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Krismawati H, Irwanto A, Pongtiku A, Irwan ID, Maladan Y, Sitanggang YA, Wahyuni T, Tanjung R, Sun Y, Liu H, Zhang F, Oktavian A, Liu J. Validation study of HLA-B*13:01 as a biomarker of dapsone hypersensitivity syndrome in leprosy patients in Indonesia. PLoS Negl Trop Dis 2020; 14:e0008746. [PMID: 33064728 PMCID: PMC7592909 DOI: 10.1371/journal.pntd.0008746] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 10/28/2020] [Accepted: 08/25/2020] [Indexed: 12/03/2022] Open
Abstract
Leprosy is a stigmatizing, chronic infection which degenerates the nervous system and often leads to incapacitation. Multi-drug therapy which consists of dapsone, rifampicin and clofazimine has been effective to combat this disease. In Indonesia, especially in Papua Island, leprosy is still a problem. Furthermore, there had been higher reports of Dapsone Hypersensitivity Syndrome (DHS) which also challenges leprosy elimination in certain aspects. Globally, DHS has a prevalence rate of 1.4% and a fatality rate up to 13%. The aim of this study is to validate HLA-B*13:01, a previously discovered biomarker for DHS in the Chinese population, as a biomarker for DHS in the Papua population.This is a case-control study of 34 leprosy patients who presented themselves with DHS (case subjects) and 52 leprosy patients without DHS (control subjects). Patients were recruited from 2 provinces: Papua and West Papua. DNA was extracted from 3 ml blood specimens. HLA-B alleles were typed using the gold-standard sequence based typing method. Results were then analysed using logistic regression and risk assessment was carried out. The results of HLA-typing showed that HLA-B*13:01 was the most significant allele associated with DHS, with odds ratio = 233.64 and P-value = 7.11×10−9, confirming the strong association of HLA-B*13:01 to DHS in the Papua population. The sensitivity of this biomarker is 91.2% and specificity is 96.2%, with an area under the curve of 0.95. HLA-B*13:01 is validated as a biomarker for DHS in leprosy patients in Papua, Indonesia, and can potentially be a good predictor of DHS to help prevent this condition in the future. Leprosy as a chronic infectious disease that affects the skin and nervous system is treated with a treatment cocktail, including rifampicin, clofazimine and dapsone. Unfortunately, one of these drugs, namely dapsone, may cause the patient to exhibit adverse symptoms that appear as skin hypersensitivity and may potentially lead to death up to 9.9% of the time. In a previous study, it has been established that this adverse drug reaction, which is called dapsone hypersensitivity syndrome (DHS), is associated with an allele in the human leukocyte antigen, HLA-B*13:01. In the light of validating the association of HLA-B*13:01 with DHS in a leprosy endemic area like Indonesia, we conducted a study involving leprosy patients who had DHS during the course of their multi-drug treatment as well as leprosy patients who managed to complete their course of treatment without exhibiting DHS. The results of this study validated the association of HLA-B*13:01 and DHS at a very significant level of evidence and the odds of people carrying at least one allele is 233.3-times the risk of non-carriers. This allele was also able to predict a person at risk of DHS 95% of the time. Thus, screening of HLA-B*13:01 to prevent DHS is warranted.
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Affiliation(s)
- Hana Krismawati
- Institute of Research and Development for Biomedicine Papua, National Institute of Health Research and Development, Jayapura, Indonesia
| | - Astrid Irwanto
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
- Nalagenetics Pte Ltd, Singapore, Singapore
| | - Arry Pongtiku
- Faculty of Public Health Medicine, University of Cendrawasih Papua, Jayapura, Indonesia
| | - Ishak Darryl Irwan
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore
| | - Yustinus Maladan
- Institute of Research and Development for Biomedicine Papua, National Institute of Health Research and Development, Jayapura, Indonesia
| | - Yuli Arisanti Sitanggang
- Institute of Research and Development for Biomedicine Papua, National Institute of Health Research and Development, Jayapura, Indonesia
| | - Tri Wahyuni
- Institute of Research and Development for Biomedicine Papua, National Institute of Health Research and Development, Jayapura, Indonesia
| | - Ratna Tanjung
- Institute of Research and Development for Biomedicine Papua, National Institute of Health Research and Development, Jayapura, Indonesia
| | - Yonghu Sun
- Shandong Provincial Institute of Dermatology and Venereology & Provincial Hospital for Skin Diseases, Shandong First Medical University & Shandong Academy for Medical Sciences, Jinan, China
| | - Hong Liu
- Shandong Provincial Institute of Dermatology and Venereology & Provincial Hospital for Skin Diseases, Shandong First Medical University & Shandong Academy for Medical Sciences, Jinan, China
| | - Furen Zhang
- Shandong Provincial Institute of Dermatology and Venereology & Provincial Hospital for Skin Diseases, Shandong First Medical University & Shandong Academy for Medical Sciences, Jinan, China
| | - Antonius Oktavian
- Institute of Research and Development for Biomedicine Papua, National Institute of Health Research and Development, Jayapura, Indonesia
| | - Jianjun Liu
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- * E-mail:
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Liu H, Li Y, Hung KKH, Wang N, Wang C, Chen X, Sheng D, Fu X, See K, Foo JN, Low H, Liany H, Irwan ID, Liu J, Yang B, Chen M, Yu Y, Yu G, Niu G, You J, Zhou Y, Ma S, Wang T, Yan X, Goh BK, Common JEA, Lane BE, Sun Y, Zhou G, Lu X, Wang Z, Tian H, Cao Y, Chen S, Liu Q, Liu J, Zhang F. Genome-wide linkage, exome sequencing and functional analyses identify ABCB6 as the pathogenic gene of dyschromatosis universalis hereditaria. PLoS One 2014; 9:e87250. [PMID: 24498303 PMCID: PMC3911924 DOI: 10.1371/journal.pone.0087250] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 12/19/2013] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND As a genetic disorder of abnormal pigmentation, the molecular basis of dyschromatosis universalis hereditaria (DUH) had remained unclear until recently when ABCB6 was reported as a causative gene of DUH. METHODOLOGY We performed genome-wide linkage scan using Illumina Human 660W-Quad BeadChip and exome sequencing analyses using Agilent SureSelect Human All Exon Kits in a multiplex Chinese DUH family to identify the pathogenic mutations and verified the candidate mutations using Sanger sequencing. Quantitative RT-PCR and Immunohistochemistry was performed to verify the expression of the pathogenic gene, Zebrafish was also used to confirm the functional role of ABCB6 in melanocytes and pigmentation. RESULTS Genome-wide linkage (assuming autosomal dominant inheritance mode) and exome sequencing analyses identified ABCB6 as the disease candidate gene by discovering a coding mutation (c.1358C>T; p.Ala453Val) that co-segregates with the disease phenotype. Further mutation analysis of ABCB6 in four other DUH families and two sporadic cases by Sanger sequencing confirmed the mutation (c.1358C>T; p.Ala453Val) and discovered a second, co-segregating coding mutation (c.964A>C; p.Ser322Lys) in one of the four families. Both mutations were heterozygous in DUH patients and not present in the 1000 Genome Project and dbSNP database as well as 1,516 unrelated Chinese healthy controls. Expression analysis in human skin and mutagenesis interrogation in zebrafish confirmed the functional role of ABCB6 in melanocytes and pigmentation. Given the involvement of ABCB6 mutations in coloboma, we performed ophthalmological examination of the DUH carriers of ABCB6 mutations and found ocular abnormalities in them. CONCLUSION Our study has advanced our understanding of DUH pathogenesis and revealed the shared pathological mechanism between pigmentary DUH and ocular coloboma.
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Affiliation(s)
- Hong Liu
- Shandong Provincial Institute of Dermatology and Venereology, Provincial Academy of Medical Science, Jinan, Shandong, China
- Shandong Provincial Hospital for Skin Diseases, Shandong University, Jinan, Shandong, China
- Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
- Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China
| | - Yi Li
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - Ken Kwok Hon Hung
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - Na Wang
- Shandong Provincial Institute of Dermatology and Venereology, Provincial Academy of Medical Science, Jinan, Shandong, China
- Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Chuan Wang
- Shandong Provincial Institute of Dermatology and Venereology, Provincial Academy of Medical Science, Jinan, Shandong, China
- Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Xuechao Chen
- Shandong Provincial Institute of Dermatology and Venereology, Provincial Academy of Medical Science, Jinan, Shandong, China
- Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Donglai Sheng
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - Xi’an Fu
- Shandong Provincial Institute of Dermatology and Venereology, Provincial Academy of Medical Science, Jinan, Shandong, China
- Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Kelvin See
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - Jia Nee Foo
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - Huiqi Low
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - Herty Liany
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - Ishak Darryl Irwan
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
| | - Jian Liu
- Shandong Provincial Institute of Dermatology and Venereology, Provincial Academy of Medical Science, Jinan, Shandong, China
- Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Baoqi Yang
- Shandong Provincial Hospital for Skin Diseases, Shandong University, Jinan, Shandong, China
- Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China
| | - Mingfei Chen
- Shandong Provincial Institute of Dermatology and Venereology, Provincial Academy of Medical Science, Jinan, Shandong, China
- Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Yongxiang Yu
- Shandong Provincial Institute of Dermatology and Venereology, Provincial Academy of Medical Science, Jinan, Shandong, China
- Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Gongqi Yu
- Shandong Provincial Institute of Dermatology and Venereology, Provincial Academy of Medical Science, Jinan, Shandong, China
- Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Guiye Niu
- Shandong Provincial Institute of Dermatology and Venereology, Provincial Academy of Medical Science, Jinan, Shandong, China
- Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Jiabao You
- Shandong Provincial Institute of Dermatology and Venereology, Provincial Academy of Medical Science, Jinan, Shandong, China
- Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Yan Zhou
- Shandong Provincial Institute of Dermatology and Venereology, Provincial Academy of Medical Science, Jinan, Shandong, China
- Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Shanshan Ma
- Shandong Provincial Institute of Dermatology and Venereology, Provincial Academy of Medical Science, Jinan, Shandong, China
- Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Ting Wang
- Shandong provincial Eye Hospital, Jinan, Shandong, China
| | - Xiaoxiao Yan
- Shandong Provincial Hospital for Skin Diseases, Shandong University, Jinan, Shandong, China
- Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China
| | | | | | | | - Yonghu Sun
- Shandong Provincial Institute of Dermatology and Venereology, Provincial Academy of Medical Science, Jinan, Shandong, China
- Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Guizhi Zhou
- Shandong Provincial Institute of Dermatology and Venereology, Provincial Academy of Medical Science, Jinan, Shandong, China
- Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Xianmei Lu
- Shandong Provincial Institute of Dermatology and Venereology, Provincial Academy of Medical Science, Jinan, Shandong, China
- Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Zhenhua Wang
- Weifang People’s Hospital, Weifang, Shandong, China
| | - Hongqing Tian
- Shandong Provincial Hospital for Skin Diseases, Shandong University, Jinan, Shandong, China
- Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China
| | - Yuanhua Cao
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College Nanjing, Jiangsu, China
| | - Shumin Chen
- Shandong Provincial Institute of Dermatology and Venereology, Provincial Academy of Medical Science, Jinan, Shandong, China
- Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
| | - Qiji Liu
- Shandong University, Jinan, Shandong, China
| | - Jianjun Liu
- Human Genetics, Genome Institute of Singapore, A*STAR, Singapore, Singapore
- School of Life Sciences, Anhui Medical University, Hefei, Anhui, China
- * E-mail: (JJL); (FRZ)
| | - Furen Zhang
- Shandong Provincial Institute of Dermatology and Venereology, Provincial Academy of Medical Science, Jinan, Shandong, China
- Shandong Provincial Hospital for Skin Diseases, Shandong University, Jinan, Shandong, China
- Shandong Provincial Key Lab for Dermatovenereology, Jinan, Shandong, China
- Shandong Provincial Medical Center for Dermatovenereology, Jinan, Shandong, China
- Shandong Clinical College, Anhui Medical University, Jinan, Shandong, China
- * E-mail: (JJL); (FRZ)
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