Skip Navigation

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (126)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Vaidya, B.
Right arrow Articles by Pearce, S. H. S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Vaidya, B.
Right arrow Articles by Pearce, S. H. S.
Social Bookmarking
 Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

The cytotoxic T lymphocyte antigen-4 is a major Graves' disease locus
Human Molecular Genetics Pages 1195-1199 ©1999 Oxford University Press


The cytotoxic T lymphocyte antigen-4 is a major Graves' disease locus
Introduction
Results
   Chromosome 2q31-q33 linkage analysis.
   Analysis of chromosome 2q31-q33 linkage conditioned for the CTLA4A/G genotype
   MHC linkage analysis
   Analysis of CTLA-4 linkage conditioned for MHC haplotype sharing
Discussion
Materials And Methods
   Patients
   Genotyping
   Statistical analysis
Abbreviations
Acknowledgements
References


The cytotoxic T lymphocyte antigen-4 is a major Graves' disease locus

Bijayeswar Vaidya*, Helen Imrie*, Petros Perros1, Eric T. Young2, William F. Kelly3, David Carr4, David M. Large5, Anthony D. Toft6, Mark I. McCarthy7, Pat Kendall-Taylor, Simon H. S. Pearce+

Endocrine Group, Department of Medicine, 4th Floor Leech Building, The Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH, UK,1Department of Medicine, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK, 2Department of Medicine, Wansbeck General Hospital, Ashington, Northumbria NE63 9JJ, UK, 3Diabetes Care Centre, Middlesbrough General Hospital, Middlesbrough TS5 5AZ, UK, 4Department of Medicine, North Tees General Hospital, Stockton on Tees TS19 8PE, UK, 5Department of Medicine, Cumberland Infirmary, Carlisle CA2 7HY, UK, 6Endocrine Unit, Royal Infirmary of Edinburgh, Edinburgh EH3 9YW, UK and 7Section of Endocrinology, Division of Medicine, Imperial College School of Medicine at St Mary's, London W2 1PG, UK

Received January 25, 1999; Revised and Accepted March 30, 1999

Graves' disease (GD) is an autoimmune thyroid disorder that is inherited as a complex trait. We have genotyped 77 affected sib-pairs with autoimmune thyroid disease for eight polymorphic markers spanning the cytotoxic T lymphocyte antigen-4 (CTLA-4) region of chromosome 2q31-q33, and for five markers spanning the major histocompatibility complex (MHC) region of chromosome 6p21. Non-parametric analysis showed linkage of GD to the CTLA-4 region with a peak non-parametric linkage (NPL) score of 3.43 (P= 0.0004) at the marker D2S117. The proportion of affected full-sibs sharing zero alleles (z0) reached a minimum of 0.113 close to D2S117, giving a locus-specific [lambda]s for this region of 2.2. Families with brother-sister sib-pairs showed a peak NPL of 3.46 (= 0.0003, [lambda]s > 10) at D2S117, compared with 2.00 (= 0.02, [lambda]s = 1.9) in the families with only affected females, suggesting a stronger influence in families with affected males. Association between GD and the G allele of the Thr17Ala polymorphism within the CTLA-4 gene (CTLA4A/G) was observed using unaffected sib controls (P= 0.005). Lesser evidence for linkage was found at the MHC locus, with a peak NPL score of 1.95 (P = 0.026), between the markers D6S273 and TNF[alpha]. We demonstrate that the CTLA-4 locus ([lambda]s = 2.2) and the MHC locus ([lambda]s = 1.6) together confer ~50% of the inherited susceptibility to GD disease in our population.

INTRODUCTION

Graves' disease (GD) is a common organ-specific autoimmune disorder, which is characterized by thyroid hormone oversecretion, diffuse goitre and specific orbital complications (termed thyroid-associated orbitopathy; TAO). GD affects 0.4-0.8% of the female population over a life time (1-3), and has a concordance rate in monozygotic twins of 20-30% compared with 5-7% in dizygotic twins or female sibs (2-4). Familial risk studies combined with local population prevalence data have been used to estimate that the excess risk of GD to a female sib of a GD proband ([lambda]s) is between 10 and 15 (2,3). In common with other autoimmune disorders (5-9), GD is likely to have a complex genetic basis, with several different genes each contributing in various degrees to the inherited susceptibility. Furthermore, autoimmune hypothyroidism (AH), which is the other common manifestation of thyroid autoimmunity, occurs with an increased frequency in GD kindreds, suggesting that both forms of autoimmune thyroid disease (AITD) could share some susceptibility alleles (10,11). Similarly, there is an excess prevalence of GD amongst subjects with type 1 diabetes mellitus (IDDM) and their relatives, suggesting that GD and IDDM could also share susceptibility alleles (10-12).

Population-based case-control studies have shown a consistent association of GD with HLA-DR3-carrying major histocompatibility complex (MHC) haplotypes (DRB1*0304-DQB1*0201-DQA1*0501) in Caucasian populations (2,10,13-15); however, these MHC allelic associations may be different from those of AH (10). Evidence for linkage of GD to MHC has also been found in some populations (10,15-17), but this has been difficult to reproduce (18,19). Other candidate susceptibility loci, including the thyrotropin receptor, immunoglobulin heavy chain (Gm), interleukin 1 receptor antagonist, T cell antigen receptor [beta] and the thyroid hormone receptor [beta] gene have been found to be associated with GD in some populations studied, but not in others (16,20-25). Recently, evidence for varying degrees of genetic linkage have been reported between AITD and markers on the long arms of chromosomes 14 (14q31) and 20 (20q11) and on the X chromosome (Xq21) (19,26,27). These studies await confirmation in different populations.

The cytotoxic T lymphocyte antigen-4 (CTLA-4) is a co-stimulatory molecule that is a key negative regulator of T cell function (28). The CTLA-4 gene lies on chromosome 2q33, and recent studies have demonstrated linkage and association of IDDM with markers on 2q31-q33 (designated IDDM7 and IDDM12) (29-32). Transmission disequilibrium at alleles of two CTLA-4 polymorphisms defines the IDDM12 region (30,31), and the same alleles have been associated with GD and AH in case-control studies (32-36). However, recent genetic linkage studies have failed to confirm CTLA-4 as a GD susceptibility locus (19,37). In this study, we have taken an affected sib-pair approach to examine the CTLA-4 region of chromosome 2q31-q33 and the MHC region of 6p21 for evidence of linkage to GD.

RESULTS

Chromosome 2q31-q33 linkage analysis.

We examined the cohort of 77 affected AITD sib-pairs (Table 1) for linkage to eight polymorphic markers over a 30 cM region of chromosome 2q31-q33, which encompassed the IDDM7 and CTLA-4 (IDDM12) regions. Non-parametric analysis with the GENEHUNTER package showed a broad region of excess allele sharing (up to 65%) amongst affected sibs. When all subjects with AITD were designated as affected, the peak multipoint non-parametric linkage (NPL) score was 3.43 (P = 0.0004) at the marker D2S117, which is close to the CTLA-4 region (Fig. 1). Designation of only GD cases as affected (71 sib-pairs) showed a peak NPL score of 3.07 (P = 0.001; Fig. 1), suggesting homogeneity between GD and AH at this locus. The proportion of the 72 full-sibs with AITD sharing zero alleles (z0) reached a minimum of 0.113 close to D2S117, suggesting that the locus-specific [lambda]s for this region is 2.2. The 24 families with affected AITD males (brother-sister sib-pairs) showed a peak NPL of 3.46 (P = 0.0003, z0 < 1 × 10-4, [lambda]s > 10), compared with 2.00 (P = 0.02, z0 = 0.132, [lambda]s = 1.9) in the 40 families with only affected females, suggesting that this locus has a much stronger influence in families with affected males. An intrafamilial association analysis, using unaffected sibs as controls, showed an excess of the G allele at the diallelic CTLA4A/G polymorphism (Thr17Ala) (P = 0.005), and of the 112 mobility unit (mu) allele of CTLA4[AT]n (P = 0.02) in GD probands (Table 2). The odds ratio (OR) for the G allele at CTLA4A/G in GD probands was 2.01 (95% CI 1.13-4.55; P = 0.047) compared with unaffected sibs, and for the GG genotype (versus AG and AA) was 4.56 (95% CI 1.06-22.02; P = 0.028). The OR for the G allele in affected GD males compared with affected female sibs was 1.55 (95% CI 0.68-3.52; P = 0.2).


Figure 1. Multipoint linkage analysis of eight markers on chromosome 2q31-q33. (A) Percentage information content over the marker map. (B) The NPL score obtained by `scoring all' affected subjects with Graves' disease (solid line) and AITD (dashed line) using the GENEHUNTER package is shown, against the marker map on the x-axis. The diallelic polymorphism CTLA4A/G is at the same map position as CTLA4[AT]n. The peak NPL score of 3.43 occurs at the marker D2S117.

Table 1. Phenotypes of affected sib-pairs with autoimmune thyroid disease
  Graves' disease only (GD-GD) Mixed Graves' and AH (GD-AH)a All autoimmune thyroid disease
Full sib-pairs 66 6 72
Half sib-pairs 5 0 5
Total 71 6 77
aFamilies were selected on the basis of two affected GD sibs. GD-AH sib-pairs make up additional members of the same families.

Table 2. Pair-wise association between affected (GD) and unaffected sib controls at linked chromosome 2q31-q33 markers
Marker Allele Graves' probandsa Unaffected sibsa P-valueb
D2S389 203 mu 10/12 5/17 NS
D2S117 206 mu 8/10 3/15 NS
CTLA4A/G G 20/6 10/16 0.005
CTLA4[AT]n 112 mu 14/4 7/11 0.020
D2S116 150 mu 9/7 3/13 NS
aNumber of occurrences of candidate alleles/non-occurrences (45).
bFisher's exact test, corrected for multiple allelic comparisons.

Analysis of chromosome 2q31-q33 linkage conditioned for the CTLA4A/G genotype

Families were weighted according to the CTLA4A/G genotype of the proband, and non-parametric linkage analysis was carried out with AITD subjects designated as affected. The maximum evidence for linkage came from the families whose proband carried the AG genotype, with a peak NPL score of 2.76 occurring at D2S117 (Table 3). Lesser evidence for linkage was found in the families with AA- or GG-carrying probands, with peak NPL scores of 2.14 and 1.36, respectively (Table 3). Despite the association between GD and the G allele of CTLA4A/G, we find no evidence that the linkage is confined to families whose probands carry this allele.

Table 3. Analysis of chromosome 2q31-q33 linkage, conditioned for the CTLA4A/G genotype of the proband
Genotypes of probands Peak NPL score P-value No. of families
GG 1.36 0.087 13
AG 2.76 0.003 30
AA 2.14 0.016 21
GG or AG 3.05 0.001 43
AG or AA 3.28 0.0006 51
All families 3.43 0.0004 64

MHC linkage analysis

Examination of five microsatellite markers spanning a 23 cM region of chromosome 6p21 encompassing the MHC locus showed a modest increase in allele sharing (up to 58%) amongst the 71 affected GD sib-pairs, with a peak multipoint NPL score of 1.95 (P = 0.026) occurring at the markers D6S273 and TNF[alpha] (Fig. 2). Scoring all subjects with AITD as being affected led to a decrease in the peak NPL score (1.40), in keeping with GD and AH having different MHC susceptibility alleles. The minimum z0 value for the 66 full sib-pairs with GD was 0.161 at the marker TNF[alpha], suggesting that the locus-specific [lambda]s for the MHC region is 1.6.


Figure 2. Multipoint linkage analysis of five markers spanning theMHC region. (A) Percentage information content over the marker map. (B) NPL scores obtained for Graves' disease (solid line) and AITD (dashed line) are shown against the marker order on the x-axis. The peak NPL score of 1.95 occurs at the markers D6S273 and TNF[alpha].

Analysis of CTLA-4 linkage conditioned for MHC haplotype sharing

Families were subdivided according to identity by descent (IBD) haplotype sharing at the TNF[alpha] locus, and the linkage to the chromosome 2 markers was re-examined. The peak NPL score for sib-pairs sharing two MHC haplotypes was 2.38 (P = 0.008), compared with 2.19 (P = 0.015) for sibs sharing 1 or 0 MHC haplotypes.

DISCUSSION

We have demonstrated, for the first time, unequivocal evidence (P = 0.0004) for linkage of GD to the D2S117 region of 2q33 (Fig. 1), with a locus-specific [lambda]s of 2.2. The type 1 diabetes loci IDDM7 and the CTLA-4 gene (IDDM12) are close to the linked region, and it is possible that both may contain susceptibility polymorphisms that contribute to the linkage we observe. Our association analysis, which shows evidence for intrafamilial allelic association at the two CTLA-4 markers (CTLA4A/G and CTLA4[AT]n) but not at other loci within this region (Table 2), would suggest that a susceptibility polymorphism(s) lies at, or close to, the CTLA-4 locus. However, subgroup analysis shows that the evidence for linkage to this region is not confined to families with G allele-carrying CTLA4A/G genotypes, such that the effect of this polymorphism alone is not sufficient to explain the observed linkage. The strength of the linkage that we observed in the 24 families with affected male GD members (P = 0.0003, [lambda]s > 10), also suggests that this polymorphism(s) may have a critical role in the susceptibility of males to GD.

Previous studies of the CTLA4[AT]n marker have not shown linkage to AITD; however, both these studies have employed a parametric method of linkage analysis which may be sensitive to mis-specification of background allele frequencies and the mode of inheritance (19,37). Furthermore, these studies combined families from a mixed ethnic background and used a more phenotypically varied population, with many families having only AH-affected subjects (19,37). Thus, our current study has important methodological differences from theCTLA-4 linkage studies reported previously. Despite this, genuine differences in the contribution of the various susceptibility loci for GD are likely to exist between the UK and other populations, as has been already been demonstrated for the CTLA-4 and other loci, in different IDDM populations (6-9,30,31).

In our population, MHC appears to have less influence on GD susceptibility than the CTLA-4 region, with weaker evidence of linkage (NPL score 1.95, P = 0.026), and a locus-specific [lambda]s of 1.6 (Fig. 2). This contrasts with the findings in IDDM, where MHC has a consistently strong effect in all populations (6-9). However, our finding is not unexpected, as >95% of Caucasian IDDM subjects have a `susceptible' IDDMMHC haplotype (DR3/DR4), compared with ~50% of control subjects, whereas only 50-60% of GD subjects carry the GD susceptible haplotype (DR3), compared with 20-30% of control subjects. Thus, MHC has a stronger influence on the development of IDDM than on GD. Our results also show that previous linkage studies of mixed AITD populations (mixed GD/AH families) (18,19) may have been unable to detect linkage of MHC to AITD due to allelic heterogeneity between GD and AH at this locus (10).

Using a multiplicative model, we can estimate that the CTLA-4 locus ([lambda]s = 2.2) confers 29-34% of the total genetic susceptibility to GD in our population (38). It is therefore unlikely that any other locus will have an effect on GD susceptibility that is stronger than that of CTLA-4. Our data also allow us to estimate, for the first time, that the MHC region ([lambda]s = 1.6) confers 17-20% of the genetic susceptibility to GD. Thus, taken together, these two loci account for ~50% of the inherited predisposition to GD in our population.

MATERIALS AND METHODS

Patients

Sixty-four families with two or more sibs affected with GD (including 146 with GD, 20 with AH and 72 unaffected subjects) were recruited from the north of England and the Lothian region of Scotland. GD was confirmed by the finding of biochemical hyperthyroidism, with evidence of one of the following: (i) significant TAO (American Thyroid Association Class 3 or worse) (39); (ii) diffuse increase in thyroid uptake on radionuclide scan; and (iii) positive serum thyrotropin-binding inhibitory immunoglobulin antibodies. The cohort of families comprised 53 full-sibs both with GD, five GD sib-trios, one GD quartet, five half-sibs with GD and six mixed GD/AH full-sibs (Table 1). Parents (n= 49) and unaffected sibs (n= 36) were studied wherever available. Additional second degree relatives had GD (n= 4), AH (n= 3) or were unaffected (n= 5). There were 122 female and 24 male GD patients, with a mean age at onset of 35.5 years (range 9-67 years). Fifty-four (37%) of the GD patients had significant TAO and two had thyroid dermopathy. All members of these sibships were Caucasian, and >95% of grandparents were of mainland UK or Irish origin. DNA from normal control subjects without evidence or family history of autoimmune disease were also obtained from the local population. All studies were carried out with the approval of the regional and district ethics committees.

Genotyping

The microsatellite markers were genotyped using fluorescently labelled PCR and resolved on a semi-automated 373 sequencer (Applied Biosystems, Foster City, CA). The primers, except for CTLA4[AT]n, were taken from the Genethon genetic linkage map (http://www.genethon.fr/genethon_en.html ). The CTLA4[AT]n primers were: 5[prime]-GCC AGT GAT GCT AAA GGT TG-3[prime] and 5[prime]-ACA CAA AAA CAT ACG TGG CTC-3[prime]. Using these primers, the 112 mu allele of CTLA4[AT]n is equivalent to the 106 mu allele described previously (33). The marker map was derived from Genethon and the Southampton University database (http://cedar.genetics.soton.ac.uk/public_html/gmap.html ). The CTLA-4A/G polymorphism in exon 1 of the CTLA-4gene was amplified using the following primers 5[prime]-CCA CGG CTT CCT TTC TCG TA-3[prime] and 5[prime]-AGT CTC ACT CAC CTT TGC AG-3[prime] followed by digestion with the restriction enzyme Bst71I (Promega, Southampton, UK) (32). The Bst71I digestion assay for the CTLA4A/G polymorphism was validated by direct DNA sequencing in five subjects, as described previously (40).

Statistical analysis

Two-point and multipoint NPL scores and marker information content were calculated using the `score all' function of the GENEHUNTER package (41). The minimum proportion of full sib-pairs sharing zero alleles (z0) was calculated for each region using MAPMAKER/SIBS (42). Data from the chromosome 2 markers were weighted (0 or 1) for CTLA4A/G allele status using the modified GENEHUNTER-plus version 2 software, as described previously (43,44). The population allele frequencies for each marker were derived from local Caucasian controls. Family-based association analysis was performed on probands using an unaffected sib as an intrafamilial control (45), and were analysed using Fisher's exact test. P-values were Bonferroni corrected for multiple allelic comparisons, except for the markers CTLA4A/G and CTLA4[AT]n, where candidate alleles were known. ORs were calculated by Woolf's method (46).

ABBREVIATIONS

AH, autoimmune hypothyroidism; AITD, autoimmune thyroid disease; CI, confidence interval; CTLA-4, cytotoxic T lymphocyte antigen-4; GD, Graves' disease; HLA, human leukocyte antigen; IDDM, type 1 diabetes mellitus; MHC, major histocompatibility complex; mu, mobility units; NPL, non-parametric linkage; OR, odds ratio; TAO, thyroid-associated orbitopathy.

ACKNOWLEDGEMENTS

We are grateful to Kath Brown and Kim Johnson for sample collection, and to Dr Dorothy Trump, the British Thyroid Foundation (Janis Hickey) and Thyroid Eye Disease (Sally Mitchell) for help recruiting. This work was supported by the Wellcome Trust.

REFERENCES

1. Tunbridge, W.G.M., Evered, D.C., Hall, R., Appleton, D., Brewis, M., Clark, F., Evans, J.G., Young, E., Bird, T. and Smith, P.A. (1977) The spectrum of thyroid disease in a community: the Whickham survey. Clin. Endocrinol., 7, 481-493.

2. Stenszky, V., Kozma, L., Balâzs, C., Rochlitz, S., Bear, J.C. and Farid, N.R. (1985) The genetics of Graves' disease: HLA and disease susceptibility. J. Clin. Endocrinol. Metab., 61, 735-740. MEDLINE Abstract

3. Bartels, E.D. (1941) Heredity in Graves' Disease.Einar Munksgaard, Copenhagen.

4. Brix, T.H., Christensen, K., Holm, N.V., Harvald, B. and Hegedüs, L. (1998) A population-based study of Graves' disease in Danish twins. Clin. Endocrinol., 48, 397-400.

5. Vyse, T.J. and Todd, J.A. (1996) Genetic analysis of autoimmune disease. Cell, 85, 311-318. MEDLINE Abstract

6. Davies, J.L., Kawaguchi, Y., Bennett, S.T., Copeman, J.B., Cordell, H.J., Pritchard, L.E., Reed, P.W., Gough, S.C.L., Jenkins, S.C., Palmer, S.M., Balfour, K.M., Rowe, B.R., Farrall, M., Barnett, A.H., Bain, S.C. and Todd, J.A. (1994) A genome-wide search for human type 1 diabetes susceptibility genes. Nature, 371, 130-136. MEDLINE Abstract

7. Hashimoto, L., Habita, C., Beressi, J.P., Delepine, M., Besse, C., Cambon-Thomsen, A., Deschamps, I., Rotter, J.I., Djoulah, S., James, M.R., Froguel, P., Weissenbach, J., Lanthrop, G.M. and Julier, C. (1994) Genetic mapping of a susceptibility locus for insulin-dependent diabetes mellitus on chromosome 11q. Nature, 371, 161-164. MEDLINE Abstract

8. Concannon, P., Gogolin-Ewens, K.J., Hinds, D.A., Wapelhorst, B., Morrison, V.A., Stirling, B., Mitra, M., Farmer, J., Williams, S.R., Cox, N.J., Bell, G.I., Risch, N. and Spielman, R.S. (1998) A second-generation screen of the human genome for susceptibility to insulin-dependent diabetes mellitus. Nature Genet., 19, 292-296. MEDLINE Abstract

9. Mein, C.A., Esposito, L., Dunn, M.G., Johnson, G.C.L., Timms, A.E., Goy, J.V., Smith, A.N., Sebag-Montefiore, L., Merriman, M.E., Wilson, A.J., Pritchard, L.E., Cucca, F., Barnett, A.H., Bain, S.C. and Todd, J.A. (1998) A search for type 1 diabetes susceptibility genes in families from the United Kingdom. Nature Genet., 19, 297-300. MEDLINE Abstract

10. Volpé, R. (1990) Immunology of human thyroid disease. In Volpé, R. (ed.), Autoimmune Diseases of the Endocrine System.CRC Press, Boca Raton, FL, pp. 73-239.

11. Torfs, C.P., King, M.C., Huey, B., Malmgren, J. and Grumet, F.C. (1986) Genetic interrelationship between insulin-dependent diabetes mellitus, the autoimmune thyroid diseases, and rheumatoid arthritis. Am. J. Hum. Genet., 38, 170-187. MEDLINE Abstract

12. Payami, H., Joe, S. and Thomson, G. (1989) Autoimmune thyroid disease in type 1 diabetic families. Genet. Epidemiol., 6, 137-141. MEDLINE Abstract

13. Payami, H., Joe, S., Farid, N.R., Stenszky, V., Chan, S.H., Yeo, P.P.B., Cheah, J.S. and Thomson, G. (1989) Relative predispositional effects (RPEs) of marker alleles with disease: HLA-DR alleles and Graves disease. Am. J. Hum. Genet., 45, 541-546. MEDLINE Abstract

14. Yanagawa, T., Mangklabruks, A., Chang, Y.B., Okamoto, Y., Fisfalen, M.E., Curran, P.G. and DeGroot, L.J. (1993) Human histocompatability leukocyte antigen-DQA1*0501 allele associated with genetic susceptibility to Graves' disease in a Caucasian population. J. Clin. Endocrinol. Metab., 76, 1569-1574. MEDLINE Abstract

15. Heward, J.M., Allahabadia, A., Daykin, J., Carr-Smith, J., Daly, A., Armitage, M., Dodson, P.M., Sheppard, M.C., Barnett, A.H., Franklyn, J.A. and Gough, S.C.L. (1998) Linkage disequilibrium between the human leukocyte antigen class II region of the major histocompatibility complex and Graves' disease. J. Clin. Endocrinol. Metab., 83, 3394-3397. MEDLINE Abstract

16. Uno, H., Sasazuki, T., Tamai, H. and Matsumoto, H. (1981) Two major genes, linked to HLA and Gm, control susceptibility to Graves' disease. Nature, 292, 768-770. MEDLINE Abstract

17. Shields, D.C., Ratanachaiyavong, S., McGregor, A.M., Collins, A. and Morton, N.E. (1994) Combined segregation and linkage analysis of Graves disease with a thyroid autoantibody diathesis. Am. J. Hum. Genet., 55, 540-554. MEDLINE Abstract

18. Roman, S.H., Greenberg, D., Rubinstein, P., Wallenstein, S. and Davies, T.F. (1992) Genetics of autoimmune thyroid disease: lack of evidence for linkage to HLA within families. J. Clin. Endocrinol. Metab., 74, 496-503. MEDLINE Abstract

19. Tomer, Y., Barbesino, G., Keddache, M., Greenberg, D.A. and Davies, T.F. (1997) Mapping of a major susceptibility locus for Graves' disease (GD-1) to chromosome 14q31. J. Clin. Endocrinol. Metab., 82, 1645-1648. MEDLINE Abstract

20. Cuddihy, R.M., Dutton, C.M. and Bahn, R.S. (1995) A polymorphism in the extracellular domain of the thyrotropin receptor is highly associated with autoimmune thyroid disease in females. Thyroid, 5, 89-95. MEDLINE Abstract

21. Blakemore, A.I.F., Watson, P.F., Weetman, A.P. and Duff, G.W. (1995) Association of Graves' disease with an allele of the interleukin-1 receptor antagonist gene. J. Clin. Endocrinol. Metab., 80, 111-115. MEDLINE Abstract

22. Demaine, A., Welsh, K.I., Hawe, B.S. and Farid, N.R. (1987) Polymorphism of the T cell receptor [beta]-chain in Graves' disease. J. Clin. Endocrinol. Metab., 65, 643-646. MEDLINE Abstract

23. Tassi, V., Scarnecchia, L., Di Cerbo, A., Pirro, M.T., Di Paola, R., Liuzzi, A., Torlontano, M., Zingrillo, M., D'Aloiso, L. and De Filippis, V. (1995) A thyroid hormone receptor [beta] gene polymorphism associated with Graves' disease. J. Mol. Endocrinol., 15, 267-272. MEDLINE Abstract

24. Kotsa, K.D., Watson, P.F. and Weetman, A.P. (1997) No association between a thyrotropin receptor gene polymorphism and Graves' disease in the female population. Thyroid, 7, 31-33. MEDLINE Abstract

25. Cuddihy, R.M. and Bahn, R.S. (1996) Lack of an association between alleles of interleukin-1 alpha and interleukin-1 receptor antagonist genes and Graves' disease in a North American Caucasian population. J. Clin. Endocrinol. Metab., 81, 4476-4478. MEDLINE Abstract

26. Tomer, Y., Barbesino, G., Greenberg, D.A., Concepcion, E. and Davies, T.F. (1998) A new Graves disease-susceptibility locus maps to chromosome 20q11.2. Am. J. Hum. Genet., 63, 1749-1756. MEDLINE Abstract

27. Barbesino, G., Tomer, Y., Concepcion, E.S., Davies, T.F. and Greenberg, D.A. (1998) Linkage analysis of candidate genes in autoimmune thyroid disease. II. Selected gender-related genes and the X chromosome. J. Clin. Endocrinol. Metab., 83, 3290-3295. MEDLINE Abstract

28. Waterhouse, P., Penninger, J.M., Timms, E., Wakeham, A., Shahinian, A., Lee, K.P., Thompson, C.B., Griesser, H. and Mak, T.W. (1995) Lymphoproliferative disorders with early lethality in mice deficient in Ctla-4. Science, 270, 985-988. MEDLINE Abstract

29. Copeman, J.B., Cucca, F., Hearne, C.M., Cornall, R.J., Reed, P.W., R[oslash]nningen, K.S., Undlien, D.E., Nisticò, L., Buzzetti, R., Tosi, R., Pociot, F., Nerup, J., Cornélis, F., Barnett, A.H., Bain, S.C. and Todd, J.A. (1995) Linkage disequilibrium mapping of a type 1 diabetes susceptibility gene (IDDM 7)to chromosome 2q31-q33. Nature Genet., 9, 80-85. MEDLINE Abstract

30. Nisticò, L., Buzzetti, R., Pritchard, L.E., Van der Auwera, B., Giovannini, C., Bosi, E., Larrad, M.T.M., Rios, M.S., Chow, C.C., Cockram, C.S., Jacobs, K., Mijovic, C., Bain, S.C., Barnett, A.H., Vandewalle, C.L., Schuit, F., Gorus, F.K., Belgian Diabetes Registry, Tosi, R., Pozzilli, P. and Todd, J.A. (1996) The CTLA-4gene region of chromosome 2q33 is linked to, and associated with, type 1 diabetes. Hum. Mol. Genet., 5, 1075-1080. MEDLINE Abstract

31. Marron, M.P., Raffel, L.J., Garchon, H.J., Jacob, C.O., Serrano-Rios, M., Larrad, M.T.M., Teng, W.P., Park, Y., Zhang, Z.X., Goldstein, D.R., Tao, Y.W., Beaurain, G., Bach, J.F., Huang, H.S., Luo, D.F., Zeidler, A., Rotter, J.I., Yang, M.C.K., Modilevsky, T., Maclaren N.K. and She, J.X. (1997) Insulin-dependent diabetes mellitus (IDDM) is associated with CTLA4 polymorphisms in multiple ethnic groups. Hum. Mol. Genet., 6, 1275-1282. MEDLINE Abstract

32. Donner, H., Rau, H., Walfish, P.G., Braun, J., Siegmund, T., Finke, R., Herwig, J., Usadel, K.H. and Badenhoop, K. (1997) CTLA4 alanine-17 confers genetic susceptibility to Graves' disease and to type 1 diabetes mellitus. J. Clin. Endocrinol. Metab., 82, 143-146. MEDLINE Abstract

33. Yanagawa, T., Hidaka, Y., Guimaraes, V., Soliman, M. and DeGroot, L.J. (1995) CTLA-4gene polymorphism associated with Graves' disease in a Caucasian population. J. Clin. Endocrinol. Metab., 80, 41-45. MEDLINE Abstract

34. Kotsa, K., Watson, P.F. and Weetman, A.P. (1997) A CTLA-4gene polymorphism is associated with both Graves disease and autoimmune hypothyroidism. Clin. Endocrinol., 46, 551-554.

35. Donner, H., Braun, J., Seidl, C., Rau, H., Finke, R., Ventz, M., Walfish, P.G., Usadel, K.H. and Badenhoop, K. (1997) Codon 17 polymorphism of the cytotoxic T lymphocyte antigen 4 gene in Hashimoto's thyroiditis and Addison's disease.J. Clin. Endocrinol. Metab., 82, 4130-4132. MEDLINE Abstract

36. Yanagawa, T., Taniyama, M., Enomoto, S., Gomi, K., Maruyama, H., Ban, Y. and Saruta, T. (1997) CTLA 4gene polymorphism confers susceptibility to Graves' disease in Japanese. Thyroid, 7, 843-846. MEDLINE Abstract

37. Barbesino, G., Tomer, Y., Concepcion, E., Davies, T.F., Greenberg, D.A. and the International Consortium for the Genetics of Autoimmune Thyroid Disease. (1998) Linkage analysis of candidate genes in autoimmune thyroid disease: 1. Selected immunoregulatory genes. J. Clin. Endocrinol. Metab., 83, 1580-1584. MEDLINE Abstract

38. Risch, N. (1987) Assessing the role of HLA-linked and unlinked determinants of disease. Am. J. Hum. Genet., 40, 1-14. MEDLINE Abstract

39. Werner, S.C. (1977) Modification of the classification of the eye changes of Graves' disease: recommendations of the ad hoc committee of the American Thyroid Association. J. Clin. Endocrinol. Metab., 44, 203-204. MEDLINE Abstract

40. Pearce, S.H.S., Trump, D., Wooding, C., Besser, G.M., Chew, S.L., Grant, D.B., Heath, D.A., Hughes, I.A., Paterson, C.R., Whyte, M.P. and Thakker, R.V. (1995) Calcium-sensing receptor mutations in familial benign hypercalcemia and neonatal hyperparathyroidism. J. Clin. Invest., 96, 2683-2692. MEDLINE Abstract

41. Kruglyak, L., Daly, M.J., Reeve-Daly, M.P. and Lander, E.S. (1996) Parametric and nonparametric linkage analysis: a unified multipoint approach. Am. J. Hum. Genet., 58, 1347-1363. MEDLINE Abstract

42. Kruglyak, L. and Lander, E.S. (1995) Complete multipoint sib-pair analysis of qualitative and quantitative traits. Am. J. Hum. Genet., 57, 439-454. MEDLINE Abstract

43. Kong, A. and Cox, N.J. (1997) Allele-sharing models: LOD scores and accurate linkage tests. Am. J. Hum. Genet., 61, 1179-1188. MEDLINE Abstract

44. Cox, N.J., Frigge, M., Nicolae, D.L., Concannon, P., Hanis, C.L., Bell, G.I. and Kong, A. (1999) Loci on chromosomes 2 (NIDDM1) and 15 interact to increase susceptibility to diabetes in Mexican Americans. Nature Genet., 21, 213-215. MEDLINE Abstract

45. Curtis, D. (1997) Use of siblings as controls in case-control association studies. Ann. Hum. Genet., 61, 319-333. MEDLINE Abstract

46. Woolfe, B. (1995) On estimating the relation between blood group and disease. Ann. Hum. Genet., 19, 251-253.


*These authors contributed equally to this work
+To whom correspondence should be addressed. Tel: +44 191 222 8026; Fax. +44 191 222 0723; Email: spearce{at}hgmp.mrc.ac.uk


This page is run by Oxford University Press, Great Clarendon Street, Oxford OX2 6DP, as part of the OUP Journals
Comments and feedback: jnl.info{at}oup.co.uk
Last modification:
Copyright© Oxford University Press, 1999.

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
IOVSHome page
K. K. L. Chong, S. W. Y. Chiang, G. W. K. Wong, P. O. S. Tam, T.-K. Ng, Y.-J. Hu, G. H. F. Yam, D. S. C. Lam, and C.-P. Pang
Association of CTLA-4 and IL-13 Gene Polymorphisms with Graves' Disease and Ophthalmopathy in Chinese Children
Invest. Ophthalmol. Vis. Sci., June 1, 2008; 49(6): 2409 - 2415.
[Abstract] [Full Text] [PDF]


Home page
J. Clin. Endocrinol. Metab.Home page
A. Sutherland, J. Davies, C. J. Owen, S. Vaikkakara, C. Walker, T. D. Cheetham, R. A. James, P. Perros, P. T. Donaldson, H. J. Cordell, et al.
Genomic Polymorphism at the Interferon-Induced Helicase (IFIH1) Locus Contributes to Graves' Disease Susceptibility
J. Clin. Endocrinol. Metab., August 1, 2007; 92(8): 3338 - 3341.
[Abstract] [Full Text] [PDF]


Home page
J. Clin. Endocrinol. Metab.Home page
C. J. Owen, H. Kelly, J. A. Eden, M. E. Merriman, S. H. S. Pearce, and T. R. Merriman
Analysis of the Fc Receptor-Like-3 (FCRL3) Locus in Caucasians with Autoimmune Disorders Suggests a Complex Pattern of Disease Association
J. Clin. Endocrinol. Metab., March 1, 2007; 92(3): 1106 - 1111.
[Abstract] [Full Text] [PDF]


Home page
J. Clin. Endocrinol. Metab.Home page
J. M. Barker
Type 1 Diabetes-Associated Autoimmunity: Natural History, Genetic Associations, and Screening
J. Clin. Endocrinol. Metab., April 1, 2006; 91(4): 1210 - 1217.
[Abstract] [Full Text] [PDF]


Home page
Am. J. PsychiatryHome page
W. W. Eaton, M. Byrne, H. Ewald, O. Mors, C.-Y. Chen, E. Agerbo, and P. B. Mortensen
Association of Schizophrenia and Autoimmune Diseases: Linkage of Danish National Registers
Am J Psychiatry, March 1, 2006; 163(3): 521 - 528.
[Abstract] [Full Text] [PDF]


Home page
J. Clin. Endocrinol. Metab.Home page
H. Ikegami, T. Awata, E. Kawasaki, T. Kobayashi, T. Maruyama, K. Nakanishi, A. Shimada, S. Amemiya, Y. Kawabata, S. Kurihara, et al.
The Association of CTLA4 Polymorphism with Type 1 Diabetes Is Concentrated in Patients Complicated with Autoimmune Thyroid Disease: A Multicenter Collaborative Study in Japan
J. Clin. Endocrinol. Metab., March 1, 2006; 91(3): 1087 - 1092.
[Abstract] [Full Text] [PDF]


Home page
J. Clin. Endocrinol. Metab.Home page
J. C. Taylor, S. C. Gough, P. J. Hunt, T. H. Brix, K. Chatterjee, J. M. Connell, J. A. Franklyn, L. Hegedus, B. G. Robinson, W. M. Wiersinga, et al.
A Genome-Wide Screen in 1119 Relative Pairs with Autoimmune Thyroid Disease
J. Clin. Endocrinol. Metab., February 1, 2006; 91(2): 646 - 653.
[Abstract] [Full Text] [PDF]


Home page
J Mol EndocrinolHome page
C E Jennings, C J Owen, V Wilson, and S H S Pearce
A haplotype of the CYP27B1 promoter is associated with autoimmune Addison's disease but not with Graves' disease in a UK population
J. Mol. Endocrinol., June 1, 2005; 34(3): 859 - 863.
[Abstract] [Full Text] [PDF]


Home page
J. Clin. Endocrinol. Metab.Home page
Y. Ban, E. S. Concepcion, R. Villanueva, D. A. Greenberg, T. F. Davies, and Y. Tomer
Analysis of Immune Regulatory Genes in Familial and Sporadic Graves' Disease
J. Clin. Endocrinol. Metab., September 1, 2004; 89(9): 4562 - 4568.
[Abstract] [Full Text] [PDF]


Home page
Endocr. Rev.Home page
B. S. Prabhakar, R. S. Bahn, and T. J. Smith
Current Perspective on the Pathogenesis of Graves' Disease and Ophthalmopathy
Endocr. Rev., December 1, 2003; 24(6): 802 - 835.
[Abstract] [Full Text] [PDF]


Home page
Endocr. Rev.Home page
Y. Tomer and T. F. Davies
Searching for the Autoimmune Thyroid Disease Susceptibility Genes: From Gene Mapping to Gene Function
Endocr. Rev., October 1, 2003; 24(5): 694 - 717.
[Abstract] [Full Text] [PDF]


Home page
J. Clin. Endocrinol. Metab.Home page
J. E. Collins, J. M. Heward, J. Carr-Smith, J. Daykin, J. A. Franklyn, and S. C. L. Gough
Association of a Rare Thyroglobulin Gene Microsatellite Variant with Autoimmune Thyroid Disease
J. Clin. Endocrinol. Metab., October 1, 2003; 88(10): 5039 - 5042.
[Abstract] [Full Text] [PDF]


Home page
J. Clin. Endocrinol. Metab.Home page
H. H. Kacem, A. Rebai, N. Kaffel, S. Masmoudi, M. Abid, and H. Ayadi
PDS Is a New Susceptibility Gene to Autoimmune Thyroid Diseases: Association and Linkage Study
J. Clin. Endocrinol. Metab., May 1, 2003; 88(5): 2274 - 2280.
[Abstract] [Full Text] [PDF]


Home page
J. Clin. Endocrinol. Metab.Home page
Y. Jin, W. Teng, S. Ben, X. Xiong, J. Zhang, S. Xu, Y. Y. Shugart, L. Jin, J. Chen, and W. Huang
Genome-Wide Scan of Graves' Disease: Evidence for Linkage on Chromosome 5q31 in Chinese Han Pedigrees
J. Clin. Endocrinol. Metab., April 1, 2003; 88(4): 1798 - 1803.
[Abstract] [Full Text] [PDF]


Home page
J. Clin. Endocrinol. Metab.Home page
B. Vaidya, P. Kendall-Taylor, and S. H. S. Pearce
The Genetics of Autoimmune Thyroid Disease
J. Clin. Endocrinol. Metab., December 1, 2002; 87(12): 5385 - 5397.
[Full Text] [PDF]


Home page
J. Biol. Chem.Home page
S. Anjos, A. Nguyen, H. Ounissi-Benkalha, M.-C. Tessier, and C. Polychronakos
A Common Autoimmunity Predisposing Signal Peptide Variant of the Cytotoxic T-lymphocyte Antigen 4 Results in Inefficient Glycosylation of the Susceptibility Allele
J. Biol. Chem., November 22, 2002; 277(48): 46478 - 46486.
[Abstract] [Full Text] [PDF]


Home page
J. Immunol.Home page
Y. Nagayama, M. Kita-Furuyama, T. Ando, K. Nakao, H. Mizuguchi, T. Hayakawa, K. Eguchi, and M. Niwa
A Novel Murine Model of Graves' Hyperthyroidism with Intramuscular Injection of Adenovirus Expressing the Thyrotropin Receptor
J. Immunol., March 15, 2002; 168(6): 2789 - 2794.
[Abstract] [Full Text] [PDF]


Home page
Rheumatology (Oxford)Home page
B. Vaidya, S. H. S. Pearce, S. Charlton, N. Marshall, A. D. Rowan, I. D. Griffiths, P. Kendall-Taylor, T. E. Cawston, and S. Young-Min
An association between the CTLA4 exon 1 polymorphism and early rheumatoid arthritis with autoimmune endocrinopathies
Rheumatology, February 1, 2002; 41(2): 180 - 183.
[Abstract] [Full Text] [PDF]


Home page
Rheumatology (Oxford)Home page
H. H. Kacem, N. Kaddour, F.-Z. Adyel, Z. Bahloul, and H. Ayadi
HLA-DQB1 CAR1/CAR2, TNFa IR2/IR4 and CTLA-4 polymorphisms in Tunisian patients with rheumatoid arthritis and Sjogren's syndrome
Rheumatology, December 1, 2001; 40(12): 1370 - 1374.
[Abstract] [Full Text] [PDF]


Home page
J. Biol. Chem.Home page
G. Dodt, D. Warren, E. Becker, P. Rehling, and S. J. Gould
Domain Mapping of Human PEX5 Reveals Functional and Structural Similarities to Saccharomyces cerevisiae Pex18p and Pex21p
J. Biol. Chem., November 2, 2001; 276(45): 41769 - 41781.
[Abstract] [Full Text] [PDF]


Home page
J. Med. Genet.Home page
B. Fritz, I. Dietze, A. Wandall, M. Aslan, A. Schmidt, E. Kattner, R. Schwerdtfeger, and U. Friedrich
A supernumerary marker chromosome with a neocentromere derived from 5p14{right-arrow}pter
J. Med. Genet., August 1, 2001; 38(8): 559 - 565.
[Full Text] [PDF]


Home page
Hum Mol GenetHome page
K. Sakai, S. Shirasawa, N. Ishikawa, K. Ito, H. Tamai, K. Kuma, T. Akamizu, M. Tanimura, K. Furugaki, K. Yamamoto, et al.
Identification of susceptibility loci for autoimmune thyroid disease to 5q31-q33 and Hashimoto's thyroiditis to 8q23-q24 by multipoint affected sib-pair linkage analysis in Japanese
Hum. Mol. Genet., June 1, 2001; 10(13): 1379 - 1386.
[Abstract] [Full Text] [PDF]


Home page
GutHome page
P Holopainen, K Mustalahti, P Uimari, P Collin, M Maki, and J Partanen
Candidate gene regions and genetic heterogeneity in gluten sensitivity
Gut, May 1, 2001; 48(5): 696 - 701.
[Abstract] [Full Text] [PDF]


Home page
J. Clin. Endocrinol. Metab.Home page
Y. Tomer, D. A. Greenberg, G. Barbesino, E. Concepcion, and T. F. Davies
CTLA-4 and Not CD28 Is a Susceptibility Gene for Thyroid Autoantibody Production
J. Clin. Endocrinol. Metab., April 1, 2001; 86(4): 1687 - 1693.
[Abstract] [Full Text]


Home page
J. Clin. Endocrinol. Metab.Home page
H. Imrie, B. Vaidya, P. Perros, W. F. Kelly, A. D. Toft, E. T. Young, P. Kendall-Taylor, and S. H. S. Pearce
Evidence for a Graves' Disease Susceptibility Locus at Chromosome Xp11 in a United Kingdom Population
J. Clin. Endocrinol. Metab., February 1, 2001; 86(2): 626 - 630.
[Abstract] [Full Text]


Home page
J. Clin. Endocrinol. Metab.Home page
T. H. Brix, K. O. Kyvik, K. Christensen, and L. Hegedüs
Evidence for a Major Role of Heredity in Graves' Disease: A Population-Based Study of Two Danish Twin Cohorts
J. Clin. Endocrinol. Metab., February 1, 2001; 86(2): 930 - 934.
[Abstract] [Full Text]


Home page
J. Clin. Endocrinol. Metab.Home page
Y. Ban, M. Taniyama, and Y. Ban
Vitamin D Receptor Gene Polymorphism Is Associated with Graves' Disease in the Japanese Population
J. Clin. Endocrinol. Metab., December 1, 2000; 85(12): 4639 - 4643.
[Abstract] [Full Text]


Home page
J. Immunol.Home page
C. Pioli, L. Gatta, V. Ubaldi, and G. Doria
Inhibition of IgG1 and IgE Production by Stimulation of the B Cell CTLA-4 Receptor
J. Immunol., November 15, 2000; 165(10): 5530 - 5536.
[Abstract] [Full Text] [PDF]


Home page
Hum Mol GenetHome page
T. Furuya, J. L. Salstrom, S. McCall-Vining, G. W. Cannon, B. Joe, E. F. Remmers, M. M. Griffiths, and R. L. Wilder
Genetic dissection of a rat model for rheumatoid arthritis: significant gender influences on autosomal modifier loci
Hum. Mol. Genet., September 1, 2000; 9(15): 2241 - 2250.
[Abstract] [Full Text] [PDF]


Home page
J. Clin. Endocrinol. Metab.Home page
Q.-Y. Chen, D. Nadell, X.-Y. Zhang, A. Kukreja, Y.-J. Huang, J. Wise, F. Svec, R. Richards, K. E. Friday, A. Vargas, et al.
The Human Leukocyte Antigen HLA DRB3*0202/DQA1*0501 Haplotype Is Associated with Graves' Disease in African Americans
J. Clin. Endocrinol. Metab., April 1, 2000; 85(4): 1545 - 1549.
[Abstract] [Full Text]


Home page
J. Clin. Endocrinol. Metab.Home page
B. Vaidya, H. Imrie, D. R. Geatch, P. Perros, S. G. Ball, P. H. Baylis, D. Carr, S. J. Hurel, R. A. James, W. F. Kelly, et al.
Association Analysis of the Cytotoxic T Lymphocyte Antigen-4 (CTLA-4) and Autoimmune Regulator-1 (AIRE-1) Genes in Sporadic Autoimmune Addison's Disease
J. Clin. Endocrinol. Metab., February 1, 2000; 85(2): 688 - 691.
[Abstract] [Full Text]


Home page