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Genome-Wide Association Study Identifies ROBO2 as a Novel Susceptibility Gene for Anthracycline-Related Cardiomyopathy in Childhood Cancer Survivors.
- Source :
-
Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2023 Mar 20; Vol. 41 (9), pp. 1758-1769. Date of Electronic Publication: 2022 Dec 12. - Publication Year :
- 2023
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Abstract
- Purpose: Interindividual variability in the dose-dependent association between anthracyclines and cardiomyopathy suggests a modifying role of genetic susceptibility. Few previous studies have examined gene-anthracycline interactions. We addressed this gap using the Childhood Cancer Survivor Study (discovery) and the Children's Oncology Group (COG) study COG-ALTE03N1 (replication).<br />Methods: A genome-wide association study (Illumina HumanOmni5Exome Array) in 1,866 anthracycline-exposed Childhood Cancer Survivor Study participants (126 with heart failure) was used to identify single-nucleotide polymorphisms (SNPs) with either main or gene-environment interaction effect on anthracycline-related cardiomyopathy that surpassed a prespecified genome-wide threshold for statistical significance. We attempted replication in a matched case-control set of anthracycline-exposed childhood cancer survivors with (n = 105) and without (n = 160) cardiomyopathy from COG-ALTE03N1.<br />Results: Two SNPs (rs17736312 [ ROBO2 ]) and rs113230990 (near a CCCTC-binding factor insulator [< 750 base pair]) passed the significance cutoff for gene-anthracycline dose interaction in discovery. SNP rs17736312 was successfully replicated. Compared with the GG/AG genotypes on rs17736312 and anthracyclines ≤ 250 mg/m <superscript>2</superscript> , the AA genotype and anthracyclines > 250 mg/m <superscript>2</superscript> conferred a 2.2-fold (95% CI, 1.2 to 4.0) higher risk of heart failure in discovery and an 8.2-fold (95% CI, 2.0 to 34.4) higher risk in replication. ROBO2 encodes transmembrane Robo receptors that bind Slit ligands (SLIT). Slit-Robo signaling pathway promotes cardiac fibrosis by interfering with the transforming growth factor-β1/small mothers against decapentaplegic (Smad) pathway, resulting in disordered remodeling of the extracellular matrix and potentiating heart failure. We found significant gene-level associations with heart failure: main effect ( TGF-β1 , P = .007); gene*anthracycline interaction ( ROBO2 *anthracycline, P = .0003); and gene*gene*anthracycline interaction ( SLIT2 * TGF-β1* anthracycline, P = .009).<br />Conclusion: These findings suggest that high-dose anthracyclines combined with genetic variants involved in the profibrotic Slit-Robo signaling pathway promote cardiac fibrosis via the transforming growth factor-β1/Smad pathway, providing credence to the biologic plausibility of the association between SNP rs17736312 ( ROBO2 ) and anthracycline-related cardiomyopathy.
- Subjects :
- Child
Humans
Transforming Growth Factor beta1 genetics
Transforming Growth Factor beta1 therapeutic use
Genome-Wide Association Study
Anthracyclines adverse effects
Antibiotics, Antineoplastic therapeutic use
Fibrosis
Receptors, Immunologic genetics
Receptors, Immunologic therapeutic use
Cancer Survivors
Neoplasms drug therapy
Cardiomyopathies chemically induced
Cardiomyopathies genetics
Heart Failure chemically induced
Heart Failure genetics
Subjects
Details
- Language :
- English
- ISSN :
- 1527-7755
- Volume :
- 41
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Journal of clinical oncology : official journal of the American Society of Clinical Oncology
- Publication Type :
- Academic Journal
- Accession number :
- 36508697
- Full Text :
- https://doi.org/10.1200/JCO.22.01527