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Background Toll-like receptors (TLRs) are essential components of the immune response to fungal pathogens. We examined the role of TLR polymorphisms in conferring a risk of invasive aspergillosis among recipients of allogeneic hematopoietic-cell transplants.
Methods We analyzed 20 single-nucleotide polymorphisms (SNPs) in the toll-like receptor 2 gene (TLR2), the toll-like receptor 3 gene (TLR3), the toll-like receptor 4 gene (TLR4), and the toll-like receptor 9 gene (TLR9) in a cohort of 336 recipients of hematopoietic-cell transplants and their unrelated donors. The risk of invasive aspergillosis was assessed with the use of multivariate Cox regression analysis. The analysis was replicated in a validation study involving 103 case patients and 263 matched controls who received hematopoietic-cell transplants from related and unrelated donors.
Results In the discovery study, two donor TLR4 haplotypes (S3 and S4) increased the risk of invasive aspergillosis (adjusted hazard ratio for S3, 2.20; 95% confidence interval [CI], 1.14 to 4.25; P=0.02; adjusted hazard ratio for S4, 6.16; 95% CI, 1.97 to 19.26; P=0.002). The haplotype S4 was present in carriers of two SNPs in strong linkage disequilibrium (1063 A/G [D299G] and 1363 C/T [T399I]) that influence TLR4 function. In the validation study, donor haplotype S4 also increased the risk of invasive aspergillosis (adjusted odds ratio, 2.49; 95% CI, 1.15 to 5.41; P=0.02); the association was present in unrelated recipients of hematopoietic-cell transplants (odds ratio, 5.00; 95% CI, 1.04 to 24.01; P=0.04) but not in related recipients (odds ratio, 2.29; 95% CI, 0.93 to 5.68; P=0.07). In the discovery study, seropositivity for cytomegalovirus (CMV) in donors or recipients, donor positivity for S4, or both, as compared with negative results for CMV and S4, were associated with an increase in the 3-year probability of invasive aspergillosis (12% vs. 1%, P=0.02) and death that was not related to relapse (35% vs. 22%, P=0.02).
Conclusions This study suggests an association between the donor TLR4 haplotype S4 and the risk of invasive aspergillosis among recipients of hematopoietic-cell transplants from unrelated donors.
Source Information
From the Institute for Systems Biology (P.-Y.B., M.J., S.D.R., S.L., A.A.); the Program in Infectious Diseases (P.-Y.B., K.A.M., W.M.L., A.U., M.B.), the Clinical Research Division (J.A.H.), and Quantitative Genetic Epidemiology, Division of Public Health Sciences (L.P.Z.), Fred Hutchinson Cancer Research Center; and the Department of Medicine, University of Washington (J.W.C., K.A.M., W.M.L., J.A.H., M.B.) — all in Seattle.
Address reprint requests to Dr. Boeckh at the Vaccine and Infectious Disease Institute, Program in Infectious Diseases, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., Seattle, WA 98109, or at mboeckh{at}fhcrc.org.
Related Letters:
Toll-like Receptor 4 Polymorphisms and Aspergillosis
Levitz S. M., Shoham S., Cleary J. D., Cervera C., Moreno A., Lozano F., Asakura Y., Komatsu T., Bochud P.-Y., Marr K. A., Boeckh M.
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N Engl J Med 2009;
360:634-636, Feb 5, 2009.
Correspondence
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