Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, FL, USA.
Department of Biostatistics and Health Data Science, Indiana University School of Medicine, IN, USA; Department of Computer and Information Technology, Purdue University, IN, USA.
Eur J Cancer. 2024 Dec;213:115114. doi: 10.1016/j.ejca.2024.115114. Epub 2024 Nov 9.
INTRODUCTION: Immune checkpoint inhibitors (ICIs) enhance the immune system's ability to target and destroy cancer cells, but can also trigger immune-related adverse events (irAEs), such as acute kidney injury (ICI-AKI), complicating patient management. Limited knowledge of genetic predispositions to ICI-AKI highlights the need for genomic studies to improve therapeutic strategies. OBJECTIVE: To identify genetic predispositions for ICI-AKI using large-scale real-world data. METHODS: A systematic literature search led to 14 candidate variants related to irAEs. We performed a candidate variant association study with these variants using the All of Us cohort. An ICI-treated cohort and a general cohort were established to evaluate ICI-AKI risk. Logistic regression, adjusted for sex, evaluated the impact of each candidate genotype, separately for self-reported and ancestry-estimated race. Kaplan-Meier survival analysis assessed genetic effects on AKI-free survival. RESULTS: The ICI cohort (n = 414) showed a one-year AKI incidence rate of 23.2 %, significantly higher than the general cohort (6.5 %, n = 213,282). The rs16957301 variant (chr13:100324308, T > C) in the PCCA gene was a significant risk genotype for ICI-AKI among self-reported White (Beta=0.93, CI: 0.32 - 1.54, ORs= 2.53, Bonferroni-corrected P-value=0.047) and ancestry estimated Europeans (Beta = 0.94, CI: 0.31 - 1.57, ORs= 2.56, Bonferroni-corrected P-value=0.044). Self-reported White with the rs16957301 risk genotypes (TC/CC) developed AKI significantly earlier (3.6 months) compared to the reference genotype (TT, 7.0 months, log-rank P = 0.04). Consistent results were found in ancestry-estimated Europeans. This variant did not present significant AKI risks in the general cohort (Beta: -0.008-0.035, FDR: 0.75-0.99). CONCLUSION: Our findings suggest that rs16957301 in PCCA may serve as an ICI-AKI risk marker in Caucasians. Further studies are needed to validate this association and explore risks in other populations.
简介:免疫检查点抑制剂(ICIs)增强了免疫系统靶向和破坏癌细胞的能力,但也可能引发免疫相关的不良事件(irAEs),如急性肾损伤(ICI-AKI),从而使患者的管理复杂化。对 ICI-AKI 遗传易感性的了解有限,突出了基因组研究对于改善治疗策略的必要性。
目的:使用大规模真实世界数据确定 ICI-AKI 的遗传易感性。
方法:系统文献检索导致了 14 个与 irAEs 相关的候选变异。我们使用 All of Us 队列对这些变异进行了候选变异关联研究。建立了 ICI 治疗队列和一般队列来评估 ICI-AKI 风险。逻辑回归,调整了性别,分别评估了每个候选基因型对自我报告和祖先估计种族的影响。Kaplan-Meier 生存分析评估了遗传对 AKI 无事件生存的影响。
结果:ICI 队列(n=414)的一年 AKI 发生率为 23.2%,明显高于一般队列(n=213282,6.5%)。PCCA 基因中的 rs16957301 变异(chr13:100324308,T>C)在自我报告的白人(Beta=0.93,CI:0.32-1.54,ORs=2.53,Bonferroni 校正 P 值=0.047)和祖先估计的欧洲人中是 ICI-AKI 的显著风险基因型(Beta=0.94,CI:0.31-1.57,ORs=2.56,Bonferroni 校正 P 值=0.044)。具有 rs16957301 风险基因型(TC/CC)的自我报告的白人发生 AKI 的时间明显早于参考基因型(TT,7.0 个月,对数秩检验 P=0.04)。在祖先估计的欧洲人中也得到了一致的结果。该变体在一般队列中并未表现出显著的 AKI 风险(Beta:-0.008-0.035,FDR:0.75-0.99)。
结论:我们的研究结果表明,PCCA 中的 rs16957301 可能是白种人中的 ICI-AKI 风险标志物。需要进一步的研究来验证这种关联,并探索其他人群的风险。
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