HLA-DRB1*03:01 and HLA-DRB1*04:01 modify the presentation and outcome in autoimmune hepatitis type-1

Genes Immun. 2015 Jun;16(4):247-52. doi: 10.1038/gene.2014.82. Epub 2015 Jan 22.

Abstract

The classical human leukocyte antigen (HLA)-DRB1*03:01 and HLA-DRB1*04:01 alleles are established autoimmune hepatitis (AIH) risk alleles. To study the immune-modifying effect of these alleles, we imputed the genotypes from genome-wide association data in 649 Dutch AIH type-1 patients. We therefore compared the international AIH group (IAIHG) diagnostic scores as well as the underlying clinical characteristics between patients positive and negative for these HLA alleles. Seventy-five percent of the AIH patients were HLA-DRB1*03:01/HLA-DRB1*04:01 positive. HLA-DRB1*03:01/HLA-DRB1*04:01-positive patients had a higher median IAIHG score than HLA-DRB1*03:01/HLA-DRB1*04:01-negative patients (P<0.001). We did not observe associations between HLA alleles and alanine transaminase levels (HLA-DRB1*03:01: P=0.2; HLA-DRB1*04:01; P=0.5); however, HLA-DRB1*03:01 was independently associated with higher immunoglobulin G levels (P=0.04). The HLA-DRB1*04:01 allele was independently associated with presentation at older age (P=0.03) and a female predominance (P=0.04). HLA-DRB1*03:01-positive patients received immunosuppressive medication and liver transplantation. In conclusion, the HLA-DRB1*03:01 and HLA-DRB1*04:01 alleles are both independently associated with the aggregate diagnostic IAIHG score in type-1 AIH patients, but are not essential for AIH development. HLA-DRB1*03:01 is the strongest genetic modifier of disease severity in AIH.

Publication types

  • Clinical Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age of Onset
  • Aged
  • Cohort Studies
  • Female
  • Genetic Predisposition to Disease
  • HLA-DRB1 Chains / genetics*
  • HLA-DRB1 Chains / immunology
  • Hepatitis, Autoimmune / diagnosis
  • Hepatitis, Autoimmune / etiology
  • Hepatitis, Autoimmune / genetics*
  • Hepatitis, Autoimmune / therapy
  • Humans
  • Immunoglobulin G / blood
  • Liver Transplantation
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Treatment Outcome

Substances

  • HLA-DRB1 Chains
  • HLA-DRB1*03:01 antigen
  • HLA-DRB1*04:01 antigen
  • Immunoglobulin G