Frecuencia de 14 variantes genéticas asociadas con el riesgo y el tratamiento del cáncer de mama en una población colombiana

Introducción: las variaciones genéticas se han relacionado con el riesgo y la eicacia del tratamiento. Es sabido que muchos polimorfismos en cáncer de mama influyen en la susceptibilidad, el riesgo de cáncer y el resultado del tratamiento. Los polimorfismos varían entre las poblaciones, y por tanto, es necesario realizar estudios locales. Objetivo: establecer la frecuencia de polimorismos asociados al riesgo de cáncer de mama y la farmacogenómica del tratamiento en un grupo de individuos colombianos. Métodos: los datos de los perfiles de microarreglos, incluidos los polimorismos genéticos asociados con el tratamiento del cáncer de mama, se obtuvieron de forma retrospectiva (Pathway Genomics®). Se estudiaron la frecuencia del marcador CYP2D6 rs3892097 y un panel de cáncer de mama (CAS8 rs1045485, CHEK21100delC, ESR1 rs2046210,FGFR2 rs1219648, intergenic_2q35rs13387042, intergenic_8q24 rs13281615, MSRP30 rs10941679, TNRC9 rs3803662, AKAP9 rs6964587, LSP1 rs3817198, MAP3K1rs889312, PALBS1592 delT, ESR1 rs3020314). Resultados: se analizaron los datos de microarreglos de 68 hombres y 92 mujeres. Todos los polimorfismos siguieron el equilibrio Hardy-Weinberg. Las frecuencias fenotípicas de CYP2D6 rs3892097 C/T, CAS8 rs1045485 G/C, y aquellas de los genes incluidos en un panel de cáncer de mama (CAS8 rs1045485, CHEK21100delC, FGFR2rs1219648, intergenic_2q35rs13387042, intergenic_8q24 rs13281615, MSRP30 rs10941679, TNRC9 rs3803662, LSP1 rs3817198, MAP3K1rs889312, PALBS1592 del T, ESR1rs3020314) no difirieron significativamente de los datos publicados previamente. ESR1 rs2046210, con frecuencias alélicas de C = 0,04 y T = 0,02, y AKAP9 rs6964587, con una frecuencia de A = 0,005, se determinaron como raras.Investigación científica277-288Introduction: Genetic variations have been related to risk and treatment efficacy. Many polymorphisms in breast cancer are known to influence susceptibility, breast cancer risk and treatment outcome. Polymorphisms vary among populations; therefore, local studies are necessary. Objective: To establish the frequency of polymorphisms associated to breast cancer risk and treatment pharmacogenomics in a group of Colombian individuals. Methods: Data from microarray profiles including gene polymorphisms associated with breast cancer treatment were retrospectively collected (Pathway Genomics®). The frequency of marker CYP2D6 rs3892097 and a breast cancer panel (CAS8 rs1045485, CHEK21100delC, ESR1 rs2046210, FGFR2 rs1219648, intergenic_2q35rs13387042, intergenic_8q24 rs13281615, MSRP30 rs10941679, TNRC9 rs3803662, AKAP9 rs6964587, LSP1 rs3817198, MAP3K1rs889312, PALBS1592 delT, ESR1 rs3020314) were studied. Results: Microarray data from 68 men and 92 women were analyzed. All polymorphisms were in Hardy-Weinberg equilibrium. Genotypic frequencies of CYP2D6 rs3892097 C/T, CAS8 rs1045485 G/C, and those of genes included in a breast cancer panel (CAS8 rs1045485, CHEK21100delC, FGFR2rs1219648, intergenic_2q35rs13387042, intergenic_8q24 rs13281615, MSRP30 rs10941679, TNRC9 rs3803662, LSP1 rs3817198, MAP3K1rs889312, PALBS1592 del T, ESR1rs3020314) did not significantly differ from previously published data. ESR1 rs2046210, with allele frequencies of C=0.04 and T=0.02, and AKAP9 rs6964587, with a frequency of A=0.005, were determined as rare. Conclusions: The population studied was not significantly different in allele distribution from previously reported data at HapMap. Genotypes in Colombian population are similar to other previously studied groups of healthy subjects. Extended use of genotyping pharmacogenetic polymorphisms will prevent toxicity and adverse effects in tamoxifen treatment (for example in CYP2D6 rs3892097). Therefore, therapeutic alternatives should be evaluated based on individual pharmacogenetic studies

Peripheral blood lymphocyte CD4 and CD8 co-expression in HIV positive patients

Objetivo. La coexpresión en membrana de las moléculas CD4 y CD8 en leucocitos de sangre periférica se halla generalmente restringida a casos de leucemias agudas T prolinfocíticas o de leucemias T del adulto y no representa más de 3% a 5% de los linfocitos T periféricos. En este trabajo buscamos establecer la frecuencia de elevación de los linfocitos CD4+CD8+ de la totalidad de las muestras de pacientes remitidos para tipificación al Instituto de Referencia Andino en el ano 2007. Diseño. Se hizo la tipificación de 1.883 subpoblaciones de linfocitos T de individuos diferentes y, luego, se procedió a la revisión retrospectiva de los resultados que correspondían a la totalidad de los análisis del 2007 en nuestro instituto. Además, se tabularon 142 muestras recibidas en enero de 2008 con el fin de determinar valores de referencia para la población estudiada. Metodología. Las muestras de sangre total se marcaron con anticuerpos monoclonales fluorescentes utilizando el reactivo Cyto-Stat® triCHROME1M CD8-FITC/CD4-RD1/CD3-PC5 y, luego, se procesaron en un citómetro Epics XL-MCL. Resultados. El análisis de los pacientes tipificados en 2007 reveló la existencia de dos individuos (0,11%) en los que se presentó el fenómeno de aumento de la coexpresión en membrana de las moléculas CD4 y CD8. Conclusiones. El hallazgo de este fenotipo linfocitario en sangre periférica de pacientes no leucémicos debe alertar a los laboratorios que tipifican aisladamente los linfocitos CD4+ sin evaluar los marcadores CD3 y CD8, puesto que podrían estar sobreestimando los recuentos y porcentajes reales de células CD4+CD8 en la sangre periférica de sus pacientes y subestimando una subpoblación de linfocitos que es infrecuente, pero que se ha reportado como funcional y diferenciada en una variedad de infecciones y modelos experimentales.Q3Artículo original267-276Objective: Membrane co-expression of CD4 and CD8 molecules in peripheral blood leukocytes is usually restricted to acute prolympho-cytic T cell leukemia or adult T cell leukemias, and it does not represent more than 3-5% of peripheral T lymphocytes in non-leukemic patients. The aim of this work was to define the frequency of CD4+CD8‘ lymphocytes among all the patient samples received at a reference laboratory in Colombia during 2007. Design: A total of 1,883 different samples were typed for T cell subpopulations in 2007, and the corresponding results were reviewed. Additionally, 142 samples received and typed in January 2008 were tabulated in order to establish reference values. Materials and methods: Whole blood samples were labeled with fluorescent monoclonal antibodies using the Cyto-Stat® triC HROME™ C D8-FITC/C D4-RD1 /C D3-PC 5 reagent and thereafter processed in an Epics XL-MCL cytometer. Results: The review of all of the patients analysed in 2007 revealed the existence of 2 individuals (0.11%) in which we found high levels of CD4+CD8+ membrane co-expression. Conclusions: The finding of this rare lymphocytic phenotype in peripheral blood of non-leukemic patients should alert the laboratories that in typing CD4+ lymphocytes alone and not evaluating CD3 and CD8 markers, they might be overestimating the real percentages of CD4+CD8 cells on some patients, as well as underestimating an uncommon lymphocyte subpopulation that has been characterized as functionally distinct in a variety of infections and experimental models

Low HLA polymorphism in Colombian mestizos

Objetivo. Este trabajo tiene como objetivo describir la frecuencia de alelos y de haplotipos de antígenos HLA de clases I y II en población mestiza colombiana. Metodología. Se estudiaron 197 individuos colombianos no emparentados y 157 individuos emparentados que conformaban 53 familias, provenientes de diferentes regiones del país, remitidos para estudios de HLA de clases I y II por el método PCR-SSP a los laboratorios de inmunología del Hospital Militar Central de Bogotá y al Instituto de Referencia Andino. Resultados. El haplotipo HLA-A*24 B*35 DR*04 fue el más frecuente en la población estudiada, lo cual concuerda con otros estudios de mestizos colombianos. Conclusiones. El desequilibrio de Hardy-Weinberg hallado en la población analizada en el presente estudio, debe alertar sobre una eventual reducción en el repertorio de respuesta inmunitaria en los colombianos, lo cual podría ser el origen de una consecuente fragilidad de la población frente a nuevas infecciones que podrían convertirse en epidemias.Artículo original359-370Objective: This paper aims to describe the allele frequency and haplotype of HLA class I and II molecules in a Colombian mestizo population. Methodology: HLA class I and II molecules on 197 unrelated Colombian individuals and 157 unrelated individuals making up 53 families from different regions of the country were studied at the Immunology Laboratory at the Military Hospital Central of Bogotá and at the Instituto de Referencia Andino by the PCR-SSP method. Results: The haplotype HLA-A * 24 B*35 DR*04 was the most common, which is consistent with other studies carried out in Colombian mestizos. Conclusions: The Hardy-Weinberg disequilibrium found in the population analyzed in this study should alert on a possible reduction of the immune response repertoire in Colombia, which could be the origin of a consequent fragility of the population in face of new infections that could eventually become epidemic

Espectro de mutaciones en los genes BRCA1 y BRCA2 asociados a cáncer de mama en Colombia

6 páginasIntroduction: The risk of developing breast and ovarian cancer is higher in families that carry mutations in BRCA1 or BRCA2 genes, and timely mutation detection is critical.Objective: To identify the presence of mutations in the Colombian population and evaluate two testing strategies.Methods: From a total universe of 853 individual blood samples tests referred for BRCA1 and BRCA2 typing, 256 cases were analyzed by complete direct sequencing of both genes in Myriad Genetics, and the remaining 597 cases were studied by partial sequencing based on founder mutations in a PCR test designed by ourselves ("Profile Colombia").Results: We found 107 patients carrying deleterious mutations in this group of patients, 69 (64.5%) located in BRCA1, and 38 (35.5%) in BRCA2. Overall, we detected 39 previously unreported mutations in Colombia (22 in BRCA1 and 17 in BRCA2) and only 4 out of the 6 previously reported founder mutations. Sixty four out of 597 patients (10.7%) studied by "Profile Colombia" showed mutations in BRCA1 or BRCA2, and 41/256 patients (16%) showed mutations by complete BRCA1-BRCA2 sequencing

Mutational analysis of HIV in Colombian patients

Objetivo. La resistencia a los medicamentos antirretrovirales se ha asociado con mutaciones características en los genes que codifican las enzimas que son el blanco de la terapia antirretroviral. En el presente trabajo se busca evaluar, desde el punto de vista cualitativo y cuantitativo, las diferentes mutaciones reveladas por la tipificación molecular de virus procedentes de diferentes pacientes remitidos al Instituto de Referencia Andino, en Bogotá, para la genotipificación con fines terapéuticos.Diseño: Se hizo la tipificación de un total de 1.064 mutaciones diferentes en virus procedentes de 16 pacientes no relacionados entre sí, con solicitud de genotipificación del VIH para análisis de sensibilidad a antirretrovirales. Se procedió a la tabulación de las mutaciones encontradas en cuatro categorías principales: a-mutaciones asociadas a resistencia, b- mutaciones silenciosas, c- polimorfismos genéticos por fuera de los sitios asociados a resistencia, y de mutaciones en sitios de resistencia que hasta el momento no han sido asociadas a resistencia.Metodología. Se seleccionaron, en estricto orden de llegada, 16 muestras de sangre en EDTA de pacientes con solicitud de genotipificación del VIH para análisis de sensibilidad a antirretrovirales. Se extrajo el ARN viral de cada muestra por el método QIAamp® y se procedió a su amplificación por medio de la PCR con transcriptasa inversa (RT-PCR). Una vez amplificado el ácido nucleico viral, se procedió a su tipificación molecular en el secuenciador LongReadTower-Opengene®, utilizando el estuche Trugene HIV-1®. Las secuencias obtenidas se transcribieron a hoja electrónica Excel®, y se hizo un cálculo de frecuencias de mutaciones por conteo directo. Resultados. Se revelaron por el método de secuenciación viral 1.064 mutaciones diferentes entre las que solamente 164 (15,4%) estaban asociadas a resistencia a los antirretrovirales (68 en el gen de la retrotranscriptasa o transcriptasa inversa y 96 en el gen de la proteasa). El 84,5% restante corresponde a polimorfismos (n=301), mutaciones silenciosas (n=564) y a otras mutaciones (n=35) que hasta el momento no han sido asociadas con resistencia, pero que pueden ser fuente de fracasos recurrentes en los tratamientos antirretrovirales. Se encontraron tres genotipos virales idénticos en tres pacientes de diferente procedencia en el país, lo cual puede constituir un indicador de utilidad ejemplar para la trazabilidad epidemiológica de esta virosis, en la medida en que la coincidencia de perfiles de mutación en virus aislados a partir de diferentes pacientes se puede asociar a la infección con una misma cepa circulante en una región determinada. Se presenta la cartografía molecular de las 1.064 mutaciones diferentes identificadas en 16 pacientes estudiados, enla cual se revelan codones cuya secuencia muta con mayor frecuencia. Entre los que están asociados con resistencia al tratamiento antirretroviral, se encontró que el codón 63 de la proteasa, con 18 mutaciones, y el codón 184 de la retrotranscriptasa, con 14 mutaciones, alojaron la mayor cantidad de variantes en losvirus secuenciados en este estudio preliminar. Conclusiones. La tipificación genética del VIH puede servir de fundamento molecular a investigaciones epidemiológicas, más allá de su evidente utilidad en el estudio de la resistencia a antirretrovirales, para lo cual se están utilizando exclusivamente estos análisis hoy en día.Artículo original350-370Objective: Resistance to antiretroviral drugs has been associated with characteristic mutations in the genes that encode enzymes which are the target of anti-retroviral therapy. In this paper we evaluate the different mutations revealed by molecular typing of viruses from different patients who were referred to be genotyped at the Instituto de Referenda Andino in Bogotá for therapeutic purposes. Design: A total number of 1064 mutations in viruses from 16 HIV infected unrelated patients were initially genotyped for the analysis of sensitivity to antiretrovirals. Afterwards, we proceeded to the tabulation of the mutations found in four main categories: a- resistance mutations, b- silent mutations, c-genetic polymorphisms outside of sites associated with resistance, and d- mutations at sites not yet associated with resistance. Materials and methods: Sixteen EDTA blood samples drawn from patients with HIV genotyping application for analysis of sensitivity to antiretroviral drugs were selected in strict order of arrival. Viral RNA was extracted from each sample by the QIAamp® method, and we then proceeded to its amplification by reverse transcriptase PCR (RT-PCR). Once the viral nucleic acid was successfully amplified, we proceeded to molecular typing in the sequencer LongRead-Tower-Opengene®, using the Trugene® HIV-1 kit. The sequences obtained were transcribed to an Excel® spreadsheet, to calculate the frequencies of mutations by direct counting. Results: We revealed 1064 viral mutations among which only 164 (15,4%) were associated with resistance to antiretroviral drugs (68 in the retrotranscriptase or reverse transcriptase gene and 96 in the protease). The remaining 84,5% corresponds to polymorphisms (n=301), silent mutations (n=564), and other mutations (n=35) that have not been associated with resistance so far: but can be a source of recurring failures on antiretroviral treatment. We also found three identical viral genotypes in 3 unrelated patients coming from different geographic areas in the country. This finding implies that viral genotyping can be a useful indicator for epidemiological tracking of this viral disease. We also report the molecular mapping of the 1064 mutations identified in all 16 patients studied, which show which codons mutate more frequently. Among these, the codon 63 of the protease, with 18 mutations, and codon 184 of the retrotranscriptase, with 14 mutations, housed the higher number of variants in the viruses that were sequenced in this preliminary’ study.Conclusions: Genetic typing of HIV can be the basis of molecular epidemiological investigations, beyond their obvious utility in the study of resistance to antiretroviral drugs for which these tests are used exclusively today

Balancing groundwater conservation and rural livelihoods under water and climate uncertainties: An integrated hydro-economic modeling framework

In arid countries worldwide, social conflicts between irrigation-based human development and the conservation of aquatic ecosystems are widespread and attract many public debates. This research focuses on the analysis of water and agricultural policies aimed at conserving groundwater resources and maintaining rurallivelihoods in a basin in Spain's central arid region. Intensive groundwater mining for irrigation has caused overexploitation of the basin's large aquifer, the degradation of reputed wetlands and has given rise to notable social conflicts over the years. With the aim of tackling the multifaceted socio-ecological interactions of complex water systems, the methodology used in this study consists in a novel integration into a common platform of an economic optimization model and a hydrology model WEAP (Water Evaluation And Planning system). This robust tool is used to analyze the spatial and temporal effects of different water and agricultural policies under different climate scenarios. It permits the prediction of different climate and policy outcomes across farm types (water stress impacts and adaptation), at basin's level (aquifer recovery), and along the policies’ implementation horizon (short and long run). Results show that the region's current quota-based water policies may contribute to reduce water consumption in the farms but will not be able to recover the aquifer and will inflict income losses to the rural communities. This situation would worsen in case of drought. Economies of scale and technology are evidenced as larger farms with cropping diversification and those equipped with modern irrigation will better adapt to water stress conditions. However, the long-term sustainability of the aquifer and the maintenance of rurallivelihoods will be attained only if additional policy measures are put in place such as the control of illegal abstractions and the establishing of a water bank. Within the policy domain, the research contributes to the new sustainable development strategy of the EU by concluding that, in water-scarce regions, effective integration of water and agricultural policies is essential for achieving the water protection objectives of the EU policies. Therefore, the design and enforcement of well-balanced region-specific polices is a major task faced by policy makers for achieving successful water management that will ensure nature protection and human development at tolerable social costs. From a methodological perspective, this research initiative contributes to better address hydrological questions as well as economic and social issues in complex water and human systems. Its integrated vision provides a valuable illustration to inform water policy and management decisions within contexts of water-related conflicts worldwide

Cost-effectiveness of groundwater conservation measures: A multi-level analysis with policy implications

Groundwater in Spain, as in other arid and semiarid countries worldwide, has been widely used in the expansion of irrigated agriculture. In the Spanish Mancha Occidental aquifer, the excessive, and sometimes illegal, water abstraction for irrigation has promoted outstanding socioeconomic development in the area, but it has also resulted in exploitation of the aquifer and degradation of valuable wetlands. Water policies implemented in the region have not yet managed to restore the aquifer and face strong social opposition. This paper uses a multi-scale modeling approach to explore the environmental and socio-economic impacts of alternative water conservation measures at the farm and basin levels. It also analyzes their comparative cost-effectiveness to help policy makers identify the least costly policy option for achieving the goal of the Mancha Occidental aquifer's sustainability. To conduct this analysis, a Mathematical Programming Model has been developed to simulate: the closing-up and taxed-legalization of unlicensed wells, uniform volumetric and block-rate water prices, water quotas, and water markets. Aggregate results show that net social costs are not substantially different across policy option, so none of the considered policy options will be clearly more cost-effective than the others. However, there are significant differences between private and public costs (at the farm and sub-basin levels), which will be critical for determining the application in practice of these policies. Results show that controlling illegal water mining (through the legalization of unlicensed wells) is necessary, but is not sufficient to recover the aquifer. Rather, effective water management in this area will require the implementation of other water management policies as well. Among them, uniform volumetric and block-rate water pricing policies will entail the lowest net social cost, but will produce important income losses in the smallest and most water-intensive farms, which might put at risk the viability of these farms and the social acceptance of the policies. Further investigations on social costs, policy enforcement capacity and public participation in water management are highly recommende

Guía de práctica clínica SENPE/SEGHNP/SEFH sobre nutrición parenteral pediátrica

Introduction: Parenteral nutrition (PN) in childhood is a treatment whose characteristics are highly variable depending on the age and pathology of the patient. Material and methods: The Standardization and Protocols Group of the Spanish Society for Parenteral and Enteral Nutrition (SENPE) is an interdisciplinary group formed by members of the SENPE, the Spanish Society of Gastroenterology, Hepatology and Pediatric Nutrition (SEGHNP) and the Spanish Society of Hospital Pharmacy (SEFH) that intends to update this issue. For this, a detailed review of the literature has been carried out, looking for the evidences that allow us to elaborate a Clinical Practice Guide following the criteria of the Oxford Center for Evidence-Based Medicine. Results: This manuscript summarizes the recommendations regarding indications, access routes, requirements, modifications in special situations, components of the mixtures, prescription and standardization, preparation, administration, monitoring, complications and home NP. The complete document is published as a monographic number. Conclusions: This guide is intended to support the prescription of pediatric PN. It provides the basis for rational decisions in the context of the existing evidence. No guidelines can take into account all of the often compelling individual clinical circumstances.Introducción: la nutrición parenteral (NP) en la infancia es un tratamiento cuyas características son muy variables en función de la edad y la patología que presente el paciente. Material y métodos: el grupo de Estandarización y Protocolos de la Sociedad Española de Nutrición Parenteral y Enteral (SENPE) es un grupo interdisciplinar formado por miembros de la SENPE, Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica (SEGHNP) y Sociedad Española de Farmacia Hospitalaria (SEFH) que pretende poner al día este tema. Para ello, se ha realizado una revisión pormenorizada de la literatura buscando las evidencias que nos permiten elaborar una Guía de Práctica Clínica siguiendo los criterios del Oxford Centre for Evidence-Based Medicine. Resultados: este manuscrito expone de forma resumida las recomendaciones en cuanto a indicaciones, vías de acceso, requerimientos, modificaciones en situaciones especiales, componentes de las mezclas, prescripción y estandarización, preparación, administración, monitorización, complicaciones y NP domiciliaria. El documento completo se publica como número monográfico. Conclusiones: esta guía pretende servir de apoyo para la prescripción de la NP pediátrica. Constituye la base para tomar decisiones en el contexto de la evidencia existente. Ninguna guía puede tener en cuenta todas las circunstancias clínicas individuale