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The HLA-A, B and DR phenotypes of 109 unrelated Tunisian individuals have been determined. The HLA-A and B antigen frequencies were compared with data reported for European Caucasoids and various Arab populations. Most similarities in antigen frequencies were seen between Tunisians and Kabyles from North Africa. A high frequency of HLA-A23 and HLA-Bw50 was observed in Tunisians and all Arab populations. A very close similarity in HLA-DR antigen frequencies exists between Tunisians and European Caucasoids. Linkage disequilibria between alleles of HLA loci were examined; many instances of previously reported antigen associations were seen in Tunisians, together with a number of associations which have not been described elsewhere. Aw34B8 and A2DRw14 are suggested as being common haplotypes in Tunisians.

Polymorphism of the gene encoding components of the renin-angiotensin-aldosterone synthase system (RAAS) represents an area of intense research of cardiovascular disease associations. Numerous studies have addressed the role of RAAS gene polymorphisms in the development and progression of renal disease. Also, it has been reported that patient with ACE (DD) and angiotensinogen AGT (TT) genotypes are associated with chronic allograft dysfunction (CAD). We investigated the effects of gene polymorphisms of the renin-angiotensin-aldosterone system in renal transplant patients (81 males and 50 females; mean age 29.6+/-10.2 years). Genotypes were determined using polymerase chain reaction sequence specific primers and PCR followed by RFLP analysis. Renal allograft recipients with chronic allograft dysfunction had significantly higher frequencies of the MM genotype than those without CAD (P0.05). The other genetic polymorphisms of the RAAS were not associated with CAD. This study proves that determination of AGT M235T genotype before transplantation may help identify patients who are at risk for chronic renal transplant dysfunction.

The aim of this study is to define a reliable reckoning of gene frequencies and six-locus haplotypic frequencies of HLA-A, HLA-B, HLA-C, HLA-DRB1, HLA-DQA1, HLA-DQB1 and HLA-DPB1 in the Tunisian population. One hundred unrelated random, healthy people originating from various parts of Tunisia were typed for the alleles of the loci mentioned above by using the molecular techniques polymerase chain reaction – hybridization with oligonucleotide probe (PCR-SSO) and sequence specific primers (SSP). The population studied appeared to be in Hardy–Weinberg equilibrium. Allelic frequency distributions were observed at each locus. The most frequent HLA-A alleles were HLA-A*02 (39%) HLA-A*0101 (25%), HLA-A*30 (21%) and HLA-A*2301 (18%). Moreover, HLA-3A*3601, HLA-1A*6601, HLA-1A*3402 and HLA-2A*8001 were found; however, no HLA-A*4301 was detected. For the HLA-B locus, the most common in descending order were HLA-B*44 (22%), HLA-B*5001 (19%), HLA-B*51 (16%) and HLA-B*18 (15%). Among the 28 alleles HLA-Cw detected, HLA-Cw*6 and HLA-Cw*7 were highly predominant with the frequencies of 33 and 30%, respectively. For the HLA class-II loci, HLA-DRB1*0701, HLA-DRB1*11, HLA-DRB1*13 and HLA-DRB1*03 were the most frequent DR alleles. For the HLA-DPB1, HLA-DPB1*0401, HLA-DPB1*0301 and HLA-DPB1*0201 were the most frequent DP alleles. Many haplotypes were in a strong positive-linkage disequilibrium. The most frequent haplotypes for HLA-A, HLA-B, HLA-C and HLA-DRDQ were HLA-A*3301, HLA-B*1402, HLA-Cw*0802, HLA-DRB1*0102, HLA-DQA1*0101 and HLA-DQB1*0501; HLA-A*2402, HLA-B*0801, HLA-Cw*0702, HLA-DRB1*0301, HLA-DQA1*0501 and HLA-DQB1*0201; HLA-A*2902, HLA-B*4403.1, HLA-Cw*1601, HLA-DRB1*0701, HLA-DQA1*0201 and HLA-DQB1*0202; HLA-A*3002, HLA-B*1801, HLA-Cw*0501, HLA-DRB1*0301, HLA-DQA1*0501 and HLA-DQB1*0201, with frequencies between 0.025 and 0.015. These data can be used as control data for HLA disease associations and paternity studies, but they are also important for the evaluation of the probability rate of success in determining the optimal matched donor in unrelated stem transplantation for Tunisian patients or patients of Tunisian origin.

Late loss of kidney allograft, caused by immunological and non-immunological factors, remains a major problem in the field of transplantation. The aim of this study was to analyze the risk factors affecting long-term kidney graft survival more than 15 years. In a retro-spective analysis, clinical and laboratory variables and outcome of 330 patients who received a kidney transplant from living or cadaveric ABO-compatible donors at the Charles Nicolle Hospital, Tunis between 1986 and 2005 were recorded. A total of 58 patients who had follow-up data longer than 15 years constituted the subjects of this study. Patients were classified into two groups: Group I (Gp I), those who had kidney graft survival more than 15 years and Group II (Gp II), those who had kidney graft survival less than 15 years. There were 27 patients in Gp I (46.5%) and 31 in Gp II (53.5%). Graft loss in Gp II patients occurred in the first year in 15.1%, at three years in 35.5 %, at five years in 71 % and at 10 years in 83.9 %. The cause of graft loss was chronic graft dysfunction in 24 cases (77.4%), recurrence of the original kidney disease in three and graft versus host disease, urinary fistula, vascular rejection and graft rupture in one case each. There was no statistically significant difference between recipient and donor age or sex, duration on dialysis, number of acute rejections and infections between the two groups. Eleven of 27 patients (40.7 %) in Gp I and eight of 31 patients (25.8 %) in Gp II received total mismatched kidneys while the others received kidneys with varying degrees of match. The HLA DR2 matching was higher in Gp I (44.4 %) than in Gp II (29 %), whereas DR3 matching was higher in Gp II (45.2 %) in comparison with Gp I (11.1 %). Cross-match was negative in all our patients. Thirteen patients (48.1%) in Gp I and 17 (54.8 %) in Gp II.had a history of having episode(s) of acute rejection The number of acute rejection episodes did not contribute significantly to long-term graft survival in our series. Delayed graft function significantly lowered long-term graft survival; it was seen in seven cases in Gp I (25.9 %) versus 23 cases in Gp II (74.2 %) (X2=13.46). In our study, the long-term graft survival was similar to what is reported from developed countries. The main risk factors were HLA DR matching and delayed graft function.

Interleukin-6, a potent pro-inflammatory cytokine, might be involved in Behçet's disease (BD) pathological pathways. We investigated IL-6 levels in sera and synovial fluids collected from BD patients. The IL-6 production was also studied in vivo, by measuring its activity in culture supernatants of PBMC and alveolar macrophages, stimulated or not with LPS. The patients with BD were compared to RA patients and healthy controls. High IL-6 levels were observed in sera, synovial fluid and LPS stimulated PBMC supernatants, from active BD patients, similar to those of RA patients. Alveolar macrophages production of IL-6 was significantly elevated in two active BD patients with an interstitial pneumonia, when compared to controls. These elevated levels of IL-6 suggest its involvement in the inflammatory sites of BD, which may be related to the progression of the acute lesions, at least in the joints and in the lungs.

Twenty-five Tunisian families were analyzed for their complement alleles in order to detect duplications at the C4 loci. In this population, the most characteristic duplications are C4A2, B1.12 or C4A1, B1,12 always associated with BFS07 and C2C. This previously undescribed C4B1,12 duplication was found in seven families, five times in association with HLA-A2, B50.

The C3, BF, C4A and C4B polymorphisms were studied in a Tunisian population sample. The allelic frequencies for C3 were S = 0.844 and F = 0.148, and for BF, S = 0.535, F = 0.331, SO7 = 0.075 and F1 = 0.041. The most frequent C4 alleles were A3 and B1 followed in a decreasing order by A2, B2 and the A and B null alleles. The results indicate that the Tunisian population is intermediate between the Caucasian and Arab populations with some trace admixture of African Blacks.