The Presence of Risk and Protective HLA-DQ Haplotype Combinations and PLA2R1 Risk SNP in Hungarian Patients with Membranous Nephropathy.

With primary membranous nephropathy (pMN), the genetic background is not precisely known. Certain HLA-DQ serotypes however like HLA-DQ 2.5, and single-nucleotide polymorphisms (SNPs) in the phospholipase A2 receptor 1 (PLA2R1) gene pose a risk for the development of pMN. As antigen presentation is linked to a 3-dimensional conformation of the HLA-DQA/DQB dimer, we thought that the specific HLA-DQ haplotype combinations might also be risk factors in the evolution of MN. The HLA-DQ haplotype combinations and the PLA2R1 gene risk variant (rs4664308) genotypes were examined in 67 patients with MN (52 primary, 15 secondary [sMN]) and 77 controls. Based on the presence or absence of PLA2R1 risk alleles, we used a scoring system to assess the risk and to identify protective HLA-DQ haplotype combinations. The HLA-DQ 2.5 serotype was significantly enriched in both pMN and sMN patients compared to the controls. The pMN group had a significantly higher frequency of the PLA2R1 risk allele compared to the sMN group and the controls. HLA-DQ 2.5 appeared to carry the highest risk for the development of pMN, while HLA-DQ 7.5 and 6.2 seemed to be protective. Our results indicate that the HLA-DQ 2.5 probably carries the highest risk in both pMN and sMN, suggesting that this serotype has less specificity for antigens, and it induces an autoimmune response. Here, PLA2R1 played a role in the development of pMN but not in sMN.