- Poster presentation
- Open Access
A novel mutation in NLRC4 in a large pedigree with an anakinra responsive autoinflammatory disease
Pediatric Rheumatology volume 13, Article number: P30 (2015)
Autoinflammatory disorders (AID) are characterized by chronic or recurrent systemic inflammation associated with various clinical presentations. It is a genetically heterogeneous group of diseases. Recently, gain of function mutations in NLRC4 have been described to be associated with autoinflammatory disease. Here, we report a novel NLRC4 mutation in a large pedigree with an anakinra responsive autoinflammaotry disease.
To identify the genetic defect causing an anakinra responsive autoinflammatory syndrome in a large pedigree.
Patients and methods
We performed whole exome sequencing in the members of a large 6 generation pedigree with an autoinflammatory disease, characterized by recurrent episodes of urticarial skin rash, joint pain and/or swelling, irritation of the eyes, and fatigue. Data with regards to the clinical phenotype were collected retrospectively from the medical charts. Functional studies in monocytes, and histology and immunohistochemical staining in skin biopsies obtained from lesional and uninvolved skin of three patients are currently being performed.
No mutations were detected in the 20 autoinflammatory associated genes known at the time. Exome sequencing revealed a novel p.Ser445Pro variant in NLRC4.The p.Ser445Pro variant segregated with the 13 affected family members. Prediction software programs (Sift, Polyphen) indicate the variant has pathogenic properties. Moreover the variant is located next to the recently described p.His443Pro pathogenic mutation. In all affected family members, the clinical phenotype was influenced by weather conditions, stress, and infection. Severity of the clinical phenotype varied considerably. Moreover, in a subset of the patients, the clinical symptoms resolved promptly after anakinra treatment, indicating involvement of interleukin-1 while other other patients only partially responded to anakinra. Biopsies of lesional skin showed a neutrophilic infiltrate in the dermis. Functional studies in monocytes, and immunohistochemical staining in skin biopsies obtained from lesional and uninvolved skin of patients will provide more insight in the functional effects of the identified NLRC4 variant.
In this study we identify and describe a novel variant in NLRC4 in a large pedigree with an partially anakinra responsive autoinflammatory syndrome, and expanded the clinical phenotype associated with NLRC4-inflammasome mediated autoinflammatory disease.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.
The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.
To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/.
The Creative Commons Public Domain Dedication waiver (https://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
About this article
Cite this article
Volker-Touw, N., de Koning, H., van Kempen, T. et al. A novel mutation in NLRC4 in a large pedigree with an anakinra responsive autoinflammatory disease. Pediatr Rheumatol 13 (Suppl 1), P30 (2015). https://doi.org/10.1186/1546-0096-13-S1-P30
- Immunohistochemical Staining
- Skin Biopsy
- Clinical Phenotype
- Exome Sequencing
- Recurrent Episode