Genetics of focal segmental glomerulosclerosis and human immunodeficiency virus-associated collapsing glomerulopathy: the role of MYH9 genetic variation.

Genetics of focal segmental glomerulosclerosis and human immunodeficiency virus-associated collapsing glomerulopathy: the role of MYH9 genetic variation.
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DOI:
10.1016/j.semnephrol.2010.01.003
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发表时间:
2010-03
影响因子:
3.3
通讯作者:
Kopp, Jeffrey B.
Kopp, Jeffrey B.
中科院分区:
医学2区
文献类型:
--
作者:
Winkler, Cheryl A.;Nelson, George;Oleksyk, Taras K.;Nava, M. Berenice;Kopp, Jeffrey B.

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直到最近,对肾小球疾病的遗传原因的了解仅限于某些罕见或不常见的遗传性疾病,以及在候选基因研究中确定的罕见或影响小的基因。这些遗传因素只占肾脏疾病的很小一部分。然而,非洲裔美国人和欧洲裔美国人在多种肾脏疾病发病率上的显著差异,不能完全用文化或经济因素来解释,这表明有很大的未知遗传影响。由于FSGS和hiv相关的坍缩肾小球病(HVAN)存在显著的种族差异,我们进行了一项混合作图研究,以确定致病的遗传因素。混合图谱发现,非肌肉肌球蛋白基因MYH9的遗传变异对FSGS和HIVAN都有极大的影响,比值比为4到8,归因分数为70-100%。先前发现,罕见的遗传性MYH9疾病指出MYH9变异破坏负责维持足细胞结构的肌动蛋白-肌球蛋白丝的机制,足细胞在肾小球中提供三种滤过屏障之一。MYH9变异对非糖尿病肾病的影响较小但仍高度显著,对糖尿病肾病的影响较弱但显著;目前尚不清楚潜在的隐匿性FSGS是否与MYH9与这些疾病的关联有关。MYH9变异对疾病的强大预测能力表明,这些变异的基因检测在个性化医疗、遗传风险评估和潜在诊断中具有明确的作用。
Until recently knowledge of genetic causes of glomerular disease was limited to certain rare or uncommon inherited diseases, and to a genes, either rare or with small effect, identified in candidate gene studies. These genetic factors accounted for only a very small fraction of kidney disease. However, the striking differences in frequency of many forms of kidney disease between African Americans and European Americans, which could not be completely explained by cultural or economic factors, pointed to a large unidentified genetic influence. Since FSGS and HIV-associated collapsing glomerulopathy (HVAN) have striking racial disparities, we performed an admixture mapping study to identify contributing genetic factors. Admixture mapping identified genetic variants in the non-muscle myosin gene MYH9 as having an extreme influence on both FSGS and HIVAN, with odds ratios from 4 to 8 and attributable fractions of 70–100%. Previously identified, rare inherited MYH9 disorders point to a mechanism by which MYH9 variation disrupts the actin-myosin filaments responsible for maintaining the structure of podocytes, the cells that provide one of three filtration barriers in the glomeruli. MYH9 variation has a smaller but still highly significant effect on non-diabetic kidney disease, and a weaker but significant effect on diabetic kidney disease; it is unclear whether underlying cryptic FSGS is responsible for the MYH9 association with these diseases. The strong predicted power of MYH9 variation for disease indicates a clear role for genetic testing for these variants in personalized medicine, for assessment of genetic risk, and potentially for diagnosis.
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