Study reveals molecular mechanism behind new DOT1L-related disorder

A study from the laboratory of Dr. Hugo J. Bellen, a distinguished service professor at Baylor College of Medicine and a principal investigator at the Jan and Dan Duncan Neurological Research Institute (Duncan NRI) at Texas Children’s Hospital, has discovered that gain-of-function variants in the DOT1L gene cause a new disorder. Further studies revealed that the majority of the symptoms in the patients were surprisingly due to an increase in the enzymatic activity of a histone methylase encoded by this gene. This study was published in the American Journal of Human Genetics. This project originated when the Undiagnosed Diseases Network, SickKids Complex Care Genomics project in Canada headed by Dr. Gregory Costain, and a search of the GeneMatcher database identified nine unrelated individuals with intellectual disability, developmental delays, distinctive facial features, and other overlapping features carried variants in DOT1L gene. We found this intriguing because this gene had not been previously associated with a genetic or neurological disorder.” Dr. Hugo J. Bellen, distinguished service professor at Baylor College of Medicine DOT1L is an evolutionarily conserved gene found in a broad range of species from yeast to man. It encodes an enzyme – lysine methyltransferase (KMT) – that adds methyl groups to a specific amino acid (lysine 79 aka K79) present on a particular histone (H3). Methylation of specific lysine residues within histones acts as a switch to turn ‘on’ or ‘off’ the expression of target genes. So far, only partial loss-of-function DOT1L variants in around half of KMT-encoding genes (16 of 34) have been shown to cause dominant human developmental disorders. “We found the variants in DOT1L cause a dominant disorder through a gain-of-function mechanism, which is different from other KMTs,” said Dr. Bellen. Although DOT1L is involved in several fundamental cellular processes, and its misregulation has been implicated in cancer, prior to this study it was not clear how variants in the DOT1L gene cause a congenital disorder. So, Dr. Zelha Nil, the first author and postdoctoral associate in the Bellen lab, turned to fruit flies to address that question. DOT1L and its fruit fly version, grappa (gpp) have similar protein sequences and are also likely to have overlapping functions. Most disease-causing human variants in DOT1L are located in its enzymatic domain. Furthermore, gpp is expressed in a large subset of neurons and some glial cells. The team generated a fly gpp mutant, which grew slowly and died in larval stages. Using these mutant flies and flies in which gpp RNA was knocked down, they found compelling evidence that gpp is essential for the survival of the flies and required for proper development as well as the development and function of the fly nervous system, and for H3K79 methylation. Related Stories “We attempted to suppress the lethality of gpp mutant flies by expressing the human DOT1L gene in flies,” Dr. Zelha Nil said. “To our surprise, expressing normal or variant versions of the human DOT1L gene in tissues where it occurs naturally in flies was not sufficient for gpp mutants who had lost both copies of the gene to survive. Surprisingly, flies with a partial loss of gpp that expressed the human DOT1L variants were less viable and had more profound morphological defects than the normal DOT1L expressing flies, suggesting the human DOT1L expression in flies was toxic.” Consistent with this observation, gpp mutant flies and cultured cells expressing variant versions of human DOT1L exhibited significantly higher levels of H3K79 methylation than normal DOT1L, suggesting that elevated levels of methylation are the likely molecular cause of the symptoms seen in the patients. “Based on our studies in flies, it appears that the variants result in excess enzymatic activity of DOT1Lin these patients,” Dr. Bellen said. “While additional studies are needed to unravel the exact mechanism of disease pathogenesis, our study suggests that reducing DOT1L activity is a viable therapeutic strategy that can be developed in the future to treat this new genetic condition.” Others involved in the study were Ashish R. Deshwar, Yan Huang, Scott Barish, Xi Zhang, Sanaa Choufani, Polona Le Quesne Stabej, Ian Hayes, Patrick Yap, Chad Haldeman-Englert, Carolyn Wilson, Trine Prescott, Kristian Tveten, Arve Vøllo, Devon Haynes, Patricia G. Wheeler, Jessica Zon, Cheryl Cytrynbaum, Rebekah Jobling, Moira Blyth, Siddharth Banka, Alexandra Afenjar, Cyril Mignot, Florence Robin-Renaldo, Boris Keren, Oguz Kanca, Xiao Mao, Daniel J. Wegner, Kathleen Sisco, Marwan Shinawi, Undiagnosed Disease Network, Michael F. Wangler, Rosanna Weksberg, Shinya Yamamoto, and Gregory Costain. Their institutional affiliations can be found here. The study was funded by a grant from the NIH Commonfund to the Model Organisms Screening Center of the UDN, the Office of Research Infrastructure Programs of the NIH, the Huffington Foundation, the Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital to H.J.B, the Baylor College of Medicine IDDRC, through a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development for use of the Microscopy Core facilities, NIHR Manchester Biomedical Research Centre and Canadian Institutes of Health Research (CIHR) grants. Texas Children’s Hospital Journal reference: Nil, Z., et al. (2023). Rare de novo gain-of-function missense variants in DOT1L are associated with developmental delay and congenital anomalies. American Journal of Human Genetics. doi.org/10.1016/j.ajhg.2023.09.009.

What Is Lymphatic Drainage Massage—And How Do You Do It?

Lymphatic drainage massage, also known as manual lymphatic drainage (MLD), is a gentle yet powerful technique designed to facilitate the movement of lymph, a vital fluid that plays a crucial role in our body’s immune system. This therapeutic approach employs manual pressure to stimulate lymphatic vessels, encouraging the natural flow of lymph and addressing conditions like lymphedema, a swelling of the limbs caused by lymphatic system dysfunction. In this comprehensive guide, we will delve into the workings of the lymphatic system, the techniques involved in lymphatic drainage massage, its potential benefits, and the associated risks. Understanding the Lymphatic System The lymphatic system is a complex network of thin tubes, known as lymph vessels, which intricately connect to hundreds of lymph nodes throughout the body. Lymph, or lymphatic fluid, is the clear fluid left behind once blood has circulated through our tissues and organs. This lymph travels through the lymph vessels, ultimately reaching lymph nodes. These lymph nodes act as filters, capturing harmful bacteria, abnormal cells, and waste. Excess lymph is then reabsorbed into the bloodstream via lymph vessels. However, when conditions such as lymphedema or lymph node damage disrupt the normal functioning of the lymphatic system, lymph fluid accumulates, leading to swelling, most commonly in the arms and legs. If left untreated, lymphedema can result in severe, potentially life-threatening infections. Performing a Lymphatic Drainage Massage Certified lymphedema therapists (CLTs) are typically trained professionals who perform lymphatic drainage massage. This category of specialists includes physical therapists, occupational therapists, nurses, and massage therapists. When diagnosed with lymphedema, healthcare providers often refer patients to CLTs for manual lymphatic drainage sessions. Additionally, CLTs can teach individuals how to conduct lymphatic massages at home. A lymphatic drainage massage, whether performed by a professional or at home, comprises two primary phases: 1. Clearing: Involves the movement of lymph through the body’s tissues. 2. Reabsorption: Focuses on directing lymph toward lymph nodes for processing. The process of a lymphatic drainage massage session typically follows these steps: Lymphatic drainage massage often constitutes a part of complete decongestive therapy (CDT), a comprehensive approach to reducing lymphedema and associated swelling. CDT encompasses several elements, including wearing compression bandages or sleeves, performing specific exercises to promote lymphatic drainage, and addressing skin conditions caused by swelling. Benefits of Lymphatic Drainage Massage Lymphatic drainage massage offers a range of potential benefits, including: Risks Associated with Lymphatic Drainage Massage Lymphatic drainage massage is generally considered safe and low-risk. However, certain health conditions may contraindicate this therapy. Individuals with the following conditions should avoid lymphatic drainage massage: Lymphatic drainage massage should not cause pain or bruising, as it employs extremely gentle pressure and is distinct from deep tissue massage. If any discomfort arises during the massage, it is crucial to promptly inform the CLT or healthcare provider for appropriate adjustments. Conclusion Lymphatic drainage massage, a therapeutic technique rooted in gentle and precise movements, has emerged as a valuable approach to addressing a range of health concerns, notably the management of lymphedema-related swelling. Ongoing research endeavors are shedding light on its potential benefits for an array of conditions, underscoring its versatility within the realm of complementary and alternative therapies. One of the key strengths of lymphatic drainage massage lies in its safety and non-invasiveness, rendering it a suitable choice for individuals seeking relief from various health issues. However, it’s essential to note that specific contraindications exist, and individuals with certain medical conditions should exercise caution when considering this therapy. As our knowledge of the lymphatic system’s intricacies continues to deepen, lymphatic drainage massage may very well evolve further as a valuable tool in holistic healthcare. The potential applications of this therapy extend beyond mere relaxation, positioning it as an increasingly promising avenue for enhancing overall health and well-being. As research advances, we can anticipate more precise guidelines and a broader spectrum of therapeutic possibilities associated with lymphatic drainage massage.

Woman finds front porch, door covered in blood after North Nashville murder

NASHVILLE, Tenn. (WSMV) – A man is dead after a shooting in North Nashville on Thursday night. Metro Nashville Police said 44-year-old Terran Frazier was shot twice and ran up to homes along Phillips Street and 14th Avenue North trying to get help as he was bleeding out. Danielle was home alone when she heard Frazier breathing heavily on her front porch and then he started banging on her door. Her dog started barking and she thought the man was trying to break into her house. Instead of looking out the peephole, she called 911 and hid inside her home. “Scared and worried, and just not really knowing what was going on,” Danielle said. “Being alone, I just really didn’t want to be by the door in case it wasn’t someone who was hurt, and it was someone trying to break into the house. I had two thoughts. If this person is hurt, they need help. If they are not hurt and are trying to break in, I need help.” After about five minutes of knocking, Danielle said it went quiet and police showed up a short time later. When she opened the door, she found a giant pool of blood on her porch and across her door. “It just broke my heart opening the door and seeing the handprints and just not being able to help,” Danielle said. “Feeling guilty for not being able to help in the moment.” Officers found Frazier a short distance away collapsed on the sidewalk in front of another house. He was taken to the hospital where he died. READ MORE: Police identify victim in fatal North Nashville shooting Sean Heggem had just gotten into town on a weekend trip from California with his wife and friends after the shooting happened. Their rideshare driver pulled up to their vacation rental along Phillips Street when they saw what they thought was a homeless man stumbling down the road. Heggem said Frazier came over to their car and started banging on the window asking for help. They quickly noticed he was shot and called 911 too. “Kind of shocking to see that,” Heggem said. “Having another human being affectively bleeding out. You show up and it’s like, It’s a heck of a welcoming to Nashville.’” There was a trail of blood down the sidewalk in front of their vacation rental. Police blocked off the entire area and searched for evidence. Danielle hired a cleaning crew to take care of the blood that covered her front porch as she tried to figure out why Frazier spent so much time at her house. She thinks he came there because it was very close to where the shooting happened. “I don’t know if it’s because we leave the porch light on or because the house is yellow,” Danielle said. Metro Nashville Police said detectives are working active leads searching for who shot Frazier. Copyright 2023 WSMV. All rights reserved.

VIDEO: A call to action to improve health for all

October 14, 2023 2 min watch Add topic to email alerts Receive an email when new articles are posted on Please provide your email address to receive an email when new articles are posted on . <button type="button" class="btn btn-primary" data-loading-text="Loading ” data-action=”subscribe”> Subscribe Added to email alerts We were unable to process your request. Please try again later. If you continue to have this issue please contact [email protected]. Back to Healio BOSTON — During the Edward H. Kass Lecture at IDWeek, Louise Ivers, MD, MPH, FIDSA, FASTMH, addressed the crowd about infections, inequalities and the hope that everyone can contribute to improving health for all. “My talk was really focused on how there are massive inequities in the world as it relates to infectious diseases but also many other diseases, too,” Ivers, faculty director of the Center for Global Health at the Harvard Global Health Institute, told Healio. “The chief cause of deaths — six out of the top 10 causes of deaths — in low-income countries are due to infectious diseases. Even though we have the diagnostics and therapeutics and the vaccines to prevent many of those diseases, we still see these huge disparities.” Ivers called on everyone in the infectious disease field to “stand up and take bold action to change the status quo.” Published by: Read more about Add topic to email alerts Receive an email when new articles are posted on Please provide your email address to receive an email when new articles are posted on . <button type="button" class="btn btn-primary" data-loading-text="Loading ” data-action=”subscribe”> Subscribe Added to email alerts We were unable to process your request. Please try again later. If you continue to have this issue please contact [email protected]. Back to Healio IDWeek

Lumped-parameter model as a non-invasive tool to assess coronary blood flow in AAOCA patients

Abstract Anomalous aortic origin of the coronary artery (AAOCA) is a rare disease associated with sudden cardiac death, usually related to physical effort in young people. Clinical routine tests fail to assess the ischemic risk, calling for novel diagnostic approaches. To this aim, some recent studies propose to assess the coronary blood flow (CBF) in AAOCA by computational simulations but they are limited by the use of data from literature retrieved from normal subjects. To overcome this limitation and obtain a reliable assessment of CBF, we developed a fully patient-specific lumped parameter model based on clinical imaging and in-vivo data retrieved during invasive coronary functional assessment of subjects with AAOCA. In such a way, we can estimate the CBF replicating the two hemodynamic conditions in-vivo analyzed. The model can mimic the effective coronary behavior with high accuracy and could be a valuable tool to quantify CBF in AAOCA. It represents the first step required to move toward a future clinical application with the aim of improving patient care. The study was registered at Clinicaltrial.gov with (ID: NCT05159791, date 2021-12-16). Introduction Anomalous aortic origin of the coronary artery (AAOCA) is a rare congenital disease with several anatomical variants, such as the origin from the opposite sinus of Valsalva1. In some cases, an intramural tract may also be present in the most proximal zone, whereby part of the coronary artery (CA) is enclosed within the aortic wall2. Although AAOCA is often asymptomatic3, it is related to sudden cardiac death (SCD) or ischemic events, usually associated with high-intensity physical activity, especially in young athletes4,5. Risk estimation based on pre-operative tests is critical to AAOCA diagnosis and management because traditional clinical exams, such as stress tests, usually fail to recognize adverse events related to ischemia and SCD6. Moreover, the mechanisms linking the anatomical abnormality with the risk of SCD are still unclear. In this context, computational simulations have contributed to clarifying some mechanical and physiological aspects linked to ischemia since they can simulate extreme stress conditions, which are not traditionally evaluated in diagnostic tests. Previous biomechanical studies using structural finite element analysis7 have shown a limited expansion of the anomalous CA under increasing pressure, particularly within the intramural tract8. Furthermore, 3D computational fluid dynamics (CFD)9,10,11, and 3D fluid-structure interaction (FSI) simulations12,13,14were performed to assess coronary blood flow (CBF) and coronary perfusion in AAOCA. However, it is worth noting that these hemodynamic investigations were based on the analytically computed coronary resistance based on physiological hypotheses for healthy subjects, probably poorly reliable in AAOCA patients. In addition, the results were not validated due to the lack of in-vivo CBF measurements. Finally, the available patient-specific simulations deal with a small cohort of patients, not attaining general conclusions for the AAOCA population. Therefore we aimed to develop a patient-specific lumped-parameter model (LPM) fed by anatomical, hemodynamic, and functional data retrieved from AAOCA patients that could accurately estimate CBF at two different conditions. We validate the model accuracy in replicating in-vivo conditions by comparing the results with in-vivo measurements. Methods This study was approved by the IRCCS Policlinico San Raffaele ethical committee (record number 19/int/2021, approved 09/06/2021). All patients enrolled in the study at IRCCS Policlinico San Donato gave written informed consent. All methods were carried out in accordance with relevant guidelines and regulations. In particular, the present work includes data retrieved from 19 AAOCA patients, recruited for the NECESSARY study (GR-2019-12369116, Italian Ministry of Health) between November 2021 and May 2023 (ClinicalTrials.gov Identifier: NCT05159791). The study population consists of patients with AAOCA, subjects with other congenital cardiac abnormalities or contraindications to performing the required diagnostic tests were excluded. All patients recruited did not present atherosclerotic plaque and calcification or diagnosis of severe stenosis. The study involved the collection of clinical data and coronary anomaly classification. Details regarding the acquisition, post-processing, and use of such data are described in the following sections, and a schematic representation is also shown in Fig. 1. Figure 1 Schematic representation of the lumped-parameter model and input data used to calibrate it. On the top, IVUS registration was illustrated in the yellow rectangle: a slice was selected to extract the geometrical measurements related to the more proximal tract (OSTIUM) of a right CA. In the green rectangle, the points selected along the centerline of the 3D model of the aortic root were shown; they were used to measure aortic geometrical parameters. The 3D model was reconstructed through the segmentation of CT. In the middle, signals recorded during the coronary functional assessment were shown in the blue rectangle. For both rest and hyperemic conditions CBF (Q) and CA resistance (R) were assessed. Aortic pressure wave signal was used to extract patient values to rescale both aortic and left ventricular pressure waves taken from literature14. On the bottom, the purple rectangle enclosed a schematic representation of the lumped-parameter model. Each arterial segment was represented by the circuit highlighted in gray, aortic BCs were defined by the Windkessel circuit colored in orange, and the BC of the CAs were defined in the blue dashed rectangle. Full size image Clinical data acquisition Computed tomography (CT) scans were performed on a dual-source CT system (Somatom Flash; Siemens Medical Solutions, Forchheim, Germany). CT parameters were 0.6 mm slice thickness, 0.3 mm increment, kernel Bv38, and Admire with strength 2. For patients that had performed the CT in other centers (n(=)16), a maximum slice thickness of 0.6 mm was required. Cardiac magnetic resonance imaging (MRI) examinations were performed with a 1.5 T unit (Magnetom AERA, Siemens Medical Solutions, Forchheim, Germany) with 45 mT/m gradient power, using twelve channel surface phased-array coil placed over the thorax and with the patient in supine position. Image acquisition was gated by the electrocardiogram (ECG) signal and respiration control (breath-holding) to produce a CINE sequence throughout all the systole and diastole and to avoid cardiac and respiratory artifacts. An MRI study included a complete set of short-axis (from base to apex) CINE images, using an ECG-triggered steady-state free precession pulse sequence acquired with the following

Association of rs2073618 polymorphism and osteoprotegerin levels with hypertension and cardiovascular risks in patients with type 2 diabetes mellitus

Abstract There are reports of link of osteoprotegerin (OPG) gene polymorphism to type-2 diabetes (T2D) and hypertension (HTN). The objective of the study was to assess the allele frequency of OPG (rs2073618) gene polymorphism and its association with heart rate variability (HRV) and blood pressure variability profile as CVD risks in diabetes mellitus patients with hypertension undergoing treatment. T2D patients on treatment without hypertension (n = 172), with hypertension (n = 177) and 191 healthy volunteers were recruited for the study. Their blood pressure variability including baroreflex sensitivity (BRS), heart rate variability (HRV), OPG, insulin, lipid profile, receptor-activator for NFkB (RANK), receptor-activator for NFkB-Ligand (RANKL), and tumor necrosis factor-α (TNF-α) were estimated. Allele frequency of OPG (rs2073618) gene polymorphism was assessed from the DNA samples. BRS and HRV indices were decreased, and RANKL/OPG and TNF-α were increased in T2D and T2D + HTN groups, respectively compared to healthy control group. The reduction in BRS was contributed by increased inflammation and reduced SDNN of HRV in GG genotype in T2D + HTN. In GG + GC subgroup, it was additionally contributed by rise in RANKL/OPG level (β − 0.219; p 0.008). Presence of mutant GG genotype contributed to the risk of hypertension among T2D patients (OR 3.004) as well as in general population (OR 2.79). It was concluded that CV risks are more in T2D patients with HTN expressing OPG rs2073618 gene polymorphism. Introduction According to World Health Report 2002, cardiovascular diseases (CVD) will be the largest cause of death and disability by 2020 in India. Nearly half of these deaths are likely to occur in young and middle-aged individuals (30–69 years) especially who have diabetes and or hypertension or are genetically susceptible to develop diabetes and or hypertension1,2. Diabetes mellitus and hypertension are two major established risk factors for CVD3. Further, coexistence of hypertension with insulin resistance increases the risk of target organ damage and clinical cardiovascular accidents4. Nevertheless, not all patients with diabetes mellitus develop hypertension at least in the first 5 years5. However, a quite significant number of patients with diabetes develop hypertension quite early after acquiring the disease6. Genetic susceptibility for hypertension has been proposed to play important role in nearly 50% of insulin resistant individuals to develop hypertension, in the early phase of the disease even after receiving standard antidiabetic treatment7. Till date, no study has been conducted to assess the pathophysiological difference in the CVD risk profile of diabetes patients with or without having hypertension. Vascular calcification, a factor common to both CVD and hypertension is no longer considered as age related phenomenon8. Irrespective of the site and degree of involvement, the vascular calcification is a strong independent predictor of cardiovascular mortality9. The intimal calcification is associated with atherosclerosis while medial calcification seen in ageing is associated with arterial stiffening leading to reduced vascular compliance8. Arterial stiffening due to atherosclerosis accelerated by calcification is a known pathophysiological mechanism of hypertension10. Osteoprotegerin (OPG) is a biomarker of vascular calcification and associated with CVD. OPG is a decoy receptor for receptor-activator for NFkB-ligand (RANKL), which has been implicated in pathophysiology of CVD. OPG has also been linked to myocardial stiffness11, hypertension and diabetes12. Recently we have reported the link of OPG to CVD risk in diabetes13. The TNFRSF11B gene at 8q24.12 of chromosome 8 encodes OPG in humans. There are several reports of single nucleotide polymorphisms (SNP) for OPG gene, linked to DM and CVD14. Among these, the 1181 G > C SNP polymorphism has been particularly associated with CVD, left ventricular hypertrophy in essential hypertension15 and abnormal coronary arteries16. The rs2073618 of OPG is an exon variant with G > C transversion at exon 1. This leads to change in the third amino acid of the signal peptide from lysine (AAG), into asparagine (AAC). Polymorphism at exon region can influence splicing by affecting the binding sites of enhancers and silencers thus affecting protein level in circulation. However, studies relating RANK/RANKL/OPG level or associated gene polymorphisms in this pathway, in relation to blood pressure alteration, are scarce in Indian population. We hypothesize that any alteration in the levels of receptors such as RANK and OPG; their major ligands such as RANKL and TNF-alpha; or the corresponding allele polymorphism of OPG could play a pivotal role in insulin resistance associated hypertension and subsequent increase in CV risks in the Southern Indian (Tamil) population. Sympathetic nervous system (SNS) activation and retrograde inflammation are two major mechanisms in the genesis of hypertension17,18,19, insulin resistance20,21 as well as CVD22,23. Blood pressure variability (BPV) and heart rate variability (HRV) are two sensitive methods of measurements of CV risks in health and disease24,25,26. Decreased baroreflex sensitivity (BRS) an important parameter of BPV and decreased HRV as the marker of reduced cardiovagal modulation are the recently established indices of CVD risks in diabetes and hypertension. As BRS is influenced by mechanical properties of vascular wall, high vascular transmural pressure could alter the BRS and influences the autonomic regulation of blood pressure in diabetes with hypertension. Recently we have reported the plausible role of OPG in decreased cardiovagal modulation in diabetes13. Also, we have reported the link OPG with decreased BRS in patients with diabetes receiving oral anti-diabetic drugs27. However, the CVD risks has not been assessed in patients with diabetes with or without hypertension expressing SNP of OPG gene. Therefore, the primary objective of the study was to assess the allele frequency of OPG (rs2073618) gene polymorphism in diabetes mellitus patients under treatment with hypertension compared with similar age, gender and ethnicity matched diabetes patients without hypertension. Also, we have assessed the HRV and BPV profile as CVD risks and their association with gene polymorphism of OPG in these patients. Materials and methods Study design This was a single center cross sectional comparative study in the Southern Indian (Tamil) population consisting of three groups. The study was first approved by an institution research review board and the Ethics Committee (Human studies: JIP/IEC/2018/305) prior to commencement. Verbal approval followed by written informed consent was obtained from the participants before recruitment. Participants Participants were divided into three groups: control group, test