Study of the Carnitine Metabolism in Pregnancy, Rheumatoid Arthritis, Systemic Sclerosis and IBD by Tandem Mass Spectrometry

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A karnitin észterek profilszerű meghatározásának jelentősége a humán karnitin metabolizmus vizsgálatában = Determination of the carnitine ester profiles as a tool in study of human carnitine metabolism

Primer karnitin hiányban megfigyeltük, hogy a drámaian csökkent karnitin észter szintek a karnitin kezelés hatására csak mérsékelten emelkedtek. Heterozigóta családtagokban egy közel proporcionális csökkenés volt az észterekben. Az SLC22 TC haplotípust nem találtuk hajlamosító tényezőnek. Vizsgáltuk a karnitin észter profilt tünetmenetes celiákiásokban, ulceratív colitisben és felnőtt Crohn betegekben. Beteganyagunkban az IGR2096a_1T és IGR2198a_1 C ellélok hajlamosítónak adódtak Crohn betegségre. A karnitin profil vizsgálata a IGR2230a_1 genotípusban nem mutatott eltérést. Elsőként vizsgáltuk az irodalomban a karnitin észterek profiljának alakulását a terhesség folyamán egészen a szülésig. A vizsgálatok dinamikus rendszert fedtek fel: átalakult a terhes nő karnitin profilja a graviditás során nem-terhes nőkhöz viszonyítva. Vizsgáltuk az SLC22A4 C6607T és a RUNX1 G24658C variánsokat rheumatoid arthritisben. Nem találtunk hajlamosító polimorfizmust vagy specifikus eltérést a karnitin észter profilban sem. Interleukin 23 receptor variánsokat tanulmányoztuk rheumatoid arthritises betegekben és megfigyeltük az allélok megosztott hajlamosító természetét. Megfigyeltük, hogy a gén 3?UTR C2370A allélikus variánsa hajlamosító gén relabáló-remittáló típusú multiplex sclerosisban. Vizsgáltuk az apolipoprotein A 5 gén T-1131C, T1259C, IVS3-476A, és C56G variánsai és a triglicerid szintek alakulását, megfigyeltük, hogy több allél hajlamosító variáns strokeban és metabolikus szindrómában | We observed dramatic decrease of the carnitine esters in primary carnitine deficiency which underwent a moderate increase on the effect of carnitine supplementation. In heterozygous relatives a proportional decrease of carnitine esters could be observed. We did not found the SLC22 TC haplotypes to confer risk. The carnitine ester profile was investigated n asymptomatic celiac disease patients, ulcerative colitis, and adult Crohn subjects. In our patients IGR2096a_1T and IGR2198a_1 C alleles were susceptibility genes for Crohn disease; the carnitine profile was normal in IGR2230a_1 genotype. We examined the carnitine ester profile during pregnancy first in the literature. We found a very dynamic system: in pregnant woman the carnitine ester profile was changed comparing with non-pregnants, and was further modified during the progress of pregnancy. We studied the SLC22A4 C6607T and RUNX1 G24658C variants in rheumatoid arthritis and could not establish their susceptibility nature, nor we could detect change in the carnitine ester profiles. In rheumatoid arthritis and in remitting-relapsing form of multiple sclerosis we found the functional variants of the interleukin 23 receptor as shared susceptibility factors. We studied the association of T-1131C, T1259C, IVS3-476A, and C56G variants with the plasma triglycerides, and could verify a susceptibility nature for some of the in stroke and metabolic syndrome

A középkorú lakosság morbiditásának és mortalitásának összefüggése az MHC centrális régiójában található egyes génvariánsokkal és haplotipusokkal = Relationship between the morbidity and mortality of the middle-age people with some gene variants and haplotypes in the central region of MHC

A projekt keretében -korábbi adataink utánvizsgálat céljából - a középkorú lakosság morbiditásának és mortalitásának összefüggéseit tanulmányoztuk az MHC centrális régiójában található egyes génvariánsokkal és haplotipusokkal. Fontosabb új eredményeink: 1. Új módszert dolgoztunk ki a C4A és C4B gének kópiaszámának meghatározására 2. A C4B*Q0 (a C4B gén alacsony kópia száma) és a fokozott cardiovascularis morbiditás és mortalitás között kapcsolatot sikerült megerősítenünk az új genotipizálási módszer segítségével, 3. Elsőként sikerült feltérképezni az ősi kiterjesztett MHC haplotípusok előfordulását a magyar populációban és bizonyítottuk, hogy a leggyakoribb, 8.1 j. ősi haplotípus hordozóinak colorectalis carcinoma kockázata lényegesen nagyobb, mint a nem-hordozóké. 4. A C4B*Q0 genotípus és a fokozott cardiovascularis morbiditás és mortalitás között összefüggés egyik lehetséges magyarázata az, hogy a 21-hidroxiláz enzimet kódoló CYP-21 gén funkcionális rendellenessége és a C4A/C4B génszán közötti összefüggés áll fenn. Közel 100 egyén CYP-21 génjének szekvenálása segítségével találtunk ilyen összefüggést: a gén 4-es intronjában taláható két SNP ritka allélje csak a C4B*Q0 hordozókban fordult elő. Projektünk célkitűzéseit sikerült teljesíteni, a kapott eredményeinket 15, rangos nemzetközi folyóiratokban megjelent közleményben publikáltuk. | In order to reexamine our previous findings we studied the possible relationship between the cardiovascular morbidity/mortality of the middle-aged people and some alleles and haplotypes encoded in the central MHC region. Main results of the project: 1. A new method was worked out for direct counting of the copy number of the C4A and C4B genes. 2. Using this new method we have supported by new findings the strong association between the low copy number of the C4B genes (C4B*Q0) and the high rate of cardiovascular morbidity and mortality. 3. We were the first to map the occurrence of the ancestral extended MHC haplotypes in the Hungarian population and found that the carriers of the so-called 8.1 ancestral haplotype have an increased risk to develop colorectal cancer. 4. One of the possible explanation of the strong correlation between the C4B*Q0 genotype and the increased cardiovascular morbidity and mortality could be an association of the functional abnormalities of the CYP-21 gene (that encodes the 21-hydroxylase enzyme) and the C4A/C4B gene counts. We have examined this possibility by sequencing the CYP-21 gene in almost 100 subjects and found that the rare alleles of two SNPs in intron 4 of the gene occurs only in the C4B*Q0 carriers. Aims of the project were satisfied, the results were published in 15 papers in high-ranked international journals

Prevalence of SLC22A4, SLC22A% and CARD15 gene mutations in Hungarian pediatric patients with Crohn's disease

AIM: To investigate the frequency of the common NOD2/CARD15 susceptibility variants and two functional polymorphisms of OCTN cation transporter genes in Hungarian pediatric patients with Crohn’s disease (CD). METHODS: A cohort of 19 unrelated pediatric and 55 unrelated adult patients with Crohn’s disease and 49 healthy controls were studied. Genotyping of the three common CD-associated CARD15 variants (Arg702Trp, Gly908Arg and 1007finsC changes) with the SLC22A4 1672C→T, and SLC22A5 -207G→C mutations was performed by direct sequencing of the specific regions of these genes. RESULTS: At least one CARD15 mutation was present in 52.6% of the children and in 34.5% of the adults compared to 14.3% in controls. Surprisingly, strongly different mutation profile was detected in the pediatric versus adult patients. While the G908R and 1007finsC variants were 18.4% and 21.1% in the pediatric group, they were 1.82% and 11.8% in the adults, and were 1.02% and 3.06% in the controls, respectively. The R702W allele was increased approximately two-fold in the adult subjects, while in the pediatric group it was only approximately 64% of the controls (9.09% in the adults, 2.63% in pediatric patients, and 4.08% in the controls). No accumulation of the OCTN variants was observed in any patient group versus the controls. CONCLUSION: The frequency of the NOD2/CARD15 susceptibility variants in the Hungarian pediatric CD population is high and the profile differs from the adult CD patients, whereas the results for SLC22A4 and SLC22A5 mutation screening do not confirm the assumption that the carriage of these genotypes means an obligatory susceptibility to CD

Changes of plasma fasting carnitine ester profile in patients with ulcerative colitis

AIM: To determine the plasma carnitine ester profile in adult patients with ulcerative culitis (UC) and compared with healthy control subjects. METHOD: Using ESI triple quadrupole tandem mass spectrometry, the carnitine ester profile was measured in 44 patients with UC and 44 age- and sex-matched healthy controls. RESULTS: There was no significant difference in the fasting free carnitine level between the patients with UC and the healthy controls. The fasting propionyl- (0.331 ± 0.019 vs 0.392 ± 0.017 μmol/L), butyryl- (0.219 ± 0.014 vs 0.265 ± 0.012), and isovalerylcarnitine (0.111 ± 0.008 vs 0.134 ± 0.008) levels were decreased in the UC patients. By contrast, the level of octanoyl- (0.147 ± 0.009 vs 0.114 ± 0.008), decanoyl- (0.180 ± 0.012 vs 0.137 ± 0.008), myristoyl- (0.048 ± 0.003 vs 0.039 ± 0.003), palmitoyl- (0.128 ± 0.006 vs 0.109 ± 0.004), palmitoleyl- (0.042 ± 0.003 vs 0.031 ± 0.002) and oleylcarnitine (0.183 ± 0.007 vs 0.163 ± 0.007; P < 0.05 in all comparisons) were increased in the patients with UC. CONCLUSION: Our data suggest selective involvement of the carnitine esters in UC patients, probably due to their altered metabolism

Plasma carnitine ester profile in Crohn's disease and ulcerative colitis patients with different IGR2230a_1 genotypes

An association has been repeatedly demonstrated between inflammatory bowel disease (IBD) and the IBD5 locus in the 5q31 chromosomal region. The aim of the present study was to examine the prevalence of the IGR2230a_1 intronic nucleotide polymorphism of the slc22a5 gene (coding for the OCTN2 carnitine transporter protein) lying within this region, and its possible relationship with the carnitine metabolism in Hungarian IBD patients and controls. We genotyped by restriction fragment length polymorphism 200 Crohn's disease (CD) and 246 ulcerative colitis (UC) patients, as well as 187 healthy controls. From plasma samples we determined detailed carnitine ester profiles of 76 CD, 43 UC patients and 45 control persons using electrospray ionization triple quadruple tandem mass spectrometry. The distribution of the genotypes was not significantly different in the CD or the UC group compared with the controls. We found no significant alterations of the carnitine profile in the carrier/non-carrier or the homozygote/non-homozygote comparisons in both the CD and the UC groups, stratified by IGR2230a_1 genotype. Our data suggest that this polymorphism alone is not associated with CD and UC in the Hungarian population, and has no effect on the carnitine metabolism

Plasma carnitine ester profiles in Crohn's disease patients characterized for SLC22A4 C1672T and SLC22A5 G-207C genotypes

Crohn's disease (CD) is a chronic inflammatory bowel disorder caused by environmental and genetic factors. The purpose of this study was to analyse the possible influence of functional variants of genes of OCTN cation transporters on the carnitine ester profile of patients with CD. Genotyping for SLC22A4 1672C --> T, SLC22A5-207G --> C mutations and three common NOD2 variants (R702W, G908R and 1007finsC) were performed in 100 adult CD patients and in ninety-four healthy controls by direct sequencing. The carnitine ester profile was determined using ESI triple quadrupole tandem MS. Contrary to the NOD2/CARD15 mutations, none of the SLC variants showed increased prevalence in the CD group, the prevalence of TC haplotype did not differ between the patients and the controls. In the mixed group of CD patients the fasting propionyl- (0.243 (sem 0.008) v. 0.283 (sem 0.014) micromol/l), butyryl- (0.274 (sem 0.009) v. 0.301 (sem 0.013)) and isovalerylcarnitine (0.147 (sem 0.006) v. 0.185 (sem 0.009)) levels were decreased; while the level of octenoyl- (0.086 (sem 0.006) v. 0.069 (sem 0.005)), myristoleyl- (0.048 (sem 0.003) v. 0.037 (sem 0.003)), palmitoyl- (0.140 (sem 0.005) v. 0.122 (sem 0.004)) and oleylcarnitine (0.172 (sem 0.006) v. 0.156 (sem 0.008); P < 0.05 in all comparisons) were increased. After sorting the patients into SLC22A genotype-specific subgroups, no significant differences could be observed between them. The carnitine ester profile data suggest selective involvement of the carnitine esters in CD patients, probably due to their altered metabolism

Prevalence of SLC22A4 1672T and SLC22A5 −207C combination defined TC haplotype in Hungarian ulcerative colitis patients

Ulcerative colitis (UC) is a chronic inflammatory disease of the gastrointestinal tract. The aim of this study was to verify the prevalence rate of the haplotype called TC, determined by combination of two functional alleles of OCTN cation transporter genes (SLC22A4 1672T and SLC22A5 -207C combination variants) in ulcerative colitis patients and unrelated healthy controls. The "TC haplotype" has recently been suggested to confer risk for UC. A total of 121 unrelated Hungarian subjects with UC and 110 matched controls were genotyped for the two single nucleotide polymorphisms. The genotypes were determined by using PCR/RFLP assay and direct sequencing. The SLC22A4 1672T allele frequency was 46.7% in the patients with UC and 46.4% in the controls, whereas the SLC22A5 -207C allele occurred in 48.8% of the patients and 51.4% of the controls. The prevalence of the TC haplotype was 19% in the patient group and 22.7% in controls. Since there was no accumulation of the TC haplotype in the patient group, our observation suggests that carrying the TC haplotype is not associated with a higher risk for UC in the Hungarian population

Pszeudo-Bartter-szindróma kialakulása kapcsán felismert C1529G- és G3978A-mutációk együttese által okozott cisztás fibrosis = Pseudo-Bartter syndrome in a case of cystic fibrosis caused by C1529G and G3978A compound heterozygosity

A beteg nyolc hónapos életkorban került vizsgálatra pár napja észlelt étvágytalanság és mérsékelt elesettség miatt. Laboratóriumi eredményei súlyos hypokalaemiát, hyponatraemiát és hypochloraemiás alkalosist mutattak. Mivel az alacsony szérumelektrolit-értékeknek megfelelően alacsony vizeletelektrolit-ürítés és emelkedett renin-, aldoszteronszint volt észlelhető, az állapot pszeudo-Bartter-szindrómának felelt meg. Felvetődött a mucoviscidosis diagnózisa, ezt az emelkedett verejtékkloridszint igazolta. A cisztás fibrosis transzmembrán regulátor gén 27 exonjának szekvenálása során a szerzők két, ritkán előforduló mutációt detektáltak kevert heterozigóta formában, az egyik a 10. exonban talált C1529G-, a másik a 20. exonban azonosított G3978A-mutáció. Ezek a cserék a mutáció helyén stopkodon létrejöttéhez vezetnek mindkét allélon (S466X és W1282X). A mutációk közül az első hordozását az egyébként tünetmentes anyában, az utóbbiét a szintén panaszmentes apában sikerült kimutatni. A gyermekben és az anyában a fentiek mellett a 17-es exonban még egy G3341A-mutációt is találtak, ami elméletileg R1070Q-aminosav-cserével is jár. A gyakorlatban azonban ez nem következhet be a gyermekben a C1529G-mutációval társuló stopkodon kialakulása miatt, így következménnyel sem kell számolni. Ezek az eltérések ΔF508-mutációval kombinálva eltérő súlyosságú tüneteket okoznak a különböző betegekben; együttes előfordulásukról azonban a szerzőknek nincs ismeretük. A beteg másfél éves nyomon követése során a kórlefolyás benignusnak tűnt. | The 8-month-old patient was hospitalized after a few days of apathy and feeding difficulty with moderate exsiccation. Severe hypokalemia, hyponatremia, hypochloremia associated with alcalosis were found, which were accompanied by the decreased urinary electrolytes and elevated serum renin and aldosteron, therefore the condition corresponded to a pseudo-Bartter syndrome. The diagnosis of cystic fibrosis was arisen, which was established by the elevated sweat cloride levels. Sequencing of the 27 exons of the cystic transmembrane regulator gene two rare mutations were detected in compound heterozygous form: in the exon 10 a C1529G transversion, whereas in the exon 20 a G3978A transition was verified, both of them result in development of premature stopcodons (S466X and W1282X, respectively). Carriage of first mutation could be found in the asymptomatic mother, while the other one was identified in the father. In the proband and in the mother a G3341A mutation was also detected in exon 17, which causes an R1070Q amino acid change. However, this likely cannot associate with pathology since the existing premature stopcodon on the same allele does not allow synthesis of protein. These mutations have been described in combination with ΔF508 mutation, however, their simultaneous presence in the same subject has not been reported. During the one and half year follow-up the clinical picture appeared benign