1. Genome-Wide Meta-analysis Identifies Genetic Variants Associated With Glycemic Response to Sulfonylureas
- Author
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Dawed, Adem Y, Yee, Sook Wah, Zhou, Kaixin, van Leeuwen, Nienke, Zhang, Yanfei, Siddiqui, Moneeza K, Etheridge, Amy, Innocenti, Federico, Xu, Fei, Li, Josephine H, Beulens, Joline W, van der Heijden, Amber A, Slieker, Roderick C, Chang, Yu-Chuan, Mercader, Josep M, Kaur, Varinderpal, Witte, John S, Lee, Ming Ta Michael, Kamatani, Yoichiro, Momozawa, Yukihide, Kubo, Michiaki, Palmer, Colin NA, Florez, Jose C, Hedderson, Monique M, Hart, Leen MT, Giacomini, Kathleen M, Pearson, Ewan R, investigators:, MetGen Plus, Pearson, Ewan, Dawed, Adem, Holman, Rury, Coleman, Ruth, Hart, Leen T, Slieker, Roderick, Beulens, Joline, van der Heijden, Amber, Nijpels, Giel, Elders, Petra, Rutters, Femke, Stricker, Bruno, Ahmadizar, Fariba, de Keyser, Catherine, Koov, Adriaan, Out, Mattijs, Kloviņš, Jānis, Zaharenko, Linda, Javorsky, Martin, Tkac, Ivan, Florez, Jose, Giacomini, Kathy, Hedderson, Monique, Motsinger-Reif, Alison, Wagner, Michael, Semiz, Sabina, Dujic, Tanja, Christensen, Mette, Brøsen, Kim, Waterworth, Dawn, Ehm, Meg, Ma, Ronald, Psaty, Bruce, and Floyd, James
- Subjects
Pharmacology and Pharmaceutical Sciences ,Biomedical and Clinical Sciences ,Prevention ,Diabetes ,Human Genome ,Genetics ,Evaluation of treatments and therapeutic interventions ,6.1 Pharmaceuticals ,Metabolic and endocrine ,Blood Glucose ,Diabetes Mellitus ,Type 2 ,Genome-Wide Association Study ,Glycated Hemoglobin ,Humans ,Hypoglycemic Agents ,Likelihood Functions ,Liver-Specific Organic Anion Transporter 1 ,Metformin ,Sulfonylurea Compounds ,for MetGen Plus ,for the DIRECT Consortium ,MetGen Plus investigators: - Abstract
ObjectiveSulfonylureas, the first available drugs for the management of type 2 diabetes, remain widely prescribed today. However, there exists significant variability in glycemic response to treatment. We aimed to establish heritability of sulfonylurea response and identify genetic variants and interacting treatments associated with HbA1c reduction.Research design and methodsAs an initiative of the Metformin Genetics Plus Consortium (MetGen Plus) and the DIabetes REsearCh on patient straTification (DIRECT) consortium, 5,485 White Europeans with type 2 diabetes treated with sulfonylureas were recruited from six referral centers in Europe and North America. We first estimated heritability using the generalized restricted maximum likelihood approach and then undertook genome-wide association studies of glycemic response to sulfonylureas measured as HbA1c reduction after 12 months of therapy followed by meta-analysis. These results were supported by acute glipizide challenge in humans who were naïve to type 2 diabetes medications, cis expression quantitative trait loci (eQTL), and functional validation in cellular models. Finally, we examined for possible drug-drug-gene interactions.ResultsAfter establishing that sulfonylurea response is heritable (mean ± SEM 37 ± 11%), we identified two independent loci near the GXYLT1 and SLCO1B1 genes associated with HbA1c reduction at a genome-wide scale (P < 5 × 10-8). The C allele at rs1234032, near GXYLT1, was associated with 0.14% (1.5 mmol/mol), P = 2.39 × 10-8), lower reduction in HbA1c. Similarly, the C allele was associated with higher glucose trough levels (β = 1.61, P = 0.005) in healthy volunteers in the SUGAR-MGH given glipizide (N = 857). In 3,029 human whole blood samples, the C allele is a cis eQTL for increased expression of GXYLT1 (β = 0.21, P = 2.04 × 10-58). The C allele of rs10770791, in an intronic region of SLCO1B1, was associated with 0.11% (1.2 mmol/mol) greater reduction in HbA1c (P = 4.80 × 10-8). In 1,183 human liver samples, the C allele at rs10770791 is a cis eQTL for reduced SLCO1B1 expression (P = 1.61 × 10-7), which, together with functional studies in cells expressing SLCO1B1, supports a key role for hepatic SLCO1B1 (encoding OATP1B1) in regulation of sulfonylurea transport. Further, a significant interaction between statin use and SLCO1B1 genotype was observed (P = 0.001). In statin nonusers, C allele homozygotes at rs10770791 had a large absolute reduction in HbA1c (0.48 ± 0.12% [5.2 ± 1.26 mmol/mol]), equivalent to that associated with initiation of a dipeptidyl peptidase 4 inhibitor.ConclusionsWe have identified clinically important genetic effects at genome-wide levels of significance, and important drug-drug-gene interactions, which include commonly prescribed statins. With increasing availability of genetic data embedded in clinical records these findings will be important in prescribing glucose-lowering drugs.
- Published
- 2021