1
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Najm R, Yavuz L, Jain R, El Naofal M, Ramaswamy S, Abuhammour W, Loney T, Nowotny N, Alsheikh-Ali A, Abou Tayoun A, Kandasamy RK. IFIH1 loss of function predisposes to inflammatory and SARS-CoV-2-related infectious diseases. Scand J Immunol 2024:e13373. [PMID: 38757311 DOI: 10.1111/sji.13373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/03/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024]
Abstract
The IFIH1 gene, encoding melanoma differentiation-associated protein 5 (MDA5), is an indispensable innate immune regulator involved in the early detection of viral infections. Previous studies described MDA5 dysregulation in weakened immunological responses, and increased susceptibility to microbial infections and autoimmune disorders. Monoallelic gain-of-function of the IFIH1 gene has been associated with multisystem disorders, namely Aicardi-Goutieres and Singleton-Merten syndromes, while biallelic loss causes immunodeficiency. In this study, nine patients suffering from recurrent infections, inflammatory diseases, severe COVID-19 or multisystem inflammatory syndrome in children (MIS-C) were identified with putative loss-of-function IFIH1 variants by whole-exome sequencing. All patients revealed signs of lymphopaenia and an increase in inflammatory markers, including CRP, amyloid A, ferritin and IL-6. One patient with a pathogenic homozygous variant c.2807+1G>A was the most severe case showing immunodeficiency and glomerulonephritis. The c.1641+1G>C variant was identified in the heterozygous state in patients suffering from periodic fever, COVID-19 or MIS-C, while the c.2016delA variant was identified in two patients with inflammatory bowel disease or MIS-C. There was a significant association between IFIH1 monoallelic loss of function and susceptibility to infections in males. Expression analysis showed that PBMCs of one patient with a c.2016delA variant had a significant decrease in ISG15, IFNA and IFNG transcript levels, compared to normal PBMCs, upon stimulation with Poly(I:C), suggesting that MDA5 receptor truncation disrupts the immune response. Our findings accentuate the implication of rare monogenic IFIH1 loss-of-function variants in altering the immune response, and severely predisposing patients to inflammatory and infectious diseases, including SARS-CoV-2-related disorders.
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Affiliation(s)
- Rania Najm
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Lemis Yavuz
- Al Jalila Children's Hospital, Dubai, United Arab Emirates
| | - Ruchi Jain
- Al Jalila Genomics Center of Excellence, Al Jalila Children's Specialty Hospital, Dubai Health, Dubai, United Arab Emirates
| | - Maha El Naofal
- Al Jalila Genomics Center of Excellence, Al Jalila Children's Specialty Hospital, Dubai Health, Dubai, United Arab Emirates
| | - Sathishkumar Ramaswamy
- Al Jalila Genomics Center of Excellence, Al Jalila Children's Specialty Hospital, Dubai Health, Dubai, United Arab Emirates
| | | | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Norbert Nowotny
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
- Institute of Virology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Alawi Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
- Dubai Health, Dubai, United Arab Emirates
| | - Ahmad Abou Tayoun
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
- Al Jalila Genomics Center of Excellence, Al Jalila Children's Specialty Hospital, Dubai Health, Dubai, United Arab Emirates
| | - Richard K Kandasamy
- Departments of Laboratory Medicine and Pathology and Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
- Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Manipal Academy of Higher Education (MAHE), Manipal, India
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2
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Badla BA, Hanifa MS, Jain R, Naofal ME, Halabi N, Yaslam S, Ramaswamy S, Taylor A, Alfalasi R, Shenbagam S, Khansaheb H, Al Suwaidi H, Nowotny N, Popatia R, Al Khayat A, Alsheikh-Ali A, Loney T, AlDabal LM, Abou Tayoun A. Genetic determinants of severe COVID-19 in young Asian and Middle Eastern patients: a case series. Sci Rep 2023; 13:20294. [PMID: 37985737 PMCID: PMC10661561 DOI: 10.1038/s41598-023-47718-0] [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: 08/17/2023] [Accepted: 11/17/2023] [Indexed: 11/22/2023] Open
Abstract
Studies of genetic factors associated with severe COVID-19 in young adults have been limited in non-Caucasian populations. Here, we clinically characterize a case series of patients with COVID-19, who were otherwise healthy, young adults (N = 55; mean age 34.1 ± SD 5.0 years) from 16 Asian, Middle Eastern, and North African countries. Using whole exome sequencing, we identify rare, likely deleterious variants affecting 16 immune-related genes in 17 out of 55 patients (31%), including 7 patients (41% of all carriers or 12.7% of all patients) who harbored multiple such variants mainly in interferon and toll-like receptor genes. Protein network analysis as well as transcriptomic analysis of nasopharyngeal swabs from an independent COVID-19 cohort (N = 50; 42% Asians and 22% Arabs) revealed that most of the altered genes, as identified by whole exome sequencing, and the associated molecular pathways were significantly altered in COVID-19 patients. Genetic variants tended to be associated with mortality, intensive care admission, and ventilation support. Our clinical cases series, genomic and transcriptomic findings suggest a possible role for interferon pathway genes in severe COVID-19 and highlight the importance of extending genetic studies to diverse populations to better understand the human genetics of disease.
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Affiliation(s)
- Beshr Abdulaziz Badla
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, UAE
| | - Mohamed Samer Hanifa
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, UAE
| | - Ruchi Jain
- Al Jalila Genomics Center of Excellence, Al Jalila Children's Specialty Hospital, Dubai Health, Dubai, UAE
| | - Maha El Naofal
- Al Jalila Genomics Center of Excellence, Al Jalila Children's Specialty Hospital, Dubai Health, Dubai, UAE
| | - Nour Halabi
- Al Jalila Genomics Center of Excellence, Al Jalila Children's Specialty Hospital, Dubai Health, Dubai, UAE
| | - Sawsan Yaslam
- Al Jalila Genomics Center of Excellence, Al Jalila Children's Specialty Hospital, Dubai Health, Dubai, UAE
| | - Sathishkumar Ramaswamy
- Al Jalila Genomics Center of Excellence, Al Jalila Children's Specialty Hospital, Dubai Health, Dubai, UAE
| | - Alan Taylor
- Al Jalila Genomics Center of Excellence, Al Jalila Children's Specialty Hospital, Dubai Health, Dubai, UAE
| | - Roudha Alfalasi
- Al Jalila Genomics Center of Excellence, Al Jalila Children's Specialty Hospital, Dubai Health, Dubai, UAE
| | - Shruti Shenbagam
- Al Jalila Genomics Center of Excellence, Al Jalila Children's Specialty Hospital, Dubai Health, Dubai, UAE
| | - Hamda Khansaheb
- Medical Education and Research Department, Dubai Health, Dubai, UAE
| | - Hanan Al Suwaidi
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, UAE
| | - Norbert Nowotny
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, UAE
- Institute of Virology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Rizwana Popatia
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, UAE
| | | | - Alawi Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, UAE
- Dubai Health, Dubai, UAE
| | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, UAE
| | | | - Ahmad Abou Tayoun
- Al Jalila Genomics Center of Excellence, Al Jalila Children's Specialty Hospital, Dubai Health, Dubai, UAE.
- Center for Genomic Discovery, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, UAE.
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3
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Divakar MK, Jain A, Bhoyar RC, Senthivel V, Jolly B, Imran M, Sharma D, Bajaj A, Gupta V, Scaria V, Sivasubbu S. Whole-genome sequencing of 1029 Indian individuals reveals unique and rare structural variants. J Hum Genet 2023; 68:409-417. [PMID: 36813834 DOI: 10.1038/s10038-023-01131-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/24/2023]
Abstract
Structural variants contribute to genetic variability in human genomes and they can be presented in population-specific patterns. We aimed to understand the landscape of structural variants in the genomes of healthy Indian individuals and explore their potential implications in genetic disease conditions. For the identification of structural variants, a whole genome sequencing dataset of 1029 self-declared healthy Indian individuals from the IndiGen project was analysed. Further, these variants were evaluated for potential pathogenicity and their associations with genetic diseases. We also compared our identified variations with the existing global datasets. We generated a compendium of total 38,560 high-confident structural variants, comprising 28,393 deletions, 5030 duplications, 5038 insertions, and 99 inversions. Particularly, we identified around 55% of all these variants were found to be unique to the studied population. Further analysis revealed 134 deletions with predicted pathogenic/likely pathogenic effects and their affected genes were majorly enriched for neurological disease conditions, such as intellectual disability and neurodegenerative diseases. The IndiGenomes dataset helped us to understand the unique spectrum of structural variants in the Indian population. More than half of identified variants were not present in the publicly available global dataset on structural variants. Clinically important deletions identified in IndiGenomes might aid in improving the diagnosis of unsolved genetic diseases, particularly in neurological conditions. Along with basal allele frequency data and clinically important deletions, IndiGenomes data might serve as a baseline resource for future studies on genomic structural variant analysis in the Indian population.
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Affiliation(s)
- Mohit Kumar Divakar
- CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, New Delhi, 110025, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Abhinav Jain
- CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, New Delhi, 110025, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Rahul C Bhoyar
- CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, New Delhi, 110025, India
| | - Vigneshwar Senthivel
- CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, New Delhi, 110025, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Bani Jolly
- CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, New Delhi, 110025, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Mohamed Imran
- CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, New Delhi, 110025, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Disha Sharma
- CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, New Delhi, 110025, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Anjali Bajaj
- CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, New Delhi, 110025, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Vishu Gupta
- CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, New Delhi, 110025, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Vinod Scaria
- CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, New Delhi, 110025, India. .,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India.
| | - Sridhar Sivasubbu
- CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, New Delhi, 110025, India. .,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India.
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4
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El Naofal M, Ramaswamy S, Alsarhan A, Nugud A, Sarfraz F, Janbaz H, Taylor A, Jain R, Halabi N, Yaslam S, Alfalasi R, Shenbagam S, Rabea F, Bitzan M, Yavuz L, Wafadari D, Abulhoul H, Shankar S, Al Maazmi M, Rizk R, Alloub Z, Elbashir H, Babiker MOE, Chencheri N, AlBanna A, Sultan M, El Bitar M, Kherani S, Thalange N, Alshryda S, Di Donato R, Tzivinikos C, Majid I, Freeman AF, Gonzalez C, Khan AO, Hamdan H, Abuhammour W, AlAwadhi M, AlKhayat A, Alsheikh-Ali A, Abou Tayoun AN. The genomic landscape of rare disorders in the Middle East. Genome Med 2023; 15:5. [PMID: 36703223 PMCID: PMC9881316 DOI: 10.1186/s13073-023-01157-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/19/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Rare diseases collectively impose a significant burden on healthcare systems, especially in underserved regions, like the Middle East, which lack access to genomic diagnostic services and the associated personalized management plans. METHODS We established a clinical genomics and genetic counseling facility, within a multidisciplinary tertiary pediatric center, in the United Arab Emirates to locally diagnose and manage patients with rare diseases. Clinical genomic investigations included exome-based sequencing, chromosomal microarrays, and/or targeted testing. We assessed the diagnostic yield and implications for clinical management among this population. Variables were compared using the Fisher exact test. Tests were 2-tailed, and P < .05 was considered statistically significant. RESULTS We present data on 1000 patients with rare diseases (46.2% females; average age, 4.6 years) representing 47 countries primarily from the Arabian Peninsula, the Levant, Africa, and Asia. The cumulative diagnostic yield was 32.5% (95% CI, 29.7-35.5%) and was higher for genomic sequencing-based testing than chromosomal microarrays (37.9% versus 17.2%, P = 0.0001) across all indications, consistent with the higher burden of single gene disorders. Of the 221 Mendelian disorders identified in this cohort, the majority (N = 184) were encountered only once, and those with recessive inheritance accounted for ~ 62% of sequencing diagnoses. Of patients with positive genetic findings (N = 325), 67.7% were less than 5 years of age, and 60% were offered modified management and/or intervention plans. Interestingly, 24% of patients with positive genetic findings received delayed diagnoses (average age, 12.4 years; range 7-37 years), most likely due to a lack of access to genomic investigations in this region. One such genetic finding ended a 15-year-long diagnostic odyssey, leading to a life-threatening diagnosis in one patient, who was then successfully treated using an experimental allogenic bone marrow transplant. Finally, we present cases with candidate genes within regions of homozygosity, likely underlying novel recessive disorders. CONCLUSIONS Early access to genomic diagnostics for patients with suspected rare disorders in the Middle East is likely to improve clinical outcomes while driving gene discovery in this genetically underrepresented population.
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Affiliation(s)
- Maha El Naofal
- Al Jalila Genomics Center of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Sathishkumar Ramaswamy
- Al Jalila Genomics Center of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Ali Alsarhan
- General Pediatrics Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Ahmed Nugud
- General Pediatrics Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Fatima Sarfraz
- General Pediatrics Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Hiba Janbaz
- General Pediatrics Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Alan Taylor
- Al Jalila Genomics Center of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Ruchi Jain
- Al Jalila Genomics Center of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Nour Halabi
- Al Jalila Genomics Center of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Sawsan Yaslam
- Al Jalila Genomics Center of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Roudha Alfalasi
- Al Jalila Genomics Center of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Shruti Shenbagam
- Al Jalila Genomics Center of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Fatma Rabea
- grid.510259.a0000 0004 5950 6858College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Martin Bitzan
- Kidney Center of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Lemis Yavuz
- General Pediatrics Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Deena Wafadari
- General Pediatrics Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Hamda Abulhoul
- Department of Metabolic Medicine, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Shiva Shankar
- Critical Care Centre of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Munira Al Maazmi
- Critical Care Centre of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Ruba Rizk
- Adolescent Medicine, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Zeinab Alloub
- Neurodevelopment Section, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Haitham Elbashir
- Neuroscience Center of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Mohamed O. E. Babiker
- Neurology Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Nidheesh Chencheri
- Neurology Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Ammar AlBanna
- Mental Health Center of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Meshal Sultan
- Mental Health Center of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Mohamed El Bitar
- ENT Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Safeena Kherani
- ENT Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Nandu Thalange
- Endocrinology Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Sattar Alshryda
- Orthopedics Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Roberto Di Donato
- Cardiology Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Christos Tzivinikos
- Gastroenterology Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Ibrar Majid
- Orthopedics Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Alexandra F. Freeman
- grid.419681.30000 0001 2164 9667National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD USA
| | - Corina Gonzalez
- grid.48336.3a0000 0004 1936 8075Immune Deficiency Cellular Therapy Program, National Cancer Institute, NIH, Bethesda, MD USA
| | - Arif O. Khan
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Hisham Hamdan
- Pulmonology and Sleep Medicine Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Walid Abuhammour
- Infectious Diseases Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Mohamed AlAwadhi
- Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Abdulla AlKhayat
- Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Alawi Alsheikh-Ali
- grid.510259.a0000 0004 5950 6858College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates ,grid.414167.10000 0004 1757 0894Dubai Health Authority, Dubai, United Arab Emirates
| | - Ahmad N. Abou Tayoun
- Al Jalila Genomics Center of Excellence, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates ,grid.510259.a0000 0004 5950 6858Center for Genomic Discovery, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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5
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Abuhammour W, Yavuz L, Jain R, Abu Hammour K, Al-Hammouri GF, El Naofal M, Halabi N, Yaslam S, Ramaswamy S, Taylor A, Wafadari D, Alsarhan A, Khansaheb H, Deesi ZO, Varghese RM, Uddin M, Al Suwaidi H, Al-Hammadi S, Alkhaja A, AlDabal LM, Loney T, Nowotny N, Al Khayat A, Alsheikh-Ali A, Abou Tayoun A. Genetic and Clinical Characteristics of Patients in the Middle East With Multisystem Inflammatory Syndrome in Children. JAMA Netw Open 2022; 5:e2214985. [PMID: 35639375 PMCID: PMC9157271 DOI: 10.1001/jamanetworkopen.2022.14985] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Clinical, genetic, and laboratory characteristics of Middle Eastern patients with multisystem inflammatory syndrome in children (MIS-C) have not yet been documented. OBJECTIVE To assess the genetic and clinical characteristics of patients with MIS-C of primarily Arab and Asian origin. DESIGN, SETTING, AND PARTICIPANTS A prospective, multicenter cohort study was conducted from September 1, 2020, to August 31, 2021, in the United Arab Emirates and Jordan. Forty-five patients with MIS-C and a matched control group of 25 healthy children with a confirmed SARS-CoV-2 infection status were recruited. Whole exome sequencing in all 70 participants was performed to identify rare, likely deleterious variants in patients with MIS-C and to correlate genetic findings with the clinical course of illness. EXPOSURES SARS-CoV-2. MAIN OUTCOMES AND MEASURES Fever, organ system complications, laboratory biomarkers, whole exome sequencing findings, treatments, and clinical outcomes were measured. The Mann-Whitney U test was used to assess the association between genetic variants and MIS-C attributes. The Fisher exact test was used to compute the genetic burden in MIS-C relative to controls. RESULTS A total of 45 patients with MIS-C (23 [51.1%] male; 30 [66.7%] of Middle Eastern origin; mean [SD] age, 6.7 [3.6] years) and 25 controls (17 [68.0%] male; 24 [96.0%] of Middle Eastern origin; mean [SD] age 7.4 [4.0] years) participated in the study. Key inflammatory markers were significantly dysregulated in all patients with MIS-C. Mucocutaneous and gastrointestinal manifestations were each reported in 36 patients (80.0%; 95% CI, 66.1%-89.1%), cardiac findings were reported in 22 (48.9%; 95% CI, 35.0%-63.0%), and neurologic findings were reported in 14 (31.1%; 95% CI, 19.5%-45.6%). Rare, likely deleterious heterozygous variants in immune-related genes, including TLR3, TLR6, IL22RA2, IFNB1, and IFNA6, were identified in 19 patients (42.2%; 95% CI, 29.0%-56.7%), of whom 7 had multiple variants. There was higher enrichment of genetic variants in patients relative to controls (29 vs 3, P < .001). Patients with those variants tended to have earlier disease onset (7 patients [36.8%; 95% CI, 19.1%-58.9%] with genetic findings vs 2 [7.7%; 95% CI, 2.1%-24.1%] without genetic findings were younger than 3 years at onset) and resistance to treatment (8 patients [42.1%; 95% CI, 23.1%-63.7%] with genetic findings vs 3 patients [11.5%; 95% CI, 4.0%-29.0%] without genetic findings received 2 doses of intravenous immunoglobulin). CONCLUSIONS AND RELEVANCE The results of this cohort study suggest that rare, likely deleterious genetic variants may contribute to MIS-C disease. This finding paves the way for additional studies with larger, diverse populations to fully characterize the genetic contribution to this new disease entity.
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Affiliation(s)
| | - Lemis Yavuz
- Al Jalila Children’s Hospital, Dubai, United Arab Emirates
| | - Ruchi Jain
- Al Jalila Genomics Center, Al Jalila Children’s Hospital, Dubai, United Arab Emirates
| | - Khawla Abu Hammour
- Department of Biopharmaceutics and Clinical Pharmacy, The University of Jordan, Amman, Jordan
| | | | - Maha El Naofal
- Al Jalila Genomics Center, Al Jalila Children’s Hospital, Dubai, United Arab Emirates
| | - Nour Halabi
- Al Jalila Genomics Center, Al Jalila Children’s Hospital, Dubai, United Arab Emirates
| | - Sawsan Yaslam
- Al Jalila Genomics Center, Al Jalila Children’s Hospital, Dubai, United Arab Emirates
| | | | - Alan Taylor
- Al Jalila Genomics Center, Al Jalila Children’s Hospital, Dubai, United Arab Emirates
| | - Deena Wafadari
- Al Jalila Children’s Hospital, Dubai, United Arab Emirates
| | - Ali Alsarhan
- Al Jalila Children’s Hospital, Dubai, United Arab Emirates
| | - Hamda Khansaheb
- Medical Education and Research Department, Dubai Health Authority, Dubai, United Arab Emirates
| | - Zulfa Omar Deesi
- Microbiology and Infection Control Unit, Pathology and Genetics Department, Latifa Hospital for Women and Children, Dubai, United Arab Emirates
| | - Rupa Murthy Varghese
- Virology Laboratory, Microbiology and Infection Control Unit, Latifa Hospital for Women and Children, Dubai, United Arab Emirates
| | - Mohammed Uddin
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Hanan Al Suwaidi
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Suleiman Al-Hammadi
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Abdulmajeed Alkhaja
- Medical Education and Research Department, Dubai Health Authority, Dubai, United Arab Emirates
| | - Laila Mohamed AlDabal
- Medical Affairs Department, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Norbert Nowotny
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- Institute of Virology, University of Veterinary Medicine Vienna, Vienna, Austria
| | | | - Alawi Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- Dubai Health Authority, Dubai, United Arab Emirates
| | - Ahmad Abou Tayoun
- Al Jalila Genomics Center, Al Jalila Children’s Hospital, Dubai, United Arab Emirates
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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