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对多效性免疫介导疾病基因的扫描确定了甲型血友病中基线FVIII抑制物状态的新决定因素。

A scan of pleiotropic immune mediated disease genes identifies novel determinants of baseline FVIII inhibitor status in hemophilia A.

作者信息

Almeida Marcio A, Diego Vincent P, Viel Kevin R, Luu Bernadette W, Haack Karin, Raja Rajalingam, Ameri Afshin, Chitlur Meera, Rydz Natalia, Lillicrap David, Watts Raymond G, Kessler Craig M, Ramsey Christopher, Dinh Long V, Kim Benjamin, Powell Jerry S, Manusov Eron G, Peralta Juan M, Bouls Ruayda, Abraham Shirley M, Shen Yu-Min, Murillo Carlos M, Mead Henry, Lehmann Paul V, Fine Eli J, Escobar Miguel A, Kumar Satish, Konkle Barbara A, Williams-Blangero Sarah, Kasper Carol K, Almasy Laura, Cole Shelley A, Blangero John, Howard Tom E

机构信息

South Texas Diabetes and Obesity Institute, and Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, USA.

Histonis, Inc., Portsmouth, NH, USA.

出版信息

Genes Immun. 2025 Apr 22. doi: 10.1038/s41435-025-00325-7.

Abstract

Hemophilia-A (HA) is the X-linked bleeding disorder caused by heterogeneous factor (F)VIII gene (F8)-mutations and deficiencies in plasma-FVIII-activity that prevent intrinsic-pathway mediated coagulation-amplification. Severe-HA patients (HAPs) require life-long infusions of therapeutic-FVIII-proteins (tFVIIIs) but 30% develop neutralizing-tFVIII-antibodies called "FVIII-inhibitors (FEIs)". We investigated the genetics underlying the variable risk of FEI-development in 450 North American HAPs (206 and 244 respectively self-reporting black-African- or white-European-ancestry) by analyzing the genotypes of single-nucleotide-variations (SNVs) in candidate immune-mediated-disease (IMD)-genes using a binary linear-mixed model of genetic association with baseline-FEI-status, the dependent variable, while simultaneously accounting for their genetic relationships and heterogeneous-F8-mutations to prevent the statistical problem of non-independence. We a priori selected gene-centric-association-scans of pleiotropic-IMD-genes implicated in the development of either ≥2 autoimmune-/autoinflammatory-disorders (AADs) or FEIs and ≥1 AAD. We found that baseline-FEI-status was significantly associated with NOS2A (rs117382854; p = 3.2 × 10) and B3GNT2 (rs10176009; p = 5.1 × 10)-pleiotropic-IMD-genes known previously to function in anti-microbial-/-tumoral-immunity but not in the development of FEIs-and confirmed associations with CTLA4 (rs231780; p = 2.2 × 10). We also found that baseline-FEI-status has a substantial heritability (55%) that involves (i) a F8-mutation-specific component of ~8%, (ii) an additive-genetic contribution from SNVs in IMD-genes of ~47%, and (iii) race, which is a significant determinant independent of F8-mutation-types and non-F8-genetics.

摘要

血友病A(HA)是一种X连锁出血性疾病,由异质性因子(F)VIII基因(F8)突变和血浆F VIII活性缺乏引起,这些突变和缺乏会阻止内源性途径介导的凝血放大。重度HA患者(HAPs)需要终身输注治疗性F VIII蛋白(tFVIIIs),但约30%的患者会产生称为“F VIII抑制剂(FEIs)”的中和性tF VIII抗体。我们通过使用与基线FEI状态(因变量)的遗传关联二元线性混合模型分析候选免疫介导疾病(IMD)基因中的单核苷酸变异(SNVs)基因型,同时考虑它们的遗传关系和异质性F8突变以防止非独立性的统计问题,研究了450名北美HAPs(分别有206名和244名自我报告为非洲裔或欧洲裔白人血统)中FEI发生风险可变的潜在遗传学因素。我们预先选择了与≥2种自身免疫性/自身炎症性疾病(AADs)或FEIs以及≥1种AAD发生相关的多效性IMD基因的以基因为中心的关联扫描。我们发现基线FEI状态与NOS2A(rs117382854;p = 3.2×10)和B3GNT2(rs10176009;p = 5.1×10)这两个多效性IMD基因显著相关,这两个基因以前已知在抗微生物/肿瘤免疫中起作用,但与FEIs的发生无关,并证实了与CTLA4(rs231780;p = 2.2×10)的关联。我们还发现基线FEI状态具有相当高的遗传度(约55%),其中包括(i)约8%的F8突变特异性成分,(ii)IMD基因中SNVs的加性遗传贡献约为47%,以及(iii)种族,种族是一个独立于F8突变类型和非F8基因的重要决定因素。

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