title: Type 1 diabetes in the Spanish population: additional factors to class II HLA-DR3 and -DR4.
abstract: BACKGROUND
  The Major Histocompatibility Complex is the main genetic contributor to susceptibility to type 1 diabetes (T1D); genome-wide scans have consistently mapped increased predisposition to this region. The highest disease risk has been associated with HLA-DR3 and HLA-DR4. In particular, the DR3-positive ancestral haplotype 18.2 was reported as highly diabetogenic. We aimed to corroborate whether this haplotype increases the susceptibility conferred by the DQ2-DR3 alleles in a Mediterranean population. We also searched for additional susceptibility factors to the classic DQ2-DR3 and DQ8-DR4.
  
  
  RESULTS
  Genetic MHC markers were analysed in a case-control study with 302 T1D patients and 529 ethnically matched controls. DR3-TNFa1b5 carrier rate was significantly higher in DR3-positive heterozygous T1D patients than in DR3-positive heterozygous controls (p = 0.0019; odds ratio OR [95% confidence interval CI] = 2.26 [1.3-3.93]). This data was confirmed analysing the allelic frequency, which includes the information corresponding to the DR3-homozygous individuals (p = 0.001; OR = 2.09) and by using the Arlequin software to check the DR3-positive haplotypes (p = 0.004;OR = 1.93). The present results provide strong evidence of a second susceptibility region in the ancestral haplotype 18.2 in the Spanish population. Moreover, we searched for T1D susceptibility factors in addition to the MHC classical ones, within the DR2-DQ6/DR3-DQ2/DR4-DQ8 negative population. Several genetic markers in both MHC class II (DQA1*0101-DQB1*0501 [p = 0.007;OR = 2.81], DQA1*0201-DQB1*0202 [p = 0.03; OR = 2.35]) and III (TNFa2b1 [p = 0.01 OR = 2.74], BAT-2*2 [p = 0.004; OR = 3.19]) were found. These different alleles associated with T1D were not independent and we observed linkage disequilibrium among them leading us to describe two new risk haplotypes (DQA1*0101-DQB1*0501-TNFa2b1 and DQA1*0201-DQB1*0202- BAT-2*2). Finally, we studied a T1D susceptibility/protection marker located in extended class I, D6S2223; however, no association was observed in our population.
  
  
  CONCLUSIONS
  Our results suggest that other associated MHC haplotypes might present susceptibility factors in loci different from HLA-class II and that the class II molecules are not necessarily the universal etiologic factor in every MHC haplotype.
authors.affiliation: Immunology Department, Hospital Universitario San Carlos, Madrid, Spain. eurcelay@hcsc.es
authors.forename: Elena
authors.initials: E
authors.lastname: Urcelay
authors.forename: José L
authors.initials: JL
authors.lastname: Santiago
authors.forename: Hermenegildo
authors.initials: H
authors.lastname: de la Calle
authors.forename: Alfonso
authors.initials: A
authors.lastname: Martínez
authors.forename: Julián
authors.initials: J
authors.lastname: Méndez
authors.forename: José M
authors.initials: JM
authors.lastname: Ibarra
authors.forename: Carlos
authors.initials: C
authors.lastname: Maluenda
authors.forename: Miguel
authors.initials: M
authors.lastname: Fernández-Arquero
authors.forename: Emilio G
authors.initials: EG
authors.lastname: de la Concha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000483:Alleles; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000235:genetics* / Q000276:immunology*; D005260:Female; D020022:Genetic Predisposition to Disease; D005838:Genotype; D015803:HLA-DR3 Antigen / Q000235:genetics*; D015804:HLA-DR4 Antigen / Q000235:genetics*; D006239:Haplotypes; D006579:Heterozygote; D006801:Humans; D007223:Infant; D008297:Male; D018895:Microsatellite Repeats; D008875:Middle Aged; D016017:Odds Ratio; D017422:Sequence Analysis, DNA / Q000379:methods*; D012984:Software; D013030:Spain
chemical_list: D015803:HLA-DR3 Antigen; D015804:HLA-DR4 Antigen