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Katelaris CH, Grumach AS, Bork K. Angioedema With Normal Complement Studies: What Do We Know? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2309-2314. [PMID: 37343921 DOI: 10.1016/j.jaip.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/01/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023]
Abstract
Angioedema is generally readily recognizable clinically and is characterized by localized nonpitting edema involving subcutaneous, submucosal, or deep dermal tissue caused by increased vascular permeability and extravasation of intravascular fluid. It can occur via a variety of mechanisms. A number of clinical conditions (masqueraders) are occasionally mistaken for angioedema. Clinical classification of the various angioedema forms begins with noting the presence or absence of concurrent urticaria or wheals. Pathogenesis can be considered through two broad categories: mast cell-mediated with release of vasoactive mediators causing angioedema usually associated with urticaria or in the context of an anaphylactic reaction; and bradykinin (BK)-driven, in which increased vascular permeability is mediated by BK. BK-mediated angioedema does not occur with urticaria, nor does it respond to antiallergic medications. The various forms of hereditary angioedema are included in this category, requiring specific tests of C4 and C1 inhibitor level and function to confirm the diagnosis. Angiotensin converting enzyme inhibitors, which impair the degradation of BK, account for up to a third of all patients with angioedema presenting to the emergency department. Finally, angioedema may occur by yet unknown mechanisms; under this circumstance, it is difficult to manage.
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Affiliation(s)
- Constance H Katelaris
- Immunology/Allergy Unit, Department of Medicine, Campbelltown Hospital and Faculty of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia.
| | - Anete S Grumach
- Clinical Immunology, Department of Clinical Medicine, Faculty of Medicine, Centro Universitario FMABC, Santo Andre, São Paulo, Brazil.
| | - Konrad Bork
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
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2
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Kim KM, Lim HW. The uses of tranexamic acid in dermatology: a review. Int J Dermatol 2022; 62:589-598. [PMID: 35323992 DOI: 10.1111/ijd.16160] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 01/21/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022]
Abstract
Tranexamic acid is a plasmin inhibitor that is used off-label for the treatment of melasma. The use of tranexamic acid has expanded in the field of dermatology based on its anti-inflammatory and anti-melanin-producing properties, which include the treatment of rosacea, urticaria, and post-inflammatory hyperpigmentation. Tranexamic acid may have more uses in dermatology that require future studies. It should be used with caution during the COVID-19 pandemic given its procoagulant nature.
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Affiliation(s)
- Katelyn M Kim
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Henry W Lim
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
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3
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Jones DH, Bansal P, Bernstein JA, Fatteh S, Harper J, Hsu FI, O’Connor M, Park N, Suez D. Clinical profile and treatment outcomes in patients with hereditary angioedema with normal C1 esterase inhibitor. World Allergy Organ J 2022; 15:100621. [PMID: 35145604 PMCID: PMC8804245 DOI: 10.1016/j.waojou.2021.100621] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 11/01/2021] [Accepted: 12/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background Hereditary angioedema (HAE) is often caused by low serum levels or functional deficiency in C1 inhibitor (C1-INH); however, in some cases, C1-INH serum level and function are measured as normal (HAE-nl-C1INH). Management of HAE-nl-C1INH is similar to management of HAE with C1-INH deficiency, including on-demand therapy for angioedema attacks and, potentially, prophylaxis. Recombinant human C1 esterase inhibitor (rhC1-INH) is indicated for treatment of acute HAE attacks. This study assessed the clinical profile and treatment outcomes in an HAE-nl-C1INH population with a history of rhC1-INH treatment. Methods Medical records containing patient-reported outcomes from ten US treatment centers were analyzed retrospectively for medical history, angioedema attack characteristics, attack treatments, and clinical outcomes. Results Twenty-three patients were included, with wide US geographic representation. Most patients (87.0%) were female; median age was 36.0 years (range, 19–67 years). Of 20 patients with available data, 4 had their first angioedema attack during childhood (aged <12 years), 3 during adolescence (aged 12–17 years), and 13 during adulthood (aged 18–29 years, n = 7; aged ≥30 years, n = 6). Median age at HAE-nl-C1INH diagnosis was 31.5 years (range, 9–59 years). Previous failed treatments included high-dose antihistamines (n = 20) and corticosteroids (n = 20). Use of US Food and Drug Administration (FDA)–approved HAE therapy positively impacted patient-reported assessments of angioedema attacks. Most patients were taking rhC1-INH or lanadelumab as prophylaxis and icatibant or rhC1-INH for acute management. Most patients reported improved disease control with these therapies, including reductions in angioedema attack frequency and severity. Although most patients were receiving prophylactic therapy, availability of treatment for breakthrough attacks was important. Conclusion Findings from this retrospective study support use of FDA-approved HAE medications for prophylaxis and acute treatment of HAE attacks in patients with HAE-nl-C1INH. Individualized HAE treatment regimens were needed to optimize therapeutic outcomes.
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Gutierrez M, Veronez CL, Rodrigues Valle SO, Gonçalves RF, Ferriani MPL, Moreno AS, Arruda LK, Aun MV, Giavina-Bianchi P, Alonso MLO, Pesquero JB, Grumach AS. Unnecessary Abdominal Surgeries in Attacks of Hereditary Angioedema with Normal C1 Inhibitor. Clin Rev Allergy Immunol 2021; 61:60-65. [PMID: 33755867 DOI: 10.1007/s12016-021-08852-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 12/23/2022]
Abstract
Hereditary angioedema (HAE) is an autosomal dominant disease mostly due to the deficiency of C1 inhibitor (C1-INH). HAE with normal C1-INH was first described in 2000 and associated with mutations in the coagulation factor XII in 2006. Both diseases are associated with high bradykinin production, resulting in increased vascular permeability. Gastrointestinal edema due to HAE can be misdiagnosed as acute abdomen and unnecessary surgical procedures may be performed. The present study evaluates the prevalence of surgical procedures and/or acute abdomen in HAE patients with the coagulation factor XII mutation. It is a retrospective study where patients were diagnosed with recurrent angioedema without urticaria, normal C1-INH levels, and positive family history of angioedema. All patients were evaluated for the known mutations located at exon 9 of the F12 gene. Medical records were evaluated and questionnaires were applied to 52 patients with normal C1-INH levels (age range 13-76 years; 47/52, 90.38% women; 5/52, 9.61% men). F12 mutation was present in 32/52 patients (61.5%). Acute abdominal pain was diagnosed in 16/52 (30.76%) patients, appendicitis in 9/16 (56.2%), and undetermined diagnosis in 7/16 (43.7%). Among patients diagnosed with acute abdominal pain, 13/16 (81.2%) underwent surgery and 3/16 (18.7%) improved without surgical intervention. We conclude that many HAE patients with coagulation factor XII mutation were misdiagnosed with acute abdomen and subjected to unnecessary invasive procedures. It is critical to disseminate information about this rare mutation in patients with otherwise normal C1-INH activity, in order to speed up diagnosis and avoid misconduct.
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Affiliation(s)
- Marcel Gutierrez
- Faculdade de Medicina, Centro Universitario Saude ABC, Santo Andre, Sao Paulo, SP, Brazil
| | - Camila L Veronez
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California San Diego, San Diego, USA.,Research Service, San Diego Veterans Affairs Healthcare, San Diego, USA
| | - Solange O Rodrigues Valle
- Serviço de Imunologia. Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Adriana S Moreno
- Ribeirão Preto School of Medicine, University of São Paulo, Ribeirao Preto, SP, Brazil
| | - L Karla Arruda
- Ribeirão Preto School of Medicine, University of São Paulo, Ribeirao Preto, SP, Brazil
| | - Marcelo Vivolo Aun
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, SP, Brazil.,Albert Einstein School of Medicine, Faculdade Israelita de Ciências da Saúde, Sao Paulo, SP, Brazil
| | - Pedro Giavina-Bianchi
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Maria Luiza Oliva Alonso
- Serviço de Imunologia. Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Joao B Pesquero
- Department of Biophysics, Federal University of São Paulo, Sao Paulo, Brazil
| | - Anete S Grumach
- Faculdade de Medicina, Centro Universitario Saude ABC, Santo Andre, Sao Paulo, SP, Brazil.
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5
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Germenis AE, Rijavec M, Veronez CL. Leveraging Genetics for Hereditary Angioedema: A Road Map to Precision Medicine. Clin Rev Allergy Immunol 2021; 60:416-428. [PMID: 33507496 DOI: 10.1007/s12016-021-08836-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2021] [Indexed: 12/25/2022]
Abstract
Biochemical studies performed during the last decades resulted in the development of various innovative medicinal products for hereditary angioedema (HAE). These therapeutic agents target the production or the function of bradykinin-the main mediator of HAE due to C1-inhibitor (C1-INH) deficiency. However, despite these remarkable achievements, current knowledge cannot provide convincing explanations for the clinical variability of the disease. As a consequence, treatment indications apply for drugs available for C1-INH deficiency. The advent of high-throughput next-generation sequencing technologies may assist in covering the missing part of our understanding of HAE pathogenesis. During the last 3 years alone, several new entities were added to the already described genotypes. The recent discovery of four novel target genes expands our understanding of other causes which may explain recurrent angioedema in individuals and families with normal C1-INH activity. Furthermore, new genetic technologies allowed the recognition of deep intronic variants associated with the disease, and elegant functional studies characterized new variants for the C1-INH gene. Thus, evidence has been provided regarding pathogenetic aspects remaining obscure for many years, such as the defective intracellular transport of mutant C1-INH, and environmental effect on the disease expression. Therefore, it seems that the stage for Precision Medicine era in HAE management is ready. Disease endotypes are expected to be uncovered and specified targets for therapeutic intervention will be detected, promising a more effective, individualized management of the disease.
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Affiliation(s)
- Anastasios E Germenis
- Department of Immunology and Histocompatibility, School of Medicine, University of Thessaly, 3 Panepistimiou Street, GR-41500, Biopolis Larissa, Greece.
| | - Matija Rijavec
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Camila Lopes Veronez
- Department of Medicine, Division of Rheumatology, Allergy and Immunology, University of California San Diego, San Diego, CA, USA.,Research Service, San Diego Veterans Affairs Healthcare, San Diego, CA, USA
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Sharma J, Jindal AK, Banday AZ, Kaur A, Rawat A, Singh S, Longhurst H. Pathophysiology of Hereditary Angioedema (HAE) Beyond the SERPING1 Gene. Clin Rev Allergy Immunol 2021; 60:305-315. [PMID: 33442779 DOI: 10.1007/s12016-021-08835-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2021] [Indexed: 11/29/2022]
Abstract
Hereditary Angioedema (HAE) is an autosomal dominant disorder characterized clinically by recurrent episodes of swelling involving subcutaneous tissues, gastrointestinal tract, and oro-pharyngeal area. Gene mutations are the most common genetic cause of HAE and observed in more than 90% of patients. More than 700 mutation variants have been described so far. Patients with angioedema who have no mutations in the gene for C1-INH and normal levels and activity of this inhibitor are labelled: normal C1 inhibitor HAE. These include genetic mutations in factor 12 gene, plasminogen gene, angiopoietin gene, kininogen 1, and myoferlin genes. The clinical manifestations of patients with these mutations are similar to with patients with C1-INH gene mutations. However, a later age of onset, oro-pharyngeal involvement, and higher female preponderance have been reported in these rare subtypes of hereditary angioedema. With the advent and increased accessibility of whole-exome sequencing, it is expected that new genetic defects and novel pathophysiological pathways will be identified in families with HAE of unknown cause or normal C1-INH angioedema. This review covers some of the recent advances in the field of HAE. The review focuses on pathophysiology of HAE beyond the well-known C1-INH deficiency phenotypes, including various biomarkers that can serve the diagnosis and management of these rare disorders.
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Affiliation(s)
- Jyoti Sharma
- Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Kumar Jindal
- Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Aaqib Zaffar Banday
- Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anit Kaur
- Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Rawat
- Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hilary Longhurst
- Department of Clinical Immunology, University College Hospitals, London and Addenbrooke's Hospital, Cambridge, UK
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Bork K, Machnig T, Wulff K, Witzke G, Prusty S, Hardt J. Clinical features of genetically characterized types of hereditary angioedema with normal C1 inhibitor: a systematic review of qualitative evidence. Orphanet J Rare Dis 2020; 15:289. [PMID: 33059692 PMCID: PMC7559394 DOI: 10.1186/s13023-020-01570-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/05/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Hereditary angioedema (HAE) with normal C1 inhibitor (C1-INH) (HAEnCI) is associated with skin swellings, abdominal attacks, and the risk of asphyxia due to upper airway obstruction. Several different gene mutations linked to the HAE phenotype have been identified. Our aim was to qualitatively assess and describe the clinical differentiators of these genetically identified HAEnCI types. To achieve this, we performed a systematic literature review of patients with angioedema symptoms and a genetically confirmed diagnosis of an HAEnCI type. RESULTS A systematic literature search, conducted in March 2020, returned 132 records, 43 of which describe patients with symptoms of angioedema and a genetically confirmed diagnosis of an HAEnCI type. Overall, this included 602 patient cases from 220 families. HAEnCI with a mutation in the coagulation factor XII gene (F12) (HAE-FXII) was diagnosed in 446 patients from 185 families (male:female ratio = 1:10). Estrogens (oral contraceptives, hormonal replacement therapy, and pregnancy) negatively impacted the course of disease in most female patients (252 of 277). Asphyxia occurred in 2 of 446 patients. On-demand and/or long-term prophylaxis treatment included C1-INH concentrates, icatibant, progestins, and tranexamic acid. HAEnCI with a specific mutation in the plasminogen gene (HAE-PLG) was diagnosed in 146 patients from 33 families (male:female ratio = 1:3). Estrogens had a negative influence on the course of disease in the minority of female patients (14 of 62). Tongue swelling was an important clinical feature. Asphyxia occurred in 3 of 146 patients. On-demand treatment with icatibant and C1-INH concentrate and long-term prophylaxis with progestins and tranexamic acid were effective. HAEnCI with a specific mutation in the angiopoietin-1 gene (HAE-ANGPT1) was diagnosed in 4 patients from 1 family and HAEnCI with a specific mutation in the kininogen-1 gene (HAE-KNG1) in 6 patients from 1 family. CONCLUSIONS A number of clinical differentiators for the different types of HAEnCI have been identified which may support clinicians to narrow down the correct diagnosis of HAEnCI prior to genetic testing and thereby guide appropriate treatment and management decisions. However, confirmation of the causative gene mutation by genetic testing will always be required.
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Affiliation(s)
- Konrad Bork
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
| | | | - Karin Wulff
- University Medicine, Ernst Moritz Arndt University, Greifswald, Germany
| | - Guenther Witzke
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | | | - Jochen Hardt
- Department of Medical Psychology and Medical Sociology, Johannes Gutenberg University, Mainz, Germany
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Corvillo F, de la Morena-Barrio ME, Marcos-Bravo C, López-Trascasa M, Vicente V, Emsley J, Caballero T, Corral J, López-Lera A. The FXII c.-4T>C Polymorphism as a Disease Modifier in Patients With Hereditary Angioedema Due to the FXII p.Thr328Lys Variant. Front Genet 2020; 11:1033. [PMID: 33133137 PMCID: PMC7549737 DOI: 10.3389/fgene.2020.01033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/11/2020] [Indexed: 11/30/2022] Open
Abstract
Background Hereditary angioedema due to the Thr328Lys variant in the coagulation factor XII (HAE-FXII) affects mainly women in whom the symptomatology is dependent on high estrogen levels. Clinical variability and incomplete penetrance are challenging features that hinder the diagnosis and management of HAE-FXII. The c.-4T>C Kozak polymorphism is the only common variation accounting for FXII plasma levels and was previously shown to modify the course of HAE due to C1-Inhibitor deficiency. Objectives To assess the influence of the c.-4T>C polymorphism on disease expression in 39 Spanish HAE-FXII index patients. Methods The c.-4T>C polymorphism was sequenced by the standard Sanger method, and HAE severity was calculated according to the score by Cumming et al. (2003) The activation of the contact system was quantified by the kallikrein-like activity of plasma in chromogenic assays upon activation with high-molecular-weight dextran sulfate. Results The c.-4CC genotype was overrepresented in the studied cohort: 82% were CC-homozygous (expected frequency = 59%) and 18% were CT-heterozygous (expected frequency = 39%) (p = 0.001). Patients with a c.-4CC genotype exhibited higher kallikrein-like activity (0.9659 ± 0.1136) than those with a c.-4TC genotype (0.7645 ± 0.1235) (p = 0.024) or healthy donors. Moreover, the polymorphism influenced HAE-FXII severity score (c.-4CC = 4.43 ± 2.28 vs c.-4TC = 2.0 ± 1.15; p = 0.006) but not the degree of estrogen dependence or time until remission. Conclusion The c.-4T>C polymorphism is overrepresented in a Spanish HAE-FXII cohort and significantly influences the degree of contact system activation and the clinical severity of the disease.
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Affiliation(s)
- Fernando Corvillo
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | - María Eugenia de la Morena-Barrio
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Madrid, Spain.,Hematology and Medical Oncology Department, University Hospital Morales Meseguer, Centro Regional de Hemodonación, University of Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Carmen Marcos-Bravo
- Allergy Department, University Hospital Complex of Vigo, Hospital Meixoeiro, Vigo, Spain
| | - Margarita López-Trascasa
- Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain.,Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Vicente Vicente
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Madrid, Spain.,Hematology and Medical Oncology Department, University Hospital Morales Meseguer, Centro Regional de Hemodonación, University of Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Jonas Emsley
- Centre for Biomolecular Sciences, School of Pharmacy, University of Nottingham, Nottingham, United Kingdom
| | - Teresa Caballero
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain.,Allergy Department, La Paz University Hospital, Madrid, Spain
| | - Javier Corral
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Madrid, Spain.,Hematology and Medical Oncology Department, University Hospital Morales Meseguer, Centro Regional de Hemodonación, University of Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Alberto López-Lera
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Madrid, Spain.,Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain
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Firinu D, Arba M, Vincenzoni F, Iavarone F, Costanzo G, Cabras T, Castagnola M, Messana I, Del Giacco SR, Sanna MT. Proteomic Analysis of the Acid-Insoluble Fraction of Whole Saliva from Patients Affected by Different Forms of Non-histaminergic Angioedema. J Clin Immunol 2020; 40:840-850. [PMID: 32519288 DOI: 10.1007/s10875-020-00802-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/01/2020] [Indexed: 01/17/2023]
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Bova M, Suffritti C, Bafunno V, Loffredo S, Cordisco G, Del Giacco S, De Pasquale TMA, Firinu D, Margaglione M, Montinaro V, Petraroli A, Radice A, Brussino L, Zanichelli A, Zoli A, Cicardi M. Impaired control of the contact system in hereditary angioedema with normal C1-inhibitor. Allergy 2020; 75:1394-1403. [PMID: 31860755 DOI: 10.1111/all.14160] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/11/2019] [Accepted: 11/21/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Hereditary angioedema (HAE) comprises HAE with C1-inhibitor deficiency (C1-INH-HAE) and HAE with normal C1-INH activity (nl-C1-INH-HAE), due to mutations in factor XII (FXII-HAE), plasminogen (PLG-HAE), angiopoietin 1 (ANGPT1-HAE), kininogen 1 genes (KNG1-HAE), or angioedema of unknown origin (U-HAE). The Italian network for C1-INH-HAE (ITACA) created a registry including different forms of angioedema without wheals. OBJECTIVE We analyzed clinical and laboratory features of a cohort of Italian subjects with nl-C1-INH-HAE followed by ITACA to identify specific biomarkers. METHODS A total of 105 nl-C1-INH-HAE patients were studied. Plasma concentrations of cleaved high-molecular-weight kininogen (cHK), vascular endothelial growth factors (VEGFs), angiopoietins (Angs), and secreted phospholipase A2 enzymes (sPLA2 ) were evaluated. RESULTS We identified 43 FXII-HAE patients, 58 U-HAE, and 4 ANGPT1-HAE. We assessed a prevalence of 1:1.4 × 106 for FXII-HAE and 1:1.0 × 106 for U-HAE. cHK levels in U-HAE patients were similar to controls in plasma collected using protease inhibitors cocktail (PIC), but they significantly increased in the absence of PIC. In FXII-HAE patients, cHK levels, in the absence of PIC, were significantly higher than in controls. We found a significant increase of VEGF-A, VEGF-C, and Ang1 levels in U-HAE patients compared to controls. In FXII-HAE, only VEGF-C levels were increased. Ang2 concentrations and sPLA2 activity were not modified. The levels of these mediators in ANGPT1-HAE patients were not altered. CONCLUSIONS Our results suggest that pathogenesis of FXII-, ANGPT1-, and U-HAE moves through an unbalanced control of kallikrein activity, with bradykinin as most likely mediator. VEGFs and Ang1 participate in the pathophysiology of U-HAE increasing the basal vascular permeability.
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Affiliation(s)
- Maria Bova
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research University of Naples Federico II Naples Italy
| | - Chiara Suffritti
- Department of Biomedical and Clinical Sciences Luigi Sacco University of Milan Milan Italy
| | - Valeria Bafunno
- Medical Genetics Department of Clinical and Experimental Medicine University of Foggia Foggia Italy
| | - Stefania Loffredo
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research University of Naples Federico II Naples Italy
- Institute of Experimental Endocrinology and Oncology “G. Salvatore” National Research Council Naples Italy
| | - Giorgia Cordisco
- Medical Genetics Department of Clinical and Experimental Medicine University of Foggia Foggia Italy
| | | | | | - Davide Firinu
- Department of Medical Sciences University of Cagliari Cagliari Italy
| | - Maurizio Margaglione
- Medical Genetics Department of Clinical and Experimental Medicine University of Foggia Foggia Italy
| | | | - Angelica Petraroli
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research University of Naples Federico II Naples Italy
| | - Anna Radice
- Department of Allergy University of Florence Florence Italy
| | - Luisa Brussino
- Department of Medical Science University of Torino Turin Italy
| | | | - Alessandra Zoli
- Department of Clinical Immunology Ospedali Riuniti Ancona Italy
| | - Marco Cicardi
- Department of Biomedical and Clinical Sciences Luigi Sacco University of Milan Milan Italy
- IRCCS‐ICS Maugeri Milano Italy
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Betschel S, Badiou J, Binkley K, Borici-Mazi R, Hébert J, Kanani A, Keith P, Lacuesta G, Waserman S, Yang B, Aygören-Pürsün E, Bernstein J, Bork K, Caballero T, Cicardi M, Craig T, Farkas H, Grumach A, Katelaris C, Longhurst H, Riedl M, Zuraw B, Berger M, Boursiquot JN, Boysen H, Castaldo A, Chapdelaine H, Connors L, Fu L, Goodyear D, Haynes A, Kamra P, Kim H, Lang-Robertson K, Leith E, McCusker C, Moote B, O’Keefe A, Othman I, Poon MC, Ritchie B, St-Pierre C, Stark D, Tsai E. The International/Canadian Hereditary Angioedema Guideline. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2019; 15:72. [PMID: 31788005 PMCID: PMC6878678 DOI: 10.1186/s13223-019-0376-8] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/10/2019] [Indexed: 12/20/2022]
Abstract
This is an update to the 2014 Canadian Hereditary Angioedema Guideline with an expanded scope to include the management of hereditary angioedema (HAE) patients worldwide. It is a collaboration of Canadian and international HAE experts and patient groups led by the Canadian Hereditary Angioedema Network. The objective of this guideline is to provide evidence-based recommendations, using the GRADE system, for the management of patients with HAE. This includes the treatment of attacks, short-term prophylaxis, long-term prophylaxis, and recommendations for self-administration, individualized therapy, quality of life, and comprehensive care. New to the 2019 version of this guideline are sections covering the diagnosis and recommended therapies for acute treatment in HAE patients with normal C1-INH, as well as sections on pregnant and paediatric patients, patient associations and an HAE registry. Hereditary angioedema results in random and often unpredictable attacks of painful swelling typically affecting the extremities, bowel mucosa, genitals, face and upper airway. Attacks are associated with significant functional impairment, decreased health-related quality of life, and mortality in the case of laryngeal attacks. Caring for patients with HAE can be challenging due to the complexity of this disease. The care of patients with HAE in Canada, as in many countries, continues to be neither optimal nor uniform. It lags behind some other countries where there are more organized models for HAE management, and greater availability of additional licensed therapeutic options. It is anticipated that providing this guideline to caregivers, policy makers, patients, and advocates will not only optimize the management of HAE, but also promote the importance of individualized care. The primary target users of this guideline are healthcare providers who are managing patients with HAE. Other healthcare providers who may use this guideline are emergency and intensive care physicians, primary care physicians, gastroenterologists, dentists, otolaryngologists, paediatricians, and gynaecologists who will encounter patients with HAE and need to be aware of this condition. Hospital administrators, insurers and policy makers may also find this guideline helpful.
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Affiliation(s)
| | | | | | | | - Jacques Hébert
- Department of Medicine, Laval University, Quebec City, QC Canada
| | - Amin Kanani
- Division of Allergy and Clinical Immunology, St. Paul’s Hospital, Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Paul Keith
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Gina Lacuesta
- Department of Medicine, Dalhousie University, Halifax, NS Canada
| | - Susan Waserman
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Bill Yang
- University of Ottawa Medical School, Ottawa, ON Canada
| | | | - Jonathan Bernstein
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH USA
| | - Konrad Bork
- Department of Dermatology, University Hospital of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | | | - Marco Cicardi
- Department of Internal Medicine, Universita degli Studi di Milano, Ospedale L. Sacco, Milan, Italy
| | - Timothy Craig
- Departments of Medicine and Pediatrics, Penn State University, Hershey, PA USA
| | - Henriette Farkas
- 3rd Department of Internal Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Anete Grumach
- Laboratory of Clinical Immunology, Faculdade de Medicine ABC, Sao Paulo, Brazil
| | - Connie Katelaris
- Campbelltown Hospital, Western Sydney University, New South Wales, Australia
| | - Hilary Longhurst
- Addenbrooke’s Hospital, Cambridge and University College Hospital, London, England UK
| | - Marc Riedl
- University of California, San Diego, San Diego, CA USA
| | - Bruce Zuraw
- University of California, San Diego, San Diego, CA USA
| | | | - Jean-Nicolas Boursiquot
- Division of Allergy and Clinical Immunology, Centre hospitalier universitaire de Québec, Laval University, Quebec City, QC Canada
| | | | | | - Hugo Chapdelaine
- Institut de recherches cliniques de Montréal, Montreal, QC Canada
| | - Lori Connors
- Department of Medicine, Dalhousie University, Halifax, NS Canada
| | - Lisa Fu
- Toronto Allergy Group, Toronto, ON Canada
| | - Dawn Goodyear
- Southern Alberta Rare Blood and Bleeding Disorders Program, Foothills Medical Centre, University of Calgary, Calgary, AB Canada
| | - Alison Haynes
- Division of Pediatrics, Faculty of Medicine, Memorial University, St John’s, NF Canada
| | - Palinder Kamra
- Janeway Children’s Health and Rehabilitation Centre, Memorial University, St John’s, NF Canada
| | - Harold Kim
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON Canada
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON Canada
| | | | - Eric Leith
- Department of Medicine, University of Toronto, Oakville, ON Canada
| | - Christine McCusker
- Department of Immunology, McGill University Health Centre, Montreal, QC Canada
| | - Bill Moote
- Department of Medicine, Western University, London, ON Canada
| | - Andrew O’Keefe
- Division of Pediatrics, Faculty of Medicine, Memorial University, St John’s, NF Canada
| | - Ibraheem Othman
- College of Medicine, University of Saskatchewan, Regina, SK Canada
| | - Man-Chiu Poon
- Departments of Medicine, Pediatrics and Oncology, University of Calgary Cumming School of Medicine, Calgary, AB Canada
| | - Bruce Ritchie
- Departments of Medicine and Medical Oncology, University of Alberta, Edmonton, AB Canada
| | | | - Donald Stark
- Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Ellie Tsai
- Department of Internal Medicine, Queen’s University, Kingston, ON Canada
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Firinu D, Loffredo S, Bova M, Cicardi M, Margaglione M, Del Giacco S. The role of genetics in the current diagnostic workup of idiopathic non-histaminergic angioedema. Allergy 2019; 74:810-812. [PMID: 30421787 DOI: 10.1111/all.13667] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Davide Firinu
- Department of Medical Sciences and Public Health University of Cagliari Monserrato Italy
| | - Stefania Loffredo
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI) University of Naples Federico II Naples Italy
| | - Maria Bova
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research (CISI) University of Naples Federico II Naples Italy
| | - Marco Cicardi
- Department of Biomedical and Clinical Sciences Luigi Sacco Luigi Sacco Hospital Milan University of Milan Milan Italy
| | - Maurizio Margaglione
- Medical Genetics Department of Clinical and Experimental Medicine University of Foggia Foggia Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health University of Cagliari Monserrato Italy
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13
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Del Giacco SR, Firinu D, Minciullo PL, Barca MP, Manconi PE, Tartarisco G, Cristani M, Saija A, Gangemi S. Oxidative stress markers in patients with hereditary angioedema. Arch Med Sci 2019; 15:92-98. [PMID: 30697258 PMCID: PMC6348350 DOI: 10.5114/aoms.2017.66160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 01/18/2017] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Hereditary angioedema due to C1-INH deficiency (C1-INH-HAE) or with normal C1-INH is characterized by recurrent swellings due to uncontrolled production of vasoactive mediators, among which bradykinin (BK) is crucial. Through the binding and activation of the two human BK-receptors, kinins may have dual beneficial and deleterious effects in vascular and inflammation physiopathology by inducing oxidative stress. We aimed to assess the serum concentrations of advanced glycation end products (AGEs) and advanced oxidation protein products (AOPPs) in patients affected by HAE. MATERIAL AND METHODS Blood samples were collected to measure the serum concentrations of AGEs and AOPPs by spectrofluorimetric and spectrophotometric methods in patients affected by C1-INH-HAE and FXII-HAE during the remission state. RESULTS We showed that the circulating levels of AOPPs observed on control group (0.94 (0.36) nmol/mg) were significantly lower than those observed on the C1-INH-HAE group (1.68 (0.47) nmol/mg; p = 0.002) and FXII-HAE (1.50 (0.27) nmol/mg; p = 0.001). Moreover, the circulating levels of AGEs were significantly higher in C1-INH-HAE group (211.58 (151.05) AU/g; p = 0.02) than the FXII group (141.48 (89.59) AU/g), thus demonstrating a state of heightened oxidative stress. CONCLUSIONS Our observations show additional underlying events involved in HAE and are of central importance for further investigations of differences in bradykinin receptors signaling among the two disease subgroups.
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Affiliation(s)
| | - Davide Firinu
- Department of Medical Sciences “M. Aresu”, University of Cagliari, Cagliari, Italy
| | - Paola Lucia Minciullo
- School and Operative Unit of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maria Pina Barca
- Department of Medical Sciences “M. Aresu”, University of Cagliari, Cagliari, Italy
| | - Paolo Emilio Manconi
- Department of Medical Sciences “M. Aresu”, University of Cagliari, Cagliari, Italy
| | - Gennaro Tartarisco
- National Research Council of Italy (CNR) – Institute of Applied Science and Intelligent System (ISASI), Messina Unit, Messina, Italy
| | - Mariateresa Cristani
- Department of Drug Sciences and Health Products, University of Messina, Messina, Italy
| | - Antonella Saija
- Department of Drug Sciences and Health Products, University of Messina, Messina, Italy
| | - Sebastiano Gangemi
- School and Operative Unit of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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14
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Bouillet L, Defendi F, Hardy G, Cesbron JY, Boccon-Gibod I, Deroux A, Mansard C, Launay D, Gompel A, Floccard B, Jaussaud R, Beaudouin E, Armengol G, Olliver Y, Gayet S, Du Than A, Sailler L, Guez S, Sarrat A, Sorin L, de Moreuil C, Pelletier F, Javaud N, Marmion N, Fain O, Fauré J, Dumestre-Pérard C. Diagnostic biologique des angioedèmes bradykiniques : les recommandations du CREAK. Presse Med 2019; 48:55-62. [DOI: 10.1016/j.lpm.2018.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/01/2018] [Accepted: 06/25/2018] [Indexed: 02/08/2023] Open
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Mehmood A, Abdullah HMA, Inayat F, Ullah W. Wolf in the sheep's clothing: intestinal angioedema mimicking infectious colitis. BMJ Case Rep 2018; 11:11/1/e226682. [PMID: 30567241 DOI: 10.1136/bcr-2018-226682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Hereditary angioedema (HAE) is a relatively rare clinical entity that can potentially cause life-threatening airway or intestinal oedema, patients with the latter usually presents with symptoms of gastroenteritis like vomiting, diarrhoea and abdominal pain. Here, we present a unique case of a less recognised type of HAE that is type III in a patient who presented with signs and symptoms consistent with infectious colitis. She previously had similar episodes and was managed multiple times with antibiotics, with no satisfactory response. There, she underwent extensive diagnostic evaluation. On the basis of findings of further investigations on the current visit, she was eventually diagnosed with intestinal angioedema. To the best of our knowledge, the present paper represents the third reported case of type III HAE-induced intestinal angioedema. Additionally, we undertake a literature review of HAE.
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Affiliation(s)
- Asif Mehmood
- Internal Medicine, Abington Hospital - Jefferson Health, Abington, Pennsylvania, USA
| | | | | | - Waqas Ullah
- Internal Medicine, Abington Hospital - Jefferson Health, Abington, Pennsylvania, USA
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16
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Abstract
Non-hereditary angioedema (AE) with normal C1 esterase inhibitor (C1INH) can be presumably bradykinin- or mast cell-mediated, or of unknown cause. In this systematic review, we searched PubMed, EMBASE, and Scopus to provide an overview of the efficacy of different treatment options for the abovementioned subtypes of refractory non-hereditary AE with or without wheals and with normal C1INH. After study selection and risk of bias assessment, 61 articles were included for data extraction and analysis. Therapies were described for angiotensin-converting enzyme inhibitor-induced AE (ACEi-AE), for idiopathic AE, and for AE with wheals. Described treatments consisted of ecallantide, icatibant, C1INH, fresh frozen plasma (FFP), tranexamic acid (TA), and omalizumab. Additionally, individual studies for anti-vitamin K, progestin, and methotrexate were found. Safety information was available in 26 articles. Most therapies were used off-label and in few patients. There is a need for additional studies with a high level of evidence. In conclusion, in acute attacks of ACEi-AE and idiopathic AE, treatment with icatibant, C1INH, TA, and FFP often leads to symptom relief within 2 h, with limited side effects. For prophylactic treatment of idiopathic AE and AE with wheals, omalizumab, TA, and C1INH were effective and safe in the majority of patients.
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17
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Veronez CL, Moreno AS, Constantino-Silva RN, Maia LS, Ferriani MP, Castro FF, Valle SR, Nakamura VK, Cagini N, Gonçalves RF, Mansour E, Serpa FS, Coelho Dias GA, Piccirillo MA, Toledo E, de Souza Bernardes M, Cichon S, Stieber C, Arruda LK, Pesquero JB, Grumach AS. Hereditary Angioedema with Normal C1 Inhibitor and F12 Mutations in 42 Brazilian Families. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1209-1216.e8. [DOI: 10.1016/j.jaip.2017.09.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/29/2017] [Accepted: 09/22/2017] [Indexed: 01/14/2023]
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18
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Firinu D, Bassareo PP, Zedda AM, Barca MP, Crisafulli A, Mercuro G, Del Giacco S. Impaired Endothelial Function in Hereditary Angioedema During the Symptom-Free Period. Front Physiol 2018; 9:523. [PMID: 29867566 PMCID: PMC5964294 DOI: 10.3389/fphys.2018.00523] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 04/24/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction: The presence of coronary endothelial dysfunction was previously shown in Hereditary Angioedema (HAE) patients. The aim of our study was to evaluate the effect of HAE on systemic endothelial function and whether there was a relationship among endothelial function, asymmetric dimethylarginine (ADMA) -which is a strong inhibitor of nitric oxide synthesis-, and disease severity scores. Methods: Twenty-four HAE patients (18 females, aged 47.9 ± 2 years) without factors known to interfere with endothelial function were studied and compared with 24 healthy peers age- and gender-matched. Endothelial function was assessed by means of non-invasive finger plethysmography (reactive hyperaemia index: RHI) and ADMA levels by high-performance liquid chromatography. HAE severity scores have been calculated according to published literature. Results: In HAE patients RHI was lower (2.03 ± 0.46 vs. 2.82 ± 0.34, p < 0.0001) and ADMA higher (0.636 ± 7 vs. 585 ± 5 micromol/L, p < 0.01) than in controls. A statistically significant inverse correlation was revealed between RHI and patients' ADMA levels (r = −0.516, p = 0.009) as well as between RHI and patients' chronological age (r = −0.49, p = 0.015). A statistically significant correlation between RHI and ADMA was confirmed even when excluding the possible influence of cholesterol (r = −0.408, p = 0.048). No other significant correlations were found with the examined laboratory and clinical parameters (chronological age, age at disease onset, disease duration, severity scores, and gender). Conclusion: The dysfunction previously shown in HAE patients at the coronary arteries seems to involve the peripheral vessels as well, without a correlation with disease severity.
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Affiliation(s)
- Davide Firinu
- Unit of Internal Medicine, Department of Medical Sciences and Public Health, Allergy and Clinical Immunology, University of Cagliari, Cagliari, Italy
| | - Pier P Bassareo
- Unit of Cardiology and Angiology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Angela M Zedda
- Unit of Cardiology and Angiology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Maria P Barca
- Unit of Internal Medicine, Department of Medical Sciences and Public Health, Allergy and Clinical Immunology, University of Cagliari, Cagliari, Italy
| | - Antonio Crisafulli
- Sports Physiology Lab., Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giuseppe Mercuro
- Unit of Cardiology and Angiology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Stefano Del Giacco
- Unit of Internal Medicine, Department of Medical Sciences and Public Health, Allergy and Clinical Immunology, University of Cagliari, Cagliari, Italy
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19
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Bafunno V, Firinu D, D'Apolito M, Cordisco G, Loffredo S, Leccese A, Bova M, Barca MP, Santacroce R, Cicardi M, Del Giacco S, Margaglione M. Mutation of the angiopoietin-1 gene (ANGPT1) associates with a new type of hereditary angioedema. J Allergy Clin Immunol 2018; 141:1009-1017. [PMID: 28601681 DOI: 10.1016/j.jaci.2017.05.020] [Citation(s) in RCA: 187] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/03/2017] [Accepted: 05/10/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Valeria Bafunno
- Medical Genetics, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Maria D'Apolito
- Medical Genetics, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Giorgia Cordisco
- Medical Genetics, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Stefania Loffredo
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Angelica Leccese
- Medical Genetics, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Maria Bova
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Maria Pina Barca
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Rosa Santacroce
- Medical Genetics, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Marco Cicardi
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital Milan, Milan, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Maurizio Margaglione
- Medical Genetics, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy.
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20
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Magerl M, Germenis AE, Maas C, Maurer M. Hereditary Angioedema with Normal C1 Inhibitor. Immunol Allergy Clin North Am 2017; 37:571-584. [DOI: 10.1016/j.iac.2017.04.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Stieber C, Cichon S, Magerl M, Nöthen MM. Clinical Utility Gene Card for hereditary angioedema with normal C1 inhibitor (HAEnC1). Eur J Hum Genet 2017; 25:ejhg2017104. [PMID: 28905884 PMCID: PMC5602008 DOI: 10.1038/ejhg.2017.104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 04/12/2017] [Accepted: 05/23/2017] [Indexed: 12/15/2022] Open
Abstract
1. Name of the disease (synonyms) Hereditary angioedema type III (HAE-III) Estrogen-related hereditary angioedema Hereditary angioedema with factor XII mutations (FXII-HAE) Hereditary angioedema of unknown origin (U-HAE) 2. OMIM# of the disease 610618 3. Name of the analysed genes or DNA/chromosome segments: Coagulation factor XII; Hageman factor; F12; chromosome 5q.35.2-q35.3 4. OMIM# of the gene(s) 610619 Review of the analytical and clinical validity as well as of the clinical utility of DNA-based testing for mutations in the F12 gene(s) in ⊠ diagnostic, ⊠ predictive and ⊠ prenatal settings and for, ⊠ risk assessment in relatives.
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Affiliation(s)
- Christiane Stieber
- Center for Rare Diseases Bonn, University Hospital of Bonn, Bonn, Germany.,Institute of Human Genetics, University of Bonn School of Medicine &University Hospital of Bonn, Bonn,Germany.,Department of Genomics, Life&Brain Center, University of Bonn, Bonn, Germany
| | - Sven Cichon
- Division of Medical Genetics, Department of Biomedicine, University Hospital of Basel, Basel, Switzerland
| | - Markus Magerl
- Department of Dermatology and Allergy, Comprehensive Allergy Center Charité, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Markus M Nöthen
- Center for Rare Diseases Bonn, University Hospital of Bonn, Bonn, Germany.,Institute of Human Genetics, University of Bonn School of Medicine &University Hospital of Bonn, Bonn,Germany.,Department of Genomics, Life&Brain Center, University of Bonn, Bonn, Germany
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22
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Deroux A, Boccon-Gibod I, Fain O, Pralong P, Ollivier Y, Pagnier A, Djenouhat K, Du-Thanh A, Gompel A, Faisant C, Launay D, Bouillet L. Hereditary angioedema with normal C1 inhibitor and factor XII mutation: a series of 57 patients from the French National Center of Reference for Angioedema. Clin Exp Immunol 2017; 185:332-7. [PMID: 27271546 DOI: 10.1111/cei.12820] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 05/27/2016] [Accepted: 05/31/2016] [Indexed: 11/29/2022] Open
Abstract
Hereditary angioedema (HAE) is a rare disease associated with either a quantitative or qualitative deficiency in C1-inhibitor (C1-INH) or normal C1-INH. HAE with normal C1-INH is associated in 20% of cases with mutations in the gene for factor XII (FXII) or FXII-HAE. A recent review described 41 families, including 14 German and 15 Spanish families. We have constructed a register of French patients and their characteristics. A national survey was launched through the French National Center of Reference for Angioedema (CREAK) to study the clinical, biological and therapeutic characteristics of patients with HAE linked to a mutation of FXII gene. Fifty-seven patients were identified from 24 different families. In most cases they were young women (mean age at diagnosis: 31 years, mean age at first symptom: 21 years, female/male ratio: 76%). Twenty-one per cent of the patients experienced angioedema attacks only during pregnancy or when on oestrogen contraception. Sixty-three per cent had attacks at all times, but they were more severe during these same periods. Male carriers of the mutation were more frequently asymptomatic than females (P = 0·003). C1-INH concentrate and icatibant were both effective for treating attacks. The prophylactic use of tranexamic acid led to a 64% decrease in the number of attacks. This is one of the largest series reported of HAE patients with FXII mutation. The therapeutic management appeared to be identical to that of HAE with C1-INH deficiency.
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Affiliation(s)
- A Deroux
- Internal Medicine Department, Centre Hospitalier Des Alpes, Grenoble, France
| | - I Boccon-Gibod
- Internal Medicine Department, Centre Hospitalier Des Alpes, Grenoble, France
| | - O Fain
- Internal Medicine Department, Hôpital Saint Antoine, Université Paris, France
| | - P Pralong
- Dermatology Department, Allergology and Photobiology, CHU De Grenoble, Grenoble, France
| | - Y Ollivier
- Internal Medicine Department, Caen, France
| | - A Pagnier
- Internal Medicine Department, Centre Hospitalier Des Alpes, Grenoble, France
| | - K Djenouhat
- Service De Biologie Médicale, EPH De Rouïba, Alger, Algéria
| | - A Du-Thanh
- Dermatology Department, Hôpital Saint-Eloi, Centre Hospitalier Universitaire De Montpellier, Montpellier, France
| | - A Gompel
- Gynecology Department, CHU Paris-Centre, Hopital, Cochin, Paris, France
| | - C Faisant
- Internal Medicine Department, Centre Hospitalier Des Alpes, Grenoble, France
| | - D Launay
- Université Lille, Lille Inflammation Research International Center, Lille, France.,Département De Médecine Interne Et Immunologie Clinique, Lille, Lille, France
| | - L Bouillet
- Internal Medicine Department, Centre Hospitalier Des Alpes, Grenoble, France
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23
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Bork K, Wulff K, Witzke G, Hardt J. Treatment for hereditary angioedema with normal C1-INH and specific mutations in the F12 gene (HAE-FXII). Allergy 2017; 72:320-324. [PMID: 27905115 DOI: 10.1111/all.13076] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2016] [Indexed: 11/28/2022]
Abstract
Hereditary angioedema with normal C1 esterase inhibitor and mutations in the F12 gene (HAE-FXII) is associated with skin swellings, abdominal pain attacks, and the risk of asphyxiation due to upper airway obstruction. It occurs nearly exclusively in women. We report our experience treating HAE-FXII with discontinuation of potential trigger factors and drug therapies. The study included 72 patients with HAE-FXII. Potential triggers included estrogen-containing oral contraceptives (eOC), hormonal replacement therapy, or angiotensin-converting enzyme inhibitors. Drug treatment comprised plasma-derived C1 inhibitor (pdC1-INH) for acute swelling attacks and progestins, tranexamic acid, and danazol for the prevention of attacks. Discontinuation of eOC was effective in 25 (89.3%) of 28 women and led to a reduction in the number of attacks (about 90%). After ending hormonal replacement therapy, three of eight women became symptom-free. Three women with exacerbation of HAE-FXII during intake of quinapril or enalapril had no further HAE-FXII attacks after discontinuation of those drugs. Eleven women were treated with pdC1-INH for 143 facial attacks. The duration of the treated facial attacks (mean: 26.6 h; SD: 10.1 h) was significantly shorter than that of the previous 88 untreated facial attacks in the same women (mean: 64.1 h; SD: 28.0 h; P < 0.01). The mean reduction in attack frequency was 99.8% under progestins after discontinuing eOC (16 women), 93.8% under tranexamic acid (four women), and 100% under danazol (three women). For patients with HAE-FXII, various treatment options are available which completely or at least partially reduce the number or duration of attacks.
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Affiliation(s)
- K. Bork
- Department of Dermatology; Johannes Gutenberg University; Mainz Germany
| | - K. Wulff
- University Medicine; Ernst Moritz Arndt University; Greifswald Germany
| | - G. Witzke
- Department of Dermatology; Johannes Gutenberg University; Mainz Germany
| | - J. Hardt
- Department of Medical Psychology and Medical Sociology; Johannes Gutenberg University; Mainz Germany
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de Maat S, Björkqvist J, Suffritti C, Wiesenekker CP, Nagtegaal W, Koekman A, van Dooremalen S, Pasterkamp G, de Groot PG, Cicardi M, Renné T, Maas C. Plasmin is a natural trigger for bradykinin production in patients with hereditary angioedema with factor XII mutations. J Allergy Clin Immunol 2016; 138:1414-1423.e9. [DOI: 10.1016/j.jaci.2016.02.021] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 02/11/2016] [Accepted: 02/26/2016] [Indexed: 10/22/2022]
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Piñero-Saavedra M, González-Quevedo T, Saenz de San Pedro B, Alcaraz C, Bobadilla-González P, Fernández-Vieira L, Hinojosa B, García-Lozano R. Hereditary angioedema with F12 mutation: Clinical features and enzyme polymorphisms in 9 Southwestern Spanish families. Ann Allergy Asthma Immunol 2016; 117:520-526. [PMID: 27788882 DOI: 10.1016/j.anai.2016.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/20/2016] [Accepted: 09/02/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Information on F12 mutation hereditary angioedema (HAE) is still limited, but Spain is now recognized as having one of the highest concentrations of cases in Western Europe. OBJECTIVE To describe unique features of HAE in Spanish carriers of the F12 mutation and investigate a potential role for angiotensin-converting enzyme (ACE) and aminopeptidase-P polymorphisms in disease expression. METHODS This was a prospective observational cohort study of 35 individuals (80% females) from 9 unrelated families carrying the p.Thr309Lys mutation. We analyzed detailed medical records and complement activity (C4, C1q, C1 inhibitor) and screened for mutations in exon 9 of the F12 gene and 2 polymorphisms: XPNPEP2 c-2399A and the ACE insertion/deletion polymorphism. RESULTS The p.Thr309Lys mutation was found in all individuals. Three of the 9 index patients had a clinically negative family history, and 72% of males and 29% of females were asymptomatic. Sixteen females (44% estrogen dependent, 56% estrogen sensitive) were clearly symptomatic. The most common locations of attacks were the abdomen (63%), face (25%), and peripheral structures (6%). Triggers other than hyperestrogenic states included stress and minor trauma or pressure. Short-term treatment with C1-inhibitor concentrate and icatibant and long-term prophylaxis with tranexamic acid were useful. The combination of the I allele and A allele was detected in 17% of patients. CONCLUSION The polymorphisms analyzed were not a major determinant of disease expression in our population. We recommend searching for F12 mutations in women with edema attacks without associated wheals and with normal C1-inhibitor levels, particularly when they develop symptoms during hyperestrogenic states or are of Western European or African origin.
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Affiliation(s)
- Macarena Piñero-Saavedra
- Reference Unit for Angioedema in Andalusia, Allergy Department, Virgen del Rocío University Hospital, Seville, Spain
| | - Teresa González-Quevedo
- Reference Unit for Angioedema in Andalusia, Allergy Department, Virgen del Rocío University Hospital, Seville, Spain.
| | | | - Cristina Alcaraz
- Allergy Department, Virgen Macarena University Hospital, Seville, Spain
| | | | | | - Belén Hinojosa
- Allergy Department, Virgen de la Cinta Specialities Center, Huelva, Spain
| | - Raúl García-Lozano
- Immunology Department, Virgen del Rocío University Hospital, Seville, Spain
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Henao MP, Kraschnewski JL, Kelbel T, Craig TJ. Diagnosis and screening of patients with hereditary angioedema in primary care. Ther Clin Risk Manag 2016; 12:701-11. [PMID: 27194914 PMCID: PMC4859422 DOI: 10.2147/tcrm.s86293] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hereditary angioedema (HAE) is a rare autosomal dominant disease that commonly manifests with episodes of cutaneous or submucosal angioedema and intense abdominal pain. The condition usually presents due to a deficiency of C1 esterase inhibitor (C1-INH) that leads to the overproduction of bradykinin, causing an abrupt increase in vascular permeability. A less-understood and less-common form of the disease presents with normal C1-INH levels. Symptoms of angioedema may be confused initially with mast cell-mediated angioedema, such as allergic reactions, and may perplex physicians when epinephrine, antihistamine, or glucocorticoid therapies do not provide relief. Similarly, abdominal attacks may lead to unnecessary surgeries or opiate dependence. All affected individuals are at risk for a life-threatening episode of laryngeal angioedema, which continues to be a source of fatalities due to asphyxiation. Unfortunately, the diagnosis is delayed on average by almost a decade due to a misunderstanding of symptoms and general lack of awareness of the disease. Once physicians suspect HAE, however, diagnostic methods are reliable and available at most laboratories, and include testing for C4, C1-INH protein, and C1-INH functional levels. In patients with HAE, management consists of acute treatment of an attack as well as possible short- or long-term prophylaxis. Plasma-derived C1-INH, ecallantide, icatibant, and recombinant human C1-INH are new treatments that have been shown to be safe and effective in the treatment of HAE attacks. The current understanding of HAE has greatly improved in recent decades, leading to growing awareness, new treatments, improved management strategies, and better outcomes for patients.
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Affiliation(s)
- Maria Paula Henao
- Department of Medicine, Pennsylvania State University College of Medicine at Hershey Medical Center, Hershey, PA, USA
| | - Jennifer L Kraschnewski
- Department of Medicine, Pennsylvania State University College of Medicine at Hershey Medical Center, Hershey, PA, USA
| | - Theodore Kelbel
- Division of Allergy and Immunology, Pennsylvania State University College of Medicine at Hershey Medical Center, Hershey, PA, USA
| | - Timothy J Craig
- Department of Medicine and Pediatrics, Pennsylvania State University College of Medicine at Hershey Medical Center, Hershey, PA, USA
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