Background. Microlymphocytotoxicity (MLCT) and flowcytometry (FC) are the conventional serological methods to detect HLA-B* 27. Due to some disadvantages in these methods, most of the HLA laboratories have now switched over to molecular methods. Molecular techniques based on commercial kits are expensive; as such many laboratories with limited funds in developing countries cannot afford these techniques. Aims. Our main aim was to standardize a simple inexpensive in-house PCR-SSP technique for HLA-B* 27 typing. Materials and Methods. Sequence Specific primers were designed to amplify all the subtypes of B* 27 using IMGT-HLA sequence database. Accuracy was checked by retyping of 90 PCR-SSOP typed controls. Results. The presence of 149?bp specific band with control band on 2% agarose gel showed B* 27 positivity. No discrepancies were found when compared with PCR-SSOP results. The frequency of HLA-B* 27 was found to be significantly increased (68.75% versus 4.40%, O.R 46.909: value ) among 700 SpA patients as compared to controls. Clinically, 54% of patients had polyarticular arthritis with SI joints involvement (68%) and restricted spine flexion (60%). Conclusion. In-house PCR-SSP technique is very simple and inexpensive technique to detect B* 27 allele, which was strongly associated with SpA patients from Western India. 1. Introduction Human leucocyte antigen-B27 is a major histocompatibility complex class I molecule that is strongly associated with AS and related seronegative spondyloarthritis (SpA). Ankylosing spondylitis (AS) is associated with B27 with a relative risk of 95 which is the highest among all HLA disease associations [1]. The association of HLA-B27 with AS was first reported in 1973 [2, 3] and confirmed with related SpA later by many other investigators [4–7]. The frequency of HLA-B27 ranges from 80% to 90% among patients as compared to 4–8% in controls. This high association stimulated considerable interest in HLA-B* 27 testing as a diagnostic tool in these inflammatory diseases. The frequency of HLA-B27 in AS or other related SpA among Indian population varies from 40% to 80% as compared to 1.4–8% of controls as shown in Table 1 [8–15]. Techniques generally employed for the routine typing of HLA-B27 are the microlymphocytotoxicity test (MLCT) [16] and Flow cytometry (FC) [17]. Both these tests rely on the detection of cell surface antigens by antibodies. There are some disadvantages in MLCT like requirement of viable cells, cross-reactive nature of HLA antigens, unavailability of B* 27 specific antisera which cover all HLA-B* 27 alleles
References
[1]
S. Gonzalez-Roces, M. V. Alvarez, S. Gonzalez et al., “HLA-B27 polymorphism and worldwide susceptibility to ankylosing spondylitis,” Tissue Antigens, vol. 49, no. 2, pp. 116–123, 1997.
[2]
D. A. Brewerton, F. D. Hart, A. Nicholls, M. Caffrey, D. C. James, and R. D. Sturrock, “Ankylosing spondylitis and HL-A 27,” The Lancet, vol. 1, no. 7809, pp. 904–907, 1973.
[3]
L. Schlosstein, P. I. Terasaki, R. Bluestone, and C. M. Pearson, “High association of an HL-A antigen, W27, with ankylosing spondylitis,” The New England Journal of Medicine, vol. 288, no. 14, pp. 704–706, 1973.
[4]
C. Lopez-Larrea, K. Sujirachato, N. K. Mehra et al., “HLA-B27 subtypes in Asian patients with ankylosing spondylitis. Evidence for new associations,” Tissue Antigens, vol. 45, no. 3, pp. 169–176, 1995.
[5]
S. R. Kankonkar, S. C. Raikar, S. V. Joshi, and S. J. Tijoriwala, “Association of HLA B27 antigen in Indian patients of ankylosing spondylitis and other autoimmune diseases,” Journal of Association of Physicians of India, vol. 46, no. 4, pp. 345–350, 1998.
[6]
U. Kanga, N. K. Mehra, C. L. Larrea, N. M. Lardy, A. Kumar, and T. E. W. Feltkamp, “Seronegative spondyloarthropathies and HLA-B27 subtypes: a study in Asian Indians,” Clinical Rheumatology, vol. 15, no. 1, pp. 13–18, 1996.
[7]
M. A. Khan, “HLA-B27 polymorphism and association with disease,” Journal of Rheumatology, vol. 27, no. 5, pp. 1110–1114, 2000.
[8]
A. Chopra, D. Raghunath, and A. Singh, “Spectrum of seronegative spondarthritides (SSA) with special reference to HLA profiles,” The Journal of the Association of Physicians of India, vol. 38, no. 5, pp. 351–355, 1990.
[9]
U. Shankarkumar, J. P. Devraj, K. Ghosh, and D. Mohanty, “Seronegative spondarthritis and human leucocyte antigen association,” British Journal of Biomedical Science, vol. 59, no. 1, pp. 38–41, 2002.
[10]
U. Shankarkumar, K. Ghosh, and D. Mohanty, “Novel HLA B*2714 and B*2708 allele associations in seronegative spondarthritis patients and haemophilia patients with chronic synovitis in India,” Tissue Antigens, vol. 62, no. 2, pp. 175–178, 2003.
[11]
R. Madhavan, M. Parthiban, C. Panchapakesa Rajendran, A. N. Chandrasekaran, L. Zake, and C. B. Sanjeevi, “HLA class I and class II association with ankylosing spondylitis in a southern Indian population,” Annals of the New York Academy of Sciences, vol. 958, pp. 403–407, 2002.
[12]
G. K. Sonkar and U. Usha, “Role of HLA B27 in diagnosis of seronegative spondyloarthropathies,” Indian Journal of Pathology and Microbiology, vol. 50, no. 4, pp. 908–913, 2007.
[13]
G. K. Sonkar, U. Usha, and S. Singh, “Is HLA-B27 a useful test in the diagnosis of juvenile spondyloarthropathies?” Singapore Medical Journal, vol. 49, no. 10, pp. 795–799, 2008.
[14]
S. Singh, G. K. Sonkar, and U. Singh, “Association of various inflammatory diseases with human leukocyte antigens B27, B7, Bw4 and Bw6 in patients with SSA,” Rheumatology International, vol. 29, no. 9, pp. 1013–1016, 2009.
[15]
M. N. Mishra and V. Singal, “Human leukocyte antigen B27 in 453 Asian Indian patients with seronegative spondyloarthropathy,” Iranian Journal of Immunology, vol. 7, no. 4, pp. 252–256, 2010.
[16]
P. I. Terasaki and J. D. McClelland, “Microdroplet assay of human serum cytotoxins,” Nature, vol. 204, no. 4962, pp. 998–1000, 1964.
[17]
R. Pei, M. Arjomand-Shamsai, C. T. Deng, A. Cesbron, J. D. Bignon, and J.-H. Lee, “A monospecific HLA-B27 fluorescein isothiocyanate-conjugated monoclonal antibody for rapid, simple and accurate HLA-B27 typing,” Tissue Antigens, vol. 41, no. 4, pp. 200–203, 1993.
[18]
J. Neumuller, D. W. Schwartz, E. Dauber, and W. R. Mayr, “Evaluation for four monoclonal antibodies against HLA-B27 for their reliability in HLA-B27 typing with flow cytometry (FC): comparision with the classic microlymphocytotoxic test (MLCT),” Cytometry, vol. 26, pp. 209–215, 1996.
[19]
O. Dominguez, E. Coto, E. Martinez-Naves, S. Y. Choo, and C. Lopez-Larrea, “Molecular typing of HLA-B27 alleles,” Immunogenetics, vol. 36, no. 5, pp. 277–282, 1992.
[20]
O. Olerup, “HLA-B27 typing by a group-specific PCR amplification,” Tissue Antigens, vol. 43, no. 4, pp. 253–256, 1994.
[21]
T. Wagner, C. Oberkanins, B. Weinmayr, W. Helmberg, F. Kury, and G. Lanzer, “HLA-B*27 typing by group-specific hybridization in microtiter plates,” Tissue Antigens, vol. 52, no. 2, pp. 175–178, 1998.
[22]
J. Kirveskari, H. Kellner, M. Wuorela et al., “False-negative serological HLA-B27 typing results may be due to altered antigenic epitopes and can be detected by polymerase chain reaction,” British Journal of Rheumatology, vol. 36, no. 2, pp. 185–189, 1997.
[23]
S. van der Linden, H. A. Valkenburg, and A. Cats, “Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria,” Arthritis and Rheumatism, vol. 27, no. 4, pp. 361–368, 1984.
[24]
M. Rudwaleit, D. van der Heijde, R. Landewé et al., “The Assessment of SpondyloArthritis international Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general,” Annals of the Rheumatic Diseases, vol. 70, no. 1, pp. 25–31, 2011.
[25]
B. Kulkarni, D. Mohanty, and K. Ghosh, “Frequency distribution of human platelet antigens in the Indian population,” Transfusion Medicine, vol. 15, no. 2, pp. 119–124, 2005.
[26]
O. Nathalang, S. Tantimavanich, K. Nillakupt, P. Arnutti, and C. Jaruchaimontree, “HLA-B27 testing in Thai patients using the PCR-SSP technique,” Tissue Antigens, vol. 67, no. 3, pp. 233–236, 2006.
[27]
M. Schaffer and O. Olerup, “HLA-AB typing by polymerase-chain reaction with sequence-specific primers: more accurate, less errors, and increased resolution compared to serological typing,” Tissue Antigens, vol. 58, no. 5, pp. 299–307, 2001.