ITM2A Expands Evidence for Genetic and Environmental Interaction in Graves’ Disease Pathogenesis

Context: Graves’ disease (GD) is a common autoimmune disease triggered by genetic predisposition and environmental factors. However, the mechanisms of interaction between genetic and environmental factors contributing to the development of GD remain unknown. Objective: To identify GD susceptibility variants and genes on Xq21.1 locus and interpret the contribution of interaction between genetic predisposition on Xq21.1 and environmental factors to GD. Design: We performed refining study on Xq21.1 in a two-stage study and carried out eQTL analysis of the best association signal with GD. Setting and Participants: 4,316 GD patients and 4,374 sex-matched controls were collected from the Chinese Han population by cooperation with multiple hospitals. Results: We identified rs3827440 or its linkage SNPs was probably the causal variant in the Xq21.1 locus, with the most significant association with GD in our combined cohorts (P=2.45×10-15). The genotypes of rs3827440 were correlated with the expression of ITM2A in monocytes and PBMCs from healthy volunteers. Notably, the expression of ITM2A in monocytes after lipopolysaccharide (LPS) and interferon-γ (INF-γ) stimulation showed significant difference among the volunteers carried different genotypes of rs3827440 (P=9.40×10-7 and P=1.26×10-5, for 24h LPS and INF-γ stimulation, respectively). Moreover, ITM2A expression was significantly decreased in PBMCs from untreated GD patients than that from controls. Conclusion: The results suggest that ITM2A might be a susceptibility gene for GD in the Xq21.1 locus, and environmental factors, such as viral and bacterial infections, probably contribute to GD pathogenesis by interacting with the risk SNP rs3827440 mediating the regulation of ITM2A expression.