• Georgia Ramantani, Jürgen Kohlhase, Christoph Hertzberg, A Micheil Innes, Kerstin Engel, Susan Hunger, Wiktor Borozdin, Jean K Mah, Kristina Ungerath, Hartmut Walkenhorst, Hans-Helmut Richardt, Johannes Buckard, Andrea Bevot, Corinna Siegel, Celina von Stülpnagel, Chrysanthy Ikonomidou, Kara Thomas, Virginia Proud, Frank Niemann, Dagmar Wieczorek, Martin Häusler, Pascal Niggemann, Volkan Baltaci, Karsten Conrad, Pierre Lebon, and Min Ae Lee-Kirsch.
• Technische Universität Dresden, Dresden, Germany.
• Arthritis Rheum. 2010 May 1; 62 (5): 1469-77.

ObjectiveAicardi-Goutières syndrome (AGS) is an early-onset encephalopathy resembling congenital viral infection that is characterized by basal ganglia calcifications, loss of white matter, cerebrospinal fluid (CSF) lymphocytosis, and elevated interferon-alpha levels in the CSF. Studies have shown that AGS is an autosomal-recessive disease linked to mutations in 5 genes, encoding the 3'-repair DNA exonuclease 1 (TREX1), the 3 subunits of ribonuclease H2 (RNASEH2A-C), and sterile alpha motif domain and HD domain-containing protein 1 (SAMHD1). In this study we further characterized the phenotypic spectrum of this disease.MethodsClinical and laboratory data were obtained from 26 patients fulfilling the clinical diagnostic criteria for AGS. Genomic DNA was screened for mutations in all 5 AGS genes by direct sequencing, and sera were analyzed for autoantibodies.ResultsIn 20 patients with AGS, 20 mutations, 12 of which were novel, were identified in all 5 AGS genes. Clinical and laboratory investigations revealed a high prevalence of features (some not previously described in patients with AGS) that are commonly seen in patients with systemic lupus erythematosus (SLE), such as thrombocytopenia, leukocytopenia, antinuclear antibodies, erythematous lesions, oral ulcers, and arthritis, which were observed in 12 (60%) of 20 patients with AGS. Moreover, the coexistence of AGS and SLE, was for the first time, demonstrated in 2 patients with molecularly proven AGS.ConclusionThese findings expand the phenotypic spectrum of lupus erythematosus in AGS and provide further insight into its disease mechanisms by showing that activation of the innate immune system as a result of inherited defects in nucleic acid metabolism could lead to systemic autoimmunity.

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