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Association of methylenetetrahytrofolate reductase (MTHFR) C677T and A1298C polymorphisms with the susceptibility of childhood acute lymphoblastic leukaemia (ALL) in Chinese population
© Li et al.; licensee BioMed Central Ltd. 2014
Received: 10 August 2013
Accepted: 13 January 2014
Published: 29 January 2014
The aim of this study was to investigate the relationship between the polymorphisms of the methylenetetrahytrofolate reductase (MTHFR) gene and susceptibility to childhood acute lymphoblastic leukemia (ALL).
A case–control study was conducted among 98 children with ALL and 93 age- and sex- matched non-ALL controls. Genotyping of MTHFR C677T and A1298C polymorphisms was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The odds ratios (ORs) of MTHFR genotypes were used to assess the associations of these polymorphisms with childhood ALL susceptibility.
No significant differences were observed for frequencies of the 677CC, 677CT and 677TT genotypes between patients and controls. Frequencies of the 1298AA, 1298 AC and 1298CC genotypes between the two groups were significantly different. The risk of ALL with the 1298C allele carriers (AC + CC) was elevated by 1.1 times compared with the AA genotype [OR = 2.100; 95% CI (1.149; 3.837); P = 0.015].
The MTHFR A1298C polymorphism is associated with susceptibility to childhood ALL in the Chinese population.
Acute lymphoblastic leukemia (ALL) is a malignant disorder of lymphoid progenitor cells with a peak prevalence at the ages 2–5 years old  and accounts for one third of all childhood malignancies [2, 3]. Although the rapid progress in the clinical diagnosis and effective treatment of childhood ALL has led to a cure rate of more than 80% in children , the precise pathogenesis of ALL is not clearly known. With the development of genetic pharmacology, people have gradually realized that individual differences in disease are mainly due to genetic polymorphisms, especially single nucleotide polymorphisms (SNPs) . SNPs, a type of polymorphism involving variation of a single base pair, may directly affect the structure or expression of the protein. Therefore, the characterization and detection of the SNP distribution differences in different populations will help to identify human susceptibility genes related to some diseases.
Polymorphisms of the methylenetetrahydrofolate reductase (MTHFR) gene were shown to be associated with leukemogenesis . MTHFR is a folate metabolic enzyme, catalyzing the reduction of 5,10-methylenetetrahydrofolate to 5-methyltetrahydrofolate [7, 8]. Two common SNPs of the MTHFR gene, C677T and A1298C, have been identified. MTHFR C677T converts alanine into valine at codon 222, and A1298C converts glutamic acid into alanine at codon 429. Changes in these two loci can lead to decrease of enzyme activity and plasma folate level, as well as homocysteine level elevation . Associations of the polymorphisms with a number of cancers, including prostate cancer, colorectal cancer, renal carcinoma and bladder cancer, have also been proposed [8, 10]. Recently, the relativity between MTHFR polymorphisms and susceptibility to childhood ALL has come under intense scrutiny [2, 6, 11–16]. Because the MTHFR gene distribution varies among different populations [3, 6], although relationships of MTHFR polymorphisms and leukemia in different populations have been reported [2, 6, 11–19], whether C677T and A1298C gene polymorphisms are involved in the susceptibility to childhood leukemia remains largely controversial.
In the present study, we used the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique to investigate whether MTHFR polymorphisms and their allele frequency may be correlated to susceptibility to childhood ALL among the Chinese population.
From October 2007 to April 2011, a total of 98 children (54 boys, 44 girls) with ALL were diagnosed by bone marrow cytology in Nanjing Children’s Hospital, Nanjing, China. Patient ages ranged from 0.9 to 11 years old (mean, 5.1 years old). Meanwhile, a total of 93 controls (1.2-13 years old; mean, 5.7 years old) hospitalized during the same period were recruited from clinical departments other than hematology or oncology of Nanjing Children’s Hospital. The controls had no blood disease or family history of ALL assessed by medical history and clinical examination. There was no significant difference between the two groups in gender and age distribution (P > 0.05). All individuals and/or their parents provided informed consent to participate in this study, and the protocol was approved by the medical research ethics committee of Nanjing Children’s Hospital.
Genotyping of MTHFR variants
Characteristics of PCR primers sequence, target fragment length and annealing temperature used for genotyping MTHFR polymorphisms
Primers sequence (5′ → 3′)
Restriction endonuclease mapping analysis
MTHFR C677T: the PCR products were digested by HinfI (TaKaRa, Dalian, China) after overnight incubation at 37°C. The final products were subjected to electrophoresis on 2% agarose, and the genotypes were determined by examining the stained gel in 0.2% ethidium bromide. A fragment of 387 bp indicated a CC wild genotype; 3 fragments of 387, 235 and 152 bp were indicators of a CT heterozygote; a TT homozygous mutant produced two fragments of 235 bp and 152 bp, respectively.
MTHFR A1298C: PCR products were digested with MboII (TaKaRa, Dalian, China). The final products were subjected to electrophoresis on 2% agarose, and the genotypes were determined by examining the stained gel in 0.2% ethidium bromide. The AA wild genotype produced five fragments of 56, 31, 30, 28 and 18 bp, respectively; the AC heterozygote produced six of fragments 84, 56, 31, 30, 28 and 18 bp, respectively; the CC homozygous mutant produced four fragments of 84, 31, 30 and 18 bp, respectively. GENESCAN™672 software (Applied Biosystems, Foster City, CA, USA) was used for collecting information from every band, and GeneMapper software (Applied Biosystems, Foster City, CA, USA) was used to analyze the data.
Data were input into Epidata3.0 to establish a database. Statistical analysis was performed by SPSS16.0 (SPSS Inc., Chicago, IL, USA). Hardy-Weinberg equilibrium was assessed by the χ2 goodness of fit test. Genotype and allele frequencies were expressed by percentile, and the haplotype and linkage disequilibrium were estimated by SHEsis software (Bio-X Life Science Research Center of Shanghai Jiao Tong University, Shanghai, China). The χ2 test was used to examine differences in MTHFR genotypes and allele frequencies between cases and controls. The odds ratio (OR) and 95% confidence interval (CI) were used for correlation analysis of ALL morbidity, and the MTHFR genotype. P < 0.05 was considered statistically significant.
Hardy-Weinberg equilibrium test
Compositions of the MTHFR C677T genotype and MTHFR A1298C genotype in the Hardy-Weinberg equilibrium test
MTHFR C677T genotype
MTHFR A1298C genotype
MTHFR C677T genotype and allele frequency distribution
Frequencies of MTHFR C677T polymorphisms in childhood ALL patients and controls
Patient no. (%)
Control no. (%)
0.930 (0.481 - 1.799)
1.795 (0.790 - 4.079)
CT + TT
1.133 (0.609 - 2.106)
1.300 (0.868 - 1.947)
MTHFR A1298C genotype and allele frequency distribution
Frequencies of MTHFR A1298C polymorphisms in childhood ALL patients and controls
Patient no. (%)
Control no. (%)
2.084 (1.131 - 3.841)
2.481 (0.219 - 28.104)
AC + CC
2.100 (1.149 - 3.837)
1.806 (1.068 - 3.053)
In recent years, many articles have reported on the MTHFR polymorphism and susceptibility to ALL, but they are soundly inconclusive. In this study, by investigating the distribution of MTHFR C677T and A1298C genotypes and their allele frequencies in ALL children and non-ALL controls, we found that MTHFR A1298C was significantly related to the susceptibility to childhood ALL.
In 1999, Skibola et al.  first reported that the MTHFR C677T mutation could reduce the susceptibility to adult ALL, and their results suggested that the risk of ALL was reduced by 4.3 times for people carrying the TT genotype. Subsequently, Franco et al.  had similar findings that the C677T mutation can reduce the risk of childhood ALL. Later, multiple documents reported a protective effect of the TT genotype on the pathogenesis of ALL [3,6,11,12,]. However, the association is mostly not statistically significant [3, 13], and some studies even suggested that the C677T mutation is an ALL risk factor . A meta-analysis including 13 studies with a total of 4,894 individuals indicated that the C677T mutation was not associated with childhood ALL . In this study, we also report a statistically non-significant difference of genotype frequencies among cases and controls, indicating that the MTHFR C677T gene polymorphism has no relation to the risk of childhood ALL. This result is in accordance with the results of Atashrazm et al.  and Oliveira et al. .
The MTHFR A1298C polymorphism was associated with an elevated risk of childhood ALL . Alcasabas et al.  found that the ALL risk of MTHFR 1298C carriers (AC + CC type) was 1.57 times higher than that of the AA genotype carriers. Kim et al. [24, 25] had similar findings. Other studies in Germany , the UK , north Indian  and Kurdish  showed no associations between the MTHFR A1298C polymorphism and risk of ALL. In our study, the risk of ALL in MTHFR 1298 AC genotype carriers was 2.084-fold that of the 1298AA genotype carriers (OR = 2.084, 95% CI: 1.131 - 3.841, P = 0.018), and the OR of the MTHFR A1298C genotype for AC + CC between patients and controls was 2.100 (95% CI, 1.149 - 3.837; P = 0.015). This indicates that A1298C is a risk factor for childhood ALL in the Chinese population, which is in accordance with the results of previous studies [6, 7, 24, 26].
These data indicate that the MTHFR A1298C but not the C677T polymorphism is a potential biomarker for childhood ALL risk in the Chinese population, which is inconsistent with the results of Yan et al.  and Tong et al. . We speculated that the inconsistent results in the relationship between MTHFR gene polymorphisms and childhood ALL in different studies might result from the following reasons: first, MTHFR gene distribution varied among different populations ; second, MTHFR polymorphisms may be affected by the level of intracellular folate, which is related to eating habits and nutritional intake; third, single SNPs provide insufficient information for comprehensive analysis of the MTHFR polymorphism; besides, other genes may regulate the susceptibility to childhood ALL, such as RFC1 80G > A and NNMT IVS -151C > T variants . Eventually, linkage of haplotypes in the two loci would help to identify genetic markers associated with drug response differences.
The level of MTHFR 1298CC homozygous mutation is relatively low. In the present study, there were only two cases with CC genotypes among 98 patients. The previous studies found that the 1298CC homozygous mutation rate was only about 10% [3, 12, 18, 20]. Thus, we speculated that the lower number of CC cases in this study was caused by the low total number of cases in this study (98 patients and 93 controls), which may induce a high occasionality. Therefore, we combined the genotypes of AC and CC to calculate the distribution of MTHFR A1298C to improve the reliability of our findings.
It is important to note that the small sample size is a major limitation in our study because only 98 cases and 93 controls were included. However, our study is still significant for providing valid data on MTHFR C677T and A1298C genotypes for further study of MTHFR polymorphisms and childhood ALL in the Chinese population. In addition, more case–control studies with larger sample sizes and more genotypes of different ethnic pediatric populations are necessary.
In conclusion, we investigated the relationship between the polymorphism of MTHFR C677T and A1298C mutation and the susceptibility to childhood ALL by PCR-RFLP in 98 children with ALL and 93 non-ALL controls. The results indicated that the MTHFR A1298C polymorphism, not C677T, is associated with susceptibility to childhood ALL in the Chinese population. However, in the future, it will be necessary to expand the sample size and consider additional factors for exploring the relationship between the MTHFR polymorphism and the incidence of ALL to provide more accurate information for clinical research.
- Pui C-H, Robison LL, Look AT: Acute lymphoblastic leukaemia. The Lancet 2008, 371: 1030–1043. 10.1016/S0140-6736(08)60457-2View ArticleGoogle Scholar
- Lightfoot TJ, Johnston WT, Painter D, Simpson J, Roman E, Skibola CF, Smith MT, Allan JM, Taylor GM: Genetic variation in the folate metabolic pathway and risk of childhood leukemia. Blood 2010, 115: 3923–3929. 10.1182/blood-2009-10-249722PubMedPubMed CentralView ArticleGoogle Scholar
- Atashrazm F, Zaker F, Aghaeipour M, Pazhakh V: Polymorphisms of the methylene tetrahydrofolate reductase and susceptibility to acute lymphoblastic leukemia in children. Lab Med 2011, 42: 275–279. 10.1309/LM7BFTEZ98ZZMWPQView ArticleGoogle Scholar
- Conter V, Bartram CR, Valsecchi MG, Schrauder A, Panzer-Grümayer R, Möricke A, Aricò M, Zimmermann M, Mann G, De Rossi G: Molecular response to treatment redefines all prognostic factors in children and adolescents with B-cell precursor acute lymphoblastic leukemia: results in 3184 patients of the AIEOP-BFM ALL 2000 study. Blood 2010, 115: 3206–3214. 10.1182/blood-2009-10-248146PubMedView ArticleGoogle Scholar
- Nicoloso MS, Sun H, Spizzo R, Kim H, Wickramasinghe P, Shimizu M, Wojcik SE, Ferdin J, Kunej T, Xiao L: Single-nucleotide polymorphisms inside microRNA target sites influence tumor susceptibility. Cancer Res 2010, 70: 2789–2798. 10.1158/0008-5472.CAN-09-3541PubMedPubMed CentralView ArticleGoogle Scholar
- Zanrosso CW, Hatagima A, Emerenciano M, Ramos F, Figueiredo A, Félix TM, Segal SL, Giugliani R, Muniz MTC, Pombo-de-Oliveira MS: The role of methylenetetrahydrofolate reductase in acute lymphoblastic leukemia in a Brazilian mixed population. Leuk Res 2006, 30: 477–481. 10.1016/j.leukres.2005.08.008PubMedView ArticleGoogle Scholar
- Alcasabas P, Ravindranath Y, Goyette G, Haller A, del Rosario L, Lesaca‒Medina MY, Darga L, Ostrea EM, Taub JW, Everson RB: 5, 10‒methylenetetrahydrofolate reductase (MTHFR) polymorphisms and the risk of acute lymphoblastic leukemia (ALL) in Filipino children. Pediatr Blood Cancer 2008, 51: 178–182. 10.1002/pbc.21511PubMedView ArticleGoogle Scholar
- Castro R, Rivera I, Ravasco P, Camilo M, Jakobs C, Blom H, De Almeida I: 5, 10-methylenetetrahydrofolate reductase (MTHFR) 677C → T and 1298A → C mutations are associated with DNA hypomethylation. J Med Genet 2004, 41: 454–458. 10.1136/jmg.2003.017244PubMedPubMed CentralView ArticleGoogle Scholar
- Ogino S, Wilson RB: Genotype and haplotype distributions of MTHFR 677C > T and 1298A > C single nucleotide polymorphisms: a meta-analysis. J Hum Genet 2003, 48: 0001–0007. 10.1007/s100380300000View ArticleGoogle Scholar
- Heijmans BT, Boer JM, Suchiman HE, Cornelisse CJ, Westendorp RG, Kromhout D, Feskens EJ, Slagboom PE: A common variant of the methylenetetrahydrofolate reductase gene (1p36) is associated with an increased risk of cancer. Cancer Res 2003, 63: 1249–1253.PubMedGoogle Scholar
- Chatzidakis K, Goulas A, Athanassiadou-Piperopoulou F, Fidani L, Koliouskas D, Mirtsou V: Methylenetetrahydrofolate reductase C677T polymorphism: Association with risk for childhood acute lymphoblastic leukemia and response during the initial phase of chemotherapy in greek patients. Pediatr Blood Cancer 2006, 47: 147–151. 10.1002/pbc.20574PubMedView ArticleGoogle Scholar
- de Jonge R, Tissing WJ, Hooijberg JH, Jansen G, Kaspers GJ, Lindemans J, Peters GJ, Pieters R: Polymorphisms in folate-related genes and risk of pediatric acute lymphoblastic leukemia. Blood 2009, 113: 2284–2289. 10.1182/blood-2008-07-165928PubMedView ArticleGoogle Scholar
- Oliveira E, Alves S, Quental S, Ferreira F, Norton L, Costa V, Amorim A, Prata MJ: The MTHFR C677T and A1298C polymorphisms and susceptibility to childhood acute lymphoblastic leukemia in Portugal. J Pediatr Hematol Oncol 2005, 27: 425–429. 10.1097/01.mph.0000177513.81465.94PubMedView ArticleGoogle Scholar
- Krajinovic M, Lamothe S, Labuda D, Lemieux-Blanchard E, Theoret Y, Moghrabi A, Sinnett D: Role of MTHFR genetic polymorphisms in the susceptibility to childhood acute lymphoblastic leukemia. Blood 2004, 103: 252–257. 10.1182/blood-2003-06-1794PubMedView ArticleGoogle Scholar
- Reddy H, Jamil K: Polymorphisms in the MTHFR gene and their possible association with susceptibility to childhood acute lymphocytic leukemia in an Indian population. Leuk Lymphoma 2006, 47: 1333–1339. 10.1080/10428190600562773PubMedView ArticleGoogle Scholar
- Chiusolo P, Reddiconto G, Cimino G, Sica S, Fiorini A, Farina G, Vitale A, Sorà F, Laurenti L, Bartolozzi F: Methylenetetrahydrofolate reductase genotypes do not play a role in acute lymphoblastic leukemia pathogenesis in the Italian population. Haematol 2004, 89: 139–144.Google Scholar
- Schnakenberg E, Mehles A, Cario G, Rehe K, Seidemann K, Schlegelberger B, Elsner HA, Welte KH, Schrappe M, Stanulla M: Polymorphisms of methylenetetrahydrofolate reductase (MTHFR) and susceptibility to pediatric acute lymphoblastic leukemia in a German study population. BMC Med Genet 2005, 6: 23.PubMedPubMed CentralView ArticleGoogle Scholar
- Nikbakht M, MalekZadeh K, Kumar Jha A, Askari M, Marwaha R, Kaul D, Kaur J: Polymorphisms of MTHFR and MTR genes are not related to susceptibility to childhood ALL in North India. Exp Oncol 2012, 34: 43–48.PubMedGoogle Scholar
- Azhar MR, Rahimi Z, Vaisi-Raygani A, Akramipour R, Madani H, Parsian A: Lack of association between MTHFR C677T and A1298C polymorphisms and risk of childhood acute lymphoblastic leukemia in the Kurdish population from Western Iran. Genet Test Mol Biomarkers 2012, 16: 198–202. 10.1089/gtmb.2011.0041PubMedView ArticleGoogle Scholar
- Skibola CF, Smith MT, Kane E, Roman E, Rollinson S, Cartwright RA, Morgan G: Polymorphisms in the methylenetetrahydrofolate reductase gene are associated with susceptibility to acute leukemia in adults. Proc Natl Acad Sci 1999, 96: 12810–12815. 10.1073/pnas.96.22.12810PubMedPubMed CentralView ArticleGoogle Scholar
- Franco RF, Simões BP, Tone LG, Gabellini SM, Zago MA, Falcão RP: The methylenetetrahydrofolate reductase C677T gene polymorphism decreases the risk of childhood acute lymphocytic leukaemia. Br J Haematol 2001, 115: 616–618. 10.1046/j.1365-2141.2001.03140.xPubMedView ArticleGoogle Scholar
- Aplenc R, Thompson J, Han P, La M, Zhao H, Lange B, Rebbeck T: Methylenetetrahydrofolate reductase polymorphisms and therapy response in pediatric acute lymphoblastic leukemia. Cancer Res 2005, 65: 2482–2487. 10.1158/0008-5472.CAN-04-2606PubMedView ArticleGoogle Scholar
- Pereira TV, Rudnicki M, Pereira AC, Pombo-de-Oliveira MS, Franco RF: 5, 10-Methylenetetrahydrofolate reductase polymorphisms and acute lymphoblastic leukemia risk: a meta-analysis. Cancer Epidemiol Biomarkers Prev 2006, 15: 1956–1963. 10.1158/1055-9965.EPI-06-0334PubMedView ArticleGoogle Scholar
- Kim NK, Chong SY, Jang MJ, Hong SH, Kim HS, Cho EK, Lee JA, Ahn MJ, Kim CS, Oh D: Association of the methylenetetrahydrofolate reductase polymorphism in Korean patients with childhood acute lymphoblastic leukemia. Anticancer Res 2006, 26: 2879–2881.PubMedGoogle Scholar
- Yan J, Yin M, Dreyer ZE, Scheurer ME, Kamdar K, Wei Q, Okcu MF: A meta-analysis of MTHFR C677T and A1298C polymorphisms and risk of acute lymphoblastic leukemia in children. Pediatr Blood Cancer 2012, 58: 513–518. 10.1002/pbc.23137PubMedView ArticleGoogle Scholar
- Kim YI: Methylenetetrahydrofolate reductase polymorphisms, folate, and cancer risk: a paradigm of gene‒nutrient interactions in carcinogenesis. Nutr Rev 2000, 58: 205–209.PubMedView ArticleGoogle Scholar
- Tong N, Fang Y, Li J, Wang M, Lu Q, Wang S, Tian Y, Rong L, Sun J, Xu J: Methylenetetrahydrofolate reductase polymorphisms, serum methylenetetrahydrofolate reductase levels, and risk of childhood acute lymphoblastic leukemia in a Chinese population. Cancer Sci 2010, 101: 782–786. 10.1111/j.1349-7006.2009.01429.xPubMedView ArticleGoogle Scholar
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