Abstract
We have identified an underrecognized severe adverse drug reaction (ADR) of trimethoprim-sulfamethoxazole (TMP-SMX) associated respiratory failure in previously healthy children and young adults. We investigated potential genetic risk factors associated with TMP-SMX induced respiratory failure in a cohort of seven patients. We explored whole genome sequence among seven patients representing nearly half of all reported cases worldwide and 63 unrelated control individuals in two stages: (1) human leukocyte antigen (HLA) locus variation as several other ADRs have been associated HLA genetic variants and (2) coding variation to catalog and explore potential rare variants contributing to this devastating reaction. All cases were either heterozygous (carriers) or homozygous for the common HLA-B*07:02–HLA-C*07:02 haplotype. Despite the small sample size, this observation is statistically significant both in conservative comparison to maximum reported population frequencies (binomial P = 0.00017 for HLA-B and P = 0.00028 for HLA-C) and to our control population assessed by same HLA genotyping approach (binomial P = 0.000001 for HLA-B and P = 0.000018 for HLA-C). No gene elsewhere in the genome harnessed shared rare case enriched coding variation. Our results suggests that HLA-B*07:02 and HLA-C*07:02 are necessary for a patient to develop respiratory failure due to TMP-SMX.
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Acknowledgements
We would like to thank the patients and families who contributed to this work.
Funding
The research reported in this publication was supported by the National Institute of General Medical Sciences of the National Institutes of Health under award number R01GM129783 (JLG). Imputed HLA control data for Fig. 1 was provided under the scope of P50GM115305 (EJP).
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Participated in research design: JLG, JOM, NM, RE, AG, EJP, and TP. Conducted experiments: NM, RE, AG, EJP, and TP. Performed data analysis: JLG, NM, RE, AG, EJP, and TP. Wrote or contributed to the writing of the manuscript: JLG, JOM, NM, RE, AG, EJP, and TP.
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EJP reports grants from National Institutes of Health (P50GM115305, R01HG010863, R01AI152183, R21AI139021, U01AI154659) and from the National Health and Medical Research Council of Australia. She receives Royalties from Uptodate and consulting fees from Janssen, Vertex, Biocryst and Regeneron. She is co-director of IIID Pty Ltd that holds a patent for HLA-B*57:01 testing for abacavir hypersensitivity, and has a patent pending for Detection of Human Leukocyte Antigen-A*32:01 in connection with Diagnosing Drug Reaction with Eosinophilia and Systemic Symptoms without any financial remuneration and not directly related to the submitted work.
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Goldman, J.L., Miller, J.O., Miller, N. et al. HLA-B*07:02 and HLA-C*07:02 are associated with trimethoprim-sulfamethoxazole respiratory failure. Pharmacogenomics J 22, 124–129 (2022). https://doi.org/10.1038/s41397-022-00266-8
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DOI: https://doi.org/10.1038/s41397-022-00266-8
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