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However, its use is limited by serious adverse events, including acute pancreatitis. Prior studies have found an association between the <jats:italic>HLA<\/jats:italic> region and thiopurine\u2010induced acute pancreatitis (TIAP); however, in clinical practice, many patients with pancreatitis do not meet this strict criterion. We aimed to identify additional genes associated with azathioprine\u2010related pancreatitis using genome\u2010wide and transcriptome\u2010wide association studies (GWAS and TWAS) by broadening the definition of pancreatitis. We conducted a retrospective study of azathioprine users with inflammatory conditions. We used electronic health records linked to genomic data from BioVU (Vanderbilt's biobank) and replicated the results using NIH's <jats:italic>All of Us<\/jats:italic>. The primary outcome was acute pancreatitis, and the secondary outcome was pancreatic injury. Sixteen patients with pancreatitis and 2085 control subjects were included from BioVU; the <jats:italic>All of Us<\/jats:italic> cohort included &lt;\u200920 patients with pancreatitis and 847 control subjects. The GWAS analysis (adjusted for 10 principal components of genetic ancestry, sex, age, and azathioprine indication) in the BioVU cohort found an association between pancreatic injury and rs2948386 in <jats:italic>RAB19<\/jats:italic> (OR\u2009=\u20093.47, <jats:italic>P<\/jats:italic>\u2009=\u20091.46E<jats:sup>\u22128<\/jats:sup>), which was replicated in <jats:italic>All of Us<\/jats:italic> (OR\u2009=\u20092.70, <jats:italic>P<\/jats:italic>\u2009=\u20094.18E<jats:sup>\u22123<\/jats:sup>). We also conducted a TWAS adjusting for the same factors above and found a significant association between genetically predicted pancreatic expression of <jats:italic>SERPINB9P1<\/jats:italic> with pancreatic injury (BioVU: effect size\u2009=\u20090.42, <jats:italic>P<\/jats:italic>\u2009=\u20091.48E\u20105; <jats:italic>All of Us<\/jats:italic>: effect size\u2009=\u20090.48, <jats:italic>P<\/jats:italic>\u2010value\u2009=\u20090.01). In summary, we identified two new genetic associations for azathioprine\u2010related pancreatic injury: the predicted expression of <jats:italic>SERPINB9P1<\/jats:italic> and a SNP in <jats:italic>RAB19<\/jats:italic>.<\/jats:p>","DOI":"10.1002\/cpt.70003","type":"journal-article","created":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T13:31:13Z","timestamp":1753277473000},"page":"946-953","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<i>RAB19<\/i>, <i>SERPINB9P1<\/i>, and Pancreatitis in Patients Taking Azathioprine in Routine Clinical Practice: Genome and Transcriptome\u2010Wide Association Studies"],"prefix":"10.1002","volume":"118","author":[{"given":"Shailja C.","family":"Shah","sequence":"first","affiliation":[{"name":"Division of Gastroenterology University of California  San Diego California USA"},{"name":"VA San Diego Healthcare System  San Diego California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tyler S.","family":"Reese","sequence":"additional","affiliation":[{"name":"Department of Medicine Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3143-5915","authenticated-orcid":false,"given":"Laura L.","family":"Daniel","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Miami  Miami Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacy","family":"Zanussi","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Miami  Miami Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3404-3802","authenticated-orcid":false,"given":"Alyson L.","family":"Dickson","sequence":"additional","affiliation":[{"name":"Department of Medicine Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Puran","family":"Nepal","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Miami  Miami Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1106-2923","authenticated-orcid":false,"given":"Ran","family":"Tao","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tyne","family":"Miller\u2010Fleming","sequence":"additional","affiliation":[{"name":"Department of Medicine Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9693-8207","authenticated-orcid":false,"given":"Peter","family":"Straub","sequence":"additional","affiliation":[{"name":"Department of Medicine Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9020-3826","authenticated-orcid":false,"given":"Jennifer","family":"Maizel","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Miami  Miami Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adriana M.","family":"Hung","sequence":"additional","affiliation":[{"name":"Department of Medicine Vanderbilt University Medical Center  Nashville Tennessee USA"},{"name":"VA Tennessee Valley Healthcare System  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei\u2010Qi","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth J.","family":"Phillips","sequence":"additional","affiliation":[{"name":"Department of Medicine Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy J.","family":"Cox","sequence":"additional","affiliation":[{"name":"Department of Medicine Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. 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