Associations of HLA-DRB1, DQB1 and DPB1 alleles with pulmonary tuberculosis in south India.

Ravikumar, M.; Dheenadhayalan, V.; Rajaram, K.; Shanmuga Lakshmi, S.; Paul Kumaran, P.; Paramasivan, C.N.; Balakrishnan, K.; Pitchappan, R.M.

Tubercle and Lung Disease; 1999; 79; 309-317.          

Setting : Tuberculosis is endemic in south India: sputum positive pulmonary tuberculosis is predisposed by HLA-DR2 in south India and few other populations of the world.

Objective : To study HLA-DRB1, DQB1, DQA1 and DPB1 allelic polymorphism in pulmonary tuberculosis patients and endemic controls from south India.

Design : One hundred and twenty-six, sputum positive pulmonary tuberculosis patients and 87, endemic controls, from Madurai were studied for MHC class II allelic polymorphism by PCR-SSOP method. XI IHWC primers and probes and non-radioactive probing methods were employed.

Results : : HLA-DRB1*1501 AND dqb1*0601 predisposed for pulmonary tuberculosis (DRB1*1501; odds ratio (OR)=2.68, 95% confidence interval (CI)=1.30-5.89, P value (P) =0.013, aetiological fraction (EF)=0.17; DQB1*0601; OR=2.32, CI=1.29-4.27, P =0.008, EF=0.26). Haplotype DRB1*1501-DQB1*0601 was higher in patients (1324 per 10 000, X 2 =27.07) than controls (F=404/10 000, X 2 =8.84). In a subset of 63 caste matched samples, DPB1*04 was preventive (OR=0.45, CI=0.21-0.95, P =0.036, PF=0.26): the distributions of DRB1*1501-DQB1*0601-DPB1*04 phenotypes were different between patients and controls ( P =0.0092). These alleles were predominant in patients and controls of T5SU caste.

Conclusion : HLA-DRB1*1501 and DQB1*0601 predisposed to sputum positive pulmonary tuberculosis, and DPB1*04 was preventive and epistatic to this risk. Caste T5SU is an ideal model to study immunology of tuberculosis.

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