Nora Szabo, Stefanie Heilmann-Heimbach, Niclas Eriksson, Carlo Maj, Henning Bundgaard, Mia Wadelius, Per Hoffmann, Börge Schmidt, Markus M Nöthen, Michael Steffens, Carina M Mathey, Julia Westmeier, Annika B Scheer, Cynthia M Bulik, Bettina Wedi, Dorothea Wieczorek, Lukas Koch, Clemens Schöffl, Nomun Ganjuur, Thorsten Hornung, Timo Buhl, Gerda Wurpts, Trine Andresen, Sisse Rye Ostrowski, Eva Rye Rasmussen, Bernhardt Sachs, Jens Greve, Friederike S David, Maria Koromina, Erik Sørensen, Ole B Pedersen, Emel Aygören-Pürsün, Signe Bek Sørensen, Mikael Landén, Christian von Buchwald, Henrik Ullum, Harald Löffler, Philipp M Amann, Andreas J Forstner, Laven Mavarani, Heinrich Dickel, Pär Hallberg, Patrik K E Magnusson, Anette Bygum, Ulla Vogel, Vibeke Andersen, Jonas Ghouse, Christian Erikstrup, Stefan Herms, Kristi Krebs, Lili Milani
Journal: The Journal of allergy and clinical immunology 2024;153(4):1073-1082
PMID: 38300190
BACKGROUND
Angioedema is a rare but potentially life-threatening adverse drug reaction in patients receiving angiotensin-converting enzyme inhibitors (ACEis). Research suggests that susceptibility to ACEi-induced angioedema (ACEi-AE) involves both genetic and nongenetic risk factors. Genome- and exome-wide studies of ACEi-AE have identified the first genetic risk loci. However, understanding of the underlying pathophysiology remains limited.
OBJECTIVE
We sought to identify further genetic factors of ACEi-AE to eventually gain a deeper understanding of its pathophysiology.
METHODS
By combining data from 8 cohorts, a genome-wide association study meta-analysis was performed in more than 1000 European patients with ACEi-AE. Secondary bioinformatic analyses were conducted to fine-map associated loci, identify relevant genes and pathways, and assess the genetic overlap between ACEi-AE and other traits. Finally, an exploratory cross-ancestry analysis was performed to assess shared genetic factors in European and African-American patients with ACEi-AE.
RESULTS
Three genome-wide significant risk loci were identified. One of these, located on chromosome 20q11.22, has not been implicated previously in ACEi-AE. Integrative secondary analyses highlighted previously reported genes (BDKRB2 [bradykinin receptor B2] and F5 [coagulation factor 5]) as well as biologically plausible novel candidate genes (PROCR [protein C receptor] and EDEM2 [endoplasmic reticulum degradation enhancing alpha-mannosidase like protein 2]). Lead variants at the risk loci were found with similar effect sizes and directions in an African-American cohort.
CONCLUSIONS
The present results contributed to a deeper understanding of the pathophysiology of ACEi-AE by (1) providing further evidence for the involvement of bradykinin signaling and coagulation pathways and (2) suggesting, for the first time, the involvement of the fibrinolysis pathway in this adverse drug reaction. An exploratory cross-ancestry comparison implicated the relevance of the associated risk loci across diverse ancestries.
Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.
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