CN109207575B - 一种用于预测甲氨蝶呤治疗银屑病临床疗效的基因标志物及检测试剂盒 - Google Patents

一种用于预测甲氨蝶呤治疗银屑病临床疗效的基因标志物及检测试剂盒 Download PDF

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CN109207575B
CN109207575B CN201710529763.9A CN201710529763A CN109207575B CN 109207575 B CN109207575 B CN 109207575B CN 201710529763 A CN201710529763 A CN 201710529763A CN 109207575 B CN109207575 B CN 109207575B
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徐金华
颜克香
张学军
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Abstract

本发明属生物技术领域,涉及银屑病药物疗效检测基因标志物及检测试剂盒,本发明提出了LCE3D SNP位点rs4112788AG基因型作为预测甲氨蝶呤治疗银屑病的临床疗效的基因标志物;通过研究LCE3D SNP位点rs4112788基因型与MTX治疗银屑病临床疗效的关系提供了检测试剂盒,针对携带LCE3D SNP位点rs4112788AG基因型与否的银屑病患者用MTX治疗干预的有效率以及肝毒性的风险的发生情况,预测评估MTX治疗银屑病的临床疗效,有助于指导临床医生制定适合的MTX治疗干预方案,为提高MTX的临床疗效提供基础。

Description

一种用于预测甲氨蝶呤治疗银屑病临床疗效的基因标志物及 检测试剂盒
技术领域
本发明属于生物技术领域,涉及银屑病药物疗效检测试剂盒,具体涉及一种新型的一种用于预测甲氨蝶呤(MTX)治疗银屑病临床疗效的检测试剂盒,该试剂盒通过检测银屑病患者易感基因LCE3D的SNP位点,预测MTX的临床疗效。可以指导临床医生制定适合的MTX治疗干预方案,为提高MTX的临床疗效提供基础。
背景技术
现有技术公开了银屑病为常见的慢性炎症性疾病,可累及皮肤、指甲、关节、肾脏、心血管等多个脏器。由于该疾患发病率高、病程长、易复发、难根治,给患者带来严重的身心损害和经济负担。目前临床实践中常采用的药物干预中,如常使用的阿维A有效率只有20%左右,而且会引起血脂增高,增加患者心血管疾病的风险,且部分患者还会出现肝肾功能的损害;生物制剂的临床有效率虽然高在50%-80%左右,但由于价格昂贵,致使大多数患者无力承担;甲氨蝶呤(MTX)为目前较常采用的较经济、有效的治疗银屑病的药物,但由于其存在有骨髓抑制和肝纤维化影响的风险,严重限制了MTX在银屑病治疗中的广泛应用。因此,寻找一个生物标记预测MTX的临床疗效和毒副作用,有利于提高临床疗效和降低毒副作用,该课题成为越来越多的本领域科学家和医生关注的热点。
研究显示,银屑病是一定遗传背景下由免疫细胞与角质形成细胞相互作用共同介导的慢性炎症性疾病,临床表现为边界清楚的白色鳞屑性斑块,特征性的组织病理表现与表皮分化异常密切相关。有研究表明,表皮分化复合物(epidermal differentialcomplex,EDC)基因是一呈簇状分布于染色体1q21上的基因家族,它参与调控表皮的终末分化;晚期角质化包膜基因簇(late cornified envelope gene cluster)位于EDC基因区,编码的晚期角质化包膜蛋白(LCE)复合物在表皮分化过程中起重要作用;LCE基因簇编码的异常角质化包膜蛋白可能影响角化不全或角化过度性角质形成细胞外膜的稳定性,从而导致角质形成细胞未能正常分化而聚集,继而干扰角质形成细胞终末期分化。有学者对汉族人银屑病进行了全基因组关联分析(genome-wide association study,GWAS)研究,发现LCE基因簇中LCE1B与LCE3D基因多态性与银屑病关联。MTX在1972年被FDA批准治疗银屑病,其结构类似叶酸,与二氢叶酸还原酶不可逆地结合,发挥抗增殖活性,诱导凋亡和增加腺苷浓度,具有抗炎和免疫调节作用。
既往的研究发现叶酸代谢通路相关的酶的基因多态性与MTX治疗类风湿性关节炎的临床疗效和毒副作用的相关:如MTHFR1298A>C(rs1801131),ATIC347C>G(rs2372536),RFC-180G>A(rs1051266),SLC19A1A>G(rs2838956)and SLC19A1G>A(rs7499)与MTX的临床疗效相关;而RFC-180G>A(rs1051266)基因多态性与MTX的毒性相关。迄今尚鲜见有关MTX治疗银屑病相关的基因多态性,尤其是从银屑病易感基因位点出发的研究探讨的报道。
基于现有技术的研究现状,本申请的发明人拟通过研究LCE3D SNP位点rs4112788基因型与MTX治疗银屑病临床疗效的关系,提供LCE3D SNP位点rs4112788AG基因型作为预测MTX治疗银屑病的临床疗效的基因标志物,以及用于预测甲氨蝶呤治疗银屑病临床疗效的检测试剂盒。
发明内容
本发明的目的是基于现有技术的现状,提供新的预测MTX临床疗效的基因标志物,本发明通过研究携带LCE3D SNP位点rs4112788AG基因型的银屑病患者用MTX治疗有效率以及不增加肝毒性的风险的情况,提出了LCE3D SNP位点rs4112788AG基因型可作为预测MTX治疗银屑病的临床疗效的基因标志物;
本发明的进一步目的是提供用于预测甲氨蝶呤治疗银屑病临床疗效的检测试剂盒。本发明中,通过研究LCE3D SNP位点rs4112788基因型与MTX治疗银屑病临床疗效的关系,如携带LCE3D SNP位点rs4112788AG基因型与否的银屑病患者用MTX治疗的有效率以及肝毒性的风险的发生情况用于预测MTX治疗银屑病的临床疗效的评估,有助于指导临床医生制定适合的MTX治疗干预方案。
本发明中,检测了90例银屑病患者LCE3D SNP位点rs4112788的基因型与MTX治疗银屑病临床疗效间的关系,结果显示:1)携带LCE3D易感基因AG基因型的患者在治疗第8周PASI50的改善率为72%,显著高于携带AA/GG基因型患者(38%/37%),差异有统计学意义,p<0.01;2)携带LCE3D易感基因AG基因型的患者在治疗第12周PASI50和PASI75改善率分别为86%和64%,显著高于AA基因型(50%和25%)和GG基因型(60%和31%)患者,差异有统计学意义,p<0.05;3)银屑病患者中50%的患者携带AG基因型,9%的患者携带AA基因型,41%的患者携带GG基因型;4)携带AG基因型患者采用MTX干预发生肝功能异常和肝纤维指标异常的概率为30%和30%,与AA型(25%和25%)和GG型(37%和43%)比较,肝毒性的发生率无统计学差异,p>0.05。
本发明经试验结果证实,检测银屑病患者LCE3D SNP位点rs4112788的基因型,可用作预测MTX治疗银屑病的临床疗效。
本发明进一步实验把结果显示,未经基因检测MTX治疗银屑病的临床疗效为47%,针对携带LCE3D SNP位点rs4112788AG基因型的银屑病患者采用MTX治疗干预,其有效率可提高至65%,且未见增加肝毒性的风险;未经基因检测时MTX引起肝功能异常和肝纤维化指标异常的概率分别为34和37%,针对携带LCE3D SNP位点rs4112788AG基因型的银屑病患者采用MTX治疗干预发生肝毒性的概率为30%,结果表明,携带LCE3D SNP位点rs4112788AG基因型的银屑病患者采用MTX治疗干预有效率高,且不增加肝毒性的风险。
本发明提供了新的预测MTX临床疗效的基因标志物,尤其是LCE3D SNP位点rs4112788AG基因型可作为预测MTX治疗银屑病的临床疗效的基因标志物;
本发明进一步提供了用于预测甲氨蝶呤治疗银屑病临床疗效的检测试剂盒,针对携带LCE3D SNP位点rs4112788AG基因型否的银屑病患者采用MTX治疗干预其治疗有效率高,且不增加肝毒性的风险;本发明可用于预测MTX治疗银屑病的临床疗效的评估,有助于指导临床医生制定适合的MTX治疗干预方案。
本发明所述的两个基因的基因图谱,可查找如下述:
https://www.ncbi.nlm.nih.gov/genome/gdv/browser/?cfg=NCID_1_ 17674144_130.14.18.128_9146_1497362468_1541845085
https://www.ncbi.nlm.nih.gov/genome/gdv/browser/?cfg=NCID_1_ 17676740_130.14.18.128_9146_1497362669_947243872
具体实施方式
实施例1:MTX治疗银屑病的临床疗效和毒副作用观察实验
材料与方法:
1)银屑病患者:选定2015年1月到2017年6月到华山医院皮肤科银屑病专病门诊就诊的银屑病患者为观察对象。
2)用药干预方法:治疗第1周和第2周每周单次口服MTX7.5mg,第3周到第4周每周单次口服10mg,第5周到第12周每周单次口服12.5mg。
3)纳入标准
(1)年龄18-60岁;
(2)诊断为寻常型、关节病型、红皮病型和脓疱型银屑病的患者,体表受累面积(BSA)>10%或或银屑病面积与严重程度指数(PASI)>10;
(3)填写完整流行病学调查表,签署知情同意书者。
4)排除标准
(1)其他特殊类型的寻常型银屑病患者(点滴型、反向型);
(2)年龄<18岁、妊娠、哺乳期妇女,或6个月内计划生育者及伴侣;
(3)已知对本研究所用药物过敏、及含有相关药物成分过敏的患者;
(4)2w内未使用过除保湿剂外的治疗银屑病其他外用药物,4w内未使用过治疗银屑病的系统用药等其他治疗方案的患者;
(5)造血系统、循环系统、呼吸系统、消化系统、免疫系统等其他原发性疾病患者,原发或继发免疫缺陷、肝脏纤维化或慢性肝病、结核患者,其他感染性疾病及精神疾病患者等;
(6)正在接受其他免疫抑制剂治疗及近期接种或计划接种疫苗患者;
5)定期随访指标:血尿常规,肝肾功能,肝纤维化,血脂,血糖,糖化血红蛋白。
结果显示,MTX干预使47%的银屑病患者获得PASI75的改善;30%的患者有胃肠道不适等不良反应;34%的患者和37%的患者出现肝功能异常和肝纤维化指标的异常;36%患者伴有血脂异常;37%患者伴有高血压;18%患者合并糖尿病。90例银屑病患者的一般信息及临床疗效如表1所示,
表1 90例银屑病患者的一般资料
Figure BDA0001339194800000051
实施例2银屑病易感基因与MTX临床疗效间的相关性
材料与方法:提取患者DNA,利用sequenom平台对90例患者的18个非HLA位点进行基因分型,按12w是否达到PASI75分别定义为有效组和无效组,经生物信息学分析,结果显示,LCE3D基因型在有效组和无效组间有统计学意义;
(1)MTX治疗有效组和无效组患者信息比较
用MTX治疗12周达到PASI75改善设为有效组,余下设为无效组,有效组病程(19±12)显著长于无效组(14±11),差异有统计学意义p<0.05;
LCE3DSNP位点rs4112788AG基因型的概率在有效组(67%)显著高于无效组(31%),差异有统计学意义p<0.05(如表2所示);
(2)携带LCE3DSNP位点rs4112788不同基因型患者信息比较.
实验结果表明,携带LCE3DSNP位点rs4112788AG基因型患者对MTX的临床疗效为65%,优于携带AA型25%或GG型31%患者,差异有统计学意义,p<0.01(如表2所示)。
表2 MTX治疗有效组和无效组一般资料和基因型的比较
Figure BDA0001339194800000061
表3携带LCE3DSNP位点rs4112788不同基因型患者信息比较
Figure BDA0001339194800000062
Figure BDA0001339194800000071

Claims (4)

1.LCE3D SNP位点rs4112788在用于制备预测甲氨蝶呤治疗银屑病的临床疗效的基因标志物中的用途。
2.按权利要求1所述的用途,其特征在于,针对携带LCE3D SNP位点rs4112788AG基因型的银屑病患者采用甲氨蝶呤治疗干预有效率以及不增加肝毒性的风险的情况,预测甲氨蝶呤治疗干预的疗效。
3.LCE3D SNP位点rs4112788在用于制备预测甲氨蝶呤治疗银屑病临床疗效的检测试剂盒中的用途。
4.按权利要求3所述的用途,其特征在于,所述的检测试剂盒通过检测LCE3D SNP位点rs4112788基因型与甲氨蝶呤治疗银屑病临床疗效的关系,针对携带LCE3D SNP位点rs4112788AG基因型与否的采用甲氨蝶呤治疗干预的有效率以及肝毒性的风险的发生情况,预测评估甲氨蝶呤治疗银屑病的临床疗效。
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