Predicting and Preventing Chemotherapy-Induced Cardiotoxicity in African American Children

项目摘要 阿霉素是蒽环类化疗药物中的一员，约有60%的 患有肉瘤、母细胞瘤、白血病和淋巴瘤的儿童癌症患者。虽然阿霉素是一种 在这些患者中非常有效的，约16%的儿科患者遭受阿霉素引起的心脏毒性(DIC)，其中 会导致心力衰竭，需要进行心脏移植。我们最近的工作表明，DIC是原来的2.5倍 流行于儿童癌症的非裔美国人(AA)幸存者。尽管经过了50多年的研究 在这一领域，目前预测或预防DIC的潜力仍然很小。有一个明显的 需要新的和创新的方法来克服这一障碍。候选基因和全基因组 以欧洲人为主的协会研究已经确定了&gt；100单核苷酸多态(SNPs)。 在统计上与DIC相关，但由于以下困难，实验验证尚不可行 体外分离培养人心肌细胞。在我们最近的工作中，我们展示了特定于患者的人类 诱导多能干细胞来源的心肌细胞(hiPSC-CMS)是预测患者 DIC发生的可能性，首次证实DIC存在基因组基础。在这里，我们 假设HiPSC-CMS可以用三种不同的方式来研究相关的遗传变异 对再生障碍性贫血幸存者进行DIC：第一，发现新的预测性SNPs；第二，验证SNPs；第三， 检查调节的通路并确定特定的基因型别的心肌保护方法。在目标1中， 我们将从100名儿童癌症AA成年幸存者中产生HiPSC，这些幸存者具有不同的生物协变量 在体外评估他们对阿霉素的反应，以验证我们之前的发现和 验证此工具的威力。在目标2中，我们将使用这100条特定于患者的线路来识别药物反应 差异表达、剪接和染色质可及性数量性状基因座(deQTL、dsQTL和dcaQTL)， 评估生物协变量，如阿霉素剂量、癌症诊断年龄、达到的年龄、性别、BMI、 放射治疗(胸部除外)和癌症诊断，包括单独诊断和合并诊断。到时候我们会的 通过基因组编辑验证这些变异，并机械地检查导致DIC的途径 易感性集中在已知在心肌病、心肌保护和阿霉素中起作用的基因 新陈代谢。然后，我们将使用上面的发现来发现/重新利用基因组信息的心脏保护 用于预防DIC的药物具有特定的基因型别。在目标3中，我们将建立DIC的风险预测模型 纳入临床风险因素和上述功能性评估基因变异的再生障碍性贫血幸存者，评估其 预测性能，在独立的AA幸存者中进行验证，并在基于Web的用户中实施- 友好的工具，用于更广泛的临床和研究用途。总而言之，这项工作将为我们提供 为什么再生障碍性贫血幸存者会经历DIC，并通过以下方式提供1个完全由人类验证的SNP数据供临床应用 一个用户友好的工具，和2，新的心脏保护途径，可以有针对性地防止DIC。

Project Summary Doxorubicin is a member of the anthracycline group of chemotherapy drugs prescribed to approximately 60% of pediatric cancer patients suffering with sarcomas, blastomas, leukemia, and lymphoma. Although doxorubicin is highly effective in these patients, ~16% of pediatric patients suffer doxorubicin-induced cardiotoxicity (DIC) which can lead to heart failure requiring heart transplant. Our recent work has shown that DIC is 2.5x more prevalent in African American (AA) survivors of childhood cancer. Despite more than 50 years of research in this field, there is still, at present, little potential for either predicting or preventing DIC. There is an obvious need for novel and innovative approaches to overcome this hurdle. Candidate gene and genome-wide association studies, predominantly in Europeans, have identified >100 single nucleotide polymorphisms (SNPs) that are statistically correlated with DIC, yet experimental validation has not been feasible due to the difficulty in isolating and culturing human cardiomyocytes in vitro. In our recent work, we showed that patient-specific human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) are efficient predictors of a patient’s likelihood of developing DIC, confirming for the first time that there is a genomic basis to DIC. Here, we hypothesize that hiPSC-CMs can be utilized in three different modalities to study genetic variants associated with DIC in AA survivors: firstly, to discover novel predictive SNPs; secondly, to validate SNPs; and thirdly, to examine the modulated pathways and determine genotype-specific cardioprotective methodologies. In Aim 1, we will generate hiPSC from 100 AA adult survivors of childhood cancer with diverse biological covariates who were exposed to doxorubicin assess their response to doxorubicin in vitro to validate our previous findings and verify the power of this tool. In Aim 2, we will use these 100 patient-specific lines to identify drug response differential expression, splicing and chromatin accessibility quantitative trait loci (deQTL, dsQTL and dcaQTL), assessing biological covariates such as doxorubicin dose, age at cancer diagnosis, attained age, sex, BMI, radiotherapy (other than involving chest), and cancer diagnosis both individually and combined. We will then validate these variants with genome editing, and mechanistically examine pathways causative to DIC susceptibility concentrating on genes with known roles in cardiomyopathy, cardioprotection, and doxorubicin metabolism. We will then use the discoveries above to discover/repurpose genome-informed cardioprotective drugs to prevent DIC in a genotype-specific manner. In Aim 3, we will build a risk prediction model for DIC among AA survivors incorporating clinical risk factors and functionally assessed genetic variants above, evaluate its prediction performance, validate it in independent AA survivors, and implement it in a web-based and user- friendly tool for broader clinical and research use. In summary, this work will deliver us the genetic rationale for why AA survivors experience DIC and provide 1, fully human validated SNP data for clinical application through a user-friendly tool, and 2, novel cardioprotective pathways that can be targeted to protect against DIC.