title: Association of VEGF and eNOS gene polymorphisms in type 2 diabetic retinopathy.
abstract: OBJECTIVE
  Vascular endothelial growth factor (VEGF) is a major mediator of angiogenesis, and nitric oxide (NO) is an upstream and downstream regulator of VEGF mediated angiogenesis. VEGF and NO have been suggested to play an important role in the pathogenesis of microvascular complications in diabetic retinopathy (DR). The objective of this study was to examine the genetic variations of the VEGF and eNOS gene and assess their possible relationship to DR in type 2 diabetic patients in the Indian population.
  
  
  METHODS
  In this study, 210 unrelated patients were enrolled and categorized into two study groups: a DR group, consisting of patients with proliferative diabetic retinopathy, and a diabetic without retinopathy (DWR) group comprised of patients with type 2 diabetes of more than 15 years duration who showed no signs of DR or had fewer than five dots or blot hemorrhages. Association of the genetic polymorphisms in the promoter and 5' UTR region of VEGF and the intron4 region of eNOS were studied. Total genomic DNA was isolated from peripheral blood leukocytes. PCR-RFLP analysis was performed for all samples to evaluate the genotypes. The distributions of the genotypes were compared using the chi2 test. Haplotype estimation and multiple logistic regression analysis were carried out to analyze the significance of polymorphisms.
  
  
  RESULTS
  We investigated four reported polymorphisms in the VEGF (5' UTR, promoter) and one reported polymorphism (intron 4) in the eNOS gene in Type 2 diabetes patients with (n=120) and without (n=90) retinopathy. The genotype distribution of the C(-7)T, T(-1498)C, and C(-634)G polymorphisms of VEGF differed significantly between patients with DR and DWR (p=0.001, p=0.0001, and p=0.021, respectively). Allele C in the -1498 region (p=0.0001) and T in -7 region (p=0.002) were also found to be significantly increased in patients with retinopathy. Calculated odds ratios (OR) for three heterozygous genotypes of C(-7)T, T(-1498)C, and C(-634)G regions were 4.17 (95% CI: 1.90-9.18, p=0.0001), 4.37 (95% CI: 2.44-7.84, p=0.0001), and 2.33 (95% CI: 1.24-4.36, p=0.008), respectively, and was found to be significantly higher in the DR group when compared with the DWR group. Multiple logistic regression analysis revealed that the nongenetic parameters, age (p=0.024) and duration of diabetes (p=0.009), and the genetic parameters, like VEGF C(-7)T (p=0.002) and T(-1498)C (p=0.001) polymorphisms, were significantly associated with DR. The frequencies of haplotype consisting of the majority of alleles in VEGF were found to be significantly associated with DR. The genotype distribution of eNOS did not differ significantly between the two study groups, and therefore the eNOS intron 4 polymorphism was considered to be less significant.
  
  
  CONCLUSIONS
  This is the first study to report VEGF and eNOS gene polymorphisms in patients with DR in the Indian population. The data suggest that the polymorphisms in the 5' UTR and promoter region of VEGF could be regarded as a major genetic risk factor for DR.
authors.affiliation: Department of Genetics, Aravind Medical Research foundation, Lions Aravind Institute of Community Ophthalmology (LAICO), Aravind Eye Care System, Madurai, India.
authors.forename: Balasubbu
authors.initials: B
authors.lastname: Suganthalakshmi
authors.forename: Rajendran
authors.initials: R
authors.lastname: Anand
authors.forename: Ramasamy
authors.initials: R
authors.lastname: Kim
authors.forename: Rajendran
authors.initials: R
authors.lastname: Mahalakshmi
authors.forename: Sundaramoorthi
authors.initials: S
authors.lastname: Karthikprakash
authors.forename: Perumalsamy
authors.initials: P
authors.lastname: Namperumalsamy
authors.forename: Periasamy
authors.initials: P
authors.lastname: Sundaresan
mesh_terms: D020121:5' Untranslated Regions; D000328:Adult; D044466:Asian People / Q000235:genetics; D003924:Diabetes Mellitus, Type 2; D003930:Diabetic Retinopathy / Q000235:genetics*; D005260:Female; D020022:Genetic Predisposition to Disease; D006239:Haplotypes; D006801:Humans; D007194:India; D007438:Introns; D008297:Male; D008875:Middle Aged; D052250:Nitric Oxide Synthase Type III / Q000235:genetics*; D011110:Polymorphism, Genetic; D011401:Promoter Regions, Genetic; D042461:Vascular Endothelial Growth Factor A / Q000235:genetics*
chemical_list: D020121:5' Untranslated Regions; D042461:Vascular Endothelial Growth Factor A; D052250:Nitric Oxide Synthase Type III