title: Presence of the methylenetetrahydrofolate reductase gene polymorphism MTHFR C677T in molar tissue but not maternal blood predicts failure of methotrexate treatment for low-risk gestational trophoblastic neoplasia.
abstract: Gestational trophoblastic neoplasia (GTN) is a rare tumor, and its genomic constitution is different from the maternal genome because of its gestational origin. Methotrexate (MTX) is a standard chemotherapeutic agent for low-risk GTN. An association between polymorphisms of the methylenetetrahydrofolate reductase (MTHFR) gene and MTX treatment outcome has been reported in various diseases. Thus, we examined the association between clinical outcome and MTHFR polymorphisms in both tumor and blood DNA of low-risk GTN patients. MTHFR C677T (rs1801133) and A1298C (rs1801131) were genotyped using high-resolution melting assays in 62 Japanese low-risk GTN patients and in 52 antecedent molar tissues. We compared the genotypes of MTHFR polymorphisms with the clinical outcome of 5-day MTX treatment. Twenty-five patients entered remission and 37 patients developed drug resistance or adverse effects that necessitated a drug change. The MTHFR 677T allele in molar tissue was significantly related to the need for drug change (P=0.006; odds ratio [OR], 3.13; 95% confidence interval [CI], 1.31-7.49), in contrast to MTHFR 1298C (P=0.18; OR, 0.63; 95% CI, 0.32-1.25). The MTHFR 677T and 1298C alleles obtained from patients' blood DNA were not related to MTX treatment outcome (P=0.49; OR 1.31; 95% CI, 0.61-2.91 and P=0.10; OR 0.52; 95% CI, 0.22-1.15, respectively). These data demonstrate for the first time that the genotype of MTHFR 677TT in molar tissue is associated with ineffective MTX treatment in Japanese low-risk GTN patients.
authors.affiliation: Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo, Chiba 260-8670, Japan. Electronic address: magnoliaqu313@yahoo.co.jp.
authors.forename: Jia
authors.initials: J
authors.lastname: Qu
authors.affiliation: Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo, Chiba 260-8670, Japan. Electronic address: hirokazu-usui@faculty.chiba-u.jp.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Usui
authors.affiliation: Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo, Chiba 260-8670, Japan. Electronic address: kakuhiroshikun@yahoo.co.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kaku
authors.affiliation: Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo, Chiba 260-8670, Japan. Electronic address: shozu@faculty.chiba-u.jp.
authors.forename: Makio
authors.initials: M
authors.lastname: Shozu
mesh_terms: D000328:Adult; D006063:Chorionic Gonadotropin / Q000097:blood; D005260:Female; D020022:Genetic Predisposition to Disease / Q000235:genetics*; D031901:Gestational Trophoblastic Disease / Q000097:blood / Q000188:drug therapy* / Q000201:enzymology / Q000235:genetics*; D006207:Half-Life; D006801:Humans; D008727:Methotrexate / Q000494:pharmacology* / Q000627:therapeutic use; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics*; D008963:Molar / Q000378:metabolism*; D009035:Mothers; D011247:Pregnancy; D017211:Treatment Failure
chemical_list: D006063:Chorionic Gonadotropin; D042965:Methylenetetrahydrofolate Reductase (NADPH2); D008727:Methotrexate
keywords: Gestational trophoblastic neoplasia; Methotrexate; Methylenetetrahydrofolate reductase; Molar pregnancy; Single nucleotide polymorphism