HLA-A: Difference between revisions

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{{further|Human leukocyte antigen|History and naming of human leukocyte antigens}}
| update_page = yes
{{heteropolypeptide
| require_manual_inspection = no
  | heteropolymer = [[MHC class I]], A
| update_protein_box = yes
  | polymer_type = heterodimer
| update_summary = no
  | protein_type = [[Transmembrane receptor|Cell surface receptor]]
| update_citations = no
  | function = Peptide presentation for immune recognition
  | image = Illustration_HLA-A.png
  | image_source = Illustration of HLA-A  | SubunitCount = 2
  | subunit1 = α
  | gene1 = <span class=plainlinks>[http://www.genenames.org/data/hgnc_data.php?match=HLA-A HLA-A]</span>
  | locus1 = [[Chromosome 6]]p21.3
  | subunit2 = β<sub>2</sub>M
  | gene2 = [[Beta-2 microglobulin|B2M]]
  | locus2 = [[Chromosome 15]]q22
}}
}}
{{GNF_Protein_box
'''HLA-A''' is a group of [[human leukocyte antigen]]s (HLA) that are coded for by the HLA-A [[locus (genetics)|locus]], which is located at human chromosome 6p21.3.<ref name="HLA Nomenclature">{{cite web | url = http://hla.alleles.org | title = HLA Nomenclature @ hla.alleles.org | date = 10 Nov 2013 | format = | work = | publisher = Anthony Nolan Research Institute | accessdate = 8 Dec 2013 }}</ref> HLA is a [[major histocompatibility complex]] (MHC) antigen specific to humans.  HLA-A is one of three major types of human [[MHC class I]] [[cell surface receptor]]s. The others are [[HLA-B]] and [[HLA-C]].<ref name="Statistics">{{cite web | url = http://www.ebi.ac.uk/ipd/imgt/hla/stats.html | title = Statistics | date = | work = | publisher = European Bioinformatics Institute (EBI) / European Molecular Biology Laboratory (EMBL) | accessdate = 13 Dec 2013 }}</ref> The receptor is a [[heterodimer]], and is composed of a heavy α chain and smaller β chain. The α chain is encoded by a variant [[#HLA-A gene|HLA-A gene]], and the β chain (β<sub>2</sub>-microglobulin) is an invariant [[Beta-2 microglobulin|β<sub>2</sub> microglobulin]] molecule.<ref name="HLA System">{{cite web | url = http://www.merckmanuals.com/professional/immunology_allergic_disorders/biology_of_the_immune_system/human_leukocyte_antigen_hla_system.html | title = Human Leukocyte Antigen (HLA) System: Biology of the Immune System | author = Delves PJ | date = Aug 2013 | work = Merck Manual Professional | publisher Merck Sharp & Dohme Corp | accessdate = 14 Dec 2013 }}</ref> The β<sub>2</sub> microglobulin protein is coded for by a separate region of the human genome.<ref name="GeneCards beta microglobulin">{{cite web | url = http://www.genecards.org/cgi-bin/carddisp.pl?gene=B2M | title = B2M Gene | date = 7 Nov 2013 | work = GeneCards | publisher = Weizmann Institute of Science | accessdate = 14 Dec 2013 }}</ref>
| image = A2-peptide.PNG
| image_source = HLA-A2 with bound peptide
| Name = Major histocompatibility complex, class I, A
| HGNCid = 4931
| Symbol = HLA-A
| AltSymbols =;
| OMIM = 142800
| ECnumber = 
| Homologene = 74421
| MGIid = 95904
<!-- The Following entry is a time stamp of the last bot update.  It is typically hidden data -->
| DateOfBotUpdate = 07:27, 9 October 2007 (UTC)
| Function = {{GNF_GO|id=GO:0005515 |text = protein binding}} {{GNF_GO|id=GO:0032393 |text = MHC class I receptor activity}}
| Component = {{GNF_GO|id=GO:0005887 |text = integral to plasma membrane}} {{GNF_GO|id=GO:0016020 |text = membrane}} {{GNF_GO|id=GO:0016021 |text = integral to membrane}} {{GNF_GO|id=GO:0042612 |text = MHC class I protein complex}}
| Process = {{GNF_GO|id=GO:0002474 |text = antigen processing and presentation of peptide antigen via MHC class I}} {{GNF_GO|id=GO:0006955 |text = immune response}} {{GNF_GO|id=GO:0019882 |text = antigen processing and presentation}}  
| Orthologs = {{GNF_Ortholog_box
    | Hs_EntrezGene = 3105
    | Hs_Ensembl =
    | Hs_RefseqProtein = NP_002107
    | Hs_RefseqmRNA = NM_002116
    | Hs_GenLoc_db =   
    | Hs_GenLoc_chr =
    | Hs_GenLoc_start =   
    | Hs_GenLoc_end =   
    | Hs_Uniprot =
    | Mm_EntrezGene = 14972
    | Mm_Ensembl =
    | Mm_RefseqmRNA = NM_001001892
    | Mm_RefseqProtein = NP_001001892
    | Mm_GenLoc_db =   
    | Mm_GenLoc_chr =
    | Mm_GenLoc_start =   
    | Mm_GenLoc_end =
    | Mm_Uniprot =   
  }}
}}
{{CMG}}
__NOTOC__


MHC Class I molecules such as HLA-A are part of a process that presents short polypeptides to the immune system. These polypeptides are typically 7-11 amino acids in length and originate from proteins being expressed by the cell. There are two classes of polypeptide that can be presented by an HLA protein: those that are supposed to be expressed by the cell (self) and those of foreign derivation (non-self).<ref name="Davis">{{cite book | author = [[Daniel M. Davis]] | title = The Compatibility Gene. How Our Bodies Fight Disease, Attract Others, and Define Our Selves. | publisher = [[Oxford University Press]] | location = Oxford | year = 2014 | isbn = 0-19-931641-4 }}</ref> Under normal conditions [[cytotoxic T cells]], which normally patrol the body in the blood, "read" the peptide presented by the complex. T cells, if functioning properly, only bind to non-self peptides. If binding occurs, a series of events is initiated culminating in cell death via [[apoptosis]].<ref>{{cite web | url = https://www.youtube.com/watch?v=VPvCekgPwRI | title = MHC class I assembly and presentation | author = Accorsi D | date = 14 Sep 2012 | format = | work = | publisher = YouTube | accessdate = 8 Dec 2013 }}</ref> In this manner, the human body eliminates any cells infected by a virus or expressing proteins they shouldn't be (e.g. cancerous cells).


==Overview==
For humans, as in most mammalian populations, MHC Class I molecules are extremely variable in their [[primary structure]], and HLA-A is ranked among the genes in humans with the fastest-evolving coding sequence. As of December 2013, there are 2432 known HLA-A [[alleles]] coding for 1740 active [[proteins]] and 117 [[Null allele|null proteins]].<ref name="Statistics"/> This level of variation on MHC Class I is the primary cause of transplant rejection, as random transplantation between donor and host is unlikely to result in a matching of HLA-A, B or C antigens. Evolutionary biologists also believe that the wide variation in HLAs is a result of a balancing act between conflicting pathogenic pressures. Greater variety of HLAs decreases the probability that the entire population will be wiped out by a single pathogen as certain individuals will be highly resistant to each pathogen.<ref name="Davis"/> The effect of HLA-A variation on HIV/AIDS progression is [[#HIV/AIDS|discussed below]].


'''HLA-A''' a [[human leukocyte antigen]] belongs to the [[major histocompatibility complex|MHC]] [[MHC Class I|class I]] heavy chain [[Receptor (immunology)|receptor]]s. The HLA-A is a [[heterodimer]]ic receptor consisting of an HLA-A mature gene product and β2-microglobulin. The mature A chain is anchored in the membrane. MHC Class I molecules, such as HLA-A, are expressed in nearly all cells, and present small peptides to the immune system which surveys for non-self peptides. As in most mammalian populations, MHC Class I molecules are extremely variable in their [[primary structure]], and HLA-A is ranked among the genes in humans with the fastest evolving coding sequence. After typing millions of individuals, as of 10/15/2007 617 variant [[allele]]s have been identified, encoding for 486 protein [[isoforms]].
==HLA-A gene==
{{Infobox_gene}}
The HLA-A gene is located on the short arm of chromosome 6 and encodes the larger, α-chain, constituent of HLA-A. Variation of HLA-A α-chain is key to HLA function. This variation promotes genetic diversity in the population. Since each HLA has a different affinity for peptides of certain structures, greater variety of HLAs means greater variety of antigens to be 'presented' on the cell surface, enhancing the likelihood that a subset of the population will be resistant to a given foreign invader. This decreases the likelihood that a single pathogen has the capability to wipe out the entire human population.


==Function==
Each individual can express up to two types of HLA-A, one from each of their parents. Some individuals will inherit the same HLA-A from both parents, decreasing their individual HLA diversity; however, the majority of individuals will receive two different copies of HLA-A. This same pattern follows for all HLA groups.<ref name="U Mich HLA Matching">{{cite web | url = http://www.stanford.edu/dept/HPST/transplant/html/hla.html | title = HLA Matching, Antibodies, and You | author = Fix M | year = 1998 | work = Kidney Transplantation: Past, Present, and Future | publisher = University of Michigan Medical Center/Stanford University | accessdate = 14 Dec 2013 }}</ref> In other words, every single person can only express either one or two of the 2432 known HLA-A alleles.
MHC Class I molecules present smaller peptides, generally 9mers but longer molecules are tolerated, to the immune system.
Several target cells include CD8<sup>+</Sup> T-lymphocytes. In response to signalling these lymphocytes result in apototic cell death. This mechanism is the result of responses to viral infection or intracellular microbial infections in which, as a means of preventing propagation, affected cells are killed and the antigens are presented to the immune system for Class II presentation and antibody development. Over a short period of time antibodies develop that can neutralize the ability of viruses and invasive bacteria to invade cells.
{| class="wikitable" align="left"
|+ Subpages for A serotypes 
|-
| colspan = "4" | Serotypes of {{Gene|HLA-A}} gene products
|-
| '''Broad</br>antigens''' || colspan = "3" align="center" | Split antigens
|-
| [[HLA-A1]] || || ||
|-
| [[HLA-A2]] || ||  ||
|-
| [[HLA-A3]] || ||  ||
|-
| '''[[HLA-A9]]''' || [[HLA-A23]] || [[HLA-A24]]  ||
|-
| rowspan = 2 | '''[[HLA-A10]]''' || [[HLA-A25]] || [[HLA-A26]] || [[HLA-A34]]
|-
| [[HLA-A43]] || [[HLA-A66]] ||
|-
| [[HLA-A11]] || ||  ||
|-
| rowspan = 2 | '''[[HLA-A19]]''' || [[HLA-A29]] || [[HLA-A30]] || [[HLA-A31]]
|-
| [[HLA-A32]] || [[HLA-A33]] || [[HLA-A74]]
|-
| '''[[HLA-A28]]''' ||  [[HLA-A68]]  || [[HLA-A69]]
|-
| [[HLA-A36]] || || ||
|- 
| [[HLA-A80]] || || ||
|}


== Structure and Serology ==
{{further|Human leukocyte antigen}}
The HLA-A chain forms a binding cleft much like the MHC Class II molecules, the sides of the cleft are composed of alpha helices, the base is beta sheet and one end the relative closure limits the optimal length of peptide.


To the right is a table of serotypes of HLA-A and there general relationships.
===Alleles===


{{-}}
All HLAs are assigned a name by the World Health Organization Naming Committee for Factors of the HLA System. This name is organized to provide the most information about the particular allele while keeping the name as short as possible. An HLA name looks something like this:


==Nomenclature==
HLA-A*02:01:01:02L
HLA alleles<ref name=Marsh>{{cite journal | author = Marsh SG, Albert ED, Bodmer WF, Bontrop RE, Dupont B, Erlich HA, Geraghty DE, Hansen JA, Hurley CK, Mach B, Mayr WR, Parham P, Petersdorf EW, Sasazuki T, Schreuder GM, Strominger JL, Svejgaard A, Terasaki PI, and Trowsdale J.  | title = Nomenclature for factors of the HLA System, 2004. | journal = Tissue antigens | volume = 65 | pages = 301-369 | year = 2005 | id = PMID 15787720}}</ref> and specificity<br/>. Some Allele groups have been updated with recent information from the [http://www.ebi.ac.uk/imgt/hla/allele.html IMGT/HLA Database]


Explanation - within each allele group there are alleles that are recognized by the serological typing for that group (e.g. A24-serotype) some within the group may also recognize the broad antigen typing (A9, A10, A19, A28) or only the broad antigen typing, some by alternative serological within the group (e.g. A2403), and some by no serological method.  
All alleles receive at least a four digit classification (HLA-A*02:12). The A signifies which HLA gene the allele belongs to. There are many HLA-A alleles, so that classification by serotype simplifies categorization. The next pair of digits indicates this assignment. For example, [http://www.ebi.ac.uk/cgi-bin/ipd/imgt/hla/get_allele.cgi?A*02:02 HLA-A*02:02], [http://www.ebi.ac.uk/cgi-bin/ipd/imgt/hla/get_allele.cgi?A*02:04 HLA-A*02:04], and [http://www.ebi.ac.uk/cgi-bin/ipd/imgt/hla/get_allele.cgi?A*02:324 HLA-A*02:324] are all members of the A2 serotype (designated by the *02 prefix).<ref name="Statistics"/> This group is the primary factor responsible for HLA compatibility. All numbers after this cannot be determined by serotyping and are designated through gene sequencing. The second set of digits indicates what HLA protein is produced. These are assigned in order of discovery and as of December 2013 there are 456 different HLA-A*02 proteins known (assigned names HLA-A*02:01 to HLA-A*02:456). The shortest possible HLA name includes both of these details.<ref name="HLA Nomenclature"/> Each extension beyond that signifies a nucleotide change that may or may not change the protein and the interpretation of the extensions is covered in greater detail in [[History and naming of human leukocyte antigens#Current HLA naming system|current HLA naming system]].
Obviously some groups are more closely related than other groups, and this is often reflected in broad antigen reactivity.


==Associated Diseases==
===Protein===
{| class="wikitable"
|+ HLA-A associated diseases
|-
| '''Assoc.</br>disease''' || colspan = "3" align="center" | Serotypes
|-
| Ankylosing</br>spondylitis</br>factor  ||[[HLA-A24|A24]] ||  ||
|-
| Diabetes, Type-I</br> (factor)  ||[[HLA-A1|A1]]  || [[HLA-A24|A24]]
|-
| Hemochromatosis</br> (lower CD8+ cells) || [[HLA-A3|A3]] ||  ||
|-
| [[myasthenia gravis]]</br>factor || [[HLA-A3|A3]] || [[HLA-A24|A24]]  || [[HLA-A30|A30]]
|-
| Leukemia, T-cell</br> Adult onset  ||[[HLA-A26|A26]]  || [[HLA-A68|A68]]  ||
|-
| Multiple </br> Sclerosis  ||[[HLA-A3|A3]]  ||  ||
|-
| Papilloma</br> virus susept.  ||[[HLA-A11|A11]]  ||  ||
|-
| Spontaneous</br> abortion  ||[[HLA-A2|A2]]  ||  ||
|-
|}


===Diseases by Haplotype===
The protein coded for by the HLA-A gene is 365 amino acids long and weighs roughly 41,000 Daltons (Da).<ref name="GeneCards HLA-A">{{cite web|title=Major Histocompatibility Complex, Class I, A|url=http://www.genecards.org/cgi-bin/carddisp.pl?gene=HLA-A|work=Gene Cards|publisher=Weizmann Institute of Science|accessdate=16 December 2013|date=7 November 2013}}</ref> It contains 8 exons.<ref name="NCBI HLA-A">{{cite web|title=HLA-A major histocompatibility complex, class I, A ['''Homo sapiens''' (human)]|url=https://www.ncbi.nlm.nih.gov/gene/3105|work=National Center for Biotechnology Information|publisher=U.S. National Library of Medicine|accessdate=16 December 2013|date=12 December 2013}}</ref>
A*02:Cw*16 : higher viral load in HIV<ref name = "HIV1_HLAI">{{cite journal | author = Noble J, Valdes A, Bugawan T, Apple R, Thomson G, Erlich H | title = The HLA class I A locus affects susceptibility to type 1 diabetes. | journal = Hum Immunol | volume = 63 | issue = 8 | pages = 657-64 | year = 2002 | id = PMID 12121673}}</ref><br/>
{| class="wikitable"
A*23:B*14 : higher viral load in HIV<ref name = "HIV1_HLAI"/><br/>
A*23:Cw*07 : higher viral load in HIV<ref name = "HIV1_HLAI"/><br/>
A*30:Cw*03 : higher viral load in HIV<ref name = "HIV1_HLAI"/><br/>
 
==Historical Guide to Understanding Nomenclature==
{|style="margin-left:2em;  border:1px #ccffdd solid; background:#ebffef" align="right"
|-
|-
|
! Exon !! Protein segment
{|style="text-align:left; margin-left:1em; background:#ebffef"
|- align = "center"
| <div style="font-size:medium; line-height:120%;">'''Overview'''</div>
|-
|-
| '''A simple list that grew'''
| 1 || Signal peptide
|-
|-
| column width = "300px" | A list of a dozen antigens was subdivided according to patterns of 'exclusivity'; the first clearly identified were HLA-A1, A2 and A3.
| 2 || α1 domain
|- valign="bottom"
| row height = "30px" | '''Identification of "Blank" antigens'''
|-
|-
| column width = "300px" | The unidentified or "blank" antigens became known as in "W" antigens, such as W35 (later B35) into a list of ~150 [[serotype]]s covering 9 [[locus (genetics)|genetic loci]]
| 3 || α2 domain
|- valign="bottom"
| row height = "30px"|  '''Protein and Gene Sequencing'''
|-
|-
| column width = "300px" | The need for more precise identifications led to a brief period of protein sequencing followed by gene sequencing and allele typing (using [[PCR]]). Thousands of alleles and proteins have been identified for these 9 genetic loci. 
| 4 || α3 domain
|- valign="bottom"
|  row height = "50px"|  '''Gene identification effort reveals evolutionary '''<br />'''importance'''
|-
|-
| column width = "300px" | The HLA genes are the fastest changing known coding genes in humans. The HLA proteins have a high rate of selection for variation. Many of the sites revealed by allograft antibodies (serotypes) are involved in binding foreign peptides<br />
| 5 || transmembrane region
|-
|-
|}
| 6 || cytoplasmic tail
|}
 
The naming of HLA "[[antigen]]s" is deeply rooted in the discovery  history of their [[serotype]]s and [[allele]]s. There is no doubt that, except to an experienced HLA geneticist or immunologist, HLA terminology is bewildering
 
Perspective is important to an understanding this system.
 
Clinically, the point was to explain illness within the patients, who were transplant recipients. From this perspective, the cause of rejections are antigens, in the same way bacterial antigens can cause inflammatory response.
 
* [[Lymphoid tissue|Lymphoid]] "antigens" became an experimental [[artifact]] of medical techniques (i.e., of transplantation). More simply, a familiarity with the human immune system resulted understinding that, in allograft (different graft) rejection, the cause was antibody production to allotypic proteins in donor tissue.
 
* HLA [[gene product]]s (ie, antigen-presenting, [[cell-surface receptor]]s) do not appear to have evolved to be transplantation antigens, nor to interfere with transplantation, organ transplantation being unknown until 1960. The HLA genes are much older. Variation of HLA has led to an estimate that they are at least 60 million years in age for humans (DRB1)<ref name="pmid8533083">{{cite journal | author = Ayala FJ | title = The myth of Eve: molecular biology and human origins | journal = Science | volume = 270 | issue = 5244 | pages = 1930–6 | year = 1995 | pmid = 8533083 | doi = }}</ref>
 
The scientific problem has been to explain the natural function of a molecule, such as a self [[cell-surface antigen|cell-surface receptor]] involved in [[immunity]]. It also seeks to explain how variation developed (perhaps by evolutionary pressure), and how the genetic mechanisms works ([[dominance (genetics)|dominant]], [[codominant]], [[Dominant gene#Incomplete dominance|semidominant]], or [[recessive]]; [[purifying selection]] or [[balancing selection]]).
 
===Transplantation and transplant rejection===
[[Image:Alloreactive Antisera.PNG|frame|left|'''A simple example of HLA antigen causing rejection''' <br\> A1, A2, B7, B8 do not cause reaction because they are in both donor and recipient, DR2 and DR3 are found on lymphoid cells]]
In the early 1960s, some physicians began more aggressive attempts at [[organ transplantation]]. Knowing little about ''compatibility factors'', they attempted transplantation between humans and even between non-humans and humans. <ref name="pmid14081245">{{cite journal | author = REEMTSMA K, MCCRACKEN BH, SCHLEGEL JU, PEARL M | title = HETEROTRANSPLANTATION OF THE KIDNEY: TWO CLINICAL EXPERIENCES | journal = Science | volume = 143 | issue = | pages = 700–2 | year = 1964 | pmid = 14081245 | doi = }}</ref> [[Immunosuppressive drugs]] worked for a time, but transplanted organs would either always fail or the patients would die from infections. Patients received skin, [[white blood cell]] or kidney donations from other donors (called [[allograft]]s, meaning 'of different genetics' graft). If these [[allograft]]s were rejected, it was found that the 'rejection' response was accompanied by an [[antibody]] mediated [[agglutination]] of red blood cells (See figure).<ref name="pmid4866325">{{cite journal | author = Rapaport FT, Kano K, Milgrom F | title = Heterophile antibodies in human transplantation | journal = J. Clin. Invest. | volume = 47 | issue = 3 | pages = 633–42 | year = 1968 | pmid = 4866325 | doi = }}</ref> The search for these cell surface antigens began. The process by which antibodies reduced function several fold.
* [[Transplant rejection#Acute rejection|Acute rejection - Antibodies]] could attract lymphocytes and cause them to lyse cells via the  immune system's [[classical complement pathway]]
* Antibodies could bind to and alter function (eg, flow of a fluid, or prevention of binding of ligands to receptors)
* [[Cytokine]] responses that cause systemic responses.
<br />
<br />
 
====Different antigens can be identified====
In the accompanying figure, two similar [[haplotype]]s (unknown to early clinicians) are identical, except for the one ''antigen'' in the top haplotype. The transplant may not be rejected, but if rejection does occur that ''[[antigen]]'' in the donor tissue may have induced the dominant alloreactive antibody in the recipient.
<br />
<br />
 
====Assaying Antiserum====
[[Image:anti-HLA agglutinated RBC.PNG|frame|right|'''Agglutination of [[HLA-A3]] positive [[red blood cell]]s''' (RBCs) with anti-A3 alloreactive [[antisera]] containing Anti-A3 [[IgM]]]]
'''Hemagglutination assay'''. In generating an immune response to an antigen, the [[B-cell]]s go through a process of maturation, from surface IgM production, to serum IgM production, to maturation into a [[plasma cell]] producing IgG. Graft recipients who generate an immune response have both IgM and IgG. The IgM can be used directly in [[hemagglutination]] assays, depicted on the left. IgM has 10 antigen binding regions per molecule, allowing crosslinking of cells. An antiserum specific for HLA-A3 will then agglutinate HLA-A3 bearing red blood cells if the concentration of IgM in the antiserum is sufficiently high. Alternatively, a second antibody to the invariable (F<sub>c</sub>) region of the IgG can be used to crosslink antibodies on different cells, causing agglutination.
 
'''Complement fixation assay'''. The [[complement fixation test]] was modified to assay Antiserum mediated RBC lysis.
 
'''Chromium release assay'''. This assay measures the release of (biological) radioactive chromium from cells as a result of killer cell activity. These cells are attracted to class I antigens that either carry foreign antigens, or are foreign to the immune system.
 
====The role of haplotypes in identifying antigens====
{|style="margin-right:1em;  border:1px #ccffdd solid; background:#ebffef; text-align:center;" align="left"
|-
| || colspan = "3" | '''Haplotype 1''' || colspan = "3" |'''Haplotype 2'''
|-
! width = "80" | || width = "20" | A || width = "20" |Cw || width = "20" |B || width = "20" |A || width = "20" |Cw || width = "20" |B 
|-
|Donor || 1 || 7 || 8 || '''3''' || 7 || 7 
|-
|Recipient||  1 || 7 || 8 || '''2''' || 7 || 7
|-
|Alloreactivity||  || || || <font color = "red">'''3'''</font>||
||
|-
| colspan = "7" align="right"|<font color = "light green">.</font>
|-
|Donor || 1 || 7 || 8 || '''2''' || 7 || 8
|-
|Recipient||  1 || 7 || 8 || '''3''' || 7 || 8
|-
|-
|Alloreactivity||  || || || <font color = "red">'''2'''</font>|| ||
| 7 || cytoplasmic tail
|-
| colspan = "7" align="right"|<font color = "light green">.</font>
|-
|Donor || 1 || 7 || 8 || '''9''' || 7 || 8
|-
|Recipient||  1 || 7 || 8 || '''3''' || 7 || 8
|-
|Alloreactivity||  || || || <font color = "red">'''9'''</font>|| ||
|-
| colspan = "7" align="right"|<font color = "light green">.</font>
|-
|Donor || 3 || 7 || 7 || '''1''' || 7 || 8
|-
|Recipient||  3 || 7 || 7 || '''2''' || 7 || 8
|-
|Alloreactivity||  || || || <font color = "red">'''1'''</font>|| ||
|-
|-
| 8 || Unspecified
|}
|}
The HLA-A [[signal peptide]] is a series of hydrophobic amino acids present at the [[N-terminus]] of the protein that directs it to the [[endoplasmic reticulum]] where the remaining seven domains are translated.<ref name="GeneCards HLA-A"/><ref name="NCBI HLA-A"/><ref name="Essential Cell Biology">{{cite book|last=Alberts|first=Bruce|title=Essential Cell Biology|year=2010|publisher=Garland Science|isbn=9780815341291|edition=Third}}</ref> The three α domains form the binding groove that holds a peptide for presentation to [[Cytotoxic T cell|CD8+ t-cells]]. The transmembrane region is the region that is embedded in the phospholipid bilayer surrounding the ER lumen.<ref name="NCBI HLA-A"/> The HLA-A protein is a single-pass [[transmembrane protein]].<ref name="GeneCards HLA-A"/> In other words, the first four domains of the protein are inside the ER lumen, while the last three domains are present outside the lumen, giving the protein the orientation required for proper function. The last three domains of the protein form a tail of primarily [[β-sheet]]s that remains in the cell's cytosol.<ref name="NCBI HLA-A"/>


Each person has two HLA [[haplotype]]s genes, one from each parent. The haplotype frequencies in Europeans are in strong [[linkage disequilibrium]]. This means there are much higher frequencies of certain haplotypes relative to the expectation based on serotype (or [[allele]]) frequencies. This aided the discovery of HLA antigens, but was unknown to the pioneering researchers,.
[[File:Peptide Loading Complex.jpg|framed|left|Tracking the process of translating, assembling, and expressing the HLA-A gene<ref>{{cite web|last=Tampé|first=Robert|title=P16 Translocation mechanism and viral inhibition of the MHC I peptide-loading complex|url=http://www.sfb807.de/robert-tampe.html|work=Molecular Understanding of Transmembrane Processes|publisher=Institute of Biochemistry Biocenter|accessdate=16 December 2013}}</ref>]]
Once the HLA-A protein is completely translated, it must be folded into the proper shape. A molecular [[chaperone protein]] called [[calnexin]] and an enzyme called [https://www.ncbi.nlm.nih.gov/pubmed/14871896 ERp57] assist in the folding process. Calnexin holds the HLA-A heavy chain while Erp57 catalyzes disulfide bonds between the heavy chain and the light, β<sub>2</sub>-microglobulin chain. This bond induces a conformational change in the heavy chain, forming the binding groove. Calnexin then dissociates with the complex, now referred to as a peptide loading complex, and is replaced by [[calreticulin]], another chaperone protein. Short peptides are continually transported from around the cell into the ER lumen by a specialized transport protein called [[Transporter associated with antigen processing|TAP]]. TAP then binds to the peptide loading complex along with another protein, called [[tapasin]]. At this point the peptide loading complex consists of HLA-A (heavy chain), β<sub>2</sub>-microglobulin (light chain), an ERp57 enzyme, calreticulin chaperone protein, TAP (with a bound peptide fragment), and tapasin. Tapasin increases the stability of TAP, in addition to stabilizing the entire peptide loading complex. At this point TAP releases the peptide it transported into the ER lumen. The proximity of the HLA-A binding groove to TAP is ensured by the peptide loading complex. This increases the likelihood that the peptide will find the groove. If the peptide's affinity for the HLA-A protein is great enough, it binds in the groove.<ref name="Accorsi MHC Class I">{{cite web|last=Accorsi|first=Diego|title=MHC class I assembly and presentation|url=https://www.youtube.com/watch?v=VPvCekgPwRI|work=Immunology Toronto|publisher=Department of Immunology and Biochemistry and Biomedical Communications at the University of Toronto|accessdate=16 December 2013|date=14 September 2012}}</ref> Research suggests that tapasin may actively load peptides from TAP into the HLA-A complex while also holding class I molecules in the ER lumen until a high affinity peptide has been bound.<ref name=Tapasin>{{cite journal | vauthors = Grandea AG, Van Kaer L | title = Tapasin: an ER chaperone that controls MHC class I assembly with peptide | journal = Trends in Immunology | volume = 22 | issue = 4 | pages = 194–9 | date = April 2001 | pmid = 11274924 | doi = 10.1016/S1471-4906(01)01861-0 }}</ref>


In the table, on the right, a fortuitous transplant between two unrelated individual has resulted in an antiserum alloreactive to a single antigen. This allows researchers to match at least one antigen. Donors with A3 can be distinguished from recipients that lack A3.  
After a peptide of high enough affinity has bonded to the class I MHC, calreticulin, ERp57, TAP, and tapasin release the molecule.<ref name="Accorsi MHC Class I"/> At this point the class I complex consists of an HLA-A protein bonded to a β<sub>2</sub>-microglobulin and a short peptide. It is still anchored in the ER membrane by the transmembrane domain. At some point the ER will receive a signal and the portion of the membrane holding the complex will bud off and be transported to the golgi bodies for further processing. From the golgi bodies, the complex is transported, again via vesicle transport, to the cell membrane. This is the point at which the orientation mentioned previously becomes important. The portion of the HLA-A complex holding the peptide must be on the exterior surface of the cell membrane. This is accomplished by vesicle fusion with the cell membrane.<ref name="Essential Cell Biology"/>


In the case of the 5th example, there are several combinations, for example A2-Cw7-B7/A1-Cw7-B8, A2-Cw7-B7/A2-, A10-Cw7-B8. Given the distribution of haplotype in European Americans it is possible to estimate the probability of a random appearance of a single allotypic antigen. The most readily detected antigens are A3, A2, A1, A9, A10, and A11. Thus, the order of the antigens detected is largely a function of haplotype frequencies that could be combined to expose  single antigen specificity when the highest probability is multiple specificities. Very rare halotype alleles in this population tend to have been identified much later, in other populations. 
== Function ==


In the next stage researchers are capable of matching 3 alleles (unknown as the HLA-A) but not the B except through linkage with A.  
===Natural function===
Occasionally A recombined with another B and resulted in a B allele mismatch.
MHC Class I molecules present small peptides, typically 7-10 amino acids in length, to the immune system. A glycoprotein called [[CD8]] binds to residues 223-229 in the α3 domain of HLA-A and this glycoprotein stabilizes interactions between the t-cell receptor on cytotoxic (CD8+) T-lymphocytes and the Class I MHC.<ref name=CD8>{{cite web|title=CD8|url=http://www.tcells.org/scientific/CD8/|work=T-cell Modulation Group|publisher=tcells.org|accessdate=17 December 2013|year=2009}}</ref>  The T-cell receptor also has the potential to bind to the peptide being presented by the MHC. In a properly functioning immune system, only t-cells that do not bind self peptides are allowed out of the thymus, thus, if a T-cell binds to the peptide, it must be a foreign or abnormal peptide. The t-cell then initiates [[apoptosis]], or programmed cell death. This process can happen as quickly as 5 minutes after initial foreign antigen presentation, although typically it takes several hours for death to become apparent.<ref name=Immunobiology>{{cite book|last=Janeway|first=Charles A.|title=Immunobiology the immune system health & disease|year=2001|publisher=Garland|location=New York|isbn=081533642X|url=https://www.ncbi.nlm.nih.gov/books/NBK27101/|edition=5.|accessdate=17 December 2013|chapter=8}}</ref> This process is the basis of acquired immunity and serves as the primary defense against viruses and other intracellular pathogens.


{|style="margin-left:1em;  border:1px #ccffdd solid; background:#ebffef; align:center;" align="right"
===Other activities===
|-
| || colspan = "3" | '''Haplotype 1''' || colspan = "3" |'''Haplotype 2'''
|-
| || width = "30" | A || width = "30" |Cw || width = "30" |B || width = "30" |A || width = "30" |Cw || width = "30" |B
|-
|Donor || 1 || 7 || 8 || 2 || 7 || 7
|-
|Recipient|| 1 || 7 || 8 || 2 || 7 || 8
|-
|Alloreactivity||  || || || ||
|| <font color = "red">7</font>
|-
| colspan = "7" align="right"|<font color = "light green">.</font>
|-
|Donor || 3 || 7 || 7 || 2 || 7 || 8
|-
|Recipient||  3 || 7 || 7 || 2 || 7 || 7
|-
|Alloreactivity||  || || || ||
|| <font color = "red">8</font>
|-
|}


In this instance, the A1/A2, A2/A3, A1/A3 are matched, decreasing the probability of a rejection because many are linked to a given haplotype. Occasionally the 'recombinant' A2-Cw7-B8 will cause alloreactivity to B8 if it was in the donor, or B7 if in the recipient.
By the 1960s, it became evident that factors on donated organs and tissues often resulted in destruction of the donated tissue by the host's immune system. MHCs were originally discovered as a result of this observation (see [[History and naming of human leukocyte antigens#Discovery|history of HLAs]] for more details).<ref name="Davis"/> There are two types of peptide presenting complexes, Class I and Class II MHCs. Each of these has multiple HLA genes, of which HLA-A is but one. There are three major HLAs that should be matched between donors and recipients. They are HLA-A, HLA-B, (both Class I MHCs) and HLA-DR (a Class II MHC).<ref name="U Mich HLA Matching"/> If the two tissues have the same genes coding for these three HLAs, the likelihood and severity of rejection is minimized.<ref name="pmid25516409">{{cite journal | vauthors = Solomon S, Pitossi F, Rao MS | title = Banking on iPSC--is it doable and is it worthwhile | journal = Stem Cell Reviews | volume = 11 | issue = 1 | pages = 1–10 | date = February 2015 | pmid = 25516409 | pmc = 4333229 | doi = 10.1007/s12015-014-9574-4 }}</ref>


This linkage disequilibrium in Europeans explains why A1, A2, A3, "A7"[B7], and "A8"[B8] were identified first. It would have taken substantially longer to identify other alleles because frequencies were lower, and haplotypes that migrated into the European population had undergone equilibration or were from multiple sources.
==Role in disease==
 
{| class="wikitable" align = "right" style = "margin-left: 2em;"
This is the genetic background against which scientists tried to uncover and understand the histocompatibility antigens.
|+ HLA-A associated diseases
 
|-  
===A list of antigens created===
| '''Associated disease''' || colspan = "3" align="center" | Serotypes
In the late 1960's, scientist began reacting sera from patients with rejecting transplants to donor or 'third party' tissues. Their [[sera]] (the liquid part of the blood when blood clots) was sensitized to the cells from donors - it was ''alloreactive''. Serum is rich in antibodies and can react to specific, inoculated antigens, becoming an ''[[antiserum]]''. An alloreactive antiserum could have strong reaction with the cells from one person (e.g., the transplant donor), mild reaction to another's cells, and no reaction to a third's cells (e.g., a close relative). Likewise, a different alloreactive antiserum might not react with the first, show moderate reaction to a second, and strong reaction to the third person's cells.
|-
 
| Ankylosing spondylitis  || align = "center" width = "35px" |[[HLA-A24|A24]] || width = "35px" | || width = "35px" |
As a result of this complex reactivity, scientists were able to identify 15 antigens. These were assigned, a simple number, from 1 to 15. At first these 15 antigens were called the Hu-1 antigens<ref name="pmid4887739">{{cite journal | author = Bach FH, Amos DB | title = Hu-1: Major histocompatibility locus in man | journal = Science | volume = 156 | issue = 781 | pages = 1506–8 | year = 1967 | pmid = 4887739 | doi = }}</ref> and tentatively tagged as gene products of the Human equivalent of the mouse histocompatibility locus. In 1968, it was discovered that matching these antigens between kidney donor and recipient improved the likelihood of kidney survival in the recipient.<ref name="pmid4876470">{{cite journal | author = Patel R, Mickey MR, Terasaki PI | title = Serotyping for homotransplantation. XVI. Analysis of kidney transplants from unrelated donors | journal = N. Engl. J. Med. | volume = 279 | issue = 10 | pages = 501–6 | year = 1968 | pmid = 4876470 | doi = }}</ref> The antigen list still exists,  although it has been reorganized to fit what we have since learned about genetics, refined, and greatly expanded.
|-
 
| Diabetes, type-I<ref name = "Diabetes_HLAI">{{cite journal | vauthors = Noble JA, Valdes AM, Bugawan TL, Apple RJ, Thomson G, Erlich HA | title = The HLA class I A locus affects susceptibility to type 1 diabetes | journal = Human Immunology | volume = 63 | issue = 8 | pages = 657–64 | date = August 2002 | pmid = 12121673 | doi = 10.1016/S0198-8859(02)00421-4 }}</ref>   || align = "center"| [[HLA-A1|A1]] || align = "center"| [[HLA-A24|A24]] || width = "35px" |
===Lymphocyte bearing antigens recognized===
|-  
[[Image:LAvsA4.PNG|left]]
| Hemochromatosis (lower CD8+ cells) || align = "center"| [[HLA-A3|A3]] ||   ||
As the study of these 'rejection' [[sera]] and "allo"-antigens progressed, certain patterns in the antibody recognition were recognized. The first major observation, in 1969, was that an allotypic antibodies to "4" ("Four") was only found on lymphocytes, while most of the antigens, termed "LA", recognized most cells in the body.<ref name="pmid5773111">{{cite journal | author = Mann DL, Rogentine GN, Fahey JL, Nathenson SG | title = Molecular heterogeneity of human lymphoid (HL-A) alloantigens | journal = Science | volume = 163 | issue = 874 | pages = 1460–2 | year = 1969 | pmid = 5773111 | doi = }}</ref>
|-  
 
| [[Myasthenia gravis]] || align = "center"| [[HLA-A3|A3]] || align = "center"| [[HLA-A24|A24]]   || align = "center"| [[HLA-A30|A30]]
This group "4" antigen on lymphocytes would expand into "4a", "4b" and so on, becoming the "D" series (HLA-D (Class II) antigens) DP, DQ, and DR. This is an interesting history in itself.
|-  
 
| Leukemia, T-cell,  Adult ||align = "center"| [[HLA-A26|A26]]  || align = "center"| [[HLA-A68|A68]]  ||
The Hu-1 antigens were renamed the Human-lymphoid (HL) alloantigens (HL-As). Alloantigen comes from the observation that a tolerated protein in the donor becomes antigenic in the recipient. This can be compared with an [[autoantigen]], in which a person develops antibodies to one or more of their own proteins. This also suggested  the donor and recipient have a different genetic makeup for these antigens. The "LA" group thereafter was composed of HL-A1, A2, A3, A5, A6, A7, A8, A9, A10, A11, A12, A13, A14 and A15 until further divisions and renaming were necessary. Some of the antigens above, for example HL-A1, are similar to [[HLA-A1]], as they are the same serotype. Some of the above, like A5, are not mentioned within the last few years, as they have been renamed.
|-  
 
| Multiple  sclerosis  ||align = "center"| [[HLA-A3|A3]] ||  ||
===Subclassification of lymphoid antigens===
|-  
[[Image:HL-Series A and B.PNG|right]]
| Papilloma virus susept. ||align = "center"| [[HLA-A11|A11]] ||  ||  
A series of tests on cultured cells revealed that, within the "LA" group, a donor tissue might have some antigens but not others. For example, an antiserum may react with patterns (on a given tissue):
|-  
 
| Spontaneous abortion  ||align = "center"| [[HLA-A2|A2]] ||  ||
* A1, A2, A7, A12
|-
* A1, A3, A7, A8
* A1, A11, A8, A5
* A1, A8
* A2, A3, A7, A12
* A2, A11, A
* A2, A7, A12
* A3, A11, A7, B5
* A3, A7
* A11, A5
 
But fail to react in the following patterns:
 
* A1, A2, A3, ...
* A1, A2, A11
* A2, A3, A11
* . . . A7, A8, A12
 
===The HLA serotype series===
====Series "A"====
{|style="margin-left:2em;  border:1px #ccffdd solid; background:#ebffef" align="right"
|-
|
{|style="text-align:left; margin-left:1em; background:#ebffef"
|- align = "center"
| <div style="font-size:medium; line-height:120%;">'''Genetics of Serotyping'''</div>
|-
| '''Effects of intraseries exclusion'''
|-
| column width = "300px" | Once it was determined that a tissue with two antigens of a series (such as "A") excluded the possibility of a third antigen of the same series, HLA serotypes began to clarify the genetic alleles present in humans. HL-Series "A" antigens became the HLA-A locus gene products, but with exceptions. Some serotypes, such as HL-A1 were so homogeneous in nature that mistaking that serotyped allele (HLA-A*0101) for another allele was unlikely. <br />
|-
|'''Interpreting Serotypes as Alleles'''
|-
| column width = "300px" | HL-A1 antiserum reacts to [[HLA-A1]] [[gene product]], a cell surface antigen, the similar cell surface antigens are found on almost all cells in the body. The frequency of HLA-A1 alleles is: HLA-A1'''*0101'''- 17.3%, '''*0103'''- 0.016%. The frequency of *0101 is 1000 times more abundant than *0103, or 99.9% of the time you have identified the correct allele with the serotype. The false negative rate for [[HLA-A1#Serotype|HLA-A1 serotype]] is 1% and the giving the HLA-A1 serotyping a [[specificity (tests)|specificity]] of 98.9% for the A1*0101 allele.<br />
|-
|'''Increasing confidence of Interpretation'''
|-
| column width = "300px" | Sensitivity is lower, particularly in the study of non-caucasians as the HL-A1 can cross-react to similar sites on  [[Genetic recombination|genetic recombinant]]s (most often [[gene conversion]]). Sensitivity can be improved by knowing the haplotype. In Europe, HLA-A1 is strongly linked to a 'chunk of chromosome' called a 'haplotype'. This haplotype, Super-B8, is A1-Cw7-B8-DR3-DQ2, about 2 million DNA codons (the [[nucleotide]] building blocks) long. This chunk has avoided recombination for 1000s of years. When the A1 serotype is found with B8 (ie, the 'old' HL-A8) serotype in Europe, there is an even greater chance the HL-A1 antiserum has detected the A1*0101 allele's gene product. <br />
|}
|}
|}
If 2 members of the series (A1, 2, 3, 9, 10, 11) were typed, a reaction with a third member of the series to the donor was not observed. This 'exclusivity' identified series "A".<ref>Bach ML, Bach FH. ''The genetics of histocompatibility''.(1970) Hosp. Practice 5(8): 33-44</ref> One might notice the simarities of this numeric series with the [[Template:HLA-A serotypes|HLA-A series]], as series "A" antigens are the first six members of [[HLA-A]]. Inadvertently, the scientist had discovered an antibody set that recognized only [[gene product]]s from one locus,{{Gene|HLA-A}} the "antigens" being the gene products. The implication is that an alloreactive antisera can be a tool for genetic identification.
==== Series "B" ====
Not long after the series A antigens were separated from the (rapidly expanding) list of antigens, it was determined another group also could be separated along the same ''logical'' lines.  This group included HL-A5, A7, A8, A12.  This became the series "B".
Note the similarity of Series "B" to the first few members [[Template:HLA-B serotypes|HLA-B serotypes]]. The names of these antigens were necessarily changed to fit the new putative series they were assigned to. From HL-A# to HLA-B#. The problem was that the literature was using "A7" and would soon be using "B7" as short hand for [[HLA-B7]].


==== Pseudo-series "w" ====
HLAs serve as the sole link between the immune system and what happens inside cells. Thus any alteration on the part of the HLA, be it decreased binding to a certain peptide or increased binding to a certain peptide, is expressed as, respectively, increased susceptibility to disease or decreased susceptibility to disease. In other words, certain HLAs may be incapable of binding any of the short peptides produced by [[proteolysis]] of pathogenic proteins. If this is the case, there is no way for the immune system to tell that a cell is infected. Thus the infection can proliferate largely unchecked. It works the other way too. Some HLAs bind pathogenic peptide fragments with very high affinity. This in essence "supercharges" their immune system in regards to that particular pathogen, allowing them to manage an infection that might otherwise be devastating.<ref name="Davis"/>
Since it was now certain, by the early 1970s, that the "antigens" were encoded by different series, implicit loci, numeric lists became somewhat cumbersome. Many groups were discovering antigens. In these instances an antigen was assigned a temporary name, like "RoMa2" and after discussion, the next open numeric slot could be assigned, but not to an "A" or "B" series until proper testing had been done. To work around this problem a 'workshop' number "w#" was often assigned while testing continued to determined which series the antigen belonged to.


====Series "C"====
=== {{anchor|HIV/AIDS}} HIV/AIDS===
Before too long, a series "C" was uncovered. Series C has proved difficult to serotype, and the alleles in the series still carry the "w" tag signifying that status; in addition, it reminds us that Series C were not assigned names the same way as Series A and B, it has its own numeric list Cw1, Cw2, Cw3.
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===Serotype group expansion and refinement===
One of the most researched examples of differential immune regulation of a pathogen is that of [[human immunodeficiency virus]]. Because HIV is an RNA virus, it mutates incredibly quickly. This changes the peptides produced via proteolysis, which changes the peptides able to be presented to the immune system by the infected cell's MHCs. Any virus with a mutation that creates a peptide with high affinity for a particular HLA is quickly killed by the immune system, and thus does not survive and that high affinity peptide is no longer produced. However, it turns out that even HIV has some conserved regions in its genome, and if a HLA is capable of binding to a peptide produced from a conserved region, there is little the HIV can do to avoid immune detection and destruction.<ref name="Davis"/> This is the principle behind HLA-mediated differential HIV loads.
By the mid 1970s, genetic research was finally beginning to make sense of the simple list of antigens, a new series "C" had been discovered and, in turn genetic research had determined the order of HLA-A, C, B and D encoding loci on the human [[chromosome 6|6]]p.<ref name="pmid136874">{{cite journal | author = Yunis EJ, Dupont B, Hansen J | title = Immunogenetic aspects of allotransplantation | journal = Adv. Exp. Med. Biol. | volume = 73 Pt B | issue = | pages = 231–51 | year = 1976 | pmid = 136874 | doi = }}</ref> With new series came new antigens; Cw1 and 2 were quickly populated, although Cw typing lagged. Almost half of the antigens could not be resolved by serotyping in the early 90's. Currently genetics defines 18 groups.  


At this point, Dw was still being used to identify DR, DQ, and DP antigens. The ability to identify new antigens far exceeded the ability to characterize those new antigens.  
With over 2000 variations of the HLA-A coded MHC, it is difficult to determine the impact of all variants upon HIV loads. However, a select few have been implicated. HLA-A*30 has been shown to decrease viral load to less than 10,000 copies/cubic millimeter, considered quite low. On the other hand, HLA-A*02 has been implicated in high viral load (greater than 100,000 copies/cubic millimeter) when associated with HLA-B*45. Additionally, the haplotypes HLA-A*23-C*07 and HLA-A*02-C*16 typically expressed increased viral loads within the sample population of Zambians. One of the most effective HIV-inhibiting haplotypes was HLA-A*30-C*03 while one of the least effective was HLA-A*23*B*14. In summation, HLA-A*23 was highly correlated with increased HIV load among the sample population, although it is important to note that across samples of differing ethnicity this correlation decreases significantly.<ref name="HIV load in Zambians">{{cite journal | vauthors = Tang J, Tang S, Lobashevsky E, Myracle AD, Fideli U, Aldrovandi G, Allen S, Musonda R, Kaslow RA | title = Favorable and unfavorable HLA class I alleles and haplotypes in Zambians predominantly infected with clade C human immunodeficiency virus type 1 | journal = Journal of Virology | volume = 76 | issue = 16 | pages = 8276–84 | date = August 2002 | pmid = 12134033 | pmc = 155130 | doi = 10.1128/JVI.76.16.8276-8284.2002 }}</ref>


As technology for transplanation was deployed around the world, it became clear that these antigens were far from a complete set, and in fact hardly useful in some areas of the world (eg, Africa, or those descended from Africans). Some serotyping antibodies proved to be poor, with broad specificities, and new serotypes were found that identified a smaller set of antigens more precisely. These broad antigen groups, like A9 and B5, were subdivided into "split" antigen groups, A23 & A24 and B51 & B52, respectively. As the HL-A serotyping developed, so did identification of new antigens.
Although classification of the effect of individual HLA genes and alleles on the presence of HIV is difficult, there are still some strong conclusions that can be made. Individuals who are homozygous in one or more Class I HLA genes typically progress to AIDS much more rapidly than heterozygotes. In some homozygous individuals the rate of progression is double that of heterozygotes. This differential progression is correlated fairly tightly with the degree of heterozygosity.<ref name="Heterozygote advantage">{{cite journal | vauthors = Carrington M, Nelson GW, Martin MP, Kissner T, Vlahov D, Goedert JJ, Kaslow R, Buchbinder S, Hoots K, O'Brien SJ | title = HLA and HIV-1: heterozygote advantage and B*35-Cw*04 disadvantage | journal = Science | volume = 283 | issue = 5408 | pages = 1748–52 | date = March 1999 | pmid = 10073943 | doi = 10.1126/science.283.5408.1748 }}</ref> In summation, certain HLA-A alleles are associated with differing viral loads in HIV infected patients; however, due to the diversity amongst those alleles, it is difficult to classify each and every allele's impact upon immune regulation of HIV. Nevertheless, it is possible to correlate heterozygosity in HLA-A alleles to decreased rate of progression to AIDS.


===Genetic identification===
Not only do certain HLA alleles prescribe increased or decreased resistance to HIV, but HIV is able to alter HLA expression, and does so selectively to avoid being eliminated by [[natural killer cells]] (NK cells). Research has shown that HIV downregulates Class I MHC expression in infected cells. However, doing so indiscriminately opens up the opportunity for attack by NK cells, because NK cells respond to downregulation of HLA-C and HLA-E. Obviously, this mechanism has put selective pressure on the HIV virus. Thus, HIV has evolved the capability to downregulate HLA-A and HLA-B without significantly disturbing the expression of HLA-C and HLA-E.<ref name="HLA Downregulation">{{cite journal | vauthors = Cohen GB, Gandhi RT, Davis DM, Mandelboim O, Chen BK, Strominger JL, Baltimore D | title = The selective downregulation of class I major histocompatibility complex proteins by HIV-1 protects HIV-infected cells from NK cells | journal = Immunity | volume = 10 | issue = 6 | pages = 661–71 | date = June 1999 | pmid = 10403641 | doi = 10.1016/S1074-7613(00)80065-5 }}</ref> A protein coded for by the HIV genome, [[Nef (protein)|negative regulatory factor]] (Nef), induces this change by binding to the cytoplasmic tail of the Class I MHC while it is still in the endoplasmic reticulum or occasionally while it is in the early stages of trafficking through the golgi bodies. This complex of MHC and Nef then causes adaptor protein 1 (AP-1) to direct the MHC to the lysosomes for degradation instead of to the cell membrane where it normally functions.<ref name="HIV Nef">{{cite journal | vauthors = Leonard JA, Filzen T, Carter CC, Schaefer M, Collins KL | title = HIV-1 Nef disrupts intracellular trafficking of major histocompatibility complex class I, CD4, CD8, and CD28 by distinct pathways that share common elements | journal = Journal of Virology | volume = 85 | issue = 14 | pages = 6867–81 | date = July 2011 | pmid = 21543478 | pmc = 3126561 | doi = 10.1128/JVI.00229-11 }}</ref> In addition to selective HLA downregulation, [[Nef (protein)|negative regulatory factor]] (Nef) enables HIV to downregulate CD4 and CD8. These glycoproteins are essential for, respectively, helper t-cell and cytotoxic t-cell binding to MHCs. Without these cofactors, both types of t-cells are less likely to bind to HLAs and initiate apoptosis, even if the HLA is expressing an HIV derived (non-self) peptide. Both of these proteins are also targeted at their cytoplasmic tail domain.<ref name="HIV Nef"/> The combination of these abilities greatly enhances HIV's ability to avoid detection by the immune system.
In the early 1980's, it was discovered that a restriction fragment segregates with individuals who bear the [[HLA-B8]] serotype. By 1990, it was discovered that a single amino acid sequence difference between HLA-B44 (B*4401 versus B*4402) could result in allograft rejection. This revelation appeared to make serotyping based matching strategies problematic if many such differences existed. In the case of B44, the antigen had already been split from the B12 broad antigen group. In 1983, the cDNA sequences of [[HLA-A3]] and [[HLA-Cw3|Cw3]]<ref name="pmid6609814">{{cite journal | author = Strachan T, Sodoyer R, Damotte M, Jordan BR | title = Complete nucleotide sequence of a functional class I HLA gene, HLA-A3: implications for the evolution of HLA genes | journal = EMBO J. | volume = 3 | issue = 4 | pages = 887–94 | year = 1984 | pmid = 6609814 | doi = }}</ref> All three sequences compared well with mouse MHC class I antigens. The Western European [[HLA-B7]] antigen had been sequenced (although the first sequence had errors and was replaced). In short order, many HLA class I alleles were sequenced
including 2 Cw1 alleles.<ref name="pmid3375250">{{cite journal | author = Parham P, Lomen CE, Lawlor DA, ''et al'' | title = Nature of polymorphism in HLA-A, -B, and -C molecules | journal = Proc. Natl. Acad. Sci. U.S.A. | volume = 85 | issue = 11 | pages = 4005–9 | year = 1988 | pmid = 3375250 | doi = }}</ref>


By 1990, the full complexity of the HLA class I antigens was beginning to be understood. At the time new serotypes were being determined, the problem with multiple alleles for each serotype was becoming apparent by nucleotide sequencing. [[RFLP]] analysis helped determine new alleles, but sequencing was more thorough. Throughout the 1990s, PCR kits, called SSP-PCR kits were developed that allowed, at least under optimal conditions, the purification of DNA, PCR and Agarose Gel identification of alleles within an 8 hour day. Alleles that could not be clearly identified by serotype and PCR could be sequenced, allowing for the refinement of new PCR kits.
==Summary==


Serotypes like B*4401, B*4402, B*4403, each abundant within those with B44 serotypes could be determined with unambiguous accuracy. The molecular genetics has advanced HLA technology markedly over serotyping technology, but serotyping still survives. Serotyping can help to reveal which primers for sequencing may best work for new sequences. Serotyping had idnetified the most similar antigens that now form the HLA subgroups.
HLA-A is one particular group of the human Class I MHCs. It consists of several hundred different genes and several thousand variant alleles. HLA-A is critical to the cytotoxic t-cell controlled immune response to viruses and other intracellular pathogens. Because each HLA-A gene has a high affinity for slightly different peptides, certain HLA-As are associated with increased risk, more rapid progression, and/or increased severity of many diseases. For similar reasons, HLA-A matching is essential to successful tissue transplants.


==References==
== References ==
{{reflist|2}}
{{reflist|2}}


==External links==
== External links ==
* [http://tech.groups.yahoo.com/group/DNAanthro/ Molecular Anthropology Yahoo Group]
* [http://tech.groups.yahoo.com/group/DNAanthro/ Molecular Anthropology Yahoo Group]
* [http://www.allelefrequencies.net HLA Allele and Haplotype Frequency Database]
* [http://www.allelefrequencies.net HLA Allele and Haplotype Frequency Database]
* [http://hla.alleles.org/proteins/class1.html HLA Nomenclature Full List of Class I Proteins]


{{Surface antigens}}
{{Surface antigens}}
{{PDB_Gallery|geneid=3105}}


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Revision as of 13:45, 31 August 2017

(heterodimer)
Illustration of HLA-A
Protein type Cell surface receptor
Function Peptide presentation for immune recognition
Subunit
name
Gene Chromosomal
locus
α HLA-A Chromosome 6p21.3
β2M B2M Chromosome 15q22

HLA-A is a group of human leukocyte antigens (HLA) that are coded for by the HLA-A locus, which is located at human chromosome 6p21.3.[1] HLA is a major histocompatibility complex (MHC) antigen specific to humans. HLA-A is one of three major types of human MHC class I cell surface receptors. The others are HLA-B and HLA-C.[2] The receptor is a heterodimer, and is composed of a heavy α chain and smaller β chain. The α chain is encoded by a variant HLA-A gene, and the β chain (β2-microglobulin) is an invariant β2 microglobulin molecule.[3] The β2 microglobulin protein is coded for by a separate region of the human genome.[4]

MHC Class I molecules such as HLA-A are part of a process that presents short polypeptides to the immune system. These polypeptides are typically 7-11 amino acids in length and originate from proteins being expressed by the cell. There are two classes of polypeptide that can be presented by an HLA protein: those that are supposed to be expressed by the cell (self) and those of foreign derivation (non-self).[5] Under normal conditions cytotoxic T cells, which normally patrol the body in the blood, "read" the peptide presented by the complex. T cells, if functioning properly, only bind to non-self peptides. If binding occurs, a series of events is initiated culminating in cell death via apoptosis.[6] In this manner, the human body eliminates any cells infected by a virus or expressing proteins they shouldn't be (e.g. cancerous cells).

For humans, as in most mammalian populations, MHC Class I molecules are extremely variable in their primary structure, and HLA-A is ranked among the genes in humans with the fastest-evolving coding sequence. As of December 2013, there are 2432 known HLA-A alleles coding for 1740 active proteins and 117 null proteins.[2] This level of variation on MHC Class I is the primary cause of transplant rejection, as random transplantation between donor and host is unlikely to result in a matching of HLA-A, B or C antigens. Evolutionary biologists also believe that the wide variation in HLAs is a result of a balancing act between conflicting pathogenic pressures. Greater variety of HLAs decreases the probability that the entire population will be wiped out by a single pathogen as certain individuals will be highly resistant to each pathogen.[5] The effect of HLA-A variation on HIV/AIDS progression is discussed below.

HLA-A gene

VALUE_ERROR (nil)
Identifiers
Aliases
External IDsGeneCards: [1]
Orthologs
SpeciesHumanMouse
Entrez
Ensembl
UniProt
RefSeq (mRNA)

n/a

n/a

RefSeq (protein)

n/a

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Location (UCSC)n/an/a
PubMed searchn/an/a
Wikidata
View/Edit Human

The HLA-A gene is located on the short arm of chromosome 6 and encodes the larger, α-chain, constituent of HLA-A. Variation of HLA-A α-chain is key to HLA function. This variation promotes genetic diversity in the population. Since each HLA has a different affinity for peptides of certain structures, greater variety of HLAs means greater variety of antigens to be 'presented' on the cell surface, enhancing the likelihood that a subset of the population will be resistant to a given foreign invader. This decreases the likelihood that a single pathogen has the capability to wipe out the entire human population.

Each individual can express up to two types of HLA-A, one from each of their parents. Some individuals will inherit the same HLA-A from both parents, decreasing their individual HLA diversity; however, the majority of individuals will receive two different copies of HLA-A. This same pattern follows for all HLA groups.[7] In other words, every single person can only express either one or two of the 2432 known HLA-A alleles.

Alleles

All HLAs are assigned a name by the World Health Organization Naming Committee for Factors of the HLA System. This name is organized to provide the most information about the particular allele while keeping the name as short as possible. An HLA name looks something like this:

HLA-A*02:01:01:02L

All alleles receive at least a four digit classification (HLA-A*02:12). The A signifies which HLA gene the allele belongs to. There are many HLA-A alleles, so that classification by serotype simplifies categorization. The next pair of digits indicates this assignment. For example, HLA-A*02:02, HLA-A*02:04, and HLA-A*02:324 are all members of the A2 serotype (designated by the *02 prefix).[2] This group is the primary factor responsible for HLA compatibility. All numbers after this cannot be determined by serotyping and are designated through gene sequencing. The second set of digits indicates what HLA protein is produced. These are assigned in order of discovery and as of December 2013 there are 456 different HLA-A*02 proteins known (assigned names HLA-A*02:01 to HLA-A*02:456). The shortest possible HLA name includes both of these details.[1] Each extension beyond that signifies a nucleotide change that may or may not change the protein and the interpretation of the extensions is covered in greater detail in current HLA naming system.

Protein

The protein coded for by the HLA-A gene is 365 amino acids long and weighs roughly 41,000 Daltons (Da).[8] It contains 8 exons.[9]

Exon Protein segment
1 Signal peptide
2 α1 domain
3 α2 domain
4 α3 domain
5 transmembrane region
6 cytoplasmic tail
7 cytoplasmic tail
8 Unspecified

The HLA-A signal peptide is a series of hydrophobic amino acids present at the N-terminus of the protein that directs it to the endoplasmic reticulum where the remaining seven domains are translated.[8][9][10] The three α domains form the binding groove that holds a peptide for presentation to CD8+ t-cells. The transmembrane region is the region that is embedded in the phospholipid bilayer surrounding the ER lumen.[9] The HLA-A protein is a single-pass transmembrane protein.[8] In other words, the first four domains of the protein are inside the ER lumen, while the last three domains are present outside the lumen, giving the protein the orientation required for proper function. The last three domains of the protein form a tail of primarily β-sheets that remains in the cell's cytosol.[9]

File:Peptide Loading Complex.jpg
Tracking the process of translating, assembling, and expressing the HLA-A gene[11]

Once the HLA-A protein is completely translated, it must be folded into the proper shape. A molecular chaperone protein called calnexin and an enzyme called ERp57 assist in the folding process. Calnexin holds the HLA-A heavy chain while Erp57 catalyzes disulfide bonds between the heavy chain and the light, β2-microglobulin chain. This bond induces a conformational change in the heavy chain, forming the binding groove. Calnexin then dissociates with the complex, now referred to as a peptide loading complex, and is replaced by calreticulin, another chaperone protein. Short peptides are continually transported from around the cell into the ER lumen by a specialized transport protein called TAP. TAP then binds to the peptide loading complex along with another protein, called tapasin. At this point the peptide loading complex consists of HLA-A (heavy chain), β2-microglobulin (light chain), an ERp57 enzyme, calreticulin chaperone protein, TAP (with a bound peptide fragment), and tapasin. Tapasin increases the stability of TAP, in addition to stabilizing the entire peptide loading complex. At this point TAP releases the peptide it transported into the ER lumen. The proximity of the HLA-A binding groove to TAP is ensured by the peptide loading complex. This increases the likelihood that the peptide will find the groove. If the peptide's affinity for the HLA-A protein is great enough, it binds in the groove.[12] Research suggests that tapasin may actively load peptides from TAP into the HLA-A complex while also holding class I molecules in the ER lumen until a high affinity peptide has been bound.[13]

After a peptide of high enough affinity has bonded to the class I MHC, calreticulin, ERp57, TAP, and tapasin release the molecule.[12] At this point the class I complex consists of an HLA-A protein bonded to a β2-microglobulin and a short peptide. It is still anchored in the ER membrane by the transmembrane domain. At some point the ER will receive a signal and the portion of the membrane holding the complex will bud off and be transported to the golgi bodies for further processing. From the golgi bodies, the complex is transported, again via vesicle transport, to the cell membrane. This is the point at which the orientation mentioned previously becomes important. The portion of the HLA-A complex holding the peptide must be on the exterior surface of the cell membrane. This is accomplished by vesicle fusion with the cell membrane.[10]

Function

Natural function

MHC Class I molecules present small peptides, typically 7-10 amino acids in length, to the immune system. A glycoprotein called CD8 binds to residues 223-229 in the α3 domain of HLA-A and this glycoprotein stabilizes interactions between the t-cell receptor on cytotoxic (CD8+) T-lymphocytes and the Class I MHC.[14] The T-cell receptor also has the potential to bind to the peptide being presented by the MHC. In a properly functioning immune system, only t-cells that do not bind self peptides are allowed out of the thymus, thus, if a T-cell binds to the peptide, it must be a foreign or abnormal peptide. The t-cell then initiates apoptosis, or programmed cell death. This process can happen as quickly as 5 minutes after initial foreign antigen presentation, although typically it takes several hours for death to become apparent.[15] This process is the basis of acquired immunity and serves as the primary defense against viruses and other intracellular pathogens.

Other activities

By the 1960s, it became evident that factors on donated organs and tissues often resulted in destruction of the donated tissue by the host's immune system. MHCs were originally discovered as a result of this observation (see history of HLAs for more details).[5] There are two types of peptide presenting complexes, Class I and Class II MHCs. Each of these has multiple HLA genes, of which HLA-A is but one. There are three major HLAs that should be matched between donors and recipients. They are HLA-A, HLA-B, (both Class I MHCs) and HLA-DR (a Class II MHC).[7] If the two tissues have the same genes coding for these three HLAs, the likelihood and severity of rejection is minimized.[16]

Role in disease

HLA-A associated diseases
Associated disease Serotypes
Ankylosing spondylitis A24
Diabetes, type-I[17] A1 A24
Hemochromatosis (lower CD8+ cells) A3
Myasthenia gravis A3 A24 A30
Leukemia, T-cell, Adult A26 A68
Multiple sclerosis A3
Papilloma virus susept. A11
Spontaneous abortion A2

HLAs serve as the sole link between the immune system and what happens inside cells. Thus any alteration on the part of the HLA, be it decreased binding to a certain peptide or increased binding to a certain peptide, is expressed as, respectively, increased susceptibility to disease or decreased susceptibility to disease. In other words, certain HLAs may be incapable of binding any of the short peptides produced by proteolysis of pathogenic proteins. If this is the case, there is no way for the immune system to tell that a cell is infected. Thus the infection can proliferate largely unchecked. It works the other way too. Some HLAs bind pathogenic peptide fragments with very high affinity. This in essence "supercharges" their immune system in regards to that particular pathogen, allowing them to manage an infection that might otherwise be devastating.[5]

HIV/AIDS

One of the most researched examples of differential immune regulation of a pathogen is that of human immunodeficiency virus. Because HIV is an RNA virus, it mutates incredibly quickly. This changes the peptides produced via proteolysis, which changes the peptides able to be presented to the immune system by the infected cell's MHCs. Any virus with a mutation that creates a peptide with high affinity for a particular HLA is quickly killed by the immune system, and thus does not survive and that high affinity peptide is no longer produced. However, it turns out that even HIV has some conserved regions in its genome, and if a HLA is capable of binding to a peptide produced from a conserved region, there is little the HIV can do to avoid immune detection and destruction.[5] This is the principle behind HLA-mediated differential HIV loads.

With over 2000 variations of the HLA-A coded MHC, it is difficult to determine the impact of all variants upon HIV loads. However, a select few have been implicated. HLA-A*30 has been shown to decrease viral load to less than 10,000 copies/cubic millimeter, considered quite low. On the other hand, HLA-A*02 has been implicated in high viral load (greater than 100,000 copies/cubic millimeter) when associated with HLA-B*45. Additionally, the haplotypes HLA-A*23-C*07 and HLA-A*02-C*16 typically expressed increased viral loads within the sample population of Zambians. One of the most effective HIV-inhibiting haplotypes was HLA-A*30-C*03 while one of the least effective was HLA-A*23*B*14. In summation, HLA-A*23 was highly correlated with increased HIV load among the sample population, although it is important to note that across samples of differing ethnicity this correlation decreases significantly.[18]

Although classification of the effect of individual HLA genes and alleles on the presence of HIV is difficult, there are still some strong conclusions that can be made. Individuals who are homozygous in one or more Class I HLA genes typically progress to AIDS much more rapidly than heterozygotes. In some homozygous individuals the rate of progression is double that of heterozygotes. This differential progression is correlated fairly tightly with the degree of heterozygosity.[19] In summation, certain HLA-A alleles are associated with differing viral loads in HIV infected patients; however, due to the diversity amongst those alleles, it is difficult to classify each and every allele's impact upon immune regulation of HIV. Nevertheless, it is possible to correlate heterozygosity in HLA-A alleles to decreased rate of progression to AIDS.

Not only do certain HLA alleles prescribe increased or decreased resistance to HIV, but HIV is able to alter HLA expression, and does so selectively to avoid being eliminated by natural killer cells (NK cells). Research has shown that HIV downregulates Class I MHC expression in infected cells. However, doing so indiscriminately opens up the opportunity for attack by NK cells, because NK cells respond to downregulation of HLA-C and HLA-E. Obviously, this mechanism has put selective pressure on the HIV virus. Thus, HIV has evolved the capability to downregulate HLA-A and HLA-B without significantly disturbing the expression of HLA-C and HLA-E.[20] A protein coded for by the HIV genome, negative regulatory factor (Nef), induces this change by binding to the cytoplasmic tail of the Class I MHC while it is still in the endoplasmic reticulum or occasionally while it is in the early stages of trafficking through the golgi bodies. This complex of MHC and Nef then causes adaptor protein 1 (AP-1) to direct the MHC to the lysosomes for degradation instead of to the cell membrane where it normally functions.[21] In addition to selective HLA downregulation, negative regulatory factor (Nef) enables HIV to downregulate CD4 and CD8. These glycoproteins are essential for, respectively, helper t-cell and cytotoxic t-cell binding to MHCs. Without these cofactors, both types of t-cells are less likely to bind to HLAs and initiate apoptosis, even if the HLA is expressing an HIV derived (non-self) peptide. Both of these proteins are also targeted at their cytoplasmic tail domain.[21] The combination of these abilities greatly enhances HIV's ability to avoid detection by the immune system.

Summary

HLA-A is one particular group of the human Class I MHCs. It consists of several hundred different genes and several thousand variant alleles. HLA-A is critical to the cytotoxic t-cell controlled immune response to viruses and other intracellular pathogens. Because each HLA-A gene has a high affinity for slightly different peptides, certain HLA-As are associated with increased risk, more rapid progression, and/or increased severity of many diseases. For similar reasons, HLA-A matching is essential to successful tissue transplants.

References

  1. 1.0 1.1 "HLA Nomenclature @ hla.alleles.org". Anthony Nolan Research Institute. 10 Nov 2013. Retrieved 8 Dec 2013.
  2. 2.0 2.1 2.2 "Statistics". European Bioinformatics Institute (EBI) / European Molecular Biology Laboratory (EMBL). Retrieved 13 Dec 2013.
  3. Delves PJ (Aug 2013). "Human Leukocyte Antigen (HLA) System: Biology of the Immune System". Merck Manual Professional. Merck Sharp & Dohme Corp. Retrieved 14 Dec 2013.
  4. "B2M Gene". GeneCards. Weizmann Institute of Science. 7 Nov 2013. Retrieved 14 Dec 2013.
  5. 5.0 5.1 5.2 5.3 5.4 Daniel M. Davis (2014). The Compatibility Gene. How Our Bodies Fight Disease, Attract Others, and Define Our Selves. Oxford: Oxford University Press. ISBN 0-19-931641-4.
  6. Accorsi D (14 Sep 2012). "MHC class I assembly and presentation". YouTube. Retrieved 8 Dec 2013.
  7. 7.0 7.1 Fix M (1998). "HLA Matching, Antibodies, and You". Kidney Transplantation: Past, Present, and Future. University of Michigan Medical Center/Stanford University. Retrieved 14 Dec 2013.
  8. 8.0 8.1 8.2 "Major Histocompatibility Complex, Class I, A". Gene Cards. Weizmann Institute of Science. 7 November 2013. Retrieved 16 December 2013.
  9. 9.0 9.1 9.2 9.3 "HLA-A major histocompatibility complex, class I, A [Homo sapiens (human)]". National Center for Biotechnology Information. U.S. National Library of Medicine. 12 December 2013. Retrieved 16 December 2013.
  10. 10.0 10.1 Alberts, Bruce (2010). Essential Cell Biology (Third ed.). Garland Science. ISBN 9780815341291.
  11. Tampé, Robert. "P16 Translocation mechanism and viral inhibition of the MHC I peptide-loading complex". Molecular Understanding of Transmembrane Processes. Institute of Biochemistry Biocenter. Retrieved 16 December 2013.
  12. 12.0 12.1 Accorsi, Diego (14 September 2012). "MHC class I assembly and presentation". Immunology Toronto. Department of Immunology and Biochemistry and Biomedical Communications at the University of Toronto. Retrieved 16 December 2013.
  13. Grandea AG, Van Kaer L (April 2001). "Tapasin: an ER chaperone that controls MHC class I assembly with peptide". Trends in Immunology. 22 (4): 194–9. doi:10.1016/S1471-4906(01)01861-0. PMID 11274924.
  14. "CD8". T-cell Modulation Group. tcells.org. 2009. Retrieved 17 December 2013.
  15. Janeway, Charles A. (2001). "8". Immunobiology the immune system health & disease (5. ed.). New York: Garland. ISBN 081533642X. Retrieved 17 December 2013.
  16. Solomon S, Pitossi F, Rao MS (February 2015). "Banking on iPSC--is it doable and is it worthwhile". Stem Cell Reviews. 11 (1): 1–10. doi:10.1007/s12015-014-9574-4. PMC 4333229. PMID 25516409.
  17. Noble JA, Valdes AM, Bugawan TL, Apple RJ, Thomson G, Erlich HA (August 2002). "The HLA class I A locus affects susceptibility to type 1 diabetes". Human Immunology. 63 (8): 657–64. doi:10.1016/S0198-8859(02)00421-4. PMID 12121673.
  18. Tang J, Tang S, Lobashevsky E, Myracle AD, Fideli U, Aldrovandi G, Allen S, Musonda R, Kaslow RA (August 2002). "Favorable and unfavorable HLA class I alleles and haplotypes in Zambians predominantly infected with clade C human immunodeficiency virus type 1". Journal of Virology. 76 (16): 8276–84. doi:10.1128/JVI.76.16.8276-8284.2002. PMC 155130. PMID 12134033.
  19. Carrington M, Nelson GW, Martin MP, Kissner T, Vlahov D, Goedert JJ, Kaslow R, Buchbinder S, Hoots K, O'Brien SJ (March 1999). "HLA and HIV-1: heterozygote advantage and B*35-Cw*04 disadvantage". Science. 283 (5408): 1748–52. doi:10.1126/science.283.5408.1748. PMID 10073943.
  20. Cohen GB, Gandhi RT, Davis DM, Mandelboim O, Chen BK, Strominger JL, Baltimore D (June 1999). "The selective downregulation of class I major histocompatibility complex proteins by HIV-1 protects HIV-infected cells from NK cells". Immunity. 10 (6): 661–71. doi:10.1016/S1074-7613(00)80065-5. PMID 10403641.
  21. 21.0 21.1 Leonard JA, Filzen T, Carter CC, Schaefer M, Collins KL (July 2011). "HIV-1 Nef disrupts intracellular trafficking of major histocompatibility complex class I, CD4, CD8, and CD28 by distinct pathways that share common elements". Journal of Virology. 85 (14): 6867–81. doi:10.1128/JVI.00229-11. PMC 3126561. PMID 21543478.

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