Pathogenesis of immunoglobulin A nephropathy: recent insight from genetic studies.

Pathogenesis of immunoglobulin A nephropathy: recent insight from genetic studies.
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DOI:
10.1146/annurev-med-041811-142014
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发表时间:
2013
影响因子:
10.5
通讯作者:
Gharavi AG
Gharavi AG
中科院分区:
医学1区
文献类型:
--
作者:
Kiryluk K;Novak J;Gharavi AG

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最近的全基因组关联研究(GWAS)已经确定了免疫球蛋白A肾病(IgAN)的多个易感基因座,IgAN是最常见的肾小球肾炎形式,涉及获得性免疫的独立缺陷(MHC区域中染色体6p 21上的三个位点),先天免疫(8 p23 DEFA基因座,17 p23 TNFSF 13基因座,22 q12 HORMAD 2基因座)和补体旁路途径(1 q32 CFH/CFHR基因座)。在对85个人群的地理空间分析中,基于复制的GWAS基因座的遗传风险评分在亚洲人中最高,在欧洲人中居中,在非洲人中最低,这反映了世界人群中流行率的已知差异。遗传风险评分还发现了以前未预料到的北方欧洲IgAN引起的肾衰竭患病率增加。IgAN风险等位基因对许多免疫介导的疾病具有相反的影响,这表明选择导致了不同人群中风险等位基因频率的变化。通过对遗传学、免疫学和生物化学数据的分析,我们提出了一个多步骤的发病机制模型,该模型为疾病机制的剖析提供了可检验的假设。
Recent genome-wide association studies (GWAS) have identified multiple susceptibility loci for immunoglobulin A nephropathy (IgAN), the most common form of glomerulonephritis, implicating independent defects in adaptive immunity (three loci on chromosome 6p21 in the MHC region), innate immunity (8p23 DEFA locus, 17p23 TNFSF13 locus, 22q12 HORMAD2 locus), and the alternative complement pathway (1q32 CFH/CFHR locus). In geospatial analysis of 85 populations, a genetic risk score based on the replicated GWAS loci is highest in Asians, intermediate in Europeans, and lowest in Africans, capturing the known difference in prevalence among world populations. The genetic risk score also uncovered a previously unsuspected increased prevalence of IgAN-attributable kidney failure in Northern Europe. The IgAN risk alleles have opposing effects on many immune-mediated diseases, suggesting that selection has contributed to variation in risk allele frequencies among different populations. Incorporating genetic, immunologic, and biochemical data, we present a multistep pathogenesis model that provides testable hypotheses for dissecting the mechanisms of disease.
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