Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

HLA-B*51:01 is strongly associated with clindamycin-related cutaneous adverse drug reactions

Abstract

Clindamycin causes cutaneous adverse drug reactions (cADRs), sometimes with the mechanisms of pathogenicity or risk factors unknown. This study aims to assess whether HLA alleles are associated with clindamycin-related cADRs in the Han Chinese population. We performed an association study of 12 subjects with clindamycin-related cADRs, 279 controls and 26 clindamycin-tolerant subjects. Subjects who received clindamycin through intravenous drip were analyzed separately. Unbiased, in silico docking was conducted. We found 6 out of 12 clindamycin-induced cADR patients carried HLA-B*51:01, and all of them received clindamycin via intravenous drip (6/9). The carrier frequency of HLA-B*51:01 is significantly higher compared with the control group (P=0.0006; OR=9.731, 95% CI: 2.927–32.353) and the clindamycin-tolerant group (OR=24.000, 95% CI: 3.247–177.405). In silico docking showed clindamycin is potentially more stable inside HLA-B*51:01 protein. Our results suggested, for the first time, that HLA-B*51:01 is a risk allele for clindamycin-related cADRs in Han Chinese, especially when clindamycin is administered via intravenous drip.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Spizek J, Rezanka T . Lincomycin clindamycin and their applications. Appl Microbiol Biotechnol 2004; 64: 455–464.

    Article  CAS  PubMed  Google Scholar 

  2. Guay D . Update on clindamycin in the management of bacterial, fungal and protozoal infections. Expert Opin Pharmacother 2007; 8: 2401–2444.

    Article  CAS  PubMed  Google Scholar 

  3. Frankel RI . Clindamycin–efficacy and toxicity. West J Med 1975; 122: 526–530.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. The US Food and Drug Administration (2015). Drug label. http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/050162s085lbl.pdf.

  5. Huang X, Li J, Zheng L, Li Y . Adverse reactions and safety of clindamycin. Advers Drug React J 2003; 5: 83–87.

    Google Scholar 

  6. Zeng J, Li X, Li Y, Yang A, Li J, Tan H . Analysis of 215 cases adverse reaction caused by clindamycin. Acad J Guangdong Coll Pharm 2006; 2: 80–81.

    Google Scholar 

  7. Geddes AM, Bridgwater FA, Williams DN, Oon J, Grimshaw GJ . Clinical and bacteriological studies with clindamycin. Br Med J 1970; 2: 703–704.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Fass RJ, Scholand JF, Hodges GR, Saslaw S . Clindamycin in the treatment of serious anaerobic infections. Ann Intern Med 1973; 78: 853–859.

    Article  CAS  PubMed  Google Scholar 

  9. Mazur N, Greenberger PA, Regalado J . Clindamycin hypersensitivity appears to be rare. Ann Allergy Asthma Immunol 1999; 82: 443–445.

    Article  CAS  PubMed  Google Scholar 

  10. Mahboob A, Haroon TS . Drugs causing fixed eruptions: a study of 450 cases. Int J Dermatol 1998; 37: 833–838.

    Article  CAS  PubMed  Google Scholar 

  11. Sánchez-Borges M, Thong B, Blanca M, Ensina LF, González-Díaz S, Greenberger PA et al. Hypersensitivity reactions to non beta-lactam antimicrobial agents, a statement of the WAO special committee on drug allergy. World Allergy Organ J 2013; 6: 18.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Chung WH, Hung SL, Hong HS, Hsih MS, Yang LC, Ho HC et al. A marker for Stevens–Johnson syndrome. Nature 2005; 428: 486.

    Article  Google Scholar 

  13. Locharernkul C, Loplumlert J, Limotai C, Korkij W, Desudchit T, Tongkobpetch S et al. Carbamazepine and phenytoin induced Stevens-Johnson syndrome is associated with HLA-B*1502 allele in Thai population. Epilepsia 2008; 49: 2087–2091.

    Article  PubMed  Google Scholar 

  14. Mehta TY, Prajapati LM, Mittal B, Joshi CG, Sheth JJ, Patel DB et al. Association of HLA-B*1502 allele and carbamazepine-induced Stevens-Johnson syndrome among Indians. Indian J Dermatol Venereol Leprol 2009; 75: 579–582.

    Article  PubMed  Google Scholar 

  15. Tassaneeyakul W, Tiamkao S, Jantararoungtong T, Chen P, Lin SY, Chen WH et al. Association between HLA-B*1502 and carbamazepine-induced severe cutaneous adverse drug reactions in a Thai population. Epilepsia 2010; 51: 926–930.

    Article  PubMed  Google Scholar 

  16. Then SM, Rani ZZ, Raymond AA, Ratnaningrum S, Jamal R . Frequency of the HLA-B*1502 allele contributing to carbamazepine-induced hypersensitivity reactions in a cohort of Malaysian epilepsy patients. Asian Pac J Allergy Immunol 2011; 29: 290–293.

    CAS  PubMed  Google Scholar 

  17. Kim SH, Lee KW, Song WJ, Kim SH, Jee YK, Lee SM et al. Carbamazepine-induced severe cutaneous adverse reactions and HLA genotypes in Koreans. Epilepsy Res 2011; 97: 190–197.

    Article  CAS  PubMed  Google Scholar 

  18. Ozeki T, Mushiroda T, Yowang A, Takahashi A, Kubo M, Shirakata Y et al. Genome-wide association study identifies HLA-A*3101 allele as a genetic risk factor for carbamazepine-induced cutaneous adverse drug reactions in Japanese population. Hum Mol Genet 2011; 20: 1034–1041.

    Article  CAS  PubMed  Google Scholar 

  19. McCormack M, Alfirevic A, Bourgeois S, Farrell JJ, Kasperaviciute D, Carrington M et al. HLA-A*3101 and carbamazepine-induced hypersensitivity reactions in Europeans. N Engl J Med 2011; 364: 1134–1143.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. The US Food and Drug Administration (2015). Drug http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm124718.htm.

  21. The US Food and Drug Administration (2015). Drug http://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders/ucm123927.htm.

  22. Illing PT, Vivian JP, Purcell AW, Rossjohn J, McCluskey J . Human leukocyte antigen-associated drug hypersensitivity. Curr Opin Immunol 2013; 25: 81–89.

    Article  CAS  PubMed  Google Scholar 

  23. US National Library of Medicine National Institutes of Health (2015). dbMHC Home http://www.ncbi.nlm.nih.gov/projects/gv/mhc.

  24. Trachtenberg E, Vinson M, Hayes E, Hsu M, Houtchens K, Hsia Y et al. SouthernHan Chinese from People's Republic of China. Anthropology/human genetic diversitypopulation reports. In: Hanen JA Immunobiology of the Human MHC: Proceedings of the 13th International Histocompatibility Workshop and Conference, Volume I. IHWG Press: Seattle, 2007: 616–617.

    Google Scholar 

  25. Meyer D, Singe RM, Mack SJ, Lancaster A, Nelson MP, Erlich H et al. Single Locus Polymorphism of Classical HLA Genes. In: Hansen JA (ed) Immunobiology of the Human MHC: Proceedings of the 13th International Histocompatibility Workshop and Conference. IHWG Press: Seattle, 2007, pp 653–704.

    Google Scholar 

  26. Yang F, Gu B, Zhang L, Xuan J, Luo H, Zhou P et al. HLA-B*13:01 is associated with salazosulfapyridine-induced drug rash with eosinophilia and systemic symptoms in Chinese Han population. Pharmacogenomics 2014; 15: 1461–1469.

    Article  CAS  PubMed  Google Scholar 

  27. Maenaka K, Maenaka T, Tomiyama H, Takiguchi M, Stuart DI, Jones EY . Nonstandard peptide binding revealed by crystal structures of Hla-B5101 complexed with HIV immunodominant epitopes. J Immunol 2000; 165: 3260–3267.

    Article  CAS  PubMed  Google Scholar 

  28. Berman HM, Westbrook J, Feng Z, Gilliland G, Bhat TN, Weissig H et al. The protein data bank. Nucleic Acids Res 2000; 28: 235–242.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Berman HM, Henrick K, Nakamura H . Nakamura announcing the worldwide Protein Data Bank. Nat Struct Biol 2003; 10: 980.

    Article  CAS  PubMed  Google Scholar 

  30. Røder G, Blicher T, Justesen S, Johannesen B, Kristensen O, Kastrup J et al. Crystal structures of two peptide-HLA-B*1501 complexes; structural characterization of the HLA-B62 supertype. Acta Crystallogr 2006; 62: 1300–1310.

    Google Scholar 

  31. Boyington JC, Motyka SA, Schuck P, Brooks AG, Sun PD . Crystal structure of an NK cell immunoglobulin-like receptor in complex with its class I MHC ligand. Nature 2000; 405: 537–543.

    Article  CAS  PubMed  Google Scholar 

  32. Martin AM, Nolan D, Gaudieri S, Almeida CA, Nolan R, James I et al. Predisposition to abacavir hypersensitivity conferred by HLA-B*5701 and a haplotypic Hsp70-Hom variant. Proc Natl Acad Sci USA 2004; 101: 4180–4185.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Shanghai Bureau of Statistics (2015). Statistical data http://www.stats-sh.gov.cn/sjfb/201501/276593.html.

  34. Mokhtari F, Nikyar Z, Naeini BA, Esfahani AA, Rahmani S . Adverse cutaneous drug reactions: eight year assessment in hospitalized patients. J Res Med Sci 2014; 19: 720–725.

    PubMed  PubMed Central  Google Scholar 

  35. Middleton D, Hawkins BR, Williams F Chinese from Hong Kong, People's Republic of China. Anthropology/human genetic diversity population reports. In: Hansen JA (ed) Immunobiology of the Human MHC: Proceedings of the 13th International Histocompatibility Workshop and Conference, Volume I. IHWG Press: Seattle, 2007, pp 617–618.

    Google Scholar 

  36. Shi YW, Min FL, Liu XR, Zan LX, Gao MM, Yu MJ, Liao WP . Hla-B alleles and lamotrigine-induced cutaneous adverse drug reactions in the Han Chinese population. Basic Clin Pharmacol Toxicol 2011; 109: 42–46.

    Article  CAS  PubMed  Google Scholar 

  37. Ueta M, Kannabiran C, Wakamatsu TH, Kim MK, Yoon KC, Seo KY et al. Trans-ethnic study confirmed independent associations of HLA-A*02:06 and HLA-B*44:03 with cold medicine-related Stevens-Johnson syndrome with severe ocular surface complications. Sci Rep 2014; 4: 5981.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Bouazza N, Pestre V, Jullien V, Curis E, Urien S, Salmon D, Tréluyer JM . Population pharmacokinetics of clindamycin orally and intravenously administered in patients with osteomyelitis. Br J Clin Pharmacol 2012; 74: 971–977.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Yun J, Mattsson J, Schnyder K, Fontana S, Largiadèr CR, Pichler WJ, Yerly D . Allopurinol hypersensitivity is primarily mediated by dose-dependent oxypurinol-specific T cell response. Clin Exp Allergy 2013; 43: 1246–1255.

    Article  CAS  PubMed  Google Scholar 

  40. Wynalda MA, Hutzler JM, Koets MD, Podoll T, Wienkers LC . In vitro metabolism of clindamycin in human liver and intestinal microsomes. Drug Metab Dispos 2003; 31: 878–887.

    Article  CAS  PubMed  Google Scholar 

  41. Xie HG, Wood AJ, Kim RB, Stein CM, Wilkinson GR . Genetic variability in CYP3A5 and its possible consequences. Pharmacogenomics 2004; 5: 243–272.

    Article  CAS  PubMed  Google Scholar 

  42. Nelson MR, Bacanu SA, Mosteller M, Li L, Bowman CE, Roses AD et al. Genome-wide approaches to identify pharmacogenetic contributions to adverse drug reactions. Pharmacogenomics J 2009; 9: 23–33.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by the National Natural Science Foundation of China (grants 81472873, 81071287 and 31371274), Science and Technology Commission of Shanghai Municipality (14DJ1400100), Scientific and Technological Research in Open Collaborative Projects of Henan Province (152106000044) and HHS|NIH|U.S. National Library of Medicine (4R00LM009826-03). We thank the patients for their cooperation. The work was done in Shanghai, China.

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to X Luo or Q Xing.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

PowerPoint slides

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yang, Y., Chen, S., Yang, F. et al. HLA-B*51:01 is strongly associated with clindamycin-related cutaneous adverse drug reactions. Pharmacogenomics J 17, 501–505 (2017). https://doi.org/10.1038/tpj.2016.61

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/tpj.2016.61

This article is cited by

Search

Quick links