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[HLA and Bf in idiopathic nephrotic syndrome in children: differences between corticosensitive and corticoresistant forms].

An association between HLA-DR7 and the steroid sensitive idiopathic nephrotic syndrome in the children has already been reported. Immunogenetic data in the less frequent steroid resistant form of this disease have never been published. In this study, we analyse HLA-A, B and DR typing in 99 cases of nephrotic children divided in 72 with the steroid sensitive (SS) form and 27 with the steroid resistant (SR) syndrome, in comparison with those of 207 healthy controls; Bf allotypes were determined in 53 of the patients. The results show the increased frequency of DR7 in the SS syndrome (75% vs 30%, RR = 6.9, pc less than 10(-6), while the SR one is more associated to DR3 (52% vs 27%, RR = 3, p less than 0.004). In the SS patients, atopy is associated to DR7 (p less than 0.001), which is not the case in the SR group. Furthermore, a high relative risk is associated to the phenotype DR3/DR7 (30% vs 4%; RR = 9.3; pc less than 0.0004), for the SR disease; besides, this phenotype is associated to an early onset of the disease and to lesions of focal sclerosis. Thus a heterozygous effect in the SR form of idiopathic nephrotic syndrome of children has been demonstrated; the steroid sensitive and the steroid resistant forms of the disease seem to have different immunogenetic components.

Adrenal Cortex Hormones↗

Behçet's disease in Taiwan--a review of 53 cases.

Clinical manifestations and immunogenetic aspects of Behçet's disease were investigated in the Veterans General Hospital of the National Yang-Ming Medical College, Taiwan. Diagnosis of Behçet's disease was made according to the diagnostic criteria proposed by the Japanese Research Committee of Behçet's disease. Fifty-three patients including 33 men and 20 women have been diagnosed as having Behçet's disease in the past 10 years; 20 cases with the complete type and 33 cases with the incomplete type. About half of these cases were diagnosed in the past 2 years, predominantly by ophthalmologists. Of the 53 cases, ocular lesions were found in 35 cases, 25 men and 10 women. The ages of the onset of the ocular lesions ranged from 10 to 50 years, with the peak distribution between 20-30 years. Bilateral involvement was seen in 24 men and 8 women, and a total of 67 eyes were affected; 37 eyes (55.2%) had the final visual acuity of 0.1 or lower. Immunogenetic study revealed that the incidence of HLA-B51 was significantly higher in the patients than in the normal population.

Adolescent↗

[Comparative immunological and morphological studies following transplantation of fresh and preserved allogeneic vein and artery segments in rat experiments].

Immunological and morphological investigations were carried out on immunogenetically different strain combinations of inbred rats following transplantation of fresh allogeneic and implantation of formalin preserved vein segments. In contrast to vital allogeneic transplants, which evoke an immunological response depending on immunogenetic difference between donor and recipient, there is neither humoral nor cellular immunological response after implantation of formalin fixed vein segments. Therefore, from an immunological standpoint, strongly allogeneic vein implants preserved by formalin can be used for replacement of arteries.

Animals↗

[Diagnostic significance of scleroderma and myositis-associated autoantibodies].

In more than 95% of patients with systemic sclerosis and in about 60% of patients suffering from idiopathic inflammatory myopathies autoantibodies directed at different nuclear or cytoplasmic antigens can be detected with different methods. Scleroderma-associated autoantibodies can be visualized as antinuclear antibodies (ANA) by immunofluorescence assays using cultured monolayer cells. In case of a negative ANA result the diagnosis of systemic sclerosis is unlikely. In individual patients the different autoantibodies (against DNA topoisomerase I (Scl-70), centromeric antigens, fibrillarin, To (Th), RNA polymerases, NOR-90, U1-nRNP, PM-Scl, Ku) are mutually exclusive. They can be detected early in the course of diseases, most often are persistent, and are closely associated with immunogenetic markers. They are characteristic for distinct subsets of patients homogeneous in clinical manifestations as well as in disease outcome. Myositis-associated autoantibodies are directed to nuclear (about 60% of myositis patients; PM-Scl, Mi-2) or cytoplasmic antigens (about 35-40%; Jo-1 and other aminoacyl-tRNA-synthetases, signal recognition particle (SRP), KJ and others) and likewise are related to distinct clinical, prognostic, and immunogenetic traits leading to the description of characteristic antibody-based syndromes. Based on published results and on our own investigations, the diagnostic potential of scleroderma- and myositis-associated antibodies is evaluated and a new classification of systematic myositic and sclerodermatous disease is proposed.

Antibodies, Antinuclear↗

A prospective study of factors determining the outcome of unrelated marrow donor searches: report from the International Marrow Unrelated Search and Transplant Study Working Group on behalf of collaborating centres.

Outcomes of searches for unrelated bone marrow donors were analysed to identify factors influencing the probability of identifying an HLA-matched donor and proceeding to an unrelated donor bone marrow transplant (UD-BMT). Between March 1989 and January 1991, 649 unrelated marrow donor searches were entered into the study. Searches were referred from transplant centres in Europe and North America to the Anthony Nolan Research Centre panel and/or the British Bone Marrow and Platelet Donor Panel, two predominantly Caucasian donor registries. Patient immunogenetic and clinical characteristics were documented on study search request forms and search outcomes were monitored at the donor registry. Data were analysed using proportional hazards regression. Major factors predicting favourable search outcomes were patient common Caucasian HLA phenotype and Caucasian ethnic group. Probability of search failure was increased by advanced disease, rare Caucasian HLA phenotype and referral to the smaller registry. Search failure frequently occurred at the mixed lymphocyte reaction stage. This study illustrates the relative roles of clinical, immunogenetic and registry factors in determining the outcome of searches. The information may be used to devise strategies to locate HLA-matched donors for a higher proportion of patients for whom UD-BMT is the preferred treatment.

Adult↗

[The characteristics of HLA antigen distribution in patients with chronic glomerulonephritis and arterial hypertension].

A clinical immunogenetic analysis revealed highly significant positive and negative associations between HLA antigens and chronic glomerulonephritis (CGN), ethnic characteristics of the distribution of HLA-antigen allele variants associated with hypertensive nephritis. Immunogenetic markers of high risk to develop CGN with arterial hypertension, severe hypertension, progressive nephritis are listed.

Adult↗

[Genetics of autoimmune diseases].

Strategies for studying the genetics of autoimmune diseases have undergone a considerable evolution during the last years, especially due to molecular biology techniques and to systematic genome studies. Genetic factors account for 20 to 40% of the risk, and environmental elements play a major role. The major histocompatibility complex comprising HLA genes remains the immunogenetic system most studied and most closely associated with various autoimmune diseases. These associations are mainly observed with HLA class II genes polymorphisms; the precise knowledge of their structure has allowed to define HLA sequence polymorphisms which are themselves risk markers: specific combinations of HLA-DQA and DQB alleles in insulin-dependent diabetes mellitus or a given DR, DQ haplotype for multiple sclerosis. No strong association with HLA-DP has been demonstrated. In all cases the genes involved have a normal structure and the disease is secondary to the combination of a given set of genes with environmental factors. The present knowledge of insulin-dependent diabetes mellitus and multiple sclerosis genetics is rather advanced. Other genes of the HLA region might also be involved in the genetic susceptibility. Results about other immunogenetic systems (T cell receptor genes or heavy chain immunoglobulin genes) are still contradictory but no major gene for autoimmune susceptibility seems to exist in these regions; however autoimmune diseases are under polygenic control; susceptibility genes shared between different diseases often occurring within the same families (Graves' disease and insulin-dependent diabetes mellitus) and genes specific for a given disease (insulin gene region in diabetes) both exist. The present rapid progress in this area is due to the use of highly polymorphic markers randomly distributed across the genome (microsatellites being most informative) and that of animal models: the list of "candidate genes or regions" potentially involved in the genetics of autoimmune diseases is enlarging; the development of coordinated epidemiological studies of molecular genetics along with the sharing of biological resources between different teams allow to build up powerful informative studies which will confirm or refute those "candidates". However, once the list of genes involved is established their mechanism of action will still take time to elucidate.

Autoimmune Diseases↗

[Searching for genetic markers--in the fields of forensic medicine and human genetics].

Research on genetic markers in the fields of forensic medicine and human genetics did not begin in earnest until 1968. Study of an extended family in Wakayama Prefecture resulted in the discovery of the variant Bm type in the ABO blood group system. This family of nearly 40 members composed of Group A, B, O and AB spouses and type Bm monozygotic twins provided the best research material possible. An extremely rare case of an individual with type O red blood cells but no anti-A or anti-B antibodies led to the discovery of type AmBm. Fishman and Mitsuhashi advocated the concept of immunogenetic RNA. We attempted to examine the immunogenetic RNA function by isolating RNA from the human spleen but obtained no definitive results. Many researchers had since examined the genetic markers in erythrocytes, leukocytes, serum proteins and blood cell enzymes, but research on genetic marker in saliva had not been advanced. We searched for genetic markers in the parotid saliva and developed the PmF and Ph systems. A salivary amylase variant and acid phosphatase polymorphism were also discovered. We elucidated the genetic structure and geographic gradinet of the salivary genetic markers, such as the Pa, Pb, Pr, Db and PIF systems, in Japanese. The genetic markers in the tear and saliva of mice and rats were also detected. We demonstrated RFLP polymorphism using an amylase cDNA probe. Our report was one of the first on polymorphism in the field of forensic medicine in Japan. Interest was also directed to polymorphism in platelet and we employed two-dimensional electrophoresis to establish the ThA and ThB systems which are controlled by autosomal codominant genes. Regarding the research on monoclonal antibody production and their application in forensic medicine, we cloned and produced antibodies for ABO, MN and Lewis grouping. Anti-glycopholin-A, anti-glycopholin-B and anti-glycolipid monoclonal antibodies were also produced and used to divide the red blood cell antigens roughly into three classes; the glycopholin-A (MN), glycopholin-B (Ss. Duffy Kell-Cellano, Lutheran, Diego, Xg) and the glycolipid (ABO, Lewis, P) classes. Red blood cell protein membrane proteases were also isolated from Nepenthes alata extract and lectin which are used in grouping animal blood cells. In the research on erythrocyte differentiation and erythrocyte group substance expression, we established a selective two phase liquid culture system for culturing precursor cells of peripheral erythrocytes, and demonstrated the expression of red blood cell antigens such as ABO, Rh and Duffy antigens in the early period (4 to 9 days) of Phase 2. Recently, research on identifying the genes which code for polymorphism in erythrocytes or erythrocyte enzymes is making progress. For example, a study indicated a possible relationship between an isoform of the glycophorin A gene and the MN variant. In the cDNA sequence of the Fy (a-b+) and (a + b-) types in the Duffy system, a GAT (Asp) to GGT (Gly) substitution in the codon for residual 44 was detected. Research on the Rh gene is being pursued energetically. Two clones of the Rh gene have been isolated; Rh Pl composed of 1251 bases, and Rh Pll estimated to be Ph PI with a base substitution at position 41 and an amino acid substitution at position 31. Seven isoforms of Ph Pl and 5 isoforms of Ph Pll have been obtained. The delineation of the Rh gene which contains as many as 50 types of Rh antigen genes is in progress. The red blood cell enzyme EsD system is also used commonly in the field of forensic genetics. In EsD polymorphism, type EsD1 contains G at base 569, type EsD2 contains A and type EsD1-2 shows a heterologous conjugation of G and A. Due to the development of immunosuppressive agents, bone marrow transplant can now be conducted even when the ABO and Rh systems are not compatible, as long as the HLA is compatible. In this case, all the erythrocyte polymorphic types or erythrocyte enzyme polymorphic types are transformed to t

ABO Blood-Group System↗

[Narcolepsy].

Narcolepsy is a rather unknown but not exceptional condition. Its prevalence, 2 to 6/10000, is ranging among this of multiple sclerosis. Narcolepsy is remarkable for clinical, polygraphic and immunogenetic features which make it a kind of model of disorders of alertness. It was first described in 1877. It has recently benefited from consistent pathophysiological progresses, which have been facilitated by the discovery of a natural canine model. The two main symptoms are irresistible and refreshing episodes of sleep and cataplexy a loss of muscle tone emotionally triggered. Polygraphically the sleep onset REM period is the major feature. Immunogenetically the condition is remarkable for an almost 100% association with HLA DR2-DQ1. Narcolepsy is a debilitating, chronic condition. Its treatment is threefold including stimulants against excessive daytime sleepiness and irresistible episodes of sleep, modafinil a new compound with awakening properties has just been introduced, antidepressants against cataplexy and associated symptoms and hypnotics against disrupted sleep.

Adolescent↗

Long-term health outcomes and quality of life in American and Italian inception cohorts of patients with juvenile rheumatoid arthritis. II. Early predictors of outcome.

OBJECTIVE: To determine whether demographic, clinical, and immunogenetic variables measurable during the first 6 months of illness long-term health outcomes and quality of life in patients with juvenile rheumatoid arthritis (JRA). METHODS: Patient eligibility criteria: (1) first examined in our units between 1958 and 1990 within 6 months of onset of symptoms; (2) diagnosis of JRA by American College of Rheumatology criteria; (3) disease duration of at least 5 years at the time of assessment of outcome. Instruments used: (1) the Health Assessment Questionnaire (HAQ, short form), or Childhood HAQ (CHAQ) to measure disability (0-3 scale), (2) pain, and (3) parental assessment of overall well being, each scored on a 15 cm visual analog scale; (4) the Quality of Life Scales (QOLS) (adults only). Independent variables that showed significant results using univariate tests underwent multiple logistic regression analysis. RESULTS: 227 patients were available for analysis. Mean duration of disease at time of assessment of outcome was 15 years (range 5.3-36.1). Univariate tests allowed 11 variables for disability, 9 for pain, 7 for overall well being, and 4 for QOL into the multivariate analysis. The best predictor of higher disability was the articular severity score (odds ratio, OR, 5.69) while antinuclear antibody positivity foretold less disability (OR 0.29). HLA-DR5 positivity conferred the greatest risk for pain (OR 3.34), while HLA-B5, DR3, and C3 were protective (OR 0.25, 0.28, 0.33, respectively). Early hand involvement was the strongest predictor of poorer overall well being (OR 8.75). Only the erythrocyte sedimentation rate was predictive of future QOL, but the model yielded a low C statistic (< 70%) and the OR 95% confidence limits were extreme (OR 9.77; 95% confidence interval, 1.22-77.8). CONCLUSION: Clinical and immunogenetic variables measurable within 6 months of onset of JRA can be used to predict future disability, pain, and well being. QOL appears more difficult to forecast, perhaps due to the multiple domains that make up this outcome. Further study is needed to identify other genetic and laboratory factors that predict outcome in JRA with greater precision.

Adolescent↗

Age-of-onset related HLA-DQA1 genetic heterogeneity of insulin-dependent diabetes mellitus.

OBJECTIVE: To clarify whether there is an association of insulin-dependent diabetes mellitus (IDDM) susceptibility with HLA-DQA1 locus in adult-onset IDDM. PATIENTS AND METHODS: Possible heterogeneity in immunogenetic aspects was investigated by comparing the findings on relationship between HLA-DQA1 52 Arg(+) and IDDM predisposition in three groups with different ages of IDDM onset (group A 14 years, group B 15-30 years, group C > 31 years). RESULTS: The frequency of HLA-DQA1 52 Arg(+) in group A (87.5%) was higher than that in control (53.9%, P < 0.05) and in group B and C (P < 0.05). The frequency of HLA-DQA1 52 Arg(+)/Arg(+) phenotype in group A (75%) was higher than that in group C (23.1%, P < 0.05). CONCLUSION: The contribution of HLA-DQA1 52 arginine to IDDM susceptibility is heterogeneous. Further study is necessary to clarify the immunogenetic entity of IDDM.

Adult↗

Contrasting patterns of newer histocompatibility determinants in patients with rheumatoid arthritis and systemic lupus erythematosus.

The Ia alloantigens as measures of different alleles of loci in the major histocompatibility complex were determined in patients with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA). The Ia specificities of reagents used were defined by their pattern of reaction with lymphoblastoid lines derived from normal donors homozygous for HLA-D determinants. The reagent specificities included those associated with a single Dw type as well as those reacting with a single specificity shared by several Dw types. Patients with RA had a marked elevation in the frequency of alloantigens detected by reagent sera that recognize various determinants shared by cell lines from HLA-Dw4, Dw7, or Dw10 individuals (Ia 4-7-10). The frequency of mixed lymphocyte culture alleles Dw4 and Dw10 was found to be increased; however this elevation did not approach the higher frequency for the serologically determined antigens of the Ia 4-7-10 group. In contrast, patients with SLE had an increased frequency of reactions with the reagent alloantisera defined by reactions with either HLA-Dw2 or Dw3 positive cell lines. The data suggest that immunogenetic factors are relevant to both groups of patients, but that these are entirely distinct for each disease.

Arthritis, Rheumatoid↗

Major histocompatibility complex (MHC)-linked genes affecting development.

Genes affecting growth and development which are linked to the major histocompatibility complex have been found in the mouse (t-complex) and in the rat (growth and reproduction complex, grc), and there is some evidence that they also exist in humans. The genes of the t-complex have different effects depending upon the specific combinations involved: skeletal and fertility abnormalities, complete or partial embryonic mortality, high transmission ratios (segregation distortion) in males, high level of linkage disequilibrium with H-2, and suppression of recombination over the adjacent portion of the chromosome. The grc in the homozygous state causes small body size, sterility in the male and reduced fertility in the female, partial embryonic mortality, and a high level of linkage disequilibrium with RT1. It also interacts epistatically with the heterozygous Tal (tail anomaly lethal) gene to cause complete embryonic death. Mice carrying t-haplotypes and rats carrying the grc have an antigen in the male germ cells which cross-reacts very strongly (t-antigen). Suggestive evidence for such genes in humans comes from (1) studies on the relationship between skeletal defects and HLA haplotypes; (2) the association of specific HLA and complement haplotypes with a high transmission ratio in males, linkage disequilibrium among certain HLA and complement specificities and suppression of recombination in some MHC haplotypes; and (3) the lack of homozygotes in an isolated inbreeding population of desert nomads (Kel Kummer Tuaregs). In addition, immunogenetic studies on couples having chronic spontaneous abortions suggest that there is an unusually high incidence of homozygosity for the HLA-D/DR and HLA-A loci in these couples, and this finding is consistent with the presence of linked loci which behave like t or grc.

Animals↗

The HLA linkage group and disease susceptibility.

The HLA linkage group, located on chromosome 6, is composed of serologically defined (SD-) loci (HLA-A, -B and -C) and of a MLC (= mixed lymphocyte culture-) or lymphocyte defined (LD-) locus (HLA-D). Different alleles of these loci are linked together as well as with loci for the synthesis of some complement components and the properdin factor B (= Bf-system) by strong positive linkage disequilibria (gametic association). The indication of a HLA linked genetic control of immunoresponsiveness makes the HLA system one of the biologically most important immunogenetic systems in man. The associations, found between single HLA determinants and diseases, can be explained in different ways, but may contribute to a better understanding of the etiopathogenesis of diseases and of the biological role of the HLA linkage group.

Alleles↗

Major histocompatibility complex class II antigens in steroid-sensitive nephrotic syndrome in Chinese children.

Steroid-sensitive nephrotic syndrome (SSNS) has been postulated to have an immunopathogenic basis. To determine whether SSNS is associated with specific class II antigens of the major histocompatibility complex, we studied HLA-DR and DQ in 40 children with SSNS. HLA-DR7 was found in 40% of SSNS patients compared with only 11.23% of controls (P = 0.00025). HLA-DR9 occurred in 71.40% of patients with frequent relapses, compared with 27.37% of controls (P = 0.016). It seems likely that SSNS has an immunogenetic basis.

Child↗

An interactive program for determining tentative gene assignments from immunological data.

This paper announces an interactive program that could be useful for workers investigating new immunogenetic systems and theoreticians seeking to resolve persistent puzzling questions about systems already developed. The program seeks symbolic representations of data and its interpretations. By its ability to work with symbolizations in their most general form it is able to reveal symbolic patterns that may correspond directly to otherwise unexpected genetic models.

Immunogenetics↗

Computer methodology for simulation and prediction of alloimmune responses: expected antibody specificities.

The methodology presented here was developed for simulating planned alloimmunization results, with regard to the type and number of expected antibody specificities. The computer program designed for this purpose was adapted to an immunogenetic model using Boolean algebra. It was written to help immunogeneticists avoid handling routine data preceding selection of donor-recipient pairs, specially concerning blood type alloimmunizations in animals: all of the donor-recipient combinations and the expected antibody specificities (their limit number being specified in each particular immunization program) are provided in the print-out.

Animals↗

Felty's and pseudo-Felty's syndromes.

Felty's syndrome, consisting of rheumatoid arthritis, leukopenia, and splenomegaly, has been recognized as a distinct clinical entity for more than 60 years. Clinical and laboratory manifestations of the condition are reviewed. The major sources of morbidity and mortality remain recurrent local and systemic infections. Immunogenetic analysis shows a strong association with HLA-DR4, in addition to DQ beta 3b and C4B null allele. Potential mechanisms of neutropenia are contrasted, including impaired granulopoiesis and neutrophil-immune complex interactions. Lithium carbonate and splenectomy may have a role in the treatment of fulminant disease. Maintenance therapy should be directed at control of the underlying inflammatory arthropathy. A syndrome of proliferation of large granular lymphocytes and neutropenia, associated with rheumatoid arthritis in 23% to 39% of cases, has been described recently. Cases of "pseudo-Felty's" syndrome are often confused with traditional Felty's syndrome, which has twice the prevalence. The clinical and laboratory distinctions between these two conditions are elaborated.

Antigens, CD↗