Itial non-parametric linkage CP21 cost analysis for the chromosomes showing suggestive linkage. Allele frequencies for the Affymetrix HMA10K Array were estimated using 20 affected individuals from six families and MERLIN was used for multipoint NPL analysis. doi:10.1371/journal.pone.0056225.grs5186 has been associated with increased serum levels of highsensitivity C-reactive protein and inflammation, and the CC genotype is putatively correlated with hypertension [36,37] (Table S2). Out of six probands, five were homozygous AA, oneheterozygous AC, and none had the CC genotype, thus supporting a potential role 22948146 in inflammation for the A allele. However, no statistically significant difference in allele frequencies was detected for rs5186 between cases and controls in the acute cohort. NoGenetic Susceptibility to ErysipelasTable 3. Non-parametric genome-wide linkage analysis results with MERLIN.Chromosomal locus 3q22 3p24 3p22 9q34 10q25 11q24 21q22 22qMax NPLall 3.25 2.53 2.64 3.84 2.40 2.27 3.24 2.Genome-wide p-value 0.64 0.97 0.94 0.24 0.98 1.00 0.64 0.Marker(s) rs361239-rs1429759 rs1994987 rs2167176 rs578802-rs708616 rs1337987-rs959127 rs1940007-rs1940006 rs743337-rs717205 rs719925-rsPhysical locus (bp) 136701295?37656598 30456489 35383108 135453277?35564946 113538188?13611569 126754451?26754515 35265524?5310905 45758758?Max NPLall = maximum non-parametric linkage score when testing for allele sharing among affected individuals. doi:10.1371/journal.pone.0056225.tother variants that might explain linkage to 1662274 this region were found in AGTR1. We chose two AGTR1 promoter area SNPs (rs9862062 and rs718424) that showed association to erysipelas in Haploview analysis, and genotyped them in the family material and in the acute erysipelas cohort by direct sequencing. The reference Gallele of rs9862062 was suggestively associated in the combined family (probands and marry-ins) and acute erysipelas cohort (Fisher’s exact test, two-tailed p-value 0.006) and the reference Tallele of rs718424 showed suggestive association with a p-value of 0.017.DiscussionIndividual response to potentially fatal pathogens is modulated by both environmental and host genetic factors [8,9]. Streptococcal infections can vary from localized pharyngitis or erysipelas to potentially fatal necrotizing fasciitis and sepsis. We have used erysipelas/cellulitis, a localized infection of the skin and underlying subcutaneous tissues to identify 52 families with a possibly increased susceptibility to streptococcal infections. This is to our knowledge the largest systematically collected clinical material on familial segregation of recurrent erysipelas. We performed a linkage scan on the six most informative families segregating erysipelas and found evidence for suggestive linkage in seven chromosomal regions, with a maximum NPL score of 3.84 at 9q34. Further fine mapping of the four most significant ZK 36374 site regions in all of the collected families revealed significant linkage to the chromosome 9q34 region which is syntenic to mouse chromosome 2 (22 to 34 Mb), where a quantitative trait locus (QTL) for GAS susceptibility in mice has been identified [18]. In mouse, 37 candidate genes involved in immune response, cell signalling, cellular assembly and organization, and lipid metabolism were studied for quantitative expression levels pre- and postinfection in strains resistant and susceptible to severe GAS infection. Genes associated with early immune response and upregulated in susceptible strains and d.Itial non-parametric linkage analysis for the chromosomes showing suggestive linkage. Allele frequencies for the Affymetrix HMA10K Array were estimated using 20 affected individuals from six families and MERLIN was used for multipoint NPL analysis. doi:10.1371/journal.pone.0056225.grs5186 has been associated with increased serum levels of highsensitivity C-reactive protein and inflammation, and the CC genotype is putatively correlated with hypertension [36,37] (Table S2). Out of six probands, five were homozygous AA, oneheterozygous AC, and none had the CC genotype, thus supporting a potential role 22948146 in inflammation for the A allele. However, no statistically significant difference in allele frequencies was detected for rs5186 between cases and controls in the acute cohort. NoGenetic Susceptibility to ErysipelasTable 3. Non-parametric genome-wide linkage analysis results with MERLIN.Chromosomal locus 3q22 3p24 3p22 9q34 10q25 11q24 21q22 22qMax NPLall 3.25 2.53 2.64 3.84 2.40 2.27 3.24 2.Genome-wide p-value 0.64 0.97 0.94 0.24 0.98 1.00 0.64 0.Marker(s) rs361239-rs1429759 rs1994987 rs2167176 rs578802-rs708616 rs1337987-rs959127 rs1940007-rs1940006 rs743337-rs717205 rs719925-rsPhysical locus (bp) 136701295?37656598 30456489 35383108 135453277?35564946 113538188?13611569 126754451?26754515 35265524?5310905 45758758?Max NPLall = maximum non-parametric linkage score when testing for allele sharing among affected individuals. doi:10.1371/journal.pone.0056225.tother variants that might explain linkage to 1662274 this region were found in AGTR1. We chose two AGTR1 promoter area SNPs (rs9862062 and rs718424) that showed association to erysipelas in Haploview analysis, and genotyped them in the family material and in the acute erysipelas cohort by direct sequencing. The reference Gallele of rs9862062 was suggestively associated in the combined family (probands and marry-ins) and acute erysipelas cohort (Fisher’s exact test, two-tailed p-value 0.006) and the reference Tallele of rs718424 showed suggestive association with a p-value of 0.017.DiscussionIndividual response to potentially fatal pathogens is modulated by both environmental and host genetic factors [8,9]. Streptococcal infections can vary from localized pharyngitis or erysipelas to potentially fatal necrotizing fasciitis and sepsis. We have used erysipelas/cellulitis, a localized infection of the skin and underlying subcutaneous tissues to identify 52 families with a possibly increased susceptibility to streptococcal infections. This is to our knowledge the largest systematically collected clinical material on familial segregation of recurrent erysipelas. We performed a linkage scan on the six most informative families segregating erysipelas and found evidence for suggestive linkage in seven chromosomal regions, with a maximum NPL score of 3.84 at 9q34. Further fine mapping of the four most significant regions in all of the collected families revealed significant linkage to the chromosome 9q34 region which is syntenic to mouse chromosome 2 (22 to 34 Mb), where a quantitative trait locus (QTL) for GAS susceptibility in mice has been identified [18]. In mouse, 37 candidate genes involved in immune response, cell signalling, cellular assembly and organization, and lipid metabolism were studied for quantitative expression levels pre- and postinfection in strains resistant and susceptible to severe GAS infection. Genes associated with early immune response and upregulated in susceptible strains and d.