title: A polymorphism in the P2X7 gene increases susceptibility to extrapulmonary tuberculosis.
abstract: BACKGROUND
  Genetic variation influences susceptibility to clinical tuberculosis (TB). Activation of the P2X(7) receptor on human macrophages induces killing of mycobacteria. We have identified polymorphisms in the P2X(7) gene that markedly reduce this killing.
  
  
  OBJECTIVE
  To determine if polymorphisms in P2X7 are associated with increased risk of TB, the prevalence of four polymorphisms was assessed in individuals from Southeast Asia, where the majority of patients with TB in our study originate. The association of these polymorphisms with clinical TB was subsequently investigated in two separate case-control cohorts and the function of P2X(7) was assessed in subjects from one cohort.
  
  
  METHODS
  Genotyping of P2X7 polymorphisms was performed from subjects in a nested case-control study of a longitudinal refugee cohort and a separate case-control study. The functional capacity of P2X(7) was investigated by measuring ATP-mediated mycobacterial killing and apoptosis.
  
  
  RESULTS
  Only the 1513A-C polymorphism was present in Southeast Asians and the allele was associated with reduced killing of Mycobacterium tuberculosis. The 1513C allele was strongly associated with extrapulmonary, but not pulmonary, TB in the first (odds ratio, 3.8; 95% confidence interval, 1.6-9.0) and second cohorts (odds ratio, 3.7; 95% confidence interval, 1.7-8.0). ATP-mediated killing of mycobacteria was ablated in macrophages from subjects homozygous for the 1513C allele and significantly impaired in macrophages from heterozygous subjects. There was strong correlation between the degree of mycobacterial killing and ATP-induced apoptosis.
  
  
  CONCLUSIONS
  The 1513C allele increases susceptibility to extrapulmonary TB, and this defect is associated with the reduction in the capacity of macrophages to kill M. tuberculosis.
authors.affiliation: Mycobacterial Research Programme, Centenary Institute of Cancer Medicine and Cell Biology, Locked Bag No 6, Newtown, NSW, Australia.
authors.forename: Suran L
authors.initials: SL
authors.lastname: Fernando
authors.forename: Bernadette M
authors.initials: BM
authors.lastname: Saunders
authors.forename: Ronald
authors.initials: R
authors.lastname: Sluyter
authors.forename: Kristen K
authors.initials: KK
authors.lastname: Skarratt
authors.forename: Hazel
authors.initials: H
authors.lastname: Goldberg
authors.forename: Guy B
authors.initials: GB
authors.lastname: Marks
authors.forename: James S
authors.initials: JS
authors.lastname: Wiley
authors.forename: Warwick J
authors.initials: WJ
authors.lastname: Britton
mesh_terms: D000255:Adenosine Triphosphate / Q000494:pharmacology; D000328:Adult; D000483:Alleles; D017209:Apoptosis; D001210:Asia, Southeastern; D001315:Australia; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D020022:Genetic Predisposition to Disease; D005838:Genotype; D006801:Humans; D008264:Macrophages / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000276:immunology; D020641:Polymorphism, Single Nucleotide; D018048:Receptors, Purinergic P2 / Q000235:genetics*; D058486:Receptors, Purinergic P2X7; D014376:Tuberculosis / Q000235:genetics*
chemical_list: C546468:P2RX7 protein, human; D018048:Receptors, Purinergic P2; D058486:Receptors, Purinergic P2X7; D000255:Adenosine Triphosphate