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Roberts T, Stephen L, Scott C, di Pasquale T, Naser-Eldin A, Chetty M, Shaik S, Lewandowski L, Beighton P. CANDLE Syndrome: orodfacial manifestations and dental implications. Head Face Med 2015; 11:38. [PMID: 26711936 PMCID: PMC4693439 DOI: 10.1186/s13005-015-0095-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 12/17/2015] [Indexed: 12/27/2022] Open
Abstract
A South African girl with CANDLE Syndrome is reported with emphasis on the orodental features and dental management. Clinical manifestations included short stature, wasting of the soft tissue of the arms and legs, erythematous skin eruptions and a prominent abdomen due to hepatosplenomegaly. Generalized microdontia, confirmed by tooth measurement and osteopenia of her jaws, confirmed by digitalized radiography, were previously undescribed syndromic components. Intellectual impairment posed problems during dental intervention. The carious dental lesions and poor oral hygiene were treated conservatively under local anaesthetic. Prophylactic antibiotics were administered an hour before all procedures. Due to the nature of her general condition, invasive dental procedures were minimal. Regular follow-ups were scheduled at six monthly intervals. During this period, her overall oral health status had improved markedly. The CANDLE syndrome is a rare condition with grave complications including immunosuppression and diabetes mellitus. As with many genetic disorders, the dental manifestations are often overshadowed by other more conspicuous and complex syndromic features. Recognition of both the clinical and oral changes that occur in the CANDLE syndrome facilitates accurate diagnosis and appropriate dental management of this potentially lethal condition.
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Affiliation(s)
- T Roberts
- Faculty of Dentistry, University of the Western Cape, Private Bag X08, Mitchell's Plain, 7785, Cape Town, South Africa.
| | - L Stephen
- Faculty of Dentistry, University of the Western Cape, Private Bag X08, Mitchell's Plain, 7785, Cape Town, South Africa.
| | - C Scott
- Faculty of Health Sciences, University of Cape Town, Observatory, 7925, Cape Town, South Africa.
| | - T di Pasquale
- Faculty of Dentistry, University of the Western Cape, Private Bag X08, Mitchell's Plain, 7785, Cape Town, South Africa.
| | - A Naser-Eldin
- Faculty of Dentistry, University of the Western Cape, Private Bag X08, Mitchell's Plain, 7785, Cape Town, South Africa.
| | - M Chetty
- Faculty of Dentistry, University of the Western Cape, Private Bag X08, Mitchell's Plain, 7785, Cape Town, South Africa.
| | - S Shaik
- Faculty of Dentistry, University of the Western Cape, Private Bag X08, Mitchell's Plain, 7785, Cape Town, South Africa.
| | - L Lewandowski
- Duke Global Health Institute, Pediatric Rheumatology, Global Health, Duke University Medical Center, Durham, USA.
| | - P Beighton
- Faculty of Health Sciences, University of Cape Town, Observatory, 7925, Cape Town, South Africa.
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203
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Neutrophilic dermatoses and autoinflammatory diseases with skin involvement—innate immune disorders. Semin Immunopathol 2015; 38:45-56. [DOI: 10.1007/s00281-015-0549-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 11/02/2015] [Indexed: 12/22/2022]
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204
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Klinische Symptome und Pathogenese der Typ-1-Interferonopathien. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-015-3478-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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205
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Immunoproteasome subunit LMP7 Deficiency Improves Obesity and Metabolic Disorders. Sci Rep 2015; 5:15883. [PMID: 26515636 PMCID: PMC4626825 DOI: 10.1038/srep15883] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 10/05/2015] [Indexed: 11/08/2022] Open
Abstract
Inflammation plays an important role in the development of obesity and metabolic disorders; however, it has not been fully understood how inflammation occurs and is regulated in their pathogenesis. Low-molecular mass protein-7 (LMP7) is a proteolytic subunit of the immunoproteasome that shapes the repertoire of antigenic peptides on major histocompatibility complex class I molecule. In this study, we investigated the role of LMP7 in the development of obesity and metabolic disorders using LMP7-deficient mice. LMP7 deficiency conveyed resistant to obesity, and improved glucose intolerance and insulin sensitivity in mice fed with high-fat diet (HFD). LMP7 deficiency decreased pancreatic lipase expression, increased fecal lipid contents, and inhibited the increase of plasma triglyceride levels upon oral oil administration or HFD feeding. Using bone marrow-transferred chimeric mice, we found that LMP7 in both bone marrow- and non-bone marrow-derived cells contributes to the development of HFD-induced obesity. LMP7 deficiency decreased inflammatory responses such as macrophage infiltration and chemokine expression while it increased serum adiponection levels. These findings demonstrate a novel role for LMP7 and provide new insights into the mechanisms underlying inflammation in the pathophysiology of obesity and metabolic disorders.
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206
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Brehm A, Liu Y, Sheikh A, Marrero B, Omoyinmi E, Zhou Q, Montealegre G, Biancotto A, Reinhardt A, Almeida de Jesus A, Pelletier M, Tsai WL, Remmers EF, Kardava L, Hill S, Kim H, Lachmann HJ, Megarbane A, Chae JJ, Brady J, Castillo RD, Brown D, Casano AV, Gao L, Chapelle D, Huang Y, Stone D, Chen Y, Sotzny F, Lee CCR, Kastner DL, Torrelo A, Zlotogorski A, Moir S, Gadina M, McCoy P, Wesley R, Rother KI, Hildebrand PW, Brogan P, Krüger E, Aksentijevich I, Goldbach-Mansky R. Additive loss-of-function proteasome subunit mutations in CANDLE/PRAAS patients promote type I IFN production. J Clin Invest 2015; 125:4196-211. [PMID: 26524591 DOI: 10.1172/jci81260] [Citation(s) in RCA: 209] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 09/10/2015] [Indexed: 01/03/2023] Open
Abstract
Autosomal recessive mutations in proteasome subunit β 8 (PSMB8), which encodes the inducible proteasome subunit β5i, cause the immune-dysregulatory disease chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE), which is classified as a proteasome-associated autoinflammatory syndrome (PRAAS). Here, we identified 8 mutations in 4 proteasome genes, PSMA3 (encodes α7), PSMB4 (encodes β7), PSMB9 (encodes β1i), and proteasome maturation protein (POMP), that have not been previously associated with disease and 1 mutation in PSMB8 that has not been previously reported. One patient was compound heterozygous for PSMB4 mutations, 6 patients from 4 families were heterozygous for a missense mutation in 1 inducible proteasome subunit and a mutation in a constitutive proteasome subunit, and 1 patient was heterozygous for a POMP mutation, thus establishing a digenic and autosomal dominant inheritance pattern of PRAAS. Function evaluation revealed that these mutations variably affect transcription, protein expression, protein folding, proteasome assembly, and, ultimately, proteasome activity. Moreover, defects in proteasome formation and function were recapitulated by siRNA-mediated knockdown of the respective subunits in primary fibroblasts from healthy individuals. Patient-isolated hematopoietic and nonhematopoietic cells exhibited a strong IFN gene-expression signature, irrespective of genotype. Additionally, chemical proteasome inhibition or progressive depletion of proteasome subunit gene transcription with siRNA induced transcription of type I IFN genes in healthy control cells. Our results provide further insight into CANDLE genetics and link global proteasome dysfunction to increased type I IFN production.
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207
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New Insights into the Function of the Immunoproteasome in Immune and Nonimmune Cells. J Immunol Res 2015; 2015:541984. [PMID: 26636107 PMCID: PMC4617869 DOI: 10.1155/2015/541984] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 09/10/2015] [Indexed: 12/27/2022] Open
Abstract
The immunoproteasome is a highly efficient proteolytic machinery derived from the constitutive proteasome and is abundantly expressed in immune cells. The immunoproteasome plays a critical role in the immune system because it degrades intracellular proteins, for example, those of viral origin, into small proteins. They are further digested into short peptides to be presented by major histocompatibility complex (MHC) class I molecules. In addition, the immunoproteasome influences inflammatory disease pathogenesis through its ability to regulate T cell polarization. The immunoproteasome is also expressed in nonimmune cell types during inflammation or neoplastic transformation, supporting a role in the pathogenesis of autoimmune diseases and neoplasms. Following the success of inhibitors of the constitutive proteasome, which is now an established treatment modality for multiple myeloma, compounds that selectively inhibit the immunoproteasome are currently under active investigation. This paper will review the functions of the immunoproteasome, highlighting areas where novel pharmacological treatments that regulate immunoproteasome activity could be developed.
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208
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Bonilla FA, Khan DA, Ballas ZK, Chinen J, Frank MM, Hsu JT, Keller M, Kobrynski LJ, Komarow HD, Mazer B, Nelson RP, Orange JS, Routes JM, Shearer WT, Sorensen RU, Verbsky JW, Bernstein DI, Blessing-Moore J, Lang D, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph CR, Schuller D, Spector SL, Tilles S, Wallace D. Practice parameter for the diagnosis and management of primary immunodeficiency. J Allergy Clin Immunol 2015; 136:1186-205.e1-78. [PMID: 26371839 DOI: 10.1016/j.jaci.2015.04.049] [Citation(s) in RCA: 400] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 04/18/2015] [Accepted: 04/23/2015] [Indexed: 02/07/2023]
Abstract
The American Academy of Allergy, Asthma & Immunology (AAAAI) and the American College of Allergy, Asthma & Immunology (ACAAI) have jointly accepted responsibility for establishing the "Practice parameter for the diagnosis and management of primary immunodeficiency." This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. These parameters are not designed for use by pharmaceutical companies in drug promotion.
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209
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Munoz J, Marque M, Dandurand M, Meunier L, Crow YJ, Bessis D. [Type I interferonopathies]. Ann Dermatol Venereol 2015; 142:653-63. [PMID: 26363997 DOI: 10.1016/j.annder.2015.06.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/02/2015] [Accepted: 06/11/2015] [Indexed: 01/04/2023]
Abstract
Type I interferonopathies are a group of Mendelian disorders characterized by a common physiopathology: the up-regulation of type I interferons. To date, interferonopathies include Aicardi-Goutières syndrome, familial chilblain lupus, spondyenchondromatosis, PRoteasome-associated auto-inflammatory syndrome (PRAAS) and Singleton-Merten syndrome. These diseases present phenotypic overlap including cutaneous features like chilblain lupus, that can be inaugural or present within the first months of life. This novel set of inborn errors of immunity is evolving rapidly, with recognition of new diseases and genes. Recent and improved understanding of the physiopathology of overexpression of type I interferons has allowed the development of targeted therapies, currently being evaluated, like Janus-kinases or reverse transcriptase inhibitors.
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Affiliation(s)
- J Munoz
- Département de dermatologie, hôpital Caremeau, CHRU de Nîmes, 4, rue du Professeur-Debré, 30029 Nîmes, France
| | - M Marque
- Département de dermatologie, hôpital Caremeau, CHRU de Nîmes, 4, rue du Professeur-Debré, 30029 Nîmes, France
| | - M Dandurand
- Département de dermatologie, hôpital Caremeau, CHRU de Nîmes, 4, rue du Professeur-Debré, 30029 Nîmes, France
| | - L Meunier
- Département de dermatologie, hôpital Caremeau, CHRU de Nîmes, 4, rue du Professeur-Debré, 30029 Nîmes, France; UMR CNRS 5247, institut des biomolécules Max-Mousseron, faculté de pharmacie, 15, avenue Charles-Flahault, BP 14491, 34093 Montpellier cedex 05, France
| | - Y-J Crow
- Laboratoire de neurogénétique et de neuro-inflammation, institut Imagine, hôpital Necker-Enfants-Malades, université Paris Descartes, 24, boulevard du Montparnasse, 75015 Paris, France; Manchester centre for genomic medicine, institute of human development, faculty of medical and human sciences, Manchester academic health sciences centre, university of Manchester, M13 9WL Manchester, Royaume-Uni
| | - D Bessis
- Département de dermatologie, hôpital Saint-Eloi, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France; Université Montpellier 1, 163, rue Auguste-Broussonnet, 34090 Montpellier, France; Inserm U1058, UFR de pharmacie, 15, avenue Charles-Flahaut, 34093 Montpellier cedex 5, France.
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210
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Ferrington DA, Sinha D, Kaarniranta K. Defects in retinal pigment epithelial cell proteolysis and the pathology associated with age-related macular degeneration. Prog Retin Eye Res 2015; 51:69-89. [PMID: 26344735 DOI: 10.1016/j.preteyeres.2015.09.002] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 08/29/2015] [Accepted: 09/01/2015] [Indexed: 12/12/2022]
Abstract
Maintenance of protein homeostasis, also referred to as "Proteostasis", integrates multiple pathways that regulate protein synthesis, folding, translocation, and degradation. Failure in proteostasis may be one of the underlying mechanisms responsible for the cascade of events leading to age-related macular degeneration (AMD). This review covers the major degradative pathways (ubiquitin-proteasome and lysosomal involvement in phagocytosis and autophagy) in the retinal pigment epithelium (RPE) and summarizes evidence of their involvement in AMD. Degradation of damaged and misfolded proteins via the proteasome occurs in coordination with heat shock proteins. Evidence of increased content of proteasome and heat shock proteins in retinas from human donors with AMD is consistent with increased oxidative stress and extensive protein damage with AMD. Phagocytosis and autophagy share key molecules in phagosome maturation as well as degradation of their cargo following fusion with lysosomes. Phagocytosis and degradation of photoreceptor outer segments ensures functional integrity of the neural retina. Autophagy rids the cell of toxic protein aggregates and defective mitochondria. Evidence suggesting a decline in autophagic flux includes the accumulation of autophagic substrates and damaged mitochondria in RPE from AMD donors. An age-related decrease in lysosomal enzymatic activity inhibits autophagic clearance of outer segments, mitochondria, and protein aggregates, thereby accelerating the accumulation of lipofuscin. This cumulative damage over a person's lifetime tips the balance in RPE from a state of para-inflammation, which strives to restore cell homeostasis, to the chronic inflammation associated with AMD.
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Affiliation(s)
- Deborah A Ferrington
- Department of Ophthalmology and Visual Neurosciences, 2001 6th St SE, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Debasish Sinha
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Room M035 Robert and Clarice Smith Bldg, 400 N Broadway, Baltimore, MD, 21287, USA.
| | - Kai Kaarniranta
- Department of Ophthalmology, University of Eastern Finland and Kuopio University Hospital, P.O. Box 100, 70029 KYS, Finland.
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211
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Abstract
Systemic autoinflammatory diseases are a group of hereditary and non-hereditary diseases of the innate immune system, characterized by inflammation with no apparent cause, recurrence at irregular intervals and manifestation on the skin, mucous membranes, joints, bone, gastrointestinal tract, blood vessels and the central nervous system (CNS). Amyloidosis and other possibly severe long-term complications are important. Advances in genetics and molecular biology have improved understanding of the pathogenesis of these diseases, including familial Mediterranean fever, mevalonate kinase deficiency syndrome, tumor necrosis factor receptor-associated periodic syndrome, cryopyrin-associated periodic syndrome and improved others. The vast majority of these diseases are based on activation of the interleukin-1 (IL-1) pathway, so that inhibition of IL-1 provides a therapeutic option. Other syndromes are characterized by a granulomatous inflammation. Newer autoinflammatory diseases, such as chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) and stimulator of interferon genes (STING)-associated vasculopathy with onset in infancy (SAVI) are, however, driven by interferons.
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212
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Varga G, Gattorno M, Foell D, Rubartelli A. Redox distress and genetic defects conspire in systemic autoinflammatory diseases. Nat Rev Rheumatol 2015; 11:670-80. [PMID: 26241183 DOI: 10.1038/nrrheum.2015.105] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Inflammation is initiated by innate immune cell activation after contact with pathogens or tissue injury. An increasing number of observations have suggested that cellular stress, in the absence of infection or evident damage, can also induce inflammation. Thus, inflammation can be triggered by exogenous pathogen-associated molecular patterns (PAMPs) and damage-associated molecular patterns (DAMPs)-so-called classic inflammation-or by endogenous stress resulting from tissue or cellular dysfunction. External triggers and cellular stress activate the same molecular pathways, possibly explaining why classic and stress-induced inflammation have similar clinical manifestations. In some systemic autoinflammatory diseases (SAIDs), inflammatory cells exhibit reduction-oxidation (redox) distress, having high levels of reactive oxygen species (ROS), which promote proinflammatory cytokine production and contribute to the subversion of mechanisms that self-limit inflammation. Thus, SAIDs can be viewed as a paradigm of stress-related inflammation, being characterized by recurrent flares or chronic inflammation (with no recognizable external triggers) and by a failure to downmodulate this inflammation. Here, we review SAID pathophysiology, focusing on the major cytokines and DAMPs, and on the key roles of redox distress. New therapeutic opportunities to tackle SAIDs by blocking stress-induced pathways and control the response to stress in patients are also discussed.
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Affiliation(s)
- Georg Varga
- Department of Paediatric Rheumatology and Immunology, University Children's Hospital Münster, Domagkstrasse 3, 48149 Münster, Germany
| | - Marco Gattorno
- Second Division of Paediatrics, G. Gaslini Institute, 16145 Genova, Italy
| | - Dirk Foell
- Department of Paediatric Rheumatology and Immunology, University Children's Hospital Münster, Domagkstrasse 3, 48149 Münster, Germany
| | - Anna Rubartelli
- Cell Biology Unit, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Largo Rosanna Benzi 10, 16132 Genoa, Italy
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213
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McKenna GJ, Ziada HM. Periodontal Manifestations of Chronic Atypical Neutrophilic Dermatosis With Lipodystrophy and Elevated Temperature (CANDLE) Syndrome in an 11-Year-Old Patient. Clin Adv Periodontics 2015; 5:153-158. [PMID: 32689728 DOI: 10.1902/cap.2013.130071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 11/18/2013] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) is an autoinflammatory syndrome caused by an autosomal recessive gene mutation. This very rare syndrome has been reported in only 14 patients worldwide. A number of clinical signs have been reported, including joint contractures, muscle atrophy, microcytic anemia, and panniculitis-induced childhood lipodystrophy. Additional symptoms include recurrent fevers, purpuric skin lesions, periorbital erythema, and failure to thrive. To the best of the authors' knowledge, this is the first reported case of periodontal manifestations associated with CANDLE syndrome. CASE PRESENTATION An 11-year-old boy was referred to Cork University Dental School and Hospital, Cork, Ireland, with evidence of severe periodontal breakdown. The patient's medical condition was managed in Great Ormond Street Children's Hospital, London, United Kingdom. The patient's dental management included initial treatment to remove teeth of hopeless prognosis, followed by prosthodontic rehabilitation using removable partial dentures. This was followed by additional non-surgical periodontal treatment and maintenance. In the long term, the potential definitive restorative options, including dental implants, will be evaluated in discussion with the patient's medical team. CONCLUSIONS Periodontitis as a manifestation of systemic disease is one of seven categories of periodontitis as defined by the American Academy of Periodontology 1999 classification system. A number of systemic diseases have been associated with advanced periodontal breakdown, including diabetes mellitus, leukemia, and Papillon-Lefèvre syndrome. In the case described, treatment necessitated a multidisciplinary approach with input from medical and dental specialties for a young patient with severe periodontal breakdown associated with CANDLE syndrome.
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Affiliation(s)
- Gerald J McKenna
- Currently, Center for Public Health, Queen's University Belfast, Belfast, Northern Ireland; previously, Cork University Dental School and Hospital, University College Cork, Cork, Ireland
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214
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Webb K, Hlela C, Jordaan HF, Suliman S, Scriba T, Lipsker D, Scott C. A Review and Proposed Approach to the Neutrophilic Dermatoses of Childhood. Pediatr Dermatol 2015; 32:437-46. [PMID: 25727235 DOI: 10.1111/pde.12502] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Neutrophilic dermatoses (NDs) are inflammatory skin conditions that are not associated with infection. The classification and clinical approach to these conditions in children is poorly described. This review classifies these conditions into five nosological subtypes: Sweet's syndrome, pyoderma gangrenosum, aseptic pustules, neutrophilic urticarial dermatoses, and Marshall's syndrome. In addition, we review the various secondary diseases that need to be excluded in the clinical management of the NDs of childhood, with a focus on the autoinflammatory conditions that the reader may not be familiar with. We propose a practical clinical approach to these disorders.
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Affiliation(s)
- Kate Webb
- Department of Rheumatology, University of Cape Town, Cape Town, South Africa.,Department of Dermatology, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Carol Hlela
- Department of Rheumatology, University of Cape Town, Cape Town, South Africa.,Department of Dermatology, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - H Francois Jordaan
- Division of Dermatology, Department of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch, Stellenbosch, South Africa
| | - Sara Suliman
- South African TB Vaccine Initiative, University of Cape Town, Cape Town, South Africa
| | - Thomas Scriba
- South African TB Vaccine Initiative, University of Cape Town, Cape Town, South Africa
| | - Dan Lipsker
- Faculté de Médecine, Université de Strasbourg and Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Chris Scott
- Department of Rheumatology, University of Cape Town, Cape Town, South Africa
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215
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Recent advances in understanding the pathophysiology of primary T cell immunodeficiencies. Trends Mol Med 2015; 21:408-16. [DOI: 10.1016/j.molmed.2015.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/31/2015] [Accepted: 04/07/2015] [Indexed: 02/06/2023]
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216
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Deng H, Zheng W, Jankovic J. Genetics and molecular biology of brain calcification. Ageing Res Rev 2015; 22:20-38. [PMID: 25906927 DOI: 10.1016/j.arr.2015.04.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 04/14/2015] [Accepted: 04/15/2015] [Indexed: 01/01/2023]
Abstract
Brain calcification is a common neuroimaging finding in patients with neurological, metabolic, or developmental disorders, mitochondrial diseases, infectious diseases, traumatic or toxic history, as well as in otherwise normal older people. Patients with brain calcification may exhibit movement disorders, seizures, cognitive impairment, and a variety of other neurologic and psychiatric symptoms. Brain calcification may also present as a single, isolated neuroimaging finding. When no specific cause is evident, a genetic etiology should be considered. The aim of the review is to highlight clinical disorders associated with brain calcification and provide summary of current knowledge of diagnosis, genetics, and pathogenesis of brain calcification.
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Affiliation(s)
- Hao Deng
- Department of Neurology, Third Xiangya Hospital, Central South University, Changsha, China; Center for Experimental Medicine, Third Xiangya Hospital, Central South University, Changsha, China.
| | - Wen Zheng
- Department of Neurology, Third Xiangya Hospital, Central South University, Changsha, China; Center for Experimental Medicine, Third Xiangya Hospital, Central South University, Changsha, China
| | - Joseph Jankovic
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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217
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Canna SW, Goldbach-Mansky R. New monogenic autoinflammatory diseases--a clinical overview. Semin Immunopathol 2015; 37:387-94. [PMID: 25963521 PMCID: PMC4556430 DOI: 10.1007/s00281-015-0493-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 04/20/2015] [Indexed: 01/26/2023]
Abstract
Translating pathogenic insights gained from monogenic defects that cause autoinflammatory diseases into novel therapies has dramatically improved the lives of patients with these syndromes. The last 15 years have focused on the central role of IL-1 in driving autoinflammatory phenotypes and on therapies blocking IL-1 signaling. Recent discoveries from patients unresponsive to IL-1 blockade have highlighted other key inflammatory mediators and pathways. New genetic discoveries have confirmed unifying mechanisms of autoinflammation, including dysregulation of danger sensing, cell stress, and immune-receptor signaling. Recent gene discovery in novel diseases has demonstrated new concepts. First, several complex clinical syndromes, caused by mutations leading to chronic type I interferon (IFN) production present with organ manifestations different from IL-1 mediated diseases including cerebral calcifications, myositis, and interstitial lung disease and the frequent occurrence of autoantibodies. These disorders introduce type I IFN's as inflammatory mediators that cause autoinflammatory phenotypes. Second, conditions associated with high IL-18 production may provide a direct link between autoinflammation and macrophage activation syndrome. Third, dysregulation of inflammatory and cell differentiation pathways in nonhematopoietic cells, such as aberrant calcium signaling and impaired endothelial or keratinocyte development, provide an understanding of organ specificity in autoinflammatory disorders. Many of these discoveries highlight the intricate interconnections between autoinflammation, autoimmunity, immunodeficiency, and lymphoproliferation and suggest ways in which we may better diagnose and treat autoinflammatory diseases.
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Affiliation(s)
- Scott W. Canna
- Autoinflammatory Pathogenesis Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bldg. 10, room 13c103, 10 Center Dr., Bethesda, MD 20892, USA
| | - Raphaela Goldbach-Mansky
- Translational Autoinflammatory Disease Section, National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bldg. 10, room 6D47B, 10 Center Dr., Bethesda, MD 20892, USA
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218
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Torrelo A, Colmenero I, Requena L, Paller AS, Ramot Y, Lee CCR, Vera A, Zlotogorski A, Goldbach-Mansky R, Kutzner H. Histologic and Immunohistochemical Features of the Skin Lesions in CANDLE Syndrome. Am J Dermatopathol 2015; 37:517-22. [PMID: 26091509 PMCID: PMC4476069 DOI: 10.1097/dad.0000000000000340] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syndrome is a newly characterized autoinflammatory disorder, caused by mutations in PSMB8. It is characterized by early-onset fevers, accompanied by a widespread, violaceous, and often annular cutaneous eruption. Although the exact pathogenesis of this syndrome is still obscure, it is postulated that the inflammatory disease manifestations stem from excess secretion of interferons. Based on preliminary blood cytokine and gene expression studies, the signature seems to come mostly from type I interferons, which are proposed to lead to the recruitment of immature myeloid cells into the dermis and subcutis. In this study, we systematically analyzed skin biopsies from 6 patients with CANDLE syndrome by routine histopathology and immunohistochemistry methods. Skin lesions showed the presence of extensive mixed dermal and subcutaneous inflammatory infiltrate, composed of mononuclear cells, atypical myeloid cells, neutrophils, eosinophils, and some mature lymphocytes. Positive LEDER and myeloperoxidase staining supported the presence of myeloid cells. Positive CD68/PMG1 and CD163 staining confirmed the existence of histiocytes and monocytic macrophages in the inflammatory infiltrate. CD123 staining was positive, demonstrating the presence of plasmacytoid dendritic cells. Uncovering the unique histopathological and immunohistochemical features of CANDLE syndrome provides tools for rapid and specific diagnosis of this disorder and further insight into the pathogenesis of this severe life-threatening condition.
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Affiliation(s)
- Antonio Torrelo
- Department of Dermatology, Hospital del Niño Jesús, Madrid, Spain
| | - Isabel Colmenero
- Paediatric Histopathology Department, Birmingham Children’s Hospital, Birmingham, UK
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Madrid, Spain
| | - Amy S. Paller
- Department of Dermatology, Northwestern University, Chicago, USA
| | - Yuval Ramot
- Department of Dermatology and the Center for Genetic Diseases of the Skin & Hair, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Angel Vera
- Department of Dermatology, Hospital Carlos Haya, Málaga, Spain
| | - Abraham Zlotogorski
- Department of Dermatology and the Center for Genetic Diseases of the Skin & Hair, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Heinz Kutzner
- Dermatohistopathologisches Gemeinschaftslabor, Friedrichshafen, Germany
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219
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Abstract
Purpose of review Next-generation sequencing is revolutionizing the molecular taxonomy of human disease. Recent studies of patients with unexplained autoinflammatory disorders reveal germline genetic mutations that target important regulators of innate immunity. Recent findings Whole-exome analyses of previously undiagnosed patients have catalyzed the recognition of two new disease genes. First, a phenotypic spectrum, including livedo racemosa, fever with early-onset stroke, polyarteritis nodosa, and Sneddon syndrome, is caused by loss-of-function mutations in cat eye syndrome chromosome region, candidate 1 (CECR1), encoding adenosine deaminase 2. Adenosine deaminase 2 is a secreted protein expressed primarily in myeloid cells, and a regulator of macrophage differentiation and endothelial development. Disease-associated mutations impair anti-inflammatory M2 macrophage differentiation. Second, patients presenting with cold-induced urticaria, granulomatous rash, autoantibodies, and common variable immunodeficiency, or with blistering skin lesions, bronchiolitis, enterocolitis, ocular inflammation, and mild immunodeficiency harbor distinct mutations in phospholipase Cγ2, encoding a signaling molecule expressed in natural killer cells, mast cells, and B lymphocytes. These mutations inhibit the function of a phospholipase Cγ2 autoinhibitory domain, causing increased or constitutive signaling. Summary These findings underscore the power of next-generation sequencing, demonstrating how the primary deficiency of key molecular regulators or even regulatory motifs may lead to autoinflammation, and suggesting a possible role for cat eye syndrome chromosome region, candidate 1 and phospholipase Cγ2 in common diseases.
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220
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From bench to bedside and back again: translational research in autoinflammation. Nat Rev Rheumatol 2015; 11:573-85. [PMID: 26077920 DOI: 10.1038/nrrheum.2015.79] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Translational research approaches brought major changes to the understanding and treatment options of autoinflammatory diseases. Patients with common complex multifactorial diseases such as systemic-onset juvenile idiopathic arthritis (sJIA), and particularly those with rare monogenic autoinflammatory diseases such as cryopyrin-associated periodic syndromes (CAPS) or TNF receptor-associated periodic syndrome (TRAPS), benefited from a deeper understanding of the pathophysiological mechanisms and new treatment options emerging from preclinical studies. The study of IL-1 and IL-6 in this context led to novel therapies by forward translation. Conversely, effective treatment of sJIA and TRAPS with IL-1 blockade stimulated reverse translational efforts to study the pathophysiology of these cytokines in autoinflammatory diseases. These translational efforts led to the discovery of biomarkers such as S100 proteins, IL-18 or serum amyloid A, which are components of the inflammatory process, support diagnosis and allow for monitoring of disease activity, helping to predict patient outcomes. The ongoing characterization of autoinflammatory diseases in individual patients has led to classification into heterogeneous subgroups. Further characterization of relevant subgroups and the design of tailored treatment regimens, as well as the identification of new therapeutic targets and treatment options, are the major future challenges in the field of autoinflammatory diseases, particularly for paediatric rheumatologists.
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221
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Regulating against the dysregulation: new treatment options in autoinflammation. Semin Immunopathol 2015; 37:429-37. [PMID: 26059720 DOI: 10.1007/s00281-015-0501-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 05/14/2015] [Indexed: 12/29/2022]
Abstract
In autoinflammatory disorders, dysregulation of the innate immune response leads to an excessive cytokine release. The disease course is often characterized by high morbidity and mortality, treatment is mostly difficult and therapeutic options are limited. In most cases, life-long control of ongoing inflammation is necessary in order to improve clinical symptoms and prevent development of damage. Steroids are helpful in many conditions, but the development of serious side effects often limits their long-term use. Other immunosuppressive, steroid-sparing medications are less effective than in the treatment of autoimmune diseases or do not show any effect. So far, anti-IL1α and/or β-blocking agents as well as an IL-6 receptor-blocking monoclonal antibody and, to a lesser extent, TNF-α blocking agents were applied in autoinflammatory disorders and significantly improved the outcome. Although these progresses were made in the last years, there are still numerous challenges in order to improve drug therapy in autoinflammation. This review summarizes the current state of new drug development and discusses advantages and disadvantages of possible targets.
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222
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Abstract
Dissection of the genetic basis of Aicardi-Goutières syndrome has highlighted a fundamental link between nucleic acid metabolism, innate immune sensors and type I interferon induction. This had led to the concept of the human interferonopathies as a broader set of Mendelian disorders in which a constitutive upregulation of type I interferon activity directly relates to disease pathology. Here, we discuss the molecular and cellular basis of the interferonopathies, their categorization, future treatment strategies and the insights they provide into normal physiology.
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223
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Lee-Kirsch MA, Wolf C, Kretschmer S, Roers A. Type I interferonopathies--an expanding disease spectrum of immunodysregulation. Semin Immunopathol 2015; 37:349-57. [PMID: 25998914 DOI: 10.1007/s00281-015-0500-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 05/11/2015] [Indexed: 12/25/2022]
Abstract
Type I interferons (IFNs) play a central role in the immune defense against viral infections. Type I IFN signaling is activated by pattern recognition receptors upon sensing of viral nucleic acids and induces antiviral programs through modulation of innate and adaptive immune responses. Type I interferonopathies comprise a heterogenous group of genetically determined diseases that are characterized by inappropriate activation of type I IFN. While their phenotypic spectrum is broad, ranging from severe neurological impairment to mild cutaneous disease, systemic autoinflammation, and autoimmunity are commonly shared signs of type I interferonopathies. Although the mechanisms underlying various disease phenotypes associated with inappropriate type I IFN activation have yet to be fully elucidated, our current understanding of the molecular pathogenesis of type I interferonopathies has provided a set of candidate molecules that can be interrogated in search of targeted therapies.
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Affiliation(s)
- Min Ae Lee-Kirsch
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany,
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224
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Agyemang AF, Harrison SR, Siegel RM, McDermott MF. Protein misfolding and dysregulated protein homeostasis in autoinflammatory diseases and beyond. Semin Immunopathol 2015; 37:335-47. [DOI: 10.1007/s00281-015-0496-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 05/05/2015] [Indexed: 02/03/2023]
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225
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Dysfunction in protein clearance by the proteasome: impact on autoinflammatory diseases. Semin Immunopathol 2015; 37:323-33. [PMID: 25963519 DOI: 10.1007/s00281-015-0486-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
Abstract
During innate immune responses, proteostasis is greatly impacted by synthesis of pathogen proteins as well as by inflammatory tissue damage through radicals or other damaging molecules released by phagocytes. An adequate adaptation of cellular clearance pathways to the increased burden of damaged proteins is thus of fundamental importance for cells and tissues to prevent protein aggregation, inclusion body formation, and ultimately cell death. We here review the current understanding of the pivotal role of the ubiquitin proteasome system (UPS) in this proteostasis network. The proteolytic capacity of the UPS can be adjusted by differential gene expression, the incorporation and maturation kinetics of alternative active sites, and the attachment of different regulators. Dysregulation of this fine-tuning is likely to induce cell death but seen more often to promote inflammation as well. The link between proteostasis impairment and inflammation may play a crucial role in autoinflammation as well as in age-related diseases and currently uncharacterized diseases. Recent studies on proteasome-associated autoinflammatory syndromes (PRAAS) discovered that IFN signaling drives the inflammation caused by reduction of degradation capacity. Elucidation of these syndromes will reveal further insights in the understanding of inadequate immune responses. Knowledge related to the diversity of this degradation system will raise the awareness of potential pitfalls in the molecular diagnostics of autoinflammatory syndromes and may help to identify novel drug targets.
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226
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Abstract
CANDLE syndrome (chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature) is a recently described autoinflammatory syndrome characterized by early onset, recurrent fever, skin lesions, and multisystemic inflammatory manifestations. Most of the patients have been shown to have mutation in PSMB8 gene. Herein, we report a 2-year-old patient with young onset recurrent fever, atypical facies, widespread skin lesions, generalized lymphadenopathy, hepatosplenomegaly, joint contractures, hypertrglyceridemia, lipodystrophy, and autoimmune hemolytic anemia. Clinical features together with the skin biopsy findings were consistent with the CANDLE syndrome. The pathogenesis and treatment of this syndrome have not been fully understood. Increased awareness of this recently described syndrome may lead to recognition of new cases and better understanding of its pathogenesis which in turn may help for development of an effective treatment.
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227
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Jabbari A, Dai Z, Xing L, Cerise JE, Ramot Y, Berkun Y, Sanchez GAM, Goldbach-Mansky R, Christiano AM, Clynes R, Zlotogorski A. Reversal of Alopecia Areata Following Treatment With the JAK1/2 Inhibitor Baricitinib. EBioMedicine 2015; 2:351-5. [PMID: 26137574 PMCID: PMC4486197 DOI: 10.1016/j.ebiom.2015.02.015] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 02/20/2015] [Accepted: 02/24/2015] [Indexed: 12/24/2022] Open
Abstract
Background Alopecia areata (AA) is an autoimmune disease resulting in hair loss with devastating psychosocial consequences. Despite its high prevalence, there are no FDA-approved treatments for AA. Prior studies have identified a prominent interferon signature in AA, which signals through JAK molecules. Methods A patient with AA was enrolled in a clinical trial to examine the efficacy of baricitinib, a JAK1/2 inhibitor, to treat concomitant CANDLE syndrome. In vivo, preclinical studies were conducted using the C3H/HeJ AA mouse model to assess the mechanism of clinical improvement by baricitinib. Findings The patient exhibited a striking improvement of his AA on baricitinib over several months. In vivo studies using the C3H/HeJ mouse model demonstrated a strong correlation between resolution of the interferon signature and clinical improvement during baricitinib treatment. Interpretation Baricitinib may be an effective treatment for AA and warrants further investigation in clinical trials.
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Affiliation(s)
- Ali Jabbari
- Department of Dermatology, Columbia University, New York, NY, USA
| | - Zhenpeng Dai
- Department of Dermatology, Columbia University, New York, NY, USA
| | - Luzhou Xing
- Department of Pathology, Columbia University, New York, NY, USA
| | - Jane E Cerise
- Department of Dermatology, Columbia University, New York, NY, USA
| | - Yuval Ramot
- Department of Dermatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yackov Berkun
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | | | - Angela M Christiano
- Department of Dermatology, Columbia University, New York, NY, USA ; Department of Genetics & Development, Columbia University, New York, NY, USA
| | - Raphael Clynes
- Department of Dermatology, Columbia University, New York, NY, USA ; Department of Pathology, Columbia University, New York, NY, USA ; Department of Medicine, Columbia University, New York, NY, USA
| | - Abraham Zlotogorski
- Department of Dermatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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228
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de Jesus AA, Canna SW, Liu Y, Goldbach-Mansky R. Molecular mechanisms in genetically defined autoinflammatory diseases: disorders of amplified danger signaling. Annu Rev Immunol 2015; 33:823-74. [PMID: 25706096 DOI: 10.1146/annurev-immunol-032414-112227] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Patients with autoinflammatory diseases present with noninfectious fever flares and systemic and/or disease-specific organ inflammation. Their excessive proinflammatory cytokine and chemokine responses can be life threatening and lead to organ damage over time. Studying such patients has revealed genetic defects that have helped unravel key innate immune pathways, including excessive IL-1 signaling, constitutive NF-κB activation, and, more recently, chronic type I IFN signaling. Discoveries of monogenic defects that lead to activation of proinflammatory cytokines have inspired the use of anticytokine-directed treatment approaches that have been life changing for many patients and have led to the approval of IL-1-blocking agents for a number of autoinflammatory conditions. In this review, we describe the genetically characterized autoinflammatory diseases, we summarize our understanding of the molecular pathways that drive clinical phenotypes and that continue to inspire the search for novel treatment targets, and we provide a conceptual framework for classification.
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Affiliation(s)
- Adriana Almeida de Jesus
- Translational Autoinflammatory Diseases Section, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health (NIH), Bethesda, Maryland 20892;
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229
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Type I interferonopathies: Mendelian type I interferon up-regulation. Curr Opin Immunol 2015; 32:7-12. [DOI: 10.1016/j.coi.2014.10.005] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 09/19/2014] [Accepted: 10/10/2014] [Indexed: 12/21/2022]
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230
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Reinhardt RL, Liang HE, Bao K, Price AE, Mohrs M, Kelly BL, Locksley RM. A novel model for IFN-γ-mediated autoinflammatory syndromes. THE JOURNAL OF IMMUNOLOGY 2015; 194:2358-68. [PMID: 25637019 DOI: 10.4049/jimmunol.1401992] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Autoinflammatory disease and hyperinflammatory syndromes represent a growing number of diseases associated with inappropriately controlled inflammation in multiple organs. Systemic inflammation commonly results from dysregulated activation of innate immune cells, and therapeutic targeting of the IL-1β pathway has been used to ameliorate some of these diseases. Some hyperinflammatory syndromes, however, such as hemophagocytic lymphohistiocytosis and the newly classified proteasome disability syndromes, are refractory to such treatments, suggesting that other factors or environmental stressors may be contributing. In comparing two cytokine reporter mouse strains, we identify IFN-γ as a mediator of systemic autoinflammatory disease. Chronically elevated levels of IFN-γ resulted in progressive multiorgan inflammation and two copies of the mutant allele resulted in increased mortality accompanied by myeloproliferative disease. Disease was alleviated by genetic deletion of T-bet. These studies raise the possibility that therapeutics targeting the IFN-γ pathway might be effective in hyperinflammatory conditions refractory to IL-1β-targeted therapies.
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Affiliation(s)
- R Lee Reinhardt
- Howard Hughes Medical Institute, University of California San Francisco, San Francisco, CA 94143; Department of Medicine, University of California San Francisco, San Francisco, CA 94143; Department of Microbiology and Immunology, University of California San Francisco, San Francisco, CA 94143; Department of Immunology, Duke University Medical Center, Durham, NC 27710
| | - Hong-Erh Liang
- Howard Hughes Medical Institute, University of California San Francisco, San Francisco, CA 94143; Department of Medicine, University of California San Francisco, San Francisco, CA 94143; Department of Microbiology and Immunology, University of California San Francisco, San Francisco, CA 94143
| | - Katherine Bao
- Department of Immunology, Duke University Medical Center, Durham, NC 27710
| | - April E Price
- Howard Hughes Medical Institute, University of California San Francisco, San Francisco, CA 94143; Department of Medicine, University of California San Francisco, San Francisco, CA 94143; Department of Microbiology and Immunology, University of California San Francisco, San Francisco, CA 94143
| | | | - Ben L Kelly
- Department of Microbiology, Immunology and Parasitology, Louisiana State University Health Sciences Center, New Orleans, LA 70112
| | - Richard M Locksley
- Howard Hughes Medical Institute, University of California San Francisco, San Francisco, CA 94143; Department of Medicine, University of California San Francisco, San Francisco, CA 94143; Department of Microbiology and Immunology, University of California San Francisco, San Francisco, CA 94143;
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231
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Kluk J, Rustin M, Brogan PA, Omoyinmi E, Rowczenio DM, Willcocks LC, Melly L, Lachmann HJ. Chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature syndrome: a report of a novel mutation and review of the literature. Br J Dermatol 2015; 170:215-7. [PMID: 24001180 PMCID: PMC4232891 DOI: 10.1111/bjd.12600] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- J Kluk
- Department of Dermatology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, U.K
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232
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Goldbach-Mansky R, de Jesus AA, McDermott MF, Kastner DL. Monogenic autoinflammatory diseases. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00165-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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233
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Niewerth D, Jansen G, Assaraf YG, Zweegman S, Kaspers GJ, Cloos J. Molecular basis of resistance to proteasome inhibitors in hematological malignancies. Drug Resist Updat 2015; 18:18-35. [DOI: 10.1016/j.drup.2014.12.001] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 11/28/2014] [Accepted: 12/03/2014] [Indexed: 12/25/2022]
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234
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McDermott A, Jacks J, Kessler M, Emanuel PD, Gao L. Proteasome-associated autoinflammatory syndromes: advances in pathogeneses, clinical presentations, diagnosis, and management. Int J Dermatol 2014; 54:121-9. [PMID: 25521013 DOI: 10.1111/ijd.12695] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The disease spectrum currently known as the proteasome-associated autoinflammatory syndromes (PRAAS) was first described in 1939 in patients who presented with recurrent fevers beginning in infancy or early childhood, which were accompanied by nodular erythema, a pernio-like rash, and joint contractures. Since then, several syndromes, such as chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syndrome, Nakajo-Nishimura syndrome (NNS), joint contractures, muscle atrophy, microcytic anemia and panniculitis-induced lipodystrophy (JMP) syndrome, and Japanese autoinflammatory syndrome with lipodystrophy (JASL), have been used to categorize patients with diseases within the same spectrum. Recently, independent studies have identified mutations in the human proteasome subunit β type 8 (PSMB8) gene, which result in a sustained inflammatory response in all syndromes. Further functional studies not only suggest a causative role of PSMB8 mutations but also imply that they represent one disease spectrum, referred to as PRAAS. In this paper, we review the clinical presentations and laboratory findings of PRAAS, as well as the most recent advances in pathogeneses, diagnosis, and treatment options for patients with diseases in this spectrum.
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Affiliation(s)
- Amelia McDermott
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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235
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Meiners S, Keller IE, Semren N, Caniard A. Regulation of the proteasome: evaluating the lung proteasome as a new therapeutic target. Antioxid Redox Signal 2014; 21:2364-82. [PMID: 24437504 DOI: 10.1089/ars.2013.5798] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
SIGNIFICANCE Lung diseases are on the second rank worldwide with respect to morbidity and mortality. For most respiratory diseases, no effective therapies exist. Whereas the proteasome has been successfully evaluated as a novel target for therapeutic interventions in cancer, neurodegenerative, and cardiac disorders, there is a profound lack of knowledge on the regulation of proteasome activity in chronic and acute lung diseases. RECENT ADVANCES There are various means of how the amount of active proteasome complexes in the cell can be regulated such as transcriptional regulation of proteasomal subunit expression, association with different regulators, assembly and half-life of proteasomes and regulatory complexes, as well as post-translational modifications. It also becomes increasingly evident that proteasome activity is fine-tuned and depends on the state of the cell. We propose here that 20S proteasomes and their regulators can be regarded as dynamic building blocks, which assemble or disassemble in response to cellular needs. The composition of proteasome complexes in a cell may vary depending on tissue, cell type and compartment, stage of development, or pathological context. CRITICAL ISSUES AND FUTURE DIRECTIONS Dissecting the expression and regulation of the various catalytic forms of 20S proteasomes, such as constitutive, immuno-, and mixed proteasomes, together with their associated regulatory complexes will not only greatly enhance our understanding of proteasome function in lung pathogenesis but will also pave the way to develop new classes of drugs that inhibit or activate proteasome function in a defined setting for treatment of lung diseases.
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Affiliation(s)
- Silke Meiners
- Comprehensive Pneumology Center (CPC), University Hospital , Ludwig-Maximilians University, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL), Munich, Germany
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236
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Kitamura A, Sasaki Y, Abe T, Kano H, Yasutomo K. An inherited mutation in NLRC4 causes autoinflammation in human and mice. ACTA ACUST UNITED AC 2014; 211:2385-96. [PMID: 25385754 PMCID: PMC4235634 DOI: 10.1084/jem.20141091] [Citation(s) in RCA: 193] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Autoinflammatory syndromes cause sterile inflammation in the absence of any signs of autoimmune responses. Familial cold autoinflammatory syndrome (FCAS) is characterized by intermittent episodes of rash, arthralgia, and fever after exposure to cold stimuli. We have identified a missense mutation in the NLRC4 gene in patients with FCAS. NLRC4 has been known as a crucial sensor for several Gram-negative intracellular bacteria. The mutation in NLRC4 in FCAS patients promoted the formation of NLRC4-containing inflammasomes that cleave procaspase-1 and increase production of IL-1β. Transgenic mice that expressed mutant Nlrc4 under the invariant chain promoter developed dermatitis and arthritis. Inflammation within tissues depended on IL-1β-mediated production of IL-17A from neutrophils but not from T cells. Our findings reveal a previously unrecognized link between NLRC4 and a hereditary autoinflammatory disease and highlight the importance of NLRC4 not only in the innate immune response to bacterial infections but also in the genesis of inflammatory diseases.
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Affiliation(s)
- Akiko Kitamura
- Department of Immunology and Parasitology, Graduate School of Medicine, Tokushima University, Tokushima 770-8503, Japan
| | - Yuki Sasaki
- Department of Immunology and Parasitology, Graduate School of Medicine, Tokushima University, Tokushima 770-8503, Japan
| | - Takaya Abe
- Laboratory for Animal Resources and Genetic Engineering, RIKEN Center for Developmental Biology, Chuou-ku, Kobe 650-0047, Japan
| | - Hirotsugu Kano
- Department of Pediatrics, Teikyo University Mizonokuchi Hospital, Kawasaki, Kanagawa 213-8507, Japan
| | - Koji Yasutomo
- Department of Immunology and Parasitology, Graduate School of Medicine, Tokushima University, Tokushima 770-8503, Japan JST, CREST, Tokyo 102-0076, Japan
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237
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Abstract
Systemic autoinflammatory diseases are caused by abnormal activation of the cells that mediate innate immunity. In the past two decades, single-gene defects in different pathways, driving clinically distinct autoinflammatory syndromes, have been identified. Studies of these aberrant pathways have substantially advanced understanding of the cellular mechanisms that contribute to mounting effective and balanced innate immune responses. For example, mutations affecting the function of cytosolic immune sensors known as inflammasomes and the IL-1 signalling pathway can trigger excessive inflammation. A surge in discovery of new genes associated with autoinflammation has pointed to other mechanisms of disease linking innate immune responses to a number of basic cellular pathways, such as maintenance of protein homeostasis (proteostasis), protein misfolding and clearance, endoplasmic reticulum stress and mitochondrial stress, metabolic stress, autophagy and abnormalities in differentiation and development of myeloid cells. Although the spectrum of autoinflammatory diseases has been steadily expanding, a substantial number of patients remain undiagnosed. Next-generation sequencing technologies will be instrumental in finding disease-causing mutations in as yet uncharacterized diseases. As more patients are reported to have clinical features of autoinflammation and immunodeficiency or autoimmunity, the complex interactions between the innate and adaptive immune systems are unveiled.
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238
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New described dermatological disorders. BIOMED RESEARCH INTERNATIONAL 2014; 2014:616973. [PMID: 25243162 PMCID: PMC4163364 DOI: 10.1155/2014/616973] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/02/2014] [Accepted: 08/07/2014] [Indexed: 11/18/2022]
Abstract
Many advances in dermatology have been made in recent years. In the present review article, newly described disorders from the last six years are presented in detail. We divided these reports into different sections, including syndromes, autoinflammatory diseases, tumors, and unclassified disease. Syndromes included are “circumferential skin creases Kunze type” and “unusual type of pachyonychia congenita or a new syndrome”; autoinflammatory diseases include “chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syndrome,” “pyoderma gangrenosum, acne, and hidradenitis suppurativa (PASH) syndrome,” and “pyogenic arthritis, pyoderma gangrenosum, acne, and hidradenitis suppurativa (PAPASH) syndrome”; tumors include “acquired reactive digital fibroma,” “onychocytic matricoma and onychocytic carcinoma,” “infundibulocystic nail bed squamous cell carcinoma,” and “acral histiocytic nodules”; unclassified disorders include “saurian papulosis,” “symmetrical acrokeratoderma,” “confetti-like macular atrophy,” and “skin spicules,” “erythema papulosa semicircularis recidivans.”
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Rigante D, Vitale A, Lucherini OM, Cantarini L. The hereditary autoinflammatory disorders uncovered. Autoimmun Rev 2014; 13:892-900. [PMID: 25149390 DOI: 10.1016/j.autrev.2014.08.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 04/02/2014] [Indexed: 11/25/2022]
Abstract
There is a thriving interest in the field of hereditary autoinflammatory disorders (HAID), a gamut of heterogeneous conditions deriving from an aberrant orchestration of innate immunity, unified by the common feature of seemingly unprovoked inflammation, which might be systemic or occur in localized niches of the organism. Recurrent fever and episodic inflammation in the joints, serosal membranes, skin, gut, and other organs are the common denominator of HAID. Mutations in the inflammasome-related genes have been associated with different HAID, showing the intimate link existing between interleukin-1 (IL-1)-structured inflammasome and their pathogenesis. Differential diagnosis of HAID can be challenging, as there are no universally accepted diagnostic protocols, and near half of patients may remain without any genetic abnormality identified. The use of IL-1-antagonists has been associated with beneficial effects in a large number of HAID associated with excessive IL-1 signalling, such as cryopyrin-associated periodic syndromes, familial Mediterranean fever, and deficiency of IL-1 receptor antagonist. This review will discuss about the key-clues of HAID which might guide for an early recognition and drive decisions for treatment.
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Affiliation(s)
- Donato Rigante
- Institute of Pediatrics, Policlinico A. Gemelli, Università Cattolica Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Antonio Vitale
- Interdepartmental Research Center of Systemic Autoimmune and Autoinflammatory Diseases, Rheumatology Unit, Policlinico "Le Scotte", Università di Siena, Viale Bracci 1, 53100 Siena, Italy
| | - Orso Maria Lucherini
- Interdepartmental Research Center of Systemic Autoimmune and Autoinflammatory Diseases, Rheumatology Unit, Policlinico "Le Scotte", Università di Siena, Viale Bracci 1, 53100 Siena, Italy
| | - Luca Cantarini
- Interdepartmental Research Center of Systemic Autoimmune and Autoinflammatory Diseases, Rheumatology Unit, Policlinico "Le Scotte", Università di Siena, Viale Bracci 1, 53100 Siena, Italy.
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Liu Y, Jesus AA, Marrero B, Yang D, Ramsey SE, Sanchez GAM, Tenbrock K, Wittkowski H, Jones OY, Kuehn HS, Lee CCR, DiMattia MA, Cowen EW, Gonzalez B, Palmer I, DiGiovanna JJ, Biancotto A, Kim H, Tsai WL, Trier AM, Huang Y, Stone DL, Hill S, Kim HJ, St Hilaire C, Gurprasad S, Plass N, Chapelle D, Horkayne-Szakaly I, Foell D, Barysenka A, Candotti F, Holland SM, Hughes JD, Mehmet H, Issekutz AC, Raffeld M, McElwee J, Fontana JR, Minniti CP, Moir S, Kastner DL, Gadina M, Steven AC, Wingfield PT, Brooks SR, Rosenzweig SD, Fleisher TA, Deng Z, Boehm M, Paller AS, Goldbach-Mansky R. Activated STING in a vascular and pulmonary syndrome. N Engl J Med 2014; 371:507-518. [PMID: 25029335 PMCID: PMC4174543 DOI: 10.1056/nejmoa1312625] [Citation(s) in RCA: 938] [Impact Index Per Article: 93.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The study of autoinflammatory diseases has uncovered mechanisms underlying cytokine dysregulation and inflammation. METHODS We analyzed the DNA of an index patient with early-onset systemic inflammation, cutaneous vasculopathy, and pulmonary inflammation. We sequenced a candidate gene, TMEM173, encoding the stimulator of interferon genes (STING), in this patient and in five unrelated children with similar clinical phenotypes. Four children were evaluated clinically and immunologically. With the STING ligand cyclic guanosine monophosphate-adenosine monophosphate (cGAMP), we stimulated peripheral-blood mononuclear cells and fibroblasts from patients and controls, as well as commercially obtained endothelial cells, and then assayed transcription of IFNB1, the gene encoding interferon-β, in the stimulated cells. We analyzed IFNB1 reporter levels in HEK293T cells cotransfected with mutant or nonmutant STING constructs. Mutant STING leads to increased phosphorylation of signal transducer and activator of transcription 1 (STAT1), so we tested the effect of Janus kinase (JAK) inhibitors on STAT1 phosphorylation in lymphocytes from the affected children and controls. RESULTS We identified three mutations in exon 5 of TMEM173 in the six patients. Elevated transcription of IFNB1 and other gene targets of STING in peripheral-blood mononuclear cells from the patients indicated constitutive activation of the pathway that cannot be further up-regulated with stimulation. On stimulation with cGAMP, fibroblasts from the patients showed increased transcription of IFNB1 but not of the genes encoding interleukin-1 (IL1), interleukin-6 (IL6), or tumor necrosis factor (TNF). HEK293T cells transfected with mutant constructs show elevated IFNB1 reporter levels. STING is expressed in endothelial cells, and exposure of these cells to cGAMP resulted in endothelial activation and apoptosis. Constitutive up-regulation of phosphorylated STAT1 in patients' lymphocytes was reduced by JAK inhibitors. CONCLUSIONS STING-associated vasculopathy with onset in infancy (SAVI) is an autoinflammatory disease caused by gain-of-function mutations in TMEM173. (Funded by the Intramural Research Program of the National Institute of Arthritis and Musculoskeletal and Skin Diseases; ClinicalTrials.gov number, NCT00059748.).
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Affiliation(s)
- Y Liu
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A A Jesus
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - B Marrero
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - D Yang
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S E Ramsey
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - G A Montealegre Sanchez
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - K Tenbrock
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - H Wittkowski
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - O Y Jones
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - H S Kuehn
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - C-C R Lee
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - M A DiMattia
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - E W Cowen
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - B Gonzalez
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - I Palmer
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - J J DiGiovanna
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A Biancotto
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - H Kim
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - W L Tsai
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A M Trier
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - Y Huang
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - D L Stone
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S Hill
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - H J Kim
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - C St Hilaire
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S Gurprasad
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - N Plass
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - D Chapelle
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - I Horkayne-Szakaly
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - D Foell
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A Barysenka
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - F Candotti
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S M Holland
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - J D Hughes
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - H Mehmet
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A C Issekutz
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - M Raffeld
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - J McElwee
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - J R Fontana
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - C P Minniti
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S Moir
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - D L Kastner
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - M Gadina
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A C Steven
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - P T Wingfield
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S R Brooks
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S D Rosenzweig
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - T A Fleisher
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - Z Deng
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - M Boehm
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A S Paller
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - R Goldbach-Mansky
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
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Liu Y, Jesus AA, Marrero B, Yang D, Ramsey SE, Sanchez GAM, Tenbrock K, Wittkowski H, Jones OY, Kuehn HS, Lee CCR, DiMattia MA, Cowen EW, Gonzalez B, Palmer I, DiGiovanna JJ, Biancotto A, Kim H, Tsai WL, Trier AM, Huang Y, Stone DL, Hill S, Kim HJ, St Hilaire C, Gurprasad S, Plass N, Chapelle D, Horkayne-Szakaly I, Foell D, Barysenka A, Candotti F, Holland SM, Hughes JD, Mehmet H, Issekutz AC, Raffeld M, McElwee J, Fontana JR, Minniti CP, Moir S, Kastner DL, Gadina M, Steven AC, Wingfield PT, Brooks SR, Rosenzweig SD, Fleisher TA, Deng Z, Boehm M, Paller AS, Goldbach-Mansky R. Activated STING in a vascular and pulmonary syndrome. N Engl J Med 2014. [PMID: 25029335 DOI: 10.1056/nejmoa1312625)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND The study of autoinflammatory diseases has uncovered mechanisms underlying cytokine dysregulation and inflammation. METHODS We analyzed the DNA of an index patient with early-onset systemic inflammation, cutaneous vasculopathy, and pulmonary inflammation. We sequenced a candidate gene, TMEM173, encoding the stimulator of interferon genes (STING), in this patient and in five unrelated children with similar clinical phenotypes. Four children were evaluated clinically and immunologically. With the STING ligand cyclic guanosine monophosphate-adenosine monophosphate (cGAMP), we stimulated peripheral-blood mononuclear cells and fibroblasts from patients and controls, as well as commercially obtained endothelial cells, and then assayed transcription of IFNB1, the gene encoding interferon-β, in the stimulated cells. We analyzed IFNB1 reporter levels in HEK293T cells cotransfected with mutant or nonmutant STING constructs. Mutant STING leads to increased phosphorylation of signal transducer and activator of transcription 1 (STAT1), so we tested the effect of Janus kinase (JAK) inhibitors on STAT1 phosphorylation in lymphocytes from the affected children and controls. RESULTS We identified three mutations in exon 5 of TMEM173 in the six patients. Elevated transcription of IFNB1 and other gene targets of STING in peripheral-blood mononuclear cells from the patients indicated constitutive activation of the pathway that cannot be further up-regulated with stimulation. On stimulation with cGAMP, fibroblasts from the patients showed increased transcription of IFNB1 but not of the genes encoding interleukin-1 (IL1), interleukin-6 (IL6), or tumor necrosis factor (TNF). HEK293T cells transfected with mutant constructs show elevated IFNB1 reporter levels. STING is expressed in endothelial cells, and exposure of these cells to cGAMP resulted in endothelial activation and apoptosis. Constitutive up-regulation of phosphorylated STAT1 in patients' lymphocytes was reduced by JAK inhibitors. CONCLUSIONS STING-associated vasculopathy with onset in infancy (SAVI) is an autoinflammatory disease caused by gain-of-function mutations in TMEM173. (Funded by the Intramural Research Program of the National Institute of Arthritis and Musculoskeletal and Skin Diseases; ClinicalTrials.gov number, NCT00059748.).
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Affiliation(s)
- Y Liu
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A A Jesus
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - B Marrero
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - D Yang
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S E Ramsey
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - G A Montealegre Sanchez
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - K Tenbrock
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - H Wittkowski
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - O Y Jones
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - H S Kuehn
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - C-C R Lee
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - M A DiMattia
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - E W Cowen
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - B Gonzalez
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - I Palmer
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - J J DiGiovanna
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A Biancotto
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - H Kim
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - W L Tsai
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A M Trier
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - Y Huang
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - D L Stone
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S Hill
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - H J Kim
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - C St Hilaire
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S Gurprasad
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - N Plass
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - D Chapelle
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - I Horkayne-Szakaly
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - D Foell
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A Barysenka
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - F Candotti
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S M Holland
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - J D Hughes
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - H Mehmet
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A C Issekutz
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - M Raffeld
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - J McElwee
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - J R Fontana
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - C P Minniti
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S Moir
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - D L Kastner
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - M Gadina
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A C Steven
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - P T Wingfield
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S R Brooks
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S D Rosenzweig
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - T A Fleisher
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - Z Deng
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - M Boehm
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A S Paller
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - R Goldbach-Mansky
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
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Upregulation of immunoproteasome subunits in myositis indicates active inflammation with involvement of antigen presenting cells, CD8 T-cells and IFNΓ. PLoS One 2014; 9:e104048. [PMID: 25098831 PMCID: PMC4123911 DOI: 10.1371/journal.pone.0104048] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 07/06/2014] [Indexed: 12/24/2022] Open
Abstract
Objective In idiopathic inflammatory myopathies (IIM) infiltration of immune cells into muscle and upregulation of MHC-I expression implies increased antigen presentation and involvement of the proteasome system. To decipher the role of immunoproteasomes in myositis, we investigated individual cell types and muscle tissues and focused on possible immune triggers. Methods Expression of constitutive (PSMB5, -6, -7) and corresponding immunoproteasomal subunits (PSMB8, -9, -10) was analyzed by real-time RT-PCR in muscle biopsies and sorted peripheral blood cells of patients with IIM, non-inflammatory myopathies (NIM) and healthy donors (HD). Protein analysis in muscle biopsies was performed by western blot. Affymetrix HG-U133 platform derived transcriptome data from biopsies of different muscle diseases and from immune cell types as well as monocyte stimulation experiments were used for validation, coregulation and coexpression analyses. Results Real-time RT-PCR revealed significantly increased expression of immunoproteasomal subunits (PSMB8/-9/-10) in DC, monocytes and CD8+ T-cells in IIM. In muscle biopsies, the immunosubunits were elevated in IIM compared to NIM and exceeded levels of matched blood samples. Proteins of PSMB8 and -9 were found only in IIM but not NIM muscle biopsies. Reanalysis of 78 myositis and 20 healthy muscle transcriptomes confirmed these results and revealed involvement of the antigen processing and presentation pathway. Comparison with reference profiles of sorted immune cells and healthy muscle confirmed upregulation of PSMB8 and -9 in myositis biopsies beyond infiltration related changes. This upregulation correlated highest with STAT1, IRF1 and IFNγ expression. Elevation of T-cell specific transcripts in active IIM muscles was accompanied by increased expression of DC and monocyte marker genes and thus reflects the cell type specific involvement observed in peripheral blood. Conclusions Immunoproteasomes seem to indicate IIM activity and suggest that dominant involvement of antigen processing and presentation may qualify these diseases exemplarily for the evolving therapeutic concepts of immunoproteasome specific inhibition.
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Kanazawa N, Kunimoto K, Ishii N, Inamo Y, Furukawa F. Is CANDLE the best nomenclature? Br J Dermatol 2014; 171:659-60. [PMID: 24628124 DOI: 10.1111/bjd.12962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- N Kanazawa
- Department of Dermatology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan
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Wang H, Das L, Tan Hung Tiong J, Vasanwala RF, Arkachaisri T. CANDLE syndrome: an extended clinical spectrum. Rheumatology (Oxford) 2014; 53:2119-20. [DOI: 10.1093/rheumatology/keu298] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
During the past 15 years, a growing number of monogenic inflammatory diseases have been described and their respective responsible genes identified. The proteins encoded by these genes are involved in the regulatory pathways of inflammation and are mostly expressed in cells of the innate immune system. Diagnosis remains clinical, with genetic confirmation where feasible. Although a group of patients exhibit episodic systemic inflammation (periodic fevers), these disorders are mediated by continuous overproduction and release of pro-inflammatory mediators, such as IL-1 and IL-6, and TNF and are best considered as autoinflammatory diseases rather than periodic fevers. Treatment with biologic agents that block these cytokines, particularly IL-1, has proved to be dramatically effective in some patients. Still, in many cases of autoinflammation no genetic abnormalities are detected and treatment remains suboptimal, raising the question of novel pathogenic mutations in unexplored genes and pathways.
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Affiliation(s)
- Ricardo A G Russo
- Service of Immunology and Rheumatology, Hospital de Pediatría Garrahan, Buenos Aires, Argentina, University College London Institute of Child Health and Department of Paediatric Rheumatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK.
| | - Paul A Brogan
- Service of Immunology and Rheumatology, Hospital de Pediatría Garrahan, Buenos Aires, Argentina, University College London Institute of Child Health and Department of Paediatric Rheumatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK. Service of Immunology and Rheumatology, Hospital de Pediatría Garrahan, Buenos Aires, Argentina, University College London Institute of Child Health and Department of Paediatric Rheumatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
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Federici S, Gattorno M. A practical approach to the diagnosis of autoinflammatory diseases in childhood. Best Pract Res Clin Rheumatol 2014; 28:263-76. [DOI: 10.1016/j.berh.2014.05.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Kuller LH, Mackey RH, Walitt BT, Deane KD, Holers VM, Robinson WH, Sokolove J, Chang Y, Moreland LW. Rheumatoid arthritis in the Women's Health Initiative: methods and baseline evaluation. Am J Epidemiol 2014; 179:917-26. [PMID: 24569640 PMCID: PMC3969537 DOI: 10.1093/aje/kwu003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 01/06/2014] [Indexed: 12/15/2022] Open
Abstract
Second-generation assays for anti-cyclic citrullinated peptide (anti-CCP), a highly sensitive and specific marker for rheumatoid arthritis (RA), have redefined the epidemiology of RA. In the Women's Health Initiative (WHI) RA study (2009-2011), we evaluated the prevalence of anti-CCP positivity among 15,691 (10.2% of 161,808) WHI participants aged 50-79 years who reported RA. Using stored baseline specimens, we measured serum anti-CCP, rheumatoid factor (RF), and antinuclear antibody in a defined sample of 9,988 of black, white, and Hispanic women. In a subset of women, we measured plasma cytokine levels and number of copies of the human leukocyte antigen (HLA)-DRB1 (HLA-DRB1) shared epitope in DNA by means of Luminex polymerase chain reaction typing (Luminex Corporation, Austin, Texas). We validated classification of probable clinical RA in 2 clinics as anti-CCP positivity or self-reported validated use of disease-modifying antirheumatic drugs (DMARDs). The prevalence of anti-CCP positivity was 8.1%, and the prevalence of RF positivity was approximately 16.0%. DMARD use including prednisone was reported by 1,140 (11.4%) participants (841 excluding prednisone) but by 57.5% of anti-CCP-positive women. The prevalence of 2 shared epitopes was also much higher for anti-CCP-positive women (18.2%, as opposed to only 5.5% for women with anti-CCP-negative DMARD-positive RA and 6.6% for anti-CCP-negative, RF-negative DMARD nonusers). Median cytokine levels were much higher for anti-CCP-positive/RF-positive women. Women with anti-CCP-positive RA and anti-CCP-negative RA had different characteristics with regard to HLA shared epitope, cigarette smoking, and inflammation (cytokines).
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Affiliation(s)
- Lewis H. Kuller
- Correspondence to Dr. Lewis H. Kuller, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 North Bellefield Avenue, Room 550, Pittsburgh, PA 15261 (e-mail: )
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Abstract
While autoimmunity as cause of disease is well-established, other categories of immune-mediated diseases that are not produced by targeting of self-antigens by antibodies is in the process of being described. These so-called autoinflammatory diseases arise when an inappropriate activation of antigen-independent mechanisms occurs. Autoinflammatory diseases course with recurrent attacks of fever and multisystemic inflammation; however, the skin may also be affected by a variety of inflammatory manifestations that often alert the clinician about the presence of an autoinflammatory disease. Recognizing the cutaneous features of these syndromes will aid for prompt diagnosis and early treatment that is key for the quality of life and survival of the affected patients. In this paper, we focus on the skin manifestations of autoinflammatory diseases in children, which is the usual period of appearing of the first symptoms and signs.
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Abstract
Autoinflammatory diseases represent an expanding spectrum of genetic and non-genetic inflammatory diseases characterized by recurrent episodes of fever and systemic inflammation affecting the eyes, joints, skin, and serosal surfaces. Thus, these syndromes are recognized as disorders of innate immunity. Confirming this view, most autoinflammatory diseases are uniquely responsive to IL-1β blockade. Although many autoinflammatory diseases have a genetic cause, increasing evidence indicates that the degree of cell stress concurs to the severity of the disease phenotype. In this mini-review, I will discuss the recent advances on pathogenesis, pathophysiology and therapeutic approaches in autoinflammatory syndromes.
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Gomes AV. Genetics of proteasome diseases. SCIENTIFICA 2013; 2013:637629. [PMID: 24490108 PMCID: PMC3892944 DOI: 10.1155/2013/637629] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 11/18/2013] [Indexed: 05/28/2023]
Abstract
The proteasome is a large, multiple subunit complex that is capable of degrading most intracellular proteins. Polymorphisms in proteasome subunits are associated with cardiovascular diseases, diabetes, neurological diseases, and cancer. One polymorphism in the proteasome gene PSMA6 (-8C/G) is associated with three different diseases: type 2 diabetes, myocardial infarction, and coronary artery disease. One type of proteasome, the immunoproteasome, which contains inducible catalytic subunits, is adapted to generate peptides for antigen presentation. It has recently been shown that mutations and polymorphisms in the immunoproteasome catalytic subunit PSMB8 are associated with several inflammatory and autoinflammatory diseases including Nakajo-Nishimura syndrome, CANDLE syndrome, and intestinal M. tuberculosis infection. This comprehensive review describes the disease-related polymorphisms in proteasome genes associated with human diseases and the physiological modulation of proteasome function by these polymorphisms. Given the large number of subunits and the central importance of the proteasome in human physiology as well as the fast pace of detection of proteasome polymorphisms associated with human diseases, it is likely that other polymorphisms in proteasome genes associated with diseases will be detected in the near future. While disease-associated polymorphisms are now readily discovered, the challenge will be to use this genetic information for clinical benefit.
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Affiliation(s)
- Aldrin V. Gomes
- Department of Neurobiology, Physiology, and Behavior, University of California, Davis, CA 95616, USA
- Department of Physiology and Membrane Biology, University of California, Davis, CA 95616, USA
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