title: Immunogenetic risk and protective factors for the idiopathic inflammatory myopathies: distinct HLA-A, -B, -Cw, -DRB1 and -DQA1 allelic profiles and motifs define clinicopathologic groups in caucasians.
abstract: The idiopathic inflammatory myopathies (IIM) are systemic connective tissue diseases in which autoimmune pathology is suspected to promote chronic muscle inflammation and weakness. We have performed low to high resolution genotyping to characterize the allelic profiles of HLA-A, -B, -Cw, -DRB1, and -DQA1 loci in a large population of North American Caucasian patients with IIM representing the major clinicopathologic groups (n = 571). We confirmed that alleles of the 8.1 ancestral haplotype were important risk markers for the development of IIM, and a random forests classification analysis suggested that within this haplotype, HLA-B*0801, DRB1*0301 and/ or closely linked genes are the principal HLA risk factors. In addition, we identified several novel HLA factors associated distinctly with 1 or more clinicopathologic groups of IIM. The DQA1*0201 allele and associated peptide-binding motif (KLPLFHRL) were exclusive protective factors for the CD8+ T cell-mediated IIM forms of polymyositis (PM) and inclusion body myositis (IBM) (pc < 0.005). In contrast, HLA-A*68 alleles were significant risk factors for dermatomyositis (DM) (pc = 0.0021), a distinct clinical group thought to involve a humorally mediated immunopathology. While the DQA1*0301 allele was detected as a possible risk factor for IIM, PM, and DM patients (p < 0.05), DQA1*03 alleles were protective factors for IBM (pc = 0.0002). Myositis associated with malignancies was the most distinctive group of IIM wherein HLA Class I alleles were the only identifiable susceptibility factors and a shared HLA-Cw peptide-binding motif (AGSHTLQWM) conferred significant risk (pc = 0.019). Together, these data suggest that HLA susceptibility markers distinguish different myositis phenotypes with divergent pathogenetic mechanisms. These variations in associated HLA polymorphisms may reflect responses to unique environmental triggers resulting in the tissue pathospecificity and distinct clinicopathologic syndromes of the IIM.
authors.affiliation: From National Institute of Environmental Health Sciences (TPO, DMC, EAS, LGR, FWM), Center for Information Technology (JDM, JD), National Cancer Institute (SJC, CBF), and National Institute of Arthritis and Musculoskeletal Disease (PHP), National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland; University of Texas-Houston Health Science Center (FCA, JDR), Houston, Texas; Basic Research Program (MC, XG), SAIC Frederick National Cancer Institute, Frederick, Maryland; University of Pittsburgh School of Medicine (CVO, PAM), Pittsburgh, Pennsylvania; Malley Research Programming Inc (KM), Rockville, Maryland; Mayo Clinic (TB), Rochester, Minnesota; and United States Food and Drug Administration (LAL), Rockville, Maryland.
authors.forename: Terrance P
authors.initials: TP
authors.lastname: O'Hanlon
authors.forename: Danielle Mercatante
authors.initials: DM
authors.lastname: Carrick
authors.forename: Frank C
authors.initials: FC
authors.lastname: Arnett
authors.forename: John D
authors.initials: JD
authors.lastname: Reveille
authors.forename: Mary
authors.initials: M
authors.lastname: Carrington
authors.forename: Xiaojiang
authors.initials: X
authors.lastname: Gao
authors.forename: Chester V
authors.initials: CV
authors.lastname: Oddis
authors.forename: Penelope A
authors.initials: PA
authors.lastname: Morel
authors.forename: James D
authors.initials: JD
authors.lastname: Malley
authors.forename: Karen
authors.initials: K
authors.lastname: Malley
authors.forename: Jonathan
authors.initials: J
authors.lastname: Dreyfuss
authors.forename: Ejaz A
authors.initials: EA
authors.lastname: Shamim
authors.forename: Lisa G
authors.initials: LG
authors.lastname: Rider
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Chanock
authors.forename: Charles B
authors.initials: CB
authors.lastname: Foster
authors.forename: Thomas
authors.initials: T
authors.lastname: Bunch
authors.forename: Paul H
authors.initials: PH
authors.lastname: Plotz
authors.forename: Lori A
authors.initials: LA
authors.lastname: Love
authors.forename: Frederick W
authors.initials: FW
authors.lastname: Miller
mesh_terms: D000328:Adult; D000483:Alleles; D015415:Biomarkers; D016022:Case-Control Studies; D004198:Disease Susceptibility; D005260:Female; D014644:Genetic Variation; D015235:HLA-B Antigens; D015236:HLA-C Antigens; D006683:HLA-DQ Antigens; D006684:HLA-DR Antigens; D006801:Humans; D007249:Inflammation / Q000235:genetics / Q000276:immunology; D008297:Male; D009220:Myositis / Q000235:genetics* / Q000276:immunology; D011110:Polymorphism, Genetic; D018570:Risk Assessment; D012307:Risk Factors; D044465:White People / Q000235:genetics*
chemical_list: D015415:Biomarkers; D015235:HLA-B Antigens; D015236:HLA-C Antigens; D006683:HLA-DQ Antigens; D006684:HLA-DR Antigens