• 1
• 2
• 3
• 4

Alexandros Spyros Botsaris

Abstract

Despite all recent advances, collateral and adverse effects to drugs are still one of the biggest causes of discomfort provoked by iatrogeny in modern medicine. There is no yet efficient and cheap method developed to totally avoid them. Therefore we suggest to consider the use of Dermatoglyphics as it is a scientific study of hand lines that have been used in the identification of genetic tendencies for some conditions. The study of fingerprints, which is a part of dermatoglyphic evaluation, reveals five main groups of design and orientation of hand lines: plain arch, tented arch, radial loop, ulnar loop, and whorl. We propose that these five groups represent five clusters of similarities in physiological behavior, and that the five clusters will show different patterns of tolerance and response to most drugs used in medicine. When developed, this knowledge could be used to identify subjects prone to collateral and adverse effects to drugs and consequently prevent them.

 

Introduction

Adverse effects to drugs are one of the major causes of iatrogeny in present days, and medical science dreams of personal prescription that brings only benefits with no risk (1). The main proposal in medical science to solve this problem is developing more the knowledge about pharmacogenomics (2). Unfortunately, for applying pharmacogenomics in current drug prescription, a bigger knowledge about functions of human genome as well as mapping genes of all patients, are needed, which are goals still distant. Dermatoglyphic, a scientific study of the design of hand lines, although not widespread technique of diagnosis, has shown to reveal genetic tendency for many diseases (3).

In this article, we show that the study of hand lines reveal main groups and subgroups of patterns that have a great possibility of represent clusters of patients with distinct reaction to drug effect. The identification of clusters with different pattern of response to drugs could allow us to prevent adverse effects and adjust prescription to individual characteristics.

 

Background

The use of the fingerprint to identify the individuals and also for crime prosecution was developed by an English judge in India, Sir Edward Richard Henry. He came to this solution with the help of two Indian doctors (Haque and Bose), that told him about the individuality and specificity of fingerprints. With this discovery Henry was designed as chief of the Scotland Yard and his method became used worldwide, and it is still used nowadays (4). In many oriental medicines, we can find the examination of hand lines for the diagnosis of biotypes which, in general, correspond to five main ones (5).

To develop his methodology of study of digital and hand lines, Henry used a mathematical model of analysis of directional images, and probabilistic evaluation of line orientation, proposed by the French mathematician Henri Poincarré. After applying this methodology, he could describe five main groups of arrangement of finger and hand lines which are: plain arch, tented arch, radial loop, ulnar loop, and whorl, which are observed in more than 95% of individuals (6). Besides the five main groups, there are some rare mixed dispositions like double loop, arch with loop, arch with whorl (Peacock’s eye), etc (6).

Henry developed his methodology in the end of the XIX century, but this knowledge remained limited to personal criminal identification for more than 50 years. Charles Darwin asked his cousin Sir Francis Dalton to study the biological significance of fingerprints, in the beginning of the XX century, but no further knowledge could be developed by this time. Even though Dalton created the word and the concept of biometry, a science focused in measuring and describing specific characteristics of human beings, which is used in many fields, as in sport medicine (4), for example.

The word “Dermatoglyphics” was created by Harold Cummins, a professor of anatomy in the University of Oklahoma. He began to propose a methodology to describe hand lines and fingerprints, and showed that they could be important in the diagnosis of some conditions. Cummins created the word assembling “dermato” from skin with “glyphics” which means sculpture. Cummings´ work remained in the shadow till the pediatrician Sarah Holt made a revision on the theme and showed its importance in fast and simple diagnosis of trissomies e genetic conditions in newborns, in the seventies (3). Since then over 750 studies on this theme have been published, most of them revealing specific dermatoglyphic patterns in different diseases.

Dermatoglyphics uses more concepts than the fingerprint in its hand analysis, and it is a complete evaluation of hand lines. So the design of the hands and angles between the lines are also described. Although much more complex and specific in man, dermatoglyphic patterns can be found also in animals, making possible some investigation in this field (7). One interesting point is that complexity and variety of dermatoglyphic patterns in man have a correlation with the much more complex and unexpected reactions of human in the experimental field, to drugs and other variables. The variations in digital lines have a very close relationship with the hand lines, so conclusions of hand dermatoglytics can be applied to fingerprint lines as well (8).

Sensors and programs for digital and hand analysis have been developed because of the advancing technology of individual identification´s systems. The new products available for digital recognition are cheap and easy to install, therefore this technology could be rapidly applied to medical uses if necessary. The implementation of this innovation in medical practice could be fast and cheap, bringing enormous benefits and economy of resources to medicine. Faster and newer technology with more efficacious and effective sensors specific for dermatoglyphic are being developed, which will bring improvement in this diagnosis technique (9).

The Hypothesis

Our hypothesis is that people with the same dermatoglyphic finger basic pattern form clusters of similar profile of response to drugs. So we think that is highly probable that individuals prone to specific collateral effects to drugs can be identified by fingerprint analysis and this information can improve medical prescription. Once a cluster which is prone to collateral effects to a specific drug is identified, people with this characteristic can be prevented of using the drug, or can use it under more specific precaution recommendations. But evaluation of this hypothesis depends on collecting the fingerprints on clinical trials, with cross data analysis and comparison of the reactions of different fingerprints clusters.

Theory and Evaluation of the Hypothesis

The knowledge of drug and receptor interactions have experimented a great advance, and even a revolution in recent years. In the past, receptors were considered a static structure with a specific spatial disposition. Now we know that many stimuli can cause variations in receptors spatial configuration, and probably this is the reason for different responses to the same drug, and phenomena like tolerance, dependence and paradoxical reactions. A parallel situation is that many membrane proteins, like protein kinases, protein G and phospholipase C, can also influence receptors spatial conformation, and modulate the response to drugs and stimuli (10) That variation in response is more intense at the Central Nerve System (CNS), but can occur in almost every organ.

So, organic response to stimuli depends not only on genetics, but also on epigenetic mechanisms, that modulates expression of genes and spatial configuration of proteins. Epigenetic mechanisms are complex and can influence deeply gene function. Many receptors depend on epigenetic mechanisms to modulate their action (11). So more than a pure transcription of gene sequences, an ideal system to detect clusters, and even personal patterns of reaction to drugs and stimuli, we should also consider epigenetic manifestation. We have some evidences to propose that fingerprints are not only strongly influenced by genetic, but also by epigenetic, being a good representation of cell membrane receptors and interactions, which make an excellent instrument to the purpose that we are claiming.

One way to evaluate this hypothesis is to review briefly the knowledge of how the skin forms the hand lines. There still many controversies on the factors that determine finger and hand line formation. Even tough researchers identified influences on the hand line design by describing some rare conditions in which dermatoglyphics is deeply affected and generates great modifications from normal patterns. One of them is an abnormality on peripheral nerve or with central nervous system embryologic formation (12). This factor is probably derived from their common origin from the ectoderm, which makes both be influenced by the same chemical mediators and stimuli. An example of this close influence is the gene PHOX2B mutation, that generates the congenital central hypoventilation syndrome, with a dysfunction of the autonomous nervous system and associated with specific dermatoglyphic abnormalities (15).

A second important mechanism of formation of hand and finger lines are the so called “adhesion proteins”, which comprehends laminins, integrins, catenins and cadherins. These proteins allow cells to migrate and recognize specific sites to adhere, in the formation of skin infrastructure. (13, 14). This function is basic for the folding process that generates fingerprints. The adhesion proteins form the structures of cell adhesion, like desmossomes, but at the same time, play an important role in modulating many cell functions (16). Patients with mutation in adhesion proteins genes come with great abnormalities in hand and finger lines (17). Finally, some regulating genes like PAX, Homeobox, helix-loop-helix, have also an important role in embryologic development and in epigenetics, and can affect the phenotype expression of skin lines and folds (18, 19).

All the physiological processes are involved in fingerprint formation, eg: embryology of ectoderm derived tissues, genetics and physiology of adhesion proteins, and regulating genes function. They correspond to processes that can influence deeply physiological behavior and could generate differences of response to drugs and stimuli, that we actually observe among humans beings.

One largely unknown information about fingerprints is that they can change during lifetime, although the changes, in most people, are minimal (20). In some cases, these changes can be more pronounced, specially in patients with dermatologic inflammatory conditions affecting the hands, like psoriasis (20). The change of fingerprints in response to inflammation is one indirect evidence of the influence of epigenetic mechanisms in the determination of dermatoglyphic patterns. A study of vertebral malformations is also highly suggestive of the influence of epigenetics in dermatoglyphic patterns (25).

Dermatoglyphic specific patterns have been described in many conditions, including schizophrenia (21), bronchial asthma (22), rheumatoid arthritis (23), spina bifida cystic (24), psoriasis and eczema (26), hearing loss (27), ankylosing spondylitis (28) and Down syndrome (29), between others conditions referred in different publications. Most authors that have studied and published about dermatoglyphics agree that the dermal lines are a good representation of human genome expression.

Resuming all the data above, the hand lines studied by dermatoglyphics can serve as an expression of personal genome and epigenetics modulation of genome expression. This study allows us to separate human beings in five basic main groups of dermatoglyphic patterns (plain arch, tented arch, radial loop, ulnar loop, and whorl), that represent groups with similar genetic and epigenetic expression. They may also represent clusters of patients with similarities of physiological behavior and response to drugs and stimuli.

Additional Empirical Data

Besides the scientific information, empiric data coming from traditional oriental medicines, in special ayurvedic and Chinese medicines, support that exists five main clusters of standards individuals, that they call biotypes, that exhibit a specific pattern of physiological response (5). These biotypes are expected to react in different ways to stimuli, including reactions to drugs. Considering that knowledge about fingerprints come in part from ayurvedic medicine, it is possible that traditional oriental medicine biotypes correspond to the five basic patterns of fingerprint described by Henry, and this represents clusters of patients with genetic and epigenetic similarities. This is one more additional information suggesting that dermatoglyphics is an instrument to detect clusters of patients with specific pattern of response to drugs and stimuli.

Consequences of the Hypothesis and Discussion

If the hypothesis is correct, medical doctors will be allowed to use dermatoglyphic information to select patients which respond well to different drugs, from the ones that will present collateral or adverse effects. By the moment that clinical studies are made, dematoglyphic information of patients could be obtained focusing in the five groups (plain arch, tented arch, radial loop, ulnar loop, and whorl) and all the data is crossed to look for different pattern of response among them. It is highly possible that most patients with collateral effects and an inadequate response to a drug will concentrate in one or two groups. The next step is to use this knowledge to prevent sensitive patients to use the drugs they don’t tolerate. For example, for cancer chemotherapy, the patients that have dermatoglyphic pattern showing bad response to the main drug regimen can receive another drug combination that are less toxic for his dermatoglyfic pattern. Doctors would have better treatment results, less cost for treating drug complications, and patients would be more satisfied with drug technology.

Bibliography

1 – GINSBURG, S. G,; MCCARTHY, J. Personalized medicine: revolutionizing drug discovery and patient care. Trends in Biotechnology, 19(2):491-7, 2001.

2 – KOO, S. H. LEE, E. J. Pharmacogenetics approach to therapeutics. Clin Exp Pharmacol Physiol, may-jun.33(5-6):52-32, 2006.

3 – HOLT, S. B. The significance of dermatoglyphics in medicine. A short survey and summary. Clin Pediatr (Phila), aug. 12(8):471-84, 1973.

4 – VON MINDEN, D. L. The history of fingerprints. New York: Academy of Police, 2005.

5 – LISCUM, V.; XIAO, Fan, Z. Chinese medical palmistry: your health in your hand. Boulder: Colorado, Blue Poppy Press, 1996.

6 – FERNANDEZ, F. J. R. Impressão digital. SIM (Sector of Integrated Systems and Microsystems). São Paulo University, 2005.

7 – KIMURA, S. et al. Comparative investigations of human and rat dermatoglyphics: palmar, plantar and digital pads and flexion creases. Anat Sci Int., mar;77(1):34-46, 2002.

8 – BANIK, S. D.; PAL, P.; MUKHERJEE, D. P. Finger dermatoglyphic variations in Rengma Nagas of Nagaland India. Coll Antropol, mar;33(1):31-5, 2009.

9 – PALMA J.; LIESSNER, C. Mil'shtein S. Contactless optical scanning of fingerprints with 180 degrees view. Scanning, nov.-dec. 28(6):301-4, 2006.

10 – MORMEDE, P. et al. Molecular genetic approaches to investigate individual variations in behavioral and neuroendocrine stress responses. Psychoneuroendocrinology, jul;27(5):563-83, 2002.

11 – MURRE, C. Epigenetics of antigen-receptor gene assembly. Curr Opin Genet Dev, oct;17(5):415-21, 2007. Epub, oct, 24, 2007.

12 – KÜCKEN, M. Models for fingerprint pattern formation. Forensic Sci Int, sep 13;171(2-3):85-96, 2007.

13 – MELKER, A. A. et al. Cellular localization and signaling activity of beta-catenin in migrating neural crest cells. Dev Dyn, aug;230(4):708-26, 2004.

14 – HENTULA M.; PELTONEN, J. Peltonen S. Expression profiles of cell-cell and cell-matrix junction proteins in developing human epidermis. Arch Dermatol Res., may;293(5):259-67, 2001.

15 – TODD, E. S. et al. Characterization of dermatoglyphics in PHOX2B-confirmed congenital central hypoventilation syndrome. Pediatrics, aug;118(2):e408-14, 2006.

16 – DUSEK, R. L.; GODSEL, L. M.; GREEN, K. J. Discriminating roles of desmosomal cadherins: beyond desmosomal adhesion. J Dermatol Sci, jan;45(1):7-21, 2007.

17 – JACOB, K. N. Garg A. Laminopathies: multisystem dystrophy syndromes. Mol Genet Metab, apr 87(4):289-302, 2006.

18 – WESTERMAN, B. A.; MURRE, C.; OUDEJANS, C. B. The cellular Pax-Hox-helix connection. Biochim Biophys Acta, oct 1;1629(1-3):1-7, 2003.

19 – POLANI PE. Developmental asymmetries in experimental animals. Neurosci Biobehav Rev. 1996 Winter;20(4):645-9.

20 – .

21 – SIVKOV, S.; AKABALIEV, V. Dermatoglyphics in schizophrenia: qualitative aspects. Folia Med (Plovdiv), 40(3):44-50, 1998.

22 – GUPTA, U. K.; PRAKASH, S. Dermatoglyphics: a study of finger tip patterns in bronchial asthma and its genetic disposition. Kathmandu Univ Med J (KUMJ), oct.-dec. 1(4):267-71, 2003.

23 – RAVINDRANATH, R et al. Dermatoglyphics in rheumatoid arthritis. Indian J Med Sci, oct;57(10):437-41, 2003.

24 – IGBIGBI, P. S. Adeloye A. Dermatoglyphics of mothers of Malawian children with spina bifida cystica: a comparative study with female controls. West Afr J. Med., Jan-Mar;24(1):58-61, 2005.

25 – GOLDBERG, C. J. FOGARTY, E. E.; MOORE, D. P. Dowling FE. Fluctuating asymmetry and vertebral malformation. A study of palmar dermatoglyphics in congenital spinal deformities. Spine (Phila Pa 1976), Apr 1;22(7):775-9, 1997.

26 – POUR-JAFARI, H. et al. Dermatoglyphics in patients with eczema, psoriasis and alopecia areata. Skin Res Technol, aug;9(3):240-4, 2003.

27 – SIKI?, N. et al. Qualitative analysis of dermatoglyphics of the digito-palmar complex in children with severe recessive perceptively impaired hearing. Coll Antropol, jun. 33(2):599-605, 2009.

28 – CVJETICANIN, M. JAJI?, Z.; JAJI?, I. Quantitative analysis of digitopalmar dermatoglyphics in men with ankylosing spondylitis. Reumatizam, 47(1):5-12, 2000.

29 – RAJANGAM, S.; JANAKIRAM, S.; THOMAS, I. M. Dermatoglyphics in Down syndrome. J Indian Med Assoc, Jan;93(1):10-3, 1995.