Overview of STING-Associated Vasculopathy with Onset in Infancy (SAVI) Among 21 Patients.
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Frémond Marie-Louise, Hadchouel Alice, Berteloot Laureline, Melki Isabelle, Bresson Violaine, Barnabei Laura, Jeremiah Nadia, Belot Alexandre, Bondet Vincent, Brocq Olivier, Chan Damien, Dagher Rawane, Dubus Jean-Christophe, Duffy Darragh, Feuillet-Soummer Séverine, Fusaro Mathieu, Gattorno Marco, Insalaco Antonella, Jeziorski Eric, Kitabayashi Naoki, Lopez-Corbeto Mireia, Mazingue Françoise, Morren Marie-Anne, Rice Gillian I, Rivière Jacques G, Seabra Luis, Sirvente Jérôme, Soler-Palacin Pere, Stremler-Le Bel Nathalie, Thouvenin Guillaume, Thumerelle Caroline, Van Aerde Eline, Volpi Stefano, Willcocks Sophie, Wouters Carine, Breton Sylvain, Molina Thierry, Bader-Meunier Brigitte, Moshous Despina, Fischer Alain, Blanche Stéphane, Rieux-Laucat Frédéric, Crow Yanick J, Neven Bénédicte
Аннотация
OBJECTIVE: To describe a cohort of patients with SAVI.
METHODS: Assessment of clinical, radiological and immunological data from 21 patients (17 families) was carried out.
RESULTS: Patients carried heterozygous substitutions in STING1 previously described in SAVI, mainly the p.V155M. Most were symptomatic from infancy, but late onset in adulthood occurred in 1 patient. Systemic inflammation, skin vasculopathy, and ILD were observed in 19, 18, and 21 patients, respectively. Extensive tissue loss occurred in 4 patients. Severity of ILD was highly variable with insidious progression up to end-stage respiratory failure reached at teenage in 6 patients. Lung imaging revealed early fibrotic lesions. Failure to thrive was almost constant, with severe growth failure seen in 4 patients. Seven patients presented polyarthritis, and the phenotype in 1 infant mimicked a combined immunodeficiency. Extended features reminiscent of other interferonopathies were also found, including intracranial calcification, glaucoma and glomerular nephropathy. Increased expression of interferon-stimulated genes and interferon α protein was constant. Autoantibodies were frequently found, in particular rheumatoid factor. Most patients presented with a T-cell defect, with low counts of memory CD8+ cells and impaired T-cell proliferation in response to antigens. Long-term follow-up described in 8 children confirmed the clinical benefit of ruxolitinib in SAVI where the treatment was started early in the disease course, underlying the need for early diagnosis. Tolerance was reasonably good.
CONCLUSION: The largest worldwide cohort of SAVI patients yet described, illustrates the core features of the disease and extends the clinical and immunological phenotype to include overlap with other monogenic interferonopathies.