title: Polymorphisms in type I and II inosine monophosphate dehydrogenase genes and association with clinical outcome in patients on mycophenolate mofetil.
abstract: BACKGROUND
  Type I and II inosine monophosphate dehydrogenases (IMPDH) are the targets of mycophenolic acid (MPA), a widely used immunosuppressant. The aims of this study were: to check the presence of controversial polymorphisms in the IMPDH II gene; to look for new ones; and to investigate potential associations between the most frequent SNPs in both IMPDH genes and clinical outcome in renal transplant recipients.
  
  
  METHODS
  The DNA and clinical data of 456 patients from two clinical trials were collected. We sequenced the IMPDH II gene in 80 patients and we genotyped the 456 patients' DNA for the IMPDH II rs4974081, rs11706052, 787C>T and the IMPDH I rs2278293 and rs2278294 SNPs, all of which were earlier reported to be potentially involved in MPA treatment related outcome. We investigated the associations of biopsy proven acute rejection (BPAR), leucopenia, cytomegalovirus infections and other infections with these IMPDH polymorphisms, as well as with demographic, biological and treatment data using multivariate analysis.
  
  
  RESULTS
  Many IMPDH II variant alleles referenced in Genbank were not detected and no new polymorphisms were identified. In the whole group of 456 patients, the IMPDH I rs2278294 SNP was associated with a lower risk of BPAR and a higher risk of leucopenia over the first year post-transplantation. No other IMPDH I or IMPDH II polymorphism was significantly associated with any clinical outcome. Interestingly, calcineurin inhibitor and MPA exposures below the therapeutic range increased the risk of BPAR. Cytomegalovirus infection was the factor most closely linked with leucopenia, whereas tacrolimus was associated with fewer infections than cyclosporine.
  
  
  CONCLUSIONS
  IMPDH II genotyping may not improve MPA treatment outcome over the first year post-transplantation, in contrast to MPA and calcineurine inhibitor therapeutic drug monitoring and IMPDH I genotyping.
authors.affiliation: INSERM, UMR-S850, Limoges, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Gensburger
authors.forename: Ron H N
authors.initials: RH
authors.lastname: Van Schaik
authors.forename: Nicolas
authors.initials: N
authors.lastname: Picard
authors.forename: Yannick
authors.initials: Y
authors.lastname: Le Meur
authors.forename: Annick
authors.initials: A
authors.lastname: Rousseau
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Woillard
authors.forename: Teun
authors.initials: T
authors.lastname: Van Gelder
authors.forename: Pierre
authors.initials: P
authors.lastname: Marquet
mesh_terms: D003710:Demography; D005260:Female; D056726:Genetic Association Studies; D006801:Humans; D007168:IMP Dehydrogenase / Q000235:genetics*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D020641:Polymorphism, Single Nucleotide / Q000235:genetics*; D012044:Regression Analysis; D016896:Treatment Outcome
chemical_list: D007168:IMP Dehydrogenase; C488211:IMPDH1 protein, human; C501687:IMPDH2 protein, human; D009173:Mycophenolic Acid