HLA-DRw3 in juvenile onset diabetes mellitus in Chinese

HLA, ESD, GLOI, C3 and HP polymorphisms and juvenile insulin dependent diabetes mellitus in Tamil Nadu (south India)

Fifty juvenile insulin dependent diabetes mellitus (JIDDM) patients of Tamil Nadu (South India) were typed for HLA-A, -B, -C, -DR, and -DQ, ESD, GLOI, C3 and HP polymorphisms. The frequencies of B8, DR3, DR4, DR53 and DQ2 antigens of the HLA system were significantly higher in the patients than in controls (relative risk, RR = 4.81; 5.14; 3.98; 3.36 and 2.53, respectively). However HLA-DR2, -DR5 and -DQ1, observed less frequently in the patient group, appear to play a role of protection against the disease (RR = 0.32; 0.30 and 0.20 respectively). HLA haplotype analysis demonstrated very high relative risk associated with two hitherto unreported haplotypes namely A3,DR1 and Cw3,DR4 (RR = 27.30 and 20.00, respectively) and also scanty distribution of the haplotypes A1,B17 and DR2,DQ1 (RR = 0.39 and 0.36, respectively) in the patient group. Among other genetic markers tested, GLOI is informative with its phenotype GLOI 2-1 showing positive association with JIDDM (RR = 4.06).

Chromosome abnormalities in peripheral lymphocytes from patients with progressive systemic sclerosis

Chromosomal abnormalities in cultured peripheral lymphocytes from 14 progressive systemic sclerosis (PSS) patients and 15 normal subjects were examined. No increase was observed in the frequency of chromosome aberrations in PSS patients who had not received any medical treatment. Those who had received medication showed an increased frequency of dicentrics (0.3%) although the frequency was not significantly higher than that for normal subjects. It is not clear, however, whether the increase was due to the hypersensitivity of PSS patients to agents used for therapeutic purposes.

Cross-ethnic group comparisons of HLA class II alleles and insulin dependent diabetes mellitus

HLA class II associations with IDDM in populations of non-Caucasoid origin can provide important insights into the nature of the HLA and disease association. Firstly, HLA class II alleles that are rare in Caucasoids but common in other populations can be assessed for their contributory role in IDDM. Secondly, the different HLA class II gene linkage arrangements in different populations can help map the IDDM susceptibility determinants. This chapter reviews studies of HLA class II associations with IDDM in Asian Indians, Chinese, Japanese, Africans and black Americans. Most of these studies have been based on HLA-DR serology. However, DNA analyses, based on restriction fragment length polymorphism, sequence specific oligonucleotide hybridizations of polymerase chain reaction products and DNA sequencing, have made clear the identity of genes contributing to susceptibility or resistance to IDDM in populations of non-Caucasoid origin. DNA sequence analysis of the variable regions of the HLA-DQA, DQB and DRB genes has revealed at least eight alleles at HLA-DQA, 13 at HLA-DQB and 34 at HLA-DRB1. This chapter correlates HLA-DR and DQ allelic diversity with inherited predisposition to IDDM on a global basis. IDDM is strongly associated with the serological specificities of HLA-DQ, rather than with particular amino acid substitutions in class II alleles. DQw8 has a high risk for IDDM, DQw4, DQw5 and DQw9 have a lesser risk, while DQw6 and DQw7 are protective in IDDM. DQw2 is permissive for IDDM, depending on the presence of other HLA class II alleles. Increased heterozygosity at HLA is observed in Oriental patients, as it is in Caucasoid IDDM patients. The nature of this synergism is examined in terms of possible interactive effects between DQA and DQB alleles or DRB and DQB alleles; both effects could be operating. The conclusion from this genetic analysis is that molecular mimicry at HLA-DQ, with either foreign or autoantigens, may be an important mechanism in IDDM. Additionally, the anomalous role of DQw2 in IDDM suggests that a further mechanism, such as T cell activation, may control the ability to mount an immune response against autoantigens. Further studies, possibly with transfectant cell lines, are necessary to clarify the functional role of HLA class II genes in IDDM.

Genetics of diabetes. Trans-racial gene mapping studies

A major component of inherited susceptibility to IDDM is associated with one or more loci in the MHC. Identification of the primary susceptibility genes has been complicated by the low frequency of recombination, i.e. linkage disequilibrium, within the MHC. It is difficult to distinguish whether a detected genetic association with the disease is primary, or secondary due to linkage disequilibrium with an allele at another locus which is directly predisposing. During the evolution of different races, however, recombination within the MHC has occurred and population-specific MHC haplotypes exist. Primary susceptibility allels should be associated with disease in all racial groups, regardless of genetic background. It is unlikely that disease associations secondary to linkage disequilibrium will be consistent in these groups. This chapter reviews the known associations of candidate class II susceptibility alleles with IDDM in the five largest racial groups; white Caucasians, Asian Indians, Negroids, Japanese and Chinese. These trans-racial studies suggest that the DQ molecule has a primary role in predisposition to IDDM. There are consistent findings of a positive association with the DQA1*0301 allele and negative associations with the DQB1*0602 and DQB1*0603 alleles. These two alleles differ by a single codon and so the encoded DQ beta chains are likely to have similar functions. DR4-associated susceptibility is associated with the DQA1*0301 allele in all races tested so far but this allele cannot be the only susceptibility factor on this haplotype. The identity of the DR3-associated susceptibility factor remains unclear but the DQB1*0201 allele is a candidate. If DQB1*0201 is involved, the existence of a protective factor on the neutral DR7-DQB1*0201 haplotypes is indicated. Analysis of DR9 associated susceptibility implicates a non-DR/DQ predisposing factor.

HLA antigens in insulin-dependent diabetes mellitus

Diabetes mellitus is largely determined by genetic factors but environmental factors are necessary to convert genetic susceptibility into overt disease. Studies of twins show that the genetic impact in non-insulin-dependent diabetes mellitus is stronger than in insulin-dependent diabetes mellitus. The genetic factors involved in non-insulin-dependent diabetes mellitus are not known and the outcome of molecular genetic research has so far been disappointing. The major genetic susceptibility to insulin-dependent diabetes mellitus is conferred by genes in the HLA region on chromosome 6. Despite many advances in molecular genetics in insulin-dependent diabetes mellitus the serologically detectable HLA antigens and haplotypes are still the best available markers. This review describes the important developments in immunogenetics in insulin-dependent diabetes mellitus and summarises the main findings from earlier studies. Genetically the potential for primary prevention of insulin-dependent diabetes mellitus already exists and will become a reality as soon as the environmental determinants are identified. A wide application of immunogenetic methods will be needed in the prevention of insulin-dependent diabetes mellitus.

Identification of susceptibility loci for type 1 (insulin-dependent) diabetes by trans-racial gene mapping

A major component of inherited susceptibility to Type 1 (insulin-dependent) diabetes mellitus has been mapped to the major histocompatibility complex. Certain gene alleles in this region determine susceptibility and resistance to the disease. Mapping of susceptibility is hindered by the limitations of conventional tissue typing techniques, and by strong linkage disequilibrium within this part of the genome. Recombinant DNA technology and trans-racial studies have been used to allow finer mapping of genetic predisposition to Type 1 diabetes. These techniques have localised alleles encoding susceptibility and resistance to the DQ region. Other alleles determining disease susceptibility remain poorly localised.

Association of complement alleles C4AQ0 and C4B5 with rheumatoid arthritis in Japanese patients

We investigated polymorphisms of complement components C2, C4, and factor B (BF) in Japanese patients with rheumatoid arthritis (RA). The frequencies of C4AQ0 (32.1%) and C4B5 (35.9%) among RA patients were significantly higher than among healthy control subjects. C4B5 was strongly associated with HLA-Bw54, Bw59, DR4.1, and DQw4. C4AQ0 showed no association with HLA-Bw54 or Bw59, but there was weak association with HLA-DR4.1 and DQw4. The number of persons with both C4AQ0 and C4B5 was significantly higher in the RA patient group (relative risk 13.5). C2C and BFS were the most common alleles in RA patients, as well as in healthy control subjects. These data support the existence of 2 different putative susceptibility haplotypes (HLA-Bw54 or Bw59;C2C; BFS;C4A3;C4B5;DR4.1;DQw4 and C2C;BFS; C4AQ0;C4B1 or C4B2) in Japanese patients with RA.

Speculation on the evolution of insulin-dependent diabetes genes

A hypothesis about the evolution of insulin-dependent diabetes mellitus (IDDM)-susceptibility alleles is proposed. IDDM is known to be associated with two HLA-DR alleles, DR3 and DR4. DR3 is associated with IDDM in all ethnoracial groups including populations in which IDDM is rare, such as African and Asian populations, as well as whites in whom IDDM is common. However, in general, DR4 is associated with IDDM only in populations with white ancestry with high rates of IDDM. IDDM in American blacks illustrates the evolutionary patterns of the two diabetes alleles. The frequency of IDDM in American blacks relative to that in American whites (20% to 30%) approximates the frequency of the American black gene pool that is white-derived (also 20% to 30%), and DR4 is associated with IDDM in American blacks but not in African blacks. These data are consistent with the infusion of a dominant white-derived DR4-associated diabetes allele into the black gene pool. Recent studies of mitochondrial DNA suggest that modern humans evolved in Africa 200,000 to 300,000 years ago and that repeated migrations populated the world. The DR-population:IDDM-frequency relationships suggest that the DR3-associated diabetes allele evolved early (greater than or equal to 100,000 years ago) in Africa, whereas the DR4-associated diabetes allele evolved later (less than 15,000 years ago) in northern Europe. Recent data from studies of IDDM in families and populations which suggest that the DR4-associated allele has dominant characteristics and the DR3-associated allele has recessivelike characteristics fit into this hypothesis.

Class III gene rearrangements in Thai/Chinese supratypes containing null or defective C4 alleles

Class III gene rearrangements have been examined in Thai/Chinese individuals with supratypes bearing defective or null C4 alleles. Genomic DNA from C4 null supratypes was probed with an almost full-length 21-OH probe following digestion with Taq I and Kpn I. The HLA-B17 C4A3 BQ0 BfS DR3 Thai/Chinese supratypes (which may be associated with insulin-dependent diabetes mellitus in Orientals) lacks a 3.2 kb Taq I and a 3.9 kb Kpn I fragment hybridizing with the 21-OH probe. Similar gene rearrangements are found in Caucasoid diabetogenic supratypes HLA-B18 C4A3 BQ0 BfF1 DR3 and HLA-B8 C4AQ0 B1 BfS DR3. Interethnic comparisons suggest that class II and class III interactions may be important in disease susceptibility. By contrast, neither of two Thai/Chinese supratypes with C4AQ0 appear to have major class III gene rearrangements; disease association studies will determine the significance of C4 deficiency per se. As in Caucasoids, the electrophoretically fast C4 allele, C4A6, in Orientals has been shown to correlate with a 12 kb Bgl II fragment hybridizing with a C4 probe. It is likely that the HLA-B17 C4A6 B1 BfS DR7 supratype marks a highly conserved MHC chromosomal segment.

HLA-DR and DQ antigens in insulin-dependent diabetics in Ethiopia

Thirty-one Ethiopian insulin-dependent (or type I) diabetes mellitus (IDDM) patients and thirty-three healthy controls from the same ethnic background were typed for HLA-A, B, C, DR and DQ specificities. The frequencies of both DR3 and DR4 were significantly increased among IDDM patients (resp. p = 0.02, p = 0.01), confirming results in other populations. In contrast to observations in Caucasians, no significant negative association was found with TA10, a newly recognized DQ specificity, at least in the population studied here, whereas DQwl was more frequently observed among healthy controls (p = 0.01). Although this latter difference does not retain statistical significance after correction for the number of comparisons made, these findings may support previous results suggesting the existence of IDDM susceptibility genes associated with DR3 and DR4 and of IDDM resistance genes associated with DQ antigens.

HLA-A, B, C and DR antigen associations in insulin dependent diabetes mellitus (IDDM) in South African Negro (black) and Cape coloured people

HLA-A, B, C and DR antigen frequencies were determined in South African Negro (Black) (50) and Cape Coloured (57) patients with insulin dependent diabetes mellitus (IDDM) and in appropriate controls. The Black patients failed to show associations commonly reported for American Black patients with IDDM but did show a weakly significant increase in the DRw9 frequency. However, this antigen was rare even in the patient group and HLA associated genes do not appear to play a major role in the pathogenesis of IDDM in these people. The Cape Coloureds have a high proportion of Caucasoid genes. Coloured IDDM patients had the expected low DR2 and high DR4 frequencies. Unexpectedly the Cape Coloureds failed to show significant associations of IDDM with B8 or DR3.

HLA-system in Chinese children with insulin-dependent diabetes mellitus: a strong association with DR3

We studied the distribution of HLA-A, B, and DR and MT1, MT2, MT3 genotypes in all 20 Chinese children with insulin-dependent diabetes mellitus (IDDM) attending the four government pediatric units in Singapore. We found an increase in HLA BW22 but the corrected probability value was not statistically significant. AW33 and B17 were observed in 50% and 55% of IDDM children, respectively, compared with 11% and 13% of normal controls, respectively. The values for AW33 were as follows: corrected P = 0.00094 and relative risk (RR) = 8.17; for B17 they were corrected P = 0.001 and RR = 7.55. In addition, the frequency of DR3 was 50% in IDDM children compared with 14% of normal controls (corrected P = 0.0019, RR = 6.20). AW33, B17, and DR3 are in linkage disequilibrium in our normal Chinese population. All ten patients who were positive for DR3 also had B17. The frequency of DR4 was not increased, and there were no protection IDDM related antigens found. These differences compared with the results in Western populations may contribute to the relative rarity of IDDM among Chinese children.

Association of HLA-DR4 with myasthenia gravis in the Chinese

Since 1973 a number of studies have been conducted on the association of HLA with myasthenia gravis (MG). (Safwenberg et al. 1973, Fritze et al. 1973, Naeim et al. 1978, Bodmer & Bodmer 1978, Behan 1980). Most of these studies involved Caucasians. In this paper we report on a study carried out in Chinese patients with M.G.

HLA and disease

This review describes the greater portion of a large number of new studies on HLA and disease association which has appeared in the literature since 1979. The majority of these are concerned with the association of certain diseases with class II major histocompatibility complex antigens. The possible biologic significance of these associations in terms of their probable etiology appears to be the prevailing theme. Current thinking regarding certain heritable diseases is described. It seems that although much has been done to resolve the genetics of insulin-dependent diabetes mellitus, other diseases such a multiple sclerosis still remain a mystery. Doubtlessly, much will be gained from DNA cloning and sequencing studies proposed for the future. A great deal of new information has been obtained relative to HLA itself. New loci have been postulated in the HLA-D/DR region through the use of powerful immunochemical procedures made possibly by the advent of modern technological advances. The impact of these developments on our understanding of the function of the MHC in man and its possible relationship to disease are discussed.

HLA-A, B and HLA-DR phenotypes in Mainland Chinese patients with diabetes mellitus

HLA-A, B and DR antigens were studied in Mainland Chinese diabetes mellitus patients and controls (31 Type I DM, 50 Type II DM, 105 controls). HLA-DR3 and HLA-A9 were increased in Type I diabetics only. An increase in HLA-DR4 was noted in Type I diabetics, but the increase was not statistically significant in this small series.

HLA DR4 and rheumatoid arthritis in Japanese people

Eighty-eight Japanese patients with rheumatoid arthritis and 104 normal Japanese persons were typed for HLA A, B, C, and DR antigens. The frequency of HLA DR4 was 70.5% in patients compared with 46.1% in normal controls (P less than 0.001). However, a sex difference in the frequency of HLA DR4 in patients was noted. HLA DR4 was found in 80.6% of male patients, which was highly significant compared with controls (P less than 0.0005), while only a borderline increase of 60.5% was found in female patients (P less than 0.05). In addition, the frequency of HLA DR2 was remarkably low in male patients. These suggest the possible heterogeneity of rheumatoid arthritis in Japanese.