The 3′-untranslated region of the HLA-G gene in relation to pre-eclampsia: revisited

The maternal HLA-G 1597ΔC null mutation is associated with increased risk of pre-eclampsia and reduced HLA-G expression during pregnancy in African-American women

The non-classical major histocompatibility complex molecule, human leukocyte antigen (HLA)-G, is thought to contribute to maternal immune tolerance and successful placentation during pregnancy. Genetic polymorphisms in HLA-G are known to influence expression levels as well as the relative expression of individual protein isoforms. As diminished or aberrant HLA-G expression patterns may contribute to the development of certain pregnancy complications, we sought to investigate the association between functional HLA-G polymorphisms and the risk of pre-eclampsia (PE) in African-American women. The association between maternal and fetal genotype at six HLA-G polymorphisms and risk of PE was assessed in 372 pregnancies (314 normotensive; 58 pre-eclamptic). We observed an elevated risk of PE (P = 0.00027) in pregnancies where the mother carried the 1597ΔC allele, a null allele that abolishes expression of full-length HLA-G isoforms. Furthermore, the frequency of the maternal 1597ΔC allele was highest in the subset of pre-eclamptic pregnancies that were delivered preterm, suggesting an association between the null allele and the severity of PE. We then replicated the association between higher maternal 1597ΔC allele frequency and increased severity of PE (P = 0.038) in an independent sample of 533 African-American women. Finally, to investigate the mechanistic basis of this association, we measured circulating soluble HLA-G (sHLA-G) concentrations in maternal serum collected during pregnancy in 51 healthy, normotensive African-American control women and found significantly lower levels in women carrying the 1597ΔC allele (P = 0.012). These results demonstrate that maternal HLA-G genotype is significantly associated with risk of PE in African-American women and is predictive of circulating sHLA-G levels during pregnancy.

HLA-G haplotype structure shows good conservation between different populations and good correlation with high, normal and low soluble HLA-G expression

HLA-G molecule has considerable impact in various clinical fields, therefore many studies attempted to predict its expression based on HLA-G genotype. These studies have focused on polymorphisms in either the coding region or in one of the two untranslated regions (UTR) of the gene. The aim of our study was to determine if HLA-G haplotype defined based on SNPs 5' and 3'UTR could be used to predict soluble HLA-G expression in unstimulated individuals. Our findings showed that HLA-G haplotype structure was well conserved between distant populations and that the defined haplotypes were correlated with high, normal and low HLA-G soluble secretors. In conclusion, we showed that this genotyping strategy based on the use of a few selected SNPs rather than isolated SNP analysis allows reliable HLA-G expression in all populations. This strategy could be useful in a number of clinical settings, e.g., predicting graft compatibility immunogenetic laboratories.

HLA-G polymorphisms and soluble HLA-G protein levels in women with recurrent pregnancy loss from Basrah province in Iraq

HLA-G is a nonclassical, class I major histocompatibility complex (MHC) gene that exhibits immunomodulatory properties and likely plays a role in the maintenance of successful pregnancy. In this study, we investigated the role of HLA-G polymorphisms on risk for recurrent pregnancy loss (RPL) and on circulating levels of soluble (s)HLA-G in Iraqi women. DNA and plasma were obtained from blood samples collected at 9-12 weeks gestation from 50 women with RPL and 50 healthy pregnant women in Basrah province, Iraq. As measured by ELISA, median sHLA-G levels were significantly lower in the RPL cases compared to healthy controls (21.4 vs. 38.8 U/ml, respectively; P=0.025), and decreased with increasing maternal age (P=0.0051). However, HLA-G allele and haplotype frequencies did not differ significantly between cases and controls (P values ≥0.12 for all tests). In contrast, homozygosity for the C allele (CC) at a tri-allelic promoter polymorphism, -725C/G/T, was associated with lower concentrations of sHLA-G compared to the CG or CT genotypes (median levels 21.1 vs. 40.1 vs. 42.6 U/ml, respectively; P=0.0089). These results demonstrate that HLA-G genotype influences circulating sHLA-G levels during pregnancy but is not significantly associated with risk of RPL.

Association of 14 bp insertion/deletion polymorphism of the HLA-G gene in father with severe preeclampsia in Chinese

Preeclampsia (PE), especially severe PE including early (before 34 weeks' gestation) and late (after 34 weeks' gestation) onset PE, is one of the leading causes of maternal and fetal mortality and morbidity. It is well known that abnormal human leukocyte antigen subtype G (HLA-G) expression may contribute to PE. In this study, we investigated allelic and genotypic frequencies of the 14 bp deletion/insert polymorphism in the 3(')-untranslated region (3(')-UTR) of the HLA-G gene in cases (120 pairs of mother-offspring, 82 couples, and 67 pairs of father-offspring with severe PE) and controls (158 pairs of mother-offspring, 87 couples, and 75 pairs of father-offspring with normal pregnancy). We found that the frequencies of the +14 bp/+14 bp HLA-G genotype of the offspring were significantly higher in the severe and early onset severe PE cases compared with controls, and the frequencies of the -14 bp/-14 bp HLA-G genotype of the offspring were significantly lower in the early onset severe PE cases compared with controls. The frequency of combined -14 bp/+14 bp mother/+14 bp/+14 bp offspring genotypes was significantly higher in the severe and early onset severe PE cases compared with controls, and the frequency of combined -14 bp/+14 bp mother/-14 bp/-14 bp offspring genotypes was significantly lower in the early onset severe PE cases compared with late onset severe PE cases. The frequency of combined -14 bp/-14 bp father/-14 bp/-14 bp offspring genotypes was significantly lower in the early onset severe PE cases compared with late onset severe PE cases and controls. In overview, the HLA-G 14 bp deletion/insert polymorphism is associated with severe PE in father-offspring, and its distribution is different between the early and late onset severe PE.

Association of HLA-G low expressor genotype with severe acute graft-versus-host disease after sibling bone marrow transplantation

Background: Human leukocyte antigen-G (HLA-G) molecules play a prominent role in immune tolerance. Structurally similar to their classical HLA homologs, they are distinct by having high rate of polymorphism in the non-coding regions including a functionally relevant 14-base pair (bp) insertion/deletion (Ins/Del) allele in the 3′ untranslated region (3′UTR), rarely examined in a hematopoietic stem cell transplantation (HSCT) setting. Here, we analyzed the potential impact of HLA-G Ins/Del dimorphism on the incidence of acute graft-versus-host disease (aGvHD), transplant-related mortality (TRM), overall survival (OS), and incidence of relapse after HSCT using bone marrow (BM) as stem cell source from HLA-matched donors. Methods: One hundred fifty-seven sibling pairs, who had undergone HSCT, were studied for the distribution of the HLA-G 14 bp Ins/Del polymorphism using a polymerase chain reaction (PCR)-based technique. Potential genetic association with the incidence of aGvHD, TRM, and OS was analyzed by monovariate and multivariate analyses. Results: Monovariate analysis showed that the homozygous state for the 14-bp Ins allele is a risk factor for severe aGvHD (grade III and IV; P = 0.008), confirmed subsequently by multivariate analysis [hazard ratio (HR) = 3.5; 95% confidence interval (95%CI) = 1.3–9.5; P = 0.012]. We did not find any association between HLA-G polymorphism and the other studied complications. Conclusion: Our data suggest that the HLA-G low expressor 14 bp Ins allele constitutes a risk factor for the incidence of severe aGvHD in patients who received BM as stem cell source.

The etiology of preeclampsia: the role of the father

Preeclampsia is often considered as simply a maternal disease with variable degrees of fetal involvement. More and more the unique immunogenetic maternal-paternal relationship is appreciated, and also the specific 'genetic conflict' that is characteristic of haemochorial placentation. From that perspective, pre-eclampsia can be seen as a disease of an individual couple with primarily maternal and fetal manifestations. The maternal and fetal genomes perform different roles during development. Heritable paternal, rather than maternal, imprinting of the genome is necessary for normal trophoblast development. Large population studies have estimated that 35% of the variance in susceptibility to preeclampsia is attributable to maternal genetic effects; 20% to fetal genetic effects (with similar contributions of both parents), 13% to the couple effect, less than 1% to the shared sibling environment and 32% to unmeasured factors. Not one of these large population studies focussed on the paternal contribution to preeclampsia, which is demonstrated by (1) the effect of the length of the sexual relationship; (2) the concept of primipaternity versus primigravidity; and (3) the existence of the so-called 'dangerous' father, as demonstrated in various large population studies. It is currently unknown how the father exerts this effect. Possible mechanisms include seminal cytokine levels and their effect on maternal immune deviation, specific paternal HLA characteristics and specific paternal single nucleotide polymorphisms (SNPs), in particular in the paternally expressed genes affecting placentation. Several large cohort studies, including the large international SCOPE consortium, have identified paternal SNPs with strong associations with preeclampsia.

Evaluation of HLA-G5 plasmatic levels during pregnancy and relationship with the 14-bp polymorphism

PROBLEM

Plasmatic HLA-G levels increase during pregnancy, but the contribution of each different isoform has not been elucidated yet.

METHOD OF STUDY

HLA-G5 was analyzed by ELISA in 19 controls, 79 women in the first 8 weeks of pregnancy and in nine women monthly until delivery. Genotyping for the 14-bp polymorphism was performed by PCR amplification of exon 8.

RESULTS

HLA-G5 was detected in plasma from 80% of pregnant women. The levels did not change during pregnancy, and there were no differences compared to control non-pregnant women. There was a high interindividual variation that was maintained throughout the pregnancy. The presence of +14-bp allele was associated with HLA-G5 positivity. Pregnant women who were heterozygotic to 14-bp polymorphism had significantly higher levels of HLA-G5 compared to -14 bp/-14-bp homozygotic.

CONCLUSION

Plasmatic HLA-G5 levels do not change during pregnancy and its concentration depends on 14-bp polymorphism.

The importance of HLA-G expression in embryos, trophoblast cells, and embryonic stem cells

The nonclassical HLA-G molecule is a trophoblast-specific molecule present in almost every pregnancy. It differs from classical HLA class I molecules by the low degree of allelic variants and the high diversity of protein structures. HLA-G is reported to be a tolerogenic molecule that acts on cells of both innate and adaptive immunity. At the maternal-fetal interface HLA-G seems to be responsible largely for the reprogramming of local maternal immune response. This review will focus on the HLA-G gene expression profile in pregnancy, in preimplantation embryos, and in human embryonic stem cells with emphasis on the structural diversity of the HLA-G protein and its potential functional and diagnostic implications.

Biology of HLA-G in cancer: a candidate molecule for therapeutic intervention?

Although the expression of the non-classical HLA class I molecule HLA-G was first reported to be restricted to the fetal-maternal interface on the extravillous cytotrophoblasts, the distribution of HLA-G in normal tissues appears broader than originally described. HLA-G expression was found in embryonic tissues, in adult immune privileged organs, and in cells of the hematopoietic lineage. More interestingly, under pathophysiological conditions HLA-G antigens may be expressed on various types of malignant cells suggesting that HLA-G antigen expression is one strategy used by tumor cells to escape immune surveillance. In this article, we will focus on HLA-G expression in cancers of distinct histology and its association with the clinical course of diseases, on the underlying molecular mechanisms of impaired HLA-G expression, on the immune tolerant function of HLA-G in tumors, and on the use of membrane-bound and soluble HLA-G as a diagnostic or prognostic biomarker to identify tumors and to monitor disease stage, as well as on the use of HLA-G as a novel therapeutic target in cancer.