Paediatric Rheumatology
New insights on genetic variants and phenotypic features of childhood large-vessel vasculopathy: a systematic review and single-centre series
S. Alansari1, F. Alenzi2, A. Alsaleem3, S.M. Al-Mayouf4
- Paediatric Rheumatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
- Department of Clinical Science, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.
- Paediatric Rheumatology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
- Paediatric Rheumatology, King Faisal Specialist Hospital and Research Center, and College of Medicine, Alfaisal University, Riyadh, Saudi Arabia. mayouf@kfshrc.edu.sa, almayoufsulaiman@yahoo.com
CER16661
2024 Vol.42, N°4
PI 0923, PF 0930
Paediatric Rheumatology
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PMID: 37404170 [PubMed]
Received: 09/03/2023
Accepted : 09/06/2023
In Press: 04/07/2023
Published: 29/04/2024
Abstract
OBJECTIVES:
To describe the phenotypic, genetic, and outcome characteristics of large-vessel vasculopathy (LVV) in childhood associated with genetic variants. Additionally, a systematic literature review was conducted to delineate the differences between LVV with and without genetic variants.
METHODS:
The medical records of all children with LVV seen between January 2000 and September 2022 at our institution were retrospectively reviewed for demographic, clinical and genetic data, and outcomes at the last follow-up visit. In addition, we systematically reviewed the literature for the clinical features and known variants of previously reported cases.
RESULTS:
Eleven patients with childhood LVV were identified; five (three males) of them had proven genetic variants (two DOCK8
variants, one FOXP3, one DiGeorge syndrome, and one ZNF469 variant), while six patients had sporadic childhood LVV. Remarkably, patients with genetic variants were younger and had early-onset disease. However, the diagnosis of LVV was delayed compared to those without genetic variants. All patients with genetic variants were treated with corticosteroids, and three patients required sequential immunosuppressive drugs. Four patients underwent surgical intervention, and one received a haematopoietic stem-cell transplant (HSCT). Three patients achieved clinical remission, and two died. Furthermore, data from 20 previously published cases was extracted from the literature. All patients had inherited disorders. Of those, 14 patients had a genetically proven diagnosis. Most of them are treated with corticosteroids and immunosuppressive drugs, with partial responses. Two patients underwent HSCT. There were four deaths.
CONCLUSIONS:
This study demonstrates that a variety of inherited disorders may contribute to childhood LVV. Strong genetic evidence and the preponderance of autosomal-recessive inheritance may allow us to propose that monogenic LVV is a distinct entity.
