• Kelan G Tantisira, Jessica Lasky-Su, Michishige Harada, Amy Murphy, Augusto A Litonjua, Blanca E Himes, Christoph Lange, Ross Lazarus, Jody Sylvia, Barbara Klanderman, Qing Ling Duan, Weiliang Qiu, Tomomitsu Hirota, Fernando D Martinez, David Mauger, Christine Sorkness, Stanley Szefler, Stephen C Lazarus, Robert F Lemanske, Stephen P Peters, John J Lima, Yusuke Nakamura, Mayumi Tamari, and Scott T Weiss.
• Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, USA. rekgt@channing.harvard.edu
• N. Engl. J. Med. 2011 Sep 29; 365 (13): 1173-83.

BackgroundThe response to treatment for asthma is characterized by wide interindividual variability, with a significant number of patients who have no response. We hypothesized that a genomewide association study would reveal novel pharmacogenetic determinants of the response to inhaled glucocorticoids.MethodsWe analyzed a small number of statistically powerful variants selected on the basis of a family-based screening algorithm from among 534,290 single-nucleotide polymorphisms (SNPs) to determine changes in lung function in response to inhaled glucocorticoids. A significant, replicated association was found, and we characterized its functional effects.ResultsWe identified a significant pharmacogenetic association at SNP rs37972, replicated in four independent populations totaling 935 persons (P=0.0007), which maps to the glucocorticoid-induced transcript 1 gene (GLCCI1) and is in complete linkage disequilibrium (i.e., perfectly correlated) with rs37973. Both rs37972 and rs37973 are associated with decrements in GLCCI1 expression. In isolated cell systems, the rs37973 variant is associated with significantly decreased luciferase reporter activity. Pooled data from treatment trials indicate reduced lung function in response to inhaled glucocorticoids in subjects with the variant allele (P=0.0007 for pooled data). Overall, the mean (±SE) increase in forced expiratory volume in 1 second in the treated subjects who were homozygous for the mutant rs37973 allele was only about one third of that seen in similarly treated subjects who were homozygous for the wild-type allele (3.2±1.6% vs. 9.4±1.1%), and their risk of a poor response was significantly higher (odds ratio, 2.36; 95% confidence interval, 1.27 to 4.41), with genotype accounting for about 6.6% of overall inhaled glucocorticoid response variability.ConclusionsA functional GLCCI1 variant is associated with substantial decrements in the response to inhaled glucocorticoids in patients with asthma.

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