Childhood asthma exacerbations and the Arg16 β2 -receptor polymorphism: A meta-analysis stratified by treatment

• Published in: Journal of allergy and clinical immunology Vol. 138; no. 1; pp. 107 - 113.e5
• Main Authors: Turner, Steve, MD, Francis, Ben, PhD, Vijverberg, Susanne, PhD, Pino-Yanes, Maria, PhD, Maitland-van der Zee, Anke H., PhD, Basu, Kaninika, MD, Bignell, Lauren, MBBS, Mukhopadhyay, Somnath, MD, Tavendale, Roger, PhD, Palmer, Colin, PhD, Hawcutt, Daniel, PhD, Pirmohamed, Munir, PhD, Burchard, Esteban G., MD, MPH, Lipworth, Brian, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2016
• Subjects: Adolescent; Adrenergic beta-2 Receptor Agonists - therapeutic use; Adrenergic receptors; Alleles; Allergy and Immunology; Anti-Asthmatic Agents - therapeutic use; Arginine - chemistry; Arginine - genetics; asthma; Asthma - diagnosis; Asthma - drug therapy; Asthma - epidemiology; Asthma - genetics; Child; Child, Preschool; Codon; Cross-Sectional Studies; disease exacerbation; Disease Progression; Female; Gene Frequency; Genotype; Humans; Leukotriene Antagonists - therapeutic use; Male; Odds Ratio; Polymorphism, Single Nucleotide; Receptors, Adrenergic, beta-2 - chemistry; Receptors, Adrenergic, beta-2 - genetics; Risk Factors; therapeutics; therapeutics; GALA II; Long-acting β-agonist; ADRB2; LTRA; Pharmacogenetics of Adrenal Suppression with Inhaled Steroid Study; SNP; β 2-Adrenoceptor gene; HWE; LABA; disease exacerbation; PAGES; Short-acting β-agonist; OR; Inhaled corticosteroid; Leukotriene receptor antagonist; asthma; SABA; Paediatric Asthma Gene Environment Study; PASS; Hardy-Weinberg equilibrium; ICS; Odds ratio; Adrenergic receptors; Single nucleotide polymorphism; Genes-Environments and Admixture in Latino Americans; child
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2015.10.045

Background The Gly-to-Arg substitution at the 16 position (rs1042713) in the β2 -adrenoceptor gene (ADRB2) is associated with enhanced downregulation and uncoupling of β2 -receptors. Objectives We sought to undertake a meta-analysis to test the hypothesis that there is an interaction between the A allele of rs1042713 (Arg16 amino acid) and long-acting β-agonist (LABA) exposure for asthma exacerbations in children. Methods Children with diagnosed asthma were recruited in 5 populations (BREATHE, Genes-Environments and Admixture in Latino Americans II, PACMAN, the Paediatric Asthma Gene Environment Study, and the Pharmacogenetics of Adrenal Suppression with Inhaled Steroid Study). A history of recent exacerbation and asthma treatment was determined from questionnaire data. DNA was extracted, and the Gly16Arg genotype was determined. Results Data from 4226 children of white Northern European and Latino origin were analyzed, and the odds ratio for exacerbation increased by 1.52 (95% CI, 1.17-1.99; P  = .0021) for each copy of the A allele among the 637 children treated with inhaled corticosteroids (ICSs) plus LABAs but not for treatment with ICSs alone (n = 1758) or ICSs plus leukotriene receptor antagonist (LTRAs; n = 354) or ICSs plus LABAs plus LTRAs (n = 569). Conclusions The use of a LABA but not an LTRA as an “add-on controller” is associated with increased risk of asthma exacerbation in children carrying 1 or 2 A alleles at rs1042713. Prospective genotype-stratified clinical trials are now required to explore the potential role of rs1042713 genotyping for personalized asthma therapy in children.