Letter abstract


Nature Genetics 41, 708 - 711 (2009)
Published online: 3 May 2009 | Corrected online: 26 June 2009 | doi:10.1038/ng.372



There is an Erratum (July 2009) associated with this Letter.

Narcolepsy is strongly associated with the T-cell receptor alpha locus

Joachim Hallmayer1,2,32, Juliette Faraco1,2,32, Ling Lin1,2, Stephanie Hesselson3, Juliane Winkelmann4,5,6, Minae Kawashima1,2,7, Geert Mayer8,9, Giuseppe Plazzi10, Sona Nevsimalova11, Patrice Bourgin12, Seung-Chul Hong13, Yutaka Honda14, Makoto Honda14, Birgit Högl15, William T Longstreth Jr16,17, Jacques Montplaisir18, David Kemlink11, Mali Einen1,2, Justin Chen3, Stacy L Musone3, Matthew Akana3, Taku Miyagawa7, Jubao Duan19, Alex Desautels18, Christine Erhardt12, Per Egil Hesla20, Francesca Poli10, Birgit Frauscher15, Jong-Hyun Jeong13, Sung-Pil Lee13, Thanh G N Ton16,17, Mark Kvale3, Libor Kolesar21, Marie Dobrovolná22, Gerald T Nepom23, Dan Salomon24, H-Erich Wichmann25,26, Guy A Rouleau27, Christian Gieger25, Douglas F Levinson2, Pablo V Gejman19,28, Thomas Meitinger4,6, Terry Young29, Paul Peppard29, Katsushi Tokunaga7, Pui-Yan Kwok3, Neil Risch3,30 & Emmanuel Mignot1,2,31

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Narcolepsy with cataplexy, characterized by sleepiness and rapid onset into REM sleep, affects 1 in 2,000 individuals1, 2. Narcolepsy was first shown to be tightly associated with HLA-DR2 (ref. 3) and later sublocalized to DQB1*0602 (ref. 4). Following studies in dogs5 and mice6, a 95% loss of hypocretin-producing cells in postmortem hypothalami from narcoleptic individuals was reported7, 8. Using genome-wide association (GWA) in Caucasians with replication in three ethnic groups, we found association between narcolepsy and polymorphisms in the TRA@ (T-cell receptor alpha) locus, with highest significance at rs1154155 (average allelic odds ratio 1.69, genotypic odds ratios 1.94 and 2.55, P < 10-21, 1,830 cases, 2,164 controls). This is the first documented genetic involvement of the TRA@ locus, encoding the major receptor for HLA-peptide presentation, in any disease. It is still unclear how specific HLA alleles confer susceptibility to over 100 HLA-associated disorders9; thus, narcolepsy will provide new insights on how HLA–TCR interactions contribute to organ-specific autoimmune targeting and may serve as a model for over 100 other HLA-associated disorders9.

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  1. Center for Sleep Sciences, Stanford University School of Medicine, Palo Alto, California, USA.
  2. Department of Psychiatry, Stanford University School of Medicine, Palo Alto, California, USA.
  3. Institute for Human Genetics, University of California San Francisco School of Medicine, San Francisco, California, USA.
  4. Institute for Human Genetics, Technische Universität München, Munich, Germany.
  5. Department of Neurology, Technische Universität München, Munich, Germany.
  6. Institute of Human Genetics Helmholtz Zentrum München, Munich, Germany.
  7. Department of Human Genetics, University of Tokyo, Tokyo, Japan.
  8. Hephata-Klinik, Schwalmstadt-Treysa, Germany.
  9. Department of Neurology, Philipps University of Marburg, Marburg, Germany.
  10. University of Bologna, Bologna, Italy.
  11. Department of Neurology, Charles University in Prague, 1st Faculty of Medicine and General Teaching Hospital, Prague, Czech Republic.
  12. Sleep Clinic, Hôpital Civil, Louis Pasteur University, Strasbourg, France.
  13. Department of Neuropsychiatry, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea.
  14. Tokyo Institute of Psychiatry, Setagaya, Japan.
  15. Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
  16. Department of Neurology, University of Washington, Seattle, Washington, USA.
  17. Department of Epidemiology, University of Washington, Seattle, Washington, USA.
  18. Sleep Disorders Center, Université de Montréal, Montréal, Québec, Canada.
  19. Department of Psychiatry, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA.
  20. Coliseum on Majorstua Clinic, Oslo, Norway.
  21. Department of Immunogenetics, Institute for Clinical and Experimental Medicine, Videnska, Prague, Czech Republic.
  22. HLA typing lab, National Reference Laboratory for DNA Diagnostics, Institute of Hematology and Blood Transfusion, Prague, Czech Republic.
  23. The Benaroya Research Institute at Virginia Mason, Seattle, Washington, USA.
  24. Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, California, USA.
  25. Institute of Epidemiology Helmholtz Zentrum München, Munich, Germany.
  26. Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany.
  27. Center of Excellence in Neuromics, Université de Montréal, Montréal, Canada.
  28. NorthShore University HealthSystem, Evanston, Illinois, USA.
  29. Department of Population Health Sciences, University of Wisconsin Medical School, Madison, Wisconsin, USA.
  30. Kaiser Permanente Northern California Division of Research, Oakland, California, USA.
  31. Howard Hughes Medical Institute, Stanford University, California, USA.
  32. These authors contributed equally to this work.

Correspondence to: Emmanuel Mignot1,2,31 e-mail: mignot@stanford.edu

* NOTE: In the version of this article initially published, Seung-Chul Hong was incorrectly listed as Sheng Seung-Chul Hong. The error has been corrected in the HTML and PDF versions of the article.

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