A nationwide survey of Aicardi-Goutieres syndrome patients identifies a strong association between dominant TREX1 mutations and chilblain lesions: Japanese cohort study

作者：Abe Junya; Nakamura Kazuyuki; Nishikomori Ryuta^*; Kato Mitsuhiro; Mitsuiki Noriko; Izawa Kazushi; Awaya Tomonari; Kawai Tomoki; Yasumi Takahiro; Toyoshima Itaru; Hasegawa Kazuko; Ohshima Yusei; Hiragi Toru; Sasahara Yoji; Suzuki Yasuhiro; Kikuchi Masahiro; Osaka Hitoshi; Ohya Takashi; Ninomiya Shinya; Fujikawa Satoshi; Akasaka Manami; Iwata Naomi; Kawakita Akiko; Funatsuka Makoto; Shintaku Haruo; Ohara Osamu; Ichinose Hiroshi; Heike Toshio

来源：Rheumatology, 2014, 53(3): 448-458.

DOI：10.1093/rheumatology/ket372

• Aicardi-Goutieres syndrome
• TREX1
• SAMHD1
• dominant-type
• mosaicism
• chilblain
• autoimmunity

Objectives. Aicardi-Goutieres syndrome (AGS) is a rare, genetically determined, early onset progressive encephalopathy associated with autoimmune manifestations. AGS is usually inherited in an autosomal recessive manner. The disease is rare, therefore the clinical manifestations and genotype-phenotype correlations, particularly with regard to autoimmune diseases, are still unclear. Here we performed a nationwide survey of AGS patients in Japan and analysed the genetic and clinical data. %26lt;br%26gt;Methods. Patients were recruited via questionnaires sent to paediatric or adult neurologists in Japanese hospitals and institutions. Genetic analysis was performed and clinical data were collected. %26lt;br%26gt;Results. Fourteen AGS patients were identified from 13 families; 10 harboured genetic mutations. Three patients harboured dominant-type TREX1 mutations. These included two de novo cases: one caused by a novel heterozygous p.His195Tyr mutation and the other by a novel somatic mosaicism resulting in a p.Asp200Asn mutation. Chilblain lesions were observed in all patients harbouring dominant-type TREX1 mutations. All three patients harbouring SAMHD1 mutations were diagnosed with autoimmune diseases, two with SLE and one with SS. The latter is the first reported case. %26lt;br%26gt;Conclusion. This study is the first to report a nationwide AGS survey, which identified more patients with sporadic AGS carrying de novo dominant-type TREX1 mutations than expected. There was a strong association between the dominant-type TREX1 mutations and chilblain lesions, and between SAMHD1 mutations and autoimmunity. These findings suggest that rheumatologists should pay attention to possible sporadic AGS cases presenting with neurological disorders and autoimmune manifestations.

• 出版日期2014-3