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Wang L, Ko ER, Gilchrist JJ, Pittman KJ, Rautanen A, Pirinen M, Thompson JW, Dubois LG, Langley RJ, Jaslow SL, Salinas RE, Rouse DC, Moseley MA, Mwarumba S, Njuguna P, Mturi N, Williams TN, Scott JAG, Hill AVS, Woods CW, Ginsburg GS, Tsalik EL, Ko DC. Human genetic and metabolite variation reveals that methylthioadenosine is a prognostic biomarker and an inflammatory regulator in sepsis. Sci Adv 2017; 3:e1602096. [PMID: 28345042 PMCID: PMC5342653 DOI: 10.1126/sciadv.1602096] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 02/03/2017] [Indexed: 06/06/2023]
Abstract
Sepsis is a deleterious inflammatory response to infection with high mortality. Reliable sepsis biomarkers could improve diagnosis, prognosis, and treatment. Integration of human genetics, patient metabolite and cytokine measurements, and testing in a mouse model demonstrate that the methionine salvage pathway is a regulator of sepsis that can accurately predict prognosis in patients. Pathway-based genome-wide association analysis of nontyphoidal Salmonella bacteremia showed a strong enrichment for single-nucleotide polymorphisms near the components of the methionine salvage pathway. Measurement of the pathway's substrate, methylthioadenosine (MTA), in two cohorts of sepsis patients demonstrated increased plasma MTA in nonsurvivors. Plasma MTA was correlated with levels of inflammatory cytokines, indicating that elevated MTA marks a subset of patients with excessive inflammation. A machine-learning model combining MTA and other variables yielded approximately 80% accuracy (area under the curve) in predicting death. Furthermore, mice infected with Salmonella had prolonged survival when MTA was administered before infection, suggesting that manipulating MTA levels could regulate the severity of the inflammatory response. Our results demonstrate how combining genetic data, biomolecule measurements, and animal models can shape our understanding of disease and lead to new biomarkers for patient stratification and potential therapeutic targeting.
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Affiliation(s)
- Liuyang Wang
- Department of Molecular Genetics and Microbiology, School of Medicine, Duke University, Durham, NC 27710, USA
| | - Emily R. Ko
- Duke Regional Hospital, Department of Medicine, School of Medicine, Duke University, Durham, NC 27710, USA
- Duke Center for Applied Genomics & Precision Medicine, Department of Medicine, School of Medicine, Duke University, Durham, NC 27708, USA
| | - James J. Gilchrist
- Wellcome Trust Centre for Human Genetics, Roosevelt Drive, University of Oxford, Oxford OX3 7BN, U.K
- Department of Paediatrics, University of Oxford, Oxford OX3 9DU, U.K
| | - Kelly J. Pittman
- Department of Molecular Genetics and Microbiology, School of Medicine, Duke University, Durham, NC 27710, USA
| | - Anna Rautanen
- Wellcome Trust Centre for Human Genetics, Roosevelt Drive, University of Oxford, Oxford OX3 7BN, U.K
| | - Matti Pirinen
- Wellcome Trust Centre for Human Genetics, Roosevelt Drive, University of Oxford, Oxford OX3 7BN, U.K
| | - J. Will Thompson
- Proteomics and Metabolomics Core Facility, Duke University Medical Center, Durham, NC 27710, USA
| | - Laura G. Dubois
- Proteomics and Metabolomics Core Facility, Duke University Medical Center, Durham, NC 27710, USA
| | - Raymond J. Langley
- Department of Pharmacology and Center for Lung Biology, University of South Alabama College of Medicine, Mobile, AL 36688, USA
| | - Sarah L. Jaslow
- Department of Molecular Genetics and Microbiology, School of Medicine, Duke University, Durham, NC 27710, USA
| | - Raul E. Salinas
- Department of Molecular Genetics and Microbiology, School of Medicine, Duke University, Durham, NC 27710, USA
| | - D. Clayburn Rouse
- Division of Laboratory Animal Resources, Duke University Medical Center, Durham, NC 27710, USA
| | - M. Arthur Moseley
- Duke Center for Applied Genomics & Precision Medicine, Department of Medicine, School of Medicine, Duke University, Durham, NC 27708, USA
- Proteomics and Metabolomics Core Facility, Duke University Medical Center, Durham, NC 27710, USA
| | - Salim Mwarumba
- Kenya Medical Research Institute–Wellcome Trust Clinical Research Programme, Kilifi 80108, Kenya
| | - Patricia Njuguna
- Kenya Medical Research Institute–Wellcome Trust Clinical Research Programme, Kilifi 80108, Kenya
| | - Neema Mturi
- Kenya Medical Research Institute–Wellcome Trust Clinical Research Programme, Kilifi 80108, Kenya
| | | | | | - Thomas N. Williams
- Kenya Medical Research Institute–Wellcome Trust Clinical Research Programme, Kilifi 80108, Kenya
- Department of Medicine, Imperial College, Norfolk Place, London W2 1PG, U.K
| | - J. Anthony G. Scott
- Kenya Medical Research Institute–Wellcome Trust Clinical Research Programme, Kilifi 80108, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, U.K
| | - Adrian V. S. Hill
- Wellcome Trust Centre for Human Genetics, Roosevelt Drive, University of Oxford, Oxford OX3 7BN, U.K
- Jenner Institute, University of Oxford, Old Road Campus Research Building, Oxford OX3 7DQ, U.K
| | - Christopher W. Woods
- Duke Center for Applied Genomics & Precision Medicine, Department of Medicine, School of Medicine, Duke University, Durham, NC 27708, USA
- Division of Infectious Diseases and International Health, Department of Medicine, School of Medicine, Duke University, Durham, NC 27710, USA
- Medical Service, Durham Veterans Affairs Health Care System, Durham, NC 27705, USA
| | - Geoffrey S. Ginsburg
- Duke Center for Applied Genomics & Precision Medicine, Department of Medicine, School of Medicine, Duke University, Durham, NC 27708, USA
| | - Ephraim L. Tsalik
- Duke Center for Applied Genomics & Precision Medicine, Department of Medicine, School of Medicine, Duke University, Durham, NC 27708, USA
- Division of Infectious Diseases and International Health, Department of Medicine, School of Medicine, Duke University, Durham, NC 27710, USA
- Emergency Medicine Service, Durham Veterans Affairs Health Care System, Durham, NC 27705, USA
| | - Dennis C. Ko
- Department of Molecular Genetics and Microbiology, School of Medicine, Duke University, Durham, NC 27710, USA
- Division of Infectious Diseases and International Health, Department of Medicine, School of Medicine, Duke University, Durham, NC 27710, USA
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