Role of P2RY12 gene variants and biological variation in arterial thrombosis

Arterial thrombosis is the leading cause of morbidity and mortality in the Western world. Plaque rupture induces arterial thrombus formation, which may result in vascular occlusion. Depending on the localization of the occluded vessel, arterial thrombosis can affect the cardiovascular, cerebrovascular and peripheral arterial systems with clinical manifestations such as myocardial infarction and ischemic stroke. Arterial thrombosis is a multifactorial disease, and both genetic and environmental factors are known to contribute to its pathogenesis. In this thesis we have focused on the role of these genetic factors with an emphasis on common variation in the platelet receptor P2RY12 gene. The P2Y12 receptor plays a central role in platelet aggregation and is the pharmacologic target of widely prescribed antiplatelet drug clopidogrel (Plavix). Studies described in Part I have shown that common variation in the P2RY12 gene are a risk factor for arterial thrombosis at young age. In addition, we have shown that these genetic variations are a significant determinant of the on-clopidogrel platelet reactivity and the pharmacodynamic response to cangrelor, an alternative P2Y12 receptor antagonist. In another study we report that the com! mon variation in the P2RY12 gene is associated with the risk of restenosis within 1 year after percutaneous coronary interventions. In Part II, the biological variation of several hemostatic and inflammatory factors important in arterial thrombosis is described. In addition, we report an association between the concentrations of air pollution and a part of this biological variation, which may provide an explanation for the relationship between air pollution and cardiovascular disease

Individualized angiotensin-converting enzyme (ACE)-inhibitor therapy in stable coronary artery disease based on clinical and pharmacogenetic determinants: The PERindopril GENEtic (PERGENE) risk model

Background-Patients with stable coronary artery disease (CAD) constitute a heterogeneous group in which the treatment benefits by angiotensin-converting enzyme (ACE)-inhibitor therapy vary between individuals. Our objective was to integrate clinical and pharmacogenetic determinants in an ultimate combined risk prediction model. Methods and Results-Clinical, genetic, and outcomes data were used from 8726 stable CAD patients participating in the EUROPA/PERGENE trial of perindopril versus placebo. Multivariable analysis of phenotype data resulted in a clinical risk score (range, 0-21 points). Three single-nucleotide polymorphisms (rs275651 and rs5182 in the angiotensin-II type I-receptor gene and rs12050217 in the bradykinin type I-receptor gene) were used to construct a pharmacogenetic risk score (PGXscore; range, 0-6 points). Seven hundred eighty-five patients (9.0%) experienced the primary endpoint of cardiovascular mortality, nonfatal myocardial infarction or resuscitated cardiac arrest, during 4.2 years of follow-up. Absolute risk reductions ranged from 1.2% to 7.5% in the 73.5% of patients with PGXscore of 0 t

Effects of Ambient Air Pollution on Hemostasis and Inflammation

BACKGROUND: Air pollution has consistently been associated with increased morbidity and mortality due to respiratory and cardiovascular disease. Underlying biological mechanisms are not entirely clear, and hemostasis and inflammation are suggested to be involved. OBJECTIVES: Our aim was to study the association of the variation in local concentrations of airborne particulate matter (PM) with aerodynamic diameter < 10 mu m, carbon monoxide, nitrogen monoxide, nitrogen dioxide, and ozone with platelet aggregation, thrombin generation, fibrinogen, and C-reactive protein (CRP) levels in healthy individuals. METHODS: From 40 healthy volunteers, we collected 13 consecutive blood samples within a 1-year period and measured light-transmittance platelet aggregometry, thrombin generation, fibrinogen, and CRP. We performed regression analysis using generalized additive models to study the association between the hemostatic and inflammatory variables, and local environmental concentrations 0 air pollutants for time lags within 24 hr before blood sampling or 24-96 hr before blood sampling. RESULTS: In general, air pollutants were associated with platelet aggregation [average, +8% per interquartile range (IQR), p < 0.01] and thrombin generation (average, +1% per IQR, p < 0.015). Platelet aggregation was not affected by in vitro incubation of plasma with PM. We observed no relationship between any of the air pollutants and fibrinogen or CRP levels. CONCLUSIONS:. Air pollution increased platelet aggregation as well as coagulation activity but had no clear effect on systemic inflammation. These prothrombotic effects may partly explain the relationship between air pollution and the risk of ischemic cardiovascular disease

Nucleotide excision DNA repair is associated with age-related vascular dysfunction

Background: Vascular dysfunction in atherosclerosis and diabetes mellitus, as observed in the aging population of developed societies, is associated with vascular DNA damage and cell senescence. We hypothesized that cumulative DNA damage during aging contributes to vascular dysfunction. Methods and Results: In mice with genomic instability resulting from the defective nucleotide excision repair genes ERCC1 and XPD (Ercc1 and Xpd mice), we explored age-dependent vascular function compared with that in wild-type mice. Ercc1 mice showed increased vascular cell senescence, accelerated development of vasodilator dysfunction, increased vascular stiffness, and elevated blood pressure at a very young age. The vasodilator dysfunction was due to decreased endothelial nitric oxide synthase levels and impaired smooth muscle cell function, which involved phosphodiesterase activity. Similar to Ercc1 mice, age-related endothelium-dependent vasodilator dysfunction in Xpd animals was increased. To investigate the implications for human vascular disease, we explored associations between single-nucleotide polymorphisms of selected nucleotide excision repair genes and arterial stiffness within the AortaGen Consortium and found a significant association of a single-nucleotide polymorphism (rs2029298) in the putative promoter region of DDB2 gene with carotid-femoral pulse wave velocity. ConclusionS: Mice with genomic instability recapitulate age-dependent vascular dysfunction as observed in animal models and in humans but with an accelerated progression compared with wild-type mice. In addition, we found associations between variations in human DNA repair genes and markers for vascular stiffness, which is associated with aging. Our study supports the concept that genomic instability contributes importantly to the development of cardiovascular disease