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HLA-A*02:01 allele is associated with tanshinone-induced cutaneous drug reactions in Chinese population

Abstract

Tanshinone, a widely used Chinese patent medicine, has been confirmed to have various kinds of pharmacological effects although frequently causing cutaneous adverse drug reactions (cADRs). We aim to identify whether human leukocyte antigen (HLA) class I alleles are associated with tanshinone-induced cADRs in Han Chinese. The association study including 18 patients with tanshinone-induced cADRs, 67 tanshinone-tolerant volunteers, and two general population databases consisted of 10,689 and 169,995 healthy subjects was performed. The frequency of tanshinone-induced cADRs patients carrying HLA-A*02:01 was significantly higher when compared with the general control groups (OR = 6.25, Pc = 7.20 × 10−5; OR = 7.14, Pc = 8.00 × 10−6), and with the tolerant group (OR = 5.09, Pc = 0.024). The molecular docking assay confirmed high affinity of the ingredients of tanshinone towards HLA-A*02:01 (≤−7.5 kcal/mol). The result suggested HLA-A*02:01 may work as a promisingly predictive marker for tanshinone personalized therapy in Han Chinese.

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References

  1. Zhou L, Zuo Z, Chow MS. Danshen: an overview of its chemistry, pharmacology, pharmacokinetics, and clinical use. J Clin Pharmacol. 2005;45:1345–9.

    Article  CAS  PubMed  Google Scholar 

  2. Zhang Y, Jiang P, Ye M, Kim SH, Jiang C, Lü J. Tanshinones: sources, pharmacokinetics and anti-cancer activities. Int J Mol Sci. 2012;13:13621–66.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Hao YF, Jiang JG. Origin and evolution of China Pharmacopoeia and its implication for traditional medicines. Mini Rev Med Chem. 2015;15:595–603.

    Article  CAS  PubMed  Google Scholar 

  4. Chinese PC. Pharmacopoeia of People’s Republic of China. I. Beijing: China Medical Science Press; 2010.

    Google Scholar 

  5. Cheng TO. Cardiovascular effects of Danshen. Int J Cardiol. 2007;121:9–22.

    Article  PubMed  Google Scholar 

  6. Lee JH, Shin YJ, Kim HJ, Oh JH, Jang YP, Lee YJ. Danshen extract does not alter pharmacokinetics of docetaxel and clopidogrel, reflecting its negligible potential in P-glycoprotein- and cytochrome P4503A-mediated herb-drug interactions. Int J Pharm. 2011;410:68–74.

    Article  CAS  PubMed  Google Scholar 

  7. Cho YH, Ku CR, Hong ZY, Heo JH, Kim EH, Choi DH, et al. Therapeutic effects of water soluble danshen extracts on atherosclerosis. Evid Based Complement Altern Med. 2013;2013:623639.

    Google Scholar 

  8. Hügel HM, Jackson N. Danshen diversity defeating dementia. Bioorg Med Chem Lett. 2014;24:708–16.

    Article  PubMed  CAS  Google Scholar 

  9. Maione F, Mascolo N. Danshen and the cardiovascular system: new advances for an old remedy. Semin Thromb Hemost. 2016;42:321–2.

    Article  PubMed  Google Scholar 

  10. Wang X, Morris-Natschke SL, Lee KH. New developments in the chemistry and biology of the bioactive constituents of Tanshen. Med Res Rev. 2007;27:133–48.

    Article  PubMed  CAS  Google Scholar 

  11. Gu M, Zhang G, Su Z, Ouyang F. Identification of major active constituents in the fingerprint of Salvia miltiorrhiza Bunge developed by high-speed counter-current chromatography. J Chromatogr A. 2004;1041:239–43.

    Article  CAS  PubMed  Google Scholar 

  12. Fang X, Wang J, Zhang S, Zhao Q, Zheng Z, Song Z. Simultaneous extraction of hydrosoluble phenolic acids and liposoluble tanshinones from Salviae miltiorrhizae radix by an optimized microwave-assisted extraction method. Sep Purif Technol. 2012;86:149–56.

    Article  CAS  Google Scholar 

  13. Cha JD, Lee JH, Choi KM, Choi SM, Park JH. Synergistic effect between cryptotanshinone and antibiotics against clinic methicillin and vancomycin-resistant staphylococcus aureus. Evid Based Complement Altern Med. 2014;2014:450572.

    Article  Google Scholar 

  14. Chen W, Lu Y, Chen G, Huang S. Molecular evidence of cryptotanshinone for treatment and prevention of human cancer. Anticancer Agents Med Chem. 2013;13:979–87.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Fang J, Little PJ, Xu S. Atheroprotective effects and molecular targets of tanshinones derived from herbal medicine danshen. Med Res Rev. 2018;38:201–28.

    Article  CAS  PubMed  Google Scholar 

  16. Maione F, Cantone V, Chini MG, De Feo V, Mascolo N, Bifulco G. Molecular mechanism of tanshinone IIA and cryptotanshinone in platelet anti-aggregating effects: an integrated study of pharmacology and computational analysis. Fitoterapia. 2015;100:174–8.

    Article  CAS  PubMed  Google Scholar 

  17. Song M, Hang TJ, Zhang Z, Chen HY. Effects of the coexisting diterpenoid tanshinones on the pharmacokinetics of cryptotanshinone and tanshinone IIA in rat. Eur J Pharm Sci. 2007;32:247–53.

    Article  CAS  PubMed  Google Scholar 

  18. Song M, Hang TJ, Zhang ZX, Du R, Chen J. Determination of cryptotanshinone and its metabolite in rat plasma by liquid chromatography-tandem mass spectrometry. J Chromatogr B Anal Technol Biomed Life Sci. 2005;827:205–9.

    Article  CAS  Google Scholar 

  19. Huang HY, Luo XQ, Chan LS, Cao ZH, Sun XF, Xu JH. Cutaneous adverse drug reactions in a hospital-based Chinese population. Clin Exp Dermatol. 2011;36:135–41.

    Article  PubMed  Google Scholar 

  20. Li LF, Ma C. Epidemiological study of severe cutaneous adverse drug reactions in a city district of China. Clin Exp Dermatol. 2006;31:642–7.

    Article  PubMed  Google Scholar 

  21. Lim YL, Thirumoorthy T. Serious cutaneous adverse reactions to traditional Chinese medicines. Singap Med J. 2005;46:714–7.

    CAS  Google Scholar 

  22. Fu X, Yang F, Zhu Q, Luo X. Clinical review of 922 inpatients with drug eruptions. Chin J Dermatol. 2015;48:12.

    Google Scholar 

  23. Goncalo M, Coutinho I, Teixeira V, Gameiro AR, Brites MM, Nunes R, et al. HLA-B*58:01 is a risk factor for allopurinol-induced DRESS and Stevens-Johnson syndrome/toxic epidermal necrolysis in a Portuguese population. Br J Dermatol. 2013;169:660–5.

    Article  CAS  PubMed  Google Scholar 

  24. Zhang Y, Wang J, Zhao L-M, Peng W, Shen G-Q, Xue L, et al. Strong association between HLA-B*1502 and carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in mainland Han Chinese patients. Eur J Clin Pharmacol. 2011;67:885–7.

    Article  PubMed  Google Scholar 

  25. Bharadwaj M, Illing P, Theodossis A, Purcell AW, Rossjohn J, McCluskey J. Drug hypersensitivity and human leukocyte antigens of the major histocompatibility complex. Annu Rev Pharm Toxicol. 2012;52:401–31.

    Article  CAS  Google Scholar 

  26. Sousa-Pinto B, Pinto-Ramos J, Correia C, Gonçalves-Costa G, Gomes L, Gil-Mata S, et al. Pharmacogenetics of abacavir hypersensitivity: a systematic review and meta-analysis of the association with HLA-B*57:01. J Allergy Clin Immunol. 2015;136:1092–4.

    Article  CAS  PubMed  Google Scholar 

  27. Zhou F, Cao H, Zuo X, Zhang T, Zhang X, Liu X, et al. Deep sequencing of the MHC region in the Chinese population contributes to studies of complex disease. Nat Genet. 2016;48:740–6.

    Article  CAS  PubMed  Google Scholar 

  28. Zhou XY, Zhu FM, Li JP, Mao W, Zhang DM, Liu ML, et al. High-resolution analyses of human leukocyte antigens allele and haplotype frequencies based on 169,995 volunteers from the China Bone Marrow Donor Registry Program. PLoS ONE. 2015;10:e0139485.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  29. Haldane JB. The estimation and significance of the logarithm of a ratio of frequencies. Ann Hum Genet. 1956;20:309–11.

    Article  CAS  PubMed  Google Scholar 

  30. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143:29–36.

    Article  CAS  PubMed  Google Scholar 

  31. Wang S, Liu L, Zhao Z, Wen W, Li R, Tu P. Clinical analysis of cutaneous adverse drug reactions: a 15-year retrospective survey of 360 inpatients. J Dermatol. 2014;41(Suppl. 1):77.

  32. Zeng ZP, Jiang JG. Analysis of the adverse reactions induced by natural product-derived drugs. Br J Pharmacol. 2010;159:1374–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Chan K, Zhang H, Lin ZX. An overview on adverse drug reactions to traditional Chinese medicines. Br J Clin Pharmacol. 2015;80:834–43.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Teng L, Zu Q, Li G, Yu T, Job KM, Yang X, et al. Herbal medicines: challenges in the modern world. Part 3. China Jpn Expert Rev Clin Pharmacol. 2016;9:1225–33.

    Article  CAS  Google Scholar 

  35. Job KM, Kiang TK, Constance JE, Sherwin CM, Enioutina EY. Herbal medicines: challenges in the modern world. Part 4. Canada and United States. Expert Rev Clin Pharmacol. 2016;9:1597–609.

    Article  CAS  PubMed  Google Scholar 

  36. Sammons HM, Gubarev MI, Krepkova LV, Bortnikova VV, Corrick F, Job KM, et al. Herbal medicines: challenges in the modern world. Part 2. European Union and Russia. Expert Rev Clin Pharmacol. 2016;9:1117–27.

    Article  CAS  PubMed  Google Scholar 

  37. Lucena MI, Molokhia M, Shen Y, Urban TJ, Aithal GP, Andrade RJ, et al. Susceptibility to amoxicillin-clavulanate-induced liver injury is influenced by multiple HLA class I and II alleles. Gastroenterology. 2011;141:338–47.

    Article  CAS  PubMed  Google Scholar 

  38. Fricke-Galindo I, Martínez-Juárez IE, Monroy-Jaramillo N, Jung-Cook H, Falfán-Valencia R, Ortega-Vázquez A, et al. HLA-A*02:01:01/-B*35:01:01/-C*04:01:01 haplotype associated with lamotrigine-induced maculopapular exanthema in Mexican Mestizo patients. Pharmacogenomics. 2014;15:1881–91.

    Article  CAS  PubMed  Google Scholar 

  39. Qiu F, Jiang J, Ma Y, Wang G, Gao C, Zhang X, et al. Opposite effects of single-dose and multidose administration of the ethanol extract of danshen on CYP3A in healthy volunteers. Evid Based Complement Altern Med. 2013;2013:730734.

    Article  Google Scholar 

  40. Padovan E, Mauri-Hellweg D, Pichler WJ, Weltzien HU. T cell recognition of penicillin G: structural features determining antigenic specificity. Eur J Immunol. 1996;26:42–8.

    Article  CAS  PubMed  Google Scholar 

  41. Sullivan JR, Shear NH. The drug hypersensitivity syndrome: what is the pathogenesis? Arch Dermatol. 2001;137:357–64.

    CAS  PubMed  Google Scholar 

  42. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39:175–91.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by the National Natural Science Foundation of China (31371274, 81472873, and 81872525), the National Key Research and Development Program (2016YFC0905001) and the Shanghai Municipal Commission of Science and Technology Program (14DJ1400100), Natural Science Foundation of Henan Province (No. 182300410010), Scientific and Technological Research in Open Collaborative Projects of Henan Province (152106000044). The authors wish to acknowledge the department of dermatology (Huashan Hospital [Shanghai, China], Fudan University [Shanghai, China]) for their assistance in this article and the Department of Cardiology (the First Affiliated Hospital of Zhengzhou University [Zhengzhou, China]) for offering clinical data.

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Correspondence to Xiaoqun Luo or Qinghe Xing.

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Zhu, Q., Zhang, Y., Xuan, J. et al. HLA-A*02:01 allele is associated with tanshinone-induced cutaneous drug reactions in Chinese population. Pharmacogenomics J 20, 408–414 (2020). https://doi.org/10.1038/s41397-019-0121-1

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