Review Article

Genetic Mechanisms in Aspirin-Exacerbated Respiratory Disease

Table 1

Genetic mechanisms of AERD.

Gene nameSNPsClinical PhenotypeMechanism

Leukotriene synthesis
LTC4S−444A  >  CC allele had high genotype frequency compared with A alleleC allele may be the risk allele due to overproduction of CysLTs
ALOX5 −1708G  >  A, 21C  >  T, 270G  >  A, 1728G  >  A ALOX5 ht1(GCGA) had higher haplotype frequencyALOX5 ht1(GCGA) may be the risk haplotype
CYSLTR1 −634C  >  T, −475A  >  C, −336A  >  Ght2(TCG) showed higher frequency in AERD and higher promoter activityHigher CysLTR1 mRNA expression may be responsible for pathogenesis
CYSLTR2−819T  >  Cthe frequencies of rare allele were increased in AERD and fall in FEV1 after aspirin provocation Elevation of CysLTs production

COX/PG pathway and HLA allele
PTGERrs7543182 rs959These two polymorphisms retained their susceptibility to aspirin intolerance in first and second cohortsPTGER3 might play a significant role in aspirin hypersensitivity
TBXA2R+795T  >  CAERD patients with homozygous +795 C allele had a greater percent fall in FEV1 after aspirin exposure compared with TBXA2R+795 CT or TT genotypes.TBXA2R+795T  >  C may increase bronchoconstrictive response to ASA
HLA DPB1*0301 Patients with DPB1*0301 allele had higher prevalence of Rhino-sinusitis and lower FEV1 values.HLA markers may be important for LTRA therapy
Gene nameSNPsClinical PhenotypeMechanism

Eosinophil activation
CRTH2−466T  >  C −466T allele had higher frequency in AERD and increased serum, cellular eotaxin-2 production and lower mRNA expression −466T allele may be the risk allele by activation of eosinophils
CCR3−520T  >  CThe frequencies of rare genotypes were higher in AERD and −520G allele showed higher promoter activityHigher mRNA expression of CCR3 may cause eosinophil activation
IL 131510A  >  C, 1055C  >  T, Arg110GlnIncrease eotaxin-1 and peripheral eosinophil countEosinophil activation may occur

Mast cell activation
FCERIG −237A  >  G −344C  >  TAA type of −237A  >  G showed high serum total IgE; CC/CT of −344C/T had higher SEAMast cells may be activated
MS4A2RE237GFcER1b −109T allele had higher frequency and high promoter activityIncreased mRNA expression of −109T allele may cause mast cell activation mediated by MS4A2R receptor

Other mechanisms  
IL-10 and TGF-β1−1082 A  >  G and −509C  >  TThe frequency of rare alleles (the CT or TT genotype of TGF-β1) 509C/T and AG or GG genotype of (IL-10 )1082A/G was significantly higher in AERD and −1082G had higher promoter activityAlteration in IL-10 production caused by the −1082A/G in IL-10 may contribute to disease pathogenesis which is strengthened by a genetic interaction with TGF-β1.
ACE −262A  >  T, −115T  >  C The frequencies of the rare alleles were higher in AERD −262T had lower promoter activity and fall of FEV1 after aspirin provocationDownregulation of ACE expression
KIF3Ars 3756775Fall of FEV1 and higher mRNA expression of KIF3A in the ASA induced bronchial epithelial cells and protein expression in nasal polyp epithelia in AERDAbnormality of cilia predisposing to AERD
SLC6A12rs499368, rs557881The minor allele frequencies were higher in AERD and fall of FEV1 after aspirin provocationGABA signaling pathway in the airway epithelium may play a role
CEP687572857G  >  AFall of FEV1 after aspirin provocation by A alleleChange in polarity of the protein structure due to nonsynonymous SNP which replaces Gly with Ser

IL13: interleukin 13, CCR3: chemokine receptor 3, CRTH2: chemoattractant receptor, IL10: interleukin 10, TGF: transforming growth factor, MS4A2R: high affinity immunoglobulin epsilon receptor beta-subunit (FcERI) TBXA2R: thromboxane receptor, CysLTR1: cysteinyl leukotriene 1, CysLTR2: cysteinyl leukotriene 2, ALOX5: arachidonate 5 lipoxygenase, HLA: human leukocyte antigen, LTC4S: leukotriene C4, ACE: angiotensin-converting enzyme KIF3A: kinesin family number 2A, SLC22A2: solute carrier family 6, CEP68: centrosomal protein, PTGER: prostanoid gene, TEC: total eosinophilic count, TF: transcription factor, MAZ: myc-associated zinc finger protein, SEA: Staphylococcus enterotoxin A, FEV1: forced expiratory volume in 1 s, AERD: aspirin-exacerbated respiratory disease.