Paola Nicoletti, Harshad Devarbhavi, Ashish Goel, CE Eapen, Radha Venkatesan, Jane I Grove, Ann K Daly and Guruprasad P. Aithal
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1 Genome-wide association study (GWAS) to identify genetic risk factors that increase susceptibility to antituberculosis drug-induced liver injury (ATDILI) Paola Nicoletti, Harshad Devarbhavi, Ashish Goel, CE Eapen, Radha Venkatesan, Jane I Grove, Ann K Daly and Guruprasad P. Aithal Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York. St John's Medical College Hospital, Department of Gastroenterology, Bangalore. Christian Medical College and Hospital, Vellore. Department of Molecular Genetics, Madras Diabetes Research Foundation, Chennai. Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne. NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham 1
2 Pathogenesis of ATDILI Ramappa & Aithal. J Clin Exp Hepatol
3 NAT2 metabolism INH o Hepatic NAT 2 polymporphic o NAT2*4> NAT2*7>NAT2*6>NAT2*5 o Minor pathway enhanced 10 fold in slow acetylators Ramappa & Aithal. J Clin Exp Hepatol
4 Metaanalysis: NAT2 and ATDILI o 38 studies 2,225 patients and 4,906 controls o Modest effect of NAT2 o OR: 3.18 [ ] o Caucasians least effected Cai. PLoS One 2012;7(10):e
5 Methods o 59 cases; 111 population based controls and 109 drug-exposed controls o HumanCoreExome BeadChip o Imputation is a process of substituting missing data in GWAS. Statistical inference of unobserved genotypes. Achieved using haplotypes in the population. Narrows down the location probable causal variants. o Prediction of acetylator status of N-acetyltransferase 2 (NAT2) using typed genotypes for rs , rs and rs (NAT*5, *6 and *7 alleles respectively) 5
6 Case definition Parameter Case definition Pattern Causality assessment Method >5 x ALT >2 x ALP >3 x ALT mg Bil R= ALT/ALP Hepatocellular: Ratio 5 Cholestatic 2 Mixed >2-<5 CIOMS/RUCAM Structured expert opinion 6
7 Case control distribution Caucasians Hap MAP Gujarati Indians DILI case control cohort cases Population controls Exposed controls African Americans Asians 7
8 Gender (F/M) 30/29 Mean Age (years) (+SD) 45 (16.1) Mean Time to onset from first exposure (days) (+SD) 43.1 (55.1) Total days on drug (+SD) 46 (66.3) Cholestatic 10 Hepatocellular 30 Mixed 12 Unknown 7 RUCAM scores 3-5 (possible) (probable) 37 >8 (highly probable) 17 Cases 8
9 Results 2017 AMERICAN ASSOCIATION FOR THE STUDY OF LIVER DISEASES 9
10 GWAS analysis: specific phenotypes Extreme phenotype: 14 OLT/ Death vs Controls: 220 Latency: days of exposure as continuous variable Log transformed. Linear regression 2017 AMERICAN ASSOCIATION FOR THE STUDY OF LIVER DISEASES 10
11 NAT1/2 genotype specific analysis OR= 1.54 (95% CI ) P = 0.18 NAT2 slow acetylators were not associated with DILI 2017 AMERICAN ASSOCIATION FOR THE STUDY OF LIVER DISEASES 11
12 o Underpowered Discussion o Combination therapy GWAS of INH DILI: showed no signals o Severity of cases Strength compared to historical studies o High prevalence of slow acetylator status Stronger association in the literature 12
13 Conclusion The intensity of the conviction that a hypothesis is true has no bearing on whether it is true or not Peter Medawar The Nobel Prize in Physiology or Medicine
14 SAE Consortium, Ltd. 14
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Viral hepatitis and Hepatocellular Carcinoma Hashem B. El-Serag, MD, MPH Dan L. Duncan Professor of Medicine Chief, Gastroenterology and Hepatology Houston VA & Baylor College of Medicine Houston, TX Outline
indicated in shaded lowercase letters (hg19, Chr2: 217,955, ,957,266).
Legend for Supplementary Figures Figure S1: Sequence of 2q35 encnv. The DNA sequence of the 1,375bp 2q35 encnv is indicated in shaded lowercase letters (hg19, Chr2: 217,955,892-217,957,266). Figure S2: