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Casey A, Fiorino EK, Wambach J. Innovations in Childhood Interstitial and Diffuse Lung Disease. Clin Chest Med 2024; 45:695-715. [PMID: 39069332 DOI: 10.1016/j.ccm.2024.04.002] [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] [Indexed: 07/30/2024]
Abstract
Children's interstitial and diffuse lung diseases (chILDs) are a heterogenous and diverse group of lung disorders presenting during childhood. Infants and children with chILD disorders present with respiratory signs and symptoms as well as diffuse lung imaging abnormalities. ChILD disorders are associated with significant health care resource utilization and high morbidity and mortality. The care of patients with chILD has been improved through multidisciplinary care, multicenter collaboration, and the establishment of patient research networks in the United Stated and abroad. This review details past and current innovations in the diagnosis and clinical care of children with chILD.
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Affiliation(s)
- Alicia Casey
- Department of Pediatrics, Division of Pulmonary Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA 02115, USA.
| | - Elizabeth K Fiorino
- Department of Science Education and Pediatrics, Donald and Barabara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Jennifer Wambach
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110, USA
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2
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Weidler S, Koss S, Wolf C, Lucas N, Brunner J, Lee-Kirsch MA. A rare manifestation of STING-associated vasculopathy with onset in infancy: a case report. Pediatr Rheumatol Online J 2024; 22:9. [PMID: 38178067 PMCID: PMC10768237 DOI: 10.1186/s12969-023-00934-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/20/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND STING-associated vasculopathy with onset in infancy (SAVI) is a rare type I interferonopathy caused by heterozygous variants in the STING gene. In SAVI, STING variants confer a gain-of-function which causes overactivation of type I interferon (IFN) signaling leading to autoinflammation and various degrees of immunodeficiency and autoimmunity. CASE PRESENTATION We report the case of a 5 year old child and his mother, both of whom presented with systemic inflammatory symptoms yet widely varying organ involvement, disease course and therapeutic response. Genetic testing revealed a heterozygous STING variant, R281Q, in the child and his mother that had previously been associated with SAVI. However, in contrast to previously reported SAVI cases due to the R281Q variant, our patients showed an atypical course of disease with alopecia totalis in the child and a complete lack of lung involvement in the mother. CONCLUSIONS Our findings demonstrate the phenotypic breadth of clinical SAVI manifestations. Given the therapeutic benefit of treatment with JAK inhibitors, early genetic testing for SAVI should be considered in patients with unclear systemic inflammation involving cutaneous, pulmonary, or musculoskeletal symptoms, and signs of immunodeficiency and autoimmunity.
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Affiliation(s)
- Sophia Weidler
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Sarah Koss
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christine Wolf
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Nadja Lucas
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jürgen Brunner
- Department of Pediatrics, Innsbruck Medical University, Innsbruck, Austria
- Faculty of Medicine and Dentistry, Danube Private University, 3500, Krems, Austria
| | - Min Ae Lee-Kirsch
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Wu J, Zhou Q, Zhou H, Lu M. Case report: JAK1/2 inhibition with baricitinib in the treatment of STING-associated vasculopathy with onset in infancy. Pediatr Rheumatol Online J 2023; 21:131. [PMID: 37884945 PMCID: PMC10601276 DOI: 10.1186/s12969-023-00916-6] [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: 05/26/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Gain-of-function mutations in STING1 (also known as TMEM173) which result in constitutive activation of STING, have been reported to cause STING-associated vasculopathy with onset in infancy (SAVI). Although a wider spectrum of associated manifestations and perturbations in disease onset have been observed since its description, the genotype-phenotype correlations are not definite, and there is no established treatment protocol for SAVI. CASE PRESENTATION Herein, we report a kindred, heterozygous STING mutation (p.V155M) in which the 2-year-old proband suffered from severe interstitial lung disease (ILD) while her father was initially misdiagnosed with connective tissue disease associated with ILD at an adult age. Baricitinib was initiated after the diagnosis of SAVI in the proband combined with steroids, and during the 14-month follow-up, the respiratory symptoms were improved. However, as the improvement of laboratory indicators was limited, especially in autoimmune indices, and the lung CT images remained unaltered, it seems that JAK1/2 inhibition was unsatisfactory in completely controlling the inflammation of the disease in our study. CONCLUSIONS Baricitinib was shown to elicit some effect on the ILD but failed to control the inflammation of the disease completely. Further exploration of JAK inhibitors or other therapeutic strategies are needed to more optimally treat this inflammatory disease.
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Affiliation(s)
- Jianqiang Wu
- Department of Rheumatology Immunology and Allergy, Children's Hospital, School of Medicine, Zhejiang University, National Clinical Research Center for Child Health, 3333, Binsheng Road, Hangzhou, 310052, China
| | - Qing Zhou
- Life Sciences Institute, Zhejiang University, Hangzhou, China
| | - Hua Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Meiping Lu
- Department of Rheumatology Immunology and Allergy, Children's Hospital, School of Medicine, Zhejiang University, National Clinical Research Center for Child Health, 3333, Binsheng Road, Hangzhou, 310052, China.
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Ali HS, Kamel MM, Agwa SHA, Hakeem MSA, Meteini MSE, Matboli M. Analysis of mRNA-miRNA-lncRNA differential expression in prediabetes/type 2 diabetes mellitus patients as potential players in insulin resistance. Front Endocrinol (Lausanne) 2023; 14:1131171. [PMID: 37223012 PMCID: PMC10200895 DOI: 10.3389/fendo.2023.1131171] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 04/10/2023] [Indexed: 05/25/2023] Open
Abstract
Introduction Type 2 diabetes mellitus (T2DM) is a major global health concern. It usually develops gradually and is frequently preceded by undetectable pre-diabetes mellitus (pre-DM) stage. The purpose of this study was to identify a novel set of seven candidate genes associated with the pathogenesis of insulin resistance (IR) and pre-DM, followed by their experimental validation in patients' serum samples. Methods We used the bioinformatics tools and through a two-step process, we first identified and verified two mRNA candidate genes linked to insulin resistance molecular pathogenesis. Second, we identified a non-coding RNAs related to the selected mRNAs and implicated in the insulin resistance molecular pathways followed by pilot study for the RNA panel differential expression in 66 patients with T2DM, 49 individuals with prediabetes and 45 matched controls using real time PCR. Results The levels of expression of TMEM173 and CHUK mRNAs, hsa-miR (-611, -5192, and -1976) miRNAs gradually increased from the healthy control group to the prediabetic group, reaching their maximum levels in the T2DM group (p <10-3), whereas the levels of expression of RP4-605O3.4 and AC074117.2 lncRNAs declined gradually from the healthy control group to the prediabetic group, reaching their lowest levels in the T2DM group (p <10-3). TMEM173, CHUK mRNAs, hsa_miR (-611 & -1976) and RP4-605O3.4 lncRNA were useful in distinguishing insulin resistant from insulin sensitive groups. miR_611 together with RP4-605O3.4 exhibited significant difference in good versus poor glycemic control groups. Discussion The presented study provides an insight about this RNA based STING/NOD/IR associated panel that could be used for PreDM-T2DM diagnosis and also as a therapeutic target based on the differences of its expression level in the pre-DM and T2DM stages.
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Affiliation(s)
- Hebatalla Said Ali
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
| | - Marwa Mostafa Kamel
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
| | - Sara H. A. Agwa
- Clinical Pathology, Medical Ain Shams Research Institute, Ain Shams University, Cairo, Egypt
| | | | | | - Marwa Matboli
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
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Nayir Buyuksahin H, Basaran O, Balık Z, Bilginer Y, Ozen S, Dogru D. Interstitial lung disease in autoinflammatory disease in childhood: A systematic review of the literature. Pediatr Pulmonol 2023; 58:367-373. [PMID: 36314652 DOI: 10.1002/ppul.26220] [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: 07/06/2022] [Revised: 10/07/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND/OBJECTIVES The lung is one of the target organs in the systemic involvement of autoinflammatory disease (AID), and interstitial lung disease (ILD) is the primary phenotype of lung involvement in AID. In this review, we aimed to conduct a systematic review of the available literature to highlight ILD in AID. METHODS We conducted a systematic literature search in PubMed/MEDLINE and Scopus from the inception of the databases to January 2022. References were first screened by title and then by abstract by two authors. Eighteen original papers were selected for full-text review. RESULTS During the literature search, we identified 18 relevant articles describing 52 cases of AID and ILD. Of those, 44 patients had stimulator of interferon genes-associated vasculopathy with onset in infancy (SAVI), six had coatomer protein complex (COPA) syndrome, one had haploinsufficiency of A20, and one had mevalonate kinase deficiency. Pulmonary fibrosis, cyst formation, and ground glass areas were the most common findings in chest tomography of patients with COPA syndrome and SAVI. Janus kinase inhibitors were used to treat most of the patients with SAVI, which stabilized ILD. CONCLUSIONS ILD should be considered carefully in children with AID, especially those with interferonopathy.
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Affiliation(s)
- Halime Nayir Buyuksahin
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ozge Basaran
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, and Hacettepe University Vasculitis Research Center, Ankara, Turkey
| | - Zeynep Balık
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, and Hacettepe University Vasculitis Research Center, Ankara, Turkey
| | - Yelda Bilginer
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, and Hacettepe University Vasculitis Research Center, Ankara, Turkey
| | - Seza Ozen
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, and Hacettepe University Vasculitis Research Center, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatrics, Division of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Shen D, Fan X, Zhou Q, Xu X, Lu M. Use of Tofacitinib for infant-onset STING-associated vasculopathy: A case report from China. Medicine (Baltimore) 2022; 101:e31832. [PMID: 36482559 PMCID: PMC9726360 DOI: 10.1097/md.0000000000031832] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Stimulator of interferon gene (STING)-associated vasculopathy with onset in infancy (SAVI), caused by gain-of-function mutations in human transmembrane protein 173 (TMEM173), is characterized by widespread chronic inflammation primarily affecting the skin and lungs. Although SAVI is an inflammatory disease, typical anti-inflammatory agents have limited or no effect. METHODS AND RESULTS A 1-year-old boy presented with recurrent facial rashes since he was 8 months. Moreover, he suffered from recurrent oral ulcers, chronic cough, and failure to thrive. Laboratory parameters showed elevated erythrocyte sedimentation rate (ESR) and immunoglobulin levels. Chest high-resolution computed tomography (HRCT) showed interstitial lung disease (ILD). Whole-exome sequencing revealed a heterozygous mutation in the TMEM173 gene (c.463G > A, p.V155M). Ultimately, the patient was diagnosed with SAVI. Tofacitinib was initiated at the age of 19 months, resulting in the alleviation of facial rashes and improvement of ILD within 3 months. CONCLUSION SAVI is a difficult-to-treat type I interferonopathy. We hope that JAKi treatment will prove valuable for SAVI patients.
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Affiliation(s)
- Danping Shen
- Department of Rheumatology Immunology and Allergy, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiaorui Fan
- Life Sciences Institute, Zhejiang University, Hangzhou, China
| | - Qing Zhou
- Life Sciences Institute, Zhejiang University, Hangzhou, China
| | - Xuefeng Xu
- Department of Rheumatology Immunology and Allergy, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Meiping Lu
- Department of Rheumatology Immunology and Allergy, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
- * Correspondence: Meiping Lu, Department of Rheumatology Immunology and Allergy, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, No. 57, Zhugan Lane, Hangzhou 310003, China (e-mail: )
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Wan R, Fänder J, Zakaraia I, Lee-Kirsch MA, Wolf C, Lucas N, Olfe LI, Hendrich C, Jonigk D, Holzinger D, Steindor M, Schmidt G, Davenport C, Klemann C, Schwerk N, Griese M, Schlegelberger B, Stehling F, Happle C, Auber B, Steinemann D, Wetzke M, von Hardenberg S. Phenotypic spectrum in recessive STING-associated vasculopathy with onset in infancy: Four novel cases and analysis of previously reported cases. Front Immunol 2022; 13:1029423. [PMID: 36275728 PMCID: PMC9583393 DOI: 10.3389/fimmu.2022.1029423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 09/26/2022] [Indexed: 11/20/2022] Open
Abstract
Gain-of-function variants in the stimulator of interferon response cGAMP interactor 1 (STING1) gene cause STING-Associated Vasculopathy with onset in Infancy (SAVI). Previously, only heterozygous and mostly de novo STING1 variants have been reported to cause SAVI. Interestingly, one variant that only leads to SAVI when homozygous, namely c.841C>T p.(Arg281Trp), has recently been described. However, there are no entries in public databases regarding an autosomal recessive pattern of inheritance. Here, we report four additional unrelated SAVI patients carrying c.841C>T in homozygous state. All patients had interstitial lung disease and displayed typical interferon activation patterns. Only one child displayed cutaneous vasculitis, while three other patients presented with a relatively mild SAVI phenotype. Steroid and baricitinib treatment had a mitigating effect on the disease phenotype in two cases, but failed to halt disease progression. Heterozygous c.841C>T carriers in our analysis were healthy and showed normal interferon activation. Literature review identified eight additional cases with autosomal recessive SAVI caused by c.841C>T homozygosity. In summary, we present four novel and eight historic cases of autosomal recessive SAVI. We provide comprehensive clinical data and show treatment regimens and clinical responses. To date, SAVI has been listed as an exclusively autosomal dominant inherited trait in relevant databases. With this report, we aim to raise awareness for autosomal recessive inheritance in this rare, severe disease which may aid in early diagnosis and development of optimized treatment strategies.
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Affiliation(s)
- Rensheng Wan
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Johannes Fänder
- Institute of Anatomy and Cell Biology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Ia Zakaraia
- Institute of Anatomy and Cell Biology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Min Ae Lee-Kirsch
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav-Carus, Technische Universität Dresden, Dresden, Germany
| | - Christine Wolf
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav-Carus, Technische Universität Dresden, Dresden, Germany
| | - Nadja Lucas
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav-Carus, Technische Universität Dresden, Dresden, Germany
| | - Lisa Isabel Olfe
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Corinna Hendrich
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Danny Jonigk
- Institute of Pathology, Hannover Medical School, Hanover, Germany
- German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease, Hannover, Germany
| | - Dirk Holzinger
- Department of Pediatric Haemato-Oncology, University of Duisburg-Essen, Essen, Germany
- Department of Applied Health Sciences, University of Applied Sciences Bochum, Bochum, Germany
| | - Mathis Steindor
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children’s Hospital, University of Duisburg-Essen, Essen, Germany
| | - Gunnar Schmidt
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Claudia Davenport
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Christian Klemann
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Nicolaus Schwerk
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Matthias Griese
- Dr. von Hauner Children’s Hospital, Department of Pediatrics, German Center for Lung Research, University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | | | - Florian Stehling
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children’s Hospital, University of Duisburg-Essen, Essen, Germany
| | - Christine Happle
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Bernd Auber
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Doris Steinemann
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Martin Wetzke
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- *Correspondence: Martin Wetzke, ; Sandra von Hardenberg,
| | - Sandra von Hardenberg
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
- *Correspondence: Martin Wetzke, ; Sandra von Hardenberg,
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Wobma H, Shin DS, Chou J, Dedeoğlu F. Dysregulation of the cGAS-STING Pathway in Monogenic Autoinflammation and Lupus. Front Immunol 2022; 13:905109. [PMID: 35693769 PMCID: PMC9186411 DOI: 10.3389/fimmu.2022.905109] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/02/2022] [Indexed: 01/19/2023] Open
Abstract
One of the oldest mechanisms of immune defense against pathogens is through detection of foreign DNA. Since human DNA is compartmentalized into the nucleus, its presence in the cytosol heralds a potential threat. The cGAS-STING pathway is one of the most important cytosolic DNA sensing pathways and leads to interferon signaling, inflammasome activation, autophagy, and cell death. While STING signaling is protective at physiologic levels, chronic activation of this pathway can instead drive autoinflammation and autoimmunity. Here we discuss several monogenic disorders of the STING pathway that highlight its impact on both innate and adaptive immunity in the progressive loss of tolerance. The potential relevance of STING signaling in systemic lupus erythematosus is then discussed with a focus on future avenues for monitoring and targeting this pathway.
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Cetin Gedik K, Lamot L, Romano M, Demirkaya E, Piskin D, Torreggiani S, Adang LA, Armangue T, Barchus K, Cordova DR, Crow YJ, Dale RC, Durrant KL, Eleftheriou D, Fazzi EM, Gattorno M, Gavazzi F, Hanson EP, Lee-Kirsch MA, Montealegre Sanchez GA, Neven B, Orcesi S, Ozen S, Poli MC, Schumacher E, Tonduti D, Uss K, Aletaha D, Feldman BM, Vanderver A, Brogan PA, Goldbach-Mansky R. The 2021 European Alliance of Associations for Rheumatology/American College of Rheumatology Points to Consider for Diagnosis and Management of Autoinflammatory Type I Interferonopathies: CANDLE/PRAAS, SAVI, and AGS. Arthritis Rheumatol 2022; 74:735-751. [PMID: 35315249 DOI: 10.1002/art.42087] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/11/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Autoinflammatory type I interferonopathies, chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature/proteasome-associated autoinflammatory syndrome (CANDLE/PRAAS), stimulator of interferon genes (STING)-associated vasculopathy with onset in infancy (SAVI), and Aicardi-Goutières syndrome (AGS) are rare and clinically complex immunodysregulatory diseases. With emerging knowledge of genetic causes and targeted treatments, a Task Force was charged with the development of "points to consider" to improve diagnosis, treatment, and long-term monitoring of patients with these rare diseases. METHODS Members of a Task Force consisting of rheumatologists, neurologists, an immunologist, geneticists, patient advocates, and an allied health care professional formulated research questions for a systematic literature review. Then, based on literature, Delphi questionnaires, and consensus methodology, "points to consider" to guide patient management were developed. RESULTS The Task Force devised consensus and evidence-based guidance of 4 overarching principles and 17 points to consider regarding the diagnosis, treatment, and long-term monitoring of patients with the autoinflammatory interferonopathies, CANDLE/PRAAS, SAVI, and AGS. CONCLUSION These points to consider represent state-of-the-art knowledge to guide diagnostic evaluation, treatment, and management of patients with CANDLE/PRAAS, SAVI, and AGS and aim to standardize and improve care, quality of life, and disease outcomes.
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Affiliation(s)
- Kader Cetin Gedik
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | - Lovro Lamot
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Micol Romano
- University of Western Ontario, London, Ontario, Canada
| | | | - David Piskin
- University of Western Ontario, London Health Sciences Center, and Lawson Health Research Institute, London, Ontario, Canada
| | - Sofia Torreggiani
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, and UOC Pediatria a Media Intensità di Cura, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura A Adang
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Thais Armangue
- Sant Joan de Deu Children's Hospital and IDIBAPS-Hospital Clinic; University of Barcelona, Barcelona, Spain
| | - Kathe Barchus
- Autoinflammatory Alliance, San Francisco, California
| | - Devon R Cordova
- Aicardi-Goutieres Syndrome Americas Association, Manhattan Beach, California
| | - Yanick J Crow
- University of Edinburgh, Edinburgh, UK, and Laboratory of Neurogenetics and Neuroinflammation, Institut Imagine, University of Paris, Paris, France
| | - Russell C Dale
- University of Sydney, Sydney, New South Wales, Australia
| | - Karen L Durrant
- Autoinflammatory Alliance and Kaiser San Francisco Hospital, San Francisco, California
| | | | - Elisa M Fazzi
- ASST Civil Hospital and University of Brescia, Brescia, Italy
| | | | - Francesco Gavazzi
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, and University of Brescia, Brescia, Italy
| | - Eric P Hanson
- Riley Hospital for Children and Indiana University School of Medicine, Indianapolis
| | | | | | - Bénédicte Neven
- Necker Children's Hospital, AP-HP, Institut Imagine Institut des Maladies Genetiques, University of Paris, Paris, France
| | - Simona Orcesi
- IRCCS Mondino Foundation and University of Pavia, Pavia, Italy
| | - Seza Ozen
- Hacettepe University, Ankara, Turkey
| | | | | | | | - Katsiaryna Uss
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland
| | | | - Brian M Feldman
- Hospital for Sick Children and University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Adeline Vanderver
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia
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10
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Cetin Gedik K, Lamot L, Romano M, Demirkaya E, Piskin D, Torreggiani S, Adang LA, Armangue T, Barchus K, Cordova DR, Crow YJ, Dale RC, Durrant KL, Eleftheriou D, Fazzi EM, Gattorno M, Gavazzi F, Hanson EP, Lee-Kirsch MA, Montealegre Sanchez GA, Neven B, Orcesi S, Ozen S, Poli MC, Schumacher E, Tonduti D, Uss K, Aletaha D, Feldman BM, Vanderver A, Brogan PA, Goldbach-Mansky R. The 2021 EULAR and ACR points to consider for diagnosis and management of autoinflammatory type I interferonopathies: CANDLE/PRAAS, SAVI and AGS. Ann Rheum Dis 2022; 81:601-613. [PMID: 35086813 PMCID: PMC9036471 DOI: 10.1136/annrheumdis-2021-221814] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/11/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Autoinflammatory type I interferonopathies, chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature/proteasome-associated autoinflammatory syndrome (CANDLE/PRAAS), stimulator of interferon genes (STING)-associated vasculopathy with onset in infancy (SAVI) and Aicardi-Goutières syndrome (AGS) are rare and clinically complex immunodysregulatory diseases. With emerging knowledge of genetic causes and targeted treatments, a Task Force was charged with the development of 'points to consider' to improve diagnosis, treatment and long-term monitoring of patients with these rare diseases. METHODS Members of a Task Force consisting of rheumatologists, neurologists, an immunologist, geneticists, patient advocates and an allied healthcare professional formulated research questions for a systematic literature review. Then, based on literature, Delphi questionnaires and consensus methodology, 'points to consider' to guide patient management were developed. RESULTS The Task Force devised consensus and evidence-based guidance of 4 overarching principles and 17 points to consider regarding the diagnosis, treatment and long-term monitoring of patients with the autoinflammatory interferonopathies, CANDLE/PRAAS, SAVI and AGS. CONCLUSION These points to consider represent state-of-the-art knowledge to guide diagnostic evaluation, treatment and management of patients with CANDLE/PRAAS, SAVI and AGS and aim to standardise and improve care, quality of life and disease outcomes.
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Affiliation(s)
- Kader Cetin Gedik
- Translational Autoinflammatory Diseases Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Lovro Lamot
- Department of Pediatrics, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Micol Romano
- Division of Paediatric Rheumatology, Department of Paediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Erkan Demirkaya
- Division of Paediatric Rheumatology, Department of Paediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - David Piskin
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada.,London Health Sciences Center, Lawson Health Research Institute, London, Ontario, Canada
| | - Sofia Torreggiani
- 1Translational Autoinflammatory Diseases Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.,UOC Pediatria a Media Intensità di Cura, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Lombardia, Italy
| | - Laura A Adang
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Thais Armangue
- Pediatric Neuroimmunology Unit, Neurology Service, Sant Joan de Deu Children's Hospital, and IDIBAPS-Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Kathe Barchus
- Autoinflammatory Alliance, San Francisco, California, USA
| | - Devon R Cordova
- Aicardi-Goutieres Syndrome Americas Association, Manhattan Beach, California, USA
| | - Yanick J Crow
- Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Molecular Medicine, University of Edinburg, Edinburg, UK.,Laboratory of Neurogenetics and Neuroinflammation, Institut Imagine, Université de Paris, Paris, Île-de-France, France
| | - Russell C Dale
- Kids Neuroscience Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Karen L Durrant
- Autoinflammatory Alliance, San Francisco, California, USA.,Kaiser San Francisco Hospital, San Francisco, California, USA
| | - Despina Eleftheriou
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Elisa M Fazzi
- Child Neurology and Psychiatry Unit, Department of Clinical and Experimental Sciences ASST Civil Hospital, University of Brescia, Brescia, Italy
| | - Marco Gattorno
- Center for Autoinflammatory diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Francesco Gavazzi
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Eric P Hanson
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Min Ae Lee-Kirsch
- Department of Pediatrics, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Gina A Montealegre Sanchez
- Intramural Clinical Management and Operations Branch (ICMOB), Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Bénédicte Neven
- Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Institut Imagine Institut des Maladies Genetiques, Paris, Île-de-France, France
| | - Simona Orcesi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Lombardia, Italy
| | - Seza Ozen
- Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - M Cecilia Poli
- Department of Pediatrics, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile
| | | | - Davide Tonduti
- Child Neurology Unit, COALA (Center for Diagnosis and Treatment of Leukodystrophies), V. Buzzi Children's Hospital, Milano, Italy
| | - Katsiaryna Uss
- Translational Autoinflammatory Diseases Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Daniel Aletaha
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Brian M Feldman
- Division of Rheumatology, Hospital for Sick Children, Toronto, Ontario, Canada.,30Department of Pediatrics, Faculty of Medicine, University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Adeline Vanderver
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul A Brogan
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Raphaela Goldbach-Mansky
- Translational Autoinflammatory Diseases Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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11
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Benjamin P, Sudhakar S, D’Arco F, Löbel U, Carney O, Roux CJ, Boddaert N, Hemingway C, Eleftheriou D, Mankad K. Spectrum of Neuroradiologic Findings Associated with Monogenic Interferonopathies. AJNR Am J Neuroradiol 2022; 43:2-10. [PMID: 34949589 PMCID: PMC8757560 DOI: 10.3174/ajnr.a7362] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/29/2021] [Indexed: 01/03/2023]
Abstract
The genetic interferonopathies are a heterogeneous group of disorders thought to be caused by the dysregulated expression of interferons and are now commonly considered in the differential diagnosis of children presenting with recurrent or persistent inflammatory phenotypes. With emerging therapeutic options, recognition of these disorders is increasingly important, and neuroimaging plays a vital role. In this article, we discuss the wide spectrum of neuroradiologic features associated with monogenic interferonopathies by reviewing the literature and illustrate these with cases from our institutions. These cases include intracerebral calcifications, white matter T2 hyperintensities, deep WM cysts, cerebral atrophy, large cerebral artery disease, bilateral striatal necrosis, and masslike lesions. A better understanding of the breadth of the neuroimaging phenotypes in conjunction with clinical and laboratory findings will enable earlier diagnosis and direct therapeutic strategies.
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Affiliation(s)
- P. Benjamin
- From the Department of Radiology (P.B., S.S., F.D., U.L., O.C., K.M.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
| | - S. Sudhakar
- From the Department of Radiology (P.B., S.S., F.D., U.L., O.C., K.M.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
| | - F. D’Arco
- From the Department of Radiology (P.B., S.S., F.D., U.L., O.C., K.M.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
| | - U. Löbel
- From the Department of Radiology (P.B., S.S., F.D., U.L., O.C., K.M.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
| | - O. Carney
- From the Department of Radiology (P.B., S.S., F.D., U.L., O.C., K.M.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
| | - C.-J. Roux
- Department of Paediatric Radiology (C.-J.R., N.B.), Hôpital Necker–Enfants Malades, Paris, France
| | - N. Boddaert
- Department of Paediatric Radiology (C.-J.R., N.B.), Hôpital Necker–Enfants Malades, Paris, France,Institut Imagine (N.B.), Institut National de la Santé et de la Recherche Médicale Union Mutualiste Retraite 1163, Paris, France
| | - C. Hemingway
- Department of Paediatric Neurology (C.H.), Great Ormond Street Hospital, London, UK
| | - D. Eleftheriou
- Infection, Inflammation, and Immunology Section (D.E.), University College London Great Ormond Street Institute of Child Health, London, UK
| | - K. Mankad
- From the Department of Radiology (P.B., S.S., F.D., U.L., O.C., K.M.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
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12
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Ochfeld E, Curran ML, Chiarella SE, Ardalan K, Khojah A. A Case Report of SAVI Mimicking Early-Onset ANCA Vasculitis. J Clin Immunol 2021; 41:1652-1655. [PMID: 34089458 DOI: 10.1007/s10875-021-01072-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/20/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Elisa Ochfeld
- Pediatric Allergy-Immunology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box #60, Chicago, IL, 60611, USA. .,Division of Allergy- Immunology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Megan L Curran
- Section of Rheumatology, Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Kaveh Ardalan
- Division of Pediatric Rheumatology, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.,Division of Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Departments of Pediatrics and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amer Khojah
- Pediatric Allergy-Immunology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box #60, Chicago, IL, 60611, USA.,Division of Allergy- Immunology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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13
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Frémond ML, Crow YJ. STING-Mediated Lung Inflammation and Beyond. J Clin Immunol 2021; 41:501-514. [PMID: 33532887 DOI: 10.1007/s10875-021-00974-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/18/2021] [Indexed: 02/07/2023]
Abstract
Mendelian autoinflammatory diseases characterized by constitutive activation of the type I interferon pathway, the so-called type I interferonopathies, constitute a rapidly expanding group of inborn errors of immunity. Among the type I interferonopathies, STING-associated vasculopathy with onset in infancy (SAVI) and COPA syndrome were described in the last 6 years, both manifesting a major inflammatory lung component associated with significant morbidity and increased mortality. There is striking clinical and histopathological overlap between SAVI and COPA syndrome, although distinct features are also present. Of note, there is a remarkably high frequency of clinical non-penetrance among individuals harboring pathogenic COPA mutations. SAVI is caused by, principally heterozygous, gain-of-function mutations in STING1 (previously referred to as TMEM173) encoding STING, a key adaptor of the interferon signaling pathway induced by DNA. COPA syndrome results from heterozygous dominant-negative mutations in the coatomer protein subunit alpha, forming part of a complex involved in intracellular cargo protein transport between the Golgi and the endoplasmic reticulum (ER). Of importance, a role for COPA in regulating the trafficking of STING, an ER-resident protein which translocates to the Golgi during the process of its activation, was recently defined, thereby possibly explaining some aspects of the phenotypic overlap between SAVI and COPA syndrome. Here, we review the expanding phenotype of these diseases, highlighting common as well as specific features, and recent advances in our understanding of STING biology that have informed therapeutic decision-making in both conditions. Beyond these rare Mendelian disorders, DNA sensing through STING is likely relevant to the pathology of several diseases associated with lung inflammation, including systemic lupus erythematosus, dermatomyositis, environmental toxin exposure, and viral infection.
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Affiliation(s)
- Marie-Louise Frémond
- Université de Paris, Imagine Institute, Laboratory of Neurogenetics and Neuroinflammation, 24 boulevard du Montparnasse, F-75015, Paris, France. .,Paediatric Haematology-Immunology and Rheumatology Unit, AP-HP, Necker Hospital, F-75015, Paris, France.
| | - Yanick J Crow
- Université de Paris, Imagine Institute, Laboratory of Neurogenetics and Neuroinflammation, 24 boulevard du Montparnasse, F-75015, Paris, France.,Centre for Genomic and Experimental Medicine, Medical Research Council Institute of Genetics and Molecular Medicine, Edinburgh, UK
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