HLA GENETIC-HETEROGENEITY OF HEPATITIS-B VACCINE RESPONSE IN HEMODIALYZED PATIENTS

Major histocompatibility complex (MHC) determinants are critical to th e induction or suppression of immune response and have been shown to c ontrol the ability to produce antibodies in response to protein antige n. Hepatitis B vaccine commonly fails among patients with renal failur e, but genetic factors that modulate response to this vaccination are not yet characterized. The availability of HLA Class II genotyping by hybridization with specific oligonucleotidic probes, following DNA amp lification by the polymerase reaction (PCR), has made the analysis of HLA class II loci a reliable and practical approach. Antibody response to HBs and HLA class II oligotyping were assessed among 203 hemodialy zed patients having received a full course of vaccination. Twenty-two percent (N = 45) produced less than 10 IU (radioimmunoassay) of anti-H Bs antibodies following the fourth injection. These nonresponder patie nts had a significantly decreased frequency of the DR2 haplotype compa red to responder patients or to a group of 405 normal controls (8.9% v s. 21.5% and 26.2%, P < 0.01). The frequency of the DR3 haplotype was not increased among subjects with lower response. No significant diffe rence appeared in the responder group. These results argue in favor of the presence of HLA-linked immune response gene(s) controlling humora l response to HBs antigen, rather than in favor of the presence of an immune suppressive gene.