Low Vitamin-D Levels Combined with PKP3-SIGIRR-TMEM16J Host Variants Is Associated with Tuberculosis and Death in HIV-Infected and -Exposed Infants
Year: 2016
Type: article
Abstract: BACKGROUND: This study examined the associations of 25-hydroxyvitamin D and specific host genetic variants that affect vitamin D levels or its effects on immune function, with the risk of TB or mortality in children. METHODS: A case-cohort sample of 466 South African infants enrolled in P1041 trial (NCT00080119) underwent 25-hydroxyvitamin D testing by chemiluminescent immunoassay. Single nucleotide polymorphisms (SNPs) that alter the effect of vitamin D [e.g. vitamin D receptor (VDR)], vitamin D levels [e.g. vitamin D binding protein (VDBP)], or toll like receptor (TLR) expression (SIGIRR including adjacent genes PKP3 and TMEM16J) were identified by real-time PCR. Outcomes were time to TB, and to the composite of TB or death by 192 weeks of follow-up. Effect modification between vitamin D status and SNPs for outcomes was assessed. FINDINGS: Median age at 25-hydroxyvitamin D determination was 8 months; 11% were breastfed, 51% were HIV-infected and 26% had low 25-hydroxyvitamin D (<32ng/mL). By 192 weeks, 138 incident TB cases (43 definite/probable, and 95 possible) and 26 deaths occurred. Adjusting for HIV status and potential confounders, low 25-hydroxyvitamin D was associated with any TB (adjusted hazard ratio [aHR] 1.76, 95% CI 1.01-3.05; p = 0.046) and any TB or death (aHR 1.76, 95% CI 1.03-3.00; p = 0.038). Children with low 25-hydroxyvitamin D and TMEM 16J rs7111432-AA or PKP3 rs10902158-GG were at increased risk for probable/definite TB or death (aHR 8.12 and 4.83, p<0.05) and any TB or death (aHR 4.78 and 3.26, p<0.005) respectively; SNPs in VDBP, VDR, and vitamin D precursor or hydroxylation genes were not. There was significant interaction between low 25-hydroxyvitamin D and, TMEM 16J rs7111432-AA (p = 0.04) and PKP3 rs10902158-GG (p = 0.02) SNPs. CONCLUSIONS: Two novel SNPs, thought to be associated with innate immunity, in combination with low vitamin D levels were identified as increasing a young child's risk of developing TB disease or death. Identifying high-risk children and providing targeted interventions such as vitamin D supplementation may be beneficial. TRIAL REGISTRATION: ClinicalTrials.gov NCT00080119.
Source: PLoS ONE
Authors: Amita Gupta, Grace Montepiedra, Akshay Gupte, Bret Zeldow, Jennifer Jubulis, Barbara Detrick, Avy Violari, Shabir Madhi, Raziya Bobat, Mark Cotton, Charles Mitchell, Stephen Spector, IMPAACT NWCS113 and P1041 Study Team
Institutions: Johns Hopkins University, Harvard University, University of the Witwatersrand, Perinatal HIV Research Unit, Respiratory and Meningeal Pathogens Research Unit, National Research Foundation, University of KwaZulu-Natal, Stellenbosch University, University of Miami, University of California San Diego, Rady Children's Hospital-San Diego
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,382
Funders: Gilead Sciences, Gilead Foundation, International Maternal Pediatric Adolescent AIDS Clinical Trials Network, National Institutes of Health, National Institute of Allergy and Infectious Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke, National Institute of Child Health and Human Development, National Center for Research Resources, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: GENERAL CLINICAL RESEARCH CENTER, G2697936944, G3217561614, G3262353703, G3342746445, G4853082081, Host Genetic Factors Associated with CNS Disease of HIV-Infected Children, SDMC - IMPAACT Leadership Group, International Maternal, Adolescent and Pediatric Therapeutics Clinical Trials Network, Johns Hopkins University Baltimore India Clinical Trail Unit (JHUBI CTU), CURE CTU, PHRU-Setshaba Clinical Trials Unit, IMPAACT Leadership Group
OpenAlex ID: W2266844100