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Nobakht E, Jagadeesan M, Paul R, Bromberg J, Dadgar S. Precision Medicine in Kidney Transplantation: Just Hype or a Realistic Hope? Transplant Direct 2021; 7:e650. [PMID: 33437865 PMCID: PMC7793397 DOI: 10.1097/txd.0000000000001102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 12/17/2022] Open
Abstract
Desirable outcomes including rejection- and infection-free kidney transplantation are not guaranteed despite current strategies for immunosuppression and using prophylactic antimicrobial medications. Graft survival depends on factors beyond human leukocyte antigen matching such as the level of immunosuppression, infections, and management of other comorbidities. Risk stratification of transplant patients based on predisposing genetic modifiers and applying precision pharmacotherapy may help improving the transplant outcomes. Unlike certain fields such as oncology in which consistent attempts are being carried out to move away from the "error and trial approach," transplant medicine is lagging behind in implementing personalized immunosuppressive therapy. The need for maintaining a precarious balance between underimmunosuppression and overimmunosuppression coupled with adverse effects of medications calls for a gene-based guidance for precision pharmacotherapy in transplantation. Technologic advances in molecular genetics have led to increased accessibility of genetic tests at a reduced cost and have set the stage for widespread use of gene-based therapies in clinical care. Evidence-based guidelines available for precision pharmacotherapy have been proposed, including guidelines from Clinical Pharmacogenetics Implementation Consortium, the Pharmacogenomics Knowledge Base National Institute of General Medical Sciences of the National Institutes of Health, and the US Food and Drug Administration. In this review, we discuss the implications of pharmacogenetics and potential role for genetic variants-based risk stratification in kidney transplantation. A single score that provides overall genetic risk, a polygenic risk score, can be achieved by combining of allograft rejection/loss-associated variants carried by an individual and integrated into practice after clinical validation.
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Affiliation(s)
- Ehsan Nobakht
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University School of Medicine, Washington, DC
| | - Muralidharan Jagadeesan
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University School of Medicine, Washington, DC
| | - Rohan Paul
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University School of Medicine, Washington, DC
| | - Jonathan Bromberg
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Sherry Dadgar
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University School of Medicine, Washington, DC
- Personalized Medicine Care Diagnostics Laboratory (PMCDx), Inc., Germantown, MD
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de Oliveira Filho RA, Monteiro Júnior JGDM, Sobral Filho DC, Torres DDOC, Souto FO, Martins DBG, de Lima Filho JL, de Araújo RFF. Impact of cytokines levels and interleukin 6 (-634 C>G) polymorphism on clinical outcomes in patients with sepsis. Meta Gene 2020; 26:100814. [DOI: 10.1016/j.mgene.2020.100814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Oetting WS, Schladt DP, Dorr CR, Wu B, Guan W, Remmel RP, Iklé D, Mannon RB, Matas AJ, Israni AK, Jacobson PA; DeKAF Genomics and GEN03 Investigators. Analysis of 75 Candidate SNPs Associated With Acute Rejection in Kidney Transplant Recipients: Validation of rs2910164 in MicroRNA MIR146A. Transplantation 2019; 103:1591-602. [PMID: 30801535 DOI: 10.1097/TP.0000000000002659] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Identifying kidney allograft recipients who are predisposed to acute rejection (AR) could allow for optimization of clinical treatment to avoid rejection and prolong graft survival. It has been hypothesized that a part of this predisposition is caused by the inheritance of specific genetic variants. There are many publications reporting a statistically significant association between a genetic variant, usually in the form of a single-nucleotide polymorphism (SNP), and AR. However, there are additional publications reporting a lack of this association when a different cohort of recipients is analyzed for the same single-nucleotide polymorphism. METHODS In this report, we attempted to validate 75 common genetic variants, which have been previously reported to be associated with AR, using a large kidney allograft recipient cohort of 2390 European Americans and 482 African Americans. RESULTS Of those variants tested, only 1 variant, rs2910164, which alters the expression of the microRNA MIR146A, was found to exhibit a significant association within the African American cohort. Suggestive variants were found in the genes CTLA and TLR4. CONCLUSIONS Our results show that most variants previously reported to be associated with AR were not validated in our cohort. This shows the importance of validation when reporting the associations with complex clinical outcomes such as AR. Additional work will need to be done to understand the role of MIR146A in the risk of AR in kidney allograft recipients.
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Dorr CR, Oetting WS, Jacobson PA, Israni AK. Genetics of acute rejection after kidney transplantation. Transpl Int 2017; 31:263-277. [PMID: 29030886 DOI: 10.1111/tri.13084] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/07/2017] [Accepted: 10/09/2017] [Indexed: 01/02/2023]
Abstract
Treatment of acute rejection (AR) following kidney transplantation has improved in recent years, but there are still limitations to successful outcomes. This review article covers literature in regard to recipient and donor genetics of AR kidney and secondarily of liver allografts. Many candidate gene and some genome-wide association studies (GWASs) have been conducted for AR in kidney transplantation. Genetic associations with AR in kidney and liver are mostly weak, and in most cases, the associations have not been reproducible. A limitation in the study of AR is the lack of sufficiently large populations that account for population stratification to study the AR phenotype which in this era occurs in <10% of transplants. Furthermore, the AR phenotype has been difficult to define and the definitions of classifications have evolved over time. Literature related to the pharmacogenomics of tacrolimus is robust and has been validated in many studies. Associations between gene expression and AR are emerging as markers of outcomes and AR classification. In the future, combinations of pretransplant genotype for AR risk prediction, genotype-based immune suppressant dosing, and pharmacogenomic markers to select AR maintenance or treatment and expression markers from biopsies may provide valuable clinical tools for guiding treatment.
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Affiliation(s)
- Casey R Dorr
- Department of Nephrology, Minneapolis Medical Research Foundation, Minneapolis, MN, USA.,Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - William S Oetting
- Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | - Pamala A Jacobson
- Department of Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | - Ajay K Israni
- Department of Nephrology, Minneapolis Medical Research Foundation, Minneapolis, MN, USA.,Department of Medicine, University of Minnesota, Minneapolis, MN, USA.,Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
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Lee HJ, Kim TH, Kang SW, Kim YH, Kim SK, Chung JH, Kim YG, Moon JY, Lee SH, Ihm CG, Lee TW, Jeong KH. Association Interleukin-4 and Interleukin-4 Receptor Gene Polymorphism and Acute Rejection and Graft Dysfunction After Kidney Transplantation. Transplant Proc 2017; 48:813-9. [PMID: 27234743 DOI: 10.1016/j.transproceed.2015.12.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/25/2015] [Accepted: 12/30/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cytokine genotypes have previously been studied in patients undergoing solid organ transplantation; certain polymorphisms have been implicated in the development of acute rejection (AR) and graft dysfunction (GD). Allograft outcomes determined, in part, by alloimmune responses is mainly mediated by T-cell responses, activated and driven by cytokines. Interleukin-4 (IL-4) is one such cytokine, which exerts its biological effects through binding to the IL-4 receptor (IL-4R) complex on target cells. In the present study, we investigated whether polymorphisms of the IL-4 and/or IL-4R gene were associated with susceptibility to acute AR and GD after kidney transplantation. METHODS We analyzed 2 single nucleotide polymorphism (SNPs) of IL-4 (rs2243250 and rs2070874) and 3 SNPs of IL-4R (rs1801275, rs2107356, and rs1805010) in 344 kidney transplant recipients. These patients included 62 of whom had developed AR and 215 of whom had GD in 1 year after kidney transplantation. RESULTS The AR group included 62 patients (45 men and 17 women). There was a statistically significant difference in the male-to-female ratio and the use of tacrolimus in the AR group. The GD group included 215 patients. Patients who developed GD were more likely to be older and have an underlying cause of end-stage renal disease that was unknown compared with patients who did not have GD, the cause of which was typically known. Among the SNPs examined, 1 of the SNPs in the IL-4R gene (ie, rs1801275) showed a statistical association with AR (co-dominant model, P = .061; dominant model, P = .019; and log-addictive model, P = .029). In addition, 1 of the IL-4R SNPs (ie, rs2107356) was statistically associated with GD (dominant model, P = .034). No significant difference in the IL-4 genotype was observed between the AR/GD and non-AR/non-GD subjects. CONCLUSIONS One IL-4R gene polymorphism (rs1801275) was associated with AR. In addition, a separate IL-4R SNP (rs2107356) was statistically associated with GD after kidney transplantation.
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Affiliation(s)
- H J Lee
- Department of Nephrology, Seoul Red Cross Hospital, Seoul, Republic of Korea
| | - T H Kim
- Department of Nephrology, School of Medicine, Inje University, Busan, Republic of Korea
| | - S W Kang
- Department of Nephrology, School of Medicine, Inje University, Busan, Republic of Korea
| | - Y H Kim
- Department of Nephrology, School of Medicine, Inje University, Busan, Republic of Korea
| | - S K Kim
- Kohwang Medical Research Institute, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - J-H Chung
- Kohwang Medical Research Institute, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Y G Kim
- Department of Nephrology, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - J Y Moon
- Department of Nephrology, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - S H Lee
- Department of Nephrology, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - C G Ihm
- Department of Nephrology, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - T W Lee
- Department of Nephrology, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - K H Jeong
- Department of Nephrology, School of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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Hu Q, Tian H, Wu Q, Li J, Cheng X, Liao P. Association Between Interleukin-2 -330 T/G Polymorphism and Acute Renal Graft Rejection: A Meta-analysis. Transplant Proc 2016; 47:1746-53. [PMID: 26293045 DOI: 10.1016/j.transproceed.2015.04.090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 04/28/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Interleukin-2 (IL-2) -330 T/G promoter polymorphism is involved in the acute rejection (AR) risk of kidney transplantation. However, results from published studies on the association between recipient IL-2-330 T/G polymorphism and AR risk are conflicting and inconclusive. METHODS We searched Medline, Embase, Web of Science, and Cochrane Central Register from their inceptions through January 2015 for relevant studies. Data concerning publication information, population characteristics, and transplant information were extracted. Odds ratios (ORs) were calculated for the association between IL-2-330 T/G polymorphism and AR risk. RESULTS This meta-analysis included 8 case-control studies with 1,405 cases of renal transplant recipients. The pooled estimate showed that IL-2-330 T/G polymorphism was not associated with AR risk: TT vs TG+GG: OR(fixed,) 0.93; 95% confidence interval [CI], 0.72-1.21; P = .60; GG vs TG+TT: OR(fixed), 1.15; 95% CI, 0.76-1.72; P = .51; TG vs TT+GG: OR(fixed), 1.01; 95% CI, 0.78-1.31; P = .91; T vs G: OR(fixed), 0.93; 95% CI, 0.77-1.13; P = .48. None of subgroup analyses yielded significant results in the association between IL-2-330 T/G polymorphism and AR risk. Meta-regression confirmed that there was no significant correlation between the preselected trial characteristics and our study results. CONCLUSIONS This meta-analysis suggests that IL-2-330 T/G polymorphism may not be associated with AR risk in renal transplant recipients.
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Affiliation(s)
- Q Hu
- Chongqing Center for Clinical Laboratory, Yuzhong, Chongqing, China; Department of Clinical Laboratory Medicine, Third People's Hospital of Chongqing, Yuzhong, Chongqing, China
| | - H Tian
- Chongqing Center for Clinical Laboratory, Yuzhong, Chongqing, China; Department of Clinical Laboratory Medicine, Third People's Hospital of Chongqing, Yuzhong, Chongqing, China
| | - Q Wu
- Chongqing Center for Clinical Laboratory, Yuzhong, Chongqing, China; Department of Clinical Laboratory Medicine, Third People's Hospital of Chongqing, Yuzhong, Chongqing, China
| | - J Li
- Chongqing Center for Clinical Laboratory, Yuzhong, Chongqing, China; Department of Clinical Laboratory Medicine, Third People's Hospital of Chongqing, Yuzhong, Chongqing, China
| | - X Cheng
- Department of Cardiology, Banan People's Hospital of Chongqing, Banan, Chongqing, China
| | - P Liao
- Chongqing Center for Clinical Laboratory, Yuzhong, Chongqing, China; Department of Clinical Laboratory Medicine, Third People's Hospital of Chongqing, Yuzhong, Chongqing, China.
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Stojanova J, Pouché L, Picard N. Genetic polymorphisms in the immune response: A focus on kidney transplantation. Clin Biochem 2016; 49:363-76. [DOI: 10.1016/j.clinbiochem.2015.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/04/2015] [Accepted: 07/08/2015] [Indexed: 02/06/2023]
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Chen Z, Bouamar R, Van schaik RH, De Fijter JW, Hartmann A, Zeier M, Budde K, Kuypers DR, Weimar W, Hesselink DA, Van Gelder T. Genetic polymorphisms inIL-2,IL-10,TGF-β1, andIL-2RBand acute rejection in renal transplant patients. Clin Transplant 2014; 28:649-55. [DOI: 10.1111/ctr.12346] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2014] [Indexed: 01/05/2023]
Affiliation(s)
- Zhigang Chen
- Department of Hospital Pharmacy; Erasmus MC; Rotterdam The Netherlands
- Department of Hospital Pharmacy; Beijing Jishuitan Hospital; Beijing China
| | - Rachida Bouamar
- Department of Hospital Pharmacy; Erasmus MC; Rotterdam The Netherlands
| | | | - Johan W. De Fijter
- Department of Nephrology; Leiden University Medical Centre; Leiden The Netherlands
| | - Anders Hartmann
- Department of Transplant Medicine; Oslo University Hospital; Rikshospitalet Norway
| | - Martin Zeier
- Department of Nephrology; University of Heidelberg; Heidelberg Germany
| | - Klemens Budde
- Department of Nephrology; Charité University; Berlin Germany
| | | | - Willem Weimar
- Department of Internal Medicine; Erasmus MC; Rotterdam The Netherlands
| | | | - Teun Van Gelder
- Department of Hospital Pharmacy; Erasmus MC; Rotterdam The Netherlands
- Department of Internal Medicine; Erasmus MC; Rotterdam The Netherlands
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Sudenga SL, Wiener HW, Shendre A, Wilson CM, Tang J, Shrestha S. Variants in interleukin family of cytokines genes influence clearance of high risk HPV in HIV-1 coinfected African-American adolescents. Hum Immunol 2013; 74:1696-700. [PMID: 23973891 DOI: 10.1016/j.humimm.2013.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 06/19/2013] [Accepted: 08/10/2013] [Indexed: 10/26/2022]
Abstract
Our work aimed to examine the potential influence of variants in interleukin/interleukin receptors genes on high-risk (HR-HPV) HPV clearance. Clearance of genital HR-HPV infection was evaluated for 134 HIV-1 seropositive African-American female adolescents from the Reaching for Excellence in Adolescent Care and Health (REACH) cohort. Genotyping targeted 225 single nucleotide polymorphisms (SNPs) within the exons, 5' untranslated region (UTR) and 3' UTR sequences of 27 immune-related candidate genes encoding interleukin family of cytokines. Cox proportional hazard models were used to determine the association of type-specific HPV clearance adjusting for time-varying CD4+ T-cell count and low-risk (LR-HPV) HPV co-infections. HR-HPV clearance rates were significantly (p < 0.001) associated with five SNPs (rs228942, rs419598, rs315950, rs7737000, and rs9292618) mapped to coding and regulatory regions in three genes (IL2RB, IL1RN, and IL7R). These data suggest that the analyzed genetic variants in interleukin family of cytokines modulate HR-HPV clearance in HIV-1 seropositive African-Americans that warrants replication.
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Affiliation(s)
- Staci L Sudenga
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
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Huang X, Kühne V, Kun JFJ, Soboslay PT, Lell B, Tp V. In-vitro characterization of novel and functional regulatory SNPs in the promoter region of IL2 and IL2R alpha in a Gabonese population. BMC Med Genet 2012; 13:117. [PMID: 23217119 PMCID: PMC3564939 DOI: 10.1186/1471-2350-13-117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 11/30/2012] [Indexed: 11/16/2022]
Abstract
Background The selection pressure imposed by the parasite has a functional consequence on the immune genes, leading to altered immune function in which regulatory T cells (Tregs) induced by parasites during infectious challenges modulate or thwart T effector cell mechanism. Methods We identified and investigated regulatory polymorphisms in the immune gene IL2 and its receptor IL2R alpha (also known as CD25) in Gabonese individuals exposed to plentiful parasitic infections. Results We identified two reported variants each for IL2 and its receptor IL2R alpha gene loci. Also identified were two novel variants, -83 /-84 CT deletions (ss410961576) for IL2 and -409C/T (ss410961577) for IL2R alpha. We further validated all identified promoter variants for their allelic gene expression using transient transfection assays. Three promoter variants of the IL2 locus revealed no significant expression of the reporter gene. The identified novel variant (ss410961577C/T) of the IL2R alpha revealed a significant higher expression of the reporter gene in comparison to the major allele (P<0.05). In addition, the rs12722616C/T variant of the IL2R alpha locus altered the transcription factor binding site TBP (TATA box binding protein) and C/EBP beta (CCAAT/enhancer binding protein beta) that are believed to regulate the Treg function. Conclusions The identification and validation of such regulatory polymorphisms in the immune genes may provide a basis for future studies on parasite susceptibility in a population where T cell functions are compromised.
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Affiliation(s)
- Xiangsheng Huang
- Institute for Tropical Medicine, University of Tübingen, Wilhelmstrasse 27, Tübingen 72074, Germany
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