Cardiovascular Diseases Clinical Trial
To test whether specific genes affect lipoprotein and weight responses to vigorous exercise in identical twins.
BACKGROUND:
It is well recognized that increased exercise is associated with a number of health
benefits, which include decreases in level of obesity and improvement in lipoprotein levels.
Differences have been found to exist, however, in individual response to increased exercise,
suggesting that genetic factors may be involved in mediating this response. The elucidation
of both the specific genes responsible for these differences and the manner by which they
interact with increased exercise to influence lipoprotein levels and body weight would
contribute significantly to increasing current understanding of the way in which genes and
environment operate to determine these characteristics.
DESIGN NARRATIVE:
As part of the National Runners' Health Study, Dr. Williams and colleagues have identified
1,350 runners who have an identical (MZ) twin. Their recruitment experience shows that an
additional 3,120 MZ twins can be located nationally through Runner's World race
participation program.Twenty-eight percent of these MZ twin pairs are expected to be
discordant for vigorous exercise (sedentary versus running over 10 miles per week) and
otherwise eligible for study. The investigators propose to obtain blood for genotyping,
detailed lipoprotein subfraction measurements, clinic weights, and proximal (diet record)
and long-term (food frequency questionnaire) nutrient intakes in 400 discordant MZ twin
pairs to test whether genes affect the lipoprotein and weight response to vigorous exercise.
The analyses assume that the sedentary twin represents (theoretically) the body weight and
lipoprotein concentrations of the active twin if he or she were sedentary. They will compare
the co-twin lipoprotein and weight differences across genotypes after adjusting for diet.
Candidate genes will include single nucleotide polymorphisms (SNPs) that have been
identified by others to affect lipoproteins, weight, propensity to exercise, or that
mitigate the responses of lipoproteins to exercise. They will also compare the co-twin
phenotype differences to SNPs and haplotypes that linkage disequilibrium maps suggest
characterize most of the major genetic variation for genes affecting lipoprotein metabolism.
The lipoproteins will include detailed measurements of high-density lipoprotein (HDL) and
low-density lipoprotein (LDL) subclasses using gradient gel electrophoresis. The individual
HDL subclasses will also be analyzed after separating the HDL by immunoaffinity
chromatography into particles containing both apo A-I and apo A-II (HDL(A-I with A-II)) and
those containing apo A-I and no apo A-II (HDL(A-I without A-II)). The design provides the
advantages of both the cross-sectional association studies (large phenotypic effects) and
the training studies (controlling for genotype) without the self-selection bias of
cross-sectional association studies or the small phenotypic response of training studies.
Their first pilot study of 35 pairs of MZ twins revealed a 5.2 mg/dL difference in
HDL-cholesterol and a 12 pound weight difference between the active and sedentary twin. By
comparison, a major recent training study produced only small average increases in HDL
cholesterol (men:l.1 mg/dL; women:l.4 mg/dL) and small decreases in weight (men: 0.9 pounds;
women: 0.4 pounds) after 20 weeks of training. The larger effect size of the discordant twin
study will provide greater statistical power to detect gene-environment interactions than
the training study. DNA samples will be shared with other institutions to cross-validate
gene associations identified from training studies or other designs.
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N/A
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