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Artykuł oryginalny

Zależność między polimorfizmem kodonu 72 genu p53 a toczniem rumieniowatym układowym

Mohammad Nabavi
,
Abbas Ghaderi
,
Mohammad Javad Fattahi
,
N. Danaie
,
R. Zangooie
,
Mohammad Faranoush

Reumatologia 2014; 52, 2: 94–98
Data publikacji online: 2014/06/04
Plik artykułu:
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Introduction

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease characterized by acute and chronic inflammation of various tissues in various organs such as joints, heart, lung, kidneys, skin, etc, which leads to tissue damage [1, 2].
Various factors including genetic, epigenetic, ethnic, immunoregulatory, hormonal, and environmental factors have been associated with SLE [3–5]. It seems that interaction of specific genetic risk factors with various environmental factors causes abnormal immune responses [2, 6, 7]. However, the exact etiology of SLE has not yet been identified.
SLE is a multifactorial disease and in addition to the environmental factors multiple genes contribute to the development of the disease [8, 9]. Although SLE inheritance does not follow Mendelian inheritance patterns, it has a strong genetic basis with heritability estimates of more than 66% [10]. Up to now, more than 30 genes have been identified that have been associated with SLE and contribute to the mechanisms of SLE and predispose individuals to SLE [8, 9]. Well-known genetic risk factors that contribute to SLE development include genetic variants of HLA and Fc receptor genes, IRF5, STAT4, PTPN22, TNFAIP3, BLK, BANK1, TNFSF4 and ITGA [8, 9]. In polygenic inheritance, many genetic variants each with a small to moderate effect size contribute to SLE development.
Products of these genes associated with SLE contribute to key immunologic pathways such as Toll-like receptors, signaling pathways, immune regulation pathways and apoptosis [8, 9].
Genetic risk factors have not been totally identified. The p53 is one of the candidate genetic risk factors. p53 controls cell cycle activities leading to apoptosis of autoreactive cells, preventing the proliferation and differentiation of these cells. As a result, any mutations in the p53 gene may cause cancer and autoimmune diseases [11].
The p53 suppressor gene has been located on the short arm of chromosome 17 in exon 11. DNA damage increases p53 expression which subsequently stops the cell cycle and repairs DNA or induces cell apoptosis [11–15].
Among 14 known polymorphisms of the p53 gene, codon 72 polymorphism is the most common polymorphism associated with cancer in the general population [16].
Many studies have evaluated p53 polymorphism in which arginine to proline substitution at codon 72 changes the function of the p53 molecule and predisposes the individual to various diseases including cancer and autoimmune diseases [17–20]. As there is no such information about p53 polymorphism in Iranian patients with SLE, this study aimed to investigate the p53 polymorphism in SLE patients and evaluate the relationship between p53 and clinical and laboratory features of the disease.

Material and methods

In a case-control study, 77 patients (68 female and 9 male) with confirmed diagnosis of SLE who were admitted to Namazi Hospital, affiliated to Shiraz University of Medical Sciences, from 2003 to 2005, were included. Also, 80 healthy individuals who had been referred to the laboratory and gave a blood sample for other reasons were selected as controls.
The information required was extracted from the files and by visiting the patients. Informed consent was taken from the patients or their parents. The study protocol was approved by the ethics committee of the university.
Data including age, gender, onset of symptoms, first manifestation of the disease, complications related to the involvement of each organ and laboratory findings were collected. Then, the prevalence of the patients with homozygous or heterozygous polymorphism and the relationship between any of the mentioned parameters and the allele type were determined.

Implemented methods

By taking 10 cc of fresh blood, DNA was extracted using the salting-out method. The peripheral blood of the controls was obtained and DNA was extracted from them as well. PCR was performed to determine codon 72 polymorphism on the p53 gene. One pair of primers was designed for each allele separately (Arg and Pro). The sequence of forward and reverse primer pairs was as follows:
• Arg F: TCC CCC TTG CCG TCC CAA,
•Arg R: CTG GTG CAG GGG CCA CCC,
•Pro F: GCCAGAGGCTGGTCCCCC,
•Pro R: CGTGCAAGTCACAGACTT.
PCR products were analyzed using 2% agarose gel electrophoresis, with ethidium bromide staining, and DNA detection was done with a UV transilluminator device.
PCR products were 141 bp and 177 bp for arginine and the proline containing alleles, respectively. For heterozygous samples, both PCR bands appeared while only one band of the spectrum appeared for homozygous samples.

Data analysis

The data were analyzed using SPSS software version 14.00 for Windows (SPSS Inc., Chicago, IL) and the Pearson 2 test was used for data analysis. P value < 0.05 was considered as the statistically significant level.

Results

Among 77 patients studied with the mean age of 25.61 ±10.69 years, 9 (11.7%) patients were male and 68 (88.3%) were female. The mean age at the onset of the first symptoms of the disease was 20.65 ±1.27 years. Mean age of the control group was 51.82 ±14.25 years and all of them were female.
Of 77 patients successful DNA analysis was performed only in 65 patients. The frequency of p53 alleles in the patients with SLE was 41.6% for Arg/Pro, 28.6% for Arg/Arg and 14.3% for Pro/Pro while in the control group the most frequent type of allele was Arg/Arg with 38.8%; however, the frequency of Arg/Pro and Pro/Pro alleles was respectively 37.5% and 23.8%. There was a significant difference in the frequency of alleles between the SLE and control groups (p = 0.03) (Table I).
About 71.9% of the patients had no family history of SLE while a positive family history of SLE was found in 20.9% of the patients; positive family history of other rheumatic diseases and cancer in first-degree relatives was seen in 7% and 4.7% of the patients, respectively.
Regarding the frequency, the most important initial signs and symptoms were fever in 37%, arthritis in 33%, arthralgia in 28.4% and malar rash in 22.2% of the patients (Table II).
Among the lupus criteria for diagnosis, the most common findings were renal involvement (82.7%), anti-nuclear antibody (ANA) (81.5%), hematologic manifestation (76.5%), malar rash (74.1%), arthritis (72.7%), photosensitivity (48.1%), immunologic findings (45.5%), oral ulcer (38.3%), neurologic manifestations (seizures and psychosis) (18.5%), serositis (17.3%) and discoid rash (14.8%).
There was no significant correlation between the SLE initial manifestations, laboratory findings and different alleles of the p53 gene (p > 0.05). However, there were significant relationships between diarrhea, pulmonary involvement, photosensitivity, malar rash and p53 gene polymorphism (p < 0.05) (Table III).

Discussion

According to the findings of the present study, there are significant associations between the different allele types of p53 codon 72 and SLE in our population.
In a study in 2005 in South Korea on 90 patients with SLE who were compared with 114 controls, it was found that proline carriers had higher risk of developing SLE than those with arginine [21]. However, another study on 513 SLE patients and 567 controls of a Spanish population in 2006 could not find any significant association between codon 72 of p53 polymorphism and lupus as well as its clinical feature [14]. Therefore they concluded that p53 codon 72 polymorphism does not play an important role in the susceptibility to or severity of SLE in their population [14].
Our study showed no significant association between the initial manifestations of SLE as well as laboratory findings and p53. In a study in Poland which was performed on 155 patients and 150 controls, there was no significant association between p53 codon 72 polymorphism and initial symptoms as well as the laboratory findings of lupus but a weak association was reported between Arg/Arg genotype of p53 and lupus morbidity [18]. Our study found a significant association between p53 codon 72 polymorphism and some clinical manifestations of SLE such as photosensitivity, malar rash as well as some morbidities including diarrhea and pulmonary involvement.
A meta-analysis in 2012 that included 6 SLE studies showed that there is a significant association between the p53 C allele and SLE in Asians but not in Europeans [22]. They concluded that p53 codon 72 polymorphism could predict susceptibility to SLE only in Asians, which confirms our results [22].
Differences between findings of various studies may be due to the genetic background and environmental factors that influence disease susceptibility, lupus manifestation and progression.
Having no positive and negative control sample confirmed by sequencing was the main limitation of our study.
In conclusion, according to the results of the present study, it seems that p53 may be a determinant factor in SLE susceptibility and its manifestations and morbidity as well.

Acknowledgment

We would like to express our sincere gratitude to Farzan Institute for Research & Technology for technical assistance.

Authors declare no conflict of interests.

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Copyright: © 2014 Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.




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