1. Whole genome sequencing identifies genetic variants associated with co-trimoxazole hypersensitivity in Asians.
- Author
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Wang, Chuang-Wei, Tassaneeyakul, Wichittra, Chen, Chun-Bing, Chen, Wei-Ti, Teng, Yu-Chuan, Huang, Cheng-Yang, Sukasem, Chonlaphat, Lu, Chun-Wei, Lee, Yun-Shien, Choon, Siew-Eng, Nakkam, Nontaya, Hui, Rosaline Chung-Yee, Huang, Yen-Hua, Chang, Ya-Ching, Lin, Yang Yu-Wei, Chang, Chee-Jen, Chiu, Tsu-Man, Chantratita, Wasun, Konyoung, Parinya, and Lee, Chaw-Ning
- Abstract
Co-trimoxazole, a sulfonamide antibiotic, is used to treat a variety of infections worldwide, and it remains a common first-line medicine for prophylaxis against Pneumocystis jiroveci pneumonia. However, it can cause severe cutaneous adverse reaction (SCAR), including Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms. The pathomechanism of co-trimoxazole–induced SCAR remains unclear. We aimed to investigate the genetic predisposition of co-trimoxazole–induced SCAR. We conducted a multicountry case-control association study that included 151 patients with of co-trimoxazole–induced SCAR and 4631 population controls from Taiwan, Thailand, and Malaysia, as well as 138 tolerant controls from Taiwan. Whole-genome sequencing was performed for the patients and population controls from Taiwan; it further validated the results from Thailand and Malaysia. The whole-genome sequencing study (43 case patients vs 507 controls) discovered that the single-nucleotide polymorphism rs41554616, which is located between the HLA-B and MICA loci, had the strongest association with co-trimoxazole–induced SCAR (P = 8.2 × 10
−9 ; odds ratio [OR] = 7.7). There were weak associations of variants in co-trimoxazole–related metabolizing enzymes (CYP2D6 , GSTP1 , GCLC , N -acetyltransferase [ NAT2 ], and CYP2C8). A replication study using HLA genotyping revealed that HLA-B∗13:01 was strongly associated with co-trimoxazole–induced SCAR (the combined sample comprised 91 case patients vs 2545 controls [ P = 7.2 × 10−21 ; OR = 8.7]). A strong HLA association was also observed in the case patients from Thailand (P = 3.2 × 10−5 ; OR = 3.6) and Malaysia (P =.002; OR = 12.8), respectively. A meta-analysis and phenotype stratification study further indicated a strong association between HLA-B∗13:01 and co-trimoxazole–induced drug reaction with eosinophilia and systemic symptoms (P = 4.2 × 10−23 ; OR = 40.1). This study identified HLA-B∗13:01 as an important genetic factor associated with co-trimoxazole–induced SCAR in Asians. [ABSTRACT FROM AUTHOR]- Published
- 2021
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