Genetics of HLA-associated disease; rheumatoid arthritis

An association between rheumatoid arthritis (RA) and the HLA antigen DR4 supports the view that genes in the HLA region are important in susceptibility to this disease. To further define the basis for genetic susceptibility to RA, we analyzed HLA haplotype sharing among affected and unaffected individuals in 29 multiple-case families with definite or classic RA. We have observed a non-random distribution of HLA haplotypes to unaffected as compared with affected offspring in sibships containing two or more affected individuals having 3 of 4 parental haplotypes. These data support the view that susceptibility to RA is determined, at least in part, by genes in the HLA region of chromosome 6.     

Gm allotypes in multiple sclerosis: influence susceptibility in HLA-DQwl-positive patients from the North-East of Scotland

From the Grampian region of Scotland, 198 patients with MS and 128 normal individuals were typed for allotypes of the Gm system which encode for the constant region of IgG heavy chains. No significant independent association between a given Gm allotype or phenotype and susceptibility to MS was observed for the group of patients from this region. This was also the case when patients were classified according to sex, clinical course, and disease progression. However, a significant association was found between the Gm phenotype, Gm (3;5, 10, 11, 13, 14), and HLA DQwl in patients with MS. The relative risk of developing MS for individuals who carried both Gm (3;5,10, 11,13,14) and HLA DQwl was nearly five times greater than for individuals with neither determinant. These findings suggest that in the presence of HLA DQwl, genes associated with the Gm (3;5,10,11,13,14) phenotype have an important contributory influence on susceptibility to MS. The additive effects of Gm and HLA on susceptibility to MS would be one possible reason for the lack of a complete association between MS and a single genetic locus.     

HLA and leprosy

Although there is now accumulating evidence that the host response to Mycobacterium leprae is genetically controlled, the nature of the genetic component is still imprecise. Case-control studies as well as family studies, in various populations, have shown that HLA linked factors confer susceptibility to tuberculoid leprosy and lepromatous leprosy respectively. Recently, associations between Gm allotypes and the disease have also been reported. Further studies of the familial cosegregation of the different forms of leprosy together with the HLA and Gm markers may permit a better understanding of the underlying genetic mechanisms.     

Interaction between HLA antigens and immunoglobulin (Gm) allotypes in susceptibility to type I diabetes

HLA-A,B,C and DR typing was performed on 108 Caucasian type I diabetic patients, 68 being Gm typed. The expected association with B8, B18, Bw62, DR3 and DR4 was observed as well as an excess of DR3/4 heterozygotes. DR2 was decreased in frequency. In the total patient group, no Gm association was observed but when the patients were subgrouped according to HLA type, HLA/Gm interactive effects were seen. An increase in Gm(1,3;5) was observed in DR3 positive, DR4 negative patients. This association occurred predominantly in females (compared with DR4 and DR3/4 patients of the same Gm phenotype who were predominantly male). Further genetic heterogeneity was identified within DR3/4 patients. Within this group, Bw62 was increased (strongly suggestive of Bw62-DR4 haplotypes) within B8, Gm heterozygotes compared with B8, Gm homozygotes. This finding can be interpreted as indicating a three-way interaction between genes on two HLA haplotypes and Gm-linked genes. These results reflect the genetic heterogeneity and complexity of insulin-dependent diabetes mellitus and explain in part the previous failure of simple genetic models to adequately explain inheritance patterns observed.     

IgG heavy chain allotype (Gm), a genetic marker for human chromosome 14q32, and haematopoietic malignancies.

IgG heavy chain constant region allotypes, Gm, the genetic marker of human chromosome 14q32, are markers for susceptibility to certain diseases. We tested Gm allotypes in 365 patients with various types of haematological malignancies, 528 healthy controls and 35 healthy HTLV carriers. The frequency of specific Gm phenotypes was significantly increased in patients with adult onset null-ALL, AML, AMoL and CML in blastic crisis. Among these diseases, the frequency of Gm1,2,21 haplotype was significantly increased with adult onset null-ALL, AML and AMoL.     

No interaction between HLA and immunoglobulin IgG heavy chain allotypes in early onset type 1 diabetes

Immunoglobulin heavy and light chain genes are often discussed as susceptibility genes for insulin dependent (type 1) diabetes mellitus (IDDM) in addition to HLA-DR3 and DR4. Accordingly we analysed 175 unrelated patients for an interaction between immunoglobulin allotype antigens (Gm) and HLA. While DR3 and DR4 antigens and DR3/DR4 heterozygotes occur significantly more often among diabetics than among normal controls, their Gm allotype frequencies are very similar. An interaction between special Gm allotypes and phenotypes, on the one side, and DR3, DR4 or DR3, 4 on the other side could not be demonstrated.     

HLA DQ alpha and DQ beta restriction fragment length polymorphisms associated with Felty's syndrome and DR4-positive rheumatoid arthritis

HLA DQ alpha and DQ beta cDNA probes were used to study TaqI generated restriction fragment length polymorphisms (RFLPs) in DR4-positive patients with Felty's syndrome (FS), seropositive rheumatoid arthritis (RA), and in HLA-DR4 positive controls. The results of this analysis revealed two DQ beta RFLP patterns (DQ beta 3a and DQ beta 3b) associated with DR4, of which DQ beta 3b was found at significantly higher frequency in patients with FS (73%) or with RA (52%) than in DR4 controls (29%). Hind III generated RFLPs provide evidence that DQ beta 3b is in strong linkage disequilibrium with the gene encoding the serologically recognized epitope TA10. Results obtained using a DQ alpha chain probe revealed polymorphic differences between DQ alpha chain genes associated with different DR types, thereby providing a possible explanation for the lack of association between RA and other DR haplotypes in linkage disequilibrium with TA10. We conclude that both DQ alpha and DQ beta genes may be important in determining HLA-linked susceptibility to severe forms of RA.     

The major histocompatibility complex and insulin dependent (type 1) diabetes

The majority of the genetic component in insulin dependent (Type 1) diabetes mellitus can be explained by associations with genes on short arm of chromosome 6 located in the major histocompatibility complex. With the advent of cloning of the HLA Class II region genes it has been possible to refine the previous known association of HLA-DR3 and DR4 with this disease. Strong associations of IDDM have now been shown to exist with the DQB1 gene and/or linked genes, although this does not completely explain the HLA susceptibility to this disease.     

The Major Histocompatibility Complex and Insulin Dependent (Type 1) Diabetes

The majority of the genetic component in insulin dependent (Type 1) diabetes mellitus can be explained by associations with genes on short arm of chromosome 6 located in the major histocompatibility complex. With the advent of cloning of the HLA Class II region genes it has been possible to refine the previous known association of HLA-DR3 and DR4 with this disease. Strong associations of IDDM have now been shown to exist with the DQB1 gene and/or linked genes, although this does not completely explain the HLA susceptibility to this disease.     

Paradoxical inheritance of HLA-Iinked susceptibility to rheumatoid arthritis

In order to clarify the discrepancy between population studies showing association of rheumatoid arthritis (RA) with HLA-DR4/Dw4 and family studies failing to show linkage with HLA, we analysed 16 multicase families in which RA and DR4 status of both parents was known. 120 HLA-haplotypes of affected and unaffected children could be analysed for co-segregation with RA. In a combined analysis of both affected and unaffected children co-segregation of RA with the DR4 carrying haplotype was observed when both parents were unaffected (p = 0.001). Co-Segregation of RA with one of the two haplotypes of affected parents was observed (p = 0.01), but in this case there was no preference for the DR4 carrying haplotype. In both cases preferential inheritance of the other (not associated with RA) haplotype was observed in unaffected siblings. These data indicate that susceptibility to RA is controlled by an HLA-linked gene. This gene is often but not always identical to the gene coding for a product carrying the DR4 epitope or in strong linkage disequilibrium with it. Combined with previous population data, the present data provide evidence for genetic heterogeneity of RA. Finally, they contain a paradox, based on which a new hypothesis for HLA-linked susceptibility to RA is formulated.     

Genetic basis for rheumatoid arthritis

Rheumatoid arthritis (RA) is a common disabling disorder of unknown etiology. In the past 2 decades, a number of studies have examined the genetic basis for RA. One major focus of these studies has been to identify genes within the MHC class II (HLA-DR) chromosomal region, which confer susceptibility/resistance to RA. A strong association between HLA-DR4 and adult seropositive RA has been observed in majority of populations. In addition, there is evidence of a positive association between HLA-DR1 and RA. On the basis of prevalence of DR1 (B1*0101) and of subtypes of DR4 (B1*0401, B1*0404 and B1*0405), it has been suggested that a five amino acid sequence motif (QKRAA/QRRAA) from position 70 to 74 in the third hypervariable region of DRbeta1 molecules is associated with susceptibility to RA. These associations between RA and HLA-DR genes are however incomplete in that about 1/4 of patients do not carry RA-susceptibility DRB1 epitope. Since MHC class III region contains genes that are involved in immune response, we have recently examined the role of a number of microsatellites (D6S273, Bat2, TNFa) and HSP70 promoter region alleles in susceptibility to RA. The results demonstrate that two regions in MHC, class II (DRbeta1) and class III (D6S273, HSP70, Bat2, TNFa) more completely define the risk for development of RA.     

Genetics of celiac disease

Celiac disease (CD) is a chronic inflammatory disease of the gut resulting from ingestion of gluten, occurring in genetically susceptible individuals. The strong genetic association of CD with the DQ2 and DQ8 HLA heterodimers has been known for long, but others non-HLA genes are involved. In order to identify susceptibility genes to CD, several studies have been performed, based on either linkage analyses or candidate gene approaches. This review describes these different studies and their results. The hypothesis of the implication of the DR53 heterodimer in the HLA region has been proposed. The existence of a susceptibility locus on chromosome 5q has been evidenced through linkage analysis and candidate gene strategies have revealed the role of CTLA-4 and of the immunoglobulin gamma genes in the disease.     

Interactive effect of HLA and Gm tested in a study of 135 juvenile insulin-dependent diabetic families

Interaction between HLA and Gm for susceptibility to insulin-dependent diabetes (IDD) has been studied in 135 IDD families comparing HLA and Gm phenotype distributions in patients and sibling controls. The association analysis comparing the 135 index cases to 124 sibling controls did not show any significant interaction, but only a tendency for Gm 4,5 phenotypes to be more frequent in IDD patients, particularly in those who carried DR3/X. The sib pair analysis of 16 pairs of affected sibs did not show any distortion of segregation of Gm. On the other hand, among 98 sib pairs of one affected and one nonaffected sib, there was a significant distortion in favour of sib pairs with non-identical Gm phenotypes. However, no interaction between HLA and Gm was found. These results provide suggestive evidence that Gm or a locus very close to Gm could be involved in susceptibility to IDD.     

Co-segregation of HLA and rheumatoid arthritis in multicase families

Inheritance of parental HLA haplotypes was examined in the offspring of 95 multicase rheumatoid arthritis (RA) families. Overall, in these families there was no evidence of preferential transmission of one parental haplotype, although this might have been expected given the loading of these families with RA cases. However, there was a difference in inheritance when the affected and non-affected offspring were compared. A co-segregation analysis showed that the inheritance of parental HLA haplotypes was different between the affected and the unaffected offspring. Unlike a previous report, no difference was demonstrated in this study between the offspring of affected and non-affected parents. Similarly, the affected offspring of HLA DR4 heterozygote parents were more likely to inherit HLA DR4 than the non-affected offspring. It is concluded first that linkage studies of RA using the affected sib-pair method are not invalidated, which would have been the case in the presence of preferential transmission of HLA to all offspring. Secondly, HLA and specifically HLA-DR4 does co-segregate with RA, and, finally, parental RA status, independent of DR4, has little influence in explaining the genetic susceptibility to RA.     

Susceptibility to human cutaneous leishmaniasis and HLA, Gm, Km markers

A relationship between markers related to the immune response (HLA system, Gm and Km immunoglobulin allotypes) and susceptibility to cutaneous leishmaniasis was investigated in a population of Hmong refugees who had recently settled in French Guiana. Two approaches were used: 1) case/control comparisons of the marker phenotype distribution to detect possible associations; 2) multiple-case family studies to search for marker-linked genes. When the distribution of HLA-A, B, C, antigens and Gm, Km allotypes was compared between patients and controls, only a significant decrease of HLA-Cw7 antigen among leishmaniasis patients was detected (p = 0.01). No interaction between any two of these markers and the disease was found. On the other hand, neither an HLA, Gm or Km susceptibility gene could be demonstrated in the informative sets of affected siblings. These results are discussed with respect to those reported in other infectious diseases.     

HLA DQα and DQβ restriction fragment length polymorphisms associated with Felty's syndrome and DR4-positive rheumatoid arthritis

HLA DQα and DQβ cDNA probes were used to study TaqI generated restriction fragment length polymorphisms (RFLPs) in DR4-positive patients with Fetly's syndrome (FS), seropositive rheumatoid arthritis (RA), and in HLA-DR4 positive controls. The results of this analysis revealed two DQβ RFLP patterns (DQβ3a and DQβ3b) associated with DR4, of which DQβ3b was found at significantly higher frequency in patients with FS (73%) or with RA (52%) than in DR4 controls (29%). Hind III generated RFLPs provide evidence that DQβ3b is in strong linkage disequilibrium with the gene encoding the serologically recognized epitope TA10. Results obtained using a DQα chain probe revealed polymorphic difference between DQα chain genes associated with different DR types, thereby providing a possible explanation for the lack of association between RA and other DR haplotypes in linkage disequilibrium with TA10. We conclude that both DQα and DQβ genes may be important in determining HLA-linked susceptibility to serve forms of RA.     

Rheumatoid arthritis--a gene transfer disease

Sera from patients with rheumatoid arthritis (RA) were from the very start instrumental in detecting and delineating the human immunoglobulin (Ig) allotypes in the Gm system. Knowledge that human Ig production is under Mendelian control and not determined by templates of antigen would not have come to the fore if it were not for RA patients. Worldwide experience shows that RA patients are prone to mount an immune response to human Ig allotypes. Major Gm allotypes are defined at the amino acid and nucleotide levels. Gene technology has been developed for defining these allotypes. Studies of the Gm allotypes and anti-Gms have led to two apparently paradoxical findings: (1) In conflict with Mendelian law, non-nominal or hidden allotypes have been observed and recently documented at the DNA level. (2) In RA, an immune response to other individuals' Mendelian allotypes is prevalent, although RA is generally considered an autoimmune disease. These findings led us to conclude that RA is not initially an autoimmune disease but a gene transfer disease. A brief review of viral high-jacking and transfer of human genes is given along with reasons for considering the herpesvirus family in particular. Genes determining incompatible Ig allotypes are transferred. We have shown that these genes are expressed in RA synovia. Ig-anti-Ig complexes arise and may have arthritogenic potential, as observed in serum sickness.     

HLA—DR antigens and the rubella-specific immune response in man

Several genetic markers, HLA—A, B and DR antigens, Gm and Km types, and ABO blood types, were studied on 78 rubella seronegative schoolgirls immunized with "TO336" rubella vaccine. A marked association was found between an HLA haplotype, HLA—Aw24—Bw52—DRHO, and the low antibody responsiveness to rubella virus. The association with the DR antigen was thought to be primary to those with the HLA A or B antigens, suggesting that the gene(s) controlling the low responsiveness to rubella might be located near the HLA—DR locus in the human 6th chromosome. There was no statistically significant association between Gm, Km or ABO blood types and the rubella specific immune responsiveness as far as the primary in vivo antibody response was concerned.     

Alpha-1-antitrypsin (Pi) types in multiple sclerosis and lack of interaction with immunoglobulin (Gm) markers

Susceptibility to multiple sclerosis is thought to involve several genetic loci apart from the HLA region on chromosome 6. No Pi allotype nor phenotype was associated with the disease in 125 unrelated patients from the Grampian region of northeast Scotland. Despite a previously reported Gm-HLA association in this population there was no apparent interaction between Pi alleles and Gm type which influenced disease susceptibility.     

Properdin factor B and complement factor C4 allotypes in rheumatoid arthritis: results of a follow-up study.

The association between allotypes of properdin factor B (Bf), the fourth component of complement (C4A and C4B), and rheumatoid arthritis (RA), was investigated in a well-characterized cohort of RA patients who were followed from an early phase of the disease for a mean duration of 6 years. The frequencies of probable heterozygous C4AQ0 and of C4A3 were lower in RA patients compared to controls, irrespective of the presence of DR4 [relative risk (RR): 0.52 and 0.49, respectively, 95% confidence intervals (95% CI): 0.34-0.80 and 0.29-0.82]. The frequency of C4A4 was higher in RA patients compared to controls (RR: 1.86, 95% CI: 1.03-3.35), especially in DR4 positive RA patients compared to DR4 positive controls (RR: 2.58, 95% CI: 1.07-6.25), indicating a positive association of this allotype with RA additional to DR4. Bf and C4B allotypes were comparable in RA patients and controls. We did not find significant differences in Bf and C4 allotype frequencies in RA patients subdivided according to severity of the disease into a mild group and a progressive group. Because of inconsistent results in all studies on Bf and C4 allotypes, we conclude that C4 and Bf allotypes do not seem to have an important independent effect on determining disease susceptibility.