Relationship between vascular endothelial growth factor + 936 genotype and plasma/epithelial lining fluid vascular endothelial growth factor protein levels in patients with and at risk for ARDS.

BACKGROUND: Vascular endothelial growth factor (VEGF) is postulated to have a role in ARDS. The functional VEGF + 936 polymorphic T allele is associated with an increased susceptibility to and severity of ARDS. The reasons for this are unclear. We hypothesized that the T allele would be associated with an alteration in the relation between epithelial lining fluid (ELF) and plasma VEGF levels as a potential explanation for its association with susceptibility to and severity of ARDS. METHODS: Plasma and ELF VEGF protein levels were measured by enzyme-linked immunosorbent assay from 10 at-risk patients receiving mechanical ventilation and 16 ARDS patients with the T allele, as well as 18 at-risk patients receiving mechanical ventilation and 26 ARDS patients without the T allele (wild-type CC genotype). RESULTS: The T allele was associated with a significantly lower mean ELF VEGF level in ARDS patients (2,090 +/- 758 pg/mL vs 3,292 +/- 865 pg/mL, p < 0.05) and mean ELF/plasma VEGF level ratio (13.7 +/- 4.6 pg/mL vs 94.7 +/- 51.2 pg/mL, p < 0.01). There was no relation between the T allele and plasma VEGF level, oxygenation, or acute physiology score in at-risk and ARDS patients. ELF VEGF levels were significantly higher than plasma levels in both cohorts except for at-risk patients without the T allele (wild-type CC genotype). CONCLUSION: The T allele is associated with a significant decrease in ELF levels and the ELF/plasma ratio in ARDS patients. This may explain the increased susceptibility and physiologic derangement in ARDS patients with the T allele. We speculate VEGF has a protective function in the lung. Further studies are necessary to clarify the underlying mechanisms.

Association between non-Hodgkin lymphoma and haplotypes in the TNF region.

The cytokines tumour necrosis factor-alpha (TNFalpha) and lymphotoxin-alpha (LTalpha) are known to play key roles in B-cell growth, differentiation and maturation. Genetic polymorphism within regulatory regions of these cytokine genes can alter expression levels and may be important in development of lymphoid malignancy. This study investigates a number of single nucleotide polymorphisms (SNPs) and microsatellite variants present within these genes in a large cohort of non-Hodgkin lymphoma (NHL) cases including 211 cases of follicular lymphoma (FL) and 281 cases of diffuse large B-cell lymphoma (DLBCL), and 478 unaffected controls. The study investigated whether particular alleles at these loci, or their combination across the TNF region in the form of haplotypes, may act as markers for predisposition and development of NHL. The study provided evidence for an influence of the TNF region in the susceptibility to NHL, whereby the loci -863, -857, TNFe and TNFd categorised five haplotype groups over which risk of both FL and DLBCL varied significantly. Prediction of disease risk was improved by the addition of loci to the haplotype, demonstrating the importance of considering the haplotype-specific context of the loci in genetic risk assessment.

Haplotypes in the tumour necrosis factor region and myeloma.

This study described the haplotypic structure across a region of chromosome 6 including the tumour necrosis factor (TNF) gene, and investigated its influence on the aetiology of myeloma. A total of 181 myeloma cases from the Medical Research Council Myeloma VII trial and 233 controls from the Leukaemia Research Fund Case Control Study of Adult Acute Leukaemia were included in the analysis. Genotyping by induced heteroduplex generator analysis was carried out for single nucleotide polymorphisms (SNP) located at positions -1031, -863, -857, -308 and -238 of the 5' promoter region of TNF-alpha gene, and 252 in the LT-alpha gene; and five microsatellites, TNFa, b, c, d and e. Haplotypes were inferred statistically using the phase algorithm. A limited diversity of haplotypes was observed, with the majority of variation described by 12 frequent haplotypes. Detailed characterization of the haplotype did not provide greater determination of disease risk beyond that described by the TNF-alpha-308 SNP. Some evidence was provided for a decreased risk of myeloma associated with the TNF-alpha-308 variant allele A, odds ratio, 0.57; 95% confidence interval, 0.38-0.86. The results of this study did not support our starting hypothesis; that high producer haplotypes at the TNF locus are associated with an increased risk of developing myeloma.

Interleukin-10 and tumor necrosis factor alpha region haplotypes predict transplant-related mortality after unrelated donor stem cell transplantation.

Certain cytokine gene polymorphisms have been shown to correlate with outcome of human leukocyte antigen (HLA) identical sibling donor stem cell transplantation (SCT), but in unrelated donor SCT such information is scarce. We have studied the association between cytokine gene polymorphism and transplant-related mortality (TRM) in 182 unrelated SCTs performed at a single center. We found association of polymorphism in the tumor necrosis factor alpha (TNF alpha) and interleukin-10 (IL-10) gene and TRM. Both the TNFd4 allele and the TNF alpha -1031C alleles are associated with high risk for TRM. Statistical analysis showed that both polymorphisms were present on a single haplotype. This haplotype was associated with high risk of TRM when present in recipient or donor, 55% (43%-67%) compared with 21% (12%-30%) when absent from both (P <.01). A further allele associated with this haplotype, TNFa5, is also associated with increased risk of TRM. For IL-10, presence of the donor R2-G-C-C haplotype was associated with decreased risk of TRM, 61% (43%-79%) versus 34% (25%-43%), P =.01. In contrast, possession of the R3-G-C-C haplotype by the donor predicted reduced risk of TRM, 30% (19%-41%, 95% CI) versus 53% (40%-66%, 95% CI), P =.01. No independent associations of cytokine polymorphisms with acute graft-versus-host disease were shown.

The extent and analysis of cytokine and cytokine receptor gene polymorphism.

Cytokines play an important role in the regulation of normal immune function. In recent years cytokines and their receptors have been shown to be highly polymorphic. Polymorphisms in these genes have been associated with a number of immune diseases as well as organ transplant complications. The current disease association data is confusing and often contradictory. Whilst single locus analyses are the predominant form of cytokine polymorphism analysis, the use of polymorphic haplotypes is becoming increasingly common. This may help to give a clearer picture of the association of cytokine polymorphism with immune disfunction.