Unraveling the role of CTLA-4 variants in acute kidney injury after ICI treatments.

e14682 Background: Immune checkpoint inhibitors (ICIs) often result in various immune-related adverse events (irAEs), which limit their therapeutic application and pose challenges to clinical decision-making. Among these irAEs, the incidence rate of ICI-related acute kidney injury (ICI-AKI) is on the rise. Understanding the genetic predisposition to ICI-AKI can inform personalized treatment plans, thereby minimizing risks and optimizing outcomes. This study aims to interrogate risk loci for AKI patients to gain insights into ICI-related AKI in cancer patients and to support the design of more personalized cancer therapies. Methods: This study comprehensively integrates meta-analysis, replication genome-wide association study (GWAS), fine-mapping, and mendelian randomization (MR) to explore potential genetic variants related with ICI-AKI. We first conducted a meta-analysis of 6 ICI pharmacogenomics studies, aggregating effect sizes from these studies using both fixed-effect and random-effects models to address heterogeneity and identified 186 significant genotypes. Subsequently, a GWAS was carried out over the 186 candidate genotypes in an independent cohort from the NIH All of Us program (N = 230,013) using logistic regression, identifying14,773 patients who developed AKI. To identify causal variants, we implemented fine-mapping techniques to further refine our genotype selection. Results: Our study identified genetic variants associated with an increased risk of AKI. Among these, the variant with the strongest association was located at the cytotoxic T lymphocyte antigen 4 (CTLA-4) gene locus, rs3087243 (chr2: 203874196, G>A,T). This genotype exhibited a significant inverse relationship with AKI risk (beta = -8.19e-2, P = 2e-11), suggesting that reduced activity of the CTLA-4 gene may be linked to an elevated risk of developing AKI. Our findings indicate that cancer patients with this genotype may have a lower risk of ICI-related AKI after immunotherapy. In our future study, we will continue investigating significant SNPs including rs3087243 in cancer patients for their ICI-AKI risk. Conclusions: We identified an AKI-tolerant genotype, rs3087243. Patients with this genotype may be safter from developing ICI-related AKI after immunotherapy treatment. This work also highlights the research potential of All of Us clinicogenomics data.