Behçet disease is a multisystem disease associated with Human Leucocyte Antigen (HLA) class I polymorphism. High-resolution Next Generation Sequencing (NGS) with haplotype analysis has not been performed previously for this disease. Sixty Egyptian patients diagnosed according to the International Study Group (ISG) criteria for Behçet disease, and 160 healthy geographic and ethnic-matched controls were genotyped for HLA class I loci (HLA-A, B, C). For HLA class II loci (DRB1, DRB3/4/5, DQA1, DQB1, DPA1, DPB1), 40 control samples were genotyped. High resolution HLA genotyping was performed using NGS, and results were analyzed. Clinical manifestations were oral ulcers (100%), genital ulcers (100%), eye (55%), neurological (28%) and vascular involvement (35%). HLA-B*51:08 (OR 19.75, 95% CI 6.5 – 79; p <0.0001), HLA-B*15:03 (OR 12.15, 95% CI 3.7 – 50.7; p<0.0001), HLA-C*16:02 (OR 6.53, 95% CI 3 – 14; p<0.0001), HLA-A*68:02 (OR 3.14, 95% CI 1.1 – 8.9; p<0.01) were found to be associated with Behçet disease, as were HLA-DRB1*13:01 and HLA-DQB1*06:03 (OR 3.39, 95% CI 0.9 – 18.9; p=0.04 for both). By contrast, HLA-A*03:01 (OR 0.13, 95% CI 0 – 0.8; p =0.01) and HLA-DPB1*17:01 were found to be protective (OR 0.27, 95% CI 0.06 – 1.03; p =0.02). We identified strong linkage disequilibrium between HLA-B*51:08 and C*16:02 and A*02:01, in a haplotype associated with Behçet disease. HLA-B*51:08 was significantly associated with legal blindness (OR = 2.98 (1.06 – 8.3) p=0.01). In Egyptian Behçet patients, HLA-B*51:08 is the most common susceptibility allele and holds poor prognosis for eye involvement.
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