HLA haplotype in a patient with systemic lupus erythematosus triggered by hepatitis B vaccine.
OBJECTIVE
Find an association between hepatitis B vaccine-related systemic lupus erythematosus and HLA.


METHODS
A 27-year-old woman who developed a lupus nephritis after the administration of hepatitis B vaccine.


METHODS
We studied HLA antigen expression on lymphocytes and genomic haplotype. Class I-II HLA antigen typing was performed by the microlymphocytotoxicity test with the standard NIH method, and Class I-II HLA allele typing by polymerase chain reaction, using single-strand oligonucleotide dot-blot kits.


RESULTS
The serological haplotype was HLA A24/25, B18 (Bw6)/-, C-/-, DQ7/-, DR11(5)/52. The genomic haplotype was A*2403/2504, B*1825/1825, C*1207/ 1207, DRB1*1102/1132, DRB3*0202/0202, DQA1*0505/0505, DQB1*0301/0301. Then we sought for analogies with haplotypes known to be related to other systemic AID. Since we have found HLA alleles typical both of systemic lupus erythematosus and Sjogren's syndrome, the persistence of ENA-SSA positivity was highly suspicious for a possible overlap syndrome.


CONCLUSIONS
Hepatitis B vaccine can potentially trigger both the onset or the exacerbations of several autoimmune disorders, including systemic lupus erythematosus, by reduced immune complex clearance or molecular mimicry. This study represents the first report on the association between hepatitis B vaccine related systemic lupus erythematosus and HLA. Probably autoimmune reactions triggered by vaccines occur only in predisposed subjects, in which antigen presentation influenced by HLA haplotypes leads to the autoimmune cascade. More studies are needed to corroborate our hypothesis. They could disclose new pathways in the field of prevention.
Santoro
D
D
Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, Messina, Italy.
Vita
G
G
Vita
R
R
Mallamace
A
A
Savica
V
V
Bellinghieri
G
G
Benvenga
S
S
Gangemi
S
S
D000328:Adult; D000483:Alleles; D005260:Female; D020022:Genetic Predisposition to Disease; D006680:HLA Antigens / Q000235:genetics / Q000276:immunology*; D006239:Haplotypes; D017325:Hepatitis B Vaccines / Q000009:adverse effects*; D006801:Humans; D008181:Lupus Nephritis / Q000209:etiology* / Q000235:genetics / Q000276:immunology*; D016133:Polymerase Chain Reaction
D006680:HLA Antigens; D017325:Hepatitis B Vaccines