The island of Sardinia shows a unique high incidence of several autoimmune diseases with multifactorial inheritance, particularly type 1 diabetes and multiple sclerosis. The prior knowledge of the genetic structure of this population is fundamental to establish the optimal design for association studies in these diseases. Previous work suggested that the Sardinians are a relatively homogenous population, but some reports were contradictory and data were largely based on variants subject to selection. For an unbiased assessment of genetic structure, we studied a combination of neutral Y-chromosome variants, 21 biallelic and 8 short tandem repeats (STRs) in 930 Sardinian males. We found a high degree of interindividual variation but a homogenous distribution of the detected variability in samples from three separate regions of the island. One haplogroup, I-M26, is rare or absent outside Sardinia and is very common (0.37 frequency) throughout the island, consistent with a founder effect. A Bayesian full likelihood analysis (BATWING) indicated that the time from the most recent common ancestor (TMRCA) of I-M26, was 21.0 (16.0–25.5) thousand years ago (KYA) and that the population began to expand 14.0 (7.8–22.0) KYA. These results suggest a largely pre-Neolithic settlement of the island with little subsequent gene flow from outside populations. Consequently, Sardinia is an especially attractive venue for case-control genome wide association scans in common multifactorial diseases. Concomitantly, the high degree of interindividual variation in the current population facilitates fine mapping efforts to pinpoint the aetiologic polymorphisms.

According to Nelson's (1976) criteria, the MCST (MWCST) is a simplification of the Wisconsin Card Sorting Test (WCST). As the MCST is particularly suitable for children, the aim of this study was to establish the normative data presently lacking for that group. The MCST was administered to 1126 normal children aged 4 to 13 years. Scoring was based on all the classical parameters, according to existing criteria, plus two new ones that we propose ("categorizing efficiency" and "categorizing efficiency plus"). Strong correlation (or inverse correlation) with age is found for most parameters, including all criteria used for perseverative responses. This does not occur for "failure to maintain set," calculated according to the usual criteria. "Categorizing efficiency" and "categorizing efficiency plus" avoid the ceiling effect occurring at higher ages in the parameter categories. The MCST may be used in children 4 years of age and above. Most, but not all, of its parameters show regular improvement with age, demonstrating their validity. However, our data suggest that a participant's performance on the MCST may be based essentially on two parameters: categorizing efficiency (or categorizing efficiency plus), measuring the participant's ability to categorize, and perseverative errors (or percent perseverative errors), measuring his or her difficulty in shifting, both considered typical executive functions.

Type 1 diabetes (T1D) and multiple sclerosis (MS) are two autoimmune diseases which exhibit a considerably higher incidence in Sardinia compared with the surrounding southern European populations. Surprisingly, a 5-fold increased prevalence of T1D has also been observed in Sardinian MS patients. Susceptibility to both disorders is associated with common variants of the HLA-DRB1 and -DQB1 loci. In this study, we determined the relative contribution of genotype variation of these loci to the co-occurrence of the two disorders in Sardinia. We genotyped 1052 T1D patients and 1049 MS patients (31 of whom also had T1D) together with 1917 ethnically matched controls. On the basis of the absolute risks for T1D of the HLA-DRB1-DQB1 genotypes, we established that these loci would only contribute to a 2-fold increase in T1D prevalence in MS patients. From this evidence, we conclude that shared disease associations due to the HLA-DRB1-DQB1 loci provide only a partial explanation for the observed increased prevalence of T1D in Sardinian MS patients. The data suggest that variation at other non-HLA class II loci, and/or unknown environmental factors contribute significantly to the co-occurrence of these two traits.

Mutations of the forkhead/winged helix transcription factor FOXP3 gene on chromosome Xp11.23 cause a rare recessive monogenic disorder called IPEX (immune dysregulation, polyendocrinopathy, including type 1 diabetes, enteropathy, and X-linked syndrome). FOXP3 is necessary for the differentiation of a key immune suppressive subset of T-cells, the CD4؉CD25؉ regulatory T-cells. Previously, we reported a significant malefemale bias in the common, multifactorial form of type 1 diabetes in Sardinia and evidence of linkage of chromosome Xp11 to the disease. These findings indicate that FOXP3 is a prime functional and positional candidate locus for the common form of type 1 diabetes. In the present study, we initially scanned 82 kb of the FOXP3 region for common polymorphisms, including sequencing all of the coding and functionally relevant portions of the gene in 64 Sardinian individuals. Then the most informative polymorphisms in 418 type 1 diabetic families and in 268 male case and 326 male control subjects were sequentially genotyped and tested for disease association. There is no evidence that variants in the FOXP3 regions analyzed are associated with type 1 diabetes and account for the male-female bias observed in Sardinia. Our data indicate that allelic variation in or near the coding regions of the FOXP3 gene does not have a major role in the inherited susceptibility to the common form of type 1 diabetes. Diabetes 53: [1911][1912][1913][1914] 2004 I t is believed that most cases of type 1 diabetes result from an autoimmune, T-cell-dependent destruction of the insulin-producing pancreatic ␤-cells and subsequent irreversible insulin deficiency. Autoimmune diabetes is more commonly inherited as a common multifactorial trait but can also occur in two rare monogenic disorders, APECED (autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy) and IPEX, both of which are characterized by a severe autoimmune pathology of several organs and tissues. The FOXP3 gene and the mouse orthologue Foxp3 are members of a gene family that encode transcription factors possessing a winged helix or forkhead box ("fox") DNA-binding domain. It has been recently shown that Foxp3 represents a key regulator of the development and function of a subset of CD4 regulatory T-cells, which express the interleukin-2 receptor CD25, and are central in the regulation of both the adaptive and innate immune system (1-4). The elucidation of the molecular bases of these rare Mendelian disorders has provided insights into the etiology of autoimmunity in humans and in mice (2,3,5-9). It is possible that common DNA polymorphisms of FOXP3 also influence susceptibility to the common, multifactorial form of type 1 diabetes. This hypothesis was strengthened by the observation that in common type 1 diabetes in Sardinia there is a strong male bias in disease incidence, and evidence of linkage of disease to the same region of chromosome X that encodes FOXP3 (10,11) has been observed. Furthermore, we have excluded the involvement of a Y-chromosome gene as ...

Two alternative models have been proposed to explain the spread of agriculture in Europe during the Neolithic period. The demic diffusion model postulates the spreading of farmers from the Middle East along a Southeast to Northeast axis. Conversely, the cultural diffusion model assumes transmission of agricultural techniques without substantial movements of people. Support for the demic model derives largely from the observation of frequency gradients among some genetic variants, in particular haplogroups defined by single nucleotide polymorphisms (SNPs) in the Y-chromosome. A recent network analysis of the R-M269 Y chromosome lineage has purportedly corroborated Neolithic expansion from Anatolia, the site of diffusion of agriculture. However, the data are still controversial and the analyses so far performed are prone to a number of biases. In the present study we show that the addition of a single marker, DYSA7.2, dramatically changes the shape of the R-M269 network into a topology showing a clear Western-Eastern dichotomy not consistent with a radial diffusion of people from the Middle East. We have also assessed other Y-chromosome haplogroups proposed to be markers of the Neolithic diffusion of farmers and compared their intra-lineage variation—defined by short tandem repeats (STRs)—in Anatolia and in Sardinia, the only Western population where these lineages are present at appreciable frequencies and where there is substantial archaeological and genetic evidence of pre-Neolithic human occupation. The data indicate that Sardinia does not contain a subset of the variability present in Anatolia and that the shared variability between these populations is best explained by an earlier, pre-Neolithic dispersal of haplogroups from a common ancestral gene pool. Overall, these results are consistent with the cultural diffusion and do not support the demic model of agriculture diffusion.

There is still uncertainty concerning the joint action of the two established type 1 diabetes susceptibility loci, the HLA class II DQB1 and DRB1 genes (IDDM1) and the insulin gene (INS) promoter (IDDM2). Some previous studies reported independence, whereas others suggested heterogeneity in the relative effects of the genotypes at these disease loci. In this study, we have assessed the combined effects of the HLA-DQB1/DRB1 and INS genotypes in 944 type 1 diabetic patients and 1,023 control subjects, all from Sardinia. Genotype variation at INS significantly influenced disease susceptibility in all HLA genotype risk categories. However, there was a significant heterogeneity (P ‫؍‬ 2.4 ؋ 10

Background: The Mediterranean island of Sardinia has a strikingly high incidence of the autoimmune disorders Type 1 Diabetes (T1D) and Multiple Sclerosis (MS). Furthermore, the two diseases tend to be co-inherited in the same individuals and in the same families. These observations suggest that some unknown autoimmunity variant with relevant effect size could be fairly common in this founder population and could be detected using linkage analysis.

A male excess in Sardinian type 1 diabetic cases has previously been reported and was largely restricted to those patients carrying the HLA-DR3/nonDR4 genotype. In the present study, we have measured the maleto-female (M:F) ratio in a sample set of 542 newly collected, early-onset type 1 diabetic Sardinian patients. This data not only confirm the excess of male type 1 diabetic patients overall (M:F ratio ‫؍‬ 1.3, P ‫؍‬ 3.9 ؋ 10 ؊3 ) but also that the bias in male incidence is largely confined to patients with the DR3/nonDR4 genotype (M:F ratio ‫؍‬ 1.6, P ‫؍‬ 2.0 ؋ 10 ؊4 ). These sex effects could be due to a role for allelic variation of the Y chromosome in the susceptibility to type 1 diabetes, but to date this chromosome has not been evaluated in type 1 diabetes. We, therefore, established the frequencies of the various chromosome Y lineages and haplotypes in 325 Sardinian male patients, which included 180 cases with the DR3/nonDR4 genotype, and 366 Sardinian male control subjects. Our results do not support a significant involvement of the Y chromosome in DR3/nonDR4 type 1 diabetic cases nor in early-onset type 1 diabetes as a whole. Other explanations, such as X chromosomelinked inheritance, are thus required for the male bias in incidence in type 1 diabetes in Sardinia. Diabetes 51: [3573][3574][3575][3576] 2002