Clinical implications of DNA typing in organ transplantation. The Collaborative Transplant Study

Cooperative influence of the interleukin-6 promoter polymorphisms -597, -572 and -174 on long-term kidney allograft survival

Recently, we demonstrated an association of the IL-6 promoter polymorphism at position -174 (G-->C) with kidney allograft survival whereby carriers of the -174GG genotype were identified as having superior graft survival. As two additional polymorphisms were discovered in the neighborhood at positions -572 (G-->C) and -597 (G-->A), respectively, and as functional studies revealed a cooperative impact of all three on the IL-6 gene transcription, we investigated whether there is a combined effect on kidney transplant outcome. We determined IL-6 promoter haplotypes -597 (G-->C)/-572 (G-->A)/-174 (G-->C)(-597/-572/-174haplotype) using a PCR system with sequence-specific primers in 158 patients after primary cadaveric kidney transplantation. We here show that the -597 and -174 polymorphism are in tight-linkage disequilibrium and that homozygous carriers of the GGG-597/-572/-174 haplotype (GGG/GGG genotype) have superior 3-year graft survival rates compared with the 8.0-fold increased risk of premature graft loss in all other patients. Interestingly, patients carrying the GGG/GCG genotype had the lowest allograft survival rate. Thus determination of the combined -597/-572/-174 genotype allows for further differentiation of -174GG patients into subgroups and consequently for a more accurate identification of patients at risk. Our results indicate that the three polymorphisms act in a cooperative fashion and we provide evidence for an exceptional clinical impact of the IL-6-597/-572/-174 genotype on the success of kidney transplantation.

The interleukin-6 -174promoter polymorphism is associated with long-term kidney allograft survival

BACKGROUND

Th1-dependent effector mechanisms may be responsible for allograft rejection. Recently, interleukin-6 (IL-6) has been shown to antagonize CD4+ T cells to effector Th2 cells and, in the process, differentiate them into Th1 cells.

METHODS

To assess the role of IL-6 in long-term allograft survival, 158 patients after first cadaveric kidney transplantation were analyzed for the biallelic -174G-->C promoter polymorphism of the IL-6 gene.

RESULTS

Carriers of the -174C-allele (genotype GC/CC) had an inferior three-year graft survival (71/104 = 68.3%; P = 0.0059) with a 3.7-fold increased relative risk of graft loss compared to carriers of the -174GG-genotype (48/54 = 88.9%). The -174GC/CC-genotype retained its negative impact on graft survival when other established prognostic factors and further cytokine polymorphisms (-308TNF-alpha, TGF-beta1 codon 10 & 25, -592/-819/-1082IL-10 and +874IFN-gamma) were considered simultaneously.

CONCLUSIONS

Since the clinical impact on transplant outcome seems as important as matching for histocompatibility antigens, genotyping of the IL-6 -174polymorphism may offer a new method for identifying patients at increased risk of allograft loss.

Molecular basis of HLA polymorphism: implications in clinical transplantation

Polymorphism of the human leukocyte antigens (HLA) represents a major barrier to organ and hematopoietic stem cell (HSC) transplantation. The cloning and sequencing of HLA class I and II genes has not only provided a clear picture of the molecular basis of allelic polymorphism, but also allowed the development of a variety of PCR-based DNA typing techniques. Such methods are now progressively replacing serological typing for assessing donor/recipient HLA compatibility in clinical transplantation. The 100 serological HLA-A,B,Cw,DR,DQ,DP specificities now comprise more than 1300 alleles defined at the DNA sequence level. Most of the serotypes are subdivided into numerous allelic subtypes in worldwide populations (up to 50 alleles in some cases), although a limited number of alleles are detected in a given population group. In organ transplantation application of HLA molecular typing allowed to improve typing quality, leading to a more precise matching assessment with better clinical results. Knowledge of the molecular basis of class I gene polymorphisms also led to the development of new matching algorithms such as HLA-Matchmaker, based on immunogenic amino acid triplets localized on antibody-accessible external domains of class I antigens. The most impressive impact of novel DNA typing methods concerns matching for allogeneic HSC transplantation because subtle serologically silent sequence differences between allelic subtypes are efficiently recognized by alloreactive T-cells with potentially serious consequences for graft outcome. High resolution HLA class I and II matching has contributed to improve patients survival after unrelated HSC transplantation, although the relative importance of individual loci remains to be elucidated. Donor matching criteria should take into account parameters such as the time frame allowed by the patient's disease and the probability to identify a well matched donor based on the patient's HLA phenotype.

The IL-4 receptor alpha-chain variant Q576R is strongly associated with decreased kidney allograft survival

The involvement of the interleukin-4 (IL-4) pathway in B-lymphocyte activation and induction of a T helper 2 (Th2) cell response prompted us to investigate the influence of a recently described gain-of function mutation in the IL-4 receptor alpha-chain gene (IL-4R alpha; CD 124) on renal allograft survival. We developed a genotyping assay for the IL-4R alpha variant Q576R and investigated 203 renal transplant patients, all of whom underwent transplantation surgery at a single institution. The overall frequency of the IL-4R alpha variant Q576R in this group was 38.9% (79/203). The Kaplan-Meier method was used to estimate the graft survival of 156 patients with complete follow-up time of 24 months. Significantly higher graft survival rates (P=0.012, log-rank test) were found in patients with the wild-type IL-4 receptor (2-year graft survival 78.8%) as compared to patients with the IL-4R alpha variant Q576R (2-year graft survival 60.6%). Multifactorial cox regression analysis showed that this effect was independent of HLA matching, sex of donor and recipient, age of recipient, year of transplantation and preformed antibodies (P=0.017). These results indicate a strong association of the IL-4R alpha variant Q576R with kidney allograft loss. Genotyping of kidney allograft recipients for the IL-4R alpha variant may offer a simple method to identify high-risk patients in the post-transplantation period.