复发性、严重阿弗他口炎和黏膜溃疡为新型功能获得性突变的主要表现。

Recurrent, Severe Aphthous Stomatitis and Mucosal Ulcers as Primary Manifestations of a Novel Gain-of-Function Mutation.

机构信息

Department of Infectious and Pediatric Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.

PID Clinical Unit and Laboratory, Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary.

出版信息

Front Immunol. 2020 May 28;11:967. doi: 10.3389/fimmu.2020.00967. eCollection 2020.

Abstract

Chronic mucocutaneous candidiasis (CMC) characterized by persistent and recurrent Candida infection of the skin, nails, and the mucosa membranes has been proposed as the major infectious phenotype in patients with gain-of-function mutation of signal transducer and activator of transcription 1 (STAT1) 1. However, viral infections caused mostly by herpesviruses, and a broad range of autoimmune disorders may also be part of the clinical phenotype. We report here on a 31 years old female patient suffering from severe mucosal aphthous mucositis and ulcers and recurrent herpes simplex for decades. We found a previously unknown heterozygous sequence variant in (c.1219C>G; L407V) affecting the DNA-binding domain of the protein in the patient and her 4 years old daughter. We found this mutation gain-of-function (GOF) by using immunoblot and luciferase assays. We detected low proportion of IL-17A-producing CD4+ T cell lymphocytes by using intracellular staining and flow cytometry. Candida-induced secretion of IL-17A and IL-22 by mononuclear cells from the patient was markedly decreased compared to controls. These data suggest that the novel mutant allele may result in impaired differentiation of CD4+ T cells to CD4+/IL-17+ cells. The clinical phenotype of the disease in this patient was unique as it was dominated primarily by severe aphthous stomatitis and ulcerative esophagitis and only partly by typical CMC resulting in diagnostic delay. We suggest that patients with severe recurrent aphthous stomatitis and esophagitis should be evaluated for GOF mutation. Based on the broad clinical spectrum of the disease, we also suggest that CMC and CMC disease may not be an appropriate term to define clinically GOF mutation.

摘要

慢性黏膜皮肤念珠菌病(CMC)的特征是皮肤、指甲和黏膜持续性和复发性念珠菌感染,被认为是信号转导和转录激活因子 1(STAT1)1 功能获得性突变患者的主要感染表型。然而,病毒感染主要由疱疹病毒引起,广泛的自身免疫性疾病也可能是临床表型的一部分。我们在此报告一名 31 岁女性患者,患有严重的黏膜口疮性黏膜炎和溃疡以及数十年复发性单纯疱疹。我们在患者及其 4 岁的女儿中发现了一个先前未知的杂合序列变异(c.1219C>G;L407V),影响蛋白的 DNA 结合域。我们通过免疫印迹和荧光素酶测定发现了这种突变的功能获得(GOF)。我们通过细胞内染色和流式细胞术检测到 IL-17A 产生的 CD4+T 淋巴细胞的比例较低。与对照组相比,来自患者的单核细胞中念珠菌诱导的 IL-17A 和 IL-22 的分泌显著减少。这些数据表明,新型突变等位基因可能导致 CD4+T 细胞向 CD4+/IL-17+细胞的分化受损。该患者疾病的临床表型是独特的,主要表现为严重的口疮性口炎和溃疡性食管炎,而典型的 CMC 仅部分表现,导致诊断延迟。我们建议严重复发性口疮性口炎和食管炎患者应评估 GOF 突变。基于该疾病广泛的临床谱,我们还建议 CMC 和 CMC 疾病可能不是定义临床 GOF 突变的合适术语。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/19c3/7270203/904417ef95a4/fimmu-11-00967-g0001.jpg

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