title: Development of a rapid clinical TPMT genotyping assay.
abstract: OBJECTIVE
  Thiopurine compounds are commonly used in the treatment of childhood acute lymphoblastic leukemia, and as immunosuppressants following organ transplantation or for treatment of various autoimmune disorders. Thiopurine S-methyltransferase (TPMT) is required for detoxification, through S-methylation, of 6-thioguanine nucleotides (TGNs), a byproduct of thiopurine metabolism. Single nucleotide polymorphisms (SNPs) in the TPMT gene have been shown to affect its function, with some variants associated with serious clinical manifestations including severe to fatal myelosuppression and organ transplant rejection following treatment with standard thiopurine doses. In this study, we describe a TaqMan real time PCR allelic discrimination assay requiring minimal DNA input for TPMT genotyping.
  
  
  METHODS
  We designed controls for the homozygous wild type and allelic variants of TPMT*2, *3B, and *3C. Genomic DNA was extracted from an additional 412 human blood samples. The samples were tested for the TPMT*2, *3B, *3C, and *3A polymorphisms by TaqMan genotyping assays using the AB 7500 FAST Real-Time PCR instrument. Allelic discrimination plots were used to identify each mutation.
  
  
  RESULTS
  The TaqMan assay correctly genotyped all custom control DNA samples. Of the 412 tested samples, our assay identified 375 samples as wild-type *1/*1 (91.02%), 3 as *1/*2 (0.73%), 1 as *1/*3B (0.24%), 3 as *1/*3C (0.73%), 27 presumed to be *1/*3A (6.55%), and 3 as *3B/*3A (0.73%).
  
  
  CONCLUSIONS
  The clinical implications of TPMT genotyping, along with the simplicity and specificity of the TaqMan genotyping assays make this test highly suitable for use in a clinical laboratory.
authors.affiliation: Department of Pathology, The Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Burchard
authors.affiliation: Department of Pathology, The Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Ahmad N
authors.initials: AN
authors.lastname: Abou Tayoun
authors.affiliation: Department of Pathology, The Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Department of Pathology, The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
authors.forename: Joel A
authors.initials: JA
authors.lastname: Lefferts
authors.affiliation: Department of Medicine, The Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Dartmouth-Hitchcock Medical Center, Norris Cotton Cancer Center, Lebanon, NH, USA.
authors.forename: Lionel D
authors.initials: LD
authors.lastname: Lewis
authors.affiliation: Department of Pathology, The Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Tsongalis
authors.affiliation: Department of Pathology, The Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. Electronic address: mark.a.cervinski@hitchcock.org.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Cervinski
mesh_terms: D004342:Drug Hypersensitivity / Q000235:genetics*; D005838:Genotype; D060005:Genotyping Techniques / Q000379:methods*; D006801:Humans; D008780:Methyltransferases / Q000235:genetics* / Q000302:isolation & purification; D009154:Mutation; D020641:Polymorphism, Single Nucleotide; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000235:genetics* / Q000473:pathology; D011686:Purine-Pyrimidine Metabolism, Inborn Errors / Q000235:genetics*; D013866:Thioguanine
chemical_list: D008780:Methyltransferases; C022745:thiopurine methyltransferase; D013866:Thioguanine
keywords: Allelic discrimination; Laboratory developed test; TPMT; TaqMan; Thiopurine S-methyltransferase