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Mitochondrial DNA Haplogroup C4 Can Increase the Risk of Active Tuberculosis Disease in Southwest China

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Mitochondrial DNA Haplogroup C4 Can Increase the Risk of Active Tuberculosis Disease in Southwest China INT J TUBERC LUNG DIS 23(6):692–697 Q 2019 The Union http://dx.doi.org/10.5588/ijtld.18.0437 Mitochondrial DNA haplogroup C4 can increase the risk of active tuberculosis disease in Southwest China T. Hu,* Y. Xu,*† Y. Song,* X. Xia,* A-M. Zhang* *Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, †The First People’s Hospital of Yunnan Province, Kunming, China SUMMARY BACKGROUND: Tuberculosis (TB) remains a serious patients were divided into five subgroups for further health problem worldwide. Host genetic factors are analyses, the mtDNA haplogroup C4 showed different reported to be correlated with tuberculous infection. frequencies among the five subgroups. The frequency of However, few mitochondrial genetic studies of TB the haplogroup C4 was much lower in the pulmonary patients have been carried out. TB (pTB) and pleural TB (plTB) group (1.4%) than in OBJECTIVE: To investigate the role of mitochondrial the non-pTB and plTB group (9.3%, P ¼ 0.027). DNA (mtDNA) in tuberculous infection. mtDNA copy numbers were significantly higher in TB DESIGN: We recruited 243 TB patients and 261 normal patients than in NCs (99.09 6 54.54 vs. 73.90 6 43.92; controls (NCs) to compare their mtDNA haplogroups P , 0.0001); results in male/female/total TB patients and copy numbers. and matched NCs were similar. RESULTS: The frequency of mtDNA haplogroup C4 CONCLUSION: mtDNA haplogroups and copy num- was significantly higher in TB patients (7%) than in NCs bers were found to have an important role in active TB (2.8%, P ¼ 0.042). However, this difference disappeared disease. when TB patients were separated into male and female KEY WORDS: TB; mtDNA haplogroup; mtDNA copy groups and compared with sex-matched NCs. When TB numbers TUBERCULOSIS (TB) IS caused by Mycobacterium factors might be associated with TB;4 however, the tuberculosis and is the largest cause of infectious pathogenic mechanisms of TB are not well under- disease-related death.1 Approximately one third of stood. Host genetic polymorphisms, most of which the world’s population are infected by M. tuberculo- occur in immune-related genes, have been reported to sis, but not all individuals develop active TB disease. influence TB in different populations.5 Genetic Although effective vaccines, drugs and the DOTS polymorphisms in Toll-like receptor genes and some programme are used to prevent tuberculous infection, cytokine genes have been studied in depth.6 In a study many new cases are detected every year, particularly by Yu et al., four polymorphisms in the interleukin-17 among those with human immunodeficiency virus gene were selected, genotyped and compared in TB (HIV) co-infection.2 About 10.4 million individuals patients and normal controls (NCs). They identified developed active TB disease in 2016. TB recurrence is an association between TB and host genetic varia- higher in countries with a high incidence or popula- tions.7 However, the effects of genetic factors differ tion with HIV infection.3 The control of tuberculous between populations. infection therefore remains an important problem. Mitochondria are the ‘energy factories’ of cells and China is among the five top TB burden countries, and play important parts in the regulation of the accounted for approximately 56% of the total metabolism, cycle, signalling pathways and develop- number of TB patients, together with Indonesia, the ment of cells.8 Mitochondrial function and genetic Philippines, Pakistan and India in 2016.2 background in many diseases have been widely The pathogenic factors that could lead individuals studied. Genetic,9 infectious,10 nervous system and/ with tuberculous infection progress to active TB are or psychotic11 and complex diseases12 are affected by complex. HIV infection, tobacco smoking, nutrition- the mitochondrial DNA (mtDNA) background/hap- al status, old age, host response, and many other logroup. Although genetic polymorphisms and TB have been assessed before,13 few studies on mtDNA TH and YX contributed equally to this study. and TB have been conducted. Correspondence to: A-Mei Zhang, Molecular Virus Units, Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan 650500, China. e-mail: [email protected] Article submitted 27 June 2018. Final version accepted 5 November 2018. mtDNA influence active TB disease 693 We recruited TB patients and NCs to investigate tion in the lung or lymph nodes of these patients. To the association between mtDNA and TB in a further investigate the relationship between mtDNA Southwest China population. and TB patients with different clinical characteristics, we divided the TB patients into five subgroups. Approximately one third of them had secondary MATERIALS AND METHODS pulmonary TB (pTB) (group 1: 78/243, 32.1%). Subjects Patients other than those with pTB had secondary All TB patients and NCs were recruited and pTB combined with pleural TB (plTB) (group 2: 72/ diagnosed by physicians in the First People’s Hospital, 243, 29.6%), secondary pTB combined with tracheal Kunming, Yunnan Province, China. All TB patients TB (tTB) (group 3: 34/243, 14.0%), plTB (group 4: were diagnosed according to the criteria set down in 39/243, 16.1%) and other TB (group 5: 20/243, ‘Diagnosis and therapy directory of pulmonary TB’ 8.2%). and ‘Diagnosis and therapy directory of tracheal TB’ of the Chinese Medical Association, Beijing, and the DNA extraction, polymerase chain reaction and ‘Diagnosis criterion of pulmonary TB’ of the Nation- sequencing al Health Commission of the People’s Republic of Genomic DNA was extracted from the whole blood China, Beijing, China. of each patient using a TIANamp Genomic DNA kit All patients underwent radiography, bronchial (Tiangen, Beijing, China). The polymerase chain endoscopy, pleural endoscopy, biopsy and thoracen- reaction (PCR) cycle was 948C for 5 min, 30 cycles tesis. Cell samples were subject to the interferon- at 948C for 30 s, 58C for 30 s, 728C for 2 min and one gamma release assay (IGRA) and Ziehl-Neelsen extension cycle at 728C for 5 min.14 The following staining. Patients were diagnosed with active TB primers were used to amplify the mtDNA control disease based on test results, clinical features and region of each sample using 23TSINGKETM Master treatment effects. Mix (Tsingke, Beijing, China): L15594 (forward In total, 243 TB patients were from six provinces in primer, 50-CGCCTACACAATTCTCCGATC-30) and Southwest China: Yunnan (n ¼ 207), Guizhou (n ¼ H901 (reverse primer, 50-ACTTGGGTTAATCG- 19), Sichuan (n ¼ 4), Hunan (n ¼ 3), Hubei (n ¼ 3), TGTGACC-30). The PCR products were then se- Guangxi (n ¼ 3) and Chongqing (n ¼ 4). However, quenced using the reported primers and conditions on most (85.2%) were from Yunnan Province. Among a 3730 DNA analyser (Applied Biosystems, Foster all TB patients, 141 were male and 102 were female City, CA, USA).9 The sequences obtained were (male:female ratio 1.38). Matched NCs (n ¼ 261), compared using the revised Cambridge reference considered healthy upon physical examination, were sequence (rCRS),15 and variations were recorded. recruited. NCs were identified not to have tubercu- The mtDNA haplogroups of each sample were lous infection based on Ziehl-Neelsen staining, classified according to genetic polymorphisms and radiography and IGRA. Hepatitis B virus (HBV), phyloTree (www.phylotree.org).16 MitoTool (www. hepatitis C virus (HCV) and HIV infection were also mitotool.org) was used to further identify the eliminated in NCs using enzyme-linked immunosor- mtDNA haplogroups of each sample.17 The mtDNA bent assays. The male:female ratio of NCs was 1.23:1 copy numbers of TB patients and NCs were then (144 males and 117 females). The mean 6 standard analysed according to the method used in our deviation (SD) age of TB patients and NCs was previous study.18 Briefly, b-globin was used as the respectively 45.67 6 17.90 years and 38.57 6 13.16 control gene for detecting mtDNA copy numbers. years. In total, 3 ml of whole blood was collected According to the standard curves of two pairs of from all subjects for further study. None of the TB primers, the 2DDCT method was used to evaluate patients or NCs had HIV infection. All patients and mtDNA copy numbers with the ChamQTM SYBR NCs were free from other types of respiratory disease. qPCR Master Mix (Vazyme, Nanjing, China) and Written informed consent conforming to the tenets ABI 7500 Fast Real-Time PCR system (Applied of the Declaration of Helsinki was provided by each Biosystems). participant before study commencement. The study protocol was approved by the Ethics Review Board of Data analysis Kunming University of Science and Technology, The frequency of mtDNA haplogroups between all Kunming. TB patients and NCs, and the frequency of each TB subgroup, were compared using the v2 test (two- Subgroup of tuberculosis patients tailed). Only mtDNA haplogroups with numbers 5 Among the 243 TB patients, none had primary were analysed. When dividing TB patients and NCs pulmonary disease. Physicians could ascertain that into male and female groups or subgrouping TB all patients had been previously infected with M. patients for further analyses, the Fisher’s exact test tuberculosis using radiography, which showed pri- (two-tailed) was used due to the decreasing numbers mary calcification caused by M. tuberculosis infec- in each group. The Mann-Whitney U-test was used to 694 The International Journal of Tuberculosis and Lung Disease Table 1 Comparison of the frequency of mtDNA haplogroups frequencies of other mtDNA haplogroups in both between TB patients and NCs groups were similar. When we divided TB patients TB patients NCs and NCs into male and female groups, the frequency Haplogroup n (%) n (%) P value* OR (95%CI) of each haplogroup were not significantly different A 16 (6.6) 18 (8.5) 0.449 0.76 (0.38–1.54) (Table 2), which suggested that the difference of B4 27 (11.1) 27 (12.7) 0.606 0.86 (0.49–1.52) mtDNA haplogroups between TB patients and NCs B5 14 (5.8) 9 (4.2) 0.455 1.39 (0.59–3.27) was not due to a sex bias.
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