Toll-like 4 receptor variant, Asp299Gly, and reduced risk of hemorrhagic cystitis after hematopoietic stem cell transplantation.
Hemorrhagic cystitis (HC) is a major cause of morbidity after hematopoietic stem cell transplantation. Toll-like receptor 4 (TLR4) is a pattern recognition receptor of the innate immune system and induces inflammation. Individuals with the single nucleotide polymorphisms Thr399Ile (rs4986791) or Asp299Gly (rs4986790) of TLR4 show diminished inflammatory responsiveness to endotoxins. The genotype of TLR4 was determined in 166 children who underwent allogeneic hematopoietic stem cell transplantation and in their donors. Asp299Gly was present in 21 patients (13%) and 24 donors (14%). Thr399Ile was found in 22 patients (13%) and 25 donors (15%). The incidence of HC was significantly lower in patients with Asp299Gly (0% vs 23%; P = .009) and in patients who underwent transplantation from a donor with Asp299Gly (4% vs 23%; P = .05). The trend was the same for Thr399Ile-donor positive (8% vs 22%; P = .17), recipient positive (9% vs 22%; P = .25), donor or recipient positive (8% vs 23%; P = .04). Multivariate analysis revealed age, conditioning with busulfan, and absence of Asp299Gly as independent risk factors for HC. In conclusion, the TLR4 Asp299Gly variant seems to confer protection against hemorrhagic cystitis. This study provides the first indication that the innate immune system through TLR4 signaling pathway plays a role in the pathogenesis of HC after hematopoietic stem cell transplantation.
Department of Pediatrics, University Hospital of Jena, Kochstrasse 2, Jena, Germany. bernd.gruhn@med.uni-jena.de
Bernd
B
Gruhn
Norman
N
Klöppner
Nadine
N
Pfaffendorf-Regler
James
J
Beck
Felix
F
Zintl
Stephan
S
Bartholomä
Klaus-Michael
KM
Debatin
Daniel
D
Steinbach
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000970:Antineoplastic Agents / Q000008:administration & dosage; D002066:Busulfan / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003556:Cystitis / Q000209:etiology / Q000276:immunology*; D005260:Female; D019337:Hematologic Neoplasms / Q000276:immunology / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006483:Hemorrhagic Septicemia / Q000209:etiology / Q000276:immunology*; D006801:Humans; D007113:Immunity, Innate; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D020641:Polymorphism, Single Nucleotide; D012307:Risk Factors; D014019:Tissue Donors; D051197:Toll-Like Receptor 4 / Q000235:genetics / Q000276:immunology*; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous
D000970:Antineoplastic Agents; C495345:TLR4 protein, human; D051197:Toll-Like Receptor 4; D002066:Busulfan