Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Immunogenetics. 2024 Nov 26;77(1):3. doi: 10.1007/s00251-024-01360-w.
The blockade of the interleukin 6 receptor (IL-6R) demonstrates significant potential in various autoimmune diseases (ADs); however, the underlying therapeutic efficacy associated with this approach remains elusive. We conducted a comprehensive Mendelian randomization (MR) analysis based on large-scale genome-wide association studies to investigate the causal relationships between genetically proxied IL-6R blockade weighted by serum C-reactive protein levels and eighteen common ADs. Rheumatoid arthritis, COVID-19 infection, and COVID-19 critical illness were utilized as positive controls. The inverse-variance weighted (IVW) method was utilized as the primary analytical tool, while genetic colocalization analysis was conducted to further substantiate the causalities. Genetically proxied IL-6R blockade exhibited causally protective effects on all positive control diseases. After Bonferroni correction to IVW estimates, genetically proxied IL-6R blockade may significantly increase the risk of asthma (OR=1.031, P=2.15×10) and eczema (OR=1.066, P=5.92×10), while reducing the risk of ankylosing spondylitis (OR=0.341, P=1.39×10), Crohn's disease (OR=0.556, P=2.21×10), and type 1 diabetes (OR=0.410, P=1.78×10). Additionally, genetically proxied IL-6R blockade would suggestively reduce the risk of multiple sclerosis (OR=0.713, P=1.13×10). The results were robust under sensitivity analysis. For genetic colocalization analysis, we identified a shared causal variant rs531479718 linking serum C-reactive protein levels and asthma (posterior probability H4=0.998). Overall, our MR study demonstrated that genetically proxied IL-6R blockade may be causally associated with an increased risk of asthma and eczema, while concurrently diminishing the risk of ankylosing spondylitis, Crohn's disease, type 1 diabetes, and multiple sclerosis. These findings carry substantial implications for informing the therapeutic utilization of IL-6R blockade in the management of ADs.
阻断白细胞介素 6 受体 (IL-6R) 在各种自身免疫性疾病 (AD) 中显示出显著的潜力;然而,这种方法的潜在治疗效果仍难以捉摸。我们进行了一项基于大规模全基因组关联研究的综合孟德尔随机化 (MR) 分析,以研究通过血清 C 反应蛋白水平加权的遗传上接近的 IL-6R 阻断与十八种常见的 AD 之间的因果关系。类风湿关节炎、COVID-19 感染和 COVID-19 危重症被用作阳性对照。反方差加权 (IVW) 方法被用作主要分析工具,同时进行遗传共定位分析以进一步证实因果关系。遗传上接近的 IL-6R 阻断对所有阳性对照疾病均显示出因果保护作用。在对 IVW 估计值进行 Bonferroni 校正后,遗传上接近的 IL-6R 阻断可能会显著增加哮喘的风险 (OR=1.031,P=2.15×10) 和湿疹 (OR=1.066,P=5.92×10),同时降低强直性脊柱炎的风险 (OR=0.341,P=1.39×10)、克罗恩病 (OR=0.556,P=2.21×10) 和 1 型糖尿病 (OR=0.410,P=1.78×10)。此外,遗传上接近的 IL-6R 阻断可能会降低多发性硬化症的风险 (OR=0.713,P=1.13×10)。在敏感性分析下,结果是稳健的。对于遗传共定位分析,我们确定了一个与血清 C 反应蛋白水平和哮喘相关的共享因果变异 rs531479718 (后验概率 H4=0.998)。总体而言,我们的 MR 研究表明,遗传上接近的 IL-6R 阻断可能与哮喘和湿疹的风险增加有关,同时降低强直性脊柱炎、克罗恩病、1 型糖尿病和多发性硬化症的风险。这些发现对告知 IL-6R 阻断在 AD 管理中的治疗应用具有重要意义。