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Cytokine Gene Polymorphisms in Autoimmune Thyroid Disease

Department of Endocrinology, Radcliffe Infirmary (P.J.H., J.A.H.W.), Oxford, United Kingdom OX2 6HE; Oxford Transplant Center, Churchill Hospital (S.E.M., K.I.W.), Oxford, United Kingdom OX3 7LJ; Division of Clinical Sciences, Northern General Hospital (A.P.W.), Sheffield, United Kingdom S5 7AU; and Department of Medicine, John Radcliffe Hospital (J.I.B.), Oxford, United Kingdom OX3 9DU

Address all correspondence and requests for reprints to: Dr. P. J. Hunt, Department of Endocrinology, Riverside Block, Christchurch Hospital, Private Bag 4710, Christchurch 8001, New Zealand.

Susceptibility to the autoimmune thyroid diseases, Graves’ disease (GD) and autoimmune hypothyroidism (AIH), depends on a complex interaction between environmental and genetic factors. The human leukocyte antigen and cytotoxic T lymphocyte-associated-4 regions appear to influence susceptibility to disease, but the effect is not major, and the other genes remain unknown. Cytokines are crucial in the regulation of immune and inflammatory responses and therefore are potential candidate genes for autoimmune thyroid disease. In a case-control study, using a unified method of genotyping, we have examined 15 polymorphisms in 9 cytokine genes in 215 patients with autoimmune thyroid disease (GD, 138; AIH, 77) and 101 normal controls.

Polymorphisms in the genes for interleukin-1 (IL-1), IL-1ß, IL-1 receptor antagonist, IL-1 receptor 1, IL-4, IL-4 receptor, IL-6, IL-10, and transforming growth factor-ß were investigated. Genotyping was performed using the PCR and sequence-specific primers. Analysis showed a reduced frequency of the variant t allele in the IL-4 promoter polymorphism (position -590) in patients with GD and in the entire patient group (GD and AIH) compared with the control group [corrected P (Pc) = 0.00004 and Pc < 0.00001 for GD and all patients, respectively]. This was reflected in a reduction in the heterozygote genotype in the patient groups compared to the controls [c/t heterozygotes GD, 12%; Pc = 0.06, odds ratio, 0.4 (95% confidence interval, 0.2–0.7); all patients, 11%; Pc = 0.008; odds ratio, 0.4 (95% confidence interval, 0.2–0.7); control subjects, 23%]. There were no significant differences between the study groups for the other polymorphisms examined, and subgroup analysis revealed no association with clinical parameters of disease.

These results suggest that an IL-4 variant or a closely linked gene has a modest protective effect against the development of autoimmune thyroid disease, particularly GD. This variation in the IL-4 gene may provide further clues to the pathogenesis of autoimmune thyroid disease and other organ-specific autoimmune diseases. Furthermore, these results suggest that subtle variation in immunoregulatory genes may be associated with autoimmune disease states.

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