Genetics of Human Hypertension

人类高血压的遗传学

• 批准号: 7891154
• 负责人: GORDON H WILLIAMS
• 金额: $ 71.81万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-15 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7891154
• 关键词: AR gene; Adipocytes; Adrenal Glands; Adrenergic Receptor; Aldosterone; Angiotensin-Converting Enzyme Inhibitors; Angiotensinogen; Angiotensins; Argentina; Blood Pressure; Candidate Disease Gene; Cell Line; Cells; Characteristics; Clinical; Coronary heart disease; Data; Data Set; Defect; Diabetes Mellitus; Diet; Double-Blind Method; Family history of; France; Frequencies; Gene Targeting; Genes; Genetic; Genetic Polymorphism; Genetic Variation; Genotype; Goals; Hormonal; Human; Human Genetics; Hypertension; Hypotension; In Vitro; Individual; Insulin Resistance; Intake; Intervention; Italy; LDL Cholesterol Lipoproteins; Leucine Aminopeptidase; Mediating; Metabolic syndrome; Mutation; Netherlands; Obesity; Outcome; Pathway interactions; Pharmacogenetics; Phenotype; Population; Prevention strategy; Production; Protocols documentation; Randomized; Rattus; Receptor Gene; Recruitment Activity; Regulation; Renal function; Renin; Rest; Risk; Role; Secondary to; Sodium; Sodium Chloride; Sodium-Restricted Diet; Source; Structure; Subgroup; Switzerland; Techniques; Testing; Tissues; Triglycerides; Variant; Zona Glomerulosa; cardiovascular risk factor; cohort; expectation; genetic association; hypercholesterolemia; in vivo; kidney cell; loss of function mutation; low renin hypertension; normotensive; receptor; response; salt intake; salt sensitive; tool; translational study

DESCRIPTION (provided by applicant): An anticipated outcome of the genetic revolution is more individualized treatment and prevention strategies. For the past decade supported by a SCOR in Hypertension (HTN) we have developed a large cohort who has been carefully characterized phenotypically and genotyped for several key candidate genes. We have strong evidence that a number of these genes identify homogeneous subgroups that theoretically should respond to specific therapies. The logical next step is to test these expectations. Our focus has been on the genetic underpinnings of hormonal factors leading to HTN and its associated cardiovascular (CV) risks. From these studies, we have identified several specific intermediate phenotypes of the hypertensive population. Two are the focus of this proposal. Common characteristics are: 1) an abnormality in the regulation of aldosterone (ALDO) secretion when sodium diet is modified and 2) salt sensitive blood pressure (BP). The first intermediate phenotype, comprising 25-30% of hypertensives, is termed non-modulation. Their defect is dysregulation of tissue ANGII production when Na intake is modified in the adrenal and the vasculature. They have abnormalities in renal function but normal renin level. Non-modulators are associated with polymorphic variants of angiotensinogen (ACT) that increases angiotensinogen production-a gain in function mutation- and adipocyte derived leucine aminopeptidase (ALAP) that reduces ANGII degradation- a loss of function mutation. Thereby in two ways non-modulators can increase tissue levels of ANGII. The pathophysiologic features of non-modulation are corrected by administrating an ACE inhibitor. The second intermediate phenotype, only recently identified by our group, is part of the more traditional salt sensitive sub-group: low renin HTN. These individuals have disproportionately increased ALDO levels in contrast to the reduced ALDO levels observed in non-modulators, and are associated with polymorphisms in the ¿-2 adrenergic receptor gene. This intermediate phenotype may comprise a third or more of low renin hypertensives. The overall goal of the present proposal is to expand on these preliminary findings in three ways. First, in non-modulators we will determine the relationship of the two major gene variants to the presence of the metabolic syndrome/insulin resistance-a major feature of non-modulation. Second, for both phenotypes, we will determine the likely mechanism(s) underlying the increased risk of HTN using in vivo and in vitro techniques. Third, for the non-modulators, we will determine the likelihood that therapy directed at these mechanism(s) will be more effective in reducing BP, than will non-specific therapy- pharmacogenetics. Thus, the ultimate outcome of this project is to develop tools for individualized therapy in a substantial fraction of the hypertensive population using mechanistically and genetically driven approaches.

描述（由适用提供）：遗传革命的预期结果是更个性化的治疗和预防策略。在过去的十年中，在高血压（HTN）的SCOR支持下，我们开发了一个大型队列，该队列经过表征，并针对几个关键候选基因进行了基因分型。我们有强有力的证据表明，这些基因中的许多基因在理论上应该对特定疗法做出反应。逻辑下一步是测试这些期望。我们的重点一直放在导致HTN及其相关心血管（CV）风险的遗传基础上。从这些研究中，我们确定了高血压人群的几种特定的中间表型。两个是该提议的重点。共同特征是：1）当钠饮食修饰和2）盐敏感血压（BP）时，醛固酮（Aldo）分泌的绝对是绝对的。第一个中间表型，占高血压的25-30％，称为不调制。它们的缺陷是当Na摄入量在肾上腺和脉管系统中修饰时，组织AngII的产生失调。它们的肾功能异常，但肾素水平正常。非调节剂与血管紧张素原（ACT）的多态性变异剂相关，可增加血管紧张素的产生 - 功能突变和脂肪细胞衍生的亮氨酸氨基肽酶（ALAP）的增益，减少了血管静脉降解 - 功能突变的丧失。因此，通过两种方式，非调节剂可以增加组织水平的ANGII。非调节的病理生理特征通过ACE抑制剂纠正。第二个中间表型，直到我们组最近才确定，是更传统的盐敏感亚组的一部分：低肾素HTN。与在非调节剂中观察到的ALDO水平降低相比，这些个体的ALDO水平不成比例，并且与€-2肾上腺素受体基因中的多态性有关。该中间表型可能包括三分之一或更多的低肾素高血压。本提案的总体目标是通过三种方式扩展这些初步发现。首先，在非调节剂中，我们将确定两个主要基因变体与代谢综合征/胰岛素抵抗的存在的关系 - 非调节的主要特征。其次，对于两种表型，我们将确定使用体内和体外技术增加HTN风险增加的可能性机制。第三，对于非调节剂，我们将确定针对这些机制的治疗将比非特异性治疗 - 药物遗传学更有效。这是该项目的最终结果是使用机械和遗传驱动的方法在高血压种群中开发了个性化治疗的工具。