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*
Institute für Pharmakologie,
Universitätsklinikum Essen, Essen,
Germany
Institute für Medizinische Informatik,
Biometrie und Epidemiologie,
Universitätsklinikum Essen, Essen,
Germany
Institute für Transfusionsmedizin
§
Institute für Immunologie,
Universitätsklinikum Essen, Essen,
Germany
||
Institute für Humangenetik,
Universitätsklinikum Essen, Essen,
Germany
¶
Institute für Klinik
für Neurochirurgie
Universitätsklinikum Essen, Essen,
Germany
#
Institute für Abteilung
für Kardiologie,
Universitätsklinikum Essen, Essen,
Germany
**
Institut für Rechtsmedizin,
Universität
Münster, Münster,
Germany

National Blood Transfusion Service Zimbabwe, Avondale, Harare,
Zimbabwe

The South African Blood Transfusion Service, Johannesburg, South
Africa
§§
Molekulare Humangenetik, Ruhr-Universität,
Bochum, Germany
||||
Blood Bank of San Bernardino and Riverside Counties, San Bernardino,
California
¶¶
Section on Nephrology, Department of Medicine, Bowman Gray School of
Medicine, Winston-Salem, North Carolina
##
Universitätsklinikum Benjamin Franklin,
Abteilung für Endokrinologie und Nephrologie,
Berlin, Germany
***
Riyadh Armed Forces Hospital, Division of Neurosurgery, Riyadh, Saudi
Arabia

The Aga Khan University, Department of Physiology and Pharmacology,
Karachi, Pakistan

Laboratory for Tissue Immunology, Falmouth Building, Medical School, Cape
Town, South Africa
§§
Departement of Clinical Microbiology and Immunology, University of Oulu,
Oulu, Finland
||||
Department of Pediatrics, Shandong Provincial Hospital, Jinan, Shandong,
People's Republic of China
¶¶
Division of Clinical Immunology, Tongji Medical University, Wuhan,
People's Republic of China.
Correspondence to Dr. Winfried Siffert, Institut für Pharmakologie, Universitätsklinikum, Hufelandstrasse 55, D-45122 Essen, Germany. Phone: +49 201 723 3470; Fax: +49 201 723 5968; E-mail: winfried.siffert{at}uni-essen.de
Abstract
Abstract. Recently, it was demonstrated that one allele (825T) of
the gene encoding the G protein ß3 subunit (GNB3) is associated
with hypertension in Germans. This study investigates a possible association
with obesity in young male Germans, Chinese, and black South Africans with
low, intermediate, and high 825T allele frequencies, respectively. In each of
these three distinct cohorts, the 825T allele frequency was increased
significantly in overweight (body mass index [BMI]
25 kg/m2)
and obese individuals (BMI >27 kg/m2) compared to those with
normal weight. The 825T allele frequencies in these three BMI groups were,
respectively, 29.5, 39.3, and 47.7% in Germans, 46.8, 53.9, and 58.6% in
Chinese, and 83.1, 87.7, and 90.9% in South Africans. In each of these three
distinct groups, the 825T allele was significantly associated with obesity
with odds ratios between 2 and 3. More urban than rural black Africans were
overweight despite similar 825T allele frequencies in both populations, which
underscores the role of both genetic and environmental factors. BP values in
young male whites increased significantly with increasing BMI values but were
independent of the C825T polymorphism, suggesting that hypertension associated
with the 825T allele could be a consequence of obesity. Genotyping of 5254
individuals from 55 native population samples from Africa, the Americas,
Europe, Asia, Australia, and New Guinea demonstrated highest 825T allele
frequencies in black Africans (82%) and intermediate values in east Asians
(47%). It is anticipated that high frequencies of the 825T allele in Africans
and Asians may contribute to an obesity and hypertension epidemic if
Westernization of lifestyles continues.
Currently available data suggest a worldwide continuous increase in obesity prevalence, which is recently also being observed in developing countries (1). This prompts some authors to predict an "obesity epidemic" (2) with an increased prevalence of hypertension, stroke, coronary artery disease, and type 2 diabetes mellitus, for which obesity is a major risk factor (3). A considerable part of obesity is due to environmental factors and lifestyle, but between 40 and 70% of the variation of body mass index (BMI) is estimated to be heritable (4).
We recently described a C825T polymorphism in the gene GNB3 encoding the ß3 subunit of heterotrimeric G proteins, which are key components of intracellular signal transduction in all cells of the body (5). The 825T allele is associated with the occurrence of a splice variant, termed Gß3-s, which, despite a deletion of 41 amino acids, is functionally active in a reconstituted system. The GNB3 825T allele is also associated with enhanced G protein activation, resulting in increased cell proliferation (6,7) and hypertension in Caucasians (5,8,9). The frequency of the 825T allele (fT) was markedly increased to 50% in young Canadian Oji-Cree Indians compared to 25 to 30% in Caucasians and, unexpectedly, the 825T allele was associated with lower rather than increased BP values (10). Nevertheless, fT was increased (57%) in subjects under antihypertensive therapy, although this was not statistically increased from control subjects potentially due to the small number of hypertensive individuals in this population. Similarly, fT amounted to 49% in Japanese, but no association of the 825T allele with hypertension was detected (11). Taken together, these findings suggested significant ethnic differences in 825T allele distributions and, possibly, inter-ethnic differences in associations with hypertension.
The present study was designed to investigate two main topics. First, we searched for a potential association between the 825T allele and obesity in individuals of different ethnicity and living habits in their native country. Second, we determined the worldwide ethnic distribution and the presumed ancestral state of the GNB3 825 polymorphism.
Our analyses were based on some underlying considerations: First,
Na+/H+ exchanger activity, i.e., the
intermediate phenotype leading to the detection of the C825T polymorphism
(5,12),
is elevated in obese hypertensive and normotensive subjects but not in lean
individuals (13). Thus,
hypertension associated with enhanced G protein activation as indicated by the
825T allele could develop secondary to obesity. Furthermore, intracellular
signal transduction via pertussis toxin (PTX)-sensitive G proteins is
of major importance in adipogenesis
(14). Transgenic mice lacking
the PTX-sensitive Gi
2 subunit are lean and deficient in fat mass
(15). On the other hand,
increased expression of Gi
2 or expression of constitutively active
Gi
2 subunits in fibroblasts results in lipid accumulation and
adipogenic conversion of cells
(16). Thus, we tested for an
association of the GNB3 825T polymorphism and obesity in several
ethnic groups.
Materials and Methods
This study was conducted in agreement with the Declaration of Helsinki, and informed consent was obtained from all enrolled individuals.
BMI Study
In addition to nutritional status and physical activity, BMI strongly
depends on age, gender, social and ethnic background, as well as country of
residence (17). Furthermore,
existing disorders and medication can exert uncontrollable effects on body
weight. Therefore, all measures were taken to render the involved study groups
as similar as possible. In the present study, only men ages 18 to 30 were
included. No attempt was made to specifically enrich the sample with
underweight or overweight individuals. Thus, the enrolled cohorts roughly
resemble cross-sectional samples of the respective gender and age groups of
the respective countries. Body weight was determined in light clothing, and
body height was measured without shoes, heels together, with back to the wall.
Overweight was defined as BMI
25.0 kg/m2 and obesity as
>27.0 kg/m2
(3).
German Cohort. We recruited 277 healthy male Caucasoid individuals ages 18 to 30 yr at the Department of Blood Transfusion Medicine, University Hospital of Essen. These individuals attend the blood bank usually every 3 mo for blood donation and are under close health surveillance to guarantee high-quality blood products. According to German law, blood donors must be free of any medication and acute or chronic infectious diseases, to mention but a few requirements. Thus, these individuals represent a cross-sectional sample of young healthy men of the German population. BP is measured regularly in these individuals at every visit in the sitting position after a rest of 10 min using standard sphygmomanometry.
Chinese Population Sample. Male healthy Chinese subjects ages 18 to 30 yr were recruited at the Jinan Technical College and the Tongji Medical University at Wuhan and the samples were combined.
African Populations. Black male, healthy individuals ages 18 to 30 yr were recruited by the National Blood Transfusion Service Zimbabwe (Harare; n = 450) and The South African Blood Transfusion Service (Johannesburg; n = 256).
Ethnic Distribution Study
DNA samples were obtained from previously established, anonymous human
diversity collections or from newly recruited volunteers. No further
information regarding health status is available. Thus, reported values are
estimates of 825T allele frequencies in the different populations studied and
cannot be used as reference values for disease-related studies. DNA samples
from the West Pygmies were purchased from the Coriell Institute for Medical
Research (Camden, NJ). DNA samples from nonhuman primates were prepared from
mouth swabs and obtained from different zoos in Germany.
DNA Preparation and Genotyping
DNA was prepared and PCR-based genotyping was done as described previously
(5). In the BMI studies, all
genotyping was performed in a blinded manner, i.e., investigators
were unaware of the individuals' data. PCR products of nonhuman primate DNA
samples were directly sequenced using standard procedures.
Statistical Analyses
Allele frequencies were compared using Cochran-Mantel-Haenszel test for
trend over the three genotypes. Other frequency comparisons were done using
the
2 test or the
2 test for trend. Wherever
continuous variables were compared, t test (in case of two groups) or
one-way ANOVA (in case of more than two groups) was applied. When odds ratios
(OR) adjusted for other terms (age or sample collective) were calculated,
logistic regression was used. All confidence intervals are calculated at the
95% level.
Results
Characterization of Enrolled Individuals
Anthropometric data of the enrolled individuals are summarized in
Table 1. 825T allele
frequencies differed significantly between different ethnic groups and were
lowest in Germans (31.9%), intermediate in Chinese (47.7%), and highest in
Africans (81.4 to 84.1%). BMI values were significantly higher in Germans
compared to all other ethnic groups (Figure
1). Remarkably, BMI was higher in urban compared to rural
Zimbabweans. Using a definition for underweight of BMI <18.5
kg/m2, a marked difference between Germany, a completely
industrialized country with a largely uniform lifestyle, and the developing
countries was observed. Conversely, the risk of being overweight (BMI
25.0
kg/m2 versus <25.0 kg/m2) was increased in
Germany compared to China, South Africa, and Harare
(Figure 1 and
Table 1). Interestingly, within
Zimbabwe a significantly increased OR of 3.4 (1.8 to 6.7; P = 0.0002)
for overweight was found upon comparison of the urban with the rural sample,
which again shows the impact of lifestyle on BMI. Having confirmed this
expected relationship between BMI and country of residence, we subsequently
investigated the potential association between the 825T allele and BMI within
the specified populations.
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825T Allele, BMI, and BP in German Men
BMI was significantly different between genotypes (TT = 24.9 ± 2.3
kg/m2; TC = 23.6 ± 2.4 kg/m2; CC = 23.1 ±
2.5 kg/m2; P = 0.003)
(Table 2). This difference was
also seen when the TT and TC genotypes were combined (23.8 ± 2.4
kg/m2) and compared with the CC genotype (P = 0.01). BMI
was correlated with weight but not height. Age was not significantly different
between genotypes (TT = 26.4 ± 2.8; TC = 25.3 ± 3.5; CC = 25.7
± 3.3 yr; P = 0.2). 825T allele frequency was 29.5, 39.3, and
47.7% in normal weight, overweight, and obesity, respectively
(Table 2 and
Figure 2). Genotype
distribution of the overweight and obese group was significantly different
from the group with normal weight (P < 0.05). For overweight (BMI
25 kg/m2 versus <25 kg/m2), OR (TT/CC)
was 2.5 (1.1 to 6.1; P = 0.03) and OR (TC/CC) was 1.5 (0.8 to 2.6;
P = 0.2). OR (TT/CC) for BMI >27 kg/m2 versus
< 25 kg/m2 was 5.0 (1.4 to 18.3; P = 0.0083) and OR
(TC/CC) was 2.2 (0.8 to 6.3; P = 0.13). Systolic BP values were not
significantly different between genotypes (TT: 129.6 ± 79.6 mmHg; TC:
129.3 ± 78.6 mmHg; CC: 130.4 ± 11.0 mmHg; P = 0.86),
but significantly increased in the overweight and obese group compared to that
with BMI <25 (P = 0.003) (Table
2). Systolic BP increased linearly by 0.5 mmHg per BMI unit
(r2 = 0.05; P = 0.0002). Likewise, diastolic BP
values were independent of genotype (TT: 79.6 ± 6.1 mmHg; TC: 78.6
± 8.4 mmHg; CC: 79.5 ± 7.9 mmHg; P = 0.78), but again
significantly increased with BMI (P < 0.001)
(Table 2) with a mean slope of
0.6 mmHg per BMI unit (r2 = 0.09; P < 0.0001).
Hence, the C825T polymorphism is apparently not directly associated with BP
values in this group of young normotensive individuals, whereas BP values
increase significantly with increased BMI values.
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825T Allele and BMI in Chinese Men
Age was not significantly different between genotypes in the Chinese cohort
(TT = 24.8 ± 4.5; TC = 24.6 ± 4.4; CC = 24.2 ± 4.3 yr).
When compared by one-way ANOVA, BMI values were not significantly different
between genotypes (TT = 22.0 ± 3.0 kg/m2; TC = 22.2 ±
2.7 kg/m2; CC = 21.8 ± 2.4 kg/m2; P =
0.2). However, when the values of TT and TC genotypes were combined (BMI =
22.1 ± 2.7 kg/m2), a statistically nonsignificant trend
(P = 0.1) for increased BMI compared to CC genotype was noticed. 825T
allele frequency was 46.8, 53.9, and 58.6% in normal weight, overweight, and
obese individuals, respectively (Table
3 and Figure 2). OR
(TT/CC) for overweight versus normal weight was 1.8 (1.0 to 3.1;
P = 0.03) and OR (TC/CC) was 1.7 (1.0 to 2.7; P = 0.04). For
BMI >27 kg/m2 versus <25 kg/m2, OR
(TT/CC) was 2.7 (1.2 to 6.2; P = 0.01) and OR (TC/CC) was 1.8 (0.9 to
4.0; P = 0.09).
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825T Allele and BMI in Black African Men
825T allele frequency and genotype distributions were similar in
individuals from South Africa and Zimbabwe regardless of rural or urban origin
(Table 4). The rural African
sample had significantly lower age and body weight compared to the urban
African sample (P < 0.01). The prevalence of overweight in rural
Africans (5%) was significantly lower than in Africans from Harare (17.4%) and
Johannesburg (20.9%). Using these latter figures, we calculate a crude OR for
overweight (combined urban versus rural) of 3.8 (2.1 to 7.1;
P < 0.0001), age-adjusted OR of 2.7 (1.4 to 5.3), indicating a
strong effect of environmental influences on BMI. The risk for overweight
associated with the 825T allele was difficult to estimate within the
respective African samples due to the relative lack of individuals with the CC
genotype. Only a common logistic model, therefore, was calculated for the
samples pooled from the Johannesburg and Harare populations. Crude OR (TT/CC)
for overweight in the combined urban Johannesburg and Harare samples was 3.8
(0.5 to 28.9; P = 0.16), and crude OR (TC/CC) is 3.1 (0.4 to 24.3;
P = 0.25). Although these values did not reach statistical
significance due to the low number of homozygous 825C allele carriers, this
effect was qualitatively similar to that observed in Germans and Chinese.
Age-adjusted OR (TC/TT) was 0.7 (0.3 to 1.7), and OR (CC/TT) was calculated at
0.6 (0.1 to 5.3). In the Johannesburg sample, 825T allele frequency increased
to 90.9% in individuals with BMI >27 kg/m2
(Table 4 and
Figure 2). There was no
correlation between age and genotype in the African samples.
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Finally, the impact of the 825T allele on overweight in "lean" populations was estimated after combining the Chinese (Table 3) and African (Table 4) samples. After adjustment for age and sample collective, OR (TT/CC) was 1.8 (1.1 to 3.0; P < 0.02) and OR (TC/CC) was 1.6 (0.97 to 2.5; P = 0.06). Thus, the effect of the 825T allele on overweight was remarkably similar in "lean" and fully Westernized populations.
Ethnic Distribution of the GNB3 825T Allele
A total of 5254 DNA samples of unrelated individuals was analyzed. The
ethnic distribution of the 825T allele is displayed in
Table 5 and
Figure 3. All populations with
n > 40 were in Hardy-Weinberg equilibrium (HWE). This suggests
that preferential selection of genotypes is not (or is no longer) detectable.
The geographic frequency distribution of the 825T allele displays marked
frequency intervals that correspond to the subdivision into major human ethnic
groups, with black Africans (excluding the admixed American blacks, and the
small Guinean sample) ranging from 74 to 91%, Mongoloids from 42 to 52%, and
Caucasoid (except the Middle East) from 21 to 38%. In the Middle East and
North Africa, the frequencies are transitional compared to Africans, ranging
from 45 to 56%. The Amerindians have a wide frequency range (11 to 42%).
Interestingly, the Khoisanoids and Pygmies, isolated descendants of the most
ancient African populations
(18,19),
have lower values than other Africans, between 66 and 72%. Similarly, 825T
allele frequencies were high in North Australian aborigines and individuals
from Highland Papua New Guinea, but still lower than in Africans. In
Table 5, the overall allele
frequency of each major ethnic group (e.g., 82% for black Africans)
is also given, averaging over subpopulation averages rather than over
individuals, to avoid distortion due to variable sample sizes. To test whether
the frequency differences between ethnic groups might be artifacts of
inadequate sample sizes, the nine major ethnic groupings in
Table 5 were submitted to 2 by
2 comparisons (20). Most
pairwise differences were found to be statistically significant at the
P < 0.05 level, except for comparisons involving the Pygmies and
the Papuans, for whom the sample sizes are smallest. Motivated by the
uniformity of 825T allele frequencies among Europeans (Germans approximately
30%) and black Africans (approximately 82%), we estimated the proportion of
European admixture in U.S. blacks (72% 825T allele) at 21%, in good agreement
with previous estimates of 15 to 20%
(21).
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We also genotyped and sequenced DNA from unrelated animals of the species Pan troglodytes (common chimpanzee; n = 4), Pan paniscus (pygmy/Bonobo chimpanzee; n = 2), Gorilla gorilla (lowland gorilla; n = 3), Pongo pygmaeus (orangutan; n = 3), Cercopithecus aethiops (African green monkey; n = 1), Macaca mulatta (rhesus monkey; n = 3), and Sanguinus oedipus (cotton top tamarin; n = 1). All of these primates were typed homozygous carriers of the C825 allele in the GNB3, indicating the stability of this position for at least 30 million years, which in turn suggests that the C allele is the evolutionary ancestral allele in primates.
Discussion
825T Allele and BMI
The worldwide increasing prevalence of obesity prompts many researchers to
determine modifiable and nonmodifiable (genetic) factors underlying this
epidemic (22). We have
investigated here whether the GNB3 825T allele, which predisposes for
hypertension (5,
8,
9), potentially predisposes for
obesity. This approach was prompted by the observation that enhanced signaling
via PTX-sensitive G proteins enhances adipogenesis
(16), whereas animals lacking
the G protein G
i2 subunit are runted due to deficiency in fat mass
(15). Thus, intracellular
signal transduction via G
i2 could play a major role in the
pathogenesis of obesity (14).
Interestingly, the splice variant Gß3-s associated with the 825T allele
can interact with G
i2
(5), and recent studies have
confirmed that activation of heterotrimeric G proteins is enhanced in the
presence of this splice variant
(23). Thus, the 825T allele is
not a nonfunctional genetic marker. Instead, it can be used for the prediction
of enhanced intracellular signal transduction in humans. It should be noted,
however, that linkage equilibrium with a yet unidentified alteration in
GNB3 cannot be excluded. The complete coding region of the G protein
ß3 subunit cDNA has been sequenced, and no changes apart from the C825T
polymorphism have been identified
(5). However, potential
relevant mutations in introns of GNB3 cannot be excluded. The
GNB3 locus located on chromosome 12p13 is flanked by the
gene encoding CD4 and genes of unknown identity
(24). Therefore,linkage
disequilibrium of the GNB3 825T allele with polymorphisms in these
genes cannot be excluded. However, this latter possibility appears rather
unlikely since the 825T allele is closely associated with enhanced G protein
signaling (5), and no sequences
have been identified in the vicinity of 12p13 that encode for G
protein subunits or regulators of G protein function.
To investigate the effect of the 825T allele on BMI and BP in ethnically and culturally diverse populations, we set up the population cohorts as homogeneously as possible by including only men in the age range of 18 to 30 yr. Although individuals were selected at random to resemble a healthy, quasi cross-sectional sample from the considered age groups, they obviously did not constitute a random sample of the respective populations. This makes selection effects a possible disadvantage of the study. However, whereas selection may act on phenotype, despite all cautionary measures taken, there is no rationale for over- or undersampling a certain genotype given the phenotype. Furthermore, the prevalences of underweight and overweight in the sample are in good accordance with what is known of these traits in the general populations. As an example, the prevalences of underweight (5.8%) and overweight (13.3%) in our Chinese sample are similar to those reported by others, which were 11.6 and 9.8%, respectively, with an increasing trend for obesity as a result of lifestyle changes (25, 26). Likewise, higher BMI in urban compared to rural areas of Zimbabwe has been documented (27).
We have used BMI as a measure of body fat mass, although we are aware of
the fact that BMI is also influenced by muscle and bone mass. However, more
sophisticated techniques for direct assessment of body fat, e.g.,
densitometry or bioelectrical impedance techniques, were not available in
China and in Africa. On the other hand, most investigators agree that BMI
values can be used to compare body composition across ethnic groups
(28,
29). The BMI cutoff point of
25 kg/m2 used here for defining overweight is commonly
accepted. Obesity, on the other hand, is frequently defined as a BMI value of
30 kg/m2, although others have used a cutoff value of >27
kg/m2 in recent studies
(30). Since most of our
samples were taken from developing/transitional countries in which overt
obesity is relatively rare in the studied age groups, we here defined obesity
as a BMI > 27 kg/m2.
A consistent and significant effect of the 825T allele on BMI is evident in three ethnically and culturally diverse populations. This effect was most pronounced in Germans, whose lifestyle is characterized by high-caloric, fat-enriched nutrition and low physical activity. A similar effect of the 825T allele on BMI was found in the Chinese cohort, despite the fact that nutrition is poor in fat but rich in rice and vegetables, thus being quite different from that of Germans. Interestingly, the OR (TT/CC) for overweight were comparable in the Chinese and the German samples. The precise risk for overweight associated with the 825T allele is difficult to estimate in the African samples due to the relative lack of individuals with the CC genotype. However, only one (= 4.8%) out of a total of 21 CC genotypes was found in the overweight group, suggesting a qualitatively similar effect. In general, we estimate the OR (TT/CC) for overweight to be approximately 2 to 3 for all populations studied, a rather impressive value for such a highly variable phenotype, and our finding of a consistent association across different ethnic groups makes a fortuitous association very unlikely.
On the basis of the available data, it is difficult to say whether the 825T allele exerts a codominant or a recessive influence on BMI, the latter being a weak phenotype and a quantitative trait strongly influenced by environmental factors. On the cellular level, one 825T allele suffices to generate Gß3-s via alternative splicing and to establish a phenotype of enhanced G protein reactivity (5). Anecdotal evidence suggests that G protein activation is further enhanced in cells from individuals with the TT genotype (W. Siffert, unpublished observations). Thus, the 825T allele appears to exert a codominant effect on G protein signaling on the cellular level, which may be explained by an increased expression of the splice variant Gß3-s in the presence of two affected alleles. Previous studies on hypertension suggested at least a gene-dose effect regarding BP with an increased risk for homozygous compared to heterozygous individuals (5). A similar trend was observed here, as heterozygous 825T allele had increased OR for overweight and obesity. This effect was statistically significant in the Chinese group. At present, we cautiously propose a codominant effect of the 825T allele on overweight, this hypothesis being, however, largely based on previously made observations on the cellular level (5). A definite answer to this pending question requires a different study setup, for example a case-control study specifically designed to compare genotype distribution in overtly obese (BMI >30 kg/m2) and normal weight individuals. Furthermore, studies are required to clarify the molecular mechanisms that may be responsible for the tendency to gain weight in individuals carrying an 825T allele. Although studies on transgenic animals and transfected cell lines suggest a major role of PTX-sensitive G proteins in adipogenesis (15, 16), such findings do not explain the associations made here. Additional studies on transgenic animals expressing Gß3-s are urgently required to establish a potential causal relationship between this splice variant, enhanced G protein activation, and obesity. In addition, characterization of signal transduction in adipocytes from homozygous 825T and C825 allele carriers is essential to determine whether obesity actually results from increased lipid accumulation.
The present study also demonstrates that obesity is not an inherited disease, but obviously requires the interaction of multiple susceptibility genes with environmental factors. This is illustrated by the large difference in overweight prevalence in the urban Harare and Johannesburg versus the rural Zimbabwe sample. The lifestyle of the rural sample is drastically different from the urban one with regard to two major aspects: The fat content of the diet is low and it consists mainly of maize meal and vegetables. Due to the lack of private cars and public transportation facilities, these individuals are accustomed to walking long distances. Thus, the level of physical activity can be considered high. In contrast, individuals from Johannesburg and Harare are largely Westernized with a high level of fat-rich nutrition and alcohol consumption. Thus, in the presence of an almost identical frequency of the 825T allele in the African rural and urban samples, only individuals exposed to an "unhealthy" Western lifestyle appear at risk for overweight. It is tempting to speculate that the 825T allele might be neutral as long as lifestyle resembles that of our hunter-gatherer ancestors but may become detrimental upon Westernization. Thus, presence of the 825T allele can only increase the risk for obesity in concert with certain behavorial or environmental factors, but clearly does not cause obesity by its sole presence. This would also be in accordance with the observation that the prevalence of overweight was highest in Germans despite lowest 825T allele frequency of the characterized samples. As an alternative hypothesis, one could propose that the genetic background of the different ethnic groups studied differs with regard to many other genes that induce or prevent obesity, thereby potentially enhancing or reducing the effect of the 825T allele in Chinese and black Africans. Although the genetic background of Caucasoid, Asian, and black populations is certainly different, we do not believe that this is a major argument to be considered here for two reasons. First, we found a consistent association of the 825T allele with BMI in individuals of different ethnic origin. Second, it is rather unlikely that urban and rural black individuals from Zimbabwe, all belonging to the Zimbabwean Shona tribe, differ substantially with regard to their genetic background. Nevertheless, overweight in the urban Zimbabwean sample was significantly more frequent compared to the rural sample. Hence, the gene effect is seen only when certain environmental factors come into play. Such a scenario is also compatible with the "thrifty genotype hypothesis" proposed by Neel (31). This hypothesis suggests that "ancestral," body fat-conserving genes may still be operative in modern man and may contribute to diabetes in conjunction with a sedentary lifestyle.
825T Allele and BP
Three independent case-control studies
(5,
9,
32) and one association study
in a WHO MONICA cohort (8) have
confirmed an association of the GNB3 825T allele with hypertension in
Caucasians. However, the mechanism by which enhanced G protein activation
contributes to high BP has remained obscure. Based on theoretical
considerations, increased vasoconstriction can be ruled out as most vasoactive
hormones activate receptors coupled to PTX-insensitive G proteins. Homozygous
and heterozygous 825T allele carriers do not respond with an exaggerated BP
increase upon infusion of an
2-adrenergic receptor-activating compound
(33). Thus, hypertension in
825T allele carriers appears to result from slow-acting mechanisms. The
findings presented here for the German cohort apparently support this
theoretical concept. Whereas BP was virtually independent of the C825T
polymorphism, both systolic and diastolic BP were significantly dependent on
BMI, and it is commonly known that overweight and obesity are main risk
factors for hypertension. As a working hypothesis, therefore, we propose that
the 825T allele may predominantly increase the risk for obesity, which, over
years, could then precipitate in hypertension. A definite answer to this
pending question requires additional studies specifically designed to address
this problem.
Worldwide Distribution of the 825T Allele
The GNB3 825T allele frequencies reflect ethnic subdivisions
(34,
35). The data, therefore, are
compatible with (but they do not necessarily prove) a scenario in which the
allele frequencies were subjected to random drift during racial
differentiation. To investigate the alternative scenario of drift through
selection, we have calculated the HWE for the larger samples (n >
40). As is seen in Table 5,
there is no significant deviation from HWE, indicating that any recent
selection on the genotypes is not detectable in our data. This does not
exclude the possibility that selection is at work, but is not significantly
affecting HWE. Also, significant selection may have acted during earlier
times, but it seems unlikely that the selective forces would have desisted by
today across all of the diverse ethnic groups and cultures that we tested for
HWE. Furthermore, there are no correlations between 825T allele frequency and
climate or lifestyle of the sampled populations, which include
hunter-gatherers, nomadic pastoralists, sedentary agriculturalists, and
industrialized Westerners. There remains the hypothesis that disease was
involved in producing the current frequency distribution, which may be
investigated when sufficient data on prehistoric diseases become available. It
should be noted here that immune cell activation was found enhanced in
Caucasoid 825T allele carriers as inferred from increased neutrophil
chemotaxis (36). The 825T
allele was absent in all of the primates we typed thus far, including the
closest relatives of humans, the common chimp, pygmy chimp/Bonobo, lowland
gorilla, and orangutan, suggesting that C is the ancestral state at nucleotide
position 825, and that the mutation of C to T probably occurred since the
human-chimpanzee split approximately 5 million years ago. A lower bound for
the 825C to T mutation may be postulated on the basis of its present
distribution in human populations: The hunter-gatherer West Pygmies and the
Khoisan, who have been genetically isolated since an early African founder
event about 100,000 years ago
(18,
19), harbor both the 825C and
825T alleles at appreciable frequencies
(Table 5). Accordingly, the C/T
polymorphism would already have been present at the time of the subsequent
major east African expansion 60,000 to 80,000 years ago, which probably
populated Eurasia and repopulated most of Africa
(18,
37,
38). Because agriculture did
not commence until after climatic stabilization at the end of the Younger
Dryas glacial phase 11,400 years ago
(39), it is unlikely that
agricultural lifestyle was involved in shaping the early 825C/T
distribution.
Conclusions and Perspectives
Our findings may explain part of the significant ethnic differences
regarding susceptibility to obesity and obesity-related disorders
(40,41,42).
For example, black Americans display a higher prevalence of obesity,
hypertension, and type 2 diabetes mellitus compared to whites in the United
States (43,
44). Black Americans still
share much of their genetic makeup with their ancestors from West Africa, and
many studies have been conducted to investigate the relationship between
environmental factors, BMI, hypertension, and type 2 diabetes. The prevalence
of hypertension and type 2 diabetes was consistently found to be low in
African communities, but strongly increased across the Caribbean toward the
United States (41,
44). Even within the African
community, lifestyle changes (urbanization) contribute significantly to the
prevalence of obesity and hypertension as illustrated by an increased
prevalence of hypertension and obesity in urban Nigeria compared to rural
farmers in the same country
(41,
44,45,46).
Compatible observations have been made in Australian aborigines who, upon
adapting a "Western" lifestyle, show exceedingly high rates of
obesity-related disorders, this process being apparently reversible if
aborigines reverted temporarily to traditional hunter-gatherer diets and
lifestyles (47). General lack
of obesity may explain why the !Kung bushmen do not display an age-dependent
BP rise (48) despite a high
825T allele frequency. We have shown here that black Americans as well as
Australian aborigines display high frequencies of the 825T allele
(Table 5). Assuming that the
effect of the 825T allele on BMI described here for Germans, Chinese, and
black Africans is similar in black Americans and Australian aborigines, we
speculate that the high number of 825T allele carriers could be a major
determinant for the observed difference in the prevalence of obesity and
obesity-related disorders in specific ethnic groups living in countries with
largely uniform lifestyle conditions. Finally, if Westernization of lifestyle
continues at the present rate, the high prevalence of the 825T allele may be
predictive of an obesity and hypertension epidemic in developing
countries.
Acknowledgments
Acknowledgments
This study was supported by grants from the Fritz Thyssen-Stiftung (Germany) and from the Ministerium für Wissenschaft und Forschung Nordrhein-Westfalen (Germany). We thank H. Benkmann, A. Ishanov, E. Santos, P. v. Helden, J. ter Meulen, and the Musqueam Indian Band for human samples, and W. Schempp, U. Rümpler, and B. Uphoff for primate samples.
Footnotes
American Society of Nephrology
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