Impact of Genetic Polymorphisms on 6-Thioguanine Nucleotide Levels and Toxicity in Pediatric Patients with IBD Treated with Azathioprine. Issue 12 (31st August 2015)

• Record Type: Journal Article
• Authors: Lee, Mi-Na; Kang, Ben; Choi, So Yoon; Kim, Mi Jin; Woo, Sook Young; Kim, Jong-Won; Choe, Yon Ho; Lee, Soo-Youn
• Is Part Of: Inflammatory bowel diseases. Volume 21:Issue 12(2015:Dec.)
• Page Start: 2897
• Page End: 2908
• Publication Date: 2015-08-31
• Subjects: azathioprine -- inflammatory bowel disease -- pediatric -- polymorphisms -- TPMT; Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1097/MIB.0000000000000570
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract : Background: Thiopurine-related toxicity results in discontinuation of therapy in up to 30% of patients with inflammatory bowel disease. Although thiopurine S -methyltransferase (TPMT) is implicated in toxicity, not all toxicity can be attributed to TPMT polymorphisms. We investigated the effects of polymorphisms of genes involved in thiopurine and folate metabolism pathways on 6-thioguanine nucleotide levels and toxicity. Methods: Retrospective clinical data and blood samples were collected from 132 pediatric patients with inflammatory bowel disease treated with azathioprine. Eighty-seven genetic polymorphisms of 30 genes were screened using the MassARRAY system, and 70 polymorphisms of 28 genes were selected for further analysis. Results: TPMT genotype ( P < 0.001), concurrent use of mesalazine ( P = 0.006), ABCC5 (rs2293001) ( P < 0.001), ITPA (rs2236206 and rs8362) ( P = 0.010 and P = 0.003), and ABCB1 (rs2032582) ( P = 0.028) were all associated with the ratio of 6-thioguanine nucleotides to azathioprine dose. ADK (rs10824095) ( P = 0.004, odds ratio [OR] = 6.220), SLC29A1 (rs747199) ( P = 0.016, OR = 5.681), and TYMS (rs34743033) ( P = 0.045, OR = 3.846) were associated with neutropenia. ABCC1 (rs2074087) ( P = 0.022, OR = 3.406), IMPDH1 (rs2278294) ( P = 0.027, OR = 0.276), and IMPDH2 (rs11706052) ( P = 0.034, OR = 3.639) had a significant impact on lymphopenia. Conclusions: This study describes genetic polymorphisms in genes whose products may affect pharmacokinetics and which may predict the relative likelihood of benefit or risk from thiopurine treatment. These findings may serve as a basis for personalized thiopurine therapy in pediatric patients with inflammatory bowel disease, although our data need to be validated in further studies.