Original Article

Association between TNFSF10 polymorphism and migraine susceptibility in a Chinese population

Journal of International Medical Research 2015, Vol. 43(3) 326–331 ! The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0300060514565681 imr.sagepub.com

Shasha Jia1, Wanli Dong2, Xianju Zhou1, Zhiguo Chen1 and Wenwei Yun1

Abstract Objective: To investigate the correlation between migraine in a Chinese population and a 4 base pair (GAGT) insertion/deletion polymorphism (rs35975099) localized near the 3’ end of the tumour necrosis factor superfamily 10 gene, TNFSF10. Methods: Ethnically Han Chinese patients with migraine and healthy control subjects were recruited. TNFSF10 genotype and allele frequencies were determined via polymerase chain reaction and polyacrylamide gel electrophoresis. Results: Rs35975099 was in Harvey–Weinberg equilibrium in patients with migraine (n ¼ 269) and control subjects (n ¼ 374). There were no significant relationships between allele or genotype frequency and migraine. Conclusion: There was no functional significance of the TNFSF10 gene polymorphism rs35975099 in migraine pathogenesis.

Keywords Migraine, TNFSF10, gene polymorphisms, susceptibility Date received: 25 October 2014; accepted: 3 December 2014

Introduction Migraine is a polygenically inherited chronic neurovascular disorder that can negatively impact work, study, daily activities and health-related quality-of-life. The lifetime prevalence of migraine is between 14% and 16%, and it is three times more common in women than in men.1,2 Migraine is clinically classified between two subtypes based on the presence or absence of aura, symptoms of which include hallucinations, paraesthesia,

1

Department of Neurology, Laboratory of Neurological Diseases, Changzhou No.2 People’s Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, China 2 Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China Corresponding author: Wenwei Yun, Department of Neurology, Laboratory of Neurological Diseases, Changzhou No. 2 Peoples’ Hospital, The Affiliated Hospital of Nanjing Medical University, 29 Xinglong Alley, Changzhou, Jiangsu 213003, China. Email: [email protected]

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disturbed vision and weakness. Although the pathological mechanism of migraine is unclear, evidence suggests inflammation may be involved.3,4 Tumour necrosis factor (TNF) is a key cytokine involved in inflammatory reactions and inflammation-related hyperalgesia.5 TNF may play a pivotal role in migraine via activation of meningeal nociceptors, reducing threshold cerebral excitability and propagating neuronal hyperexcitability.6,7 The TNF superfamilies (TNFSF) and TNF receptor superfamilies (TNFRSF) have extensive actions in cell differentiation and survival, and in controlling expression of inflammatory cytokines.8 TNFSF/TNFRSF gene polymorphisms have now been recported in migraine. These include TNF- 308 G>A,9 TNF- 252 A>G,10 TNFSF711 and TNFRSF1B.12 TNFSF10 has been shown to exert therapeutic efficacy for inflammatory diseases in experimental animal models,13 suggesting a role in the progression of inflammation. TNFSF10 polymorphisms are also correlated with cancer susceptibility,14,15 but there is no direct evidence that TNFSF10 polymorphism is associated with migraine. The aim of this study was to investigate the correlation between migraine in a Chinese population and a 4 base pair (GAGT) insertion/deletion polymorphism (rs35975099) localized near the 3’ end of TNFSF10.

Patients and methods Study population The study enrolled unrelated ethnically Han Chinese patients with migraine, attending the Neurological Outpatient Service, First Affiliated Hospital of Soochow University, Suzhou, China, for diagnosis or follow-up between October 2008 and December 2010. Migraine was diagnosed and classified according to the International Classification of Headache Disorders-II criteria, as recommended by the International Headache

Society.16 Ethnically Han Chinese control subjects were recruited from individuals completing a nutritional survey in the same geographical area as the patients. Subjects with migraine, a family history of migraine, or any severe or recurrent headache in direct relatives were excluded. Data regarding tobacco use (more than one cigarette per day for >1 year) and alcohol use (at least one alcoholic drink per week) were recorded for patients and control subjects. The ethics committee of Soochow University, Suzhou, China approved the study, and all subjects provided written informed consent prior to enrolment.

Genotyping Peripheral blood (3 ml) was taken from each subject and stored at –20 until use. DNA was extracted from whole blood17 and polymerase chain reaction (PCR) for TNFSF10 was carried out as described.18 Primer sequences were: forward 50 - GGC CCTATGTCCAAATAAGGTT-30 ; reverse 50 - GTTCTGGGTTGAGTTGTGCTG-30 . PCR cycling conditions were 94 C for 7 min followed by 35 cycles of 94 C for 40 s, 60 C for 40 s and 72 C for 40 s, and a final extension step at 72 C for 5 min. PCR products were separated by 7% nondenaturing polyacrylamide gel electrophoresis and visualized by silver staining. Genotype was determined by number and size of bands on the gel. In order to confirm the reproducibility of PCR genotyping, 10% of samples were randomly selected and re-examined by another technician.

Statistical analyses Hardy–Weinberg Equilibrium (HWE) was analysed by 2-test. Between-group comparisons of genotypic and allelic distribution were made by 2-test. Logistic regression analysis (adjusted for sex, age, alcohol and tobacco use, and clinical characteristics) was

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conducted to obtain odds ratios (ORs) and 95% confidence intervals (CIs) for the correlation between rs35975099 and migraine risk. All statistical analyses were two-sided and performed using SAS statistical software, version 8.0 (SAS Institute Inc., Cary, NC, USA). P-values 0.05 were considered statistically significant.

Results The study enrolled 269 patients with migraine (78 male/191 female; mean age 34.3  11.7 years; age range 14–65 years) and 374 healthy control subjects (106 male/268 female; mean age 35.4  10.6 years; age range 18–70 years). There were no significant between-group differences in age, sex distribution, tobacco use (patient group 50/269 [18.6%] vs control group 59/374 [15.8%]) or alcohol use (patient group 55/269 [20.4%] vs control group 76/ 374 [20.3%]). Clinical characteristics of the patient group are shown in Table 1. Repeat PCR confirmed that PCR genotyping was 100% reproducible. Genotype frequency was in HWE, in patients and in control subjects. Data regarding allele and genotype frequencies are presented in Table 2. There were no statistically significant between-group differences in allele or genotype distribution, with or without adjustment for sex, age, tobacco and alcohol use. Results of stratification analysis for the patient group are shown in Table 3. There were no significant differences in allele or genotype distribution when patients were stratified by sex, age of disease onset, family history of migraine or migraine type.

Discussion Our study found no association between genotype or allele distribution of the TNFSF10 gene polymorphism rs35975099 and migraine in Chinese patients with migraine.

Table 1. Clinical characteristics of Chinese patients with migraine, included in a study investigating the correlation between the occurrence of migraine and rs35975099, a 4 base pair (GAGT) insertion/deletion polymorphism localized near the 3’ end of the tumour necrosis factor superfamily 10 gene (TNFSF10) (n ¼ 269). Characteristic

Total

Age, years Sex, male/female Tobacco usea Alcohol useb Pain severityc Low Moderate Severe Frequency of attacks/month 1 2–4 5 Age at migraine onset, years Family history of migraine Migraine type With aura Without aura Time since diagnosis, years

34.3  11.7 78/191 (29.0/71.0) 50 (18.6) 55 (20.4) 41 (15.2) 49 (18.2) 179 (66.6) 51 (19.0) 140 (52.0) 78 (29.0) 25.5  9.1 170 (63.2) 17 (6.3) 252 (93.7) 8.8  3.7

Data presented as mean  SD or n (%). a More than one cigarette per day for >1 year. b At least one drink per week. c Low, no effect on daily activity; moderate, slight effect on daily activity; severe, severe effect on daily activity.

Migraine is a primary headache disorder with an unclear pathogenesis, although evidence suggests that  40% of migraine susceptibility is due to multiple genetic factors.19,20 Studies support the involvement of proinflammatory cytokines (especially TNF) in migraine.21,22 Our earlier study revealed a relationship between TNFRSF1B polymorphism and an augmented risk of migraine.12 TNFSF10 is involved in acute and chronic inflammatory central nervous system disorders23 and has many functions in the peripheral and central nervous system, including cell death and immune modulation.24 There is no evidence for a correlation

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Table 2. Logistic regression analysis of genotype and allele frequencies of rs35975099, a 4 base pair (GAGT) insertion/deletion polymorphism localized near the 3’ end of the tumour necrosis factor superfamily 10 gene (TNFSF10), in patients with migraine and in healthy control subjects. Genotype/Allele

Patient group n ¼ 269

Control group n ¼ 374

Crude OR (95% CI)

Adjusted ORa (95% CI)

Insertion/insertion Insertion/deletion Deletion/deletion Insertion Deletion

48 128 93 224 314

47 189 138 283 465

1.00 (reference) 0.66 (0.41, 1.08) 0.66 (0.40, 1.10) 1.00 (reference) 0.85 (0.68, 1.08)

1.00 (reference) 0.61 (0.38, 1.07) 0.63 (0.39, 1.06) – –

(17.8) (47.6) (34.6) (41.6) (58.4)

(12.6) (50.5) (36.9) (37.8) (62.2)

Data presented as n (%). OR, odds ratio; CI, confidence interval. a Adjusted for age, sex, and smoking and drinking status.

Table 3. Genotype and allele frequencies of rs35975099, a 4 base pair (GAGT) insertion/deletion polymorphism localized near the 3’ end of the tumour necrosis factor superfamily 10 gene (TNFSF10), in patients with migraine stratified according to sex, age at onset, family history and migraine subtype (n ¼ 269). Genotype Characteristic Sex Male, n ¼ 78 Female, n ¼ 191 Age at onset of migraine, years 0.05; 2-test).

between altered plasma or cerebral spinal fluid TNFSF10 concentrations and migraine, however. The findings of the present study indicate no functional significance for TNFSF10 rs35975099 in migraine susceptibility in a Chinese population,

suggesting that TNFSF10 may not play a major role in migraine, in this demographic group. Our study has several limitations. First, the rate of migraine with aura was 6.3% in the present study, which is significantly

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lower than the 20% reported by others.25,26 This may be due to between-study differences in population demographics and the possibility of selection bias in our study. Secondly, our study had a relatively small sample size, and further larger scale studies are required. In conclusion, we have found no major role for the TNFSF10 gene polymorphism rs35975099 in the pathogenesis of migraine.

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Declaration of conflicting interest The authors declare that there are no conflicts of interest.

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Funding

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This study was funded by Research and Innovation Project for College Graduates in Jiangsu Province (CX09B_032Z). 13.

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Association between TNFSF10 polymorphism and migraine susceptibility in a Chinese population.

To investigate the correlation between migraine in a Chinese population and a 4 base pair (GAGT) insertion/deletion polymorphism (rs35975099) localize...
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