Can Multiple Lifestyle Behaviours Be Improved in People with Familial Hypercholesterolemia? Results of a Parallel Randomised Controlled Trial

Objective

To evaluate the efficacy of an individualised tailored lifestyle intervention on physical activity, dietary intake, smoking and compliance to statin therapy in people with Familial Hypercholesterolemia (FH).

Methods

Adults with FH (n = 340) were randomly assigned to a usual care control group or an intervention group. The intervention consisted of web-based tailored lifestyle advice and face-to-face counselling. Physical activity, fat, fruit and vegetable intake, smoking and compliance to statin therapy were self-reported at baseline and after 12 months. Regression analyses were conducted to examine between-group differences. Intervention reach, dose and fidelity were assessed.

Results

In both groups, non-significant improvements in all lifestyle behaviours were found. Post-hoc analyses showed a significant decrease in saturated fat intake among women in the intervention group (β = −1.03; CI −1.98/−0.03). In the intervention group, 95% received a log on account, of which 49% logged on and completed one module. Nearly all participants received face-to-face counselling and on average, 4.2 telephone booster calls. Intervention fidelity was low.

Conclusions

Individually tailored feedback is not superior to no intervention regarding changes in multiple lifestyle behaviours in people with FH. A higher received dose of computer-tailored interventions should be achieved by uplifting the website and reducing the burden of screening questionnaires. Counsellor training should be more extensive.

Trial Registration

Dutch Trial Register NTR1899     

Diversification within grapevine cultivars goes through chimeric states.

Vitis vinifera 'Pinot' clones were analysed at 50 microsatellite loci to assess intravarietal genetic diversity. When analysing leaf tissue DNAs, polymorphism mainly resulted from the appearance of a third allele when two were expected for heterozygous loci in a diploid species. The sequencing of the three microsatellite alleles at two loci has confirmed their simultaneous presence in the leaf tissues. A hypothesis explaining the triallelic profiles at a locus is the presence of a periclinal chimera meristem structure, in which genetically different cell layers coexist. The periclinal chimeric state of two Vitis vinifera 'Pinot gris' clones was confirmed by splitting and analysing the genotypes resulting from L1 and L2 cell layers in progeny derived from self-fertilization, in root tissues, and in plants regenerated from somatic embryogenesis. Prevalence of chimerism in polymorphic clones observed in a collection of 145 accessions belonging to 'Pinot gris', 'Pinot noir', Pinot blanc', 'Pinot meunier', and 'Pinot moure' cultivars was demonstrated. The accumulation of somatic mutations and cell layer rearrangements allowed us to deduce the relationships between the various genotypes and to open a way for understanding the diversification process and the phylogeny in the 'Pinot' group.     

Multimodal biomarker discovery for active Onchocerca volvulus infection

The neglected tropical disease onchocerciasis, or river blindness, is caused by infection with the filarial nematode Onchocerca volvulus. Current estimates indicate that 17 million people are infected worldwide, the majority of them living in Africa. Today there are no non-invasive tests available that can detect ongoing infection, and that can be used for effective monitoring of elimination programs. In addition, to enable pharmacodynamic studies with novel macrofilaricide drug candidates, surrogate endpoints and efficacy biomarkers are needed but are non-existent. We describe the use of a multimodal untargeted mass spectrometry-based approach (metabolomics and lipidomics) to identify onchocerciasis-associated metabolites in urine and plasma, and of specific lipid features in plasma of infected individuals (O. volvulus infected cases: 68 individuals with palpable nodules; lymphatic filariasis cases: 8 individuals; non-endemic controls: 20 individuals). This work resulted in the identification of elevated concentrations of the plasma metabolites inosine and hypoxanthine as biomarkers for filarial infection, and of the urine metabolite cis-cinnamoylglycine (CCG) as biomarker for O. volvulus. During the targeted validation study, metabolite-specific cutoffs were determined (inosine: 34.2 ng/ml; hypoxanthine: 1380 ng/ml; CCG: 29.7 ng/ml) and sensitivity and specificity profiles were established. Subsequent evaluation of these biomarkers in a non-endemic population from a different geographical region invalidated the urine metabolite CCG as biomarker for O. volvulus. The plasma metabolites inosine and hypoxanthine were confirmed as biomarkers for filarial infection. With the availability of targeted LC-MS procedures, the full potential of these 2 biomarkers in macrofilaricide clinical trials, MDA efficacy surveys, and epidemiological transmission studies can be investigated.     

Initial recruitment of neutrophils to alveolar structures in acute lung injury

The adult respiratory distress syndrome and bacterial pneumonia are both characterized by an influx of neutrophils into the lung. The neutrophil has been implicated as having a "pathological" role in adult respiratory distress syndrome, in contrast to its role in bacterial pneumonia. We hypothesized that processes resulting in neutrophil recruitment to the lung are distinct, depending on whether the inflammatory stimulus arises in the intravascular or the alveolar compartment of the lung. Anesthetized sheep with lung lymph fistulas were utilized to access the three compartments of the lung relevant to studies of transpulmonary neutrophil migration. Serum, lung lymph, and bronchoalveolar lavage fluid were studied for neutrophil influx and chemotactic activity before and after administration of endotoxin by either an intravascular or inhaled alveolar route. Both groups developed significant neutrophil influx into the lymph and bronchoalveolar lavage fluid by 3 h postendotoxin. Those animals receiving intravascular endotoxin developed chemotactic gradients opposing neutrophil migration into the lung in contrast to animals receiving alveolar endotoxin, suggesting that neutrophil influx into the lung occurs by random migration.     

Genetic Characterization of a new allele of the rabbit group b Ck allotypes

An inherited variant (b4^v) of the rabbit kappa-chain allotype b4 is characterized by the presence of serine in place of alanine at position 121 and leucine in place of glutamine at position 124. The variant was traced through eight generations of a pedigreed rabbit family. Genetic analysis of this trait demonstrated that it is an allele of the other group b allotypes, and recent breedings have produced rabbits homozygous for this light-chain type. Two findings, other than the amino acid sequence differences, distinguish b4^v from b4 in our colony. First, the level of expression of b4^v in heterozygous rabbits is less than that of b4. For example, in b4b4^v rabbits, approximately 30% of the preimmune IgG carries b4^v. In b4^vb5 animals, 46% of the IgG carries the allotype b5, although in animals of allotype b4b5, 38% of the IgG is b5. Second, retrospective analysis of some litters revealed an abnormally low frequency of b4^v in male heterozygotes. However, male b4^vb4^v homozygotes were found at the expected frequency in prospective crosses between b4^vb5 rabbits.For reasons of simplicity the variant will be referred to here as b4^v     

Homogeneous rabbit immunoglobulin lacking group a allotypes: amino acid sequence analysis of the heavy chain.

The partial amino acid sequence of rabbit a-negative heavy chain has been determined for residues 1--43 as: less than EEQLEESGGGLVQPGGSLKLSCKGSGFDFSVYGVTWVRQAPGK; and for residues 64--120 as: MNGRFTISSDNAQNRLYLQLNSLTAADTATYFCARSMVVVAGVHSYFDVWGPGTLVTV. Comparison of this sequence with the human heavy chain subgroup III shows homology of 78% suggesting that a common ancestral variable region gene existed in mammals prior to speciation. The constant region of the a-negative chain is structurally identical with that of a-positive chains, whereas the variable region differs substantially between a-positive and a-negative molecules. These findings support the concept that two genes encode one immunoglobulin polypeptide chain and demonstrate the existence in the rabbit of variable region subgroups similar to those reported for humans and other species. A novel approach to the initial fragmentation of the heavy chain was developed in this study. This method, which involved digestion of the H chain with the protease V8, produced a free N terminus and should have wide application in future studies on heavy chains with blocked amino terminals.     

Structural characterization of antigens encoded by rabbitRLA-11 histocompatibility genes

Products of rabbitRLA-11 histocompatibility genes were isolated from rabbit lymphoid tumor cells (RL-5) and characterized. The tumor cells were grown in culture with radioactive amino acids and were lysed by treatment with the detergent NP-40. Glycoprotein molecules were isolated by affinity chromatography using immobilized lentil lectin. Chromatography on purified sheep anti-rabbit beta-2-microglobulin yielded a 43,000 dalton glycoprotein fraction, designated RLA-11gp, which was noncovalently associated with beta-2-microglobulin. N-terminal amino acid sequence analysis using radiochemical methods allowed assignment of 28 of the N-terminal 35 residues. The data revealed 89% homology of the RLA-11gp N-terminus with that of the human HLA-B7 and 82% with the mouse H-2K^b histocompatibility antigens. Comparison of the RLA-11 gp N-terminal sequence data obtained in this work to sequence data reported for major histocompatibility complex antigens of other species revealed no amino acid substitutions unique to the rabbit antigens.     

High Trait Anxiety: A Challenge for Disrupting Fear Memory Reconsolidation

Disrupting reconsolidation may be promising in the treatment of anxiety disorders but the fear-reducing effects are thus far solely demonstrated in the average organism. A relevant question is whether disrupting fear memory reconsolidation is less effective in individuals who are vulnerable to develop an anxiety disorder. By collapsing data from six previous human fear conditioning studies we tested whether trait anxiety was related to the fear-reducing effects of a pharmacological agent targeting the process of memory reconsolidation - n = 107. Testing included different phases across three consecutive days each separated by 24 h. Fear responding was measured by the eye-blink startle reflex. Disrupting the process of fear memory reconsolidation was manipulated by administering the β-adrenergic receptor antagonist propranolol HCl either before or after memory retrieval. Trait anxiety uniquely predicted the fear-reducing effects of disrupting memory reconsolidation: the higher the trait anxiety, the less fear reduction. Vulnerable individuals with the propensity to develop anxiety disorders may need higher dosages of propranolol HCl or more retrieval trials for targeting and changing fear memory. Our finding clearly demonstrates that we cannot simply translate observations from fundamental research on fear reduction in the average organism to clinical practice.