The Connotation of Variances in the Risk Predictors, Medications, Homocysteine, and Homocysteine Pathway Gene Polymorphisms with CVA/Stroke

Abstract

Cerebrovascular accidents (CVAs) are vascular multifactorial, multigenic ailments with intricate genetic, environmental risk influences. The present study aimed to establish affiliation of CVAs/stroke with blood parameters, differences in prescribed drugs consumption, and with differences in homocysteine pathway genes polymorphisms. The participants in study included controls n = 251, transient ischemic attack (TIA) patients n = 16, and stroke cases n = 122, respectively, (total participants, n = 389). The analyzed single nucleotide polymorphisms (SNPs) included C677T(rs1801133), A1298C(rs1801131) of methylene tetrahydrofolate reductase (MTHFR), A2756G(rs1805087) of methyl tetrahydrofolate homocysteine methyltransferase/methionine synthase (MS), and the A192G(rs662) of paraoxonase 1(PON1) genes, all validated by tetra-primer allele refractory mutation system polymerase chain reaction (T-ARMS-PCR). The insertion deletion (I/D; rs4646994) polymorphism in angiotensin converting enzyme (ACE) gene was analyzed using routine PCR. All studied traits were scrutinized through analysis of variance (ANOVA), and later through regression analysis. Through ANOVA and multiple comparison, there was association of CVA with serum homocysteine, cholesterol, and with diastolic blood pressure readings. When data was subjected to regression, serum homocysteine and diastolic blood pressure (significant through ANOVA), as well as two additional traits, high-density lipoproteins (HDL), and rs1801133 MTHFR SNP sustained statistical significance and noteworthy odds in relation to CVA and stroke. The ailments affecting cerebral vasculature are mutifactorial, whereby genes, proteins, and environmental cues all exert cumulative effects enhancing CVA risk. The current study emphasizes that SNPs and variation in circulating biomarkers can be used for screening purposes and for reviewing their effects in stroke/CVA-linked risk progression.

Polimorfismo de metilenotetrahidrofolato reductasa en pacientes jóvenes con ataque cerebrovascular e infección por virus de inmunodeficiencia humana

“…En pacientes con enfermedad controlada y en manejo con terapia antirretroviral, el riesgo no está tan claramente definido (12). Algunas de las explicaciones que se han encontrado sobre este fenómeno incluyen: aumento de aterosclerosis, infecciones del sistema nervioso central, coagulopatías y vasculopatías secundarias (12,(14)(15), y los "recientemente conocidos" factores de riesgo avanzados, (polimorfismos genéticos) también se consideran como factores de riesgo independientes importantes (16)(17). El estudio MEGASTROKE-GWAS encontró asociaciones entre mutaciones de genes y el desarrollo de factores de riesgo de ACV como la hiperhomocisteinemia (18)(19).…”

“…Este gen presenta variantes alélicas que pueden alterar la actividad de la proteína, comparada con el alelo original (23). Las variantes mejor caracterizadas son los polimorfismos de nucleótido único (SNP) en las posiciones 677 (MTHFR 677C>T) y 1298 (MTHFR 1298A>C) (7,16,23). Además, el polimorfismo 677C>T reduce la conversión de 5,10-metilenotetrahidrofolato a 5-metilentetrahidrofolato, aumenta los niveles de homocisteína y se relaciona con un mayor NIHSS y Rankin Score (21).…”