2. BALcanOSH MEDNARODNA KONFERENCA ZA REGIONALNO SODELOVANJE, BLED, SLOVENIJA

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1 Vita Dolžan 1, Metoda Dodič-Fikfak 2, Alenka Franko 2 1 Pharmacogenetics Lab., Inst. of Biochemistry, Faculty of Medicine, University of Ljubljana, Slovenia 2 Clinical Institute of Occupational Medicine,University Medical Centre Ljubljana, Slovenija 10. in 11. november BALcanOSH MEDNARODNA KONFERENCA ZA REGIONALNO SODELOVANJE, BLED, SLOVENIJA

2 ASBESTOS RELATED DISEASES asbestosis pleural diseases: pleural plaques, diffuse pleural thickening, pleural effusion malignant mesothelioma of pleura or peritoneum lung cancer other cancers: buccal mucosa, pharynx, larynx, ovary, kidney, gastointestinal tract

3 ASBESTOSIS asbestos exposure?? genetic factors most common among diseases caused by asbestos interstitial pulmonary process develops slowly after a long latency period develops into diffuse pulmonary fibrosis associated with increased risk of lung cancer.

4 MOLECULAR MECHANISMS ASSOCIATED WITH PATHOGENESIS OF ASBESTOS RELATED DISEASES - still poorly understood redox active Fe in asbestos fibers alveolar macrophages activated by phagocytosis asbestos inos asbestos fibers NO reactive oxygen species (ROS) reactive nitric species (RNS) ROS and NO and their reactive products damage biomolecules: lipids, proteins and DNA

5 DEFENCE MECHANISMS AGAINST ROS antioxidant enzymes proteins binding Fe and Cu antioxidants (endogenous, exogenous)

6 ANTIOXIDANT ENZYMES - primary line of enzymatic defence against ROS Superoxide dismutases MnSOD, EcSOD, Cu/ZnSOD Catalase CAT SOD O O H + H 2 O 2 + O 2 CAT 2H 2 O 2 2H 2 O + O 2

7 GLUTATHIONE S-TRANSFERASES: GSTM1, GST T1, GSTP1 - secondary line of enzymatic defence against ROS asbestos ROS and RNS GST electrophiles + glutathione Inactivate the electrophiles produced by ROS and RNS

8 GENETIC VARIABILITY IN ANTIOXIDANT DEFENCE The genes coding for MnSOD, ECSOD, CAT, GSTM1, GST T1, GSTP1 and inos are polymorphic

9 GENETIC POLYMORPHISM presence of 2 or more alleles in the population the freuency of the rare allele > 1 % Single nucleotide polymorphisms - SNPs Copy number variations CNVs; including gene deletions and duplications 9

10 GENE-ENVIRONMENT INTERACTIONS Besides environmental and/or occupational exposure to different hazards and lifestyle factors, genetic factors as well as the interactions between different genotypes, between genotypes and lifestyle factors, and between genotypes and environmental/occupational exposure to hazards may also have an important influence on the development of diseases and should be further investigated

11 THE AIM OF THE STUDY to investigate influence of gene-gene and gene-environment interactions on the risk of developing asbestosis

12 COHORT OF 2,080 WORKERS >> nested case control study All 356 cases with asbestosis 186 male 76 female 40 died, 2 cancer, 52 refused to participate controls 183 male 82 female 29 died, 9 cancer, 63 refused to participate 265 Diagnosis of asbestosis Data on smoking Duration of exposure Data on cumulative exposure

13 SALONIT ANHOVO Cumulative exposure Anhovo

14 DIAGNOSIS OF ASBESTOSIS State Board for Recognition of Occupational Asbestos Diseases The Helsinki Criteria American Thoracic Society recommendations

-262C>T GSTP1 Ile105Val and Ala114Val Multiplex PCR: GST

15 MOLECULAR GENETIC METHODS ANALYSES OF POLYMORPHISMS Real-time PCR: MnSOD Ala-9Val ECSOD Arg213Gly CAT -262C>T GSTP1 Ile105Val and Ala114Val Multiplex PCR: GST T1-null GSTM1-null Short tandem repeat (CCT T T)n in the inos gene

16 STATISTICAL METHODS Standard descriptive statistics T-test: differences in the means of variables between cases and controls Chi-square test: differences in proportions between groups Univariate logistic regression analysis: associations between asbestosis and individual variables Multivariate logistic modeling : simple categorical models followed by logistic regression models using dummy variables OR and 95 % CI

17 RESULTS Environmental factors and asbestosis risk OR 95%CI Cumulative exposure Smoking

18 Genetic factors and asbestosis risk Genotype MnSOD 9Ala/Ala vs. Ala/Val+Val/Val ECSOD Arg/Gly vs. Arg/Arg CAT 262 TT vs. CT+CC GSTM1-null vs. present GSTT1- null vs. present GSTP1 high vs. inter/slow conjugation inos LL vs. SL+SS OR (95 % CI) 1,50 (1,01 2,24) 1,63 (0,62 4,27) 1,36 (0,70 2,62) 1,01 (0,71 1,43) 0,61 (0,40 0,94) 1,49 (1,06 2,10) 1,20 (0,85 1,69) OR (95 % CI) Adj for smoking 1,49 (1,00 2,23) 1,65 (0,63 4,32) 1,37 (0,71 2,66) 0,99 (0,70 1,41) 0,63 (0,41 0,97) 1,50 (1,06 2,13) 1,17 (0,83 1,66) OR (95 % CI) Adj for cumulative asbestos exposure 1,48 (0,96 2,28) 2,07 (0,72 5,94) 1,91 (0,93 3,91) 0,97 (0,67 1,42) 0,60 (0,38 0,96) 1,36 (0,94 1,98) 1,19 (0,82 1,73)

19 MODEL OF CAUSATION?? cumulative exposure?? smoking? inos MnSOD ECSOD CAT GSTT1 GSTM1

20 Interaction between MnSOD and CAT and asbestosis risk MnSOD Cases Controls Ala/Val and Val/Val Ala/Ala OR = 0.67 (95% CI = ) CAT TT MnSOD Cases Controls Ala/Val and Val/Val 16 8 Ala/Ala 6 8 OR = 2.67 (95% CI = ) CAT CT in CC MnSOD Cases Controls Ala/Val and Val/Val Ala/Ala OR = 0.59 (95% CI = ) Interaction: OR = 4.49 (95% CI = ); p = Biologically plausible: MnSOD and CAT catalyse sequential reactions

21 Interaction between inos and CAT and asbestosis risk inos Cases Controls LL SL +SS OR = 1.20 (95% CI = ) CAT TT inos Cases Controls LL 15 5 SL +SS 7 12 OR = 5.14 (95% CI = ) CAT CT in CC inos Cases Controls LL SL +SS OR = 1.08 (95% CI = ) Interaction: OR = 4.78 (95% CI = ); p = 0.031

22 MODEL OF CAUSATION?? cumulative exposure?? smoking? inos MnSOD CAT GSTT1 ECSOD GSTM1

23 Interaction between GSTM1 and smoking and asbestosis risk Smoking Cases Controls ever never OR = 0.98 (95% CI = ) GSTM -null Smoking Cases Controls ever never OR = 2.67 (95% CI = ) GSTM -null Smoking Cases Controls ever never OR = 0.55 (95% CI = ) Interaction: OR = 2.67 (95% CI = ); p = both asbestos and smoking increase ROS production role of GSTM1

24 MODEL OF CAUSATION?? cumulative exposure?? smoking? inos GSTM1 GSTT1 MnSOD CAT ECSOD

25 Interaction between inos and cumulative exposure Cum. exposure Cases Controls > OR = 4.40 (95% CI = ) inos LL Cum. exposure Cases Controls > OR = 3.09 (95% CI = ) inos SL + SS Cum. exposure Cases Controls > OR = 5.74 (95% CI = ) OR = 0.55 (95% CI = ); p = 0.037

26 ASBESTOSIS GENETIC FACTORS GENE-ENVIRONMENT INTERACTIONS

27 CONCLUSIONS molecular markers as basis for the development of new methods for an earlier diagnosis of diseases understanding of pathogenesis of diseases and enable their prevention to identify new targets for a more effective treatment

28 GENETIC FACTORS DISCRIMINATION

29 THANK YOU FOR YOUR AT TENTION Supported by: ARRS projects: L3-9129, L ARRS programme: P1-0170]

30 30

31 Antioxidant enzyme polymorphisms DNA protein MnSOD GCT > GTT -9 Ala > -9 Val EcSOD CGG > GGG 213 Arg > 213 Gly CAT -262 C > -262 T expression

32 GST polymorphisms DNA protein GSTP1 exon 5 GSTP1 exon 6 c.313 A > c.341 G C>T > > p.105 Ile>Val p.114 Ala>Val GSTM1 Gene present > Gene deletion GSTT1 Gene present > Gene deletion

33 inos polymorphisms

The Uncoupling Protein 2 Ala55val Polymorphism is Associated with Diabetes Mellitus in a Balinese Population

Original Article 39 The Uncoupling Protein 2 Ala55val Polymorphism is Associated with Diabetes Mellitus in a Balinese Population Abstract Background. The activity of uncoupling proteins have been reported