Human genetic and metabolite variation reveals that methylthioadenosine is a prognostic biomarker and an inflammatory regulator in sepsis.

Journal Article (Clinical Trial;Journal Article;Multicenter Study)

Sepsis is a deleterious inflammatory response to infection with high mortality. Reliable sepsis biomarkers could improve diagnosis, prognosis, and treatment. Integration of human genetics, patient metabolite and cytokine measurements, and testing in a mouse model demonstrate that the methionine salvage pathway is a regulator of sepsis that can accurately predict prognosis in patients. Pathway-based genome-wide association analysis of nontyphoidal Salmonella bacteremia showed a strong enrichment for single-nucleotide polymorphisms near the components of the methionine salvage pathway. Measurement of the pathway's substrate, methylthioadenosine (MTA), in two cohorts of sepsis patients demonstrated increased plasma MTA in nonsurvivors. Plasma MTA was correlated with levels of inflammatory cytokines, indicating that elevated MTA marks a subset of patients with excessive inflammation. A machine-learning model combining MTA and other variables yielded approximately 80% accuracy (area under the curve) in predicting death. Furthermore, mice infected with Salmonella had prolonged survival when MTA was administered before infection, suggesting that manipulating MTA levels could regulate the severity of the inflammatory response. Our results demonstrate how combining genetic data, biomolecule measurements, and animal models can shape our understanding of disease and lead to new biomarkers for patient stratification and potential therapeutic targeting.

Full Text

Duke Authors

Cited Authors

  • Wang, L; Ko, ER; Gilchrist, JJ; Pittman, KJ; Rautanen, A; Pirinen, M; Thompson, JW; Dubois, LG; Langley, RJ; Jaslow, SL; Salinas, RE; Rouse, DC; Moseley, MA; Mwarumba, S; Njuguna, P; Mturi, N; Wellcome Trust Case Control Consortium 2, ; Kenyan Bacteraemia Study Group, ; Williams, TN; Scott, JAG; Hill, AVS; Woods, CW; Ginsburg, GS; Tsalik, EL; Ko, DC

Published Date

  • March 2017

Published In

Volume / Issue

  • 3 / 3

Start / End Page

  • e1602096 -

PubMed ID

  • 28345042

Pubmed Central ID

  • PMC5342653

Electronic International Standard Serial Number (EISSN)

  • 2375-2548

Digital Object Identifier (DOI)

  • 10.1126/sciadv.1602096


  • eng

Conference Location

  • United States