Rare genetic variations linked to schizophrenia

Many of the genetic variations that increase risk for schizophrenia are rare, making it difficult to study their role in the disease. To overcome this, the Psychiatric Genomics Consortium, an international team led by Jonathan Sebat, PhD, at University of California San Diego School of Medicine, analysed the genomes of more than 41,000 people in the largest genome-wide study of its kind to date. Their study reveals several regions of the genome where mutations increase schizophrenia risk between four- and 60-fold.

These mutations, known as copy number variants, are deletions or duplications of the DNA sequence. A copy number variant may affect dozens of genes, or it can disrupt or duplicate a single gene. This type of variation can cause significant alterations to the genome and lead to psychiatric disorders, said Sebat, who is a professor and chief of the Beyster Center for Genomics of Neuropsychiatric Diseases at UC San Diego School of Medicine. Sebat and other researchers previously discovered that relatively large copy number variants occur more frequently in schizophrenia than in the general population.

In this latest study, Sebat teamed up with more than 260 researchers from around the world, part of the Psychiatric Genomics Consortium, to analyse the genomes of 21,094 people with schizophrenia and 20,227 people without schizophrenia. They found eight locations in the genome with copy number variants associated with schizophrenia risk. Only a small fraction of cases (1.4 percent) carried these variants. The researchers also found that these copy number variants occurred more frequently in genes involved in the function of synapses, the connections between brain cells that transmit chemical messages.
With its large sample size, this study had the power to find copy number variants with large effects that occur in more than 0.1 percent of schizophrenia cases. However, the researchers said they are still missing many variants. More analyses will be needed to detect risk variants with smaller effects, or ultra-rare variants.

“This study represents a milestone that demonstrates what large collaborations in psychiatric genetics can accomplish,” Sebat said. “We’re confident that applying this same approach to a lot of new data will help us discover additional genomic variations and identify specific genes that play a role in schizophrenia and other psychiatric conditions.”

University of California San Diego Health health.ucsd.edu/news/releases/Pages/2016-11-22-study-finds-rare-genetic-variations-linked-to-schizophrenia.aspx

Genetic defects link carbohydrate digestion to irritable bowel syndrome

Irritable bowel syndrome (IBS) affects a large portion of the general population. New research coordinated by Karolinska Institutet now shows a link between defective sucrase-isomaltase gene variants and IBS.
Irritable bowel syndrome (IBS) is the most common gastrointestinal disorder. More than 10% of the population suffer from recurrent symptoms including abdominal pain, gas, diarrhoea and constipation. What causes IBS is largely unknown, and this hampers the development of effective treatment for many patients.

Now an international research team led by scientists from Karolinska Institutet in Sweden have identified defective sucrase-isomaltase gene variants that increase the risk of IBS.
“People with IBS often connect their symptoms to certain foods, particularly fermentable carbohydrates. We tested the hypothesis that genetic changes in the breakdown of disaccharides – small carbohydrates from sugars and starches – may be associated with increased risk of IBS,” says corresponding author Mauro D’Amato from Karolinska Institutet.

The researchers studied DNA variants in the gene encoding the enzyme sucrase-isomaltase (SI), due to the observation that SI mutations are often found in hereditary forms of sucrose intolerance, whose main characteristics diarrhoea, abdominal pain and bloating are also common in IBS.

By screening 1887 study participants from multiple centres in Sweden, Italy and US, they found that rare defective SI mutations were twice more common among IBS cases than healthy controls, and a common variant with reduced enzymatic activity was also associated with increased risk of IBS.

“A significant decrease in the enzymatic activity of sucrase-isomaltase would be compatible with poor carbohydrate digestion in the intestine, possibly leading to mal-absorption and bowel symptoms” says co-senior author Hassan Naim from the University of Veterinary Medicine Hannover.
“Our results provide rationale for novel nutrigenetic studies in IBS, with potential for personalizing treatment options based on SI genotype” adds Mauro D’Amato.

Karolinska Institute ki.se/en/news/new-research-links-genetic-defects-in-carbohydrate-digestion-to-irritable-bowel-syndrome

Expression of specific gene differentiates moles from melanoma

Most melanomas are driven by mutations that spur out-of-control cell replication, while nevi (moles composed of non-cancerous cells at the skin surface) harbouring the same mutations do not grow wildly. However, changes in the level of gene expression can cause nevi to become melanomas.

Dermatologists surmise that 30 to 40 percent of melanomas (approximately 30,000 cases per year) may arise in association with a nevus. However, clinicians would like to be able to better distinguish between the two, especially in borderline cases when they examine skin tissue after a patient biopsy.

Senior author John T. Seykora, MD, PhD, a professor of Dermatology in the Perelman School of Medicine at the University of Pennsylvania, led a study that found that decreased levels of the gene p15 represents a way to determine if a nevus is transitioning to a melanoma. The protein p15 functions to inhibit nevus cell proliferation.

“We showed that p15 expression is a robust biomarker for distinguishing nevus from melanoma,” said Seykora. “Making this distinction has been a long-standing issue for dermatologists. We hope that this new finding will help doctors determine if a nevus has transformed to melanoma. This could help doctors and patients in difficult cases. Current research will hopefully move this into the realm of standard practice in about one to two years.”

Decreased expression in the related protein p16 has also been associated with melanoma, but p15 appears to be a primary driver of oncogene-induced cell senescence in nevus cells. When p15 levels drop, then nevus cells begin to grow.

The team stained human nevus and melanoma tissue samples with p15 and p16 antibodies.  Staining was evaluated and graded for percentage and intensity to determine an “H score,” which correlates with the level of protein in the cells. This approach could also form the basis of a clinical determination, taking the form of an antibody test for p15 from a patient’s biopsy specimen. “If the staining level is high then that would be most consistent with a benign nevus,” Seykora said. “If the staining level is low then that would be consistent with a melanoma.”

RNA was also extracted from 14 nevus and melanoma tissue samples to determine levels of p15 mRNA.  The expression of p15 mRNA was significantly increased in melanocytic nevi compared with melanomas as determined by real-time quantitative RT-PCR analysis.

Penn Medicine www.uphs.upenn.edu/news/News_Releases/2016/11/seykora/

Reason for pancreatic cancer’s resistance to chemotherapy found

A pioneering University of Liverpool research team have published a study that identifies the mechanism in the human body that causes resistance of pancreatic cancer cells to chemotherapy.

Pancreatic cancer is one of the leading causes of cancer death and current therapies are not very effective. Thus, a better understanding of the molecular mechanisms that impair the response of cancer patients to chemotherapy, the standard treatment of care for this disease, is essential to design more effective treatments for this lethal disease.

Tumour associated macrophages (TAM) and fibroblasts are non-cancerous cells that are found within solid tumours, including pancreatic cancer. Accumulating evidence suggests that TAM and fibroblasts can support cancer progression, resistance to therapy and metastasis. However, the precise mechanisms by which these cells contribute to pancreatic cancer progression and response to therapy is not completely understood.

The research team led by Dr Ainhoa Mielgo Iza, a Sir Henry Dale Fellow, from the University’s Institute of Translational Medicine, has been studying how these cells contribute to chemo resistance in pancreatic cancer.

The study found that TAM and fibroblasts directly support chemotherapy resistance of pancreatic cancer cells by secreting insulin-like growth factors.

These proteins activate a survival signalling pathway on pancreatic cancer cells making them resistant to chemotherapy.

Analysis of biopsies from pancreatic cancer patients revealed that this survival pathway is activated in 72% of the patients.

Dr Mielgo, said: “These findings are very exciting because they uncover a mechanism that causes pancreatic cancer resistance to chemotherapy.

“Our research interest is to understand the complex interactions in the tumour microenvironment with the aim of finding new therapeutic targets for cancer.

“These results describe a combination treatment that could be more effective in treating this disease.”

University of Liverpool news.liverpool.ac.uk/2016/11/22/mechanism-found-that-causes-resistance-of-pancreatic-cancer-to-chemotherapy/

Heart disease and rheumatoid arthritis risk raised by genetic changes in blood cells

24 research studies from the landmark BLUEPRINT project and IHEC consortia reveal how variation in blood cells’ characteristics and numbers can affect a person’s risk of developing complex diseases such as heart disease, and autoimmune diseases including rheumatoid arthritis, asthma, coeliac disease and type 1 diabetes.

The papers, along with another 17 in high-impact journals, represent the culmination of a five-year, £25 million (€30 million) project that brought together 42 leading European universities, research institutes and industry partners and the work of IHEC. The project’s goals were to explore and describe the range of epigenetic changes that take place in bone marrow as stem cells develop into different types of mature blood cell. It also sought to match epigenetic changes and genetic differences to the physical characteristics of each cell type and use this knowledge to understand how these can lead to blood disorders, cancer and other complex diseases*.

In the first study, Sanger Institute researchers worked closely with colleagues at the University of Cambridge and the University of Oxford to carry out the largest and most in-depth study of DNA and blood cell characteristics using the UK BioBank resource and the INTERVAL study. By comparing almost 30 million DNA sequence differences in more than 173,000 people with variation in the physical properties of blood cells the scientists identified 2,500 previously undiscovered locations in the genome that influence blood cell characteristics and functions. Further work showed that genetic differences affecting some of these characteristics are linked to increased risk of heart attack, or to rheumatoid arthritis and other common autoimmune diseases.

“The scale, resolution and homogeneity of our work were vital. Because we examined so many people we were able to discover important ‘rare and low frequency’ genetic differences that are present in fewer than 10 per cent of the population. We found that these can have a much larger impact on the characteristics of blood cells than the common differences studied previously. Of the more than 300 rare and low frequency difference we found, 74 appear to affect the structure of proteins. These give us important clues as to which biological pathways are involved in controlling the production, function and characteristics of blood cells.”

The team found that genetic differences that cause people to have more young red blood cells in their peripheral bloodstreams also increase the risk they will have a heart attack.

“When mature red blood cells rupture in our blood the body replaces them with new, young red cells – a process known as haemolysis. So we think that increased haemolysis and increased risk of coronary heart disease are affected by the same biological pathways. Identifying these pathways may offer new treatment possibilities.”

Dr Adam Butterworth, one of the study’s senior authors, from the University of Cambridge
‘By combining our detailed genetic information with data from the BLUEPRINT project, we were able to identify with high certainty ‘active’ regions of the human genome that are more likely to be involved in disease mechanisms.’

Heather Elding, one of the paper’s first authors, from the Sanger Institute
For example, in another new finding, the research team showed that genetic differences that increased the amount of certain white blood cells, known as eosinophils, also increased the risk of a person developing rheumatoid arthritis, asthma, coeliac disease and type 1 diabetes.

In the second paper, researchers collaborated with scientists at the University of Cambridge, McGill University in Canada and several UK and European institutions to explore the role that epigenetics plays in the development and function of three major human immune cell types: CD14+ monocytes, CD16+ neutrophils and naïve CD4+ T cells, from the genomes of 197 individuals. They studied the contributions of various genetic control mechanisms, including epigenetic changes such as methyl tags on promoter regions in the DNA and histone modifications, to understand how these different levels of regulation interacted with genetic differences to change the expression of genes, immune function and, ultimately, human disease.

The team identified 345 regions of the genome where they could pinpoint the likely molecular causes underlying a person’s predisposition to immune-related diseases such as inflammatory bowel disease, type 1 diabetes and multiple sclerosis.

“We have created an expansive, high-resolution atlas of variations that deepens our understanding of the interplay between the genetic and epigenetic machinery that drives the three primary cells of the human immune system. We have identified hundreds of genetic variations associated with autoimmune diseases that appear to affect the activity of genes in specific regions of the genome, pointing to biological pathways that may be involved in disease and which, ultimately, may be treatable with medication.”

Sanger Institute www.sanger.ac.uk/news/view/landmark-project-shows-heart-disease-and-rheumatoid-arthritis-risk-raised-genetic-changes

Analysing DNA modifications in glioblastoma

Using state-of-the-art molecular biology and statistical approaches, researchers at Dartmouth’s Norris Cotton Cancer Center (NCCC) have identified the functional role of two distinct DNA modifications in glioblastoma (GBM) tissues. The signature of one of these pattern disruptions in particular, 5hmC, had a particularly strong association with patient survival.

Glioblastoma (GBM) is a rare but deadly type of cancer that originates in the brain. Roughly 12,000 new cases are confirmed in the U.S. each year and its highly infiltrative nature renders it particularly difficult to treat.

One of the distorted molecular features of GBM is faulty epigenetic regulation. The epigenome involves modifications to DNA that dictate which genes are turned off and on within a particular cell-type. Defects here are known to contribute to cancer and current methods to predict brain tumour patient prognosis are based on epigenetic tumour subtypes. However, the epigenome is complex and there are recently discovered epigenetic marks that remain understudied in GBM.

Led by Cancer Center Member, Brock Christensen, PhD, Associate Professor of Epidemiology at Dartmouth’s Geisel School of Medicine, researchers broke new territory by analysing the profile of multiple DNA modifications, 5-methylcytosine (5mC) and 5-hydroxymethylcytosine (5-hmC), in a set of 30 glioblastomas in collaboration with clinicians at NCCC. ‘An intense interest has emerged in detailing the functional role of distinct DNA modifications in both healthy and disease tissues,’ said Christensen. ‘Here, we uncovered that specific DNA 5mC and 5hmC patterns are disrupted in GBM and uniquely characterize the molecular switches of the genome known as ‘enhancers.’ Importantly, we discovered that 5hmC signatures had a particularly strong association with patient survival.’

Previous technical limitations prohibited scientists from simultaneously studying high-resolution 5mC and 5hmC levels in a cancer genome. The Dartmouth study utilizes state-of-the-art molecular biology and statistical approaches, including the Dartmouth Discovery Computing Cluster and Nano String nCounter technology, to identify the levels of the distinct DNA modifications across the critical regions of the genome. ‘Together, our work reveals more about the powerful influence of the epigenome in cancer and highlights the distinct functional role of 5hmC,’ explains Christensen.

Norris Cotton Cancer Center www.eurekalert.org/pub_releases/2016-11/dmc-drb112316.php

Cancer signalling pathway could lead to new cancer therapies

Researchers from the University of Wisconsin School of Medicine and Public Health and Carbone Cancer Center have better defined a pro-growth signalling pathway common to many cancers that, when blocked, kills cancer cells but leaves healthy cells comparatively unharmed.

The study could establish new avenues of therapeutic treatments for many types of solid tumours.

Growth signals typically come in the form of chemical agonists outside of cells that bind to protein receptors on cells. Activated receptors are responsible for transmitting the signal to the inside of the cell, ultimately generating a growth messenger called PIP3.

Two years ago, research out of UW–Madison professor Richard Anderson’s lab found that some of these agonist-stimulated receptors continue to transmit the signal even after they have been pulled into the cell, sequestered in vesicles called endosomes and presumably on their way to being degraded.

“According to dogma in the literature, receptors shouldn’t make PIP3 at these internal sites, but they were,” Anderson says. “We set out to ask, ‘Why is that?’”

In this new study, a postdoctoral fellow in Anderson’s lab, Suyong Choi, showed that the proteins known to be in this signal transmission cascade were all present on endosomes inside the cell, supporting the idea that the key growth message was being signalled from these internal compartments.

However, there was one fact which they could not biologically explain: In a typical signalling cascade, each step amplifies the signal, suggesting there should be more and more of the messenger molecules; but here, levels of PIP3 and other intermediary messengers were too low to be detected in endosomes.

“A scaffold completely solves this issue, because it acts like an assembly line, bringing together all of the proteins and passing one messenger molecule to the next protein in the cascade until the last protein, PI3K, is activated and generates PIP3,” Anderson says. “Suyong Choi found that the scaffolding protein IQGAP1 brings all of these proteins together like a happy family on the endosome. It’s an incredibly efficient mechanism.”

Choi discovered that the IQGAP1 complex pulls together all of the signalling components in the PI3K pathway. Remarkably, this assembly happens in response to nearly all agonists that switch on growth and cell survival signals in cells. Once Choi had established how the proteins in the complex interacted, he was able to block scaffold formation in cells by adding a small, competing fragment of the IQGAP1 protein.

“It worked beautifully to block assembly of IQGAP1 and PI3K complex,” Anderson says. “The really cool thing was, when we treated different cells with these inhibitory fragments, the disruption of IQGAP1 and PI3K complex formation had almost no effect on normal cells but it killed cancer cells very efficiently.”

PI3K is an essential protein, and cells (and whole organisms) die if they do not have any functional PI3K because the protein is involved in multiple signalling pathways. However, it is specifically this pathway, mediated through IQGAP1, that is required for the growth and survival of cancer cells but not normal cells. In fact, mice lacking IQGAP1 develop normally but are resistant to developing solid tumours.

“Pharmaceutical companies have developed PI3K inhibitors, but many of these have failed, likely because they’re hitting all PI3Ks and the different pathways,” Anderson said. “If you can specifically disrupt this agonist-activated PI3K pathway, the one that has a specific role in cancer, then you can effectively treat

University of Wisconsin School of Medicine and Public Health www.med.wisc.edu/news-events/cancer-signaling-pathway-could-lead-to-new-cancer-therapies/49720

Study supports lower cut-off point for defining pre-diabetes

The health risks and mortality associated with pre-diabetes seem to increase at the lower cut-off point for blood sugar levels recommended by some guidelines, finds a large study published.

Pre-diabetes is a ‘pre-diagnosis’ of diabetes — when a person’s blood glucose level is higher than normal, but not high enough to be considered diabetes. If left untreated, pre-diabetes can develop into type 2 diabetes. An estimated 79 million people in the US and 7 million people in the UK are thought to be affected.

Doctors define pre-diabetes as impaired fasting glucose (higher than normal blood sugar levels after a period of fasting), impaired glucose tolerance (higher than normal blood sugar levels after eating), or raised haemoglobin levels.

But the cut-off points vary across different guidelines and remain controversial.

For example, the World Health Organization (WHO) defines pre-diabetes as fasting plasma glucose of 6.1-6.9 mmol/L, while the 2003 American Diabetes Association (ADA) guideline recommends a cut-off point of 5.6-6.9 mmol/L.

Results of studies on the association between pre-diabetes and risk of cardiovascular disease and all cause mortality are also inconsistent. Furthermore, whether raised haemoglobin levels for defining pre-diabetes is useful for predicting future cardiovascular disease is unclear.

So a team of researchers from the affiliated Hospital at Shunde, Southern Medical University in China analysed the results of 53 studies involving over 1.6 million individuals to shed more light on associations between different definitions of pre-diabetes and the risk of cardiovascular disease, coronary heart disease, stroke, and all cause mortality.

They found that pre-diabetes, defined as impaired fasting glucose or impaired glucose tolerance, was associated with an increased risk of cardiovascular disease and all cause mortality.

The risk increased in people with a fasting glucose concentration as low as 5.6 mmol/L – the lower cut-off point according to ADA criteria.

Raised haemoglobin levels were also associated with an increased risk of cardiovascular disease and coronary heart disease, but not with an increased risk of stroke and all cause mortality.

The authors point to some study limitations that could have influenced their results, and say pulling observational evidence together in a systematic review and meta-analysis is a good way to consider all the evidence at once, ‘but we cannot make statements about cause and effect. We would need to look at experimental evidence for that.’

However, they say their findings ‘strongly support’ the lower cut-off point for impaired fasting glucose and raised haemoglobin levels proposed by the ADA guideline.

And they conclude that lifestyle change — eating a healthy balanced diet, keeping weight under control, and doing regular physical activity — is the most effective treatment.

EurekAlert www.eurekalert.org/pub_releases/2016-11/b-ssl112216.php

Biomarker identified to aid in prognosis of paediatric ependymomas

A multi-institutional group of researchers, led by investigators at Children’s Hospital Los Angeles and the University of Michigan, have identified a simple and inexpensive tool for assessing the prognosis of paediatric brain tumours called ependymomas. Their study, which demonstrates the epigenetic mechanism behind these tumours, may offer future opportunities for novel therapeutic options.

Childhood posterior fossa ependymomas (PF) are tumours found largely in the hind brain (consisting of the cerebellum, pons and the brainstem) of children. Routine assessment of tumour grade and other markers in PF ependymomas do not correlate well with outcomes in these tumours, highlighting the need for new prognostic markers. Genomic sequencing efforts have not identified mutations in these tumours, and the origin of PF ependymomas remains obscure.

While lacking recurrent genetic mutations, a subset of these tumours exhibit alterations in DNA methylation. In this study, the researchers looked at modification of histones – protein components of the chromatin around which DNA winds, and which play a role in gene regulation – in particular, histone H3.

Co-lead investigator, Sriram Venneti, MD, PhD, of the Department of Pathology at the University of Michigan, observed that histone H3 is modified differently in paediatric posterior fossa ependymoma. Specifically, 80 percent of these tumours exhibited loss of the H3K27me3 a repressive mark, while 20 percent of tumours retained H3K27me3.  Researchers went back and looked at MRIs and outcomes of children treated for these tumours and identified that tumours with loss of H3K27me3 tumours behaved more aggressively and showed poor overall survival.  This suggests that reduced H3K27me3 may be a prognostic indicator in PF ependymomas.

“Detection of H3K27me3 by immunohistochemical staining is a widely available and cost effective surrogate molecular marker.  This test can be readily implemented in most departments of pathology and provides a much-needed tool to risk stratify and identify ependymoma patients who would potentially benefit from epigenetic therapies,” said co-lead investigator Alexander R. Judkins, MD, of the Department of Pathology and Laboratory Medicine at CHLA and Keck School of Medicine of the University of Southern California.

This loss in H3K27me3, along with other epigenetic changes, was similar to that observed in another type of paediatric brain tumour of the hind brain region termed diffuse intrinsic pontine gliomas (DIPGs).  This suggests that both of these tumours arise from similar epigenetic states. Intriguingly, researchers found that certain progenitor cells in this part of the brain also showed low H3K27me3, suggesting – as both tumours share epigenetic similarities – that low methylation of H3K27me3 is important to the development of tumours in this region of the brain.

Children’s Hospital of Los Angeles www.chla.org/press-release/biomarker-identified-aid-prognosis-pediatric-ependymomas

Genetic marker found for resistance to malaria treatment in Cambodia

Scientists at the Wellcome Trust Sanger Institute and their collaborators have discovered genetic markers in malaria parasites linked with resistance to the anti-malarial drug piperaquine. This research will allow health officials to monitor the spread of resistance, and help doctors and public health officers decide where the treatment is most likely to be effective.

Resistance to this key anti-malarial drug has recently emerged in Cambodia, leading to complete treatment failure there, threatening global efforts to treat and eliminate malaria.

Malaria is caused by Plasmodium parasites and in 2015, the World Health Organisation estimated that more than 200 million people were infected and nearly half a million people died worldwide from the disease. Children under the age of five made up 70 percent of these deaths. Malaria is a treatable disease when caught early enough, but is a huge problem in many areas due to drug resistance.

Piperaquine is a powerful drug, which is used in combination with another anti-malarial, artemisinin, as a first-line treatment in many areas of the world. Resistance to artemisinin emerged more than seven years ago in South East Asia, but until recently the combination of the drugs still successfully killed the malaria parasites there.  Now, the development of piperaquine resistance has led to complete failure of treatment in Cambodia.

Researchers carried out a genome-wide association study on approximately 300 Plasmodium falciparum samples from Cambodia to study the genetic basis behind piperaquine resistance. They looked at thousands of variations in the DNA sequence of the parasites, comparing these across samples with different levels of resistance to piperaquine.

“By studying the genomes of these parasites we found two genetic markers that are linked with piperaquine resistance. Not only can we now use these markers to monitor the spread of the drug resistant malaria, they will also help towards understanding as much as possible about the biology and evolution of the parasite.”

Dr Roberto Amato, lead author from the Wellcome Trust Sanger Institute
The scientists found that extra copies of the genes encoding two proteins of a family called plasmepsin, were linked with piperaquine resistance. Plasmepsins are part of a biological pathway that is targeted by other anti-malarial drugs, so this marker could also help the researchers understand the mechanism of the drug resistance. In addition to this, a mutation on chromosome 13 was found to be a second genetic marker linked with the resistance. Both markers were observed in parasites infecting patients who were not responding to treatment.

“The emergence of piperaquine resistance in these Cambodian parasites has led to complete treatment failure there. These malaria parasites are now resistant to both drugs, and since they are no longer being killed, resistance to both drugs will spread. This will threaten global attempts to eliminate malaria.”

Sanger Institute www.sanger.ac.uk/news/view/genetic-marker-found-resistance-malaria-treatment-cambodia