This thesis, titled __Genetic and pharmacogenetic determinants of cardiovascular disease__ is divided in three sections. In section one the genetic determinants of coronary restenosis are explored.... Show moreThis thesis, titled __Genetic and pharmacogenetic determinants of cardiovascular disease__ is divided in three sections. In section one the genetic determinants of coronary restenosis are explored. In the first genome-wide association study on this condition, in the GENetic DEterminants of Restenosis study, we describe a novel locus on chromosome 12 possibly associated with restenosis. Furthermore, by using several analysis tools on this data, we describe multiple biological pathways and genes that are likely associated with restenosis. In section two, we focus on genetic factors involved in three other (cardio)vascular diseases. We explore the role of DNA repair genes in myocardial infarction and stroke and the genetic determinants of dialysis shunt failure. Section three is on pharmacogenetics. In particular, we were interested in genetic variation involved in aspirin and clopidogrel resistance. We validated two genetic polymorphisms associated with recurrent thrombotic events during treatment with these agents in patients with an acute myocardial infarction. Genetic research is a fast developing field of research. By increasing our knowledge on the molecular background of diseases, genetics potentially could lead to more personalized treatment in the near future. Show less
Preeclampsia is a pregnancy-specific condition that originates in the placenta. Despite decades of research, its pathogenesis remains largely unknown. However, several risk factors for preeclampsia... Show morePreeclampsia is a pregnancy-specific condition that originates in the placenta. Despite decades of research, its pathogenesis remains largely unknown. However, several risk factors for preeclampsia have been identified, including a (family) history of preeclampsia, autoimmune disease and conditions associated with endothelial damage, including hypertension, diabetes mellitus and preexistent renal disease. This thesis aims to further investigate through which mechanisms these risk factors increase the risk for preeclampsia. It deals with both the genetic background of preeclampsia, as well as the role of complement activation in its pathogenesis. Finally, it touches upon the role of angiogenic factors in the development of preeclampsia. Show less
Karakaya, B.; Vreeburg, M.D.; Megens, H.J.; van't Slot, R.; Bevova, M.; Ruven, H.J.T.; ... ; Moorsel, C.H.M. van 2013
This thesis concerns the clinical and genetic aspects of familial thoracic aortic aneurysms and dissections, in particular in Marfan syndrome. It includes the Dutch multidisciplinary guidelines for... Show moreThis thesis concerns the clinical and genetic aspects of familial thoracic aortic aneurysms and dissections, in particular in Marfan syndrome. It includes the Dutch multidisciplinary guidelines for diagnosis and management of Marfan syndrome. These guidelines contain practical directions for referring physicians and specialists involved in the recognition, diagnosis, monitoring and treatment of Marfan syndrome. Furthermore, the revised Ghent nosology for Marfan syndrome, established by an international panel of experts, is presented. One chapter concerns a specific subgroup of missense mutations in FBN1 that are predicted to substitute the first aspartic acid of various calcium-binding Epidermal Growth Factor-like (cbEGF) fibrillin-1 domains. One of the mutations was found in a homozygous state in three cases from a large consanguineous family. A series of ten patients carrying a whole-gene deletion of one allele of FBN1 is described in another chapter. In a further chapter a three-generational family is discussed with family members at risk for serious aortic disease as a result of an interstitial deletion of chromosome 15 that disrupts SMAD3. Finally two unrelated children with classic Marfan syndrome and recurrent intracranial hypertension are described. Show less
Blitterswijk, M. van; Es, M.A. van; Verbaan, D.; Hilten, J.J. van; Scheffer, H.; Warrenburg, B.P. van de; ... ; Berg, L.H. van den 2013
Variation in structure and composition of the DNA are found throughout our genome. All types of variation are collectively called __genomic variation__. Identification and analysis of genomic... Show moreVariation in structure and composition of the DNA are found throughout our genome. All types of variation are collectively called __genomic variation__. Identification and analysis of genomic variation is important to distinguish neutral variants (__non pathogenic__) from variants involved in disease (__pathogenic__). Identification of new disease genes will increase our knowledge of the molecular pathogenesis of genetic disorders. Every technical advance in genetic analysis has revealed new levels of variation, ranging from single nucleotide differences to full chromosome changes. As new DNA methods are applied, increasing numbers of variants with unclear significance to disease (UVs) are identified and choices have to be made regarding the variants that deserve follow-up work. When the pathogenic consequence of a variant is unclear, the effect has to be studied in detail at other levels (functional studies, RNA studies, in silico analysis tools, and databases). The research described in this thesis outlines the rapid development and application of molecular techniques for detecting (pathogenic) genomic variation in the context of genetic disorders. Show less
Wit, J.M.; Duyvenvoorde, H.A. van; Scheltinga, S.A.; Bruin, S. de; Hafkenscheid, L.; Kant, S.G.; ... ; Losekoot, M. 2012
Uveal melanoma (UM) is the most common malignancy of the eye in adults and it is the second most common form of melanoma after cutaneous melanoma (CM). The identification of patients who have a... Show moreUveal melanoma (UM) is the most common malignancy of the eye in adults and it is the second most common form of melanoma after cutaneous melanoma (CM). The identification of patients who have a high risk of developing metastases would allow the possibility of providing adjuvant therapies to prevent metastases. The application of FISH on transvitreal fine-needle aspiration biopsies is thought to be a reliable method for assaying genetic parameters such as chromosome 3 loss. However, this is based on the assumption that this chromosomal abnormality is distributed homogeneously throughout the tumor. We show that UM can be heterogeneous for the number of copies of chromosome 3 and investigated whether any evidence can be found for heterogeneity in the regulation of tumor-suppressor genes (TSG). Recently, a segregation study identified a potential locus harboring a TSG. One of the genes in this area, RASEF, was analyzed whether the RASEF gene was affected by mutations or gene silencing due to promoter methylation. The MAPK pathway is involved in the balance between melanocyte proliferation and differentiation. Whereas mutant B-RAF and N-RAS are responsible for the activation of the MAPK pathway in most CM, mutations in these genes are usually absent in UM. Nowadays, an assay with increased potential to identify mutations is available and we set out to reanalyze UM cell lines and primary UM for B-RAF mutations. We set out to explore the MAPK pathway by using MAPK profiling and tyrosine kinase arrays. Finally, conclusions drawn from above mentioned studies are summarized and put into perspective. Show less
Rheumatoid arthritis (RA) is a disease characterized by arthritis of mainly the small joints of the hands and feet, which is thought to be the result of an autoimmune response. It is the most... Show moreRheumatoid arthritis (RA) is a disease characterized by arthritis of mainly the small joints of the hands and feet, which is thought to be the result of an autoimmune response. It is the most common inflammatory arthritis with a prevalence of 0.5-1.0% in European and North-American populations 1. There is substantial geographic variation in the occurrence of RA with very high prevalences reported in native American-Indian populations 2, and very low prevalences in populations from South-East Asia 3. The disease is approximately three times more frequent in women than in men, and the prevalence increases with age. Besides the potentially destructive arthritis, patients can be affected by various extraarticular features such as secondary Sj_gren__s syndrome, interstitial lung disease, pericarditis and pleuritis. Fortunately, the advent of tumor necrosis factor (TNF) inhibitors and other biological agents have led to a therapeutic revolution for patients with rheumatoid arthritis 4. Instead of having to resign to an inevitably progressive and debilitating disease course, modern-day treatment aims at achieving the lowest possible disease activity and ultimately remission. Nonetheless, rheumatoid arthritis continues to be a major cause of (partial) disability and of loss of productivity, and is associated with substantial economic costs 5. Classification criteria for the disease were first phrased in 1956 6 after Sir Alfred Garrod had introduced the term rheumatoid arthritis in 1876 in an attempt to counteract the unsatisfactory use of designations such as __chronic rheumatism__ and __rheumatic gout__ 7. The purpose of the classification criteria was to facilitate both clinical diagnosis and scientific research. For many years since, the 1987 American College of Rheumatology (ACR) classification criteria have been used to this end, despite the fact that the incorporation of items such as erosive radiographic changes led to limited diagnostic value of these criteria for patients with early arthritis 8. In order to facilitate the study of persons with earlier stages of disease, the ACR and the European League Against Rheumatism (EULAR) have recently developed the 2010 classification criteria for RA as shown in Table 1 9. It is worthwhile to note that these criteria are based on patient characteristics which were associated with the decision by the physician to start treatment with methotrexate. These criteria are a reflection of the shift towards increasingly earlier diagnosis and treatment of rheumatoid arthritis. Show less
Scherptong, R.W.C.; Vliegen, H.W.; Wall, E.E. van der; Hilhorst-Hofstee, Y.; Bax, J.J.; Scholte, A.J.; Delgado, V. 2011
