Rheumatoid Arthritis
Impact of interactions of cigarette smoking with NAT2 polymorphisms on rheumatoid arthritis risk in African Americans
Ted R. Mikuls,
Tricia LeVan, Karen A. Gould, Fang Yu, Geoffrey M. Thiele,
Kimberly K. Bynote,
Doyt Conn, Beth L. Jonas, Leigh F. Callahan, Edwin Smith, Richard Brasington,
Larry W. Moreland,
Richard Reynolds, Angelo Gaffo, S. Louis Bridges Jr.,
Corresponding Author
Ted R. Mikuls
University of Nebraska Medical Center and Omaha VA Medical Center, Omaha, Nebraska
Department of Medicine, University of Nebraska Medical Center, 986270 Nebraska Medical Center, Omaha, NE 68198-6270Search for more papers by this authorGeoffrey M. Thiele
University of Nebraska Medical Center and Omaha VA Medical Center, Omaha, Nebraska
Search for more papers by this authorKimberly K. Bynote
University of Nebraska Medical Center, Omaha
Search for more papers by this authorRichard Brasington
Washington University Medical Center, St. Louis, Missouri
Search for more papers by this authorLarry W. Moreland
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Search for more papers by this authorTed R. Mikuls,
Tricia LeVan, Karen A. Gould, Fang Yu, Geoffrey M. Thiele,
Kimberly K. Bynote,
Doyt Conn, Beth L. Jonas, Leigh F. Callahan, Edwin Smith, Richard Brasington,
Larry W. Moreland,
Richard Reynolds, Angelo Gaffo, S. Louis Bridges Jr.,
Corresponding Author
Ted R. Mikuls
University of Nebraska Medical Center and Omaha VA Medical Center, Omaha, Nebraska
Department of Medicine, University of Nebraska Medical Center, 986270 Nebraska Medical Center, Omaha, NE 68198-6270Search for more papers by this authorGeoffrey M. Thiele
University of Nebraska Medical Center and Omaha VA Medical Center, Omaha, Nebraska
Search for more papers by this authorKimberly K. Bynote
University of Nebraska Medical Center, Omaha
Search for more papers by this authorRichard Brasington
Washington University Medical Center, St. Louis, Missouri
Search for more papers by this authorLarry W. Moreland
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Search for more papers by this authorAbstract
Objective
To examine whether polymorphisms in genes coding for drug-metabolizing enzymes (DMEs) have an impact on rheumatoid arthritis (RA) risk due to cigarette smoking in African Americans.
Methods
Smoking status was evaluated in African American patients with RA compared with non-RA controls, with smoking exposure categorized as heavy smoker (≥10 pack-years) versus never smoker/<10 pack-years. Individuals were genotyped for a homozygous deletion polymorphism in the M1 gene loci of glutathione S-transferase (GSTM1-null) in addition to tagging single-nucleotide polymorphisms (SNPs) in N-acetyltransferase 1 (NAT1), NAT2, and epoxide hydrolase 1 (EPXH1). Associations of these genotypes with RA risk were examined using logistic regression, and gene–smoking interactions were assessed.
Results
There were no significant associations of any DME genotype with RA. After adjustment for multiple comparisons, there were significant additive interactions between heavy smoking and the NAT2 SNPs rs9987109 (Padditive = 0.000003) and rs1208 (Padditive = 0.00001); the attributable proportion due to interaction ranged from 0.61 to 0.67. None of the multiplicative gene–smoking interactions examined remained significant with regard to overall disease risk, after adjustment for multiple testing. There was no evidence of significant gene–smoking interactions in analyses of GSTM1-null, NAT1, or EPXH1. DME gene–smoking interactions were similar when cases were limited to those patients who were positive for anti–citrullinated protein antibodies.
Conclusion
Among African Americans, RA risk imposed by heavy smoking appears to be mediated in part by genetic variation in NAT2. While further studies are needed to elucidate the mechanisms underpinning these interactions, these SNPs appear to identify African American smokers at a much higher risk for RA, in whom the relative risk is at least 2-fold higher when compared to nonsmokers lacking these risk alleles.
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