Printer Friendly

Association between rs6759298 and Ankylosing Spondylitis in Iranian Population.


Ankylosing Spondylitis (AS) is the most prevalent disease among the Spondylarthritis (SpAs) family. SpAs are a group of disorders characterized by positive Human Leukocyte Antigene-B27 (HLA-B27) and inflammation of the axial skeleton or peripheral joints. SpAs are categorized based on their associated disorders and the anatomical locations involved. Co-occurrence with psoriasis and Inflammatory Bowel Disease (IBD) proposes that these disorders and SpAs may share a common pathophysiologic pathway. On the other hand, reactive arthritis as another member of the SpA group suggests that microbial factors may also play a role (1).

AS is an autoinflammatory SpA, which is characterized by progressive sacroiliitis to the axial skeleton. Osteophyte formation and spine ankylosis are morbid manifestations, which reduce spine mobility and chest expansion. As opposed to most autoimmune diseases, AS is a male dominant disorder with a sex ratio of 3.8:1 (2). Disease onset is characterized by inflammatory pain of the sacroiliac joint that can be detected using various imaging methods. HLA-B27 is present in 73% of Iranian patients and can therefore be used as a reliable auxiliary tool for AS diagnosis (3-5). Symptoms such as peripheral arthritis, enthesitis, and uveitis are the most common non-axial involvements seen in AS patients (6).

Due to the prevalence and morbidity of AS, many studies have been performed to elucidate its precise pathogenesis. Similar to other non-infectious diseases, gene polymorphisms have been found to play a noticeable role, which has been confirmed by Single Nucleotide Polymorphism (SNP) analyses on genes such as Cytotoxic T-lymphocyte-associated Protein-4 (CTLA4), Programmed cell Death-1 (PD1) and Endoplasmic Reticulum Aminopeptidasel (ERAP1) (7-9). Among these SNPs, HLA-B27 has the most reliable role,

based on its significantly different prevalence between patients and healthy individuals. As an antigen presenting molecule. HLA-B27 has been attributed with several hypotheses, indicating the antigen processing/presenting defect in AS and its role in adaptive immunity. Recent hypotheses suggest a pathologic role for HLA-B27 in innate immunity and Endoplasmic Reticulum (ER) stress (10-12). These claims were challenged by explanations given for the function of ERAP1 in AS pathogenesis. ERAP1, a non-HLA protein, is involved in the antigen presenting process in the endoplasmic reticulum and its gene interaction with HLA-B27 has recently been proved (9,13). According to other gene polymorphism studies carried out in the Iranian population, Interleukin-1 Receptor (IL-1R) and PD1 were also suggested as non-HLA genes which may be associated with AS pathogenesis (7,9).

In addition to many SNPs in genes such as CTLA4, PD1 and ERAP1, recent studies have shown that there is a strong association between few intragenic SNPs and AS in different populations. For instance, three SNPs in 2p15 locus (rs10865331, rs10865332, and rs4672503) and three SNPs at chromosome 21q22 (rs2242944, rs2836878, and rs378108) achieved genomewide significance with AS risk (14).

Genome-Wide Association Studies (GWASs) have shown a number of potentially functional intronic variants such as those in 2p 15, 21q22 locus, and rs6759298 (15,16). In this study, polymorphism of rs6759298 was analyzed in an Iranian AS cohort. Then, its probable associations with clinical manifestations and disease activity indices were analyzed.

Materials and Methods

Study population

This study was conducted on 403 AS patients from the outpatient rheumatology clinic of Rheumatology Research Center, Tehran University of Medical Sciences who fulfilled the 1984 modified New York criteria for classification of AS (17). They consisted of 89 female and 314 male individuals (3.52:1 ratio) with a mean age of 38.14 years (minimum 18 and maximum 75 years old, standard deviation (SD)=10.26). The control group for this study was composed of 506 age, sex, and ethnicity matched healthy individuals with a mean age of 36.6 years old and a 3.21:1 ratio of male to female individuals (386 males and 120 females, SD= 10.73). Clinical manifestations such as uveitis, aphthae, arthritis, enthesitis and clinical indices such as Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrologie Index (BASMI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Ankylosing Spondylitis Quality of Life (ASQOL) were evaluated. Peripheral blood collection began on November 2013 and finished on June 2015. Written informed consent forms were taken from all individuals and study protocol was approved by the Ethics Committee of Tehran University of Medical Sciences.

DNA preparation and polymorphism analysis

Blood samples were collected in EDTA tubes and their leukocytes were used as a genomic DNA reservoir, with extraction using the standard phenol-chloroform method and subsequent storing at -20 [degrees]C (18) . rs-6759298 SNP was genotyped by the amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) with a reverse primer sequence of (5'-TGGTGGTTCTGTAGGTAAATGG-3') for the C allele, (5 '-TGGTGGTTCTGTAGGTAAATGC-3 ') for the G allele and (5'-GCCTTGTCAGATTCTTCAG-3') for the forward primer sequence. Figure 1 shows PCR products from three samples with C allele.

PCR cycling for rs6759298 was carried out in three steps; A: initial denaturation at 95 [degrees]C for 5 min, B: 10 cycles each of 30 s at 95 [degrees]C, 30 s at 65.7 [degrees]C and 60 s at 72 [degrees]C, 25 cycles each of 30 s at 95 [degrees]C, 30 s at 60.6 [degrees]C and 60 s at 72 [degrees]C, and C: final incubation at 95 [degrees]C for 10 min. The PCR products were electrophoresed on 2% agarose gels and photographs were taken by the Vilber Loumat gel documentation instrument.

Direct Sanger sequencing of three samples with CC. CG, and GG genotypes were performed by 3730x1 DNA Analyzer (Applied Biosystems) using big dye terminator (Figure 2).

Statistical analysis

The control group was tested to meet the Hardy-Weinberg Equilibrium (HWE). The allele/genotype and clinical manifestations associations were analyzed by chi-squares test with Odds Ratio (OR) and 95% Confidence Intervals (CI). Probable correlation of rs6759298 genotypes with indices was analyzed with one-way ANOVA. P-values were adjusted with the Benjamini-Hochberg method to control for False Discovery Rates (FDR). The SPSS for Windows software (version 19.0, IBM SPSS Inc., USA) was used to perform all analyses.


No significant deviation of rs6759298 genotype distribution from Hardy-Weinberg Equilibrium was observed in healthy controls. The associations between allele and genotype frequencies with disease susceptibility are shown in table 1. According to these results, GG genotype and G allele significantly increased the susceptibility to AS [p=2x[10.sup.6] and 7.44x[10.sup.-9], OR (95% CI)=2.16 (1.56-2.98) and 1.73 (1.43-2.08), respectively].

In addition to the preceding results, association of the rs6759298 genotypes and clinical manifestations is shown in table 2. Among a wide range of signs and symptoms, the most prevalent items were analyzed: enthesitis, arthritis, uveitis, and oral aphthae. Correlation of the mentioned genotypes with clinical indices is also included in table 2. No associations were discovered in this survey.


By conducting several GWASs in AS patients over the past few years, researchers have identified a number of potentially functional intronic variants (14,18) . However, it is not yet known whether such SNPs have direct functional significance or are simply in Linkage Disequilibrium (LD) with another functional SNP (15). In the current study, one of the most significant intergenic SNPs associated with AS was examined for the first time among the Iranian population.

rs6759298 SNP belongs to the 2p15 gene desert, containing some other SNPs associated with AS (16). According to HapMap genotype data (HapMap #27, on NCBI B36 assembly), rs6759298 is not included within the LD blocks of its neighboring genes. Therefore, rs-6759298 association with AS is unlikely due to an adjacent functional gene only.

The closest protein-coding genes to rs6759298 are B3GNT2 genes (UDP-GlcNAc: betaGal beta-l,3-N acetylglucosaminyltransferase) which codify for a type II transmembrane protein involved in the biosynthesis of poly-N-acetyllactosamine chains, COMMD1 (copper metabolism domain containing, coding a regulator of copper homeostasis, sodium uptake, and NF-kappa-B signaling, and finally TMEM17 (transmembrane protein 17), coding a transmembrane component of a complex, which is required for ciliogenesis and sonic hedgehog/SHH signaling (20,22). Although B3GNT2 that encodes UDP-GlcNAc is the closest gene to rs6759298, there is not any known immunological function for UDP-GlcNAc. Then, our variant was tested to predict probable functional consequences (ENSR 00001045107). Results suggested that rs6759298 is located within a promoter flanking region which has unknown regulatory functions and is active in the GM12878, HSMM tube, and K.562 cell lines (14,23). Therefore, it is assumed that it could be a proximal promoter element for an AS-associated gene in the same region which has not yet been discovered. Another explanation is that it could be part of a long-range regulatory element involved in the transcription regulation of the aforementioned genes.


To the best of our knowledge, this is the first study that provides evidence of association of the rs6759298 SNP with AS patients in the Iranian population. However, further molecular studies are necessary to demonstrate the exact role of such variants in the pathogenesis of AS.


This survey was supported by grants (Grant No: 93-03-41-24477) from the research deputy of Tehran University of Medical Sciences.

Conflict of Interest

The authors declare that there is no conflict of interest.


(1.) Akgul O. Ozgocmen S. Classification criteria for spondyloarthropathies. World J Orthop 2011:2(12): 107-115.

(2.) Shahlaee A. Mahmoudi M. Nicknam MH. Farhadi F. Fallahi S, Jamshidi AR. Gender differences in Iranian patients with ankylosing spondylitis. Clin Rheumatol 2015: 34(2):285-293.

(3.) Nicknam MH. Mahmoudi M. Amirzargar AA. Ganjalikhani Hakemi M. Khosravi F, Jamshidi AR. et al. Determination of HLA-B27 subtypes in Iranian patients with ankylosing spondylitis. Iran J Allergy Asthma Immunol 2008:7(1): 19-24.

(4.) Nicknam MH. Mahmoudi M. Amirzargar AA. Jamshidi AR. Rezaei N. Nikbin B. HLA-B27 subtypes and tumor necrosis factor alpha promoter region polymorphism in Iranian patients with ankylosing spondylitis. Eur Cytokine Netw 2009;20(l): 17-20.

(5.) Brewerton DA. Hart FD. Nicholls A. Caffrey M. James DC. Sturrock RD. Ankylosing spondylitis and HL-A 27. Lancet 1973:l(7809):904-907.

(6.) Jamshidi AR. Shahlaee A. Farhadi E. Fallahi S. Nicknam MFI. Bidad K. et al. Clinical characteristics and medical management of Iranian patients with ankylosing spondylitis. Mod Rheumatol 2014:24(3):499-504.

(7.) Soleimanifar N. Amirzargar AA. Mahmoudi M. Pourfathollah AA, Azizi E. Jamshidi AR. et al. Study of programmed cell death 1 (PDCD1) gene polymorphims in Iranian patients with ankylosing spondylitis. Inflammation 2011:34(6):707-712.

(8.) Mahmoudi M. Amirzargar AA. Jamshidi AR. Farhadi E. Noori S. Avraee M. et al. Association of IL1R polymorphism with HLA-B27 positive in Iranian patients with ankylosing spondylitis. Eur Cytokine Netw 2011;22(4): 175-180.

(9.) Mahmoudi M. Jamshidi AR. Amirzargar AA. Farhadi E. Nourijelyani K. Fallahi S, et al. Association between endoplasmic reticulum aminopeptidase-1 (ERAP-1) and susceptibility to ankylosing spondylitis in Iran. Iran J Allergy Asthma Immunol 2012:11(4):294-300.

(10.) Hacquard-Bouder C. Chimenti MS. Giquel B. Donnadieu E, Fert I. Schmitt A. et al. Alteration of antigen-independent immunologic synapse formation between dendritic cells from HLA-B27-transgenic rats and CD4+ T cells: selective impairment of costimulatory molecule engagement by mature HLA-B27. Arthritis Rheum 2007; 56(5):1478-1489.

(11.) Mear JP, Schreiber KL, Munz C, Zhu X, Stevanovic S, Rammensee HG. et al. Misfolding of HLA-B27 as a resuit of its B pocket suggests a novel mechanism for its role in susceptibility to spondyloarthropathies. J Immunol 1999:163(12):6665-6670.

(12.) Fussell H. Nesbeth D. Lenart I. Campbell EC. Lynch S. Santos S, et al. Novel detection of in vivo HLA-B27 conformations correlates with ankylosing spondylitis association. Arthritis Rheum 2008:58(11):3419-3424.

(13.) Reeves E. Elliott T. James E. Edwards CJ. ERAP1 in the pathogenesis of ankylosing spondylitis. Immunol Res 2014;60(2-3):257-269.

(14.) Australo-Anglo-American Spondyloarthritis Consortium (TASC).Reveille JD. Sims AM.Danoy P. Evans DM. Leo P. et al. Genome-wide association study of ankylosing spondylitis identities non-MHC susceptibility loci. Nat Genet 2010;42(2): 123-127.

(15.) Robinson PC. Claushuis TA. Cortes A. Martin TM. Evans DM, Leo P. et al. Genetic dissection of acute anterior uveitis reveals similarities and differences in associations observed with ankylosing spondylitis. Arthritis Rheumatol 2015;67(1):140-151.

(16.) International Genetics of Ankylosing Spondylitis Consortium (IGAS). Cortes A, Hadler J, Pointon JP. Robinson PC. Karaderi T. et al. Identification of multiple risk variants for ankylosing spondylitis through high-density genotyping of immune-related loci. Nat Genet 2013:45 (7):730-738.

(17.) Deodhar A. Axial spondyloarthritis criteria and modified NY criteria: issues and controversies. Clin Rheumatol 2014:33(6):741-747.

(18.) Abtahi S. Farazmand A. Mahmoudi M. Ashraf-Ganjouei A. Javinani A. Nazari B. et al. IL-IA rs 1800587. IL-IB rs1143634 and IL-1R1 rs2234650 polymorphisms in Iranian patients with systemic sclerosis. Int J Immunogenet 2015;42(6):423-427.

(19.) Wellcome Trust Case Control Consortium. Australo-Anglo-American Spondylitis Consortium (TASC). Burton PR. Clayton DG. Cardon LR. Craddock N, et al. Association scan of 14,500 nonsynonymous SNPs in four diseases identifies autoimmunity variants. Nat Genet 2007:39(11): 1329-1337.

(20.) McDonald FJ. COMMD1 and ion transport proteins: what is the COMMection? Focus on "COMMD1 interacts with the COOH terminus of NKCC1 in Calu-3 airway epithelial cells to modulate NKCC1 ubiquitination". Am J Physiol Cell Physiol 2013;305(2):C129-130.

(21.) Kenny EE, Pe'er I, Karban A. Ozelius L. Mitchell AA, Ng SM. et al. A genome-wide scan of Ashkenazi Jewish Crohn's disease suggests novel susceptibility loci. PLoS Genet 2012;8(3):e 1002559.

(22.) Okada Y. Wu D. Trynka G. Raj T. Terao C. Ikari K. et al. Genetics of rheumatoid arthritis contributes to biology and drug discovery. Nature 2014:506(7488):376-381.

(23.) Roberts AR. Vecellio M. Chen L. Ridley A. Cortes A. Knight JC. et al. An ankylosing spondylitis-associated genetic variant in the IL23R-IL12RB2 intergenic region modulates enhancer activity and is associated with increased Th1-cell differentiation. Ann Rheum Dis 2016: 75(12):2150-2156.

Mahdi Mahmoudi (1), Masoud Carshasbi (2*), Amir Ashraf-Ganjouei (1,3), Ali lavinani (1,3), Mahdi Vojdanian (1), Masoumeh Saafi (4), Nooshin Ahmadzadeh (1), and Ahmadreza Jamshidi (1) (*)

(1.) Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran

(2.) Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

(3.) Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran

(4.) Department of Genetics, Islamic Azad University, Tabriz Branch, Tabriz, Iran

(*) Corresponding authors:

Ahmadreza Jamshidi, M.D., Rheumatology Research Center, Shariati Hospital, Kargar Aue., Tehran, Iran

Masoud Garshasbi, Ph.D., Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University Tehran, Iran, Tehran, Iran

Tel/Fax: +98 21 88220065. 82884569


Received: 11 Mar 2017

Accepted: 29 May 2017
Table 1 - Alleles and genotypes distribution of rs6759298 polymorphism
in Iranian AS patient and healthy individuals

                             Control  AS (1)
dbSNP      Allele genotypes  (N=506)  (N=403)  p-value

           C                 611      378      -
           G                 399      428      7.44x[10.sup.-9] (*)
           CC                186       90      -
           GC                241      198      0.65
           GG                 79      115      2x[10.sup.6] (*)
HWE (3)                                        0.95

dbSNP      Allele genotypes  OR (95% CI) (2)

           C                 -
           G                 1 73 (1.43-2.08)
           CC                -
           GC                1.06(0.82-1.38)
           GG                2 16 (1 56-2.98)
HWE (3)

(1)) Ankylosing Spondylitis; (2)) Odd Ratio with 95% of Confidence
Interval; (3)) Hardy-Weinberg equilibrium;

(*) Significant p-values.

Table 2, Association of rs6759298 polymorphism with clinical
manifestations and indices

Clinical manifestation  GG  GC   CC  p-value  p-value (1)  Clinical

Uveitis                 13   19  17  0.263    0.477        BASFI (2)
Aphthae                 23   53  36  0.358    0.477        BASMI (3)
Arthritis               34   73  46  0.758    0.758        BASDAI (4)
Enthesitis              46  114  65  0.221    0.477        ASQOL (5)

                        GG     GC     CC
Clinical manifestation  mean   mean   mean   p-value  p-value (1)

Uveitis                 4.239  3.608  3.919  0.216    0.288
Aphthae                 4.236  3.974  3 926  0.520    0.520
Arthritis               5.292  4.573  4.413  0.066    0.264
Enthesitis              8.702  7.206  7.764  0.136    0.272

(1)) FDR-adjusted P-value for multiple testing using the
Benjamini-Hochberg method; (2)) Bath Ankylosing Spondylitis Functional
Index; (3)) Bath Ankylosing Spondylitis Metrologie Index; (4)) Bath
Ankylosing Spondylitis Disease Activity Index; 5) Ankylosing
Spondylitis Quality of Life.
COPYRIGHT 2018 Avicenna Research Institute
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2018 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:Original Article
Author:Mahmoudi, Mahdi; Carshasbi, Masoud; Ashraf-Ganjouei, Amir; Javinani, Ali; Vojdanian, Mahdi; Saafi, M
Publication:Avicenna Journal of Medical Biotechnology (AJMB)
Article Type:Report
Geographic Code:7IRAN
Date:Jul 1, 2018
Previous Article:Interleukin-2 and Interferon-Camma Single Nucleotide Polymorphisms in Iranian Patients with Chronic Heart Failure.
Next Article:Menstrual Blood-Derived Stromal Stem Cells Augment CD4+ T Cells Proliferation.

Terms of use | Privacy policy | Copyright © 2021 Farlex, Inc. | Feedback | For webmasters |