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Hu N, Wang E, Zhu Y, Shen M, Han F. Deficiency of adenosine deaminase 2 (DADA2) with recurrent ischemic stroke, fever and cutaneous changes: A case report. Neurol Sci 2025; 46:2867-2874. [PMID: 39798069 DOI: 10.1007/s10072-025-07991-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Accepted: 12/30/2024] [Indexed: 01/13/2025]
Affiliation(s)
- Nan Hu
- Department of Neurology, Peking Union Medical College Hospital, 100730, Beijing, China
| | - Erqian Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, 100730, Beijing, China
| | - Yicheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, 100730, Beijing, China
| | - Min Shen
- Department of Neurology, Peking Union Medical College Hospital, 100730, Beijing, China.
- Department of Rare Diseases, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College; State Key Laboratory of Complex Severe and Rare Diseases, PUMCH; Department of Rheumatology and Clinical Immunology, PUMCH; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology;Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, 100730, Beijing, China.
| | - Fei Han
- Department of Neurology, Peking Union Medical College Hospital, 100730, Beijing, China.
- Department of Rare Diseases, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences & Peking Union Medical College; State Key Laboratory of Complex Severe and Rare Diseases, PUMCH; Department of Rheumatology and Clinical Immunology, PUMCH; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology;Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, 100730, Beijing, China.
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2
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Gül A, Aksentijevich I, Brogan P, Gattorno M, Grayson PC, Ozen S. The pathogenesis, clinical presentations and treatment of monogenic systemic vasculitis. Nat Rev Rheumatol 2025:10.1038/s41584-025-01250-9. [PMID: 40369133 DOI: 10.1038/s41584-025-01250-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2025] [Indexed: 05/16/2025]
Abstract
Many monogenic autoinflammatory diseases, including DADA2 (deficiency of adenosine deaminase 2), HA20 (haploinsufficiency of A20), SAVI (STING-associated vasculopathy with onset in infancy), COPA syndrome, LAVLI (LYN kinase-associated vasculopathy and liver fibrosis) and VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome, present predominantly with vasculitis and constitute a substantial subgroup of vasculitic conditions associated with a 'probable aetiology'. The spectrum of monogenic vasculitis encompasses all sizes and types of blood vessel, ranging from large vessels to medium-size and small vessels, and from the arterial side to the venous side of the vasculature. Monogenic vasculitis typically starts early in life during infancy or childhood; VEXAS syndrome, which presents in late adulthood, is an exception. The activation of myeloid cells via inflammasome and nuclear factor-κB pathways, type I interferon-enhanced autoimmune mechanisms and/or dysregulated adaptive immune responses have an important role in the development of immune-mediated endothelial dysfunction and vascular damage. Genetic testing is essential for the diagnosis of underlying monogenic autoinflammatory diseases; however, the penetrance of genetic variants can vary. Increased awareness and recognition of distinctive clinical findings could facilitate earlier diagnosis and allow for more-targeted treatments.
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Affiliation(s)
- Ahmet Gül
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
| | - Ivona Aksentijevich
- Inflammatory Disease Section, National Human Genome Research Institute, Bethesda, MD, USA
| | - Paul Brogan
- Infection, Immunity and Inflammation, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Marco Gattorno
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Peter C Grayson
- National Institutes of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Seza Ozen
- Department of Paediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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3
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Macaraeg M, Baker E, Handorf E, Matt M, Baker EK, Brunner H, Grom AA, Henrickson M, Huggins J, Zhang W, Lee P, Marsh R, Schulert GS. Clinical, Immunologic, and Genetic Characteristics in Patients With Syndrome of Undifferentiated Recurrent Fevers. Arthritis Rheumatol 2025; 77:596-605. [PMID: 39622767 DOI: 10.1002/art.43065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 08/18/2024] [Accepted: 10/17/2024] [Indexed: 12/08/2024]
Abstract
OBJECTIVE Syndrome of undifferentiated recurrent fevers (SURF) is characterized by recurrent fevers and autoinflammation without a confirmed molecular diagnosis of a hereditary recurrent fever syndrome, and not fulfilling criteria for periodic fever, adenitis, pharyngitis, aphthous stomatitis syndrome (PFAPA). The goal of this study was to characterize clinical features of patients with SURF compared to patients with PFAPA and to analyze their cytokine signature, genetic variations, and responses to treatment. METHODS We enrolled 46 patients observed at Cincinnati Children's Hospital Medical Center. Baseline data and inflammatory cytokines were collected at enrollment, and their clinical course was followed. Cytokine analysis was performed using a cytokine multiplex assay. Many patients had specific or whole exome genetic testing. RESULTS The prevalence of rash and arthralgias were higher in patients with SURF compared to patients with PFAPA. Pharyngitis and adenopathy were less frequent. A subset of patients with SURF clustered together with elevated proinflammatory cytokines and more frequently required biologic therapy. Focused analysis of whole exome sequencing data revealed that variants of unknown clinical significance (VUCS) were frequently identified in genes implicated in B cell development, immunodeficiencies, and inflammatory bowel disease risk. Treatments for patients with SURF commonly included on-demand steroids, colchicine, and anti-interleukin-1 therapy. CONCLUSION Our findings suggest SURF is a heterogeneous group but has distinct clinical and immunologic features from disorders such as PFAPA. Patients have frequent VUCS, which may have relevance to disease pathogenesis. A subset of patients showed more inflammation and an increased need for biologic therapy. Further research is necessary to define whether there exist distinct SURF endotypes and to better predict treatment outcomes.
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Affiliation(s)
- Marci Macaraeg
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Elizabeth Baker
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Michael Matt
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Hermine Brunner
- University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Alexei A Grom
- University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michael Henrickson
- University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jennifer Huggins
- University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Wenying Zhang
- University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Pui Lee
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Rebecca Marsh
- University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Grant S Schulert
- University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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4
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Schultheiß C, Schmidt-Barbo P, Paschold L, Esperanzate C, Behn A, Mikolajczyk R, Kastner DL, Aksentijevich I, Binder M. Deficiency of adenosine deaminase 2 skews adaptive immune repertoires toward specific sets of T- and B-cell receptors. J Allergy Clin Immunol 2025; 155:1664-1674. [PMID: 39924119 DOI: 10.1016/j.jaci.2025.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 01/20/2025] [Accepted: 01/29/2025] [Indexed: 02/11/2025]
Abstract
BACKGROUND Adenosine deaminase 2 deficiency (DADA2) is a genetic disorder caused by biallelic hypomorphic or loss-of-function mutations in the ADA2 gene, which encodes a protein deaminase regulating extracellular adenosine metabolism. Clinical features encompass inflammatory vasculopathy, early-onset strokes, and a complex presentation involving both immunodeficiency and autoinflammation/autoimmunity. OBJECTIVE Our aim was to determine a DADA2-specific adaptive immune architecture. METHODS We profiled immunoglobulin levels and peripheral B- and T-cell phenotypes in 47 previously reported and 5 unreported patients with DADA2. Levels of 21 cytokines and chemokines were quantified in patients with or without anti-TNF treatment. To characterize the DADA2 immune architecture, we performed T- and B-cell receptor immunosequencing. We trained a binary LightGBM classifier to distinguish DADA2 T- and B-cell immune repertoires from healthy individuals. RESULTS We detected hypogammaglobulinemia in 65% of patients with DADA2 (34 of 52) and cytopenias in 48% (25 of 52). Flow cytometric profiling revealed contraction of B- and T-cell memory compartments. In addition, we observed elevated levels of TNF, IL-8, several interferons, a proliferation-inducing ligand (APRIL), B-cell activating factor (BAFF), and soluble CD40 ligand (sCD40L). High serum levels of TNF, BAFF, and sCD40L persisted under anti-TNF therapy. Next-generation immunosequencing of peripheral lymphocytes showed restricted T-cell receptor repertoires and B cells, which were particularly skewed toward immunoglobulin heavy chain V4-34 rearrangements. With high accuracy, our machine learning algorithm separated individuals with DADA2 from healthy individuals on the basis of immunogenetic parameters regarding B-cell clone fraction, CDR3 length, and selected Kidera factors. CONCLUSIONS Our findings underscore the significant influence of ADA2 on the adaptive immune system, which results in a highly specific immunogenetic signature in patients with DADA2.
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MESH Headings
- Humans
- Adenosine Deaminase/deficiency
- Adenosine Deaminase/genetics
- Adenosine Deaminase/immunology
- Male
- Female
- Adaptive Immunity
- Receptors, Antigen, B-Cell/immunology
- Receptors, Antigen, B-Cell/genetics
- T-Lymphocytes/immunology
- B-Lymphocytes/immunology
- Receptors, Antigen, T-Cell/immunology
- Receptors, Antigen, T-Cell/genetics
- Adult
- Agammaglobulinemia/immunology
- Agammaglobulinemia/genetics
- Child
- Child, Preschool
- Cytokines
- Severe Combined Immunodeficiency/immunology
- Adolescent
- Intercellular Signaling Peptides and Proteins/genetics
- Intercellular Signaling Peptides and Proteins/deficiency
- Intercellular Signaling Peptides and Proteins/immunology
- Young Adult
- Receptor, Adenosine A2A
- Hereditary Autoinflammatory Diseases
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Affiliation(s)
- Christoph Schultheiß
- Division of Medical Oncology, University Hospital Basel, Basel, Switzerland; Laboratory of Translational Immuno-Oncology, Department of Biomedicine, University and University Hospital Basel; Basel, Switzerland
| | - Paul Schmidt-Barbo
- Division of Medical Oncology, University Hospital Basel, Basel, Switzerland; Laboratory of Translational Immuno-Oncology, Department of Biomedicine, University and University Hospital Basel; Basel, Switzerland; Collaborative Research Institute Intelligent Oncology (CRIION), Freiburg, Germany
| | - Lisa Paschold
- Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Carl Esperanzate
- Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Md
| | - Alissa Behn
- Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Centre for Health Sciences, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Daniel L Kastner
- Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Md
| | - Ivona Aksentijevich
- Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Md
| | - Mascha Binder
- Division of Medical Oncology, University Hospital Basel, Basel, Switzerland; Laboratory of Translational Immuno-Oncology, Department of Biomedicine, University and University Hospital Basel; Basel, Switzerland; Collaborative Research Institute Intelligent Oncology (CRIION), Freiburg, Germany.
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Tiwari-Heckler S, Pita-Juarez Y, Vierbaum L, Michl P, Vlachos IS, Merle U, Jiang ZG. Novel Link Between Myeloid-Specific Adenosine Deaminase 2 and CXCL10-CXCR3 Axis in Infectious ARDS. Int J Mol Sci 2025; 26:3678. [PMID: 40332245 PMCID: PMC12027617 DOI: 10.3390/ijms26083678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2025] [Revised: 04/07/2025] [Accepted: 04/10/2025] [Indexed: 05/08/2025] Open
Abstract
Acute respiratory distress syndrome (ARDS) is a severe complication of lung injury characterized by hyperinflammation and fibrosis. Here, we show a significant association between the monocyte-derived enzyme adenosine deaminase 2 (ADA2) and SARS-CoV-2 induced ARDS. We note an interesting link between ADA2 and the chemokine CXCL10 and its receptor CXCR3. By using published datasets of spatial transcriptomics and single-cell RNAseq, we show that ADA2 is highly expressed by inflammatory CD14+CD16+ monocytes, along with profibrotic genes, in lungs affected by COVID-19. This study reveals important associations between key pathophysiological features of ARDS, linking hypoxia, infiltrative CXCR3 monocytes, and a monocyte-derived exoenzyme ADA2.
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Affiliation(s)
- Shilpa Tiwari-Heckler
- Department of Gastroenterology, Infectiology and Toxicology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Yered Pita-Juarez
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Lisa Vierbaum
- Department of Gastroenterology, Infectiology and Toxicology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Patrick Michl
- Department of Gastroenterology, Infectiology and Toxicology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Ioannis S. Vlachos
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Uta Merle
- Department of Gastroenterology, Infectiology and Toxicology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Z Gordon Jiang
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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Kumar S, Chugh A, Kumar SC, Punnen A, Bhat C, Patra P, Viswanathan V, Gupta A, Aggarwal M, Nayak AR, Lingappa L, Sharma J, Gupta N, Naranje P, Jana M, Bagri NK, Hari P, Ramanan AV. Clinical spectrum of and outcomes for Indian children with deficiency of adenosine deaminase 2 (DADA2): a multicentric study. Rheumatology (Oxford) 2025; 64:2179-2184. [PMID: 39259214 DOI: 10.1093/rheumatology/keae489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 08/09/2024] [Accepted: 08/20/2024] [Indexed: 09/12/2024] Open
Abstract
OBJECTIVES Deficiency of adenosine deaminase-2 (DADA2) is a monogenic disorder closely resembling PAN and can present to physicians across various specialties. Through this case series, we aimed to study and describe the clinical spectrum of and outcomes for Indian children with DADA2. METHODS The de-identified data from all participating centres were entered in an Excel spreadsheet, and the coordinating centre (All India Institute of Medical Sciences, New Delhi) screened the data for accuracy and completeness. RESULTS We enrolled 16 children (11 females) in the study; the mean (s.d.) age at the time of onset of symptoms for males and females was 46.2 (47) and 73.6 (50.4) months, respectively. The most common clinical features in this cohort were fever and rash in 80% of patients. More than half of the children, n (%) [8, (53%)] had a CNS stroke. The other clinical features were hypertension [5(33%)], anaemia [3 (20%)] and arthralgia/arthritis in 4 (26%). These children were managed with various immunomodulators: steroids [13, (86%)], anti-TNF agents [12, (80%)], CYC [2 (13%)] and MMF [3 (20%)]. The median [interquartile range (IQR)] duration of follow-up for this cohort was 17 (10, 29) months. Fourteen children achieved remission, and none had recurrent strokes after the initiation of anti-TNF drugs. CONCLUSION DADA-2 closely resembles PAN; early age of onset and CNS stroke are striking differentiating features from classic PAN. Most children respond well to anti-TNF agents without serious adverse events being observed during short-term follow-up.
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Affiliation(s)
- Sathish Kumar
- Division of Pediatric Rheumatology, Department of Pediatrics, Christian Medical College, Vellore, India
| | - Akagri Chugh
- Department of Pediatrics, Division of Pediatric Rheymatology, All India Institute of Medical Sciences, New Delhi, India
| | - Samantha Cheryl Kumar
- Division of Pediatric Rheumatology, Department of Pediatrics, Christian Medical College, Vellore, India
| | - Anu Punnen
- Division of Pediatric Rheumatology, Department of Pediatrics, Christian Medical College, Vellore, India
| | - Chandrika Bhat
- Pediatric Rheumatology Services, Rainbow Children Hospital, Bangalore, India
| | - Pratap Patra
- Department of Pediatrics, All India Institute of Medical Sciences, Patna, India
| | - Vijay Viswanathan
- Pediatric Rheumatology Services, Department of Pediatrics, Jupiter Hospital, Thane, India
| | - Aditya Gupta
- Department of Pediatrics, Division of Pediatric Rheymatology, All India Institute of Medical Sciences, New Delhi, India
| | - Mukul Aggarwal
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Amiya Ranjan Nayak
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Lokesh Lingappa
- Division of Pediatric Neurosciences, Rainbow Children's Hospital, Bangalore, India
| | - Jyoti Sharma
- Department of Pediatrics, Division of Pediatric Rheymatology, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Gupta
- Department of Pediatrics, Division of Pediatric Rheymatology, All India Institute of Medical Sciences, New Delhi, India
| | - Priyanka Naranje
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Manisha Jana
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Narendra Kumar Bagri
- Department of Pediatrics, Division of Pediatric Rheymatology, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Hari
- Department of Pediatrics, Division of Pediatric Rheymatology, All India Institute of Medical Sciences, New Delhi, India
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7
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Dong L, Lu B, Luo W, Gu X, Wu C, Trotta L, Seppanen M, Zhang Y, Zavialov AV. Intracellular concentration of ADA2 is a marker for monocyte differentiation and activation. Front Med 2025; 19:359-375. [PMID: 39832022 DOI: 10.1007/s11684-024-1110-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 09/18/2024] [Indexed: 01/22/2025]
Abstract
Adenosine, a critical molecule regulating cellular function both inside and outside cells, is controlled by two human adenosine deaminases: ADA1 and ADA2. While ADA1 primarily resides in the cytoplasm, ADA2 can be transported to lysosomes within cells or secreted outside the cell. Patients with ADA2 deficiency (DADA2) often suffer from systemic vasculitis due to elevated levels of TNF-α in their blood. Monocytes from DADA2 patients exhibit excessive TNF-α secretion and differentiate into pro-inflammatory M1-type macrophages. Our findings demonstrate that ADA2 localizes to endolysosomes within macrophages, and its intracellular concentration decreases in cells secreting TNF-α. This suggests that ADA2 may function as a lysosomal adenosine deaminase, regulating TNF-α expression by the cells. Interestingly, pneumonia patients exhibit higher ADA2 concentrations in their bronchoalveolar lavage (BAL), correlating with elevated pro-inflammatory cytokine levels. Conversely, cord blood has low ADA2 levels, creating a more immunosuppressive environment. Additionally, secreted ADA2 can bind to apoptotic cells, activating immune cells by reducing extracellular adenosine levels. These findings imply that ADA2 release from monocytes during inflammation, triggered by growth factors, may be crucial for cell activation. Targeting intracellular and extracellular ADA2 activities could pave the way for novel therapies in inflammatory and autoimmune disorders.
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Affiliation(s)
- Liang Dong
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
- Center for Cell Lineage and Development, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, 510530, China
| | - Bingtai Lu
- Department of Respiratory Medicine, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Centre, State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, 510623, China
| | - Wenwen Luo
- International Center for Aging and Cancer (ICAC), Hainan Medical University, Haikou, 571199, China
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Xiaoqiong Gu
- Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Chengxiang Wu
- Tulane National Primate Research Center, Covington, USA
| | - Luca Trotta
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Mikko Seppanen
- Adult Immunodeficiency Unit, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Rare Diseases Center, Hospital for Children and Adolescents, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Yuxia Zhang
- Department of Respiratory Medicine, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Centre, State Key Laboratory of Respiratory Diseases, Guangzhou Medical University, Guangzhou, 510623, China
| | - Andrey V Zavialov
- International Center for Aging and Cancer (ICAC), Hainan Medical University, Haikou, 571199, China.
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China.
- Turku Center for Biotechnology, Turku, Finland.
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8
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Han F, Fan S, Hou B, Zhou L, Yao M, Shen M, Zhu Y, Wardlaw JM, Ni J. Inflammatory disorders that affect the cerebral small vessels. Chin Med J (Engl) 2025:00029330-990000000-01479. [PMID: 40090970 DOI: 10.1097/cm9.0000000000003574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Indexed: 03/19/2025] Open
Abstract
ABSTRACT This comprehensive review synthesizes the latest advancements in understanding inflammatory disorders affecting cerebral small vessels, a distinct yet understudied category within cerebral small vessel diseases (SVD). Unlike classical SVD, these inflammatory conditions exhibit unique clinical presentations, imaging patterns, and pathophysiological mechanisms, posing significant diagnostic and therapeutic challenges. Highlighting their heterogeneity, this review spans primary angiitis of the central nervous system, cerebral amyloid angiopathy-related inflammation, systemic vasculitis, secondary vasculitis, and vasculitis in autoinflammatory diseases. Key discussions focus on emerging insights into immune-mediated processes, neuroimaging characteristics, and histopathological distinctions. Furthermore, this review underscores the importance of standardized diagnostic frameworks, individualized immunomodulation approaches, and novel targeted therapies to address unmet clinical demands.
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Affiliation(s)
- Fei Han
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Siyuan Fan
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Bo Hou
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Lixin Zhou
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Ming Yao
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Min Shen
- Department of Rare Diseases, Department of Rheumatology and Clinical Immunology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Yicheng Zhu
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, University of Edinburgh, Edinburgh EH16 4SB, United Kingdom
| | - Jun Ni
- Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
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9
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Bayindir Y, Jelusic M, Ozen S. Highlights from the breakout session: vasculitis in paediatric rheumatology. Rheumatology (Oxford) 2025; 64:i131-i133. [PMID: 40071400 DOI: 10.1093/rheumatology/keae406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 05/13/2025] Open
Abstract
The 21st International Vasculitis Workshop, held in Barcelona, Spain, from April 7 to 10, 2024, highlighted advances in pediatric vasculitis, focusing on a holistic, multidisciplinary approach. Common childhood vasculitides, including IgA Vasculitis (IgAV) and Kawasaki Disease (KD), were discussed. The Ankara 2008 criteria for IgAV, endorsed by EULAR and PReS, were evaluated for their performance in adults, showing high sensitivity but necessitating further refinement for improved specificity. Studies on genetic associations, such as Human Leukocyte Antigen (HLA) polymorphisms in IgAV, and biomarkers like S100A8/A9, HMGB1, and RAGE, were presented. Kawasaki disease research included novel anti-apolipoprotein A-2 antibodies, showing promise in reducing coronary arteritis. Monogenic vasculitides, such as deficiency of ADA2, were addressed with new consensus-driven recommendations. The workshop underscored the importance of continued research and tailored therapeutic strategies to improve outcomes in pediatric vasculitis, paving the way for advancements in diagnosis, management, and understanding of these complex diseases.
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Affiliation(s)
- Yagmur Bayindir
- Department of Paediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Marija Jelusic
- Department of Paediatrics, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Seza Ozen
- Department of Paediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Bulté D, Barzaghi F, Mesa-Nuñez C, Rigamonti C, Basso-Ricci L, Visconti C, Crippa S, Pettinato E, Gilioli D, Milani R, Quaranta P, Caorsi R, Cafaro A, Cangemi G, Lupia M, Schena F, Grossi A, Di Colo G, Federici S, Insalaco A, De Benedetti F, Marktel S, Di Micco R, Bernardo ME, Scala S, Cicalese MP, Conti F, Miano M, Gattorno M, Dufour C, Aiuti A, Mortellaro A. Early bone marrow alterations in patients with adenosine deaminase 2 deficiency across disease phenotypes and severities. J Allergy Clin Immunol 2025; 155:616-627.e8. [PMID: 39284370 PMCID: PMC11804788 DOI: 10.1016/j.jaci.2024.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 09/03/2024] [Accepted: 09/05/2024] [Indexed: 10/15/2024]
Abstract
BACKGROUND Deficiency of adenosine deaminase 2 (DADA2) is a complex monogenic disease caused by recessive mutations in the ADA2 gene. DADA2 exhibits a broad clinical spectrum encompassing vasculitis, immunodeficiency, and hematologic abnormalities. Yet, the impact of DADA2 on the bone marrow (BM) microenvironment is largely unexplored. OBJECTIVE This study comprehensively examined the BM and peripheral blood of pediatric and adult patients with DADA2 presenting with rheumatologic/immunologic symptoms or severe hematologic manifestations. METHODS Immunophenotyping of hematopoietic stem cells (HSCs), progenitor cells, and mature cell populations was performed for 18 patients with DADA2. We also conducted a characterization of mesenchymal stromal cells. RESULTS Our study revealed a significant decrease in primitive HSCs and progenitor cells, alongside their reduced clonogenic capacity and multilineage differentiation potential. These BM defects were evident in patients with both severe and nonsevere hematologic manifestations, including pediatric patients, demonstrating that BM disruption can emerge silently and early on, even in patients who do not show obvious hematologic symptoms. Beyond stem cells, there was a reduction in mature cell populations in the BM and peripheral blood, affecting myeloid, erythroid, and lymphoid populations. Furthermore, BM mesenchymal stromal cells in patients with DADA2 exhibited reduced clonogenic and proliferation capabilities and were more prone to undergo cellular senescence marked by elevated DNA damage. CONCLUSIONS Our exploration into the BM landscape of patients with DADA2 sheds light on the critical hematologic dimension of the disease and emphasizes the importance of vigilant monitoring, even in the case of subclinical presentation.
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Affiliation(s)
- Dimitri Bulté
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Barzaghi
- Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cristina Mesa-Nuñez
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Rigamonti
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Luca Basso-Ricci
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Camilla Visconti
- Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefania Crippa
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emanuela Pettinato
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Diego Gilioli
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Milani
- Immunohematology and Transfusion Medicine Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Pamela Quaranta
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberta Caorsi
- UOC Rheumatology and Autoinflammatory Diseases, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Alessia Cafaro
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giuliana Cangemi
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Michela Lupia
- Hematology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Francesca Schena
- UOC Rheumatology and Autoinflammatory Diseases, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Alice Grossi
- Laboratorio Genetica e Genomica delle Malattie Rare, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giulia Di Colo
- Vita-Salute San Raffaele University, Milan, Italy; Immunology, Rheumatology, Allergy and Rare Disease Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Silvia Federici
- Division of Rheumatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonella Insalaco
- Division of Rheumatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Sarah Marktel
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Di Micco
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Ester Bernardo
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Serena Scala
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Pia Cicalese
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesca Conti
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Maurizio Miano
- Hematology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marco Gattorno
- UOC Rheumatology and Autoinflammatory Diseases, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Carlo Dufour
- Hematology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Alessandro Aiuti
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandra Mortellaro
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Lou S, Hu W, Wei P, He D, Fu P, Ding K, Chen Z, Dong Z, Zheng J, Wang K. Artificial Nanovesicles Derived from Cells: A Promising Alternative to Extracellular Vesicles. ACS APPLIED MATERIALS & INTERFACES 2025; 17:22-41. [PMID: 39692623 DOI: 10.1021/acsami.4c12567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2024]
Abstract
As naturally secreted vesicles by cells, extracellular vesicles (EVs) play essential roles in modulating cell-cell communication and have significant potential in tissue regeneration, immune regulation, and drug delivery. However, the low yield and uncontrollable heterogeneity of EVs have been obstacles to their widespread translation into clinical practice. Recently, it has been discovered that artificial nanovesicles (NVs) produced by cell processing can inherit the components and functions of the parent cells and possess similar structures and functions to EVs, with significantly higher yields and more flexible functionalization, making them a powerful complement to natural EVs. This review focuses on recent advances in the research of artificial NVs as replacements for natural EVs. We provide an overview comparing natural EVs and artificial NVs and summarize the top-down preparation strategies of NVs. The applications of NVs prepared from stem cells, differentiated cells, and engineered cells are presented, as well as the latest advances in NV engineering. Finally, the main challenges of artificial NVs are discussed.
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Affiliation(s)
- Saiyun Lou
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, China
- Department of Respiratory and Critical Care Medicine, Ningbo No. 2 Hospital, Ningbo 315010, China
| | - Wei Hu
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, China
- Department of Respiratory and Critical Care Medicine, Ningbo No. 2 Hospital, Ningbo 315010, China
| | - Pengyao Wei
- Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Ningbo Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering of Chinese Academy of Sciences, Ningbo 315300, China
| | - Dongdong He
- Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Ningbo Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering of Chinese Academy of Sciences, Ningbo 315300, China
| | - Pan Fu
- Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Ningbo Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering of Chinese Academy of Sciences, Ningbo 315300, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Kejian Ding
- School of Materials Science and Chemical Engineering, Ningbo University, Ningbo,Zhejiang 315211, China
| | - Zhenyi Chen
- School of Materials Science and Chemical Engineering, Ningbo University, Ningbo,Zhejiang 315211, China
| | - Zhaoxing Dong
- Department of Respiratory and Critical Care Medicine, Ningbo No. 2 Hospital, Ningbo 315010, China
| | - Jianping Zheng
- Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Ningbo Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering of Chinese Academy of Sciences, Ningbo 315300, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Kaizhe Wang
- Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Ningbo Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering of Chinese Academy of Sciences, Ningbo 315300, China
- University of Chinese Academy of Sciences, Beijing 100049, China
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12
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Ayan G, Basaran O, Firlatan B, Kilic L, Bilginer Y, Alikasifoglu M, Karadag O, Ozen S. Long-term follow-up of anti-TNF treatment in adult and pediatric DADA2 patients: Insights from real-world data. Int J Rheum Dis 2024; 27:e15377. [PMID: 39558610 DOI: 10.1111/1756-185x.15377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Revised: 09/25/2024] [Accepted: 10/06/2024] [Indexed: 11/20/2024]
Abstract
BACKGROUND/PURPOSE Our objective was to investigate real-world outcomes and treatment strategies in individuals affected by DADA2 using over 10-year period real-life experience. METHODS This descriptive analysis encompassed all adult/pediatric patients with DADA2 from our Vasculitis Research Center prospective database. Patients on anti-TNF therapy have been specifically examined, analyzing the treatment's duration, indications, and outcomes. Treatment responses were based on physicians' assessments and categorized as full response (symptom-free with normal acute phase reactants) or partial/no response. RESULTS Totally 32 patients (Adult/Childhood age: 19/13) were analyzed. Anti-TNF agents were prescribed to 27 of the 32 patients. Over a median follow-up of 58 months on anti-TNF therapy, 10 patients (35.7%) exhibited a complete response, predominantly in cases with nervous system or skin involvement. Partial responses were observed in the other 10 patients (35.7%). Currently, 20/ 27 patients remain on anti-TNF treatment. Among the seven who are not on anti-TNF now: five died (four of them with a late diagnosis, one could not continue due to cardiomyopathy), one refused treatment and one had a cure after bone marrow transplantation. We have become aware that four patients increased their dose interval and one returned to the normal interval after an increase in CRP. The first patient was diagnosed in 2013 and over the last 10 years, 6/32 (18.8%) of the patients died. CONCLUSION Anti-TNF treatment is beneficial for vasculitic and inflammatory lesions. The clinical course of patients is diverse, especially if the diagnosis is delayed, with a mortality rate of up to 20% over a 10-year period.
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Affiliation(s)
- Gizem Ayan
- Division of Rheumatology, Department of Internal Medicine, Medical Faculty, Hacettepe University, Ankara, Turkey
- Vasculitis Research Centre, Hacettepe University, Ankara, Turkey
| | - Ozge Basaran
- Vasculitis Research Centre, Hacettepe University, Ankara, Turkey
- Division of Pediatric Rheumatology, Department of Pediatrics, Medical Faculty, Hacettepe University, Ankara, Turkey
| | - Busra Firlatan
- Division of Rheumatology, Department of Internal Medicine, Medical Faculty, Hacettepe University, Ankara, Turkey
- Vasculitis Research Centre, Hacettepe University, Ankara, Turkey
| | - Levent Kilic
- Division of Rheumatology, Department of Internal Medicine, Medical Faculty, Hacettepe University, Ankara, Turkey
- Vasculitis Research Centre, Hacettepe University, Ankara, Turkey
| | - Yelda Bilginer
- Vasculitis Research Centre, Hacettepe University, Ankara, Turkey
- Division of Pediatric Rheumatology, Department of Pediatrics, Medical Faculty, Hacettepe University, Ankara, Turkey
| | - Mehmet Alikasifoglu
- Division of Medical Genetics, Medical Faculty, Hacettepe University, Ankara, Turkey
| | - Omer Karadag
- Division of Rheumatology, Department of Internal Medicine, Medical Faculty, Hacettepe University, Ankara, Turkey
- Vasculitis Research Centre, Hacettepe University, Ankara, Turkey
| | - Seza Ozen
- Vasculitis Research Centre, Hacettepe University, Ankara, Turkey
- Division of Pediatric Rheumatology, Department of Pediatrics, Medical Faculty, Hacettepe University, Ankara, Turkey
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13
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Dantas JG, Biegelmeyer E, Zarur EB, Pinheiro FAG. Rare primary vasculitis: update on multiple complex diseases and the new kids on the block. Adv Rheumatol 2024; 64:79. [PMID: 39385260 DOI: 10.1186/s42358-024-00421-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 09/26/2024] [Indexed: 10/12/2024] Open
Abstract
Systemic vasculitis is a group of rare diseases that share an essential characteristic: inflammation of blood vessel walls. This injury occurs during the disease course, but specific features vary for each entity. In this paper, we will address relevant aspects of the newest monogenic mutation vasculitis, such as deficiency of adenosine deaminase 2 (ADA2) and VEXAS syndrome (UBA1), and other relevant vasculitis, such as Cogan syndrome and Susac syndrome that may share some similarities with them.
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Affiliation(s)
- Joao Gabriel Dantas
- Rheumatology Division, Universidade Federal de São Paulo, Rua Botucatu, 740, 3° andar, São Paulo, SP, 04023-062, Brazil
| | - Erika Biegelmeyer
- Rheumatology Division, Universidade Federal de São Paulo, Rua Botucatu, 740, 3° andar, São Paulo, SP, 04023-062, Brazil
| | - Eduarda Bonelli Zarur
- Rheumatology Division, Universidade Federal de São Paulo, Rua Botucatu, 740, 3° andar, São Paulo, SP, 04023-062, Brazil
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14
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Dong L, Luo W, Maksym S, Robson SC, Zavialov AV. Adenosine deaminase 2 regulates the activation of the toll-like receptor 9 in response to nucleic acids. Front Med 2024; 18:814-830. [PMID: 39078537 DOI: 10.1007/s11684-024-1067-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/31/2024] [Indexed: 07/31/2024]
Abstract
Human cells contain two types of adenosine deaminases (ADA) each with unique properties: ADA1, which is present in all cells where it modulates intracellular functions and extracellular signaling, and ADA2, which is secreted by immune cells. The exact intracellular functions of ADA2 remain undetermined and less defined than those of ADA1. ADA2 has distinct characteristics, such as low adenosine affinity, heparin-binding ability, and putative lysosomal entry. Here, we confirm that ADA2 is a lysosomal protein that binds toll-like receptor 9 (TLR9) agonists, specifically CpG oligodeoxynucleotides (CpG ODNs). We show that interferon-alpha (IFN-α) is secreted in response to TLR9 activation by CpG ODNs and natural DNA and markedly increases when ADA2 expression is downregulated in plasmacytoid dendritic cells (pDCs). Additionally, the pretreatment of pDCs with RNA further stimulates IFN-α secretion by pDCs after activation with CpG ODNs. Our findings indicate that ADA2 regulates TLR9 responses to DNA in activated pDCs. In conclusion, decreasing ADA2 expression or blocking it with specific oligonucleotides can enhance IFN-α secretion from pDCs, improving immune responses against intracellular infections and cancer.
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Affiliation(s)
- Liang Dong
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
- Center for Cell Lineage and Development, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, 510530, China
| | - Wenwen Luo
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Skaldin Maksym
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
- Joint Biotechnology Laboratory, University of Turku, Turku, 20520, Finland
| | - Simon C Robson
- Center for Inflammation Research, Departments of Anesthesia and Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, 02215, USA
| | - Andrey V Zavialov
- International Center for Aging and Cancer (ICAC), Hainan Medical University, Haikou, 571199, China.
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China.
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15
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Wouters M, Ehlers L, Dzhus M, Kienapfel V, Bucciol G, Delafontaine S, Hombrouck A, Pillay B, Moens L, Meyts I. Human ADA2 Deficiency: Ten Years Later. Curr Allergy Asthma Rep 2024; 24:477-484. [PMID: 38970744 PMCID: PMC11364588 DOI: 10.1007/s11882-024-01163-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/08/2024]
Abstract
PURPOSE OF REVIEW In this review, an update is provided on the current knowledge and pending questions about human adenosine deaminase type 2 deficiency. Patients have vasculitis, immunodeficiency and some have bone marrow failure. Although the condition was described ten years ago, the pathophysiology is incompletely understood RECENT FINDINGS: Endothelial instability due to increased proinflammatory macrophage development is key to the pathophysiology. However, the physiological role of ADA2 is a topic of debate as it is hypothesized that ADA2 fulfils an intracellular role. Increasing our knowledge is urgently needed to design better treatments for the bone marrow failure. Indeed, TNFi treatment has been successful in treating DADA2, except for the bone marrow failure. Major advances have been made in our understanding of DADA2. More research is needed into the physiological role of ADA2.
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Affiliation(s)
- Marjon Wouters
- Laboratory for Inborn Errors of Immunity, Microbiology Immunology and Transplantation, KU Leuven, Louvain, Belgium.
| | - Lisa Ehlers
- Laboratory for Inborn Errors of Immunity, Microbiology Immunology and Transplantation, KU Leuven, Louvain, Belgium
| | - Mariia Dzhus
- Laboratory for Inborn Errors of Immunity, Microbiology Immunology and Transplantation, KU Leuven, Louvain, Belgium
| | - Verena Kienapfel
- Laboratory for Inborn Errors of Immunity, Microbiology Immunology and Transplantation, KU Leuven, Louvain, Belgium
| | - Giorgia Bucciol
- Laboratory for Inborn Errors of Immunity, Microbiology Immunology and Transplantation, KU Leuven, Louvain, Belgium
- Department of Pediatrics, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Selket Delafontaine
- Laboratory for Inborn Errors of Immunity, Microbiology Immunology and Transplantation, KU Leuven, Louvain, Belgium
| | - Anneleen Hombrouck
- Laboratory for Inborn Errors of Immunity, Microbiology Immunology and Transplantation, KU Leuven, Louvain, Belgium
| | - Bethany Pillay
- Laboratory for Inborn Errors of Immunity, Microbiology Immunology and Transplantation, KU Leuven, Louvain, Belgium
| | - Leen Moens
- Laboratory for Inborn Errors of Immunity, Microbiology Immunology and Transplantation, KU Leuven, Louvain, Belgium
| | - Isabelle Meyts
- Laboratory for Inborn Errors of Immunity, Microbiology Immunology and Transplantation, KU Leuven, Louvain, Belgium
- Department of Pediatrics, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium
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李 婷, 宋 红. [Advances in gene therapy for inborn errors of immunity]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:865-870. [PMID: 39148393 PMCID: PMC11334546 DOI: 10.7499/j.issn.1008-8830.2404027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/20/2024] [Indexed: 08/17/2024]
Abstract
Inborn errors of immunity (IEI) are a diverse group of disorders caused by defects in immune system structure or function, involving both innate and adaptive immunity. The 2022 update of the IEI classification includes 485 distinct disorders, categorized into ten major disease groups. With the rapid development of molecular biology, the specific pathogenesis of many IEI has been revealed, making gene therapy possible in preclinical and clinical research of this type of disease. This article reviews the advancements in gene therapy for IEI, aiming to increase awareness and understanding of these disorders.
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Monda S, Tiller G, Gowdie P, McLean C, Renton WD. Deficiency of adenosine deaminase 2 (DADA2) presenting with diffuse skeletal muscle vasculitis. J Paediatr Child Health 2024; 60:250-253. [PMID: 38804661 DOI: 10.1111/jpc.16572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/20/2023] [Accepted: 05/19/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Sally Monda
- Paediatric Rheumatology, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Georgina Tiller
- Paediatric Rheumatology, Monash Children's Hospital, Melbourne, Victoria, Australia
- Paediatric Rheumatology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Peter Gowdie
- Paediatric Rheumatology, Monash Children's Hospital, Melbourne, Victoria, Australia
- Paediatric Rheumatology, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Catriona McLean
- Anatomical Pathology, Alfred Health, Melbourne, Victoria, Australia
| | - William D Renton
- Paediatric Rheumatology, Monash Children's Hospital, Melbourne, Victoria, Australia
- Paediatric Rheumatology, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
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Brix A, Belleri L, Pezzotta A, Pettinato E, Mazzola M, Zoccolillo M, Marozzi A, Monteiro R, Del Bene F, Mortellaro A, Pistocchi A. ADA2 regulates inflammation and hematopoietic stem cell emergence via the A 2bR pathway in zebrafish. Commun Biol 2024; 7:615. [PMID: 38777862 PMCID: PMC11111730 DOI: 10.1038/s42003-024-06286-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
Deficiency of adenosine deaminase 2 (DADA2) is an inborn error of immunity caused by loss-of-function mutations in the adenosine deaminase 2 (ADA2) gene. Clinical manifestations of DADA2 include vasculopathy and immuno-hematological abnormalities, culminating in bone marrow failure. A major gap exists in our knowledge of the regulatory functions of ADA2 during inflammation and hematopoiesis, mainly due to the absence of an ADA2 orthologue in rodents. Exploring these mechanisms is essential for understanding disease pathology and developing new treatments. Zebrafish possess two ADA2 orthologues, cecr1a and cecr1b, with the latter showing functional conservation with human ADA2. We establish a cecr1b-loss-of-function zebrafish model that recapitulates the immuno-hematological and vascular manifestations observed in humans. Loss of Cecr1b disrupts hematopoietic stem cell specification, resulting in defective hematopoiesis. This defect is caused by induced inflammation in the vascular endothelium. Blocking inflammation, pharmacological modulation of the A2r pathway, or the administration of the recombinant human ADA2 corrects these defects, providing insights into the mechanistic link between ADA2 deficiency, inflammation and immuno-hematological abnormalities. Our findings open up potential therapeutic avenues for DADA2 patients.
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Affiliation(s)
- Alessia Brix
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, L.I.T.A., via Fratelli Cervi 93, Segrate, 20054, Milan, Italy
| | - Laura Belleri
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, L.I.T.A., via Fratelli Cervi 93, Segrate, 20054, Milan, Italy
- Department of Development, Institut de la Vision, 17 Rue Moreau, 75012, Paris, France
| | - Alex Pezzotta
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, L.I.T.A., via Fratelli Cervi 93, Segrate, 20054, Milan, Italy
| | - Emanuela Pettinato
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy
| | - Mara Mazzola
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, L.I.T.A., via Fratelli Cervi 93, Segrate, 20054, Milan, Italy
| | - Matteo Zoccolillo
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy
| | - Anna Marozzi
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, L.I.T.A., via Fratelli Cervi 93, Segrate, 20054, Milan, Italy
| | - Rui Monteiro
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, Edgbaston, B15 2TTB, UK
| | - Filippo Del Bene
- Department of Development, Institut de la Vision, 17 Rue Moreau, 75012, Paris, France
| | - Alessandra Mortellaro
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.
| | - Anna Pistocchi
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, L.I.T.A., via Fratelli Cervi 93, Segrate, 20054, Milan, Italy.
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Yuxuan B, Yan D. Adenosine deaminase 2 deficiency in a Chinese patient: Report of one novel mutation and literature review. J Cosmet Dermatol 2024; 23:68-75. [PMID: 37466107 DOI: 10.1111/jocd.15920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/26/2023] [Accepted: 06/25/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE Through a case of deficiency of adenosine deaminase 2 (DADA2) to improve domestic clinicians' understanding of the disease, and to review the literature, promote dermatologists for clinical secondary primary lesion diagnosis. METHOD Analysis of a case diagnosed with DADA2 deficiency of clinical manifestations, laboratory, imaging examination and treatment methods, and discussion through literature analysis. RESULTS The child with recurrent fever, limbs nodular erythema, gradually in the limbs. CT of lower limb skin showed mild edema of the spinous layer, intact basal layer, dilated vascular congestion in the superficial dermis, visible RBC extravasation, and changes of telangiectasia ring purpura were considered. Cranial magnetic resonance imaging (MRI) showed a left choroidal cleft cyst. Genetic test was the CECR1 mutation. The treatment with adalimumab was effective. CONCLUSION In this case, DADA2 is the seventh case in China, and the CECR1 mutation site (c.254A> T p.N85I,c.851G>T p. G284V) was a compound heterozygous mutation. Mastering the clinical characteristics is helpful for clinicians to diagnose this disease.
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Affiliation(s)
- Bai Yuxuan
- Graduate School, Inner Mongolia Medical University, Hohhot, China
- Dermatology Department, People's Hospital of Inner Mongolia Autonomous Region, Hohhot, China
| | - Duan Yan
- Dermatology Department, People's Hospital of Inner Mongolia Autonomous Region, Hohhot, China
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20
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Verschoof MA, van Meenen LCC, Andriessen MVE, Brinkman DMC, Kamphuis S, Kuijpers TW, Leavis HL, Legger GE, Mulders‐Manders CM, de Pagter APJ, Rutgers A, van Well GTJ, Coutinho JM, Hak AE, van Montfrans JM, Klouwer FCC. Neurological phenotype of adenosine deaminase 2 deficient patients: a cohort study. Eur J Neurol 2024; 31:e16043. [PMID: 37584090 PMCID: PMC11235617 DOI: 10.1111/ene.16043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/22/2023] [Accepted: 08/11/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND AND PURPOSE Patients with adenosine deaminase 2 (ADA2) deficiency can present with various neurological manifestations due to vasculopathies and autoinflammation. These include ischaemic and hemorrhagic stroke, but less clearly defined neurological symptoms have also been reported. METHODS In this cohort study, patients with confirmed ADA2 deficiency from seven university hospitals in the Netherlands were included. The frequency and recurrence rates of neurological manifestations before and after initiation of tumor necrosis factor α (TNF-α) inhibiting therapy were analyzed. RESULTS Twenty-nine patients were included with a median age at presentation of 5 years (interquartile range 1-17). Neurological manifestations occurred in 19/29 (66%) patients and were the presenting symptom in 9/29 (31%) patients. Transient ischaemic attack (TIA)/ischaemic stroke occurred in 12/29 (41%) patients and was the presenting symptom in 8/29 (28%) patients. In total, 25 TIAs/ischaemic strokes occurred in 12 patients, one after initiation of TNF-α inhibiting therapy and one whilst switching between TNF-α inhibitors. None was large-vessel occlusion stroke. Two hemorrhagic strokes occurred: one aneurysmatic subarachnoid hemorrhage and one spontaneous intracerebral hemorrhage. Most neurological symptoms, including cranial nerve deficits, vertigo, ataxia and seizures, were caused by TIAs/ischaemic strokes and seldom recurred after initiation of TNF-α inhibiting therapy. CONCLUSIONS Neurological manifestations, especially TIA/ischaemic stroke, are common in patients with ADA2 deficiency and frequently are the presenting symptom. Because it is a treatable cause of young stroke, for which antiplatelet and anticoagulant therapy are considered contraindicated, awareness amongst neurologists and pediatricians is important. Screening for ADA2 deficiency in young patients with small-vessel ischaemic stroke without an identified cause should be considered.
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Affiliation(s)
| | | | - M. Valérie E. Andriessen
- Department of Pediatric Immunology and Infectious DiseasesUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Daniëlle M. C. Brinkman
- Department of PediatricsWillem‐Alexander Children's Hospital, Leiden University Medical CenterLeidenThe Netherlands
| | - Sylvia Kamphuis
- Department of Pediatric RheumatologySophia Children's Hospital, Erasmus University Medical Center RotterdamRotterdamThe Netherlands
| | - Taco W. Kuijpers
- Department of Pediatric Immunology and Infectious DiseasesAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Helen L. Leavis
- Department of Rheumatology and Clinical ImmunologyUniversity Medical Center and Utrecht UniversityUtrechtThe Netherlands
| | - G. Elizabeth Legger
- Department of Pediatric Rheumatology and ImmunologyUniversity Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Catharina M. Mulders‐Manders
- Department of Internal Medicine, Radboud Expertise Center for Immunodeficiency and AutoinflammationRadboud University Medical CenterNijmegenThe Netherlands
| | - Anne P. J. de Pagter
- Department of PediatricsWillem‐Alexander Children's Hospital, Leiden University Medical CenterLeidenThe Netherlands
| | - Abraham Rutgers
- Department of Rheumatology and Clinical ImmunologyUniversity Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Gijs T. J. van Well
- Division of Pediatric Infectious Diseases, Immunology & Rheumatology, Department of PediatricsMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Jonathan M. Coutinho
- Department of NeurologyAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - A. Elisabeth Hak
- Departments of Internal Medicine and Rheumatology and Clinical ImmunologyAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Joris M. van Montfrans
- Department of Pediatric Immunology and Infectious DiseasesUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Femke C. C. Klouwer
- Department of NeurologyAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
- Department of Pediatric NeurologyEmma Children's Hospital, Amsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
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21
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Abstract
Systemic autoinflammatory diseases (SAIDs) are a heterogeneous group of disorders caused by excess activation of the innate immune system in an antigen-independent manner. Starting with the discovery of the causal gene for familial Mediterranean fever, more than 50 monogenic SAIDs have been described. These discoveries, paired with advances in immunology and genomics, have allowed our understanding of these diseases to improve drastically in the last decade. The genetic causes of SAIDs are complex and include both germline and somatic pathogenic variants that affect various inflammatory signaling pathways. We provide an overview of the acquired SAIDs from a genetic perspective and summarize the clinical phenotypes and mechanism(s) of inflammation, aiming to provide a comprehensive understanding of the pathogenesis of autoinflammatory diseases.
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Affiliation(s)
- Jiahui Zhang
- Life Sciences Institute, Zhejiang University, Hangzhou, China
| | - Pui Y Lee
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ivona Aksentijevich
- Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA;
| | - Qing Zhou
- Life Sciences Institute, Zhejiang University, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China;
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22
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Dzhus M, Ehlers L, Wouters M, Jansen K, Schrijvers R, De Somer L, Vanderschueren S, Baggio M, Moens L, Verhaaren B, Lories R, Bucciol G, Meyts I. A Narrative Review of the Neurological Manifestations of Human Adenosine Deaminase 2 Deficiency. J Clin Immunol 2023; 43:1916-1926. [PMID: 37548813 PMCID: PMC10661818 DOI: 10.1007/s10875-023-01555-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 07/14/2023] [Indexed: 08/08/2023]
Abstract
Deficiency of human adenosine deaminase type 2 (DADA2) is a complex systemic autoinflammatory disorder characterized by vasculopathy, immune dysregulation, and hematologic abnormalities. The most notable neurological manifestations of DADA2 are strokes that can manifest with various neurological symptoms and are potentially fatal. However, neurological presentations can be diverse. We here present a review of the neurological manifestations of DADA2 to increase clinical awareness of DADA2 as the underlying diagnosis. We reviewed all published cases of DADA2 from 1 January 2014 until 19 July 2022 found via PubMed. A total of 129 articles describing the clinical features of DADA2 were included in the analysis. Six hundred twenty-eight patients diagnosed with DADA2 were included in the review. 50.3% of patients had at least signs of one reported neurological event, which was the initial or sole manifestation in 5.7% and 0.6%, respectively. 77.5% of patients with neurological manifestations had at least signs of one cerebrovascular accident, with lacunar strokes being the most common and 35.9% of them having multiple stroke episodes. There is a remarkable predilection for the brain stem and deep gray matter, with 37.3% and 41.6% of ischemic strokes, respectively. Other neurological involvement included neuropathies, focal neurological deficits, ophthalmological findings, convulsions, and headaches. In summary, neurological manifestations affect a significant proportion of patients with DADA2, and the phenotype is broad. Neurological manifestations can be the first and single manifestation of DADA2. Therefore, stroke, encephalitis, posterior reversible encephalopathy syndrome, mononeuropathy and polyneuropathy, and Behçet's disease-like presentations should prompt the neurologist to exclude DADA2, especially but not only in childhood.
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Affiliation(s)
- Mariia Dzhus
- Department of Microbiology, Immunology and Transplantation, Inborn Errors of Immunity, KU Leuven, Leuven, Belgium
| | - Lisa Ehlers
- Department of Microbiology, Immunology and Transplantation, Inborn Errors of Immunity, KU Leuven, Leuven, Belgium
| | - Marjon Wouters
- Department of Microbiology, Immunology and Transplantation, Inborn Errors of Immunity, KU Leuven, Leuven, Belgium
| | - Katrien Jansen
- Department of Development and Regeneration, Department of Pediatrics, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Rik Schrijvers
- Department of General Internal Medicine-Allergy and Clinical Immunology, Allergy and Clinical Immunology Research Group, Department of Microbiology, Immunology and Transplantation, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Lien De Somer
- Department of Pediatric Rheumatology, Laboratory of Immunobiology, Rega Institute, European Reference Network for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases, University Hospital Leuven and KU Leuven, Leuven, Belgium
| | - Steven Vanderschueren
- Department of General Internal Medicine, European Reference Network for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases, Department of Microbiology, Immunology and Transplantation, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Marco Baggio
- Department of Microbiology, Immunology and Transplantation, Inborn Errors of Immunity, KU Leuven, Leuven, Belgium
| | - Leen Moens
- Department of Microbiology, Immunology and Transplantation, Inborn Errors of Immunity, KU Leuven, Leuven, Belgium
| | | | - Rik Lories
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, Division of Rheumatology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Giorgia Bucciol
- Department of Microbiology, Immunology and Transplantation, Inborn Errors of Immunity, Department of Pediatrics, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Isabelle Meyts
- Department of Microbiology, Immunology and Transplantation, Inborn Errors of Immunity, Department of Pediatrics, European Reference Network for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases, University Hospitals Leuven and KU Leuven, Leuven, Belgium.
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23
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Agajany N, Horev L, Agajany N, Kenan G. Cerebral Aneurysms and Recurrent TIAs in a 42-Year-Old Patient With DADA2 Mutation: A Case Report. Neurol Genet 2023; 9:e200097. [PMID: 37646004 PMCID: PMC10461712 DOI: 10.1212/nxg.0000000000200097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/14/2023] [Indexed: 08/31/2023]
Abstract
Objectives Deficiency of adenosine deaminase 2 (DADA2) is a rare, recessively inherited autoinflammatory disease with a wide clinical spectrum of manifestations, including strokes and vasculitis. Methods We report a case of a patient with DADA2 who presented with neurologic manifestations. Results A 42-year-old woman with a known diagnosis of polyarteritis nodosa experienced several episodes of TIAs. Neuroimaging revealed 2 aneurysms in unusual locations. Her young age, ethnic origin, absent of cardiovascular risk factors, and skin involvement raised the suspicion of DADA2. Genetic testing confirmed the diagnosis, and a directed treatment with anti-TNF was initiated. Discussion DADA2, although thought to be rare, needs to be borne in mind when evaluating patients with a combination of neurologic and systemic symptoms, as early diagnosis and treatment are imperative in preventing permanent disability.
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Affiliation(s)
- Netta Agajany
- From the Departments of Neurology (Netta Agajany, G.K.) and Dermatology (L.H.) and Pediatrics (Netanel Agajany), Shamir Medical Center
| | - Liran Horev
- From the Departments of Neurology (Netta Agajany, G.K.) and Dermatology (L.H.) and Pediatrics (Netanel Agajany), Shamir Medical Center
| | - Netanel Agajany
- From the Departments of Neurology (Netta Agajany, G.K.) and Dermatology (L.H.) and Pediatrics (Netanel Agajany), Shamir Medical Center
| | - Gilad Kenan
- From the Departments of Neurology (Netta Agajany, G.K.) and Dermatology (L.H.) and Pediatrics (Netanel Agajany), Shamir Medical Center
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24
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Chen L, Mamutova A, Kozlova A, Latysheva E, Evgeny F, Latysheva T, Savostyanov K, Pushkov A, Zhanin I, Raykina E, Kurnikova M, Mersiyanova I, Platt CD, Jee H, Brodeur K, Du Y, Liu M, Weiss A, Schulert GS, Rodriguez-Smith J, Hershfield MS, Aksentijevich I, Zhou Q, Nigrovic PA, Shcherbina A, Alexeeva E, Lee PY. Comparison of disease phenotypes and mechanistic insight on causal variants in patients with DADA2. J Allergy Clin Immunol 2023; 152:771-782. [PMID: 37150360 DOI: 10.1016/j.jaci.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Deficiency of adenosine deaminase 2 (DADA2) results in heterogeneous manifestations including systemic vasculitis and red cell aplasia. The basis of different disease phenotypes remains incompletely defined. OBJECTIVE We sought to further delineate disease phenotypes in DADA2 and define the mechanistic basis of ADA2 variants. METHODS We analyzed the clinical features and ADA2 variants in 33 patients with DADA2. We compared the transcriptomic profile of 14 patients by bulk RNA sequencing. ADA2 variants were expressed experimentally to determine impact on protein production, trafficking, release, and enzymatic function. RESULTS Transcriptomic analysis of PBMCs from DADA2 patients with the vasculitis phenotype or pure red cell aplasia phenotype exhibited similar upregulation of TNF, type I interferon, and type II interferon signaling pathways compared with healthy controls. These pathways were also activated in 3 asymptomatic individuals with DADA2. Analysis of ADA2 variants, including 7 novel variants, showed different mechanisms of functional disruption including (1) unstable transcript leading to RNA degradation; (2) impairment of ADA2 secretion because of retention in the endoplasmic reticulum; (3) normal expression and secretion of ADA2 that lacks enzymatic function; and (4) disruption of the N-terminal signal peptide leading to cytoplasmic localization of unglycosylated protein. CONCLUSIONS Transcriptomic signatures of inflammation are observed in patients with different disease phenotypes, including some asymptomatic individuals. Disease-associated ADA2 variants affect protein function by multiple mechanisms, which may contribute to the clinical heterogeneity of DADA2.
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Affiliation(s)
- Liang Chen
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Anna Mamutova
- Federal State Autonomous Institution "National Medical Research Center for Children's Health" of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Anna Kozlova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | | | - Frolov Evgeny
- NRC Institute of Immunology FMBA of Russia, Moscow, Russia
| | | | - Kirill Savostyanov
- Federal State Autonomous Institution "National Medical Research Center for Children's Health" of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Alexander Pushkov
- Federal State Autonomous Institution "National Medical Research Center for Children's Health" of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Ilya Zhanin
- Federal State Autonomous Institution "National Medical Research Center for Children's Health" of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Elena Raykina
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Maria Kurnikova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Irina Mersiyanova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Craig D Platt
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Hyuk Jee
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Kailey Brodeur
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Yan Du
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass; Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Meng Liu
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Aaron Weiss
- Department of Pediatrics, Maine Medical Center, Portland, Me
| | - Grant S Schulert
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jackeline Rodriguez-Smith
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Michael S Hershfield
- Department of Medicine and Biochemistry, Duke University School of Medicine, Durham, NC
| | - Ivona Aksentijevich
- Inflammatory Disease Section, National Human Genome Research Institute, Bethesda, Md
| | - Qing Zhou
- Life Sciences Institute, Zhejiang University, Hangzhou, China
| | - Peter A Nigrovic
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass; Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Mass
| | - Anna Shcherbina
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Ekaterina Alexeeva
- Federal State Autonomous Institution "National Medical Research Center for Children's Health" of the Ministry of Health of the Russian Federation, Moscow, Russia; Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Pui Y Lee
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
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25
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Gagne S, Sivaraman V, Akoghlanian S. Interferonopathies masquerading as non-Mendelian autoimmune diseases: pattern recognition for early diagnosis. Front Pediatr 2023; 11:1169638. [PMID: 37622085 PMCID: PMC10445166 DOI: 10.3389/fped.2023.1169638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 07/05/2023] [Indexed: 08/26/2023] Open
Abstract
Type I interferonopathies are a broad category of conditions associated with increased type I interferon gene expression and include monogenic autoinflammatory diseases and non-Mendelian autoimmune diseases such as dermatomyositis and systemic lupus erythematosus. While a wide range of clinical presentations among type I interferonopathies exists, these conditions often share several clinical manifestations and implications for treatment. Presenting symptoms may mimic non-Mendelian autoimmune diseases, including vasculitis and systemic lupus erythematosus, leading to delayed or missed diagnosis. This review aims to raise awareness about the varied presentations of monogenic interferonopathies to provide early recognition and appropriate treatment to prevent irreversible damage and improve quality of life and outcomes in this unique patient population.
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Affiliation(s)
- Samuel Gagne
- Division of Pediatric Rheumatology, Nationwide Children’s Hospital, Columbus, OH, United States
| | - Vidya Sivaraman
- Division of Pediatric Rheumatology, Nationwide Children’s Hospital, Columbus, OH, United States
- Department of Pediatrics, The Ohio State University, Columbus, OH, United States
| | - Shoghik Akoghlanian
- Division of Pediatric Rheumatology, Nationwide Children’s Hospital, Columbus, OH, United States
- Department of Pediatrics, The Ohio State University, Columbus, OH, United States
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26
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Zhang Y, Liu W, Shu Z, Li Y, Sun F, Li ZG, Han TX, Mao HW, Wang TY. Delayed-onset adenosine deaminase deficiency with a novel synonymous mutation and a case series from China. World J Pediatr 2023; 19:687-700. [PMID: 37154862 DOI: 10.1007/s12519-023-00729-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/11/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Adenosine deaminase (ADA) is a key enzyme in the purine salvage pathway. Genetic defects of the ADA gene can cause a subtype of severe combined immunodeficiency. To date, few Chinese cases have been reported. METHODS We retrospectively reviewed the medical records of patients diagnosed with ADA deficiency in Beijing Children's Hospital and summarized the previously published ADA deficiency cases from China in the literature. RESULTS Nine patients were identified with two novel mutations (W272X and Q202 =). Early-onset infection, thymic abnormalities and failure to thrive were the most common manifestations of Chinese ADA-deficient patients. The ADA genotype has a major effect on the clinical phenotype. Notably, a novel synonymous mutation (c.606G>A, p.Q202=) was identified in a delayed-onset patient, which affected pre-mRNA splicing leading to a frameshift and premature truncation of the protein. Furthermore, the patient showed γδT cells expansion with an increased effect or phenotype, which may be associated with the delayed onset of disease. In addition, we reported cerebral aneurysm and intracranial artery stenosis for the first time in ADA deficiency. Five patients died with a median age of four months, while two patients received stem cell transplantation and are alive. CONCLUSIONS This study described the first case series of Chinese ADA-deficient patients. Early-onset infection, thymic abnormalities and failure to thrive were the most common manifestations in our patients. We identified a synonymous mutation that affected pre-mRNA splicing in the ADA gene, which had never been reported in ADA deficiency. Furthermore, we reported cerebral aneurysm in a delayed-onset patient for the first time. Further study is warranted to investigate the underlying mechanisms.
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Affiliation(s)
- Yue Zhang
- Department of Immunology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nan Lishi Road, Xicheng District, Beijing, 100045, China
| | - Wei Liu
- Hematology Oncology Center, Henan Children's Hospital, Children's Hospital Affiliated of Zhengzhou University, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Zhou Shu
- Department of Immunology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nan Lishi Road, Xicheng District, Beijing, 100045, China
| | - Yan Li
- Department of Immunology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nan Lishi Road, Xicheng District, Beijing, 100045, China
| | - Fei Sun
- Department of Immunology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nan Lishi Road, Xicheng District, Beijing, 100045, China
| | - Zhi-Gang Li
- Hematologic Disease Laboratory, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
- Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nan Lishi Road, Xicheng District, Beijing, 100045, China
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Capital Medical University, Beijing, China
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Tong-Xin Han
- Department of Immunology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nan Lishi Road, Xicheng District, Beijing, 100045, China
| | - Hua-Wei Mao
- Department of Immunology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nan Lishi Road, Xicheng District, Beijing, 100045, China.
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China.
| | - Tian-You Wang
- Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nan Lishi Road, Xicheng District, Beijing, 100045, China.
- Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics, Capital Medical University, Beijing, China.
- Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China.
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27
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Simão Raimundo D, Cordeiro AI, Parente Freixo J, Valente Pinto M, Neves C, Farela Neves J. Case Report: Patient with deficiency of ADA2 presenting leukocytoclastic vasculitis and pericarditis during infliximab treatment. Front Pediatr 2023; 11:1200401. [PMID: 37388286 PMCID: PMC10303984 DOI: 10.3389/fped.2023.1200401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/15/2023] [Indexed: 07/01/2023] Open
Abstract
Deficiency of adenosine deaminase 2 (DADA2), first reported in 2014, is a disease with great phenotypic variability, which has been increasingly reported. Therapeutic response depends on the phenotype. We present a case of an adolescent with recurrent fever, oral aphthous ulcers, and lymphadenopathy from 8 to 12 years of age and subsequently presented with symptomatic neutropenia. After the diagnosis of DADA2, therapy with infliximab was started, but after the second dose, she developed leukocytoclastic vasculitis and showed symptoms of myopericarditis. Infliximab was switched to etanercept, with no relapses. Despite the safety of tumor necrosis factor alpha inhibitors (TNFi), paradoxical adverse effects have been increasingly reported. The differential diagnosis between disease new-onset manifestations of DADA2 and side effects of TNFi can be challenging and warrants further clarification.
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Affiliation(s)
- Diana Simão Raimundo
- Pediatrics Department, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - Ana Isabel Cordeiro
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - João Parente Freixo
- Centro de Genética Preditiva e Preventiva, Instituto de Biologia Molecular e Celular, Instituto de Investigação e Inovação em Saúde, Porto, Portugal
| | - Marta Valente Pinto
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM); Egas Moniz School of Health & Science, Caparica, Almada, Portugal
| | - Conceição Neves
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - João Farela Neves
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
- NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal
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Li GM, Han X, Wu Y, Wang W, Tang HX, Lu MP, Tang XM, Lin Y, Deng F, Yang J, Wang XN, Liu CC, Zheng WJ, Wu BB, Zhou F, Luo H, Zhang L, Liu HM, Guan WZ, Wang SH, Tao PF, Jin TJ, Fang R, Wu Y, Zhang J, Zhang Y, Zhang TN, Yin W, Guo L, Tang WJ, Chang H, Zhang QY, Li XZ, Li JG, Zhou ZX, Yang SR, Yang KK, Xu H, Song HM, Deuitch NT, Lee PY, Zhou Q, Sun L. A Cohort Study on Deficiency of ADA2 from China. J Clin Immunol 2023; 43:835-845. [PMID: 36807221 PMCID: PMC10110724 DOI: 10.1007/s10875-023-01432-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 01/08/2023] [Indexed: 02/21/2023]
Abstract
PURPOSE Deficiency of adenosine deaminase 2 (DADA2), an autosomal recessive autoinflammatory disorder caused by biallelic loss-of-function variants in adenosine deaminase 2 (ADA2), has not been systemically investigated in Chinese population yet. We aim to further characterize DADA2 cases in China. METHODS A retrospective analysis of patients with DADA2 identified through whole exome sequencing (WES) at seventeen rheumatology centers across China was conducted. Clinical characteristics, laboratory findings, genotype, and treatment response were analyzed. RESULTS Thirty patients with DADA2 were enrolled between January 2015 and December 2021. Adenosine deaminase 2 enzymatic activity was low in all tested cases to confirm pathogenicity. Median age of disease presentation was 4.3 years and the median age at diagnosis was 7.8 years. All but one patient presented during childhood and two subjects died from complications of their disease. The patients most commonly presented with systemic inflammation (92.9%), vasculitis (86.7%), and hypogammaglobinemia (73.3%) while one patient presented with bone marrow failure (BMF) with variable cytopenia. Twenty-three (76.7%) patients were treated with TNF inhibitors (TNFi), while two (6.7%) underwent hematopoietic stem cell transplantation (HSCT). They all achieved clinical remission. A total of thirty-nine ADA2 causative variants were identified, six of which were novel. CONCLUSION To establish early diagnosis and improve clinical outcomes, genetic screening and/or testing of ADA2 enzymatic activity should be performed in patients with suspected clinical features. TNFi is considered as first line treatment for those with vascular phenotypes. HSCT may be beneficial for those with hematological disease or in those who are refractory to TNFi.
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Affiliation(s)
- Guo-Min Li
- National Children's Medical Center, Shanghai, China
- Department of Rheumatology, Children's Hospital of Fudan University, Shanghai, China
| | - Xu Han
- Life Sciences Institute, Zhejiang University, Hangzhou, China
| | - Ye Wu
- Peking University First Hospital, Beijing, China
| | - Wei Wang
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hong-Xia Tang
- Wuhan Children's Hospital Tongji Medical College Huazhong University of Science & Technology, Wuhan, China
| | - Mei-Ping Lu
- Department of Rheumatology Immunology and Allergy, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xue-Mei Tang
- Department of Rheumatology and Immunology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Lin
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Fan Deng
- The Children's Hospital of Soochow, Suzhou, China
| | - Jun Yang
- Department of Rheumatology and Immunology, Shenzhen Children's Hospital, Shenzhen, China
| | - Xin-Ning Wang
- Affiliated Children's Hospital of Capital Institute of Pediatrics, Beijing, China
| | - Cong-Cong Liu
- Division of Rheumatology, Immunology & Allergy in the Department of Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Wen-Jie Zheng
- Department of Rheumatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Bing-Bing Wu
- National Children's Medical Center, Shanghai, China
- Medical Transformation Centre, Children's Hospital of Fudan University, Shanghai, China
| | - Fang Zhou
- No. 960 Hospital of the Joint Service Support Force of the Chinese People's Liberation Army, Jinan, China
| | - Hong Luo
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Liang Zhang
- Hunan Provincial People's Hospital, Hunan, China
| | - Hai-Mei Liu
- National Children's Medical Center, Shanghai, China
- Department of Rheumatology, Children's Hospital of Fudan University, Shanghai, China
| | - Wan-Zhen Guan
- National Children's Medical Center, Shanghai, China
- Department of Rheumatology, Children's Hospital of Fudan University, Shanghai, China
| | - Shi-Hao Wang
- Life Sciences Institute, Zhejiang University, Hangzhou, China
| | - Pan-Feng Tao
- Life Sciences Institute, Zhejiang University, Hangzhou, China
| | - Tai-Jie Jin
- Life Sciences Institute, Zhejiang University, Hangzhou, China
| | - Ran Fang
- Life Sciences Institute, Zhejiang University, Hangzhou, China
| | - Yuan Wu
- Peking University First Hospital, Beijing, China
| | - Jie Zhang
- Peking University First Hospital, Beijing, China
| | - Yao Zhang
- Peking University First Hospital, Beijing, China
| | - Tian-Nan Zhang
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Yin
- Wuhan Children's Hospital Tongji Medical College Huazhong University of Science & Technology, Wuhan, China
| | - Li Guo
- Department of Rheumatology Immunology and Allergy, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wen-Jing Tang
- Department of Rheumatology and Immunology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Hong Chang
- Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qiu-Ye Zhang
- Affiliated Hospital of Qingdao University, Qingdao, China
| | | | - Jian-Guo Li
- Affiliated Children's Hospital of Capital Institute of Pediatrics, Beijing, China
| | - Zhi-Xuan Zhou
- Affiliated Children's Hospital of Capital Institute of Pediatrics, Beijing, China
| | - Si-Rui Yang
- Division of Rheumatology, Immunology & Allergy in the Department of Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Kang-Kang Yang
- Department of Rheumatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hong Xu
- National Children's Medical Center, Shanghai, China
- Department of Rheumatology, Children's Hospital of Fudan University, Shanghai, China
| | - Hong-Mei Song
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Pui Y Lee
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Qing Zhou
- Life Sciences Institute, Zhejiang University, Hangzhou, China.
| | - Li Sun
- National Children's Medical Center, Shanghai, China.
- Department of Rheumatology, Children's Hospital of Fudan University, Shanghai, China.
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van der Geest KS, Slijkhuis BG, Tomelleri A, Gheysens O, Jiemy WF, Piccolo C, Nienhuis P, Sandovici M, Brouwer E, Glaudemans AW, Mulder DJ, Slart RH. Positron Emission Tomography Imaging in Vasculitis. Cardiol Clin 2023; 41:251-265. [PMID: 37003681 DOI: 10.1016/j.ccl.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Systemic vasculitides comprise a group of autoimmune diseases affecting blood vessels. [18F]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT) plays an important role in the diagnosis and therapeutic monitoring of vasculitides affecting large-sized and medium-sized vessels. FDG-PET/CT also provides complementary information to other vascular imaging tools. The resolution and sensitivity of newer generation scanners continues to increase, hereby improving the ability of FDG-PET/CT to accurately assess the full disease extent in patients with vasculitis. Novel tracers targeting specific immune cells will allow for more detailed detection of vascular infiltrates.
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30
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Lee PY, Batu ED, Ozen S. Editorial: DADA2 and other monogenic vasculitides. Front Immunol 2022; 13:1108853. [PMID: 36569902 PMCID: PMC9773834 DOI: 10.3389/fimmu.2022.1108853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- Pui Y. Lee
- Division of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States,*Correspondence: Pui Y. Lee,
| | - Ezgi D. Batu
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Türkiye
| | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Türkiye
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31
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Aymonnier K, Amsler J, Lamprecht P, Salama A, Witko‐Sarsat V. The neutrophil: A key resourceful agent in immune‐mediated vasculitis. Immunol Rev 2022; 314:326-356. [PMID: 36408947 DOI: 10.1111/imr.13170] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The term "vasculitis" refers to a group of rare immune-mediated diseases characterized by the dysregulated immune system attacking blood vessels located in any organ of the body, including the skin, lungs, and kidneys. Vasculitides are classified according to the size of the vessel that is affected. Although this observation is not specific to small-, medium-, or large-vessel vasculitides, patients show a high circulating neutrophil-to-lymphocyte ratio, suggesting the direct or indirect involvement of neutrophils in these diseases. As first responders to infection or inflammation, neutrophils release cytotoxic mediators, including reactive oxygen species, proteases, and neutrophil extracellular traps. If not controlled, this dangerous arsenal can injure the vascular system, which acts as the main transport route for neutrophils, thereby amplifying the initial inflammatory stimulus and the recruitment of immune cells. This review highlights the ability of neutrophils to "set the tone" for immune cells and other cells in the vessel wall. Considering both their long-established and newly described roles, we extend their functions far beyond their direct host-damaging potential. We also review the roles of neutrophils in various types of primary vasculitis, including immune complex vasculitis, anti-neutrophil cytoplasmic antibody-associated vasculitis, polyarteritis nodosa, Kawasaki disease, giant cell arteritis, Takayasu arteritis, and Behçet's disease.
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Affiliation(s)
- Karen Aymonnier
- INSERM U1016, Institut Cochin, Université Paris Cité, CNRS 8104 Paris France
| | - Jennifer Amsler
- INSERM U1016, Institut Cochin, Université Paris Cité, CNRS 8104 Paris France
| | - Peter Lamprecht
- Department of Rheumatology and Clinical Immunology University of Lübeck Lübeck Germany
| | - Alan Salama
- Department of Renal Medicine, Royal Free Hospital University College London London UK
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32
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Luo W, Dong L, Chen F, Lei W, He L, Zhou Q, Lamy T, Zavialov AV. ELISA based assays to measure adenosine deaminases concentration in serum and saliva for the diagnosis of ADA2 deficiency and cancer. Front Immunol 2022; 13:928438. [PMID: 35967411 PMCID: PMC9366848 DOI: 10.3389/fimmu.2022.928438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/11/2022] [Indexed: 12/25/2022] Open
Abstract
Adenosine deaminases (ADAs) are enzymes of purine metabolism converting adenosine to inosine. There are two types of ADAs in humans ADA1 and ADA2. While both ADA1 and ADA2 share the same substrate, they differ in expression, cellular localization, and catalytic properties. The genetic deficiency of ADA1 results in severe combined immunodeficiency (SCID), while lack in ADA2 (DADA2) results in multiple phenotypes ranging from systemic inflammation to vascular pathology. Clinical studies have shown that the levels of ADAs in biological fluids are altered in pathophysiological conditions, suggesting that ADA activity could be a convenient marker for the diagnosis of immune diseases and cancer. Here, we describe sensitive and straightforward ELISA assays to measure ADA1 and ADA2 concentrations in biological fluids. Analysis of the serum and saliva samples from the healthy controls and DADA2 patients revealed that ADA2 enzyme concentration is significantly lower in patients than in healthy controls. In contrast, the concentration of ADA2 increases in the serum of patients with large granular leukocyte leukemia (LGLL) and patients’ saliva with head and neck cancer. Thus, this simple, non-invasive method allows for distinguishing healthy controls from the affected patient. It can be implemented in screening and diagnosis of DADA2 and follow up the treatment of LGLL and several types of head and neck cancer.
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Affiliation(s)
- Wenwen Luo
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Liang Dong
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Fenghong Chen
- Otorhinolaryngology Hospital, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wenbin Lei
- Otorhinolaryngology Hospital, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liya He
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Qing Zhou
- Life Sciences Institute, Zhejiang University, Hangzhou, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
| | - Thierry Lamy
- Department of Hematology, Pontchaillou University Hospital, Rennes, France
| | - Andrey V. Zavialov
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
- Turku Centre for Biotechnology, University of Turku, Turku, Finland
- *Correspondence: Andrey V. Zavialov,
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33
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Signa S, Bertoni A, Penco F, Caorsi R, Cafaro A, Cangemi G, Volpi S, Gattorno M, Schena F. Adenosine Deaminase 2 Deficiency (DADA2): A Crosstalk Between Innate and Adaptive Immunity. Front Immunol 2022; 13:935957. [PMID: 35898506 PMCID: PMC9309328 DOI: 10.3389/fimmu.2022.935957] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/10/2022] [Indexed: 11/30/2022] Open
Abstract
Deficiency of Adenosine deaminase 2 (DADA2) is a monogenic autoinflammatory disorder presenting with a broad spectrum of clinical manifestations, including immunodeficiency, vasculopathy and hematologic disease. Biallelic mutations in ADA2 gene have been associated with a decreased ADA2 activity, leading to reduction in deamination of adenosine and deoxyadenosine into inosine and deoxyinosine and subsequent accumulation of extracellular adenosine. In the early reports, the pivotal role of innate immunity in DADA2 pathogenic mechanism has been underlined, showing a skewed polarization from the M2 macrophage subtype to the proinflammatory M1 subtype, with an increased production of inflammatory cytokines such as TNF-α. Subsequently, a dysregulation of NETosis, triggered by the excess of extracellular Adenosine, has been implicated in the pathogenesis of DADA2. In the last few years, evidence is piling up that adaptive immunity is profoundly altered in DADA2 patients, encompassing both T and B branches, with a disrupted homeostasis in T-cell subsets and a B-cell skewing defect. Type I/type II IFN pathway upregulation has been proposed as a possible core signature in DADA2 T cells and monocytes but also an increased IFN-β secretion directly from endothelial cells has been described. So far, a unifying clear pathophysiological explanation for the coexistence of systemic inflammation, immunedysregulation and hematological defects is lacking. In this review, we will explore thoroughly the latest understanding regarding DADA2 pathophysiological process, with a particular focus on dysregulation of both innate and adaptive immunity and their interacting role in the development of the disease.
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Affiliation(s)
- Sara Signa
- Center for Autoinflammatory Diseases and Immunodeficiencies, Istituto di Ricovero e cura a carattere scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Arinna Bertoni
- Center for Autoinflammatory Diseases and Immunodeficiencies, Istituto di Ricovero e cura a carattere scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences (DINOGMI), University of Genoa, Genoa, Italy
| | - Federica Penco
- Center for Autoinflammatory Diseases and Immunodeficiencies, Istituto di Ricovero e cura a carattere scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Roberta Caorsi
- Center for Autoinflammatory Diseases and Immunodeficiencies, Istituto di Ricovero e cura a carattere scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Alessia Cafaro
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, Istituto di Ricovero e cura a carattere scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Giuliana Cangemi
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, Istituto di Ricovero e cura a carattere scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Stefano Volpi
- Center for Autoinflammatory Diseases and Immunodeficiencies, Istituto di Ricovero e cura a carattere scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences (DINOGMI), University of Genoa, Genoa, Italy
| | - Marco Gattorno
- Center for Autoinflammatory Diseases and Immunodeficiencies, Istituto di Ricovero e cura a carattere scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
- *Correspondence: Marco Gattorno,
| | - Francesca Schena
- Center for Autoinflammatory Diseases and Immunodeficiencies, Istituto di Ricovero e cura a carattere scientifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
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Hashem H, Dimitrova D, Meyts I. Allogeneic Hematopoietic Cell Transplantation for Patients With Deficiency of Adenosine Deaminase 2 (DADA2): Approaches, Obstacles and Special Considerations. Front Immunol 2022; 13:932385. [PMID: 35911698 PMCID: PMC9336546 DOI: 10.3389/fimmu.2022.932385] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/20/2022] [Indexed: 01/07/2023] Open
Abstract
Deficiency of adenosine deaminase 2 (DADA2) is an inherited autosomal recessive disease characterized by autoinflammation (recurrent fever), vasculopathy (livedo racemosa, polyarteritis nodosa, lacunar ischemic strokes, and intracranial hemorrhages, end organ vasculitis), immunodeficiency, lymphoproliferation, immune cytopenias, and bone marrow failure. Allogeneic hematopoietic cell transplantation (HCT) is curative for DADA2 as it reverses the hematological, immune and vascular phenotype of DADA2. The primary goal of HCT in DADA2, like in other non-malignant diseases, is engraftment with the establishment of normal hematopoiesis and normal immune function. Strategies in selecting a preparative regimen should take into consideration the specific vulnerabilities to endothelial dysfunction and liver toxicity in DADA2 patients. Overcoming an increased risk of graft rejection while minimizing organ toxicity, graft-versus-host disease, and infections can be particularly challenging in DADA2 patients. This review will discuss approaches to HCT in DADA2 patients including disease-specific considerations, barriers to successful engraftment, post-HCT complications, and clinical outcomes of published patients with DADA2 who have undergone HCT to date.
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Affiliation(s)
- Hasan Hashem
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, Bone Marrow Transplant Unit, King Hussein Cancer Center (KHCC), Amman, Jordan
- *Correspondence: Hasan Hashem, ; Isabelle Meyts,
| | - Dimana Dimitrova
- Experimental Transplantation and Immunotherapy Branch, National Cancer Institute of the National Institutes of Health, Bethesda, MD, United States
| | - Isabelle Meyts
- Department of Pediatrics, Microbiology, Immunology, and Transplantation, The European Reference Network Rare Immunodeficiency Autoinflammatory and Autoimmune Diseases Network (ERN RITA) Core Center, University Hospitals Leuven, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
- *Correspondence: Hasan Hashem, ; Isabelle Meyts,
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Kisla Ekinci RM, Anlas O, Ozalp O. Clinical presentation of children with Deficiency of Adenosine deaminase 2: A case series. Eur J Med Genet 2022; 65:104555. [PMID: 35777620 DOI: 10.1016/j.ejmg.2022.104555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/09/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022]
Abstract
Deficiency of Adenosine deaminase 2 (DADA2) is a monogenic inflammatory disease, caused by mutations in ADA2 gene, which encodes an extracellular enzyme acting as a monocyte differentiation factor. DADA2 is first described with the clinical picture resembling polyarteritis nodosa, including livedo racemose, recurrent fever, musculoskeletal complaints. Besides, some patients have cytopenia, lymphoproliferation and mild to moderate immunodeficiency. The most crucial complication of DADA2 is neurological involvement, especially arterial stroke, which necessitates continuous treatment with anti-tumor necrosis factor α (anti-TNFα) treatment for preventing further stroke attacks. Herein, we report 5 DADA2 patients from 5 unrelated families, all had G47R mutation in at least one allele. All patients had livedo racemose, and 4 patients suffered from recurrent fever. Besides, musculoskeletal complaints and gastrointestinal symptoms were present in 4 and 3 patients, respectively. One patient had chronic arthritis and only one patient had a history of recurrent stroke without any sequela. Hematological and immunological involvement occurred in 3 and 4 patients, respectively, whereas only one had significant panhypogammaglobulinemia, requiring replacement therapy. We started etanercept treatment to all patients, which resulted the complete resolution of systemic inflammatory attacks and skin lesions and provided neurologically symptom free during their follow-up. With this report, we emphasize the importance of early referral of the patients with suspected livedo racemose to avoid the delay of DADA2 diagnosis for favorable outcome.
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Affiliation(s)
| | - Ozlem Anlas
- Department of Medical Genetics, Adana City Training and Research Hospital, Adana, Turkey.
| | - Ozge Ozalp
- Department of Medical Genetics, Adana City Training and Research Hospital, Adana, Turkey.
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36
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Grayson PC, Kaplan MJ. Diseases of blood vessels: Immune system involvement in vasculitis and vasculopathy. Semin Immunopathol 2022; 44:255-258. [PMID: 35503576 PMCID: PMC9063614 DOI: 10.1007/s00281-022-00929-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Peter C Grayson
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health / NIAMS, 10 Center Drive, Building 10, 12N Rm 248B, Bethesda, MD, 20892, USA.
| | - Mariana J Kaplan
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health / NIAMS, 10 Center Drive, Building 10, 12N Rm 248B, Bethesda, MD, 20892, USA
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