■ AbstractThe use of DNA-based genetic typing has enabled the identification of type 1 diabetes mellitus (T1DM) susceptible and protective major histocompatibility complex (MHC) class II alleles and haplotypes. The application of this approach has also progressed to locate MHC class I alleles that contribute to the clinicopathology of T1DM. Recent studies have shown a widespread involvement of genes from the MHC class I gene region in the clinicopathology of T1DM. These genes are demonstrated to be involved in contributing to progression from the preclinical stage of the disease, which is characterized by the occurrence of islet-specific antibodies, to clinical disease and also to the occurrence of autoimmunity. They can either contribute directly to disease development or indirectly in concert with other susceptible MHC class II alleles or haplotypes via linkage disequilibrium. Class I alleles may also be negatively associated with T1DM. These findings are useful for the development of future strategies in designing tolerogenic approaches for the prevention or even reversal of T1DM. In this article, the latest evidence for the different kinds of participation of HLA class I genes in the etiology of T1DM is reviewed. A metaanalysis which included existing association studies was also carried out in order to re-assess the relevance of class I genes in diabetes development. The analysis of an enlarged heterogeneous sample confirmed the involvement of previously detected serotypes in the etiology of T1DM, such as A24, B8 and B18, and revealed hitherto unknown associations with B60 and B62. The analysis points out that much of the conflicting results of previous association studies originate from inadequate sample sizes and accentuate the value of future investigations of larger samples for identifying linkage in multigenic diseases.Keywords: type 1 diabetes · HLA class I · cross-study analysis · serotype association Introduction ype 1 diabetes mellitus (T1DM) is a multifactorial and multigenic autoimmune organ disease characterized by progressive T cell-mediated destruction of the pancreatic β-cells . The major determinants of this disease are genes of the human leucocyte antigen (HLA) region, which are highly polymorphic. In a multiplicative model, they account for between 20 and 53% of T1DM susceptibility markers [1]. Gene products of HLA class I genes function as antigen presenting molecules for CD8 + cytotoxic T lymphocytes (CTL) and determine the antigen specificity of the CTL-mediated immune response against pathogens and self-antigens. T cell reactions with islet-specific self-antigens may lead to clonal proliferation of autoreactive CTLs directed against pancreatic β-cells provoking destruction of these organ cells.Initial genetic analyses clearly rejected a dominant major locus. In contrast, a series of other genes, such as the coding sequences for TAP (transporters associated with antigen processing), LMP (large multifunc- Copyright © by the SBDR tional proteases) and TNF-α, the MIC-A (MHC class I chain-r...