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Qian M, Zhou J, Wu J, Zhang H, Yu S, Xu H, Yang Y, Zhou F, Yang Q, Shao L, Zhang W, Jiang N, Ruan Q. A rare missense p.C125Y mutation in the TNFRSF1A gene identified in a Chinese family with tumor necrosis factor receptor-associated periodic fever syndrome. Front Genet 2024; 15:1413641. [PMID: 38978873 PMCID: PMC11228257 DOI: 10.3389/fgene.2024.1413641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 05/31/2024] [Indexed: 07/10/2024] Open
Abstract
Background Tumor necrosis factor receptor-associated periodic syndrome (TRAPS) is a rare autosomal dominant disorder with a low incidence in Asia. The most frequent clinical manifestations include fever, rash, myalgia, joint pain and abdominal pain. Misdiagnosis rates are high because of the clinical and genetic variability of the disease. The pathogenesis of TRAPS is complex and yet to be fully defined. Early genetic diagnosis is the key to precise treatment. Methods In this study, a Chinese family with suspected TRAPS were analyzed by genome-wide SNP genotyping, linkage analysis and targeted sequencing for identification of mutations in causative genes. To study the pathogenicity of the identified gene mutation, we performed a conservation analysis of the mutation site and protein structure analysis. Flow cytometry was used to detect TNFRSF1A shedding and quantitative real-time PCR were used to assess the activation of unfolded protein response (UPR) in the mutation carriers and healthy individuals. Results A typical TRAPS family history, with a pattern of autosomal dominant inheritance, led to the identification of a rare mutation in the TNFRSF1A gene (c.G374A [p.Cys125Tyr]) with unknown significance. The patient responded well to corticosteroids, and long-term therapy with colchicine effectively reduced the inflammatory attacks. No amyloid complications occurred during the 6-year follow-up. In silico protein analysis showed that the mutation site is highly conversed and the mutation prevents the formation of intrachain disulfide bonds in the protein. Despite a normal shedding of the TNFRSF1A protein from stimulated monocytes in the TRAPS patients with p.C125Y mutation, the expression of CHOP and the splicing of XBP1 was significantly higher than healthy controls, suggesting the presence of an activation UPR. Conclusion This is the first report of a Chinese family with the rare p.C125Y mutation in TNFRSF1A. The p.C125Y mutation does not result in aberrant receptor shedding, but instead is associated with an activated UPR in these TRAPS patients, which may provide new insights into the pathogenesis of this rare mutation in TRAPS.
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Affiliation(s)
- Mengqing Qian
- Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Department of Infectious Diseases, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jingyu Zhou
- Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Department of Infectious Diseases, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jing Wu
- Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Department of Infectious Diseases, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Haocheng Zhang
- Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Department of Infectious Diseases, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shenglei Yu
- Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Department of Infectious Diseases, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Haoxin Xu
- Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Department of Infectious Diseases, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yixuan Yang
- Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Department of Infectious Diseases, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Feiran Zhou
- Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Department of Infectious Diseases, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qingluan Yang
- Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Department of Infectious Diseases, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lingyun Shao
- Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Department of Infectious Diseases, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wenhong Zhang
- Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Department of Infectious Diseases, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Sci-Tech Inno Center for Infection and Immunity, Shanghai, China
| | - Ning Jiang
- Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Department of Infectious Diseases, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Sci-Tech Inno Center for Infection and Immunity, Shanghai, China
- Department of Biostatistics and Computational Biology, State Key Laboratory of Genetic Engineering (SKLG), School of Life Sciences, Fudan University, Shanghai, China
| | - Qiaoling Ruan
- Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Department of Infectious Diseases, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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2
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Ben-Chetrit E, Touitou I. The significance of carrying MEFV variants in symptomatic and asymptomatic individuals. Clin Genet 2024. [PMID: 38818540 DOI: 10.1111/cge.14566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 06/01/2024]
Abstract
Familial Mediterranean fever (FMF) is an autoinflammatory disease characterized by recurrent attacks of fever, serositis (peritonitis, pleuritis, or synovitis), and erysipelas-like erythema. Genetic variants in the MEFV gene are associated with this disease. Familial Mediterranean fever is considered an autosomal recessive disease. However, in Middle Eastern countries, a third of the patients expressing FMF manifestations, carry a single mutation only. Moreover, some cases of pure dominant inheritance linked to specific single MEFV variants have also been described. This complex inheritance of MEFV-associated inflammatory diseases poses a serious challenge when interpreting the results of genetic testing in patients having recurrent fever syndromes. In addition, in certain situations, asymptomatic individuals may be incidentally found to carry MEFV variants. These cases pose the question of their exact diagnosis and whether they should be treated. Previous studies have focused on genetic results interpretations among symptomatic patients. In the current article, we would like to elaborate on the genetic interpretation in cases of symptomatic individuals suspected to have FMF and on asymptomatic individuals carrying MEFV variants. We aim to assist physicians unfamiliar with FMF to cope with genetic results interpretation when facing symptomatic and asymptomatic individuals carrying MEFV variants and suggest a management plan accordingly.
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Affiliation(s)
- Eldad Ben-Chetrit
- Rheumatology Unit, Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Isabelle Touitou
- CEREMAIA, Department of Genetics, CHU of Montpellier, INSERM, University of Montpellier, Montpellier, France
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Kishida D, Yazaki M, Nakamura A, Tsuchiya-Suzuki A, Ichikawa T, Shimojima Y, Sekijima Y. Impact of multiple MEFV variants of unknown significance on the diagnosis and clinical presentation of familial Mediterranean fever. Immunol Med 2024:1-6. [PMID: 38780575 DOI: 10.1080/25785826.2024.2358587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
The detection of variants of unknown significance (VUS) in familial Mediterranean fever (FMF) is common; however, their diagnostic value remains elusive, and the interpretation of multiple VUS remains difficult. Therefore, we examined FMF diagnosis-associated factors 1-year post-genetic testing in patients with only VUS and assessed the impact of multiple VUS on diagnosis and clinical features. A 1-year follow-up was conducted on patients clinically suspected of having FMF without confirmatory diagnosis owing to the presence of only VUS. Clinical features were compared between patients with a single VUS and those with multiple VUS among patients diagnosed with FMF. Among 261 patients followed up, 202 were diagnosed with FMF based on clinical judgment. No specific clinical symptoms or variant patterns at genetic testing were associated with diagnosis at 1 year. Multiple VUS was significantly and independently associated with a lower response to colchicine than single VUS among patients diagnosed with FMF. However, clinical symptoms showed no correlation with the number of VUS. In conclusion, predicting FMF diagnosis 1-year post-genetic testing in patients with only VUS remains challenging. Moreover, the impact of multiple VUS on FMF may be limited owing to the lack of correlation with clinical features, except colchicine response.
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Affiliation(s)
- Dai Kishida
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Masahide Yazaki
- Institute for Biomedical Sciences, Shinshu University, Matsumoto, Japan
- Department of Clinical Laboratory Sciences, Shinshu University School of Health Sciences, Matsumoto, Japan
| | - Akinori Nakamura
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
- Department of Clinical Research, National Hospital Organization Matsumoto Medical Center, Matsumoto, Japan
| | - Ayako Tsuchiya-Suzuki
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Takanori Ichikawa
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Yasuhiro Shimojima
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
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Niewold TB, Aksentijevich I, Gorevic PD, Gibson G, Yao Q. Genetically transitional disease: conceptual understanding and applicability to rheumatic disease. Nat Rev Rheumatol 2024; 20:301-310. [PMID: 38418715 DOI: 10.1038/s41584-024-01086-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 03/02/2024]
Abstract
In genomic medicine, the concept of genetically transitional disease (GTD) refers to cases in which gene mutation is necessary but not sufficient to cause disease. In this Perspective, we apply this novel concept to rheumatic diseases, which have been linked to hundreds of genetic variants via association studies. These variants are in the 'grey zone' between monogenic variants with large effect sizes and common susceptibility alleles with small effect sizes. Among genes associated with rare autoinflammatory diseases, many low-frequency and/or low-penetrance variants are known to increase susceptibility to systemic inflammation. In autoimmune diseases, hundreds of HLA and non-HLA genetic variants have been revealed to be modest- to moderate-risk alleles. These diseases can be reclassified as GTDs. The same concept could apply to many other human diseases. GTD could improve the reporting of genetic testing results, diagnostic yields, genetic counselling and selection of therapy, as well as facilitating research using a novel approach to human genetic diseases.
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Affiliation(s)
- Timothy B Niewold
- Department of Rheumatology, Hospital for Special Surgery, New York, NY, USA
| | - Ivona Aksentijevich
- Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter D Gorevic
- Division of Rheumatology, Allergy and Immunology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Greg Gibson
- Center for Integrative Genomics, School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Qingping Yao
- Division of Rheumatology, Allergy and Immunology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA.
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5
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Tuncer Kuru F, Gokcen N, Yazici A, Cefle A. Disease severity and genotype-phenotype correlation in adult patients with familial Mediterranean fever. Mod Rheumatol 2023; 34:214-219. [PMID: 36688581 DOI: 10.1093/mr/road007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/30/2022] [Accepted: 01/05/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To assess the relationships of disease severity with genotype and phenotype in adult familial Mediterranean fever patients. METHODS Two-hundred seventy-five patients included in the study were divided into four groups according to their mutations: Group 1, M694V homozygous; Group 2, M694V-other; Group 3, other-other; and Group 4, no meaningful gene variants. Disease severity was evaluated using the Pras disease severity score. The association between Pras scores and other possible predictors was assessed by the multiple linear regression analysis. RESULTS In this study, 12.4% of all patients were in Group 1, 55.3% were in Group 2, 26.5% were in Group 3, and 5.8% were in Group 4. Pras scores were higher in Group 1 than in Groups 2, 3, and 4 (post hoc pairwise comparisons; P = .001, P < .001, and P = .001, respectively). Age at disease onset and age at diagnosis were found moderately and strongly correlated with Pras scores. Patients with moderate and severe disease were intensely involved in Group 1. CONCLUSIONS Higher Pras scores, earlier age of symptoms and diagnosis, more frequent arthritis and erysipelas-like erythema, and higher colchicine dose are closely associated with M694V homozygous familial Mediterranean fever patients. These patients also have mostly moderate and severe disease severity.
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Affiliation(s)
- Fatma Tuncer Kuru
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Neslihan Gokcen
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ayten Yazici
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ayse Cefle
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kocaeli University, Kocaeli, Turkey
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Mir A, Ivory C, Cowan J. Concurrence of familial Mediterranean fever and Behçet's disease: a case report and review of the literature. J Med Case Rep 2023; 17:438. [PMID: 37865787 PMCID: PMC10590508 DOI: 10.1186/s13256-023-04185-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/20/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Familial Mediterranean fever and Behçet's disease are distinct disorders that are prevalent in the Mediterranean and Middle Eastern populations. They are characterized by unprovoked inflammatory episodes caused by overexpression of proinflammatory cytokines. Although reported previously, the overlapping presentation of familial Mediterranean fever and Behçet's disease remains uncommon. CASE PRESENTATION A 46-year-old Lebanese-Canadian man who presented with recurrent oral and genital ulcers, polyarticular synovitis, ocular swelling, recurrent infections, and fevers was later found to have heterozygous mutations of pathogenic MEFV c.2080A > G (p. Met 694Val) and c.2082G > A (p.Met694IIe) genes indicating familial Mediterranean fever. He was treated with prednisone, colchicine, and azathioprine, with inadequate symptoms control. Treatment was complicated by recurrent infections. CONCLUSIONS Our case contributes to the growing literature demonstrating the presentation of predominantly Behçet's disease-like features in the setting of diagnosis of familial Mediterranean fever. These findings emphasize that clinicians should be aware that patients with familial Mediterranean fever may present with Behçet's disease-like clinical manifestations.
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Affiliation(s)
- Adhora Mir
- Department of Medicine, University of Ottawa, 501 Smyth Rd, Ottawa, ON, Canada
| | - Catherine Ivory
- Department of Medicine, University of Ottawa, 501 Smyth Rd, Ottawa, ON, Canada
| | - Juthaporn Cowan
- Department of Medicine, University of Ottawa, 501 Smyth Rd, Ottawa, ON, Canada.
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7
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Ehlers L, Rolfes E, Lieber M, Müller D, Lainka E, Gohar F, Klaus G, Girschick H, Hörstermann J, Kümmerle-Deschner J, Brunner J, Palm-Beden K, Tenbrock K, von Wrangel L, Faßhauer M, Blank N, Trauzeddel R, von Stuckrad ASL, Higgins S, Welzel T, Lutz T, Hentgen V, Foell D, Wittkowski H, Kallinich T. Treat-to-target strategies for the management of familial Mediterranean Fever in children. Pediatr Rheumatol Online J 2023; 21:108. [PMID: 37752496 PMCID: PMC10521475 DOI: 10.1186/s12969-023-00875-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 08/11/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND The objective of this initiative was to develop a treat-to-target (T2T) approach for the management of patients with Familial Mediterranean Fever (FMF), including the definition of a complex treatment target, and establish strategies that improve patient care and long-term outcome. METHODS An initial set of statements as well as a flow chart visualising the proposed concept was developed. To adapt the preliminary statements to the current state of knowledge, a systematic literature search was performed and the modified statements were subject to a Delphi approach. To ensure the applicability of the statements in daily practice, an online survey was conducted among paediatric rheumatologists in Germany. In addition, data from the national AID-NET registry were analysed with respect to therapeutic response. RESULTS This T2T initiative yielded a total of 26 statements guiding FMF management with respect to diagnosis, treatment targets, treatment strategies and monitoring. The online survey identified cut-off values for inflammatory markers indicating treatment intensification and appropriate measures in case of colchicine intolerance or non-adherence. The analysis of data derived from the national AID-NET showed that colchicine therapy was successfully terminated in 61% of patients (27 out of 44) with heterozygous MEFV mutations. Multidimensional treatment targets incorporating objective and subjective reported outcome measures were developed. These provide the basis for stratifying patients into the following treatment paths: continue colchicine, persisting attacks / inflammation, colchicine intolerance, persisting arthritis, colchicine reduction and adjustment/reduction of biologics. CONCLUSIONS The proposed consensus treatment plan for the management of FMF incorporates multidimensional targets allowing transparent treatment decisions, which will promote personalised disease management and increase adherence to therapy.
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Affiliation(s)
- Lisa Ehlers
- Department of Paediatric Pulmonology, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Elisabeth Rolfes
- Department of Paediatric Pulmonology, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mareike Lieber
- Department of Paediatric Pulmonology, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Dominik Müller
- Department of Paediatrics, Division of Gastroenterology, Nephrology and Metabolic Diseases, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Elke Lainka
- Department of Paediatrics II, University Hospital Essen, Children's Hospital, Essen, Germany
| | - Faekah Gohar
- Clinic of Paediatric and Adolescent Rheumatology, St. Josef-Stift Sendenhorst, Northwest German Center for Rheumatology, Sendenhorst, Germany
| | - Günter Klaus
- KfH Center of Paediatric Nephrology, Department of Paediatric Nephrology, Marburg, Germany
| | - Hermann Girschick
- Vivantes Klinikum Friedrichshain, Children's Hospital, Berlin, Germany
| | - Jana Hörstermann
- Deutsches Rheuma-Forschungszentrum (DRFZ), An Institute of the Leibniz Association, Berlin, Germany
| | - Jasmin Kümmerle-Deschner
- Autoinflammation Reference Center Tübingen (arcT), Division of Paediatric Rheumatology, Department of Paediatrics, University Hospital Tübingen, Tübingen, Germany
| | - Jürgen Brunner
- Department of Paediatrics, Medical University Innsbruck, Danube Private University, Innsbruck, Krems, Austria
| | - Katharina Palm-Beden
- Clinic of Paediatric and Adolescent Rheumatology, St. Josef-Stift Sendenhorst, Northwest German Center for Rheumatology, Sendenhorst, Germany
| | - Klaus Tenbrock
- Department of Paediatric Pneumology, Allergology and Immunology, RWTH Aachen, Aachen, Germany
| | | | - Maria Faßhauer
- ImmunoDeficiencyCenter Leipzig (IDCL), Hospital St. Georg GmbH Leipzig, Academic Teaching Hospital of the University of Leipzig, Leipzig, Germany
| | - Norbert Blank
- Department of Hematology, Oncology and Rheumatology, Internal Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
| | - Ralf Trauzeddel
- Department of Paediatrics, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Anne Sae Lim von Stuckrad
- Department of Paediatric Pulmonology, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sonja Higgins
- Paediatric medical practice Hürthpark, Hürth, Germany
| | - Tatjana Welzel
- Autoinflammation Reference Center Tübingen (arcT), Division of Paediatric Rheumatology, Department of Paediatrics, University Hospital Tübingen, Tübingen, Germany
- Paediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel (UKBB), University Basel, Basel, Switzerland
| | - Thomas Lutz
- Center for Rheumatology, Paediatric Rheumatology, Heidelberg, Germany
| | - Véronique Hentgen
- Department of Paediatrics, National Reference Center for Auto-inflammatory Diseases and Amyloidosis, CEREMAIA, Versailles Hospital, Versailles, France
| | - Dirk Foell
- Department of Paediatric Rheumatology and Immunology, University Hospital Münster, Münster, Germany
| | - Helmut Wittkowski
- Department of Paediatric Rheumatology and Immunology, University Hospital Münster, Münster, Germany
| | - Tilmann Kallinich
- Department of Paediatric Pulmonology, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
- Deutsches Rheuma-Forschungszentrum (DRFZ), An Institute of the Leibniz Association, Berlin, Germany.
- Berlin Institute of Health (BIH), Berlin, Germany.
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Shu Z, Zhang Y, Han T, Li Y, Piao Y, Sun F, Ma J, Mo W, Sun J, Chan KW, Yang W, Lau YL, Mao H. The genetic and clinical characteristics and effects of Canakinumab on cryopyrin-associated periodic syndrome: a large pediatric cohort study from China. Front Immunol 2023; 14:1267933. [PMID: 37809096 PMCID: PMC10551459 DOI: 10.3389/fimmu.2023.1267933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023] Open
Abstract
Cryopyrin-associated periodic syndrome (CAPS) comprises a group of disorders characterized by recurrent bouts of systemic inflammation related to overactivation of inflammasome. So far, neither large cases of the correlation between genotype and phenotype nor treatment strategies have been clearly stated in China. Here, we studied the clinical and genetic characteristics and their correlation from 30 CAPS patients in China. We identified the pathogenesis for novel mutations by activating NLRP3 inflammasome for peripheral cells with ATP plus LPS, compared characteristics with other case series, and analyzed treatment outcomes of these patients. The patients harbored 19 substitutions in NLRP3, and 8 of them were novel mutations. Among these novel mutations, percentages of severe musculoskeletal, ophthalmologic, and neurological symptoms were higher compared with other case serials. The correlation of phenotypes and their variants seemed different in our cases, such as T350M, S333G/I/R, and F311V (somatic mosaicism). Ten patients received Canakinumab treatment, which proved effective at alleviating musculoskeletal, neurological, auditory, visual manifestations, fever, and rash for 10-20 months follow-up. Patients treated with prednisolone or prednisolone plus thalidomide or methotrexate, tocilizumab, TNF inhibiting agents, and sirolimus achieved only partial remission. Importantly, we firstly identified somatic mosaicism mutation of F311V, which was severe. Our study extended the spectrum of genotype and phenotype and characteristics of their correlations and provided detailed responses to different treatment strategies. These data provide guidance for future diagnosis and management for CAPS.
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Affiliation(s)
- Zhou Shu
- Department of Immunology, Ministry of Education, Key Laboratory of Major Diseases in Children, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
| | - Yue Zhang
- Department of Immunology, Ministry of Education, Key Laboratory of Major Diseases in Children, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
| | - Tongxin Han
- Department of Immunology, Ministry of Education, Key Laboratory of Major Diseases in Children, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
| | - Yan Li
- Department of Immunology, Ministry of Education, Key Laboratory of Major Diseases in Children, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
| | - Yurong Piao
- Department of Immunology, Ministry of Education, Key Laboratory of Major Diseases in Children, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
| | - Fei Sun
- Department of Immunology, Ministry of Education, Key Laboratory of Major Diseases in Children, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
| | - Jin Ma
- Department of Immunology, Ministry of Education, Key Laboratory of Major Diseases in Children, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
| | - Wenxiu Mo
- Department of Immunology, Ministry of Education, Key Laboratory of Major Diseases in Children, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
| | - Jiapeng Sun
- Department of Immunology, Ministry of Education, Key Laboratory of Major Diseases in Children, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
| | - Koon-Wing Chan
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wanling Yang
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yu-Lung Lau
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Huawei Mao
- Department of Immunology, Ministry of Education, Key Laboratory of Major Diseases in Children, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Genetics of Birth Defects, Beijing, China
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9
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Lancieri M, Bustaffa M, Palmeri S, Prigione I, Penco F, Papa R, Volpi S, Caorsi R, Gattorno M. An Update on Familial Mediterranean Fever. Int J Mol Sci 2023; 24:ijms24119584. [PMID: 37298536 DOI: 10.3390/ijms24119584] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/18/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023] Open
Abstract
(1) Background: Familial Mediterranean Fever (FMF) is the prototypal autoinflammatory disease, characterized by recurrent bursts of neutrophilic inflammation. (2) Methods: In this study we look at the most recent literature on this condition and integrate it with novel information on treatment resistance and compliance. (3) Results: The canonical clinical presentation of FMF is in children with self-limited episodes of fever and polyserositis, associated with severe long-term complications, such as renal amyloidosis. It has been described anecdotally since ancient times, however only recently it has been characterized more accurately. We propose an updated overview on the main aspects of pathophysiology, genetics, diagnosis and treatment of this intriguing disease. (4) Conclusions: Overall, this review presents the all the main aspects, including real life outcome of the latest recommendation on treatment resistance of FMF, a disease, that not only helped understanding the pathophysiology of the auto inflammatory process but also the functioning of the innate immune system itself.
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Affiliation(s)
- Maddalena Lancieri
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Marta Bustaffa
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Serena Palmeri
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Ignazia Prigione
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Federica Penco
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Riccardo Papa
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Stefano Volpi
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Roberta Caorsi
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Marco Gattorno
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
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10
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Mortensen SB, Hansen AE, Byg KE, Diederichsen L, Schade Larsen C, Goldschmidt MI, Jakobsen MA, Assing K, Lambertsen KL, Andersen DC, Johansen IS. Monocyte secretory profiling in a clinical and MEFV genotype-characterized cohort of Danish familial Mediterranean fever patients: diagnostic potential of CCL1 and CXCL1. Scand J Rheumatol 2023; 52:181-189. [PMID: 35258407 DOI: 10.1080/03009742.2022.2028382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The autoinflammatory disease familial Mediterranean fever (FMF), characterized by recurrent attacks of sterile fever, serosal, and/or synovial inflammation, is caused by variants in the Mediterranean fever gene, MEFV, coding for the pyrin inflammasome sensor. The diagnosis of FMF is mainly based on clinical symptoms and confirmed by detection of disease-associated MEFV variants. However, the diagnosis is challenging among patients carrying variants of uncertain clinical significance (VUS). In this study, we aimed to identify potential FMF discriminatory diagnostic markers in a cohort of clinically characterized FMF patients. METHOD We established a cohort of clinically and MEFV genotype-characterized FMF patients by enrolling patients from major Danish hospitals (n = 91). The secretory profile of pyrin inflammasome-activated monocytes from healthy donors (HDs) and MEFV-characterized FMF patients (n = 28) was assessed by analysing cell supernatants for a custom-designed panel of 23 cytokines, chemokines, and soluble tumour necrosis factor receptors associated with monocyte and macrophage function. RESULTS MEFV genotypes in Danish FMF patients were associated with age at symptom onset (p < 0.05), FMF among relatives (p < 0.01), proportion of patients in colchicine treatment (p < 0.01), and treatment response (p < 0.05). Secretion of chemokines CCL1 and CXCL1 from pyrin-activated FMF monocytes was significantly decreased compared to HDs (p < 0.05), and could discriminate FMF patients with 'non-confirmatory' MEFV genotypes from HDs with 80.0% and 70.0% sensitivity for CCL1 and CXCL1, respectively (p < 0.05). CONCLUSION Our data suggest that a functional diagnostic assay based on CCL1 or CXCL1 levels in pyrin-activated patient monocytes may contribute to FMF diagnosis in patients with VUS.
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Affiliation(s)
- S B Mortensen
- Research Unit for Infectious Diseases, Odense University Hospital/University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Clinical Immunology, Odense University Hospital, Odense, Denmark.,OPEN, Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - A E Hansen
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - K-E Byg
- Department of Rheumatology, Odense University Hospital, Odense, Denmark.,Department of Neurology, Odense University Hospital, Odense, Denmark.,BRIDGE - Brain Research - Inter-Disciplinary Guided Excellence; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - L Diederichsen
- Department of Rheumatology, Odense University Hospital, Odense, Denmark.,Department of Rheumatology, Copenhagen University Hospital, Copenhagen, Denmark
| | - C Schade Larsen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - M I Goldschmidt
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - M A Jakobsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - K Assing
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - K L Lambertsen
- Department of Neurology, Odense University Hospital, Odense, Denmark.,BRIDGE - Brain Research - Inter-Disciplinary Guided Excellence; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Neurobiology Research; Institute for Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - D C Andersen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Laboratory of Molecular and Cellular Cardiology/Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - I S Johansen
- Research Unit for Infectious Diseases, Odense University Hospital/University of Southern Denmark, Odense, Denmark
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11
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Liu J, Zhang R, Yi Z, Lin Y, Chang H, Zhang Q. Identification of a variant in NLRP3 gene in a patient with Muckle-Wells syndrome: a case report and review of literature. Pediatr Rheumatol Online J 2023; 21:15. [PMID: 36765385 PMCID: PMC9918341 DOI: 10.1186/s12969-023-00795-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/22/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Cryopyrin-associated periodic syndrome (CAPS), a rare genetic autoimmune disease, is composed of familial cold autoinflammatory syndrome (FCAs), Muckle-Wells syndrome (MWS), and neonatal onset multisystem inflammatory disease (NOMID). MWS is caused by dominantly inherited or de novo gain-of-function mutations in the NOD-like receptor 3 (NLRP3) gene. At present, there is no report about the variation of R262W in China. CASE PRESENTATION We reported a 3-year-old Chinese boy who had recurrent fever without obvious inducement, bilateral conjunctival congestion, and urticarial-like rash. Laboratory examination showed elevation in leukocyte count, neutrophil count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) and serum amyloid protein (SAA) levels. Whole exome sequencing identified a missense variation c.784-786delinsTGG (p.R262W) in the coding region of the NLRP3 gene. CONCLUSION A classical variant of the NLRP3 gene in a patient with MWS was first reported in China.
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Affiliation(s)
- Jia Liu
- grid.412521.10000 0004 1769 1119Deparment of Pediatric Nephrology, Rheumatology and Immunity, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ranran Zhang
- grid.412521.10000 0004 1769 1119Deparment of Pediatric Nephrology, Rheumatology and Immunity, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhi Yi
- grid.412521.10000 0004 1769 1119Deparment of Pediatric Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yi Lin
- grid.412521.10000 0004 1769 1119Deparment of Pediatric Nephrology, Rheumatology and Immunity, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hong Chang
- grid.412521.10000 0004 1769 1119Deparment of Pediatric Nephrology, Rheumatology and Immunity, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qiuye Zhang
- Deparment of Pediatric Nephrology, Rheumatology and Immunity, The Affiliated Hospital of Qingdao University, Qingdao, China.
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12
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Abbara S, Monfort JB, Savey L, Moguelet P, Saadoun D, Bachmeyer C, Fain O, Terrier B, Amoura Z, Mathian A, Gilardin L, Buob D, Job-Deslandre C, Dufour JF, Sberro-Soussan R, Grateau G, Georgin-Lavialle S. Vasculitis and familial Mediterranean fever: Description of 22 French adults from the juvenile inflammatory rheumatism cohort. Front Med (Lausanne) 2022; 9:1000167. [PMID: 36388918 PMCID: PMC9649929 DOI: 10.3389/fmed.2022.1000167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/11/2022] [Indexed: 01/27/2023] Open
Abstract
Objective The frequency of vasculitis may be increased in patients with Familial Mediterranean Fever (FMF), according to several studies. Our aim was to assess the characteristics of French adult patients with both diseases. Methods Patients with vasculitis were selected from patients followed for FMF in the French JIR-cohort. Results Twenty-two patients were included [polyarteritis nodosa (PAN) n = 10, IgA vasculitis n = 8, unclassified vasculitis n = 2, granulomatosis with polyangiitis n = 1, and microscopic polyangiitis n = 1]. Pathogenic mutations in exon 10 were found in all 21 patients (96%) for which MEFV testing results were available, and 18 (82%) had two pathogenic mutations. Histology showed vasculitis in 59% of patients. Most patients with FMF-associated PAN were HBV-negative and had an inactive FMF before PAN onset, and 40% had a peri-renal or central nervous system bleeding. Most patients with FMF-associated IgA vasculitis had an active FMF before vasculitis onset, and 25% had digestive bleeding. Both patients with unclassified vasculitis had ischemic and/or hemorrhagic complications. Conclusion This study confirms the predominance of PAN and IgA vasculitis in patients with FMF and the high frequency of bleeding in FMF-associated PAN. FMF should be considered in case of persistent symptoms and/or inflammatory syndrome despite vasculitis treatment in Mediterranean patients.
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Affiliation(s)
- Salam Abbara
- Département de Médecine Interne, Centre de Référence des Maladies Auto-Inflammatoires et des Amyloses d’Origine Inflammatoire (CEREMAIA), Hôpital Tenon, Sorbonne Université, AP-HP, Paris, France
| | - Jean-Benoit Monfort
- Département de Dermatologie, Hôpital Tenon, Sorbonne Université, AP-HP, Paris, France
| | - Léa Savey
- Département de Médecine Interne, Centre de Référence des Maladies Auto-Inflammatoires et des Amyloses d’Origine Inflammatoire (CEREMAIA), Hôpital Tenon, Sorbonne Université, AP-HP, Paris, France
| | - Philippe Moguelet
- Département d’Anatomo-Pathologie, Hôpital Tenon, Sorbonne Université, AP-HP, Paris, France
| | - David Saadoun
- Département de Médecine Interne et Immunologie Clinique, Centre National de Référence Maladies Autoimmunes Systémiques Rares, Centre National de Référence Maladies Autoinflammatoires et Amylose Inflammatoire, INSERM UMR_S 959, Immunologie-Immunopathologie-Immunotherapie, i3 and Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biothérapie i2B, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Claude Bachmeyer
- Département de Médecine Interne, Centre de Référence des Maladies Auto-Inflammatoires et des Amyloses d’Origine Inflammatoire (CEREMAIA), Hôpital Tenon, Sorbonne Université, AP-HP, Paris, France
| | - Olivier Fain
- Service de Médecine Interne, Hôpital Saint-Antoine, Sorbonne Université, APHP, Paris, France
| | - Benjamin Terrier
- Service de Médecine Interne, Centre de Référence Maladies Systémiques et Autoimmunes Rares d’Ile de France, Hôpital Cochin, Université Paris Cité, AP-HP, Paris, France
| | - Zahir Amoura
- Service de Médecine Interne 2, Institut E3M, Inserm UMRS, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Groupement Hospitalier Pitié–Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Alexis Mathian
- Service de Médecine Interne 2, Institut E3M, Inserm UMRS, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Groupement Hospitalier Pitié–Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Laurent Gilardin
- Département de Médecine Interne et Immunologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - David Buob
- Département d’Anatomo-Pathologie, Hôpital Tenon, Sorbonne Université, AP-HP, Paris, France
| | - Chantal Job-Deslandre
- Service de Pédiatrie, Immunologie, Hématologie et Rhumatologie, Centre de Référence pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémique Rare de l’Enfant (RAISE), Hôpital Necker-Enfants Malades, AP-HP, Université Paris Cité, Paris, France
| | - Jean-François Dufour
- Service Médecine Interne, Hôpital Nord-Ouest, Centre Hospitalier Villefranche sur Saône, Gleize, France
| | - Rebecca Sberro-Soussan
- Service de Transplantation Rénale Adulte, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Cité, Paris, France
| | - Gilles Grateau
- Département de Médecine Interne, Centre de Référence des Maladies Auto-Inflammatoires et des Amyloses d’Origine Inflammatoire (CEREMAIA), Hôpital Tenon, Sorbonne Université, AP-HP, Paris, France
| | - Sophie Georgin-Lavialle
- Département de Médecine Interne, Centre de Référence des Maladies Auto-Inflammatoires et des Amyloses d’Origine Inflammatoire (CEREMAIA), Hôpital Tenon, Sorbonne Université, AP-HP, Paris, France
- INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
- *Correspondence: Sophie Georgin-Lavialle,
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13
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Kırnaz B, Gezgin Y, Berdeli A. MEFV gene allele frequency and genotype distribution in 3230 patients' analyses by next generation sequencing methods. Gene 2022; 827:146447. [PMID: 35358658 DOI: 10.1016/j.gene.2022.146447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/23/2022] [Accepted: 03/18/2022] [Indexed: 11/30/2022]
Abstract
Familial Mediterranean Fever (FMF, OMIM ID: 249100) is the most common autoinflammatory, autosomal recessive disease caused by mutations in the MEFV gene. It is widespread in the Mediterranean, primarily among Turkish, Armenian, Arab and Jewish. This study aims to examine genotype distributions of common MEFV variants in the Turkish population using targeted NGS and to evaluate all rare mutations. It included 3230 people applying to Ege University Children's Hospital Molecular Medicine Laboratory with the suspicion of autoinflammatory disease between 2017 and 2021. MEFV missense variant was detected in 1839 (56.9%) individuals. One or more mutations were found in them. 1063 patients were heterozygous (57.8%), 410 were compound heterozygous (22.3%), 238 were complex genotype (12.9%), and 128 were homozygous (7%). 56 different mutations and 141 genotypes were detected, two of which were novel (p.His87Arg, c.260A > G and p.Leu396Phe, c.1186C > T). These were determined as 6benign, 40 uncertain significant, 3 likely pathogenic and 7 pathogenic according to the ACMG classification. The most common ones were R202Q (n = 1097, 37.48%), E148Q (n = 512, 17.49%), M694V (n = 493, 16.84%), V726A (n = 155, 5.30%), M680I (n = 150, 5.12%), P369S (n = 108, 3.69%), R408Q (n = 95, 3.25%) respectively. They constitute 89.17 % of the entire patient population. In conclusion, DNA variants/mutations in the MEFV gene were evaluated in 3230 patients. To date, no mutation screening has been encountered in such a large population using NGS. Genotype distributions of both common and rare mutations were revealed. The obtained data will hopefully contribute to the future genotype-phenotype studies of FMF disease.
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Affiliation(s)
- Berkay Kırnaz
- Ege University, Faculty of Medicine, Molecular Medicine Laboratory, İzmir, Turkey.
| | - Yüksel Gezgin
- Ege University, Faculty of Medicine, Molecular Medicine Laboratory, İzmir, Turkey
| | - Afig Berdeli
- Ege University, Faculty of Medicine, Molecular Medicine Laboratory, İzmir, Turkey; Ege University, Faculty of Medicine, Department of Pediatric Rheumatology, Izmir, Turkey
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14
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Schmidt J, Berghaus S, Blessing F, Herbeck H, Blessing J, Schierack P, Rödiger S, Roggenbuck D, Wenzel F. Genotyping of familial Mediterranean fever gene (MEFV)-Single nucleotide polymorphism-Comparison of Nanopore with conventional Sanger sequencing. PLoS One 2022; 17:e0265622. [PMID: 35298548 PMCID: PMC8929590 DOI: 10.1371/journal.pone.0265622] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Through continuous innovation and improvement, Nanopore sequencing has become a powerful technology. Because of its fast processing time, low cost, and ability to generate long reads, this sequencing technique would be particularly suitable for clinical diagnostics. However, its raw data accuracy is inferior in contrast to other sequencing technologies. This constraint still results in limited use of Nanopore sequencing in the field of clinical diagnostics and requires further validation and IVD certification. Methods We evaluated the performance of latest Nanopore sequencing in combination with a dedicated data-analysis pipeline for single nucleotide polymorphism (SNP) genotyping of the familial Mediterranean fever gene (MEFV) by amplicon sequencing of 47 clinical samples. Mutations in MEFV are associated with Mediterranean fever, a hereditary periodic fever syndrome. Conventional Sanger sequencing, which is commonly applied in clinical genetic diagnostics, was used as a reference method. Results Nanopore sequencing enabled the sequencing of 10 target regions within MEFV with high read depth (median read depth 7565x) in all samples and identified a total of 435 SNPs in the whole sample collective, of which 29 were unique. Comparison of both sequencing workflows showed a near perfect agreement with no false negative calls. Precision, Recall, and F1-Score of the Nanopore sequencing workflow were > 0.99, respectively. Conclusions These results demonstrated the great potential of current Nanopore sequencing for application in clinical diagnostics, at least for SNP genotyping by amplicon sequencing. Other more complex applications, especially structural variant identification, require further in-depth clinical validation.
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Affiliation(s)
- Jonas Schmidt
- Institute for Laboratory Medicine, Singen, Germany
- Faculty of Medical and Life Sciences, Furtwangen University, Villingen-Schwenningen, Germany
- Faculty Environment and Natural Sciences, Institute of Biotechnology, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | | | - Frithjof Blessing
- Institute for Laboratory Medicine, Singen, Germany
- Faculty of Medical and Life Sciences, Furtwangen University, Villingen-Schwenningen, Germany
| | | | | | - Peter Schierack
- Faculty Environment and Natural Sciences, Institute of Biotechnology, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg University of Technology Cottbus–Senftenberg, Senftenberg, Germany
| | - Stefan Rödiger
- Faculty Environment and Natural Sciences, Institute of Biotechnology, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg University of Technology Cottbus–Senftenberg, Senftenberg, Germany
| | - Dirk Roggenbuck
- Faculty Environment and Natural Sciences, Institute of Biotechnology, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg University of Technology Cottbus–Senftenberg, Senftenberg, Germany
- * E-mail:
| | - Folker Wenzel
- Faculty of Medical and Life Sciences, Furtwangen University, Villingen-Schwenningen, Germany
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15
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Batu ED, Basaran O, Bilginer Y, Ozen S. Familial Mediterranean Fever: How to Interpret Genetic Results? How to Treat? A Quarter of a Century After the Association with the Mefv Gene. Curr Rheumatol Rep 2022; 24:206-212. [PMID: 35435612 DOI: 10.1007/s11926-022-01073-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW To provide an up-to-date approach to diagnosis and management of FMF patients. RECENT FINDINGS Familial Mediterranean fever (FMF) is the most common monogenic autoinflammatory disease and prototype monogenic autoinflammatory recurrent fever syndrome. Although it is one of the well-known autoinflammatory disorders, evaluations in the etiopathogenesis and genetics of the disease have shown that FMF is more complex than previously known. Since the number of reported MEFV variants increased, evaluating the genetic test results has become more challenging. Here, we suggest a roadmap for clinicians to facilitate their decisions regarding diagnosis, treatment, and follow-up in FMF patients with different genotype-phenotype combinations. The correct interpretation of genetic test results is crucial for timely diagnosis, appropriate treatment, and follow-up of FMF patients.
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Affiliation(s)
- Ezgi Deniz Batu
- Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, 06100, Turkey
| | - Ozge Basaran
- Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, 06100, Turkey
| | - Yelda Bilginer
- Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, 06100, Turkey
| | - Seza Ozen
- Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, 06100, Turkey.
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16
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McNaughton P, Willcocks S, Lum SH, Whitehead B, Peake J, Preece K. Making a diagnosis of periodic fever syndrome: Experience from a single tertiary centre. J Paediatr Child Health 2022; 58:404-408. [PMID: 34499401 DOI: 10.1111/jpc.15722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/28/2021] [Accepted: 08/13/2021] [Indexed: 11/27/2022]
Abstract
AIM This study aims to evaluate the utility of genetic testing of patients diagnosed with periodic fever syndromes and to assess the validity of existing scoring criteria. METHODS This study retrospectively reviewed the clinical history of patients diagnosed with periodic fever syndromes at Queensland Children's Hospital between November 2014 and June 2018. RESULTS Forty-three patients were diagnosed with periodic fever syndromes. Diagnoses in the cohort included periodic fever, adenitis, pharyngitis and aphthous stomatitis (10), tumour necrosis factor receptor-associated periodic syndrome (9), cryopyrin-associated periodic syndrome (6), mevalonate kinase deficiency (4) while 14 remained unspecified. No presenting symptoms were uniquely associated with any particular diagnosis. Genetic testing of between 1 and 26 genes was performed in 26 (60%) patients. Two (7.7%) patients had pathogenic variants identified. Variants of uncertain significance which were insufficient to confirm a monogenic disorder were identified in a further 7 (27%) patients. The Eurofever classification criteria correlated with clinical diagnosis for patients diagnosed with cryopyrin-associated periodic syndrome (P = 0.046) and tumour necrosis factor receptor-associated periodic syndrome (P = 0.025) but not for patients diagnosed with mevalonate kinase deficiency (P = 0.47); however, the Eurofever classification criteria were often positive for more than one diagnosis in these patients. CONCLUSION The European classification criteria can form a potentially useful tool to guide diagnosis; however, clinical judgement remains essential, because the score is often positive for multiple diagnoses. The diagnostic yield of genetic testing in this cohort was low and genetic testing may be more useful to confirm a strong clinical suspicion than to clarify a diagnosis for patients with less clear symptoms.
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Affiliation(s)
- Peter McNaughton
- Immunology Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
| | - Sophie Willcocks
- Immunology Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Su Han Lum
- Children's haematopoetic stem cell transplant unit, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | - Ben Whitehead
- University of Queensland, Brisbane, Queensland, Australia.,Rheumatology Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Jane Peake
- Immunology Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
| | - Kahn Preece
- Paediatric Immunology Department, John Hunter Children's Hospital, Newcastle, New South Wales, Australia.,University of Newcastle, Newcastle, Australia
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17
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Güneş-Yılmaz S, Kasap-Demir B, Soyaltın E, Erfidan G, Özdemir-Şimşek Ö, Arslansoyu-Çamlar S, Alaygut D, Mutlubaş F. Prediction of More Severe MEFV Gene Mutations in Childhood. Turk Arch Pediatr 2022; 56:610-617. [PMID: 35110061 PMCID: PMC8849490 DOI: 10.5152/turkarchpediatr.2021.21147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aim: This study aimed to present the demographic, clinical, and laboratory features of children clinically diagnosed with familial Mediterranean fever (FMF) and to predict more severe mutations by evaluating those findings. Methods: We enrolled cases diagnosed with FMF with a defined variation in at least one allele. The medical charts of the patients were reviewed retrospectively. The patients were grouped as homozygous, compound heterozygous, and simple heterozygous cases, with and without M694V mutation. We compared the data between the subgroups using logistic regression analysis and determined the risk factors for being homozygous or compound heterozygous for M694V. Results: A total of 263 (M/F =109/154) cases were included. The mean age at the onset of symptoms, follow-up duration, and time to diagnosis were 6.75 ± 3.9 (0.25-17) years, 51.78 ± 39.31 (6-166) months, and 9.23 ± 14.44 (1-132) months, respectively. The rates of parental consanguinity, positive family history for FMF, and FMF in a first-degree relative were 15%, 42%, and 31.4% respectively. The most common symptom was abdominal pain (85%). There was no difference between the growth parameters of the cases during the initial and final control periods. The most frequent alleles were M694V, E148Q, and V726A. The most common accompanying disease was IgA vasculitis (20%). Almost 90% of the cases fulfilled all the defined criteria. The rate of patients having a first-degree relative with FMF was higher, Hb values were lower, and the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values were higher during the attack period; the ESR and CRP values were higher in the attack-free period; and Pras disease severity scores were higher in homozygous or compound heterozygous cases carrying M694V. The presence of FMF in a first-degree relative increases the probability of being homozygous and compound heterozygous for M694V by a factor of 2.39; and each 1 unit increase in the Pras score increases this probability by a factor of 1.43. The threshold Pras score for this possibility is 5.5 (AUC = 0.651; 95% CI, 0.545-0.757; P = .006; sensitivity, 65%; specificity, 55%). Conclusion: M694V was the most common and severe mutation in our cohort. The presence of a first-degree relative with FMF and Pras scores ≥5.5 may predict a homozygous or compound heterozygous mutation for M694V.
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Affiliation(s)
- Seviye Güneş-Yılmaz
- Department of Pediatrics, University of Health Sciences, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Belde Kasap-Demir
- Department of Pediatric Nephrology and Rheumatology, İzmir Katip Çelebi University School of Medicine, İzmir, Turkey;Department of Pediatric Nephrology, University of Health Sciences, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Eren Soyaltın
- Department of Pediatric Nephrology, University of Health Sciences, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Gökçen Erfidan
- Department of Pediatric Nephrology, University of Health Sciences, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Özgür Özdemir-Şimşek
- Department of Pediatric Nephrology, University of Health Sciences, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Seçil Arslansoyu-Çamlar
- Department of Pediatric Nephrology, University of Health Sciences School of Medicine, İzmir, Turkey
| | - Demet Alaygut
- Department of Pediatric Nephrology, University of Health Sciences School of Medicine, İzmir, Turkey
| | - Fatma Mutlubaş
- Department of Pediatric Nephrology, University of Health Sciences School of Medicine, İzmir, Turkey
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18
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Dundar M, Fahrioglu U, Yildiz SH, Bakir-Gungor B, Temel SG, Akin H, Artan S, Cora T, Sahin FI, Dursun A, Sezer O, Gurkan H, Erdogan M, Gunduz CNS, Bisgin A, Ozdemir O, Ulgenalp A, Percin EF, Yildirim ME, Tekes S, Bagis H, Yuce H, Duman N, Bozkurt G, Yararbas K, Yildirim MS, Arman A, Mihci E, Eraslan S, Altintas ZM, Aymelek HS, Ruhi HI, Tatar A, Ergoren MC, Cetin GO, Altunoglu U, Caglayan AO, Yuksel B, Ozkul Y, Saatci C, Kenanoglu S, Karasu N, Dundar B, Ozcelik F, Demir M, Siniksaran BS, Kulak H, Kiranatlioglu K, Baysal K, Kazimli U, Akalin H, Dundar A, Boz M, Bayram A, Subasioglu A, Colak FK, Karaduman N, Gunes MC, Kandemir N, Aynekin B, Emekli R, Sahin IO, Ozdemir SY, Onal MG, Senel AS, Poyrazoglu MH, Kisaarslan ANP, Gursoy S, Baskol M, Calis M, Demir H, Zararsiz GE, Erdogan MO, Elmas M, Solak M, Ulu MS, Thahir A, Aydin Z, Atasever U, Sag SO, Aliyeva L, Alemdar A, Dogan B, Erguzeloglu CO, Kaya N, Ozkinay F, Cogulu O, Durmaz A, Onay H, Karaca E, Durmaz B, Aykut A, Cilingir O, Aras BD, Gokalp EE, Arslan S, Temena A, Haziyeva K, Kocagil S, Bas H, Susam E, Keklikci AR, Sarac E, Kocak N, Nergiz S, Terzi YK, Dincer SA, Baskin ES, Genc GC, Bahadir O, Sanri A, Yigit S, Tozkir H, Yalcintepe S, Ozkayin N, Kiraz A, Balta B, Gonen GA, Kurt EE, Ceylan GG, Ceylan AC, Erten S, Bozdogan ST, Boga I, Yilmaz M, Silan F, Kocabey M, Koc A, Cankaya T, Bora E, Bozkaya OG, Ercal D, Ergun MA, Ergun SG, Duman YS, Beyazit SB, Uzel VH, Em S, Cevik MO, Eroz R, Demirtas M, Firat CK, Kabayegit ZM, Altan M, Mardan L, Sayar C, Tumer S, Turkgenc B, Karakoyun HK, Tunc B, Kuru S, Zamani A, Geckinli BB, Ates EA, Clark OA, Toylu A, Coskun M, Nur B, Bilge I, Bayramicli OU, Emmungil H, Komesli Z, Zeybel M, Gurakan F, Tasdemir M, Kebudi R, Karabulut HG, Tuncali T, Kutlay NY, Kahraman CY, Onder NB, Beyitler I, Kavukcu S, Tulay P, Tosun O, Tuncel G, Mocan G, Kale H, Uyguner ZO, Acar A, Altinay M, Erdem L. Clinical and molecular evaluation of MEFV gene variants in the Turkish population: a study by the National Genetics Consortium. Funct Integr Genomics 2022; 22:291-315. [PMID: 35098403 DOI: 10.1007/s10142-021-00819-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 02/08/2023]
Abstract
Familial Mediterranean fever (FMF) is a monogenic autoinflammatory disorder with recurrent fever, abdominal pain, serositis, articular manifestations, erysipelas-like erythema, and renal complications as its main features. Caused by the mutations in the MEditerranean FeVer (MEFV) gene, it mainly affects people of Mediterranean descent with a higher incidence in the Turkish, Jewish, Arabic, and Armenian populations. As our understanding of FMF improves, it becomes clearer that we are facing with a more complex picture of FMF with respect to its pathogenesis, penetrance, variant type (gain-of-function vs. loss-of-function), and inheritance. In this study, MEFV gene analysis results and clinical findings of 27,504 patients from 35 universities and institutions in Turkey and Northern Cyprus are combined in an effort to provide a better insight into the genotype-phenotype correlation and how a specific variant contributes to certain clinical findings in FMF patients. Our results may help better understand this complex disease and how the genotype may sometimes contribute to phenotype. Unlike many studies in the literature, our study investigated a broader symptomatic spectrum and the relationship between the genotype and phenotype data. In this sense, we aimed to guide all clinicians and academicians who work in this field to better establish a comprehensive data set for the patients. One of the biggest messages of our study is that lack of uniformity in some clinical and demographic data of participants may become an obstacle in approaching FMF patients and understanding this complex disease.
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Affiliation(s)
- Munis Dundar
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey.
| | - Umut Fahrioglu
- Department of Medical Biology, Faculty of Medicine, Near East University, 99138, Nicosia, Cyprus. .,DESAM Institute, Near East University, 99138, Nicosia, Cyprus. .,Genetics and Cancer Diagnosis-Research Centre, Centre of Excellence, Near East University, 99138, Nicosia, Cyprus.
| | - Saliha Handan Yildiz
- Department of Medical Genetics, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, 03030, Turkey
| | - Burcu Bakir-Gungor
- Department of Computer Engineering, Faculty of Engineering and Natural Sciences, Abdullah Gul University, Kayseri, 38080, Turkey
| | - Sehime Gulsun Temel
- Department of Medical Genetics, Faculty of Medicine, Bursa Uludag University, Gorukle, Bursa, 16059, Turkey.,Department of Histology and Embryology, Faculty of Medicine, Bursa Uludag University, Gorukle, Bursa, 16059, Turkey.,Department of Translational Medicine, Health Sciences Institute, Bursa Uludag University, Gorukle, Bursa, 16059, Turkey
| | - Haluk Akin
- Department of Medical Genetics, Faculty of Medicine, Ege University, Izmir, 35100, Turkey
| | - Sevilhan Artan
- Department of Medical Genetics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, 26040, Turkey
| | - Tulin Cora
- Department of Medical Biology and Genetics, Faculty of Medicine, Selcuk University, Konya, 42131, Turkey
| | - Feride Iffet Sahin
- Department of Medical Genetics, Faculty of Medicine, Baskent University, Ankara, 06490, Turkey
| | - Ahmet Dursun
- Department of Medical Genetics, Faculty of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, 67600, Turkey
| | - Ozlem Sezer
- Department of Medical Genetics, Samsun Education and Research Hospital, Samsun, 55090, Turkey
| | - Hakan Gurkan
- Department of Medical Genetics, Faculty of Medicine, Trakya University, Edirne, 22130, Turkey
| | - Murat Erdogan
- Division of Medical Genetics, Kayseri City Education and Research Hospital, Kayseri, 38080, Turkey
| | - C Nur Semerci Gunduz
- Department of Medical Genetics, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, 06800, Turkey.,Ataturk Training and Research Hospital, Genetic Diseases Diagnosis Center, Ankara, 06230, Turkey
| | - Atil Bisgin
- Department of Medical Genetics, Faculty of Medicine, Cukurova University AGENTEM (Adana Genetic Diseases Diagnosis and Treatment Center and Medical Genetics), Adana, 01790, Turkey
| | - Ozturk Ozdemir
- Department of Medical Genetics, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, 17100, Turkey
| | - Ayfer Ulgenalp
- Department of Medical Genetics, Faculty of Medicine, Dokuz Eylul University, Izmir, 35340, Turkey.,Department of Pediatric Genetics, Faculty of Medicine, Dokuz Eylul University, Izmir, 35340, Turkey
| | - E Ferda Percin
- Department of Medical Genetics, Faculty of Medicine, Gazi University, Besevler Ankara, 06560, Turkey
| | - Malik Ejder Yildirim
- Department of Medical Genetics, Faculty of Medicine, Cumhuriyet University, Sivas, 58140, Turkey
| | - Selahaddin Tekes
- Department of Medical Genetics, Faculty of Medicine, Dicle University, Diyarbakir, 21280, Turkey
| | - Haydar Bagis
- Department of Medical Genetics, Faculty of Medicine, Adiyaman University, Adiyaman, 02040, Turkey
| | - Huseyin Yuce
- Department of Medical Genetics, Faculty of Medicine, Duzce University, Duzce, 81620, Turkey
| | - Nilgun Duman
- Department of Medical Genetics, Faculty of Medicine, Dragos Hospital, Bezmi Alem Vakif University, Istanbul, 34844, Turkey
| | - Gokay Bozkurt
- Department of Medical Genetics, Faculty of Medicine, Aydin Adnan Menderes University, Aydin, 09010, Turkey
| | - Kanay Yararbas
- Acibadem Labgen Genetic Diagnosis Center, Acibadem University, Istanbul, 34755, Turkey
| | - Mahmut Selman Yildirim
- Department of Medical Genetics, Meram Medical Faculty, Necmettin Erbakan University, Konya, 42080, Turkey
| | - Ahmet Arman
- Department of Medical Genetics, Faculty of Medicine, Marmara University, Istanbul, 34854, Turkey
| | - Ercan Mihci
- Department of Medical Genetics, Faculty of Medicine, Akdeniz University, Antalya, 07070, Turkey.,Department of Pediatric Genetics, Faculty of Medicine, Akdeniz University, Antalya, 07070, Turkey
| | - Serpil Eraslan
- Diagnostic Center for Genetic Diseases, Koc University Hospital, Koc University, Istanbul, 34010, Turkey
| | - Zuhal Mert Altintas
- Department of Medical Genetics, Faculty of Medicine, Mersin University, Mersin, 33343, Turkey
| | - Huri Sema Aymelek
- Department of Medical Genetics, Faculty of Medicine, Van Yuzuncu Yil University, Van, 65080, Turkey.,Division of Medical Genetics, Bursa City Hospital, Bursa, 16110, Turkey
| | - Hatice Ilgin Ruhi
- Department of Medical Genetics, Faculty of Medicine, Ankara University, Ankara, 06590, Turkey
| | - Abdulgani Tatar
- Department of Medical Genetics, Faculty of Medicine, Ataturk University, Erzurum, 25240, Turkey
| | - Mahmut Cerkez Ergoren
- DESAM Institute, Near East University, 99138, Nicosia, Cyprus.,Department of Medical Genetics, Faculty of Medicine, Near East University, 99138, Nicosia, Cyprus
| | - G Ozan Cetin
- Department of Medical Genetics, Faculty of Medicine, Pamukkale University, Denizli, 20070, Turkey
| | - Umut Altunoglu
- Department of Medical Genetics, Istanbul Medical Faculty, Istanbul University, Istanbul, 34093, Turkey.,Department of Medical Genetics, Faculty of Medicine (KUSOM), Koc University, Istanbul, 34010, Turkey
| | - Ahmet Okay Caglayan
- Department of Medical Genetics, Faculty of Medicine, Dokuz Eylul University, Izmir, 35340, Turkey.,Department of Medical Genetics, Faculty of Medicine, Istanbul Bilim University, Istanbul, 34394, Turkey
| | - Berrin Yuksel
- Department of Medical Genetics, Faculty of Medicine, Usak University, Usak, 64050, Turkey
| | - Yusuf Ozkul
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey
| | - Cetin Saatci
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey
| | - Sercan Kenanoglu
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey
| | - Nilgun Karasu
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey
| | - Bilge Dundar
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey.,Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA
| | - Firat Ozcelik
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey
| | - Mikail Demir
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey.,Department of Medical Genetics, Faculty of Medicine, Van Yuzuncu Yil University, Van, 65080, Turkey
| | - Betul Seyhan Siniksaran
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey
| | - Hande Kulak
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey.,Department of Medical Genetics, Faculty of Medicine, Van Yuzuncu Yil University, Van, 65080, Turkey
| | - Kubra Kiranatlioglu
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey
| | - Kubra Baysal
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey
| | - Ulviyya Kazimli
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey
| | - Hilal Akalin
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey
| | - Ayca Dundar
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey.,Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA
| | - Mehmet Boz
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey
| | - Arslan Bayram
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey.,Department of Medical Genetics, Etlik Zubeyde Hanim Women's Diseases Education and Research Hospital, Ankara, 06050, Turkey
| | - Asli Subasioglu
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey.,Department of Medical Genetics, Faculty of Medicine, Izmir Katip Celebi University, Izmir, 35620, Turkey
| | - Fatma Kurt Colak
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey.,Department of Medical Genetics, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, 46040, Turkey
| | - Neslihan Karaduman
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey.,Division of Medical Genetics, Kirikkale High Specialization Hospital, Kirikkale, 71300, Turkey
| | - Meltem Cerrah Gunes
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey.,Department of Medical Genetics, Faculty of Medicine, Kocaeli University, Kocaeli, 41001, Turkey
| | - Nefise Kandemir
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey.,Department of Medical Genetics, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, 06110, Turkey
| | - Busra Aynekin
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey
| | - Rabia Emekli
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey
| | - Izem Olcay Sahin
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey
| | - Sevda Yesim Ozdemir
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey.,Department of Medical Genetics, Faculty of Medicine, Uskudar University, Istanbul, 34662, Turkey
| | - Muge Gulcihan Onal
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey
| | | | - Muammer Hakan Poyrazoglu
- Department of Pediatrics, Division of Nephrology, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey
| | - Ayse Nur Pac Kisaarslan
- Department of Child Health and Diseases, Division of Pediatric Rheumatology, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey
| | - Sebnem Gursoy
- Department of Gastroenterology, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey
| | - Mevlut Baskol
- Department of Gastroenterology, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey
| | - Mustafa Calis
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey
| | - Huseyin Demir
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey
| | - Gozde Erturk Zararsiz
- Department of Biostatistics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey
| | - Mujgan Ozdemir Erdogan
- Department of Medical Genetics, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, 03030, Turkey
| | - Muhsin Elmas
- Department of Medical Genetics, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, 03030, Turkey
| | - Mustafa Solak
- Department of Medical Genetics, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, 03030, Turkey
| | - Memnune Sena Ulu
- Department of Internal Medicine, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, 03030, Turkey
| | - Adam Thahir
- Department of Computer Engineering, Faculty of Engineering and Natural Sciences, Abdullah Gul University, Kayseri, 38080, Turkey
| | - Zafer Aydin
- Department of Computer Engineering, Faculty of Engineering and Natural Sciences, Abdullah Gul University, Kayseri, 38080, Turkey
| | - Umut Atasever
- Department of Computer Engineering, Faculty of Engineering and Natural Sciences, Abdullah Gul University, Kayseri, 38080, Turkey
| | - Sebnem Ozemri Sag
- Department of Medical Genetics, Faculty of Medicine, Bursa Uludag University, Gorukle, Bursa, 16059, Turkey
| | - Lamiya Aliyeva
- Department of Medical Genetics, Faculty of Medicine, Bursa Uludag University, Gorukle, Bursa, 16059, Turkey
| | - Adem Alemdar
- Department of Translational Medicine, Health Sciences Institute, Bursa Uludag University, Gorukle, Bursa, 16059, Turkey
| | - Berkcan Dogan
- Department of Medical Genetics, Faculty of Medicine, Bursa Uludag University, Gorukle, Bursa, 16059, Turkey.,Department of Translational Medicine, Health Sciences Institute, Bursa Uludag University, Gorukle, Bursa, 16059, Turkey
| | - Cemre Ornek Erguzeloglu
- Department of Translational Medicine, Health Sciences Institute, Bursa Uludag University, Gorukle, Bursa, 16059, Turkey
| | - Niyazi Kaya
- Department of Medical Genetics, Faculty of Medicine, Bursa Uludag University, Gorukle, Bursa, 16059, Turkey
| | - Ferda Ozkinay
- Department of Medical Genetics, Faculty of Medicine, Ege University, Izmir, 35100, Turkey.,Department of Pediatrics and Health, Genetics and Teratology, Faculty of Medicine, Ege University, Izmir, 35100, Turkey
| | - Ozgur Cogulu
- Department of Medical Genetics, Faculty of Medicine, Ege University, Izmir, 35100, Turkey.,Department of Pediatrics and Health, Genetics and Teratology, Faculty of Medicine, Ege University, Izmir, 35100, Turkey
| | - Asude Durmaz
- Department of Medical Genetics, Faculty of Medicine, Ege University, Izmir, 35100, Turkey
| | - Huseyin Onay
- Department of Medical Genetics, Faculty of Medicine, Ege University, Izmir, 35100, Turkey
| | - Emin Karaca
- Department of Medical Genetics, Faculty of Medicine, Ege University, Izmir, 35100, Turkey
| | - Burak Durmaz
- Department of Medical Genetics, Faculty of Medicine, Ege University, Izmir, 35100, Turkey
| | - Ayca Aykut
- Department of Medical Genetics, Faculty of Medicine, Ege University, Izmir, 35100, Turkey
| | - Oguz Cilingir
- Department of Medical Genetics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, 26040, Turkey
| | - Beyhan Durak Aras
- Department of Medical Genetics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, 26040, Turkey
| | - Ebru Erzurumluoglu Gokalp
- Department of Medical Genetics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, 26040, Turkey
| | - Serap Arslan
- Department of Medical Genetics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, 26040, Turkey
| | - Arda Temena
- Department of Medical Genetics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, 26040, Turkey
| | - Konul Haziyeva
- Department of Medical Genetics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, 26040, Turkey
| | - Sinem Kocagil
- Department of Medical Genetics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, 26040, Turkey
| | - Hasan Bas
- Department of Medical Genetics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, 26040, Turkey
| | - Ezgi Susam
- Department of Medical Genetics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, 26040, Turkey
| | - Ali Riza Keklikci
- Department of Medical Genetics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, 26040, Turkey
| | - Elif Sarac
- Department of Medical Genetics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, 26040, Turkey
| | - Nadir Kocak
- Department of Medical Biology and Genetics, Faculty of Medicine, Selcuk University, Konya, 42131, Turkey
| | - Suleyman Nergiz
- Department of Medical Biology and Genetics, Faculty of Medicine, Selcuk University, Konya, 42131, Turkey
| | - Yunus Kasim Terzi
- Department of Medical Genetics, Faculty of Medicine, Baskent University, Ankara, 06490, Turkey
| | - Selin Akad Dincer
- Department of Medical Genetics, Faculty of Medicine, Baskent University, Ankara, 06490, Turkey
| | - Esra Sidika Baskin
- Department of Pediatric Nephrology, Faculty of Medicine, Baskent University, Ankara, 06490, Turkey
| | - Gunes Cakmak Genc
- Department of Medical Genetics, Faculty of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, 67600, Turkey
| | - Oguzhan Bahadir
- Department of Medical Genetics, Faculty of Medicine, Erciyes University, Kayseri, 38039, Turkey.,Department of Medical Genetics, Samsun Education and Research Hospital, Samsun, 55090, Turkey
| | - Aslihan Sanri
- Department of Medical Genetics, Samsun Education and Research Hospital, Samsun, 55090, Turkey
| | - Serbulent Yigit
- Department of Genetics, Faculty of Veterinary, Ondokuz Mayis University, Samsun, 55270, Turkey.,Department of Medical Biology, Faculty of Medicine, Gaziosmanpasa University, Tokat, 60030, Turkey
| | - Hilmi Tozkir
- Department of Medical Genetics, Faculty of Medicine, Trakya University, Edirne, 22130, Turkey
| | - Sinem Yalcintepe
- Department of Medical Genetics, Faculty of Medicine, Trakya University, Edirne, 22130, Turkey
| | - Nese Ozkayin
- Department of Pediatrics, Division of Nephrology, Faculty of Medicine, Trakya University, Edirne, 22130, Turkey
| | - Aslihan Kiraz
- Division of Medical Genetics, Kayseri City Education and Research Hospital, Kayseri, 38080, Turkey
| | - Burhan Balta
- Division of Medical Genetics, Kayseri City Education and Research Hospital, Kayseri, 38080, Turkey
| | - Gizem Akinci Gonen
- Division of Medical Genetics, Kayseri City Education and Research Hospital, Kayseri, 38080, Turkey
| | - E Emre Kurt
- Department of Medical Genetics, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, 06800, Turkey.,Ataturk Training and Research Hospital, Genetic Diseases Diagnosis Center, Ankara, 06230, Turkey
| | - Gulay Gulec Ceylan
- Department of Medical Genetics, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, 06800, Turkey.,Ataturk Training and Research Hospital, Genetic Diseases Diagnosis Center, Ankara, 06230, Turkey
| | - Ahmet Cevdet Ceylan
- Department of Medical Genetics, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, 06800, Turkey.,Ataturk Training and Research Hospital, Genetic Diseases Diagnosis Center, Ankara, 06230, Turkey
| | - Sukran Erten
- Department of Rheumatology, Ataturk Training Research Hospital, Ankara Yildirim Beyazit University, Ankara, 06230, Turkey
| | - Sevcan Tug Bozdogan
- Department of Medical Genetics, Faculty of Medicine, Cukurova University AGENTEM (Adana Genetic Diseases Diagnosis and Treatment Center and Medical Genetics), Adana, 01790, Turkey
| | - Ibrahim Boga
- Department of Medical Genetics, Faculty of Medicine, Cukurova University AGENTEM (Adana Genetic Diseases Diagnosis and Treatment Center and Medical Genetics), Adana, 01790, Turkey
| | - Mustafa Yilmaz
- Division of Pediatric Rheumatology, Faculty of Medicine, Cukurova University, Adana, 01790, Turkey
| | - Fatma Silan
- Department of Medical Genetics, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, 17100, Turkey
| | - Mehmet Kocabey
- Department of Medical Genetics, Faculty of Medicine, Dokuz Eylul University, Izmir, 35340, Turkey
| | - Altug Koc
- Department of Medical Genetics, Faculty of Medicine, Dokuz Eylul University, Izmir, 35340, Turkey
| | - Tufan Cankaya
- Department of Medical Genetics, Faculty of Medicine, Dokuz Eylul University, Izmir, 35340, Turkey
| | - Elcin Bora
- Department of Medical Genetics, Faculty of Medicine, Dokuz Eylul University, Izmir, 35340, Turkey
| | - Ozlem Giray Bozkaya
- Department of Medical Genetics, Faculty of Medicine, Dokuz Eylul University, Izmir, 35340, Turkey.,Department of Pediatric Genetics, Faculty of Medicine, Dokuz Eylul University, Izmir, 35340, Turkey
| | - Derya Ercal
- Department of Medical Genetics, Faculty of Medicine, Dokuz Eylul University, Izmir, 35340, Turkey.,Department of Pediatric Genetics, Faculty of Medicine, Dokuz Eylul University, Izmir, 35340, Turkey
| | - Mehmet Ali Ergun
- Department of Medical Genetics, Faculty of Medicine, Gazi University, Besevler Ankara, 06560, Turkey
| | - Sezen Guntekin Ergun
- Department of Medical Genetics, Faculty of Medicine, Gazi University, Besevler Ankara, 06560, Turkey.,Department of Medical Biology, Faculty of Medicine, Hacettepe University, Ankara, 06100, Turkey
| | - Yesim Sidar Duman
- Department of Medical Genetics, Faculty of Medicine, Cumhuriyet University, Sivas, 58140, Turkey
| | - Serife Busra Beyazit
- Department of Medical Genetics, Faculty of Medicine, Cumhuriyet University, Sivas, 58140, Turkey
| | - Veysiye Hulya Uzel
- Department of Pediatric Hematology, Faculty of Medicine, Dicle University, Diyarbakir, 21280, Turkey
| | - Serda Em
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Dicle University, Diyarbakir, 21280, Turkey
| | - Muhammer Ozgur Cevik
- Department of Medical Genetics, Faculty of Medicine, Adiyaman University, Adiyaman, 02040, Turkey
| | - Recep Eroz
- Department of Medical Genetics, Faculty of Medicine, Duzce University, Duzce, 81620, Turkey
| | - Mercan Demirtas
- Department of Medical Genetics, Faculty of Medicine, Dragos Hospital, Bezmi Alem Vakif University, Istanbul, 34844, Turkey
| | - Cem Koray Firat
- Department of Child Health and Diseases, Faculty of Medicine, Dragos Hospital, Bezmi Alem Vakif University, Istanbul, 34844, Turkey
| | - Zehra Manav Kabayegit
- Department of Medical Genetics, Faculty of Medicine, Aydin Adnan Menderes University, Aydin, 09010, Turkey
| | - Mustafa Altan
- Department of Medical Genetics, Faculty of Medicine, Aydin Adnan Menderes University, Aydin, 09010, Turkey
| | - Lamiya Mardan
- Department of Medical Genetics, Faculty of Medicine, Aydin Adnan Menderes University, Aydin, 09010, Turkey
| | - Ceyhan Sayar
- Acibadem Labgen Genetic Diagnosis Center, Acibadem University, Istanbul, 34755, Turkey
| | - Sait Tumer
- Acibadem Labgen Genetic Diagnosis Center, Acibadem University, Istanbul, 34755, Turkey
| | - Burcu Turkgenc
- Acibadem Labgen Genetic Diagnosis Center, Acibadem University, Istanbul, 34755, Turkey
| | | | - Betul Tunc
- Acibadem Labgen Genetic Diagnosis Center, Acibadem University, Istanbul, 34755, Turkey
| | - Seda Kuru
- Acibadem Labgen Genetic Diagnosis Center, Acibadem University, Istanbul, 34755, Turkey
| | - Aysegul Zamani
- Department of Medical Genetics, Meram Medical Faculty, Necmettin Erbakan University, Konya, 42080, Turkey
| | - Bilgen Bilge Geckinli
- Department of Medical Genetics, Faculty of Medicine, Marmara University, Istanbul, 34854, Turkey
| | - Esra Arslan Ates
- Department of Medical Genetics, Marmara Teaching and Research Hospital, Marmara University, Istanbul, 34899, Turkey
| | - Ozden Altiok Clark
- Department of Medical Genetics, Faculty of Medicine, Akdeniz University, Antalya, 07070, Turkey
| | - Asli Toylu
- Department of Medical Genetics, Faculty of Medicine, Akdeniz University, Antalya, 07070, Turkey
| | - Mert Coskun
- Department of Medical Genetics, Faculty of Medicine, Akdeniz University, Antalya, 07070, Turkey
| | - Banu Nur
- Department of Pediatric Genetics, Faculty of Medicine, Akdeniz University, Antalya, 07070, Turkey
| | - Ilmay Bilge
- Department of Pediatric Nephrology, Koc University Hospital, Istanbul, 34010, Turkey
| | - Oya Uygur Bayramicli
- Department of Gastroenterology and Hepatology, Med American Ambulatory Care Center, Istanbul, 34724, Turkey
| | - Hakan Emmungil
- Department of Rheumatology, Faculty of Medicine, Trakya University, Edirne, 22100, Turkey
| | - Zeynep Komesli
- Department of Internal Medicine, Koc University Hospital, Istanbul, 34010, Turkey
| | - Mujdat Zeybel
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Koc University, Istanbul, 34010, Turkey
| | - Figen Gurakan
- Department of Pediatrics, VKV American Hospital, Istanbul, 34365, Turkey
| | - Mehmet Tasdemir
- Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Koc University, Istanbul, 34010, Turkey
| | - Rejin Kebudi
- Department of Pediatric Hematology-Oncology, Institute of Oncology, Istanbul University, Istanbul, 34093, Turkey
| | - Halil Gurhan Karabulut
- Department of Medical Genetics, Faculty of Medicine, Ankara University, Ankara, 06590, Turkey
| | - Timur Tuncali
- Department of Medical Genetics, Faculty of Medicine, Ankara University, Ankara, 06590, Turkey
| | - Nuket Yurur Kutlay
- Department of Medical Genetics, Faculty of Medicine, Ankara University, Ankara, 06590, Turkey
| | - Cigdem Yuce Kahraman
- Department of Medical Genetics, Faculty of Medicine, Ataturk University, Erzurum, 25240, Turkey
| | - Nerin Bahceciler Onder
- Department of Pediatrics, Faculty of Medicine, Near East University, 99138, Nicosia, Cyprus
| | - Ilke Beyitler
- Department of Pediatrics, Faculty of Medicine, Near East University, 99138, Nicosia, Cyprus
| | - Salih Kavukcu
- Department of Pediatric Nephrology, Faculty of Medicine, Dokuz Eylul University, Izmir, 35340, Turkey
| | - Pinar Tulay
- DESAM Institute, Near East University, 99138, Nicosia, Cyprus.,Department of Medical Genetics, Faculty of Medicine, Near East University, 99138, Nicosia, Cyprus
| | - Ozgur Tosun
- Department of Biostatistics, Faculty of Medicine, Near East University, 99138, Nicosia, Cyprus
| | - Gulten Tuncel
- DESAM Institute, Near East University, 99138, Nicosia, Cyprus
| | - Gamze Mocan
- Department of Pathology, Faculty of Medicine, Near East University, 99138, Nicosia, Cyprus
| | - Hamdi Kale
- Department of Medical Genetics, Istanbul Medical Faculty, Istanbul University, Istanbul, 34093, Turkey
| | - Zehra Oya Uyguner
- Department of Medical Genetics, Istanbul Medical Faculty, Istanbul University, Istanbul, 34093, Turkey
| | - Aynur Acar
- Department of Molecular Biology and Genetics, Faculty of Arts and Sciences, Demiroglu Bilim University, Sisli, Istanbul, 34394, Turkey
| | - Mert Altinay
- Department of Molecular Biology and Genetics, Faculty of Arts and Sciences, Demiroglu Bilim University, Sisli, Istanbul, 34394, Turkey
| | - Levent Erdem
- Department of Internal Medicine, Faculty of Medicine, Demiroglu Bilim University, Sisli, Istanbul, 34394, Turkey
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19
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Kul Cinar O, Putland A, Wynne K, Eleftheriou D, Brogan PA. Hereditary Systemic Autoinflammatory Diseases: Therapeutic Stratification. Front Pediatr 2022; 10:867679. [PMID: 35573950 PMCID: PMC9096795 DOI: 10.3389/fped.2022.867679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/29/2022] [Indexed: 11/30/2022] Open
Abstract
Hereditary systemic autoinflammatory diseases (SAIDs) are rare, often severe conditions characterised by mutations in the key regulators of innate immune responses. Dramatic advances in the molecular genetics and next-generation sequencing in the past decade enabled identification of novel mutations that play a pivotal role in the mechanistic pathways of inflammation. Although genetic testing may not always provide straightforward guidance in diagnosis and clinical decision making, through translational research, it sheds light into molecular immunopathogenesis, particularly in IL-1 inflammasome and cytokine signalling pathways. These remarkable insights provided a better understanding of autoinflammatory conditions and their association with the innate and adaptive immune systems, as well as leading to development of cytokine-targetted biologic treatments. Use of targetted therapeutics not only helps control disease flares, reduce acute-phase responses and prevent devastating complications such as amyloidosis, but also improves health-related quality of lives and support patients to pursue almost a normal life. Herein, we discuss the commonest monogenic SAIDs, describe their immunopathology, and summarise the approaches in the management and targetted treatment of these conditions, including presentation of novel data based on a cohort of children with these rare diseases from a single quaternary referral centre in London.
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Affiliation(s)
- Ovgu Kul Cinar
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,Division of Medicine, National Amyloidosis Centre and Centre for Acute Phase Proteins, University College London, Royal Free Campus, London, United Kingdom
| | - Amber Putland
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Karen Wynne
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Despina Eleftheriou
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,Section of Infection, Immunity and Inflammation, Institute of Child Health, University College London Great Ormond Street, London, United Kingdom.,Paediatric Rheumatology, ARUK Centre for Adolescent Rheumatology, Institute of Child Health, University College London (UCL) Great Ormond Street Hospital, London, United Kingdom
| | - Paul A Brogan
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,Section of Infection, Immunity and Inflammation, Institute of Child Health, University College London Great Ormond Street, London, United Kingdom
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20
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Güngörer V, Yorulmaz A, Arslan Ş. The clinical effect of gene mutations in familial Mediterranean fever disease. Pediatr Int 2022; 64:e15052. [PMID: 34743384 DOI: 10.1111/ped.15052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/01/2021] [Accepted: 10/31/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Familial Mediterranean fever (FMF) is a self-limiting, autoinflammatory disease characterized by inflammation of the serosal surfaces and recurrent episodes of fever. The aim of this study is to determine the effect of genetic mutations on clinical features in children with FMF. METHODS A total of 303 patients aged 0-18 years, who were diagnosed with FMF, according to Yalcinkaya-Özen diagnostic criteria and whose Mediterranean fever gene (MEFV) analysis was studied, were evaluated retrospectively. The clinical and demographic characteristics of the patients and the relationship between common alleles and genotypes were investigated. RESULTS The most common mutation in patients was M694V heterozygous. When the patients were divided into four groups, M694V homozygous, M694V heterozygous, M694V/other allele combined heterozygous, and other mutations, Arthritis was statistically significantly higher in the group that was M694V homozygous compared to the other groups. It was observed that the presence of the M694V allele significantly increased the frequency of periodic fever, aphthous stomatitis, pharyngitis, adenitis syndrome. The frequency of arthritis was significantly higher in patients who were E148Q homozygous than in patients who were heterozygous. Appendectomy history was significantly higher in the group carrying the V726A allele. CONCLUSIONS FMF disease and the effect of genetics on the disease can be better understood, thanks to studies evaluating the genotype-phenotype relationship. In this regard, we believe that studies evaluating the clinical and genotype relationship with a large series are needed.
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Affiliation(s)
- Vildan Güngörer
- Departments of Pediatric Rheumatology, Selcuk University Faculty of Medicine, Konya, Turkey
| | | | - Şükrü Arslan
- Departments of Pediatric Rheumatology, Selcuk University Faculty of Medicine, Konya, Turkey
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21
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Gilbert S, Gabriel H, Pankow A, Biskup S, Wagner AD. [What is confirmed in the diagnostics of autoinflammatory fever diseases?]. Internist (Berl) 2021; 62:1290-1294. [PMID: 34878559 DOI: 10.1007/s00108-021-01221-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/29/2022]
Abstract
Periodic fever syndromes (PFS) are a group of rare autoinflammatory diseases, which are characterized by disorders of the innate immune reaction and life-long recurrent episodes of inflammatory symptoms. This article describes the diagnostic approach. In addition to the patient medical history, physical examination and laboratory determinations, gene tests are becoming increasingly more important. The panel diagnostics using high throughput sequencing or next generation sequencing (NGS) is the method of choice for the detection of a genetic cause of PFS. This article discusses the diagnostic decision support systems (DDSS) that can play a future role in the diagnosis of rare diseases, especially those with complex patterns of symptoms.
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Affiliation(s)
- Stephen Gilbert
- Ada Health GmbH, Karl-Liebknecht-Str. 1, 10178, Berlin, Deutschland.,Else Kröner-Fresenius Center for Digital Health, Faculty of Medicine Carl Gustav Carus, Louisenstr. 120, 61348, Bad Homburg, Deutschland.,Technische Universität Dresden, Dresden, Deutschland
| | - Heinz Gabriel
- Praxis für Humangenetik Tübingen, Paul-Ehrlich-Str. 23, 72076, Tübingen, Deutschland
| | - Anne Pankow
- Abt. für Nieren- und Hochdruckerkrankungen, Ambulanz für seltene entzündliche, Systemerkrankungen mit Nierenbeteiligung, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.,Klinik für Rheumatologie und Immunologie, Berlin, Charité, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Saskia Biskup
- Praxis für Humangenetik Tübingen, Paul-Ehrlich-Str. 23, 72076, Tübingen, Deutschland
| | - Annette Doris Wagner
- Abt. für Nieren- und Hochdruckerkrankungen, Ambulanz für seltene entzündliche, Systemerkrankungen mit Nierenbeteiligung, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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22
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Samukawa S, Yoshimi R, Kirino Y, Nakajima H. The PRY/SPRY domain of pyrin/TRIM20 interacts with β 2-microglobulin to promote inflammasome formation. Sci Rep 2021; 11:23613. [PMID: 34880353 PMCID: PMC8654936 DOI: 10.1038/s41598-021-03073-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 11/26/2021] [Indexed: 01/04/2023] Open
Abstract
Pyrin/TRIM20 is expressed in the neutrophils and monocytes/macrophages and regulates caspase-1 activation and interleukin-1β maturation. Although the mutations in the PRY/SPRY domain of pyrin cause familial Mediterranean fever (FMF), the mechanism of how mutated pyrin provokes excessive inflammation in FMF patients is not well understood. The present study investigated the role of pyrin/TRIM20 in inflammation and the pathogenesis of FMF. β2-Microglobulin (β2MG) was identified as the novel pyrin ligand binding to the PRY/SPRY domain by yeast two-hybrid screenings and co-immunoprecipitation analysis. β2MG was co-localized with pyrin not only in the HEK293 cells overexpressing these proteins but also in the monosodium urate-stimulated human neutrophils in the speck-like structures. The pyrin–β2MG interaction triggered the binding of pyrin and proline–serine–threonine phosphatase interacting protein 1 (PSTPIP1) and then the subsequent recruitment of apoptosis-associated speck-like protein containing caspase recruitment domain (ASC). Caspase-1 p20 subunit, produced by pyrin inflammasome, also interacted with the pyrin PRY/SPRY domain and inhibited the pyrin–β2MG interaction. FMF-associated pyrin mutation M694V did not affect pyrin–β2MG interaction but weakened this inhibition. Our findings suggest that β2MG functions as the pyrin ligand inducing pyrin inflammasome formation and that the FMF-associated pyrin mutations weakened negative feedback of caspase-1 p20 subunit.
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Affiliation(s)
- Sei Samukawa
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Ryusuke Yoshimi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Yohei Kirino
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Hideaki Nakajima
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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23
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Tirosh I, Yacobi Y, Vivante A, Barel O, Ben-Moshe Y, Erez Granat O, Spielman S, Semo Oz R, Shinar Y, Gerstein M. Clinical significance of E148Q heterozygous variant in paediatric familial Mediterranean fever. Rheumatology (Oxford) 2021; 60:5447-5451. [PMID: 33560333 DOI: 10.1093/rheumatology/keab128] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 01/19/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES FMF results from mutations in the Mediterranean fever (MEFV) gene. The p. E148Q protein alternation is one of the most frequent in the MEFV gene, yet the exact E148Q genotype-phenotype correlation remains unclear. The aim of this study was to examine clinical significance of heterozygous E148Q variant in a paediatric FMF cohort. METHODS We compared the clinical manifestations and disease severity score of four genetic subgroups: (group 1) patients harbouring a single heterozygous p. E148Q variant (n = 6); (group 2) patients harbouring a single p. M694V heterozygous variant (n = 88); (group 3) patients harbouring compound heterozygous p. M694V and p. E148Q variants (n = 36); and (group 4) homozygotes for p. M694V variant (n = 160). RESULTS Of 646 FMF children from our centre, only 1% (six patients) of our genetically characterized FMF cohort had a single E148Q variant, most presenting with recurrent fevers and abdominal pain. None of the participants was found to harbour homozygous E148Q. Overall, M694V/E148Q compound heterozygosity did not exhibit a more severe phenotype compared with patients with a single M694V variant. The former group were less likely to have abdominal pain and exertional leg pain (P < 0.004 and P < 0.001, respectively) and more likely to have chest pain (P < 0.01). Both subgroups showed milder clinical phenotype compared with patients with M694V homozygosity. CONCLUSION Our findings demonstrate that a single heterozygous E148Q variant is unlikely to cause FMF in children and that E148Q/M694V is clinically indistinguishable from a single M694V variant. Thus, E148Q heterozygosity does not result in clinically meaningful phenotype in children.
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Affiliation(s)
- Irit Tirosh
- Department of Paediatrics B.,Paediatric Rheumatology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Centre, Tel Hashomer.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv
| | - Yonatan Yacobi
- Department of Paediatrics B.,Paediatric Rheumatology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Centre, Tel Hashomer.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv
| | - Asaf Vivante
- Department of Paediatrics B.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv
| | - Ortal Barel
- The Genomic Unit, Sheba Cancer Research Centre, Sheba Medical Centre, Tel Hashomer
| | - Yishay Ben-Moshe
- Department of Paediatrics B.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv
| | - Ortal Erez Granat
- Department of Paediatrics B.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv
| | - Shiri Spielman
- Paediatric Rheumatology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Centre, Tel Hashomer.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv.,Department of Paediatrics A, Edmond and Lily Safra Children's Hospital, Sheba Medical Centre, Tel Hashomer, Israel
| | - Rotem Semo Oz
- Section of Paediatric Rheumatology, University of Chicago Medical Centre, Chicago, IL, USA
| | - Yael Shinar
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv.,Department of Genetics, Sheba Medical Centre, Tel Hashomer, Israel
| | - Maya Gerstein
- Paediatric Rheumatology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Centre, Tel Hashomer.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv
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24
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Tanatar A, Karadağ ŞG, Sönmez HE, Çakan M, Ayaz NA. Comparison of Pediatric Familial Mediterranean Fever Patients Carrying Only E148Q Variant With the Ones Carrying Homozygous Pathogenic Mutations. J Clin Rheumatol 2021; 27:182-186. [PMID: 31972733 DOI: 10.1097/rhu.0000000000001261] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aims of this study were to compare demographic data, clinical features, and severity scores of familial Mediterranean fever patients carrying E148Q variant with the patients having homozygous pathogenic MEFV mutations and to evaluate both of these groups for the performance of Tel-Hashomer, Livneh, and pediatric diagnostic criteria. METHODS The demographic and clinical data of patients with familial Mediterranean fever either heterozygous or homozygous for E148Q variant (group 1) and patients with homozygous mutations (M694V, M694I, M680I, V726A) (group 2) were collected retrospectively. All patients were evaluated for 3 diagnostic criteria. RESULTS E148Q variant was present in 128 patients (22.9%), 112 of whom had heterozygous and 16 of whom had homozygous E148Q mutation. Group 2 had 430 patients (77.1%), 372 of whom had homozygous M694V mutation, 50 of whom had homozygous M680I mutation, 5 of whom had homozygous V726A mutation, and 3 of whom had homozygous M694I mutation. Pleuritis, arthritis, recurrent fever, erysipelas-like erythema, and anemia were significantly more common in group 2 than group 1 (p < 0.05). Moderate and severe Pras scores were significantly higher in group 2 (p < 0.001). During attack-free periods, C-reactive protein, erythrocyte sedimentation rate, and serum amyloid A were found significantly higher in group 2 than in group 1 (p < 0.05). The percentage of children diagnosed according to Tel-Hashomer and pediatric criteria was significantly higher in group 2 than in group 1 (p < 0.05). Both groups show similar diagnostic utility by Livneh criteria. CONCLUSIONS Children with the E148Q variant met the 3 diagnostic criteria; they had a milder disease course both clinically and in laboratory means.
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Affiliation(s)
- Ayşe Tanatar
- From the Department of Pediatric Rheumatology, University of Health Sciences, Kanuni Sultan Süleyman Research and Training Hospital, Istanbul, Turkey
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25
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Delplanque M, Ducharme-Bénard S, Moguelet P, Chasset F, Grateau G, Georgin-Lavialle S, Bachmeyer C. Is neutrophilic dermatosis a manifestation of familial Mediterranean fever? Scand J Rheumatol 2021; 51:42-49. [PMID: 34159892 DOI: 10.1080/03009742.2021.1904588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives: Familial Mediterranean fever (FMF) is the most frequent monogenic autoinflammatory disease. It is associated with MEFV mutations. Its main features are recurrent episodes of fever and serositis. Patients can display dermatological manifestations such as erysipelas-like erythema, generally considered as a neutrophilic dermatosis (ND). It has been suggested that FMF can be associated with other types of ND. Our aim was to perform a systematic review of the literature to assess the link between ND and FMF.Method: A systematic review of the literature was performed using MEDLINE from 1946 to 2018. Three independent investigators identified reports of non-erysipelas-like erythema neutrophilic dermatosis (NEND) associated with FMF, selected the criteria to establish the diagnosis of FMF and ND, and evaluated the link between the two conditions. FMF-associated NEND was supported by confirmation of both diagnoses and exclusion of other causes of ND.Results: Eighteen articles were selected. Nine articles reported FMF patients with the following NEND: neutrophilic panniculitis (n = 4), Sweet syndrome (n = 6), and pyoderma gangrenosum (n = 1). None of these cases was supported by histological confirmation, fulfilled diagnostic criteria for definitive or probable FMF, or confirmed the exclusion of all the most frequent diseases associated with NEND. As a result, there is insufficient evidence to support a potential relationship between NEND and FMF.Conclusions: The association between FMF and NEND remains unclear. In FMF patients with NEND, every differential diagnosis and alternative cause of NEND should be excluded before drawing any conclusions about a potential causal relationship.
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Affiliation(s)
- M Delplanque
- Internal Medicine Department, Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), Tenon Hospital, Paris, France
| | - S Ducharme-Bénard
- Internal Medicine Department, Sacré-Coeur Hospital, Montreal, Canada
| | - P Moguelet
- Anatomopathology Department, Tenon Hospital, Paris, France
| | - F Chasset
- Dermatology Department, Tenon Hospital, Paris, France
| | - G Grateau
- Internal Medicine Department, Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), Tenon Hospital, Paris, France
| | - S Georgin-Lavialle
- Internal Medicine Department, Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), Tenon Hospital, Paris, France
| | - C Bachmeyer
- Internal Medicine Department, Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), Tenon Hospital, Paris, France
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26
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Monogenic Autoinflammatory Diseases: State of the Art and Future Perspectives. Int J Mol Sci 2021; 22:ijms22126360. [PMID: 34198614 PMCID: PMC8232320 DOI: 10.3390/ijms22126360] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 12/18/2022] Open
Abstract
Systemic autoinflammatory diseases are a heterogeneous family of disorders characterized by a dysregulation of the innate immune system, in which sterile inflammation primarily develops through antigen-independent hyperactivation of immune pathways. In most cases, they have a strong genetic background, with mutations in single genes involved in inflammation. Therefore, they can derive from different pathogenic mechanisms at any level, such as dysregulated inflammasome-mediated production of cytokines, intracellular stress, defective regulatory pathways, altered protein folding, enhanced NF-kappaB signalling, ubiquitination disorders, interferon pathway upregulation and complement activation. Since the discover of pathogenic mutations of the pyrin-encoding gene MEFV in Familial Mediterranean Fever, more than 50 monogenic autoinflammatory diseases have been discovered thanks to the advances in genetic sequencing: the advent of new genetic analysis techniques and the discovery of genes involved in autoinflammatory diseases have allowed a better understanding of the underlying innate immunologic pathways and pathogenetic mechanisms, thus opening new perspectives in targeted therapies. Moreover, this field of research has become of great interest, since more than a hundred clinical trials for autoinflammatory diseases are currently active or recently concluded, allowing us to hope for considerable acquisitions for the next few years. General paediatricians need to be aware of the importance of this group of diseases and they should consider autoinflammatory diseases in patients with clinical hallmarks, in order to guide further examinations and refer the patient to a specialist rheumatologist. Here we resume the pathogenesis, clinical aspects and diagnosis of the most important autoinflammatory diseases in children.
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27
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Babaoglu H, Armagan B, Bodakci E, Satis H, Atas N, Sari A, Yasar Bilge NS, Bilici Salman R, Yardımcı GK, Avanoglu Guler A, Karadeniz H, Kilic L, Ozturk MA, Goker B, Haznedaroglu S, Kalyoncu U, Kasifoglu T, Tufan A. Predictors of persistent inflammation in familial Mediterranean fever and association with damage. Rheumatology (Oxford) 2021; 60:333-339. [PMID: 32778893 DOI: 10.1093/rheumatology/keaa378] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/01/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Persistent inflammation is an insidious and less studied feature of FMF. We investigated clinical determinants of persistent inflammation and its associations with individual damage items. METHODS This is a cross-sectional analysis of 917 FMF patients, who fulfilled the Tel Hashomer criteria and had at least 6 months' follow-up. Patients were stratified based on whether they had persistent inflammation. We used logistic regression analysis to investigate independent predictors of persistent inflammation and the associated individual damage items. RESULTS One hundred and forty-two (15%) patients had persistent inflammation. Active FMF (54%) was the most prominent reason for the persistent inflammation. Spondylarthritis (16%), other inflammatory arthritis (8%) and IBD (2%) were other frequent reasons. Male gender, history of exertional leg pain, inflammatory comorbidities, M694V homozygosity, colchicine resistance, lower education levels and musculoskeletal attack dominance were found to be the independent predictors of persistent inflammation. Earlier disease onset led to a tendency towards persistent inflammation. Patients with persistent inflammation were more likely to suffer damage. There is an increased risk of developing proteinuria, amyloidosis and renal insufficiency. CONCLUSION We identified, for the first time, the predictors of persistent inflammation in adult FMF patients and related individual damage items of the Autoinflammatory Disease Damage Index. Persistent inflammation is insidious and one of the chief causes of damage; therefore, especially patients with these predictors should be followed up more closely. If detected, underlying inflammatory comorbidities should be assessed meticulously as early detection and proper treatment strategies may favourably impact the natural history of the disease.
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Affiliation(s)
- Hakan Babaoglu
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gazi University, Ankara
| | - Berkan Armagan
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara
| | - Erdal Bodakci
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Hasan Satis
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gazi University, Ankara
| | - Nuh Atas
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gazi University, Ankara
| | - Alper Sari
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara
| | - Nazife Sule Yasar Bilge
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Reyhan Bilici Salman
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gazi University, Ankara
| | - Gozde Kubra Yardımcı
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara
| | - Aslihan Avanoglu Guler
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gazi University, Ankara
| | - Hazan Karadeniz
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gazi University, Ankara
| | - Levent Kilic
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara
| | - Mehmet Akif Ozturk
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gazi University, Ankara
| | - Berna Goker
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gazi University, Ankara
| | - Seminur Haznedaroglu
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gazi University, Ankara
| | - Umut Kalyoncu
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara
| | - Timucin Kasifoglu
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Abdurrahman Tufan
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gazi University, Ankara
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Rapid Flow Cytometry-Based Assay for the Functional Classification of MEFV Variants. J Clin Immunol 2021; 41:1187-1197. [PMID: 33733382 DOI: 10.1007/s10875-021-01021-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/09/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE Pathogenic MEFV variants cause pyrin-associated autoinflammatory diseases (PAADs), which include familial Mediterranean fever (FMF), FMF-like disease, and pyrin-associated autoinflammation with neutrophilic dermatosis (PAAND). The diagnosis of PAADs is established by clinical phenotypic and genetic analyses. However, the pathogenicity of most MEFV variants remains controversial, as they have not been functionally evaluated. This study aimed to establish and validate a new functional assay to evaluate the pathogenicity of MEFV variants. METHODS We transfected THP-1 monocytes with 32 MEFV variants and analyzed their effects on cell death with or without stimulation with Clostridium difficile toxin A (TcdA) or UCN-01. These variants were classified using hierarchical cluster analysis. Macrophages were obtained from three healthy controls and two patients with a novel homozygous MEFVP257L variant, for comparison of IL-1β secretion using a cell-based assay and a novel THP-1-based assay. RESULTS Disease-associated MEFV variants induced variable degrees of spontaneous or TcdA/UCN-01-induced cell death in THP-1. Cell death was caspase-1 dependent and was accompanied by ASC speck formation and IL-1β secretion, indicating that pathogenic MEFV variants induced abnormal pyrin inflammasome activation and subsequent pyroptotic cell deaths in this assay. The MEFV variants (n = 32) exhibiting distinct response signatures were classified into 6 clusters, which showed a good correlation with the clinical phenotypes. Regarding the pathogenicity of MEFVP257L variants, the results were consistent between the cell-based assay and the THP-1-based assay. CONCLUSION Our assay facilitates a rapid and comprehensive assessment of the pathogenicity of MEFV variants and contributes to a refined definition of PAAD subtypes.
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Okuyan HM, Begen MA. miRNAs as attractive diagnostic and therapeutic targets for Familial Mediterranean Fever. Mod Rheumatol 2021; 31:949-959. [PMID: 33427536 DOI: 10.1080/14397595.2020.1868674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Familial Mediterranean Fever (FMF) is a hereditary early-onset disease that causes periodical fever attack, excessive release of IL-1β, serositis, arthritis and peritonitis. Genetic analyses conducted on FMF patients (mutated and non-mutated) have highlighted that additional contributing factors such as epigenetics and environment play a role in clinical manifestations of FMF. Recently researchers report that microRNAs (miRNAs), implicated in epigenetic mechanisms, may contribute to the pathogenesis of FMF. miRNAs, a member of the captivating noncoding RNA family, are the single-strand transcripts that work in physiological and pathophysiological processes by regulating target gene expression. Recent studies have shown that miRNAs are associated with various mechanisms involved in the pathogenesis of FMF, such as apoptosis, inflammation and autophagy. Moreover, these miRNAs molecules might have potential use in treatment, therapeutic response monitoring and the diagnosis of subtypes of the disease in the future. Motivated by these potential benefits (diagnostic and therapeutic) of miRNAs, we focus on recent advances of clinical significances and potential action mechanisms of miRNAs in FMF pathogenesis and discuss their potential use for FMF.
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Affiliation(s)
- Hamza Malik Okuyan
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada.,Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Sakarya University of Applied Sciences, Sakarya, Turkey
| | - Mehmet A Begen
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry; Ivey Business School; University of Western Ontario, London, Canada
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Öztürk K, Coşkuner T, Baglan E, Sönmez HE, Yener GO, Çakmak F, Demirkan FG, Tanatar A, Karadag SG, Ozdel S, Demir F, Çakan M, Aktay Ayaz N, Sözeri B. Real-Life Data From the Largest Pediatric Familial Mediterranean Fever Cohort. Front Pediatr 2021; 9:805919. [PMID: 35127599 PMCID: PMC8812847 DOI: 10.3389/fped.2021.805919] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/27/2021] [Indexed: 11/29/2022] Open
Abstract
Familial Mediterranean fever (FMF) is the most common monogenic autoinflammatory disease manifesting phenotypic heterogeneity. It is a clinically diagnosed disease supported by MEditerranean FeVer (MEFV) gene mutation analysis. However, the phenotype-genotype correlation is not yet established clearly. We aimed to determine the clinical findings, phenotype-genotype correlation, and treatment outcomes within a large pediatric FMF cohort. The medical charts of children with FMF who were diagnosed and followed up at the eight pediatric rheumatology units were reviewed retrospectively. All patients in the cohort were analyzed for sequence variants in exon 2,3,5 and 10 of the MEFV gene. Patients without any mutations or with polymorphisms including R202Q were excluded. A total of 3,454 children were involved in the study. The mean ± standard deviation of current age, age at symptom onset, and age at diagnosis were 12.1 ± 5.2, 5.1 ± 3.8, and 7.3 ± 4.0 years, respectively. Of 3,454 patients, 88.2% had abdominal pain, 86.7% had fever, 27.7% had arthritis, 20.2% had chest pain, 23% had myalgia, and 13.1% had erysipelas-like erythema. The most common MEFV mutation patterns were homozygous (32.5%) and heterozygous (29.9%) mutations of exon 10. Homozygous M694V was present in 969 patients (28.1%). Allele frequencies of common mutations were M694V (55.3%), M680I (11.3%), V726A (7.6%), and E148Q (7.2%). Children carrying homozygous or compound heterozygous exon 10 mutations had an earlier age of disease onset (4.6 vs. 5.6 years, p = 0.000) and a higher number of attacks per year (11.1 vs. 9.6, p = 0.001). Although 8% of the patients had a family history of amyloidosis, 0.3% (n = 11) had the presence of amyloidosis. M694V homozygosity was detected in nine patients who developed amyloidosis. Colchicine resistance was present in 4.2% of our patients. In this largest pediatric cohort reviewed and presented to date, patients with exon 10 mutations, particularly the M694V homozygous mutation, have been demonstrated earlier disease onset, annual attack count, and more frequent colchicine-resistant cases. Although E148Q is considered as a polymorphism in some populations, it was identified as a disease-causing mutation in our cohort. Secondary amyloidosis is still happening in adults however, it is extremely rare among children, presumably due to increased awareness, tight control, and the availability of anti-IL1 agents in colchicine-resistant cases.
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Affiliation(s)
- Kübra Öztürk
- Istanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Taner Coşkuner
- Department of Rheumatology, Umraniye Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Esra Baglan
- Dr. Sami Ulus Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | | | | | - Figen Çakmak
- Pediatric Rheumatology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Fatma Gül Demirkan
- Pediatric Rheumatology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayşe Tanatar
- Pediatric Rheumatology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Semanur Ozdel
- Dr. Sami Ulus Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Ferhat Demir
- Department of Rheumatology, Umraniye Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mustafa Çakan
- Zeynep Kamil Maternity and Childrens Hospital, Istanbul, Turkey
| | - Nuray Aktay Ayaz
- Pediatric Rheumatology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Betül Sözeri
- Department of Rheumatology, Umraniye Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
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Yago T, Asano T, Fujita Y, Migita K. Familial Mediterranean fever phenotype progression into anti-cyclic citrullinated peptide antibody-positive rheumatoid arthritis:a case report. Fukushima J Med Sci 2020; 66:160-166. [PMID: 33162488 PMCID: PMC7790467 DOI: 10.5387/fms.2020-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Familial Mediterranean fever (FMF) is caused by dysfunction of the MEFV gene product, pyrin. Here we report a case of FMF phenotype which developed into rheumatoid arthritis (RA), based on a positive result for anti-cyclic citrullinated peptide (CCP) antibody (Ab). A 42-year-old woman presented to our clinic with more than 6 months of intermittent arthralgia in the wrists, feet, and fingers associated with menstruation. No fever was reported and there was no family history of FMF or other autoimmune diseases. Laboratory tests revealed elevated C-reactive protein (CRP) and rheumatoid factor (RF). Tests for autoantibodies including anti-CCP Ab, antinuclear Ab, and anti-DNA Ab were all negative. Genetic analysis identified an R304R homozygous mutation in MEFV; however, the pathological significance is unclear because this mutation does not cause amino acid substitution. We diagnosed incomplete FMF phenotype despite the lack of fever due to periodic arthritis, lack of autoantibodies, and complete resolution of arthritis following colchicine treatment within a day. Several months later, increased stiffness and arthralgia persistently occurred in finger joints on both sides. Ultrasonography revealed synovitis at the metacarpophalangeal and metatarsophalangeal joints. Laboratory analysis revealed the patient to be positive for anti-CCP Ab. Therefore, we finally diagnosed RA. Her arthritis diminished following administration of methotrexate and salazosulfapyridine. We consider the possibility that pyrin dysfunction may have affected the acquired immunity, contributing to the onset of RA as an autoimmune disease. This is an interesting case of equivalent FMF progressing into RA and will be valuable to raise awareness of a continuum from autoinflammatory to autoimmune disease.
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Affiliation(s)
- Toru Yago
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Tomoyuki Asano
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Yuya Fujita
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Kiyoshi Migita
- Department of Rheumatology, Fukushima Medical University School of Medicine
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Endo Y, Koga T, Kawakami A. Comment on: Successful hydroxychloroquine treatment for familial Mediterranean fever in a Japanese patient with concurrent systemic lupus erythematosus: reply. Rheumatology (Oxford) 2020; 59:e156-e157. [DOI: 10.1093/rheumatology/keaa563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 08/06/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yushiro Endo
- Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Tomohiro Koga
- Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
| | - Atsushi Kawakami
- Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Medical Sciences, Nagasaki, Japan
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Batu ED, Ozen S. Comment on: Successful hydroxychloroquine treatment for familial Mediterranean fever in a Japanese patient with concurrent systemic lupus erythematosus. Rheumatology (Oxford) 2020; 59:e155. [DOI: 10.1093/rheumatology/keaa562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/06/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ezgi Deniz Batu
- Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Ozen
- Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Sözeri B, Demir F, Sönmez HE, Karadağ ŞG, Demirkol YK, Doğan ÖA, Doğanay HL, Ayaz NA. Comparison of the clinical diagnostic criteria and the results of the next-generation sequence gene panel in patients with monogenic systemic autoinflammatory diseases. Clin Rheumatol 2020; 40:2327-2337. [PMID: 33165748 DOI: 10.1007/s10067-020-05492-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/04/2020] [Accepted: 10/29/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION/OBJECTIVES The clinicians initially prefer to define patients with the systemic autoinflammatory disease (SAID)'s based on recommended clinical classification criteria; then, they confirm the diagnosis with genetic testing. We aimed to compare the initial phenotypic diagnoses of the patients who were followed up with the preliminary diagnosis of a monogenic SAID, and the genotypic results obtained from the next-generation sequence (NGS) panel. METHOD Seventy-one patients with the preliminary diagnosis of cryopyrin-associated periodic fever syndrome (CAPS), mevalonate kinase deficiency (MKD), or tumor necrosis factor-alpha receptor-associated periodic fever syndrome (TRAPS) were included in the study. The demographic data, clinical findings, laboratory results, and treatments were recorded. All patients were examined by NGS panel analysis including 16 genes. The genetic results were compared with the initial Federici score to determine whether they were compatible with each other. RESULTS Thirty patients were initially classified as MKD, 22 as CAPS, and 19 as TRAPS. The frequency of clinical manifestations was urticarial rash 57.7%, diarrhea 49.2%, abdominal pain 47.8%, arthralgia 45%, oral aphthae 43.6%, myalgia 32.3%, tonsillitis 28.1%, and conjunctivitis 25.3%, respectively. After NGS gene panel screening, 13 patients were diagnosed with CAPS, 8 with MKD, 7 with familial Mediterranean fever, 5 with TRAPS, and 2 with NLRP12-associated periodic syndrome. The remaining 36 patients were genetically identified as undefined SAID since they were not classified as one of the defined SAIDs after the result of the NGS panel. CONCLUSIONS We have demonstrated that clinical diagnostic criteria may not always be sufficient to establish the correct diagnosis. There is still low accordance between clinical diagnoses and molecular analyses. In the case of a patient with a preliminary diagnosis of a monogenic SAID with the negative result of target gene analysis, other autoinflammatory diseases should also be kept in mind in the differential diagnosis. Key Points • Monogenic autoinflammatory diseases can present with different clinical manifestations. • The clinical diagnostic criteria may not always be sufficient to reach the correct diagnosis in autoinflammatory diseases. • In the case of a patient with a preliminary diagnosis of a monogenic SAID with the negative result of target gene analysis, other autoinflammatory diseases should be kept in mind in the differential diagnosis.
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Affiliation(s)
- Betül Sözeri
- Department of Pediatric Rheumatology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ferhat Demir
- Department of Pediatric Rheumatology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
| | - Hafize Emine Sönmez
- Department of Pediatric Rheumatology, Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Şerife Gül Karadağ
- Department of Pediatric Rheumatology, Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Yasemin Kendir Demirkol
- Department of Pediatric Genetics, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Özlem Akgün Doğan
- Department of Pediatric Genetics, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Hamdi Levent Doğanay
- Genomic Laboratory (GLAB), Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Shinar Y, Ceccherini I, Rowczenio D, Aksentijevich I, Arostegui J, Ben-Chétrit E, Boursier G, Gattorno M, Hayrapetyan H, Ida H, Kanazawa N, Lachmann HJ, Mensa-Vilaro A, Nishikomori R, Oberkanins C, Obici L, Ohara O, Ozen S, Sarkisian T, Sheils K, Wolstenholme N, Zonneveld-Huijssoon E, van Gijn ME, Touitou I. ISSAID/EMQN Best Practice Guidelines for the Genetic Diagnosis of Monogenic Autoinflammatory Diseases in the Next-Generation Sequencing Era. Clin Chem 2020; 66:525-536. [PMID: 32176780 DOI: 10.1093/clinchem/hvaa024] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/08/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Monogenic autoinflammatory diseases are caused by pathogenic variants in genes that regulate innate immune responses, and are characterized by sterile systemic inflammatory episodes. Since symptoms can overlap within this rapidly expanding disease category, accurate genetic diagnosis is of the utmost importance to initiate early inflammation-targeted treatment and prevent clinically significant or life-threatening complications. Initial recommendations for the genetic diagnosis of autoinflammatory diseases were limited to a gene-by-gene diagnosis strategy based on the Sanger method, and restricted to the 4 prototypic recurrent fevers (MEFV, MVK, TNFRSF1A, and NLRP3 genes). The development of best practices guidelines integrating critical recent discoveries has become essential. METHODS The preparatory steps included 2 online surveys and pathogenicity annotation of newly recommended genes. The current guidelines were drafted by European Molecular Genetics Quality Network members, then discussed by a panel of experts of the International Society for Systemic Autoinflammatory Diseases during a consensus meeting. RESULTS In these guidelines, we combine the diagnostic strength of next-generation sequencing and recommendations to 4 more recently identified genes (ADA2, NOD2, PSTPIP1, and TNFAIP3), nonclassical pathogenic genetic alterations, and atypical phenotypes. We present a referral-based decision tree for test scope and method (Sanger versus next-generation sequencing) and recommend on complementary explorations for mosaicism, copy-number variants, and gene dose. A genotype table based on the 5-category variant pathogenicity classification provides the clinical significance of prototypic genotypes per gene and disease. CONCLUSIONS These guidelines will orient and assist geneticists and health practitioners in providing up-to-date and appropriate diagnosis to their patients.
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Affiliation(s)
- Yael Shinar
- Laboratory of FMF, Amyloidosis and Rare Autoinflammatory Diseases, Heller Institute, Sheba Medical Center, Tel Hashomer, Israel
| | | | | | | | - Juan Arostegui
- Department of Immunology, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Eldad Ben-Chétrit
- Rheumatology Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Guilaine Boursier
- Department of Medical Genetics, Rare Diseases and Personalized Medicine, Reference Center CEREMAIA, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Marco Gattorno
- Center for Autoinflammatory Diseases and Immunodeficiency, IRCCS Giannina Gaslini, Genova
| | | | - Hiroaki Ida
- Department of Medicine, Division of Respirology, Neurology and Rheumatology, Kurume University School of Medicine, Kurume, Japan
| | - Nobuo Kanazawa
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | | | | | - Ryuta Nishikomori
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | | | - Laura Obici
- Amyloidosis Research and Treatment Centre, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Osamu Ohara
- Department of Applied Genomics, Kazusa DNA Research Institute, Kisarazu, Japan
| | - Seza Ozen
- Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Tamara Sarkisian
- Center of Medical Genetics and Primary Health Care, Yerevan, Armenia
| | - Katie Sheils
- European Molecular Genetics Quality Network (EMQN), Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester, UK
| | - Nicola Wolstenholme
- European Molecular Genetics Quality Network (EMQN), Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester, UK
| | - Evelien Zonneveld-Huijssoon
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marielle E van Gijn
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Isabelle Touitou
- Department of Medical Genetics, Rare Diseases and Personalized Medicine, Reference Center CEREMAIA, CHU Montpellier, University of Montpellier, Montpellier, France.,Stem Cells, Cellular Plasticity, Regenerative Medicine and Immunotherapies, INSERM, Montpellier, France
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Sahr T, Kiltz U, Weseloh C, Kallinich T, Braun J. [Results of the systematic literature search as basis for the "Evidence-based treatment recommendations for familial Mediterranean fever patients with insufficient response or intolerability to colchicine" of the Society for Pediatric and Adolescent Rheumatology and the German Society for Rheumatology]. Z Rheumatol 2020; 79:943-951. [PMID: 32997267 PMCID: PMC7647992 DOI: 10.1007/s00393-020-00886-0] [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] [Accepted: 08/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Familial Mediterranean fever (FMF) is a genetic disease of childhood and adulthood which is relatively rare in Germany. It is characterized by recurrent febrile attacks, peritonitis, pleuritis and arthritis. The established treatment with colchicine is effective and well-tolerated by most patients; however, some patients do not adequately respond or do not tolerate this treatment. Biologics can be considered for some of these patients. The Society for Pediatric and Adolescent Rheumatology (GKJR) and the German Society for Rheumatology (DGRh) have agreed to develop joint recommendations for this specific clinical situation. AIM Implementation of a systematic literature search (SLR) on the basis of the EULAR recommendations published in 2016 as the foundation for the development of evidence-based treatment recommendations for FMF patients with insufficient response or intolerance to colchicine. METHODS The SLR was performed using references from various databases as an update of the SLR carried out by EULAR up to 2014, whereby all articles must have been published between 1 January 2015 and 31 December 2017. The Rayyan abstract tool for the preselection and the classification of the Oxford Centre for Evidence Based Medicine 2009 were used for the preparation of the evidence tables. RESULTS The search yielded 360 hits and after duplicate matching 263. A total of 88 publications were included (34%) and 102 excluded (39%), a review of the full publication was necessary for a further 73 (28%) and 43 were discussed more intensively. Finally, 64 publications (24%) remained. A total of 4 case-control studies, 31 cohort studies, 8 case series, 7 controlled studies (including 5 abstracts), 10 reviews, 4 meta-analyses and systematic reviews were accepted. DISCUSSION The SLR was carried out in a scientifically accurate and transparent manner according to international standards. The SLR proved to be a good basis for a consensus on the 5 overarching principles and the 10 recommendations, so that the joint activity of the GKJR and DGRh was successfully and even promptly concluded. The recommendations are a solid basis for treating patients of all ages with FMF. The explanations on the problem of colchicine resistance play an important role here.
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Affiliation(s)
- T Sahr
- Rheumazentrum Ruhrgebiet, Herne, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
| | - U Kiltz
- Rheumazentrum Ruhrgebiet, Herne, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
| | - C Weseloh
- Deutsche Gesellschaft für Rheumatologie, Berlin, Deutschland
| | - T Kallinich
- Pädiatrie m.S. Pulmonologie und Immunologie, Sozialpädiatrisches Zentrum, Universitätsmedizin Charité Berlin, Berlin, Deutschland
| | - J Braun
- Rheumazentrum Ruhrgebiet, Herne, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland.
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Celiksoy M, Dogan C, Erturk B, Keskin E, Ada B. The MEFV gene and its association with familial Mediterranean fever, severe atopy, and recurrent respiratory tract infections. Allergol Immunopathol (Madr) 2020; 48:430-440. [PMID: 32359823 DOI: 10.1016/j.aller.2019.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/25/2019] [Accepted: 12/17/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Familial Mediterranean fever (FMF) is the most common auto-inflammatory disease and is characterized by self-limiting episodes of fever and polyserositis. The aim of this study was to determine the atopic clinical findings associated with the MEFV gene. METHODS A retrospective chart review was conducted of pediatric patients who had received a diagnosis of familial Mediterranean fever between August 2015 and November 2018. RESULTS A total of 454 patients with familial Mediterranean fever were evaluated. The median age of diagnosis was 60 months (min-max: 6-228) and the percentage of patients who were male was 57.5%. A MEFV gene mutation was determined in 310 (68.3%) children. The most frequent genetic mutation was a R202Q heterozygote mutation, which was found in 95 patients (20.9%). When compared with MEFV-negative patients, elevation of serum amyloid A and fibrinogen levels during an episode of FMF was found to occur more frequently in MEFV-positive patients (p=0.019 and 0.027, respectively). Male gender, cigarette exposure, and a younger diagnosis age were seen more frequently in patients who had episodes with fever (p=0.039, 0.022, and 0.001, respectively). Chronic cough with sputum and persistent purulent rhinitis were more frequent in the group which did not experience fever episodes (p=0.003 and 0.002, respectively). CONCLUSIONS While being a periodic fever syndrome, familial Mediterranean fever also presents as a multisystemic disease with heterogeneous clinical symptoms. Severe atopic diseases and recurrent respiratory tract infections are characteristic features of this disease.
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Ait-Idir D, Djerdjouri B. Differential mutational profiles of familial Mediterranean fever in North Africa. Ann Hum Genet 2020; 84:423-430. [PMID: 32818295 DOI: 10.1111/ahg.12404] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 11/30/2022]
Abstract
Familial Mediterranean fever (FMF) is a recessive autoinflammatory disease, mainly occurring in the eastern Mediterranean. In these populations, the five FMF founder mutations are differently distributed. In Algeria, the FMF-causing variants remain poorly explored. This retrospective study aims to report the mutational profile of Algerian FMF patients and to compare it with North African FMF patients. One hundred eighty-three unrelated patients clinically suspected of FMF were recruited from various Algerian hospitals (2007-2015) and tested for mutations in exon 10 of MEFV gene. Molecular analysis identified 144 mutant alleles among 87 of 183 patients (47.5%). p.M694I was the most prevalent pathogenic allele, accounting for 63.2% of mutant alleles, followed by p.M694V and p.M680I occurring with a same frequency (14.5%). Others, p.A744S (6.2%) and p.I692del (1.3%), are less frequent. Interestingly, p.M694I was the most recurrent in patients with renal AA-amyloidosis. Our results provide the first genetic data on FMF in Algeria, demonstrating the predominance of p.M694I and the absence of p.V726A, compared to other North African countries (Morocco, Tunisia, and Egypt). In conclusion, North African FMF patients display differential mutational profiles that may result from the difference in ethnic origin and the genetic heterogeneity among these populations.
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Affiliation(s)
- Djouher Ait-Idir
- Research Laboratory, Biodiversity, Biotechnology, Environment and Sustainable Development, Department of Biology, Faculty of Sciences, M'Hamed Bougara University, Boumerdes, Algeria
| | - Bahia Djerdjouri
- Laboratory of Cellular and Molecular Biology, Faculty of Biological Sciences, University of Sciences and Technology Houari Boumediene, Algiers, Algeria
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Clinical Features at Onset and Genetic Characterization of Pediatric and Adult Patients with TNF- α Receptor-Associated Periodic Syndrome (TRAPS): A Series of 80 Cases from the AIDA Network. Mediators Inflamm 2020; 2020:8562485. [PMID: 32831641 PMCID: PMC7428902 DOI: 10.1155/2020/8562485] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/19/2020] [Indexed: 11/29/2022] Open
Abstract
This study explores demographic, clinical, and therapeutic features of tumor necrosis factor receptor-associated periodic syndrome (TRAPS) in a cohort of 80 patients recruited from 19 Italian referral Centers. Patients' data were collected retrospectively and then analyzed according to age groups (disease onset before or after 16 years) and genotype (high penetrance (HP) and low penetrance (LP) TNFRSF1A gene variants). Pediatric- and adult-onset were reported, respectively, in 44 and 36 patients; HP and LP variants were found, respectively, in 32 and 44 cases. A positive family history for recurrent fever was reported more frequently in the pediatric group than in the adult group (p < 0.05). With reference to clinical features during attacks, pericarditis and myalgia were reported more frequently in the context of adult-onset disease than in the pediatric age (with p < 0.01 and p < 0.05, respectively), while abdominal pain was present in 84% of children and in 25% of adults (p < 0.01). Abdominal pain was significantly associated also to the presence of HP mutations (p < 0.01), while oral aphthosis was more frequently found in the LP variant group (p < 0.05). Systemic amyloidosis occurred in 25% of subjects carrying HP variants. As concerns laboratory features, HP mutations were significantly associated to higher ESR values (p < 0.01) and to the persistence of steadily elevated inflammatory markers during asymptomatic periods (p < 0.05). The presence of mutations involving a cysteine residue, abdominal pain, and lymphadenopathy during flares significantly correlated with the risk of developing amyloidosis and renal impairment. Conversely, the administration of colchicine negatively correlated to the development of pathologic proteinuria (p < 0.05). Both NSAIDs and colchicine were used as monotherapy more frequently in the LP group compared to the HP group (p < 0.01). Biologic agents were prescribed to 49 (61%) patients; R92Q subjects were more frequently on NSAIDs monotherapy than other patients (p < 0.01); nevertheless, they required biologic therapy in 53.1% of cases. At disease onset, the latest classification criteria for TRAPS were fulfilled by 64/80 (80%) patients (clinical plus genetic items) and 46/80 (57.5%) patients (clinical items only). No statistically significant differences were found in the sensitivity of the classification criteria according to age at onset and according to genotype (p < 0.05). This study describes one of the widest cohorts of TRAPS patients in the literature, suggesting that the clinical expression of this syndrome is more influenced by the penetrance of the mutation rather than by the age at onset itself. Given the high phenotypic heterogeneity of the disease, a definite diagnosis should rely on both accurate working clinical assessment and complementary genotype.
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Kehribar DY, Özgen M. The importance of Mediterranean fever gene in familial Mediterranean fever. Eur J Rheumatol 2020; 7:eurjrheum.2020.20107. [PMID: 32716837 PMCID: PMC7574771 DOI: 10.5152/eurjrheum.2020.20107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/13/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Familial Mediterranean fever (FMF) is the most common autoinflammatory disease characterized by recurrent serositis attacks and fever. The discovery of the Mediterranean fever (MEFV) gene has been a milestone in FMF etiopathogenesis. Our knowledge about the relationship between the MEFV gene and FMF phenotype increases each day. This study aims to investigate the relationship between MEFV gene mutations and the FMF clinical findings of a single-center FMF cohort. METHODS Gender, age, age at symptom onset, age at diagnosis, clinical characteristics, and MEFV gene analysis of the patients were recorded. RESULTS A total of 837 FMF patients were included in this study. There were 515 females and 322 males. The age at symptom onset was 18.3±10.9 years, while the age at diagnosis was 24.4±10.9 years. The most common symptom that accompanied fever was peritonitis (91.1%), while the other common clinical findings were pleuritis (45%), myalgia (44%), and arthritis (36%). A total of 47 patients developed amyloidosis. A total of 553 (66%) FMF patients had M694V mutation, 221 (26%) of which were homozygous, while 332 (40%) were heterozygous. Exon 10 mutation frequency was 759 (91%), while the non-exon 10 mutation frequency was 78 (9%). There was no wild type among the patients. CONCLUSION In conclusion, the fact that a vast majority of the disease burden was constituted by the exon 10, especially M694V mutations and that none of the 837 patients from our cohort had a wild-type FMF proved the significance of MEFV gene mutation analysis. Therefore, we speculate that it is necessary to examine the MEFV gene mutations in each FMF suspected case. It seems plausible to re-evaluate the FMF diagnosis for cases in which a wild type MEFV gene mutation occurs.
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Affiliation(s)
- Demet Yalçın Kehribar
- Department of Internal Medicine, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Metin Özgen
- Department of Rheumatology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
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Van Gorp H, Huang L, Saavedra P, Vuylsteke M, Asaoka T, Prencipe G, Insalaco A, Ogunjimi B, Jeyaratnam J, Cataldo I, Jacques P, Vermaelen K, Dullaers M, Joos R, Sabato V, Stella A, Frenkel J, De Benedetti F, Dehoorne J, Haerynck F, Calamita G, Portincasa P, Lamkanfi M. Blood-based test for diagnosis and functional subtyping of familial Mediterranean fever. Ann Rheum Dis 2020; 79:960-968. [PMID: 32312770 PMCID: PMC7307214 DOI: 10.1136/annrheumdis-2019-216701] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Familial Mediterranean fever (FMF) is the most common monogenic autoinflammatory disease (AID) worldwide. The disease is caused by mutations in the MEFV gene encoding the inflammasome sensor Pyrin. Clinical diagnosis of FMF is complicated by overlap in symptoms with other diseases, and interpretation of genetic testing is confounded by the lack of a clear genotype-phenotype association for most of the 340 reported MEFV variants. In this study, the authors designed a functional assay and evaluated its potential in supporting FMF diagnosis. METHODS Peripheral blood mononuclear cells (PBMCs) were obtained from patients with Pyrin-associated autoinflammation with an FMF phenotype (n=43) or with autoinflammatory features not compatible with FMF (n=8), 10 asymptomatic carriers and 48 healthy donors. Sera were obtained from patients with distinct AIDs (n=10), and whole blood from a subset of patients and controls. The clinical, demographic, molecular genetic factors and other characteristics of the patient population were assessed for their impact on the diagnostic test read-out. Interleukin (IL)-1β and IL-18 levels were measured by Luminex assay. RESULTS The ex vivo colchicine assay may be performed on whole blood or PBMC. The functional assay robustly segregated patients with FMF from healthy controls and patients with related clinical disorders. The diagnostic test distinguished patients with classical FMF mutations (M694V, M694I, M680I, R761H) from patients with other MEFV mutations and variants (K695R, P369S, R202Q, E148Q) that are considered benign or of uncertain clinical significance. CONCLUSION The ex vivo colchicine assay may support diagnosis of FMF and functional subtyping of Pyrin-associated autoinflammation.
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Affiliation(s)
- Hanne Van Gorp
- VIB Center for Inflammation Research, Zwijnaarde, Belgium
- Department of Internal Medicine and Paediatrics, Ghent University, Gent, Belgium
| | - Linyan Huang
- VIB Center for Inflammation Research, Zwijnaarde, Belgium
- Department of Internal Medicine and Paediatrics, Ghent University, Gent, Belgium
- School of Medical Technology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Pedro Saavedra
- VIB Center for Inflammation Research, Zwijnaarde, Belgium
- Department of Internal Medicine and Paediatrics, Ghent University, Gent, Belgium
| | | | - Tomoko Asaoka
- VIB Center for Inflammation Research, Zwijnaarde, Belgium
- Department of Internal Medicine and Paediatrics, Ghent University, Gent, Belgium
| | - Giusi Prencipe
- Rheumatology Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Benson Ogunjimi
- Department of Paediatrics, Antwerp University Hospital, Edegem, Belgium
- Antwerp Center for Translational Immunology and Virology (ACTIV), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Wilrijk, Belgium
- Centre for Health Economics Research & Modeling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Wilrijk, Belgium
- Department of Paediatric Rheumatology, Antwerp Hospital Network, Berchem, Belgium
- Department of Paediatrics, University Hospital Brussel, Jette, Belgium
- Antwerp centre for paediatric rheumatology and auto-inflammatory diseases, Antwerp Hospital Network and Antwerp University Hospital, Antwerp, Belgium
| | - Jerold Jeyaratnam
- Department of Pediatric Rheumatology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ilaria Cataldo
- Department of Biosciences, Biotechnologies and Biopharmaceutics, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Peggy Jacques
- VIB Center for Inflammation Research, Zwijnaarde, Belgium
- Department of Paediatric Rheumatology, Ghent University, Gent, Belgium
| | - Karim Vermaelen
- Department of Internal Medicine and Paediatrics, Ghent University, Gent, Belgium
- Tumor Immunology Laboratory, Department of Pulmonary Medicine, Ghent University Hospital, Gent, Belgium
| | - Melissa Dullaers
- VIB Center for Inflammation Research, Zwijnaarde, Belgium
- Clinical Immunology Research Lab, Centre for Primary Immunodeficiency Ghent, Ghent University Hospital, Gent, Belgium
| | - Rik Joos
- Antwerp centre for paediatric rheumatology and auto-inflammatory diseases, Antwerp Hospital Network and Antwerp University Hospital, Antwerp, Belgium
- Department of Pediatric Rheumatology, Ghent University Hospital, Gent, Belgium
| | - Vito Sabato
- Antwerp centre for paediatric rheumatology and auto-inflammatory diseases, Antwerp Hospital Network and Antwerp University Hospital, Antwerp, Belgium
- Immunology-Allergology-Rheumatology, University of Antwerp and Antwerp University Hospital, Edegem, Belgium
| | - Alessandro Stella
- Division of Medical Genetics, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Joost Frenkel
- Department of Pediatric Rheumatology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Joke Dehoorne
- VIB Center for Inflammation Research, Zwijnaarde, Belgium
- Department of Paediatric Rheumatology, Ghent University, Gent, Belgium
| | - Filomeen Haerynck
- Clinical Immunology Research Lab, Centre for Primary Immunodeficiency Ghent, Ghent University Hospital, Gent, Belgium
- Department of Paediatric Immunology and Pulmonology, Centre for Primary Immunodeficiency Ghent, Jeffrey Modell Diagnosis and Research Centre, Ghent University Hospital, Gent, Belgium
| | - Giuseppe Calamita
- Department of Biosciences, Biotechnologies and Biopharmaceutics, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Piero Portincasa
- Division of Internal Medicine, Department of Biomedical Sciences and Human Oncology, Clinica Medica "A Murri", University of Bari "Aldo Moro", Bari, Italy
| | - Mohamed Lamkanfi
- VIB Center for Inflammation Research, Zwijnaarde, Belgium
- Department of Internal Medicine and Paediatrics, Ghent University, Gent, Belgium
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Demir F, Doğan ÖA, Demirkol YK, Tekkuş KE, Canbek S, Karadağ ŞG, Sönmez HE, Ayaz NA, Doğanay HL, Sözeri B. Genetic panel screening in patients with clinically unclassified systemic autoinflammatory diseases. Clin Rheumatol 2020; 39:3733-3745. [PMID: 32458238 DOI: 10.1007/s10067-020-05108-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/14/2020] [Accepted: 04/16/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Systemic autoinflammatory diseases (SAIDs) may not always present with typical clinical findings of a monogenic disease. We aimed to genetically screen and diagnose these clinically unclassified patients by next-generation sequencing (NGS) analysis. METHOD A total of 64 patients who had clinical findings of a periodic fever syndrome but did not meet the clinical diagnostic criteria for any SAID or had clinical findings for more than one monogenic SAID were identified as "clinically unclassified SAIDs." NGS panel analysis, including 16 genes, was performed in these patients. Patients, who could not be classified as one of the defined SAID after the result of the NGS gene analysis, were identified as "undefined SAID." RESULTS The most common autoinflammatory symptoms in unclassified SAID patients were abdominal pain (60.9%), arthralgia (48.4%), urticarial rash (43.8%), myalgia (40.6%), oral aphthae (28.1%), and conjunctivitis (20.3%), respectively. In the result of the NGS gene panel screening, pathogenic, likely pathogenic variants, or VUS (variants of uncertain significance) were detected in 36 of 64 patients in at least one gene in the NGS panel. A total of 15 patients were diagnosed with a monogenic SAID according to both phenotypic and genotypic data; 12 patients as FMF, two patients as FCAS, and one patient as TRAPS, respectively. A total of 49 patients who did not meet the classification criteria including genetic results for a monogenic SAID were followed as undefined SAID. CONCLUSIONS The classification criteria described for SAIDs so far unfortunately do not cover all patients with signs of periodic fevers. The NGS gene panel appears to be a useful diagnostic tool for some of the patients with clinically unclassified SAID findings. Key Points • The classification criteria described for SAIDs do not cover all patients with signs of periodic fevers • The use of the undefined SAID nomenclature will benefit clinicians for diagnosis and initiating early treatment • The NGS panel appears to be a useful diagnostic tool in patients with clinically unclassified SAIDs.
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Affiliation(s)
- Ferhat Demir
- Department of Pediatric Rheumatology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
| | - Özlem Akgün Doğan
- Department of Pediatric Genetics, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Yasemin Kendir Demirkol
- Department of Pediatric Genetics, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Kübra Ermiş Tekkuş
- Genomic Laboratory (GLAB), Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sezin Canbek
- Genomic Laboratory (GLAB), Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Şerife Gül Karadağ
- Department of Pediatric Rheumatology, Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Hafize Emine Sönmez
- Department of Pediatric Rheumatology, Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Hamdi Levent Doğanay
- Genomic Laboratory (GLAB), Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Betül Sözeri
- Department of Pediatric Rheumatology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Theodoropoulou K, Wittkowski H, Busso N, Von Scheven-Gête A, Moix I, Vanoni F, Hengten V, Horneff G, Haas JP, Fischer N, Palm-Beden K, Berendes R, Heubner G, Jansson A, Lainka E, Leimgruber A, Morris M, Foell D, Hofer M. Increased Prevalence of NLRP3 Q703K Variant Among Patients With Autoinflammatory Diseases: An International Multicentric Study. Front Immunol 2020; 11:877. [PMID: 32477355 PMCID: PMC7241420 DOI: 10.3389/fimmu.2020.00877] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 04/16/2020] [Indexed: 12/23/2022] Open
Abstract
Background: The NLRP3 inflammasome has been recognized as one of the key components of innate immunity. Gain-of-function mutations in the exon 3 of NLRP3 gene have been implicated in inflammatory diseases suggesting the presence of functionally important sites in this region. Q703K (c.2107C>A, p.Gln703Lys, also known in the literature as Q705K) is a common variant of NLRP3, that has been considered to be both clinically unremarkable or disease-causing with a reduced penetrance. Objectives: We aimed to investigate the potential genetic impact of the NLRP3 variant Q703K in patients with recurrent fever presenting with two autoinflammatory diseases: PFAPA (periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis) and CAPS (cryopyrin-associated periodic syndrome), as well as with undefined autoinflammatory disease (uAID). Methods: This is an international multicentric observational retrospective study characterizing the clinical phenotype of patients presenting with recurrent fever suspected to be of auto-inflammatory origin and where the Q703K NLRP3 variant was found. Monocytes of parents of 6 Q703K+ PFAPA patients were studied and levels of pro-inflammatory cytokines produced by monocytes of Q703K+ and Q703K- parents have been compared by ELISA. Results: We report 42 patients with the Q703K NLRP3 genetic variant: 21 were PFAPA patients, 6 had a CAPS phenotype, and 15 had an uAID. The phenotypes of PFAPA, CAPS and uAID were quite similar between Q703K positive and negative patients with the exception of increased prevalence of pharyngitis in the Q703K positive CAPS population compared to the negative one. The in vitro production of IL-1β was not significantly different between Q703K+ and Q703K- monocytes from asymptomatic parents. Conclusion: The evidence we report in our study shows an increased prevalence of NLRP3 Q703K in patients with autoinflammatory diseases, suggesting an association between the Q703K variant and the risk of PFAPA, CAPS and uAID syndromes. However, we did not show a functional effect of this mutation on the inflammasome basal activity.
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Affiliation(s)
- Katerina Theodoropoulou
- Pediatric Rheumatology Unit of Western Switzerland, Pediatric Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Pediatric Department, Geneva University Hospital (HUG), Geneva, Switzerland.,Department of Biochemistry, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Helmut Wittkowski
- Department of Pediatric Rheumatology and Immunology, University Children's Hospital, Muenster, Germany
| | - Nathalie Busso
- Service of Rheumatology, DAL, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Annette Von Scheven-Gête
- Pediatric Rheumatology Unit of Western Switzerland, Pediatric Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Pediatric Department, Geneva University Hospital (HUG), Geneva, Switzerland
| | - Isabelle Moix
- Department of Genetics, SYNLAB, Lausanne, Switzerland
| | - Federica Vanoni
- Pediatric Rheumatology Unit of Western Switzerland, Pediatric Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Pediatric Department, Geneva University Hospital (HUG), Geneva, Switzerland.,Istituto Pediatrico Della Svizzera Italiana, Bellinzona, Switzerland
| | - Veronique Hengten
- Department of General Pediatrics, French Reference Center for Autoinflammatory Diseases (CEREMAIA), Versailles Hospital, Versailles, France
| | - Gerd Horneff
- Asklepios Children's Hospital, St. Augustin, Germany
| | - Johannes-Peter Haas
- German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - Nadine Fischer
- German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - Katharina Palm-Beden
- Department of Pediatric Rheumatology, St. Josef-Stift Sendenhorst, Sendenhorst, Germany
| | - Rainer Berendes
- Departement of Pediatric Rheumatology, St. Marien-Childrens-Hospital Landshut, Landshut, Germany
| | - Georg Heubner
- Departement of Pediatrics, Städtisches Klinikum Dresden, Dresden, Germany
| | - Annette Jansson
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital LMU Munich, Munich, Germany
| | - Elke Lainka
- Division of Pediatric Rheumatology, University Hospital Essen, Essen, Germany
| | - Annette Leimgruber
- Service of Immunology and Allergology, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | | | - Dirk Foell
- Department of Pediatric Rheumatology and Immunology, University Children's Hospital, Muenster, Germany
| | - Michaël Hofer
- Pediatric Rheumatology Unit of Western Switzerland, Pediatric Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Pediatric Department, Geneva University Hospital (HUG), Geneva, Switzerland
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44
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Comorbidities and phenotype-genotype correlation in children with familial Mediterranean fever. Rheumatol Int 2020; 41:113-120. [PMID: 32347339 DOI: 10.1007/s00296-020-04592-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/18/2020] [Indexed: 01/20/2023]
Abstract
Familial Mediterranean fever (FMF) is the most common monogenic autoinflammatory disease manifesting with phenotypic heterogeneity. The phenotype-genotype correlation is not established clearly yet. Furthermore, some comorbidities such as vasculitis and inflammatory arthritis may accompany FMF. Herein, we aimed to define phenotype-genotype correlation and comorbid diseases of children with FMF. The medical records of 1687 children diagnosed and followed up as FMF were reviewed retrospectively. Disease severity was assessed by PRAS score. A total of 1687 children (841 girls, 846 boys) were involved in the study. The mean ± standard deviation of current age, age at symptom onset, and age at diagnosis were 13.1 ± 5.4, 5.4 ± 4, and 8 ± 4.2 years, respectively. Median (min-max) follow-up period was 3 (0.5-18) years. Among them, 118 (7%) patients had at least one concomitant disease and 72% of them were carrying at least one M694V mutation. Patients with a concomitant disease expressed a more severe course of disease when compared to ones without a concomitant disease (23.7% vs 8.8%, p < 0.001). Children carrying homozygous M694V mutation had significantly earlier age of disease onset and severe disease course (p < 0.001). Forty-four patients (2.6%) were colchicine resistant and most of them were carrying homozygous M694V mutation. Sixteen colchicine-resistant patients were treated with anakinra while 28 received canakinumab. Juvenile idiopathic arthritis (JIA) and immunoglobulin A vasculitis were the most commonly seen associated diseases and the patients with a concomitant disease demonstrated more severe course. This is the largest pediatric cohort studied and presented since now. We confirmed that carrying M694V mutation is associated both with a severe disease course and a predisposition to comorbidities.
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Schnappauf O, Aksentijevich I. Current and future advances in genetic testing in systemic autoinflammatory diseases. Rheumatology (Oxford) 2020; 58:vi44-vi55. [PMID: 31769854 PMCID: PMC6878845 DOI: 10.1093/rheumatology/kez294] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/22/2019] [Indexed: 12/31/2022] Open
Abstract
Systemic autoinflammatory diseases (SAIDs) are a group of inflammatory disorders caused by dysregulation in the innate immune system that leads to enhanced immune responses. The clinical diagnosis of SAIDs can be difficult since individually these are rare diseases with considerable phenotypic overlap. Most SAIDs have a strong genetic background, but environmental and epigenetic influences can modulate the clinical phenotype. Molecular diagnosis has become essential for confirmation of clinical diagnosis. To date there are over 30 genes and a variety of modes of inheritance that have been associated with monogenic SAIDs. Mutations in the same gene can lead to very distinct phenotypes and can have different inheritance patterns. In addition, somatic mutations have been reported in several of these conditions. New genetic testing methods and databases are being developed to facilitate the molecular diagnosis of SAIDs, which is of major importance for treatment, prognosis and genetic counselling. The aim of this review is to summarize the latest advances in genetic testing for SAIDs and discuss potential obstacles that might arise during the molecular diagnosis of SAIDs.
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Affiliation(s)
- Oskar Schnappauf
- Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ivona Aksentijevich
- Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
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46
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Stolberg NG, Verbsky JW. Autoinflammatory Disorders with Perinatal Onset. Clin Perinatol 2020; 47:41-52. [PMID: 32000928 DOI: 10.1016/j.clp.2019.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Autoinflammatory disorders are rare genetic defects that result in inflammation in the absence of an infectious or autoimmune disease. Although very rare, these disorders can occur in the perinatal period, and recognizing their presentation is important because there are often long-term complications and effective targeted therapies for these disorders. Most of these disorders present with rash, fevers, and laboratory evidence of inflammation. Importantly, these disorders can now be separated into their pathophysiologic mechanisms of action, which can also guide therapies. The article reviews the different mechanisms of autoinflammatory disorders and highlights those disorders that can present in the newborn period.
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Affiliation(s)
- Nissim G Stolberg
- Division of Rheumatology, Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - James W Verbsky
- Division of Rheumatology, Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
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47
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Hints for Genetic and Clinical Differentiation of Adult-Onset Monogenic Autoinflammatory Diseases. Mediators Inflamm 2019; 2019:3293145. [PMID: 32082075 PMCID: PMC7012260 DOI: 10.1155/2019/3293145] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/16/2019] [Indexed: 12/16/2022] Open
Abstract
Monogenic autoinflammatory diseases (mAIDs) are inherited errors of innate immunity characterized by systemic inflammation recurring with variable frequency and involving the skin, serosal membranes, synovial membranes, joints, the gastrointestinal tube, and/or the central nervous system, with reactive amyloidosis as a potential severe long-term consequence. Although individually uncommon, all mAIDs set up an emerging chapter of internal medicine: recent findings have modified our knowledge regarding mAID pathophysiology and clarified that protean inflammatory symptoms can be variably associated with periodic fevers, depicting multiple specific conditions which usually start in childhood, such as familial Mediterranean fever, tumor necrosis factor receptor-associated periodic syndrome, cryopyrin-associated periodic syndrome, and mevalonate kinase deficiency. There are no evidence-based studies to establish which potential genotype analysis is the most appropriate in adult patients with clinical phenotypes suggestive of mAIDs. This review discusses genetic and clinical hints for an ideal diagnostic approach to mAIDs in adult patients, as their early identification is essential to prompt effective treatment and improve quality of life, and also highlights the most recent developments in the diagnostic work-up for the most frequent hereditary periodic febrile syndromes worldwide.
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48
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Marino A, Tirelli F, Giani T, Cimaz R. Periodic fever syndromes and the autoinflammatory diseases (AIDs). J Transl Autoimmun 2019; 3:100031. [PMID: 32743516 PMCID: PMC7388371 DOI: 10.1016/j.jtauto.2019.100031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 12/14/2022] Open
Abstract
Innate immune system represents the ancestral defense against infectious agents preserved along the evolution and species; it is phylogenetically older than the adaptive immune system, which exists only in the vertebrates. Cells with phagocytic activity such as neutrophils, macrophages, and natural killer (NK) cells play a key role in innate immunity. In 1999 Kastner et al. first introduced the term “autoinflammation” describing two diseases characterized by recurrent episodes of systemic inflammation without any identifiable infectious trigger: Familial Mediterranean Fever (FMF) and TNF Receptor Associated Periodic Syndrome (TRAPS). Autoinflammatory diseases (AIDs) are caused by self-directed inflammation due to an alteration of innate immunity leading to systemic inflammatory attacks typically in an on/off mode. In addition to inflammasomopathies, nuclear factor (NF)-κB-mediated disorders (also known as Rhelopathies) and type 1 interferonopathies are subjects of more recent studies. This review aims to provide an overview of the field with the most recent updates (see “Most recent developments in..” paragraphs) and a description of the newly identified AIDs. Autoinflammatory diseases are caused by self-directed inflammation. Alteration of innate immunity leads to systemic inflammation attacks. The autoinflammatory field is exponentially expanding. The advances in AIDs have led to new insights into immune system understanding. Autoimmunity and autoinflammation features may be simultaneously present.
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Affiliation(s)
- Achille Marino
- Department of Pediatrics, Desio Hospital, ASST Monza, Desio, MB, Italy.,Biomedical Sciences, University of Florence, Florence, Italy
| | - Francesca Tirelli
- Rheumatology Unit, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Teresa Giani
- Rheumatology Unit, Meyer Children's Hospital, University of Florence, Florence, Italy.,Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Rolando Cimaz
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
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Hua Y, Wu D, Shen M, Yu K, Zhang W, Zeng X. Phenotypes and genotypes of Chinese adult patients with systemic autoinflammatory diseases. Semin Arthritis Rheum 2019; 49:446-452. [DOI: 10.1016/j.semarthrit.2019.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 04/27/2019] [Accepted: 05/06/2019] [Indexed: 11/15/2022]
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Positive Impact of Expert Reference Center Validation on Performance of Next-Generation Sequencing for Genetic Diagnosis of Autoinflammatory Diseases. J Clin Med 2019; 8:jcm8101729. [PMID: 31635385 PMCID: PMC6832712 DOI: 10.3390/jcm8101729] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/10/2019] [Accepted: 10/15/2019] [Indexed: 12/13/2022] Open
Abstract
Monogenic autoinflammatory diseases (AIDs) are caused by variants in genes that regulate innate immunity. The current diagnostic performance of targeted next-generation sequencing (NGS) for AIDs is low. We assessed whether pre-analytic advice from expert clinicians could help improve NGS performance from our 4 years of experience with the sequencing of a panel of 55 AIDs genes. The study included all patients who underwent routine NGS testing between September 2014 and January 2019 at the laboratory of autoinflammatory diseases (Montpellier, France). Before March 2018, all medical requests for testing were accepted. After this time, we required validation by a reference center before NGS: the positive advice could be obtained after a face-to-face consultation with the patient or presentation of the patient’s case at a multidisciplinary staff meeting. Targeted NGS resulted in an overall 7% genetic confirmation, which is consistent with recent reports. The diagnostic performance before and after implementation of the new pre-requisite increased from 6% to 10% (p = 0.021). Our study demonstrated, for the first time, the beneficial effect of a two-step strategy (clinical expert advice, then genetic testing) for AIDs diagnosis and stressed the possible usefulness of the strategy in anticipation of the development of pan-genomic analyses in routine settings.
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