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Fayand A, Cescato M, Le Corre L, Terré A, Wacheux M, Zhu YYJ, Melet A, Moreau TRJ, Bodaghi B, Bonnet F, Bronnimann D, Cuisset L, Faria R, Grateau G, Pillet P, Mulders-Manders CM, Neven B, Quartier P, Richer O, Savey L, Truchetet ME, Py BF, Boursier G, Herbeuval JP, Georgin-Lavialle S, Rodero MP. Pathogenic variants in the NLRP3 LRR domain at position 861 are responsible for a boost-dependent atypical CAPS phenotype. J Allergy Clin Immunol 2023; 152:1303-1311.e1. [PMID: 37506976 DOI: 10.1016/j.jaci.2023.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/13/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Cryopyrin-associated periodic syndrome (CAPS) is associated with NLRP3 pathogenic variants, mostly located in the NACHT (neuronal apoptosis inhibitor protein, MHC class 2 transcription activator, incompatibility locus protein from Podospora anserina, telomerase-associated protein) domain. Cold-induced urticarial rash is among the main clinical features. However, this study identified a series of 14 patients with pathogenic variants of the Y861 residue (p.Tyr861) of the LRR domain of NLRP3 and minimal prevalence of cold-induced urticarial rash. OBJECTIVES This study aimed to address a possible genotype/phenotype correlation for patients with CAPS and to investigate at the cellular levels the impact of the Y861C substitution (p.Tyr861Cys) on NLRP3 activation. METHODS Clinical features of 14 patients with CAPS and heterozygous substitution at position 861 in the LRR domain of NLRP3 were compared to clinical features of 48 patients with CAPS and pathogenic variants outside the LRR domain of NLRP3. IL-1β secretion by PBMCs and purified monocytes from patients and healthy donors was evaluated following LPS and monosodium urate crystal stimulation. RESULTS Patients with substitution at position 861 of NLRP3 demonstrated a higher prevalence of sensorineural hearing loss while being less prone to skin urticarial. In contrast to patients with classical CAPS, cells from patients with a pathogenic variant at position 861 required an activation signal to secrete IL-1β but produced more IL-1β during the early and late phase of secretion than cells from healthy donors. CONCLUSIONS Pathogenic variants of Y861 of NLRP3 drive a boost-dependent oversecretion of IL-1β associated with an atypical CAPS phenotype.
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Affiliation(s)
- Antoine Fayand
- Department of Internal Medicine, National Reference Center for Autoinflammatory Diseases and Amyloid A Amyloidosis, Tenon Hospital, Sorbonne Université, Paris, France; Laboratoire de Chimie et de Biochimie Pharmacologiques et Toxicologiques, Centre National de la Recherche Scientifique, Université Paris Cité, Paris, France
| | - Margaux Cescato
- Laboratoire de Chimie et de Biochimie Pharmacologiques et Toxicologiques, Centre National de la Recherche Scientifique, Université Paris Cité, Paris, France
| | - Laurent Le Corre
- Laboratoire de Chimie et de Biochimie Pharmacologiques et Toxicologiques, Centre National de la Recherche Scientifique, Université Paris Cité, Paris, France
| | - Alexandre Terré
- Department of Internal Medicine, National Reference Center for Autoinflammatory Diseases and Amyloid A Amyloidosis, Tenon Hospital, Sorbonne Université, Paris, France; Laboratoire Mécanismes Cellulaires et Moléculaires des Désordres Hématologiques et Implications Thérapeutiques, Institut Imagine, Institut National de la Santé et de la Recherche Médicale, Université Paris Cité, Paris, France
| | - Margaux Wacheux
- Laboratoire de Chimie et de Biochimie Pharmacologiques et Toxicologiques, Centre National de la Recherche Scientifique, Université Paris Cité, Paris, France
| | - Yixiang Y J Zhu
- Laboratoire de Chimie et de Biochimie Pharmacologiques et Toxicologiques, Centre National de la Recherche Scientifique, Université Paris Cité, Paris, France
| | - Armelle Melet
- Laboratoire de Chimie et de Biochimie Pharmacologiques et Toxicologiques, Centre National de la Recherche Scientifique, Université Paris Cité, Paris, France
| | - Thomas R J Moreau
- Laboratoire de Chimie et de Biochimie Pharmacologiques et Toxicologiques, Centre National de la Recherche Scientifique, Université Paris Cité, Paris, France; Translational Immunology Unit, Institut Pasteur, Université Paris Cité, Paris, France
| | - Bahram Bodaghi
- Department of Ophthalmology, Instituts Hospitalo-Universitaires FOReSIGHT, Pitié-Salpêtrière Hospital, Assistance Publique-Hȏpitaux de Paris, Sorbonne Université, Paris, France
| | - Fabrice Bonnet
- Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Didier Bronnimann
- Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Laurence Cuisset
- Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Raquel Faria
- Unidade de Imunologia Clínica, Centro Hospitalar Universitário do Porto, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Gilles Grateau
- Department of Internal Medicine, National Reference Center for Autoinflammatory Diseases and Amyloid A Amyloidosis, Tenon Hospital, Sorbonne Université, Paris, France
| | - Pascal Pillet
- Service de Pédiatrie et Rhumatologie Pédiatrique, Hôpital Pellegrin-Enfants, Bordeaux, France
| | - Catharina M Mulders-Manders
- Department of Internal Medicine, Radboud Expertise Center for Immunodeficiency and Autoinflammation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Benedicte Neven
- Pediatric Immunology-Hematology and Rheumatology Unit, Necker Hospital, Université Paris Cité, Paris, France
| | - Pierre Quartier
- Pediatric Immunology-Hematology and Rheumatology Unit, Necker Hospital, Université Paris Cité, Paris, France; RAISE Reference Centre for Rare Diseases, Paris, France
| | - Olivier Richer
- Service de Pédiatrie et Rhumatologie Pédiatrique, Hôpital Pellegrin-Enfants, Bordeaux, France
| | - Léa Savey
- Department of Internal Medicine, National Reference Center for Autoinflammatory Diseases and Amyloid A Amyloidosis, Tenon Hospital, Sorbonne Université, Paris, France
| | - Marie-Elise Truchetet
- Department of Rheumatology, Hôpital Pellegrin, Bordeaux, France; Unite de Mixte Recherche 5164 ImmunoConcept, Bordeaux University Hospital, Bordeaux University, Bordeaux, France
| | - Bénédicte F Py
- Centre International de Recherche en Infectiologie, Université Lyon, Lyon, France; U1111, Institut National de la Santé et de la Recherche Médicale, Université Claude Bernard Lyon 1, Lyon, France; Unite de Mixte Recherche 5308, Centre National de la Recherche Scientifique, École Normale Supérieure de Lyon, Lyon, France
| | - Guilaine Boursier
- Laboratoire de Génétique des Maladies Rares et Autoinflammatoires, Service de Génétique Moléculaire et Cytogénomique, National Reference Center for Autoinflammatory Diseases and AA Amyloidosis, Centre Hospitalier Universitaire Montpellier, Université de Montpellier, Montpellier, France
| | - Jean-Philippe Herbeuval
- Laboratoire de Chimie et de Biochimie Pharmacologiques et Toxicologiques, Centre National de la Recherche Scientifique, Université Paris Cité, Paris, France
| | - Sophie Georgin-Lavialle
- Department of Internal Medicine, National Reference Center for Autoinflammatory Diseases and Amyloid A Amyloidosis, Tenon Hospital, Sorbonne Université, Paris, France.
| | - Mathieu P Rodero
- Laboratoire de Chimie et de Biochimie Pharmacologiques et Toxicologiques, Centre National de la Recherche Scientifique, Université Paris Cité, Paris, France.
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Fayand A, Hentgen V, Posseme C, Lacout C, Picard C, Moguelet P, Cescato M, Sbeih N, Moreau TRJ, Zhu YYJ, Charuel JL, Corneau A, Deibener-Kaminsky J, Dupuy S, Fusaro M, Hoareau B, Hovnanian A, Langlois V, Le Corre L, Maciel TT, Miskinyte S, Miyara M, Moulinet T, Perret M, Schuhmacher MH, Rignault-Bricard R, Viel S, Vinit A, Soria A, Duffy D, Launay JM, Callebert J, Herbeuval JP, Rodero MP, Georgin-Lavialle S. Successful treatment of JAK1-associated inflammatory disease. J Allergy Clin Immunol 2023; 152:972-983. [PMID: 37343845 DOI: 10.1016/j.jaci.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 06/02/2023] [Accepted: 06/13/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Gain-of-function variants of JAK1 drive a rare immune dysregulation syndrome associated with atopic dermatitis, allergy, and eosinophilia. OBJECTIVES This study sought to describe the clinical and immunological characteristics associated with a new gain-of-function variant of JAK1 and report the therapeutic efficacy of Janus kinase (JAK) inhibition. METHODS The investigators identified a family affected by JAK1-associated autoinflammatory disease and performed clinical assessment and immunological monitoring on 9 patients. JAK1 signaling was studied by flow and mass cytometry in patients' cells at basal state or after immune stimulation. A molecular disease signature in the blood was studied at the transcriptomic level. Patients were treated with 1 of 2 JAK inhibitors: either baricitinib or upadacitinib. Clinical, cellular, and molecular response were evaluated over a 2-year period. RESULTS Affected individuals displayed a syndromic disease with prominent allergy including atopic dermatitis, ichthyosis, arthralgia, chronic diarrhea, disseminated calcifying fibrous tumors, and elevated whole blood histamine levels. A variant of JAK1 localized in the pseudokinase domain was identified in all 9 affected, tested patients. Hyper-phosphorylation of STAT3 was found in 5 of 6 patients tested. Treatment of patients' cells with baricitinib controlled most of the atypical hyper-phosphorylation of STAT3. Administration of baricitinib to patients led to rapid improvement of the disease in all adults and was associated with reduction of systemic inflammation. CONCLUSIONS Patients with this new JAK1 gain-of-function pathogenic variant displayed very high levels of blood histamine and showed a variable combination of atopy with articular and gastrointestinal manifestations as well as calcifying fibrous tumors. The disease, which appears to be linked to STAT3 hyperactivation, was well controlled under treatment by JAK inhibitors in adult patients.
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Affiliation(s)
- Antoine Fayand
- Laboratoire de Chimie et de Biochimie Pharmacologiques et Toxicologiques, Centre National de la Recherche Scientifique (CNRS), Paris, France; Department of Internal Medicine, Tenon Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France
| | - Véronique Hentgen
- Pediatric Infectious Disease Group, Créteil, France; Department General Pediatrics, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Céline Posseme
- Translational Immunology Unit, Institut Pasteur, Université de Paris Cité, Paris, France
| | - Carole Lacout
- Genetic Laboratory, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France; Department of Internal Medicine, Tenon Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France
| | - Capucine Picard
- Study Center for Primary Immunodeficiencies, Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris (APHP), Université de Paris Cité, Paris, France
| | - Philippe Moguelet
- Department of Pathology, Sorbonne Université, Tenon Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Margaux Cescato
- Laboratoire de Chimie et de Biochimie Pharmacologiques et Toxicologiques, Centre National de la Recherche Scientifique (CNRS), Paris, France
| | - Nabiha Sbeih
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutical Implications, Université de Paris Cité, Paris, France
| | - Thomas R J Moreau
- Laboratoire de Chimie et de Biochimie Pharmacologiques et Toxicologiques, Centre National de la Recherche Scientifique (CNRS), Paris, France
| | - Yixiang Y J Zhu
- Laboratoire de Chimie et de Biochimie Pharmacologiques et Toxicologiques, Centre National de la Recherche Scientifique (CNRS), Paris, France
| | - Jean-Luc Charuel
- Département of Immunology, Groupement Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Aurélien Corneau
- Production et Analyse de données en Sciences de la vie et en Santé (PASS), Plateforme de Cytométrie de la Pitié-Salpêtrière, Unité Mixte de Service (UMS) 037, Sorbonne Université, Paris, France
| | - Joelle Deibener-Kaminsky
- Department of Internal Medicine and Clinical Immunology, Nancy University Hospital, University of Lorraine, Nancy, France; Molecular Engineering and Articular Physiopathology, Unité Mixte de Recherche 7365, Centre national de la recherche scientifique (CNRS), University of Lorraine, Nancy, France
| | - Stéphanie Dupuy
- BioMedTech Facilities, Institut national de la santé et de la recherche médicale (INSERM) Unité mixte de services (US) 36, Centre national de la recherche scientifique (CNRS) Unité d'appui et de recherche (UAR) 2009, Université de Paris Cité, Paris, France
| | - Mathieu Fusaro
- Study Center for Primary Immunodeficiencies, Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris (APHP), Université de Paris Cité, Paris, France
| | - Benedicte Hoareau
- Production et Analyse de données en Sciences de la vie et en Santé (PASS), Plateforme de Cytométrie de la Pitié-Salpêtrière, Unité Mixte de Service (UMS) 037, Sorbonne Université, Paris, France
| | - Alain Hovnanian
- Laboratory of Genetic Skin Diseases, Institut National de la Santé et de la Recherche Médicale (INSERM) U1163, Imagine Institute, Université de Paris Cité, Paris, France; Department of Genomics Medicine of Rare Diseases, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Vincent Langlois
- Department of Internal Medicine, Jacques Monod Hospital, Le Havre, France
| | - Laurent Le Corre
- Macromolecular Modeling Platform, Laboratoire de Chimie et Biochimie, Pharmacologiques et Toxicologiques, Centre national de la recherche scientifique (CNRS), Unité Mixte de Recherche (UMR) 8601, Université de Paris Cité, Paris, France
| | - Thiago T Maciel
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutical Implications, Université de Paris Cité, Paris, France
| | - Snaigune Miskinyte
- Laboratory of Genetic Skin Diseases, Institut National de la Santé et de la Recherche Médicale (INSERM) U1163, Imagine Institute, Université de Paris Cité, Paris, France
| | - Makoto Miyara
- Département of Immunology, Groupement Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France; Centre d'Immunologie et des Maladies Infectieuses, Institut national de la santé et de la recherche médicale (INSERM) U1135, Hôpital Pitié-Salpêtrière AP-HP, Sorbonne Université, Paris, France
| | - Thomas Moulinet
- Department of Internal Medicine and Clinical Immunology, Nancy University Hospital, University of Lorraine, Nancy, France; Molecular Engineering and Articular Physiopathology, Unité Mixte de Recherche 7365, Centre national de la recherche scientifique (CNRS), University of Lorraine, Nancy, France
| | - Magali Perret
- Immunology Laboratory, Lyon Sud Hospital, Hospices Civils de Lyon, University of Claude Bernard-Lyon 1, Lyon, France
| | | | - Rachel Rignault-Bricard
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutical Implications, Université de Paris Cité, Paris, France
| | - Sébastien Viel
- Department of Genomics Medicine of Rare Diseases, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Angélique Vinit
- Production et Analyse de données en Sciences de la vie et en Santé (PASS), Plateforme de Cytométrie de la Pitié-Salpêtrière, Unité Mixte de Service (UMS) 037, Sorbonne Université, Paris, France
| | - Angèle Soria
- Dermatology-Allergology Department, Sorbonne Université, Tenon Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Darragh Duffy
- Translational Immunology Unit, Institut Pasteur, Université de Paris Cité, Paris, France
| | - Jean-Marie Launay
- Service of Biochemistry and Molecular Biology, Institut national de la santé et de la recherche médicale (INSERM) U942, Hospital Lariboisière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Jacques Callebert
- Service of Biochemistry and Molecular Biology, Institut national de la santé et de la recherche médicale (INSERM) U942, Hospital Lariboisière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Jean Philippe Herbeuval
- Laboratoire de Chimie et de Biochimie Pharmacologiques et Toxicologiques, Centre National de la Recherche Scientifique (CNRS), Paris, France
| | - Mathieu P Rodero
- Laboratoire de Chimie et de Biochimie Pharmacologiques et Toxicologiques, Centre National de la Recherche Scientifique (CNRS), Paris, France
| | - Sophie Georgin-Lavialle
- Department of Internal Medicine, Tenon Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France.
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