Resumo Introdução: No momento, não há métodos para se predizer o desenvolvimento de discinesias induzidas por levodopa (DIL), uma frequente complicação do tratamento da doença de Parkinson (DP). Preditores clínicos e polimorfismos de nucleotídeo único (SNP) têm sido associados às DIL na DP. Objetivo: Investigar a associação entre variáveis clínicas e genéticas com as DIL e desenvolver um modelo de predição diagnóstica de DIL na DP. Métodos: Foram avaliados 430 pacientes com DP em uso de levodopa. A presença de DIL foi definida como escore ≥1 no item 4.1 da MDS-UPDRS Parte IV. Nós testamos a associação entre variáveis clínicas específicas e sete SNPs com o desenvolvimento de DIL, usando modelos de regressão logística. Resultados: Em relação às variáveis clínicas, idade de início da doença, duração da doença, sintomas motores iniciais e uso de agonistas dopaminérgicos estiveram associados às DIL. Apenas o genótipo CC do SNP rs2298383 no gene ADORA2A esteve associado com DIL após o ajuste. Nós desenvolvemos dois modelos preditivos diagnósticos com acurácia razoável, mas sugerimos o uso do modelo preditivo clínico. Esse modelo de predição tem uma área sob a curva de 0,817 (intervalo de confiança de 95% [IC95%] 0,77‒0,85) e sem perda significativa de ajuste (teste de qualidade de ajuste de Hosmer-Lemeshow p=0,61). Conclusão: A probabilidade prevista de DIL pode ser estimada, com acurácia razoável, por meio do uso de um modelo preditivo diagnóstico clínico, que combina a idade de início da doença, duração da doença, sintomas motores iniciais e uso de agonistas dopaminérgicos.

Abstract Background: There are currently no methods to predict the development of levodopa-induced dyskinesia (LID), a frequent complication of Parkinson's disease (PD) treatment. Clinical predictors and single nucleotide polymorphisms (SNP) have been associated to LID in PD. Objective: To investigate the association of clinical and genetic variables with LID and to develop a diagnostic prediction model for LID in PD. Methods: We studied 430 PD patients using levodopa. The presence of LID was defined as an MDS-UPDRS Part IV score ≥1 on item 4.1. We tested the association between specific clinical variables and seven SNPs and the development of LID, using logistic regression models. Results: Regarding clinical variables, age of PD onset, disease duration, initial motor symptom and use of dopaminergic agonists were associated to LID. Only CC genotype of ADORA2A rs2298383 SNP was associated to LID after adjustment. We developed two diagnostic prediction models with reasonable accuracy, but we suggest that the clinical prediction model be used. This prediction model has an area under the curve of 0.817 (95% confidence interval [95%CI] 0.77‒0.85) and no significant lack of fit (Hosmer-Lemeshow goodness-of-fit test p=0.61). Conclusion: Predicted probability of LID can be estimated with reasonable accuracy using a diagnostic clinical prediction model which combines age of PD onset, disease duration, initial motor symptom and use of dopaminergic agonists.

Abstract Warfarin is an oral anticoagulant prescribed to prevent and treat thromboembolic disorders. It has a narrow therapeutic window and must have its effect controlled. Prothrombin test, expressed in INR value, is used for dose management. Time in therapeutic range (TTR) is an important outcome of quality control of anticoagulation therapy and is influenced by several factors. The aim of this study was to identify genetic, demographic, and clinical factors that can potentially influence TTR. In total,422 patients using warfarin were investigated. Glibenclamide co-medication and presence of CYP2C9*2 and/or *3 alleles were associated with higher TTR, while amiodarone, acetaminophen and verapamil co-medication were associated with lower TTR. Our data suggest that TTR is influenced by co-medication and genetic factors. Thus, individuals in use of glibenclamide may need a more careful monitoring and genetic testing (CYP2C9*2 and/or *3 alleles) may improve the anticoagulation management. In addition, in order to reach and maintain the INR in the target for a longer period, it is better to discuss dose adjustment in office instead of by telephone assessment. Other studies are needed to confirm these results and to find more variables that could contribute to this important parameter.

Abstract Sickle cell hemoglobin is the result of a mutation at the sixth amino acid position of the beta (β) globin chain. The HBB*S gene is in linkage disequilibrium with five main haplotypes in the β-globin-like gene cluster named according to their ethnic and geographic origins: Bantu (CAR), Benin (BEN), Senegal (SEN), Cameroon (CAM) and Arabian-Indian (ARAB). These haplotypes demonstrated that the sickle cell mutation arose independently at least five times in human history. The distribution of βS haplotypes among Brazilian populations showed a predominance of the CAR haplotype. American populations were clustered in two groups defined by CAR or BEN haplotype frequencies. This scenario is compatible with historical records about the slave trade in the Americas. When all world populations where the sickle cell gene occurs were analyzed, three clusters were disclosed based on CAR, BEN or ARAB haplotype predominance. These patterns may change in the next decades due to recent migrations waves. Since these haplotypes show different clinical characteristics, these recent migrations events raise the necessity to develop optimized public health programs for sickle cell disease screening and management.

The population of Argentina has already been studied with regard to several genetic markers, but much more data are needed for the appropriate definition of its genetic profile. This study aimed at investigating the admixture patterns and genetic structure in Central Argentina, using biparental markers and comparing the results with those previously obtained by us with mitochondrial DNA (mtDNA) in the same samples. A total of 521 healthy unrelated individuals living in 13 villages of the Córdoba and San Luis provinces were tested. The individuals were genotyped for ten autosomal ancestry informative markers (AIMs). Allele frequencies were compared with those of African, European and Native American populations, chosen to represent parental contributions. The AIM estimates indicated a greater influence of the Native American ancestry as compared to previous studies in the same or other Argentinean regions, but smaller than that observed with the mtDNA tests. These differences can be explained, respectively, by different genetic contributions between rural and urban areas, and asymmetric gene flow occurred in the past. But a most unexpected finding was the marked interpopulation genetic homogeneity found in villages located in diverse geographic environments across a wide territory, suggesting considerable gene flow.

The Metabolic Syndrome (MetS) is defined as a pattern of metabolic disturbances, which include central obesity, insulin resistance and hyperglycemia, dyslipidemia, and hypertension. Milk has been promoted as a healthy beverage that can improve the management of MetS. Most human adults, however, down-regulate the production of intestinal lactase after weaning. Lactase encoded by the LCT gene is necessary for lactose digestion. The -13910C > T SNP (rs4988235) is responsible for the lactase persistence phenotype in European populations. We herein investigated whether the lactase persistence genotype is also associated with the MetS in subjects from a Brazilian population of European descent. This study consisted of 334 individuals (average age of 41 years) genotyped by PCR-based methods for the -13910C > T SNP. Clinical data were assessed and the genotypes were tested for their independent contribution to the MetS using chi-square tests and multiple logistic regression analysis. Univariate analyses showed that hypertension and MetS prevalence were higher in individuals with the lactase non-persistence genotype than in lactase persistence subjects. Furthermore, lactase persistence was associated with a lower risk for MetS (OR = 0.467; 95% CI 0.264-0.824; p = 0.009). These results suggest that LCT genotypes can be a valuable tool for the management of MetS treatment.

Durante o tratamento para tuberculose (TB) um dos efeitos adversos mais graves é a hepatite induzida por drogas (ATD) que tem sido associada a mutações nos genes que codificam as enzimas metabolizadoras destas drogas. A terapia de seis meses é composta por isoniazida, (INH), rifampicina (RMP), pirazinamida (PZA) e etambutol (EMB). N-acetiltransferase 2 (NAT2), citocromo P450 2E1 (CYP2E1) e glutationa-S-transferase (loci GSTM1 e GSTT1) estão envolvidos no metabolismo da isoniazida, o fármaco mais tóxico no tratamento da TB. Este estudo foi desenhado para estimar a frequência dos polimorfismos nos genes CYP2E1, GSTM1 e GSTT1 que estão relacionados com a resposta à essas drogas, e também identificar fatores clínicos de risco para ATD. Foram incluídos no estudo 245 pacientes brasileiros em tratamento para TB que foram genotipados utilizando a reação em cadeia de polímeras e sequenciamento dos polimorfismos. As frequências de alelos polimórficos CYP2E1 Rsal, Dral e PstIencontradas forame 8%, 8,5% e 12%, respectivamente. Os genes GSTM1 e GSTT1 estão ausentes em 42,9% e 12,4% da população, respectivamente. Quinze pacientes (6,1%) desenvolveram hepatotoxicidade. As características clínicas (HIV, sexo feminino e TB extrapulmonar) e NAT2 perfil de acetilação lenta estão em maior risco de ATD nesta população. Genótipo para GSTM1 e GSTT1 não mostrou nenhuma influência na resposta à droga.

Anti-tuberculosis drug-induced hepatitis (ATD- induced hepatitis) has been linked to polymorphisms in genes encoding drug metabolizing enzymes. N-acetyltransferase 2 (NAT2), cytochrome P450 2E1 (CYP2E1) and glutathione S-transferase (loci GSTM1 and GSTT1) are involved in the metabolism of isoniazid, the most toxic drug for the treatment of tuberculosis (TB). This study was designed to determine the frequency and to evaluate whether polymorphisms at CYP2E1, GSTM1 and GSTT1 genes are associated with drug response, as well as to identify clinical risk factors for ATD-induced hepatitis. A total of 245 Brazilian patients undergoing treatment for TB were genotyped using polymerase chain reaction and restriction fragment length polymorphism and sequencing methods. The frequencies of the CYP2E1 polymorphic alleles RsaI, PstI and DraI are 8%, 8.5% and 12%, respectively. GSTM1 and GSTT1 genes are deleted in 42.9% and 12.4% of the population, respectively. Fifteen patients (6.1%) developed hepatotoxicity. Clinical (HIV, female sex and extrapulmonary TB) and genetic characteristics (CYP2E1 without any mutations, having NAT2 slow acetylator profile) are at higher risk of developing ATD-induced hepatitis in this population. Genotyping for GSTM1 and GSTT1 showed no influence on drug response.

Alpha thalassemia has not been systematically investigated in Brazil. In this study, 493 unrelated individuals from the southernmost Brazilian state of Rio Grande do Sul were screened for deletional forms of α-thalassemia. One hundred and one individuals had microcytic anemia (MCV < 80 fL) and a normal hemoglobin pattern (Hb A2 < 3.5% and Hb F < 1%). The subjects were screened for -α3.7,-α4.2,-α20.5, -SEA and -MED deletions but only the -α3.7 allele was detected. The -α3.7 allele frequency in Brazilians of European and African ancestry was 0.02 and 0.12, respectively, whereas in individuals with microcytosis the frequency was 0.20. The prevalence of α-thalassemia was significantly higher in individuals with microcytosis than in healthy individuals (p = 0.001), regardless of their ethnic origin. There were also significant differences in the hematological parameters of individuals with -α3.7/αα, -α3.7/α3.7 and β-thalassemia trait compared to healthy subjects. These data suggest that α-thalassemia is an important cause of microcytosis and mild anemia in Brazilians.

Gene polymorphisms involved in the metabolism of drugs and chemical carcinogens seem to be responsible for differences in the susceptibility of individuals to cancer, but genetic population studies are needed to characterize these polymorphisms in different ethnic populations. We investigated polymorphisms of the cytochrome P450 (CYP) gene CYP1A1 and the glutathione S-transferase (GSTs) genes GSTM1, GSTT1 and GSTP1 in a sample of Afro-Brazilians from the southern Brazilian city of Porto Alegre to verify if there were ethnic differences compared to the polymorphisms of the same genes in a previously described sample of Brazilians of European descent from the same city. The allele frequencies detected in the Afro-Brazilian population investigated in this study were CYP1A1*2A (30%) and GSTP1*Val (42%) while the frequency of the GSTM1 null genotype was 34% and that of the GSTT1 null genotype was 28%. Significant differences in genotype distribution and allelic frequencies were detected between Brazilians of African and of European descent from Porto Alegre in terms of the polymorphisms CYP1A1*2A (p = 0.003), GSTP1-Ile105Val (p = 0.002) and the GSTM1 null genotype (p = 0.01) but there was no detectable significant difference in respect to GSTT1 null genotype frequencies.

Os níveis de lipídeos séricos são características multifatoriais determinadas por um grande número de fatores genéticos e ambientais. A identificação do componente genético dessas características tem sido intensamente investigada nos últimos anos. Esses estudos têm enfocado principalmente polimorfismos nos genes que codificam proteínas estruturais e enzimas relacionadas com o metabolismo de lipídeos. Estudos mais recentes mostraram que o efeito desses polimorfismos depende em parte das interações dos diferentes genótipos com os fatores de risco clássicos tais como tabagismo, sobrepeso ou sedentarismo. A variabilidade encontrada nesses genes parece também influir na resposta a fármacos comumente utilizados no tratamento das hiperlipidemias.

Serum lipid levels are multifactorial traits determined by a high number of genetic and environmental factors. The identification of the genetic component of this traits have been intensively investigated in the last years. These studies focused mainly on polymorphisms in genes coding for structural proteins and enzymes related to lipid metabolism. More recent studies showed that the effect of these polymorphisms depend in part on the interactions of different genotypes with classic risk factors like tabagism, overweight or physical inactivity. The variability observed in these genes seems to influence drug response of those commonly used in hyperlipidemia treatment.

Os níveis de lipídeos séricos são características multifatoriais determinadas por um grande número de fatores genéticos e ambientais. A identificação do componente genético dessas características tem sido intensamente investigada nos últimos anos. Esses estudos têm enfocado principalmente polimorfismos nos genes que codificam proteínas estruturais e enzimas relacionadas com o metabolismo de lipídeos. Estudos mais recentes mostraram que o efeito desses polimorfismos depende em parte das interações dos diferentes genótipos com os fatores de risco clássicos tais como tabagismo, sobrepeso ou sedentarismo. A variabilidade encontrada nesses genes parece também influir na resposta a fármacos comumente utilizados no tratamento das hiperlipidemias.

Serum lipid levels are multifactorial traits determined by a high number of genetic and environmental factors. The identification of the genetic component of this traits have been intensively investigated in the last years. These studies focused mainly on polymorphisms in genes coding for structural proteins and enzymes related to lipid metabolism. More recent studies showed that the effect of these polymorphisms depend in part on the interactions of different genotypes with classic risk factors like tabagism, overweight or physical inactivity. The variability observed in these genes seems to influence drug response of those commonly used in hyperlipidemia treatment.

Haplótipos derivados de cinco sítios de restrição polimórficos presentes no agrupamento da globina beta foram investigados em 86 cromossomos da população mapuche da Argentina. Esses resultados foram analisados em conjunto com os previamente obtidos para dez tribos indígenas brasileiras. Oito haplótipos foram identificados, dos quais os mais freqüentes foram o 2 (57%) e o 6 (27%). A presença do haplótipo 3 em 2% dos cromossomos dos Mapuches é uma evidência de mistura com indivíduos de ancestralidade africana. Devido ao alto número de haplótipos, a heterozigosidade medida pelo índice Gini-Simpson é mais alta nos Mapuches do que nos índios brasileiros. A distribuição haplotípica nos Mapuches é também significativamente diferente da observada nas tribos brasileiras. Essa heterogeneidade poderia ser parcialmente explicada pela mistura com populações não-indígenas.

Haplotypes derived from five polymorphic restriction sites in the beta-globin gene cluster were investigated in 86 chromosomes from the Argentinian Mapuche. These results were integrated with those previously obtained for ten Brazilian Indian tribes. Eight haplotypes were identified, the most frequent being 2 (57%) and 6 (27%). The presence of haplotype 3 in 2% of the Mapuche chromosomes is probably an evidence of admixture with individuals of African ancestry. Due to the high number of haplotypes observed, heterozygosity as measured by the Gini-Simpson index was higher in the Mapuche than in Brazilian Indians. The haplotypic distribution in the Mapuche was also significantly different from those of all Brazilian tribes investigated. This heterogeneity could be at least partially explained by admixture with non-Indian populations.