- Cantu, E;
- Suzuki, Y;
- Diamond, JM;
- Ellis, J;
- Tiwari, J;
- Beduhn, B;
- Nellen, JR;
- Shah, R;
- Meyer, NJ;
- Lederer, DJ;
- Kawut, SM;
- Palmer, SM;
- Snyder, LD;
- Hartwig, MG;
- Lama, VN;
- Bhorade, S;
- Crespo, M;
- Demissie, E;
- Wille, K;
- Orens, J;
- Shah, PD;
- Weinacker, A;
- Weill, D;
- Wilkes, D;
- Roe, D;
- Ware, LB;
- Wang, F;
- Feng, R;
- Christie, JD;
- Group, for the Lung Transplant Outcomes
The authors previously identified plasma plasminogen activator inhibitor-1 (PAI-1) level as a quantitative lung injury biomarker in primary graft dysfunction (PGD). They hypothesized that plasma levels of PAI-1 used as a quantitative trait could facilitate discovery of genetic loci important in PGD pathogenesis. A two-stage cohort study was performed. In stage 1, they tested associations of loci with PAI-1 plasma level using linear modeling. Genotyping was performed using the Illumina CVD Bead Chip v2. Loci meeting a p < 5 × 10(-4) cutoff were carried forward and tested in stage 2 for association with PGD. Two hundred ninety-seven enrollees were evaluated in stage 1. Six loci, associated with PAI-1, were carried forward to stage 2 and evaluated in 728 patients. rs3168046 (Toll interacting protein [TOLLIP]) was significantly associated with PGD (p = 0.006). The increased risk of PGD for carrying at least one copy of this variant was 11.7% (95% confidence interval 4.9-18.5%). The false-positive rate for individuals with this genotype who did not have PGD was 6.1%. Variants in the TOLLIP gene are associated with higher circulating PAI-1 plasma levels and validate for association with clinical PGD. A protein quantitative trait analysis for PGD risk prioritizes genetic variations in TOLLIP and supports a role for Toll-like receptors in PGD pathogenesis.