Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, USA.
J Clin Immunol. 2020 Nov;40(8):1065-1081. doi: 10.1007/s10875-020-00847-x. Epub 2020 Aug 27.
Heterozygous gain-of-function (GOF) mutations in STAT1 in patients with chronic mucocutaneous candidiasis (CMC) and hypothyroidism were discovered in 2011. CMC is the recurrent or persistent mucocutaneous infection by Candida fungi, and hypothyroidism results from autoimmune thyroiditis. Patients with these diseases develop other infectious diseases, including viral, bacterial, and fungal diseases, and other autoimmune manifestations, including enterocolitis, immune cytopenia, endocrinopathies, and systemic lupus erythematosus. STAT1-GOF mutations are highly penetrant with a median age at onset of 1 year and often underlie an autosomal dominant trait. As many as 105 mutations at 72 residues, including 65 recurrent mutations, have already been reported in more than 400 patients worldwide. The GOF mechanism involves impaired dephosphorylation of STAT1 in the nucleus. Patient cells show enhanced STAT1-dependent responses to type I and II interferons (IFNs) and IL-27. This impairs Th17 cell development, which accounts for CMC. The pathogenesis of autoimmunity likely involves enhanced type I IFN responses, as in other type I interferonopathies. The pathogenesis of other infections, especially those caused by intramacrophagic bacteria and fungi, which are otherwise seen in patients with diminished type II IFN immunity, has remained mysterious. The cumulative survival rates of patients with and without severe disease (invasive infection, cancer, and/or symptomatic aneurysm) at 60 years of age are 31% and 87%, respectively. Severe autoimmunity also worsens the prognosis. The treatment of patients with STAT1-GOF mutations who suffer from severe infectious and autoimmune manifestations relies on hematopoietic stem cell transplantation and/or oral JAK inhibitors.
2011 年发现,慢性黏膜皮肤念珠菌病(CMC)和甲状腺功能减退症伴杂合子功能获得性(GOF)STAT1 突变的患者。CMC 是由念珠菌真菌引起的复发性或持续性黏膜皮肤感染,而甲状腺功能减退症是由自身免疫性甲状腺炎引起的。患有这些疾病的患者会发展出其他传染病,包括病毒、细菌和真菌感染,以及其他自身免疫表现,包括肠炎、免疫性血细胞减少症、内分泌病和系统性红斑狼疮。STAT1-GOF 突变具有高度外显性,发病中位年龄为 1 岁,通常为常染色体显性遗传。在全球 400 多名患者中,已经报道了多达 72 个残基的 105 个突变,包括 65 个重复突变。GOF 机制涉及 STAT1 在核内去磷酸化的受损。患者细胞表现出增强的 STAT1 依赖性对 I 型和 II 型干扰素(IFN)和 IL-27 的反应。这会损害 Th17 细胞的发育,这就是 CMC 的原因。自身免疫的发病机制可能涉及增强的 I 型 IFN 反应,就像在其他 I 型干扰素病中一样。其他感染的发病机制,特别是那些在 II 型 IFN 免疫减弱的患者中看到的吞噬细胞内细菌和真菌引起的感染的发病机制,仍然神秘。无严重疾病(侵袭性感染、癌症和/或有症状的动脉瘤)的患者和有严重疾病的患者的累积生存率分别为 60 岁时为 31%和 87%。严重的自身免疫也会使预后恶化。患有 STAT1-GOF 突变且有严重感染和自身免疫表现的患者的治疗依赖于造血干细胞移植和/或口服 JAK 抑制剂。