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The role of antigens and HLA class I haplotypes in indigenous women in Tashkent with hysteromyoma.

Introduction

In recent years there has been a definite upward trend in incidence of hysteromyoma. The prevalence of uterine fibroids varies widely, according to foreign authors the average prevalence is about 30% (Volkov et al., 2004; Kazubskaya et al., 2007).

According to modern ideas, fibroids are benign tumors of monoclonal origin. The tumor grows as a genetically abnormal clone of cells; due to mutation gains it acquires the ability of unregulated growth. Factors triggering this mechanism are not well established (Egorova et al., 2007; Kazubskaya et al., 2007; Lanchinsky et al., 2004).

From a clinical point of view, many researchers identify a number of risk factors that contribute to the emergence hysteromyoma: profuse menstruation, late menarche, frequent abortions, inflammatory diseases of the uterus and appendages, the presence of TORCH infections dishormonal breast diseases and disorders of thyroid function. It is noted also the role of hereditary factors to the disease. The hereditary predisposition is multifactorial in the nature. Thus, the risk of developing fibroids is 4 times higher in women with a burdened heredity of this pathology. When the disease is at a young age the hereditary is much higher. 17.5% cases of oncological diseases in genital sphere and other organs (endometrial, cervical, ovarian, breast, etc.) occur in this category of women (Egorova et al., 2007; Kazubskaya et al., 2007; Lanchinsky et al., 2004).

The antigens of HLA histocompatibility system play a significant role in predisposition to tumors. These protein products provide regulation of immune responses, they participate in recognition of their own and foreign agents, and ensure the survival of the human species in terms of endogenous and exogenous aggression (Khaitov and Alekseev, 2001; Karell et al., 2000). There are studies of tumors in various diseases in indigenous Uzbeks (retinoblastoma, colorectal cancer, cancer of the gastrointestinal tract, skin cancer) (Ravshanov et al., 2000; Tuhfatullina et al., 2000; Kuryazov, 2007; Kholikov et al., 2009). However, we have not seen study on the HLA-system in uterine cancer; this state motivated the purpose of this study.

Materials and methods

We surveyed 177 women aged 20 to 55 years, with a clear diagnosis--uterine fibroids. All clinical examination was conducted at the Department of obstetrics, gynecology and perinatal medicine, Tashkent Institute of Postgraduate Medical Education. The surveyed women were persons of Uzbek nationality, which was determined using the passport data, given the lineage of three generations according to the materials of HLA VII Workshop. Immunogenetic studies (typing HLA class I to identify antigens A, B, CW) were performed at the Institute of Immunology, Academy of Sciences of Uzbekistan. To perform serological typing of HLA-antigens of class I there was used of purified lymphocyte suspension allocated by the method of Boyum (1968). HLA-phenotype was defined using the standard micro-lymphocytes-toxic test of P. Terasaki (Mattius et al., 1970) using a panel of HLA-antisera of the St. Petersburg Institute of Hematology and Blood Transfusion (Gisans company). The control group consisted of 301 donors without autoimmune diseases and heredity; these donors were examined at the Institute of Immunology, Academy of Sciences of Uzbekistan. Healthy patients were belonged to the Uzbek ethnic group of persons living in the region for three generations. Processing of statistical data was performed using programs MS Excel and a number of formulas (Bland et. al., 1996; Muller, Ehninger, and Goldmann, 2003; Howell et al., 1987).

Results and discussion

The study of the general group of women with hysteromyoma found 35 HLA-class I antigens: 13 antigens for HLA-A locus; 17 antigens for HLA-B locus and 5 antigens at HLA-Cw locus.

Immunogenetic studies in the total group of patients with hysteromyoma in a comparative perspective with a healthy group of Uzbek nationality revealed the characteristic features (Table 1). HLA-A28 antigen was the most frequently registered in HLA-A locus (in 20.3% vs. 4.9% in control, P <0.05). With a lowest frequency was expressed HLA-A2 antigen (in 20.9% vs. 36.9% in the control, P <0.01).

It must be noted that antigens were detected in the total group with hysteromyoma: A25 5.6%, A29--4.5%, A24--2.8%, A21--2.2%, A23--1.6% of cases; these antigens were not found in the control group.

The study of HLA-B locus in patients with hysteromyoma has found that HLA-B8 and B22 antigens occurred most often (P <0.001) compared with the control (14.6% versus 4.7% in controls; 12.4 % vs. 1.3%). HLA-B35 antigen occurred with the lowest frequency (14.1% versus 27.2% in control, P <0.01).

Analysis of data on the distribution of HLA-Cw locus antigens in the general group with hysteromyoma showed that HLA-Cw5 antigen encountered most frequently relatively to control group (9.6% vs. 2.3% in controls, P <0.05). HLA-Cw4 antigen had relatively low frequency comparing to the control (15.8% vs. 36.2%, P <0.001).

We have measured the validity of connection with the group of patients with hysteromyoma for the following antigens: B22 ([chi square]=26.7; etiologic fraction EF=0.112; relative risk RR=10.5; Pc<0.001); B8 ([chi square]=17.9; EF=0.108; RR=3.8; Pc<0.001). This result points on a positive association of these markers with the risk of developing diseases of hysteromyoma. A28 antigens provided additive effect (([chi square]=13.5; EF=0.806; RR=4.8), Cw5 ([chi square]=12.3; EF=0.074; RR=4.4).

Negative association to the risk of hysteromyoma was demonstrated by Cw4 ([chi square]=19.7; PF=1.7; RR=0.3; Pc<0.001), A2 ([chi square]=12.6; PF=1.3; RR=0.4, Pc<0.01) and B35 ([chi square]=12.6; PF=1.2; RR=0.4; Pc<0.01). This confirms the protective effect of these antigens.

Since the inheritance of HLA-genes occurs in a codominant pattern, we can not rely on a one marker antigen. We took into account the combination of antigens identified in the HLA-phenotype.

Analysis of the distribution in frequency of haplotype associations for subtypes HLA ABCw and B in the total group with hysteromyoma showed specific characteristics. With the highest incidence in the total group with hysteromyoma occurred the following graphotype variations: A28-B22 (5.6%), A1-B5 (5%), A3-B5 (4.5%), A1-B13, A2-B7 and A10-B8 (3.9% respectively), A1-B7, A3, B8 and A9-B17 (3.3% respectively). With the lowest frequency (1.1%) occurred 30 haplotypes.

To study predisposition to predisposition to uterine fibroid disease we analyzed significant haplotype combinations through defining haplotypes frequency (H) and the linkage disequilibrium ratio D. The difference between the observed and expected frequency of their co-occurrence gives a quantitative characterization of gamete association known as the index or the value of linkage disequilibrium.

In this subgroup there were found six haplotypes with statistical significance in comparison to the control group. These haplotypes are presented in Table 2.

There significant difference in comparison to the control values was set for the following haplotypes: A28-B22 ([chi square]=12.8; RR=18.0; LD=0.0033; P<0.001); A28-B18 ([chi square]=9.08; RR= 8.7; LD=0.0025; P<0.05); A10-B8 ([chi square]=6.53; RR=6.1; LD=0.0049; P<0.05); A3-B8 ([chi square]=5.13; RR=5.2; LD=0.0040; P<0.05); A2-B35 ([chi square]=3.82; RR=0.1; LD=0.0089; P<0.001); A2-B5 ([chi square]=2.10; RR= 0.1; LD=0.0072; P<0.05).

Positive nonzero value of the delta linkage disequilibrium was established for all haplotypes; the observed haplotype frequency was 1.3 and 2.2 times higher than a theoretically expected values. However, the true positive association was established for the A28-B22 haplotype and negative one--for the A2-B35 haplotype.

There were identified 50 variations in haplotype frequency distribution in the total group with hysteromyoma by HLA A-Cw subtype. The highest frequencies of haplotypes were identified for B17-Cw5 (3.9%), B7-Cw2, B8-Sw3 and B13-Cw3 (2.8% respectively). The lowest frequency encountered in nine haplotypes with a 1.1% rate.

In this group there were identified two haplotypes having statistical significance in comparison to the control group (Table 3).

The reliability in this group in comparison to the healthy one has been fixed for haplotypes: B17-Cw5 ([chi square]=5.13; RR= 12.3; LD=0.0025; P<0.05) and B5-Cw4 ([chi square]=3.32; RR= 0.2; LD=0.0118; P<0.001).

Observed frequencies of haplotypes are 1.5 and 2.5 times higher than the theoretically expected values. But the true association was determined for B5-Cw4 haplotype in the hysteromyoma group.

Conclusion

Our studies in the total group of patients with hysteromyoma have established a positive association in the risk of hysteromyoma with HLA-B8 antigens, B22 and A28-B22 haplotype; antigens HLA-A28 Cw5 and B17-Sw5 haplotype perform as auxiliary markers. HLA-A2, B35, Cw4 antigens and A2-B35, B5-Cw4 haplotypes show the negative association.

Studies of Ravshanov et al. (2000), Kuryazov et al. (2007), Kholikov et al. (2009) show that some antigenic variations (A2, A28, B35, Cw4 antigens) occur in these diseases represented by the group of indigenous women in Tashkent. Immunogenetic studies could be useful for searching of individual genes involved in determination of disease, particularly among patients with hysteromyoma.

References

Bland, M., et. al., 1996. An introduction to medical statistics, 3rd ed., Oxford University Press

Muller, C., Ehninger, G., Goldmann S., 2003 "Gene and haplotype frequency for the loci HLA-A, HLA-B, and HLA-DR based on over 13,000 German blood donors," Human Immunology, Vol.64, No.1, pp.137-51

Egorova, V., Bermisheva, A., Khusnutdinova, K. et al., 2007. "Current concepts of molecular and genetic basis of hysteromyoma" [Zh. med. Genetics.], in Russian, Moscow, No.9, pp.11-15

Howell, C. et al., 1987. "Statistical methods for physiology" 2nd Ed. PWS-Kent publishing company, pp.118-42

Karell, K., Klinger, N., Holopainen, P. et al. 2000. "Major histocompatibility complex (MHC)-linked micro satellite markers in a founder population" Tissue Antigens . Vol.56, pp.45-51

Kazubskaya, P., Bellevue, F., Nefedov, D., 2007. "Other clinical and genetic analysis of primary multiple malignant neoplasms" [Ros. oncology. Journ], in Russian, Moscow. No.2, pp.4-9

Khaitov, M., Alekseev, P., 2001., "The physiological role of major histocompatibility complex of man", Zh. Immunology, No3, pp.4-11

Kholikov, K., Ghafoor-Akhundov, A., Aripova, W. et al., 2009. "Immunogenetic approaches to the diagnosis of skin cancer in the Uzbek population". Nauch., Thm., Journ., Immunology. [them. II Mechnikov], in Russian, Moscow, Vol.30, No.5, pp.312-14

Kuryazov, B., Aripova, T., Mirkamalova, L., 2007. Cancer of gastrointestinal tract [Rak jeludochnogo trakta], in Russian, Tashkent

Lanchinsky, I., Ishchenko, I., IHarioshkin, N., 2004. "Genetics and molecular biology of hysteromyoma / obstetrician and Gynecology," [Genetika i molekuljarnaya biologiya, mioma matki / akusherstvo ginekologii], in Russian, Moscow., No.2, pp.14-17

Mattius, L., Ihde, D., Piazza, A., Cepellini, R., Bodmer, F. et al., 1970 "New approaches to the population genetic segregation analysis of the HLA system. In Terasaki PI (ed): Histocompatibility Testing". Copenhagen: Munksgaard

Ravshanov, S., Tukhvatulin, Z., Muratova, T. et al., 2000. "About the possibilities of using immunogenetic and cytogenetic methods for identifying genetic markers in Uzbek people having neoplasms," Collection of conference papers, 3rd All-Russian Scientific and Practical. Comference [Sbornik dokladov, Vserossiyskaya nauchno-prakticheskaya Konferencia], in Russian, Moscow, January 25-27, pp.145-46

Volkov, R., Evtushenko, I., Ivanov, S. et al., 2004. "Myoma: Current state of matter," Siberian Journal of Medicine [Sibirskiy Med. Jurnal], in Russian, No.4, pp.126-30

LANDISH ISANBAEVA

Department of ObstetricsGynecology and Perinatal Medicine, Tashkent Institute of Postgraduate Medical Education, Uzbekistan
TABLE 1. COMPARATIVE POLYMORPHISM OF HLA CLASS I
ANTIGENS IN THE TOTAL HYSTEROMYOMA GROUP OF PATIENTS

N     HLA       AG%         AG% Healthy     Relative risk
            Hysteromyoma   curves (n=301)       (PR)
              (n=177)

1.    A1        20.9            22.6             0.9
2.    A2      20.9 **           36.9             0.4
3.    A3        29.9            19.3             1.8
4.    A9        22.0            21.3             1.0
5.    A10       24.2            13.3             2.0
6.    A11       19.2            18.3             1.0
7.    A19       18.6            11.9             1.7
8.    A21       2.2              --              6.9
9.    A23       1.6              --              5.2
10.   A24       2.8              --              8.7
11.   A25       5.6              --             21.0
12.   A28      20.3 *           4.9              4.8
13.   A29       4.5              --
14.   B5        19.2            22.9             0.7
15.   B7        12.9            17.9             0.6
16.   B8      14.6 ***          4.7              3.8
17.   B12       7.3             9.3              0.7
18.   B13       19.7            15.9             1.3
19.   B14       7.9             8.3              0.9
20.   B15       10.7            5.3              2.1
21.   B16       11.8            4.9              3.5
22.   B17       19.2            10.9             1.9
23.   B18       9.6             3.7              2.8
24.   B21       4.5             10.3             0.4
25.   B22     124 ***           1.3             10.5
26.   B27       7.9             8.9              0.8
27.   B35     14.1 **           27.2             0.4
28.   B40       11.2            10.6             1.0
29.   B41       5.6             7.0              0.8
30.   B51       2.8             2.0              1.4
31.   Cw1       1.1             4.7              0.2
32.   Cw2       13.5            16.3             0.8
33.   Cw3       19.7            9.6              2.3
34.   Cw4     15.8 ***          36.2             0.3
35.   Cw5      9.6 *            2.3              4.4
36.   Cw6        --             2.0              --
37.   Cw8        --              --              --
38.
39.
40.

Note: N--number of persons with antigen identified; AG--antigen
frequency in %; GF--gene frequency; RR--criterion of the relative
risk *--P <0.05, ***--P <0.001, **--P <0.01.

TABLE 2. SIGNIFICANT HAPLOTYPE ASSOCIATION
IN THE TOTAL HYSTEROMYOMA GROUP

Haplotypes      D        H      Difference    [X.sup.2]
subtype A-B

A2-B5         0.0100   0.0172      1.7           2.10
A2-B35        0.0073   0.0162      2.2           3.82
A3-B8         0.0109   0.0149      1.3           5.13
A10-B8        0.0089   0.0138      1.5           6.53
A28-B18       0.0048   0.0073      1.5           9.08
A28-B22       0.0063   0.0096      1.5           12.8

Haplotypes    [LD.sub.    RR      P
subtype A-B   [DELTA]]

A2-B5          0.0072    0.1    <0.05
A2-B35         0.0089    0.1    <0.001
A3-B8          0.0040    5.2    <0.05
A10-B8         0.0049    6.1    <0.05
A28-B18        0.0025    8.7    <0.05
A28-B22        0.0033    18.0   <0.001

Note: D--expected frequency; H--observed frequency;
[LD.sub.[DELTA]]--delta value of linkage disequilibrium; RR-
criterion of the relative risk (relative risk); [X.sup.2]--
Pearson's chi-square test.

TABLE 3. SIGNIFICANT HAPLOTYPE ASSOCIATION
IN THE TOTAL HYSTEROMYOMA GROUP

Haplotypes      D        H      Difference   [X.sup.2]
subtype B-C

B5-Cw4        0.0075   0.0193      2.5         3.32
B17-Cw5       0.0046   0.0071      1.5         5.13

Haplotypes    [LD.sub.    RR      P
subtype B-C   [DELTA]]

B5-Cw4         0.0118    0.2    <0.001
B17-Cw5        0.0025    12.3   <0.05

Note: D--expected frequency; H--observed frequency;
[LD.sub.[DELTA]]--delta value of linkage disequilibrium; RR--
criterion of the relative risk (relative risk); [X.sup.2]--
Pearson's chi-square test.
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Author:Isanbaeva, Landish
Publication:Medical and Health Science Journal
Article Type:Report
Geographic Code:9UZBE
Date:Jul 1, 2011
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