h tt p : / / w w w . b j m i c r o b i o l . c o m . b r /
Medical
Microbiology
DEFB1
gene
polymorphisms
and
tuberculosis
in
a
Northeastern
Brazilian
population
Ronaldo
Celerino
da
Silva
a,c,∗,1,
Heidi
Lacerda
Alves
da
Cruz
a,c,1,
Lucas
André
Cavalcanti
Brandão
c,d,
Rafael
Lima
Guimarães
a,c,
Lilian
Maria
Lapa
Montenegro
b,
Haiana
Charifker
Schindler
b,
Ludovica
Segat
e,
Sergio
Crovella
a,caDepartmentofGenetics,FederalUniversityofPernambuco(UFPE),Recife,Pernambuco,Brazil
bDepartmentofImmunology,AggeuMagalhãesResearchCenter(CPqAM–FIOCRUZ–Pernambuco),Recife,Pernambuco,Brazil cLaboratoryofImmunopathologyKeizoAsami(LIKA),FederalUniversityofPernambuco(UFPE),Recife,Pernambuco,Brazil dDepartmentofPathology,FederalUniversityofPernambuco,Recife,Pernambuco,Brazil
eInstituteforMaternalandChildHealth–IRCCS“BurloGarofolo”,Trieste,Italy
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r
t
i
c
l
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o
Articlehistory:
Received17September2014 Accepted5September2015 Availableonline2March2016 AssociateEditor:JorgeLuizMello Sampaio Keywords: Tuberculosis Innateimmunity DEFB1 Genotyping Polymorphism
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-Defensin-1,anantimicrobialpeptideencodedbytheDEFB1gene,isknowntoplayan importantroleinlungmucosalimmunity.InourassociationstudyweanalyzedthreeDEFB1
functionalpolymorphisms−52G>A(rs1799946),−44C>G(rs1800972)and−20G>A(rs11362) in92tuberculosispatientsand286healthycontrols,bothfromNortheastBrazil:no associ-ationwasfoundbetweenthestudiedDEFB1polymorphismsandthedisease.Howeverwe cannotexcludethatthislackofassociationcouldbeduetothelownumberofsubjects analyzed,assuggestedbythelowstatisticalpowerachievedforthethreeanalyzedSNPs (valuesbetween0.16and0.50).
©2016SociedadeBrasileiradeMicrobiologia.PublishedbyElsevierEditoraLtda.Thisis anopenaccessarticleundertheCCBY-NC-NDlicense
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
∗ Correspondingauthor.
E-mail:ronaldocelerino@yahoo.com.br(R.CelerinodaSilva). 1 R.C.S.andH.L.A.C.contributedequallytothewritingofthearticle.
http://dx.doi.org/10.1016/j.bjm.2015.09.001
1517-8382/©2016SociedadeBrasileiradeMicrobiologia.PublishedbyElsevierEditoraLtda.ThisisanopenaccessarticleundertheCC BY-NC-NDlicense(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Introduction
Mycobacterial diseases are a majorhealth concern, affect-ingapproximatelyone-thirdoftheworld’spopulation.1The most common clinical form of the disease is pulmonary tuberculosis,agranulomatousdiseaseofthelungscausedby
Mycobacteriumtuberculosis.Extrapulmonarytuberculosismay occurwhenthebacillusinfectsotherorgans.2–4
The general risk of infected individuals to develop the disease duringtheir lifetimeranges between5 and 10%.2,3 A possible genetic predisposition to tuberculosis (TB) has been suggested in several studies.5–8 Moreover evidence existthatextrapulmonaryTBistheresultofanunderlying immunedefect,4however,thefunctionalcorrelationbetween geneticpolymorphismsandimmunologicdefectshouldbeyet unraveled.7
Themucosalimmunityofairepitheliaiscomplex,andthe innateimmunesystem,mainlybythemucosalsecretionof antimicrobialpeptidesgradient,isthoughttoplayan impor-tantroleindefenseagainstM.tuberculosis,althoughtheexact mechanismsareyetpoorlyunderstood.9,10
The human -defensin-1 (hBD-1) is a small (29–47 aminoacids)cationicantimicrobialpeptide,11constitutively expressedinairwayepitheliathatplaysanimportantrolein mucosalimmunityinthelung.12–15 Thispeptideisencoded byDEFB1gene,locatedatchromosome8p22-23.16
Three single nucleotide polymorphisms (SNPs), located at −52G>A (rs1799946), −44C>G (rs1800972) and −20G>A (rs11362)positioninthe5 untranslatedregion(UTR)ofthe
DEFB1genehavebeenreportedtopromotefunctional alter-ationofhBD-1expressionindifferentcellmodels.17,18These SNPs were firstly described byDörk and Stuhrmann19 and have been then associated with chronic obstructive pul-monary disease,20 increased levels of Candida albicans in the oral cavity,21 increased risk for Human Immunodefi-ciencyVirus1infection,22–25 susceptibilitytomycobacterial diseases8,26andotherdiseases.27–31
Consideringthepossibleroleoftheinnateimmune sys-tem in the risk of tuberculosis infection, this study aims toexaminewhetherfunctional polymorphismsat5UTRin
DEFB1 gene are associated with the occurrence of active tuberculosis.
Patients
and
methods
Studypopulation
Ninety-twoTBpatientswereenrolledfromfivereference cen-terforTBfollowupinRecife(Pernambuco,NortheastBrazil): HospitaldasClínicas–UniversidadeFederaldePernambuco (HC-UFPE),InstitutodeMedicinaIntegralProfessorFernando Figueira(IMIP),HospitalBarãodeLucena(HBL/US)and Hos-pitalOtáviodeFreitas.Ofthe92patientsanalyzed,64(69.6%) presentedwithpulmonaryTB(36malesand28females,mean age21years±18.7)and28(30.4%)withextrapulmonaryTB(17 malesand11females,meanage23years±21.7).The diagno-siswasbasedonclinicalsymptomsandradiographicfindings, alongwithbacteriologicalconfirmation(culture,smearand/or polymerase chainreaction) as described bythe Diagnostic
Standards and Classificationof Tuberculosis inAdults and Children.32
As control group, we enrolled 286 healthy individ-uals (163 females/123 males; mean age 27 years±20.3), unrelated to patients, with negative Mantoux test, show-ing no symptoms of tuberculosis or previous history of the disease. All patients and control subjects came from the same geographical area (Pernambuco, Brazil), were all HIV-1 negative and were not under immunosuppressive medication.
Sinceethnicityisanimportantissueingeneticanalyses, patientsandcontrolsreportedtheirself-declaredskinbased ethnic origin.During ethnicity reporta healthprofessional accompaniedtheprocedureguaranteeingthecorrectnessof theprocedure.Afterethnicityassessmentweverifiedthe self-reportedandhealthprofessionalcheckedresults,byanalyzing in the controls 12 Ancestry informativemarkers (AIMs) as recently reported by Coelho et al.33 Absence or extremely poorcorrelationbetweenskinbasedethnicity and thetrue geneticbackground,asrevealedbythe12AIMsanalysis,was observed.So,wediscardedtheself-declaredskinbased eth-nicoriginandconsideredonlythegeneticAIMsfindings.In fact,ourstudiedpopulationconsistsofastrongadmixtureof European-Caucasian,AfricanandSouthAmerican Amerindi-ans population, leading the genetic North East Brazilian compositionunique;consequentlyitisimpossibletostratify our populationforethnicity,being anadmixtureofaround 58%European,24%Africanand18%Amerindianasrecently reported.33
Written informed consent was obtained from the par-ticipants or their parents. The CPqAM/FIOCRUZ Ethics Committee (CEP Registration – 55/05) approved the study. Patients underwent a standardizedclinical–epidemiological questionnaire.
DEFB1genotyping
GenomicDNAwasextractedfromwholebloodusingQIAamp DNA Blood Kit according to manufacturer instructions (QIAampDNABloodMidiKit,Qiagen).
The DEFB1 5UTR polymorphisms −52G>A (rs1799946), −44C>G (rs1800972) and −20G>A (rs11362) were geno-typed by direct sequencing, according to Braida et al.22 Sequences were handled using the 4Peaks
(http://nucleobytes.com/index.php/4peaks) and CodonCode
Alignersoftware(http://www.codoncode.com/aligner/).
Statisticalanalysis
Chi-square test was used to verify the Hardy–Weinberg equilibrium and the Fisher’s exact test was employed for pair-wisecomparisonofallele,genotypeandhaplotype fre-quencies using contingency tables as appropriate; only p
values<0.05 were considered to besignificant. All the sta-tistical analyses were carried out using the open-sourceR package (http://www.r-project.org). The power ofthe study wascheckedbysoftwareG*powersoftwareversion3.1.34 Hap-lotypeswerecomputed usingtheArlequinversion 3.5.1.335 andHaploviewsoftware.36
Table1–AllelesandgenotypesdistributionofSNPs–inthe5untranslatedregion(UTR)ofDEFB1geneintuberculosis patients(TB)andhealthycontrols(HC)fromNortheastBrazil.
SNPs TBpatients n=92 Healthycontrols n=268 p-value,OR(95%CI) All pTB Allvs.HC pTBvs.HC -52G>A(rs1799946) G 97(0.53) 68(0.54) 309(0.54) Reference Reference A 87(0.47) 58(0.46) 263(0.46) p=0.80,1.05(0.74–1.49) p=1.00,1.00(0.67–1.50) GG 29(0.32) 19(0.30) 89(0.31) Reference Reference GA 39(0.42) 30(0.48) 131(0.46) p=0.78,0.91(0.51–1.65) p=0.87,1.07(0.54–2.15) AA 24(0.26) 14(0.22) 66(0.23) p=0.75,1.11(0.56–2.19) p=1.00,0.99(0.43–2.26) GA/AA 63(0.68) 44(0.70) 197(0.69) p=1.00,0.98(0.58–1.69) p=1.00,1.05(0.56–2.01) −44C>G(rs1800972) C 153(0.83) 102(0.81) 491(0.86) Reference Reference G 31(0.17) 24(0.19) 81(0.14) p=0.40,1.23(0.75–1.96) p=0.17,143(0.82–2.40) CC 66(0.72) 42(0.67) 213(0.74) Reference Reference CG 21(0.23) 18(0.29) 65(0.23) p=0.89,1.04(0.56–1.88) p=0.29,1.40(0.71–2.69) GG 5(0.05) 3(0.05) 8(0.03) p=0.32,2.01(0.50–7.25) p=0.40,1.90(0.31–8.32) CG/GG 26(0.28) 21(0.34) 73(0.26) p=0.59,1.15(0.65–1.99) p=0.21,1.46(0.77–2.71) −20G>A(rs11362) G 118(0.64) 82(0.65) 361(0.63) Reference Reference A 66(0.36) 44(0.35) 211(0.37) p=0.86,0.96(0.66–1.37) p=0.76,0.92(0.60–1.40) GG 39(0.42) 26(0.41) 115(0.40) Reference Reference GA 40(0.43) 30(0.48) 131(0.46) p=0.70,0.90(0.52–1.54) p=1.00,1.01(0.54–1.90) AA 13(0.14) 7(0.11) 40(0.14) p=1.00,0.96(0.42–2.06) p=0.66,0.77(0.26–2.02) GA/AA 53(0.57) 37(0.59) 171(0.60) p=0.72,0.91(0.55–1.52) p=0.89,0.96(0.53–1.74) pTB,pulmonarytuberculosis;OR,oddsratio;95%CI,95%confidenceinterval;SNP,singlenucleotidepolymorphism.Referenceindicatesthe mostfrequentallelesandgenotypes.
Results
Thegenotypingresultsofthethree5UTRDEFB1functional
polymorphisms−52G>A(rs1799946),−44C>G(rs1800972)and
−20G>A (rs11362) in TBpatients and healthy controls, are
showninTable1.AllSNPswereinHardy–Weinberg
equilib-riumforbothTBpatientsandhealthycontrols.
DEFB1 SNPs allele and genotype frequencies were sim-ilar in TB patients and healthy controls and no signif-icant difference has been found (p>0.05), also when TB patientswerestratifiedaccordingtothepulmonaryformof disease.
Wecomputedthehaplotypesandobservedthatthethree SNPsinthe5UTRofDEFB1areinstronglinkagedisequilibrium (D>0.9),formingfourhaplotypes(Table2).However,no sig-nificantdifferenceswerefoundwhencomparingTBpatients andhealthycontrols(Table2).
In addition, we estimated the linkage disequilibrium andthe possiblehaplotypes,using Haploviewsoftware,for Brazilianhealthy controls (BRA)and healthy individuals of African (AFR), Caucasian (CEU) and Ad Mixed American (AMR) origin, provided by 1000 Genome Project Database
(www.1000genomes.org). We noted that DEFB-1 SNPs were
in perfect linkage disequilibrium (D=1.0) and have dif-ferent haplotype distributions in the studied populations
(Table3).
Thepost hocanalysisofthestudy throughtheG*power software,indicate the followingpowerfor threeSNPs:0.30 (−52G>A),0.5(−44C>G)and0.16(−20G>A).
Discussion
In the current study, no association was found between −52G>A (rs1799946), −44C>G(rs1800972), −20G>A (rs11362)
DEFB1polymorphismsandTBinaBrazilianpopulation,also whenconsideringthepulmonaryformofthedisease.
Inacase–controlstudy,Wuetal.8analyzedDEFB15UTR
polymorphismsin102patientswithpulmonaryTBand148 healthy controlsofChinese Han populationobserving that theDEFB1−44C/Cgenotypewasassociatedwithpulmonary TBsusceptibility(OR=2.096)andtheGGG(−52/−44/−20) hap-lotype was associated with the pulmonary TB protection (OR=0.348).
In a recent work, performed on a limited number of Mexicanpatients(27withpulmonaryTBand16with extra-pulmonary TB)and controls (n=49), López Camposet al.37 described an association between DEFB1 −44C>G SNP (CG genotypeinacodominantgeneticmodel)andsusceptibilityto extrapulmonaryTB,butnotwiththepulmonaryTB, hypoth-esizing a role forhBD-1 inthe fight againstM. tuberculosis
outsidethelung.
Ourfindingshavediscrepancieswiththeresultsobtained byWuetal.8onHanpopulationandbyLopezCamposetal.37 inMexicans:wecanhypothesizethatthedifferencescouldbe, atleastinpart,duetoethnicity,sincethefrequenciesDEFB1
SNPsvaryindifferentpopulations.AccordingtotheNCBIand HapMapdatabases,38for−52SNP(rs1799946)thefrequency oftheancestralalleleis0.64inEuropean(CEU),0.56in Sub-SaharaAfrican(YRI)and0.40inAsian(HCB);thefrequency
Table2–Haplotypesfrequencydistributionof5UTRDEFBSNPsintuberculosispatients(TB)andhealthycontrols(HC) fromNortheastBrazil.
Haplotypes(−52/−44/−20) TBpatients Healthycontrols 2n=572 p-value,OR(95%CI) All 2n=184 pTB 2n=126 Allvs.HC pTBvs.HC
ACG 86(0.47) 58(0.46) 264(0.46) Reference Reference
GCA 64(0.35) 42(0.34) 210(0.37) p=0.78,0.94(0.63–1.38) p=0.74,0.91(0.57–1.44) GGG 30(0.16) 22(0.18) 80(0.14) p=0.61,1.15(0.68–1.91) p=0.47,1.25(0.68–2.23) GCG 4(0.01) 4(0.02) 18(0.03) p=0.61,0.68(0.16–2.15) p=1.00,1.01(0.24–3.23) pTB,pulmonarytuberculosis;OR,oddsratio;95% CI,95%confidenceinterval;nc,notcalculable.Referenceindicatesthemostfrequent haplotypes.
Table3–Haplotypesfrequenciesinhealthyindividualofdifferentethnicorigin.
Haplotypes Frequencies
Brazilian(BRA) African(AFR) Caucasian(CEU) AdMixed American(AMR)
ACG 0.460 0.588 0.399 0.297
GCA 0.369 0.300 0.354 0.438
GGG 0.142 0.064 0.000 0.000
GCG 0.030 0.049 0.247 0.261
of ancestral allele of −44 SNP (rs1800972) is 0.26 in
Euro-pean(CEU),0.04inSub-SaharaAfrican(YRI)and0.12inAsian
(HCB);for−20SNP (rs11362),thefrequencyis0.61in
Euro-pean(CEU),0.60inSub-Sahara(YRI)and0.71inAsian(HCB).
Inaddition,theSNPsanalyzedinBrazilianhealthyindividuals
andhealthy individualofAfrican (AFR),inCaucasian (CEU)
andAdMixedAmerican(AMR)origin,wereinperfectlinkage
disequilibrium (D=1.0) and presented different haplotypic
distribution(Table3),suggestingthatethnicsbackgroundmay
beresponsibleforthedifferencesobservedinpopulationsthat havebeenstudied.Additionally,intheHanChinese popula-tionnolinkagedisequilibriumwasdetected(D<0.5)8andas aconsequencecomparingDEFB1haplotyperesultswithour findingshasnotbeenpossible.Moreover,whenlookingatthe Mexicanpopulationithastoberemarkedthatthestudyof LopezCamposetal.37justanalyzedoneDEFB1SNP−44C>G andotherSNPsincathelicidinencodingCAMPgene.So,itwas notpossibletocompareourDEFB1haplotypeswiththeresults reportedforMexicanpatients.Furthermore,DEFB1rs1800972 alleleandgenotypefrequenciesreportedintheMexican popu-lation(notinHardy–WeimbergEquilibrium)weresignificantly different(0.0002)fortheCalleletoBrazilianones.
However,wecannotexclude,thatthelackofassociation reportedinourstudy,couldbeduetothelimitedsamplesize; thepowerofourstudy(posthocPower≤0.5)indicatesthatnot findinganassociationbetweenSNPswithTBdevelopment, couldbeduetoatypeIIerror.Thisisastronglimitationof ourstudy,andseeingthatalsotheworks ofWuetal.8and LopezCamposetal.37sufferthesamesamplesizeproblem,we areconvincedthatanyfurtherstudydealingwithassociation betweendefensinsgenepolymorphismandTB,shouldenroll greaternumberofpatients,maybejoiningseveralresearch groups,inordertoachievebetterstatisticalpowertoprovide adefinitiveanswerontheroleofdefensinsinsusceptibilityto TB.
Allthisconsidered,evenifourresultsseemtoexcludean associationbetweenDEFB1polymorphismsandTB develop-mentinNortheastBrazilianpopulation,sinceDEFB1couldbea potentialcandidategeneforsusceptibilitytoTBandonlyvery fewstudieshaveaddressedthistopicachievingcontroversial results,wedothinkthatfurtherstudiesonalargernumberof patientsandinotherpopulationsareneededtodisclosethe roleofDEFB1variationsintuberculosisdevelopment.
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
Acknowledgments
Theauthorsthankallthehealthprofessionalsfromthe hospi-talsinvolvedinthestudythatcollaboratedwiththeresearch. We thank the Laboratory of Immunoepidemiology – Cen-trode PesquisasAggeuMagalhões/Fundac¸ão Oswaldo Cruz (CPqAM/FIOCRUZ),theLaboratoryofImmunopathologyKeizo Asami, the Department of Genetics, Federal University of Pernambuco, theGraduateProgram inGenetics for suppor-tingphysicalandscientific,aswellasFundac¸ãodeAmparo à Ciência eTecnologiadoEstado de Pernambuco(FACEPE), Coordenac¸ão deAperfeic¸oamentoPessoaldeNívelSuperior (CAPES)andConselhoNacionaldeDesenvolvimento Cientí-ficoeTecnológico(CNPq),forfinancialsupport.
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