A severe, chronic and irreversible kidney disease affecting discrete rural populations in the Balkan Peninsula countries, Balkan endemic nephropathy (BEN) has been a scientific puzzle for more than half a century. Many environmental and other factors have been suggested as the primary cause and recent significant findings have linked BEN to aristolochic acids, phytotoxins derived from the plant Aristolochia clematitis, found in high density in the endemic areas. However, given that the incidence of BEN is less than 10% in affected villages, and it tends to have a family aggregation, as yet unidentified genetic factors may also play a role. To further explore this possibility, a pilot study was initiated to investigate the DNA methylation of CYP1A1, CYP1A2, NAT1, NQO1 and GSTT1 in blood samples from a group of Romanian BEN patients, compared to healthy controls and non-BEN chronic kidney disease (CKD) subjects. Our study revealed a more pronounced hypomethylation pattern in BEN and non-BEN CKD groups, compared to the healthy control group at specific CpGs across all five genes interrogated. Average methylation across the five regions investigated indicated significant differences only at GSTT1, in both BEN patients (p = 0.028) and non-BEN disease subjects (p = 0.015), relative to healthy individuals. Since GSTT1 active genotype appears to be a common feature of Serbian and Romanian BEN patients, GSTT1 epigenetic variation and increased gene activity could act as a predisposing (co)factor in BEN populations from the affected countries. BEN and non-BEN CKD groups show similar methylation patterns with exception of GSTT1 CpG8 (p = 0.046).
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This work was supported by a grant of the Romanian National Authority for Scientific Research and Innovation, CNCS-UEFISCDI, Project Number II-RU-TE-2014-4-0151.
Conflict of interest
Alexandra Ivan, Dilys Lam, Mirabela Iustina Cristea, Ada Telea, Alexandra Teodora Gruia, Camelia Oprean, Florin Margineanu, Florina Maria Bojin, Richard Saffery, Virgil Paunescu, and Calin Adrian Tatu declare that they have no competing interests.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethical Committee for scientific research approval of the County Hospital “Pius Branzeu’ Timisoara, Romania and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Ivan, A., Lam, D., Cristea, M.I. et al. Differential methylation pattern of xenobiotic metabolizing genes and susceptibility to Balkan endemic nephropathy, in a cohort of Romanian patients. J Nephrol 33, 91–100 (2020). https://doi.org/10.1007/s40620-019-00621-2
- Balkan endemic nephropathy
- Aristolochic acid
- Gene methylation
- Xenobiotic metabolism