Genetics: HLA-DQA*05:01

forestglip

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HLA-DQA*05:01

Potential association from DecodeME:

Human leukocyte antigen alleles

We tested for association of ME/CFS status to HLA alleles. For this, we imputed alleles in cases following the imputation approach used for UKB controls (25).

A single class II HLA allele (HLA- DQA1*05:01) was associated with ME/CFS at genome-wide significance (p = 1.4 x 10-10; Fig. S7; Table S7). The frequency of HLA-DQA1*05:01 among cases (21.7%) was lower than among controls (23.2%) and so is predicted to protect against ME/CFS.

This association was robust to testing restricted to the genetically more homogeneous White British genetic ancestries subset (Supplementary Methods; p = 7.2 x 10-8).

Nevertheless, we did not find associations to HLA-DRB1*03:01 (p=0.27) or HLA-DQB1*02:01 (p=0.042), despite expecting them due to their strong linkage disequilibrium with HLA-DQA1*05:01.

We will need to repeat this analysis using HLA alleles that have been imputed for cases and controls jointly in order to verify (or dismiss) the potential association.

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Nevertheless, we did not find associations to HLA-DRB1*03:01 (p=0.27) or HLA-DQB1*02:01 (p=0.042), despite expecting them due to their strong linkage disequilibrium with HLA-DQA1*05:01.

Interesting given they didn’t actually measure DQA1*05:01

As far as I understand they inferred its value by imputation (using linkage disequilibrium) which is ever more interesting and confusing given it didn’t return the expected associations with other linkages.

I hope we will get some higher resolution data from SequenceME to clear this up.
 
Also interesting that the allele is protective—if it was a risk allele you could feel more comfortable assuming that the gene is involved in the disease somehow, either as mediator or part of a trigger.

But a protective allele for HLA doesn’t lend itself to easy interpretation. Coupled with some of the other hits, the most straightforward interpretation seems to say that a couple genes that enhance viral protection across different facets of the immune system make it slightly less likely to develop ME/CFS. It’s certainly a different story than what HLA hits usually indicate in other diseases, at the very least.
 
Interesting given they didn’t actually measure DQA1*05:01

As far as I understand they inferred its value by imputation (using linkage disequilibrium) which is ever more interesting and confusing given it didn’t return the expected associations with other linkages.
Apologies if this is a stupid question but how do you know which SNPs are measured and which ones are imputed? Do they mention this somewhere in the text or is it somewhere in the data?
 
Also interesting that the allele is protective—if it was a risk allele you could feel more comfortable assuming that the gene is involved in the disease somehow, either as mediator or part of a trigger.
Just in case there's a connection, this other study found other suggestive (not significant after correction) protective HLA alleles (one of which, interestingly, it says, is protective against rheumatoid arthritis):

Human Leukocyte Antigen alleles associated with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Fluge, Mella et al 2020
Paper said:
There were two alleles with a negative association with ME/CFS, suggesting a potential protection, namely B*08:01 (OR = 0.7 [95% CI 0.6–0.9], pnc = 0.01, pc = n.s.) and DPB1*02:01 (OR = 0.7 [95% CI 0.6–0.9], pnc = 0.02, pc = n.s.) (Table 2). These alleles were not in LD (D’ = −0.29), indicating that the associations are independent.
Paper said:
HLA-B*08:01 showed reduced frequency in ME/CFS compared to controls in our material. This allele most often occur on the haplotype C*07:01-B*08:01-DRB1*03:01-DQB1*02:01, which was also less prevalent among ME/CFS patients in our material. This ancestral haplotype, AH8.1, is a risk factor for a wide variety of AID, including myasthenia gravis, systemic lupus erythematosus and coeliac disease31, but protective against rheumatoid arthritis34,35. In the existing literature on HLA and CFS, HLA-DRB1 is the locus most frequently studied. In four out of five studies, the frequency of DR3/DRB1*03 was lower in the patient group23,24,25,28, while in the fifth study the frequency was similar in both groups22. Hence, this haplotype seems truly less prevalent among ME/CFS patients.
 
If I’ve found the correct gene here, I’ve got a few thoughts.
The HLA complex is the human version of the major histocompatibility complex (MHC), a gene family that occurs in many species. The HLA-DQA1 gene belongs to a group of MHC genes called MHC class II. MHC class II genes provide instructions for making proteins that are present on the surface of certain immune system cells. These proteins attach to protein fragments (peptides) outside the cell. MHC class II proteins display these peptides to the immune system. If the immune system recognizes the peptides as foreign (such as viral or bacterial peptides), it triggers a response to attack the invading viruses or bacteria.
If the proteins that are supposed to pick up foreign proteins and present them to T cells, actually function worse in ME/CFS, could it be that this makes them more prone to pick up junk and try to present the junk to T cells?

If you couple that with some genes that makes T cells behave a bit differently, it might be the foundation of @Jonathan Edwards hypothesis.

I suppose a reduced ability to fight viruses also could fit with a viral persistence hypothesis.
 
If the proteins that are supposed to pick up foreign proteins and present them to T cells, actually function worse in ME/CFS, could it be that this makes them more prone to pick up junk and try to present the junk to T cells?
Well this specific allele from the study seems to protect against getting ME/CFS, which I don't think would fit with that. Maybe it's more like it's good at presenting a specific virus to T cells that is a common cause of ME/CFS and this fights the infection more quickly?
 
Well this specific allele from the study seems to protect against getting ME/CFS, which I don't think would fit with that. Maybe it's more like it's good at presenting a specific virus to T cells that is a common cause of ME/CFS and this fights the infection more quickly?
Does Decode ME have the data of what infection agent people report triggered ME? Stratifying by that vis à vis this allele could be interesting.
 
The genetic findings and the lack of autoantibodies seem to say that roughly the following might be occurring:

An immune response against pathogens leads to the side effect of a non-antibody mediated immune attack against the brain.

Presumably parts of the brain that are especially involved in regulating the various processes that are affected in ME, handling upright posture, fatigue, recovering from exertion, processing sensory stimuli, etc. Presumably the immune attack is mild but enough to cause persistent problems and dysregulation.
 
Well this specific allele from the study seems to protect against getting ME/CFS, which I don't think would fit with that. Maybe it's more like it's good at presenting a specific virus to T cells that is a common cause of ME/CFS and this fights the infection more quickly?
I might have misunderstood something then.

I thought the gene that’s protective against ME/CFS is also associated with a more effective response to viruses and bacteria?

So not having a better ability to pick up the right peptides, makes you more likely to have ME/CFS.

Have I got it all backwards?
 
I thought the gene that’s protective against ME/CFS is also associated with a more effective response to viruses and bacteria?
Are you referring to a different gene in the main part of the study? This HLA part was looked at separately and they found another protective gene here (though they say they'll need to verify the association is correct).
 
I am not sure that a protective effect of an MHC allelle is particularly puzzling. After all, the whole idea of having polymorphic MHC genes with lots of different alleles is that each one in preserved in evolution because it lowers risk of some infection or other.

B27 lowers risk of AIDS and some other infections. Interesting to see that Fluge and Mella picked up on a potential protective effect of HLA A1,B8, C7.01, DR3, DQB1 0201. Judging by discussions with Chris at advisory board meetings there are complications to the interpretation here that would be worth laying out in detail. It sounds pretty certain that the Fluge and Mella findings are compatible with the DecodeME findings on the basis the for DQ risk with one allele inherently implies protection from others (they mean the same thing).

Something that I realised looking at diseases associated with DQ is that although some of them appear to involve antibody and B cells they do so in a way that is not typical of autoimmunity. In MS B cells seem to be important and there are oligoclonal CSF IgG bands but no obvious single autoantibody specificity has emerged. In coeliac, uniquely, the T cell response appears to be against a specific foreign antigen, gluten, with antibodies to self tansglutaminase. In narcolepsy it is still rather unclear where DQ fits in. Even in type 1 diabetes the story remains rather unclear.

ME/CFS might involve some similarly atypical 'auto-responsive' process but, as said, a weak protective role for a DQ allele is very unlike the very strong risk roles for speific alleles in the above diseases.

I am tempted to think that if anything a DQ signal is nudging things towards the more innate side of T cell recognition, which can use DQ, as seen with MAIT cells and gamma delta cells. It may just indicate a non-specific threshold effect due to perhaps binding outside of the traditional active site but even if it just does that it maybe should not be ignored.
 
The genetic findings and the lack of autoantibodies seem to say that roughly the following might be occurring:

An immune response against pathogens leads to the side effect of a non-antibody mediated immune attack against the brain.

Presumably parts of the brain that are especially involved in regulating the various processes that are affected in ME, handling upright posture, fatigue, recovering from exertion, processing sensory stimuli, etc. Presumably the immune attack is mild but enough to cause persistent problems and dysregulation.
I don't think they really suggest that, they just say that having some alleles that generally have been linked to neuronal or immune cell functioning make one slightly more likely to develop ME/CFS for reasons unknown. On their own, they don't give hints to pathophysiology. Disappointing, I know, but caution is warranted in over-interpreting evidence
 
Maybe it's more like it's good at presenting a specific virus to T cells that is a common cause of ME/CFS and this fights the infection more quickly?
That would be my guess. Combined with the RABGAP1L finding as well, it seems like we have a set of genes that generally have to do with susceptibility to the trigger. Which may be more or less separate from the actual disease process
 
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