Behçet disease, new insights in disease associations and manifestations: a next-generation sequencing study

M. Elfishawi, G. Mossallam, D. G. Augusto, G. Montero-Martin, H. de Bruin, L. Van de Pasch, P. J. Norman, E. Rozemuller, M. Fernandez-Vina, A. Abrudescu, J. A. Hollenbach, K. Zaky, S. Elfishawi

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Behçet disease is a multi-system disease associated with human leukocyte 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 the results were analyzed. Clinical manifestations were oral ulcers (100%), genital ulcers (100%), eye (55%) and neurological (28%) and vascular involvement (35%). HLA-B*51:08 [odds ratio (OR) = 19·75, 95% confidence interval (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, 95% CI = 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.

Original languageEnglish
Pages (from-to)144-151
Number of pages8
JournalClinical and Experimental Immunology
Issue number1
StatePublished - Apr 2021


  • Behçet disease
  • epidemiology
  • genetics
  • next-generation sequencing
  • susceptibility


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