CC BY 4.0 · Glob Med Genet 2021; 08(01): 011-018
DOI: 10.1055/s-0041-1723008
Original Article

CTLA-4 (+49A/G) Polymorphism in Type 1 Diabetes Children of Sudanese Population

1   Department of Basic Medical Sciences, Faculty of Applied Medical Sciences, Albaha University, Al Bahah, Saudi Arabia
2   Department of Biochemistry and Nutrition, Faculty of Medicine, University of Gezira, Wad Madani, Sudan
› Author Affiliations

Abstract

Background Type 1 diabetes mellitus (T1DM) is an organ-specific T cell-mediated autoimmune disease, characterized by destruction of pancreatic islets. Cytotoxic lymphocyte antigen-4 (CTLA-4) is a negative regulator of T cell proliferation, thus conferring susceptibility to autoimmunity.

Aims This study aimed to investigate the association of CTLA-4 +49A/G (rs231775) polymorphism with a risk of T1DM in Sudanese children.

Methods This a case–control study included 100 children with T1DM, referred to the pediatric clinic at referral pediatric teaching hospital in Gezira State-Sudan. Hundred unrelated healthy controls were recruited from departments in the same hospital. Genomic deoxyribonucleic acid (DNA) was extracted from Ethylenediaminetetraacetic Acid (EDTA)-preserved blood using QIAamp DNA Blood Mini Kit (QIAamp Blood) (QIAGEN; Valencia, CA). The polymerase chain reaction PCR restriction fragment length polymorphism (PCR-RFLP) and sequencing were applied for the CTLA-4 (+49A/G) genotyping. The changes accompanied the polymorphism were evaluated using relevant bioinformatics tools.

Results The genotype and allele frequencies of the CTLA-4 (+49A/G) polymorphism were significantly different between the patients and controls (p = 0.00013 and 0.0002, respectively). In particular, the frequency of the G allele, GG homozygous genotype, and AG heterozygous genotype were significantly increased in patients than in controls ([28% versus 7%, odds ratio (OR) = 5.16, 95% confidence interval [CI] = 2.77–9.65, p = 0.00] [12% versus 2%, OR = 6.68, CI = 1.46–30.69, p = 0.01] [32% versus 10%, OR = 4.24, CI = 1.95–9.21, p = 0.00], respectively). The presence of the G allele (homozygous) showed an influence on the signal peptide polarity, hydrophobicity, and α-helix propensity of the CTLA-protein.

Conclusion The results further support the association of CTLA-4 (+49A/G) polymorphism and the risk of T1DM in our study population.

Ethical Approval

The informed consent was obtained from all the subjects and the study was approved by the University of Gezira Ethics Committee (UGEC) and was performed in accordance with Helsinki Declaration of 1975.




Publication History

Article published online:
15 February 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Zheng P, Wu Y, Guo Y, Lee C, Liu Y. B7-CTLA4 interaction enhances both production of antitumor cytotoxic T lymphocytes and resistance to tumor challenge. Proc Natl Acad Sci U S A 1998; 95 (11) 6284-6289
  • 2 Linsley PS, Brady W, Urnes M, Grosmaire LS, Damle NK, Ledbetter JA. CTLA-4 is a second receptor for the B cell activation antigen B7. J Exp Med 1991; 174 (03) 561-569
  • 3 Wang XB, Giscombe R, Yan Z, Heiden T, Xu D, Lefvert AK. Expression of CTLA-4 by human monocytes. Scand J Immunol 2002; 55 (01) 53-60
  • 4 Carreno BM, Bennett F, Chau TA. et al. CTLA-4 (CD152) can inhibit T cell activation by two different mechanisms depending on its level of cell surface expression. J Immunol 2000; 165 (03) 1352-1356
  • 5 Ostrov DA, Shi W, Schwartz JC, Almo SC, Nathenson SG. Structure of murine CTLA-4 and its role in modulating T cell responsiveness. Science 2000; 290 (5492): 816-819
  • 6 Anjos S, Nguyen A, Ounissi-Benkalha H, Tessier MC, Polychronakos C. A common autoimmunity predisposing signal peptide variant of the cytotoxic T-lymphocyte antigen 4 results in inefficient glycosylation of the susceptibility allele. J Biol Chem 2002; 277 (48) 46478-46486
  • 7 Mäurer M, Loserth S, Kolb-Mäurer A. et al. A polymorphism in the human cytotoxic T-lymphocyte antigen 4 ( CTLA4) gene (exon 1 +49) alters T-cell activation. Immunogenetics 2002; 54 (01) 1-8
  • 8 Kavvoura FK, Ioannidis JP. CTLA-4 gene polymorphisms and susceptibility to type 1 diabetes mellitus: a HuGE Review and meta-analysis. Am J Epidemiol 2005; 162 (01) 3-16
  • 9 Alshareef SA, Omar SM, Hamdan HZ, Adam I. Cytotoxic T-lymphocyte antigen-4 +49A/G polymorphisms in Sudanese adults with type 1 diabetes and latent autoimmune diabetes. BMC Res Notes 2019; 12 (01) 769
  • 10 American Diabetes Association. Classification and diagnosis of Diabetes. Diabetes Care 2017; 40 (Suppl 1): S11-S24
  • 11 Haneda M, Noda M, Origasa H. et al. Japanese clinical practice guideline for diabetes 2016. Diabetol Int 2018; 9 (01) 1-45
  • 12 Capriotti E, Calabrese R, Fariselli P, Martelli PL, Altman RB, Casadio R. WS-SNPs&GO: a web server for predicting the deleterious effect of human protein variants using functional annotation. BMC Genomics 2013; 14 (Suppl. 03) S6
  • 13 Ng PC, Henikoff S. Predicting deleterious amino acid substitutions. Genome Res 2001; 11 (05) 863-874
  • 14 Deléage G, Roux B. An algorithm for protein secondary structure prediction based on class prediction. Anal Biochem 1987; 163: 292-297
  • 15 Roseman MA. Hydrophilicity of polar amino acid side-chains is markedly reduced by flanking peptide bonds. J Mol Biol 1988; 200 (03) 513-522
  • 16 Mosaad YM, Elsharkawy AA, El-Deek BS. Association of CTLA-4 (+49A/G) gene polymorphism with type 1 diabetes mellitus in Egyptian children. Immunol Invest 2012; 41 (01) 28-37
  • 17 Osei K, Schuster DP, Amoah AG, Owusu SK. Diabetes in Africa. Pathogenesis of type 1 and type 2 diabetes mellitus in sub-Saharan Africa: implications for transitional populations. J Cardiovasc Risk 2003; 10 (02) 85-96
  • 18 Saleh HM, Rohowsky N, Leski M. The CTLA4-819 C/T and +49 A/G dimorphisms are associated with type 1 diabetes in Egyptian children. Indian J Hum Genet 2008; 14 (03) 92-98
  • 19 Benmansour J, Stayoussef M, Al-Jenaidi FA. et al. Association of single nucleotide polymorphisms in cytotoxic T-lymphocyte antigen 4 and susceptibility to autoimmune type 1 diabetes in Tunisians. Clin Vaccine Immunol 2010; 17 (09) 1473-1477
  • 20 Gunavathy N, Asirvatham A, Chitra A, Jayalakshmi M. Association of CTLA-4 and CD28 gene polymorphisms with type 1 diabetes in South Indian population. Immunol Invest 2019; 48 (06) 659-671
  • 21 Wang B, Du W, Jia Y, Zhang X, Ma G. Cytotoxic T-lymphocyte-associated protein 4 +49A/G polymorphisms contribute to the risk of type 1 diabetes in children: An updated systematic review and meta-analysis with trial sequential analysis. Oncotarget 2017; 8 (06) 10553-10564
  • 22 Tang ST, Tang HQ, Zhang Q, Wang CJ, Wang YM, Peng WJ. Association of cytotoxic T-lymphocyte associated antigen 4 gene polymorphism with type 1 diabetes mellitus: a meta-analysis. Gene 2012; 508 (02) 165-187
  • 23 Ahmadi S, Rostamzadeh J, Khosravi D, Shariati P, Shakiba N. Association of CTLA-4 gene 49A/G polymorphism with the incidence of type 1 diabetes mellitus in the Iranian Kurdish population. Pak J Biol Sci 2013; 16 (24) 1929-1935
  • 24 Ranjouri MR, Aob P, Mansoori Derakhshan S, Shekari Khaniani M, Chiti H, Ramazani A. Association study of IL2RA and CTLA4 gene variants with type I diabetes mellitus in children in the northwest of Iran. Bioimpacts 2016; 6 (04) 187-193
  • 25 Mojtahedi Z, Omrani GR, Doroudchi M, Ghaderi A. CTLA-4 +49 A/G polymorphism is associated with predisposition to type 1 diabetes in Iranians. Diabetes Res Clin Pract 2005; 68 (02) 111-116
  • 26 Douroudis K, Laine AP, Heinonen M. et al. Association of CTLA4 but not ICOS polymorphisms with type 1 diabetes in two populations with different disease rates. Hum Immunol 2009; 70 (07) 536-539
  • 27 Angel B, Balic I, Santos JL, Codner E, Carrasco E, Pérez-Bravo F. Associations of the CTLA-4 polymorphisms with type 1 diabetes in a Chilean population: case-parent design. Diabetes Res Clin Pract 2009; 85 (03) e34-e36
  • 28 Chistiakov DA, Savost'anov KV, Nosikov VV. CTLA4 gene polymorphisms are associated with, and linked to, insulin-dependent diabetes mellitus in a Russian population. BMC Genet 2001; 2: 6
  • 29 Osei-Hyiaman D, Hou L, Zhiyin R. et al. Association of a novel point mutation (C159G) of the CTLA4 gene with type 1 diabetes in West Africans but not in Chinese. Diabetes 2001; 50 (09) 2169-2171
  • 30 Kumar N, Kaur G, Kanga U. et al. CTLA4+49G allele associates with early onset of type 1 diabetes in North Indians. Int J Immunogenet 2015; 42 (06) 445-452
  • 31 Cinek O, Drevínek P, Sumník Z. et al. The CTLA4 +49 A/G dimorphism is not associated with type 1 diabetes in Czech children. Eur J Immunogenet 2002; 29 (03) 219-222
  • 32 Kouki T, Sawai Y, Gardine CA, Fisfalen ME, Alegre ML, DeGroot LJ. CTLA-4 gene polymorphism at position 49 in exon 1 reduces the inhibitory function of CTLA-4 and contributes to the pathogenesis of Graves' disease. J Immunol 2000; 165 (11) 6606-6611
  • 33 Arafa RM, Desouky SM, Emam SM, Abed NT, Mohamed SY. Detection of cytotoxic T-lymphocyte associated antigen-4 gene polymorphism in type 1 diabetes mellitus. Egypt J Immunol 2015; 22 (01) 49-57
  • 34 Çelmeli F, Türkkahraman D, Özel D, Akçurin S, Yegin O. CTLA-4 (+49A/G) polymorphism and type-1 diabetes in Turkish children. J Clin Res Pediatr Endocrinol 2013; 5 (01) 40-43
  • 35 Korolija M, Renar IP, Hadzija M. et al. Association of PTPN22 C1858T and CTLA-4 A49G polymorphisms with type 1 diabetes in Croatians. Diabetes Res Clin Pract 2009; 86 (03) e54-e57
  • 36 Van der Auwera BJ, Vandewalle CL, Schuit FC. et al. CTLA-4 gene polymorphism confers susceptibility to insulin-dependent diabetes mellitus (IDDM) independently from age and from other genetic or immune disease markers. The Belgian Diabetes Registry. Clin Exp Immunol 1997; 110 (01) 98-103
  • 37 Marron MP, Raffel LJ, Garchon HJ. et al. Insulin-dependent diabetes mellitus (IDDM) is associated with CTLA4 polymorphisms in multiple ethnic groups. Hum Mol Genet 1997; 6 (08) 1275-1282
  • 38 Chen Z, Fei M, Fu D. et al. Association between cytotoxic T lymphocyte antigen-4 polymorphism and type 1 diabetes: a meta-analysis. Gene 2013; 516 (02) 263-270
  • 39 Balic I, Angel B, Codner E, Carrasco E, Pérez-Bravo F. Association of CTLA-4 polymorphisms and clinical-immunologic characteristics at onset of type 1 diabetes mellitus in children. Hum Immunol 2009; 70 (02) 116-120
  • 40 Lemos MC, Coutinho E, Gomes L. et al. The CTLA4 +49 A/G polymorphism is not associated with susceptibility to type 1 diabetes mellitus in the Portuguese population. Int J Immunogenet 2009; 36 (03) 193-195
  • 41 Ahmedov G, Ahmedova L, Sedlakova P, Cinek O. Genetic association of type 1 diabetes in an Azerbaijanian population: the HLA-DQ, -DRB1*04, the insulin gene, and CTLA4. Pediatr Diabetes 2006; 7 (02) 88-93
  • 42 Kristiansen OP, Larsen ZM, Pociot F. CTLA-4 in autoimmune diseases--a general susceptibility gene to autoimmunity?. Genes Immun 2000; 1 (03) 170-184