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Segura-Tudela A, López-Nevado M, Nieto-López C, García-Jiménez S, Díaz-Madroñero MJ, Delgado Á, Cabrera-Marante O, Pleguezuelo D, Morales P, Paz-Artal E, Gil-Niño J, Marco FM, Serrano C, González-Granado LI, Quesada-Espinosa JF, Allende LM. Enrichment of Immune Dysregulation Disorders in Adult Patients with Human Inborn Errors of Immunity. J Clin Immunol 2024; 44:61. [PMID: 38363452 PMCID: PMC10873437 DOI: 10.1007/s10875-024-01664-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/26/2024] [Indexed: 02/17/2024]
Abstract
Human inborn errors of immunity (IEI) comprise a group of diseases resulting from molecular variants that compromise innate and adaptive immunity. Clinical features of IEI patients are dominated by susceptibility to a spectrum of infectious diseases, as well as autoimmune, autoinflammatory, allergic, and malignant phenotypes that usually appear in childhood, which is when the diagnosis is typically made. However, some IEI patients are identified in adulthood due to symptomatic delay of the disease or other reasons that prevent the request for a molecular study. The application of next-generation sequencing (NGS) as a diagnostic technique has given rise to an ever-increasing identification of IEI-monogenic causes, thus improving the diagnostic yield and facilitating the possibility of personalized treatment. This work was a retrospective study of 173 adults with IEI suspicion that were sequenced between 2005 and 2023. Sanger, targeted gene-panel, and whole exome sequencing were used for molecular diagnosis. Disease-causing variants were identified in 44 of 173 (25.43%) patients. The clinical phenotype of these 44 patients was mostly related to infection susceptibility (63.64%). An enrichment of immune dysregulation diseases was found when cohorts with molecular diagnosis were compared to those without. Immune dysregulation disorders, group 4 from the International Union of Immunological Societies Expert Committee (IUIS), were the most prevalent among these adult patients. Immune dysregulation as a new item in the Jeffrey Model Foundation warning signs for adults significantly increases the sensitivity for the identification of patients with an IEI-producing molecular defect.
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Affiliation(s)
- Alejandro Segura-Tudela
- Department of Immunology, University Hospital, 12 de Octubre, Avda. de Andalucía S/N, 28041, Madrid, Spain
- Research Institute Hospital, 12 Octubre (imas12), Madrid, Spain
| | - Marta López-Nevado
- Department of Immunology, University Hospital, 12 de Octubre, Avda. de Andalucía S/N, 28041, Madrid, Spain
- Research Institute Hospital, 12 Octubre (imas12), Madrid, Spain
| | - Celia Nieto-López
- Department of Immunology, University Hospital, 12 de Octubre, Avda. de Andalucía S/N, 28041, Madrid, Spain
- Research Institute Hospital, 12 Octubre (imas12), Madrid, Spain
| | - Sandra García-Jiménez
- Department of Immunology, University Hospital, 12 de Octubre, Avda. de Andalucía S/N, 28041, Madrid, Spain
- Research Institute Hospital, 12 Octubre (imas12), Madrid, Spain
| | - María J Díaz-Madroñero
- Department of Immunology, University Hospital, 12 de Octubre, Avda. de Andalucía S/N, 28041, Madrid, Spain
| | - Ángeles Delgado
- Department of Immunology, University Hospital, 12 de Octubre, Avda. de Andalucía S/N, 28041, Madrid, Spain
| | - Oscar Cabrera-Marante
- Department of Immunology, University Hospital, 12 de Octubre, Avda. de Andalucía S/N, 28041, Madrid, Spain
- Research Institute Hospital, 12 Octubre (imas12), Madrid, Spain
| | - Daniel Pleguezuelo
- Department of Immunology, University Hospital, 12 de Octubre, Avda. de Andalucía S/N, 28041, Madrid, Spain
- Research Institute Hospital, 12 Octubre (imas12), Madrid, Spain
| | - Pablo Morales
- Department of Immunology, University Hospital, 12 de Octubre, Avda. de Andalucía S/N, 28041, Madrid, Spain
- Research Institute Hospital, 12 Octubre (imas12), Madrid, Spain
| | - Estela Paz-Artal
- Department of Immunology, University Hospital, 12 de Octubre, Avda. de Andalucía S/N, 28041, Madrid, Spain
- Research Institute Hospital, 12 Octubre (imas12), Madrid, Spain
- School of Medicine, Complutense University of Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Jorge Gil-Niño
- Department of Internal Medicine, University Hospital, 12 de Octubre, Madrid, Spain
| | - Francisco M Marco
- Unit of Immunology, University Hospital General Dr Balmis, Alicante, Spain
| | - Cristina Serrano
- Department of Immunology, University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Luis I González-Granado
- Research Institute Hospital, 12 Octubre (imas12), Madrid, Spain
- School of Medicine, Complutense University of Madrid, Madrid, Spain
- Unit of Immunodeficiencies, Department of Pediatrics, University Hospital, 12 de Octubre, Madrid, Spain
| | - Juan F Quesada-Espinosa
- Research Institute Hospital, 12 Octubre (imas12), Madrid, Spain
- Department of Genetics, University Hospital, 12 de Octubre, Madrid, Spain
| | - Luis M Allende
- Department of Immunology, University Hospital, 12 de Octubre, Avda. de Andalucía S/N, 28041, Madrid, Spain.
- Research Institute Hospital, 12 Octubre (imas12), Madrid, Spain.
- School of Medicine, Complutense University of Madrid, Madrid, Spain.
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