HLA-B*39:01:01 is a novel risk factor for antithyroid drug-induced agranulocytosis in Japanese population.

Antithyroid drug (ATD) is a mainstay of Graves' disease (GD). About 0.1-0.5% of patients with GD treated with ATD exhibit ATD-induced agranulocytosis, which is characterized by severe reduction of circulating neutrophils. Immune-mediated responses have been proposed as a possible mechanism for the pathogenesis of ATD-induced agranulocytosis. Although it has been reported that the HLA class II allele (HLA-DRB108:03) was associated with ATD-induced agranulocytosis in multiple populations, the entire HLA region have not been explored in Japanese. Therefore, we performed HLA sequencing for 10 class I and 11 class II genes in 87 patients with ATD-induced agranulocytosis and 384 patients with GD who did not show ATD-induced agranulocytosis. By conducting case-control association studies at the HLA allele and haplotype levels, we replicated the association between HLA-DRB108:03:02 and ATD-induced agranulocytosis (P = 5.2 × 10, odds ratio = 2.80), and identified HLA-B39:01:01 as an independent risk factor (P = 1.4 × 10, odds ratio = 3.35). To verify reproducibility of the novel association of HLA-B39:01:01, we reanalyzed allele frequency data for HLA-B39:01:01 from previous case-control association studies. The association of HLA-B39:01:01 was significantly replicated in Chinese (P = 9.0 × 10), Taiwanese (P = 1.1 × 10), and European populations (P = 5.2 × 10). A meta-analysis combining results from the previous and current studies reinforced evidence of the association between HLA-B*39:01:01 and ATD-induced agranulocytosis (P = 1.2 × 10, pooled OR = 3.66, 95% CI; 2.41-5.57). The results of this study will provide a better understanding of the pathogenesis of ATD-induced agranulocytosis in the context of HLA-mediated hypersensitivity reactions.