Blackwell J M, Fakiola M, Ibrahim M E, Jamieson S E, Jeronimo S B, Miller E N, Mishra A, Mohamed H S, Peacock C S, Raju M, Sundar S, Wilson M E
Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Western Australia, Australia.
Parasite Immunol. 2009 May;31(5):254-66. doi: 10.1111/j.1365-3024.2009.01102.x.
Ninety per cent of the 500,000 annual new cases of visceral leishmaniasis (VL) occur in India/Bangladesh/Nepal, Sudan and Brazil. Importantly, 80-90% of human infections are sub-clinical or asymptomatic, usually associated with strong cell-mediated immunity. Understanding the environmental and genetic risk factors that determine why two people with the same exposure to infection differ in susceptibility could provide important leads for improved therapies. Recent research using candidate gene association analysis and genome-wide linkage studies (GWLS) in collections of families from Sudan, Brazil and India have identified a number of genes/regions related both to environmental risk factors (e.g. iron), as well as genes that determine type 1 vs. type 2 cellular immune responses. However, until now all of the allelic association studies carried out have been underpowered to find genes of small effect sizes (odds ratios or OR < 2), and GWLS using multicase pedigrees have only been powered to find single major genes, or at best oligogenic control. The accumulation of large DNA banks from India and Brazil now makes it possible to undertake genome-wide association studies (GWAS), which are ongoing as part of phase 2 of the Wellcome Trust Case Control Consortium. Data from this analysis should seed research into novel genes and mechanisms that influence susceptibility to VL.
每年50万例内脏利什曼病(VL)新发病例中,90%发生在印度/孟加拉国/尼泊尔、苏丹和巴西。重要的是,80%至90%的人类感染为亚临床或无症状感染,通常与强大的细胞介导免疫相关。了解决定为何两个感染暴露相同的人易感性不同的环境和遗传风险因素,可为改进治疗方法提供重要线索。最近在来自苏丹、巴西和印度的家庭样本中,运用候选基因关联分析和全基因组连锁研究(GWLS),已确定了一些与环境风险因素(如铁)相关的基因/区域,以及决定1型与2型细胞免疫反应的基因。然而,到目前为止,所有已开展的等位基因关联研究都缺乏足够的效力来发现效应大小较小的基因(优势比或OR<2),而使用多病例家系的GWLS仅能发现单个主要基因,或至多发现寡基因控制。印度和巴西大型DNA库的积累,现在使得开展全基因组关联研究(GWAS)成为可能,这是威康信托病例对照联合体第二阶段正在进行的一部分。该分析的数据应为研究影响VL易感性的新基因和机制提供依据。
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