Interleukin-18 as a drug repositioning opportunity for inflammatory bowel disease: A Mendelian randomization study

Lauren E Mokry, Sirui Zhou, Cong Guo, Robert A Scott, Luke Devey, Claudia Langenberg, Nick Wareham, Dawn M Waterworth, Lon Cardon, Phillipe Sanseau, George Davey Smith, Brent Richards

Research output: Contribution to journalArticle (Academic Journal)peer-review

25 Citations (Scopus)
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Support from human genetics increases the probability of success in drug development. However, few examples exist of successful genomically-driven drug repositioning. Given that a Mendelian form of severe enterocolitis is due to up-regulation of the interleukin-18 (IL18) signaling pathway, and pharmacologic inhibition of IL18 has been shown to reverse this enterocolitis, we undertook a Mendelian randomization study to test the causal effect of elevated IL18 levels on inflammatory bowel disease susceptibility (IBD) in 12,882 cases and 21,770 controls. Mendelian randomization is an established method to assess the role of biomarkers in disease etiology in a manner that minimizes confounding and prevents reverse causation. Using three SNPs that explained almost 7% of the variance in IL18 level, we found that each genetically predicted standard deviation increase in IL18 was associated with an increase in IBD susceptibility (odds ratio = 1.22, 95% CI = 1.11–1.34, P-value = 6 × 10−5). This association was further validated in 25,042 IBD cases and 34,915 controls (odds ratio = 1.13, 95% CI = 1.05–1.20). Recently, an anti-IL18 monoclonal antibody, which decreased free IL18 levels, was found to be safe, yet ineffective in a phase II trial for type 2 diabetes. Taken together, these genomic findings implicated IBD as an alternative indication for anti-IL18 therapy, which should be tested in randomized controlled trials.
Original languageEnglish
Article number9386 (2019)
Number of pages7
JournalScientific Reports
Issue number1
Publication statusPublished - 28 Jun 2019


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