Association Between NR3C1 Gene Polymorphisms and Toxicity Induced by Glucocorticoids Therapy in Saudi Children with Acute Lymphoblastic Leukemia

Document Type : Research Articles


1 Medical laboratory Technology Department, Faculty of Applied medical Science, King Abdulaziz University, Jeddah, Saudi Arabi.

2 Zoology Department, Faculty of Science, Mansoura University, Mansoura, Egypt.

3 Clinical Pharmacology Department, Faculty of Medicine, Seuz Canal University. Ismailia, Egypt.


Background: Glucocorticoids (GCs) are key hormones used for the treatment of acute lymphoblastic leukemia
(ALL) in children, but their cytotoxic effects are not well defined. The aim of this study was to evaluate the association
between polymorphisms in NR3C1 encoding for protein involved in the GCs metabolism and its role in the development
of ALL and the toxicity outcome, in terms of liver toxicity, glucose abnormality and infections, in ALL Saudi children.
Methods: The following polymorphisms BCII rs41423247, ER22/23 EK rs6189 and rs6190 and N363S rs6195 in
NR3C1 were analyzed in 70 children with ALL treated according to the ALL 2000 study protocol in comparison to
60 control subjects. Treatment toxicities and their association with genotypes were evaluated according to Common
Toxicity Criteria (NCI-CTC). Results: This study demonstrated that the NR3C1 did not contribute to the development
of childhood ALL. Homozygous ER22/23EK polymorphism was not found in both ALL patients and in control group
whereas the heterozygous polymorphism was only observed in the control group (6.66%). The toxicology data in
this study showed a significant difference between ALL patients carrying N363S polymorphism and wild type (40%
and 6.51% respectively, P= 0.009) and a high-risk factor in the toxicity of glucose abnormality (OR=10.167; 1.302-
79.339).BCII shows increased risk factors towards the liver toxicity (OR=2.667; 0.526-7.330) as well as the glucose
abnormality (OR=7.5; 1.039-54.116). Conclusion: This study suggested that the polymorphisms in NR3C1 were not
associated with the development of ALL in children. N363S polymorphism was sensitive to glucocorticoids and it may
contribute to the glucose abnormality for these patients.


Main Subjects