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利用药物靶点孟德尔随机化探索白细胞介素 6 受体阻断在自身免疫性疾病中的治疗潜力。

Exploring the therapeutic potential of interleukin-6 receptor blockade in autoimmune diseases using drug target mendelian randomization.

机构信息

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.

出版信息

Immunogenetics. 2024 Nov 26;77(1):3. doi: 10.1007/s00251-024-01360-w.

Abstract

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.

摘要

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。

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