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Abstract
Background: Recent evidence suggests that the alpha1-antitrypsin [AT] gene may play a role in the pathogenesis of the fibromyalgia syndrome [FMS]. The objective of the present study is to compare the AT gene frequency between FMS patients and the general population [GP] from the central region of the Asturias Province in Northern Spain.
Method: The AT proteinase inhibitor phenotypes were characterized by isoelectric focusing on serum from a cohort of 250 individual FMS subjects, who fulfilled the American College of Rheumatology criteria for FMS, and on serum from a control cohort of 1,111 GP subjects. The FMS subjects [238 females and 12 males] were enlisted from an outpatient hospital clinic setting. The mean age of the FMS cohort was of 49.02 years. The GP control cohort [45 percent males and 55 percent females] was enrolled using an epidemiological technique of simple random sampling in the general population from the same region of Asturias. The GP sample size was 1,111, the mean age was of 46.2 years. Mean outcome measures were AT-PI phenotyping characterization [performed by isoelectric focusing] and AT serum concentration [measured by nephelometry].
Results: Calculated mean allele frequencies for PI*S and PI*Z [the two most frequent AT deficiency alleles] were 64 [95 percent confidence interval [CI]: 45–90] and 40 [CI: 25–62] per 1,000, respectively, for the FMS cohort, as compared with 100 [CI: 88–113] and 19.7 [CI: 14.5–26.6] per 1,000 for the GP cohort. Calculated prevalences [Hardy-Weinberg statistics formula] were 1/14 in FMS versus 1/29 in GP for MZ; 1/195 in FMS versus 1/254 in GP for SZ; and 1/625 in FMS versus 1/2,573 in GP for ZZ. For PI*Z, the calculated odd ratio among FMS versus GP was 2.06 [CI: 1.16–3.63]. A binomial proof [contrast hypothesis] stated that FMS AT-Z gene frequency differed significantly from the GP Z gene frequency [P = 0.007].
Conclusion: The most common AT severe-deficient allele [i.e., PI*Z] has been found with a two-fold higher frequency in the FMS cohort than in the GP cohort. The high odds ratio found for PI*Z indicates a significant difference for PI*Z frequency in the FMS cohort as compared with the GP cohort. Our findings suggest that AT deficiency might play an important role in FMS development and clinical expression in, at least, a subset of FMS subjects.