La cocaïna i l’èxtasi (MDMA, 3,4-metilendioximetamfetamina) són drogues psicoestimulants que incrementen l’activitat del sistema nerviós central i perifèric amb efectes com l’augment de l’estat d’alerta, la resistència, la productivitat, la motivació, la locomoció, el ritme cardíac i la pressió sanguínia. Ambdues drogues tenen efectes sobre l’estat d’ànim, tot induint sentiments d’eufòria i provocant plaer i recompensa. El seu consum, principalment per part d’adolescents i adults joves, té conseqüències greus per a la salut, i a la llarga el consum reiterat pot esdevenir crònic donant lloc a abús o dependència. Tant la cocaïna com l’MDMA actuen principalment activant els sistemes de neurotransmissió dopaminèrgica i serotoninèrgica en els circuits neuronals de plaer i de recompensa. La genètica juga un paper molt important en la transició del consum a l’abús i a la dependència: d’una banda totes dues drogues indueixen canvis en l’expressió gènica que estan a la base de les neuroadaptacions i del remodelatge dels circuits neuronals que condueixen al consum crònic, i de l’altra hi ha factors genètics de predisposició a la dependència que poden afavorir el desenvolupament d’aquest fenomen en certs individus. El treball que es presenta en aquesta Tesi Doctoral ha permès identificar variacions en el genoma que predisposen a la dependència de cocaïna, així com alteracions en el transcriptoma de cèl•lules neuronals (in vitro) o de determinades estructures cerebrals (in vivo) causades per l’acció de la cocaïna o de l’MDMA. Així, s’ha estudiat la participació de variants genètiques de susceptibilitat a la dependència de cocaïna mitjançant estudis d’associació de tipus cas–control cobrint sistemes gènics sencers implicats en la neurotransmissió dopaminèrgica i serotoninèrgica, en el control de l’alliberament de neurotransmissors i factors neurotròfics i els seus receptors. S’han avaluat un total 446 variants polimòrfiques en 52 gens, seleccionades mitjançant criteris de cobertura genètica. Els resultats més remarcables són la identificació de dos haplotips de risc per la dependència a cocaïna als gens 5-HT1E i NSF (que codifiquen per un receptor de serotonina i per una proteïna implicada l’alliberament de vesícules de neurotransmissor, respectivament). En el cas de l’haplotip de risc del gen NSF, a més predisposa a la dependència ràpida (en dos o menys anys des de l’inici del consum). També s’ha avaluat l’efecte del tractament agut amb cocaïna sobre l’expressió gènica en cèl•lules humanes SH-SY5Y diferenciades a neurones dopaminèrgiques mitjançant microarrays i l’estudi mostra alteracions en la transcripció de gens implicats en la regulació de la transcripció i expressió gènica, moviment cel•lular i adaptacions neuronals. I finalment, s’ha estudiat l’efecte de l’administració activa i passiva d’MDMA sobre la transcripció gènica en quatre estructures cerebrals de ratolí implicades en el fenomen de recompensa. L’estudi de l’efecte directe del MDMA sobre l’expressió gènica mitjançant la comparació de ratolins que reben una solució salina de forma passiva i ratolins que reben MDMA de forma passiva o activa, mostra alteracions en la transcripció de gens implicats principalment en la funció immunitària i en processos inflamatoris a les quatre estructures cerebrals estudiades. La comparació entre el consum actiu i passiu d’MDMA ha permès identificar canvis d’expressió relacionats amb neuroadaptacions i canvis de plasticitat sinàptica a hipocamp i als nuclis dorsals de rafe. En aquesta última regió cal destacar quatre gens que se sobreexpressen com a conseqüència del consum actiu d’MDMA, tots ells implicats en la plasticitat sinàptica, els canvis en la morfologia de les espines dendrítiques i processos neuronals relacionats amb la memòria i l’aprenentatge: Camk2a, Kalrn, Ddn i Egr3. Aquesta troballa reforçaria la idea que aquesta estructura cerebral podria estar involucrada en el comportament de cerca activa d’MDMA, tot recolzant el potencial addictiu d’aquesta droga. / Cocaine and ecstasy (MDMA, 3,4-metilendioximetamfetamina) are psychostimulant drugs that activate the central and peripheral nervous system increasing alertness, energy and motor activity, motivation, cardiac rate and blood preassure. Both drugs have effects on mood, inducing feelings of well-being, euphoria, pleasure and reward. Cocaine and ecstasy use, mainly used by young people, has serious detrimental health effects, and repeated use can become chronic leading to abuse or dependence. Both drugs exert their main psychostimulant effects by activating the dopaminergic and serotoninergic neurotransmission systems in the brain circuits involved in pleasure and reward. Genetics play an important role in the transition from use to abuse and dependence: on one hand, both drugs induce changes in gene expression that are on the basis of neuroadaptations and neuronal circuit remodeling that lead to the chronic use, on the other hand, there are genetic risk factors that predispose to dependency that can drive the development of addiction in some individuals. The work presented in this Doctoral Thesis has allowed to identify genomic variants that predispose to cocaine dependence, as well as gene expression changes in the transcriptome in in vitro and in vivo models. For this purpose, the participation of susceptibility genetic variants to cocaine dependence have been studied using case-control association studies, covering whole gene systems involved in dopaminergic and serotoninergic neurotransmission, in the control of neurotransmitter release, and also encoding neurotrophic factors and their receptors. It has also been evaluated gene expression changes in a human dopaminergic neuronal model after an acute exposure to cocaine. Finally the effect of active and passive MDMA administration on gene expression in mice has been evaluated in four brain structures involved in reward and reinforcing effects of the drug.

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Statistical heterogeneity refers to differences among results of studies combined in a meta-analysis beyond that expected by chance. On the one hand, excessive heterogeneity can diminish power to discover genetic signals; on the other, moderate heterogeneity can reveal important biological differences among studies. Given its double-edged nature, this thesis dissects heterogeneity in genetic association meta-analyses from three vantage points. First, a novel multi-variant statistic, M is proposed to detect genome-wide (systematic) heterogeneity patterns in genetic association meta-analyses. This was motivated by the limited availability of appropriate methodology to measure the impact of heterogeneity across genetic signals, since traditional metrics (Q, I² and T²) measure heterogeneity at individual variants. Second, given that meta-analyses comprising small numbers of studies typically report imprecise summary effect estimates; GWAS-derived empirical heterogeneity priors are used to improve precision in estimation of average genetic effects and heterogeneity in smaller meta-analyses (e.g. ≤ 10 studies). Third, a critical evaluation of the Han-Eskin random-effects model shows how it can identify small effect heterogeneous loci overlooked by traditional fixed and random-effects methods. This work draws attention to the existence of genome-wide heterogeneity patterns, to reveal systematic differences among the ascertainment criteria of participating studies in a meta-analysis of coronary disease (CAD) risk. Furthermore, simulation studies with the Han-Eskin random-effects model revealed inflated genetic signals at small effect loci when heterogeneity levels were high. However, it did reveal an additional CAD risk variant overlooked by traditional meta-analysis methods. We therefore recommend a holistic approach to exploring heterogeneity in meta-analyses which assesses heterogeneity of genetic effects both at individual variants with traditional statistics and across multiple genetic signals with the M statistic. Furthermore, it is critically important to review forest plots for small effect loci identified using the Han-Eskin random-effects model amidst moderate-to-high heterogeneity (I² ≥ 40%).

Malgré la mise en oeuvre de la leucoréduction systématique, les transfusions plaquettaires restent génératrices de réactions post-transfusionnelles (encore appelées « Effets Indésirables Receveur, EIR »). Nous savons que les plaquettes sanguines relarguent des molécules proinflammatoires (e.g. CD40 ligand soluble ou sCD40L) durant leur préparation et stockage et leurs taux augmentés sont associées aux EIR. Le travail de cette thèse vise à mieux comprendre les mécanismes de survenue des EIR post transfusion plaquettaire, dans le contexte de l’inflammation. La première partie de nos travaux n’a pas retrouvé de polymorphismes génétiques du gène CD40LG qui pourraient modifier l’affinité du couple Récepteur/Ligand, en cas d’EIR. Dans un second temps, une caractérisation haplotypique de CD40LG n’a pas non plus permis de retrouver d’association avec l’apparition d’EIR. Nous avons ensuite tenté d’identifier des marqueurs génétiques de surexpression de sCD40L (et par conséquence, d’EIR). Pour cela, nous avons étendu l’investigation à douze polymorphismes de CD40LG mais aussi des marqueurs génétiques connus comme indépendamment liés à l’expression de sCD40L : au niveau de son récepteur CD40 et d’ITGA2. Ont été retrouvés associés à une modification significative de sécrétion de sCD40L, d’une part le polymorphisme rs126643 (ITGA2), un haplotype étendu de CD40LG et aussi un haplotype interchromosomique (CD40LG–CD40–ITGA2). Toutefois, ces haplotypes n’ont pas pu être retrouvés associés à l’apparition d’EIR. Nous avons également montré que lors du stockage de concentrés plaquettaires (CP) non leucoréduits, les « modificateurs de réponse biologique » (BRM) leucocytaires diffèrent d’une part, dominent et influencent d’autre part les BRM d’origine plaquettaire. Nous nous sommes ensuite intéressés à un autre BRM individualisé dans les produits transfusés : l’ADN mitochondrial, classé comme un signal de danger endogène (ou DAMP) et nous avons retrouvé une augmentation significative de ceux-ci dans les CP ayant induit un EIR. Nous avons alors entrepris une étude protéomique (LC-MS/MS) et transcriptomique (RNA-seq) sur des CP ayant induit ou non un EIR. L’enrichissement des protéines et gènes différentiellement exprimés présente principalement un rôle dans l’activation plaquettaire, la coagulation, l’apoptose et la dégranulation qui représentent des processus en liaison étroite. Le transcriptome plaquettaire a confirmé l’étiologie apoptique par la mise en évidence de la dérégulation calcique mitochondriale. De plus, l’obtention de l’enrichissement de sa voie intrinsèque permet d’expliquer l’abondance des ADNmt retrouvés précédemment dans les CP associés aux EIR. Par ailleurs, l’état d’activation et la dégranulation des plaquettes expliquent l’abondance des BRM retrouvés en cas d’EIR. Ainsi, nous avons identifié de nouveaux marqueurs inflammatoires hautement exprimés dans le groupe EIR. Après validation de ces résultats par des études complémentaires, ces marqueurs pourraient être proposés comme cibles de prévention d’EIR en modifiant, par exemple la préparation des CP / Despite the implementation of systematic leucoreduction, platelet transfusions are still generating transfusion reactions (also called "Adverse Events or AEs"). We know that platelets release proinflammatory molecules during preparation and storage of platelet components (PCs) notably the soluble CD40 ligand or sCD40L and high levels are associated with AEs. In this thesis, we aimed to understand the mechanisms of occurrence of inflammatory platelet transfusion reactions. In the first part, we investigated the genetic polymorphisms of CD40LG. We failed to identify a significant association with AEs but we identified genetic markers of sCD40L overexpression: a CD40LG haplotype and also an interchromosomal haplotype (CD40LG-CD40-ITGA2). However, these haplotypes have not been found to be associated with AEs. In the second part, we showed that, during storage of non leucoreduced PCs, leukocyte-derived "biological response modifiers" (BRMs) dominate and influence the platelet-derived BRMs. Then, we found increased levels of another individualized BRM in PCs involved in AEs: mitochondrial DNA, classified as an endogenous danger-associated molecular pattern (DAMP). In the last part, we performed an integrated proteomic and transcriptomic study by LC-MS/MS and RNA-seq, respectively, to better understand the pathophysiology of AEs in a case-control approach. The biological enrichment of differentially expressed genes revealed a significant association with platelet activation, apoptosis and inflammatory mechanisms which may be involved in platelet transfusion reactions. This study provides novel insights into the molecular mechanisms underlying the occurrence of AEs and could give paths to prevent them

INTRODUÇÃO: A persistência de um microambiente cronicamente inflamado no estômago tem sido descrita como um componente crítico tanto para a iniciação, quanto para a progressão tumoral. Além disso, variações genéticas tem demonstrado influenciar na variabilidade interindividual da resposta inflamatória. Desta forma, esse estudo teve como objetivo investigar a associação de polimorfismos em genes relacionados à resposta inflamatória com o risco para o desenvolvimento do câncer gástrico, com suas variáveis anatomopatológicas e com a sobrevida global e livre de doença em uma amostra da população Brasileira. MÉTODOS: Dezesseis variantes genéticas selecionadas em onze genes (COX-2, OGG1, TNFB, TNFA, HSPA1L, HSPA1B, VEGFA, IL17F, LGALS3, PHB e TP53) foram genotipadas em 262 indivíduos controles e 178 pacientes diagnosticados com câncer gástrico. As análises de associações genéticas foram realizadas em diferentes modelos (Genótipos, Alelos, Dominante e Recessivo) considerando a amostra total de casos (N=178) e estratificada somente para os casos com o subtipo histológico difuso de Lauren (N=112). Também foi investigado o desequilíbrio de ligação entre os polimorfismos e as análises de associação com os haplótipos formados foram realizadas por meio dos softwares Haploview e PLINK. RESULTADOS: No estudo caso-controle, indivíduos portadores do alelo Pro do polimorfismo rs1042522 (TP53) apresentaram risco cerca de duas vezes maior em desenvolver o câncer gástrico em análise multivariada, sendo esse risco ainda maior quando considerado somente os casos com o subtipo difuso. Por outro lado, a presença do alelo A do polimorfismo rs699947 (VEGFA) foi associada com uma proteção para o câncer gástrico. Em relação às variáveis anatomopatológicas, os polimorfismos rs689466 (COX-2); rs1052133 (OGG1); rs699947, rs833061 e rs2010963 (VEGFA); rs4644 (LGALS3) e rs1042522 (TP53) foram significativamente associados com características de pior progressão da doença, enquanto que rs5275 (COX-2); rs2227956 (HSPA1L) e rs3025039 (VEGFA) foram associados às variáveis de melhor progressão da doença, na amostra total de casos. Também foi observado que o polimorfismo rs909253 (TNFB) foi capaz de predizer uma melhor progressão da doença quando considerado somente os casos com subtipo difuso. Além disso, em relação ao impacto sobre a sobrevida, rs909253 (TNFB) foi associado a um melhor prognóstico quando analisadas ambas as curvas de sobrevida global e livre de doença, enquanto que portadores do alelo His do polimorfismo rs4644 (LGALS3) apresentaram um pior prognóstico com menor tempo de sobrevida livre de doença. Por fim, nas análises de associação com os haplótipos, identificamos que o haplótipo CTC (formado por rs699947, rs833061 e rs2010963 do gene VEGFA), demonstrou ser um fator de maior suscetibilidade ao câncer gástrico. Também foram observadas associações entre o haplótipo GG (TNFB/TNFA) e invasão perineural; haplótipo ACG (VEGFA) e invasão sanguínea; haplótipo CTC (VEGFA) e invasão para outros órgãos; haplótipo GT (rs689466 e rs5275 do gene COX-2) e subtipo histológico intestinal. CONCLUSÕES: Os resultados desse estudo nos ajudaram a esclarecer o potencial papel desses polimorfismos em genes envolvidos com a modulação da resposta inflamatória na patogênese do câncer gástrico, indicando que variantes genéticas do hospedeiro atuam conjuntamente com outros fatores, influenciando na suscetibilidade, progressão e prognóstico dessa doença / INTRODUCTION: The chronic inflammatory microenvironment in the stomach has been described as a critical component for both tumor initiation and progression. Furthermore, genetic variants have shown to influence the interindividual variations in the inflammatory response. Therefore, we aimed to investigate whether polymorphisms in inflammatory response related-genes were associated with risk for gastric tumor development, clinical outcomes, overall and disease free survival of this disease in a Brazilian population sample. METHODS: Sixteen selected genetic variants in eleven genes (COX-2, OGG1, TNFB, TNFA, HSPA1L, HSPA1B, VEGFA, IL17F, LGALS3, PHB and TP53) were genotyped in 262 control individuals and 178 gastric cancer patients. Genetic association analyses were investigated in different models (Genotype, Allele, Dominant and Recessive) in both total sample (N=178) and stratified for the diffuse histological subtype based on Lauren´s classification (N=112). We also calculated the linkage disequilibrium among the polymorphisms and the haplotype associations were carried out using Haploview and PLINK softwares. RESULTS: In the case-control study, rs1042522 (TP53) Pro allele carriers presented about 2-fold higher risk for developing gastric cancer in a multivariate analysis and this association was even stronger when analyzing only cases with the diffuse subtype. On the other hand, the presence of A allele of rs699947 (VEGFA) was associated with a protection for developing gastric cancer. About the significant associations detected with the clinicopathological features, we found that rs689466 (COX-2); rs1052133 (OGG1); rs699947, rs833061 and rs2010963 (VEGFA); rs4644 (LGALS3) and rs1042522 (TP53) were able to predict outcomes associated with a worse progression of the disease while rs5275 (COX-2); rs2227956 (HSPA1L) and rs3025039 (VEGFA) were associated with better outcomes in the total sample. We also observed that the polymorphism rs909253 (TNFB) was able to predict a better outcome only for the individuals diagnosed with the diffuse subtype. Additionally, regarding the impact on the survival curves, rs909253 (TNFB) was associated with a better prognosis when analyzing both the overall and disease-free survivals while rs4644 (LGALS3) His allele carriers presented a worse prognosis with shorter disease-free survival. Finally, concerning the haplotype associations, we found that CTC haplotype (composed by rs699947, rs833061 and rs2010963 of VEGFA) showed an association with gastric malignancy. We also observed associations between GG haplotype (TNFB/TNFA) and perineural invasion; ACG haplotype (VEGFA) and venous vascular invasion; CTC haplotype (VEGFA) and invasion to other organs and GT haplotype (rs689466 and rs5275 of COX-2 gene) and the intestinal histologic subtype. CONCLUSIONS: These results helped us to clarify the potential role of these polymorphisms in genes involved in the modulation of the inflammatory response in the pathogenesis of gastric malignancy, highlighting that the host genetic variants act together with other factors to influence in the susceptibility, progression and prognosis of gastric cancer

Abstract The metabolic syndrome is a cluster of components predisposing to type 2 diabetes and cardiovascular disease. Abdominal obesity and insulin resistance seem to be central in the metabolic syndrome, although no unifying pathophysiological mechanism is available. The aim of this thesis was to determine out how the variation in PTP1B and adiponectin gene as well as variations in the plasma adiponectin concentration contribute to the risk of obesity related diseases. PTP1B is a negative regulator of insulin signalling and therefore considered a candidate gene for type 2 diabetes. In the first study, it was found that three PTP1B polymorphisms studied have not strong impact on type 2 diabetes. However, one SNP may be slightly protective against type 2 diabetes, since it was more frequent in the healthy group compared to group of patients with type 2 diabetes. Another SNP was associated with body mass index (BMI). The combination of certain alleles of PTP1B and LEPR (leptin receptor) genes was also associated to BMI. Adiponectin is an adipocytokine expressed in adipose tissue. It has insulin sensitizing effects in liver and muscle and it has also beneficial effects on cardiovascular health. In the second study, the contribution of adiponectin genotypes with obesity-related phenotypes was studied. In Caucasians, the carriers of rare allele of Tyr111His polymorphism were more insulin resistant and at a higher risk of developing type 2 diabetes. In African-Americans, other polymorphisms were associated with BMI and lipids. Thus, the effects of polymorphisms on obesity related phenotypes seemed to be different between ethnic groups. Plasma adiponectin levels were measured from different study groups. In the third study, it was found out that low plasma adiponectin levels associated with different components of the metabolic syndrome and there was a trend towards reductions in adiponectin with an increasing number of components. Fourth study indicated that baseline low adiponectin level associated with a more than 2-fold risk for developing impaired glucose tolerance or type 2 diabetes in the follow-up study of normoglycemic middle-aged Finnish subjects. In the fifth study, plasma adiponectin levels were measured from postmenopausal women receiving estrogen replacement therapy. We observed a reduction in adiponectin levels in women having peroral estradiol which could be part of the "early harm" profile on cardiovascular risk factors of the peroral estrogen replacement therapy detected in clinical trials. These studies further strengthen the role of plasma adiponectin in the obesity related diseases and bring new information of polymorphisms in the adiponectin and PTP1B genes in different populations. / Tiivistelmä Metabolinen oireyhtymä on kertymä tekijöitä, jotka altistavat tyypin 2 diabetekselle ja sydän- ja verisuonitaudeille. Keskivartalolihavuus ja insuliiniresistenssi, eli insuliinin heikentynyt teho, vaikuttavat olevan keskeisiä metabolisessa oireyhtymässä. Kuitenkaan taustalla olevaa syntymekanismia ei täysin tunneta. Väitöskirjatyön tavoitteena oli tutkia PTP1B- ja adiponektiinigeenin muuntelun sekä plasman adiponektiinitason yhteyttä metaboliseen oireyhtymään, sen osatekijöihin ja seurauksiin. PTP1B on insuliinin toimintaa soluissa estävä molekyyli. Ensimmäisessä tutkimuksessa havaittiin että kolme tutkittua PTP1B-geenin nukleotidimuutosta eivät ole vahvasti yhteydessä tyypin 2 diabetekseen. Eräs nukleotidimuutos saattaisi olla lievästi suojaava tyypin 2 diabetesta vastaan, sillä se oli yleisempi terveillä kuin tyypin 2 diabetesta sairastavilla. PTP1B:n ja leptiinireseptorigeenin eräiden alleelien yhdistelmä oli yhteydessä painoindeksiin. Adiponektiini on rasvakudoksen erittämä hormoni, jolla on suotuisia, insuliinin vaikutusta edesauttavia vaikutuksia elimistössä sekä edullisia vaikutuksia verenkiertoelimistössä. Toisessa työssä havaittiin että Amerikan valkoihoisilla, joilla oli eräs harvinainen adiponektiinigeenin alleeli (Tyr111His), oli heikompi insuliinin teho kuin henkilöillä joilla ei ollut kyseistä muutosta. Tämä alleeli oli yleisempi suomalaisilla tyypin 2 diabetesta sairastavilla kuin terveillä, mikä saattaa tarkoittaa että se liittyy suurentuneeseen riskiin tyypin 2 diabetekselle. Afroamerikkalaisilla taas toiset nukleotidimuutokset olivat yhteydessä lihavuuteen ja plasman rasva-arvoihin. Adiponektiinin pitoisuutta plasmassa mitattiin erilaisissa aineistoissa. Kolmannessa tutkimuksessa havaittiin, että matala pitoisuus oli yhteydessä metabolisen oireyhtymän eri osatekijöihin ja pitoisuus oli sitä matalampi, mitä enemmän osatekijöitä henkilöllä on. Neljännessä tutkimuksessa havaittiin että matala plasman adiponektiinipitoisuus oli yhteydessä suurentuneeseen riskiin saada huonontunut glukoosin sietokyky tai tyypin 2 diabetes tulevaisuudessa. Viidennessä tutkimuksessa adiponektiinitaso määritettiin naisilta jotka olivat ohittaneet vaihdevuodet ja saivat estrogeenikorvaushoitoa. Havaittiin että plasman adiponektiinitaso laski niillä naisilla, jotka saivat korvaushoitoa suun kautta. Tämä saattaisi osittain selittää suun kautta annettavan estrogeenikorvaushoidon epäedullista vaikutusta sydän ja -verisuonitautien riskitekijöihin. Tutkimus vahvistaa edelleen adiponektiinin merkitystä lihavuuteen liittyvissä sairauksissa ja tuo uutta tietoa adiponektiini- ja PTP1B-geenien muuntelun merkityksestä eri väestöissä.

Abstract Each year in Finland, approximately 5.7% of infants are born preterm, i.e., before 37 completed weeks of gestation. Preterm birth is a major cause of mortality and several neonatal morbidities, especially the respiratory diseases. Infants born very preterm (<32 wk) are at higher risk of developing a chronic lung disease called bronchopulmonary dysplasia (BPD). The genetic factors predisposing to spontaneous preterm birth (SPTB) and BPD are incompletely known. The aims of this thesis project were to identify genetic factors that affect susceptibility to SPTB and BPD. Genetic case-control association studies were performed in mothers and infants of northern Finnish origin (SPTB study), or in multiple populations of very preterm infants of Finnish or European origin (BPD study). The candidate genes were selected based on their proposed roles in inflammation which is involved in both SPTB and BPD susceptibility. Additionally, the aim was to study the possible functional role of polymorphisms in the gene encoding surfactant protein B (SP-B) that have been shown previously to associate with pulmonary function. An association between Met31Thr polymorphisms in the gene encoding SP-D (SFTPD) and SPTB infants was found. The other collectin genes that were studied, encoding SP-A and mannose-binding lectin, did not associate with SPTB in mothers or infants. An intronic polymorphism in the gene encoding Kit ligand (KITLG) was associated with the risk of BPD in the northern Finnish and in the combined population that originated from Finland, Canada and Hungary. The role of KITLG in BPD was further supported by biomarker data, which showed higher concentrations of Kit ligand at the time of birth in infants that later developed BPD. The genes encoding interleukin 6 (IL-6), its receptors, IL-10, tumor necrosis factor alpha or glucocorticoid receptor did not associate with BPD susceptibility. Finally, a genetic variant 131Thr in the gene encoding SP-B (SFTPB) was associated with lower SP-B levels in vivo and delayed secretion in vitro. To date, there is no effective method to prevent SPTB, and especially the extremely preterm infants are at an increased risk of developing serious respiratory diseases. Better understanding of the mechanisms underlying both SPTB and BPD could help in the successful prediction of risk groups as well as in the design of new preventive and treatment strategies. / Tiivistelmä Noin 5,7 % lapsista syntyy Suomessa ennenaikaisesti, eli ennen kuin raskaus on kestänyt täydet 37 viikkoa. Ennenaikainen syntymä altistaa vastasyntyneen lapsen vakaville pitkäaikaissairauksille. Erityisesti hyvin pienillä keskosilla, jotka ovat syntyneet ennen 32. raskausviikkoa, on suurempi riski sairastua vakavaan hengitysvaikeuteen eli bronkopulmonaaliseen dysplasiaan, joka tunnetaan myös nimellä BPD-tauti. Perinnölliset tekijät vaikuttavat niin spontaanin ennenaikaisen syntymän (SEAS) kuin BPD-taudinkin taustalla, mutta nämä tekijät tunnetaan huonosti. Tässä väitöskirjatyössä pyrittiin tunnistamaan perinnöllisiä tekijöitä, jotka vaikuttavat SEAS:in ja BPD-taudin taustalla. Perinnöllisen taustan selvittämisessä ehdokasgeenien sisältämien muuntelevien kohtien esiintyvyyttä verrattiin terveiden verrokkien ja tautitapausten välillä. SEAS-tutkimuksessa tutkimusväestö koostui suomalaisista äideistä ja heidän lapsistaan. BPD-tutkimuksessa oli mukana hyvin ennenaikaisesti syntyneitä lapsia Suomesta, Kanadasta ja Unkarista. Tämän lisäksi kokeellisten tutkimusten avulla tutkittiin aiemmin keuhkosairauksiin liittyneen geenin muuntelevien kohtien osuutta sen koodaaman surfaktanttiproteiini (SP) B:n toiminnassa. Tutkimuksissa havaittiin SP-D:tä koodaavan geenin Met31Thr-polymorfismin olevan mahdollinen riskitekijä SEAS:lle lapsilla, mutta se ei selittänyt SEAS-riskiä äideissä. SP-A:ta ja mannoosia sitovaa lektiiniä koodaavilla geeneillä ei ollut yhteyttä SEAS-riskiin. Kit-ligandia koodaavan geenin intronissa sijaitseva polymorfismi selitti BPD-tautiriskiä pohjoissuomalaisessa sekä yhdistetyssä tutkimusväestössä. Lisäksi lapsilla, jotka myöhemmin sairastuivat BPD-tautiin, havaittiin suurempia Kit-ligandipitoisuuksia syntymähetkellä. Interleukiini 6:ta (IL-6), sen reseptoreita, IL-10:ta, tuumorinekroosifaktori-alfaa tai glukokortikoidireseptoria koodaavien geenien polymorfismien ja BPD-taudin välillä ei ollut yhteyttä. SP-B:tä koodaavan geenin Ile131Thr-polymorfismin Thr-variaatio liittyi alhaisempaan SP-B:n pitoisuuteen lapsivedessä sekä hidastuneeseen proteiinin tuottoon kokeellisessa solumallissa. Tulokset antavat uutta tietoa SEAS:n ja BPD-taudin perinnöllisestä taustasta. Tämä tieto voi auttaa synnytyksen käynnistymiseen sekä BPD-alttiuteen johtavien biologisten mekanismien selvittämisessä ja uusien hoitokeinojen kehittämisessä.

Memory deficits and executive dysfunction are highly prevalent among HIV-infected adults. These conditions can affect their quality of life, antiretroviral adherence, and HIV risk behaviors. Several factors have been suggested including the role of genetics in relation to HIV disease progression. This dissertation aimed to determine whether genetic differences in HIV-infected individuals were correlated with impaired memory, cognitive flexibility and executive function and whether cognitive decline moderated alcohol use and sexual transmission risk behaviors among HIV-infected alcohol abusers participating in an NIH-funded clinical trial comparing the efficacy of the adapted Holistic Health Recovery Program (HHRP-A) intervention to a Health Promotion Control (HPC) condition in reducing risk behaviors. A total of 267 individuals were genotyped for polymorphisms in the dopamine and serotonin gene systems. Results yielded significant associations for TPH2, GALM, DRD2 and DRD4 genetic variants with impaired executive function, cognitive flexibility and memory. SNPs TPH2 rs4570625 and DRD2 rs6277 showed a risk association with executive function (odds ratio = 2.5, p = .02; 3.6, p = .001). GALM rs6741892 was associated with impaired memory (odds ratio = 1.9, p = .006). At the six-month follow-up, HHRP-A participants were less likely to report trading sex for food, drugs and money (20.0%) and unprotected insertive or receptive oral (11.6%) or vaginal and/or anal sex (3.2%) than HPC participants (49.4%, p

L’asthme est une maladie inflammatoire chronique des voies respiratoires. C’est une maladie complexe et hétérogène, présentant un large spectre de manifestations cliniques dans lequel l’âge de début joue un rôle important. L’asthme résulte de nombreux facteurs génétiques et environnementaux et des interactions entre ces facteurs.Afin d’identifier de nouveaux gènes de susceptibilité à l’asthme et aux maladies allergiques, nous avons réalisé des études d’association pan-génomiques et de clonage positionnel en prenant en compte des mécanismes complexes : 1) empreinte parentale, 2) hétérogénéité de la maladie et 3) interactions gène-environnement.Nous avons tout d’abord réalisé une étude de clonage positionnel pour le phénotype asthme-plus-rhinite dans des familles d’origine européenne de quatre études indépendantes (770 familles recensées par un asthmatique et incluant 3200 sujets) en prenant en compte l'effet de l'origine parentale. L’intégration de données génétiques et épigénétiques, nous a permis d’identifier un mécanisme de médiation de l’effet d’un variant génétique transmis par le père sur le phénotype combiné asthme-plus-rhinite, par une méthylation différentielle d’un site CpG localisé dans le gène MTNR1A.Nous avons ensuite pris en compte la variabilité de l’âge de début de l'asthme dans la modélisation de la maladie par des méthodes d’analyse de survie et avons réalisé une méta-analyse d’études d'association pan-génomiques du délai de survenue de l’asthme dans neuf populations d’origine européenne (5462 asthmatiques et 8424 non asthmatiques). Nous avons ainsi identifié un nouveau locus de susceptibilité à l’asthme localisé dans la région 16q12. Nous avons également mis en évidence que les variants génétiques des régions 9p24 et 17q12-q21 étaient associés à un asthme précoce alors que les variants en 16q12 étaient associés à un asthme plus tardif. Enfin, nous avons réalisé une méta-analyse de cinq études d’interaction pan-génomiques du délai de survenue de l’asthme avec l’exposition au tabagisme passif dans l’enfance (3643 exposés et 5275 non-exposés). Nous avons montré que l’effet des variants génétiques des régions 9p24 et 17q12-q21 sur le délai de survenue de l’asthme était augmenté par l’exposition au tabagisme parental dans l’enfance.La prise en compte de mécanismes complexes dans les études génétiques, nous a permis d’identifier de nouveaux gènes de susceptibilité à l’asthme et de mieux comprendre les mécanismes physiopathologiques à l'origine de l’asthme et de son expression variable au cours de la vie. / Asthma is a chronic airway inflammatory disease. It is a complex and heterogeneous disease with a wide spectrum of clinical manifestations in which the age of onset plays an important role. Asthma results from many genetic and environmental factors and from interactions between these factors.To identify new susceptibility genes to asthma and allergic diseases, we performed genome-wide association studies and positional cloning studies, while taking into account complex mechanisms: 1) parental imprinting, 2) heterogeneity of the disease and 3) gene-by-environment interactions.We first conducted a positional cloning study for asthma-plus-rhinitis in European families of four independent studies (770 families ascertained through an asthmatic and including 3200 subjects) while taking into account parent-of-origin effects. The integration of genetic and epigenetic data enabled us to identify that the effect of a paternally inherited genetic variant on the combined phenotype asthma-plus-rhinitis was mediated by a differentially methylated CpG site within MTNR1A gene. We then took into account the variability of age-of-asthma onset in the disease modeling using survival analysis methods and conducted a meta-analysis of genome-wide association studies of time-to-asthma onset in nine European populations (5,462 asthmatics and 8,424 non-asthmatics). We identified a new asthma susceptibility locus in 16q12. We also showed that genetic variants of 9p24 and 17q12-q21 regions were associated with early-onset asthma while 16q12 variants were associated with later-onset asthma. Finally, we performed a meta-analysis of five genome-wide interaction studies of time-to-asthma onset with early-life tobacco smoke exposure (3,643 exposed and 5,275 unexposed). We showed that the effect of genetic variants of 9p24 and 17q12-q21 regions on time-to-asthma onset was increased by early-life tobacco smoke exposure.Studying complex mechanisms in genetic studies led to identify new asthma susceptibility genes and to better understand the pathophysiological mechanisms underlying asthma and its variable expression throughout life.

Die systematische Untersuchung genetischer Prädispositionsfaktoren für kardiovaskuläre Erkrankungen und ihrer Komplikationen hat sich zu einem besonders intensiv bearbeiteten Forschungsfeld im Bereich der Pharmakogenomik entwickelt. In eigenen Untersuchungen wurden Polymorphismen in Kandidatengenen des Gerinnungssystems (thrombozytäre Glycoproteine Ibalpha, Ia/IIa, Gerinnungsfaktor VII) sowie des Homozysteinstoffwechsels (MTHFR, Interaktion mit der endothelialen NO-Synthase) in ihrer Assoziation zur koronaren Herzerkrankung und deren Komplikationen untersucht. Die Ergebnisse deuten darauf hin, dass sowohl der Kozak-Sequenz Polymorphismus im thrombozytären Glycoprotein Ibalpha Gen als auch der Arg353Gln Polymorphismus im Gerinnungsfaktor VII Gen als mögliche Risikoprädiktoren für Frühkomplikationen nach Koronarinterventionen in Betracht kommen. Zudem zeigte sich bei Patienten mit Hyperhomozysteinämie, dass Frauen, nicht jedoch Männer mit steigender Anzahl der CA-repeats des Intron 13 CA-Repeat Polymorphismus des endothelialen NO-Synthase Gens (eNOS) ein signifikantes und ansteigendes Exzess-Risiko für akute Koronarsyndrome hatten. Die anderen untersuchten Kandidatengene erwiesen sich in unserer Studienpopulation als nicht geeignet zur Risikoprädiktion von koronarer Herzerkrankung und Frühkomplikationen nach Katheterinterventionen. Die Ergebnisse zeigen exemplarisch auch methodische Herausforderungen für Assoziationsstudien zur Untersuchung genetischer Einflüsse auf komplexe Erkrankungen wie die koronare Herzerkrankung. Eine Bestätigung der Assoziation dieser hereditären Suszeptibilitätsfaktoren mit dem Komplikationsrisiko nach Koronarinterventionen in unabhängigen Populationen ist daher notwendig. Im Sinne einer zunehmend individualisierten Therapie könnten sie dann zu einer Identifizierung von Patientengruppen beitragen, die einer intensiveren Überwachung und Therapie, z.B. nach Katheterintervention, bedürfen. / Genetic susceptibility factors for cardiovascular diseases and disease complications are being investigated intensively within pharmacogenomics research programs. We studied polymorphisms in candidate genes of the coagulation system (platelet glycoproteins Ibalpha, Ia/IIa, coagulation factor VII) and of the homocysteine system (MTHFR, interaction with the endothelial NO-synthase) in their association to coronary artery disease and thrombotic complications. The results suggest that both the Kozak sequence polymorphism of the glycoprotein Ibalpha gene and the Arg353Gln polymorphism of the coagulation factor VII gene may be possible risk predictors for early complications following coronary catheter interventions. Moreover, in hyperhomocysteinemic patients, women were at higher risk for acute coronary syndromes with increasing numbers of CA repeats of the intron 13 CA repeat polymorphism of the endothelial NO-synthase gene. This effect modification was not observed in men. The other candidate genes did in our study population not prove to be suitable for risk prediction of coronary artery disease and of complications following coronary catheter interventions. The results also demonstrate methodological challenges in association studies on genetic influences on complex diseases such as coronary artery disease. Therefore, replication in independent populations is necessary. After confirmation, these hereditary susceptibility factors could be utilised for an improved risk assessment after catheter interventions. In terms of increasingly individualised treatment, these susceptibility factors could contribute to the identification of patients, who are in need of more intensive monitoring and treatment, e.g. in coronary artery disease and coronary catheter interventions.