IntroductionThe genetics of systemic lupus erythematosus (SLE) was last reviewed in depth in 1992.1.2 The premise that genetic factors are involved in SLE was originally based on the observations of an increased frequency of SLE in identical twins 3-6 and among first degree relatives 7-1 1 and an increased frequency of immune abnormalities in relatives of patients with SLE.12-31 However, no single gene defect has been discovered as the cause of SLE. In fact, based on mathematical models it has been postulated that at least four genes are implicated in the cause of SLE. 32 Subsequent to the discovery that a number of autoimmune diseases and immune abnormalities are influenced by genetic factors, it seemed logical to examine genes in patients with SLE. Resultant numerous studies examined the frequency of genes associated with classical components of the immune system (MHC, complement, T cell receptor (TCR) and immunoglobulins) in patients with SLE. This manuscript reviews the possible role of these and other genetic factors in SLE with particular emphasis on studies from different racial and ethnic groups in various countries.
The dataThe associations between SLE and various MHC loci and alleles in different countries is given in Table 1. The B8-DR3 haplotype is associated with SLE in Caucasians: in Australia, among English-Canadians, in Czechoslovakia, England, France, Germany, Hungary, Italy, Scandinavia and Switzerland. Both DR2 and DR3 (haplotypes) are associated with SLE in Bulgaria, Russia and the USA. SLE is also associated with DR2 in Greece, with DQ6 among French-Canadians, with DR4 among Indians, with the B 18-DR3 haplotype in Spain and with no DR in Italy. There was a stronger association with the B8/DR3 associated extended haplotype (Al-B8-C4AO-DR3-DQW2) than any of its alleles.33,34,54.69,70.73.112,115 SLE in Afro-Americans is associated with both DR2 and DR3 in the USA; with DR2 in Toronto and in South African coloured people; and with no DR in the USA and the French West Indies. It should be noted that SLE is not seen in West and Central Africa.213 SLE in the Orient is associated with DR2 and DR3 in China and with DR2 in Japan, Korea and Singapore. There was a stronger association with the extended DRB 1 * 1501 haplotype (DRB I -DRB5-DQA I -DQB I) than any of its alleles in Japan and Korea.SLE has also been associated with sharing of HLA haplotypes in the parents of SLE patients in the USA. 214 SLE in patients in Central Europe was not associated with homozygosity in class II MHC loci/haplotypes.'-' S SLE has also been associated with complement components deficiencies. Heterozygous deficiency of the complement component C4A has been noted frequently in SLE patients in Australia, among English-Canadians, in England, Germany and Scandinavia; and in some studies in patients with SLE in China, France, Japan and the USA. There is no increased frequency of C4A deficiency in SLE patients in Taiwan, Spain and in French-Canadians. Furthermore the frequency of SLE is at least 50% in patients with homozygou...