G-quadruplexes (G4s) are prevalent DNA structures that regulate transcription but also threaten genome stability. How G4 dynamics are controlled remains poorly understood. Here, we report that RNA tra Show more
G-quadruplexes (G4s) are prevalent DNA structures that regulate transcription but also threaten genome stability. How G4 dynamics are controlled remains poorly understood. Here, we report that RNA transcripts govern G4 landscapes through coordinated G-loop assembly and disassembly. G-loop assembly involves activation of the ATM and ATR kinases, followed by homology-directed invasion of RNA opposite the G4 strand mediated by BRCA2 and RAD51. Disassembly of the G-loop resolves the G4 structure through DHX36-FANCJ-mediated G4 unwinding, which triggers nucleolytic incision and subsequent hybrid strand renewal by DNA synthesis. Inhibition of G-loop disassembly causes global G4 and R-loop accumulation, leading to transcriptome dysregulation, replication stress, and genome instability. These findings establish an intricate G-loop assembly-disassembly mechanism that controls G4 landscapes and is essential for cellular homeostasis and survival. Show less
Lipoprotein(a) [Lp(a)] is a known independent risk factor for cardiovascular disease, yet awareness and management remain limited. The psychosocial implications of elevated Lp(a)-levels have been poor Show more
Lipoprotein(a) [Lp(a)] is a known independent risk factor for cardiovascular disease, yet awareness and management remain limited. The psychosocial implications of elevated Lp(a)-levels have been poorly characterized. To compare cardiovascular outcomes and cardiovascular risk factor (CVRF) modification in individuals with normal vs. elevated Lp(a) levels, and to assess the impact of individualized prevention recommendations. For the first time, the individual psychological stress caused by Lp(a) is being surveyed. The ELITE study is a prospective, interventional cohort study conducted in north-western Germany. Participants were regularly assessed for CVRFs, including Lp(a), hypertension, dyslipidemia, diabetes mellitus, weight, nicotine - as well as lipoprotein (a), physical activity, dietary habits, depression and stress. They received written, personalized prevention recommendations. Follow-up averaged 4.4 years. Two groups were analyzed: Group 1 (Gr1, n=3,241) with normal Lp(a), and Group 2 (Gr2, n=841) with elevated Lp(a ≥75 nmol/l). Gr2 (mean Lp(a) 154.8 nmol/l) and Gr1 (mean Lp(a) 16.4 nmol/l) were comparable in age (~53 years) and sex distribution (~49% female). Most participants with elevated Lp(a) were previously unaware of their levels; 30% were referred to specialists, and ~40% reported concern or anxiety. Combined cardiovascular endpoints (CHD, stroke, heart failure, PAD, carotid stenosis, AF) occurred significantly more often in Gr2 (p<0.001), despite similar CVRF profiles, except for higher baseline LDL-C in Gr2 (p<0.001). Hypertension (61%) and physical inactivity (57%) were the most prevalent CVRFs. Personalized prevention measures led to significant improvements in blood pressure, LDL-C, smoking, physical activity, and weight in both groups. Lipid-lowering therapy improved markedly in Gr2 (12% to 23%). Elevated Lp(a) is associated with a significantly higher rate of cardiovascular events, independent of traditional CVRFs. This confirms a causal role of Lp(a) in CV morbidity. Personalized written prevention recommendations improved CVRFs across both groups, though further optimization is needed. Notably, elevated Lp(a) also imposes a psychosocial burden, underlining the need for enhanced education, counseling, and clinical pathways. Show less