Impact of SLCO1B3 polymorphisms on clinical outcomes in lung allograft recipients receiving mycophenolic acid

Laneshia K. Tague, Derek E. Byers, Ramsey Hachem, Daniel Kreisel, Alexander S. Krupnick, Hrishikesh S. Kulkarni, Catherine Chen, Howard J. Huang, Andrew Gelman

Research output: Contribution to journalArticle

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Abstract

Single-nucleotide polymorphisms (SNPs) in genes involved in mycophenolic acid (MPA) metabolism have been shown to contribute to variable MPA exposure, but their clinical effects are unclear. We aimed to determine if SNPs in key genes in MPA metabolism affect outcomes after lung transplantation. We performed a retrospective cohort study of 275 lung transplant recipients, 228 receiving mycophenolic acid and a control group of 47 receiving azathioprine. Six SNPs known to regulate MPA exposure from the SLCO, UGT and MRP2 families were genotyped. Primary outcome was 1-year survival. Secondary outcomes were 3-year survival, nonminimal (≥A2 or B2) acute rejection, and chronic lung allograft dysfunction (CLAD). Statistical analyses included time-to-event Kaplan–Meier with log-rank test and Cox regression modeling. We found that SLCO1B3 SNPs rs4149117 and rs7311358 were associated with decreased 1-year survival [rs7311358 HR 7.76 (1.37–44.04), p = 0.021; rs4149117 HR 7.28 (1.27–41.78), p = 0.026], increased risk for nonminimal acute rejection [rs4149117 TT334/T334G: OR 2.01 (1.06–3.81), p = 0.031; rs7311358 GG699/G699A: OR 2.18 (1.13–4.21) p = 0.019] and lower survival through 3 years for MPA patients but not for azathioprine patients. MPA carriers of either SLCO1B3 SNP had shorter survival after CLAD diagnosis (rs4149117 p = 0.048, rs7311358 p = 0.023). For the MPA patients, Cox regression modeling demonstrated that both SNPs remained independent risk factors for death. We conclude that hypofunctional SNPs in the SLCO1B3 gene are associated with an increased risk for acute rejection and allograft failure in lung transplant recipients treated with MPA.

Original languageEnglish (US)
JournalPharmacogenomics Journal
DOIs
StatePublished - Jan 1 2019

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Mycophenolic Acid
Allografts
Single Nucleotide Polymorphism
Lung
Survival
Azathioprine
Genes
Lung Transplantation
varespladib methyl
Cohort Studies
Retrospective Studies
Control Groups

ASJC Scopus subject areas

  • Molecular Medicine
  • Genetics
  • Pharmacology

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Impact of SLCO1B3 polymorphisms on clinical outcomes in lung allograft recipients receiving mycophenolic acid. / Tague, Laneshia K.; Byers, Derek E.; Hachem, Ramsey; Kreisel, Daniel; Krupnick, Alexander S.; Kulkarni, Hrishikesh S.; Chen, Catherine; Huang, Howard J.; Gelman, Andrew.

In: Pharmacogenomics Journal, 01.01.2019.

Research output: Contribution to journalArticle

Tague, Laneshia K. ; Byers, Derek E. ; Hachem, Ramsey ; Kreisel, Daniel ; Krupnick, Alexander S. ; Kulkarni, Hrishikesh S. ; Chen, Catherine ; Huang, Howard J. ; Gelman, Andrew. / Impact of SLCO1B3 polymorphisms on clinical outcomes in lung allograft recipients receiving mycophenolic acid. In: Pharmacogenomics Journal. 2019.
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abstract = "Single-nucleotide polymorphisms (SNPs) in genes involved in mycophenolic acid (MPA) metabolism have been shown to contribute to variable MPA exposure, but their clinical effects are unclear. We aimed to determine if SNPs in key genes in MPA metabolism affect outcomes after lung transplantation. We performed a retrospective cohort study of 275 lung transplant recipients, 228 receiving mycophenolic acid and a control group of 47 receiving azathioprine. Six SNPs known to regulate MPA exposure from the SLCO, UGT and MRP2 families were genotyped. Primary outcome was 1-year survival. Secondary outcomes were 3-year survival, nonminimal (≥A2 or B2) acute rejection, and chronic lung allograft dysfunction (CLAD). Statistical analyses included time-to-event Kaplan–Meier with log-rank test and Cox regression modeling. We found that SLCO1B3 SNPs rs4149117 and rs7311358 were associated with decreased 1-year survival [rs7311358 HR 7.76 (1.37–44.04), p = 0.021; rs4149117 HR 7.28 (1.27–41.78), p = 0.026], increased risk for nonminimal acute rejection [rs4149117 TT334/T334G: OR 2.01 (1.06–3.81), p = 0.031; rs7311358 GG699/G699A: OR 2.18 (1.13–4.21) p = 0.019] and lower survival through 3 years for MPA patients but not for azathioprine patients. MPA carriers of either SLCO1B3 SNP had shorter survival after CLAD diagnosis (rs4149117 p = 0.048, rs7311358 p = 0.023). For the MPA patients, Cox regression modeling demonstrated that both SNPs remained independent risk factors for death. We conclude that hypofunctional SNPs in the SLCO1B3 gene are associated with an increased risk for acute rejection and allograft failure in lung transplant recipients treated with MPA.",
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AU - Tague, Laneshia K.

AU - Byers, Derek E.

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AU - Kreisel, Daniel

AU - Krupnick, Alexander S.

AU - Kulkarni, Hrishikesh S.

AU - Chen, Catherine

AU - Huang, Howard J.

AU - Gelman, Andrew

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AB - Single-nucleotide polymorphisms (SNPs) in genes involved in mycophenolic acid (MPA) metabolism have been shown to contribute to variable MPA exposure, but their clinical effects are unclear. We aimed to determine if SNPs in key genes in MPA metabolism affect outcomes after lung transplantation. We performed a retrospective cohort study of 275 lung transplant recipients, 228 receiving mycophenolic acid and a control group of 47 receiving azathioprine. Six SNPs known to regulate MPA exposure from the SLCO, UGT and MRP2 families were genotyped. Primary outcome was 1-year survival. Secondary outcomes were 3-year survival, nonminimal (≥A2 or B2) acute rejection, and chronic lung allograft dysfunction (CLAD). Statistical analyses included time-to-event Kaplan–Meier with log-rank test and Cox regression modeling. We found that SLCO1B3 SNPs rs4149117 and rs7311358 were associated with decreased 1-year survival [rs7311358 HR 7.76 (1.37–44.04), p = 0.021; rs4149117 HR 7.28 (1.27–41.78), p = 0.026], increased risk for nonminimal acute rejection [rs4149117 TT334/T334G: OR 2.01 (1.06–3.81), p = 0.031; rs7311358 GG699/G699A: OR 2.18 (1.13–4.21) p = 0.019] and lower survival through 3 years for MPA patients but not for azathioprine patients. MPA carriers of either SLCO1B3 SNP had shorter survival after CLAD diagnosis (rs4149117 p = 0.048, rs7311358 p = 0.023). For the MPA patients, Cox regression modeling demonstrated that both SNPs remained independent risk factors for death. We conclude that hypofunctional SNPs in the SLCO1B3 gene are associated with an increased risk for acute rejection and allograft failure in lung transplant recipients treated with MPA.

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