{"title":"Pancreatitis Polygenic Risk Score is Associated with Acute Pancreatitis in Multifactorial Chylomicronemia Syndrome","authors":"","doi":"10.1016/j.jacl.2024.04.063","DOIUrl":null,"url":null,"abstract":"<div><h3>Study Funding</h3><p>This work was supported by the Cardiometabolic Health, Diabetes and Obesity Research Network (CMDO) from Le Fonds de recherche du Québec (FRQS). Luigi Bouchard received a Senior Research Scholar from the FRQS and is a member of the FRQS-Centre Hospitalier</p></div><div><h3>Background/Synopsis</h3><p>The most common cause of severe hypertriglyceridemia is multifactorial chylomicronemia syndrome (MCS). MCS is associated with an increased risk of acute pancreatitis (AP), but the risk is highly heterogenous between patients. The maximal concentration of triglycerides (TG) and the presence of a heterozygous rare pathogenic variant in a TG-related metabolism gene are known predictors of AP in MCS patients. Previous genome-wide association studies identified pancreatitis susceptibility genes. However, no study has assessed whether the accumulation of common variants in these pancreatitis susceptibility genes could help predict the risk of AP in MCS patients.</p></div><div><h3>Objective/Purpose</h3><p>To determine if a weighted polygenic risk score (PRS) including common variants in known pancreatitis susceptibility genes is associated with AP in MCS patients.</p></div><div><h3>Methods</h3><p>A total of 114 patients MCS underwent gene sequencing for the five canonical genes involved in TG metabolism (LPL, APOA5, APOC2, GPIHBP1, and LMF1). In addition, we genotyped eight single nucleotide polymorphisms (SNPs) in genes previously associated with pancreatitis (ABCG8, CLDN2, CTRB1/2, CTRC, PRSS1, PRSS2, SPINK1, and TWIST2). A weighted PRS was calculated to account for the phenotypic effect of each SNP locus.</p></div><div><h3>Results</h3><p>A high pancreatitis-PRS score (defined as ≥ 0.44 and representing the median PRS score) was associated with a 2.94-fold increased risk of AP (p=0.02) among patients with MCS. The association between the pancreatitis-PRS and AP remained statistically significant after correction for known predictors of acute pancreatitis, including age, sex, body mass index, diabetes, the maximal TG concentration and the presence of a heterozygous pathogenic rare variant in a TG-related metabolism gene (p=0.04). MCS patients with a high pancreatitis - PRS and heterozygous for a pathogenic rare variant in a TG metabolism-related gene had a 9.50-fold increased risk of AP (p=0.001), compared to those with a low-PRS and no pathogenic variant.</p></div><div><h3>Conclusions</h3><p>This is the first study to show that the accumulation of common variants in known pancreatitis susceptibility genes is associated with AP in MCS patients. MCS patients with both a high pancreatitis-PRS score and a heterozygous pathogenic rare variant in a TG-related metabolism gene have higher risk of AP, similar to what is seen in monogenic form of severe hypertriglyceridemia. Genetic testing, including both rare and common variants, could help clinicians to identify MCS patients who may be at higher risk of acute pancreatitis and who may benefit from precision medicine.</p></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":null,"pages":null},"PeriodicalIF":3.6000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of clinical lipidology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1933287424001107","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
引用次数: 0
Abstract
Study Funding
This work was supported by the Cardiometabolic Health, Diabetes and Obesity Research Network (CMDO) from Le Fonds de recherche du Québec (FRQS). Luigi Bouchard received a Senior Research Scholar from the FRQS and is a member of the FRQS-Centre Hospitalier
Background/Synopsis
The most common cause of severe hypertriglyceridemia is multifactorial chylomicronemia syndrome (MCS). MCS is associated with an increased risk of acute pancreatitis (AP), but the risk is highly heterogenous between patients. The maximal concentration of triglycerides (TG) and the presence of a heterozygous rare pathogenic variant in a TG-related metabolism gene are known predictors of AP in MCS patients. Previous genome-wide association studies identified pancreatitis susceptibility genes. However, no study has assessed whether the accumulation of common variants in these pancreatitis susceptibility genes could help predict the risk of AP in MCS patients.
Objective/Purpose
To determine if a weighted polygenic risk score (PRS) including common variants in known pancreatitis susceptibility genes is associated with AP in MCS patients.
Methods
A total of 114 patients MCS underwent gene sequencing for the five canonical genes involved in TG metabolism (LPL, APOA5, APOC2, GPIHBP1, and LMF1). In addition, we genotyped eight single nucleotide polymorphisms (SNPs) in genes previously associated with pancreatitis (ABCG8, CLDN2, CTRB1/2, CTRC, PRSS1, PRSS2, SPINK1, and TWIST2). A weighted PRS was calculated to account for the phenotypic effect of each SNP locus.
Results
A high pancreatitis-PRS score (defined as ≥ 0.44 and representing the median PRS score) was associated with a 2.94-fold increased risk of AP (p=0.02) among patients with MCS. The association between the pancreatitis-PRS and AP remained statistically significant after correction for known predictors of acute pancreatitis, including age, sex, body mass index, diabetes, the maximal TG concentration and the presence of a heterozygous pathogenic rare variant in a TG-related metabolism gene (p=0.04). MCS patients with a high pancreatitis - PRS and heterozygous for a pathogenic rare variant in a TG metabolism-related gene had a 9.50-fold increased risk of AP (p=0.001), compared to those with a low-PRS and no pathogenic variant.
Conclusions
This is the first study to show that the accumulation of common variants in known pancreatitis susceptibility genes is associated with AP in MCS patients. MCS patients with both a high pancreatitis-PRS score and a heterozygous pathogenic rare variant in a TG-related metabolism gene have higher risk of AP, similar to what is seen in monogenic form of severe hypertriglyceridemia. Genetic testing, including both rare and common variants, could help clinicians to identify MCS patients who may be at higher risk of acute pancreatitis and who may benefit from precision medicine.
期刊介绍:
Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. While preference is given to material of immediate practical concern, the science that underpins lipidology is forwarded by expert contributors so that evidence-based approaches to reducing cardiovascular and coronary heart disease can be made immediately available to our readers. Sections of the Journal will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.