Key result
The genetic variant rs2920656C > T near ANGPT2 was associated with a reduced risk of developing acute kidney injury sub-phenotype 2 (OR 0.45) and decreased plasma angiopoietin-2 concentrations.
Why the study?
It was unknown whether endothelial dysfunction biomarkers differentiating acute kidney injury sub-phenotypes are markers or causal mediators in their development.
Does the genetic variant rs2920656C > T near ANGPT2 reduce the risk of AKI-SP2 in critically ill patients?
Case-Control (n=421)
Yes
Does the genetic variant rs2920656C > T near ANGPT2 reduce the risk of AKI-SP2 in critically ill patients?
Odds Ratio: 0.45 (95% CI 0.31–0.66)
p-value: p=FDR = 0.003
Genetic variation near ANGPT2 is associated with a reduced risk of a severe acute kidney injury sub-phenotype, suggesting plasma angiopoietin-2 plays a causal role in its development.
Supports angiopoietin-2 as a potential AKI-SP2 target; hypothesis-generating and requires prospective validation before clinical consideration.
BACKGROUND: We previously identified two acute kidney injury (AKI) sub-phenotypes (AKI-SP1 and AKI-SP2) with different risk of poor clinical outcomes and response to vasopressor therapy. Plasma biomarkers of endothelial dysfunction (tumor necrosis factor receptor-1, angiopoietin-1 and 2) differentiated the AKI sub-phenotypes. However, it is unknown whether these biomarkers are simply markers or causal mediators in the development of AKI sub-phenotypes. METHODS: We tested for associations between single-nucleotide polymorphisms within the Angiopoietin-1, Angiopoietin-2, and Tumor Necrosis Factor Receptor 1A genes and AKI- SP2 in 421 critically ill subjects of European ancestry. Top performing single-nucleotide polymorphisms (FDR < 0.05) were tested for cis-biomarker expression and whether genetic risk for AKI-SP2 is mediated through circulating biomarkers. We also completed in vitro studies using human kidney microvascular endothelial cells. Finally, we calculated the renal clearance of plasma biomarkers using 20 different timed urine collections. RESULTS: A genetic variant, rs2920656C > T, near ANGPT2 was associated with reduced risk of AKI-SP2 (odds ratio, 0.45; 95% CI, 0.31-0.66; adjusted FDR = 0.003) and decreased plasma angiopoietin-2 (p = 0.002). Causal inference analysis showed that for each minor allele (T) the risk of developing AKI-SP2 decreases by 16%. Plasma angiopoietin-2 mediated 41.5% of the rs2920656 related risk for AKI-SP2. Human kidney microvascular endothelial cells carrying the T allele of rs2920656 produced numerically lower levels of angiopoietin-2 although this was not statistically significant (p = 0.07). Finally, analyses demonstrated that angiopoietin-2 is minimally renally cleared in critically ill subjects. CONCLUSION: Genetic mediation analysis provides supportive evidence that angiopoietin-2 plays a causal role in risk for AKI-SP2.
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Bhatraju et al. (2020) conducted a case-control in Acute kidney injury (AKI) sub-phenotypes (n=421). rs2920656C > T variant near ANGPT2 vs. rs2920656 C allele was evaluated on Development of AKI-SP2 compared to AKI-SP1 (OR 0.45, 95% CI 0.31-0.66, p=FDR = 0.003). The genetic variant rs2920656C > T near ANGPT2 was associated with a reduced risk of developing acute kidney injury sub-phenotype 2 (OR 0.45) and decreased plasma angiopoietin-2 concentrations.
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