Fine-mapping of the human leukocyte antigen locus as a risk factor for Alzheimer disease: A case–control study
Open accessAbstract
BACKGROUND: Alzheimer disease (AD) is a progressive disorder that affects cognitive function. There is increasing support for the role of neuroinflammation and aberrant immune regulation in the pathophysiology of AD. The immunoregulatory human leukocyte antigen (HLA) complex has been linked to susceptibility for a number of neurodegenerative diseases, including AD; however, studies to date have failed to consistently identify a risk HLA haplotype for AD. Contributing to this difficulty are the complex genetic organization of the HLA region, differences in sequencing and allelic imputation methods, and diversity across ethnic populations. METHODS AND FINDINGS: Building on prior work linking the HLA to AD, we used a robust imputation method on two separate case-control cohorts to examine the relationship between HLA haplotypes and AD risk in 309 individuals (191 AD, 118 cognitively normal [CN] controls) from the San Francisco-based University of California, San Francisco (UCSF) Memory and Aging Center (collected between 1999-2015) and 11,381 individuals (5,728 AD, 5,653 CN controls) from the Alzheimer's Disease Genetics Consortium (ADGC), a National Institute on Aging (NIA)-funded national data repository (reflecting samples collected between 1984-2012). We also examined cerebrospinal fluid (CSF) biomarker measures for patients seen between 2005-2007 and longitudinal cognitive data from the Alzheimer's Disease Neuroimaging Initiative (n = 346, mean follow-up 3.15 ± 2.04 y in AD individuals) to assess the clinical relevance of identified risk haplotypes. The strongest association with AD risk occurred with major histocompatibility complex (MHC) haplotype A*03:01~B*07:02~DRB1*15:01~DQA1*01:02~DQB1*06:02 (p = 9.6 x 10-4, odds ratio [OR] [95% confidence interval] = 1.21 [1.08-1.37]) in the combined UCSF + ADGC cohort. Secondary analysis suggested that this effect may be driven primarily by individuals who are negative for the established AD genetic risk factor, apolipoprotein E (APOE) ɛ4. Separate analyses of class I and II haplotypes further supported the role of class I haplotype A*03:01~B*07:02 (p = 0.03, OR = 1.11 [1.01-1.23]) and class II haplotype DRB1*15:01- DQA1*01:02- DQB1*06:02 (DR15) (p = 0.03, OR = 1.08 [1.01-1.15]) as risk factors for AD. We followed up these findings in the clinical dataset representing the spectrum of cognitively normal controls, individuals with mild cognitive impairment, and individuals with AD to assess their relevance to disease. Carrying A*03:01~B*07:02 was associated with higher CSF amyloid levels (p = 0.03, β ± standard error = 47.19 ± 21.78). We also found a dose-dependent association between the DR15 haplotype and greater rates of cognitive decline (greater impairment on the 11-item Alzheimer's Disease Assessment Scale cognitive subscale [ADAS11] over time [p = 0.03, β ± standard error = 0.7 ± 0.3]; worse forgetting score on the Rey Auditory Verbal Learning Test (RAVLT) over time [p = 0.02, β ± standard error = -0.2 ± 0.06]). In a subset of the same cohort, dose of DR15 was also associated with higher baseline levels of chemokine CC-4, a biomarker of inflammation (p = 0.005, β ± standard error = 0.08 ± 0.03). The main study limitations are that the results represent only individuals of European-ancestry and clinically diagnosed individuals, and that our study used imputed genotypes for a subset of HLA genes. CONCLUSIONS: We provide evidence that variation in the HLA locus-including risk haplotype DR15-contributes to AD risk. DR15 has also been associated with multiple sclerosis, and its component alleles have been implicated in Parkinson disease and narcolepsy. Our findings thus raise the possibility that DR15-associated mechanisms may contribute to pan-neuronal disease vulnerability.
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Previous analyses in the ADGC have linked both HLA class I and II haplotypes with Alzheimer's disease risk.
“Previous analyses in the ADGC (5,728 Alzheimer’s disease cases and 5,653 controls) have linked both HLA class I and II haplotypes with Alzheimer’s disease risk106.”
From Genetic meta-analysis of diagnosed Alzheimer’s disease identifies new risk loci and implicates Aβ, tau, immunity and lipid processing (2019) · cites this paper as [106]
A specific class II HLA-DR haplotype, DR15, has been suggested to impart risk for both AD and MS.
“Beyond these findings, a specific class II human leukocyte antigen (HLA)-DR haplotype, DR15, has been suggested to impart risk for both AD and MS (7, 8).”
From The Transcriptional Landscape of Microglial Genes in Aging and Neurodegenerative Disease (2019) · cites this paper as [8]
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Sun, Y., Zhu, J., Zhou, D., Canchi, S., Wu, C., Cox, N. J., Rissman, R. A., Gamazon, E. R., & Wu, L. (2021) · Figshare · doi:10.6084/m9.figshare.16557345
Sun, Y., Zhu, J., Zhou, D., Canchi, S., Wu, C., Cox, N. J., Rissman, R. A., Gamazon, E. R., & Wu, L. (2021) · Figshare · doi:10.6084/m9.figshare.16557378
Sun, Y., Zhu, J., Zhou, D., Canchi, S., Wu, C., Cox, N. J., Rissman, R. A., Gamazon, E. R., & Wu, L. (2021) · Figshare · doi:10.6084/m9.figshare.16557333
Sun, Y., Zhu, J., Zhou, D., Canchi, S., Wu, C., Cox, N. J., Rissman, R. A., Gamazon, E. R., & Wu, L. (2021) · Figshare · doi:10.6084/m9.figshare.16557360
Sun, Y., Zhu, J., Zhou, D., Canchi, S., Wu, C., Cox, N. J., Rissman, R. A., Gamazon, E. R., & Wu, L. (2021) · Figshare · doi:10.6084/m9.figshare.16557354
Sun, Y., Zhu, J., Zhou, D., Canchi, S., Wu, C., Cox, N. J., Rissman, R. A., Gamazon, E. R., & Wu, L. (2021) · Figshare · doi:10.6084/m9.figshare.16557342
Sun, Y., Zhu, J., Zhou, D., Canchi, S., Wu, C., Cox, N. J., Rissman, R. A., Gamazon, E. R., & Wu, L. (2021) · Figshare · doi:10.6084/m9.figshare.16557357
Sun, Y., Zhu, J., Zhou, D., Canchi, S., Wu, C., Cox, N. J., Rissman, R. A., Gamazon, E. R., & Wu, L. (2021) · Figshare · doi:10.6084/m9.figshare.16557375
Sun, Y., Zhu, J., Zhou, D., Canchi, S., Wu, C., Cox, N. J., Rissman, R. A., Gamazon, E. R., & Wu, L. (2021) · Figshare · doi:10.6084/m9.figshare.16557348
Sun, Y., Zhu, J., Zhou, D., Canchi, S., Wu, C., Cox, N. J., Rissman, R. A., Gamazon, E. R., & Wu, L. (2021) · Figshare · doi:10.6084/m9.figshare.16557369
Sun, Y., Zhu, J., Zhou, D., Canchi, S., Wu, C., Cox, N. J., Rissman, R. A., Gamazon, E. R., & Wu, L. (2021) · Figshare · doi:10.6084/m9.figshare.16557336
Immunogenetics of neurological disease
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Genetic Factors in Neuroimmune Diseases
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Sun, Y., Zhu, J., Zhou, D., Canchi, S., Wu, C., Cox, N. J., Rissman, R. A., Gamazon, E. R., & Wu, L. (2021) · Figshare · doi:10.6084/m9.figshare.16557339
Cruz, L. A., Liu, S., Miskimen, K. L. S., Bailey, J. N. C., Kinzy, T. G., Song, Y. E., Laux, R. A., Miron, P. L., Ogrocki, P. K., Lerner, A. J., et al. (2026) · Annals of Human Genetics · doi:10.64898/2026.01.25.26344754
Yang, X., Jiang, J., Li, W., Pan, R., & Li, Y. (2026) · The Journal of Prevention of Alzheimer s Disease · doi:10.1016/j.tjpad.2026.100509
- Authors
- Steele, N. Z. R., Carr, J. S., Bonham, L. W., Geier, E. G., Damotte, V., Miller, Z. A., Desikan, R. S., Boehme, K. L., Mukherjee, S., Crane, P. K., Kauwe, J. S. K., Kramer, J. H., Miller, B. L., Coppola, G., Hollenbach, J. A., Huang, Y., & Yokoyama, J. S.
- Affiliations
- University of California, San Francisco (US)
- Gladstone Institutes (US)
- Johns Hopkins University (US)
- Brigham Young University (US)
- University of Washington (US)
- University of California, Los Angeles (US)
- Corresponding author
- Yokoyama, Jennifer S.
- ORCID
- Venue
- PLOS Medicine
- Publisher
- Public Library of Science (PLoS)
- Published
- 2017-03-28
- Volume
- 14
- Issue
- 3
- Pages
- e1002272
- ISSN
- 1549-1277 (ISSN-L)
- 1549-1676
- PMC
- PMC5369701
- OpenAlex
- W2597790250
- Cited by
- 91
- References
- 82
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 10 · 2023: 10 · 2022: 14 · 2021: 15 · 2020: 5 · 2019: 8 · 2018: 10 · 2017: 3
- FWCI
- 5.22
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- Larry L. Hillblom Foundation (2016-A-005-SUP, Hillblom Aging Network)
- National Institute on Aging (AG049152, R01 AG048017, K23 AG048291, AG023501, AG1972403)
- Tau Consortium
- National Alzheimer's Coordinating Center (Junior Investigator Award)
- Foundation of the American Society of Neuroradiology (Alzheimer's Imaging Grant)
- National Institutes of Health (RC1 AG035610, R01 AG26938)
- The John Douglas French Alzheimer's Foundation
- Dr. Miriam and Sheldon G. Adelson Medical Research Foundation
- CHDI Foundation
- Takeda Pharmaceutical Company
- National Institute of Neurological Disorders and Stroke (P30 NS062691)
- Topics
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic Associations and Epidemiology
- Keywords
- Alzheimer's disease, human leukocyte antigen, HLA haplotypes, major histocompatibility complex, genetic risk, neuroinflammation, APOE ε4, APOE ε2, APOE ε3, cerebrospinal fluid biomarkers, CSF tau, cognitive decline
- MeSH terms
- Aged, Aged, 80 and over, Alzheimer Disease, Chromosome Mapping, Female, Haplotypes, HLA Antigens, Humans, Male, Middle Aged, Risk Factors, San Francisco, United States, Case-Control Studies
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