A Rare Noncoding Enhancer Variant in SCN5A Contributes to the High Prevalence of Brugada Syndrome in Thailand.

BACKGROUND: Brugada syndrome (BrS) is a cardiac arrhythmia disorder that causes sudden death in young adults. Rare genetic variants in the SCN5A gene encoding the Nav1.5 sodium channel and common noncoding variants at this locus are robustly associated with the condition. BrS is particularly prevalent in Southeast Asia but the underlying ancestry-specific factors remain largely unknown. METHODS: Genome sequencing of BrS probands and population-matched controls from Thailand was performed to identify rare noncoding variants at the SCN5A-SCN10A locus that were enriched in patients with BrS. A likely causal variant was prioritized by computational methods and introduced into human induced pluripotent stem cell (hiPSC) lines using CRISPR-Cas9. The effect of the variant on SCN5A expression and Nav1.5 sodium channel current was then assessed in hiPSC-derived cardiomyocytes (hiPSC-CMs). RESULTS: A rare noncoding variant in an SCN5A intronic enhancer region was highly enriched in patients with BrS (detected in 3.9% of cases with a case-control odds ratio of 45.2). The variant affects a nucleotide conserved across all mammalian species and predicted to disrupt a Mef2 transcription factor binding site. Heterozygous introduction of the enhancer variant in hiPSC-CMs caused significantly reduced SCN5A expression from the variant-containing allele and a 30% reduction in Nav1.5-mediated sodium current density compared with isogenic controls, confirming its pathogenicity. Patients with the variant had severe phenotypes, with 89% experiencing cardiac arrest. CONCLUSIONS: This is the first example of a functionally validated rare noncoding variant at the SCN5A locus and highlights how genome sequencing in understudied populations can identify novel disease mechanisms. The variant partly explains the increased prevalence of BrS in this region and enables the identification of at-risk variant carriers to reduce the burden of sudden cardiac death in Thailand.

Hepatitis B and hepatitis C virus in Thai blood donors.

Hepatitis B virus (HBV) and hepatitis C virus (HCV) are major causes of transfusion-transmitted infection (TTI). In Thailand, the prevalence of HBV infection in new blood donors has decreased gradually from 7.1% in 1988 to 2.6% in 2009. This drastic decline in HBV prevalence is mostly the result of an effective expanded program on immunization (EPI) against HBV; the current coverage rate with HBV vaccine in newborns is more than 98% nation-wide. The prevalence of HCV infection, has decreased at a slower rate due to lack of HCV vaccination. The use of healthy volunteer blood donors and nucleic acid amplification technology (NAT) has also contributed to the steady decrease in rates of HBV and HCV infections. We summarize the current status of the EPI program for preventing HBV and the current strategy of HBV and HCV screening in new blood donors.

Response of health care workers with isolated antibody to hepatitis B core antigen to hepatitis B vaccine.

Isolated hepatitis B core antibody (antiHBc) without hepatitis B surface antigen (HBsAg) or hepatitis B surface antibody (antiHBs) is found during routine screening for hepatitis B virus (HBV) markers. Isolated antiHBc may indicate immunity against HBV or occult infection. To determine the immune response of health care workers (HCWs) with isolated antiHBc, HCWs were divided into two groups. A single dose of recombinant hepatitis B (HB) vaccine was administered to HCWs with isolated antiHBc (n = 36) and healthy HCWs (n = 20) seronegative for HBsAg, antiHBc and antiHBs. One month later, the subjects were tested for antiHBs. Twenty-one of 36 HCW (58.3%) in the antiHBc group had antiHBs, while only 1 of 20 HCW (5.0%) in the seronegative control group had a detectable antiHBs titer exceeding 10 mIU/ml. The antiHBs response in HCWs with antiHBc was significantly higher than in the seronegative group. The subjects' sera were tested for HBV DNA by nested PCR. Of those with antiHBc, 4 had detectable HBV DNA (occult HBV infection). None of these 4 responded to the vaccine. Therefore, the response elicited by a single dose of HB vaccine administered to patients with antiHBc may serve as an indicator of occult HBV infection.

Diagnostic and Prognostic Roles of Serum Osteopontin and Osteopontin Promoter Polymorphisms in Hepatitis B-related Hepatocellular Carcinoma.

BACKGROUND: The aims of this study were to evaluate the diagnostic and prognostic roles of serum osteopontin (OPN) and single nucleotide polymorphisms (SNPs) in the OPN promoter in patients with hepatitis B-related hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Four groups were studied, which included 157 patients with HCC, 73 with liver cirrhosis (LC) and 97 with chronic hepatitis (CH), along with 80 healthy subjects. Serum OPN and alpha-fetoprotein (AFP) levels were measured. The SNPs -66 T/G, -156 G/δG and -433 C/T within the OPN promoter were determined by direct sequencing. RESULTS: Serum OPN levels were significantly higher in patients with HCC than in the other groups. Area under receiver operating characteristics curves in distinguishing HCC from chronic liver disease (CLD; CH and LC) were 0.782 (95% CI; 0.729-0.834) for OPN and 0.888 (95% CI; 0.850-0.927) for AFP. Using the optimal cut-off value (70 ng/mL), OPN had sensitivity and specificity of 72% and 71%, respectively. Serum OPN was superior to AFP in detecting early-stage HCC (68% vs. 46%). A combination of both markers yielded an improved sensitivity for detecting early HCC to 82%. A high OPN level was significantly correlated with advanced BCLC stage and was an independent prognostic factor for HCC. The SNPs -156 and -443 were associated with susceptibility to HCC, but were not related to overall survival. CONCLUSIONS: Serum OPN is a useful diagnostic and prognostic marker for HCC. The combined use of serum OPN and AFP improved the diagnosis of early HCC. Genetic variation in the OPN promoter is associated with the risk, but not the prognosis of HCC.