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Zaidi G, Bhatia V, Sahoo SK, Sarangi AN, Bharti N, Zhang L, Yu L, Eriksson D, Bensing S, Kämpe O, Bharani N, Yachha SK, Bhansali A, Sachan A, Jain V, Shah N, Aggarwal R, Aggarwal A, Srinivasan M, Agarwal S, Bhatia E. Autoimmune polyendocrine syndrome type 1 in an Indian cohort: a longitudinal study. Endocr Connect 2017; 6:289-296. [PMID: 28446514 PMCID: PMC5510449 DOI: 10.1530/ec-17-0022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 04/26/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Autoimmune polyendocrine syndrome type 1 (APS1) is a rare autosomal recessive disorder characterized by progressive organ-specific autoimmunity. There is scant information on APS1 in ethnic groups other than European Caucasians. We studied clinical aspects and autoimmune regulator (AIRE) gene mutations in a cohort of Indian APS1 patients. DESIGN Twenty-three patients (19 families) from six referral centres in India, diagnosed between 1996 and 2016, were followed for [median (range)] 4 (0.2-19) years. METHODS Clinical features, mortality, organ-specific autoantibodies and AIRE gene mutations were studied. RESULTS Patients varied widely in their age of presentation [3.5 (0.1-17) years] and number of clinical manifestations [5 (2-11)]. Despite genetic heterogeneity, the frequencies of the major APS1 components (mucocutaneous candidiasis: 96%; hypoparathyroidism: 91%; primary adrenal insufficiency: 55%) were similar to reports in European series. In contrast, primary hypothyroidism (23%) occurred more frequently and at an early age, while kerato-conjunctivitis, urticarial rash and autoimmune hepatitis were uncommon (9% each). Six (26%) patients died at a young age [5.8 (3-23) years] due to septicaemia, hepatic failure and adrenal/hypocalcaemic crisis from non-compliance/unexplained cause. Interferon-α and/or interleukin-22 antibodies were elevated in all 19 patients tested, including an asymptomatic infant. Eleven AIRE mutations were detected, the most common being p.C322fsX372 (haplotype frequency 37%). Four mutations were novel, while six others were previously described in European Caucasians. CONCLUSIONS Indian APS1 patients exhibited considerable genetic heterogeneity and had highly variable clinical features. While the frequency of major manifestations was similar to that of European Caucasians, other features showed significant differences. A high mortality at a young age was observed.
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Affiliation(s)
- Ghazala Zaidi
- Departments of EndocrinologySanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Vijayalakshmi Bhatia
- Departments of EndocrinologySanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Saroj K Sahoo
- Departments of EndocrinologySanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Aditya Narayan Sarangi
- Departments of GastroenterologySanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Niharika Bharti
- Departments of EndocrinologySanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Li Zhang
- Department of ImmunologyBarbara Davis Centre for Childhood Diabetes, Denver, USA
| | - Liping Yu
- Department of ImmunologyBarbara Davis Centre for Childhood Diabetes, Denver, USA
| | - Daniel Eriksson
- Department of Medicine (Solna)Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Sophie Bensing
- Department of Molecular Medicine and SurgeryKarolinska Institutet, and Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - Olle Kämpe
- Department of Medicine (Solna)Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
- Science for Life LaboratoryDepartment of Medical Sciences, Uppsala University, Sweden
| | - Nisha Bharani
- Department of EndocrinologyAmrita Institute of Medical Sciences, Kochi, India
| | - Surendra Kumar Yachha
- Departments of Paediatric GastroenterologySanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Anil Bhansali
- Department of EndocrinologyPostgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alok Sachan
- Department of EndocrinologySri Venkateshwara Institute of Medical Sciences, Tirupathi, India
| | - Vandana Jain
- Department of PaediatricsAll India Institute of Medical Sciences, New Delhi, India
| | - Nalini Shah
- Department of EndocrinologyKing Edward Memorial Hospital, Seth GS Medical College, Mumbai, India
| | - Rakesh Aggarwal
- Departments of GastroenterologySanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Amita Aggarwal
- Departments of Clinical ImmunologySanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Muthuswamy Srinivasan
- Departments of Medical GeneticsSanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sarita Agarwal
- Departments of Medical GeneticsSanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Eesh Bhatia
- Departments of EndocrinologySanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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