A Gene Variant in CERS2 Is Associated with Rate of Increase in Albuminuria in Patients with Diabetes from ONTARGET and TRANSCEND

<div><p>Although albuminuria and subsequent advanced stage chronic kidney disease are common among patients with diabetes, the rate of increase in albuminuria varies among patients. Since genetic variants associated with estimated glomerular filtration rate (eGFR) were identified in cross sectional studies, we asked whether these variants were also associated with rate of increase in albuminuria among patients with diabetes from ONTARGET and TRANSCEND—randomized controlled trials of ramipril, telmisartan, both, or placebo. For 16 genetic variants associated with eGFR at a genome-wide level, we evaluated the association with annual rate of increase in albuminuria estimated from urine albumin:creatinine ratio (uACR). One of the variants (rs267734) was associated with rate of increase in albuminuria. The annual rate of increase in albuminuria among risk homozygotes (69% of the study population) was 11.3% (95%CI; 7.5% to 15.3%), compared with 5.0% (95%CI; 3.3% to 6.8%) for heterozygotes (27% of the population), and 1.7% (95%CI; −1.7% to 5.3%) for non-risk homozygotes (4% of the population); P = 0.0015 for the difference between annual rates in the three genotype groups. These estimates were adjusted for age, sex, ethnicity, and principal component of genetic heterogeneity. Among patients without albuminuria at baseline (uACR<30 mg/g), each risk allele was associated with 50% increased risk of incident albuminuria (OR = 1.50; 95%CI 1.15 to 1.95; P = 0.003) after further adjustment for traditional risk factors including baseline uACR and eGFR. The rs267734 variant is in almost perfect linkage-disequilibrium (r² = 0.94) with rs267738, a single nucleotide polymorphism encoding a glutamic acid to alanine change at position 115 of the ceramide synthase 2 (CERS2) encoded protein. However, it is unknown whether CERS2 function influences albuminuria. In conclusion, we found that rs267734 in CERS2 is associated with rate of increase in albuminuria among patients with diabetes and elevated risk of cardiovascular disease.</p></div

Association between SNPs and change in albuminuria.

<p>Results were adjusted for age, sex, 10 largest principal components of genetic variation and self-reported ethnicity (for “all ethnic groups” results).</p><p>Association between SNPs and change in albuminuria.</p

SNPs associated with eGFR in cross-sectional studies.

<p>LD, linkage disequilibrium.</p><p>SNPs associated with eGFR in cross-sectional studies.</p

Association between SNPs and baseline albuminuria.

<p>β is the expected change in log-transformed baseline albuminuria for each risk allele. Models are adjusted for age, sex, 10 largest principal components of genetic variation, and self-reported ethnicity.</p><p>Association between SNPs and baseline albuminuria.</p

Regional plot for the CERS2 locus.

<p>SNPs are plotted by association P value of linear mixed models adjusted for age, sex, and principal components of genetic variation for the association between SNP and annual rate of change in albuminuria. and genomic position (NCBI Build 36). The original hit (rs267734) is labeled. The magnitude of linkage disequilibrium (r²) between each SNP and rs267734 is indicated by the intensity of the red coloring. Estimates of recombination rates are shown by the blue line. Gene positions are indicated by green arrows. Gene names are labeled. Linkage disequilibrium and recombination rates were estimated from the Utah residents of Northern and Western European ancestry (CEU) HapMap population (release 22). Plots were prepared using SNAP <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0106631#pone.0106631-Laviad1" target="_blank">[22]</a>. Panel A: P values adjusted for rs267734. Panel B: P values not adjusted for rs267734.</p

Baseline characteristics.

<p>SD, standard deviation. IQR, inter-quartile range. NA, not applicable.</p><p>Baseline characteristics.</p

Association between SNPs and baseline eGFR.

<p>β is the expected change in log-transformed baseline eGFR for each risk allele. Models are adjusted for age, sex, 10 largest principal components of genetic variation, and self-reported ethnicity.</p><p>Association between SNPs and baseline eGFR.</p

Association of the SNPs in <i>FBN-1</i> with Thoracic Aortic Dissection or Aneurysm.

<p>*Adjusted for sex and study center.</p>†<p>Adjusted for sex, study center, age, hypertension, and smoking.</p

Characteristics of Dissection, Non-dissecting Aneurysm Cases, and Controls.

<p>*P value for Dissection cases vs. controls;</p>†<p>P value for Non-dissecting aneurysm cases vs. controls.</p><p>Data presented as mean ± standard deviation for age and as a number (%) of subjects for other variables.</p><p><i>P</i> values are from Fisher exact test, except those for age, which are from the Wilcoxon rank sum test.</p

Association of two SNPs in <i>FBN-1</i> with Non-dissecting Thoracic Aortic Aneurysm.

<p>*Adjusted for sex and study center.</p>†<p>Adjusted for sex, study center, age, hypertension, and smoking.</p