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Erschienen in: Current Rheumatology Reports 11/2017

01.11.2017 | Orphan Diseases (B Manger, Section Editor)

Deficiency of Adenosine Deaminase 2 (DADA2), an Inherited Cause of Polyarteritis Nodosa and a Mimic of Other Systemic Rheumatologic Disorders

verfasst von: Hasan Hashem, Susan J Kelly, Nancy J Ganson, Michael S Hershfield

Erschienen in: Current Rheumatology Reports | Ausgabe 11/2017

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Abstract

Purpose of Review

A new autoinflammatory disease, deficiency of adenosine deaminase 2 (DADA2), caused by mutations in the CECR1 gene, was first reported in 2014. This review aims to update progress in defining, treating, and understanding this multi-faceted disorder.

Recent Findings

DADA2 was first described in patients with systemic inflammation, mild immune deficiency, and vasculopathy manifested as recurrent stroke or polyarteritis nodosa (PAN). More than 125 patients have now been reported, and the phenotype has expanded to include children and adults presenting primarily with pure red cell aplasia (PRCA), or with antibody deficiency. Age of onset and clinical severity vary widely, even among related patients, and are not clearly related to CECR1 genotype. Inflammatory features often respond to anti-TNF agents, but marrow failure and severe immune deficiency may require hematopoietic stem cell transplantation.

Summary

ADA2 is expressed and secreted by monocytes and macrophages, but its biological function and the pathogenesis of DADA2 are uncertain and will remain an important area of research. Pre-clinical investigation of ADA2 replacement therapy and CECR1-directed gene therapy are warranted, but complicated by the absence of a suitable animal model.
Literatur
2.
Zurück zum Zitat •• Zhou Q, Yang D, Ombrello AK, Zavialov AV, Toro C, Zavialov AV, et al. Early-onset stroke and vasculopathy associated with mutations in ADA2. N Engl J Med. 2014;370(10):911–20. https://doi.org/10.1056/NEJMoa1307361. The first report of DADA2 as a cause of early-onset stroke. Provides experimental evidence supporting causalityof ADA2 deficiency and evidence implicating M1 macrophage polarization in pathogenesis CrossRefPubMedPubMedCentral •• Zhou Q, Yang D, Ombrello AK, Zavialov AV, Toro C, Zavialov AV, et al. Early-onset stroke and vasculopathy associated with mutations in ADA2. N Engl J Med. 2014;370(10):911–20. https://​doi.​org/​10.​1056/​NEJMoa1307361. The first report of DADA2 as a cause of early-onset stroke. Provides experimental evidence supporting causalityof ADA2 deficiency and evidence implicating M1 macrophage polarization in pathogenesis CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat •• Navon Elkan P, Pierce SB, Segel R, Walsh T, Barash J, Padeh S, et al. Mutant adenosine deaminase 2 in a polyarteritis nodosa vasculopathy. N Engl J Med. 2014;370(10):921–31. https://doi.org/10.1056/NEJMoa1307362. The first report of DADA2 as a cause of familial and sporadic PAN. Provides evidence of the efficacy of anti-TNF therapy in controlling autoinflammation CrossRefPubMed •• Navon Elkan P, Pierce SB, Segel R, Walsh T, Barash J, Padeh S, et al. Mutant adenosine deaminase 2 in a polyarteritis nodosa vasculopathy. N Engl J Med. 2014;370(10):921–31. https://​doi.​org/​10.​1056/​NEJMoa1307362. The first report of DADA2 as a cause of familial and sporadic PAN. Provides evidence of the efficacy of anti-TNF therapy in controlling autoinflammation CrossRefPubMed
4.
Zurück zum Zitat Schrader WP, Pollara B, Meuwissen HJ. Characterization of the residual adenosine deaminating activity in the spleen of a patient with combined immunodeficiency disease and adenosine deaminase deficiency. Proc Natl Acad Sci U S A. 1978;75(1):446–50.CrossRefPubMedPubMedCentral Schrader WP, Pollara B, Meuwissen HJ. Characterization of the residual adenosine deaminating activity in the spleen of a patient with combined immunodeficiency disease and adenosine deaminase deficiency. Proc Natl Acad Sci U S A. 1978;75(1):446–50.CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Berkun Y, Segel R, Navon-Elkan P. Adenosine deaminase 2 deficiency: more than monogenic vasculitis. Isr Med Assoc J. 2017;19(7):435–7.PubMed Berkun Y, Segel R, Navon-Elkan P. Adenosine deaminase 2 deficiency: more than monogenic vasculitis. Isr Med Assoc J. 2017;19(7):435–7.PubMed
14.
15.
Zurück zum Zitat • Van Eyck L Jr, Hershfield MS, Pombal D, Kelly SJ, Ganson NJ, Moens L, et al. Hematopoietic stem cell transplantation rescues the immunologic phenotype and prevents vasculopathy in patients with adenosine deaminase 2 deficiency. J Allergy Clin Immunol. 2015;135(1):283–7 e5. https://doi.org/10.1016/j.jaci.2014.10.010. Describes the complicated course and successful HSCT in one of two siblings with DADA2, and documents elevated IL-6 in both siblings CrossRefPubMedPubMedCentral • Van Eyck L Jr, Hershfield MS, Pombal D, Kelly SJ, Ganson NJ, Moens L, et al. Hematopoietic stem cell transplantation rescues the immunologic phenotype and prevents vasculopathy in patients with adenosine deaminase 2 deficiency. J Allergy Clin Immunol. 2015;135(1):283–7 e5. https://​doi.​org/​10.​1016/​j.​jaci.​2014.​10.​010. Describes the complicated course and successful HSCT in one of two siblings with DADA2, and documents elevated IL-6 in both siblings CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat •• Belot A, Wassmer E, Twilt M, Lega JC, Zeef LA, Oojageer A, et al. Mutations in CECR1 associated with a neutrophil signature in peripheral blood. Pediatr Rheumatol Online J. 2014;12:44. https://doi.org/10.1186/1546-0096-12-44. Disconvery of interfereon signature and overexpression of neutrophil genes in two patients with DADA2. Suggests inflammatory features and PAN may result from chronic neutophil activation CrossRefPubMedPubMedCentral •• Belot A, Wassmer E, Twilt M, Lega JC, Zeef LA, Oojageer A, et al. Mutations in CECR1 associated with a neutrophil signature in peripheral blood. Pediatr Rheumatol Online J. 2014;12:44. https://​doi.​org/​10.​1186/​1546-0096-12-44. Disconvery of interfereon signature and overexpression of neutrophil genes in two patients with DADA2. Suggests inflammatory features and PAN may result from chronic neutophil activation CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat • Batu ED, Karadag O, Taskiran EZ, Kalyoncu U, Aksentijevich I, Alikasifoglu M, et al. A case series of adenosine deaminase 2-deficient patients emphasizing treatment and genotype-phenotype correlations. J Rheumatol. 2015;42(8):1532–4. https://doi.org/10.3899/jrheum.150024. Highlights weak correlation between genotype and phenotype CrossRefPubMed • Batu ED, Karadag O, Taskiran EZ, Kalyoncu U, Aksentijevich I, Alikasifoglu M, et al. A case series of adenosine deaminase 2-deficient patients emphasizing treatment and genotype-phenotype correlations. J Rheumatol. 2015;42(8):1532–4. https://​doi.​org/​10.​3899/​jrheum.​150024. Highlights weak correlation between genotype and phenotype CrossRefPubMed
26.
Zurück zum Zitat • Nanthapisal S, Murphy C, Omoyinmi E, Hong Y, Standing A, Berg S, et al. Deficiency of adenosine deaminase type 2: a description of phenotype and genotype in fifteen cases. Arthritis Rheumatol. 2016;68(9):2314–22. https://doi.org/10.1002/art.39699. Highlights phenotypic heterogeneity in related patients homozygous for the same CECR1 mutation CrossRefPubMed • Nanthapisal S, Murphy C, Omoyinmi E, Hong Y, Standing A, Berg S, et al. Deficiency of adenosine deaminase type 2: a description of phenotype and genotype in fifteen cases. Arthritis Rheumatol. 2016;68(9):2314–22. https://​doi.​org/​10.​1002/​art.​39699. Highlights phenotypic heterogeneity in related patients homozygous for the same CECR1 mutation CrossRefPubMed
29.
Zurück zum Zitat • Van Montfrans JM, Hartman EA, Braun KP, Hennekam EA, Hak EA, Nederkoorn PJ, et al. Phenotypic variability in patients with ADA2 deficiency due to identical homozygous R169Q mutations. Rheumatology (Oxford). 2016;55(5):902–10. https://doi.org/10.1093/rheumatology/kev439. Highlights phenotypic heterogeneity in related patients homozygous for the same CECR1 mutation CrossRef • Van Montfrans JM, Hartman EA, Braun KP, Hennekam EA, Hak EA, Nederkoorn PJ, et al. Phenotypic variability in patients with ADA2 deficiency due to identical homozygous R169Q mutations. Rheumatology (Oxford). 2016;55(5):902–10. https://​doi.​org/​10.​1093/​rheumatology/​kev439. Highlights phenotypic heterogeneity in related patients homozygous for the same CECR1 mutation CrossRef
35.
37.
Zurück zum Zitat •• Schepp J, Proietti M, Frede N, Buchta M, Hubscher K, Rojas Restrepo J, et al. Screening of 181 patients with antibody deficiency for deficiency of adenosine deaminase 2 sheds new light on the disease in adulthood. Arthritis Rheumatol. 2017;69(8):1689–700. https://doi.org/10.1002/art.40147. Screening idenitfied DADA2 in 11 (6%) of 181 patients with antibody deficiency (CVID) CrossRefPubMed •• Schepp J, Proietti M, Frede N, Buchta M, Hubscher K, Rojas Restrepo J, et al. Screening of 181 patients with antibody deficiency for deficiency of adenosine deaminase 2 sheds new light on the disease in adulthood. Arthritis Rheumatol. 2017;69(8):1689–700. https://​doi.​org/​10.​1002/​art.​40147. Screening idenitfied DADA2 in 11 (6%) of 181 patients with antibody deficiency (CVID) CrossRefPubMed
38.
Zurück zum Zitat Skrabl-Baumgartner A, Plecko B, Konig N, Hershfield M, Gruber-Sedlmayr U, Lee-Kirsch MA. Autoimmune phenotype with type I interferon signature in two brothers with ADA2 deficiency carrying a novel CECR1 mutation. Pediatr Rheumatol. 2017;15(1):67. https://doi.org/10.1186/s12969-017-0193-x. Skrabl-Baumgartner A, Plecko B, Konig N, Hershfield M, Gruber-Sedlmayr U, Lee-Kirsch MA. Autoimmune phenotype with type I interferon signature in two brothers with ADA2 deficiency carrying a novel CECR1 mutation. Pediatr Rheumatol. 2017;15(1):67. https://​doi.​org/​10.​1186/​s12969-017-0193-x.
40.
Zurück zum Zitat •• Hashem H, R A, Kumar AR, Müller I, Babor F, Bredius R et al. Hematopoietic stem cell transplantation rescues the hematological, immunological and vascular phenotype in DADA2. Blood. 2017, in Press. Reviews the experience with HSCT performed in 14 patients with DADA2. •• Hashem H, R A, Kumar AR, Müller I, Babor F, Bredius R et al. Hematopoietic stem cell transplantation rescues the hematological, immunological and vascular phenotype in DADA2. Blood. 2017, in Press. Reviews the experience with HSCT performed in 14 patients with DADA2.
42.
Zurück zum Zitat Richard E, Arredondo-Vega FX, Santisteban I, Kelly SJ, Patel DD, Hershfield MS. The binding site of human adenosine deaminase for CD26/dipeptidyl peptidase IV: the Arg142Gln mutation impairs binding to cd26 but does not cause immune deficiency. J Exp Med. 2000;192(9):1223–36.CrossRefPubMedPubMedCentral Richard E, Arredondo-Vega FX, Santisteban I, Kelly SJ, Patel DD, Hershfield MS. The binding site of human adenosine deaminase for CD26/dipeptidyl peptidase IV: the Arg142Gln mutation impairs binding to cd26 but does not cause immune deficiency. J Exp Med. 2000;192(9):1223–36.CrossRefPubMedPubMedCentral
43.
Zurück zum Zitat Homma K, Matsushita T, Natori S. Purification, characterization, and cDNA cloning of a novel growth factor from the conditioned medium of NIH-Sape-4, an embryonic cell line of Sarcophaga peregrina (flesh fly). J Biol Chem. 1996;271(23):13770–5.CrossRefPubMed Homma K, Matsushita T, Natori S. Purification, characterization, and cDNA cloning of a novel growth factor from the conditioned medium of NIH-Sape-4, an embryonic cell line of Sarcophaga peregrina (flesh fly). J Biol Chem. 1996;271(23):13770–5.CrossRefPubMed
47.
Zurück zum Zitat Charlab R, Valenzuela JG, Andersen J, Ribeiro JM. The invertebrate growth factor/CECR1 subfamily of adenosine deaminase proteins. Gene. 2001;267(1):13–22.CrossRefPubMed Charlab R, Valenzuela JG, Andersen J, Ribeiro JM. The invertebrate growth factor/CECR1 subfamily of adenosine deaminase proteins. Gene. 2001;267(1):13–22.CrossRefPubMed
Metadaten
Titel
Deficiency of Adenosine Deaminase 2 (DADA2), an Inherited Cause of Polyarteritis Nodosa and a Mimic of Other Systemic Rheumatologic Disorders
verfasst von
Hasan Hashem
Susan J Kelly
Nancy J Ganson
Michael S Hershfield
Publikationsdatum
01.11.2017
Verlag
Springer US
Erschienen in
Current Rheumatology Reports / Ausgabe 11/2017
Print ISSN: 1523-3774
Elektronische ISSN: 1534-6307
DOI
https://doi.org/10.1007/s11926-017-0699-8

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