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Massey V, Nguyen CTE, François T, De Bruycker JJ, Bonnefoy A, Lapeyraque AL, Decaluwe H. CNS Inflammation as the First Sign of Complement Factor I Deficiency: A Severe Myelitis Treated With Intense Immunotherapy and Eculizumab. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200191. [PMID: 38134378 PMCID: PMC10751016 DOI: 10.1212/nxi.0000000000200191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/30/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Complement factor I (CFI) deficiency is a rare autosomal recessive inborn error of immunity. In this report, we highlight that complete CFI deficiency may present with isolated and severe CNS inflammation without associated systemic features nor prior non-CNS episodes. This inflammation may respond to complement blockade therapy. METHODS This is a case description of a young girl with severe longitudinal transverse myelitis treated with aggressive immunotherapy that included eculizumab. Published cases of CFI-associated CNS inflammation were reviewed and discussed. RESULTS A primary immunodeficiency panel revealed 2 germline pathogenic variants in the CFI gene. Further complement testing of the index case and her family confirmed complete CFI deficiency. DISCUSSION We describe a unique case of severe spinal inflammation secondary to complete CFI deficiency. Although rare, isolated CNS inflammation may be the primary manifestation of complete CFI deficiency. To halt the uncontrolled complement-mediated inflammation associated with CFI deficiency, prompt targeted blockade of the complement pathway using eculizumab may be life changing in the acute phase. Long-lasting blockade of the complement pathway is also essential to prevent relapse in this subgroup of patients.
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Affiliation(s)
- Valérie Massey
- From the Immunology and Rheumatology Division (V.M., J.J.D.B., H.D.), Department of Pediatrics, Sainte-Justine University Hospital Center; Allergy and Immunology Division (V.M.), Sacré-Coeur Hospital; Neurology Division (C.-T.E.N.), Department of Pediatrics; Intensive Care Division (T.F., A.B.), Department of Pediatrics; Clinical Department of Laboratory Medicine (A.B.), OPTILAB; and Nephrology Division (A.-L.L.), Department of Pediatrics, Sainte-Justine University Hospital Center, Montreal, Canada
| | - Cam-Tu Emilie Nguyen
- From the Immunology and Rheumatology Division (V.M., J.J.D.B., H.D.), Department of Pediatrics, Sainte-Justine University Hospital Center; Allergy and Immunology Division (V.M.), Sacré-Coeur Hospital; Neurology Division (C.-T.E.N.), Department of Pediatrics; Intensive Care Division (T.F., A.B.), Department of Pediatrics; Clinical Department of Laboratory Medicine (A.B.), OPTILAB; and Nephrology Division (A.-L.L.), Department of Pediatrics, Sainte-Justine University Hospital Center, Montreal, Canada
| | - Tine François
- From the Immunology and Rheumatology Division (V.M., J.J.D.B., H.D.), Department of Pediatrics, Sainte-Justine University Hospital Center; Allergy and Immunology Division (V.M.), Sacré-Coeur Hospital; Neurology Division (C.-T.E.N.), Department of Pediatrics; Intensive Care Division (T.F., A.B.), Department of Pediatrics; Clinical Department of Laboratory Medicine (A.B.), OPTILAB; and Nephrology Division (A.-L.L.), Department of Pediatrics, Sainte-Justine University Hospital Center, Montreal, Canada
| | - Jean Jacques De Bruycker
- From the Immunology and Rheumatology Division (V.M., J.J.D.B., H.D.), Department of Pediatrics, Sainte-Justine University Hospital Center; Allergy and Immunology Division (V.M.), Sacré-Coeur Hospital; Neurology Division (C.-T.E.N.), Department of Pediatrics; Intensive Care Division (T.F., A.B.), Department of Pediatrics; Clinical Department of Laboratory Medicine (A.B.), OPTILAB; and Nephrology Division (A.-L.L.), Department of Pediatrics, Sainte-Justine University Hospital Center, Montreal, Canada
| | - Arnaud Bonnefoy
- From the Immunology and Rheumatology Division (V.M., J.J.D.B., H.D.), Department of Pediatrics, Sainte-Justine University Hospital Center; Allergy and Immunology Division (V.M.), Sacré-Coeur Hospital; Neurology Division (C.-T.E.N.), Department of Pediatrics; Intensive Care Division (T.F., A.B.), Department of Pediatrics; Clinical Department of Laboratory Medicine (A.B.), OPTILAB; and Nephrology Division (A.-L.L.), Department of Pediatrics, Sainte-Justine University Hospital Center, Montreal, Canada
| | - Anne-Laure Lapeyraque
- From the Immunology and Rheumatology Division (V.M., J.J.D.B., H.D.), Department of Pediatrics, Sainte-Justine University Hospital Center; Allergy and Immunology Division (V.M.), Sacré-Coeur Hospital; Neurology Division (C.-T.E.N.), Department of Pediatrics; Intensive Care Division (T.F., A.B.), Department of Pediatrics; Clinical Department of Laboratory Medicine (A.B.), OPTILAB; and Nephrology Division (A.-L.L.), Department of Pediatrics, Sainte-Justine University Hospital Center, Montreal, Canada
| | - Hélène Decaluwe
- From the Immunology and Rheumatology Division (V.M., J.J.D.B., H.D.), Department of Pediatrics, Sainte-Justine University Hospital Center; Allergy and Immunology Division (V.M.), Sacré-Coeur Hospital; Neurology Division (C.-T.E.N.), Department of Pediatrics; Intensive Care Division (T.F., A.B.), Department of Pediatrics; Clinical Department of Laboratory Medicine (A.B.), OPTILAB; and Nephrology Division (A.-L.L.), Department of Pediatrics, Sainte-Justine University Hospital Center, Montreal, Canada
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Rolfes M, Harroud A, Zorn KC, Tubati A, Omura C, Kurtz K, Matloubian M, Berger A, Chiu CY, Wilson MR, Ramachandran PS. Complement Factor I Gene Variant as a Treatable Cause of Recurrent Aseptic Neutrophilic Meningitis: A Case Report. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:e200121. [PMID: 37339889 DOI: 10.1212/nxi.0000000000200121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/10/2023] [Indexed: 06/22/2023]
Abstract
Mutations in the complement factor I (CFI) gene have previously been identified as causes of recurrent CNS inflammation. We present a case of a 26-year-old man with 18 episodes of recurrent meningitis, who had a variant in CFI(c.859G>A,p.Gly287Arg) not previously associated with neurologic manifestations. He achieved remission with canakinumab, a human monoclonal antibody targeted at interleukin-1 beta.
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Affiliation(s)
- Mary Rolfes
- From the Weill Institute for Neurosciences (M.R., M.R.W.), Department of Neurology, University of California, San Francisco; Montreal Neurological Institute and Hospital (A.H.), Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada; Department of Biochemistry and Biophysics (K.C.Z., A.T.); Department of Laboratory Medicine (C.O., C.Y.C.); Kaiser Permanente Santa Rosa Medical Center (K.K.)Department of Medicine (M.M.), Division of Rheumatology; Department of Medicine (A.B.), Molecular Medicine Consult Service; Department of Medicine (C.Y.C.), Division of Infectious Diseases, University of California, San Francisco; The Peter Doherty Institute for Infection and Immunity (P.S.R.); Department of Neurology (P.S.R.), Royal Melbourne Hospital; and Department of Neurology (P.S.R.), St.Vincent's Hospital, University of Melbourne, Australia
| | - Adil Harroud
- From the Weill Institute for Neurosciences (M.R., M.R.W.), Department of Neurology, University of California, San Francisco; Montreal Neurological Institute and Hospital (A.H.), Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada; Department of Biochemistry and Biophysics (K.C.Z., A.T.); Department of Laboratory Medicine (C.O., C.Y.C.); Kaiser Permanente Santa Rosa Medical Center (K.K.)Department of Medicine (M.M.), Division of Rheumatology; Department of Medicine (A.B.), Molecular Medicine Consult Service; Department of Medicine (C.Y.C.), Division of Infectious Diseases, University of California, San Francisco; The Peter Doherty Institute for Infection and Immunity (P.S.R.); Department of Neurology (P.S.R.), Royal Melbourne Hospital; and Department of Neurology (P.S.R.), St.Vincent's Hospital, University of Melbourne, Australia
| | - Kelsey C Zorn
- From the Weill Institute for Neurosciences (M.R., M.R.W.), Department of Neurology, University of California, San Francisco; Montreal Neurological Institute and Hospital (A.H.), Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada; Department of Biochemistry and Biophysics (K.C.Z., A.T.); Department of Laboratory Medicine (C.O., C.Y.C.); Kaiser Permanente Santa Rosa Medical Center (K.K.)Department of Medicine (M.M.), Division of Rheumatology; Department of Medicine (A.B.), Molecular Medicine Consult Service; Department of Medicine (C.Y.C.), Division of Infectious Diseases, University of California, San Francisco; The Peter Doherty Institute for Infection and Immunity (P.S.R.); Department of Neurology (P.S.R.), Royal Melbourne Hospital; and Department of Neurology (P.S.R.), St.Vincent's Hospital, University of Melbourne, Australia
| | - Asritha Tubati
- From the Weill Institute for Neurosciences (M.R., M.R.W.), Department of Neurology, University of California, San Francisco; Montreal Neurological Institute and Hospital (A.H.), Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada; Department of Biochemistry and Biophysics (K.C.Z., A.T.); Department of Laboratory Medicine (C.O., C.Y.C.); Kaiser Permanente Santa Rosa Medical Center (K.K.)Department of Medicine (M.M.), Division of Rheumatology; Department of Medicine (A.B.), Molecular Medicine Consult Service; Department of Medicine (C.Y.C.), Division of Infectious Diseases, University of California, San Francisco; The Peter Doherty Institute for Infection and Immunity (P.S.R.); Department of Neurology (P.S.R.), Royal Melbourne Hospital; and Department of Neurology (P.S.R.), St.Vincent's Hospital, University of Melbourne, Australia
| | - Charles Omura
- From the Weill Institute for Neurosciences (M.R., M.R.W.), Department of Neurology, University of California, San Francisco; Montreal Neurological Institute and Hospital (A.H.), Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada; Department of Biochemistry and Biophysics (K.C.Z., A.T.); Department of Laboratory Medicine (C.O., C.Y.C.); Kaiser Permanente Santa Rosa Medical Center (K.K.)Department of Medicine (M.M.), Division of Rheumatology; Department of Medicine (A.B.), Molecular Medicine Consult Service; Department of Medicine (C.Y.C.), Division of Infectious Diseases, University of California, San Francisco; The Peter Doherty Institute for Infection and Immunity (P.S.R.); Department of Neurology (P.S.R.), Royal Melbourne Hospital; and Department of Neurology (P.S.R.), St.Vincent's Hospital, University of Melbourne, Australia
| | - Kenneth Kurtz
- From the Weill Institute for Neurosciences (M.R., M.R.W.), Department of Neurology, University of California, San Francisco; Montreal Neurological Institute and Hospital (A.H.), Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada; Department of Biochemistry and Biophysics (K.C.Z., A.T.); Department of Laboratory Medicine (C.O., C.Y.C.); Kaiser Permanente Santa Rosa Medical Center (K.K.)Department of Medicine (M.M.), Division of Rheumatology; Department of Medicine (A.B.), Molecular Medicine Consult Service; Department of Medicine (C.Y.C.), Division of Infectious Diseases, University of California, San Francisco; The Peter Doherty Institute for Infection and Immunity (P.S.R.); Department of Neurology (P.S.R.), Royal Melbourne Hospital; and Department of Neurology (P.S.R.), St.Vincent's Hospital, University of Melbourne, Australia
| | - Mehrdad Matloubian
- From the Weill Institute for Neurosciences (M.R., M.R.W.), Department of Neurology, University of California, San Francisco; Montreal Neurological Institute and Hospital (A.H.), Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada; Department of Biochemistry and Biophysics (K.C.Z., A.T.); Department of Laboratory Medicine (C.O., C.Y.C.); Kaiser Permanente Santa Rosa Medical Center (K.K.)Department of Medicine (M.M.), Division of Rheumatology; Department of Medicine (A.B.), Molecular Medicine Consult Service; Department of Medicine (C.Y.C.), Division of Infectious Diseases, University of California, San Francisco; The Peter Doherty Institute for Infection and Immunity (P.S.R.); Department of Neurology (P.S.R.), Royal Melbourne Hospital; and Department of Neurology (P.S.R.), St.Vincent's Hospital, University of Melbourne, Australia
| | - Amy Berger
- From the Weill Institute for Neurosciences (M.R., M.R.W.), Department of Neurology, University of California, San Francisco; Montreal Neurological Institute and Hospital (A.H.), Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada; Department of Biochemistry and Biophysics (K.C.Z., A.T.); Department of Laboratory Medicine (C.O., C.Y.C.); Kaiser Permanente Santa Rosa Medical Center (K.K.)Department of Medicine (M.M.), Division of Rheumatology; Department of Medicine (A.B.), Molecular Medicine Consult Service; Department of Medicine (C.Y.C.), Division of Infectious Diseases, University of California, San Francisco; The Peter Doherty Institute for Infection and Immunity (P.S.R.); Department of Neurology (P.S.R.), Royal Melbourne Hospital; and Department of Neurology (P.S.R.), St.Vincent's Hospital, University of Melbourne, Australia
| | - Charles Y Chiu
- From the Weill Institute for Neurosciences (M.R., M.R.W.), Department of Neurology, University of California, San Francisco; Montreal Neurological Institute and Hospital (A.H.), Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada; Department of Biochemistry and Biophysics (K.C.Z., A.T.); Department of Laboratory Medicine (C.O., C.Y.C.); Kaiser Permanente Santa Rosa Medical Center (K.K.)Department of Medicine (M.M.), Division of Rheumatology; Department of Medicine (A.B.), Molecular Medicine Consult Service; Department of Medicine (C.Y.C.), Division of Infectious Diseases, University of California, San Francisco; The Peter Doherty Institute for Infection and Immunity (P.S.R.); Department of Neurology (P.S.R.), Royal Melbourne Hospital; and Department of Neurology (P.S.R.), St.Vincent's Hospital, University of Melbourne, Australia
| | - Michael R Wilson
- From the Weill Institute for Neurosciences (M.R., M.R.W.), Department of Neurology, University of California, San Francisco; Montreal Neurological Institute and Hospital (A.H.), Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada; Department of Biochemistry and Biophysics (K.C.Z., A.T.); Department of Laboratory Medicine (C.O., C.Y.C.); Kaiser Permanente Santa Rosa Medical Center (K.K.)Department of Medicine (M.M.), Division of Rheumatology; Department of Medicine (A.B.), Molecular Medicine Consult Service; Department of Medicine (C.Y.C.), Division of Infectious Diseases, University of California, San Francisco; The Peter Doherty Institute for Infection and Immunity (P.S.R.); Department of Neurology (P.S.R.), Royal Melbourne Hospital; and Department of Neurology (P.S.R.), St.Vincent's Hospital, University of Melbourne, Australia
| | - Prashanth S Ramachandran
- From the Weill Institute for Neurosciences (M.R., M.R.W.), Department of Neurology, University of California, San Francisco; Montreal Neurological Institute and Hospital (A.H.), Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada; Department of Biochemistry and Biophysics (K.C.Z., A.T.); Department of Laboratory Medicine (C.O., C.Y.C.); Kaiser Permanente Santa Rosa Medical Center (K.K.)Department of Medicine (M.M.), Division of Rheumatology; Department of Medicine (A.B.), Molecular Medicine Consult Service; Department of Medicine (C.Y.C.), Division of Infectious Diseases, University of California, San Francisco; The Peter Doherty Institute for Infection and Immunity (P.S.R.); Department of Neurology (P.S.R.), Royal Melbourne Hospital; and Department of Neurology (P.S.R.), St.Vincent's Hospital, University of Melbourne, Australia.
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3
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Hallam TM, Sharp SJ, Andreadi A, Kavanagh D. Complement factor I: Regulatory nexus, driver of immunopathology, and therapeutic. Immunobiology 2023; 228:152410. [PMID: 37478687 DOI: 10.1016/j.imbio.2023.152410] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/23/2023] [Accepted: 06/01/2023] [Indexed: 07/23/2023]
Abstract
Complement factor I (FI) is the nexus for classical, lectin and alternative pathway complement regulation. FI is an 88 kDa plasma protein that circulates in an inactive configuration until it forms a trimolecular complex with its cofactor and substrate whereupon a structural reorganization allows the catalytic triad to cleave its substrates, C3b and C4b. In keeping with its role as the master complement regulatory enzyme, deficiency has been linked to immunopathology. In the setting of complete FI deficiency, a consumptive C3 deficiency results in recurrent infections with encapsulated microorganisms. Aseptic cerebral inflammation and vasculitic presentations are also less commonly observed. Heterozygous mutations in the factor I gene (CFI) have been demonstrated to be enriched in atypical haemolytic uraemic syndrome, albeit with a very low penetrance. Haploinsufficiency of CFI has also been associated with decreased retinal thickness and is a strong risk factor for the development of age-related macular degeneration. Supplementation of FI using plasma purified or recombinant protein has long been postulated, however, technical difficulties prevented progression into clinical trials. It is only using gene therapy that CFI supplementation has reached the clinic with GT005 in phase I/II clinical trials for geographic atrophy.
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Affiliation(s)
- T M Hallam
- Gyroscope Therapeutics Limited, A Novartis Company, Rolling Stock Yard, London N7 9AS, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne NE1 7RU, UK; National Renal Complement Therapeutics Centre, Building 26, Royal Victoria Infirmary, UK
| | - S J Sharp
- Gyroscope Therapeutics Limited, A Novartis Company, Rolling Stock Yard, London N7 9AS, UK
| | - A Andreadi
- Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne NE1 7RU, UK; National Renal Complement Therapeutics Centre, Building 26, Royal Victoria Infirmary, UK
| | - D Kavanagh
- Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne NE1 7RU, UK; National Renal Complement Therapeutics Centre, Building 26, Royal Victoria Infirmary, UK; NIHR Newcastle Biomedical Research Centre, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK.
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4
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Levit E, Leon J, Lincoln MR. Pearls & Oy-sters: Homozygous Complement Factor I Deficiency Presenting as Fulminant Relapsing Complement-Mediated CNS Vasculitis. Neurology 2023; 101:e220-e223. [PMID: 36941072 PMCID: PMC10351560 DOI: 10.1212/wnl.0000000000207079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 01/05/2023] [Indexed: 03/23/2023] Open
Abstract
A 36-year-old man presented multiple times with fever, headache, alteration of mental status, and focal neurologic deficits. MRI revealed extensive white matter lesions that were partially reversed between episodes. Workup revealed persistently low complement factor C3, low factor B, and absent alternative complement pathway activity. Biopsy revealed neutrophilic vasculitis. Genetic testing revealed a homozygous variant in complement factor I (CFI), which was thought to be pathogenic. CFI regulates complement-mediated inflammation, and deficiency in this factor leads to unchecked alternative pathway activity and decrease in C3 and factor B through consumption. The patient has remained stable since starting IL-1β inhibition. Complement factor I is a rare disorder that should be considered in patients with atypical relapsing neurologic disease associated with neutrophilic pleocytosis.
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Affiliation(s)
- Elle Levit
- From the Yale University School of Medicine (E.L.), New Haven, CT; Miami VA Healthcare System (J.L.), Veterans Health Administration, Miami, FL; Division of Neurology, Department of Medicine (M.R.L.), University of Toronto, ON; Keenan Research Centre for Biomedical Science (M.R.L.), Toronto, ON, Canada.
| | - Janice Leon
- From the Yale University School of Medicine (E.L.), New Haven, CT; Miami VA Healthcare System (J.L.), Veterans Health Administration, Miami, FL; Division of Neurology, Department of Medicine (M.R.L.), University of Toronto, ON; Keenan Research Centre for Biomedical Science (M.R.L.), Toronto, ON, Canada
| | - Matthew R Lincoln
- From the Yale University School of Medicine (E.L.), New Haven, CT; Miami VA Healthcare System (J.L.), Veterans Health Administration, Miami, FL; Division of Neurology, Department of Medicine (M.R.L.), University of Toronto, ON; Keenan Research Centre for Biomedical Science (M.R.L.), Toronto, ON, Canada
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5
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Zhang Y, Goodfellow RX, Ghiringhelli Borsa N, Dunlop HC, Presti SA, Meyer NC, Shao D, Roberts SM, Jones MB, Pitcher GR, Taylor AO, Nester CM, Smith RJH. Complement Factor I Variants in Complement-Mediated Renal Diseases. Front Immunol 2022; 13:866330. [PMID: 35619721 PMCID: PMC9127439 DOI: 10.3389/fimmu.2022.866330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/08/2022] [Indexed: 11/26/2022] Open
Abstract
C3 glomerulopathy (C3G) and atypical hemolytic uremic syndrome (aHUS) are two rare diseases caused by dysregulated activity of the alternative pathway of complement secondary to the presence of genetic and/or acquired factors. Complement factor I (FI) is a serine protease that downregulates complement activity in the fluid phase and/or on cell surfaces in conjunction with one of its cofactors, factor H (FH), complement receptor 1 (CR1/CD35), C4 binding protein (C4BP) or membrane cofactor protein (MCP/CD46). Because altered FI activity is causally related to the pathogenesis of C3G and aHUS, we sought to test functional activity of select CFI missense variants in these two patient cohorts. We identified 65 patients (16, C3G; 48, aHUS; 1 with both) with at least one rare variant in CFI (defined as a MAF < 0.1%). Eight C3G and eleven aHUS patients also carried rare variants in either another complement gene, ADAMTS13 or THBD. We performed comprehensive complement analyses including biomarker profiling, pathway activity and autoantibody testing, and developed a novel FI functional assay, which we completed on 40 patients. Seventy-eight percent of rare CFI variants (31/40) were associated with FI protein levels below the 25th percentile; in 22 cases, FI levels were below the lower limit of normal (type 1 variants). Of the remaining nine variants, which associated with normal FI levels, two variants reduced FI activity (type 2 variants). No patients carried currently known autoantibodies (including FH autoantibodies and nephritic factors). We noted that while rare variants in CFI predispose to complement-mediated diseases, phenotypes are strongly contingent on the associated genetic background. As a general rule, in isolation, a rare CFI variant most frequently leads to aHUS, with the co-inheritance of a CD46 loss-of-function variant driving the onset of aHUS to the younger age group. In comparison, co-inheritance of a gain-of-function variant in C3 alters the phenotype to C3G. Defects in CFH (variants or fusion genes) are seen with both C3G and aHUS. This variability underscores the complexity and multifactorial nature of these two complement-mediated renal diseases.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Richard J. H. Smith
- Molecular Otolaryngology and Renal Research Laboratories, University of Iowa, Iowa City, IA, United States
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6
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Moon J. Rare genetic causes of meningitis and encephalitis. ENCEPHALITIS 2022; 2:29-35. [PMID: 37469651 PMCID: PMC10295911 DOI: 10.47936/encephalitis.2021.00164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/15/2021] [Accepted: 12/24/2021] [Indexed: 07/21/2023] Open
Abstract
Differential diagnosis of meningitis and encephalitis is often very challenging because it cannot be determined based on symptoms, and the diseases have various causes. This article explains rare genetic causes of meningitis and encephalitis. Autoinflammatory disorders include cryopyrin-associated periodic syndromes, familial Mediterranean fever, and tumor necrosis factor receptor-associated periodic syndrome. Furthermore, other genetic disorders, such as complement factor I deficiency, phosphatidylinositol glycan anchor biosynthesis class T mutation, and neuronal intranuclear inclusion disease, can present as meningitis and encephalitis.
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Affiliation(s)
- Jangsup Moon
- Rare Disease Center, Departments of Genomic Medicine and Neurology, Seoul National University Hospital, Seoul, Korea
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de Jong S, de Breuk A, Bakker B, Katti S, Hoyng CB, Nilsson SC, Blom AM, van den Heuvel LP, den Hollander AI, Volokhina EB. Functional Analysis of Variants in Complement Factor I Identified in Age-Related Macular Degeneration and Atypical Hemolytic Uremic Syndrome. Front Immunol 2022; 12:789897. [PMID: 35069568 PMCID: PMC8766660 DOI: 10.3389/fimmu.2021.789897] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/13/2021] [Indexed: 11/23/2022] Open
Abstract
Complement factor I (FI) is a central inhibitor of the complement system, and impaired FI function increases complement activation, contributing to diseases such as age-related macular degeneration (AMD) and atypical hemolytic uremic syndrome (aHUS). Genetic variation in complement factor I (CFI) has been identified in both AMD and aHUS, with more than half of these variants leading to reduced FI secretion levels. For many of the variants with normal FI secretion, however, functional implications are not yet known. Here we studied 11 rare missense variants, with FI secretion levels comparable to wildtype, but a predicted damaging effects based on the Combined Annotation Dependent Depletion (CADD) score. Three variants (p.Pro50Ala, p.Arg339Gln, and p.Ser570Thr) were analyzed in plasma and serum samples of carriers affected by AMD. All 11 variants (nine for the first time in this study) were recombinantly expressed and the ability to degrade C3b was studied with the C3b degradation assay. The amount of degradation was determined by measuring the degradation product iC3b with ELISA. Eight of 11 (73%) mutant proteins (p.Pro50Ala, p.Arg339Gln, p.Ile340Thr, p.Gly342Glu, p.Gly349Arg, p.Arg474Gln, p.Gly487Cys, and p.Gly512Ser) showed significantly impaired C3b degradation, and were therefore classified as likely pathogenic. Our data indicate that genetic variants in CFI with a CADD score >20 are likely to affect FI function, and that monitoring iC3b in a degradation assay is a useful tool to establish the pathogenicity of CFI variants in functional studies.
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Affiliation(s)
- Sarah de Jong
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anita de Breuk
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bjorn Bakker
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Suresh Katti
- Gemini Therapeutics Inc., Cambridge, MA, United States
| | - Carel B Hoyng
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Sara C Nilsson
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Anna M Blom
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Lambert P van den Heuvel
- Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands.,Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anneke I den Hollander
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Human Genetics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Elena B Volokhina
- Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands.,Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, Netherlands
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8
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Lindahl H, Bryceson YT. Neuroinflammation Associated With Inborn Errors of Immunity. Front Immunol 2022; 12:827815. [PMID: 35126383 PMCID: PMC8807658 DOI: 10.3389/fimmu.2021.827815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/27/2021] [Indexed: 01/16/2023] Open
Abstract
The advent of high-throughput sequencing has facilitated genotype-phenotype correlations in congenital diseases. This has provided molecular diagnosis and benefited patient management but has also revealed substantial phenotypic heterogeneity. Although distinct neuroinflammatory diseases are scarce among the several thousands of established congenital diseases, elements of neuroinflammation are increasingly recognized in a substantial proportion of inborn errors of immunity, where it may even dominate the clinical picture at initial presentation. Although each disease entity is rare, they collectively can constitute a significant proportion of neuropediatric patients in tertiary care and may occasionally also explain adult neurology patients. We focus this review on the signs and symptoms of neuroinflammation that have been reported in association with established pathogenic variants in immune genes and suggest the following subdivision based on proposed underlying mechanisms: autoinflammatory disorders, tolerance defects, and immunodeficiency disorders. The large group of autoinflammatory disorders is further subdivided into IL-1β-mediated disorders, NF-κB dysregulation, type I interferonopathies, and hemophagocytic syndromes. We delineate emerging pathogenic themes underlying neuroinflammation in monogenic diseases and describe the breadth of the clinical spectrum to support decisions to screen for a genetic diagnosis and encourage further research on a neglected phenomenon.
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Affiliation(s)
- Hannes Lindahl
- Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
- Center for Molecular Medicine, Department of Clinical Neuroscience, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Yenan T. Bryceson
- Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
- Center for Hematology and Regenerative Medicine, Department of Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Brogelmann Research Laboratory, Department of Clinical Sciences, University of Bergen, Bergen, Norway
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9
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Bouzroud W, Tazzite A, yousra I, Gazzaz B, Dehbi H. Complement Factor I deficiency: A novel homozygous CFI gene mutation. SAGE Open Med Case Rep 2022. [DOI: 10.1177/2050313x221105992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Complement Factor I deficiency is a very rare autosomal recessive disease, with only 38 cases reported in the literature. It is caused by a homozygous mutation in the CFI gene (complement Factor I), which encodes for the Factor I protein, an important regulator of the complement system. Clinically, complement Factor I deficiency presents various symptoms in several organs. We report the case of a child with a history of seizures and unexplained recurrent fever. Whole exome sequencing revealed a novel homozygous missense CFI gene mutation (V270F) of unknown significance. Using multiple bioinformatics tools, we suggest the probable pathogenicity of this mutation. This analysis will help us manage precisely his case, preventing infections and the development of kidney failure, a possible and fatal consequence of complement Factor I deficiency. This study emphasizes the importance of molecular analysis in the diagnosis of rare and atypical diseases and in the establishment of appropriate and effective care.
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Affiliation(s)
- Wafaa Bouzroud
- Medical Genetics Laboratory, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Amal Tazzite
- Laboratory of Cellular and Molecular Pathology, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Ibenbrahim yousra
- Medical Genetics Laboratory, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Bouchaïb Gazzaz
- Laboratory of Cellular and Molecular Pathology, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Genetics Analysis Institute, Royal Gendarmerie, Rabat, Morocco
| | - Hind Dehbi
- Medical Genetics Laboratory, Ibn Rochd University Hospital, Casablanca, Morocco
- Laboratory of Cellular and Molecular Pathology, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
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10
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Kar S, Krishnamurthy S, Karunakar P, Maya M, Thangaraj A, Agarwal Y. A rare cause of recurrent acute kidney injury in a 3-year-old girl: Answers. Pediatr Nephrol 2021; 36:2033-2037. [PMID: 33427983 DOI: 10.1007/s00467-020-04885-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/27/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Shrutiprajna Kar
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
| | - Sriram Krishnamurthy
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India.
| | - Pediredla Karunakar
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
| | - Malini Maya
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
| | - Abarna Thangaraj
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
| | - Yamini Agarwal
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
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11
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Naesens L, Smet J, Tavernier SJ, Schelstraete P, Hoste L, Lambrecht S, Verhelst H, van der Werff Ten Bosch J, Ferster A, Blumental S, Hilbert P, Kerre T, Vande Walle J, Licht C, Roumenina LT, Stordeur P, Haerynck F. Plasma C3d levels as a diagnostic marker for complete complement factor I deficiency. J Allergy Clin Immunol 2020; 147:749-753.e2. [PMID: 32853637 DOI: 10.1016/j.jaci.2020.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/27/2020] [Accepted: 08/06/2020] [Indexed: 01/02/2023]
Affiliation(s)
- Leslie Naesens
- Primary Immunodeficiency Research Lab, Center for Primary Immunodeficiency Ghent, Jeffrey Modell Diagnosis and Research Center, Ghent University Hospital, Ghent, Belgium; Department of Hematology, Center for Primary Immunodeficiency Ghent, Jeffrey Modell Diagnosis and Research Center, Ghent University Hospital, Ghent, Belgium
| | - Julie Smet
- Belgian National Reference Center for the Complement System, Laboratory of Immunology, LHUB-ULB, Université Libre de Bruxelles, Brussels, Belgium
| | - Simon J Tavernier
- Primary Immunodeficiency Research Lab, Center for Primary Immunodeficiency Ghent, Jeffrey Modell Diagnosis and Research Center, Ghent University Hospital, Ghent, Belgium; Laboratory of Immunoregulation, VIB Inflammation Research Center, Ghent, Belgium
| | - Petra Schelstraete
- Department of Pediatrics, Division of Pediatric Pulmonology, Infectious Diseases and Immunology, Ghent University Hospital, Ghent, Belgium
| | - Levi Hoste
- Primary Immunodeficiency Research Lab, Center for Primary Immunodeficiency Ghent, Jeffrey Modell Diagnosis and Research Center, Ghent University Hospital, Ghent, Belgium; Department of Pediatrics, Division of Pediatric Pulmonology, Infectious Diseases and Immunology, Ghent University Hospital, Ghent, Belgium
| | - Stijn Lambrecht
- Division of Laboratory Medicine, Department of Clinical Chemistry, Ghent University Hospital, Ghent, Belgium
| | - Helene Verhelst
- Department of Pediatrics, Division of Pediatric Neurology, University Hospital Ghent, Ghent, Belgium
| | - Jutte van der Werff Ten Bosch
- Department of Pediatrics, Division of Pediatric Oncology and Immunology, Universitair Ziekenhuis Brussel, Jette, Belgium
| | - Alina Ferster
- Department of Pediatrics, Department of Haematology-Oncology, Children's University Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Sophie Blumental
- Department of Pediatrics, Department of Haematology-Oncology, Children's University Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Pascale Hilbert
- Department of Human Genetics, Institut de Pathologie et Génétique, Gosselies, Belgium
| | - Tessa Kerre
- Department of Hematology, Center for Primary Immunodeficiency Ghent, Jeffrey Modell Diagnosis and Research Center, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- Department of Pediatrics, Division of Pediatric Nephrology, University Hospital Ghent, Ghent, Belgium
| | - Christoph Licht
- Department of Pediatrics, Division of Pediatric Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lubka T Roumenina
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Patrick Stordeur
- Belgian National Reference Center for the Complement System, Laboratory of Immunology, LHUB-ULB, Université Libre de Bruxelles, Brussels, Belgium
| | - Filomeen Haerynck
- Primary Immunodeficiency Research Lab, Center for Primary Immunodeficiency Ghent, Jeffrey Modell Diagnosis and Research Center, Ghent University Hospital, Ghent, Belgium; Department of Pediatrics, Division of Pediatric Pulmonology, Infectious Diseases and Immunology, Ghent University Hospital, Ghent, Belgium.
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12
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Skattum L. Clinical Complement Analysis-An Overview. Transfus Med Rev 2019; 33:207-216. [PMID: 31672339 DOI: 10.1016/j.tmrv.2019.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 12/11/2022]
Abstract
The complement system plays an important role in varying types of disease, ranging from inflammatory and autoimmune disorders to immune deficiency states. In addition, new settings have emerged where complement analysis is of interest to monitor complement-directed therapy and aid identification of transplant complications. Therefore, it is critical that clinical laboratories offer optimized and timely complement analysis. This review presents a comprehensive overview of the most important complement analysis methods that are currently used. It also points to some areas within complement diagnostics where development is needed, for example, regarding certain analytes for which practical methods suitable for the routine laboratory are lacking. Furthermore, it contains a more detailed discussion on complement autoantibody assessment. The list of analyses providing clinically valuable information includes analysis of complement function, quantification of individual complement components and complement activation fragments, identification of autoantibodies to complement, as well as genetic complement analyses. There is still a shortage of commercially available methods suitable for high-throughput screening of complement deficiency and for assessment of complement activation, but development is under way. There is also ongoing work within the complement community to improve standardization of measurements, and recently, an extensive quality assurance program has been initiated.
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Affiliation(s)
- Lillemor Skattum
- Department of Laboratory Medicine, Section of Microbiology, Immunology and Glycobiology, Lund University, and Clinical Immunology and Transfusion Medicine, Region Skåne, Lund, Sweden.
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13
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El Sissy C, Rosain J, Vieira-Martins P, Bordereau P, Gruber A, Devriese M, de Pontual L, Taha MK, Fieschi C, Picard C, Frémeaux-Bacchi V. Clinical and Genetic Spectrum of a Large Cohort With Total and Sub-total Complement Deficiencies. Front Immunol 2019; 10:1936. [PMID: 31440263 PMCID: PMC6694794 DOI: 10.3389/fimmu.2019.01936] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/30/2019] [Indexed: 01/11/2023] Open
Abstract
The complement system is crucial for defense against pathogens and the removal of dying cells or immune complexes. Thus, clinical indications for possible complete complement deficiencies include, among others, recurrent mild or serious bacterial infections as well as autoimmune diseases (AID). The diagnostic approach includes functional activity measurements of the classical (CH50) and alternative pathway (AP50) and the determination of the C3 and C4 levels, followed by the quantitative analysis of individual components or regulators. When biochemical analysis reveals the causal abnormality of the complement deficiency (CD), molecular mechanisms remains frequently undetermined. Here, using direct sequencing analysis of the coding region we report the pathogenic variants spectrum that underlie the total or subtotal complement deficiency in 212 patients. We identified 107 different hemizygous, homozygous, or compound heterozygous pathogenic variants in 14 complement genes [C1Qβ (n = 1), C1r (n = 3), C1s (n = 2), C2 (n = 12), C3 (n = 5), C5 (n = 12), C6 (n = 9), C7 (n = 17), C8 β (n = 7), C9 (n = 3), CFH (n = 7), CFI (n = 18), CFP (n = 10), CFD (n = 2)]. Molecular analysis identified 17 recurrent pathogenic variants in 6 genes (C2, CFH, C5, C6, C7, and C8). More than half of the pathogenic variants identified in unrelated patients were also found in healthy controls from the same geographic area. Our study confirms the strong association of meningococcal infections with terminal pathway deficiency and highlights the risk of pneumococcal and auto-immune diseases in the classical and alternative pathways. Results from this large genetic investigation provide evidence of a restricted number of molecular mechanisms leading to complement deficiency and describe the clinical potential adverse events of anti-complement therapy.
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Affiliation(s)
- Carine El Sissy
- Assistance Publique - Hôpitaux de Paris (AP-HP), Laboratoire d'Immunologie, Hôpital Européen Georges-Pompidou, Paris, France
| | - Jérémie Rosain
- Assistance Publique - Hôpitaux de Paris (AP-HP), Laboratoire d'Immunologie, Hôpital Européen Georges-Pompidou, Paris, France
| | - Paula Vieira-Martins
- Assistance Publique - Hôpitaux de Paris (AP-HP), Laboratoire d'Immunologie, Hôpital Européen Georges-Pompidou, Paris, France
| | - Pauline Bordereau
- Assistance Publique - Hôpitaux de Paris (AP-HP), Laboratoire d'Immunologie, Hôpital Européen Georges-Pompidou, Paris, France
| | - Aurélia Gruber
- Assistance Publique - Hôpitaux de Paris (AP-HP), Laboratoire d'Immunologie, Hôpital Européen Georges-Pompidou, Paris, France
| | - Magali Devriese
- Assistance Publique - Hôpitaux de Paris (AP-HP), Laboratoire d'Immunologie, Hôpital Européen Georges-Pompidou, Paris, France
| | - Loïc de Pontual
- Pediatrics Department, Jean Verdier Hospital, Assistance Publique des Hôpitaux de Paris, Paris 13 University, Bondy, France
| | - Muhamed-Kheir Taha
- Invasive Bacterial Infection and National Reference Center for Meningococci, Pasteur Institut, Paris, France
| | - Claire Fieschi
- Department of Clinical Immunology, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.,Inserm U1126, Centre Hayem, Hôpital Saint-Louis, Paris, France
| | - Capucine Picard
- Paris University, INSERM UMR1163, Imagine Institute, Paris, France.,Study Center for Primary Immunodeficiencies (AP-HP), Hôpital Necker-Enfants maladies Hospital, Paris, France
| | - Véronique Frémeaux-Bacchi
- Assistance Publique - Hôpitaux de Paris (AP-HP), Laboratoire d'Immunologie, Hôpital Européen Georges-Pompidou, Paris, France.,Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, USPC, Université Paris Descartes, Complement and Diseases Team, Paris, France
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14
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Shields AM, Pagnamenta AT, Pollard AJ, Taylor JC, Allroggen H, Patel SY. Classical and Non-classical Presentations of Complement Factor I Deficiency: Two Contrasting Cases Diagnosed via Genetic and Genomic Methods. Front Immunol 2019; 10:1150. [PMID: 31231365 PMCID: PMC6568211 DOI: 10.3389/fimmu.2019.01150] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/07/2019] [Indexed: 11/13/2022] Open
Abstract
Deficiency of complement factor I is a rare immunodeficiency that typically presents with increased susceptibility to encapsulated bacterial infections. However, non-infectious presentations including rheumatological, dermatological and neurological disease are increasingly recognized and require a high-index of suspicion to reach a timely diagnosis. Herein, we present two contrasting cases of complement factor I deficiency: one presenting in childhood with invasive pneumococcal disease, diagnosed using conventional immunoassays and genetics and the second presenting in adolescence with recurrent sterile neuroinflammation, diagnosed via a genomic approach. Our report and review of the literature highlight the wide spectrum of clinical presentations associated with CFI deficiency and the power of genomic medicine to inform rare disease diagnoses.
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Affiliation(s)
- Adrian M Shields
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom.,Department of Clinical Immunology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Alistair T Pagnamenta
- NIHR Oxford Biomedical Research Centre, Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | | | - Jenny C Taylor
- NIHR Oxford Biomedical Research Centre, Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Holger Allroggen
- Department of Neurology, University Hospital Coventry, Coventry, United Kingdom
| | - Smita Y Patel
- Clinical Immunology Service, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
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15
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Nanthapisal S, Eleftheriou D, Gilmour K, Leone V, Ramnath R, Omoyinmi E, Hong Y, Klein N, Brogan PA. Cutaneous Vasculitis and Recurrent Infection Caused by Deficiency in Complement Factor I. Front Immunol 2018; 9:735. [PMID: 29696024 PMCID: PMC5904195 DOI: 10.3389/fimmu.2018.00735] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 03/26/2018] [Indexed: 11/23/2022] Open
Abstract
Cutaneous leukocytoclastic vasculitis arises from immune complex deposition and dysregulated complement activation in small blood vessels. There are many causes, including dysregulated host response to infection, drug reactions, and various autoimmune conditions. It is increasingly recognised that some monogenic autoinflammatory diseases cause vasculitis, although genetic causes of vasculitis are extremely rare. We describe a child of consanguineous parents who presented with chronic cutaneous leukocytoclastic vasculitis, recurrent upper respiratory tract infection, and hypocomplementaemia. A homozygous p.His380Arg mutation in the complement factor I (CFI) gene CFI was identified as the cause, resulting in complete absence of alternative complement pathway activity, decreased classical complement activity, and low levels of serum factor I, C3, and factor H. C4 and C2 levels were normal. The same homozygous mutation and immunological defects were also identified in an asymptomatic sibling. CFI deficiency is thus now added to the growing list of monogenic causes of vasculitis and should always be considered in vasculitis patients found to have persistently low levels of C3 with normal C4.
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Affiliation(s)
- Sira Nanthapisal
- Infection Inflammation and Rheumatology Section, Great Ormond Street Institute of Child Health, University College London, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom.,Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Despina Eleftheriou
- Infection Inflammation and Rheumatology Section, Great Ormond Street Institute of Child Health, University College London, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Kimberly Gilmour
- Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Valentina Leone
- Department of Paediatric Rheumatology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Radhika Ramnath
- Department of Histopathology, St. James University Hospital, Leeds, United Kingdom
| | - Ebun Omoyinmi
- Infection Inflammation and Rheumatology Section, Great Ormond Street Institute of Child Health, University College London, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Ying Hong
- Infection Inflammation and Rheumatology Section, Great Ormond Street Institute of Child Health, University College London, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Nigel Klein
- Infection Inflammation and Rheumatology Section, Great Ormond Street Institute of Child Health, University College London, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Paul A Brogan
- Infection Inflammation and Rheumatology Section, Great Ormond Street Institute of Child Health, University College London, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
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16
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Early Versus Late Diagnosis of Complement Factor I Deficiency: Clinical Consequences Illustrated in Two Families with Novel Homozygous CFI Mutations. J Clin Immunol 2017; 37:781-789. [PMID: 28942469 DOI: 10.1007/s10875-017-0447-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 09/18/2017] [Indexed: 12/11/2022]
Abstract
The complement system is an important effector arm of innate immunity and plays a crucial role in the defense against common pathogens. But effective defense and maintenance of homeostasis requires a careful balance between complement activation and regulation. Factor I (FI) is one of the most important regulators of the complement system. Complete FI deficiency is a rare autosomal recessive disorder typically resulting in severe, recurrent infection by encapsulated bacteria. In the present study, we describe two patients from unrelated families with complete FI deficiency diagnosed at very different ages: Patient 1 is a 60-year-old man who had experienced several severe infections (pneumonia, meningitis, sepsis) since childhood, one of which caused significant and permanent neurologic sequelae. In contrast, patient 2 was diagnosed at the age of 4 years after a single infectious episode (otitis media) and through detection of a flat beta2 peak on serum protein electrophoresis. This early diagnosis of FI deficiency enabled prompt implementation of a therapeutic intervention consisting of vaccination with encapsulated bacteria and prophylactic antibiotics. The two patients had novel homozygous mutations in the CFI gene (p.Gly162Asp and p.His380Arg) that disrupted protein function. Interestingly, p.His380Arg is the first mutation described affecting a residue of the highly conserved FI catalytic triad (His380, Asp429, and Ser525). This study illustrates the importance of early versus late diagnosis of FI deficiency and, in general, highlights the clinical relevance of prompt detection of complement system deficiencies.
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17
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Tohidpour A, Morgun AV, Boitsova EB, Malinovskaya NA, Martynova GP, Khilazheva ED, Kopylevich NV, Gertsog GE, Salmina AB. Neuroinflammation and Infection: Molecular Mechanisms Associated with Dysfunction of Neurovascular Unit. Front Cell Infect Microbiol 2017; 7:276. [PMID: 28676848 PMCID: PMC5476750 DOI: 10.3389/fcimb.2017.00276] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/06/2017] [Indexed: 12/11/2022] Open
Abstract
Neuroinflammation is a complex inflammatory process in the central nervous system, which is sought to play an important defensive role against various pathogens, toxins or factors that induce neurodegeneration. The onset of neurodegenerative diseases and various microbial infections are counted as stimuli that can challenge the host immune system and trigger the development of neuroinflammation. The homeostatic nature of neuroinflammation is essential to maintain the neuroplasticity. Neuroinflammation is regulated by the activity of neuronal, glial, and endothelial cells within the neurovascular unit, which serves as a “platform” for the coordinated action of pro- and anti-inflammatory mechanisms. Production of inflammatory mediators (cytokines, chemokines, reactive oxygen species) by brain resident cells or cells migrating from the peripheral blood, results in the impairment of blood-brain barrier integrity, thereby further affecting the course of local inflammation. In this review, we analyzed the most recent data on the central nervous system inflammation and focused on major mechanisms of neurovascular unit dysfunction caused by neuroinflammation and infections.
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Affiliation(s)
- Abolghasem Tohidpour
- Research Institute of Molecular Medicine and Pathobiochemistry, Krasnoyarsk State Medical University named after Prof. V.F. Voino-YasenetskyKrasnoyarsk, Russia
| | - Andrey V Morgun
- Research Institute of Molecular Medicine and Pathobiochemistry, Krasnoyarsk State Medical University named after Prof. V.F. Voino-YasenetskyKrasnoyarsk, Russia.,Department of Paediatrics, Krasnoyarsk State Medical University named after Prof. V.F. Voino-YasenetskyKrasnoyarsk, Russia
| | - Elizaveta B Boitsova
- Research Institute of Molecular Medicine and Pathobiochemistry, Krasnoyarsk State Medical University named after Prof. V.F. Voino-YasenetskyKrasnoyarsk, Russia.,Department of Children Infectious Diseases, Krasnoyarsk State Medical University named after Prof. V.F. Voino-YasenetskyKrasnoyarsk, Russia
| | - Natalia A Malinovskaya
- Research Institute of Molecular Medicine and Pathobiochemistry, Krasnoyarsk State Medical University named after Prof. V.F. Voino-YasenetskyKrasnoyarsk, Russia
| | - Galina P Martynova
- Department of Children Infectious Diseases, Krasnoyarsk State Medical University named after Prof. V.F. Voino-YasenetskyKrasnoyarsk, Russia
| | - Elena D Khilazheva
- Research Institute of Molecular Medicine and Pathobiochemistry, Krasnoyarsk State Medical University named after Prof. V.F. Voino-YasenetskyKrasnoyarsk, Russia
| | - Natalia V Kopylevich
- Research Institute of Molecular Medicine and Pathobiochemistry, Krasnoyarsk State Medical University named after Prof. V.F. Voino-YasenetskyKrasnoyarsk, Russia
| | - Galina E Gertsog
- Research Institute of Molecular Medicine and Pathobiochemistry, Krasnoyarsk State Medical University named after Prof. V.F. Voino-YasenetskyKrasnoyarsk, Russia
| | - Alla B Salmina
- Research Institute of Molecular Medicine and Pathobiochemistry, Krasnoyarsk State Medical University named after Prof. V.F. Voino-YasenetskyKrasnoyarsk, Russia
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18
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Franco-Jarava C, Colobran R, Mestre-Torres J, Vargas V, Pujol-Borrell R, Hernández-González M. Clinical laboratory standard capillary protein electrophoresis alerted of a low C3 state and lead to the identification of a Factor I deficiency due to a novel homozygous mutation. Immunol Lett 2016; 174:19-22. [PMID: 27091480 DOI: 10.1016/j.imlet.2016.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/11/2016] [Accepted: 04/13/2016] [Indexed: 10/22/2022]
Abstract
Complement factor I (CFI) deficiency is typically associated to recurrent infections with encapsulated microorganisms and, less commonly, to autoimmunity. We report a 53-years old male who, in a routine control for non-alcoholic fatty liver disease, presented a flat beta-2 fraction at the capillary protein electropherogram. Patient's clinical records included multiple oropharyngeal infections since infancy and an episode of invasive meningococcal infection. Complement studies revealed reduced C3, low classical pathway activation and undetectable Factor I. CFI gene sequencing showed a novel inherited homozygous deletion of 5 nucleotides in exon 12, causing a frameshift leading to a truncated protein. This study points out that capillary protein electrophoresis can alert of possible states of low C3, which, once confirmed and common causes ruled out, can lead to CFI and other complement deficiency diagnosis. This is important since they constitute a still underestimated risk of invasive meningococcemia that can be greatly reduced by vaccination.
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Affiliation(s)
- Clara Franco-Jarava
- Immunology Division, Hospital Universitari Vall d'Hebron (HUVH), Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Roger Colobran
- Immunology Division, Hospital Universitari Vall d'Hebron (HUVH), Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.
| | - Jaume Mestre-Torres
- Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Victor Vargas
- Liver Unit, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, CIBEREHD, Barcelona, Spain
| | - Ricardo Pujol-Borrell
- Immunology Division, Hospital Universitari Vall d'Hebron (HUVH), Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Manuel Hernández-González
- Immunology Division, Hospital Universitari Vall d'Hebron (HUVH), Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
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Novel CFI mutation in a patient with leukocytoclastic vasculitis may redefine the clinical spectrum of Complement Factor I deficiency. Clin Immunol 2015; 160:315-8. [PMID: 25988862 DOI: 10.1016/j.clim.2015.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 05/07/2015] [Accepted: 05/08/2015] [Indexed: 01/20/2023]
Abstract
Factor I is an important regulator of the complement system. Lack of Factor I causes uncontrolled activation of the complement system leading to consumption of C3. Complete deficiency of Factor I is a rare condition and only around 40 cases has been reported in the literature. The clinical presentation of Factor I deficiency varies and includes severe recurrent bacterial infections, glomerulonephritis and autoimmune diseases. The patient, a 28-years old woman with consanguineous parents, presented with recurrent leukocytoclastic vasculitis in the lower extremities with no associated systemic involvement, and without increased infection tendency. Initial testing showed low C3 concentration and a detailed complement evaluation absence of complement Factor I. Sequencing revealed a homozygous missense mutation in exon 2 of the CFI gene (SCV000221312). Even though the clinical symptoms of CFI mutations vary among patients sole association with leukocytoclastic vasculitis redefines the clinical spectrum of complete Factor I deficiency.
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