG GAGGAGGGAG GGGCGCTCTT
TCCTGGAGGT
GGTCCAGAGC ACCGGGTGGA CAGCCCTGGG GGAAAACTTC CACGTTTTGA
TGGAGGTTAT
CTTTGATAAC TCCACAGTGA CCTGGTTCGC CAAAGGAAAA GCAGGCAACG TGAGCTGTTT
46. Sequence of the mutant allele -G:
CCCTAAAAGC ACACCCTGCA AACCTGCCAT GAATTGACAC TCTGTTTCTA TCCCTTTTCC CCTTGTGTCT GTGTCTGGAG GAAGAGGATA AAGGACAAGC TGCCCCAAGT CCTAGCGGGC
AGCTCGAGGA AGTGAAACTT ACACGTTGGT CTCCTGTTTC CTTACCAAGC
TTTTACCATG
GTAACCCCTG GTCCCGTTCA GCCACCACCA CCCCACCCAG CACACCTCCA
ACCTCAGCCA GACAAGGTTG TTGACACAAG AGAGCCCTCA GGGGCACAGA GAGAGTCTGG
ACACGTGGGG
X
AGTCAGCCGT GTATCATCGG AGGCGGCCGG GCACATGGCA GGGATGAGGG
AAAGACCAAG AGTCCTCTGT TGGGCCCAAG TCCTAGACAG ACAAAACCTA GACAATCACG
TGGCTGGCTG
CATGCCCTGT GGCTGTTGGG CTGGGCCCAG GAGGAGGGAG GGGCGCTCTT
TCCTGGAGGT
GGTCCAGAGC ACCGGGTGGA CAGCCCTGGG GGAAAACTTC CACGTTTTGA TGGAGGTTAT
CTTTGATAAC TCCACAGTGA CCTGGTTCGC CAAAGGAAAA GCAGGCAACG
TGAGCTGTTT
PLA2G7
SNP name and number (in NCBI SNP database):
PLA2G7 G824T (824 is nucleotide number according to mRNA transcript NM_005084, nucleotide numbering starts at the start codon, 25966 is the nucleotide number in NW_923073), no rs number in NCBI SNP database. Gene name and number (in NCBI nucleotide database): phospholipase A2, group VII (platelet-activating factor acetylhydrolase, plasma),
NM_000504 (mRNA transcript) from homo sapiens chromosome 6 genomic contig
(NW_923073).
Also known as: PAFAH; LDL-PLA2
47. Sequence of the WT allele G824:
TATCCCTCAAGCAGCCACTCTCTTCTGTATCCTTGCCTTTGTACATGTTGTCCCCTT GGCCTGACACACCCTTCCCCTTGCCTAACTCCTACCTAATTTCAAGACTCCAGTTGA GCATCACCTCCTCTAAGAAGCTTTCTTGGACCCCAATACCCACTTCTGGACTGGGCT CGCTGTCTGTCATGTGTGCTCCTTTGTACCACTGTACTGTATTGCATCATGCCTCTG TATAACTTTCTTCCCTGATGGACTGCAAACTCACTGAAATGAGACTGCAGTACCTGG CACAGAGTAGGTACTCAATAAATACTCATGGAATGAACAAACAAATAAACATGGGGT GAGGAGAGGCAGAAGTCAGAACTGATGTTGAAGTTTCCAGTGTGGGTGACTACAAAG AACATTAAGTTTACTTTCAAACCTTTACATATGTTATATATATGTGTAAATGTGTTT TATATGTGTATATAGATGTATATGTGTGTATGGTATGTATAAATGTATGTGTGTATA TGTATATTCTATTTTATAAGAAATCAATGTATTTAACCATCCCCATGAAATGAACAA TTATATGATTGACAAAATCATTTCTTCTAACACCACGAAATAGCTATAAATTTATAT CATGCTTTTTCAAATAGGACTCTAATAGCAGTAATTGGACATTCTTTTGGTGGAGCA ACGGTTATTCAGACTCTTAGTGAAGATCAGAGATTCAGGTAAGAAAATAAGATAGTA AAGCAAGAGAATAGTAAATTATTGGAAGAAATTATATTGTGAGATATAATTTTTTAT TCAAATTCTTAGTGAAGAAGGGATCTCTTGGAGTTTATAAGGCTATTCTTTTGCCCC
CATAAAATACTCTATATACATTTTCCTAGGCTAAAACATCTACCTCTCCTGCTATTA AAATCTCCCCCTACTCCCATAAGTTTTCCCTCATTATTCTTGTTTACCCAAGGGGTT AACACTTTTCACTGAAAAATTTATCTTTATATAATTTTTTGTGACATAATGATTGTG ATAATAATA
48. Sequence of the mutant allele T824:
TATCCCTCAAGCAGCCACTCTCTTCTGTATCCTTGCCTTTGTACATGTTGTCCCCTT GGCCTGACACACCCTTCCCCTTGCCTAACTCCTACCTAATTTCAAGACTCCAGTTGA GCATCACCTCCTCTAAGAAGCTTTCTTGGACCCCAATACCCACTTCTGGACTGGGCT CGCTGTCTGTCATGTGTGCTCCTTTGTACCACTGTACTGTATTGCATCATGCCTCTG TATAACTTTCTTCCCTGATGGACTGCAAACTCACTGAAATGAGACTGCAGTACCTGG CACAGAGTAGGTACTCAATAAATACTCATGGAATGAACAAACAAATAAACATGGGGT GAGGAGAGGCAGAAGTCAGAACTGATGTTGAAGTTTCCAGTGTGGGTGACTACAAAG AACATTAAGTTTACTTTCAAACCTTTACATATGTTATATATATGTGTAAATGTGTTT TATATGTGTATATAGATGTATATGTGTGTATGGTATGTATAAATGTATGTGTGTATA TGTATATTCTATTTTATAAGAAATCAATGTATTTAACCATCCCCATGAAATGAACAA TTATATGATTGACAAAATCATTTCTTCTAACACCACGAAATAGCTATAAATTTATAT CATGCTTTTTCAAATAGGACTCTAATAGCAGTAATTGGACATTCTTTTGGTGGAGCA ACGTTTATTCAGACTCTTAGTGAAGATCAGAGATTCAGGTAAGAAAATAAGATAGTA AAGCAAGAGAATAGTAAATTATTGGAAGAAATTATATTGTGAGATATAATTTTTTAT TCAAATTCTTAGTGAAGAAGGGATCTCTTGGAGTTTATAAGGCTATTCTTTTGCCCC CATAAAATACTCTATATACATTTTCCTAGGCTAAAACATCTACCTCTCCTGCTATTA AAATCTCCCCCTACTCCCATAAGTTTTCCCTCATTATTCTTGTTTACCCAAGGGGTT AACACTTTTCACTGAAAAATTTATCTTTATATAATTTTTTGTGACATAATGATTGTG ATAATAATA
FGF2
SNP name and number (in NCBI SNP database):
FGF2 T-553A (nucleotide number 4320453 in NWJ)018389203), rs 308398
Gene name and number (in NCBI nucleotide database): fibroblast growth factor 2 (basic), NM_002006 (mRNA transcript) from homo sapiens chromosome 4 genomic contig (NW_0018389203).
Also known as: BFGF; FGFB; HBGF-2
49. Sequence of the WT allele T-553:
ATCTCCCACA CACTCAACAT TATGTGTTGC ACACAGTAGG TACTCAATAC
ATGCAAGTTT
TCTGAATAGA TATTTTCCTA GTCATCTGTG GCACCTGCTA TATCCTACTG
AAAATTACCA
AAATGCAATT AACTTCAATT TTACATTTGG GATTTACAGA AAATAACTCT CTCTCCAAGA
AATGCATAAC AATTTAGCTA GGGCAAATGC CAGGTCCGAG TTAAGACATT
AATGCGCTTC
GATCGCGATA AGGATTTATC CTTATCCCCA TCCTCATCTT TCTGCGTCGT
CTAATTCAAG T
TAGGTCAGTA AAGGAAACCT TTTCGTTTTA GCAACCCAAT CTGCTCCCCT
TCTCTGGCCT
CTTTCTCTCC TTTTGTTGGT AGACGACTTC AGCCTCTGTC CTTTAATTTT
AAAGTTTATG CCCCACTTGT ACCCCTCGTC TTTTGGTGAT TTAGAGATTT TCAAAGCCTG
CTCTGACACA
GACTCTTCCT TGGATTGCAA CTTCTCTACT TTGGGGTGGA AACGGCTTCT
CCGTTTTGAA
ACGCTAGCGG GGAAAAAATG GGGGAGAAAG TTGAGTTTAA ACTTTTAAAA GTTGAGTCAC
50. Sequence of the mutant allele A-553: ATCTCCCACA CACTCAACAT TATGTGTTGC ACACAGTAGG TACTCAATAC
ATGCAAGTTT
TCTGAATAGA TATTTTCCTA GTCATCTGTG GCACCTGCTA TATCCTACTG
AAAATTACCA
AAATGCAATT AACTTCAATT TTACATTTGG GATTTACAGA AAATAACTCT CTCTCCAAGA
AATGCATAAC AATTTAGCTA GGGCAAATGC CAGGTCCGAG TTAAGACATT
AATGCGCTTC
GATCGCGATA AGGATTTATC CTTATCCCCA TCCTCATCTT TCTGCGTCGT
CTAATTCAAG A
TAGGTCAGTA AAGGAAACCT TTTCGTTTTA GCAACCCAAT CTGCTCCCCT
TCTCTGGCCT
CTTTCTCTCC TTTTGTTGGT AGACGACTTC AGCCTCTGTC CTTTAATTTT
AAAGTTTATG CCCCACTTGT ACCCCTCGTC TTTTGGTGAT TTAGAGATTT TCAAAGCCTG
CTCTGACACA
GACTCTTCCT TGGATTGCAA CTTCTCTACT TTGGGGTGGA AACGGCTTCT
CCGTTTTGAA
ACGCTAGCGG GGAAAAAATG GGGGAGAAAG TTGAGTTTAA ACTTTTAAAA GTTGAGTCAC
GNB3
SNP name and number (in NCBI SNP database): GNB3 Ser (S)275Ser (S), [C825T (according to mRNA transcript NM_002075, nucleotide numbering starts at the start codon, position on NW 001838050 is
1363824], rs5443
Gene name and number (in NCBI nucleotide database): guanine nucleotide binding protein (G protein), beta polypeptide 3, NM_002075 (mRNA transcript) from homo sapiens chromosome 12 genomic contig (NW
001838050)
51 . Sequence of the WT allele C825:
TCACTGCAGG CAAGCCTTGG TGCTCTTGCC TGCGACGTGG AAATGATGCC
TGCCTGCAGC GCTGTATAGT GCAGAGCGGG CGAGGGGCAT AGGGAAGTCA CTGGCACGTG
GTATGTGTTG
GCAGGGCTGC TTCTCACCCC AAACCAAGGG AGGGACAGGC AGGGAGGCTG
AGAGCAGCGG
CTTGCCCTGG AGCTGTCAGG TGGGAGGCAG AGGGCGGGAG AGGCTGTGGG CTGCCCAGGT
CTGATCCCTG ACCCACTTGC CACCCGTGCC CTCAGTTCTT CCCCAATGGA
GAGGCCATCT
GCACGGGCTC GGATGACGCT TCCTGCCGCT TGTTTGACCT GCGGGCAGAC
CAGGAGCTGA TCTGCTTCTC CCACGAGAGC ATCATCTGCG GCATCACGTC
C
GTGGCCTTCT CCCTCAGTGG CCGCCTACTA TTCGCTGGCT ACGACGACTT
CAACTGCAAT
GTCTGGGACT CCATGAAGTC TGAGCGTGTG GGTAAGGGCC AGCCCTGGCT GCTGCTTCCT
CAGCTGGAAG GACCCTCCCC AGCCCTCCCT CCCCATTCTG TACCCCCCAT
CAGCTCCCAT
TTCGGACTCT CTTACTGCTG TCCCTTGTCA CTGGGTGACT CCACCCCTGG
AATCCAGTAC CCCTTGGTTC CCAACTAGGA CTGTTTTCCC TCAGTGTTGC TCTAAGCAGC
CTCTCTCCAC
TGCCCAATGC CATGACTGCT CCCTGCCCTA GGAGATCTGT GGACCATGAC
TGTCCAGTCA
GTTCTGGGTT CCTGGCATTT CAGGGGCACC CACTGAGAGG
52. Sequence of the mutant allele T825:
TCACTGCAGG CAAGCCTTGG TGCTCTTGCC TGCGACGTGG AAATGATGCC
TGCCTGCAGC
GCTGTATAGT GCAGAGCGGG CGAGGGGCAT AGGGAAGTCA CTGGCACGTG GTATGTGTTG
GCAGGGCTGC TTCTCACCCC AAACCAAGGG AGGGACAGGC AGGGAGGCTG
AGAGCAGCGG
CTTGCCCTGG AGCTGTCAGG TGGGAGGCAG AGGGCGGGAG AGGCTGTGGG
CTGCCCAGGT CTGATCCCTG ACCCACTTGC CACCCGTGCC CTCAGTTCTT CCCCAATGGA
GAGGCCATCT
GCACGGGCTC GGATGACGCT TCCTGCCGCT TGTTTGACCT GCGGGCAGAC
CAGGAGCTGA
TCTGCTTCTC CCACGAGAGC ATCATCTGCG GCATCACGTC T
GTGGCCTTCT CCCTCAGTGG CCGCCTACTA TTCGCTGGCT ACGACGACTT
CAACTGCAAT
GTCTGGGACT CCATGAAGTC TGAGCGTGTG GGTAAGGGCC AGCCCTGGCT
GCTGCTTCCT CAGCTGGAAG GACCCTCCCC AGCCCTCCCT CCCCATTCTG TACCCCCCAT
CAGCTCCCAT
TTCGGACTCT CTTACTGCTG TCCCTTGTCA CTGGGTGACT CCACCCCTGG
AATCCAGTAC
CCCTTGGTTC CCAACTAGGA CTGTTTTCCC TCAGTGTTGC TCTAAGCAGC CTCTCTCCAC
TGCCCAATGC CATGACTGCT CCCTGCCCTA GGAGATCTGT GGACCATGAC TGTCCAGTCA GTTCTGGGTT CCTGGCATTT CAGGGGCACC CACTGAGAGG
PPARA
SNP name and number (in NCBI SNP database): PPARA Leu (L)162Val(V), [C484G (according to mRNA transcript variants:
NM_005036, NM_001001928, nucleotide numbering starts at the start codon, position on NW_ 001838753 is 233773, or position on NTJ)11523 is 1884980 ], rs 1800206
Gene name and number (in NCBI nucleotide database): peroxisome proliferator- activated receptor alpha, NM_005036 and NMJ)01001928
(mRNA transcript variants) from homo sapiens chromosome 22 genomic contig (NW
001838753 or NTJ)11523)
Also known as: PPAR; NRlCl; hPPAR; MGC2237; MGC2452
53. Sequence of the WT allele L162 (C484):
CGCCTCAGCC TCCTAAAGTG CTGGGATTAC AGGCATGATC ACCATGCCTG
GCCTGGAATA
ACTTTTCTCT AAATTTTGTT CATTTAAAAA GAAACAATAA ATGAGCAACA AAAAAGGTGA
GTAAAGCAAG TGCGCTGGTT TCTCAGTGGC CCAGGTCTTT AAATCCACTG
TGTATTACCC
TCACAGGGCT TCTTTCGGCG AACGATTCGA CTCAAGCTGG TGTATGACAA
GTGCGACCGC AGCTGCAAGA TCCAGAAAAA GAACAGAAAC AAATGCCAGT ATTGTCGATT
TCACAAGTGC
C
TTTCTGTCGG GATGTCACAC AACGGTAGGT AAGGTGGCCC TGCACATTTT
CCCAGTTCGT TCCTCAGTTC CCCTTCCTTG CTCCAAGGGA ACAGATCAAG CTATGGATGA
ATGTGCTTCA
ACATTTCACA CCCAAGTCAT TTTGTAATCA GAGTGGCCTA AGAAAATAAA
AGTCGCCCAG
GCGCGGTGGT TCACGCCTGT AATCCCAGCA CTTTGGGAGG CTGAGGTGGG TGGATCACCT
CAGGTCAGGA GTTTGAGACC AGCCTGGCCA ATATGGTGAA ACCCCGTCTC
TACTAAGAAT
54. Sequence of the mutant alleleV162 (G484):
CGCCTCAGCC TCCTAAAGTG CTGGGATTAC AGGCATGATC ACCATGCCTG
GCCTGGAATA
ACTTTTCTCT AAATTTTGTT CATTTAAAAA GAAACAATAA ATGAGCAACA
AAAAAGGTGA GTAAAGCAAG TGCGCTGGTT TCTCAGTGGC CCAGGTCTTT AAATCCACTG
TGTATTACCC
TCACAGGGCT TCTTTCGGCG AACGATTCGA CTCAAGCTGG TGTATGACAA
GTGCGACCGC
AGCTGCAAGA TCCAGAAAAA GAACAGAAAC AAATGCCAGT ATTGTCGATT TCACAAGTGC
G
TTTCTGTCGG GATGTCACAC AACGGTAGGT AAGGTGGCCC TGCACATTTT
CCCAGTTCGT
TCCTCAGTTC CCCTTCCTTG CTCCAAGGGA ACAGATCAAG CTATGGATGA ATGTGCTTCA
ACATTTCACA CCCAAGTCAT TTTGTAATCA GAGTGGCCTA AGAAAATAAA
AGTCGCCCAG
GCGCGGTGGT TCACGCCTGT AATCCCAGCA CTTTGGGAGG CTGAGGTGGG
TGGATCACCT CAGGTCAGGA GTTTGAGACC AGCCTGGCCA ATATGGTGAA ACCCCGTCTC
TACTAAGAAT
PPARA
SNP name and number (in NCBI SNP database):
PPARA T/G(intron 1), [position on NW_ 001838753 is 178627, or position on
NTJ)11523 is 1829973 ], rsl35539
Gene name and number (in NCBI nucleotide database): peroxisome proliferator- activated receptor alpha, NM_005036 and NMJ)01001928
(mRNA transcript variants) from homo sapiens chromosome 22 genomic contig (NW
001838753 or NTJ)11523)
Also known as: PPAR; NRlCl; hPPAR; MGC2237; MGC2452
55. Sequence of the WT allele T:
GTGGCTGCCC TGGAAGGCAC AGACCACTCA TGTCACGTCG TCCTGGGAAA
GGGGCTTCGA
GAAAGGCCTG CATTTGTCTA GGGAATCATC TACCTCTCAT TTCTATCAAA
CCAAATGGAG TCAAGCTCGC CACAGCCAGG AGCCTGCTCT TCCCGCTTAT GTGACTGTGG
TGAAATCGTG
AGCATGAGGG CTCATTTGCT TTTCAGGCTA GAACTATCAG TGACGGAGCA
AAGGCTGAAG
CCACAACTAA GCAGGCAGTG TATCTTCAAT ATAGGTCATT AGATGTATGA TTAGAGTTAA
T
AATCACCTAG GATTTAAATT CTGCTAACCT ATGTGGGTCA CAAGGAGTTT
AACTTGAGCG
CTTAATGCCT TTAAGATCAT AATCAGGAGA ACTAAAATGA GCTCTTGAGT TTCTTGGATA
ATTTGTATTC ACTCTTTCCT CCCCCTGGAC TTGGTTCTTT AGTGAAAGGA AATTCCGAAG
TTTAAAGACA ACGACATCTG GAGCCGCACA TTCCGTTCAC TGGCAGGTGC TGCACACACG CCCCTGCGAC CTCCGTGACC CTCTGTCCCC GCTCTTTCCC CTCTGCAGGC
TGCTCTCAGT
56. Sequence of the mutant allele G:
GTGGCTGCCC TGGAAGGCAC AGACCACTCA TGTCACGTCG TCCTGGGAAA GGGGCTTCGA
GAAAGGCCTG CATTTGTCTA GGGAATCATC TACCTCTCAT TTCTATCAAA
CCAAATGGAG
TCAAGCTCGC CACAGCCAGG AGCCTGCTCT TCCCGCTTAT GTGACTGTGG
TGAAATCGTG AGCATGAGGG CTCATTTGCT TTTCAGGCTA GAACTATCAG TGACGGAGCA
AAGGCTGAAG
CCACAACTAA GCAGGCAGTG TATCTTCAAT ATAGGTCATT AGATGTATGA
TTAGAGTTAA
G AATCACCTAG GATTTAAATT CTGCTAACCT ATGTGGGTCA CAAGGAGTTT
AACTTGAGCG
CTTAATGCCT TTAAGATCAT AATCAGGAGA ACTAAAATGA GCTCTTGAGT
TTCTTGGATA
ATTTGTATTC ACTCTTTCCT CCCCCTGGAC TTGGTTCTTT AGTGAAAGGA AATTCCGAAG
TTTAAAGACA ACGACATCTG GAGCCGCACA TTCCGTTCAC TGGCAGGTGC
TGCACACACG
CCCCTGCGAC CTCCGTGACC CTCTGTCCCC GCTCTTTCCC CTCTGCAGGC
TGCTCTCAGT
PPARG
SNP name and number (in NCBI SNP database):
PPARA Pro(P) 12AIa(A), [C34G (according to mRNA transcript variant 2:
NM_015869, nucleotide numbering starts at the start codon, position on NW_ 921654 is 12330520, or position on NT_022517 is 12333125 ], rsl801282
Gene name and number (in NCBI nucleotide database): peroxisome proliferator- activated receptor alpha, NM_005036 and NM_001001928
(mRNA transcript variants) from homo sapiens chromosome 3 genomic contig (NW_
921654 or NT_022517) Also known as: NR1C3; PPARGl; PPARG2
57. Sequence of the WT allele P12(C34):
TGTACCAAGT CTTGCCAAAG CAGTGAACAT TATGACACAA CTTTTTGTCA
CAGCTGGCTC
CTAATAGGAC AGTGCCAGCC AATTCAAGCC CAGTCCTTTC TGTGTTTATT
CCCATCTCTC CCAAATATTT GGAAACTGAT GTCTTGACTC ATGGGTGTAT TCACAAATTC
TGTTACTTCA
AGTCTTTTTC TTTTAACGGA TTGATCTTTT GCTAGATAGA GACAAAATAT
CAGTGTGAAT
TACAGCAAAC CCCTATTCCA TGCTGTTATG GGTGAAACTC TGGGAGATTC TCCTATTGAC
C
CAGAAAGCGA TTCCTTCACT GATACACTGT CTGCAAACAT ATCACAAGGT
AAAGTTCCTT
CCAGATACGG CTATTGGGGA CGTGGGGGCA TTTATGTAAG GGTAAAATTG CTCTTGTAGT
TTGTCTTCCA GGTTGTGTTT GTTTTAATAC TATCATGTGT ACACTCCAGT
ATTTTAATGC
TTAGCTCGTT GCTATCGCGT TCATTTAAAA ACATGTTCAG AACCTTAAAA
AAGGAAACCT AACCTAATCT ATTTTATCTC TGTGCATGGC TCCCATTTCC TGAATTTTAA
GCATTAAAGG
58. Sequence of the mutant allele A12(G34):
TGTACCAAGT CTTGCCAAAG CAGTGAACAT TATGACACAA CTTTTTGTCA CAGCTGGCTC
CTAATAGGAC AGTGCCAGCC AATTCAAGCC CAGTCCTTTC TGTGTTTATT
CCCATCTCTC
CCAAATATTT GGAAACTGAT GTCTTGACTC ATGGGTGTAT TCACAAATTC
TGTTACTTCA AGTCTTTTTC TTTTAACGGA TTGATCTTTT GCTAGATAGA GACAAAATAT
CAGTGTGAAT
TACAGCAAAC CCCTATTCCA TGCTGTTATG GGTGAAACTC TGGGAGATTC
TCCTATTGAC
G CAGAAAGCGA TTCCTTCACT GATACACTGT CTGCAAACAT ATCACAAGGT
AAAGTTCCTT
CCAGATACGG CTATTGGGGA CGTGGGGGCA TTTATGTAAG GGTAAAATTG
CTCTTGTAGT
TTGTCTTCCA GGTTGTGTTT GTTTTAATAC TATCATGTGT ACACTCCAGT ATTTTAATGC
TTAGCTCGTT GCTATCGCGT TCATTTAAAA ACATGTTCAG AACCTTAAAA
AAGGAAACCT
AACCTAATCT ATTTTATCTC TGTGCATGGC TCCCATTTCC TGAATTTTAA
GCATTAAAGG
PPARGClA
SNP name and number (in NCBI SNP database): PPARGClA Gly(G)482Ser(S), [G1444A (according to mRNA transcript:
NM_013261, nucleotide numbering starts at the start codon, position on NW_ 001838900 is 14439695, or position on NT_006316 is 14491020 ], rs8192678
Gene name and number (in NCBI nucleotide database): peroxisome proliferator- activated receptor gamma, coactivator 1 alpha, (mRNA transcript) from homo sapiens chromosome 4 genomic contig (NW_ 001838900 or NT_006316) Also known as: LEM6; PGCl; PGClA; PGC-Iv; PPARGCl; PGC-l(alpha)
59. Sequence of the WT allele G482 (G1444):
GGTGACCATG ACTATTGCCA GTCAATTAAT TCCAAAACGG AAATACTCAT
TAATATATCA CAGGAGCTCC AAGACTCTAG ACAACTAGAA AATAAAGATG TCTCCTCTGA
TTGGCAGGGG
CAGATTTGTT CTTCCACAGA TTCAGACCAG TGCTACCTGA GAGAGACTTT
GGAGGCAAGC
AAGCAGGTCT CTCCTTGCAG CACAAGAAAA CAGCTCCAAG ACCAGGAAAT CCGAGCCGAG
CTGAACAAGC ACTTCGGTCA TCCCAGTCAA GCTGTTTTTG ACGACGAAGC
AGACAAGACC
G
GTGAACTGAG GGACAGTGAT TTCAGTAATG AACAATTCTC CAAACTACCT ATGTTTATAA
ATTCAGGACT AGCCATGGAT GGCCTGTTTG ATGACAGCGA AGATGAAAGT
GATAAACTGA
GCTACCCTTG GGATGGCACG CAATCCTATT CATTGTTCAA TGTGTCTCCT
TCTTGTTCTT CTTTTAACTC TCCATGTAGA GATTCTGTGT CACCACCCAA ATCCTTATTT
TCTCAAAGAC
CCCAAAGGAT GCGCTCTCGT TCAAGGTCCT TTTCTCGACA CAGGTCGTGT
TCCCGATCAC
60. Sequence of the mutant allele S12 (A1444):
GGTGACCATG ACTATTGCCA GTCAATTAAT TCCAAAACGG AAATACTCAT
TAATATATCA
CAGGAGCTCC AAGACTCTAG ACAACTAGAA AATAAAGATG TCTCCTCTGA
TTGGCAGGGG CAGATTTGTT CTTCCACAGA TTCAGACCAG TGCTACCTGA GAGAGACTTT
GGAGGCAAGC
AAGCAGGTCT CTCCTTGCAG CACAAGAAAA CAGCTCCAAG ACCAGGAAAT
CCGAGCCGAG
CTGAACAAGC ACTTCGGTCA TCCCAGTCAA GCTGTTTTTG ACGACGAAGC AGACAAGACC
A
GTGAACTGAG GGACAGTGAT TTCAGTAATG AACAATTCTC CAAACTACCT
ATGTTTATAA
ATTCAGGACT AGCCATGGAT GGCCTGTTTG ATGACAGCGA AGATGAAAGT GATAAACTGA
GCTACCCTTG GGATGGCACG CAATCCTATT CATTGTTCAA TGTGTCTCCT
TCTTGTTCTT
CTTTTAACTC TCCATGTAGA GATTCTGTGT CACCACCCAA ATCCTTATTT
TCTCAAAGAC
CCCAAAGGAT GCGCTCTCGT TCAAGGTCCT TTTCTCGACA CAGGTCGTGT TCCCGATCAC
PPARGClA
SNP name and number (in NCBI SNP database):
PPARGClA T2842C (according to mRNA transcript: NM_013261, nucleotide numbering starts at the start codon, position on NW_ 001838900 is 14421049, or position on NT_006316 is 14472358 ], rs6821591 Gene name and number (in NCBI nucleotide database): peroxisome proliferator- activated receptor gamma, coactivator 1 alpha, (mRNA transcript) from homo sapiens chromosome 4 genomic contig (NW_ 001838900 or NT_006316) Also known as: LEM6; PGCl; PGClA; PGC-Iv; PPARGCl; PGC-l(alpha)
61. Sequence of the WT allele T2842:
GAGAGAGAGA GAGACAGGAT ATTAGTTCTA TGGAACCTGT GGTTTCTTCA
GGATTGTCAT
ATAATCATTA CGTTATGAGA GAAAGCTTGC TTCAAGTTGA TTCTGCACTT
TCTTAAAAAA
ACAGAGTACA AAGGCTGATG CCCAGACATC AGCGGCTGTC ATTTTAGGGT GGTTTGTGGT
TGGTTGGTTG GTTGGTTGGT TGTTAGTTTT CTTTCCTTTT TAATTTATAT
ATATATATAT
ATATATATAT ATTTTTCCTT TTGAATAGAA TACGAACATT TTGAAGTTCT
AGGTTTTAAG T
GTGTCTTCAT GGAACTGCTG CCATTTGAAA TGGTTTGCCC TTGCGCATTC
TGGTCAGGTG
CCCCCAGTCC TCACATGTAC CCACACATAC TTCCCCTAAA CCAAGCACAC
ACACCACACA CATACATACA CACACACATA CATGCACACA CGCACACTCC ATCACCAAGA
GACTCCAGGA
AAAGCAAAGC TGACACCCAT GAATAAACAT GTGCTTACTG GATATCATTC
TGTCTCTTGC
CTCTTCAGCA GCTGTGTTCA TGTAAACCAT TGTTGTTATT GTTGTTGTTG TTCTTGTTGT
62. Sequence of the mutant allele C2842:
GAGAGAGAGA GAGACAGGAT ATTAGTTCTA TGGAACCTGT GGTTTCTTCA GGATTGTCAT
ATAATCATTA CGTTATGAGA GAAAGCTTGC TTCAAGTTGA TTCTGCACTT TCTTAAAAAA
ACAGAGTACA AAGGCTGATG CCCAGACATC AGCGGCTGTC ATTTTAGGGT
GGTTTGTGGT
TGGTTGGTTG GTTGGTTGGT TGTTAGTTTT CTTTCCTTTT TAATTTATAT
ATATATATAT ATATATATAT ATTTTTCCTT TTGAATAGAA TACGAACATT TTGAAGTTCT
AGGTTTTAAG
C
GTGTCTTCAT GGAACTGCTG CCATTTGAAA TGGTTTGCCC TTGCGCATTC
TGGTCAGGTG CCCCCAGTCC TCACATGTAC CCACACATAC TTCCCCTAAA CCAAGCACAC
ACACCACACA
CATACATACA CACACACATA CATGCACACA CGCACACTCC ATCACCAAGA
GACTCCAGGA
AAAGCAAAGC TGACACCCAT GAATAAACAT GTGCTTACTG GATATCATTC TGTCTCTTGC
CTCTTCAGCA GCTGTGTTCA TGTAAACCAT TGTTGTTATT GTTGTTGTTG
TTCTTGTTGT
NRFl
SNP name and number (in NCBI SNP database):
NRFl A/G (intron) (position on NW_ 001839071 is 2006402, or position on
NT_007933 is 54470012], rs6949152 Gene name and number (in NCBI nucleotide database): nuclear respiratory factor 1, NM_005011 and NM_1040110 (mRNA transcript variants 1 and 2) from homo sapiens chromosome 4 genomic contig (NW_
001839071 or NT_007933)
Also known as: ALPHA-PAL
63. Sequence of the WT allele A:
CCGGATTGCT GCTTACCAGC ACTGTATGAG TAATTTTGAA TGCAAGTATG
TATTTTCTTC TTTAAGTATT AATCGGGGCC TAGAAAACCA TGTGTGGCAT TTCAGATAAT
TTAATTCTGG
GAACTGGGTA CACAGGTGTT ACAAGATGAA AGAGCACAAA AGACACTGGG
GTAATCCAGA
TAGGAAGCAC TACCACCCCT AGGTTTGGGG GAACAGAAGA GAAGAACCTG GAAGCTCAGA
GAGGTCCTCC TGCAGCTGGT AATCTGATCT CCTAGTGGAA TGCCATTCAG
CTGGTACTCA
A
CCACCAGGAG AGAAGAGGCA CAGCTGGAGT TGGGAGGTGC AACACTCCTC TTGCTGGAGC
AATGCTGATA TTATAACAAT GAAAACAGCA AAGAAATCCC TTCTTCTCTC
CCCTTCCAGT
CTCCCTAGGC AAAACCTAAC AGGATACTGG CAGTAAAGTC TGGAAAACAT
GGTTGGCAGG
CTCAGCCCCA GAGCGAGGAA TAGTGCAACT CTGACAAGAA TAGAAGACAG GGCTTGGAAG
TGAGACGGAG AGAGAGAGAT AAACAGCAAG CATAACCTTG TAGGAGAGTT ACAGAAACTG
64. Sequence of the mutant allele G:
CCGGATTGCT GCTTACCAGC ACTGTATGAG TAATTTTGAA TGCAAGTATG
TATTTTCTTC TTTAAGTATT AATCGGGGCC TAGAAAACCA TGTGTGGCAT TTCAGATAAT
TTAATTCTGG
GAACTGGGTA CACAGGTGTT ACAAGATGAA AGAGCACAAA AGACACTGGG
GTAATCCAGA
TAGGAAGCAC TACCACCCCT AGGTTTGGGG GAACAGAAGA GAAGAACCTG GAAGCTCAGA
GAGGTCCTCC TGCAGCTGGT AATCTGATCT CCTAGTGGAA TGCCATTCAG
CTGGTACTCA
G
CCACCAGGAG AGAAGAGGCA CAGCTGGAGT TGGGAGGTGC AACACTCCTC TTGCTGGAGC
AATGCTGATA TTATAACAAT GAAAACAGCA AAGAAATCCC TTCTTCTCTC
CCCTTCCAGT
CTCCCTAGGC AAAACCTAAC AGGATACTGG CAGTAAAGTC TGGAAAACAT
GGTTGGCAGG CTCAGCCCCA GAGCGAGGAA TAGTGCAACT CTGACAAGAA TAGAAGACAG
GGCTTGGAAG
TGAGACGGAG AGAGAGAGAT AAACAGCAAG CATAACCTTG TAGGAGAGTT
ACAGAAACTG
NRFl
SNP name and number (in NCBI SNP database):
NRFl C/T (intron) (position on NW_ 001839071 is 1913409, or position on NT_007933 is 54563377] , rs2402970
Gene name and number (in NCBI nucleotide database): nuclear respiratory factor 1, NM_005011 and NM_1040110 (mRNA transcript variants 1 and 2) from homo sapiens chromosome 4 genomic contig (NW_
001839071 or NT_007933) Also known as: ALPHA-PAL
65. Sequence of the WT allele C:
AGACCGGAGA CAGTGGTGAC ATCAAGACTC ACTTCCTAGT GAGTTTATTC ATGACTCAGG
CCATGTGCAT ATTTCCACTT GGATTCCTCA CAAGTGCAAG TTTCTCTTCT
AGGCTACAGG
TATCTGCAGC CAGGTGCTGT AATGGATTTA TAGTAGCCCG CCAAAAGATC
AAATATCTGA
AGCCTGACGG GTCACAAAGC TGACAGGAGC CATGACTATT GCATGAATTC
CAGATTTCAC
AGTGAAACAG AGCTGCTGCT GAAAAATGGG AGCACAGAGC TGTTCACTGG
GGCT C
TTGATTCTAG ACACTCAAAG AGGGGTACAG TTCTCTGCCC CATGTGTGTT
TCTCACCCAA
CCTTTTCATG GTGTTGAGGA GGGGAAGGGA CAGCTCAGTG GTGATTCTTC
ACTTCTCAAA CGTGTCCTCC TCCTCTGTCT TCATAATGAC CTCCTGAAGT CCAAAGTGCC
TTCCAAAATA
GCTCTTGGAA AGAGGTGGCA GTTTCCTGAC TCCCCAATCT CCCCCATCCT
GGGAGATGTG
TTGATGGCAC TAATTTGCGG GGTAGCAGAG ACTATAGTCC TACTCTCTTT ACTGGCTGGG
GCATTGGAGG CATGCAGTAA CTGTTGACTA CCACTGCTAC AACTGCTGTT
ATGATTATTA
CCATTATAAT GATTAATCAC TCACACCGAA TGGGAAGGGA AGTAACCTTC
AGAGGTTCAC TCTTAGTACT TCTGGCACAT ATGCTTAGGG CCAGGGCCAG TGAGTCTTCA
TTCGCAGAGA
GGTG
66. Sequence of the mutant allele T:
AGACCGGAGA CAGTGGTGAC ATCAAGACTC ACTTCCTAGT GAGTTTATTC
ATGACTCAGG
CCATGTGCAT ATTTCCACTT GGATTCCTCA CAAGTGCAAG TTTCTCTTCT AGGCTACAGG
TATCTGCAGC CAGGTGCTGT AATGGATTTA TAGTAGCCCG CCAAAAGATC
AAATATCTGA
AGCCTGACGG GTCACAAAGC TGACAGGAGC CATGACTATT GCATGAATTC
CAGATTTCAC AGTGAAACAG AGCTGCTGCT GAAAAATGGG AGCACAGAGC TGTTCACTGG
GGCT
T
TTGATTCTAG ACACTCAAAG AGGGGTACAG TTCTCTGCCC CATGTGTGTT
TCTCACCCAA CCTTTTCATG GTGTTGAGGA GGGGAAGGGA CAGCTCAGTG GTGATTCTTC
ACTTCTCAAA
CGTGTCCTCC TCCTCTGTCT TCATAATGAC CTCCTGAAGT CCAAAGTGCC
TTCCAAAATA
GCTCTTGGAA AGAGGTGGCA GTTTCCTGAC TCCCCAATCT CCCCCATCCT GGGAGATGTG
TTGATGGCAC TAATTTGCGG GGTAGCAGAG ACTATAGTCC TACTCTCTTT
ACTGGCTGGG
GCATTGGAGG CATGCAGTAA CTGTTGACTA CCACTGCTAC AACTGCTGTT
ATGATTATTA CCATTATAAT GATTAATCAC TCACACCGAA TGGGAAGGGA AGTAACCTTC
AGAGGTTCAC
TCTTAGTACT TCTGGCACAT ATGCTTAGGG CCAGGGCCAG TGAGTCTTCA
TTCGCAGAGA
GGTG
GABPB2
SNP name and number (in NCBI SNP database):
GABPB2 C/T (intron) (position on NW_ 001838218 is 23762751, or position on NT_010194 is 21387881], rs8031031
Gene name and number (in NCBI nucleotide database):
GA binding protein transcription factor, beta subunit 2, NM_005254, NM_016654, NM_002041 NM_0166545 an NM_181427 (mRNA transcript variants 1-5) from homo sapiens chromosome 15 genomic contig (NW_ 001838218 or NT_010194) Also known as: E4TF1; GABPB; BABPB2; E4TF1B; GABPBl; NRF2B1; NRF2B2; E4TF1-47; E4TF1-53
67. Sequence of the WT allele C:
TCTTTTTAAA GGGATTTTTT TCAAAGGAAA AATCTTAGGT GCATTTGCCA AAGTTGAATC
AGGACAAAAC CAAAACAGAG CCCAATTCTC CTGAAATTGG TTCCATGTGG
TCTAGTCATT
AAATTGACAT CCACAATACA CAGAGGGAGT ACTAAAATGT GAGGGAAGGA
AGATTAAGTT CTATCACATG CATTTAAAGG
C
ACAGAAAATC CCTATAACCC TCTGATTACC ACATCACTTG ATATTCCAAA
GAACTAAGAT
ATTTGGACTA AGGAAATTTA CACATATAAA CAGTTTATTA TGTTATGAAG AGATTAAGTG
AGATATATGT ATAAAGGTCC TTAGTC
68. Sequence of the mutant allele T:
TCTTTTTAAA GGGATTTTTT TCAAAGGAAA AATCTTAGGT GCATTTGCCA
AAGTTGAATC AGGACAAAAC CAAAACAGAG CCCAATTCTC CTGAAATTGG TTCCATGTGG
TCTAGTCATT
AAATTGACAT CCACAATACA CAGAGGGAGT ACTAAAATGT GAGGGAAGGA
AGATTAAGTT
CTATCACATG CATTTAAAGG T
ACAGAAAATC CCTATAACCC TCTGATTACC ACATCACTTG ATATTCCAAA
GAACTAAGAT
ATTTGGACTA AGGAAATTTA CACATATAAA CAGTTTATTA TGTTATGAAG
AGATTAAGTG AGATATATGT ATAAAGGTCC TTAGTC
GABPB2
SNP name and number (in NCBI SNP database):
GABPB2 A/G (intron) (position on NW_ 001838218 is 23749281, or position on NT_010194 is 21401349), rs7181866 Gene name and number (in NCBI nucleotide database):
GA binding protein transcription factor, beta subunit 2, NM_005254, NM_016654, NM_002041 NM_0166545 an NM_181427 (mRNA transcript variants 1-5) from homo sapiens chromosome 15 genomic contig (NW_ 001838218 or NT_010194) Also known as: E4TF1; GABPB; BABPB2; E4TF1B; GABPBl; NRF2B1; NRF2B2; E4TF1-47; E4TF1-53
69. Sequence of the WT allele A:
TTCTCAATTC TTCCTGTGTT CTAAGTTGAA GAACACTAGG AATCTGCTGG
GATATAAAGG
GCATGTCCTC CAAGGATTTA AGTTTAGTGT CTCCCAGTGT AATTCCTTTG
AAACGAAAAA TCATCACATG AACTCTGGTA TATTTGGATT TTTTCCTCCA TGCCCATTTT
ACCTAATGGA
GTTTTTTTCC CCTTTATTTT taaaataaat gatattttca aatattatat ccatatatgt atctcccata tacccctttt tcagaaaacc actagatgac gtgttccacc aaaaccaaaa gtaaactaga aagaataatc aagggcttca ggaaataaag atccaacata gaataggaga gagt
A cccaaaatga tggtgaaggg agaccccaag acaacagctg tgacacagac ctagaaggca aacccagatg ggagccagag aacagagttc caggaaggag gtctccaagg aaaagacagg ctggtaagtc tcctaagaag agaatgaatg tcagtggaga gtttgggatg cgttaatgac ggatacaaga aaactaagaa aagaaaaaac tagactattt ttcagaaggg agaaaaaaac tataccataa aggtatacat gtctcttgta cagtttttcc tttacacaca cacacacaga
70. Sequence of the mutant allele G:
TTCTCAATTC TTCCTGTGTT CTAAGTTGAA GAACACTAGG AATCTGCTGG
GATATAAAGG
GCATGTCCTC CAAGGATTTA AGTTTAGTGT CTCCCAGTGT AATTCCTTTG AAACGAAAAA
TCATCACATG AACTCTGGTA TATTTGGATT TTTTCCTCCA TGCCCATTTT
ACCTAATGGA
GTTTTTTTCC CCTTTATTTT taaaataaat gatattttca aatattatat ccatatatgt atctcccata tacccctttt tcagaaaacc actagatgac gtgttccacc aaaaccaaaa gtaaactaga aagaataatc aagggcttca ggaaataaag atccaacata gaataggaga
gagt G cccaaaatga tggtgaaggg agaccccaag acaacagctg tgacacagac ctagaaggca aacccagatg ggagccagag aacagagttc caggaaggag gtctccaagg aaaagacagg ctggtaagtc tcctaagaag agaatgaatg tcagtggaga gtttgggatg cgttaatgac ggatacaaga aaactaagaa aagaaaaaac tagactattt ttcagaaggg agaaaaaaac tataccataa aggtatacat gtctcttgta cagtttttcc tttacacaca cacacacaga
Claims
1. Use of a polymorphism for diagnosis of cardiac disease in a subject.
2. The use of claim 1, wherein said polymorphism is selected from the group presented in Appendix I.
3. The use of claim 2, wherein said polymorphism occurs in a gene selected from the group consisting of a renin angiotensin system gene, an adrenergic receptor gene, an inflammatory path gene, a metabolic pathway gene, a cell proliferation gene, a natriuretic peptide receptor gene, a plasminogen activator inhibitor gene and a platelet- activating factor gene.
4. The use of claim 3, wherein said polymorphism of said renin angiotensin gene is selected from the group consisting of ATlR, CYPl 1B2, CMAl and BDKRB2 polymorphism.
5. The use of claim 3, wherein said polymorphism of said adrenergic receptor gene is selected from the group consisting of ADRB2, ADRBl, ADRAlA, and ADRA2B polymorphism.
6. The use of claim 3, wherein said polymorphism of said inflammatory pathway gene is selected from the group consisting of interleukin (IL)-IO, IL-6, tumor necrosis factor (TNF), IL-IB, IL-IRN and C-reactive protein (CRP) polymorphism.
7. The use of claim 3, wherein said polymorphism of said metabolic pathway gene is selected from the group consisting of perixosome proliferator- activated receptor gene polymorphism and nuclear respiratory gene polymorphism.
8. The use of claim 7, wherein said perixosome proliferator- activated receptor gene polymorphism is selected from the group consisting of PPARA, PPARG and PPARGClAO polymorphism.
9. The use of claim 7, wherein said nuclear respiratory gene polymorphism is selected from the group consisting of GABPBl, NOS3 and GNB3 polymorphism.
10. The use of claim 3, wherein said polymorphism of said cell proliferation gene comprises FGF2 polymorphism.
11. The use of claim 3, wherein said polymorphism of said natriuretic peptide gene is selected from the group consisting of NPRl and NPR3 polymorphism.
12. The use of claim 3, wherein said polymorphism of said plasminogen activator inhibitor gene comprises SERPINE 1 polymorphism.
13. The use of claim 3, wherein said polymorphism of said platelet- activating factor gene comprises PLA2G7 polymorphism.
14. The use of claim 4, wherein said ATlR polymorphism is an Al 166C polymorphism.
15. The use of claim 4, wherein said CYPl 1B2 polymorphism is a T-344C promoter polymorphism.
16. A diagnostic kit, comprising a primer or a complementary oligonucleotide or polynucleotide, capable of selective amplifying or hybridizing to a sequence identified by one or more of SEQ ID NOs 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, 30, 32, 34, 36, 38, 40, 42, 44, 46, 48, 50, 52, 54, 56, 58, 60, 62, 64, 66, 68, or 70, for diagnosis of cardiac disease.
17. Use of one or more polynucleotide sequences having one or more of SEQ ID NOs 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, 30, 32, 34, 36, 38, 40, 42, 44, 46, 48, 50, 52, 54, 56, 58, 60, 62, 64, 66, 68, or 70, or a combination thereof, for diagnosis of cardiac disease.
18. The use of any of claims 1 to 17, wherein said cardiac disease comprises heart failure.
19. The use of claim 18, wherein said cardiac disease comprises atrial fibrillation.
20. The use of claim 19, wherein said atrial fibrillation is a complication of heart failure.
Priority Applications (5)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US13/002,336 US20110159493A1 (en) | 2008-07-03 | 2009-07-03 | Diagnostic polymorphisms for cardiac disease |
EP09773018.8A EP2307572B1 (en) | 2008-07-03 | 2009-07-03 | Diagnostic polymorphisms for cardiac disease |
CA2729640A CA2729640A1 (en) | 2008-07-03 | 2009-07-03 | Diagnostic polymorphisms for cardiac disease |
IL210424A IL210424A (en) | 2008-07-03 | 2011-01-02 | Diagnostic snps for cardiac diseases |
US14/299,792 US20140349874A1 (en) | 2008-07-03 | 2014-06-09 | Diagnostic polymorphisms for cardiac disease |
Applications Claiming Priority (4)
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---|---|---|---|
US12955008P | 2008-07-03 | 2008-07-03 | |
US61/129,550 | 2008-07-03 | ||
US13611708P | 2008-08-13 | 2008-08-13 | |
US61/136,117 | 2008-08-13 |
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US13/002,336 A-371-Of-International US20110159493A1 (en) | 2008-07-03 | 2009-07-03 | Diagnostic polymorphisms for cardiac disease |
US14/299,792 Continuation US20140349874A1 (en) | 2008-07-03 | 2014-06-09 | Diagnostic polymorphisms for cardiac disease |
Publications (2)
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---|---|
WO2010001358A2 true WO2010001358A2 (en) | 2010-01-07 |
WO2010001358A3 WO2010001358A3 (en) | 2010-06-10 |
Family
ID=41434736
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PCT/IB2009/052892 WO2010001358A2 (en) | 2008-07-03 | 2009-07-03 | Diagnostic polymorphisms for cardiac disease |
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US (2) | US20110159493A1 (en) |
EP (1) | EP2307572B1 (en) |
CA (1) | CA2729640A1 (en) |
IL (1) | IL210424A (en) |
WO (1) | WO2010001358A2 (en) |
Cited By (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2012000119A1 (en) * | 2010-07-02 | 2012-01-05 | Prognomix Inc. | A method of determining a predisposition to atrial fibrillation in a subject |
WO2012107580A1 (en) * | 2011-02-10 | 2012-08-16 | INSERM (Institut National de la Santé et de la Recherche Médicale) | In vitro diagnosis method for predicting a predisposition to cardiomyopathy |
CN103014165A (en) * | 2012-12-20 | 2013-04-03 | 宁波大学 | Kit capable of being used for detecting methylation degree of PLA2G7 gene promoter region relevant to coronary heart disease and application of kit |
Families Citing this family (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
CN105586405A (en) * | 2016-01-15 | 2016-05-18 | 汪道文 | Method for detecting gene polymorphism of ADRB2 and GRK5 and clinical application |
WO2019191010A1 (en) * | 2018-03-27 | 2019-10-03 | Aardvark Therapeutics Inc. | Personalized treatment method for congestive heart failure |
Citations (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO1996005324A1 (en) | 1994-08-09 | 1996-02-22 | Institut National De La Sante Et De La Recherche Medicale | Method for in vitro detection of a predisposition to myocardial infarction and diagnostic kit |
WO2000022166A2 (en) | 1998-10-14 | 2000-04-20 | Pyrosequencing Ab | Genes for assessing cardiovascular status and compositions for use thereof |
US20040005566A1 (en) | 2002-07-02 | 2004-01-08 | Genelink, Inc. | Kits and methods for assessing cardiovascular health |
Family Cites Families (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6582908B2 (en) * | 1990-12-06 | 2003-06-24 | Affymetrix, Inc. | Oligonucleotides |
US20030064372A1 (en) * | 2000-06-22 | 2003-04-03 | Bodnar Jackie S. | Gene and sequence variation associated with lipid disorder |
US20050089914A1 (en) * | 2002-04-12 | 2005-04-28 | Osaka Industrial Promotion Organization | Methods for determining and measuring risk of arteriosclerotic disease, microarray, apparatus and program for determining risk of arteriosclerotic disease |
-
2009
- 2009-07-03 EP EP09773018.8A patent/EP2307572B1/en not_active Not-in-force
- 2009-07-03 CA CA2729640A patent/CA2729640A1/en not_active Abandoned
- 2009-07-03 US US13/002,336 patent/US20110159493A1/en not_active Abandoned
- 2009-07-03 WO PCT/IB2009/052892 patent/WO2010001358A2/en active Application Filing
-
2011
- 2011-01-02 IL IL210424A patent/IL210424A/en not_active IP Right Cessation
-
2014
- 2014-06-09 US US14/299,792 patent/US20140349874A1/en not_active Abandoned
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Cited By (3)
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WO2012000119A1 (en) * | 2010-07-02 | 2012-01-05 | Prognomix Inc. | A method of determining a predisposition to atrial fibrillation in a subject |
WO2012107580A1 (en) * | 2011-02-10 | 2012-08-16 | INSERM (Institut National de la Santé et de la Recherche Médicale) | In vitro diagnosis method for predicting a predisposition to cardiomyopathy |
CN103014165A (en) * | 2012-12-20 | 2013-04-03 | 宁波大学 | Kit capable of being used for detecting methylation degree of PLA2G7 gene promoter region relevant to coronary heart disease and application of kit |
Also Published As
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EP2307572A2 (en) | 2011-04-13 |
EP2307572B1 (en) | 2016-08-31 |
WO2010001358A3 (en) | 2010-06-10 |
IL210424A0 (en) | 2011-03-31 |
US20140349874A1 (en) | 2014-11-27 |
CA2729640A1 (en) | 2010-01-07 |
IL210424A (en) | 2017-06-29 |
US20110159493A1 (en) | 2011-06-30 |
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