Objectives
Transthyretin (
TTR
) familial amyloid polyneuropathy (
FAP
) (
OMIM
176300) shows a variable age‐at‐onset (
AO
), including within families. We hypothesized that variants in
C1
QA
and
C1
QC
genes, might also act as genetic modifiers of
AO
in
TTR
‐
FAP
Val30Met Portuguese patients.
Methods
We analyzed
DNA
samples of 267 patients (117 families). To search for variants, all exons and flanking regions were genotyped by automated sequencing. We used generalized estimating equations (
GEE
s) to take into account the non‐independency of
AO
among relatives. Intensive in silico analyses were performed, using various software to assess mi
RNA
s target sites, splicing sites, transcription factor binding sites alterations, and gene–gene interactions.
Results
Two variants for
C1
QA
gene,
GA
genotype of rs201693493 (
P
< 0.001) and
CT
genotype of rs149050968 (
P
< 0.001), were significantly associated with later
AO
. In silico analysis demonstrated, that rs201693493 may alter splicing activity. Regarding
C1
QC
, we found three statistically significant results:
GA
genotype of rs2935537 (
P
= 0.003),
GA
genotype of rs201241346 (
P
< 0.001) and
GA
genotype of rs200952686 (
P
< 0.001). The first two were associated with earlier
AO
, whereas the third was associated with later‐onset.
Interpretation
C1
QA
was associated with later onset, whereas
C1
QC
may have a double role: variants may confer earlier or later
AO
. As found in a study in Cyprus, we confirmed the role of complement
C1Q
genes (and thus of inflammation) as modulator of
AO
in Portuguese patients with
TTR
‐
FAP
Val30Met.