Purpose
Thiopurine S-methyltransferase (TPMT) is an enzyme that metabolizes purine analogs, agents used in the treatment of acute lymphoblastic leukemia. Improper drug metabolism leads to toxicity in chemotherapy patients and reduces treatment effectiveness.
TPMT
variants associated with reduced enzymatic activity vary across populations. Therefore, studying these variants in heterogeneous populations, such as Ecuadorians, can help identify molecular causes of deficiency for this enzyme.
Methods
We sequenced the entire
TPMT
coding region in 550 Ecuadorian individuals from Afro-Ecuadorian, Indigenous, Mestizo, and Montubio ethnicities. Moreover, we conducted an ancestry analysis using 46 informative ancestry markers.
Results
We identified 8 single nucleotide variants in the coding region of
TPMT
. The most prevalent alleles were
TPMT*3A, TPMT*3B
, and
TPMT*3C
, with frequencies of 0.055, 0.012, and 0.015, respectively. Additionally, we found rare alleles
TPMT*4
and
TPMT*8
with frequencies of 0.005 and 0.003. Correlating the ancestry proportions with
TPMT
-deficient genotypes, we observed that the Native American ancestry proportion influenced the distribution of the
TPMT*1/TPMT*3A
genotype (OR = 5.977, p = 0.002), while the contribution of African ancestral populations was associated with the
TPMT*1/TPMT*3C
genotype (OR = 9.769, p = 0.003). The rates of TPMT-deficient genotypes observed in Mestizo (
f
= 0.121) and Indigenous (
f
= 0.273) groups provide evidence for the influence of Native American ancestry and the prevalence of the
TPMT*3A
allele. In contrast, although Afro-Ecuadorian groups demonstrate similar deficiency rates (
f
= 0.160), the genetic factors involved are associated with contributions from African ancestral populations, specifically the prevalent
TPMT*3C
allele.
Conclusion
The distribution of TPMT-deficient variants offers valuable insights into the populations under study, underscoring the necessity for genetic screening strategies to prevent thiopurine toxicity events among Latin American minority groups.