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The coding region of the CCR2 gene was amplified with primers CCR2F3: 5′ ATGCT GTCCA CATCT CGTTC and CCR2R3: 5′ CCCAA AGACC CACTC ATTTG (1 to 327 bp); CCR2F4: 5′ ATTAC TCTCC CATTG TGGGC and CCR2R4: 5′ GGAAA TTATT CCATC CTCGTG (277 to 604 bp); CCR2F1: 5′ TTCTG TTTAT GTCTG TGGCC and CCR2R6: 5′ GATTG ATGCA GCAGT GAGTC (555 to 904 bp); and CCR2F5: 5′ CCAAG CCACG CAGGT GACAG and CCR2R5: 5′ TTATA AACCA GCCGA GACTT (852 to 1083 bp). The products were resolved on 6% acrylamide gels (37.5:1 acrylamide:bis-acrylamide) containing 10% glycerol at room temperature. The entire CCR2 coding region was examined by SSCP in 127 individuals. One common synonymous nucleotide substitution was discovered (N260N; f = 0.46), and three additional variants (CCR2: V52V, P47L, and S87A) were found in fewer than 1% of chromosomes. CCR2-641 homozygotes (one Caucasian and one African American) were sequenced through the entire coding region of CCR2 (including the CCR2A exon) and CCR5, as well as 500 bp of the upstream region of both genes. No nucleotide alterations were identified. More than 100 individuals have been screened by SSCP across the CCR5 gene. A total of 16 additional variants in the coding region have been identified (M. Carrington et al., in preparation). All of these variants are rare (≤4%) and none is found exclusively on the CCR2-641 haplotype.
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45
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note
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Genotypes were determined by SSCP and with a PCR-RFLP assay using a Bsa Bl site introduced into the PCR primer next to the C-T transition that encodes the CCR2-641 polymorphism. Amplification with the primers CKR2_1A: 5′TTGTGGGCAACAT-GaTGG, which has a cytosine substituted with an adenine (in tower case) and CKR2_1Z: 5′GAGC-CCACAATGGGAGAGTA generated a 128-bp product. Digestion with Bsa Bl yields 110-and 18-bp fragments when an isoteocine was present instead of valine at position 64 in CCR2. These products were genotyped on 4% AMRESCO 3:1 biotechnology-grade agarose TBE gets.
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The cohorts and date of first enrollments were: the AIDS Link to the Intravenous Experience (AUVE-1988) (34), Human Growth and Development (HGDS-1989) (35), Multicenter AIDS Cohort Study (MACS-1984) (36), Multicenter Hemophiliac Cohort Study (MHCS-1985) (37) and San Francisco City Clinic Study (SFCC-1978) (38). Patient genotypes were determined from DNA extracted from immortal lymphoblastoid B-cell lines established for each patient (79). The HGDS cohort did not include seroconvertor patients.
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2 = 0.31; P = 0.86; genotypes g = 1.12; P = 0.57). The same lack of difference was observed when individual cohorts were examined.
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56
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1842416136
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note
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G = 0.44; P = 0.5. Only Caucasian individuals were examined in this analysis. CCR5-A32/A32 homozygotes were excluded to remove known protective effects (19-22) because none of these would have CCR2-641 genotypes due to linkage disequilibrium (see text).
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note
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Seroconverter patients included 891 subjects with a maximum interval of 3 years between an HIV-1 antibody-negative test date and their first HIV-1 antibody-positive test date. Seroconversion date was the midpoint between the last HIV-1 antibody-negative and first positive clinic visits. Ninety patients enrolled in the SFCC study before 31 December 1980 were included using imputed seroconversion dates based on their date of first HIV-1 antibody positive, because the likelihood of infection before 1 January 1978 (a 3-year window of infection) was extremely low (≤0.01). Seroconversion dates for the imputed SFCC subjects were set at 60 days, 120 days, and 180 days before the date for first antibody positive visit for patients enrolled in 1978, 1979, and 1980, respectively (38).
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The ALIVE cohort is composed of 94% African Americans, and the large racial difference between AUVE and other cohorts (MACS, MHCS, SFCC, and HGDS are composed of 6%, 13%, 4%, and 10% African Americans, respectively) may contribute to the absence of a survival effect of CCR2 genotypes seen in Table 1. Alternatively, the results may reflect the relatively shorter period of follow-up, because the ALIVE began enrollment in 1988 (33). In support of the latter explanation is the elevated CCR2-+/641 "protective" genotype frequency among ALIVE slow progressors relative to rapid progressors to AIDS for the three AIDS endpoints (Rg. 2). Because this result is not statistically significant, the conclusion remains tentative until longer follow-up of African American cohorts becomes available.
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Because the four cohorts show no significant differences in CCR2 allele or genotype frequency, they were pooled to test for significant differences between rapid and slow or nonprogressors, which were apparent. In addition, CCR2-641 containing genotypes were higher in all cohorts for 24 of 24 comparisons (two genotypes, four cohorts, three AIDS outcomes). Because these comparisons are interdependent, we applied a sign test to eight comparisons (four cohorts, two genotypes) to detect P ≤ 0.004.
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When a conservative sign test to three genotypes and three cohorts was applied for only one outcome, there was a significant excess of [+/Δ32], [641/+], and [641/641] (Fig. 2 and (54) for [641/641]} (P = 0.002).
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Smith, W.W.1
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note
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We gratefully acknowledge the patients, their families, and clinicians who have participated in the ALIVE, MACS, MHCS, HGDS, and SFCC cohort studies. We thank R. Boaze, R. Byrd, S. Cevario, B. Gerrard, P. Lloyd, M. McNally, M. Malasky, S. Shrestha, E. Topper, and M. Weedon for technical assistance, and S. Edelstein, A. Munoz, S. Donfield, E. Gomperts, J, Giorgi, and J. Oppenheim for helpful discussions. The Frederick Biomedical Supercomputing Center provided computational resources used in some of our analyses. Additional analyses and data mentioned here can be inspected at rex.n-ci.nih.gov/RESEARCH/basicyigd/front_page.htm.
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