Neurol Neuroimmunol Neuroinflamm 2019 Nov 12;6(6). Epub 2019 Aug 12.
From the Service of Neurology (C.G., A.I., J.S.), Hospital Clinic, Barcelona, Spain; Multidisciplinary Sleep Disorders Unit (C.G., A.I., J.S.), Hospital Clinic, Barcelona, Spain; Department of Immunology (G.E., E.P.), Hospital Clínic, Barcelona, Spain; Institute of Biotechnology and Biomedicine (X.D.), Universitat Autònoma de Barcelona, Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA) (X.D., J.D.), Barcelona, Spain; Laboratory of Parkinson Disease and Other Neurodegenerative Movement Disorders (M.E., R.F.-S.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Neuroimmunology Program (L.S., J.D., F.G.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Institute of Neurology (R.H.), Medical University of Vienna, Austria; Institute for Sleep Medicine and Neuromuscular Disorders (A.H.), University Hospital Muenster, Muenster, Germany; Department of Neurology (B.H.), Medical University of Innsbruck, Innsbruck, Austria; and Department of Neurology (J.D.), University of Pennsylvania, Philadelphia, PA.
Objectives: We investigated the associations with HLA and microtubule-associated protein tau () H1 haplotype in anti-IgLON5 disease, a recently identified disorder characterized by gait instability, brainstem dysfunction, and a prominent sleep disorder in association with IgLON5 antibodies and pathologic findings of a novel neuronal-specific tauopathy.
Methods: We compared the HLA alleles and H1/H1 genotype of 35 patients with anti-IgLON5 with healthy controls. The on-line server tool NetMHCIIpan 3.1 was used to predict the IgLON5 peptide binding to HLA Class II molecules.
Results: The HLA-DRB1*10:01-DQB1*05:01 haplotype was overrepresented in patients with anti-IgLON5 disease (OR = 54.5; 95% CI: 22.2-133.9, < 0.0001). In addition, HLA-DQA was genotyped in 27 patients, and 25 (92.6%) of them had DQ molecules composed by DQA1*01 and DQB1*05 chains compared with 148/542 (27.3%) controls (OR = 43.9; 95% CI: 10.4-185.5, < 0.0001). Patients DRB1*10:01 positive developed more frequently sleep or bulbar symptoms than those carrying other HLA alleles (70.0% vs 26.7%; = 0.011). Prediction algorithms identified 2 IgLON5 peptides (1 located in the signal sequence) that showed strong binding to HLA-DRB1*10:01 and other HLA-DRB1, but not to HLA-DQA and HLA-DQB molecules. The H1/H1 homozygous genotype was present in 20/24 (83.3%) anti-IgLON5 Caucasian patients compared with 54/116 (46.5%) healthy controls ( = 0.0007).
Conclusions: The robust association of anti-IgLON5 disease with distinct HLA Class II molecules supports a primary autoimmune origin. The significant association of H1 haplotype also suggests that an underlying neurodegenerative process could be involved in anti-IgLON5 disease.