Distribution of Killer Cell Immunoglobulin-Like Receptors in the Macedonian Population Eli Djulejica, Dejan Trajkova, Aleksandar Petlichkovskia, Ana Strezovaa, Slavica Hristomanovaa, Derek Middletonb, Mirko Spiroskia, * aInstitute of Immunobiology and Human Genetics, Faculty of Medicine, University "Ss. Kiril and Metodij", Skopje, Republic of Macedonia; bRoyal Liverpool University Hospital and School of Infection and Defence, Liverpool University, Liverpool, L7 8XP, United Kingdom *Correspondence to: Mirko Spiroski, MD, PhD Institute of Immunobiology and Human Genetics, Faculty of Medicine, University "Ss. Kiril and Metodij", 1109 Skopje, PO Box 60, Republic of Macedonia Tel.: +389-2-3110556 Fax: +389-2-3110558 URL: http://www.iibhg.ukim.edu.mk/ e-mail: mspiroski@yahoo.com Short title: KIR in Macedonians 1 Abstract The aim of this study was to analyze Killer Ig-Like Receptor (KIR) Gene Polymorphism in the Macedonian Population. The studied sample consists of 214 healthy unrelated individuals, aged 20-35 years. All individuals are of Macedonian origin and nationality, residents of different geographical regions. The spoken language is Macedonian. Blood samples were collected after written consent, DNA was isolated from peripheral blood leukocytes by the phenol-chlorophorm extraction method. PCR-based method designed to detect the presence and absence of KIR genes was used (The PEL-FREEZ KIR Genotyping SSP Kit). The population genetics analysis package, Arlequin, was used for analysis of the data. We found that all 16 KIR genes were observed in the Macedonian population and framework genes 3DL3, 2DL4, and 3DL2 were present in all individuals. Total of 56 different KIR genotypes were found to be present in Macedonian population, based on the presence of 16 KIR genes. Neighbor-Joining phylogenetic tree, constructed on the basis of standard genetic distances of KIR genes, shows that Macedonian population is in the same BrazilSouthEastCaucasian, cluster with EnglandWestMidlandsIndianAsian, RomaniCaucasians, Basque, EnglandWestMidlandsCaucasian, Reunion, and SpainGranada populations. The frequency of KIR loci in Macedonian population shares several general features with other Caucasoid populations studied before. Key words: Killer immunoglobulin-like receptor (KIR) gene polymorphism, genetic distance, KIR genotyping, PCR-SSP, Macedonian population 2 1. Introduction Killer immunoglobulin-like receptors (KIR) are cell surface molecules important in the regulation of activity of the natural killer (NK) cells and some T cells in either inhibitory or activating manner [1]. KIR molecules are encoded by the KIR gene family clustered within the leukocyte receptor complex on chromosome 19q13.4 [2, 3]. KIR genes exhibit allelic, haplotypic, and gene content variability [47]. KIR haplotypes differ in the number and kind of KIR genes they contain. Thus, KIR haplotypes can be distinguished according to their gene content. Because the individual KIR genes are polymorphic, KIR haplotypes that are identical by gene content can be further subdivided according to allele combination. Diversity in human KIR genotype therefore is sum from three components: haplotypic gene content, allelic polymorphism and the combination of maternal and paternal haplotypes. The combined effects of these three components are such that unrelated individuals usually differ in KIR genotype and ethnic populations have widely differing KIR genotype frequencies. In general, two KIR haplotypes are recognized: A and B [7-9]. The latest haplotype definition (14th International HLA and Immunogenetics Workshop, 2005) identifies haplotype A to be composed of KIR3DL3, KIR2DL3, KIR2DP1, KIR2DL1, KIR3DP1, KIR2DL4, KIR3DL1, KIR2DS4, and KIR3DL2 genes, while all other haplotypes are described as haplotype B. With the exception of null alleles and possibly 3DL3, all known KIR-s in a given individual's KIR gene repertoire are expressed [1-12]. In heterozygous individuals, NK clones can express none, one or both alleles of 3DL1 and 3DL2, but usually both alleles of 2DL4 [13]. 3 Population studies have revealed that KIR gene frequencies and genotype content vary considerably among different ethnic groups, and that frequencies of A and B haplotypes have also been found to differ between populations [4, 7, 14-22]. Results from population studies to date indicate the extent of KIR gene diversity; some of these studies have also shown the association of the presence or absence of specific KIR genes in certain human diseases [23-27]. Although comparisons with the major histocompatibility complex (MHC) are obvious, what is less clear are the functional implications of KIR diversity and whether it serves us a useful purpose [28, 29]. Macedonian population is of special interest for anthropological studying in the light of opened questions regarding its origin and the migrations which resulted in settlement of Macedonians in the heart of Balkan Peninsula. Macedonia is located in the Central Balkans, bordering Bulgaria, Greece, Albania, Serbia and Kosovo province, covering an area of 25.710 kms. According to the 2002 census, the country’s population was 2.022.577. Data on the declared ethnic affiliation from the 2002 census reported that 64.1% of the population identify themselves as Macedonian, 25.17% as Albanian, 3.95% as Turks, 2.66% as Roma, 1.78% as Serbs, 0.84% as Bosniacs, 0.48% as Vlachs and 1.04% others [30]. The country seceded peacefully from Yugoslavia after an independence referendum, held in September 1991. This is the first study of the diversity of KIR genes in Macedonian populations. The aim of this study was to determine the frequencies of 16 KIR genes and pseudogenes (KIR2DL1, KIR2DL2, KIR2DL3, KIR2DL4, KIR2DL5, KIR3DL1, KIR3DL2, KIR3DL3, KIR2DS1, KIR2DS2, KIR2DS3, KIR2DS4, KIR2DS5, KIR3DS1, KIR2DP1, and KIR3DP1), genotypes and to compare them with populations for 4 which similar data are available. Finally, genetic distances between Macedonian and other compared populations were calculated. 2. Material and Methods 2.1. Population samples The study included 214 unrelated healthy individuals, all Macedonians of Macedonian origin and nationality, and residents of different regions of the Republic of Macedonia. Each individual was interviewed on a one-to-one basis, his/her genealogy was recorded for the last three generations, and a signed consent was obtained. Admixture, if any, was recorded for each individual. Individuals with only one Macedonian parent were excluded from the study. After signing of written consent, genomic DNA was extracted from the peripheral blood leukocytes using standard phenol/chloroform procedure, described elsewhere [31], and stored in the anthropology project field of the Macedonian Human DNA Bank (hDNAMKD) [32] until processing. 2.2. PCR amplification For KIR genotyping commercially available PEL-FREEZ KIR genotyping SSP kit (Dynal Biotech, Brown Deer, WI) was used. It is a PCR-based method (using sequence-specific priming approach) designed to detect the presence and/or absence of 16 KIR genes and pseudogenes defined by the International nomenclature committee of WHO [33, 34]. Briefly, locus specific primer sets, dispensed in a 96 well thermal tray were used for amplification of genomic DNA. After mixing a reaction buffer with a human genomic DNA sample and Taq DNA polymerase, the mixture was dispensed to the tray, sealed and then thermally cycled 5 as follows: (1 min at 95, 30 cycles of 94 for 20 seconds, 63 for 20 seconds and 72 for 90 seconds). After the amplification, the PCR products are loaded and separated by electrophoresis onto a 2% agarose gel stained with ethidium bromide, after which the results are interpreted using a worksheet for the specific amplification patterns. The presence of each KIR gene was determined by the presence of a band of DNA of the expected size. All PCRs contained an internal positive control consisting of an additional pair of primers specific for the growth hormone gene [35], and a negative control. Individuals were determined negative for a particular KIR gene when a band of expected size was absent in the presence of a band for the GH gene. 2.3. Statistical analysis The occurrence of KIR genes in individuals (F) was obtained by direct counting. Gene frequencies (GF) were calculated using the formula F=1-(1-F). For analysis of the molecular polymorphism of the locus studied, the Arlequin software version 3.0 [36] (Genetics and Biometry Laboratory, University of Geneva, Switzerland) was used. The Hardy-Weinberg equilibrium [37] and the EwansWatterson [38] statistics were calculated in order to examine the presence of selective forces influencing the allele distribution. The percentage of individuals carrying each KIR gene was also calculated. Linkage disequilibrium (LD) values for two locus associations were calculated using 2×2 tables [39]. Because LD is not independent of allele frequencies, normalized LD was calculated as described previously [40, 41]. The statistical significance of LD values was assessed by Yates X2 analysis on the corresponding 2×2 contingency table. A neighbour-joining tree 6 was constructed from Nei’s genetic distances using the PHYLIP phylogeny inference package [42]. Group nomenclature (AA, AB, BB) of KIR was defined if any of genes 2DL2, 2DL5, 3DS1, 2DS1, 2DS2, 2DS3, 2DS5 are present, genotype is taken as having B. If none of these are present genotype is considered as AA. If any are present and 3DL1, 2DL1, 2DL3 and 2DS4 are all present then genotype is considered as AB. However, if any of 3DL1, 2DL1, 2DL3, 2DS4 genes are missing, genotype is considered as BB. KIR genotypes were numerated according the KIR Database >> Genotype Reference [43]. For comparison of KIR gene frequencies and genetic distance analysis, we have used data for KIR genotypic polymorphisms published at the Allelefrequencies database (www.allelefrequencies.net) [44]. The number of KIR genes allocated at this database differs for different populations, depending on the typing method used. We have included in our study and used for comparison only those having complete data for 14 different genes. According to this criterion, 33 populations were selected out of total of 82 populations. 3. Results 3.1. KIR gene frequencies The presence and absence of the 16 KIR genes (14 genes and 2 pseudogenes) determined in the 214 healthy individuals, randomly selected from the Macedonian population are shown in Table 1. All 16 KIR genes were observed in the Macedonian population and framework genes 3DL3, 2DL4, and 3DL2 were present in all individuals. The most frequently present KIR genes were: 2DL1 (0.94), 2DL2 (0.59), 2DL3 (0.89), 2DL5 (0.41), 3DL1 (0.93), 2DP1 (0.98), 2DS1 (0.48), 2DS2 7 (0.56), 2DS3 (0.36), 2DS4 (0.94), 2DS5 (0.30), 3DS1 (0.39), 3DP1 (0.99), respectively. Most of individuals (99.5%) had 3DP1; 99% had 3DP1*003, and 24% had 3DP1*001/002. In 41% of individuals we found 2DL5; 28% had 2DL5A*001, and 25% had 2DL5B*002/004. In 94% of individuals we found 2DS4; 25% had 2DS4*001-002, and 85.9% had 2DS4*003 (Table 1). <Table 1> 3.2. Genotype frequencies KIR genotypes, groups, genotype ID, number of individuals and percentage of distribution is given in Fig. 1. Total of 56 different KIR genotypes were found to be present in studied population, based on the presence of 16 KIR genes. We found one group AA, genotype ID 1 in 46 individuals (21.5%), 33 group AB, and 22 group BB genotypes. The most frequent genotypes in group AB are genotypes ID 4 with 27 individuals (12.62%) and ID 2 with 11 individuals (5.14%). The most frequent genotypes in group BB are ID 73 (2.34%) and ID 71 (1.87%). We found 5 new genotypes in AB group and 9 new genotypes in group BB which are referred in KIR database of Allelefrequencies.net (Fig. 1). <Figure 1> 3.3. Linkage disequilibrium The classical linkage disequilibrium coefficient (D), linkage disequilibrium coefficient D standardized by the maximum value it can take (Dmax), given the allele frequencies (D’), standardised simple measure of linkage disequilibrium (r2), and statistical significance (P) for KIR genes are shown in Table 2. The genes present in all individuals were excluded from the analysis. <Table 2> 8 Pair of KIR loci that displayed significant (P<0.05) LD in Macedonian population are given in Table 3. From the Table 3 we can see positive and negative LD with KIR genes. <Table 3> 3.4. Genetic distances and phylogenetic tree For comparison of KIR gene frequencies and genetic distance analysis, we have used data for KIR genotypic polymorphisms published at the Allelefrequencies database (www.allelefrequencies.net) [44]. The number of KIR genes allocated at this database differs for different populations, depending on the typing method used. We have included in our study and used for comparison only those having complete data for 14 different genes. According to this criterion, 33 populations were selected out of total of 82 populations. Diversity of investigated populations for KIR genes is given for all loci, and locus by locus on the Table 4. Measure of population differentiation (GST) for all loci was 0.067, for the locus 2DL3 was the biggest (0.133), and the smallest was for locus 2DS3 (0.046). Total genetic diversity in the pooled populations (HT) for all loci was 0.285 the biggest was for locus 2DL5 (0.440), and the smallest was for the locus 2DL4 (0.120). Mean diversity within each population (HS) for all loci was 0.317, the biggest was for the locus 2DL5 (0.419), and the smallest was for the locus 2DL4 (0.011). We did not found diversity for 3DL2 and 3DL3 loci (Table 4). <Table 4> The average heterezygosity for the different populations and their standard error is shown on Table 5 and is around 0.2 for most of the populations. The lowest heterezygosity is observed for Japanese population (0.152 ± 0.035), while it is highest in PakistanKarachi (0.374 ± 0.048). 9 <Table 5> The phylogenetic tree (Figure 2) was constructed on the basis of comparison of gene frequencies for KIR loci in different populations. It clearly shows the relations between the Macedonian and other compared populations. The closest genetic distance is observed between the studied Macedonian population and the SpainGranada population (SGD=0.00), while the most genetically distant populations were SouthAfricaXhosa (SGD=4.33) and Tarahumara (SGD=4.04) (Table 5). Populations from Oman, Lebanon, BelgiumKIRPop, Guadeloupe, Senegal and SouthAfricaXhosa are in the same cluster on the bottom of the tree. On the opposite side of the genetic tree are IndiaNorthHindus, PakistanKarachi, and SouthAsians in oner subclaster together with the rest of populations in the same claster (EnglandWestMidlandsIndianAsian, RomaniCaucasians, Basque, BrazilSouthEastCaucasian, EnglandWestMidlandsCaucasian, Reunion, Macedonia, and SpainGranada). The rest of populations are in the middle clasters (Fig. 2). <Figure 2> 4. Discussion The present study has been initiated to define reliable estimates of the KIR gene frequencies for the Macedonian population suitable for use in the anthropological studies in order to better understand genetic distances, migrations and relations between different populations and ethnic groups. We found that all 16 KIR genes were observed in the Macedonian population and framework genes 3DL3, 2DL4, and 3DL2 were present in all individuals. The most frequently present KIR genes were: 2DL1 (0.94), 2DL2 (0.59), 2DL3 (0.89), 10 2DL5 (0.41), 3DL1 (0.93), 2DP1 (0.98), 2DS1 (0.48), 2DS2 (0.56), 2DS3 (0.36), 2DS4 (0.94), 2DS5 (0.30), 3DS1 (0.39), 3DP1 (0.99), respectively. There are numerous publications of KIR gene distribution in different populations, but the most comprehensive is allelefrequencies.net database [44]. Two-dimensional plot from multidimensional scaling analysis based on pair wise RST values from KIR genotypes have shown that Poles showed close clustering with German [45], British [15], Greek [19] and Australian Caucasoid [9]. Northern Irish Caucasoid [46] and Palestinians [15] were somewhat further away. Other populations such as Asiatic Indians [17], Pakistanis from Pakistan, Pakistanis from Trinidad, Africans from Trinidad [16] and Thais [15] were even more distant, as expected. Interestingly, a Californian American sample that was the first human population described for KIR genotypes is found to be very distant from all other populations [8]. Finally, Koreans [20] and Japanese [8] were relatively close together and far away from all other groups [47]. Total of 56 different KIR genotypes were found to be present in Macedonian population, based on the presence of 16 KIR genes. We found one group AA, 33 group AB, and 22 group BB genotypes. The most frequent genotypes in group AB are genotypes ID 4 and ID 2. The most frequent genotypes in group BB are ID 73 and ID 71. We found 5 new genotypes in AB group and 9 new genotypes in group BB which are included in KIR database of Allelefrequencies.net [44]. Haplotype A was found to be predominant in all four Pacific Islands populations and has previously been shown to be prevalent in Caucasian, Korean, Thai, and Japanese populations, while haplotype B has been shown to be more frequent in North Indians, Palestinians, South Asians, and Afro-Caribbeans [4, 7, 1422]. This data also correlate with distances observed in the neighbour-joining tree 11 where Pacific Islands populations were grouped with other, predominantly haplotype A, populations and away from predominantly haplotype B populations. In general, an understanding of which markers are in strong linkage disequilibrium allows for the more rational design of genetic studies. In the KIR system in particular, where genes of different groups may act inhibitory or stimulatory and in combination with HLA ligands, knowledge of the existing disequilibria is vital to our understanding of which gene combinations are important in disease. Most KIR genes were present in similar frequencies in the four Pacific Islands populations [48], and comparable KIR polymorphism in Indonesian populations that probably reflects the large geographical spread of the Indonesian archipelago has been published [49]. Polynesians have been found to be genetically less heterogenous based on analysis of six minisatellites, but with differences observed in gene frequencies in geographically close populations, which have been largely attributed to the bottleneck effect arising from small founding populations followed by subsequent random genetic drift [50]. We report here genetic distances of 14 KIR genes for 33 populations, deposited on the allelefrequencies.net [44], and they group in several clusters. Populations from Oman, Lebanon, BelgiumKIRPop, Guadeloupe, Senegal and SouthAfricaXhosa are in the same cluster on the bottom of the tree. On the opposite side of the genetic tree are IndiaNorthHindus, PakistanKarachi, and SouthAsians in other subcluster together with the rest of populations in the same cluster (EnglandWestMidlandsIndianAsian, BrazilSouthEastCaucasian, RomaniCaucasians, Basque, EnglandWestMidlandsCaucasian, Reunion, Macedonia, and SpainGranada). The rest of populations are in the middle clusters. In the similar 12 investigation of genetic distances based on the results of 56 populations, populations tended to group together according to a geographical gradient. Macedonian population was in the same cluster together with SpainGranada [51], which is identical with our investigation. Analyses based on KIR DS or KIR haplotype B genes show that populations are related according to geography, like a good anthropological marker (i.e.:HLA or Y chromosome systems). The results based on KIR DL or KIR haplotype A genes do not show such a correlation [52]. We do not have any explanation about the population positions in the clusters, but different selective pressures in the past could be one of the explanations. In summary, the results of KIR gene frequencies, genotype frequencies, and linkage disequilibrium in Macedonian population are similar with the published data for KIR distributions in Caucasoid, and can be used for anthropological comparisons, as well for association studies with different diseases. Neighbour-Joining phylogenetic tree, constructed on the basis of standard genetic distances of KIR genes, shows that Macedonian population is in the same cluster with EnglandWestMidlandsIndianAsian, BrazilSouthEastCaucasian, RomaniCaucasians, Basque, EnglandWestMidlandsCaucasian, Reunion, and SpainGranada populations. Acknowledgement The authors thank Elena Zaharieva for isolation of genomic DNA, and taking care of the Macedonian Human DNA Bank (www.hdnamkd.org.mk). This work was supported in part from the ICGEB collaborative research program (CRP/MAC03-01), Trieste, Italy. 13 References [1] Vilches C, Parham P. KIR Diverse, rapidly evolving receptors of innate and adaptive immunity. Annu Rev Immunol 2002;20:217–251. [2] Dupont B, Selvakumar A, Steffens U. The killer cell inhibitory receptor genomic region on human chromosome 19q13.4. Tissue Antigens 1997;49:557–563. [3] Martin AM, Freitas EM, Witt CS, Christiansen FT. The genomic organization and evolution of the natural killer immunoglobulin-like receptor (KIR) gene cluster. Immunogenetics 2000;51:268–280. [4] Uhrberg M, Parham P, Wernet P. Definition of gene content for nine common group B haplotypes of the Caucasoid population: KIR haplotypes contain between seven and eleven KIR genes. Immunogenetics 2002;54:221–229. [5] Shilling HG, Young N, Guethlein LA, Cheng NW, Gardiner CM, Tyan D, Parham P. Genetic control of human NK repertoire. J Immunol 2002;169:239–247. [6] Hsu KC, Chida S, Geraghty DE, Dupont B. The killer cell immunoglobulinlike receptor (KIR) genomic region: geneorder, haplotypes and allelic polymorphism. Immunol Rev 2002;190:40–52 [7] Hsu KC, Liu XR, Selvakumar A, Mickelson E, O’Reilly RJ, Dupont B. Killer Ig-like receptor haplotype analysis by gene content: evidence for genomic diversity with a minimum of six basic framework haplotypes, each with multiple subsets. J Immunol 2002;169:5118–5129. 14 [8] Uhrberg M, Valiante NM, Shum BP, Shilling HG, Lienert-Weidenbach K, Corliss B, Tyan D, Lanier LL, Parham P. Human diversity in killer cell inhibitory receptor genes. Immunity 1997;7:753–763. [9] Witt CS, Dewing C, Sayer DC, Uhrberg M, Parham P, Christiansen FT. Population frequencies and putative haplotypes of the killer cell immunoglobulin-like receptor sequences and evidence for recombination. Transplantation 1999;68:1784–1789. [10] Valiante NM, Uhrberg M, Shilling HG, Lienert-Weidenbach K, Arnett KL, D'Andrea A, Phillips JH, Lanier LL, Parham P. Functionally and structurally distinct NK cell receptor repertoires in the peripheral blood of two human donors. Immunity 1997;7:739. [11] Uhrberg M, Valiante NM, Young NT, Lanier LL, Phillips JH, Parham P. The repertoire of killer cell Ig-like receptor and CD94:NKG2A receptors in T cells: clones sharing identical alpha beta TCR rearrangement express highly diverse killer cell Ig-like receptor patterns. J Immunol 2001;166:3923. [12] Husain Z, Alper CA, Yunis EJ, Dubey DP. Complex expression of natural killer receptor genes in single natural killer cells. Immunology 2002;106:373. [13] Chan HW, Kurago ZB, Stewart CA, Wilson MJ, Martin MP, Mace BE, Carrington M, Trowsdale J, Lutz CT. DNA Methylation Maintains Allelespecific KIR Gene Expression in Human Natural Killer Cells. J Exp Med 2003;197:245. [14] Toneva M, Lepage V, Lafay G, Dulphy N, Busson M, Lester S, Vu-Trien A, Michaylova A, Naumova E, McCluskey J, Charron D. Genomic diversity of 15 natural killer cell receptor genes in three populations. Tissue Antigens. 2001;57(4):358-62. [15] Norman PJ, Stephens HA, Verity DH, Chandanayingyong D, Vaughan RW. Distribution of natural killer cell immunoglobulin-like receptor sequences in three ethnic groups. Immunogenetics 2001;52:195–205. [16] Norman PJ, Carrington CV, Byng M, Maxwell LD, Curran MD, Stephens HA, Chandanayingyong D, Verity DH, Hameed K, Ramdath DD, Vaughan RW. Natural killer cell immunoglobulin-like receptor (KIR) locus profiles in African and South Asian populations. Genes Immun 2002;3:86–95. [17] Rajalingam R, Krausa P, Shilling HG, Stein JB, Balamurugan A, McGinnis MD, Cheng NW, Mehra NK, Parham P. Distinctive KIR and HLA diversity in a panel of North Indian Hindus. Immunogenetics 2002;53:1009–1019. [18] Yawata M, Yawata N, McQueen KL, Cheng NW, Guethlein LA, Rajalingam R, Shilling HG, Parham P. Predominance of group A KIR haplotypes in Japanese associated with diverse NK cell repertoires of KIR expression. Immunogenetics 2002;54:543–550. [19] Niokou D, Spyropoulou-Vlachou M, Darlamitsou A, Stravropoulos-Giokas C. Distribution of killer cell immunoglobulin-like receptors in the Greek population. Hum Immunol 2003;64:1167–1176. [20] Whang DH, Park H, Yoon JA, Park MH. Haplotype analysis of killer cell immunoglobulin-like receptor genes in 77 Korean families. Hum Immunol 2005;66:146–154 16 [21] Jiang K, Zhu FM, Lv QF, Yan LX. Distribution of killer cell immunoglobulinlike receptor genes in the Chinese Han population. Tissue Antigens 2005;65:556–563. [22] Denis L, Sivula J, Gourraud PA, Kerdudou N, Chout R, Ricard C, Moisan JP, Gagne K, Partanen J, Bignon JD. Genetic diversity of KIR natural killer cell markers in populations from France, Guadeloupe, Finland, Senegal and Reunion. Tissue Antigens 2005;66(4):267-76. [23] Khakoo SI, Thio CL, Martin MP, Brooks CR, Gao X, Astemborski J, Cheng J, Goedert JJ, Vlahov D, Hilgartner M, Cox S, Little AM, Alexander GJ, Cramp ME, O’Brien SJ, Rosenberg WMC, Thomas DL, Carrington M. HLA and NK cell inhibitory receptor genes in resolving hepatitis C virus infection. Science 2004;305:872–874. [24] Gaudieri S, Nolan D, McKinnon E, Witt C, Mallal S, Christiansen FT. Associations between KIR epitope combinations expressed by HLA-B/-C haplotypes found in an HIV-1 infected study population may influence NK mediated immune response. Mol Immunol 2005;42:557–560. [25] Williams F, Meenagh A, Sleator C, Cook D, Fernandez-Vina M, Bowcock AM, Middleton D. Activating killer cell immunoglobulin-like receptor gene KIR2DS1 is associated with psoriatic arthritis. Hum Immunol 2005;66:836– 841. [26] Nelson GW, Martin MP, Gladman D, Wade J, Trowsdale J, Carrington M. Heterozygote advantage in autoimmune disease: hierarchy of protection/susceptibility conferred by HLA and killer Ig-like receptor combinations in psoriatic arthritis. J Immunol 2004;173:4273–4276. 17 [27] Luszczek W, Manczak M, Cislo M, Nockowski P, Wisniewski A, Jasek M, Kusnierczyk P. Gene for the activating natural killer cell receptor, KIR2DS1, is associated with susceptibility to psoriasis vulgaris. Hum Immunol 2004;65:758–766. [28] Vilches C, Parham P. KIR Diverse, rapidly evolving receptors of innate and adaptive immunity. Annu Rev Immunol 2002;20:217–251. [29] Yawata M, Yawata N, Draghi M, Little AM, Partheniou F, Parham P. Roles for HLA and KIR polymorphisms in natural killer cell repertoire selection and modulation of effector function. J Exp Med 2006;203(3):633-45. [30] State Statistical Office of the Republic of Macedonia. Census 2002: Total population of the Republic of Macedonia according to declared ethnic affiliation. In: Statistical Yearbook of the Republic of Macedonia 2004. Skopje, 2004:61-2. [31] Towner P. Purification of DNA. Essential Molecular Biology (ed. T.A. Brown). Oxford University Press, Oxford. 1995:47-54. [32] Spiroski M, Arsov T, Petlichkovski A, Strezova A, Trajkov D, EfinskaMladenovska O, Zaharieva E. Case Study: Macedonian Human DNA Bank (hDNAMKD) as a source for public health Genetics. In: Health Determinants in the Scope of New Public Health. Ed. by Georgieva L, Burazeri G. Hans Jacobs Company: Sofia, 2005:33-44. [33] Robinson J, Waller MJ, Stoehr P, Marsh SGE. IPD - the Immuno Polymorphism Database. Nucleic Acids Research 2005;331:D523-526. [34] Marsh SGE, Parham P, Dupont B, Geraghty DE, Trowsdale J, Middleton D, Vilches C, Carrington M, Witt C, Guethlein LA, Shilling H, Garcia CA, Hsu 18 KC, Wain H. Killer-cell Immunoglobulin-like Receptors (KIR) Nomenclature Report, 2002. Immunogenetics 2003;55:220-226. [35] Gomez-Lozano N, Vilches C. Genotyping of human killer cell immunoglobulin-like receptor genes by polymerase chain reaction with sequence-specific primers: an update. Tissue Antigens 2002;59:184–193. [36] Excoffier, L. G. Laval, and S. Schneider. Arlequin ver. 3.0: An integrated software package for population genetics data analysis. Evolutionary Bioinformatics Online 2005;1:47-50. [37] Guo S, Thomson E. Performing the exact test of Hardy Weinberg proportion for multiple alleles. Biometrics 1992;48:361. [38] Watterson GA. The homozygozity test of neutrality. Genetics 1978;88:40517. [39] Mattiuz PL, Ihde D, Piazza A, Ceppellini R, Bodmer WF. New approaches to the population genetic and segregation analysis of the HLA system. In: Terasaki PI (ed) Histocompatibility testing. Munksgaard, Kopenhagen. 1971. [40] Lewontin RC, Kojima K. The evolutionary dynamics of complex polymorphisms. Evolution 1960;14:458-472 [41] Lewontin RC. The interactions of selection and linkage. Genetics 1964;49:49–67. [42] Felsenstein J. PHYLIP—phylogeny inference package (version 3.2). Cladistics 1989;5:164–6. 19 [43] Gourraud PA, Gagne K, Bignon JD, Cambon-Thomsen A, Middleton D. Preliminary analysis of a KIR haplotype estimation algorithm: a simulation study. Tissue Antigens 2007;69 Suppl 1:96-100. [44] Middleton D, Menchaca L, Rood H, Komerofsky R. New Allele Frequency Database: http://www.allelefrequencies.net. Tissue Antigens 2003;61(5):403-407. [45] Becker S, Tonn T, Füssel T, Uhrberg M, Bogdanow M, Seifried E, Seidl C. Assessment of killer cell immunoglobulinlike receptor expression and corresponding HLA class I phenotypes demonstrates heterogenous KIR expression independent of anticipated HLA class I ligands. Human Immunology. 2003;64:183. [46] Crum KA, Logue SE, Curran MD, Middleton D. Development of a PCRSSOP approach capable of defining the natural killer cell inhibitory receptor (KIR) gene sequence repertoires. Tissue Antigens 2000;56:313. [47] Luszczek W, Majorczyk E, Nowak I, Pawlik A, Jasek M, Wiśniewski A, Kuśnierczyk P. Inhibitory and activatory KIR gene frequencies in the Polish population. Int J Immunogenet 2006;33(3):167-70. [48] Velickovic M, Velickovic immunoglobulin-like Z, receptor Dunckley genes in H. Diversity Pacific of Islands killer cell populations. Immunogenetics 2006;58(7):523-32. [49] Velickovic M, Velickovic Z, Panigoro R, Dunckley H. Diversity of killer cell immunoglobulin-like receptor genes in Indonesian populations of Java, Kalimantan, Timor and Irian Jaya. Tissue Antigens 2009;73(1):9-16. 20 [50] Flint J, Boyce AJ, Martison JJ, Clegg JB. Population bottlenecks in Polynesia revealed by minisatellites. Hum Genet 1989;83:257–263. [51] Middleton D, Meenagh A, Moscoso J, Arnaiz-Villena A. Killer immunoglobulin receptor gene and allele frequencies in Caucasoid, Oriental and Black populations from different continents. Tissue Antigens 2008;71(2):105-13. [52] Middleton D, Meenagh A, Serrano-Vela JI, Moscoso J, Arnaiz-Villena A. Different Evolution of Inhibitory and Activating Killer Immunoglobulin Receptors (KIR) in Worldwide Human Populations. Open Immunology Journal 2008; 1:42-50. 21 Table 1: Observed and estimated KIR gene frequencies for Macedonian population (N = 214). OF S.D. of OF EF Frequencies for Macedonian population Inhibitory KIR 2DL4 2DL5 3DL1 3DL2 3DL3 2DS1 1 0.416 0.939 1 1 0.481 Pseudogenes 2DP1 3DP1 0.98 0.995 2DL1 0.949 2DL2 0.589 2DL3 0.897 0.009 0.005 0.015 0.034 0.021 0 0.034 0.016 0 0 0.86 0.90 0.76 0.36 0.67 1 0.24 0.74 1 1 2DS2 0.565 Noninhibitory KIR 2DS3 2DS4 0.360 0.944 2DS5 0.304 3DS1 0.392 0.034 0.034 0.033 0.16 0.031 0.033 0.28 0.34 0.20 0.76 0.17 0.22 OF, observed frequency; S.D. of OF, standard deviation of observed frequency; EF, estimated frequency. 22 Table 2. LD analysis for KIR loci in Macedonian population. 2DS2 2DS2 2DL2 2DL3 2DP1 2DL1 3DP1 3DL1 3DS1 2DL5 Da D’ r2 P D D’ r2 P D D’ r2 P D D’ r2 P D D’ r2 P D D’ r2 P D D’ r2 P D D’ r2 P D D’ r2 P 2DL2 0.2278 0.9799 0.8725 <0.0001 2DL3 -0.0447 -1.0000 0.0881 <0.0001 -0.0423 -1.0000 0.0800 <0.0001 2DP1 -0.0447 -1.0000 0.0881 <0.0001 -0.0077 -1.0000 0.0133 0.0916 0.0168 1.0000 0.1662 <0.0001 2DL1 -0.0081 -1.0000 0.0146 0.0767 -0.0165 -0.7789 0.0230 0.0266 0.0134 0.2907 0.0400 0.0034 0.0131 0.7365 0.1906 <0.0001 3DP1 -0.0177 -0.7908 0.0260 0.0182 -0.0019 -1.0000 0.0033 0.4022 0.0042 1.0000 0.0410 0.0031 0.0046 1.0000 0.2465 <0.0001 -0.0002 -1.0000 0.0003 0.8155 3DL1 -0.0020 -1.0000 0.0036 0.3795 -0.0110 -0.4388 0.0087 0.1725 0.0031 0.0569 0.0018 0.5318 -0.0011 -1.0000 0.0012 0.6076 0.0156 0.3225 0.0871 <0.0001 -0.0003 -1.0000 0.0003 0.7988 23 3DS1 -0.0077 -0.2920 0.0042 0.3409 0.0399 0.2473 0.0276 0.0151 -0.0157 -0.2517 0.0112 0.1209 -0.0067 -0.5885 0.0102 0.1394 -0.0172 -0.5510 0.0255 0.0196 -0.0028 -1.0000 0.0073 0.2124 -0.0276 -0.7467 0.0558 0.0005 2DL5 0.0304 0.1782 0.0158 0.0662 0.0822 0.4808 0.1150 <0.0001 -0.0227 -0.3775 0.0229 0.0268 -0.0016 -0.1440 0.0006 0.7304 -0.0207 -0.6887 0.0361 0.0054 0.0019 1.0000 0.0033 0.3977 -0.0215 -0.6049 0.0332 0.0077 0.1311 0.5720 0.2969 <0.0001 2DS3 0.0779 0.4312 0.1017 <0.0001 0.1153 0.7789 0.2382 <0.0001 -0.0424 -0.6450 0.0848 <0.0001 0.0067 1.0000 0.0107 0.1301 0.0091 0.4947 0.0075 0.2066 0.0017 1.0000 0.0026 0.4524 -0.0109 -0.2791 0.0090 0.1661 0.0690 0.3159 0.0868 <0.0001 0.1074 0.5109 0.2060 <0.0001 2DS5 0.1190 0.7609 0.2501 <0.0001 0.0314 0.2517 0.0193 0.0421 -0.0108 -0.1513 0.0060 0.2566 -0.0037 -0.2819 0.0035 0.3889 -0.0171 -0.4777 0.0283 0.0138 0.0014 1.0000 0.0020 0.5079 -0.0330 -0.7790 0.0900 <0.0001 0.1284 0.6961 0.3271 <0.0001 0.1027 0.5786 0.2051 <0.0001 2DS1 0.0198 0.1504 0.0076 0.2027 0.0390 0.1973 0.0252 0.0202 -0.0113 -0.2113 0.0055 0.2774 -0.0003 -0.0360 0.0000 0.9398 -0.0173 -0.6495 0.0246 0.0217 0.0022 1.0000 0.0044 0.3344 -0.0315 -1.0000 0.0697 0.0001 0.1522 0.7475 0.3891 <0.0001 0.1223 0.5668 0.2465 <0.0001 2DS4 0.0316 0.1511 0.0163 0.0620 -0.0090 -0.3920 0.0064 0.2427 -0.0011 -0.1894 0.0002 0.8192 -0.0010 -1.0000 0.0011 0.6227 0.0158 0.3258 0.0968 <0.0001 -0.0003 -1.0000 0.0003 0.8070 0.0480 0.9113 0.7628 <0.0001 -0.0294 -0.8628 0.0684 0.0001 -0.0234 -0.7147 0.0426 0.0025 2DS3 2DS5 2DS1 aD, D D’ r2 P D D’ r2 P D D’ r2 P -0.0065 -0.0593 0.0009 0.6673 0.0605 0.3240 0.0636 0.0002 0.1482 0.9407 0.4160 <0.0001 -0.0079 -0.2190 0.0051 0.2977 -0.0297 -0.7606 0.0788 <0.0001 -0.0291 -1.0000 0.0640 0.0002 The classical linkage disequilibrium coefficient measuring deviation from random association between alleles at different loci [40]; D’, the linkage disequilibrium coefficient D standardized by the maximum value it can take (Dmax), given the allele frequencies [41]; r2, another way to standardise the simple measure of linkage disequilibrium [36]; P, statistical significance. 24 Table 3. Pairs of KIR loci that displayed significant (p<0.05) LD in Macedonian population. KIR locus Positive LD Negative LD 2DS2 2DL2, 2DS3, 2DS5, 3DP1 2DL3, 2DP1 2DL2 2DS2, 3DS1, 2DL2, 2DS3, 2DL3, 2DL1 2DS52DS1 2DL3 2DP1, 2DL1, 3DP1 2DS2, 2DL2, 2DL5, 2DS3 2DP1 2DL3, 2DP1, 3DP1 2DS2 2DL1 2DL3, 2DP1 2DL2 3DP1 2DL3, 2DP1 2DS2 3DL1 2DL1 3DS1, 2DL5, 2DS5, 2DS1, 2DS4 3DS1 2DL2, 2DS1 2DL5 2DL2, 3DS1, 2DS3, 2DS5, 2DL3, 2DL1, 3DL1, 2DS4 2DS1 2DS3 2DS2, 2DS1 2DL2, 3DS1, 2DL5, 2DS5 2DS2, 2DS1 2DL2, 2DS1, 2DL5, 2DS1 2DL2, 2DS1, 2DL5 2DL5, 2DS3, 2DS5, 2DL1, 3DL1, 2DS4 2DL3 2DL1, 3DL1, 2DS4 2DL1, 3DL1, 2DS4 25 Table 4. Diversity of investigated 33 populations for KIR genes locus by locus. Locus 2DL1 2DL2 2DL3 2DL4 2DL5 3DL1 3DL2 3DL3 2DS1 2DS2 2DS3 2DS4 2DS5 3DS1 All loci Gst 0.131 0.048 0.133 0.094 0.049 0.060 No diversity No diversity 0.046 0.037 0.027 0.123 0.037 0.047 0.067 Ht 0.273 0.422 0.410 0.120 0.440 0.349 No diversity No diversity 0.360 0.415 0.251 0.387 0.330 0.333 0.285 26 Hs 0.238 0.402 0.356 0.011 0.419 0.328 No diversity No diversity 0.343 0.399 0.244 0.339 0.318 0.331 0.317 Table 5. Investigated populations, number of individuals, heterozygousity, and standard genetic distances (SGD) between Macedonian population (present study) and different populations (www.allelefrequencies.net) using KIR gene frequencies (44). Population 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. France Guadeloupe Senegal Finland Reunion Macedonia Korea Japan Africa SouthAsia Basque Mestizo Huichol Purepecha Tarahumara Argentina Belgium BrazilSouthEastCaucasian EnglandWestMidlandsAfroCaribbean EnglandWestMidlandsCaucasian EnglandWestMidlandsIndianAsian IndiaNorthHindus IrelandNorthern Italy Lebanon MexicoVeraCruzMestizos PakistanKarachi SpainGranada SwedenVasterbotten HongKongChinese Oman RomaniaCaucasians SouthAfricaXhosa Number of individuals 108 118 90 102 101 214 154 41 62 108 71 86 73 103 75 102 100 55 54 126 35 72 100 217 120 51 78 100 150 100 99 123 50 27 Heterozygosity ± SE 0.270 ± 0.042 0.250 ± 0.050 0.179 ± 0.048 0.264 ± 0.048 0.307 ± 0.046 0.299 ± 0.045 0.193 ± 0.036 0.152 ± 0.035 0.249 ± 0.047 0.356 ± 0.048 0.302 ± 0.051 0.203 ± 0.046 0.222 ± 0.051 0.219 ± 0.055 0.216 ± 0.057 0.253 ± 0.040 0.250 ± 0.043 0.267 ± 0.049 0.260 ± 0.047 0.295 ± 0.045 0.323 ± 0.050 0.354 ± 0.053 0.270 ± 0.041 0.277 ± 0.044 0.282 ± 0.047 0.317 ± 0.051 0.374 ± 0.048 0.300 ± 0.047 0.297 ± 0.047 0.231 ± 0.037 0.275 ± 0.044 0.274 ± 0.048 0.232 ± 0.061 SGD (x 102) 0.14 1.05 1.93 1.11 0.80 Reference number This paper 2.12 2.76 1.19 1.68 0.98 1.96 2.48 3.42 4.04 0.45 0.44 3.52 1.03 0.15 0.39 2.73 0.08 0.20 0.34 0.43 2.51 0.00 0.25 1.17 0.38 2.48 4.33 Figure legends Figure 1: Killer cell immunoglobulin-like receptor (KIR) locus profiles observed (KIR genotypes) and the number of individuals displaying each profile. Figure 2: Neighbour-joining tree from genetic distances based on KIR gene frequencies in Macedonian population and 32 previously reported populations (). Grou p Genotype ID AA AB AB AB AB AB AB AB AB AB AB AB AB AB AB AB AB AB AB AB AB AB AB AB AB AB AB AB AB AB AB AB AB AB BB 1 2 3 4 5 6 7 8 9 10 11 13 14 15 16 18 19 23 28 33 62 63 200 202 205 233 260 268 319 336 new 370 new 371 new 372 new 373 new 69 3DL1 2DL1 2DL3 2DS4 2DL2 2DL5 3DS1 2DS1 2DS2 2DS3 28 2DS5 2DL4 3DL2 3DL3 2DP1 3DP1 Individuals % 46 11 4 27 8 8 6 2 5 1 6 6 3 9 1 2 1 1 1 1 3 2 1 3 1 5 2 1 2 1 3 1 1 2 2 21,50 5,14 1,87 12,62 3,74 3,74 2,80 0,93 2,34 0,47 2,80 2,80 1,40 4,21 0,47 0,93 0,47 0,47 0,47 0,47 1,40 0,93 0,47 1,40 0,47 2,34 0,93 0,47 0,93 0,47 1,40 0,47 0,47 0,93 0,93 BB BB BB BB BB BB BB BB BB BB BB BB BB BB BB BB BB BB BB BB BB 2 4 1 5 2 1 2 1 1 1 3 1 1 1 1 1 1 3 1 1 1 70 71 72 73 76 87 90 113 159 294 317 318 359 new 363 new 374 new 375 new 376 new 377 new 378 new 379 new 380 new Figure 1. 29 0,93 1,87 0,47 2,34 0,93 0,47 0,93 0,47 0,47 0,47 1,40 0,47 0,47 0,47 0,47 0,47 0,47 1,40 0,47 0,47 0,47 IndiaNorthHindus PakistanKarachi SouthAsians EnglandWestMidlandsIndianAsian BrazilSouthEastCaucasian RomaniaCaucasians MexicoVeraCruzMestizos Basque EnglandWestMidlandsCaucasian Reunion Macedonia SpainGranada IrelandNorthern Africans EnglandWestMidlandsAfroCaribbean Italy France Argentina Finland HongKongChinese Koreans Japanese Mestizo Huichol Purepecha Tarahumara SwedenVasterbotten Oman Lebanon BelgiumKIRPop Guadeloupe Senegal SouthAfricaXhosa 0.012 0.010 0.008 0.006 0.004 0.002 Figure 2. 30 0.000