Associations between Potentially Modifiable Risk Factors and Alzheimer Disease: A Mendelian Randomization Study

Background

Potentially modifiable risk factors including obesity, diabetes, hypertension, and smoking are associated with Alzheimer disease (AD) and represent promising targets for intervention. However, the causality of these associations is unclear. We sought to assess the causal nature of these associations using Mendelian randomization (MR).

Methods and Findings

We used SNPs associated with each risk factor as instrumental variables in MR analyses. We considered type 2 diabetes (T2D, N _SNPs = 49), fasting glucose (N _SNPs = 36), insulin resistance (N _SNPs = 10), body mass index (BMI, N _SNPs = 32), total cholesterol (N _SNPs = 73), HDL-cholesterol (N _SNPs = 71), LDL-cholesterol (N _SNPs = 57), triglycerides (N _SNPs = 39), systolic blood pressure (SBP, N _SNPs = 24), smoking initiation (N _SNPs = 1), smoking quantity (N _SNPs = 3), university completion (N _SNPs = 2), and years of education (N _SNPs = 1). We calculated MR estimates of associations between each exposure and AD risk using an inverse-variance weighted approach, with summary statistics of SNP–AD associations from the International Genomics of Alzheimer’s Project, comprising a total of 17,008 individuals with AD and 37,154 cognitively normal elderly controls. We found that genetically predicted higher SBP was associated with lower AD risk (odds ratio [OR] per standard deviation [15.4 mm Hg] of SBP [95% CI]: 0.75 [0.62–0.91]; p = 3.4 × 10⁻³). Genetically predicted higher SBP was also associated with a higher probability of taking antihypertensive medication (p = 6.7 × 10⁻⁸). Genetically predicted smoking quantity was associated with lower AD risk (OR per ten cigarettes per day [95% CI]: 0.67 [0.51–0.89]; p = 6.5 × 10⁻³), although we were unable to stratify by smoking history; genetically predicted smoking initiation was not associated with AD risk (OR = 0.70 [0.37, 1.33]; p = 0.28). We saw no evidence of causal associations between glycemic traits, T2D, BMI, or educational attainment and risk of AD (all p > 0.1). Potential limitations of this study include the small proportion of intermediate trait variance explained by genetic variants and other implicit limitations of MR analyses.

Conclusions

Inherited lifetime exposure to higher SBP is associated with lower AD risk. These findings suggest that higher blood pressure—or some environmental exposure associated with higher blood pressure, such as use of antihypertensive medications—may reduce AD risk.     

Depressive Symptoms Are Associated with Analgesic Use in People with Alzheimer’s Disease: Kuopio ALSOVA Study

Neuropsychiatric symptoms of Alzheimer’s disease (AD) such as depression may be associated with pain, which according to the literature may be inadequately recognized and managed in this population. This study aimed to identify the factors associated with analgesic use in persons with AD; in particular, how AD severity, functional status, neuropsychiatric symptoms of AD, co-morbidities and somatic symptoms are associated with analgesic use. 236 community-dwelling persons with very mild or mild AD at baseline, and their caregivers, were interviewed over five years as part of the prospective ALSOVA study. Generalized Estimating Equations (GEEs) were used to estimate unadjusted and adjusted odds ratios (ORs) for the factors associated with analgesic use over a five year follow-up. The proportion of persons with AD using any analgesic was low (13.6%) at baseline and remained relatively constant during the follow-up (15.3% at Year 5). Over time, the most prevalent analgesic changed from non-steroidal anti-inflammatories (8.1% of persons with AD at Year 1) to acetaminophen (11.1% at Year 5). Depressive symptoms (measured by the Beck Depression Inventory, BDI) were independently associated with analgesic use, after effects of age, gender, education, AD severity, comorbidities and somatic symptoms were taken into account. For every one unit increase in BDI, the odds of analgesic use increased by 4% (OR = 1.04, 95% confidence interval CI = 1.02-1.07). Caregiver depressive symptoms were not statistically significantly associated with analgesic use of the person with AD. Depressive symptoms were significantly associated with analgesic use during the five year follow-up period. Possible explanations warranting investigation are that persons with AD may express depressive symptoms as painful somatic complaints, or untreated pain may cause depressive symptoms. Greater awareness of the association between depressive symptoms and analgesic use may lead to safer and more effective prescribing for these conditions.     

Effects of N6-benzyladenine on shoots of five willow clones (Salix spp.) cultured in vitro

Growth and differentiation in shoot cultures of five willow clones on media of different BA concentrations were compared. The tendency of axillary shoots to develop on shoot cultures depended on the genotype, the type of shoot and the number of previous subcultures. The optimum concentration for shoot multiplication was either 5×10^-7 M or 10^-6 M. On BA concentrations of 10^-5 M or higher, browning and death of shoots occurred. Depending on the genotype, shoot elongation was best on media containing 0–5×10^-7 M BA. Rooting ability was also genotype dependent. Prolonged culture in vitro improved the rooting ability of the two most reluctant clones. BA concentrations of 5×10^-7 M or higher inhibited rooting almost completely, but this was not a permanent effect. All clones could be rooted on medium containing 10^-6 M NAA. Shoots were transferred to greenhouse conditions and rooted with varying degrees of success depending on shoot size and genotype.     

Fourier transform infrared study of fully hydrated dimyristoylphosphatidylglycerol. Effects of Na+ on the sn-1' and sn-3' headgroup stereoisomers

Molecular packing and the thermotropic phase behavior of fully hydrated ammonium salts of 1,2-dimyristoyl-sn-glycero-3-phosphatidyl-sn-1'-glycerol (1'-DMPG) and the corresponding 3' stereoisomer (3'-DMPG) as well as the effects of 300 mM NaCl on these lipids were studied by Fourier transform infrared (FTIR) spectroscopy. The ammonium salts of both stereoisomer show similar thermotropic phase behavior and have an order-disorder phase transition at approximately 21 degrees C. While complexing with Na+, however, an incubation of liposomes at +6 degrees C for 3 days results in significant structural differences between liposomes of 1'-DMPG and 3'-DMPG. In the presence of 300 mM NaCl the infrared spectra for 3'-DMPG reveal the appearance of a more solidified lipid nominated here as the highly crystalline phase with a transition into the liquid-crystalline state at a significantly higher temperature (approximately at 33 degrees C) than that for 1'-DMPG (approximately at 23 degrees C). Crystal field splitting resulting from interchain vibrational coupling is observed in the CH2 scissoring mode of the 3'-DMPG(Na+) complex in the highly crystalline phase (T less than 33 degrees C); i.e., the acyl chains are packed in a rigid orthorhombic- or monoclinic-like crystal lattice. At temperatures above the transition at 33 degrees C the acyl chains of 3'-DMPG(Na+) give rise to infrared spectra indicative of hexagonal packing. The latter type of hydrocarbon chain packing is also found for the ammonium salts of 1'-DMPG and 3'-DMPG without Na+ as well as for 1'-DMPG with Na+. In addition, the binding of Na+ to 3'-DMPG causes narrowing of the bands associated with the interfacial and polar headgroup regions of 3'-DMPG and thus reveals reduced motional freedom. This demonstrates that Na+ binds tightly to 3'-DMPG, leading to the immobilization of the entire phospholipid polar headgroup. Such effects by Na+ are not observed for 1'-DMPG.     

Artificial Dispersal as a Restoration Tool in Meadows: Sowing or Planting?

Habitat fragmentation and the abandonment of former agricultural practices have led to extremely low dispersal rates for plant species growing in traditionally managed hay meadows in Sweden. Historically, seed dispersal between populations was maintained by hay movement, grazing animals, and farmers sharing their equipment. Because these means of dispersal typically are no longer occurring, artificial dispersal using seeds and plug-plants is tested here as a restoration tool. In this study, we chose two perennial herbs commonly occurring in meadows as test species, viz, Hypochoeris maculata L. (Asteraceae) and Succisa pratensis Moench. (Dipsacaceae). We found that plug-plant transplants were twice as effective as seed sowing for both species. The seed collection site was found to be important for seed-based establishment and survival; consequently, the choice of donor meadow is important when acquiring seeds used for restoration. We also found that survival of plants introduced as seeds was generally lower at sites harboring species favored by nitrogen as well as at sites in later successional phases. Both methods of introducing meadow species worked well, even though long-term establishment may well be more successful with the plug-plant method due to higher plug-plant establishment 2 years after introduction in the field.     

Long-term effect of vaccination against gonadotropin-releasing hormone, using Improvac, on hormonal profile and behaviour of male pigs

The objective of this study was to evaluate the long-term effect of a gonadotropin-releasing hormone (GnRH) vaccine, Improvac (Pfizer Ltd.), on the levels of GnRH antibodies, testosterone, estrone sulphate (E1S) and androstenone, as well as skatole and indole in male pigs. Additionally, the long-term effect of immunocastration on social and sexual behaviour was studied. Male pigs were assigned to two treatment groups: a treatment group given two doses of Improvac (n=12) and a control group of entire male pigs (n=12). The pigs were kept either 16 or 22 weeks after vaccination. Blood samples were collected five or six times; prior to both first and second vaccination, then three or four times during the 16 or 22 week period after second vaccination. Immunocastration significantly reduced levels of testosterone and E1S in plasma, and levels of androstenone in fat (P<0.001 for all). Skatole and indole levels in plasma and fat were also lower in immunocastrated pigs than in entire male pigs. These effects lasted up to 22 weeks after the second vaccination. Testis weight and bulbourethral gland length were lower in immunocastrated pigs at slaughter and these pigs showed less social, manipulating and aggressive behaviour than entire male pigs. The immunocastrated pigs remained sexually inactive throughout the study. Our study represents a further step in the evaluation of the effectiveness of Improvac as an alternative to surgical castration of entire male pigs. It shows that Improvac may have an extended effect compared with that currently implied by the directions for use.     

Discovery of novel, potent and bioavailable proline-urea based macrocyclic HCV NS3/4A protease inhibitors

A novel series of P3-truncated macrocyclic HCV NS3/4A protease inhibitors containing a P2 proline-urea or carbamate scaffold was synthesized. Very potent inhibitors were obtained through the optimization of the macrocycle size, urea and proline substitution, and bioisosteric replacement of the P1 carboxylic acid moiety. Variation of the lipophilicity by introduction of small lipophilic substituents resulted in improved PK profiles, ultimately leading to compound 13Bh, an extremely potent (K(i)=0.1 nM, EC(50)=4.5 nM) and selective (CC(50) (Huh-7 cells)>50 microM) inhibitor, displaying an excellent PK profile in rats characterized by an oral bioavailability of 54% and a high liver exposure after oral administration.     

Bacteriophage Mu integration in yeast and mammalian genomes

Genomic parasites have evolved distinctive lifestyles to optimize replication in the context of the genomes they inhabit. Here, we introduced new DNA into eukaryotic cells using bacteriophage Mu DNA transposition complexes, termed ‘transpososomes’. Following electroporation of transpososomes and selection for marker gene expression, efficient integration was verified in yeast, mouse and human genomes. Although Mu has evolved in prokaryotes, strong biases were seen in the target site distributions in eukaryotic genomes, and these biases differed between yeast and mammals. In Saccharomyces cerevisiae transposons accumulated outside of genes, consistent with selection against gene disruption. In mouse and human cells, transposons accumulated within genes, which previous work suggests is a favorable location for efficient expression of selectable markers. Naturally occurring transposons and viruses in yeast and mammals show related, but more extreme, targeting biases, suggesting that they are responding to the same pressures. These data help clarify the constraints exerted by genome structure on genomic parasites, and illustrate the wide utility of the Mu transpososome technology for gene transfer in eukaryotic cells.     

Use of a novel nonantibiotic triple marker gene cassette to monitor high survival of Pseudomonas fluorescens SBW25 on winter wheat in the field

Pseudomonas fluorescens SBW25 was tagged with a triple marker gene cassette containing gfp, encoding green fluorescent protein; luxAB, encoding luciferase; and telABkilA, encoding tellurite resistance, and the tagged strain was monitored in the first Swedish field release of a genetically modified microorganism (GMM). The cells were inoculated onto winter wheat seeds and the GMM cells (SBW25:tgl) were monitored in the field from September 2005 to May 2006 using plating, luminometry and microscopic analyses. Cell numbers were high on all sampling occasions and metabolically active cells were detected on all plant parts. Field results were similar to those obtained in a parallel phytotron study, although the amount of SBW25:tgl detected on shoots was significantly higher in the phytotron than in the field. After winter, cell counts were 100-fold higher on the roots and root-associated soil compared with prewinter measurements, although the cells had a lower relative metabolic activity. The wheat seeds were naturally infested with Microdochium nivale, but no treatment resulted in reduction of disease symptoms. No SWB25:tgl cells were ever found in bulk soil or uninoculated plants. The Swedish field trial results complement and contrast with prior field studies performed with the same parent organism in the United Kingdom under different soil, plant and climatic conditions.