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Am. J. Respir. Crit. Care Med., Volume 156, Number 5, November 1997, 1601-1605

HLA-DR Predicts the Prognosis in Scandinavian Patients with Pulmonary Sarcoidosis

MARY BERLIN, ANNA FOGDELL-HAHN, OLLE OLERUP, ANDERS EKLUND, and JOHAN GRUNEWALD

Department of Medicine, Division of Respiratory Medicine, Karolinska Hospital, Stockholm; Department of Biosciences, Karolinska Institute, Novum; Department of Clinical Immunology, Karolinska Institute at Huddinge Hospital, Huddinge; and Microbiology and Tumorbiology Center, Karolinska Institute, Stockholm, Sweden

Although most patients with sarcoidosis have a good prognosis, a significant proportion runs a more severe and prolonged disease course. There is no marker to distinguish these subpopulations of patients, however. To investigate the relationship between HLA haplotype and clinical course, 122 Scandinavian patients with sarcoidosis were genomically typed for HLA-DR, -DQA1 and -DQB1 alleles using PCR amplification with sequence-specific primers. Control subjects were 250 healthy Swedish volunteers. Patients were carefully clinically monitored for up to 10 yr. We found that HLA-DR17(3) was overrepresented among sarcoidosis patients (33%) compared with control subjects (17%, p < 0.001). Ninety-one patients were followed for more than 2 yr and classified into chronic or nonchronic patients, according to disease outcome. Among the 34 patients with a nonchronic form of sarcoidosis, 65% were DR17(3)-positive (p < 10-5 versus control subjects). On the other hand, DR14(6) and DR15(2) were significantly associated with chronic disease. Even in patients with clinical manifestations that are normally associated with good prognosis, HLA typing enabled a subgrouping into two categories with significantly different clinical courses. Therefore, HLA class II typing is a valuable tool in predicting the outcome of the disease in Scandinavian sarcoidosis patients.




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