Autoimmunity/inflammation in a monogenic primary immunodeficiency cohort

Abstract

Primary immunodeficiencies (PIDs) are rare inborn errors of immunity that have a heterogeneous phenotype that can include severe susceptibility to life-threatening infections from multiple pathogens, unique sensitivity to a single pathogen, autoimmune/inflammatory (AI/I) disease, allergies and/or malignancy. We present a diverse cohort of monogenic PID patients with and without AI/I diseases who underwent clinical, genetic and immunological phenotyping. Novel pathogenic variants were identified in <i>IKBKG</i>, <i>CTLA4</i>, <i>NFKB1</i>, <i>GATA2</i>, <i>CD40LG</i> and <i>TAZ</i> as well as previously reported pathogenic variants in <i>STAT3</i>, <i>PIK3CD</i>, <i>STAT1</i>, <i>NFKB2</i> and <i>STXBP2</i>. AI/I manifestations were frequently encountered in PIDs, including at presentation. Autoimmunity/inflammation was multisystem in those effected, and regulatory T cell (Treg) percentages were significantly decreased compared with those without AI/I manifestations. Prednisolone was used as the first-line immunosuppressive agent in all cases, however steroid monotherapy failed long-term control of autoimmunity/inflammation in the majority of cases and additional immunosuppression was required. Patients with multisystem autoimmunity/inflammation should be investigated for an underlying PID, and in those with PID early assessment of Tregs may help to assess the risk of autoimmunity/inflammation.