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Mendoza-Alvarez A, Tosco-Herrera E, Muñoz-Barrera A, Rubio-Rodríguez LA, Alonso-Gonzalez A, Corrales A, Iñigo-Campos A, Almeida-Quintana L, Martin-Fernandez E, Martinez-Beltran D, Perez-Rodriguez E, Callero A, Garcia-Robaina JC, González-Montelongo R, Marcelino-Rodriguez I, Lorenzo-Salazar JM, Flores C. A catalog of the genetic causes of hereditary angioedema in the Canary Islands (Spain). Front Immunol 2022; 13:997148. [PMID: 36203598 PMCID: PMC9531158 DOI: 10.3389/fimmu.2022.997148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Hereditary angioedema (HAE) is a rare disease where known causes involve C1 inhibitor dysfunction or dysregulation of the kinin cascade. The updated HAE management guidelines recommend performing genetic tests to reach a precise diagnosis. Unfortunately, genetic tests are still uncommon in the diagnosis routine. Here, we characterized for the first time the genetic causes of HAE in affected families from the Canary Islands (Spain). Whole-exome sequencing data was obtained from 41 affected patients and unaffected relatives from 29 unrelated families identified in the archipelago. The Hereditary Angioedema Database Annotation (HADA) tool was used for pathogenicity classification and causal variant prioritization among the genes known to cause HAE. Manual reclassification of prioritized variants was used in those families lacking known causal variants. We detected a total of eight different variants causing HAE in this patient series, affecting essentially SERPING1 and F12 genes, one of them being a novel SERPING1 variant (c.686-12A>G) with a predicted splicing effect which was reclassified as likely pathogenic in one family. Altogether, the diagnostic yield by assessing previously reported causal genes and considering variant reclassifications according to the American College of Medical Genetics guidelines reached 66.7% (95% Confidence Interval [CI]: 30.1-91.0) in families with more than one affected member and 10.0% (95% CI: 1.8-33.1) among cases without family information for the disease. Despite the genetic causes of many patients remain to be identified, our results reinforce the need of genetic tests as first-tier diagnostic tool in this disease, as recommended by the international WAO/EAACI guidelines for the management of HAE.
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Affiliation(s)
| | - Eva Tosco-Herrera
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Adrian Muñoz-Barrera
- Genomics Division, Instituto Tecnológico y de Energías Renovables, Santa Cruz de Tenerife, Spain
| | - Luis A. Rubio-Rodríguez
- Genomics Division, Instituto Tecnológico y de Energías Renovables, Santa Cruz de Tenerife, Spain
| | - Aitana Alonso-Gonzalez
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
- Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Almudena Corrales
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Iñigo-Campos
- Genomics Division, Instituto Tecnológico y de Energías Renovables, Santa Cruz de Tenerife, Spain
| | - Lourdes Almeida-Quintana
- Allergy Service, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Elena Martin-Fernandez
- Allergy Service, Hospital Universitario Dr. Molina Orosa, Las Palmas de Gran Canaria, Spain
| | - Dara Martinez-Beltran
- Allergy Service, Hospital Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Eva Perez-Rodriguez
- Allergy Service, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Ariel Callero
- Allergy Service, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Jose C. Garcia-Robaina
- Allergy Service, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Itahisa Marcelino-Rodriguez
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
- Public Health and Preventive Medicine Area, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Jose M. Lorenzo-Salazar
- Genomics Division, Instituto Tecnológico y de Energías Renovables, Santa Cruz de Tenerife, Spain
| | - Carlos Flores
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
- Genomics Division, Instituto Tecnológico y de Energías Renovables, Santa Cruz de Tenerife, Spain
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Facultad de Ciencias de la Salud, Universidad Fernando Pessoa Canarias, Las Palmas de Gran Canaria, Spain
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Mendoza-Alvarez A, Marcelino-Rodriguez I, Almeida-Quintana L, Martin-Fernandez E, Martinez-Beltran D, Almeida-Sanchez Z, Cruz-Niesvara D, Hernández-Santana G, Garcia-Robaina JC, Flores C, Callero A. First Census of Patients with Hereditary Angioedema in the Canary Islands. J Clin Med 2021; 10:jcm10204711. [PMID: 34682833 PMCID: PMC8540601 DOI: 10.3390/jcm10204711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 12/12/2022] Open
Abstract
Hereditary angioedema (HAE) is a rare genetic condition whose main symptoms are recurrent swelling in the skin, mucosa, and internal organs. Recent studies suggested that the regulation of the inflammatory response and the complement cascade are two of the pathways significantly enriched in the Canary Islands, Spain. Here, we describe the first HAE patient series in this region. Forty-one patients (33 F, 8 M) and nine healthy relatives belonging to twenty-nine families were recruited for this study, obtaining their clinical and demographic features using a data collection form, as well as blood samples for biochemical analysis. The mean age of patients was 36.8 years (ranging from 4 to 72 years). Positive family history of HAE was reported in 13 patients (32.5%), and a mean diagnosis delay of 7.9 (±12.5) years was estimated, ranging from months to 50 years. Cutaneous edema was the most common symptom (53.6%), while airway symptoms was present in 11 patients. Prophylactic treatment was indicated for 23 patients, while 14 also require on-demand rescue treatment. We estimate a minimum prevalence of 1.25:100,000 for HAE due to C1-INH deficiency or dysfunction in the Canary Islands, which is higher than the estimates for mainland Spanish populations. HAE continues to be a disease poorly recognized by health care professionals due to its confusing symptoms, leading to longer diagnosis delay. Altogether, the evidence reinforces the need for a rapid and accurate diagnosis and precision medicine-based studies to improve the patient's quality of life.
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Affiliation(s)
- Alejandro Mendoza-Alvarez
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Universidad de La Laguna, 38200 Santa Cruz de Tenerife, Spain; (A.M.-A.); (I.M.-R.); (C.F.)
| | - Itahisa Marcelino-Rodriguez
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Universidad de La Laguna, 38200 Santa Cruz de Tenerife, Spain; (A.M.-A.); (I.M.-R.); (C.F.)
| | | | | | - Dara Martinez-Beltran
- Allergy Service, Hospital Universitario Insular-Materno Infantil, 35016 Las Palmas, Spain;
| | | | - David Cruz-Niesvara
- Allergy Service, Hospital General de Fuerteventura Virgen de la Peña, 35600 Las Palmas, Spain;
| | | | - Jose C. Garcia-Robaina
- Allergy Service, Hospital Universitario Nuestra Señora de Candelaria, Universidad de La Laguna, 38200 Santa Cruz de Tenerife, Spain;
| | - Carlos Flores
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Universidad de La Laguna, 38200 Santa Cruz de Tenerife, Spain; (A.M.-A.); (I.M.-R.); (C.F.)
- Genomics Division, Instituto Tecnológico y de Energías Renovables, 38600 Santa Cruz de Tenerife, Spain
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ariel Callero
- Allergy Service, Hospital Universitario Nuestra Señora de Candelaria, Universidad de La Laguna, 38200 Santa Cruz de Tenerife, Spain;
- Correspondence: ; Tel.: +34-922-602220
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Fukunaga A, Tsuchiyama S, Lee K, Washio K, Hashimura C, Horiuchi T, Nishigori C. The relationship between complement levels and disease activity in Japanese family cases of hereditary angioedema with C1-INH deficiency. Allergol Int 2018; 67:518-520. [PMID: 29661499 DOI: 10.1016/j.alit.2018.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/26/2018] [Accepted: 03/08/2018] [Indexed: 10/17/2022] Open
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4
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Loules G, Zamanakou M, Parsopoulou F, Vatsiou S, Psarros F, Csuka D, Porebski G, Obtulowicz K, Valerieva A, Staevska M, López-Lera A, López-Trascasa M, Moldovan D, Magerl M, Maurer M, Speletas M, Farkas H, Germenis AE. Targeted next-generation sequencing for the molecular diagnosis of hereditary angioedema due to C1-inhibitor deficiency. Gene 2018; 667:76-82. [PMID: 29753808 DOI: 10.1016/j.gene.2018.05.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 05/03/2018] [Accepted: 05/09/2018] [Indexed: 11/29/2022]
Abstract
SERPING1 genotyping of subjects suspicious for hereditary angioedema due to C1-INH deficiency (C1-INH-HAE) is important for clinical practice as well as for research reasons. Conventional approaches towards the detection of C1-INH-HAE-associated SERPING1 variants are cumbersome and time-demanding with many pitfalls. To take advantage of the benefits of next-generation sequencing (NGS) technology, we developed and validated a custom NGS platform that, by targeting the entire SERPING1 gene, facilitates genetic testing of C1-INH-HAE patients in clinical practice. In total, 135 different C1-INH-HAE-associated SERPING1 variants, out of the approximately 450 reported, along with 115 negative controls and 95 randomly selected DNA samples from affected family members of C1-INH-HAE index patients, were included in the forward and reverse validation processes of this platform. Our platform's performance, i.e. analytical sensitivity of 98.96%, a false negative rate of 1.05%, analytical specificity 100%, a false positive rate equal to zero, accuracy of 99.35%, and repeatability of 100% recommends its implementation as a first line approach for the genetic testing of C1-INH-HAE patients or as a confirmatory method. A noteworthy advantage of our platform is the concomitant detection of single nucleotide variants and copy number variations throughout the whole length of the SERPING1 gene, moreover providing information about the size and the localization of the latter. During our study, 15 novel C1-INH-HAE-related SERPING1 variants were detected.
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Affiliation(s)
- Gedeon Loules
- CeMIA SA, 31 Makrigianni street, GR-41334 Larissa, Greece.
| | | | - Faidra Parsopoulou
- CeMIA SA, 31 Makrigianni street, GR-41334 Larissa, Greece; Department of Immunology & Histocompatibility, University of Thessaly, School of Health Sciences, Faculty of Medicine, 3 Panepistimiou street, Biopolis, GR-41500 Larissa, Greece.
| | - Sofia Vatsiou
- CeMIA SA, 31 Makrigianni street, GR-41334 Larissa, Greece; Department of Immunology & Histocompatibility, University of Thessaly, School of Health Sciences, Faculty of Medicine, 3 Panepistimiou street, Biopolis, GR-41500 Larissa, Greece.
| | - Fotis Psarros
- Department of Allergology, Navy Hospital, 70 Dinoktatous street, GR-11521 Athens, Greece.
| | - Dorottya Csuka
- Hungarian Angioedema Center, 3rd Department of Internal Medicine, Semmelweis University, Kutvolgyi ut 4, H-1125 Budapest, Hungary.
| | - Grzegorz Porebski
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, ul. Śniadeckich 10, 31-531 Krakow, Poland.
| | - Krystyna Obtulowicz
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, ul. Śniadeckich 10, 31-531 Krakow, Poland.
| | - Anna Valerieva
- Clinic of Allergy and Asthma, Medical University of Sofia, 1 Georgi Sofiyski St, 1431 Sofia, Bulgaria
| | - Maria Staevska
- Clinic of Allergy and Asthma, Medical University of Sofia, 1 Georgi Sofiyski St, 1431 Sofia, Bulgaria
| | - Alberto López-Lera
- Hospital La Paz Health Research Institute-IdiPAZ-Research and Center for Biomedical Network Research on Rare Diseases (CIBERER U754), Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Margarita López-Trascasa
- Hospital La Paz Health Research Institute-IdiPAZ-Research and Center for Biomedical Network Research on Rare Diseases (CIBERER U754), Paseo de la Castellana 261, 28046 Madrid, Spain.
| | - Dumitru Moldovan
- University of Medicine and Pharmacy, Tirgu Mures 540103, Romania
| | - Markus Magerl
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - Marcus Maurer
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - Matthaios Speletas
- Department of Immunology & Histocompatibility, University of Thessaly, School of Health Sciences, Faculty of Medicine, 3 Panepistimiou street, Biopolis, GR-41500 Larissa, Greece.
| | - Henriette Farkas
- Hungarian Angioedema Center, 3rd Department of Internal Medicine, Semmelweis University, Kutvolgyi ut 4, H-1125 Budapest, Hungary.
| | - Anastasios E Germenis
- CeMIA SA, 31 Makrigianni street, GR-41334 Larissa, Greece; Department of Immunology & Histocompatibility, University of Thessaly, School of Health Sciences, Faculty of Medicine, 3 Panepistimiou street, Biopolis, GR-41500 Larissa, Greece.
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Kasami S, Sowa-Osako J, Fukai K, Tokimasa S, Kaga SI, Saito R, Tanaka A, Hide M, Tsuruta D. Presymptomatic genetic diagnosis of two siblings with hereditary angioedema, presenting with unusual normal levels of serum C4. J Dermatol 2017; 45:e31-32. [PMID: 29058329 DOI: 10.1111/1346-8138.14103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sachie Kasami
- Department ofDermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Junko Sowa-Osako
- Department ofDermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kazuyoshi Fukai
- Department ofDermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Sadao Tokimasa
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shin-Ichiro Kaga
- Department ofTrauma and Critical Care Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Ryo Saito
- Department of Dermatology, University Hospital, Hiroshima University, Hiroshima, Japan
| | - Akio Tanaka
- Department of Dermatology, Institute of Biomedical and Health Sciences Hiroshima University, Hiroshima, Japan
| | - Michihiro Hide
- Department of Dermatology, Institute of Biomedical and Health Sciences Hiroshima University, Hiroshima, Japan
| | - Daisuke Tsuruta
- Department ofDermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
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