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Itoh N, Ohshima Y. The dual aspects of IgD in the development of tolerance and the pathogenesis of allergic diseases. Allergol Int 2022; 72:227-233. [PMID: 37010995 DOI: 10.1016/j.alit.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 11/28/2022] Open
Abstract
The cell-surface form of IgD is co-expressed with IgM on mature, naïve B cells as B-cell receptors. The secreted IgD antibody (Ab) is found in relatively modest concentrations in the blood and other body fluids as it has a relatively short serum half-life. IgD Abs produced in the upper-respiratory mucosa presumably participate in host defense against pathogens. The allergen-mediated cross-linkage of basophil-bound IgD Ab enhances type 2 cytokine secretion; IgD Ab may also interfere with IgE-mediated basophil degranulation, suggesting dual and opposing roles of IgD Ab in allergen sensitization and the development of allergen immune tolerance. We recently demonstrated that children with egg allergies who avoided all forms of egg have lower ovomucoid-specific IgD and IgG4 Ab levels than those who only partially avoided egg products and that different mechanisms may regulate allergen-specific IgD Ab production compared to allergen-specific IgG4 Ab production. The relationship between antigen-specific IgD Ab levels and the clinical improvement of asthma and food allergies suggests that antigen-specific IgD Ab affects the process of outgrowing allergies. We discuss the possibility that allergen-specific IgD Ab production reflects low-affinity, allergen-specific IgE production as children outgrow a food allergy.
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Affiliation(s)
- Naohiro Itoh
- Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
| | - Yusei Ohshima
- Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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2
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Cho SH, Tóth K, Kim D, Vo PH, Lin CH, Handakumbura PP, Ubach AR, Evans S, Paša-Tolić L, Stacey G. Activation of the plant mevalonate pathway by extracellular ATP. Nat Commun 2022; 13:450. [PMID: 35064110 PMCID: PMC8783019 DOI: 10.1038/s41467-022-28150-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/10/2022] [Indexed: 12/28/2022] Open
Abstract
The mevalonate pathway plays a critical role in multiple cellular processes in both animals and plants. In plants, the products of this pathway impact growth and development, as well as the response to environmental stress. A forward genetic screen of Arabidopsis thaliana using Ca2+-imaging identified mevalonate kinase (MVK) as a critical component of plant purinergic signaling. MVK interacts directly with the plant extracellular ATP (eATP) receptor P2K1 and is phosphorylated by P2K1 in response to eATP. Mutation of P2K1-mediated phosphorylation sites in MVK eliminates the ATP-induced cytoplasmic calcium response, MVK enzymatic activity, and suppresses pathogen defense. The data demonstrate that the plasma membrane associated P2K1 directly impacts plant cellular metabolism by phosphorylation of MVK, a key enzyme in the mevalonate pathway. The results underline the importance of purinergic signaling in plants and the ability of eATP to influence the activity of a key metabolite pathway with global effects on plant metabolism. Products of the mevalonate pathway support plant development. Here the authors show that the extracellular ATP receptor P2K1 phosphorylates mevalonate kinase and this affects the mevalonate pathway.
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3
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Perazzio SF, Palmeira P, Moraes-Vasconcelos D, Rangel-Santos A, de Oliveira JB, Andrade LEC, Carneiro-Sampaio M. A Critical Review on the Standardization and Quality Assessment of Nonfunctional Laboratory Tests Frequently Used to Identify Inborn Errors of Immunity. Front Immunol 2021; 12:721289. [PMID: 34858394 PMCID: PMC8630704 DOI: 10.3389/fimmu.2021.721289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 10/05/2021] [Indexed: 12/24/2022] Open
Abstract
Inborn errors of immunity (IEI), which were previously termed primary immunodeficiency diseases, represent a large and growing heterogeneous group of diseases that are mostly monogenic. In addition to increased susceptibility to infections, other clinical phenotypes have recently been associated with IEI, such as autoimmune disorders, severe allergies, autoinflammatory disorders, benign lymphoproliferative diseases, and malignant manifestations. The IUIS 2019 classification comprises 430 distinct defects that, although rare individually, represent a group affecting a significant number of patients, with an overall prevalence of 1:1,200-2,000 in the general population. Early IEI diagnosis is critical for appropriate therapy and genetic counseling, however, this process is deeply dependent on accurate laboratory tests. Despite the striking importance of laboratory data for clinical immunologists, several IEI-relevant immunoassays still lack standardization, including standardized protocols, reference materials, and external quality assessment programs. Moreover, well-established reference values mostly remain to be determined, especially for early ages, when the most severe conditions manifest and diagnosis is critical for patient survival. In this article, we intend to approach the issue of standardization and quality control of the nonfunctional diagnostic tests used for IEI, focusing on those frequently utilized in clinical practice. Herein, we will focus on discussing the issues of nonfunctional immunoassays (flow cytometry, enzyme-linked immunosorbent assays, and turbidimetry/nephelometry, among others), as defined by the pure quantification of proteins or cell subsets without cell activation or cell culture-based methods.
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Affiliation(s)
- Sandro Félix Perazzio
- Division of Rheumatology, Universidade Federal de São Paulo, Sao Paulo, Brazil.,Immunology Division, Fleury Medicine and Health Laboratory, Sao Paulo, Brazil
| | - Patricia Palmeira
- Laboratório de Investigação Médica (LIM-36), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil
| | - Dewton Moraes-Vasconcelos
- Laboratório de Investigação Médica (LIM-56), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil
| | - Andréia Rangel-Santos
- Laboratório de Investigação Médica (LIM-36), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil
| | | | - Luis Eduardo Coelho Andrade
- Division of Rheumatology, Universidade Federal de São Paulo, Sao Paulo, Brazil.,Immunology Division, Fleury Medicine and Health Laboratory, Sao Paulo, Brazil
| | - Magda Carneiro-Sampaio
- Laboratório de Investigação Médica (LIM-36), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil.,Department of Pediatrics, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil
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4
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Lung T, Sakem B, Hemmerle A, Nydegger M, Risch M, Risch L, Nydegger U. Autoimmune diseases - New insights into a troublesome field. J Transl Autoimmun 2021; 4:100108. [PMID: 34179743 PMCID: PMC8188057 DOI: 10.1016/j.jtauto.2021.100108] [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: 05/21/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 11/25/2022] Open
Abstract
Recent updates in the diagnosis and management of chronic inflammatory conditions can be brought together to better understand autoimmune diseases (ADs). With organ-specific or organ-limited and systemic ADs, physicians often are faced with a dilemma when making a diagnosis and may feel a kind of embarrassment when a more distinct nosological entity cannot be found. ADs often overlap with other diseases and good diagnostic procedures for ADs only become evidence-based when refined histopathologic, immunopathologic, and general laboratory analyses are available. Immunofluorescence analyses, Western blotting, CUT & RUN technology allow localization of the site of autoantibody-reactivity on the relevant DNA sequence. The Polymerase chain reaction technology and CRISPR-Cas9, the new gene editor using pools of synthetic non-coding RNAs in screening experiments, are expected to lead to advances in the diagnosis of ADs. The current use of mRNA as a vaccine against COVID-19 has increased confidence in the use of mRNA or long non-coding RNAs in the treatment strategy for ADs. The integration of new knowledge about innate immunity, the complement system, vaccinology, and senescence into the care of patients with ADs expands the therapeutic arsenal of disease-modifying drugs and allows for the repurposing of anti-cytokine monoclonal/biosimilar antibodies, originally designed for chronic inflammatory diseases, for ADs. This review article brings together some of the most relevant ideas; a case report included in this review highlights the difficulty of distinguishing between ADs, chronic inflammation, and/or granular disease.
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Affiliation(s)
- Thomas Lung
- Center for Laboratory Medicine Dr Risch, Vaduz, Liechtenstein
| | - Benjamin Sakem
- Center for Laboratory Medicine Dr Risch, Vaduz, Liechtenstein
| | | | - Michèle Nydegger
- Institute of Anesthesiology and Intensive Care Medicine, Triemli City Hospital, Zurich, Switzerland
| | - Martin Risch
- Center for Laboratory Medicine Dr Risch, Vaduz, Liechtenstein
- Central Laboratory, Kantonsspital Graubünden, Chur, Switzerland
| | - Lorenz Risch
- Center for Laboratory Medicine Dr Risch, Vaduz, Liechtenstein
- University of Berne, Berne, Switzerland
| | - Urs Nydegger
- Center for Laboratory Medicine Dr Risch, Vaduz, Liechtenstein
- University of Berne, Berne, Switzerland
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5
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Perdiguero P, Martín-Martín A, Benedicenti O, Díaz-Rosales P, Morel E, Muñoz-Atienza E, García-Flores M, Simón R, Soleto I, Cerutti A, Tafalla C. Teleost IgD +IgM - B Cells Mount Clonally Expanded and Mildly Mutated Intestinal IgD Responses in the Absence of Lymphoid Follicles. Cell Rep 2020; 29:4223-4235.e5. [PMID: 31875534 PMCID: PMC6941218 DOI: 10.1016/j.celrep.2019.11.101] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/19/2019] [Accepted: 11/25/2019] [Indexed: 01/06/2023] Open
Abstract
Immunoglobulin D (IgD) is an ancient antibody with dual membrane-bound and fluid-phase antigen receptor functions. The biology of secreted IgD remains elusive. Here, we demonstrate that teleost IgD+IgM− plasmablasts constitute a major lymphocyte population in some mucosal surfaces, including the gut mucosa. Remarkably, secreted IgD binds to gut commensal bacteria, which in turn stimulate IgD gene transcription in gut B cells. Accordingly, secreted IgD from gut as well as gill mucosae, but not the spleen, show a V(D)J gene configuration consistent with microbiota-driven clonal expansion and diversification, including mild somatic hypermutation. By showing that secreted IgD establishes a mutualistic relationship with commensals, our findings suggest that secreted IgD may play an evolutionary conserved role in mucosal homeostasis. IgD+IgM− B cells constitute the main non-IgT B cell subset in rainbow trout guts Gut IgD responses establish a two-way interaction with the local microbiota Mucosal but not splenic IgD undergoes clonal expansion and diversification Despite the lack of germinal centers, mucosal IgD is mildly mutated in rainbow trout
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Affiliation(s)
- Pedro Perdiguero
- Animal Health Research Center (CISA-INIA), Valdeolmos, 28130 Madrid, Spain
| | - Alba Martín-Martín
- Animal Health Research Center (CISA-INIA), Valdeolmos, 28130 Madrid, Spain
| | | | | | - Esther Morel
- Animal Health Research Center (CISA-INIA), Valdeolmos, 28130 Madrid, Spain
| | | | | | - Rocío Simón
- Animal Health Research Center (CISA-INIA), Valdeolmos, 28130 Madrid, Spain
| | - Irene Soleto
- Animal Health Research Center (CISA-INIA), Valdeolmos, 28130 Madrid, Spain
| | - Andrea Cerutti
- Catalan Institute for Research and Advanced Studies (ICREA), 08003 Barcelona, Spain; Inflammatory and Cardiovascular Disorders Research Program, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Carolina Tafalla
- Animal Health Research Center (CISA-INIA), Valdeolmos, 28130 Madrid, Spain.
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6
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Keratin 5-Cre-driven deletion of Ncstn in an acne inversa-like mouse model leads to a markedly increased IL-36a and Sprr2 expression. Front Med 2019; 14:305-317. [DOI: 10.1007/s11684-019-0722-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/07/2019] [Indexed: 10/25/2022]
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7
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Cadmus SD, Green R, Carrasco R, Levy ML, Diaz LZ. Hyper-immunoglobulin D syndrome with novel mutations in an afebrile infant. Pediatr Dermatol 2018; 35:482-485. [PMID: 29600537 DOI: 10.1111/pde.13488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hyper-immunoglobulin D syndrome is a rare autosomal-recessive autoinflammatory syndrome in which a mevalonate kinase deficiency results due to mutations of the mevalonate kinase gene. We report a case of an Asian male infant who was found to have hyper-immunoglobulin D syndrome in the absence of fever. His skin manifestations included cephalic pustulosis as well recurrent transient and fixed pink plaques and nodules on the face and extremities. Subsequent examination revealed hyper-immunoglobulin D syndrome with two novel allelic mutations in the mevalonate kinase gene: c.895G > A (p.D299N) and c.1168C > T (p.Q390). It is important for dermatologists to recognize the varied cutaneous presentations of hyper-immunoglobulin D syndrome because rapid diagnosis and treatment can significantly affect outcomes.
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Affiliation(s)
- Simi D Cadmus
- School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Reid Green
- Department of Medicine, Dell Medical School, University of Texas, Austin, TX, USA
| | - Ruy Carrasco
- Department of Pediatrics, Dell Medical School, University of Texas, Austin, TX, USA.,Dell Children's Medical Center, Austin, TX, USA
| | - Moise L Levy
- Department of Medicine, Dell Medical School, University of Texas, Austin, TX, USA.,Department of Pediatrics, Dell Medical School, University of Texas, Austin, TX, USA.,Dell Children's Medical Center, Austin, TX, USA
| | - Lucia Z Diaz
- Department of Medicine, Dell Medical School, University of Texas, Austin, TX, USA.,Department of Pediatrics, Dell Medical School, University of Texas, Austin, TX, USA.,Dell Children's Medical Center, Austin, TX, USA
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8
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Gutzeit C, Chen K, Cerutti A. The enigmatic function of IgD: some answers at last. Eur J Immunol 2018; 48:1101-1113. [PMID: 29733429 DOI: 10.1002/eji.201646547] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/27/2018] [Accepted: 04/17/2018] [Indexed: 12/20/2022]
Abstract
IgD emerged soon after IgM at the time of inception of the adaptive immune system. Despite its evolutionary conservation from fish to humans, the specific functions of IgD have only recently begun to be elucidated. Mature B cells undergo alternative mRNA splicing to express IgD and IgM receptors with identical antigenic specificity. The enigma of dual IgD and IgM expression has been tackled by several recent studies showing that IgD helps peripheral accumulation of physiologically autoreactive B cells through its functional unresponsiveness to self-antigens but prompt readiness against foreign antigens. IgD achieves this balance by attenuating IgM-mediated anergy while promoting specific responses to multimeric non-self-antigens. Additional research has clarified how and why certain mucosal B cells become plasmablasts or plasma cells specializing in IgD secretion. In particular, the microbiota has been shown to play an important role in driving class switch-mediated replacement of IgM with IgD. Secreted IgD appears to enhance mucosal homeostasis and immune surveillance by "arming" myeloid effector cells such as basophils and mast cells with IgD antibodies reactive against mucosal antigens, including commensal and pathogenic microbes. Here we will review these advances and discuss their implications in humoral immunity in human and mice.
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Affiliation(s)
- Cindy Gutzeit
- Immunology Institute, Department of Medicine, Mount Sinai Icahn School of Medicine, New York, NY, USA
| | - Kang Chen
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA.,Mucosal Immunology Studies Team (MIST), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Andrea Cerutti
- Immunology Institute, Department of Medicine, Mount Sinai Icahn School of Medicine, New York, NY, USA.,Mucosal Immunology Studies Team (MIST), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.,Program for Inflammatory and Cardiovascular Disorders, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.,Catalan Institute for Research and Advanced Studies (ICREA), Barcelona, Spain
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9
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Garcia-Prat M, Vila-Pijoan G, Martos Gutierrez S, Gala Yerga G, García Guantes E, Martínez-Gallo M, Martín-Nalda A, Soler-Palacín P, Hernández-González M. Age-specific pediatric reference ranges for immunoglobulins and complement proteins on the Optilite ™ automated turbidimetric analyzer. J Clin Lab Anal 2018; 32:e22420. [PMID: 29603375 DOI: 10.1002/jcla.22420] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 02/02/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Measurement of immunoglobulins and complement proteins are frontline tests used in the assessment of immune system integrity, and reference values can vary with age. Their measurement provides an insight into the function of the innate and adaptive immune systems. METHODS We generated pediatric reference ranges for IgG, IgA, IgM, IgD, the IgG and IgA subclasses, and C3 and C4 using the Optilite™ turbidimetric analyzer. RESULTS The concentrations of IgG, IgA, and IgD showed an increase with age, as expected, while IgM remained stable between the age groups. For the IgG subclasses, no significant differences were observed in IgG1 or IgG3, while IgG2 and IgG4 concentrations increased steadily with age. The concentration of IgG2 plateaued at 15-18 years, while IgG4 plateaued at 10-14 years. The trend of concentrations across all groups was IgG1 > IgG2 > IgG3 > IgG4. For both IgA1 and IgA2, concentrations increased significantly with age, plateauing at 15-18 years. The median IgA1 concentration was greater than IgA2 across all groups. There was a good correlation between the total IgG or IgA concentration and summation of their subclasses (R2 = 0.89, P < .0001, slope y = 0.98x + 14.51 mg/dL and R2 = 0.91, P < .0001, slope y = 1.35x-3.28 mg/dL, respectively). The concentration of C3 and C4 remained stable across the groups, with no significant differences observed. CONCLUSION We have generated age-specific reference ranges in healthy children for C3, C4, IgG, IgA, IgM, IgD and the IgG and IgA subclasses using the Optilite™ turbidimetric analyzer. These ranges will help identify individuals with abnormal concentrations, thus will aid in the diagnosis of both primary and secondary immunological disorders.
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Affiliation(s)
- Marina Garcia-Prat
- Pediatric Infectious Diseases and Immunodeficiencies Unit (UPIIP), Hospital Universitari Vall d'Hebron (HUVH), Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Jeffrey Model Foundation Excellence Center, Barcelona, Spain
| | - Gemma Vila-Pijoan
- Jeffrey Model Foundation Excellence Center, Barcelona, Spain.,Immunology Division, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Hospital Universitari, Vall d'Hebron, Barcelona, Spain
| | - Susana Martos Gutierrez
- Jeffrey Model Foundation Excellence Center, Barcelona, Spain.,Immunology Division, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Hospital Universitari, Vall d'Hebron, Barcelona, Spain
| | - Guadalupe Gala Yerga
- Jeffrey Model Foundation Excellence Center, Barcelona, Spain.,Immunology Division, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Hospital Universitari, Vall d'Hebron, Barcelona, Spain
| | - Esther García Guantes
- Jeffrey Model Foundation Excellence Center, Barcelona, Spain.,Immunology Division, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Hospital Universitari, Vall d'Hebron, Barcelona, Spain
| | - Mónica Martínez-Gallo
- Jeffrey Model Foundation Excellence Center, Barcelona, Spain.,Immunology Division, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Hospital Universitari, Vall d'Hebron, Barcelona, Spain
| | - Andrea Martín-Nalda
- Pediatric Infectious Diseases and Immunodeficiencies Unit (UPIIP), Hospital Universitari Vall d'Hebron (HUVH), Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Jeffrey Model Foundation Excellence Center, Barcelona, Spain
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit (UPIIP), Hospital Universitari Vall d'Hebron (HUVH), Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Jeffrey Model Foundation Excellence Center, Barcelona, Spain
| | - Manuel Hernández-González
- Jeffrey Model Foundation Excellence Center, Barcelona, Spain.,Immunology Division, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Hospital Universitari, Vall d'Hebron, Barcelona, Spain
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10
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Rigante D. New mosaic tiles in childhood hereditary autoinflammatory disorders. Immunol Lett 2017; 193:67-76. [PMID: 29198619 DOI: 10.1016/j.imlet.2017.11.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/29/2017] [Indexed: 12/21/2022]
Abstract
The protean clinical phenotypes of hereditary autoinflammatory disorders (HAID) are caused by abnormal activation of innate immunity and consist of seemingly unprovoked inflammatory flares localized to multiple organs, such as the skin, joints, serosal membranes, gut, and central nervous system. Different mutations in genes implied in activation of the interleukin-1 (IL-1)-structured inflammasome, cytoskeletal signaling and apoptosis contribute to the pathogenesis of different HAID, which mostly start in childhood with self-limited flares unrelated to infectious agents, autoantibody production or autoreactive cells. Though IL-1 remains pivotal in many inflammasome-mediated diseases, other cytokinopathies involving IL-18, nuclear factorκ-B, interferons, and tumor necrosis factor have provided new horizons in the definition of HAID of children: the list of HAID has expanded as a consequence of a better understanding of their pathogenetic molecular mechanisms and also application of new genetic technologies. However, diagnosis of most HAID is clinical and focused on several evidence-based criteria sets: their discrimination remains challenging for unexperienced pediatricians as there are no universally accepted algorithms, and a still relevant number of patients may linger without any clarifying genetic analysis, whose interpretation combined with processing of treatment options should be discussed on a multidisciplinary basis.
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Affiliation(s)
- Donato Rigante
- Institute of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica Sacro Cuore, Rome, Italy.
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11
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Breedveld FC, Kalden JR, Smolen JS. Advances in targeted therapy. Rheumatology (Oxford) 2016; 55:ii1-ii2. [PMID: 27856653 DOI: 10.1093/rheumatology/kew354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 08/23/2016] [Accepted: 08/23/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ferry C Breedveld
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Josef S Smolen
- Rheumatology, Medical University of Vienna, Vienna, Austria
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