New HLA DNA polymorphisms associated with rheumatoid arthritis

Studies of restriction enzyme fragment length polymorphisms (RFLP) have further clarified two DNA polymorphisms detected in DR4 positive individuals with a DQ beta probe. These patterns have been designated DQ beta omega, characterized in the Dw4 homozygous typing cell (HTC) BM14 and DQ beta phi, characterized in the Dw4 HTC MCF, and so do not correspond with different Dw types. These patterns clearly segregate in families with HLA haplotypes. We suggest that omega and phi may be polymorphisms of the DX beta gene. The previously reported DX alpha polymorphisms U and L were found with all DR types and in association with DQ beta omega (U) and DQ beta phi(L). In addition DQ beta phi was found to be strongly associated with TA10 positively (a subdivision of DQw3) although this association was not absolute. Associations between RFLP and other HLA Class II and I antigens seen in DR4 patients and DR4 controls suggest the existence of at least two preferential allelic associations (PAA), one containing omega/U and the other phi/L. PAA1: DX alpha U-DQ beta omega-TA10 negative-DQw3-Dw4-DR4----Bw62-Bw6-Cw3-A2 PAA2: DX alpha L-DQ beta phi-TA10 positive-DQw3-Dw4-DR4----B44-Bw4-Cw3-A2 The frequency of the omega pattern was higher, although not significantly in the RA patients compared with controls. However, a significantly higher frequency of omega was found in RA patients with extra-articular manifestations (EA) compared (a) with controls (p less than 0.04) and (h) with those patients without EA (p less than 0.05). In addition the frequency of phi was significantly higher in RA patients with nodules and/or erosions (N/ER) compared with patients without these features (p less than 0.008). When cumulative scores were assigned to patients after assessing the number of components fulfilled for each PAA, PAA1 appeared to be pronounced in patients with EA and PAA2 in patients with N/ER. The frequency of a previously reported DQ beta T6 band found with the enzyme Taq 1 and DQ-beta probe was found at a higher frequency in RA patients compared with controls. In addition a significantly higher frequency of this band was found in female RA patients compared to males.

HLA and rheumatoid arthritis: an analysis of multicase families

In a study of multicase RA families, significantly raised frequencies of the HLA antigens DR4, DR1, Bw62, Cw3, A2, A31 and significantly lower frequencies of DR2, DR3, and B8 were found in probands compared to normal controls. When haplotype frequencies were compared between probands and controls, two haplotypes A2-B44-DR4 and A2-Bw62-DR4 were at higher frequency in probands. These differences no longer reached significance when only DR4-containing haplotypes were compared between probands and controls. A significantly lower haplotype frequency of A1-B8-DR3 was observed in probands compared to controls. This difference did not remain significant when only non-DR4 haplotypes were compared. Using an affected sibling pair ratio method, significant linkage between HLA and RA was found (P less than 0.01). Significant linkage was also observed between HLA and seropositivity. Analysis of Hardy-Weinberg equilibrium for the DR locus did not support the suggestion that DR4-associated RA susceptibility was inherited as a dominant trait. In addition it did not support the notion of an additive effect of DR4 and DR1 in RA susceptibility as these antigens were not found together more frequently than predicted by their individual gene frequencies.

HLA and rheumatoid arthritis: susceptibility or severity?

An analysis of data collected on 440 British Caucasoid rheumatoid arthritis patients has confirmed positive association with HLA-DR4, Dw4, DRw53, and A2 and negative associations with HLA-DR2, 3, and 7. HLA-DR4 is more associated with RA 'severity' than with RA 'susceptibility', when measured by the parameters of ARA classification, seropositivity, severity of erosions and extra-articular manifestations. The association between HLA-A2, Cw3, Bw62, DR4, DRw53, and Dw4 and extra-articular disease has been confirmed in this study. The analysis of HLA and RA severity with respect to sex showed high frequencies of DR4, Dw4, and DRw53 in females, which increased in those with severe erosions, seropositivity or extra-articular disease. In males with RA, the disease appears to be associated not only with DR4, Dw4 and DRw53, but also with A2, Cw3 and Bw62. However, no significant differences in these antigen frequencies were found between male patients with severe RA and those without. Despite a significant decrease in the frequencies of DR3, B8 and A1 in most RA patient subsets, RA patients with Sjogren's syndrome showed a marked increase of A1 and B8 and patients with auto-antibodies had a significant increase in HLA-DR3 frequency when compared with patients without these features.

HLA-DQ molecular heterogeneity in HLA-DR4-Dw4 consanguineous cell lines

Two-dimensional gel analysis (NEPHGE) of the molecules precipitated by the HLA-DR monomorphic antibody L243 showed a single and identical alpha chain spot from two consanguineous cell lines, BM14 and MCF. The latter was derived from a rheumatoid arthritis patient. No apparent structural polymorphism of the HLA-DR beta chains was detected. The data suggests that the HLA-DR4 haplotype expresses one alpha chain and up to four beta chains. The electrophoretic pattern of the HLA-DQ molecules precipitated with the monomorphic antibody TU22 revealed clear differences between BM14 and MCF. These differences were mainly in the beta chain profiles. Four acidic beta chains were found with the MCF cell line wheras only three beta chains at different isoelectric points were found with the BM14 cell line. The data obtained in this study argue for a considerable heterogeneity of the HLA-DQ antigens detected at the molecular level.

HLA antigen associations with radiological changes in the hands, feet, and cervical spines in early rheumatoid arthritis

Clinical, laboratory, and genetic features measured at the onset of rheumatoid arthritis in 100 patients were compared with the severity of radiological changes in the hands and feet and in the cervical spines at a mean of 7.7 years. HLA-Dw4 was associated with more severe (p = 0.009) and HLA-Dw2 with less severe (p = 0.02)radiological changes in the hands and feet but the single strongest correlation with the severity of peripheral erosions was rheumatoid factor (p = less than 0.0001). Although none of the standard clinical or laboratory parameters correlated with severity of cervical spine changes, the presence of HLA-Dw2 and/or HLA B7 cross-reactive group were associated with more severe radiological changes in the cervical spine (p less than 0.02). Discriminant analysis selected certain standard laboratory parameters which in combination provided the most powerful prognostic index of radiological outcome in the hands and feet which was correct in 82 per cent. The addition of HLA data did not improve this figure. Conversely, the combination of the presence of HLA-Dw2, B27, and older age of onset of disease was found to be the most powerful predictor of the development of cervical spine changes and successfully predicted this complication of RA in 73 per cent.

HLA frequency and haplotype analysis in a family study of adult onset rheumatoid arthritis

Twenty-five families with probands who have rheumatoid arthritis (RA) were studied for clinical evidence of disease and for HLA status. This confirmed an association between RA and DR4 in 19/25 probands (76 per cent, p = 0.008). These 19 probands carried 24 haplotypes which contained DR4. There was no significant increase of DR4 haplotypes bearing B15(Bw62) or B44 when compared with published control haplotype data. The rare complement allele C4 B3 was detected as part of the extended haplotype A2 Cw3 B15(Bw62) DR4 C4 A*3B*3 in three probands with severe RA. Further studies to examine disease severity and autoantibody expression are in progress.

Bone-marrow transplantation has a limited role in prolonging second marrow remission in childhood lymphoblastic leukaemia

Fifty-three children with acute lymphoblastic leukaemia whose first complete remission ended in bone-marrow relapse received similar reinduction and consolidation therapy. Thirteen had an HLA-compatible sibling donor and were eligible to receive a bone-marrow transplant (BMT); five survive, all off treatment in continuing remission. Forty had no donor and received further chemotherapy; sixteen survive, twelve in remission and six off treatment. After 1-5.5 years' follow-up from relapse, there is no significant difference in survival between the groups. The major obstacle to success is marrow relapse which occurred in two eligible patients before BMT could be carried out. The lengths of first and second remissions in both groups were significantly correlated. Morbidity in survivors was substantial. The scope of BMT as retrieval therapy for ALL is limited by the instability of second remissions; this difficulty will not be overcome by increasing the number of potential donors or the use of autologous marrow.

Ontogenic and functional implications of the differential expression of HLA-DQ antigens on leukemic cells

We have examined the HLA class II antigenic profiles on different types of leukemic cells and have attempted to relate these findings to the normal differentiation pathways of the cells from which they have arisen. Monoclonal antibodies reacting with the different HLA class II determinants, HLA-DR, DRw52(MT), and DQ, were used to study the expression of these antigens on Epstein-Barr virus transformed cell lines, chronic lymphocytic leukemic cells, acute lymphoblastic leukemic blasts, acute myeloblastic leukemic blasts, and established leukemic cell lines by indirect immunofluorescence binding and immunoprecipitations. The results showed that whereas the HLA-DR and HLA-DRw52(MT2) antigens are normally expressed on the majority of the cells tested, there is a different expression of the HLA-DQ antigens on acute leukemic blasts, chronic lymphocytic leukemic cells, and leukemic cell lines indicating that the DQ molecules may be differentiation antigens preferentially expressed on mature cells. Furthermore, when the pre-B cell leukemic line NALM 6 was induced to differentiate with phorbol ester (TPA), normal expression of the HLA-DQ antigen was obtained after 5 days of culture. The absence of HLA-DQ antigens from the acute leukemic blasts suggests that these immature cells "froze" in the early stages of cell differentiation. We discuss these findings in relation to the role of these HLA class II antigens in cell differentiation and the immune response.

Different HLA associated gene combinations contribute to susceptibility for coeliac disease and dermatitis herpetiformis

Forty two white patients of British or Irish descent with coeliac disease and 28 with dermatitis herpetiformis were typed for class I HLA-A, B, and C, and class II DR and DQ antigens. In coeliac disease there was a significant increase in the frequencies of A1, B8, DR3, DR7, and DQw2 compared with controls but no increase of DR2. In dermatitis herpetiformis there were similarly increased frequencies of A1, B8, DR3, and DQw2. In contrast with coeliac disease, however, the frequency of DR7 (18%) was no different from the control group but there was an increased frequency of DR2.

Modulation of the expression of HLA class II antigens by gamma interferon and phorbol ester TPA on myeloid leukaemic cell lines

We investigated the effect of gamma interferon and phorbol ester (TPA), on the expression of HLA class II molecules of myeloid leukaemic cell lines K562, U937, KG-1, HL-60 and ML-2. Gamma interferon induced the expression of HLA-DR but not HLA-DQ on HL-60 and ML-2, increased the expression of HLA-DR and DQ on U937 and induced the expression of HLA-DQ on KG-1. TPA treatment did not affect the expression of HLA class II antigens on U937 and KG-1 and induced the expression of HLA-DR and HLA-DQ on HL-60 and ML-2. TPA treatment did not affect the HLA phenotype of K562 but gamma interferon did induce HLA class I molecules. Thus, gamma interferon cannot only increase the expression of HLA products already expressed on the cells but can also induce the de novo synthesis of these molecules on myeloid leukaemic cell lines.

Aberrant H-2-like allospecificities on K36.16 thymoma. Studies by radiobinding and immunoprecipitation with anti-H-2 monoclonal antibodies

The K36.16 thymoma expresses an H-2Dd-like allospecificity as detected by the 34-5-8 monoclonal antibody directed against H-2Dd using immunoprecipitation techniques. This monoclonal antibody gives a negative result by radio-immune assay but other anti-Dd antibodies react positively with this tumour. These results confirm and extend previous observations and are attributed to probable gene-conversion events possibly involving a donor gene from the Qa/Tla region, the products of which cross-react with Dd.

Structural variations in the H-2 genes of AKR lymphomas

K36.16 is an AKR H-2k thymoma which expresses an aberrant H-2Dd-like allospecificity, does not have a detectable amount of the H-2Kk syngeneic antigen and grows very easily in syngeneic mice. By DNA-mediated gene transfer experiments, we were able to obtain transformed clones which do express the H-2Kk molecules and are rejected by AKR mice. Southern hybridization was performed to assess whether any gross changes had occurred in the K36.16 H-2K locus or elsewhere in the MHC, which might explain the lack of H-2K expression and/or the presence of the aberrant H-2Dd-like allospecificity. Specific H-2 class I DNA probes were used to compare the K36.16 genomic DNA with normal AKR thymus DNA after digestion with a variety of restriction enzymes. After hybridization with the pH-2IIa probe a 2.8 kb 'Hind III' fragment was identified in the K36.16 genomic DNA which is absent from AKR DNA. The pH-2IIa probe detects the third, transmembrane and cytoplasmic domains of class I genes. Although these changes are indicative of MHC genome modifications it is not yet possible to link these specific Southern blot pattern variations with the phenotypic changes mentioned above.

HLA class I and class II antigen associations in acute leukaemias

HLA-A,B,C and DR antigen frequencies were determined in a group of 188 patients suffering from acute myeloid (AML) and acute lymphoid leukaemia (ALL). These antigen frequencies were compared with those obtained on a panel of normal individuals (n = 109) of the same ethnic origin. The significance of the differences in the antigen distribution and the strength of the associations between particular HLA antigens and the disease were then calculated. The results obtained show a decreased frequency of HLA-Aw19 in the overall group of patients and the group of patients with ALL. In addition, the antigen frequency of the HLA-B18 and DR5(DRw11) antigens was also decreased in the overall group of patients and in those patients with AML but not in the patients with ALL. The results suggest that the antigen Aw19 may confer some degree of resistance to the development of ALL and that the HLA-B18 and/or DR5 antigens may be resistance factors for the development of AML.

Long-term follow-up in London Transplant Group recipients of cadaver renal allografts. The influence of HLA matching on transplant outcome

The London Transplant Group followed 1341 patients with cadaver renal transplants, none of whom received cyclosporine, for six months to 14 years to determine the effect on graft survival of matching donor and recipient for HLA Class I antigens (HLA-A, -B, and -C) and Class II antigens (HLA-DR, -MT, and -DQ). Long-term graft survival was greatly improved by matching for HLA Class I antigens, especially HLA-B. Transplants that could not be matched for both B-locus antigens but were completely matched for Bw4/Bw6 also did very well. In addition, since 1978, excellent results have been obtained with HLA-DR and -DRw52/53 (HLA-MT) matching, but not with HLA-DQ matching. Multivariate analysis using the Cox regression model confirmed that combination Class I and Class II matching produced significant improvements in graft survival. Thus, transplants matched for HLA-DR plus HLA-B and those matched for HLA-MT plus HLA-B had excellent results--even better than those reported with cyclosporine treatment. Double HLA-MT incompatibilities yielded the poorest results. We conclude that this approach of combining the broad and narrow specificities of Class I and II is extremely practical and that appropriate matching of tissue types is clinically important.

HLA antigens in the pathogenesis of Menière's disease

In the Department of Otolaryngology of the London Hospital many clinical and laboratory investigations have been conducted over the past fifteen years in an attempt to unravel some of the mysteries of Menière's disease. Many of these have been directed towards diagnosis, prognosis or therapy. Some have had a bearing on the aetiology of the idiopathic disease--these were summarised by Morrison (1981), including the finding of an hereditary predisposition, of an association with migraine in a significant proportion, also familial, of a 'personality type' of patient with Menière's disease and of typical radiological changes in the skull base in the majority of sufferers. More recently Brookes (1985), writing from this department, drew attention to both the occasional finding of an association between endolymphatic hydrops and elevated levels of circulating immune complexes, and also to the immunological studies in progress in patients with Menière's disease. These latter early results were reported by Morrison (1984) and are summarised in Table I. There was a highly significant difference between the levels of circulating complement and of immune complexes in patients with Menière's disease compared with control patients. There was, however, no difference in the results of autoantibody screening nor in the levels of serum immunoglobulins between the groups.

A DR3-related DX alpha gene polymorphism strongly associates with insulin-dependent diabetes mellitus

HLA-DQ alpha and HLA-DX alpha gene polymorphisms were analyzed by Southern blot techniques in 78 Caucasoid insulin-dependent diabetes mellitus (IDDM) subjects and 55 control subjects. Five restriction fragment length polymorphisms of the HLA-DQ alpha gene correlated with HLA-DR typing. Two allelic DX alpha-related gene fragments, of 2.1 kb (U) and 1.9 kb (L) in size were identified. Genotype frequencies in the IDDM group for UU, UL, and LL were 54%, 38.5%, and 7.5%, respectively, whereas the corresponding frequencies in the control group were 24%, 40%, and 36% (P less than 0.00005 for differences in genotype frequencies). The U allele was associated particularly with IDDM patients who were DR3, with healthy controls who were DR3, as well as with IDDM patients who were not DR3. Thus, if this DX alpha U allele is not the DR3-associated IDDM susceptibility gene, it is the closest marker hitherto studied.

Differential expression of HLA-DR and HLA-DQ antigens on normal cells of the myelomonocytic lineage

We have previously shown that HLA-class II antigens have a differential expression on acute myeloblastic leukaemia (AML) blasts. These cells express HLA-DR molecules but the HLA-DQ antigens are undetectable. In this paper we study the expression of HLA-DR and HLA-DQ antigens, using monoclonal antibodies (MoAbs), on normal cells of the myelomonocytic lineage: the common myelomonocytic progenitor (CFU-GM) and the monocytes, by techniques of inhibition of CFU-GM growth and double immunofluoroscence, respectively. The results show that HLA-DR and HLA-DQ antigens are differentially expressed on normal myelomonocytic cells. While HLA-DR molecules are expressed on CFU-GM and on the majority of peripheral blood monocytes, HLA-DQ antigens are not expressed on CFU-GM and only present on a subpopulation of monocytes. This data further confirms that HLA-DR and HLA-DQ molecules are coded by different genes with independent regulation of the gene expression not only on myeloid leukaemias but also on normal cells of the myelomonocytic lineage.

Control of synthesis and expression of H-2 heavy chain and beta-2 microglobulin in AKR leukemias

In a series of newly isolated AKR leukemias, some tumors expressed large amounts of both H-2K and H-2D molecules, while others had reduced levels of both antigens. The number of H-2 antigens expressed in steady state showed a consistent correlation with the rate of synthesis of the H-2 class I heavy chain and the beta-2 microglobulin (beta 2m) light chain, and with the amount of H-2- and beta 2m-specific mRNA present in the tumors. Stimulation of leukemic cells with interferon induced an increased transcription of both H-2 and beta 2m mRNA. These results suggest that there is a mechanism that regulates, at the transcriptional level, the coordinate expression of H-2K and H-2D heavy chains, and the beta 2m light chains encoded by genes on chromosomes 17 and 2, respectively.

Identification of murine H-2Db histocompatibility antigens in cells transfected with cloned H-2 genes

Clones of mouse L-cells transformed with 21 cosmids containing 15 major histocompatibility complex class I genes of C57BL10 (H-2b) sperm cell DNA were analyzed for the expression of their transfected H-2 and Qa/Tla genes. Three cosmids contained a single gene, mapping to the H-2D region. This gene encodes the H-2Db alloantigen: mouse L-cells transfected with cosmids containing this gene reacted with monoclonal antibodies and alloantisera specific for the H-2Db antigen and expressed a 46-kd H-2 heavy chain associated with beta 2-microglobulin in their cell membranes. Furthermore, these transfected cells were stimulators of, and targets for, anti-H-2Db cytotoxic T-lymphocytes. Eighteen cosmids contained 14 different genes mapping to the Qa and Tla regions. L-cells transfected with these genes did not express class I genes reacting with alloantisera or monoclonal antibodies against Qa2, Qa4 or TL differentiation antigens. In particular, the Qa2,3 gene of C57BL10 was not identified.

HLA-DR genotyping by restriction fragment length polymorphism analyses

We have established unique restriction fragment length polymorphism (RFLP) patterns characteristic of homozygous typing cells (HTCs) for HLA-DR-1 through HLA-DR-8 haplotypes. These RFLP patterns were found to segregate in family members and correlate 100% with HLA-DR antibody phenotyping. The RFLP patterns were used to type chronic myelocytic leukemic cells which have a Philadelphia translocation from 23 randomly selected Caucasoid patients. The results show an alternative method for the determination of the HLA-DR types without using live cells and to study disease association with the HLA-DR region.

A new HLA Bw16 subtype defined in both Negroid and Saudi Arabian populations

Serological identification of a new HLA-Bw16 subtype, B39B, was made by the analysis of reaction patterns of many alloantisera and one monoclonal antibody. The B39B pattern of reactivity was shown to be distinct from HLA-Bw38, Bw39, and 8w57. Cytotoxicity testing before and after absorption suggests that the B39B specificity belongs to the HLA-B7 cross-reactive group. The B39B was clearly demonstrated in two families. This antigen was detected in Negroids and Saudi Arabian Caucasoids but not in a large panel of British Caucasoids.

Two different T-cell systems in humans, one of which is probably equivalent to Qa or Tla in mice

Two different alloantigenic systems, expressed mainly on TG and TM lymphocytes and called TCA and TCB, respectively, are described. Alloantisera from parous women are absorbed with Epstein-Barr virus-transformed B cell lines from the husband of the serum producer to remove all anti HLA-A,B,C and DR antibodies. The absorbed sera are tested against a random panel and against lymphocytes from families. Family studies indicate that the TCA system might be encoded by a gene linked to HLA and located on the telomeric side of HLA-A. The total lod scores for the material of 15 informative families is +3.301 at a recombination fraction of 15%. Furthermore we can show that the TCA molecule is associated with beta 2-microglobulin by blocking with turkey anti-beta 2 microglobulin. The antigens are dimers of peptides with a molecular weight of approximately equal to 42,000 daltons and 12,000 daltons, respectively. This implies that TCA might be equivalent to either Qa or Tla in the mouse. For the TCB system no evidence is found for linkage with any known genetic marker. Only in random population studies is an association seen between TCB and Gm.

Immunochemical analysis of class II molecules expressed by a human B cell line with the unusual class II genotype, DR5+, MB1+, (MB3-), MT2+

The human B lymphoblastoid cell line FPA was established from a consanguineous individual homozygous for the unusual serologically defined Class II genotype, DR5+, MB1+, (MB3-), MT2+. The MB1 allodeterminant is classically found only in association with DR1, 2, or w6 and DR5 is almost invariably associated with MB3. Class II molecules expressed by this unusual DR5 homozygous cell line have been characterized by immunochemical analysis using two-dimensional gel electrophoresis. These molecules were isolated from the FPA cell line by anti-DR5, anti-MT2, and anti-MB1 allosera, as well as a monoclonal antibody which defines an MB1-like determinant. However, an anti-MB3 alloserum and a monoclonal antibody which defines an MB3-like determinant did not immunoprecipitate Class II molecules from FPA. These studies document that the MB1 allodeterminant resides on DS molecules from this DR5 cell line and provide additional evidence that MB1 and MB3 are alleles of the same Class II antigen system.

HLA polymorphisms in Nigerians

The HLA class I and class II phenotypes of a panel of 114 unrelated Nigerians have been determined. The panel was tested for all the known class I antigens and comparisons of the HLA-A and -B frequencies with those of other African Negroid populations revealed some differences. Only limited comparisons could be made for the HLA-DR and -D frequencies as these are not available for any well-defined African Negroid population. The data concerning the class II antigens of this panel are the most interesting. Half of the DRw11-positive panel members are DQw3 negative and DQw1 positive. In addition, there is dissociation of some HLA-D and -DR specificities, a number of panel members are positive for an HLA-D specificity and are negative for the corresponding HLA-DR specificity. Our results show the value of population studies in the investigation of the relationship between the different HLA class II antigens.