Association of high-altitude pulmonary edema with the major histocompatibility complex.
BACKGROUND
A constitutional susceptibility has been suggested in the development of high-altitude pulmonary edema (HAPE) because HAPE generally affects healthy young people, some of whom suffer recurrent episodes. We examined whether immunogenetic susceptibility is present in HAPE-susceptible subjects.


RESULTS
The frequencies of human leukocyte antigen (HLA) alleles in 28 male and 2 female subjects with a history of HAPE were compared with those in 100 healthy volunteers. We assayed the HLA-A, -B, -C, -DR, and -DQ antigens serologically. The pulmonary hemodynamics on admission to the hospital and the ventilatory response to hypoxia and hypercapnia were retrospectively examined in 10 of the HAPE-susceptible subjects. HLA-DR6 was positive in 14 (46.7%) of the subjects with HAPE but only 16.0% of the control subjects (P=.0005), and HLA-DQ4 was positive in 12 (40.0%) of the subjects with HAPE but only 10.0% of the control subjects (P=.0001). HLA-DR6 or HLA-DQ4 was positive in 8 (100%) of the subjects with recurrent HAPE. The pulmonary arterial pressure on admission of the HLA-DR6-positive subjects with HAPE was significantly higher than that of the HLA-DR6-negative subjects with HAPE.


CONCLUSIONS
There were significant associations of HAPE with HLA-DR6 and HLA-DQ4 and of pulmonary hypertension with HLA-DR6. An immunogenetic susceptibility, which is associated with HLA class II alleles located within the major histocompatibility complex, may underlie the development of HAPE, at least in some of its forms.
Hanaoka
M
M
First Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
Kubo
K
K
Yamazaki
Y
Y
Miyahara
T
T
Matsuzawa
Y
Y
Kobayashi
T
T
Sekiguchi
M
M
Ota
M
M
Watanabe
H
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000532:Altitude Sickness / Q000235:genetics* / Q000276:immunology*; D005260:Female; D006680:HLA Antigens / Q000235:genetics / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D006935:Hypercapnia / Q000235:genetics / Q000276:immunology; D006976:Hypertension, Pulmonary / Q000235:genetics / Q000276:immunology; D000860:Hypoxia / Q000235:genetics / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011652:Pulmonary Circulation; D011654:Pulmonary Edema / Q000235:genetics* / Q000276:immunology*; D012129:Respiratory Function Tests; D012189:Retrospective Studies
D006680:HLA Antigens