Systemic Inflammation but not Oxidative Stress Is Associated with Physical Performance in Moderate Chronic Obstructive Pulmonary Disease.

Chronic obstructive pulmonary disease (COPD) patients manifest muscle dysfunction and impaired muscle oxidative capacity, which result in reduced exercise capacity and poor health status. The aim of this study was to compare the physical performance, systemic inflammation, and oxidative stress of patients with moderate COPD, and to associate physical performance with inflammatory and oxidative stress plasma markers. Twenty CONTROL (n = 10) and moderate COPD (n = 10) patients participated in this study. Systematic inflammation and oxidative stress plasma markers, maximal aerobic capacity (VO2peak), and maximal isometric strength (MVIC) of the knee extensor (KE) muscles were measured. VO2peak was 31.3% greater in CONTROL compared to COPD (P = 0.006). The MVIC strength of the KE was 43.9% greater in CONTROL compared to COPD (P = 0.002). Tumor necrosis factor-alpha (TNF-α) was 79.6% greater in COPD compared to CONTROL (P < 0.001). Glutathione peroxidase activity (GPx) activity was 27.5% lesser in COPD compared to CONTROL (P = 0.05). TNF-α concentration was correlated with KE MVC strength (R = -0.48; P = 0.045) and VO2peak (R = -0.58; P = 0.01). Meanwhile, malondialdehyde (MDA) and GPx activity were not associated with KE strength or VO2peak (P = 0.74 and P = 0.14, respectively). COPD patients showed lesser muscle strength and aerobic capacity than healthy control individuals. Furthermore, patients with COPD showed greater systemic inflammation and lesser antioxidant capacity than healthy counterparts. A moderate association was evident between levels of systemic inflammation and physical performance variables.

Design and optimization methodology for different 3D processed materials (PLA, ABS and carbon fiber reinforced nylon PA12) subjected to static and dynamic loads.

This research presents a methodology for the design and optimization of 3D printed parts with material extrusion (MEX) technology with three different commercial materials: PLA, ABS and N + CF (PA12) subjected to tensile and fatigue stresses, which included three stages: pretreatment, design of experiments and sequential optimization by statistical modeling. In the pretreatment stage, mainly the printing control factors (inner layer and contour height, printing speed, extrusion temperature, nozzle, infill arrangement and printing orientation) were determined; then, factors to optimize tensile strength as a function of printing pattern (linear, 3D, hexagonal), infill percentage (33%, 66%, 100°) and printing orientation (+45°/-45°, 0°/90°) were evaluated. Fatigue analysis was performed as a function of impression orientation using 100% infill, linear impression pattern, 5 Hz and a load range between 90 and 50% UTS. Optimization of tensile strength resulted in parts that exceeded the UTS of their corresponding filament, leading to infinite life relative to fatigue tests. Results were presented for fatigue life prediction based on Weibull analysis, Basquins model and a multivariate response surface correlation analysis. The best fatigue behavior was related to the optimized tensile strength, the infill pattern applied to the printing orientation and the intrinsic properties of ABS (1 × 107cycles, stress up to 20 MPa). With respect to the other materials, a good fatigue behavior was highlighted at the number of cycles achieved 1 × 106 (stress up to 18 MPa) and 1 × 105 (stress up to 24 MPa) for N + CF and PLA, respectively. This study contributes to a better understanding of how printing parameters correlate with tensile and fatigue properties.

Changes in Blood Markers of Oxidative Stress, Inflammation and Cardiometabolic Patients with COPD after Eccentric and Concentric Cycling Training.

Chronic obstructive pulmonary disease (COPD) patients manifest muscle dysfunction and impaired muscle oxidative capacity, which result in reduced exercise capacity and poor health status. This study examined the effects of 12-week eccentric (ECC) and concentric (CONC) cycling training on plasma markers of cardiometabolic health, oxidative stress, and inflammation in COPD patients. A randomized trial in which moderate COPD was allocated to ECC (n = 10; 68.2 ± 10.0 year) or CONC (n = 10; 71.1 ± 10.3 year) training groups. Participants performed 12-week ECC or CONC training, 2-3 sessions per week, 10 to 30 min per session. Before and after training, peak oxygen consumption, maximal power output (VO2peak and POmax), and time-to-exhaustion (TTE) tests were performed. Plasma antioxidant and oxidative markers, insulin resistance, lipid profile, and systemic inflammation markers were measured before and after training at rest. VO2peak, POmax and TTE remained unchanged after ECC and CONC. CONC induced an increase in antioxidants (p = 0.01), while ECC decreased antioxidant (p = 0.02) markers measured at rest. CONC induced lesser increase in oxidative stress following TTE (p = 0.04), and a decrease in insulin resistance (p = 0.0006) compared to baseline. These results suggest that CONC training induced an increase in insulin sensitivity, antioxidant capacity at rest, and lesser exercise-induced oxidative stress in patients with moderate COPD.

Learning Conflicts for C-arm Kinematic Modeling using Artificial Intelligence.

During common surgical tasks related to orthopedic applications, it is necessary to carefully manipulate a mobile C-arm device to achieve the desired position. In this work, we propose the application of learning conflicts analysis to improve the performance of an artificial neural network to compute the inverse kinematics of a C-arm device. Using the forward kinematics equations of a C-arm device (and the respective patient table) a training set for machine learning was generated. However, as an inverse kinematics problem may have multiple solutions, it is likely that training a neural network using forward kinematics data may generate machine learning conflicts. In this sense, we show that it is possible to eliminate those C-arm positions that may represent a learning conflict for the neural network, and thus, improve the accuracy of the model. Finally, we randomly generated a suitable validation set to verify the performance of our proposed model with data different from those used for training.

Folic Acid Induces Intake-Related Changes in the Mammary Tissue Transcriptome of C57BL/6 Mice.

Folic acid (FA) intake has been associated with increased breast cancer risk in some studies. Although underlying mechanisms are unknown, epigenetic modifications that persistently alter transcription have been suggested. We tested the hypothesis that high FA (HFA) intake alters the adult mammary transcriptome in a manner consistent with increased potential for carcinogenesis, detectable beyond the period of intake. C57BL/6 mice were fed control FA (CFA) (1 mg/kg diet) or HFA (5 mg/kg diet) diets for 4 weeks, followed by AIN93M maintenance diet for 4 weeks. Plasma 5-methyltetrahydrofolate, p-aminobenzoylglutamate and unmetabolised FA concentrations were greater (1.62, 1.56, 5.80-fold, respectively) in HFA compared to CFA mice. RNA sequencing of the mammary transcriptome (~20 million reads) showed 222 transcripts (191 upregulated) differentially expressed between groups. Gene Set Enrichment showed upregulated genes significantly enriched in Epithelial Mesenchymal Transition, Myogenesis and Apical Junction and downregulated genes in E2F targets, MYC targets and G2M checkpoint. Cancer was the most altered Disease and Disorder pathway, with Metastasis, Mammary Tumour and Growth of Tumour the most upregulated pathways. ChIP-seq enrichment analysis showed that targets of histone methyltransferase EZH2 were enriched in HFA mice. This study demonstrates HFA intake during adulthood induces mammary transcriptome changes, consistent with greater tumorigenic potential.

Enteric parasitic infection disturbs bacterial structure in Mexican children with autoantibodies for type 1 diabetes and/or celiac disease.

BACKGROUND: Intestinal bacterial dysbiosis and increased gut permeability are associated with higher risk of developing type 1 diabetes (T1D) or celiac disease (CD). There is a lack of information on parasitism involved in gut disturbance of predisposed children. We evaluated the effect of enteropathogenic parasites (Cryptosporidium spp., Cyclospora spp. G. lamblia, and Blastocystis spp.) on the bacterial structure of feces from children with autoantibodies for T1D or CD. Participants included 37 children under 18 years of age, from whom stools were analyzed for enteric parasites by qPCR and 22/37 for bacterial profile by sequencing the V3-V4 region of the 16s rRNA gene. Dietary, clinical, and socioeconomic data was recorded. RESULTS: Pathogens parasitized 28/37 participants, Cryptosporidium spp. was the most prevalent (62.2%), followed by both Cyclospora cayetanensis and Blastocystis spp (37.8%). There were no dietary differences (p > 0.05) attributable to parasitism. Co-infected participants with Cryptosporidium and Cyclospora did not differ (p = 0.064) from non-infected participants in bacterial alpha phylogenetic diversity. The same parasites' co-infection was associated with a decreased abundance of the Ruminococaceae (p = 0.04) and Verrucomicrobioceae families, of the Akkermansia genus (p = 0.009). There was a lower Firmicutes/Bacteroidetes ratio (p = 0.02) in infected than in uninfected participants. CONCLUSIONS: Cryptosporidium and Cyclospora affected the bacterial structure at family and genus levels, decreasing the ratio between Firmicutes and Bacteroidetes in children with auto-antibodies for T1D or CD, which could increase the risk of illness onset.

Reversible and Selective CO2 to HCO2 - Electrocatalysis near the Thermodynamic Potential.

Reversible catalysis is a hallmark of energy-efficient chemical transformations, but can only be achieved if the changes in free energy of intermediate steps are minimized and the catalytic cycle is devoid of high transition-state barriers. Using these criteria, we demonstrate reversible CO2 /HCO2 - conversion catalyzed by [Pt(depe)2 ]2+ (depe=1,2-bis(diethylphosphino)ethane). Direct measurement of the free energies associated with each catalytic step correctly predicts a slight bias towards CO2 reduction. We demonstrate how the experimentally measured free energy of each step directly contributes to the <50 mV overpotential. We also find that for CO2 reduction, H2 evolution is negligible and the Faradaic efficiency for HCO2 - production is nearly quantitative. A free-energy analysis reveals H2 evolution is endergonic, providing a thermodynamic basis for highly selective CO2 reduction.

Kinetics, Thermodynamics, and Competitive Adsorption of Heavy Metals from Water Using Orange Biomass.

Adsorption of heavy metals on modified orange biomass has been studied. This biomass was treated with NaOH and CaCl2 to improve its adsorption properties. Kinetic and thermodynamic studies of the adsorption of Cd2+, Ni2+, Cu2+, and Zn2+ were performed at different operating conditions, including competitive adsorption studies with binary metallic mixtures. Results show that this adsorption process was endothermic where an ion exchange mechanism played a relevant role. Adsorbent effectiveness decreased in binary solutions, indicating a strong antagonistic adsorption behavior caused by counter-ions. This antagonistic adsorption was highly dependent on the counter-ion type and its concentration. Multicomponent adsorption of Cu2+ ions was not significantly affected by the presence of other metallic counter-ions, whereas the adsorption of Ni2+ could be totally suppressed by the other ions. The modeling of binary adsorption isotherms was successful using the modified Langmuir equation, which outperformed the Ideal Absorbed Solution Theory-Sips and modified Redlich-Peterson models.

Allele-Independent Turnover of Human Leukocyte Antigen (HLA) Class Ia Molecules.

Major histocompatibility complex class I (MHCI) glycoproteins present cytosolic peptides to CD8+ T cells and regulate NK cell activity. Their heavy chains (HC) are expressed from up to three MHC gene loci (human leukocyte antigen [HLA]-A, -B, and -C in humans), whose extensive polymorphism maps predominantly to the antigen-binding groove, diversifying the bound peptide repertoire. Codominant expression of MHCI alleles is thus functionally critical, but how it is regulated is not fully understood. Here, we have examined the effect of polymorphism on the turnover rates of MHCI molecules in cell lines with functional MHCI peptide loading pathways and in monocyte-derived dendritic cells (MoDCs). Proteins were labeled biosynthetically with heavy water (2H2O), folded MHCI molecules immunoprecipitated, and tryptic digests analysed by mass spectrometry. MHCI-derived peptides were assigned to specific alleles and isotypes, and turnover rates quantified by 2H incorporation, after correcting for cell growth. MHCI turnover half-lives ranged from undetectable to a few hours, depending on cell type, activation state, donor, and MHCI isotype. However, in all settings, the turnover half-lives of alleles of the same isotype were similar. Thus, MHCI protein turnover rates appear to be allele-independent in normal human cells. We propose that this is an important feature enabling the normal function and codominant expression of MHCI alleles.

Multiple active contours driven by particle swarm optimization for cardiac medical image segmentation.

This paper presents a novel image segmentation method based on multiple active contours driven by particle swarm optimization (MACPSO). The proposed method uses particle swarm optimization over a polar coordinate system to increase the energy-minimizing capability with respect to the traditional active contour model. In the first stage, to evaluate the robustness of the proposed method, a set of synthetic images containing objects with several concavities and Gaussian noise is presented. Subsequently, MACPSO is used to segment the human heart and the human left ventricle from datasets of sequential computed tomography and magnetic resonance images, respectively. Finally, to assess the performance of the medical image segmentations with respect to regions outlined by experts and by the graph cut method objectively and quantifiably, a set of distance and similarity metrics has been adopted. The experimental results demonstrate that MACPSO outperforms the traditional active contour model in terms of segmentation accuracy and stability.

Effects of insulin and oral anti-diabetic agents on glucose metabolism, vascular dysfunction and skeletal muscle inflammation in type 2 diabetic subjects.

BACKGROUND: To test potential differences between the actions of anti-diabetic medications, we examined the effects of oral hypoglycaemic agents versus glargine-apidra insulin therapy in T2DM. METHODS: T2DM subjects were randomized to either oral hypoglycaemic agents (pioglitazone, metformin and glipizide, n = 9) or insulin therapy (n = 12) for 6 months. Carotid intimal media thickness, vascular reactivity (flow-mediated vasodilatation; percent change in brachial artery basal diameter post-ischaemia) and sublingual nitrate were measured with ultrasonography. Euglycemic hyperinsulinemic (80 mU/m(2) ) clamp with [3]-3H-glucose and muscle biopsies were performed. RESULTS: Fasting plasma glucose (~257 to ~124 mg/dL, oral hypoglycaemic agents and ~256 to ~142 mg/dL, IT) and HbA(1c) (~10.3 to ~6.4%, OHA and ~10.7 to ~7.1%, IT) improved comparably. Endogenous glucose production (~2.1 to ~1.7 mg/kg/min, oral hypoglycaemic agents and ~2.3 to ~2.0 mg/kg/min, insulin therapy) and endogenous glucose production suppression by insulin (~0.4 to ~0.3 mg/kg min, oral hypoglycaemic agents and ~0.5 to ~0.7 mg/kg min, insulin therapy) were different. Total glucose disposal × 100 increased in the oral hypoglycaemic agents group (~5.2 to ~8.1; p = 0.03), but not in insulin therapy (~6.0 to ~5.4 mg/kg/min/µU/mL × 100). OHA reduced CIMT (~0.080 to ~0.068 cm; p < 0.05), whereas insulin therapy did not (~0.075 to ~0.072 cm). After sublingual nitrate, brachial artery basal diameter increased in the OHA group (~8.7 to ~18.2%), but not in insulin therapy (~11.2 to ~15.0%; p < 0.02). Except for plasma adiponectin (~7 to ~15, oral hypoglycaemic agents versus ~6 to ~10, IT), changes in inflammatory markers in the circulation and in muscle (IκBα, super-oxidase dismutase 2, monocyte-chemo-attractant protein 1, p-ERK and JNK) were equivalent. CONCLUSIONS: Oral hypoglycaemic agents and insulin therapy treated patients achieved adequate glycemic control and the effects on circulating and muscle inflammatory biomarkers were similar, but only oral hypoglycaemic agents improved insulin sensitivity, vascular function and carotid intimal media thickness. These findings in a small sample suggest that the use of oral hypoglycaemic agents provides additional benefits to patients with T2DM.

[Adolescents increase to more gestational weight and fat than adults according to BMI pre-gestational]. / Las adolescentes aumentan más peso y grasa gestacional que las adultas, según IMC pregestacional.

INTRODUCTION: The excessive gestational weight gain predisposes to overweight and obesity postpartum, this becomes a worldwide public health problem. OBJECTIVE: To analyze gestational weight pattern and body fat in adolescents and adult women, to identify the group that would have major weight and body fat gain. MATERIAL AND METHODS: A prospective cohort study done in 64 adolescent < or = 18 years and 48 adult women. Anthropometric evaluation was realized, at 20, 24, 28, 32, 36 and 38 gestational weeks with weight and body fat percentage. Patients signed letter informed consent. RESULTS: In adolescents weight and BMI were smaller (p < 0.001), and their gestational fat gain was bigger than in the adult women (5.31 vs. 4.12 kg; p < 0.001). Pre-gestational BMI (beta = 0.459, EE = 0.089, p = 0.001), and age group (beta = - 1.400, EE = 0.735, p = 0.060) were associated to fat percentage variability. The adolescents with low weight and BMI > or = 85th percentile showed a greater gain of weight in respect to which is classified as normal weight (18.0 and 15.5 vs. 12.0 kg; p = 0.018). 54.7% of the adolescents and 64.6% of adults did gain excessive weight, more than the recommended according pre-gestational BMI. CONCLUSIONS: Age and pregestational BMI conditioned the body fat change. More than half of the patients included exceeded the recommended weight gain. The overweight or excessive weight gain adolescents have increased risk of postpartum retention weight than adult women in the same conditions.

Population structure of Phthorimaea operculella (Lepidoptera: Gelechiidae) in the United States.

The potato tuberworm, Phthorimaea operculella Zeller, is one of the most damaging pests of potatoes worldwide. Although tuberworm was recorded in California as early as 1856, it was first reported in damaging numbers in Oregon and Washington in the early 2000s. The objective of this study was to provide baseline information on the population structure of potato tuberworm in the United States. Potato tuberworm adults were collected from potato fields in the major production regions in the United States. Amplified fragment length polymorphisms (AFLP) were used to determine the genetic population structure of potato tuberworm. We used 219 individuals and 335 polymorphic AFLP bands to infer the geographic population structure of potato tuberworm. Posterior probabilities calculated using the model-based clustering method implemented in STRUCTURE, and F(st) values calculated using AFLP-SURV confirmed the existence of two distinct populations in the United States (one mostly associated to the western United States and the other one mostly associated to the eastern United States). This study provides baseline data for the molecular characterization of potato tuberworm populations, which will aid in tracking the origin of future invasions within the United States.

Association of the human leucocyte antigen region with susceptibility to Parkinson's disease.

OBJECTIVE: The core pathology of Parkinson's disease (PD) is a loss of the dopaminergic neurons in the nigro-striatal pathway, but this is only part of a more widespread pathological process, the nature of which is unknown. Recent data suggest a possible role for inflammation in this disease process. The Human Leucocyte Antigen (HLA) region is one of the most important genetic susceptibility factors in many immune-mediated diseases but has not been extensively investigated in PD. METHODS: The authors typed the HLA class II loci HLA-DRB1 and -DQB1 in 528 patients with Parkinson's disease and 3430 controls from the UK. RESULTS: The authors observed an association of HLA-DRB1 with susceptibility to Parkinson's disease. In particular, HLA-DRB1*03 was more common in patients compared with controls. CONCLUSIONS: These data suggest a possible role of the HLA region in susceptibility to Parkinson's disease and as such are consistent with other evidence supporting the role of an inflammatory process in the cellular loss in Parkinson's disease, especially of the nigral dopaminergic neurons.

The kinetics of donor HLA class I-specific antibody absorption following a combined split liver and kidney transplant.

Hyperacute rejection of a transplanted liver is rare even when the recipient has circulating donor-specific alloantibodies (DSA). There is also evidence that a transplanted liver may provide immunological protection for other organs transplanted from the same donor. We monitored the kinetics of circulating DSA in a highly sensitized recipient of a combined split liver and kidney transplant and demonstrated a reduction in antibody titres immediately after liver perfusion. The absorption of DSA was not compromised by the smaller liver mass transplanted. DSA titres remained low at 3 months post-transplant, and the recipient did not experience antibody-mediated rejection.

Impaired regulation of the TNF-alpha converting enzyme/tissue inhibitor of metalloproteinase 3 proteolytic system in skeletal muscle of obese type 2 diabetic patients: a new mechanism of insulin resistance in humans.

AIMS/HYPOTHESIS: TNF-alpha levels are increased in obesity and type 2 diabetes. The regulation of TNF-alpha converting enzyme (TACE) and its inhibitor, tissue inhibitor of metalloproteinase 3 (TIMP3), in human type 2 diabetes is unknown. METHODS: We examined TACE/TIMP3 regulation: (1) in lean and obese normal glucose tolerant (NGT) individuals and in type 2 diabetes patients; (2) following 6 h of lipid/saline infusion in NGT individuals; and (3) in cultured human myotubes from lean NGT individuals incubated with palmitate. Insulin sensitivity was assessed by a euglycaemic clamp and TACE/TIMP3 was evaluated by confocal microscopy, RT-PCR, western blotting and an in vitro activity assay. Circulating TNF-alpha, TNF-alpha-receptor 1 (TNFR1), TNF-alpha-receptor 2 (TNFR2), IL-6 receptor (IL-6R), vascular cell adhesion molecule (VCAM) and intercellular adhesion molecule (ICAM) levels were evaluated. RESULTS: TIMP3 levels were reduced and TACE enzymatic activity was increased in type 2 diabetes skeletal muscle. TACE expression, and TACE, TNF-alpha, TNFR1 and IL-6R levels were increased in type 2 diabetes, and positively correlated with insulin resistance. A 6 h lipid infusion into NGT individuals decreased insulin-stimulated glucose metabolism by 25% with increased TACE, decreased expression of the gene encoding TIMP3 and increased IL-6R release. Palmitate induced a dramatic reduction of TIMP3 and increased the TACE/TIMP3 ratio in cultured myotubes. CONCLUSIONS/INTERPRETATION: TACE activity was increased in skeletal muscle of obese type 2 diabetes patients and in lipid-induced insulin resistance. We propose that dysregulation of membrane proteolysis by TACE/TIMP3 of TNF-alpha and IL-6R is an important factor for the development of skeletal muscle insulin resistance in obese type 2 diabetes patients by a novel autocrine/paracrine mechanism.

Predicting the immunogenicity of human leukocyte antigen class I alloantigens using structural epitope analysis determined by HLAMatchmaker.

BACKGROUND: Human leukocyte antigen (HLA) matching strategies for kidney transplantation assign equal weighting to mismatches at a particular locus and take no account of variation in immunogenicity according to recipient HLA type. We examined the ability of intra- and interlocus analysis of amino-acid polymorphisms at continuous (triplet) and discontinuous positions (eplet) defined by the HLAMatchmaker program to predict alloantigen immunogenicity. METHODS: Sera from highly sensitized patients were screened for HLA class-I alloantibodies and mismatched combinations were analyzed using HLAMatchmaker to determine the number of triplet or extended-triplet and eplet mismatches. RESULTS: Logistic regression analysis revealed a strong correlation between the number of triplet or extended-triplet and eplet mismatches and both the presence and magnitude of alloantibody to mismatched HLA-A and -B specificities. The additional structural information provided by eplet analysis gave increased discrimination of mismatched-HLA specificities for alloantigens with greatest sequence disparity but this did not further improve the ability of triplet analysis to predict alloantigen immunogenicity. High antibody levels were observed for several mismatched-HLA combinations with zero triplet or eplet mismatches indicating that self triplets or eplets expressed in different conformations do not always predict nonimmunogenic epitopes. CONCLUSION: Analysis of recipient HLA type and mismatched-HLA alloantigens using the HLAMatchmaker algorithm allows prediction of immunogenic donor HLA types.

PECAM-1 polymorphism affects monocyte adhesion to endothelial cells.

BACKGROUND: Platelet endothelial cell adhesion molecule-1 (PECAM-1/CD31) plays an important role in leukocyte-endothelial cell adhesion and transmigration. Single nucleotide polymorphisms of PECAM-1 encoding amino acid substitutions at positions 98 leucine/valine (L/V), 536 serine/asparagine (S/N), and 643 arginine/glycine (R/G) occur in strong genetic linkage resulting in two common haplotypes (LSR and VNG). These PECAM-1 polymorphisms are associated with graft-versus-host disease after hematopoietic stem cell transplantation and with cardiovascular disease, but whether they influence PECAM-1 function is unknown. METHODS: We examined the effect of homozygous and heterozygous expression of the PECAM-1 LSR and VNG genotypes on the adhesive interactions of peripheral blood monocytes and activated endothelial cell monolayers under shear stress in a flow-based cell adhesion assay. RESULTS: There was no difference in monocyte adhesion between the two homozygous genotypes of PECAM-1 but when monocytes expressed both alleles in heterozygous form, firm adhesion of monocytes to endothelial cells was markedly increased. PECAM-1 polymorphism expressed in homozygous or heterozygous form by endothelial cells did not influence monocyte adhesion. CONCLUSIONS: This is, to our knowledge, the first demonstration that PECAM-1 genotype can alter the level of monocyte binding to endothelial cells and a demonstration that heterozygous expression of a polymorphic protein may lead to altered function.

A second major histocompatibility complex susceptibility locus for multiple sclerosis.

OBJECTIVE: Variation in the major histocompatibility complex (MHC) on chromosome 6p21 is known to influence susceptibility to multiple sclerosis with the strongest effect originating from the HLA-DRB1 gene in the class II region. The possibility that other genes in the MHC independently influence susceptibility to multiple sclerosis has been suggested but remains unconfirmed. METHODS: Using a combination of microsatellite, single nucleotide polymorphism, and human leukocyte antigen (HLA) typing, we screened the MHC in trio families looking for evidence of residual association above and beyond that attributable to the established DRB1*1501 risk haplotype. We then refined this analysis by extending the genotyping of classical HLA loci into independent cases and control subjects. RESULTS: Screening confirmed the presence of residual association and suggested that this was maximal in the region of the HLA-C gene. Extending analysis of the classical loci confirmed that this residual association is partly due to allelic heterogeneity at the HLA-DRB1 locus, but also reflects an independent effect from the HLA-C gene. Specifically, the HLA-C*05 allele, or a variant in tight linkage disequilibrium with it, appears to exert a protective effect (p = 3.3 x 10(-5)). INTERPRETATION: Variation in the HLA-C gene influences susceptibility to multiple sclerosis independently of any effect attributable to the nearby HLA-DRB1 gene.