title: Corticosteroid pharmacogenetics: association of sequence variants in CRHR1 with improved lung function in asthmatics treated with inhaled corticosteroids.
abstract: Corticosteroids mediate a variety of immunological actions and are commonly utilized in the treatment of a wide range of diseases. Unfortunately, therapy with this class of medications is associated with a large proportion of non-responders and significant side effects. Inhaled corticosteroids are the most commonly used asthma controller therapy. However, asthmatic response to corticosteroids also varies widely between individuals. We investigated the genetic contribution to the variation in response to inhaled corticosteroid therapy in asthma. The association of longitudinal change in lung function and single nucleotide polymorphisms from candidate genes crucial to the biologic actions of corticosteroids were evaluated in three independent asthmatic clinical trial populations utilizing inhaled corticosteroids as the primary therapy in at least one treatment arm. Variation in one gene, corticotropin-releasing hormone receptor 1 (CRHR1) was consistently associated with enhanced response to therapy in each of our three populations. Individuals homozygous for the variants of interest manifested a doubling to quadrupling of the lung function response to corticosteroids compared with lack of the variants (P-values ranging from 0.006 to 0.025 for our three asthmatic populations). As the primary receptor mediating the release of adrenocorticotropic hormone, which regulates endogenous cortisol levels, CRHR1 plays a pivotal, pleiotropic role in steroid biology. These data indicate that genetic variants in CRHR1 have pharmacogenetic effects influencing asthmatic response to corticosteroids, provide a rationale for predicting therapeutic response in asthma and other corticosteroid-treated diseases, and suggests this gene pathway as a potential novel therapeutic target.
authors.affiliation: Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Kelan G
authors.initials: KG
authors.lastname: Tantisira
authors.forename: Stephen
authors.initials: S
authors.lastname: Lake
authors.forename: Eric S
authors.initials: ES
authors.lastname: Silverman
authors.forename: Lyle J
authors.initials: LJ
authors.lastname: Palmer
authors.forename: Ross
authors.initials: R
authors.lastname: Lazarus
authors.forename: Edwin K
authors.initials: EK
authors.lastname: Silverman
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Liggett
authors.forename: Erwin W
authors.initials: EW
authors.lastname: Gelfand
authors.forename: Lanny J
authors.initials: LJ
authors.lastname: Rosenwasser
authors.forename: Brent
authors.initials: B
authors.lastname: Richter
authors.forename: Elliot
authors.initials: E
authors.lastname: Israel
authors.forename: Michael
authors.initials: M
authors.lastname: Wechsler
authors.forename: Stacey
authors.initials: S
authors.lastname: Gabriel
authors.forename: David
authors.initials: D
authors.lastname: Altshuler
authors.forename: Eric
authors.initials: E
authors.lastname: Lander
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Drazen
authors.forename: Scott T
authors.initials: ST
authors.lastname: Weiss
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy* / Q000235:genetics* / Q000503:physiopathology; D002648:Child; D005260:Female; D014644:Genetic Variation; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010597:Pharmacogenetics; D018019:Receptors, Corticotropin-Releasing Hormone / Q000235:genetics*
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D018019:Receptors, Corticotropin-Releasing Hormone