Deficient Individuals Research Articles

Prevalence of glucose 6-phosphate dehydrogenase deficiency in highly malaria-endemic municipalities in the Brazilian Amazon: A region-wide screening study

Difficulties associated with the assessment of glucose-6-phosphate dehydrogenase deficiency (G6PDd), particularly in remote areas, hinders the safe use of 8-aminoquinolines such as primaquine (PQ) and tafenoquine against Plasmodium vivax malaria due to the risk of haemolysis. This cross-sectional study was conducted in 41 malaria-endemic municipalities of six states in the Brazilian Amazon, between 2014 and 2018. Male individuals were screened for G6PDd using the qualitative Fluorescent Spot Test using fingerpick-collected whole blood samples. Point and interval estimates of the G6PDd prevalence were calculated for each state. Deficient samples were genotyped for the most prevalent variants in the Amazon. Frequencies of P. vivax malaria recurrences were estimated for G6PDd and non-G6PDd patients. This is one of the largest surveys ever conducted in Latin America, covering the entire malaria endemic area in the Brazilian Amazon. These results indicate that an important proportion of the population is at risk of hemolysis if exposed to PQ and its congener drug tafenoquine. The adoption of G6PDd screening protocols is essential to ensure the safety of individuals treated with those drugs and should also be considered when implementing malaria elimination strategies. A total of 14,847 individuals were included, of which 5.6% presented G6PDd. The state of Acre had the highest G6PDd prevalence (8.3%), followed by Amapá (5.8%), Pará (5.7%), Rondônia (5.4%), Roraima (4.2%) and Amazonas (4.0%). From 828 genotyped samples, African A+ (6.2%), African A- (39.3%) and wild-type (non-African non-Mediterranean; 54.2%) variants were found. A greater proportion of malaria recurrences was found among G6PD deficient individuals [16.7% vs 4.1%, Risk ratio 3.52 (2.16-5.74) p<0.01]. Brazilian Ministry of Health; Fundação de Amparo à Pesquisa do Estado do Amazonas (FAPEAM).

LCN2 is a new diagnostic biomarker and potential therapeutic target in idiopathic short stature.

Idiopathic short stature (ISS) is the most common paediatric endocrine disease. However, the underlying pathology of ISS remains unclear. Currently, there are no effective diagnostic markers or therapeutic strategies available for ISS. In this study, we aimed to identify differential plasma protein expression and novel biomarkers in patients with ISS, and elucidate the biological functions of candidate proteins in ISS pathogenesis. Four specimen pairs from four ISS children and age‐/sex‐matched control individuals were subjected to proteomics analysis, and 340 samples of children with a mean age 9.73 ± 0.24 years were utilized to further verify the differentially expressed proteins by enzyme‐linked immunosorbent assay (ELISA). The receiver‐operating characteristic (ROC) curve and the area under the ROC curve (AUC) were plotted. A total of 2040 proteins were identified, of which 84 were differentially expressed. In vitro and in vivo experiments confirmed the biological functions of these candidate proteins. LCN2 overexpression in ISS was verified using ELISA. Meanwhile, LCN2 showed high sensitivity and specificity in discriminating children with ISS from those with growth hormone deficiency, precocious puberty and normal control individuals. The upregulated expression of LCN2 not only suppressed food intake but also impaired chondrocyte proliferation and bone growth in chondrocytes and rats. As a result, the rats presented a short‐stature phenotype. Subsequently, we found that bone growth inhibition recovered after LCN2 overexpression was stopped in immature rats. To our knowledge, this is the first study to report that LCN2 may be a significant target for ISS diagnosis and treatment.

Correlation of vitamin D with clinical, biochemical and anthropometrical parameters of PCOS patients

Objective: To find correlation of 25-hydroxy vitamin D (25OHD) levels with various clinical biochemicals, anthropometric parameters in patients of PCOS. Study design: Cross-sectional observational study. Materials and Methods: The study was conducted at Obstetrics and Gynaecological dept. of Jawaharlal Lal Nehru medical college, AMU, Aligarh, for a period of 2 years, 2018-2020. A total number of 100 PCOS patients satisfying inclusion criteria were enrolled for the study. Frequency of Vit-D deficiency in study group was estimated. Correlation of Vit-D levels with various clinical, anthropometrical, biochemical parameters was evaluated. Based on Vit –D levels the study population was divided in to Vit-D deficient and non-deficient individuals and Paired sample t-test was used to assess changes in quantitative variables. Pearson product moment co-relation analysis was used to see correlation among different variables. Qualitative variables were interpreted using Chi square test. Statistical analysis was performed using computer program SPSS version 25.0. Observations and Results: The results of 100 PCOS patients were analysed. Vit-D deficiency was found in 74% of PCOS population. Vitamin D correlated inversely with LH, FSH Prolactin and Testosteron levels (r=-0.213, p&lt;0.05,r=-0.176;p&gt;0.05,r=-0.101;p&gt;0.05; r = 0.246, p&lt;0.01).)Though significant correlation was found with LH and testosteron only.

EEG Signal Processing for Detection of Colour Vision Deficiencies

The clinical assessment methods of detection of colour blindness are prone to subjective bias, human errors, and lack of consistency. Also, heterogeneous nature of vision deficiencies makes manual detection difficult. Hence, objective methods based on physiological signals can be used. Various studies have been undertaken to analyze the effect that colour perceived has on EEG signals and as a result can be extended to detection of colour blindness. The results of this survey indicate that there are significant differences produced in EEG signals due to changes in colour, as well as due to differences in colour perception. EEG signals also differ between healthy and colour vision deficient individuals, thereby providing a biomarker for detection. This biomarker can be exploited using machine learning algorithms for detection of colour-related vision deficiencies.

Leveraging explainable machine learning to identify gait biomechanical parameters associated with anterior cruciate ligament injury

Anterior cruciate ligament (ACL) deficient and reconstructed knees display altered biomechanics during gait. Identifying significant gait changes is important for understanding normal and ACL function and is typically performed by statistical approaches. This paper focuses on the development of an explainable machine learning (ML) empowered methodology to: (i) identify important gait kinematic, kinetic parameters and quantify their contribution in the diagnosis of ACL injury and (ii) investigate the differences in sagittal plane kinematics and kinetics of the gait cycle between ACL deficient, ACL reconstructed and healthy individuals. For this aim, an extensive experimental setup was designed in which three-dimensional ground reaction forces and sagittal plane kinematic as well as kinetic parameters were collected from 151 subjects. The effectiveness of the proposed methodology was evaluated using a comparative analysis with eight well-known classifiers. Support Vector Machines were proved to be the best performing model (accuracy of 94.95%) on a group of 21 selected biomechanical parameters. Neural Networks accomplished the second best performance (92.89%). A state-of-the-art explainability analysis based on SHapley Additive exPlanations (SHAP) and conventional statistical analysis were then employed to quantify the contribution of the input biomechanical parameters in the diagnosis of ACL injury. Features, that would have been neglected by the traditional statistical analysis, were identified as contributing parameters having significant impact on the ML model’s output for ACL injury during gait.

Glifosatın glukoz-6-fosfat dehidrogenaz enzim aktivitesi üzerindeki etkisinin in vitro koşullarda değerlendirilmesi

Purpose: The aim of this study was to investigate in vitro effect of glyphosate on Glucose 6-phosphate dehydrogenase (G6PD) enzyme activity.&#x0D; Materials and Methods: In terms of G6PD enzyme deficiency, samples taken from healthy and enzyme deficient male individuals were studied. After the hemolysates were prepared from blood sample, G6PD enyzme activities were determined by the modified Beutler method. Then, the effects of different concentrations (5.3x10-3, 5.3x10-4, 5.3x10-5, 5.3x10-6 mmol/mL) of glyphosate on G6PD activity were evaluated in normal and mutant enzymes. In addition, the in vitro effect of the antioxidant N-acetylcysteine (NAC) on the enzyme was investigated in the presence of glyphosate and without glyphosate.&#x0D; Results: While the result of normal erythrocyte G6PD activity was 12U/g for the individual, the result for the individual with enzyme deficiency was 2.5U/g Hb. The glyphosate’s maximum activity loss in the G6PD enzyme was observed in the 60th minute incubation. The highest inhibition was observed at 5.3x10-3 mmol/mL glyphosate. 4.7x10-7 mmol/mL N-Acetylcysteine partially increased the inhibition of glyphosate in the G6PD enzyme in healthy individuals, but had no effect on mutant G6PD.&#x0D; Conclusion: In humans, it is predicted that glyphosate affects G6PD enzyme activity in vitro and is an interference agent in the experimental process. In case of contamination, studies on limits of glyphosate that will not cause harmful effects in humans should be continued.

Prevalence and population genetic data of colour vision deficiency among students from selected tertiary institutions in Lagos State, Nigeria

BackgroundColour vision deficiency (CVD), also referred to as colour blindness, is the failure or decreased ability to distinguish between certain colours under normal lighting conditions. It is an X-linked genetic disorder with varying degrees of prevalence in different populations. There is presently no report on the prevalence of CVD among students of the selected tertiary institution. Hence, the present study was aimed at determining the occurrence and genetics of CVD among students from designated tertiary institutions in Lagos state. A cross-sectional survey was employed in recruiting 1191 study subjects from three tertiary institutions in Lagos, Nigeria.ResultsThe overall occurrence of CVD among the study participants was 2.85%. There were 24 (4.29%) males and 10 (1.58%) females affected. Among the colour vision deficient individuals, 18 (1.51%) and 16 (1.34%) were deuteranomalous and protanomalous, respectively. Also, the prevalence of CVD varies across ethnic groups of the studied subjects with the highest occurrences (3.57%) observed in the Yoruba ethnic subpopulation and the least (1.45%) among the Hausas.ConclusionsMore males than females were found to be colour vision deficient, and there were more deutans than protans. Early screening for CVD should be encouraged among school children to guide the choice of future profession and help mitigate work hazards resulting from being colour deficient.

Recovery of enzyme activity in biotinidase deficient individuals during early childhood.

Deficiency of the biotinidase (BTD) enzyme is an inborn error of biotin metabolism caused by biallelic pathogenic variants in the BTD gene. There are two forms, partial and profound BTD deficiency, which both can be successfully treated with pharmacological doses of biotin, justifying the inclusion of this disorder in the newborn screening in numerous countries. We investigated the BTD deficiency cohort (N = 87) in our metabolic center, as it was detected upon newborn screening since 2005, and aimed to better understand the long‐term course of BTD enzyme activity and how it may relate to the patients' genetic background. We observed that individuals with partial BTD deficiency display an elevation of BTD enzyme activity with increasing age in 48% of cases—a recovery which allowed adjustment or stop of biotin supplementation in 20% of all individuals. In addition, we were able to recruit 56 patients (64%) for genetic testing, revealing 19 different variants (2 novel), and constituting 22 different genotypes. Genotype–phenotype correlations revealed that the most abundant allele in our cohort p.(Asp444His) was also the most common variant in patients displaying recovery of BTD enzyme activity. Based on our results, we recommend to retest all patients with partial BTD deficiency at the age of 5 years, as this may result in an impact on therapy. Moreover, genetic testing of BTD deficient individuals can allow prediction of the severity of BTD deficiency and of the likelihood of BTD enzyme activity recovery with age.

A midgut-specific lytic polysaccharide monooxygenase of Locusta migratoria is indispensable for the deconstruction of the peritrophic matrix.

Lytic polysaccharide monooxygenases (LPMOs) are important enzymes that boost the hydrolysis of recalcitrant polysaccharides, such as chitin. They are found extensively in different insect species and are classified as auxiliary activities family 15 (AA15) LPMOs (LPMO15). Some of them were identified from the insect midgut and proven to act on chitin. However, knowledge about their physiological roles during insect growth and development remains limited. Here, we found that midgut-specific LPMO15s are widely distributed in different insect orders, such as the orthopteran Locusta migratoria and the lepidopteran Bombyx mori. Using L. migratoria as a model insect, the function of midgut-specific LmLPMO15-3 during development was investigated. Double-stranded RNA-mediated downregulation of LmLPMO15-3 expression at the 4th or 5th instar nymph stage severely decreased the survival rate and resulted in lethal phenotypes. Hematoxylin and eosin staining results indicated that the deficient individuals exhibited incompletely digested peritrophic matrix (PM), which suggested that LmLPMO15-3 is essential for the deconstruction of the PM during molting. This study provides direct evidence of the physiological importance of a midgut-specific LPMO15 during insect development. As L. migratoria is one of the most destructive agricultural pests, LmLPMO15-3 is a potential target for pest management.

Repeatability and reproducibility of a handheld quantitative G6PD diagnostic.

The introduction of novel short course treatment regimens for the radical cure of Plasmodium vivax requires reliable point-of-care diagnosis that can identify glucose-6-phosphate dehydrogenase (G6PD) deficient individuals. While deficient males can be identified using a qualitative diagnostic test, the genetic make-up of females requires a quantitative measurement. SD Biosensor (Republic of Korea) has developed a handheld quantitative G6PD diagnostic (STANDARD G6PD test), that has approximately 90% accuracy in field studies for identifying individuals with intermediate or severe deficiency. The device can only be considered for routine care if precision of the assay is high. Commercial lyophilised controls (ACS Analytics, USA) with high, intermediate, and low G6PD activities were assessed 20 times on 10 Biosensor devices and compared to spectrophotometry (Pointe Scientific, USA). Each device was then dispatched to one of 10 different laboratories with a standard set of the controls. Each control was tested 40 times at each laboratory by a single user and compared to spectrophotometry results. When tested at one site, the mean coefficient of variation (CV) was 0.111, 0.172 and 0.260 for high, intermediate, and low controls across all devices respectively; combined G6PD Biosensor readings correlated well with spectrophotometry (rs = 0.859, p<0.001). When tested in different laboratories, correlation was lower (rs = 0.604, p<0.001) and G6PD activity determined by Biosensor for the low and intermediate controls overlapped. The use of lyophilised human blood samples rather than fresh blood may have affected these findings. Biosensor G6PD readings between sites did not differ significantly (p = 0.436), whereas spectrophotometry readings differed markedly between sites (p<0.001). Repeatability and inter-laboratory reproducibility of the Biosensor were good; though the device did not reliably discriminate between intermediate and low G6PD activities of the lyophilized specimens. Clinical studies are now required to assess the devices performance in practice.

Skin Testing Is Useful in Assessing Aeroallergen Sensitization in IgE Deficient Patients with Environmental Allergy-Like Symptoms.

The value of aeroallergen skin testing is not known in IgE deficient individuals (IgE<2.5 kU/L). To investigate the utility of skin prick (SPT), intradermal skin testing (IDST) and measuring serum specific IgE (ssIgE) in IgE deficient patients presenting with environmental allergy-like symptoms. Individuals with IgE deficiency who had both SPT and IDST performed between 2010 to 2020 were matched (age and gender) to three different groups of non-IgE deficient patients with IgE≥2.5 kU/L (normal IgE [2.5 ≤ IgE<100], high IgE [100≤IgE<1000] and very high IgE levels [≥1000 kU/L]) who also had skin testing performed for evaluation of environmental allergy-like symptoms. Among 34 IgE deficient patients who completed SPT and IDST, 52.9% (18/34) had at least one positive skin test (4 ± 3 positive tests/patient), compared with 91.2% in those with normal, 94.1% with high or 97.1% with very high IgE levels (p < 0.01). In contrast, only one of the IgE deficient patients had detectable ssIgE, while ssIgE levels were significantly higher in all other IgE subgroups. Allergic immunotherapy was prescribed for 22.2% of the IgE-deficient patients with positive skin tests, similar to those with normal (2/31, 6.5%, p = 0.21), high IgE (9/32, 28.1%, p = 0.25) and very high IgE levels (8/33, 23.5%, p = 0.07), with similar efficacy in their symptoms control. Individuals with IgE deficiency may present with environmental allergy-like symptoms. A combination of SPT and IDST is useful for diagnosing aeroallergen sensitizations in these patients, indicating the presence of skin mast cell-bound IgE in some of these individuals, despite very low serum IgE levels. Further studies are needed to assess the exact significance of positive skin tests and the benefits of immunotherapy in this group.

Effect of Daily Vitamin D3 Supplementation on Muscle Health: An Individual Participant Meta-analysis.

The role of vitamin D on muscle health is debated. An individual participant metanalysis of 4 randomized placebo-controlled trials, investigating short-term (3-9months) effects of vitamin D3 in moderate (2800 IU) to high (7000 IU) daily oral doses on muscle health and quality of life (QoL). Inclusion criteria were either obesity (n = 52), newly diagnosed primary hyperparathyroidism (n = 41), Graves' disease (n = 86), or secondary hyperparathyroidism (n = 81). Overall (n = 260) as well as in a subgroup analysis including only vitamin D insufficient [25(OH)D < 50 nmol/L] individuals (n = 176), vitamin D supplementation did not affect measures of muscle health (isometric muscle strength, Timed Up and Go test, chair rising test, body composition, and balance) or QoL. However, a beneficial effect was present on QoL (physical component score) in vitamin D deficient [25(OH)D < 25 nmol/L] individuals (n = 34). Overall, relative changes in 25(OH)D inversely affected maximum muscle strength in a dose-response manner. Stratified into body mass index </> 30 kg/m2, vitamin D supplementation had divergent effects on isometric muscle strength, with beneficial effects in obese individuals (n = 93) at knee flexion 90° (P = 0.04), and adverse effects in nonobese individuals (n = 167) at handgrip (P = 0.02), knee extension 60° (P = 0.03) and knee flexion 60° (P < 0.01). Overall, short-term treatment with moderate to high daily doses of vitamin D did not affect muscle health or QoL. A potential beneficial effect was present on muscle strength in severely obese individuals and on QoL in vitamin D deficient individuals. Subgroup analyses, however, suggested negative effects of large relative increases in p-25(OH)D.

Genetic Bases of VitaminB12 Deficiency: Impact of MTHFR, TCN-II and GIF Polymorphisms on Vitamin B12 Level

Vitamin B12 deficiency is associated with serious health problems such as neurological disorders. In Jordan, few studies have evaluated the level of vitamin B21 in the Jordanian population with different prevalence. Genetic predisposition, lifestyle, environment, socioeconomic status, and geographic have been linked to vitamin B12 deficiency. Polymorphisms in the GIF, MTHFR, and Transcobalamins, have been proposed to be associated with the level of vitamin B12. The aim of the current study was to evaluate the impact of certain polymorphisms in MTHFR, TCN-II and GIF genes on the level of vitamin B12 in the Jordanian population. Polymorphic sites of the MTHFR (c.677 C&gt;T, rs1801133 and c.1286A&gt;C, rs1801131), TCN2-776C&gt;G (Arg259Pro) (rs1801198) and GIF-68 A&gt;G (Q5R) genes were analyzed by RFLP and DNA sequencing in a group of vitamin B12 deficient individuals (n = 100). The control group included 100 matching individuals with a normal level of vitamin B12 (&gt;200 ng/mL). Our results showed a significant association between the homologous variant of the TCN2 gene (G776G) and MTHFR c.677C&gt;T genes and vitamin B12 deficiency. On the other hand, The MTHFR c.1286A&gt;C variant and GIF variants did not show significant association with vitamin B12 deficiency. This study expounds the association of TCN2 and MTHFR polymorphisms with cobalamin levels in a Jordanian population and highlights the necessity of further studies to elucidate the molecular basis and impact of TCN2, GIF, and MTHFR gene polymorphisms on vitamin B12 deficiency and associated disorders.

Vitamin D levels among adults in a tertiary care hospital in Wayanad

Background: Vitamin D insufficiency affects nearly 50% of the population worldwide. Inadequate serum Vitamin D levels are associated with multiple conditions such as secondary hyperparathyroidism and increased fracture risk. Multiple studies carried out also showed a correlation between Vitamin D deficiency and occurrence of diabetes and hypertension (HTN) in these deficient individuals. This study aimed to determine the serum levels of Vitamin D among patients frequenting a tertiary care hospital in Wayanad and the associations with sunlight exposure, gender, dietary factors, and diabetes and HTN. Settings and Design: Cross-sectional study. Materials and Methods: Hundred patients were randomly selected from the outpatient department over 6 months and asked to fill up a questionnaire. Vitamin D analysis was done by Elecsys Vitamin D total assay. Statistical analysis used was IBM SPSS statistics for Windows, version 20.0: Association between continuous data was determined using t-test/Mann–Whitney test depending on normality of data and association between categorical variables was determined using Pearson's Chi-square test. Results: Fifty-seven percentage of patients had Vitamin D deficiency. Significantly lower values of Vitamin D were seen among women. Conclusions: The median Vitamin D levels in men were 22.785 ng/ml and 17.81 ng/ml in women. No association was established between &gt;1 h of daily sunlight exposure, the prevalence of diabetes and HTN, and daily consumption of dairy products and Vitamin D deficiency.

Multiple Sclerosis: Diagnosis and Treatment Management in Allopathy

This article summarizes the literature related to the pathogenic mechanisms and treatment options for multiple sclerosis, an autoimmune, demyelinating disorder of the central nervous system. The etiology of MS is not known, both genetic and environmental factors are known to play a role. The risk factor that is strongly associated with MS Epstein-Barr infection. Other factors subjected to modification are childhood obesity, smoking and vitamin deficient individuals. Vitamin D deficiency as a risk factor has been proposed to explain the increase in prevalence of MS with increase in the latitude. The pathogenesis involves a response which is mediated by T-cell directed against myelin and other similar proteins. The function of B-cells in the disease process is not known. Recent advancements in the understanding of multiple sclerosis has led to development of disease modifying therapies, which in turn has led to a decrease in severity of the disease and relapse rates. Disease modifying therapies act by modulating or suppressing the immune system. Moreover, several drugs have shown effectiveness in certain studies. A number of treatment options have now become available making treatment of MS possible. The management of MS is divided into 3 categories:&#x0D; &#x0D; Treatment of Exacerbations&#x0D; Slowing disease progression with Disease modifying therapies&#x0D; Symptomatic treatment&#x0D;

A Nationwide Study of GATA2 Deficiency in Norway\u2014the Majority of Patients Have Undergone Allo-HSCT

PurposeGATA2 deficiency is a rare primary immunodeficiency that has become increasingly recognized due to improved molecular diagnostics and clinical awareness. The only cure for GATA2 deficiency is allogeneic hematopoietic stem cell transplantation (allo-HSCT). The inconsistency of genotype–phenotype correlations makes the decision regarding “who and when” to transplant challenging. Despite considerable morbidity and mortality, the reported proportion of patients with GATA2 deficiency that has undergone allo-HSCT is low (~ 35%). The purpose of this study was to explore if detailed clinical, genetic, and bone marrow characteristics could predict end-point outcome, i.e., death and allo-HSCT.MethodsAll medical genetics departments in Norway were contacted to identify GATA2 deficient individuals. Clinical information, genetic variants, treatment, and outcome were subsequently retrieved from the patients’ medical records.ResultsBetween 2013 and 2020, we identified 10 index cases or probands, four additional symptomatic patients, and no asymptomatic patients with germline GATA2 variants. These patients had a diverse clinical phenotype dominated by cytopenia (13/14), myeloid neoplasia (10/14), warts (8/14), and hearing loss (7/14). No valid genotype–phenotype correlations were found in our data set, and the phenotypes varied also within families. We found that 11/14 patients (79%), with known GATA2 deficiency, had already undergone allo-HSCT. In addition, one patient is awaiting allo-HSCT. The indications to perform allo-HSCT were myeloid neoplasia, disseminated viral infection, severe obliterating bronchiolitis, and/or HPV-associated in situ carcinoma. Two patients died, 8 months and 7 years after allo-HSCT, respectively.ConclusionOur main conclusion is that the majority of patients with symptomatic GATA2 deficiency will need allo-HSCT, and a close surveillance of these patients is important to find the “optimal window” for allo-HSCT. We advocate a more offensive approach to allo-HSCT than previously described.

Association of air pollution and homocysteine with global DNA methylation: A population-based study from North India.

BackgroundAnthropogenic air pollution has been implicated in aberrant changes of DNA methylation and homocysteine increase (>15μM/L). Folate (<3 ng/mL) and vitamin B12 (<220 pg/mL) deficiencies also reduce global DNA methylation via homocysteine increase. Although B-vitamin supplements can attenuate epigenetic effects of air pollution but such understanding in population-specific studies are lacking. Hence, the present study aims to understand the role of air pollution, homocysteine, and nutritional deficiencies on methylation.MethodsWe examined cross-sectionally, homocysteine, folate, vitamin B12 (chemiluminescence) and global DNA methylation (colorimetric ELISA Assay) among 274 and 270 individuals from low- and high- polluted areas, respectively, from a single Mendelian population. Global DNA methylation results were obtained on 254 and 258 samples from low- and high- polluted areas, respectively.ResultsSignificant decline in median global DNA methylation was seen as a result of air pollution [high-0.84 (0.37–1.97) vs. low-0.96 (0.45–2.75), p = 0.01]. High homocysteine in combination with air pollution significantly reduced global DNA methylation [high-0.71 (0.34–1.90) vs. low-0.93 (0.45–3.00), p = 0.003]. Folate deficient individuals in high polluted areas [high-0.70 (0.37–1.29) vs. low-1.21 (0.45–3.65)] showed significantly reduced global methylation levels (p = 0.007). In low polluted areas, despite folate deficiency, if normal vitamin B12 levels were maintained, global DNA methylation levels improved significantly [2.03 (0.60–5.24), p = 0.007]. Conversely, in high polluted areas despite vitamin B12 deficiency, if normal folate status was maintained, global DNA methylation status improved significantly [0.91 (0.36–1.63)] compared to vitamin B12 normal individuals [0.54 (0.26–1.13), p = 0.04].ConclusionsHigh homocysteine may aggravate the effects of air pollution on DNA methylation. Vitamin B12 in low-polluted and folate in high-polluted areas may be strong determinants for changes in DNA methylation levels. The effect of air pollution on methylation levels may be reduced through inclusion of dietary or supplemented B-vitamins. This may serve as public level approach in natural settings to prevent metabolic adversities at community level.

Persistent SARS-CoV-2 infection in patients with secondary antibody deficiency: successful clearance following combination casirivimab and imdevimab (REGN-COV2) monoclonal antibody therapy

BackgroundThere is growing evidence that antibody responses play a role in the resolution of SARS-CoV-2 infection. Patients with primary or secondary antibody deficiency are at increased risk of persistent infection. This challenging clinical scenario is associated with adverse patient outcome and potentially creates an ecological niche for the evolution of novel SARS-CoV-2 variants with immune evasion capacity. Case reports and/or series have implied a therapeutic role for convalescent plasma (CP) to secure virological clearance, although concerns have been raised about the effectiveness of CP and its potential to drive viral evolution, and it has largely been withdrawn from clinical use in the UK.Case presentationWe report two cases in which persistent SARS-CoV-2 infection was cleared following administration of the monoclonal antibody combination casirivimab and imdevimab (REGN-COV2, Ronapreve). A 55-year-old male with follicular lymphoma, treated with B cell depleting therapy, developed SARS-CoV-2 infection in September 2020 which then persisted for over 200 days. He was hospitalised on four occasions with COVID-19 and suffered debilitating fatigue and malaise throughout. There was no clinical response to antiviral therapy with remdesivir or CP, and SARS-CoV-2 was consistently detected in nasopharyngeal swabs. Intrahost evolution of several spike variants of uncertain significance was identified by viral sequence analysis. Delivery of REGN-COV2, in combination with remdesivir, was associated with clinical improvement and viral clearance within 6 days, which was sustained for over 150 days despite immunotherapy for relapsed follicular lymphoma. The second case, a 68-year-old female with chronic lymphocytic leukaemia on ibrutinib, also developed persistent SARS-CoV-2 infection. Despite a lack of response to remdesivir, infection promptly cleared following REGN-COV2 in combination with remdesivir, accompanied by resolution of inflammation and full clinical recovery that has been maintained for over 290 days.ConclusionsThese cases highlight the potential benefit of REGN-COV2 as therapy for persistent SARS-CoV-2 infection in antibody deficient individuals, including after failure of CP treatment. Formal clinical studies are warranted to assess the effectiveness of REGN-COV2 in antibody-deficient patients, especially in light of the emergence of variants of concern, such as Omicron, that appear to evade REGN-COV2 neutralisation.

Genetic Variation of G6PD and CYP2D6: Clinical Implications on the Use of Primaquine for Elimination of Plasmodium vivax.

Primaquine, an 8-aminoquinoline, is the only medication approved by the World Health Organization to treat the hypnozoite stage of Plasmodium vivax and P. ovale malaria. Relapse, triggered by activation of dormant hypnozoites in the liver, can occur weeks to years after primary infection, and provides the predominant source of transmission in endemic settings. Hence, primaquine is essential for individual treatment and P. vivax elimination efforts. However, primaquine use is limited by the risk of life-threatening acute hemolytic anemia in glucose-6-phosphate dehydrogenase (G6PD) deficient individuals. More recently, studies have demonstrated decreased efficacy of primaquine due to cytochrome P450 2D6 (CYP2D6) polymorphisms conferring an impaired metabolizer phenotype. Failure of standard primaquine therapy has occurred in individuals with decreased or absent CYP2D6 activity. Both G6PD and CYP2D6 are highly polymorphic genes, with considerable geographic and interethnic variability, adding complexity to primaquine use. Innovative strategies are required to overcome the dual challenge of G6PD deficiency and impaired primaquine metabolism. Further understanding of the pharmacogenetics of primaquine is key to utilizing its full potential. Accurate CYP2D6 genotype-phenotype translation may optimize primaquine dosing strategies for impaired metabolizers and expand its use in a safe, efficacious manner. At an individual level the current challenges with G6PD diagnostics and CYP2D6 testing limit clinical implementation of pharmacogenetics. However, further characterisation of the overlap and spectrum of G6PD and CYP2D6 activity may optimize primaquine use at a population level and facilitate region-specific dosing strategies for mass drug administration. This precision public health approach merits further investigation for P. vivax elimination.

Can gene therapy be used to prevent cancer? Gene therapy for aldehyde dehydrogenase 2 deficiency.

Approximately 8% of the world population and 35 to 45% of East Asians are carriers of the hereditary disorder, aldehyde dehydrogenase 2 (ALDH2) deficiency. ALDH2 plays a central role in the liver to metabolize ethanol. With the common E487K variant, there is a deficiency of ALDH2 function; when ethanol is consumed, there is a systemic accumulation of acetaldehyde, an intermediate product in ethanol metabolism. In ALDH2 deficient individuals, ethanol consumption acutely causes the “Alcohol Flushing Syndrome” with facial flushing, tachycardia, nausea and headaches. With chronic alcohol consumption, ALDH2 deficiency is associated with a variety of disorders, including a remarkably high risk for aerodigestive tract cancers. Acetaldehyde is a known carcinogen. The epidemiologic data relating to the association of ALDH2 deficiency and cancer risk are striking: ALDH2 homozygotes that are moderate to heavy consumers of ethanol have a 7- to 12-fold increased risk for esophageal cancer, making ALDH2 deficiency the most common hereditary disorder associated with an increased cancer risk. In this review, we summarize the genetics and biochemistry of ALDH2, the epidemiology of cancer risk associated with ALDH2 deficiency, the metabolic consequences of ethanol consumption associated with ALDH2 deficiency and gene therapy strategies to correct ALDH2 deficiency and its associated cancer risk. With the goal of reducing the risk of aerodigestive tract cancers, in the context that ALDH2 is a hereditary disorder and ALDH2 functions primarily in the liver, ALDH2 deficiency is an ideal target for the application of adeno-associated virus-mediated liver directed gene therapy to prevent cancer.