1
|
Aylan Gelen S, Kara B, Eser Şimsek I, Güngör M, Zengin E, Sarper N. Autoimmune Hemolytic Anemia Due to Spondyloenchondrodysplasia with Spastic Paraparesis and Intracranial Calcification due to Mutation in ACP5. J Pediatr Genet 2024; 13:50-56. [PMID: 38567175 PMCID: PMC10984710 DOI: 10.1055/s-0041-1736560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/16/2021] [Indexed: 10/19/2022]
Abstract
Spondyloenchondrodysplasia (SPENCD) is a rare spondylometaphyseal skeletal dysplasia with characteristic lesions mimicking enchondromatosis and resulting in short stature. A large spectrum of immunologic abnormalities may be seen in SPENCD, including immune deficiencies and autoimmune disorders. SPENCD is caused by loss of tartrate-resistant acid phosphatase activity, due to homozygous mutations in ACP5 , playing a role in nonnucleic-acid-related stimulation/regulation of the type I interferon pathway. In this article, we presented a 19-year-old boy with SPENCD, presenting with recurrent autoimmune hemolytic anemia episodes since he was 5 years old. He had short stature, platyspondyly, metaphyseal changes, intracranial calcification, spastic paraparesis, and mild intellectual disability. He also had recurrent pneumonia attacks. The clinical diagnosis of SPENCD was confirmed by sequencing of the ACP5 gene, and a homozygous c.155A > C (p.K52T) variation was found, which was reported before as pathogenic. In conclusion, in early onset chronic autoimmune cytopenias an immune dysregulation may often have a role in the etiology. Associating findings and immunologic functions should be carefully evaluated in such patients in the light of the literature. The present case shows the importance of multisystemic evaluation for the detection of SPENCD that has a monogenic etiology.
Collapse
Affiliation(s)
- Sema Aylan Gelen
- Department of Pediatrics, Division of Pediatric Hematology, Kocaeli University Medical Faculty, Kocaeli, Türkiye
| | - Bülent Kara
- Department of Pediatrics, Division of Pediatric Neurology, Kocaeli University Medical Faculty, Kocaeli, Türkiye
| | - Isil Eser Şimsek
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Kocaeli University Medical Faculty, Kocaeli, Türkiye
| | - Mesut Güngör
- Department of Pediatrics, Division of Pediatric Neurology, Kocaeli University Medical Faculty, Kocaeli, Türkiye
| | - Emine Zengin
- Department of Pediatrics, Division of Pediatric Hematology, Kocaeli University Medical Faculty, Kocaeli, Türkiye
| | - Nazan Sarper
- Department of Pediatrics, Division of Pediatric Hematology, Kocaeli University Medical Faculty, Kocaeli, Türkiye
| |
Collapse
|
2
|
Gernez Y, Narula M, Cepika AM, Valdes Camacho J, Hoyte EG, Mouradian K, Glader B, Singh D, Sathi B, Rao L, Tolin AL, Weinberg KI, Lewis DB, Bacchetta R, Weinacht KG. Case report: Refractory Evans syndrome in two patients with spondyloenchondrodysplasia with immune dysregulation treated successfully with JAK1/JAK2 inhibition. Front Immunol 2024; 14:1328005. [PMID: 38347954 PMCID: PMC10859398 DOI: 10.3389/fimmu.2023.1328005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/28/2023] [Indexed: 02/15/2024] Open
Abstract
Biallelic mutations in the ACP5 gene cause spondyloenchondrodysplasia with immune dysregulation (SPENCDI). SPENCDI is characterized by the phenotypic triad of skeletal dysplasia, innate and adaptive immune dysfunction, and variable neurologic findings ranging from asymptomatic brain calcifications to severe developmental delay with spasticity. Immune dysregulation in SPENCDI is often refractory to standard immunosuppressive treatments. Here, we present the cases of two patients with SPENCDI and recalcitrant autoimmune cytopenias who demonstrated a favorable clinical response to targeted JAK inhibition over a period of more than 3 years. One of the patients exhibited steadily rising IgG levels and a bone marrow biopsy revealed smoldering multiple myeloma. A review of the literature uncovered that approximately half of the SPENCDI patients reported to date exhibited increased IgG levels. Screening for multiple myeloma in SPENCDI patients with rising IgG levels should therefore be considered.
Collapse
Affiliation(s)
- Yael Gernez
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Mansi Narula
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Alma-Martina Cepika
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Juanita Valdes Camacho
- Division of Allergy and Immunology, Department of Pediatrics, Louisiana State University (LSU) Health, Shreveport, LA, United States
| | - Elisabeth G. Hoyte
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Kirsten Mouradian
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Bertil Glader
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Deepika Singh
- Division of Rheumatology, Department of Pediatrics, Valley Children Hospital, Madera, CA, United States
| | - Bindu Sathi
- Division of Hematology, Department of Pediatrics, Valley Children Hospital, Madera, CA, United States
| | - Latha Rao
- Division of Hematology, Department of Pediatrics, Valley Children Hospital, Madera, CA, United States
| | - Ana L. Tolin
- Division of Immunology, Department of Pediatrics, Hospital Pediatrico Dr. Humberto Notti, Mendoza, Argentina
| | - Kenneth I. Weinberg
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - David B. Lewis
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Rosa Bacchetta
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Katja G. Weinacht
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| |
Collapse
|
3
|
Xi Q, Plaza Enriquez LJ, Tanni NU, Patsias I. Underdiagnosed Roifman syndrome manifested as non-ischaemic cardiomyopathy: a case report. ESC Heart Fail 2023; 10:3195-3198. [PMID: 37666272 PMCID: PMC10567627 DOI: 10.1002/ehf2.14518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/25/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023] Open
Abstract
Roifman syndrome is a rare congenital disorder characterized by growth retardation, cognitive delay, spondyloepiphyseal dysplasia, immunodeficiency, and retinal dystrophy. However, very rarely, with only one case reported to date, a patient with Roifman syndrome may develop cardiomyopathy in their lifetime. We reported a case with underdiagnosed Roifman syndrome confirmed by whole genome sequencing, manifested as non-ischaemic cardiomyopathy, which has broadened the association between non-ischaemic cardiomyopathy and the genetic disorder Roifman syndrome. We also underscored that cardiomyopathy might be part of the clinical manifestations of Roifman syndrome and the importance of whole genome sequencing for diagnosis, as RNU4ATAC is not targeted by many commercially available exome capture kits.
Collapse
Affiliation(s)
- Qianlan Xi
- Department of Internal MedicineMemorial Healthcare SystemHollywoodFLUSA
| | | | | | - Iani Patsias
- Advanced Heart Failure and TransplantMemorial Healthcare SystemHollywoodFLUSA
| |
Collapse
|
4
|
Mathiyazhagan G, Hasan F, Chauhan P, Gupta A, Yadav S, Kashyap R. Spondyloenchondrodysplasia with immune dysregulation: Role of sirolimus. Pediatr Blood Cancer 2022; 69:e29672. [PMID: 35293682 DOI: 10.1002/pbc.29672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Gopinathan Mathiyazhagan
- Department of Haematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Faheema Hasan
- Department of Haematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Priyanka Chauhan
- Department of Haematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Anshul Gupta
- Department of Haematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Sanjeev Yadav
- Department of Haematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Rajesh Kashyap
- Department of Haematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
5
|
Lodi L, Mastrolia MV, Bello F, Rossi GM, Angelotti ML, Crow YJ, Romagnani P, Vaglio A. Type I interferon-related kidney disorders. Kidney Int 2022; 101:1142-1159. [PMID: 35339535 DOI: 10.1016/j.kint.2022.02.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/04/2022] [Accepted: 02/22/2022] [Indexed: 12/15/2022]
Abstract
Type I interferon (IFN-I) mediates tissue damage in a wide range of kidney disorders, directly affecting the biology and function of several renal cell types including podocytes, mesangial, endothelial and parietal epithelial cells (PECs).Enhanced IFN-I signalling is observed in the context of viral infections, autoimmunity (e.g., systemic lupus erythematosus, SLE), and the type 1 interferonopathies (T1Is), rare monogenic disorders characterised by constitutive activation of the IFN-I pathway. All of these IFN I-related disorders can cause renal dysfunction, and share pathogenic and histopathological features. Collapsing glomerulopathy, a histopathological lesion characterised by podocyte loss, collapse of the vascular tuft and PEC proliferation, is commonly associated with viral infections, has been described in T1Is such as Aicardi-Goutières syndrome and STING-associated vasculopathy with onset in infancy (SAVI), and can also be induced by recombinant IFN-therapy. In all of these conditions, podocytes and PECs seem to be the primary target of IFN I-mediated damage. Additionally, immune-mediated glomerular injury is common to viral infections, SLE, and T1Is such as COPA syndrome and DNASE1L3 deficiency, diseases in which IFN-I apparently promotes immune-mediated kidney injury. Finally, kidney pathology primarily characterised by vascular lesions (e.g., thrombotic microangiopathy, vasculitis) is a hallmark of the T1I ADA2 deficiency as well as of SLE, viral infections and IFN-therapy.Defining the nosology, pathogenic mechanisms and histopathological patterns of IFN I-related kidney disorders has diagnostic and therapeutic implications, especially considering the likely near-term availability of novel drugs targeting the IFN-I pathway.
Collapse
Affiliation(s)
- Lorenzo Lodi
- Department of Health Sciences, University of Firenze; Immunology Unit, Department of Pediatrics, Meyer Children's Hospital, Firenze, Italy
| | - Maria V Mastrolia
- Rheumatology Unit, Department of Pediatrics, Meyer Children's Hospital, Firenze, Italy
| | - Federica Bello
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | | | - Maria L Angelotti
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Firenze, Firenze, Italy
| | - Yanick J Crow
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK; Laboratory of Neurogenetics and Neuroinflammation, Institut Imagine, Université de Paris, Paris, France
| | - Paola Romagnani
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Firenze, Firenze, Italy; Nephrology and Dialysis Unit, Department of Pediatrics, Meyer Children's Hospital, Firenze, Italy
| | - Augusto Vaglio
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Firenze, Firenze, Italy; Nephrology and Dialysis Unit, Department of Pediatrics, Meyer Children's Hospital, Firenze, Italy.
| |
Collapse
|
6
|
Hong SM, Chen W, Feng J, Dai D, Shen N. Novel Mutations in ACP5 and SAMHD1 in a Patient With Pediatric Systemic Lupus Erythematosus. Front Pediatr 2022; 10:885006. [PMID: 35633950 PMCID: PMC9136231 DOI: 10.3389/fped.2022.885006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/18/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The study of genetic predisposition to pediatric systemic lupus erythematosus (pSLE) has brought new insights into the pathophysiology of SLE, as it is hypothesized that genetic predisposition is greater in children. Furthermore, identifying genetic variants and linking disrupted genes to abnormal immune pathways and clinical manifestations can be beneficial for both diagnosis and treatment. Here, we identified genetic alterations in a patient with childhood-onset SLE and analyzed the immunological mechanisms behind them to support future diagnosis, prognosis, and treatment. METHODS Whole exome sequencing (WES) was adopted for genetic analysis of a patient with childhood-onset SLE. Gene mutations were confirmed by Sanger sequencing. Clinical data of this patient were collected and summarized. Ingenuity Pathway Analysis was used to provide interacting genes of the perturbed genes. Online Enrichr tool and Cytoscape software were used to analysis the related pathways of these genes. RESULTS We present a case of a 2-year-old girl who was diagnosed with idiopathic thrombocytopenic purpura (ITP) and SLE. The patient was characterized by cutaneous bleeding spots on both lower extremities, thrombocytopenia, decreased serum complements levels, increased urinary red blood cells, and positive ANA and dsDNA. The patient was treated with methylprednisolone and mycophenolate, but clinical remission could not be achieved. The genomic analysis identified three novel mutations in this pSLE patient, a double-stranded missense mutation in ACP5 (c.1152G>T and c.420G>A) and a single-stranded mutation in SAMHD1 (c.1423G>A). Bioinformatic analysis showed that these two genes and their interacting genes are enriched in the regulation of multiple immune pathways associated with SLE, including cytokine signaling and immune cell activation or function. Analysis of the synergistic regulation of these two genes suggests that abnormalities in the type I interferon pathway caused by genetic variants may contribute to the pathogenesis of SLE. CONCLUSION The combined complexity of polymorphisms in the coding regions of ACP5 and SAMHD1 influences the susceptibility to SLE. Alterations in these genes may lead to abnormalities in the type I interferon pathway. Our study extends the spectrum of mutations in the ACP5 and SAMHD1 genes. The identification of these mutations could aid in the diagnosis of SLE with genetic counseling and suggest potential precise treatments for specific pathways.
Collapse
Affiliation(s)
- Soon-Min Hong
- Shanghai Institute of Rheumatology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Rheumatology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Chen
- Department of Pediatrics, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jiaqi Feng
- Department of Rheumatology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Dai Dai
- Shanghai Institute of Rheumatology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Rheumatology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Nan Shen
- Shanghai Institute of Rheumatology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Rheumatology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China.,Shenzhen Futian Hospital for Rheumatic Diseases, Shenzhen, China.,State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China.,Center for Autoimmune Genomics and Etiology (CAGE) and Divisions of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Joint Research Laboratory for Rheumatology of Shenzhen University Health Science Center and Shenzhen Futian Hospital for Rheumatic Diseases, Shenzhen, China
| |
Collapse
|
7
|
Kara B, Ekinci Z, Sahin S, Gungor M, Gunes AS, Ozturk K, Adrovic A, Cefle A, Inanç M, Gul A, Kasapcopur O. Monogenic lupus due to spondyloenchondrodysplasia with spastic paraparesis and intracranial calcification: case-based review. Rheumatol Int 2020. [PMID: 32691099 DOI: 10.1007/s00296-020-04653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Spondyloenchondrodysplasia (SPENCD) is a rare skeletal dysplasia characterized with platyspondyly and metaphyseal lesions of the long bones mimicking enchondromatosis, resulting in short stature. SPENCD often coexists with neurologic disorders and immune dysregulation. Spasticity, developmental delay and intracranial calcification are main neurologic abnormalities. Large spectrum of immunologic abnormalities may be seen in SPENCD, including immune deficiencies and autoimmune disorders with autoimmune thrombocytopenia and systemic lupus erythematosus as the most common phenotypes. SPENCD is caused by loss of tartrate-resistant acid phosphatase (TRAP) activity, due to homozygous mutations in ACP5, playing a role in non-nucleic acid-related stimulation/regulation of the type I interferon pathway. We present two siblings, 13-year-old girl and 25-year-old boy with SPENCD, from consanguineous parents. Both patients had short stature, platyspondyly, metaphyseal changes, spastic paraparesis, mild intellectual disability, and juvenile-onset SLE. The age at disease-onset was 2 years for girl and 19 years for boy. Both had skin and mucosa involvement. The age at diagnosis of SLE was 4 years for girl, and 19 years for boy. The clinical diagnosis of SPENCD was confirmed by sequencing of ACP5 gene, which revealed a homozygous c.155A > C (p.K52T), a variant reported before as pathogenic. Juvenile-onset SLE accounts for about 15-20% of all SLE cases. But, the onset of SLE before 5-years of age and also monogenic SLE are rare. Our case report and the literature review show the importance of multisystemic evaluation in the diagnosis of SPENCD and to remind the necessity of investigating the monogenic etiology in early-onset and familial SLE cases.
Collapse
Affiliation(s)
- Bulent Kara
- Department of Pediatric Neurology, Medical Faculty, Kocaeli University, Kocaeli, Turkey
| | - Zelal Ekinci
- Department of Pediatric Nephrology and Rheumatology, Florence Nightingale Hospital, Istanbul, Turkey
| | - Sezgin Sahin
- Department of Pediatric Rheumatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mesut Gungor
- Department of Pediatric Neurology, Medical Faculty, Kocaeli University, Kocaeli, Turkey
| | - Ayfer Sakarya Gunes
- Department of Pediatric Neurology, Medical Faculty, Kocaeli University, Kocaeli, Turkey
| | - Kubra Ozturk
- Department of Pediatric Rheumatology, Medical Faculty, Medeniyet University, Istanbul, Turkey
| | - Amra Adrovic
- Department of Pediatric Rheumatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ayse Cefle
- Department of Rheumatology, Medical Faculty, Kocaeli University, Kocaeli, Turkey
| | - Murat Inanç
- Department of Rheumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ahmet Gul
- Department of Rheumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| |
Collapse
|
8
|
Kara B, Ekinci Z, Sahin S, Gungor M, Gunes AS, Ozturk K, Adrovic A, Cefle A, Inanç M, Gul A, Kasapcopur O. Monogenic lupus due to spondyloenchondrodysplasia with spastic paraparesis and intracranial calcification: case-based review. Rheumatol Int 2020; 40:1903-1910. [PMID: 32691099 PMCID: PMC7369505 DOI: 10.1007/s00296-020-04653-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/11/2020] [Indexed: 01/10/2023]
Abstract
Spondyloenchondrodysplasia (SPENCD) is a rare skeletal dysplasia characterized with platyspondyly and metaphyseal lesions of the long bones mimicking enchondromatosis, resulting in short stature. SPENCD often coexists with neurologic disorders and immune dysregulation. Spasticity, developmental delay and intracranial calcification are main neurologic abnormalities. Large spectrum of immunologic abnormalities may be seen in SPENCD, including immune deficiencies and autoimmune disorders with autoimmune thrombocytopenia and systemic lupus erythematosus as the most common phenotypes. SPENCD is caused by loss of tartrate-resistant acid phosphatase (TRAP) activity, due to homozygous mutations in ACP5, playing a role in non-nucleic acid-related stimulation/regulation of the type I interferon pathway. We present two siblings, 13-year-old girl and 25-year-old boy with SPENCD, from consanguineous parents. Both patients had short stature, platyspondyly, metaphyseal changes, spastic paraparesis, mild intellectual disability, and juvenile-onset SLE. The age at disease-onset was 2 years for girl and 19 years for boy. Both had skin and mucosa involvement. The age at diagnosis of SLE was 4 years for girl, and 19 years for boy. The clinical diagnosis of SPENCD was confirmed by sequencing of ACP5 gene, which revealed a homozygous c.155A > C (p.K52T), a variant reported before as pathogenic. Juvenile-onset SLE accounts for about 15–20% of all SLE cases. But, the onset of SLE before 5-years of age and also monogenic SLE are rare. Our case report and the literature review show the importance of multisystemic evaluation in the diagnosis of SPENCD and to remind the necessity of investigating the monogenic etiology in early-onset and familial SLE cases.
Collapse
Affiliation(s)
- Bulent Kara
- Department of Pediatric Neurology, Medical Faculty, Kocaeli University, Kocaeli, Turkey
| | - Zelal Ekinci
- Department of Pediatric Nephrology and Rheumatology, Florence Nightingale Hospital, Istanbul, Turkey
| | - Sezgin Sahin
- Department of Pediatric Rheumatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mesut Gungor
- Department of Pediatric Neurology, Medical Faculty, Kocaeli University, Kocaeli, Turkey
| | - Ayfer Sakarya Gunes
- Department of Pediatric Neurology, Medical Faculty, Kocaeli University, Kocaeli, Turkey
| | - Kubra Ozturk
- Department of Pediatric Rheumatology, Medical Faculty, Medeniyet University, Istanbul, Turkey
| | - Amra Adrovic
- Department of Pediatric Rheumatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ayse Cefle
- Department of Rheumatology, Medical Faculty, Kocaeli University, Kocaeli, Turkey
| | - Murat Inanç
- Department of Rheumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ahmet Gul
- Department of Rheumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| |
Collapse
|
9
|
Sacri AS, Bruwier A, Baujat G, Breton S, Blanche S, Briggs TA, Bader-Meunier B. Childhood-onset autoimmune cytopenia as the presenting feature of biallelic ACP5 mutations. Pediatr Blood Cancer 2017; 64:306-310. [PMID: 27718324 DOI: 10.1002/pbc.26195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 07/13/2016] [Accepted: 07/13/2016] [Indexed: 01/07/2023]
Abstract
Childhood-onset chronic and refractory cytopenias are rare and may be genetic in etiology. We report three pediatric cases of severe autoimmune thrombocytopenia or anemia associated with growth retardation and spastic diplegia with intracranial calcification. The identification of platyspondyly and metaphyseal lesions suggested a potential diagnosis of spondyloenchondrodysplasia (SPENCD), which was confirmed with the identification of biallelic ACP5 mutations. Two patients demonstrated elevated serum interferon alpha levels. Our report highlights ACP5-associated disease as a cause of childhood-onset autoimmune cytopenia, particularly combined with growth retardation and/or spasticity. Furthermore, a role for type I interferon in the pathogenesis of autoimmune cytopenias is supported.
Collapse
Affiliation(s)
- Anne-Sylvia Sacri
- Department of Pediatric Immunology, Hematology and Rheumatology, Hôpital Necker, APHP, Paris, France
| | - Annelyse Bruwier
- Department of Pediatric Hematology Oncology, Clinique Universitaire Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Geneviève Baujat
- Department of Clinical Genetics, Hôpital Necker, APHP, Paris, France
- Institut IMAGINE, Paris, France
| | - Sylvain Breton
- Department of Pediatric Radiology, Hôpital Necker, APHP, Paris
| | - Stéphane Blanche
- Department of Pediatric Immunology, Hematology and Rheumatology, Hôpital Necker, APHP, Paris, France
- Institut IMAGINE, Paris, France
| | - Tracy A Briggs
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PT
| | - Brigitte Bader-Meunier
- Department of Pediatric Immunology, Hematology and Rheumatology, Hôpital Necker, APHP, Paris, France
- Institut IMAGINE, Paris, France
| |
Collapse
|
10
|
Utsumi T, Okada S, Izawa K, Honda Y, Nishimura G, Nishikomori R, Okano R, Kobayashi M. A Case with Spondyloenchondrodysplasia Treated with Growth Hormone. Front Endocrinol (Lausanne) 2017; 8:157. [PMID: 28740483 PMCID: PMC5502255 DOI: 10.3389/fendo.2017.00157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/22/2017] [Indexed: 11/25/2022] Open
Abstract
Spondyloenchondrodysplasia (SPENCD) is an autosomal recessive skeletal dysplasia caused by loss of function mutations in acid phosphatase 5, tartrate resistant (ACP5). Hypomorphic ACP5 mutations impair endochondral bone growth and create an interferon (INF) signature, which lead to distinctive spondylar and metaphyseal dysplasias, and extraskeletal morbidity, such as neurological involvement and immune dysregulation, respectively. We report an affected boy with novel ACP5 mutations, a splice-site mutation (736-2 A>C) and a nonsense mutation (R176X). He presented with postnatal short stature, which led to a diagnosis of partial growth hormone (GH) deficiency at 3 years of age. GH therapy was beneficial in accelerating his growth velocity. At 6 years of age, however, metaphyseal abnormalities of the knee attracted medical attention, and subsequent assessment ascertained the typical skeletal phenotype of SPENCD, brain calcifications, and an INF signature. This anecdotal experience indicates the potential efficacy of GH for growth failure in SPENCD.
Collapse
Affiliation(s)
- Takanori Utsumi
- Department of Pediatrics, Onomichi General Hospital, Hiroshima, Japan
- *Correspondence: Takanori Utsumi,
| | - Satoshi Okada
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Kazushi Izawa
- Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshitaka Honda
- Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Gen Nishimura
- Department of Pediatric Imaging, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan
| | - Ryuta Nishikomori
- Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Rika Okano
- Department of Pediatrics, Onomichi General Hospital, Hiroshima, Japan
| | - Masao Kobayashi
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| |
Collapse
|
11
|
Azizi G, Pouyani MR, Abolhassani H, Sharifi L, dizaji MZ, Mohammadi J, Mirshafiey A, Aghamohammadi A. Cellular and molecular mechanisms of immune dysregulation and autoimmunity. Cell Immunol 2016; 310:14-26. [DOI: 10.1016/j.cellimm.2016.08.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/18/2016] [Accepted: 08/25/2016] [Indexed: 12/22/2022]
|
12
|
Briggs TA, Rice GI, Adib N, Ades L, Barete S, Baskar K, Baudouin V, Cebeci AN, Clapuyt P, Coman D, De Somer L, Finezilber Y, Frydman M, Guven A, Heritier S, Karall D, Kulkarni ML, Lebon P, Levitt D, Le Merrer M, Linglart A, Livingston JH, Navarro V, Okenfuss E, Puel A, Revencu N, Scholl-Bürgi S, Vivarelli M, Wouters C, Bader-Meunier B, Crow YJ. Spondyloenchondrodysplasia Due to Mutations in ACP5: A Comprehensive Survey. J Clin Immunol 2016; 36:220-34. [PMID: 26951490 PMCID: PMC4792361 DOI: 10.1007/s10875-016-0252-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/22/2016] [Indexed: 02/06/2023]
Abstract
Purpose Spondyloenchondrodysplasia is a rare immuno-osseous dysplasia caused by biallelic mutations in ACP5. We aimed to provide a survey of the skeletal, neurological and immune manifestations of this disease in a cohort of molecularly confirmed cases. Methods We compiled clinical, genetic and serological data from a total of 26 patients from 18 pedigrees, all with biallelic ACP5 mutations. Results We observed a variability in skeletal, neurological and immune phenotypes, which was sometimes marked even between affected siblings. In total, 22 of 26 patients manifested autoimmune disease, most frequently autoimmune thrombocytopenia and systemic lupus erythematosus. Four patients were considered to demonstrate no clinical autoimmune disease, although two were positive for autoantibodies. In the majority of patients tested we detected upregulated expression of interferon-stimulated genes (ISGs), in keeping with the autoimmune phenotype and the likely immune-regulatory function of the deficient protein tartrate resistant acid phosphatase (TRAP). Two mutation positive patients did not demonstrate an upregulation of ISGs, including one patient with significant autoimmune disease controlled by immunosuppressive therapy. Conclusions Our data expand the known phenotype of SPENCD. We propose that the OMIM differentiation between spondyloenchondrodysplasia and spondyloenchondrodysplasia with immune dysregulation is no longer appropriate, since the molecular evidence that we provide suggests that these phenotypes represent a continuum of the same disorder. In addition, the absence of an interferon signature following immunomodulatory treatments in a patient with significant autoimmune disease may indicate a therapeutic response important for the immune manifestations of spondyloenchondrodysplasia.
Collapse
Affiliation(s)
- Tracy A Briggs
- Manchester Centre for Genomic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK. .,St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
| | - Gillian I Rice
- Manchester Centre for Genomic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Navid Adib
- Department of Rheumatology, The Lady Cilento Children's Hospital, Brisbane, Australia
| | - Lesley Ades
- Department of Clinical Genetics, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Paedatrics and Child Health, The University of Sydney, Sydney, Australia
| | - Stephane Barete
- Dermatology Department, Pitie-Salpetriere Hospital, Paris, France
| | - Kannan Baskar
- Creighton University, 2500 California Plaza, NE 68178, Omaha, USA
| | - Veronique Baudouin
- Pediatric Nephrology Department, Robert Debré University Hospital - APHP, 48 boulevard Sérurier, 75019, Paris, France
| | - Ayse N Cebeci
- Goztepe Educational and Research Hospital Pediatric Endocrinology Clinic, Istanbul, Türkiye
| | - Philippe Clapuyt
- Pediatric Imaging Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - David Coman
- Neuroscience Department, The Lady Cilento Children's Hospital, Brisbane, Australia.,School of Medicine, Griffith University, Gold Coast, Australia
| | - Lien De Somer
- Pediatric Rheumatology, Department of Pediatrics, University Hospitals Leuven, B-3000, Leuven, Belgium
| | - Yael Finezilber
- Danek Gertner Institute of Human Genetics, Chaim Sheba Medical Center, Tel Aviv, Israel
| | - Moshe Frydman
- Danek Gertner Institute of Human Genetics, Chaim Sheba Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayla Guven
- Goztepe Educational and Research Hospital Pediatric Endocrinology Clinic, Istanbul, Türkiye.,Amasya University Medical Faculty, Department of Pediatric Endocrinology, Istanbul, Türkiye
| | - Sébastien Heritier
- Department of Pediatric Hematology and Oncology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Daniela Karall
- Clinic for Pediatrics I, Inherited Metabolic Disorders, Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | | | - Pierre Lebon
- Service de Virologie, AP-HP Hôpital Cochin, Paris, France
| | - David Levitt
- Department of Paediatrics, The Lady Cilento Children's Hospital, Brisbane, Australia
| | - Martine Le Merrer
- Centre de Référence des Maladies Osseuses Constitutionnelles et Institut Imagine, Hopital Necker 149 rue de Sevres, 75015, Paris, France
| | - Agnes Linglart
- APHP, Bicêtre Paris Sud, Department of Pediatric Endocrinology and Diabetology for Children, 94270, Le Kremlin Bicêtre, France.,Reference Center for Rare Disorders of the Mineral Metabolism and Plateforme d'expertise Paris Sud Maladies Rares, APHP, 94270, Le Kremlin Bicêtre, France
| | - John H Livingston
- Department of Paediatric Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Ericka Okenfuss
- Kaiser Permanente - Genetics, 1650 Response Rd, Sacramento, CA, 95815, USA
| | - Anne Puel
- Génétique Humaine des Maladies Infectieuses, INSERM UMR 1163, Université Paris Descartes Sorbonne Paris Cité, Institut Imagine, Pièce 421-B1, 24 boulevard du Montparnasse, 75015, Paris, France
| | - Nicole Revencu
- Centre for Human Genetics, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Sabine Scholl-Bürgi
- Clinic for Pediatrics I, Inherited Metabolic Disorders, Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | - Marina Vivarelli
- Division of Nephrology, IRCCS Bambino Gesu' Pediatric Hospital, Rome, Italy
| | - Carine Wouters
- Department of Microbiology and Immunology, Pediatric Immunology, KU Leuven, University of Leuven, Leuven, Belgium
| | - Brigitte Bader-Meunier
- Pediatric Immunology and Rheumatology Unit, Hôpital Necker, APHP, Paris, France.,Institut Imagine, Paris, France
| | - Yanick J Crow
- Manchester Centre for Genomic Medicine, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.,Laboratory of Neurogenetics and Neuroinflammation, Institut Imagine, 24 boulevard du Montparnasse, 75015, Paris, France
| |
Collapse
|
13
|
Bilginer Y, Düzova A, Topaloğlu R, Batu ED, Boduroğlu K, Güçer Ş, Bodur İ, Alanay Y. Three cases of spondyloenchondrodysplasia (SPENCD) with systemic lupus erythematosus: a case series and review of the literature. Lupus 2016; 25:760-5. [DOI: 10.1177/0961203316629000] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 12/30/2015] [Indexed: 11/15/2022]
Abstract
Spondyloenchondrodysplasia (SPENCD) is a rare autosomal recessive skeletal dysplasia caused by recessive mutations in the ACP5 gene, and it is characterized by the persistence of chondroid tissue islands within the bone. The clinical spectrum of SPENCD includes neurological involvement and immune dysfunction, such as systemic lupus erythematosus (SLE). To date, there are only 12 reported cases of SPENCD associated with SLE in the literature; however, detailed clinical follow-up data is absent for this comorbidity. This report presents clinical and laboratory data of three patients diagnosed with SPENCD-associated SLE. All three patients had short stature, arthralgia/arthritis, lupus nephritis, hypocomplementemia, and positive autoantibodies, including anti-nuclear and anti-dsDNA antibodies. Two patients exhibited class IV and one patient exhibited class V lupus nephritis. The early recognition of SPENCD is imperative, and this condition should be considered in patients with SLE, particularly in individuals with short stature and skeletal abnormalities. The cases presented here demonstrate that timely diagnosis and follow-up are key factors for the successful management of these conditions.
Collapse
Affiliation(s)
- Y Bilginer
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - A Düzova
- Department of Pediatrics, Division of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - R Topaloğlu
- Department of Pediatrics, Division of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - E D Batu
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - K Boduroğlu
- Department of Pediatrics, Division of Genetics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ş Güçer
- Department of Pediatrics, Division of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İ Bodur
- Department of Pediatrics, Division of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Y Alanay
- Department of Pediatrics, Pediatric Genetic Unit, Acıbadem University School of Medicine, İstanbul, Turkey
| |
Collapse
|
14
|
Roifman CM, Chitayat D. Combined immunodeficiency, facial dysmorphism, optic nerve atrophy, skeletal anomalies and developmental delay: a new syndrome. Clin Genet 2010; 76:449-57. [PMID: 19863561 DOI: 10.1111/j.1399-0004.2009.01239.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Combined immunodeficiency (SCID) can be isolated and involve the immune system only or associated with abnormalities affecting other organs, mainly the skeletal and neurological systems. We report on sisters, born to consanguineous parents, with CID, facial dysmorphism, developmental delay, optic atrophy, myoclonic seizures, and skeletal anomalies. To the best of our knowledge, this is a hitherto new syndrome with most probably autosomal recessive inheritance and unknown etiology.
Collapse
Affiliation(s)
- C M Roifman
- Division of Immunology and Allergy, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada.
| | | |
Collapse
|
15
|
Ming JE, Stiehm ER. Genetic syndromic immunodeficiencies with antibody defects. Immunol Allergy Clin North Am 2009; 28:715-36, vii. [PMID: 18940571 DOI: 10.1016/j.iac.2008.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This article reviews the major syndromic immunodeficiencies with significant antibody defects, many of which may require intravenous immunogammaglobulin therapy. The authors define syndromic immunodeficiency as an illness associated with a characteristic group of phenotypic abnormalities or laboratory features that comprise a recognizable syndrome. Many are familial with a defined inheritance pattern. Immunodeficiency may not be a major part of the illness and may not be present in all patients; thus, these conditions differ from primary immunodeficiency syndromes, in which immune abnormalities are a consistent and prominent feature of their disease.
Collapse
Affiliation(s)
- Jeffrey E Ming
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, The University of Pennsylvania School of Medicine, 3615 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | | |
Collapse
|
16
|
Navarro V, Scott C, Briggs T, Barete S, Frances C, Lebon P, Maisonobe T, Rice G, Wouters C, Crow Y. Two further cases of spondyloenchondrodysplasia (SPENCD) with immune dysregulation. Am J Med Genet A 2008; 146A:2810-5. [DOI: 10.1002/ajmg.a.32518] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
17
|
Renella R, Superti-Furga A. A new case of spondyloenchondrodysplasia with immune dysregulation confirms the pleiotropic nature of the disorder: Comment on “A Syndrome of Immunodeficiency, Autoimmunity, and Spondylometaphyseal Dysplasia” by M.L. Kulkarni, K. Baskar, and P.M. Kulkarni [2006]. Am J Med Genet A 2007; 143A:1394-5. [PMID: 17497723 DOI: 10.1002/ajmg.a.31755] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|