Genetic determinants of risk in autoimmune pulmonary alveolar proteinosis

Nat Commun. 2021 Feb 15;12(1):1032. doi: 10.1038/s41467-021-21011-y.

Abstract

Pulmonary alveolar proteinosis (PAP) is a devastating lung disease caused by abnormal surfactant homeostasis, with a prevalence of 6-7 cases per million population worldwide. While mutations causing hereditary PAP have been reported, the genetic basis contributing to autoimmune PAP (aPAP) has not been thoroughly investigated. Here, we conducted a genome-wide association study of aPAP in 198 patients and 395 control participants of Japanese ancestry. The common genetic variant, rs138024423 at 6p21, in the major-histocompatibility-complex (MHC) region was significantly associated with disease risk (Odds ratio [OR] = 5.2; P = 2.4 × 10-12). HLA fine-mapping revealed that the common HLA class II allele, HLA-DRB1*08:03, strongly drove this signal (OR = 4.8; P = 4.8 × 10-12), followed by an additional independent risk allele at HLA-DPβ1 amino acid position 8 (OR = 0.28; P = 3.4 × 10-7). HLA-DRB1*08:03 was also associated with an increased level of anti-GM-CSF antibody, a key driver of the disease (β = 0.32; P = 0.035). Our study demonstrated a heritable component of aPAP, suggesting an underlying genetic predisposition toward an abnormal antibody production.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Alleles
  • Asian People
  • Autoantibodies / biosynthesis
  • Autoantibodies / genetics*
  • Autoimmune Diseases / ethnology
  • Autoimmune Diseases / genetics*
  • Autoimmune Diseases / immunology
  • Autoimmune Diseases / pathology
  • Case-Control Studies
  • Chromosomes, Human, Pair 6
  • Female
  • Gene Expression
  • Gene Frequency
  • Genetic Predisposition to Disease*
  • Genome-Wide Association Study
  • Granulocyte-Macrophage Colony-Stimulating Factor / antagonists & inhibitors
  • Granulocyte-Macrophage Colony-Stimulating Factor / genetics*
  • Granulocyte-Macrophage Colony-Stimulating Factor / immunology
  • HLA-DRB1 Chains / genetics*
  • HLA-DRB1 Chains / immunology
  • Humans
  • Japan
  • Male
  • Middle Aged
  • Odds Ratio
  • Protein Isoforms / genetics
  • Pulmonary Alveolar Proteinosis / ethnology
  • Pulmonary Alveolar Proteinosis / genetics*
  • Pulmonary Alveolar Proteinosis / immunology
  • Pulmonary Alveolar Proteinosis / pathology
  • Pulmonary Surfactants / immunology
  • Pulmonary Surfactants / metabolism
  • Risk

Substances

  • Autoantibodies
  • HLA-DRB1 Chains
  • Protein Isoforms
  • Pulmonary Surfactants
  • Granulocyte-Macrophage Colony-Stimulating Factor