Műzes Györgyi, Sipos Ferenc
Immunology Division, Department of Internal Medicine and Hematology, Semmelweis University, 1088 Budapest, Hungary.
Int J Mol Sci. 2025 Jan 12;26(2):598. doi: 10.3390/ijms26020598.
Schnitzler syndrome is a unique autoinflammatory disease, of which 747 cases have been described worldwide to date. The main features of the syndrome are a triad of recurrent urticaria, monoclonal IgM gammopathy, systemic inflammation associated with recurrent fever, joint and bone pain, and atypical bone remodeling (osteosclerosis). The abnormal activation of the NLRP3 inflammasome produces IL-1, which drives the disease pathology, but it also involves IL-6 and IL-18. Unlike other autoinflammatory diseases, Schnitzler syndrome lacks evidence of the gene divergence causing the abnormal activation of NLRP3. However, mutations in the MEFV and MYD88 genes can be associated with the development of the disease. Due to its rarity, diagnosing the disease can be a challenging task. IL-1 inhibitors (i.e., anakinra, canakinumab, and rilonacept) are prominent in the treatment of the disease, but the IL-6 receptor inhibitor tocilizumab and the Bruton's tyrosine kinase inhibitor ibrutinib are also promising alternatives. In this summary article, we aim to provide a comprehensive overview of the clinical and molecular background of the disease and potential therapeutic targets, based on the cases reported so far. We diagnosed a patient who, to the best of our knowledge, represents the 748th documented case of this specific pathology. In the context of this patient, we would also like to draw attention to the potential pathogenic role of two novel gene mutations (variants of the MEFV gene "c.2084A>G" and the F2 gene "3'UTR c.*97G>A").
施尼茨勒综合征是一种独特的自身炎症性疾病,迄今为止全球已报道747例。该综合征的主要特征是三联征,即反复性荨麻疹、单克隆IgM丙种球蛋白病、与反复发热、关节和骨痛以及非典型骨重塑(骨硬化)相关的全身炎症。NLRP3炎性小体的异常激活产生白细胞介素-1(IL-1),其驱动疾病病理过程,但也涉及白细胞介素-6(IL-6)和白细胞介素-18(IL-18)。与其他自身炎症性疾病不同,施尼茨勒综合征缺乏导致NLRP3异常激活的基因变异证据。然而,MEFV和MYD88基因的突变可能与该疾病的发生有关。由于其罕见性,诊断该疾病可能具有挑战性。IL-1抑制剂(即阿那白滞素、卡那单抗和利洛纳塞)在该疾病的治疗中效果显著,但IL-6受体抑制剂托珠单抗和布鲁顿酪氨酸激酶抑制剂伊布替尼也是有前景的替代药物。在这篇综述文章中,我们旨在根据迄今为止报道的病例,对该疾病的临床和分子背景以及潜在治疗靶点提供全面概述。我们诊断了一名患者,据我们所知,该患者代表了这种特定病理的第748例记录病例。在该患者的背景下,我们还想提请注意两个新基因突变(MEFV基因“c.2084A>G”和F2基因“3'UTR c.*97G>A”的变异体)的潜在致病作用。