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Genetics Linked to Lupus Complications

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  • multiracialbookclub
    [Distinctions] [http://www.uthouston.edu/distinctions/gfx/orgbar.gif]
    Message 1 of 1 , Jan 28, 2007





      Genetics Linked to

      Lupus Complications:

      Large multi-ethnic, multi-regional

      finds Hispanics at greater

      of having serious kidney damage

      Texas Hispanics with Systemic Lupus Erythematosus SLE) are
      more likely to develop serious complications of kidney-damage
      than other groups, researchers at The University of Texas
      Medical School at Houston and four other universities have found.

      Studies looked at the relative effects of genetic and socioeconomic
      factors on the course and outcome of lupus in Hispanics,
      African-Americans and Caucasians in Texas and Alabama.

      Lupus is ... an inflammatory disease in which the immune
      system fails to distinguish between its own cells and

      those it considers to be enemies or foreign invaders.

      The body turns on itself, strategically
      the skin, blood, joints and kidneys.

      In more severe forms of Lupus, like SLE, other
      organs and tissues also may be affected.

      John Reveille, M.D., leads research on effects of genetic and socioeconomic factors on the course and outcome of lupus.
      John Reveille, M.D., leads
      research on effects of genetic
      and socioeconomic factors on
      the course and outcome of Lupus.
      Photo by Ester Fant

      The project is the largest multi-ethnic,
      multi-regional and multi-institutional study of
      Lupus to include a sizeable Hispanic component.

      This is crucial to identifying distinct SLE
      characteristics that could then be related
      to a person's genetic make-up, believes
      project co-investigator John Reveille,
      M.D., professor and director of the Division
      of Rheumatology and Clinical Immunogenetics
      at the UT Medical School at Houston.

      "We wanted to do these prospective studies
      to look at women with lupus diagnosed
      within the last five years," Reveille said.

      Following patients over a nine-year period,
      researchers tracked death, damage, disability and
      disease activity, or the 4 D's, as Reveille calls them.

      Reveille was surprised by findings from the LUMINA
      (LUpus in MInority populations: NAture vs.
      Project, which showed that Hispanic women:

      • had a poorer prognosis overall,
      • were more likely to have kidney
        involvement and damage, and
      • showed a more rapid rate of kidney failure.

      "This bothered Dr. Alarcón and me a great deal," he said.

      Together, Reveille and co-investigator Graciela Alarcón, M.D.,
      professor of medicine at the University of Alabama at Birmingham
      (UAB) Schools of Medicine and Public Health, have studied Lupus
      for 15 years, trying to determine which is more important
      in diagnosis, nature (genetics) or nurture (lifestyle).

      "In the LUMINA study, we have recently included
      the University of Puerto Rico, where we enrolled
      71 Lupus patients, and launched a larger study,
      PROFILE, with UT-Houston, UAB, Johns Hopkins
      in Baltimore and Northwestern University in Chicago."

      When the PROFILE study began looking at larger numbers
      of Lupus patients – over 900 total – one issue still stood out.

      Hispanics, specifically Texas Hispanics, tended to
      develop renal-damage much faster than other groups.

      Even when correcting for socio-demographic factors like income,
      education and housing, and the known psychological factors
      associated with lupus, the numbers told the same story –
      suggesting that it might still be more nature than nurture.

      "We think that the AmerIndian genetic background of
      Texas Hispanics is contributing to the higher incidence
      of renal involvement and damage
      in this group," Reveille said.

      It's not necessarily being Hispanic that's the issue, he said.

      In fact, the majority of Lupus patients from Puerto Rico
      had very mild Lupus and little renal involvement.

      He believes the disparity between the two
      groups is due to their genetic ancestry.

      "Puerto Ricans are evenly made up of Spanish,
      African and a lesser amount of AmerIndian genes,"
      he said, "while Texas Hispanics in Houston have [a]
      largely [amount of] AmerIndian and Caucasian genes."

      Does this mean having AmerIndian
      ancestry makes the Lupus prognosis worse?

      "We're currently looking at this," Reveille said.
      "We already know certain genetic markers are
      tightly associated with lupus in different groups, but
      they don't tell us why Texas Hispanics with Lupus
      have a higher rate of kidney damage and failure."

      African-American women, who, previous studies have shown,
      have a higher rate of lupus overall, have been shown also
      in the LUMINA project to fare worse than Caucasians.

      Lupus is more frequent in non-Caucasians,
      is a major disease that affects primarily young women
      in their most productive years, and is potentially deadly.

      "We know this much about lupus, but its general
      impact in Hispanics isn't well understood because
      there's been virtually no data," Reveille said.

      Results of the studies were published in the December
      issue of Lupus, and in February, Reveille was invited
      to speak at the Hispanic National Caucus in Washington,
      D.C., where he presented findings based on both
      the PROFILE and LUMINA studies.

      "This is becoming an issue that affects us all when we look
      at the population trends in the United States and realize
      Hispanics will be the majority group in 20 years," he said.

      Both PROFILE and LUMINA are funded by
      grants totaling more than $3 million from
      the National Institute of Arthritis and
      Musculoskeletal and Skin Disorders.

      Caucasians, Hispanics and African-Americans
      with SLE for less than five years may contact
      Robert Sandoval, (713) 500-6870,

      for information about participation in the studies.

      The studies monitor the patients'
      Lupus but do not offer free treatment.

      —By Kimberly Malone, Ph.D., Public Affairs



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