METHODS OF HUMAN LEUKOCYTE ANTIGEN TYPING
20170342479 · 2017-11-30
Inventors
Cpc classification
C12Q1/6881
CHEMISTRY; METALLURGY
International classification
Abstract
Described herein are methods, systems, and media for HLA typing an individual from nucleic acid or protein sequences. The methodology disclosed herein represents significant improvements over current methods of HLA typing.
Claims
1. A method of determining an individual's 4-digit human leukocyte antigen (HLA) allele composition, the method comprising: a) mapping at least one nucleic acid sequence read from the individual to known HLA allele reference sequences to identify a first set of HLA alleles that explain the at least one nucleic acid sequence read; and b) using a multiple sequence alignment (MSA) of known HLA allele reference sequences to identify one or more additional HLA allele reference sequences that match the at least one nucleic acid sequence read equally well as the first set of HLA alleles; wherein the individual's 4-digit HLA allele composition comprises the one or more additional HLA allele reference sequences that have the closest match to the at least one nucleic acid sequence read from the individual.
2. The method of claim 1, wherein nucleic acid sequence read is a DNA sequence read.
3. The method of claim 1, wherein the at least one nucleic acid sequence read is obtained by a next-generation sequencing technique.
4. The method of claim 1, wherein the at least one nucleic acid sequence read is less than 300 nucleotides.
5. The method of claim 1, wherein the at least one nucleic acid sequence read is a plurality of nucleic acid sequence reads.
6. The method of claim 1, wherein the multiple sequence alignment comprises all known HLA allele reference sequences.
7. The method of claim 1, wherein the multiple sequence alignment comprises all known HLA allele reference sequences available from IMGT/HLA database.
8. The method of claim 1, wherein the first set of HLA alleles comprise HLA alleles with at least 95% identity to the at least one nucleic acid sequence read from the individual.
9. The method of claim 1, wherein the one or more additional HLA allele reference sequences comprise HLA alleles with at least 95% identity to the at least one nucleic acid sequence read from the individual.
10. The method of claim 1, further comprising generating a solution set and a comparison set, wherein the solution set comprises the one or more additional HLA allele reference sequences that have the closest match to the at least one nucleic acid sequence read from the individual based upon core exons and the comparison set comprises HLA allele reference sequences that performed nearly as well those of the solution set.
11. The method of claim 10, wherein the core exons consist of exons 2 and 3 if the HLA allele reference sequence is a class I molecule.
12. The method of claim 10, wherein the core exons consist of exon 2 if the HLA allele reference sequence is a class II molecule.
13. The method of claim 10, further comprising comparing each of the HLA allele reference sequences of the solution set with one or more HLA allele reference sequences of the comparison set based upon all shared exons, wherein the solution set is updated with an HLA allele reference sequence from the comparison set if one or more of the HLA allele reference sequences from the comparison set better explains the nucleic acid sequence reads from the individual.
14. The method of claim 13, repeated more than once.
15. The method of claim 13, repeated until no HLA allele reference sequence from the solution set can be replaced by an HLA allele from the comparison set.
16. The method of claim 13, wherein only nucleic acid sequence reads mapped to an HLA reference sequence of the solution set or to an HLA reference sequence of the comparison set, but not to both, and not to any other HLA allele reference sequence in the solution set are used to evaluate whether the putative HLA allele should be replaced by the comparison allele.
17. The method of claim 16, repeated more than once.
18. The method of claim 16, repeated until no HLA allele reference sequence from the solution set can be replaced by an HLA allele from the comparison set.
19. The method of claim 18, further comprising checking zygosity, wherein checking zygosity determines whether an individual is heterozygous or homozygous for any one or more HLA alleles of the individual's 4-digit HLA allele composition.
20. The method of claim 19, wherein checking zygosity comprises counting the at least one nucleic acid sequence read that maps to each allele of a given HLA gene.
21. The method of claim 20, wherein the individual is determined to be homozygous if the amount of sequence reads is at least 2 times or more than the next most strongly correlated allele.
22. The method of any of claim 19, further comprising determining a full resolution HLA composition, wherein determining the full resolution HLA composition comprises extracting the at least one nucleic acid sequence read that unambiguously align to an individual's 4-digit HLA allele composition and aligning the at least one nucleic acid sequence read to all HLA allele reference sequences that are contained within the 4-digit HLA allele group.
23. The method of claim 1, wherein the individual's 4-digit HLA allele composition is the major histocompatibility complex (MHC) class I allele composition.
24. The method of claim 1, wherein the individual's 4-digit HLA allele composition is the major histocompatibility complex (MHC) class II allele composition.
25. The method of claim 1, wherein the individual's 4-digit HLA allele composition is the major histocompatibility class I and the major histocompatibility class II allele composition.
26. The method of claim 1, wherein the method is performed using a computer wherein the runtime is reduced by at least three-fold compared with a computer running the Optitype method.
27. The method of claim 1, wherein the individual suffers from an autoimmune disease.
28. The method of any of claim 1, wherein the individual is in need of an organ transplant.
29. A method of determining an individual's 4-digit human leukocyte antigen (HLA) allele composition, the method comprising: a) mapping at least one amino acid sequence translated from at least one nucleic acid sequence read from the individual to known HLA allele reference sequences to identify a first set of HLA alleles that explain the at least one amino acid sequence; and b) using a multiple sequence alignment (MSA) of known HLA allele reference sequences to identify one or more additional HLA allele reference sequences that match the at least one amino acid sequence equally well as the first set of HLA alleles; wherein the individual's 4-digit HLA allele composition comprises the one or more additional HLA allele reference sequences that have the closest match to the at least one amino acid translated from at least one nucleic acid sequence read from the individual.
30. The method of claim 29, wherein nucleic acid sequence read is a DNA sequence read.
31. The method of claim 29, wherein the at least one nucleic acid sequence read is by a next-generation sequencing technique.
32. The method of claim 29, wherein the at least one nucleic acid sequence read is less than 300 nucleotides.
33. The method of claim 29, wherein the at least one nucleic acid sequence read is a plurality of nucleic acid sequence reads.
34. The method of claim 29, wherein the multiple sequence alignment comprises all known HLA allele reference sequences.
35. The method of claim 29, wherein the multiple sequence alignment comprises all known HLA allele reference sequences available from IMGT/HLA database.
36. The method of claim 29, wherein the first set of HLA alleles comprise HLA alleles with at least 95% identity to the at least one amino acid sequence translated from at least one nucleic acid sequence read from the individual.
37. The method of claim 29, wherein the one or more additional HLA allele reference sequences comprise HLA alleles with at least 95% identity to the at least one amino acid sequence translated from at least one nucleic acid sequence read from the individual.
38. The method of claim 29, further comprising generating a solution set and a comparison set, wherein the solution set comprises the one or more additional HLA allele reference sequences that have the closest match to the at least at least one amino acid sequence based upon core exons and the comparison set comprises HLA allele reference sequences that performed nearly as well those of the solution set.
39. The method of claim 38, wherein the core exons consist of exons 2 and 3 if the HLA allele reference sequence is a class I molecule.
40. The method of claim 38, wherein the core exons consist of exon 2 if the HLA allele reference sequence is a class II molecule.
41. The method of claim 38, further comprising comparing each of the HLA allele reference sequences of the solution set with one or more HLA allele reference sequences of the comparison set based upon all shared exons, wherein the solution set is updated with an HLA allele reference sequence from the comparison set if one or more of the HLA allele reference sequences from the comparison set better explain the sequence data from the individual.
42. The method of claim 41, repeated more than once.
43. The method of claim 41, repeated until no HLA allele reference sequence from the solution set can be replaced by an HLA allele from the comparison set.
44. The method of claim 41, wherein only amino acid sequences mapped to an HLA reference sequence of the solution set or to an HLA reference sequence of the comparison set, but not to both, and not to any other HLA allele reference sequence in the solution set are used to evaluate whether the putative HLA allele should be replaced by the comparison allele.
45. The method of claim 44, repeated more than once.
46. The method of claim 44, repeated until no HLA allele reference sequence from the solution set can be replaced by an HLA allele from the comparison set.
47. The method of claim 41, further comprising checking zygosity, wherein checking zygosity determines whether an individual is heterozygous or homozygous for any one or more HLA alleles of the individual's 4-digit HLA allele composition.
48. The method of claim 47, wherein checking zygosity comprises counting the amino acid sequences that map to each allele of a given HLA gene.
49. The method of claim 47, wherein the individual is determined to be homozygous if the amount of amino acid sequences is at least 2 times or more than the next most strongly correlated allele.
50. The method of claim 47, further comprising determining a full resolution HLA composition, wherein determining the full resolution HLA composition comprises extracting the at least one amino acid sequence read that unambiguously align to an individual's 4-digit HLA allele composition and aligning the at least one amino acid sequence read all HLA allele reference sequences that are contained within the 4-digit HLA allele group.
51. The method of claim 29, wherein the individual's 4-digit HLA allele composition is the major histocompatibility complex (MEW) class I allele composition.
52. The method of claim 29, wherein the individual's 4-digit HLA allele composition is the major histocompatibility complex (MEW) class II allele composition.
53. The method of claim 29, wherein the individual's 4-digit HLA allele composition is the major histocompatibility class I and the major histocompatibility class II allele composition.
54. The method of claim 29, wherein the method is performed using a computer wherein the runtime is reduced by at least three-fold compared with a computer running the Optitype method.
55. The method of claim 29, wherein the individual suffers from an autoimmune disease.
56. The method of claim 29, wherein the individual is in need of an organ transplant.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
[0021] A better understanding of the features and advantages of the subject matter described herein will be obtained by reference to the following detailed description that sets forth illustrative embodiments and the accompanying drawings of which:
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DETAILED DESCRIPTION OF THE INVENTION
[0035] Unless otherwise defined, all technical terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. As used in this specification and the appended claims, the singular forms “a,” “an,” and “the” include plural references unless the context clearly dictates otherwise. Any reference to “or” herein is intended to encompass “and/or” unless otherwise stated.
[0036] As used herein “reference genome” refers to any standard publicly available reference genome, for example GRCh38, the Genome Reference Consortium human genome (build 38). Alternatively, the reference genome can be one that is constructed de novo from sequencing a plurality of genomes. In certain embodiments, the plurality of genomes is greater than 10,000 different genomes. In certain embodiments, the plurality of genomes is greater than 100,000 different genomes.
[0037] The methods, systems and media of this disclosure represent a substantial improvement on current HLA typing methods. The method described herein uses nucleic acid sequence reads generated from an individual's genome. In certain embodiments, the nucleic acid sequence is DNA. The nucleic acid sequence reads can be generated using any nucleic acid sequencing technology, but the full power of the method is realized using short reads generated using next-generation sequencing technologies. The technology can be any next generation technology that generates short reads such as pyrosequencing, sequencing by synthesis, sequencing by ligation, ion semiconductor sequencing, and/or sequencing arrays. The method is also compatible with older sequencing technologies such as Sanger sequencing. The reads can be paired-end reads. The average length of a nucleic acid sequence read can be less than 500, 400, 300, 200, 150, 100, 75, 50, 40, 35, 32 or 30 base pairs. Any number of reads can be used, in some cases a plurality of reads are used. In some cases, 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 500, 1,000, 2,000 or more reads are used, including increments therein.
[0038] The nucleic acid reads can be derived from DNA or RNA, isolated from a biological sample such as blood, plasma, serum, biopsy, saliva, urine or semen. The nucleic acid reads can also be cDNA reverse transcribed from the nucleic acids isolated from abiological sample. In a certain aspect, the nucleic acid can be a circulating cell free DNA or RNA. In certain instances, the DNA analyzed is nuclear genomic DNA and not mitochondrial DNA. Nucleic acid sequences from an individual can be obtained by a third-party sequencing provider or a previously determined sequence that an individual may transmit to a facility or individual performing the method herein. The individual can be a patient that is receiving a transplant or is on a transplant list, or is a prospective organ donor. In a certain embodiment, the sequencing methods used herein can be useful for prognosing or diagnosing an autoimmune disease.
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[0040] The alignment matrix generated by step 700 can be analyzed to find the individual's 4-digit HLA composition 701 by determining the top two alleles for each gene that are explained by the expanded HLA allele set 706. In a certain, embodiment, the top two alleles are based on a ranking or a probability metric. This step may be performed by using core exons and the integer linear programming method. This can be done using an alignment matrix as depicted in
[0041]
[0042] Step 701 can be further improved by iteratively updating alleles from the expanded allele set that best explain the reads 708. In some embodiments, the iterative updating considers all pairwise shared exons 707. In some embodiments, the iterative updating is first performed using core exons. Then, if desired, the iterative process can be repeated using shared exons in addition to core exons.
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[0045] Since the HLA locus is on an autosome, an individual possess two copies of each HLA gene. The individual can be either homozygous or heterozygous at a given HLA gene.
[0046] In addition to determining an individual's 4-digit HLA type, the methods of this disclosure allow the determination of a full resolution HLA type. A full resolution HLA type is the individuals HLA composition signified by each allele being identified to all four field codes as represented in
[0047]
Digital Processing Device
[0048] The systems, media, and methods described herein may include a digital processing device, or use of the same. The digital processing device includes one or more hardware central processing units (CPUs) or general purpose graphics processing units (GPGPUs) that carry out the device's functions. The digital processing device further comprises an operating system configured to perform executable instructions. The digital processing device may be reversibly connected a computer network. In various embodiments, the digital processing device is optionally and reversibly connected to: the Internet such that it accesses the World Wide Web, a cloud computing infrastructure, an intranet, and/or a data storage device.
[0049] In accordance with the description herein, suitable digital processing devices include, by way of non-limiting examples, server computers, desktop computers, laptop computers, notebook computers, sub-notebook computers, netbook computers, netpad computers, handheld computers, Internet appliances, mobile smartphones, and tablet computers. Those of skill in the art will recognize that many smartphones are suitable for use in the system described herein. Suitable tablet computers include those with booklet, slate, and convertible configurations, known to those of skill in the art.
[0050] The digital processing device includes an operating system configured to perform executable instructions. The operating system is, for example, software, including programs and data, which manages the device's hardware and provides services for execution of applications. Those of skill in the art will recognize that suitable server operating systems include, by way of non-limiting examples, FreeBSD, OpenBSD, NetBSD®, Linux, Apple® Mac OS X Server®, Oracle® Solaris®, Windows Server®, and Novell® NetWare®. Those of skill in the art will recognize that suitable personal computer operating systems include, by way of non-limiting examples, Microsoft® Windows®, Apple® Mac OS X®, UNIX®, and UNIX-like operating systems such as GNU/Linux®. In some embodiments, the operating system is provided by cloud computing. Those of skill in the art will also recognize that suitable mobile smart phone operating systems include, by way of non-examples, Nokia® Symbian® OS, Apple® iOS®, Research In Motion® BlackBerry OS®, Google® Android®, Microsoft® Windows Phone® OS, Microsoft® Windows Mobile® OS, Linux®, and Palm® WebOS®.
[0051] The digital processing device includes a storage and/or memory device. The storage and/or memory device is one or more physical apparatuses used to store data or programs on a temporary or permanent basis. In some embodiments, the device is volatile memory and requires power to maintain stored information. In some cases, the memory device is non-volatile memory and retains stored information when the digital processing device is not powered. In various embodiments, the non-volatile memory comprises: flash memory, dynamic random-access memory (DRAM), ferroelectric random access memory (FRAM), and/or phase-change random access memory (PRAM). In other cases, the memory device is a storage device including, by way of non-limiting examples, CD-ROMs, DVDs, flash memory devices, magnetic disk drives, magnetic tapes drives, optical disk drives, and cloud computing based storage. The storage and/or memory device may be a combination of memory devices such as those disclosed herein.
[0052] The digital processing device optionally includes a display to send visual information to a user. Many types of display are suitable including, by way of examples, liquid crystal displays (LCD), thin film transistor liquid crystal displays (TFT-LCD), organic light emitting diode (OLED) displays (including passive-matrix OLED (PMOLED) and/or active-matrix OLED (AMOLED) displays), and plasma displays. In some cases, the display is a touchscreen or multi-touchscreen display. Other suitable displays include video projectors and head-mounted displays in communication with the digital processing device, such as a VR headset. Suitable VR headsets include, by way of non-limiting examples, HTC Vive, Oculus Rift, Samsung Gear VR, Microsoft HoloLens, Razer OSVR, FOVE VR, Zeiss VR One, Avegant Glyph, Freefly VR headset, and the like. The display may be one or more displays and include a combination of devices such as those disclosed herein.
[0053] The digital processing device optionally includes an input device to receive information from a user. In various embodiments, the input device is: a keyboard, a pointing device including, by way of non-limiting examples, a mouse, trackball, track pad, joystick, game controller, or stylus, a touch screen or a multi-touch screen, a microphone to capture voice or other sound input, and/or a video camera or other sensor to capture motion or visual input. In a particular embodiment, the input device is a Kinect, Leap Motion, or the like. The input device may a combination of devices such as those disclosed herein.
[0054] Referring to
[0055] Continuing to refer to
[0056] Continuing to refer to
[0057] Continuing to refer to
[0058] Methods as described herein can be implemented by way of machine (e.g., computer processor) executable code stored on an electronic storage location of the digital processing device 1301, such as, for example, on the memory 1310 or electronic storage unit 1315. The machine executable or machine-readable code can be provided in the form of software. During use, the code can be executed by the processor 1305. In some cases, the code can be retrieved from the storage unit 1315 and stored on the memory 1310 for ready access by the processor 1305. In some situations, the electronic storage unit 1315 can be precluded, and machine-executable instructions are stored on memory 1310.
[0059] Reports can be delivered from for example a sequencing lab to a health care provider or consumer over the network 1330, or alternatively through the mail or a secure download site such as an FTP site.
Short Read Sequence Alignement Methods and Software
[0060] Any suitable alignment method or software can be used to align short reads described in this disclosre including any one or more of BarraCUDA, BBMap, BFAST, BigBWA, BLASTN, BLAT, Bowtie, HIVE-hexagon, BWA, BWA-PSSM, CASHX, Cloudburst, CUDA-EC, CUSHAW, CUSHAW2, CUSHAW2-GPU, CUSHAW3, drFAST, ELAND, ERNE, GASSST, GEM, Genalice MAP, Geneious Assembler, GensearchNGS, GMAP and GSNAP, GNUMAP, ISAAC, LAST, MAQ, mrFAST, mrsFAST, MOM, MOSAIK, MPscan, Novoalign & NovoalignCS, NextGENe, NextGenMap, Omixon Variant Toolkit, PALMapper, Partek Flow, PASS, PerM, PRIMEX, QPalma, RazerS, REAL, cREAL, RMAP, rNA, RTG Investigator, Segemehl, SeqMap, Shrec, SHRiMP, SLIDER, SOAP, SOAP2, SOAP3, SOAP3-dp, SOCS, SparkBWA, SSAHA, SSAHA2, Stampy, SToRM, Subread, Subjunc, Taipan, UGENE, VelociMapper, XpressAlign, or ZOOM.
Non-Transitory Computer Readable Storage Medium
[0061] The systems, media, and methods disclosed herein may include one or more non-transitory computer readable storage media encoded with a program including instructions executable by the operating system of an optionally networked digital processing device. The computer readable storage medium may be a tangible component of the digital processing device, which may be optionally removable from the digital processing device. Many types of media are suitable to store the instructions. In various embodiments, suitable computer readable storage medium include, by way of non-limiting examples, CD-ROMs, DVDs, flash memory devices, solid state memory, magnetic disk drives, magnetic tape drives, optical disk drives, cloud computing systems and services, and the like. In some cases, the program and instructions are permanently, substantially permanently, semi-permanently, or non-transitorily encoded on the media.
Computer Program
[0062] The systems, media, and methods disclosed herein may include one or more computer programs, or use of the same. A computer program includes a sequence of instructions, executable in the digital processing device's CPU, written to perform a specified task. Computer readable instructions may be implemented as program modules, such as functions, objects, Application Programming Interfaces (APIs), data structures, and the like, that perform particular tasks or implement particular abstract data types. In light of the disclosure provided herein, those of skill in the art will recognize that a computer program may be written in various versions of various languages.
[0063] The functionality of the computer readable instructions may be combined or distributed as desired in various environments. In some cases, a computer program comprises one sequence of instructions. In other cases, a computer program comprises a plurality of sequences of instructions. In some cases, a computer program is provided from one location. In other cases, a computer program is provided from a plurality of locations. In various embodiments, a computer program includes, in part or in whole, one or more software modules, one or more web applications, one or more mobile applications, one or more standalone applications, one or more web browser plug-ins, extensions, add-ins, or add-ons, or combinations thereof.
Standalone Application
[0064] A computer program may comprise a standalone application, which is a program that is run as an independent computer process, not an add-on to an existing process, e.g., not a plug-in. Those of skill in the art will recognize that standalone applications are often compiled. A compiler is a computer program(s) that transforms source code written in a programming language into binary object code such as assembly language or machine code. Suitable compiled programming languages include, by way of non-limiting examples, C, C++, Objective-C, COBOL, Delphi, Eiffel, Java™ Lisp, Python™, Visual Basic, and VB.NET, or combinations thereof. Compilation is often performed, at least in part, to create an executable program. In some cases, a computer program includes one or more executable complied applications.
Software Modules
[0065] The systems, media, and methods disclosed herein may include one or more software, server, and/or database modules, or use of the same. In view of the disclosure provided herein, software modules are created by techniques known to those of skill in the art using machines, software, and languages known to the art. The software modules disclosed herein are implemented in a multitude of ways. In various embodiments, a software module comprises a file, a section of code, a programming object, a programming structure, or combinations thereof. In further various embodiments, a software module comprises a plurality of files, a plurality of sections of code, a plurality of programming objects, a plurality of programming structures, or combinations thereof. In various embodiments, the one or more software modules comprise, by way of non-limiting examples, a web application, a mobile application, and a standalone application. In some embodiments, software modules are in one computer program or application. In other embodiments, software modules are in more than one computer program or application. In some embodiments, software modules are hosted on one machine. In other embodiments, software modules are hosted on more than one machine. In further embodiments, software modules are hosted on cloud computing platforms. In some embodiments, software modules are hosted on one or more machines in one location. In other embodiments, software modules are hosted on one or more machines in more than one location.
Databases
[0066] The systems, media, and methods disclosed herein may include one or more databases, or use of the same. In view of the disclosure provided herein, those of skill in the art will recognize that many databases are suitable for storage and retrieval of nucleic acid and amino acid sequences including HLA allele reference sequences. In various embodiments, suitable databases include, by way of non-limiting examples, relational databases, non-relational databases, object oriented databases, object databases, entity-relationship model databases, associative databases, and XML databases. Further non-limiting examples include SQL, PostgreSQL, MySQL, Oracle, DB2, and Sybase. In some embodiments, a database is internet-based. In further embodiments, a database is web-based. In still further embodiments, a database is cloud computing-based. In other embodiments, a database is based on one or more local computer storage devices.
Examples
[0067] The following illustrative examples are representative of embodiments of the software applications, systems, and methods described herein and are not meant to be limiting in any way.
Example 1—HLA Typing of Prospective Organ Transplant Recipient
[0068] In this example a patient who is diagnosed with end-stage renal disease will have their 4-digit HLA type determined so that he can be matched with a prospective donor. The patient provides a blood sample sent to a CLIA compliant facility from which DNA is extracted and sequenced using a next-generation sequencing technology such as the MiSeg™ or HiSeg™ system available from Illumina, Inc. The sequencing results will be analyzed at the facility using the methods of this discloser and the 4-digit-HLA type is transmitted to a health care service provider. At the same time an individual who may be a prospective donor, in this case a sibling of the patient, will have their 4-digit HLA type determined in the same way. Alternatively, the raw sequencing data can be transmitted to the health care provider for analysis and HLA determination.
Example 2—HLA Typing to Determine Type 1 Diabetes Risk
[0069] In this example a healthy-individual is tested to determine a risk of developing Type 1 diabetes. The individual provides a saliva sample sent to a CLIA compliant facility from which DNA is extracted and sequenced using a next-generation sequencing technology such as the MiSeg™ or HiSeg™ system available from Illumina, Inc. The sequencing results will be analyzed at the facility using the methods of this discloser and the 4-digit-HLA type is transmitted to a health care service provider. If the individual's HLA haplotype is a haplotype that is particularly associated with a high risk for developing type I diabetes (e.g., DRB1*03:01-DQA1*05:01-DQB1*02:01 or DRB1*04:01/02/04/05/08-DQA1*03:01-DQB1*03:02/04) then the individual will be monitored more closely in the future for early stage type I diabetes.
[0070] While preferred embodiments of the present invention have been shown and described herein, it will be obvious to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions will now occur to those skilled in the art without departing from the invention. It should be understood that various alternatives to the embodiments of the invention described herein may be employed in practicing the invention.