Impact of C4, C4A and C4B gene copy number variation in the susceptibility, phenotype and progression of systemic lupus erythematosus

Author(s)

Costa Pereira, Kaline Medeiros ^[1] ; Perazzio, Sandro ^[1] ; Faria, Atila Granado A. ^[1] ; Moreira, Eloisa Sa ^[2] ; Santos, Viviane C. ^[1] ; Grecco, Marcelle ^[1] ; da Silva, Neusa Pereira ^[1] ; Coelho Andrade, Luis Eduardo ^[1]

Affiliation

^[1] Univ Fed Sao Paulo, Disciplina Reumatol, Rua Botucatu 740, 3o Andar, BR-04023062 Sao Paulo, SP - Brazil

^[2] Univ Sao Paulo, Ctr Estudos Genoma Humano, Inst Biociencias, Dept Genet & Biol Evolut, Sao Paulo, SP - Brazil

• Document type: Journal article
• Source: ADVANCES IN RHEUMATOLOGY; v. 59, n. 1 AUG 6 2019.
• Web of Science Citations: 0

Abstract

Background Complement component 4 (C4) gene copy number (GCN) affects the susceptibility to systemic lupus erythematosus (SLE) in different populations, however the possible phenotype significance remains to be determined. This study aimed to associate C4A, C4B and total C4 GCN and SLE, focusing on the clinical phenotype and disease progression. Methods C4, C4A and C4B GCN were determined by real-time PCR in 427 SLE patients and 301 healthy controls, which underwent a detailed clinical evaluation according to a pre-established protocol. Results The risk of developing SLE was 2.62 times higher in subjects with low total C4 GCN (< 4 copies, OR = 2.62, CI = 1.77 to 3.87, p < 0.001) and 3.59 times higher in subjects with low C4A GCN (< 2 copies; OR = 3.59, CI = 2.15 to 5.99, p < 0.001) compared to those subjects with normal or high GCN of total C4 (>= 4) and C4A (>= 2), respectively. An increased risk was also observed regarding low C4B GCN, albeit to a lesser degree (OR = 1.46, CI = 1.03 to 2.08, p = 0.03). Furthermore, subjects with low C4A GCN had higher permanent disease damage as assessed by the Systemic Lupus International Collaborating Clinics - Damage Index (SLICC-DI; median = 1.5, 95% CI = 1.2-1.9) than patients with normal or high copy number of C4A (median = 1.0, 95% CI = 0.8-1.1; p = 0.004). There was a negative association between low C4A GCN and serositis (p = 0.02) as well as between low C4B GCN and arthritis (p = 0.02). Conclusions This study confirms the association between low C4 GCN and SLE susceptibility, and originally demonstrates an association between low C4A GCN and disease severity. (AU)