Clinical and molecular phenotypes of low-penetrance variants of NLRP3

• Verfasst von: Kümmerle-Deschner, Jasmin [VerfasserIn]
• Verfasst von: Blank, Norbert [VerfasserIn]
• Titel: Clinical and molecular phenotypes of low-penetrance variants of NLRP3
• Titelzusatz: diagnostic and therapeutic challenges
• Verf.angabe: J.B. Kuemmerle‐Deschner, D. Verma, T. Endres, L. Broderick, A.A. de Jesus, F. Hofer, N. Blank, K. Krause, C. Rietschel, G. Horneff, I. Aksentijevich, P. Lohse, R. Goldbach‐Mansky, H.M. Hoffman, S.M. Benseler
• E-Jahr: 2017
• Jahr: November 2017
• Umfang: 8 S.
• Fussnoten: Gesehen am 27.11.2018
• Titel Quelle: Enthalten in: Arthritis & rheumatology
• Ort Quelle: Hoboken, NJ : Wiley, 2014
• Jahr Quelle: 2017
• Band/Heft Quelle: 69(2017), 11, Seite 2233-2240
• ISSN Quelle: 2326-5205
• DOI: doi:10.1002/art.40208
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1584493887

Abstract

Objective Cryopyrin-associated periodic syndromes (CAPS) result from gain-of-function mutations in the NLRP3 gene, which causes excessive release of interleukin-1β (IL-1β) and systemic inflammation. While pathogenetic NLRP3 variant phenotypes are well-characterized, low-penetrance NLRP3 variants represent a significant clinical challenge. The aims of this study were to determine the clinical phenotype, the in vitro biologic phenotype, and the effect of anti-IL-1 treatment in patients with low-penetrance NLRP3 variants. Methods A multicenter study of consecutive symptomatic patients with low-penetrance NLRP3 variants recruited from 7 centers between May 2012 and May 2013 was performed. The observed findings were transferred into a study database, from which they were extracted for analysis. Controls were patients with a known pathogenetic NLRP3 variant. Clinical presentation and CAPS markers of inflammation were captured. Functional assays of inflammasome activation, including caspase 1 activity, NF-κB release, cell death, and IL-1β release, were performed. Treatment effects of IL-1 were determined. Comparisons between low-penetrance and pathogenetic NLRP3 variants were performed. Results The study included 45 patients, 21 of which were female (47%); 26 of the patients (58%) were children. NLRP3 low-penetrance variants identified in the patients were Q703K (n = 19), R488K (n = 6), and V198M (n = 20). In the controls, 28 had pathogenetic NLRP3 variants. Patients with low-penetrance NLRP3 variants had significantly more fever (76%) and gastrointestinal symptoms (73%); eye disease, hearing loss, and renal involvement were less common. Functional inflammasome testing identified an intermediate phenotype in low-penetrance NLRP3 variants as compared to wild-type and pathogenetic NLRP3 variants. All treated patients responded to IL-1 inhibition, with complete response documented in 50% of patients. Conclusion Patients with low-penetrance NLRP3 variants display a distinct clinical phenotype and an intermediate biologic phenotype, including IL-1β and non-IL-1β-mediated inflammatory pathway activation.