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Federici S, Cinicola BL, La Torre F, Castagnoli R, Lougaris V, Giardino G, Volpi S, Caorsi R, Leonardi L, Corrente S, Soresina A, Cancrini C, Insalaco A, Gattorno M, De Benedetti F, Marseglia GL, Del Giudice MM, Cardinale F. Vasculitis and vasculopathy associated with inborn errors of immunity: an overview. Front Pediatr 2024; 11:1258301. [PMID: 38357265 PMCID: PMC10866297 DOI: 10.3389/fped.2023.1258301] [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: 07/13/2023] [Accepted: 11/29/2023] [Indexed: 02/16/2024] Open
Abstract
Systemic autoinflammatory diseases (SAIDs) are disorders of innate immunity, which are characterized by unprovoked recurrent flares of systemic inflammation often characterized by fever associated with clinical manifestations mainly involving the musculoskeletal, mucocutaneous, gastrointestinal, and nervous systems. Several conditions also present with varied, sometimes prominent, involvement of the vascular system, with features of vasculitis characterized by variable target vessel involvement and organ damage. Here, we report a systematic review of vasculitis and vasculopathy associated with inborn errors of immunity.
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Affiliation(s)
- Silvia Federici
- Division of Rheumatology, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Bianca Laura Cinicola
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesco La Torre
- Department of Pediatrics, Giovanni XXIII Pediatric Hospital, University of Bari, Bari, Italy
| | - Riccardo Castagnoli
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vassilios Lougaris
- Department of Clinical and Experimental Sciences, Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, University of Brescia and ASST-Spedali Civili di Brescia, Brescia, Italy
| | - Giuliana Giardino
- Pediatric Section, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Stefano Volpi
- Center for Autoinflammatory Diseases and Immunodeficiency, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Roberta Caorsi
- Center for Autoinflammatory Diseases and Immunodeficiency, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Lucia Leonardi
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Annarosa Soresina
- Unit of Pediatric Immunology, Pediatrics Clinic, University of Brescia, ASST-Spedali Civili Brescia, Brescia, Italy
| | - Caterina Cancrini
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Academic Department of Pediatrics, Immune and Infectious Diseases Division, Research Unit of Primary Immunodeficiencies, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonella Insalaco
- Division of Rheumatology, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Marco Gattorno
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Gian Luigi Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Michele Miraglia Del Giudice
- Department of Woman, Child and of General and Specialized Surgery, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Fabio Cardinale
- Department of Pediatrics, Giovanni XXIII Pediatric Hospital, University of Bari, Bari, Italy
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2
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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: 0] [Impact Index Per Article: 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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3
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Maccora I, Maniscalco V, Campani S, Carrera S, Abbati G, Marrani E, Mastrolia MV, Simonini G. A wide spectrum of phenotype of deficiency of deaminase 2 (DADA2): a systematic literature review. Orphanet J Rare Dis 2023; 18:117. [PMID: 37179309 PMCID: PMC10183141 DOI: 10.1186/s13023-023-02721-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 05/01/2023] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION Deficiency of adenosine deaminase 2 (DADA2) is a rare monogenic autoinflammatory disease, whose clinical phenotype was expanded since the first cases, originally described as mimicker of polyarteritis nodosa, with immunodeficiency and early-onset stroke. METHODS A systematic review according to PRISMA approach, including all articles published before the 31st of August 2021 in Pubmed and EMBASE database was performed. RESULTS The search identified 90 publications describing 378 unique patients (55.8% male). To date 95unique mutations have been reported. The mean age at disease onset was 92.15 months (range 0-720 months), 32 (8.5%) showed an onset of the first signs/symptoms after 18 years old and 96 (25.4%) after 10 years old. The most frequent clinical characteristics described were cutaneous (67.9%), haematological manifestations (56.3%), recurrent fever (51.3%), neurological as stroke and polyneuropathy (51%), immunological abnormalities (42.3%), arthralgia/arthritis (35.4%), splenomegaly (30.6%), abdominal involvement (29.8%), hepatomegaly (23.5%), recurrent infections (18.5%), myalgia (17.9%), kidney involvement (17.7%) etc. Patients with skin manifestations were older than the others (101.1 months SD ± 116.5, vs. 75.3 SD ± 88.2, p 0.041), while those with a haematological involvement (64.1 months SD ± 75.6 vs. 133.1 SD ± 133.1, p < 0.001) and immunological involvement (73.03 months SD ± 96.9 vs. 103.2 SD ± 112.9, p 0.05) are younger than the others. We observed different correlations among the different clinical manifestations. The use of anti-TNFα and hematopoietic cell stems transplantation (HCST) has improved the current history of the disease. CONCLUSION Due to this highly variable phenotype and age of presentation, patients with DADA2 may present to several type of specialists. Given the important morbidity and mortality, early diagnosis and treatment are mandatory.
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Affiliation(s)
- Ilaria Maccora
- Rheumatology Unit, ERN ReConnet Center, Meyer Children's Hospital IRCCS, Florence, Italy.
- NeuroFARBA Department, University of Florence, Florence, Italy.
| | | | - Silvia Campani
- School of Health Science, University of Florence, Florence, Italy
| | - Simona Carrera
- School of Health Science, University of Florence, Florence, Italy
| | - Giulia Abbati
- School of Health Science, University of Florence, Florence, Italy
| | - Edoardo Marrani
- Rheumatology Unit, ERN ReConnet Center, Meyer Children's Hospital IRCCS, Florence, Italy
| | | | - Gabriele Simonini
- Rheumatology Unit, ERN ReConnet Center, Meyer Children's Hospital IRCCS, Florence, Italy
- NeuroFARBA Department, University of Florence, Florence, Italy
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4
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Sharma V, Deo P, Sharma A. Deficiency of adenosine deaminase 2 (DADA2): Review. Best Pract Res Clin Rheumatol 2023; 37:101844. [PMID: 37328410 DOI: 10.1016/j.berh.2023.101844] [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: 03/29/2023] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 06/18/2023]
Abstract
The deficiency of adenosine deaminase 2 (DADA2) is an autosomal recessive disease caused by loss-of-function (LOF) mutations in the ADA2 gene and was first described in 2014. Initially, it was described as vasculopathy/vasculitis that mostly affected infants and young children and closely resembled polyarteritis nodosa (PAN). Skin rash and ischemic/hemorrhagic stroke are predominant symptoms. However, the clinical spectrum of DADA2 has continued to expand since then. It has now been reported in adults as well. Besides vasculitis-related manifestations, hematological, immunological, and autoinflammatory manifestations are now well recognized. More than 100 disease-causing mutations have been described. The decrease in ADA2 enzyme leads to an increased extracellular adenosine level that, in turn, triggers a proinflammatory cascade. The disease is highly variable, and patients carrying same mutation may have different ages of presentation and clinical features. Anti-tumor necrosis factor (TNF) agents are mainstay of treatment of the vasculitis/vasculopathy phenotype. Hematopoietic stem cell transplant (HSCT) has been performed in patients with severe hematological manifestations. Recombinant ADA2 protein and gene therapy hold a promise for future.
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Affiliation(s)
- Vikas Sharma
- Rheumatology Superspeciality Cell, Department of Medicine, IGMC Shimla and Clinical Immunology and Rheumatology Division, Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Prateek Deo
- Rheumatology Superspeciality Cell, Department of Medicine, IGMC Shimla and Clinical Immunology and Rheumatology Division, Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Aman Sharma
- Rheumatology Superspeciality Cell, Department of Medicine, IGMC Shimla and Clinical Immunology and Rheumatology Division, Department of Internal Medicine, PGIMER, Chandigarh, India.
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5
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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: 0.5] [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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6
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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: 5] [Impact Index Per Article: 2.5] [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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Sumiyoshi R, Koga T, Kawakami A. Candidate biomarkers for idiopathic multicentric Castleman disease. J Clin Exp Hematop 2022; 62:85-90. [PMID: 35768241 PMCID: PMC9353853 DOI: 10.3960/jslrt.22010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The clinical manifestations of idiopathic multicentric Castleman disease (iMCD) are thought to be caused by an excess of inflammatory cytokines; however, the mechanism is yet to be known. In addition to IL-6, inflammatory cytokines, such as IL-1β and TNF-α, are noted to be elevated in iMCD, which are common in autoinflammatory diseases. The first-line treatment for iMCD is an IL-6 inhibitor. Furthermore, increases in inflammatory cytokines such as serum IL-10 and IL-23, chemokines such as CXCL13 and CXCL-10 (especially in iMCD-TAFRO), and VEGF-A have been observed, and their relationship to pathogenesis has attracted the attention of researchers. The PI3K/Akt/mTOR pathway, JAK/STAT3 pathway, and type I IFN as drivers have recently been identified as important signals and are expected to be therapeutic targets in cases where IL-6 inhibitors are ineffective.
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Affiliation(s)
- Remi Sumiyoshi
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Nagasaki University Hospital, Clinical Research Center, Nagasaki, Japan
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Center for Bioinformatics and Molecular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Pilania RK, Banday AZ, Sharma S, Kumrah R, Joshi V, Loganathan S, Dhaliwal M, Jindal AK, Vignesh P, Suri D, Rawat A, Singh S. Deficiency of Human Adenosine Deaminase Type 2 - A Diagnostic Conundrum for the Hematologist. Front Immunol 2022; 13:869570. [PMID: 35592317 PMCID: PMC9110783 DOI: 10.3389/fimmu.2022.869570] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/28/2022] [Indexed: 02/06/2023] Open
Abstract
Deficiency of adenosine deaminase type 2 (DADA2) was first described in 2014 as a monogenic cause of polyartertitis nodosa (PAN), early onset lacunar stroke and livedo reticularis. The clinical phenotype of DADA2 is, however, very broad and may involve several organ systems. Apart from vasculitis, children may present with i) Hematological manifestations (ii) Lymphoproliferation and iii) Immunodeficiencies. Patients with DADA2 can have variable patterns of cytopenias and bone marrow failure syndromes. Patients with DADA2 who have predominant haematological manifestations are associated with ADA2 gene variants that result in minimal or no residual ADA2 activity. Lymphoproliferation in patients with DADA2 may range from benign lymphoid hyperplasia to lymphoreticular malignancies. Patients may present with generalized lymphadenopathy, splenomegaly, autoimmune lymphoproliferative syndrome (ALPS) like phenotype, Hodgkin lymphoma, T-cell large granular lymphocytic infiltration of bone marrow and multicentric Castleman disease. Immunodeficiencies associated with DADA are usually mild. Affected patients have variable hypogammaglobulinemia, decrease in B cells, low natural killer cells, common variable immunodeficiency and rarely T cell immunodeficiency. To conclude, DADA2 has an extremely variable phenotype and needs to be considered as a differential diagnosis in diverse clinical conditions. In this review, we describe the evolving clinical phenotypes of DADA2 with a special focus on haematological and immunological manifestations.
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Affiliation(s)
- Rakesh Kumar Pilania
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aaqib Zaffar Banday
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Saniya Sharma
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajni Kumrah
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vibhu Joshi
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sathish Loganathan
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Manpreet Dhaliwal
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ankur Kumar Jindal
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pandiarajan Vignesh
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepti Suri
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amit Rawat
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Surjit Singh
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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9
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Stellingwerff MD, Nulton C, Helman G, Roosendaal SD, Benko WS, Pizzino A, Bugiani M, Vanderver A, Simons C, van der Knaap MS. Early-Onset Vascular Leukoencephalopathy Caused by Bi-Allelic NOTCH3 Variants. Neuropediatrics 2022; 53:115-121. [PMID: 35026854 PMCID: PMC9270846 DOI: 10.1055/a-1739-2722] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Heterozygous NOTCH3 variants are known to cause cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), with patients typically presenting in adulthood. We describe three patients presenting at an early age with a vascular leukoencephalopathy. Genome sequencing revealed bi-allelic variants in the NOTCH3 gene. METHODS Clinical records and available MRI and CT scans of three patients from two unrelated families were retrospectively reviewed. RESULTS The patients presented at 9 to 14 months of age with developmental delay, seizures, or both. The disease course was characterized by cognitive impairment and variably recurrent strokes, migraine attacks, and seizures. MRI findings pointed at a small vessel disease, with extensive cerebral white matter abnormalities, atrophy, lacunes in the basal ganglia, microbleeds, and microcalcifications. The anterior temporal lobes were spared. Bi-allelic cysteine-sparing NOTCH3 variants in exons 1, 32, and 33 were found. INTERPRETATION This study indicates that bi-allelic loss-of-function NOTCH3 variants may cause a vascular leukoencephalopathy, distinct from CADASIL.
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Affiliation(s)
- Menno D. Stellingwerff
- Department of Child Neurology, Emma Children’s Hospital, Amsterdam University Medical Centers, Vrije Universiteit and Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Corinne Nulton
- Department of Neurology, University of Pittsburgh Medical Center, Pennsylvania, United States
| | - Guy Helman
- Translational Bioinformatics, Murdoch Children’s Research Institute, The Royal Children’s Hospital, Victoria, Australia,Genetics and Genomics, Institute for Molecular Bioscience, The University of Queensland, Queensland, Australia
| | - Stefan D. Roosendaal
- Department of Radiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - William S. Benko
- Department of Neurology, University of California Davis, Sacramento, California, United States
| | - Amy Pizzino
- Division of Neurology, Children’s Hospital of Philadelphia, Abramson Research Center, Philadelphia, Pennsylvania, United States
| | - Marianna Bugiani
- Department of Pathology, Amsterdam UMC, location VUmc, The Netherlands
| | - Adeline Vanderver
- Division of Neurology, Children’s Hospital of Philadelphia, Abramson Research Center, Philadelphia, Pennsylvania, United States,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Cas Simons
- Translational Bioinformatics, Murdoch Children’s Research Institute, The Royal Children’s Hospital, Victoria, Australia,Genetics and Genomics, Institute for Molecular Bioscience, The University of Queensland, Queensland, Australia
| | - Marjo S. van der Knaap
- Department of Child Neurology, Emma Children’s Hospital, Amsterdam University Medical Centers, Vrije Universiteit and Amsterdam Neuroscience, Amsterdam, The Netherlands,Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, VU University, Amsterdam, The Netherlands
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10
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Lin B, Goldbach-Mansky R. Pathogenic insights from genetic causes of autoinflammatory inflammasomopathies and interferonopathies. J Allergy Clin Immunol 2022; 149:819-832. [PMID: 34893352 PMCID: PMC8901451 DOI: 10.1016/j.jaci.2021.10.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/31/2021] [Accepted: 10/06/2021] [Indexed: 12/22/2022]
Abstract
A number of systemic autoinflammatory diseases arise from gain-of-function mutations in genes encoding IL-1-activating inflammasomes or cytoplasmic nucleic acid sensors including the receptor and sensor STING and result in increased IL-1 and type I interferon production, respectively. Blocking these pathways in human diseases has provided proof-of-concept, confirming the prominent roles of these cytokines in disease pathogenesis. Recent insights into the multilayered regulation of these sensor pathways and insights into their role in amplifying the disease pathogenesis of monogenic and complex genetic diseases spurred new drug development targeting the sensors. This review provides insights into the pathogenesis and genetic causes of these "prototypic" diseases caused by gain-of function mutations in IL-1-activating inflammasomes (inflammasomopathies) and in interferon-activating pathways (interferonopathies) including STING-associated vasculopathy with onset in infancy, Aicardi-Goutieres syndrome, and proteasome-associated autoinflammatory syndromes that link activation of the viral sensors STING, "self" nucleic acid metabolism, and the ubiquitin-proteasome system to "type I interferon production" and human diseases. Clinical responses and biomarker changes to Janus kinase inhibitors confirm a role of interferons, and a growing number of diseases with "interferon signatures" unveil extensive cross-talk between major inflammatory pathways. Understanding these interactions promises new tools in tackling the significant clinical challenges in treating patients with these conditions.
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Affiliation(s)
- Bin Lin
- Translational Autoinflammatory Diseases Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.
| | - Raphaela Goldbach-Mansky
- Translational Autoinflammatory Diseases Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.
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11
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Albalawi R, Hanafy E, Alnafea H, Altowijiry M, Riyad S, Abufara F, Albolowi N. Novel Adenosine Deaminase 2 (ADA2) Mutations Associated With Hematological Manifestations. J Investig Med High Impact Case Rep 2021; 9:23247096211056770. [PMID: 34845942 PMCID: PMC8637373 DOI: 10.1177/23247096211056770] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Recent progress in laboratory techniques, particularly, identification of novel disease-causing genes, has led to the detection of different gene mutations that might be implicated in the pathogenesis of different hematological disorders like pure red cell aplasia (PRCA) and neutropenia. An autoinflammatory disorder known as deficiency of adenosine deaminase 2 (DADA2) has been recently noticed to present with variable hematologic abnormalities. We report 2 patients who presented with hematologic abnormalities in which 2 ADA2 gene mutations were detected. The first case is a 5-year-old girl who presented with severe PRCA and autoimmune hemolytic anemia without any other manifestation of DADA2 that resulted from a novel CECR1 c.714_738dup, p. (Ala247Glnfs*16) homozygous variant. The second case is a 10-year-old boy, known to have Hodgkin lymphoma and was under follow-up for 6 years; he presented with persistent neutropenia and was discovered to be homozygous for ADA2 c.1447_1451del, p. (Ser483Profs*5). In conclusion, we report two different novels ADA2 variants in two children; the first presented with PRCA and the second presented with persistent neutropenia. This report aims to raise the concerns regarding the use of genetic testing in different hematologic diseases with indefinite etiology, as it will lead to the best therapeutic strategies without the need for unnecessary interventions.
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Affiliation(s)
| | - Ehab Hanafy
- King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
| | | | | | - Shaima Riyad
- King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
| | - Fadwa Abufara
- King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
| | - Naif Albolowi
- King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
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12
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Sharma A, Agarwal A, Srivastava P, Garg A, Rajan R, Gupta A, Bhatia R, Singh MB, Sharma MC, Vishnu V. Hypertension with recurrent focal deficits. Pract Neurol 2021; 21:555-558. [PMID: 34059557 DOI: 10.1136/practneurol-2021-003020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 11/04/2022]
Affiliation(s)
| | | | | | - Ajay Garg
- Neuroradiology, AIIMS, New Delhi, India
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13
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Deuitch NT, Yang D, Lee PY, Yu X, Moura NS, Schnappauf O, Ombrello AK, Stone D, Kuehn HS, Rosenzweig SD, Hoffmann P, Cudrici C, Levy DM, Kessler E, Soep JB, Hay AD, Dalrymple A, Zhang Y, Sun L, Zhang Q, Tang X, Wu Y, Rao K, Li H, Luo H, Zhang Y, Burnham JM, Boehm M, Barron K, Kastner DL, Aksentijevich I, Zhou Q. TNF-inhibition in vasculitis management in adenosine deaminase 2 deficiency (DADA2). J Allergy Clin Immunol 2021; 149:1812-1816.e6. [PMID: 34780847 DOI: 10.1016/j.jaci.2021.10.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/25/2021] [Accepted: 10/28/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Deficiency of adenosine deaminase 2 (DADA2) is a recessively inherited autoinflammatory disorder caused by a loss of functional ADA2 protein. TNF inhibition (TNFi) has proven to be highly effective in treating inflammatory manifestations. OBJECTIVE To explore the pathophysiology and the underlying mechanisms of TNF inhibitor response in these patients. METHODS We performed Sanger sequencing of the ADA2 gene. We used flow cytometry, intracellular cytokine staining, transcriptome analysis, immunohistochemistry, and cell differentiation experiments to define an inflammatory signature in DADA2 patients and studied their response to TNF inhibitor treatment. RESULTS We demonstrated increased inflammatory signals and overproduction of cytokines mediated by IFN and NF-κB pathways in patients' primary cells. Treatment with TNFi led to reduction in inflammation, rescued the skewed differentiation towards the pro-inflammatory M1 macrophage subset and restored integrity of endothelial cells in blood vessels. We also report 8 novel disease-associated variants in 7 patients with DADA2. CONCLUSION Our data explore the cellular mechanism underlying effective treatment with TNFi therapies in DADA2. DADA2 vasculitis is strongly related to the presence of activated myeloid cells and the endothelial cell damage is rescued with anti-TNF treatment.
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Affiliation(s)
- Natalie T Deuitch
- National Human Genome Research Institute, National Institutes of Health, USA.
| | - Dan Yang
- National Heart, Lung, and Blood Institute, National Institutes of Health, USA
| | | | - Xiaomin Yu
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China
| | | | - Oskar Schnappauf
- National Human Genome Research Institute, National Institutes of Health, USA
| | - Amanda K Ombrello
- National Human Genome Research Institute, National Institutes of Health, USA
| | - Deborah Stone
- National Human Genome Research Institute, National Institutes of Health, USA
| | - Hye Sun Kuehn
- Department of Laboratory Medicine, National Institutes of Health Clinical Center, USA
| | - Sergio D Rosenzweig
- Department of Laboratory Medicine, National Institutes of Health Clinical Center, USA
| | - Patrycja Hoffmann
- National Human Genome Research Institute, National Institutes of Health, USA
| | - Cornelia Cudrici
- National Heart, Lung, and Blood Institute, National Institutes of Health, USA
| | - Deborah M Levy
- University of Toronto, The Hospital for Sick Children, Canada
| | | | | | | | - Austin Dalrymple
- Saint Louis University School of Medicine, SSM Health Cardinal Glennon Children's Hospital
| | - Yu Zhang
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, USA
| | - Li Sun
- Children's Hospital of Fudan University, China
| | - Qiuye Zhang
- Affiliated Hospital of Qingdao University, China
| | - Xuemei Tang
- Children's Hospital of Chongqing Medical University, China
| | - Yuan Wu
- Peking University First Hospital, China
| | - Koneti Rao
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, USA
| | - Haibo Li
- Ningbo Women and Children's Hospital, China
| | - Hong Luo
- The Second Xiangya Hospital of Central South University, China
| | - Yao Zhang
- Peking University First Hospital, China
| | | | - Manfred Boehm
- National Heart, Lung, and Blood Institute, National Institutes of Health, USA
| | - Karyl Barron
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, USA
| | - Daniel L Kastner
- National Human Genome Research Institute, National Institutes of Health, USA
| | - Ivona Aksentijevich
- National Human Genome Research Institute, National Institutes of Health, USA.
| | - Qing Zhou
- National Human Genome Research Institute, National Institutes of Health, USA; Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, China; Life Sciences Institute, Zhejiang University, China.
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14
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Dell'Orso G, Grossi A, Penco F, Caorsi R, Palmisani E, Terranova P, Schena F, Lupia M, Ricci E, Montalto S, Pierri F, Ceccherini I, Fioredda F, Dufour C, Gattorno M, Miano M. Case Report: Deficiency of Adenosine Deaminase 2 Presenting With Overlapping Features of Autoimmune Lymphoproliferative Syndrome and Bone Marrow Failure. Front Immunol 2021; 12:754029. [PMID: 34721429 PMCID: PMC8552009 DOI: 10.3389/fimmu.2021.754029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/23/2021] [Indexed: 11/20/2022] Open
Abstract
Deficiency of adenosine deaminase 2 (DADA2) is an autosomal recessive disease associated with a highly variable clinical presentation, such as vasculitis, inflammation, and hematologic manifestations. Some associations of clinical features can mimic autoimmune lymphoproliferative syndrome (ALPS). We report a case of a female patient who fulfilled the 2009 National Institute of Health revised criteria for ALPS and received a delayed diagnosis of DADA2. During her childhood, she suffered from autoimmune hemolytic anemia, immune thrombocytopenia, and chronic lymphoproliferation, which partially responded to multiple lines of treatments and were followed, at 25 years of age, by pulmonary embolism, septic shock, and bone marrow failure with myelodysplastic evolution. The patient died from the progression of pulmonary disease and multiorgan failure. Two previously unreported variants of gene ADA2/CECR1 were found through next-generation sequencing analysis, and a pathogenic role was demonstrated through a functional study. A single somatic STAT3 mutation was also found. Clinical phenotypes encompassing immune dysregulation and marrow failure should be evaluated at the early stage of diagnostic work-up with an extended molecular evaluation. A correct genetic diagnosis may lead to a precision medicine approach consisting of the use of targeted treatments or early hematopoietic stem cell transplantation.
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Affiliation(s)
- Gianluca Dell'Orso
- Hematology Unit, Istituto di Ricerca e Cura a Carattere Scintifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Alice Grossi
- Unitá Operativa Semplice Dipartimentale (UOSD) Genetics and Genomics of Rare Diseases, Istituto di Ricerca e Cura a Carattere Scintifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Federica Penco
- Clinica Pediatrica e Reumatologia e Centro Malattie Autoinfiammatorie e Immunodeficienze, Istituto di Ricerca e Cura a Carattere Scintifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Roberta Caorsi
- Clinica Pediatrica e Reumatologia e Centro Malattie Autoinfiammatorie e Immunodeficienze, Istituto di Ricerca e Cura a Carattere Scintifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Elena Palmisani
- Hematology Unit, Istituto di Ricerca e Cura a Carattere Scintifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Paola Terranova
- Hematology Unit, Istituto di Ricerca e Cura a Carattere Scintifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Francesca Schena
- Clinica Pediatrica e Reumatologia e Centro Malattie Autoinfiammatorie e Immunodeficienze, Istituto di Ricerca e Cura a Carattere Scintifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Michela Lupia
- Hematology Unit, Istituto di Ricerca e Cura a Carattere Scintifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Erica Ricci
- Covid Hospital, Unità Operativa di Malattie Infettive, Dipartimento di Scienze Pediatriche, Istituto di Ricerca e Cura a Carattere Scintifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Shana Montalto
- Covid Hospital, Unità Operativa di Malattie Infettive, Dipartimento di Scienze Pediatriche, Istituto di Ricerca e Cura a Carattere Scintifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Filomena Pierri
- Hematopoietic Stem Cell Transplantation Unit, Istituto di Ricerca e Cura a Carattere Scintifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Isabella Ceccherini
- Unitá Operativa Semplice Dipartimentale (UOSD) Genetics and Genomics of Rare Diseases, Istituto di Ricerca e Cura a Carattere Scintifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Francesca Fioredda
- Hematology Unit, Istituto di Ricerca e Cura a Carattere Scintifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Carlo Dufour
- Hematology Unit, Istituto di Ricerca e Cura a Carattere Scintifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Marco Gattorno
- Clinica Pediatrica e Reumatologia e Centro Malattie Autoinfiammatorie e Immunodeficienze, Istituto di Ricerca e Cura a Carattere Scintifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
| | - Maurizio Miano
- Hematology Unit, Istituto di Ricerca e Cura a Carattere Scintifico (IRCCS) Istituto Giannina Gaslini, Genoa, Italy
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15
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Hashem H, Bucciol G, Ozen S, Unal S, Bozkaya IO, Akarsu N, Taskinen M, Koskenvuo M, Saarela J, Dimitrova D, Hickstein DD, Hsu AP, Holland SM, Krance R, Sasa G, Kumar AR, Müller I, de Sousa MA, Delafontaine S, Moens L, Babor F, Barzaghi F, Cicalese MP, Bredius R, van Montfrans J, Baretta V, Cesaro S, Stepensky P, Benedicte N, Moshous D, Le Guenno G, Boutboul D, Dalal J, Brooks JP, Dokmeci E, Dara J, Lucas CL, Hambleton S, Wilson K, Jolles S, Koc Y, Güngör T, Schnider C, Candotti F, Steinmann S, Schulz A, Chambers C, Hershfield M, Ombrello A, Kanakry JA, Meyts I. Hematopoietic Cell Transplantation Cures Adenosine Deaminase 2 Deficiency: Report on 30 Patients. J Clin Immunol 2021; 41:1633-1647. [PMID: 34324127 PMCID: PMC8452581 DOI: 10.1007/s10875-021-01098-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/06/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Deficiency of adenosine deaminase 2 (DADA2) is an inherited inborn error of immunity, characterized by autoinflammation (recurrent fever), vasculopathy (livedo racemosa, polyarteritis nodosa, lacunar ischemic strokes, and intracranial hemorrhages), immunodeficiency, lymphoproliferation, immune cytopenias, and bone marrow failure (BMF). Tumor necrosis factor (TNF-α) blockade is the treatment of choice for the vasculopathy, but often fails to reverse refractory cytopenia. We aimed to study the outcome of hematopoietic cell transplantation (HCT) in patients with DADA2. METHODS We conducted a retrospective study on the outcome of HCT in patients with DADA2. The primary outcome was overall survival (OS). RESULTS Thirty DADA2 patients from 12 countries received a total of 38 HCTs. The indications for HCT were BMF, immune cytopenia, malignancy, or immunodeficiency. Median age at HCT was 9 years (range: 2-28 years). The conditioning regimens for the final transplants were myeloablative (n = 20), reduced intensity (n = 8), or non-myeloablative (n = 2). Donors were HLA-matched related (n = 4), HLA-matched unrelated (n = 16), HLA-haploidentical (n = 2), or HLA-mismatched unrelated (n = 8). After a median follow-up of 2 years (range: 0.5-16 years), 2-year OS was 97%, and 2-year GvHD-free relapse-free survival was 73%. The hematological and immunological phenotypes resolved, and there were no new vascular events. Plasma ADA2 enzyme activity normalized in 16/17 patients tested. Six patients required more than one HCT. CONCLUSION HCT was an effective treatment for DADA2, successfully reversing the refractory cytopenia, as well as the vasculopathy and immunodeficiency. CLINICAL IMPLICATIONS HCT is a definitive cure for DADA2 with > 95% survival.
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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), P.O Box 1269, Amman, 11941, Jordan.
| | - Giorgia Bucciol
- Department of Pediatrics, ERN RITA Core Center, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Laboratory for Inborn Errors of Immunity, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
- Hacettepe University Vasculitis Research Center, Ankara, Turkey
| | - Sule Unal
- Department of Pediatric Hematology, Research Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes, Hacettepe University, Ankara, Turkey
| | - Ikbal Ok Bozkaya
- Division of Pediatric Hematology and Oncology, Bone Marrow Transplant Unit, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Nurten Akarsu
- Department of Medical Genetics, Hacettepe University, Sihhiye, 06100, Ankara, Turkey
| | - Mervi Taskinen
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Helsinki University Hospital, Helsinki, Finland
| | - Minna Koskenvuo
- Pediatric Hematology, Oncology and Stem Cell Transplantation, Children and Adolescents, Helsinki University Hospital, Helsinki, Finland
| | - Janna Saarela
- Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Helsinki, Finland
- Centre for Molecular Medicine Norway, University of Oslo, Oslo, Norway
| | - Dimana Dimitrova
- Experimental Transplantation and Immunotherapy Branch, National Cancer Institute of the National Institutes of Health, Bethesda, MD, USA
| | | | - Amy P Hsu
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Steven M Holland
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Robert Krance
- Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Ghadir Sasa
- Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA
| | - Ashish R Kumar
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ingo Müller
- Division of Pediatric Stem Cell Transplantation and Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Monica Abreu de Sousa
- Division of Pediatric Stem Cell Transplantation and Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Selket Delafontaine
- Department of Pediatrics, ERN RITA Core Center, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Laboratory for Inborn Errors of Immunity, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Leen Moens
- Department of Microbiology, Immunology and Transplantation, Laboratory for Inborn Errors of Immunity, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Florian Babor
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Center for Child and Adolescent Health, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Federica Barzaghi
- San Raffaele Telethon Institute for Gene Therapy (TIGET), Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute Milan, Milan, Italy
| | - Maria Pia Cicalese
- Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Robbert Bredius
- Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands
| | - Joris van Montfrans
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Valentina Baretta
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Simone Cesaro
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Polina Stepensky
- Department of Bone Marrow Transplantation and Cancer Immunotherapy, Hadassah University Medical Center, Jerusalem, Israel
| | - Neven Benedicte
- Pediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Despina Moshous
- Pediatric Immunology, Hematology and Rheumatology Unit, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Guillaume Le Guenno
- Department of Internal Medicine, University Hospital Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - David Boutboul
- Clinical Immunology Department, Hospital Saint Louis, Université de Paris, Paris, France
| | - Jignesh Dalal
- Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Joel P Brooks
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Elif Dokmeci
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA
| | - Jasmeen Dara
- Department of Pediatrics, Division of Allergy, Immunology, Blood and Marrow Transplantation, University of California San Francisco, San Francisco, CA, USA
| | - Carrie L Lucas
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Sophie Hambleton
- Newcastle University Translational and Clinical Research Institute and Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, , Newcastle Upon Tyne, UK
| | - Keith Wilson
- Department of Hematology, University Hospital of Wales, Cardiff, UK
| | - Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Yener Koc
- Stem Cell Transplant Unit, Medicana International, Istanbul, Turkey
| | - Tayfun Güngör
- Division of Hematology/Oncology/Immunology, Gene Therapy, and Stem Cell Transplantation, University Children's Hospital Zurich - Eleonore Foundation & Children's Research Center (CRC), Steinwiesstrasse 75, CH-8032, Zurich, Switzerland
| | - Caroline Schnider
- Pediatric Immuno-Rheumatology of Western Switzerland, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Fabio Candotti
- Division of Immunology and Allergy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sandra Steinmann
- Department of Pediatrics, University Medical Center Ulm, Ulm, Germany
| | - Ansgar Schulz
- Department of Pediatrics, University Medical Center Ulm, Ulm, Germany
| | - Chip Chambers
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Hershfield
- Department of Medicine and Biochemistry, Duke University Medical Center, Durham, NC, USA
| | - Amanda Ombrello
- Metabolic, Cardiovascular, and Inflammatory Disease Genomics Branch, National Human Genome Research Institute (NHGRI), Bethesda, MD, USA
| | - Jennifer A Kanakry
- Experimental Transplantation and Immunotherapy Branch, National Cancer Institute of the National Institutes of Health, Bethesda, MD, USA
| | - Isabelle Meyts
- Department of Pediatrics, ERN RITA Core Center, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
- Department of Microbiology, Immunology and Transplantation, Laboratory for Inborn Errors of Immunity, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
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16
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Abinun M, Slatter MA. Haematopoietic stem cell transplantation in paediatric rheumatic disease. Curr Opin Rheumatol 2021; 33:387-397. [PMID: 34261117 DOI: 10.1097/bor.0000000000000823] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW A small proportion of children affected by rheumatic diseases suffer from severe, progressive disease, resistant to conventional antirheumatic therapies and to biologic agents interfering with inflammatory cytokines, costimulatory molecules expressed on immune system cells and intracellular signalling pathways. Adding to the poor prognosis is a high risk from significant morbidity and mortality associated with long-term treatment with multiple, often combined anti-inflammatory and immunosuppressive agents. Carefully selected patients from this unfortunate group may benefit from treatment with haematopoietic stem cell transplantation. RECENT FINDINGS The majority of patients with severe paediatric rheumatic and autoinflammatory diseases treated with autologous and/or allogeneic haematopoietic stem cell transplantation achieved long-term remission. However, the incidence of disease relapse and transplant related morbidity and mortality is still significant. SUMMARY Careful patient and donor selection, timing of the transplant earlier in the course of disease rather than the 'last resort' and choosing the most suitable conditioning regimen for each individual patient are the major factors favouring successful outcome. Close co-operation between the patients, their family, and involved medical teams is essential.
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Affiliation(s)
- Mario Abinun
- Department of Paediatric Immunology, Great North Children's Hospital, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University
| | - Mary A Slatter
- Haematopoietic Stem Cell Transplantation Unit, Great North Children's Hospital, Newcastle upon Tyne Hospitals, National Health Service Foundation Trust, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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17
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Endo Y, Koga T, Ubara Y, Sumiyoshi R, Furukawa K, Kawakami A. Mediterranean fever gene variants modify clinical phenotypes of idiopathic multi-centric Castleman disease. Clin Exp Immunol 2021; 206:91-98. [PMID: 34096620 PMCID: PMC8663796 DOI: 10.1111/cei.13632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/05/2021] [Accepted: 05/26/2021] [Indexed: 01/03/2023] Open
Abstract
Four cases of idiopathic multi-centric Castleman disease (iMCD) reportedly have variants in hereditary autoinflammatory disease-related genes; however, the frequency and role of these variants in iMCD is still unknown. We therefore investigated such gene variants among patients with iMCD and aimed to reveal the relationship between iMCD and autoinflammatory disease-related genes. We reviewed 14 Japanese iMCD patients who were recruited between January 2015 and September 2019. All patients met both the Japanese tentative diagnostic criteria for Castleman disease and the international consensus diagnostic criteria for iMCD. We performed genetic analyses for 31 autoinflammatory disease-related genes by targeted next-generation sequencing. The MEFV gene variants were observed in 10 of 14 patients with iMCD. Although iMCD had a high percentage of exons 2 or 3 variants of MEFV, comparison of data from healthy Japanese subjects indicated that there was no significant difference in the percentage between healthy Japanese subjects and patients with iMCD. Variants of uncertain significance (VUS) in the TNFRSF1A and CECR1 genes were observed in two of the patients, respectively. We divided patients into two groups-those with MEFV variants (excluding E148Q variants) and those without MEFV variants-and compared the clinical characteristics between these two groups. Patients with MEFV variants, excluding E148Q variants, exhibited a significantly higher likelihood of fever and significantly lower levels of hemoglobin than those lacking MEFV variants. Our results indicated that patients with iMCD tended to have a high frequency of MEFV gene variants and the presence of such variants can affect iMCD clinical phenotypes.
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Affiliation(s)
- Yushiro Endo
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Yoshihumi Ubara
- Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Remi Sumiyoshi
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Kaori Furukawa
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
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18
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Odumade OA, Plotkin AL, Pak J, Idoko OT, Pettengill MA, Kollmann TR, Ozonoff A, Kampmann B, Levy O, Smolen KK. Plasma Adenosine Deaminase (ADA)-1 and -2 Demonstrate Robust Ontogeny Across the First Four Months of Human Life. Front Immunol 2021; 12:578700. [PMID: 34122398 PMCID: PMC8190399 DOI: 10.3389/fimmu.2021.578700] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 05/11/2021] [Indexed: 12/14/2022] Open
Abstract
Background Human adenosine deaminases (ADAs) modulate the immune response: ADA1 via metabolizing adenosine, a purine metabolite that inhibits pro-inflammatory and Th1 cytokine production, and the multi-functional ADA2, by enhancing T-cell proliferation and monocyte differentiation. Newborns are relatively deficient in ADA1 resulting in elevated plasma adenosine concentrations and a Th2/anti-inflammatory bias compared to adults. Despite the growing recognition of the role of ADAs in immune regulation, little is known about the ontogeny of ADA concentrations. Methods In a subgroup of the EPIC002-study, clinical data and plasma samples were collected from 540 Gambian infants at four time-points: day of birth; first week of life; one month of age; and four months of age. Concentrations of total extracellular ADA, ADA1, and ADA2 were measured by chromogenic assay and evaluated in relation to clinical data. Plasma cytokines/chemokine were measured across the first week of life and correlated to ADA concentrations. Results ADA2 demonstrated a steady rise across the first months of life, while ADA1 concentration significantly decreased 0.79-fold across the first week then increased 1.4-fold by four months of life. Males demonstrated significantly higher concentrations of ADA2 (1.1-fold) than females at four months; newborns with early-term (37 to <39 weeks) and late-term (≥41 weeks) gestational age demonstrated significantly higher ADA1 at birth (1.1-fold), and those born to mothers with advanced maternal age (≥35 years) had lower plasma concentrations of ADA2 at one month (0.93-fold). Plasma ADA1 concentrations were positively correlated with plasma CXCL8 during the first week of life, while ADA2 concentrations correlated positively with TNFα, IFNγ and CXCL10, and negatively with IL-6 and CXCL8. Conclusions The ratio of plasma ADA2/ADA1 concentration increased during the first week of life, after which both ADA1 and ADA2 increased across the first four months of life suggesting a gradual development of Th1/Th2 balanced immunity. Furthermore, ADA1 and ADA2 were positively correlated with cytokines/chemokines during the first week of life. Overall, ADA isoforms demonstrate robust ontogeny in newborns and infants but further mechanistic studies are needed to clarify their roles in early life immune development and the correlations with sex, gestational age, and maternal age that were observed.
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Affiliation(s)
- Oludare A. Odumade
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- Division of Medicine Critical Care, Boston Children’s Hospital, Boston, MA, United States
| | - Alec L. Plotkin
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA, United States
| | - Jensen Pak
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA, United States
| | - Olubukola T. Idoko
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA, United States
- Vaccines & Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
- The Vaccine Centre, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Matthew A. Pettengill
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA, United States
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Tobias R. Kollmann
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Al Ozonoff
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Beate Kampmann
- Vaccines & Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
- The Vaccine Centre, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ofer Levy
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- Broad Institute of MIT & Harvard, Cambridge, MA, United States
| | - Kinga K. Smolen
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
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19
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Watanabe N, Gao S, Wu Z, Batchu S, Kajigaya S, Diamond C, Alemu L, Raffo DQ, Hoffmann P, Stone D, Ombrello AK, Young NS. Analysis of deficiency of adenosine deaminase 2 pathogenesis based on single-cell RNA sequencing of monocytes. J Leukoc Biol 2021; 110:409-424. [PMID: 33988272 DOI: 10.1002/jlb.3hi0220-119rr] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 03/31/2021] [Accepted: 08/22/2021] [Indexed: 12/31/2022] Open
Abstract
Deficiency of adenosine deaminase 2 (DADA2) is a rare autosomal recessive disease caused by loss-of-function variants in the ADA2 gene. DADA2 typically presents in childhood and is characterized by vasculopathy, stroke, inflammation, immunodeficiency, as well as hematologic manifestations. ADA2 protein is predominantly present in stimulated monocytes, dendritic cells, and macrophages. To elucidate molecular mechanisms in DADA2, CD14+ monocytes from 14 patients and 6 healthy donors were analyzed using single-cell RNA sequencing (scRNA-seq). Monocytes were purified by positive selection based on CD14 expression. Subpopulations were imputed from their transcriptomes. Based on scRNA-seq, monocytes could be classified as classical, intermediate, and nonclassical. Further, we used gene pathway analytics to interpret patterns of up- and down-regulated gene transcription. In DADA2, the frequency of nonclassical monocytes was higher compared with that of healthy donors, and M1 macrophage markers were up-regulated in patients. By comparing gene expression of each monocyte subtype between patients and healthy donors, we identified upregulated immune response pathways, including IFNα/β and IFNγ signaling, in all monocyte subtypes. Distinctively, the TNFR2 noncanonical NF-κB pathway was up-regulated only in nonclassical monocytes. Patients' plasma showed increased IFNγ and TNFα levels. Our results suggest that elevated IFNγ activates cell signaling, leading to differentiation into M1 macrophages from monocytes and release of TNFα. Immune responses and more general response to stimuli pathways were up-regulated in DADA2 monocytes, and protein synthesis pathways were down-regulated, perhaps as stress responses. Our identification of novel aberrant immune pathways has implications for therapeutic approaches in DADA2 (registered at clinicaltrials.gov NCT00071045).
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Affiliation(s)
- Naoki Watanabe
- Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Shouguo Gao
- Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Zhijie Wu
- Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Sai Batchu
- Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Sachiko Kajigaya
- Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Carrie Diamond
- Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Lemlem Alemu
- Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Diego Quinones Raffo
- Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Patrycja Hoffmann
- Inflammatory Disease Section, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Deborah Stone
- Inflammatory Disease Section, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Amanda K Ombrello
- Inflammatory Disease Section, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Neal S Young
- Hematology Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland, USA
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20
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Vasculitic peripheral neuropathy in deficiency of adenosine deaminase 2. Neuromuscul Disord 2021; 31:891-895. [PMID: 34210540 DOI: 10.1016/j.nmd.2021.05.001] [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: 01/10/2021] [Revised: 05/01/2021] [Accepted: 05/04/2021] [Indexed: 11/21/2022]
Abstract
Deficiency of adenosine deaminase 2 (DADA2) is an autosomal recessive inflammatory vasculopathy characterized by systemic vasculitis, early-onset stroke and livedo racemosa. We report a family cohort of 3 patients with ADA2 compound heterozygous mutation p.[Thr360Ala] and [Gly383Ser]. Two of them had progressive involvement of the peripheral nervous system in the fourth decade, both after stroke. In one patient, clinical and neurophysiological studies showed progression of mononeuritis multiplex to chronic axonal sensorimotor polyneuropathy, nerve biopsy had features of small vessel vasculitic neuropathy, and muscle biopsy disclosed neurogenic atrophy with reinnervation. The second patient presented with progressive sensory symptoms of the lower limbs and chronic axonal sensorimotor polyneuropathy in nerve conduction studies. These two patients had absent plasma ADA2 activity. The third patient had no neurological affection despite low, but not absent, plasma ADA2 activity. Patients were started on a tumor necrosis factor (TNF) inhibitor, which has presumed benefits for the vasculitic phenotype of DADA2.
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21
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Pinto B, Deo P, Sharma S, Syal A, Sharma A. Expanding spectrum of DADA2: a review of phenotypes, genetics, pathogenesis and treatment. Clin Rheumatol 2021; 40:3883-3896. [PMID: 33791889 DOI: 10.1007/s10067-021-05711-w] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/16/2021] [Accepted: 03/21/2021] [Indexed: 01/02/2023]
Abstract
Deficiency of adenosine deaminase 2 (DADA2) is a monogenic disease caused by biallelic mutations in ADA2 gene (previously CECR1). The aim of this review was to describe the clinical phenotypes, genetics, pathogenesis and treatment of DADA2. ADA2 is highly expressed on myeloid cells and deficiency leads to polarisation of macrophages to an M1 inflammatory type and activation of neutrophils. The pathogenesis of immunological and haematological manifestations is less clear. The spectrum of clinical presentations varies widely from asymptomatic individual to severe vasculitis, several autoinflammatory, immunological and haematological manifestations. Initially considered a childhood disease, the first presentation is now being reported well into adulthood. Vasculitis closely resembles polyarteritis nodosa. Livedoid reticularis/racemosa like skin rash and central nervous system involvement in the form of ischemic or haemorrhagic stroke are dominant manifestations. Immunological manifestations include hypogammaglobulinemia and recurrent infections. Lymphopenia is the most common haematological manifestation; pure red cell aplasia and bone marrow failure has been reported in severe cases. The disease is extremely heterogeneous with variable severity noted in patients with the same mutation and even within family members. Tumour necrosis factor inhibitors are currently the treatment of choice for vasculitic and inflammatory manifestations and also prevent strokes. Haematopoietic stem cell transplantation is a curative option for severe haematological manifestations like pure red cell aplasia, bone marrow failure and immunodeficiency. Further research is required to understand pathogenesis and all clinical aspects of this disease to enable early diagnosis and prompt treatment. Key Points • Deficiency of adenosine deaminase 2 (DADA2) is a monogenic disease caused by biallelic mutations in ADA2 gene. • The clinical features include vasculitis resembling polyarteritis nodosa, autoinflammation, haematological manifestations and immunodeficiency. • The severity varies widely from mild to fatal even in patients within a family and with the same mutation. • The treatment of choice for inflammatory and vasculitic disease is tumour necrosis factor α blockers. Bone marrow transplant may be considered for severe haematological disease.
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Affiliation(s)
- Benzeeta Pinto
- Department of Clinical Immunology and Rheumatology, St. John's National Academy of Health Sciences, Bangalore, India
| | - Prateek Deo
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Susmita Sharma
- Department of Obstetrics and Gynaecology, Adesh Medical College and Hospital, Mohri, Ambala, India
| | - Arshi Syal
- Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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22
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Wang W, Zhang T, Zheng W, Zhong L, Wang L, Li J, Liu Q, Dong Y, Song H. Diagnosis and management of adenosine deaminase 2 deficiency children: the experience from China. Pediatr Rheumatol Online J 2021; 19:44. [PMID: 33757531 PMCID: PMC7986504 DOI: 10.1186/s12969-021-00535-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 03/10/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Deficiency of adenosine deaminase 2 (DADA2) is a rare autoinflammatory disease caused by mutations in the ADA2 gene. Few Chinese cases have been reported. We describe and compare the clinical features, genotypes, and treatments of Chinese DADA2 patients and non-Chinese patients. METHODS Primary immunodeficiency disease panel or whole-exome sequencing was performed for suspected cases, and assays for adenosine deaminase 2 (ADA2) enzyme activity were also carried out for the patients and their parents. Case reports of Chinese and non-Chinese patients with DADA2 were searched in PubMed and Chinese national databases. RESULTS Seven unrelated children from China with DADA2 were included in our study. Five were identified at Peking Union Medical College Hospital, and two had been reported previously (1 on PubMed and 1 in Chinese literature). Fourteen mutations in ADA2 were identified, 7 of which have not previously been reported in non-Chinese patients. Four children who underwent enzymatic analysis had lower ADA2 activity compared with their parents. Phenotypic manifestations included fever, skin symptoms, vasculitis, and neurologic involvement. Treatments varying from steroids, immunosuppressants, and tocilizumab, anti-TNF therapy and hematopoietic stem cell transplantation (HSCT) were effective depending on phenotype and severity. CONCLUSION This study includes the largest number of Chinese DADA2 patients to date. We recommend the combination of enzymatic analysis with gene screening to confirm the diagnosis. Different genotypes were observed among Chinese DADA2 patients; most phenotypes were similar to those of non-Chinese DADA2 patients, except for growth retardation. Disease remission might not be achieved with anti-IL-6 therapy.
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Affiliation(s)
- Wei Wang
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Tiannan Zhang
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wenjie Zheng
- grid.417384.d0000 0004 1764 2632Department of Rheumatology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province China
| | - Linqing Zhong
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lin Wang
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ji Li
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qian Liu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yanqing Dong
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongmei Song
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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23
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Schnappauf O, Moura NS, Aksentijevich I, Stoffels M, Ombrello AK, Hoffmann P, Barron K, Remmers EF, Hershfield M, Kelly SJ, Cuthbertson D, Carette S, Chung SA, Forbess L, Khalidi NA, Koening CL, Langford CA, McAlear CA, Monach PA, Moreland L, Pagnoux C, Seo P, Springer JM, Sreih AG, Warrington KJ, Ytterberg SR, Kastner DL, Grayson PC, Merkel PA. Sequence-Based Screening of Patients With Idiopathic Polyarteritis Nodosa, Granulomatosis With Polyangiitis, and Microscopic Polyangiitis for Deleterious Genetic Variants in ADA2. Arthritis Rheumatol 2021; 73:512-519. [PMID: 33021335 PMCID: PMC9945880 DOI: 10.1002/art.41549] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/06/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Deficiency of adenosine deaminase 2 (DADA2) is a monogenic form of vasculitis that can resemble polyarteritis nodosa (PAN). This study was undertaken to identify potential disease-causing sequence variants in ADA2 in patients with idiopathic PAN, granulomatosis with polyangiitis (GPA), or microscopic polyangiitis (MPA). METHODS Patients with idiopathic PAN (n = 118) and patients with GPA or MPA (n = 1,107) were screened for rare nonsynonymous variants in ADA2 using DNA sequencing methods. ADA-2 enzyme activity was assessed in selected serum samples. RESULTS Nine of 118 patients with PAN (7.6%) were identified as having rare nonsynonymous variants in ADA2. Four patients (3.4%) were biallelic for pathogenic or likely pathogenic variants, and 5 patients (4.2%) were monoallelic carriers for 3 variants of uncertain significance and 2 likely pathogenic variants. Serum samples from 2 patients with PAN with biallelic variants were available and showed markedly reduced ADA-2 enzyme activity. ADA-2 enzyme testing of 86 additional patients revealed 1 individual with strongly reduced ADA-2 activity without detectable pathogenic variants. Patients with PAN and biallelic variants in ADA2 were younger at diagnosis than patients with 1 or no variant in ADA2, with no other clinical differences noted. None of the patients with GPA or MPA carried biallelic variants in ADA2. CONCLUSION A subset of patients with idiopathic PAN meet genetic criteria for DADA2. Given that tumor necrosis factor inhibition is efficacious in DADA2 but is not conventional therapy for PAN, these findings suggest that ADA-2 testing should strongly be considered in patients with hepatitis B virus-negative idiopathic PAN.
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Affiliation(s)
- Oskar Schnappauf
- NIH Intramural Sequencing Center (NISC) Comparative Sequencing Program, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Natalia Sampaio Moura
- NIH Intramural Sequencing Center (NISC) Comparative Sequencing Program, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Ivona Aksentijevich
- NIH Intramural Sequencing Center (NISC) Comparative Sequencing Program, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Monique Stoffels
- NIH Intramural Sequencing Center (NISC) Comparative Sequencing Program, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Amanda K. Ombrello
- NIH Intramural Sequencing Center (NISC) Comparative Sequencing Program, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Patrycja Hoffmann
- NIH Intramural Sequencing Center (NISC) Comparative Sequencing Program, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Karyl Barron
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | - Elaine F. Remmers
- NIH Intramural Sequencing Center (NISC) Comparative Sequencing Program, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | | | | | | | | | | | | | | | | | | | | | | | - Paul A. Monach
- Boston University School of Medicine, Boston, Massachusetts
| | | | | | - Philip Seo
- Johns Hopkins University, Baltimore, Maryland
| | | | | | | | | | - Daniel L. Kastner
- NIH Intramural Sequencing Center (NISC) Comparative Sequencing Program, National Human Genome Research Institute, NIH, Bethesda, Maryland
| | - Peter C. Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
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Zhang B, Sun Y, Xu N, Wang W, Huang X, Chen J, Shen M, Wang R, Zeng X, Zhang X. Adult-onset deficiency of adenosine deaminase 2-a case report and literature review. Clin Rheumatol 2021; 40:4325-4339. [PMID: 33638065 DOI: 10.1007/s10067-021-05587-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
Deficiency of adenosine deaminase 2 (DADA2) is an autosomal recessive disease caused by ADA2 gene mutation that is characterized by three phenotype domains: vasculopathy and inflammation, hematological abnormality, and immunodeficiency. Most patients are pediatric patients; adult-onset patients are only occasionally reported. To describe a Chinese case of adult-onset DADA2 in a Chinese patient and explore the genotype and phenotype characteristics of adult-onset DADA2. We examined the clinical, serological, and genetic features of a Chinese adult-onset DADA2 patient. English literature on DADA2 was reviewed. The clinical and genetic characteristics of different age and mutation subgroups were compared. A Chinese Han male presented with recurrent fever, rash, immunodeficiency, and significant vascular events since the age of 25 years. Serum ADA2 activity was diminished, and genotyping revealed a unique compound heterozygous mutation of exon2-10del/exon7del in the ADA2 gene leading to complete exon 7 deletion. Treatment with a TNFα inhibitor achieved disease control. A total of 269 cases carrying 102 mutations were analyzed through a literature review. Adult-onset patients had few symptoms in all three clinical domains; vasculopathy and inflammation were the major symptoms. Patients with null mutations had early disease onset and more frequent hematological abnormalities and immunodeficiency. Patients in all subgroups responded well to TNFα inhibitors. We reported the first Chinese adult-onset DADA2 patient, with a unique mutation. Screening for and differentiation of DADA2 are recommended for patients of all ages, as they might become symptomatic later in life and treatment strategies differ from those of traditional vasculitis. Key Points • We report a novel compound heterozygous deletion mutations of exons 2-10 and exon 7, leading to complete loss of exon 7 in the ADA2 gene. • Adult-onset DADA2 patients had high similarity to systemic vasculitis. • Null mutations contribute to earlier disease onset and more aggressive disease. • We suggest screening for DADA2 in patients with significant central vasculitis, hematological abnormality and immunodeficiency.
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Affiliation(s)
- Bingqing Zhang
- Department of General Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, NO. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Yang Sun
- McKusick-Zhang Center for Genetic Medicine, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China
| | - Na Xu
- Department of General Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, NO. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Wei Wang
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Xiaoming Huang
- Department of General Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, NO. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Jialin Chen
- Department of General Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, NO. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Min Shen
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, NO. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| | - Rongrong Wang
- McKusick-Zhang Center for Genetic Medicine, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China.
| | - Xuejun Zeng
- Department of General Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, NO. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| | - Xue Zhang
- McKusick-Zhang Center for Genetic Medicine, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, 100005, China
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25
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Geraldo AF, Caorsi R, Tortora D, Gandolfo C, Ammendola R, Alessio M, Conti G, Insalaco A, Pastore S, Martino S, Ceccherini I, Signa S, Gattorno M, Rossi A, Severino M. Widening the Neuroimaging Features of Adenosine Deaminase 2 Deficiency. AJNR Am J Neuroradiol 2021; 42:975-979. [PMID: 33632736 DOI: 10.3174/ajnr.a7019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023]
Abstract
Adenosine deaminase 2 deficiency (OMIM #615688) is an autosomal recessive disorder characterized by a wide clinical spectrum, including small- and medium-sized vessel vasculopathies, but data focusing on the associated neuroimaging features are still scarce in the literature. Here, we describe the clinical neuroimaging features of 12 patients with genetically proven adenosine deaminase 2 deficiency (6 males; median age at disease onset, 1.3 years; median age at genetic diagnosis, 15.5 years). Our findings expand the neuroimaging phenotype of this condition demonstrating, in addition to multiple, recurrent brain lacunar ischemic and/or hemorrhagic strokes, spinal infarcts, and intracranial aneurysms, also cerebral microbleeds and a peculiar, likely inflammatory, perivascular tissue in the basal and peripontine cisterns. Together with early clinical onset, positive family history, inflammatory flares and systemic abnormalities, these findings should raise the suspicion of adenosine deaminase 2 deficiency, thus prompting genetic evaluation and institution of tumor necrosis factor inhibitors, with a potential great impact on neurologic outcome.
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Affiliation(s)
- A F Geraldo
- Neuroradiology Unit (A.F.G., D.T., R.A., A.R., M.S.), IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Diagnostic Neuroradiology Unit, Imaging Department (A.F.G.), Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - R Caorsi
- Center for Autoinflammatory Diseases and Immunodeficiencies (R.C., S.S., M.G.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - D Tortora
- Neuroradiology Unit (A.F.G., D.T., R.A., A.R., M.S.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - C Gandolfo
- Interventional Unit (C.G.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - R Ammendola
- Neuroradiology Unit (A.F.G., D.T., R.A., A.R., M.S.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - M Alessio
- Department of Translational Medical Sciences (M.A.), Federico II University of Naples, Naples, Italy
| | - G Conti
- Pediatric Nephrology and Rheumatology Unit (G.C.), AOU G Martino, Messina, Italy
| | - A Insalaco
- Division of Rheumatology (A.I.), IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - S Pastore
- Department of Pediatrics (S.P.), Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - S Martino
- Division of Pediatric Immunology and Rheumatology, Department of Public Health and Pediatrics (S.M.), Regina Margherita Children Hospital, University of Turin, Turin, Italy
| | - I Ceccherini
- UOSD Genetics and Genomics of Rare Diseases (I.C.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - S Signa
- Center for Autoinflammatory Diseases and Immunodeficiencies (R.C., S.S., M.G.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - M Gattorno
- Center for Autoinflammatory Diseases and Immunodeficiencies (R.C., S.S., M.G.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - A Rossi
- Neuroradiology Unit (A.F.G., D.T., R.A., A.R., M.S.), IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Health Sciences (DISSAL) (A.R.), University of Genoa, Genoa, Italy
| | - M Severino
- Neuroradiology Unit (A.F.G., D.T., R.A., A.R., M.S.), IRCCS Istituto Giannina Gaslini, Genoa, Italy
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26
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Successful canakinumab treatment for activated innate response in idiopathic Castleman's disease with multiple heterozygous MEFV exon 2 variants. Clin Immunol 2020; 219:108547. [DOI: 10.1016/j.clim.2020.108547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/22/2020] [Accepted: 07/23/2020] [Indexed: 11/23/2022]
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27
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Greisenegger EK, Llufriu S, Chamorro A, Cervera A, Jimenez-Escrig A, Rappersberger K, Marik W, Greisenegger S, Stögmann E, Kopp T, Strom TM, Henes J, Joutel A, Zimprich A. A NOTCH3 homozygous nonsense mutation in familial Sneddon syndrome with pediatric stroke. J Neurol 2020; 268:810-816. [PMID: 32980981 PMCID: PMC7914241 DOI: 10.1007/s00415-020-10081-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/05/2020] [Accepted: 07/13/2020] [Indexed: 11/25/2022]
Abstract
Sneddon syndrome is a rare disorder affecting small and medium-sized blood vessels that is characterized by the association of livedo reticularis and stroke. We performed whole-exome sequencing (WES) in 2 affected siblings of a consanguineous family with childhood-onset stroke and identified a homozygous nonsense mutation within the epidermal growth factor repeat (EGFr) 19 of NOTCH3, p.(Arg735Ter). WES of 6 additional cases with adult-onset stroke revealed 2 patients carrying heterozygous loss-of-function variants in putative NOTCH3 downstream genes, ANGPTL4, and PALLD. Our findings suggest that impaired NOTCH3 signaling is one underlying disease mechanism and that bi-allelic loss-of-function mutation in NOTCH3 is a cause of familial Sneddon syndrome with pediatric stroke.
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Affiliation(s)
- Elli Katharine Greisenegger
- Department of Dermatology and Venereology, University Hospital of St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Sara Llufriu
- Laboratory of Advanced Imaging in Neuroimmunological Diseases, Center of Neuroimmunology, Hospital Clinic Barcelona, IDIBAPS and Universitat de Barcelona, Barcelona, Spain
| | - Angel Chamorro
- Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic Barcelona, Barcelona, Spain
- Institure Investigacions Biomèdicas August Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Wolfgang Marik
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stefan Greisenegger
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Elisabeth Stögmann
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Tamara Kopp
- Juvenis Medical Center, 1010, Vienna, Austria
| | - Tim M Strom
- Institute of Human Genetics, Technical University Munich, Munich, Germany
- Department of Internal Medicine II (Hematology, Oncology, Rheumatology and Clinical Immunology), Centre for Interdisciplinary Clinical Rheumatology and Immunology, Eberhard Karls-University Tuebingen, Tübingen, Germany
| | - Jörg Henes
- Department of Internal Medicine II (Hematology, Oncology, Rheumatology and Clinical Immunology), Centre for Interdisciplinary Clinical Rheumatology and Immunology, Eberhard Karls-University Tuebingen, Tübingen, Germany
| | - Anne Joutel
- Institute of Psychiatry and Neurosciences of Paris, INSERM UMR1266, University of Paris, 75014, Paris, France
| | - Alexander Zimprich
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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28
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Endo Y, Koga T, Otaki H, Sasaki D, Sumiyoshi R, Furukawa K, Tanaka Y, Katsunori Y, Kawakami A. Idiopathic multicentric Castleman disease with novel heterozygous Ile729Met mutation in exon 10 of familial Mediterranean fever gene. Rheumatology (Oxford) 2020; 60:445-450. [DOI: 10.1093/rheumatology/keaa269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/21/2020] [Indexed: 12/26/2022] Open
Abstract
Abstract
Objective
While the aetiology of idiopathic multicentric Castleman disease (iMCD) remains unclear, the involvement of autoinflammatory mechanisms has been suggested. Herein we report a Japanese patient with iMCD with a novel heterozygous Ile729Met mutation in exon 10 of the Mediterranean fever (MEFV) gene.
Methods
We performed genetic analysis via targeted next-generation sequencing analysis and Sanger sequencing and conducted molecular dynamics simulations to investigate the hydrophobic interactions around the 729th amino acid in human pyrin.
Results
In February 2011, a 59-year-old man was diagnosed with IgG4-related disease at our department based on the findings of cervical and hilar lymphadenopathies, typical lung lesions and cervical lymph node biopsy. The patient was followed up without treatment, as he was asymptomatic. However, he had been experiencing prolonged fatigue and fever with high levels of CRP since June 2017. Axillary lymph node biopsy findings led to the diagnosis of iMCD. He was successfully treated with an IL-6 inhibitor and has been in remission for 12 months. Genetic analyses for hereditary autoinflammatory disease–related genes were performed, revealing a novel heterozygous Ile729Met mutation in exon 10 of the MEFV gene. We identified that this novel mutation significantly altered the local interaction of the human pyrin B30.2 domain by molecular dynamics simulation analysis and experimentally had the potential for inflammasome activation with increased inflammatory cytokines.
Conclusion
The abnormal function of pyrin due to a mutation in the MEFV gene in this patient may have contributed to the development of MCD by inducing IL-6 production via inflammasome signalling.
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Affiliation(s)
- Yushiro Endo
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences
| | - Hiroki Otaki
- Center for Bioinformatics and Molecular Medicine, Graduate School of Biomedical Sciences, Nagasaki University
| | - Daisuke Sasaki
- Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Remi Sumiyoshi
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences
| | - Kaori Furukawa
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences
| | - Yoshimasa Tanaka
- Center for Bioinformatics and Molecular Medicine, Graduate School of Biomedical Sciences, Nagasaki University
| | - Yanagihara Katsunori
- Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Medical Sciences
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Saettini F, Fazio G, Corti P, Quadri M, Bugarin C, Gaipa G, Penco F, Moratto D, Chiarini M, Baronio M, Gazzurelli L, Imberti L, Paghera S, Giliani S, Cazzaniga G, Plebani A, Badolato R, Lougaris V, Gattorno M, Biondi A. Two siblings presenting with novel ADA2 variants, lymphoproliferation, persistence of large granular lymphocytes, and T-cell perturbations. Clin Immunol 2020; 218:108525. [PMID: 32659374 DOI: 10.1016/j.clim.2020.108525] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/26/2020] [Accepted: 07/07/2020] [Indexed: 12/25/2022]
Abstract
The presence of large granular lymphocytes has been reported in patients with ADA2 deficiency and T-LGL leukemia. Here we describe two siblings with novel ADA2 variants, expanding the mutational spectrum of ADA2 deficiency. We show that lymphoproliferation, persistence of large granular lymphocytes, T-cell perturbations, and activation of PI3K pathway, measured by means of phosphorylation levels of S6, are detectable in DADA2 patients without T-LGL leukemia.
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Affiliation(s)
- F Saettini
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, University of Milano-Bicocca, MBBM Foundation, Monza, Italy.
| | - G Fazio
- Centro Ricerca Tettamanti, University of Milan Bicocca, Monza, Italy
| | - P Corti
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, University of Milano-Bicocca, MBBM Foundation, Monza, Italy
| | - M Quadri
- Centro Ricerca Tettamanti, University of Milan Bicocca, Monza, Italy
| | - C Bugarin
- Centro Ricerca Tettamanti, University of Milan Bicocca, Monza, Italy
| | - G Gaipa
- Centro Ricerca Tettamanti, University of Milan Bicocca, Monza, Italy
| | - F Penco
- Center for Autoinflammatory disease and Immunodeficiencies, IRCCS G. Gaslini, Genova, Italy
| | - D Moratto
- Flow cytometry Laboratory, Diagnostic Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - M Chiarini
- Flow cytometry Laboratory, Diagnostic Department, ASST Spedali Civili di Brescia, Brescia, Italy
| | - M Baronio
- Pediatrics Clinic and Institute of Molecular Medicine A. Novicelli, Department of Clinical and Experimental Sciences, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - L Gazzurelli
- Pediatrics Clinic and Institute of Molecular Medicine A. Novicelli, Department of Clinical and Experimental Sciences, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - L Imberti
- Centro di Ricerca Emato-oncologica AIL (CREA), ASST Spedali Civili, Brescia, Italy
| | - S Paghera
- Centro di Ricerca Emato-oncologica AIL (CREA), ASST Spedali Civili, Brescia, Italy
| | - S Giliani
- Pediatrics Clinic and Institute of Molecular Medicine A. Novicelli, Department of Clinical and Experimental Sciences, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - G Cazzaniga
- Centro Ricerca Tettamanti, University of Milan Bicocca, Monza, Italy; Department of Medicine and Surgery, University of Milan Bicocca, Monza, Italy
| | - A Plebani
- Pediatrics Clinic and Institute of Molecular Medicine A. Novicelli, Department of Clinical and Experimental Sciences, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - R Badolato
- Pediatrics Clinic and Institute of Molecular Medicine A. Novicelli, Department of Clinical and Experimental Sciences, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - V Lougaris
- Pediatrics Clinic and Institute of Molecular Medicine A. Novicelli, Department of Clinical and Experimental Sciences, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - M Gattorno
- Center for Autoinflammatory disease and Immunodeficiencies, IRCCS G. Gaslini, Genova, Italy
| | - A Biondi
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, University of Milano-Bicocca, MBBM Foundation, Monza, Italy; Centro Ricerca Tettamanti, University of Milan Bicocca, Monza, Italy
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30
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Mitri F, Enk A, Bersano A, Kraemer M. Livedo racemosa in neurological diseases: an update on the differential diagnoses. Eur J Neurol 2020; 27:1832-1843. [DOI: 10.1111/ene.14390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/23/2020] [Accepted: 05/26/2020] [Indexed: 11/29/2022]
Affiliation(s)
- F. Mitri
- Department of Dermatology University Hospital Heidelberg Heidelberg Germany
| | - A. Enk
- Department of Dermatology University Hospital Heidelberg Heidelberg Germany
| | - A. Bersano
- Cerebrovascular Unit Fondazione IRCCS Istituto Neurologico ‘Carlo Besta’ Milan Italy
| | - M. Kraemer
- Department of Neurology Alfried Krupp von Bohlen und Halbach Hospital Essen Germany
- Department of Neurology Heinrich Heine University Hospital Düsseldorf Germany
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31
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Tull TJ, Martin B, Spencer J, Sangle S, Chua S, McGrath JA, D'Cruz DP, McGibbon DH. Sneddon syndrome associated with two novel ADA2 gene mutations. Rheumatology (Oxford) 2020; 59:1448-1450. [PMID: 31652311 DOI: 10.1093/rheumatology/kez446] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2019] [Indexed: 01/09/2023] Open
Affiliation(s)
| | | | - Jo Spencer
- School of Immunology and Microbial Sciences, King's College London (Guy's Campus)
| | | | - Serling Chua
- Department of Dermatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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32
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Guerreiro R, Gibbons E, Tábuas-Pereira M, Kun-Rodrigues C, Santo GC, Bras J. Genetic architecture of common non-Alzheimer's disease dementias. Neurobiol Dis 2020; 142:104946. [PMID: 32439597 PMCID: PMC8207829 DOI: 10.1016/j.nbd.2020.104946] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023] Open
Abstract
Frontotemporal dementia (FTD), dementia with Lewy bodies (DLB) and vascular dementia (VaD) are the most common forms of dementia after Alzheimer’s disease (AD). The heterogeneity of these disorders and/or the clinical overlap with other diseases hinder the study of their genetic components. Even though Mendelian dementias are rare, the study of these forms of disease can have a significant impact in the lives of patients and families and have successfully brought to the fore many of the genes currently known to be involved in FTD and VaD, starting to give us a glimpse of the molecular mechanisms underlying these phenotypes. More recently, genome-wide association studies have also pointed to disease risk-associated loci. This has been particularly important for DLB where familial forms of disease are very rarely described. In this review we systematically describe the Mendelian and risk genes involved in these non-AD dementias in an effort to contribute to a better understanding of their genetic architecture, find differences and commonalities between different dementia phenotypes, and uncover areas that would benefit from more intense research endeavors.
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Affiliation(s)
- Rita Guerreiro
- Center for Neurodegenerative Science, Van Andel Institute, Grand Rapids, MI, USA; Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
| | - Elizabeth Gibbons
- Center for Neurodegenerative Science, Van Andel Institute, Grand Rapids, MI, USA
| | - Miguel Tábuas-Pereira
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Celia Kun-Rodrigues
- Center for Neurodegenerative Science, Van Andel Institute, Grand Rapids, MI, USA
| | - Gustavo C Santo
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - Jose Bras
- Center for Neurodegenerative Science, Van Andel Institute, Grand Rapids, MI, USA; Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
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33
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Demirkaya E, Arici ZS, Romano M, Berard RA, Aksentijevich I. Current State of Precision Medicine in Primary Systemic Vasculitides. Front Immunol 2019; 10:2813. [PMID: 31921111 PMCID: PMC6927998 DOI: 10.3389/fimmu.2019.02813] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/15/2019] [Indexed: 12/12/2022] Open
Abstract
Precision medicine (PM) is an emerging data-driven health care approach that integrates phenotypic, genomic, epigenetic, and environmental factors unique to an individual. The goal of PM is to facilitate diagnosis, predict effective therapy, and avoid adverse reactions specific for each patient. The forefront of PM is in oncology; nonetheless, it is developing in other fields of medicine, including rheumatology. Recent studies on elucidating the genetic architecture of polygenic and monogenic rheumatological diseases have made PM possible by enabling physicians to customize medical treatment through the incorporation of clinical features and genetic data. For complex inflammatory disorders, the prevailing paradigm is that disease susceptibility is due to additive effects of common reduced-penetrance gene variants and environmental factors. Efforts have been made to calculate cumulative genetic risk score (GRS) and to relate specific susceptibility alleles for use of target therapies. The discovery of rare patients with single-gene high-penetrance mutations informed our understanding of pathways driving systemic inflammation. Here, we review the advances in practicing PM in patients with primary systemic vasculitides (PSVs). We summarize recent genetic studies and discuss current knowledge on the contribution of epigenetic factors and extracellular vesicles (EVs) in disease progression and treatment response. Implementation of PM in PSVs is a developing field that will require analysis of a large cohort of patients to validate data from genomics, transcriptomics, metabolomics, proteomics, and epigenomics studies for accurate disease profiling. This multi-omics approach to study disease pathogeneses should ultimately provide a powerful tool for stratification of patients to receive tailored optimal therapies and for monitoring their disease activity.
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Affiliation(s)
- Erkan Demirkaya
- Division of Paediatric Rheumatology, Department of Paediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Zehra Serap Arici
- Department of Paediatric Rheumatology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Micol Romano
- Division of Paediatric Rheumatology, Department of Paediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.,Department of Pediatric Rheumatology, Istituto Ortopedico Gaetano Pini, Milan, Italy
| | - Roberta Audrey Berard
- Division of Paediatric Rheumatology, Department of Paediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Ivona Aksentijevich
- Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
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34
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Zervou MI, Goulielmos GN, Matalliotakis M, Matalliotaki C, Spandidos DA, Eliopoulos E. Role of adenosine deaminase 2 gene variants in pediatric deficiency of adenosine deaminase 2: A structural biological approach. Mol Med Rep 2019; 21:876-882. [PMID: 31974608 PMCID: PMC6947897 DOI: 10.3892/mmr.2019.10862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 12/04/2019] [Indexed: 01/06/2023] Open
Abstract
Adenosine deaminase 2 (ADA2) belongs to the novel family of adenosine deaminase growth factors (ADGFs), which play an important role in tissue development. The deficiency of adenosine deaminase 2 (DADA2) is a recently recognized autosomal recessive autoinflammatory disease, characterized by various systemic vascular and inflammatory manifestations, which is associated with ADA2 mutations. Considering that a recent screening of an international registry of children with systemic primary vasculitis revealed novel and already known variants in ADA2, this study aimed to further investigate the functional significance of the rare variants detected, namely p.Gly47Arg, p.Gly47Ala, p.Arg8Trp, p.Leu351Gln and p.Ala357Thr, by using a structural biological approach. Three-dimensional models of the mutants were developed and their three-dimensional (3D) structures were subjected to detailed interaction and conformational analyses. This led to suggestions that the novel mutations found may affect the formation/stability of the homodimer or may influence the activity of the enzyme. It was thus concluded that the Arg8Trp and Gly47Arg mutations affect the position and interaction of the dimer-associated HN1 helical structure and therefore, dimer formation and stabilization, while Leu351Gln and Ala357Thr influence the metal coordination in the active site. These findings shed further light onto the structural consequences of the mutations under investigation.
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Affiliation(s)
- Maria I Zervou
- Section of Molecular Pathology and Human Genetics, Department of Internal Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - George N Goulielmos
- Section of Molecular Pathology and Human Genetics, Department of Internal Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Michail Matalliotakis
- Section of Molecular Pathology and Human Genetics, Department of Internal Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Charoula Matalliotaki
- Section of Molecular Pathology and Human Genetics, Department of Internal Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Elias Eliopoulos
- Laboratory of Genetics, Department of Biotechnology, Agricultural University of Athens, 11855 Athens, Greece
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35
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Moens L, Hershfield M, Arts K, Aksentijevich I, Meyts I. Human adenosine deaminase 2 deficiency: A multi-faceted inborn error of immunity. Immunol Rev 2019; 287:62-72. [PMID: 30565235 DOI: 10.1111/imr.12722] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/23/2018] [Indexed: 12/15/2022]
Abstract
Human adenosine deaminase 1 deficiency was described in the 1970s to cause severe combined immunodeficiency. The residual adenosine deaminase activity in these patients was attributed to adenosine deaminase 2. Human adenosine deaminase type 2 deficiency (DADA2), due to biallelic deleterious mutations in the ADA2 gene, is the first described monogenic type of small- and medium-size vessel vasculitis. The phenotype of DADA2 also includes lymphoproliferation, cytopenia, and variable degrees of immunodeficiency. The physiological role of ADA2 is still enigmatic hence the pathophysiology of the condition is unclear. Preliminary data showed that in the absence of ADA2, macrophage differentiation is skewed to a pro-inflammatory M1 subset, which is detrimental for endothelial integrity. The inflammatory phenotype responds well to anti-TNF therapy with etanercept and that is the first-line treatment for prevention of severe vascular events including strokes. The classic immunosuppressive drugs are not successful in controlling the disease activity. However, hematopoietic stem cell transplantation (HSCT) has been shown to be a definitive cure in DADA2 patients who present with a severe cytopenia. HSCT can also cure the vascular phenotype and is the treatment modality for patients' refractory to anti-cytokine therapies. In this review, we describe what is currently known about the molecular mechanisms of DADA2. Further research on the pathophysiology of this multifaceted condition is needed to fine-tune and steer future therapeutic strategies.
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Affiliation(s)
- Leen Moens
- Department of Microbiology and Immunology, Laboratory for Childhood Immunology, KU Leuven, Leuven, Belgium
| | - Michael Hershfield
- Department of Medicine, School of Medicine, Duke University, Durham, North Carolina
| | - Katrijn Arts
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Ivona Aksentijevich
- Inflammatory Disease Section, National Human Genome Research Institute, Bethesda, Maryland
| | - Isabelle Meyts
- Department of Microbiology and Immunology, Laboratory for Childhood Immunology, KU Leuven, Leuven, Belgium.,Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
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36
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Sozeri B, Ercan G, Dogan OA, Yıldız J, Demir F, Doğanay L. The same mutation in a family with adenosine deaminase 2 deficiency. Rheumatol Int 2019; 41:227-233. [PMID: 31541281 DOI: 10.1007/s00296-019-04444-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 09/11/2019] [Indexed: 10/26/2022]
Abstract
The deficiency of adenosine deaminase 2 (DADA2) has recently been defined as a monogenetic autosomal recessive autoinflammatory disease. DADA2 is mainly characterized by high fever, livedo racemose, early-onset stroke, mild immunodeficiency and clinically polyarteritis nodosa (PAN)-like symptoms. Mutations in CECR1 (cat eye syndrome chromosome region, candidate 1) are responsible for DADA2. Livedoid racemose, lacunar infarct due to involvement in small vessel of the central nervous system, peripheral neuropathy, digital ulcers and loss of fingers are predominantly seen in the disease which could progress to end-stage organ failure and death in some patients. A wide spectrum of severity in phenotype as well as in the age of onset has been reported in the literature. This phenotypic variability is also found in our clinical practice even in patients with the same mutation. Here, we present a family diagnosed with DADA2, with the previously reported p.Gly47Arg mutation in CECR1.
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Affiliation(s)
- Betul Sozeri
- Department of Pediatric Rheumatology, Umraniye Training and Research Hospital, Health Sciences University, Elmalıkent Cad 34100, Umraniye, Istanbul, Turkey.
| | - Gozde Ercan
- Department of Pediatric Rheumatology, Umraniye Training and Research Hospital, Health Sciences University, Elmalıkent Cad 34100, Umraniye, Istanbul, Turkey
| | - Ozlem Akgun Dogan
- Department of Pediatric Genetics, Umraniye Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Jale Yıldız
- Genomic Laboratory (GLAB), Umraniye Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Ferhat Demir
- Department of Pediatric Rheumatology, Umraniye Training and Research Hospital, Health Sciences University, Elmalıkent Cad 34100, Umraniye, Istanbul, Turkey
| | - Levent Doğanay
- Genomic Laboratory (GLAB), Umraniye Training and Research Hospital, Health Sciences University, Istanbul, Turkey
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Gibson KM, Morishita KA, Dancey P, Moorehead P, Drögemöller B, Han X, Graham J, Hancock REW, Foell D, Benseler S, Luqmani R, Yeung RSM, Shenoi S, Bohm M, Rosenberg AM, Ross CJ, Cabral DA, Brown KL. Identification of Novel Adenosine Deaminase 2 Gene Variants and Varied Clinical Phenotype in Pediatric Vasculitis. Arthritis Rheumatol 2019; 71:1747-1755. [PMID: 31008556 DOI: 10.1002/art.40913] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 04/16/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Individuals with deficiency of adenosine deaminase 2 (DADA2), a recently recognized autosomal recessive disease, present with various systemic vascular and inflammatory manifestations, often with young age at disease onset or with early onset of recurrent strokes. Their clinical features and histologic findings overlap with those of childhood-onset polyarteritis nodosa (PAN), a primary "idiopathic" systemic vasculitis. Despite similar clinical presentation, individuals with DADA2 may respond better to biologic therapy than to traditional immunosuppression. The aim of this study was to screen an international registry of children with systemic primary vasculitis for variants in ADA2. METHODS The coding exons of ADA2 were sequenced in 60 children and adolescents with a diagnosis of PAN, cutaneous PAN, or unclassifiable vasculitis (UCV), any chronic vasculitis with onset at age 5 years or younger, or history of stroke. The functional consequences of the identified variants were assessed by ADA2 enzyme assay and immunoblotting. RESULTS Nine children with DADA2 (5 with PAN, 3 with UCV, and 1 with antineutrophil cytoplasmic antibody-associated vasculitis) were identified. Among them, 1 patient had no rare variants in the coding region of ADA2 and 8 had biallelic, rare variants (minor allele frequency <0.01) with a known association with DADA2 (p.Gly47Arg and p.Gly47Ala) or a novel association (p.Arg9Trp, p.Leu351Gln, and p.Ala357Thr). The clinical phenotype varied widely. CONCLUSION These findings support previous observations indicating that DADA2 has extensive genotypic and phenotypic variability. Thus, screening ADA2 among children with vasculitic rash, UCV, PAN, or unexplained, early-onset central nervous system disease with systemic inflammation may enable an earlier diagnosis of DADA2.
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Affiliation(s)
- Kristen M Gibson
- University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Kimberly A Morishita
- University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Paul Dancey
- Janeway Children's Hospital and Rehabilitation Centre, Saint John's, Newfoundland and Labrador, Canada
| | - Paul Moorehead
- Janeway Children's Hospital and Rehabilitation Centre, Saint John's, Newfoundland and Labrador, Canada
| | - Britt Drögemöller
- University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Xiaohua Han
- University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Jinko Graham
- Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Dirk Foell
- University Hospital Muenster, Muenster, Germany
| | | | | | - Rae S M Yeung
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Susan Shenoi
- Seattle Children's Hospital, Seattle, Washington
| | - Marek Bohm
- Leeds General Infirmary, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Alan M Rosenberg
- Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Colin J Ross
- University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - David A Cabral
- University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Kelly L Brown
- University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
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38
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Novel insights and therapeutic approaches in idiopathic multicentric Castleman disease. Blood 2019; 132:2323-2330. [PMID: 30487129 DOI: 10.1182/blood-2018-05-848671] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/05/2018] [Indexed: 12/12/2022] Open
Abstract
Castleman disease (CD) describes a heterogeneous group of hematologic disorders that share characteristic lymph node histopathology. Patients of all ages present with either a solitary enlarged lymph node (unicentric CD) or multicentric lymphadenopathy (MCD) with systemic inflammation, cytopenias, and life-threatening multiple organ dysfunction resulting from a cytokine storm often driven by interleukin 6 (IL-6). Uncontrolled human herpesvirus-8 (HHV-8) infection causes approximately 50% of MCD cases, whereas the etiology is unknown in the remaining HHV-8-negative/idiopathic MCD cases (iMCD). The limited understanding of etiology, cell types, and signaling pathways involved in iMCD has slowed development of treatments and contributed to historically poor patient outcomes. Here, recent progress for diagnosing iMCD, characterizing etio-pathogenesis, and advancing treatments are reviewed. Several clinicopathological analyses provided the evidence base for the first-ever diagnostic criteria and revealed distinct clinical subtypes: thrombocytopenia, anasarca, fever, reticulin fibrosis/renal dysfunction, organomegaly (iMCD-TAFRO) or iMCD-not otherwise specified (iMCD-NOS), which are both observed all over the world. In 2014, the anti-IL-6 therapy siltuximab became the first iMCD treatment approved by the US Food and Drug Administration, on the basis of a 34% durable response rate; consensus guidelines recommend it as front-line therapy. Recent cytokine and proteomic profiling has revealed normal IL-6 levels in many patients with iMCD and potential alternative driver cytokines. Candidate novel genomic alterations, dysregulated cell types, and signaling pathways have also been identified as candidate therapeutic targets. RNA sequencing for viral transcripts did not reveal novel viruses, HHV-8, or other viruses pathologically associated with iMCD. Despite progress, iMCD remains poorly understood. Further efforts to elucidate etiology, pathogenesis, and treatment approaches, particularly for siltuximab-refractory patients, are needed.
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39
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Clarke K, Campbell C, Omoyinmi E, Hong Y, Al Obaidi M, Sebire N, Brogan PA. Testicular ischemia in deficiency of adenosine deaminase 2 (DADA2). Pediatr Rheumatol Online J 2019; 17:39. [PMID: 31291964 PMCID: PMC6617945 DOI: 10.1186/s12969-019-0334-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/28/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Deficiency of adenosine deaminase 2 (DADA2) is a rare autosomal recessive autoinflammatory condition. Recognised features include vasculitis predominantly affecting medium sized vessels, livedoid skin rash, central and peripheral nervous system involvement, variable degrees of immunodeficiency, and marrow failure, amongst other clinical presentations. We present the case of a six year old male with DADA2 who presented with acute testicular ischaemia secondary to vasculitis, the first such description in DADA2. CASE PRESENTATION A six year old male presented acute right-sided testicular pain. His history included transient infantile neutropenia, resolved hepatosplenomegaly, and longstanding livedo racemosa, leading to screening and confirmation of DADA2 caused by homozygous c.139G > C (p.G47R) mutation of ADA2. As his only clinical feature was that of mild livedo racemosa with normal laboratory parameters at diagnosis, he was being actively monitored prior to starting any treatment. At a routine clinic follow-up a 24 h history of testicular pain was noted on systems review. He was afebrile, and his only physical signs were that of moderate livedo racemosa, and tenderness of the right testicle. Laboratory parameters revealed C-reactive protein (CRP) 8 mg/L (reference range [RR] < 20 mg/L); erythrocyte sedimentation rate (ESR) 28 mm/hr. (RR < 10); and serum amyloid A (SAA)5 mg/L (RR < 10). Ultrasound-scan of the scrotum revealed significantly reduced perfusion of the right testes, without torsion. Surgical scrotal exploration confirmed testicular ischaemia without torsion. Histology demonstrated ischaemic seminiferous tubules with intervening haemorrhage and acute inflammatory cells, consistent with vasculitis of the testis as the cause. He was treated with high dose intravenous methyl-prednisolone followed by a weaning course of oral prednisolone, and subcutaneous adalimumab (anti-tumour necrosis factor alpha, anti-TNFα). Repeat ultrasound-scan 3 weeks later revealed good testicular perfusion, with a small area of focal infarction. At last follow-up (11 months post-event) he remained asymptomatic, on treatment with adalimumab. CONCLUSION The phenotype of DADA2 continues to expand, and we add testicular infarction to the features of DADA2. CRP and SAA cannot be relied on as reliable biomarkers to predict tissue ischaemia and hence who to target for anti-TNFα therapy in DADA2, since these remained steadfastly normal before, during, and after testicular infarction in this case.
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Affiliation(s)
- Katherine Clarke
- Department of Paediatric Rheumatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK.
| | - Cathy Campbell
- grid.420468.cDepartment of Paediatric Rheumatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Ebun Omoyinmi
- 0000000121901201grid.83440.3bInfection Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Ying Hong
- 0000000121901201grid.83440.3bInfection Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Muthana Al Obaidi
- grid.420468.cDepartment of Paediatric Rheumatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Neil Sebire
- grid.420468.cDepartment of Histopathology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Paul A. Brogan
- grid.420468.cDepartment of Paediatric Rheumatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK ,grid.420468.cDepartment of Histopathology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
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40
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Özen S, Batu ED, Taşkıran EZ, Özkara HA, Ünal Ş, Güleray N, Erden A, Karadağ Ö, Gümrük F, Çetin M, Sönmez HE, Bilginer Y, Ayvaz DÇ, Tezcan I. A Monogenic Disease with a Variety of Phenotypes: Deficiency of Adenosine Deaminase 2. J Rheumatol 2019; 47:117-125. [PMID: 31043544 DOI: 10.3899/jrheum.181384] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Deficiency of adenosine deaminase 2 (DADA2) is an autosomal recessive autoinflammatory disorder associated with ADA2 mutations. We aimed to investigate the characteristics and ADA2 enzyme activities of patients with DADA2 compared to non-DADA2 patients. METHODS This is a descriptive study of 24 patients with DADA2 who were admitted to the Adult and Pediatric Rheumatology, Pediatric Haematology, and Pediatric Immunology Departments of Hacettepe University. All ADA2 exons were screened by Sanger sequencing. Serum ADA2 enzyme activity was measured by modified spectrophotometric method. RESULTS Twenty-four patients with DADA2 were included: 14 with polyarteritis nodosa (PAN)-like phenotype (Group 1); 9 with Diamond-Blackfan anemia (DBA)-like features, and 1 with immunodeficiency (Group 2). Fourteen PAN-like DADA2 patients did not have the typical thrombocytosis seen in classic PAN. Inflammatory attacks were evident only in Group 1 patients. Serum ADA2 activity was low in all patients with DADA2 except one, who was tested after hematopoietic stem cell transplantation. There was no significant difference in ADA2 activities between PAN-like and DBA-like patients. In DADA2 patients with one ADA2 mutation, serum ADA2 activities were as low as those of patients with homozygote DADA2. ADA2 activities were normal in non-DADA2 patients. ADA2 mutations were affecting the dimerization domain in Group 1 patients and the catalytic domain in Group 2 patients. CONCLUSION We suggest assessing ADA2 activity along with genetic analysis because there are patients with one ADA2 mutation and absent enzyme activity. Our data suggest a possible genotype-phenotype correlation in which dimerization domain mutations are associated with PAN-like phenotype, and catalytic domain mutations are associated with hematological manifestations.
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Affiliation(s)
- Seza Özen
- From the Division of Rheumatology, Department of Pediatrics, Division of Immunology, Department of Internal Medicine, Department of Medical Genetics, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes, Ankara, Turkey. .,S. Özen, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; Y. Bilginer, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.D. Batu, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.Z. Taşkıran, PhD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; H.A. Özkara, MD, PhD, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Ş. Ünal, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; N. Güleray, MD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; A. Erden, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; Ö. Karadağ, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; F. Gümrük, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; M. Çetin, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes (retired); H.E. Sönmez, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; D.Ç. Ayvaz, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine; I. Tezcan, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine. E.D. Batu and E.Z. Taşkıran contributed equally to this study.
| | - Ezgi Deniz Batu
- From the Division of Rheumatology, Department of Pediatrics, Division of Immunology, Department of Internal Medicine, Department of Medical Genetics, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes, Ankara, Turkey.,S. Özen, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; Y. Bilginer, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.D. Batu, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.Z. Taşkıran, PhD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; H.A. Özkara, MD, PhD, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Ş. Ünal, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; N. Güleray, MD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; A. Erden, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; Ö. Karadağ, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; F. Gümrük, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; M. Çetin, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes (retired); H.E. Sönmez, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; D.Ç. Ayvaz, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine; I. Tezcan, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine. E.D. Batu and E.Z. Taşkıran contributed equally to this study
| | - Ekim Z Taşkıran
- From the Division of Rheumatology, Department of Pediatrics, Division of Immunology, Department of Internal Medicine, Department of Medical Genetics, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes, Ankara, Turkey.,S. Özen, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; Y. Bilginer, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.D. Batu, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.Z. Taşkıran, PhD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; H.A. Özkara, MD, PhD, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Ş. Ünal, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; N. Güleray, MD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; A. Erden, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; Ö. Karadağ, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; F. Gümrük, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; M. Çetin, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes (retired); H.E. Sönmez, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; D.Ç. Ayvaz, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine; I. Tezcan, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine. E.D. Batu and E.Z. Taşkıran contributed equally to this study
| | - Hatice Asuman Özkara
- From the Division of Rheumatology, Department of Pediatrics, Division of Immunology, Department of Internal Medicine, Department of Medical Genetics, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes, Ankara, Turkey.,S. Özen, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; Y. Bilginer, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.D. Batu, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.Z. Taşkıran, PhD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; H.A. Özkara, MD, PhD, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Ş. Ünal, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; N. Güleray, MD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; A. Erden, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; Ö. Karadağ, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; F. Gümrük, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; M. Çetin, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes (retired); H.E. Sönmez, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; D.Ç. Ayvaz, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine; I. Tezcan, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine. E.D. Batu and E.Z. Taşkıran contributed equally to this study
| | - Şule Ünal
- From the Division of Rheumatology, Department of Pediatrics, Division of Immunology, Department of Internal Medicine, Department of Medical Genetics, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes, Ankara, Turkey.,S. Özen, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; Y. Bilginer, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.D. Batu, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.Z. Taşkıran, PhD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; H.A. Özkara, MD, PhD, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Ş. Ünal, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; N. Güleray, MD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; A. Erden, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; Ö. Karadağ, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; F. Gümrük, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; M. Çetin, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes (retired); H.E. Sönmez, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; D.Ç. Ayvaz, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine; I. Tezcan, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine. E.D. Batu and E.Z. Taşkıran contributed equally to this study
| | - Naz Güleray
- From the Division of Rheumatology, Department of Pediatrics, Division of Immunology, Department of Internal Medicine, Department of Medical Genetics, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes, Ankara, Turkey.,S. Özen, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; Y. Bilginer, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.D. Batu, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.Z. Taşkıran, PhD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; H.A. Özkara, MD, PhD, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Ş. Ünal, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; N. Güleray, MD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; A. Erden, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; Ö. Karadağ, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; F. Gümrük, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; M. Çetin, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes (retired); H.E. Sönmez, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; D.Ç. Ayvaz, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine; I. Tezcan, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine. E.D. Batu and E.Z. Taşkıran contributed equally to this study
| | - Abdulsamet Erden
- From the Division of Rheumatology, Department of Pediatrics, Division of Immunology, Department of Internal Medicine, Department of Medical Genetics, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes, Ankara, Turkey.,S. Özen, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; Y. Bilginer, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.D. Batu, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.Z. Taşkıran, PhD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; H.A. Özkara, MD, PhD, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Ş. Ünal, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; N. Güleray, MD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; A. Erden, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; Ö. Karadağ, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; F. Gümrük, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; M. Çetin, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes (retired); H.E. Sönmez, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; D.Ç. Ayvaz, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine; I. Tezcan, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine. E.D. Batu and E.Z. Taşkıran contributed equally to this study
| | - Ömer Karadağ
- From the Division of Rheumatology, Department of Pediatrics, Division of Immunology, Department of Internal Medicine, Department of Medical Genetics, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes, Ankara, Turkey.,S. Özen, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; Y. Bilginer, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.D. Batu, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.Z. Taşkıran, PhD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; H.A. Özkara, MD, PhD, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Ş. Ünal, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; N. Güleray, MD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; A. Erden, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; Ö. Karadağ, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; F. Gümrük, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; M. Çetin, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes (retired); H.E. Sönmez, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; D.Ç. Ayvaz, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine; I. Tezcan, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine. E.D. Batu and E.Z. Taşkıran contributed equally to this study
| | - Fatma Gümrük
- From the Division of Rheumatology, Department of Pediatrics, Division of Immunology, Department of Internal Medicine, Department of Medical Genetics, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes, Ankara, Turkey.,S. Özen, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; Y. Bilginer, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.D. Batu, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.Z. Taşkıran, PhD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; H.A. Özkara, MD, PhD, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Ş. Ünal, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; N. Güleray, MD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; A. Erden, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; Ö. Karadağ, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; F. Gümrük, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; M. Çetin, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes (retired); H.E. Sönmez, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; D.Ç. Ayvaz, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine; I. Tezcan, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine. E.D. Batu and E.Z. Taşkıran contributed equally to this study
| | - Mualla Çetin
- From the Division of Rheumatology, Department of Pediatrics, Division of Immunology, Department of Internal Medicine, Department of Medical Genetics, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes, Ankara, Turkey.,S. Özen, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; Y. Bilginer, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.D. Batu, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.Z. Taşkıran, PhD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; H.A. Özkara, MD, PhD, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Ş. Ünal, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; N. Güleray, MD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; A. Erden, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; Ö. Karadağ, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; F. Gümrük, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; M. Çetin, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes (retired); H.E. Sönmez, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; D.Ç. Ayvaz, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine; I. Tezcan, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine. E.D. Batu and E.Z. Taşkıran contributed equally to this study
| | - Hafize Emine Sönmez
- From the Division of Rheumatology, Department of Pediatrics, Division of Immunology, Department of Internal Medicine, Department of Medical Genetics, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes, Ankara, Turkey.,S. Özen, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; Y. Bilginer, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.D. Batu, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.Z. Taşkıran, PhD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; H.A. Özkara, MD, PhD, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Ş. Ünal, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; N. Güleray, MD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; A. Erden, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; Ö. Karadağ, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; F. Gümrük, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; M. Çetin, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes (retired); H.E. Sönmez, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; D.Ç. Ayvaz, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine; I. Tezcan, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine. E.D. Batu and E.Z. Taşkıran contributed equally to this study
| | - Yelda Bilginer
- From the Division of Rheumatology, Department of Pediatrics, Division of Immunology, Department of Internal Medicine, Department of Medical Genetics, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes, Ankara, Turkey.,S. Özen, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; Y. Bilginer, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.D. Batu, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.Z. Taşkıran, PhD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; H.A. Özkara, MD, PhD, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Ş. Ünal, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; N. Güleray, MD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; A. Erden, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; Ö. Karadağ, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; F. Gümrük, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; M. Çetin, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes (retired); H.E. Sönmez, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; D.Ç. Ayvaz, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine; I. Tezcan, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine. E.D. Batu and E.Z. Taşkıran contributed equally to this study
| | - Deniz Çağdaş Ayvaz
- From the Division of Rheumatology, Department of Pediatrics, Division of Immunology, Department of Internal Medicine, Department of Medical Genetics, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes, Ankara, Turkey.,S. Özen, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; Y. Bilginer, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.D. Batu, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.Z. Taşkıran, PhD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; H.A. Özkara, MD, PhD, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Ş. Ünal, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; N. Güleray, MD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; A. Erden, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; Ö. Karadağ, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; F. Gümrük, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; M. Çetin, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes (retired); H.E. Sönmez, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; D.Ç. Ayvaz, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine; I. Tezcan, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine. E.D. Batu and E.Z. Taşkıran contributed equally to this study
| | - Ilhan Tezcan
- From the Division of Rheumatology, Department of Pediatrics, Division of Immunology, Department of Internal Medicine, Department of Medical Genetics, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes, Ankara, Turkey.,S. Özen, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; Y. Bilginer, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.D. Batu, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; E.Z. Taşkıran, PhD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; H.A. Özkara, MD, PhD, Department of Medical Biochemistry, Hacettepe University Faculty of Medicine; Ş. Ünal, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; N. Güleray, MD, Department of Medical Genetics, Hacettepe University Faculty of Medicine; A. Erden, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; Ö. Karadağ, MD, Division of Rheumatology, Department of Internal Medicine, Hacettepe University Faculty of Medicine; F. Gümrük, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes; M. Çetin, MD, Hacettepe University Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes (retired); H.E. Sönmez, MD, Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine; D.Ç. Ayvaz, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine; I. Tezcan, MD, Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine. E.D. Batu and E.Z. Taşkıran contributed equally to this study
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Beck DB, Aksentijevich I. Biochemistry of Autoinflammatory Diseases: Catalyzing Monogenic Disease. Front Immunol 2019; 10:101. [PMID: 30766537 PMCID: PMC6365650 DOI: 10.3389/fimmu.2019.00101] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/14/2019] [Indexed: 12/20/2022] Open
Abstract
Monogenic autoinflammatory disorders are a group of conditions defined by systemic or localized inflammation without identifiable causes, such as infection. In contrast to classical primary immunodeficiencies that manifest with impaired immune responses, these disorders are due to defects in genes that regulate innate immunity leading to constitutive activation of pro-inflammatory signaling. Through studying patients with rare autoinflammatory conditions, novel mechanisms of inflammation have been identified that bare on our understanding not only of basic signaling in inflammatory cells, but also of the pathogenesis of more common inflammatory diseases and have guided treatment modalities. Autoinflammation has further been implicated as an important component of cardiovascular, neurodegenerative, and metabolic syndromes. In this review, we will focus on a subset of inherited enzymatic deficiencies that lead to constitutive inflammation, and how these rare diseases have provided insights into diverse areas of cell biology not restricted to immune cells. In this way, Mendelian disorders of the innate immune system, and in particular loss of catalytic activity of enzymes in distinct pathways, have expanded our understanding of the interplay between many seemingly disparate cellular processes. We also explore the overlap between autoinflammation, autoimmunity, and immunodeficiency, which has been increasingly recognized in patients with dysregulated immune responses.
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Affiliation(s)
- David B Beck
- Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Ivona Aksentijevich
- Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
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Liu L, Wang W, Wang Y, Hou J, Ying W, Hui X, Zhou Q, Liu D, Yao H, Sun J, Wang X. A Chinese DADA2 patient: report of two novel mutations and successful HSCT. Immunogenetics 2019; 71:299-305. [DOI: 10.1007/s00251-018-01101-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/07/2018] [Indexed: 12/16/2022]
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Ulirsch JC, Verboon JM, Kazerounian S, Guo MH, Yuan D, Ludwig LS, Handsaker RE, Abdulhay NJ, Fiorini C, Genovese G, Lim ET, Cheng A, Cummings BB, Chao KR, Beggs AH, Genetti CA, Sieff CA, Newburger PE, Niewiadomska E, Matysiak M, Vlachos A, Lipton JM, Atsidaftos E, Glader B, Narla A, Gleizes PE, O'Donohue MF, Montel-Lehry N, Amor DJ, McCarroll SA, O'Donnell-Luria AH, Gupta N, Gabriel SB, MacArthur DG, Lander ES, Lek M, Da Costa L, Nathan DG, Korostelev AA, Do R, Sankaran VG, Gazda HT. The Genetic Landscape of Diamond-Blackfan Anemia. Am J Hum Genet 2018; 103:930-947. [PMID: 30503522 PMCID: PMC6288280 DOI: 10.1016/j.ajhg.2018.10.027] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/29/2018] [Indexed: 01/19/2023] Open
Abstract
Diamond-Blackfan anemia (DBA) is a rare bone marrow failure disorder that affects 7 out of 1,000,000 live births and has been associated with mutations in components of the ribosome. In order to characterize the genetic landscape of this heterogeneous disorder, we recruited a cohort of 472 individuals with a clinical diagnosis of DBA and performed whole-exome sequencing (WES). We identified relevant rare and predicted damaging mutations for 78% of individuals. The majority of mutations were singletons, absent from population databases, predicted to cause loss of function, and located in 1 of 19 previously reported ribosomal protein (RP)-encoding genes. Using exon coverage estimates, we identified and validated 31 deletions in RP genes. We also observed an enrichment for extended splice site mutations and validated their diverse effects using RNA sequencing in cell lines obtained from individuals with DBA. Leveraging the size of our cohort, we observed robust genotype-phenotype associations with congenital abnormalities and treatment outcomes. We further identified rare mutations in seven previously unreported RP genes that may cause DBA, as well as several distinct disorders that appear to phenocopy DBA, including nine individuals with biallelic CECR1 mutations that result in deficiency of ADA2. However, no new genes were identified at exome-wide significance, suggesting that there are no unidentified genes containing mutations readily identified by WES that explain >5% of DBA-affected case subjects. Overall, this report should inform not only clinical practice for DBA-affected individuals, but also the design and analysis of rare variant studies for heterogeneous Mendelian disorders.
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Affiliation(s)
- Jacob C Ulirsch
- Division of Hematology/Oncology, The Manton Center for Orphan Disease Research, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA; Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Program in Biological and Biomedical Sciences, Harvard Medical School, Boston, MA 02115, USA
| | - Jeffrey M Verboon
- Division of Hematology/Oncology, The Manton Center for Orphan Disease Research, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA; Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Shideh Kazerounian
- Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Michael H Guo
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Daniel Yuan
- Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Leif S Ludwig
- Division of Hematology/Oncology, The Manton Center for Orphan Disease Research, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA; Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Robert E Handsaker
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Nour J Abdulhay
- Division of Hematology/Oncology, The Manton Center for Orphan Disease Research, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA; Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Claudia Fiorini
- Division of Hematology/Oncology, The Manton Center for Orphan Disease Research, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA; Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Giulio Genovese
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Elaine T Lim
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Aaron Cheng
- Division of Hematology/Oncology, The Manton Center for Orphan Disease Research, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA; Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Beryl B Cummings
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Program in Biological and Biomedical Sciences, Harvard Medical School, Boston, MA 02115, USA
| | - Katherine R Chao
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Alan H Beggs
- Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Casie A Genetti
- Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Colin A Sieff
- Division of Hematology/Oncology, The Manton Center for Orphan Disease Research, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Peter E Newburger
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Edyta Niewiadomska
- Department of Pediatric Hematology/Oncology, Medical University of Warsaw, Warsaw, Poland
| | - Michal Matysiak
- Department of Pediatric Hematology/Oncology, Medical University of Warsaw, Warsaw, Poland
| | - Adrianna Vlachos
- Feinstein Institute for Medical Research, Manhasset, NY; Division of Hematology/Oncology and Stem Cell Transplantation, Cohen Children's Medical Center, New Hyde Park, NY; Hofstra Northwell School of Medicine, Hempstead, NY 11030, USA
| | - Jeffrey M Lipton
- Feinstein Institute for Medical Research, Manhasset, NY; Division of Hematology/Oncology and Stem Cell Transplantation, Cohen Children's Medical Center, New Hyde Park, NY; Hofstra Northwell School of Medicine, Hempstead, NY 11030, USA
| | - Eva Atsidaftos
- Feinstein Institute for Medical Research, Manhasset, NY; Division of Hematology/Oncology and Stem Cell Transplantation, Cohen Children's Medical Center, New Hyde Park, NY; Hofstra Northwell School of Medicine, Hempstead, NY 11030, USA
| | - Bertil Glader
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 02114, USA
| | - Anupama Narla
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 02114, USA
| | - Pierre-Emmanuel Gleizes
- Laboratory of Eukaryotic Molecular Biology, Center for Integrative Biology (CBI), University of Toulouse, CNRS, Toulouse, France
| | - Marie-Françoise O'Donohue
- Laboratory of Eukaryotic Molecular Biology, Center for Integrative Biology (CBI), University of Toulouse, CNRS, Toulouse, France
| | - Nathalie Montel-Lehry
- Laboratory of Eukaryotic Molecular Biology, Center for Integrative Biology (CBI), University of Toulouse, CNRS, Toulouse, France
| | - David J Amor
- Murdoch Children's Research Institute and Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Steven A McCarroll
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Anne H O'Donnell-Luria
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Namrata Gupta
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Stacey B Gabriel
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Daniel G MacArthur
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Eric S Lander
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Monkol Lek
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Lydie Da Costa
- University Paris VII Denis DIDEROT, Faculté de Médecine Xavier Bichat, 75019 Paris, France; Laboratory of Excellence for Red Cell, LABEX GR-Ex, 75015 Paris, France
| | - David G Nathan
- Division of Hematology/Oncology, The Manton Center for Orphan Disease Research, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Andrei A Korostelev
- RNA Therapeutics Institute, Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605, USA
| | - Ron Do
- Department of Genetics and Genomic Sciences and The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Vijay G Sankaran
- Division of Hematology/Oncology, The Manton Center for Orphan Disease Research, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA; Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Harvard Stem Cell Institute, Cambridge, MA 02138, USA.
| | - Hanna T Gazda
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Fajgenbaum DC. Novel insights and therapeutic approaches in idiopathic multicentric Castleman disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2018; 2018:318-325. [PMID: 30504327 PMCID: PMC6245974 DOI: 10.1182/asheducation-2018.1.318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Castleman disease (CD) describes a heterogeneous group of hematologic disorders that share characteristic lymph node histopathology. Patients of all ages present with either a solitary enlarged lymph node (unicentric CD) or multicentric lymphadenopathy (MCD) with systemic inflammation, cytopenias, and life-threatening multiple organ dysfunction resulting from a cytokine storm often driven by interleukin 6 (IL-6). Uncontrolled human herpesvirus-8 (HHV-8) infection causes approximately 50% of MCD cases, whereas the etiology is unknown in the remaining HHV-8-negative/idiopathic MCD cases (iMCD). The limited understanding of etiology, cell types, and signaling pathways involved in iMCD has slowed development of treatments and contributed to historically poor patient outcomes. Here, recent progress for diagnosing iMCD, characterizing etio-pathogenesis, and advancing treatments are reviewed. Several clinicopathological analyses provided the evidence base for the first-ever diagnostic criteria and revealed distinct clinical subtypes: thrombocytopenia, anasarca, fever, reticulin fibrosis/renal dysfunction, organomegaly (iMCD-TAFRO) or iMCD-not otherwise specified (iMCD-NOS), which are both observed all over the world. In 2014, the anti-IL-6 therapy siltuximab became the first iMCD treatment approved by the US Food and Drug Administration, on the basis of a 34% durable response rate; consensus guidelines recommend it as front-line therapy. Recent cytokine and proteomic profiling has revealed normal IL-6 levels in many patients with iMCD and potential alternative driver cytokines. Candidate novel genomic alterations, dysregulated cell types, and signaling pathways have also been identified as candidate therapeutic targets. RNA sequencing for viral transcripts did not reveal novel viruses, HHV-8, or other viruses pathologically associated with iMCD. Despite progress, iMCD remains poorly understood. Further efforts to elucidate etiology, pathogenesis, and treatment approaches, particularly for siltuximab-refractory patients, are needed.
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Affiliation(s)
- David C Fajgenbaum
- Division of Translational Medicine & Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Rama M, Touitou I, Sarrabay G. Reply to Sönmez et al. Eur J Hum Genet 2018; 26:1564-1565. [DOI: 10.1038/s41431-018-0242-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 07/19/2018] [Indexed: 11/09/2022] Open
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Warts and DADA2: a Mere Coincidence? J Clin Immunol 2018; 38:836-843. [DOI: 10.1007/s10875-018-0565-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/22/2018] [Indexed: 12/12/2022]
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Genetic testing for DADA2: How can we avoid missing patients? Eur J Hum Genet 2018; 26:1563-1565. [PMID: 30206352 DOI: 10.1038/s41431-018-0240-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 07/18/2018] [Indexed: 11/08/2022] Open
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The classification, genetic diagnosis and modelling of monogenic autoinflammatory disorders. Clin Sci (Lond) 2018; 132:1901-1924. [PMID: 30185613 PMCID: PMC6123071 DOI: 10.1042/cs20171498] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/30/2018] [Accepted: 08/07/2018] [Indexed: 12/13/2022]
Abstract
Monogenic autoinflammatory disorders are an increasingly heterogeneous group of conditions characterised by innate immune dysregulation. Improved genetic sequencing in recent years has led not only to the discovery of a plethora of conditions considered to be 'autoinflammatory', but also the broadening of the clinical and immunological phenotypic spectra seen in these disorders. This review outlines the classification strategies that have been employed for monogenic autoinflammatory disorders to date, including the primary innate immune pathway or the dominant cytokine implicated in disease pathogenesis, and highlights some of the advantages of these models. Furthermore, the use of the term 'autoinflammatory' is discussed in relation to disorders that cross the innate and adaptive immune divide. The utilisation of next-generation sequencing (NGS) in this population is examined, as are potential in vivo and in vitro methods of modelling to determine pathogenicity of novel genetic findings. Finally, areas where our understanding can be improved are highlighted, such as phenotypic variability and genotype-phenotype correlations, with the aim of identifying areas of future research.
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Van Nieuwenhove E, Humblet-Baron S, Van Eyck L, De Somer L, Dooley J, Tousseyn T, Hershfield M, Liston A, Wouters C. ADA2 Deficiency Mimicking Idiopathic Multicentric Castleman Disease. Pediatrics 2018; 142:peds.2017-2266. [PMID: 30139808 DOI: 10.1542/peds.2017-2266] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2018] [Indexed: 11/24/2022] Open
Abstract
Multicentric Castleman disease (MCD) is a rare entity that, unlike unicentric Castleman disease, involves generalized polyclonal lymphoproliferation, systemic inflammation, and multiple-organ system failure resulting from proinflammatory hypercytokinemia, including, in particular, interleukin-6. A subset of MCD is caused by human herpesvirus-8 (HHV-8), although the etiology for HHV-8-negative, idiopathic MCD (iMCD) cases is unknown at present. Recently, a consensus was reached on the diagnostic criteria for iMCD to aid in diagnosis, recognize mimics, and initiate prompt treatment. Pediatric iMCD remains particularly rare, and differentiation from MCD mimics in children presenting with systemic inflammation and lymphoproliferation is a challenge. We report on a young boy who presented with a HHV-8-negative, iMCD-like phenotype and was found to suffer from the monogenic disorder deficiency of adenosine deaminase 2 (DADA2), which is caused by loss-of-function mutations in CECR1 DADA2 prototypic features include early-onset ischemic and hemorrhagic strokes, livedoid rash, systemic inflammation, and polyarteritis nodosa vasculopathy, but marked clinical heterogeneity has been observed. Our patient's presentation remains unique, with predominant systemic inflammation, lymphoproliferation, and polyclonal hypergammaglobulinemia but without apparent immunodeficiency. On the basis of the iMCD-like phenotype with elevated interleukin-6 expression, treatment with tocilizumab was initiated, resulting in immediate normalization of clinical and biochemical parameters. In conclusion, iMCD and DADA2 should be considered in the differential diagnosis of children presenting with systemic inflammation and lymphoproliferation. We describe the first case of DADA2 that mimics the clinicopathologic features of iMCD, and our report extends the clinical spectrum of DADA2 to include predominant immune activation and lymphoproliferation.
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Affiliation(s)
- Erika Van Nieuwenhove
- Departments of Microbiology and Immunology and.,VIB and KU Leuven Center for Brain and Disease Research, Leuven, Belgium.,University Hospitals Leuven, Leuven, Belgium; and
| | - Stephanie Humblet-Baron
- Departments of Microbiology and Immunology and.,VIB and KU Leuven Center for Brain and Disease Research, Leuven, Belgium
| | | | - Lien De Somer
- Departments of Microbiology and Immunology and.,University Hospitals Leuven, Leuven, Belgium; and
| | - James Dooley
- Departments of Microbiology and Immunology and.,VIB and KU Leuven Center for Brain and Disease Research, Leuven, Belgium
| | - Thomas Tousseyn
- Imaging and Pathology, Translational Cell and Tissue Research, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Pathology
| | - Michael Hershfield
- Department of Medicine, School of Medicine, Duke University, Durham, North Carolina
| | - Adrian Liston
- Departments of Microbiology and Immunology and .,VIB and KU Leuven Center for Brain and Disease Research, Leuven, Belgium
| | - Carine Wouters
- Departments of Microbiology and Immunology and.,University Hospitals Leuven, Leuven, Belgium; and
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Ozen S, Batu ED. Vasculitis Pathogenesis: Can We Talk About Precision Medicine? Front Immunol 2018; 9:1892. [PMID: 30154798 PMCID: PMC6102378 DOI: 10.3389/fimmu.2018.01892] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/31/2018] [Indexed: 12/27/2022] Open
Abstract
Precision medicine is designing the medical care by taking into account the individual variability for each person. We have tried to address whether the existing data may guide precision medicine in primary systemic vasculitides (PSV). We have reviewed genome-wide association studies (GWAS) data, lessons from monogenic mimics of these diseases, and biomarker studies in immunoglobulin A vasculitis/Henoch–Schönlein purpura, Kawasaki disease, anti-neutrophil cytoplasmic antibody-associated vasculitis, polyarteritis nodosa (PAN), Takayasu arteritis, and Behçet’s disease (BD). GWAS provide insights about the pathogenesis of PSV while whole exome sequencing studies lead to discovery of monogenic vasculitides, phenotype of which could mimic other types of vasculitis such as PAN and BD. Monogenic vasculitides form a subgroup of vasculitis which are caused by single gene alterations and discovery of these diseases has enabled more specific therapies in these patients. With increasing number of studies on biomarkers, new targets for treatment appear and better and structured follow-up of PSV patients will become possible. Proteomics and metabolomics studies are required to better categorize our patients with PSV so that we can manage them appropriately and offer more targeted therapy.
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Affiliation(s)
- Seza Ozen
- Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ezgi Deniz Batu
- Division of Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
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