SAA1 alleles as risk factors in reactive systemic AA amyloidosis.

SAA1 is the predominant isoform of acute phase human SAA deposited as AA amyloid fibrils in reactive systemic amyloidosis. It has recently been reported that in the Japanese population, in whom the SAA1 gamma allele occurs with a frequency of 37%, possession of, and especially, homozygosity for this allele is a significant risk factor for AA amyloidosis in adult patients with rheumatoid arthritis (RA). In contrast we report here that in a control sample of 95 healthy adult male Caucasians the SAA1 gamma allele occurs at the much lower frequency of 5.3% and that, among 41 patients with juvenile chronic arthritis (JCA) and AA amyloidosis, there was a highly significantly increased frequency of the SAA1 alpha allele (90.2%), and particularly homozygosity for this allele (80.5%), compared both to the healthy controls (75.8% and 57.9% respectively) and to 8 JCA cases without amyloid (56.3% and 12.5%). A similar trend with respect to frequency of the SAA1 alpha allele and homozygosity for it was observed among 26 adult Caucasian RA patients with AA amyloid and 26 such cases without amyloid, although it did not reach statistical significance. These results suggest that there is probably differential amyloidogenicity amongst the different SAA1 isoforms and indicate that homozygosity for SAA1 alpha and SAA1 gamma in the different populations is a significant risk factor for development of AA amyloidosis. In Caucasian patients with JCA, the presence of the homozygous SAA1 alpha genotype indicates high risk of amyloidosis and should encourage early and aggressive anti-inflammatory therapy to keep circulating SAA levels as low as possible.