TPMT and ITPA genetic variants in Lithuanian inflammatory bowel disease patients: Prevalence and azathioprine-related side effects

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• 作者：Ruta Steponaitiene^a ; ¹ ; Juozas Kupcinskas^a ; ^b ; ¹ ; Santa Survilaite^a ; Greta Varkalaite^a ; Laimas Jonaitis^a ; ^b ; Gediminas Kiudelis^a ; ^b ; Goda Denapiene^c ; Jonas Valantinas^c ; Jurgita Skieceviciene^a ; ¹ ; Limas Kupcinskas^a ; ^b ; ¹ ; ^{l.kupcinskas@gmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Azathioprine ; IBD ; TPMT ; ITPA ; Polymorphism
• 刊名：Advances in Medical Sciences
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：61
• 期：1
• 页码：135-140
• 全文大小：892 K

文摘

Inter-individual thiopurine metabolism variability can influence treatment outcomes in inflammatory bowel disease (IBD) patients. Genetic polymorphisms in thiopurine methyltransferase (TPMT) and inosine triphosphate pyrophosphatase (ITPA) were linked with toxicity of azathioprine (AZA). The aim of the study was to investigate frequencies of TPMT and ITPA polymorphisms in Lithuanian IBD patients and analyze their association with AZA-related adverse events.

Materials/methods

Polymorphisms in TPMT (TPMT*2,*3B,*3C,*3A) and ITPA (rs1127354, rs7270101) genes were determined using PCR-RFLP and TaqMan^® genotyping assays. 551 consecutive Lithuanian IBD patients were genotyped. The use of AZA and its side effects were assessed retrospectively according to hospital medical records.

Results

Frequencies of TPMT*3A, TPMT*3B and TPMT*3C alleles were 3.1%, 0.5% and 0.1%, respectively. TPMT*2 genetic variant was not detected in the study group. The distribution of minor alleles for ITPA rs1127354 and rs7270101 polymorphisms was 9.9% and 10.5%, respectively. AZA was prescribed in 82 patients and it provoked myelotoxicity in 11%, hepatotoxicity in 6.1%, dyspepsia in 6.1%, and pancreatitis in 3.6% of cases. Among patients who had AZA-related myelotoxicity, 11.1% were TPMT compound heterozygous, 44.4% had heterozygous genotype (P < 0.01). Frequencies of ITPA minor alleles were similar among the patients with and without AZA-related side effects.

Conclusion

Frequencies of TPMT and ITPA variant alleles in Lithuanian IBD group were similar to those observed in the Northern-Eastern Europe Caucasian populations. Polymorphisms in TPMT might be associated with myelotoxicity and leukopenia in AZA treated patients, while ITPA variant alleles appear not to be linked with treatment-related side effects.