Search

SummaryObjective Non-classic congenital adrenal hyperplasia (NCAH) is common among Ashkenazi Jews (1:400). It is associated with various degrees of postnatal virilization, irregular menses and infertility. Therapy of symptomatic subjects consists of physiologic doses of glucocorticoids. The objective of this study was to evaluate the effect of glucocorticoid treatment on fertility and on pregnancy outcome in women with NCAH. Design, Setting and Patients This retrospective study included 75 women diagnosed with NCAH who were followed in our clinic and sought fertility between 2008 and 2015. Results Seventy-two women succeeded in conceiving (187 pregnancies). Time to conception was 4.0±7 months without and 3.3±3 months with glucocorticoid therapy (P=0.43). Seventeen pregnancies were achieved by glucocorticoid therapy after failure to conceive spontaneously. Time to conception before therapy initiation was 10.2±11.4 months compared to 3.3 ± 3.4 months after therapy initiation (P=0.02). Out of 187 pregnancies, 135 (72%) resulted in live births, 38 (20.3%) ended in spontaneous miscarriages during the first trimester, 7 (3.7%) were electively terminated, 3 (1.6%) were ectopic, and 4 (2.1%) were ongoing during the study with similar rate in glucocorticoid treated and untreated pregnancies. Conclusions The 96% pregnancy rate among our cohort of NCAH females was similar to the 95% rate reported for the normal population. Glucocorticoid therapy may shorten the time to conceive in a subgroup of women with NCAH. Glucocorticoid therapy did not affect the rate of first trimester miscarriage. Our 77% live birth rate was similar to the 72% live birth rate in the current healthy US population This article is protected by copyright. All rights reserved.

Between 2008 and April 2018, we recruited more than 37 000 potential Arab donors to the Hadassah Bone Marrow Donor Registry, all of whom were typed for high resolution HLA-A, -B, and -DRB1. In addition, more than 22% of them were also typed for their HLA-C and -DQB1 alleles. A comparison of the sequences obtained from these donors with the IPD-IMGT/HLA Database showed 33 novel alleles from five loci (HLA-A, -B, -C, -DR, -DQ). All of these novel HLA alleles were detected in the local Arab communities; 79% of these alleles have not been described in other groups yet and remain unique to the local Arab communities.

Five locus allele-level HLA-A, -B, -C, -DRB1, -DQB1 allele and haplotype frequencies have been calculated for almost 29,000 people from three Arab populations that live in Israel and were recruited as donors to the Hadassah bone marrow donor registry. These groups are of Muslim, Christian and Bedouin Arab descent which represent more than 90% of the Arabs that live in Israel. The goal of the study was to describe the HLA genetic profiles of the Hadassah Arab registry donors and investigate the utility of these donors for the local and international hematopoietic stem-cell transplant community. The results demonstrate that the analyzed Arab populations share at least seven of the top ten most frequent alleles. Comparison with other populations confirmed the proximity of the three Arab populations to each other and to the Be The Match® Middle Eastern population. Despite these similarities, some alleles are private to each of the three groups, possibly because of historical, environmental or societal events. Clinical data showed that Arab donors were HLA matched with Arab and international patients. This analysis indicates the value added by the Hadassah Arab donors to the local and global transplant community.

Genetic variation can affect drug pharmacokinetics and pharmacodynamics and contribute to variability between individuals in response to medications. Specifically, differences in allele frequencies among individuals and ethnic groups have been associated with variation in their propensity to develop drug hypersensitivity reactions (HSRs). This article reviews the current knowledge on the genetic background of HSRs and its relevance to Jewish and Arab populations. The focus is on human leukocyte antigen (HLA) alleles and haplotypes as predictive markers of HSRs ("immunopharmacogenetics"), but other genes and alleles are described as well. Also discussed is the translation of the pharmacogenetic information to practice recommendations.

The human leukocyte antigen (HLA) alleles B*15:02 and A*31:01 have been identified as predictive markers of adverse cutaneous effects of carbamazepine and phenytoin in Asian and North European populations, respectively. Our aim was to estimate the distribution of these alleles in Jewish and Arab populations in Israel. The HLA-B*15:02 and HLA-A*31:01 carrier rate was estimated based on data from the Hadassah Bone Marrow Registry. Data on Stevens-Johnson syndrome (SJS)- and toxic epidermal necrolysis (TEN)-related hospitalizations were obtained from the Israeli Ministry of Health (MOH) registries and from four Israeli medical centers. Of 83,705 Jewish and Arab-Muslim donors, 81 individuals of known origin carried the HLA-B*15:02. Among them, 66 were Jews of India-Cochin descent. Of the Cochin Jewish donors, 12.7% were B*15:02 carriers. HLA-A*31:01 carrier incidence among Arab and Jewish Israeli populations (3.5% and 2.2%, respectively) was within the range reported in other countries. We did not identify SJS- or TEN-related hospitalizations of Jews of Indian descent. Yet, this population should be considered at greater risk for antiepileptic drug-induced SJS and TEN. Until further data on actual risk are available, such patients should be typed for HLA-B before treatment with carbamazepine or phenytoin.

The pharmacogenetics approach to screen for the presence of the HLA-B*57:01 allele in HIV-1 infected patients is mandatory to prevent the potential development of hypersensitivity reaction to abacavir treatment. Given the limitations of current genotype methodologies, commercial real-time PCR assays were specifically developed for this purpose, but have not been sufficiently validated and are still not widely used. Here, in the context of the HIV laboratory, we assessed the ability of two commercial kits, the LightSNiP rs2395029 HPC5 assay (TIB Molbiol) and the DuplicαReal-Time HLA-B*5701 Genotyping kit (Euroclone), to retrospectively detect HLA-B*57:01 positive and negative samples of Israeli HIV-1 infected patients. The LightSNiP rs2395029 HPC5 assay had false-positive results, whereas the DuplicαReal-Time HLA-B*5701 Genotyping kit was highly accurate and could be readily implemented into clinical practice. It is hoped that this study will facilitate the assessment of additional commercial kits for HLA-B*57:01 detection and expand their use in the clinical laboratory. Such studies can likely help the use of abacavir treatment in HIV-1 infected patients.

Background Osteopetrosis is a life-threatening, rare disorder typically resulting from osteoclast dysfunction and infrequently from failure to commitment to osteoclast lineage. Patients commonly present in infancy with macrocephaly, feeding difficulties, evolving blindness and deafness, and bone marrow failure. In ∼70% of the patients there is a molecularly defined failure to maintain an acid pH at the osteoclast-bone interface (the ruffled border) which is necessary for the bone resorptive activity. Methods and results In eight patients with infantile osteopetrosis which could be cured by bone marrow transplantation, the study identified by homozygosity mapping in distantly related consanguineous pedigrees a missense mutation in a highly conserved residue in the SNX10 gene. The mutation segregated with the disease in the families and was carried by one of 211 anonymous individuals of the same ethnicity. In the patients' osteoclasts, the mutant SNX10 protein was abnormally abundant and its distribution altered. The patients' osteoclasts were fewer and smaller than control cells, their resorptive capacity was markedly deranged, and the endosomal pathway was perturbed as evidenced by the distribution of internalised dextran. Conclusions SNX10 was recently shown to interact with vacuolar type H+-ATPase (V-ATPase) which pumps protons at the osteoclast-bone interface. Mutations in TCIRG1 , the gene encoding a subunit of the V-ATPase complex, account for the majority of cases of osteopetrosis. It is speculated that SNX10 is responsible for the vesicular sorting of V-ATPase from Golgi or for its targeting to the ruffled border. A mutation in SNX10 may therefore result in ‘secondary V-ATPase deficiency’ with a failure to acidify the resorption lacuna. Determination of the sequence of the SNX10 gene is warranted in molecularly undefined patients with recessive ‘pure’ osteopetrosis of infancy.

The Jewish diaspora can be viewed as a natural process in population dispersion and differentiation. We extend genetic studies on the Jewish diaspora to an analysis of human leukocyte antigen (HLA) haplotype distributions in the Jewish peoples, and show the value of this information for the design of Jewish marrow donor registries. HLA data from the Hadassah Bone Marrow Registry having parental country-of-origin information comprise samples of geographically discrete regions. We analyzed the HLA allele and haplotype frequencies for each national sample using population genetic and clustering methods. Population differentiation among diaspora populations was shown on the basis of HLA haplotype frequencies, including differences within the more recently diverged European groups. A method of haplotype and population clustering showed patterns of unique haplotype affinities associated with specific Jewish populations. The evidence showed that diaspora Jewish populations can be sorted into distinct clades of which the Ashkenazi are but one. Relationships among Jewish populations are interpretable in light of the historical record. We suggest that a major contributing factor to the genetic divergence between Jewish groups may have been admixture with local host populations, while, at the same time, threads of Eastern Mediterranean ancestry remain evident.

This study examined a possible association of the insulin (INS) gene with type 1 diabetes (T1D) in patients and controls from four ethnic groups in Israel. We analyzed the distribution of -23HphI single nucleotide polymorphism (SNP) T/A alleles that correspond to INS variable number of tandem repeat short class I alleles (26-63 repeats) and class III alleles (141-209 repeats), respectively. The -23HphI T/T genotype was found to be positively associated with T1D in three Jewish groups (Yemenites: 93.9% patients vs 68.8% controls, P = 0.0002; Ashkenazi: 80.6% vs 50.8%, P < 10(-4); Ethiopians: 75% vs 40.5%, P = 0.002). The Yemenite healthy controls have the highest frequency of T allele from all Jewish groups studied (83.5% vs 68.8% in Ashkenazi and 64.3% in Ethiopians). The high frequency of a susceptibility allele in the Yemenites is in line with the high incidence of T1D in this population. No association was observed between T1D and the INS gene in Israeli Arabs studied (70.6% vs 66.7%). Variable incidence of T1D among different ethnicities in Israel is largely attributed to heterogeneous genetics. Human leukocyte antigen (HLA) results of our previous studies describing the susceptibility and protective haplotypes were used for combined analysis to determine possible interaction between the HLA and INS loci. Only in the Ashkenazi group such interaction was presented with statistical significance.

The direct involvement of the human leukocyte antigen class II DR-DQ genes in type 1 diabetes (T1D) is well established, and these genes display a complex hierarchy of risk effects at the genotype and haplotype levels. We investigated, using data from 38 studies, whether the DR-DQ haplotypes and genotypes show the same relative predispositional effects across populations and ethnic groups. Significant differences in risk within a population were considered, as well as comparisons across populations using the patient/control (P/C) ratio. Within a population, the ratio of the P/C ratios for two different genotypes or haplotypes is a function only of the absolute penetrance values, allowing ranking of risk effects. Categories of consistent predisposing, intermediate ('neutral'), and protective haplotypes were identified and found to correlate with disease prevalence and the marked ethnic differences in DRB1-DQB1 frequencies. Specific effects were identified, for example for predisposing haplotypes, there was a statistically significant and consistent hierarchy for DR4 DQB1*0302s: DRB1*0405 =*0401 =*0402 > *0404 > *0403, with DRB1*0301 DQB1*0200 (DR3) being significantly less predisposing than DRB1*0402 and more than DRB1*0404. The predisposing DRB1*0401 DQB1*0302 haplotype was relatively increased compared with the protective haplotype DRB1*0401 DQB1*0301 in heterozygotes with DR3 compared with heterozygotes with DRB1*0101 DQB1*0501 (DR1). Our results show that meta-analyses and use of the P/C ratio and rankings thereof can be valuable in determining T1D risk factors at the haplotype and amino acid residue levels.

Summary The distribution of HLA class II alleles and genotypes in Israelis of different ethnic origin with adult-onset type 1 diabetes (T1D) was examined. The results were compared with published findings in healthy Israelis and childhood-onset T1D Israelis. An additional comparison was made between subgroups of patients with rapidly and slowly progressive adult-onset T1D (LADA). A DNA-based low-resolution analysis was performed for DRB1 * and DQB1 * alleles and a high-resolution analysis for DRB1*04 and DQB1*1 alleles. In all, 87% of the study group was positive for DRB1*03 or DRB1*04 compared with 36% of the healthy controls. The main alleles accounting for susceptibility to T1D were DRB1*0402 , found in 77.9% of carriers of DRB1*04 and DQB1*0302 , found in 74.6% of carriers of DQB1*03 . The DQB1*0602 was not detected in any patient. The distribution was similar to that reported in Israeli children with T1D and significantly different from healthy Israelis. There was no significant difference in the distribution of HLA class II alleles between patients with rapidly progressive T1D or LADA. It may be concluded that the different ages of onset of T1D and its different forms of development in Israeli patients are apparently not caused by a different prevalence of HLA class II alleles.

The interrelationship between human leukocyte antigen immunogenetics and environmental factors and their contribution to the emergence of type 1 diabetes (T1D) were studied in Jewish immigrants from Ethiopia in Israel. This community displays high incidence of T1D, and is unique both by its ethnic segregation and its rapid exposure to a new environment after the immigration. The study population consisted of 152 Ethiopian Jews living in Israel, 33 with T1D and 119 unrelated controls. Human leukocyte antigen class II susceptible and protective alleles in the Jewish Ethiopian patients were similar to those in patients of other ethnic groups in Israel and in non-Jewish Ethiopian patients, with a few exceptions. Three haplotypes were markedly associated with diabetes in Jewish Ethiopian patients: DRB1*0301 DQA1*05 DQB1*02 (OR 4.4, p < 0.001); DRB1*0404 DQA1 03 DQB1*0302 (OR 19.2, p = 0.006), and DRB1*0405 DQA1*03 DQB1*0302 (OR 87.8, p < 0.001). The highly susceptible allele DRB1*0301 was more common in the general Ethiopian population (25.2%) than in all other ethnic groups in Israel, which may render this community prone to the disease. The age at onset of disease in patients with two susceptible haplotypes was negatively correlated with the duration of living in Israel (r = -0.621, p = 0.04). We concluded that ongoing exposure of genetically predisposed immigrants from Ethiopia to diabetogenic environmental factors eventually leads to a high incidence of overt diabetes in this ethnic group.

Nonclassical 21-hydroxylase deficiency (NC21OHD) manifests with various degrees of post natal virilization. The length of CAG repeats of the androgen receptor gene (AR) is inversely correlated to activity of the human androgen receptor (AR) and affects phenotype of several androgen-dependent disorders. The aim of the study was to investigate the associations between CAG repeat length and the phenotype of females with NC21OHD. CAG repeat length and AR inactivation were assessed in females with NC21OHD, and related to their clinical presentation. CAG repeat length and AR inactivation were assessed in 119 females with NC21OHD. Biallelic mean (BAM) of the CAG repeat length and the weighted BAM (WBAM) were related to various clinical parameters. Age at diagnosis and age of menarche positively correlated with BAM (r=0.22, p=0.02, and r=0.23, p=0.01, respectively). A shorter (25) BAM was associated with younger age at diagnosis (14.8 vs. 21.4 years, p0.01), at adrenarche (8.1 vs. 10.2 years, p0.01) and gonadarche (9.9 vs. 11.2 years, p0.01), and higher corrected height standard deviation score at diagnosis (0.77 vs. 0.15, p=0.01). Precocious pubarche and precocious puberty were more frequent in these with the shorter BAM. Results of WBAM were similar. The CAG repeat length of the AR gene contributes to the clinical diversity of the phenotype in females with NC21OHD.

The distribution of HLA class II alleles and genotypes in IDDM patients was examined in the three main Israeli ethnic groups: Ashkenazi Jews, non-Ashkenazi Jews, and Arabs. Molecular sequence specific oligonucleotide probe analysis was performed for DRB1, DQA1, and DQB1 genes. The DRB1∗03011, DQA1∗05 DQB1∗02/DRB1∗0402, DQA1∗03, DQB1∗0302 genotype was found to be the main susceptibility genotype in all three groups, with differences in the degree of association. In addition to DRB1∗0402 (more frequent among Ashkenazi Jews), DRB1∗0405, another subtype of DRB1∗04, was found to be more prevalent among non-Ashkenazi Jews and Arabs. Many alleles were found to be negatively associated with insulin dependent diabetes mellitus (IDDM). This could be a result of the high frequency of susceptible alleles, or of linkage disequilibrium to a primary negatively associated allele. The strongest negative association was observed for DQB1∗0301 in all three ethnic groups. The alleles DRB1∗1401, DRB1∗1501, DQB1∗05031, DQB1∗0602, and DQB1∗0609 were not detected in any of the 202 IDDM patients, and are probably either strongly protective or in linkage with such alleles. Despite the differences found between the three ethnic groups, an overall analysis shows that the DRB1∗04 alleles that account for susceptibility to IDDM in the Israeli population (DRB1∗0402 and ∗0405) are the same as those responsible for susceptibility to IDDM in a number of other Mediterranean populations. In contrast, the susceptible allele in most Caucasian populations is DRB1∗0401. It is noteworthy that the susceptible alleles DRB1∗0402/05 for Mediterranean and DRB1∗0401 for Caucasian populations are also frequent in the respective healthy populations. These findings support the results obtained in other studies, which point to a genetic relationship between the Israeli and Mediterranean populations.

A genetic factor contributing to multiple sclerosis (MS) disease risk is evident by the increased prevalence of disease among siblings of probands. A recent genome screen on Canadian sib pairs suffering from MS identified linkage between the genetic marker D6S461 and MS, and showed disequilibrium in transmission of its 260-bp allele from heterozygous parents to affected siblings (Ebers et al., 1996). The present study examined the allelic segregation of this marker among MS patients of Iraqi Jewish and Ashkenazi origin, two homogeneous ethnic groups that differ considerably from Caucasians. The frequency of the 260-bp allele reached 28.3% among Iraqi MS patients (n = 30) and 25.2% among the Ashkenazi patients (n = 121) compared with 19.6% (n = 28) and 21.3% (n = 115) in respective origin-matched controls (for the combined data set, p = 0.18). A secondary analysis of the frequency of the 260-bp allele in clinical subgroups showed a frequency of 38.1% among patients with juvenile MS (i.e., onset by 21 yr of age) of Ashkenazi origin (n = 21, p = 0.019) and 38.8% in the combined pool (n = 27, p = 0.0045). Most (90%) of the juvenile MS patients belonged to the relapsing-remitting subgroup, which itself showed a frequency of 28.5% of the 260-bp allele (n = 121, p = 0.045). The results suggest that the D6S461 region may contain a locus contributing to an early onset of relapsing-remitting MS.

Mycoplasmas have been incriminated in setting the stage for HIV infection and full-blown AIDS. We tested the possible involvement of mycoplasmas in activation of HIV. Two cell lines, 293 fibroblasts and Jurkat CD4+ T-cells, transfected with plasmids harboring a transcription fusion construct between HIV-long terminal repeat (HIV-LTR) and either luc or cat genes, were infected with several mycoplasmas (M. fermentans; M. penetrans, M. pirum and Ureaplasma urealyticum) and the reporter gene expression was monitored. The data presented here suggest that mycoplasmas, and specifically their membranes, play a role in the activation of HIV-LTR mediated transcription.

HTLV-1 transcription depends upon activation by the HTLV-1 tax gene product. In addition, various substances and cellular transcription factors are also known to activate the HTLV-1 long terminal repeat (LTR)-mediated transcription in the absence of Tax. In this work we demonstrate that infection of either Jurkat or 293 cell lines with herpes simplex I (HSV-1), a widespread infectious virus of humans, activates HTLV-1 LTR-mediated gene expression. Further investigation revealed that each of the immediate-early (IE) gene products--ICPO, ICP4, and ICP27--of HSV-1 transactivates the HTLV-1 LTR-mediated gene expression in the absence of Tax. The HSV-1 activation is additive to Tax activation in its presence in the cell. Three 21 base repeats upstream of the TATA box are known as the TAX responsive elements (TRE). Recombinant HTLV-1 minimal promoter composed of the HTLV-1 TATA box fused to a synthetic 21 base TRE is responsive to Tax but not to HSV-1 activation. It thus can be concluded that HSV-1 IE gene products and Tax transactivates HTLV-1 LTR mediated gene expression through different transcription complexes. The results presented in this work may point to one possible way for the transition of HTLV-1 from a quiescent to an actively replicating stage.

Different multiple sclerosis (MS) prevalence rates were reported for Muslim and Christian Arabs in Israel. In this study, we evaluated whether associations of human leukocyte antigen (HLA) genes with MS may contribute to this prevalence difference. DNA samples from Israeli Arab MS patients (n=109) and controls (n=132) were typed for HLA class I (HLA-A, -B and -C) and II (HLA-DRB1 and -DQB1) genes. Global comparisons of HLA allele frequencies revealed significant differences between Christians and Muslims; therefore, case-control analyses were stratified by religious affiliation. Disease characteristics of Muslim and Christian Arab MS patients were similar to those reported for European populations. Opposing association signals with MS were observed for alleles composing the DRB1*0301-DQB1*0201 haplotype: positive association of the HLA-DRB1*0301 allele in Muslims (P(Bonferroni)=0.004, odds ratio (OR)=3.07), and negative association in Christian Arabs (P(Bonferroni)=0.01, OR=0.12), with similar results obtained for HLA-DQB1*0201. HLA-B*52 was negatively associated with MS only in Muslims (P(Bonferroni)=0.01, OR=0.03). The study presents for the first time a high-resolution HLA gene analysis in clinically well-characterized Arab populations with MS, and shows the population-specific contribution of the DRB1*0301-DQB1*0201 haplotype to disease susceptibility.

Background: Altered iron metabolism and transferrin expression were associated with neurodegenerations including age-related macular degeneration (AMD) and Alzheimer’s disease (AD). Carriers of transferrin C2 allele alone or in combination with the hemochromatosis C282Y variant may have increased risk for developing AD. We aim to assess if these alleles also predispose to AMD.Methods: DNA was collected from 290 AMD patients and 157 unaffected, age-matched, controls. Genotyping was performed for transferrin C1/C2 alleles and hemochromatosis C282Y allele, and association with AMD was evaluated.Results: There was no association between the C1/C2 transferrin alleles and AMD. Hemochromatosis C282Y variant was identified in four individuals; one was an AMD patient and three were unaffected.Conclusion: Transferrin C2 and hemochromatosis C282Y alleles are not associated with increased risk for developing AMD in Israel.

WOS: 000274578300015, PubMed ID: 19718570, The prevalence of non-classic adrenal hyperplasia (NCAH) among Turkish women with hirsutism has not been established so far. Thus, we aimed to evaluate the prevalence of 21-hydroxylase (21-OH) deficiency by ACTH stimulation test among hirsute women. The study population consisted of 285 premenopousal women, aged 16-46 years (mean: 23.2 +/- 0.3). All were hirsute and hyperandrogenic. Androgen secreting tumors of the ovaries and the adrenal glands were excluded as well as thyroid dysfunction and hyperprolactinemia. All the patients were evaluated by 0.25 mg (i.v.) ACTH stimulation test and 17-OHP responses were obtained at 30 and 60 min. The diagnosis of NCAH due to 21-OH deficiency was considered in patients with the poststimulation 17-OHP level exceed 10 ng/ml. Six (2.1%) of the patients had NCAH due to 21-OH deficiency confirmed by genotyping. The rest of the patients were polycystic ovary syndrome (n = 166, 58.2%) and idiopathic hyperandrogenemia (n = 113, 39.7%). There were no patients with idiopathic hirsutism because patients with normal serum androgen levels were excluded. This first and most extensive national study investigating NCAH prevalence among Turkish population showed that NCAH is not prevalent in this population., The Scientific and Technical Research Council of Turkey, TUBITAK [SBAG-3170], This study was supported by The Scientific and Technical Research Council of Turkey, TUBITAK, (SBAG-3170).

BACKGROUND The mechanisms involved in the immune resistance to fungal infection of the skin are not well understood. We assessed the levels of the various lymphocyte subsets, the HLA haplotypes, the expression of various receptors on natural killer (NK) cells and the serum levels of cytokines, in a family in which four siblings had tinea corporis, while four others were healthy, in order to reveal potential factors of susceptibility to dermatophytes. OBSERVATIONS Normal numbers of T, B and NK cells were found in the peripheral blood, without significant differences between healthy and infected siblings. The frequency of CD14-positive monocytes was elevated in infected compared with healthy siblings. The proportion of NKG2A(+) NK cells was reduced in the patients compared with healthy siblings (23.8% vs. 33.8%), whereas CXCR3(+) NK cells were increased (41.5% vs. 25.6%, respectively). MHC class I and class II haplotypes were disease independent. Elevated levels of intereron-gamma, interleukin-8 (IL-8), IL-2 and tumour necrosis factor-alpha (TNFalpha) were observed only in part of the infected siblings. The serum level of TNFalpha was strongly correlated with the percentage of CD14(+) monocytes. CONCLUSIONS We studied here in detail the NK functions of a family of patients suffering from tinea corporis and observed skewed frequencies of specific NK receptors, which imply possible involvement of NK cells in susceptibility to fungal infection.

The V281L mutation in the CYP21 gene, responsible for non classical CAH, was studied in patients of different Israeli ethnic groups and compared to the data on healthy population. The Israeli population consists of many ethnic groups which can be divided into three main entities: Ashkenazi, Non Ashkenazi and Israeli Arabs. The frequency of V281L mutation in the patients of the different ethnic groups varied and was a reflection of the frequency found in the healthy population namely: very high in the Ashkenazi (74%) , lower in the non Ashkenazi (39%) and very low in the Israeli Arabs (2.9%) . The phenomenon of strong association between the HLA B14 allele and the V281L mutation found in our population study, as well as in other studies, confirmed by linkage found in patient families, can be used to distinguish between homozygote and hemizygote carrying the V281L mutation, when no family study is available. The relevance of this finding is especially important in cases of genetic counseling when a carrier of a severe mutation is involved.

Contains fulltext : 52276.pdf (Publisher’s version ) (Closed access) Infectious diseases exert a constant evolutionary pressure on the genetic makeup of our innate immune system. Polymorphisms in Toll-like receptor 4 (TLR4) have been related to susceptibility to Gram-negative infections and septic shock. Here we show that two polymorphisms of TLR4, Asp299Gly and Thr399Ile, have unique distributions in populations from Africa, Asia, and Europe. Genetic and functional studies are compatible with a model in which the nonsynonymous polymorphism Asp299Gly has evolved as a protective allele against malaria, explaining its high prevalence in subSaharan Africa. However, the same allele could have been disadvantageous after migration of modern humans into Eurasia, putatively because of increased susceptibility to severe bacterial infections. In contrast, the Asp299Gly allele, when present in cosegregation with Thr399Ile to form the Asp299Gly/Thr399Ile haplotype, shows selective neutrality. Polymorphisms in TLR4 exemplify how the interaction between our innate immune system and the infectious pressures in particular environments may have shaped the genetic variations and function of our immune system during the out-of-Africa migration of modern humans.

OBJECTIVE The cortisol response in patients with nonclassical 21-hydroxylase deficiency (NC21OHD) was assessed before and during hydrocortisone therapy and the findings were related to genotype. DESIGN Comparative study. METHODS The study sample comprised 41 patients (10 males) with NC21OHD, divided into two groups according to the genetic analysis of the CYP21 gene: Group A carried two mild mutations (n = 29), and Group B were compound heterozygotes for one mild and one severe mutation (n = 12). The 250 microg short ACTH test was performed at diagnosis. To evaluate the degree of treatment-induced suppression of adrenal function, 31 patients also underwent the 1 microg/1.73 m2 ACTH test during hydrocortisone therapy. Basal and stimulated cortisol levels and the increment in cortisol response were compared between Groups A and B and between the whole patient sample and healthy controls (32 subjects for the 250 microg test and 29 for the 1 microg/1.73 m2 test). RESULTS The basal, stimulated, and incremental cortisol levels were similar in Groups A and B; therefore, all the patients were considered together. At diagnosis, the basal cortisol levels were similar in the patients and controls, but the stimulated and incremental cortisol levels were significantly lower in the patients (p

OBJECTIVE—The Israeli Yemenite Jewish community has displayed an exceptionally rapid increase in the frequency of type 1 diabetes, having the highest rate of all Israeli ethnic groups. We studied the role of the environment, in relation to the nature and frequency of HLA class II genes, to evaluate its possible involvement in the development of diabetes. RESEARCH DESIGN AND METHODS—We interviewed 196 elderly Yemenite women, who had immigrated to Israel as adults, in programmed encounters about signs and symptoms of type 1 diabetes, infant feeding customs, and infectious diseases in Yemen. We also performed HLA oligotyping of DRB1, DQA1, and DQB1 genes in 120 unrelated Yemenite Jews, including 44 type 1 diabetic patients and 76 healthy control subjects, and used these data in correspondence analysis comparing Yemenites with different Israeli ethnic groups. RESULTS—Interviews indicated that early exposure to cow’s milk was very common in Yemen. However, none of the women could recall classical presentations of diabetes. HLA oligotyping showed that gene frequencies of non-Asp-57 (of the HLA-DQB chain) in the patients (0.94) and control subjects (0.6) were similar to those of other populations with a known high incidence of type 1 diabetes. Correspondence analysis revealed that Yemenite Jews are genetically distinct from other ethnic groups in Israel. CONCLUSIONS—The genetic distinctiveness of Yemenite Jews may explain their unusually high incidence of type 1 diabetes in Israel. Despite the presence of highly susceptible diabetogenic HLA class II genes in this community, early exposure to cow’s milk did not cause phenotypic expression of diabetes in Yemen. This finding suggests that in this population, either cow’s milk does not play a crucial role in triggering diabetes, or environmentally conferred protection, such as frequent infectious disease in Yemen, was dominant.

OBJECTIVE: To evaluate whether genotype differences can explain the clinical variability of non-classical steroid 21-hydroxylase deficiency (NC21-OHD) and to determine if genotype is related to ethnic origin. DESIGN: Genotyping for mutations in the steroid 21-hydroxylase (CYP21) gene was performed in 45 unrelated Israeli Jewish patients (nine males) with NC21-OHD (60min 17-hydroxyprogesterone (17-OHP), 45-386nmol/l) who were referred for evaluation of postnatal virilization or true precocious/early puberty. Eleven siblings diagnosed through family screening were genotyped as well. METHODS: Patients were divided by genotype into three groups: (A) homozygous or compound heterozygous for the mild mutations (V281L or P30L) (n=29; eight males); (B) compound heterozygous for one mild and one severe mutation (Q318X, I2 splice, I172N) (n=12; no males); (C) mild mutation detected on one allele only (n=4; one male; peak 17-OHP 58-151nmol/l). We then related the genotype to the ethnic origin, clinical phenotype and hormone level. Since group C was very small, comparisons were made between groups A and B only. RESULTS: At diagnosis, group B tended to be younger (5. 8+/-3.0 vs 8.1+/-4.3 years, P=0.09), had greater height SDS adjusted for mid-parental height SDS (1.6+/-1.1 vs 0.7+/-1.4, P=0.034), tended to have more advanced bone age SDS (2.9+/-1.5 vs 1.7+/-2.1, P=0.10) and had a higher peak 17-OHP level in response to ACTH stimulation (226+/-92 vs 126+/-62nmol/l, P

Objective To look for HLA class II alleles and haplotypes conferring susceptibility to multiple sclerosis (MS) in the Jewish population of Israel. Design Population-based cohort of clinically definite patients with MS tested prospectively over 7 years. Setting Referral center in a neurology clinic at a university hospital in the greater Jerusalem area in Israel. Patients A total of 162 consecutive patients with clinically definite MS from the 2 main ethnic Jewish groups in Israel: 104 Ashkenazi (80 with a relapsing remitting or secondary progressive and 24 with a primary chronic progressive course of the disease) and 58 non-Ashkenazi (36 with a relapsing remitting or secondary progressive course and 22 with a primary chronic progressive course of the disease), matched with 132 Ashkenazi and 120 non-Ashkenazi healthy controls. Main Outcome Measures The relationship between the various HLA class II alleles and haplotypes and MS, as defined by the polymerase chain reaction and sequence-specific oligonucleotide probe hybridization, among the Ashkenazi and the non-Ashkenazi Jewish sections and with respect to the different clinical courses of the disease. Results The haplotype DRB1*1501, DQA1*0102, DQB1*0602 was found to be associated with MS among both Ashkenazi and non-Ashkenazi patients ( P P =.04, respectively). Among the non-Ashkenazi patients, a new association of haplotypes DRB1*1303, DQA1*05, and DQB1*0301with MS was detected ( P =.03). The MS susceptibility alleles, DRB1*1501 , DQA1*0102 , and DQB1*0602 , were found in association with the Ashkenazi patients (P P =.02, and P =.01, respectively); DRB1*1501 and DRB1*1303 were more frequently observed among the non-Ashkenazi patients ( P =.03, P =.04, respectively). On subdivision of the patients into clinical subgroups, associations of DRB1*0801 , DQA1*010 2, DQA1*0401 , and DQB1*0602 with primary chronic progressive MS among the Ashkenazi patients were evident ( P =.03, P =.04, P =.04 and P =.05, respectively), whereas DRB1*1501 , DRB1*03011 , and DQB1*0602 were associated with relapsing remitting or secondary progressive among the non-Ashkenazi patients ( P =.05, P =.05, and P =.03, respectively). Conclusions This study, unlike previous ones, is the first to show a significant association between HLA class II alleles and MS in the Jewish population. The association with the HLA-DR2–related haplotype is similar to that among non-Jewish white patients with MS. Moreover, our data support the possibility that DRB1*1501 is the susceptibility allele responsible for the association between this haplotype and MS in the Jewish population. Our study also underscores differences in HLA profiles between Ashkenazi and non-Ashkenazi patients, and between the different clinical courses of the disease. The latter may indicate that the clinical courses of MS are influenced by the genetic background.

The association between HLA-DR and DQ and insulin dependent diabetes mellitus (IDDM) was analyzed in 47 patients and 76 controls of Yemenite Jewish origin. The IDDM susceptibility alleles DRB1∗03011, DQA1∗0501, DQB1∗02 and DRB1∗0402, DQA1∗0301, DQB1∗0302 found in Caucasians had a very strong predisposing effect also in the Yemenite IDDM group. The DRB1∗07, DQA1∗0201 and DQB1∗02 alleles were found to have a strong negative association with IDDM. None of the patients carried DRB1∗07 and DQA1∗0201 compared with healthy controls (43.7%). Our analysis revealed that the DRB1∗03011 DQA1∗0501 DQB1∗02/DRB1∗04 DQA1∗03 DQB1∗0302 heterozygous genotype confers the highest susceptibility (59.6% in patients vs. 0% in controls). The homozygous DRB1∗03 and DRB1∗04 genotypes were also found to be positively associated with the disease. 81% of the patients compared to 1.3% of controls carried the susceptibility alleles on both haplotypes. In conclusion, the development of IDDM in Yemenite Jews is strongly dependent on the presence of the susceptibility HLA alleles and on the absence of the DRB1∗07 haplotype. The Yemenite Jewish group is uniquely homogenous with regard to genetic susceptibility factors involved in the process of IDDM, and may thus be an ideal model for further genetic studies.

Aim The Arab Bone Marrow Registry in Hadassah Medical Center collected HLA typings for 18,000 Arab adult donors. We used this information to estimate population allele and haplotype frequencies (HFs). Methods We calculated HLA A ∼ B ∼ DRB1 HFs from 1,541 Christian Arab (CA) and 16,129 Muslim Arab (MA) donors typed by SBT, resolving phase and allelic ambiguity using Expectation Maximization. HFs were estimated at the four-digit level. Results The most common CA haplotype was A∗33:01 ∼ B∗14:02 ∼ DRB1∗01:02 at a frequency of 1.6%, which is the fifth most common MA haplotype at 0.9%. This haplotype was the second ranked in the US Middle Eastern/North Coast of Africa (MENAFC) at 0.8% and is also a common Jewish haplotype. The most common MA haplotype was A∗01:01 ∼ B∗52:01 ∼ DRB1∗15:02 at 1.4%, which is ranked 41st in CA at 0.04%. This haplotype was ranked 12th in MENAFC at 0.26%. The fourth ranked haplotype for both CA and MA, A∗02:05 ∼ B∗50:01 ∼ DRB1∗07:01, is the most common in Saudi Arabia, Kuwait and Qatar and the fourth most common among Jewish populations. Average homozygosity for CA and MA for HLA-A, -B and -DRB1 was estimated at 6.7% and 6.2% while the top 30 haplotypes had a cumulative frequency of 25% and 19% respectively indicating higher MA genetic diversity. Interestingly, eight DRB1 alleles: 01:02, 03:01, 04:03, 07:01, 11:01, 11:04, 13:03 and 15:02 constituted over 63% of the allele frequencies for both CA and MA while 97% and 30% of patients served by the Arab registry had one or two of these alleles respectively. Additionally, DRB1∗03:01 occurred without the common Caucasian B∗08:01 association in about 85% of CA and MA donors. Clinical data showed that 40% of transplants were for Arab patients while others were for patients worldwide. Conclusions Comparing CA and MA to other published HFs, it is clear that some haplotypes have migrated across populations while others remain isolated, thus adding these donors to the world registry is vital to increase genetic diversity for the benefits of all patients.

An in-situ assay for monitoring regulated gene expression in continuously growing mammalian cells is described. This technique can be used for the detection of the transactivator (Tat) protein in human immunodeficiency virus(HIV)-infected cells. Human kidney cells 293, harboring the luc gene, and fused to the HIV-1 long terminal repeat, were isolated and served as tester cells. Tat is supplied by transfection with a tat-carrying plasmid, or alternatively by addition of Tat-containing cell extracts, made from virus-infected or plasmid-transfected cells. Light emitted from the tester cells is recorded on film continuously, or by a photo sensor. Transactivation by HIV Tat results in a pronounced increase in light emission from the tester cells (up to 3000-fold). This assay, which detects HIV-specific gene products, may be used as a diagnostic tool for the detection of active HIV present in peripheral blood.

A new way for reconstituting highly fusogenic Sendai virus envelopes is described. As opposed to previously described methods, in the present one the detergent (Triton X-100) is removed by direct addition of SM-2 Bio-beads to the detergent solubilized mixture of the viral phospholipids and glycoproteins, thus avoiding the long dialysis step. The vesicles obtained in the present work resemble, in their composition, size and features, envelopes of intact Sendai virus particles. The present method allows the enclosure of low and high molecular weight material within the reconstituted viral envelopes.