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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Front+Immunol
2017 ; 8
(ä): 1410
Nephropedia Template TP
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English Wikipedia
Late-Onset Cryopyrin-Associated Periodic Syndromes Caused by Somatic NLRP3
Mosaicism-UK Single Center Experience
#MMPMID29163488
Rowczenio DM
; Gomes SM
; Aróstegui JI
; Mensa-Vilaro A
; Omoyinmi E
; Trojer H
; Baginska A
; Baroja-Mazo A
; Pelegrin P
; Savic S
; Lane T
; Williams R
; Brogan P
; Lachmann HJ
; Hawkins PN
Front Immunol
2017[]; 8
(ä): 1410
PMID29163488
show ga
Cryopyrin-associated periodic syndrome (CAPS) is caused by gain-of-function NLRP3
mutations. Recently, somatic NLRP3 mosaicism has been reported in some CAPS
patients who were previously classified as "mutation-negative." We describe here
the clinical and laboratory findings in eight British adult patients who
presented with symptoms typical of CAPS other than an onset in mid-late
adulthood. All patients underwent comprehensive clinical and laboratory
investigations, including analysis of the NLRP3 gene using Sanger and
amplicon-based deep sequencing (ADS) along with measurements of extracellular
apoptosis-associated speck-like protein with CARD domain (ASC) aggregates. The
clinical phenotype in all subjects was consistent with mid-spectrum CAPS, except
a median age at disease onset of 50?years. Sanger sequencing of NLRP3 was
non-diagnostic but ADS detected a somatic NLRP3 mutation in each case. In one
patient, DNA isolated from blood demonstrated an increase in the mutant allele
from 5 to 45% over 12?years. ASC aggregates in patients' serum measured during
active disease were significantly higher than healthy controls. This series
represents 8% of CAPS patients diagnosed in a single center, suggesting that
acquired NLRP3 mutations may not be an uncommon cause of the syndrome and should
be sought in all patients with late-onset symptoms otherwise compatible with
CAPS. Steadily worsening CAPS symptoms in one patient were associated with clonal
expansion of the mutant allele predominantly affecting myeloid cells. Two
patients developed AA amyloidosis, which previously has only been reported in
CAPS in association with life-long germline NLRP3 mutations.