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Cytokine Autoantibody Screening in the Swedish Addison Registry Identifies Patients With Undiagnosed APS1

Eriksson, Daniel; Dalin, Frida; Eriksson, Gabriel Nordling; Landegren, Nils; Bianchi, Matteo; Hallgren, Åsa; Dahlqvist, Per; Wahlberg, Jeanette; Ekwall, Olov and Winqvist, Ola, et al. (2018) In The Journal of clinical endocrinology and metabolism 103(1). p.179-186
Abstract

Context: Autoimmune polyendocrine syndrome type 1 (APS1) is a monogenic disorder that features autoimmune Addison disease as a major component. Although APS1 accounts for only a small fraction of all patients with Addison disease, early identification of these individuals is vital to prevent the potentially lethal complications of APS1.

Objective: To determine whether available serological and genetic markers are valuable screening tools for the identification of APS1 among patients diagnosed with Addison disease.

Design: We systematically screened 677 patients with Addison disease enrolled in the Swedish Addison Registry for autoantibodies against interleukin-22 and interferon-α4. Autoantibody-positive patients were... (More)

Context: Autoimmune polyendocrine syndrome type 1 (APS1) is a monogenic disorder that features autoimmune Addison disease as a major component. Although APS1 accounts for only a small fraction of all patients with Addison disease, early identification of these individuals is vital to prevent the potentially lethal complications of APS1.

Objective: To determine whether available serological and genetic markers are valuable screening tools for the identification of APS1 among patients diagnosed with Addison disease.

Design: We systematically screened 677 patients with Addison disease enrolled in the Swedish Addison Registry for autoantibodies against interleukin-22 and interferon-α4. Autoantibody-positive patients were investigated for clinical manifestations of APS1, additional APS1-specific autoantibodies, and DNA sequence and copy number variations of AIRE.

Results: In total, 17 patients (2.5%) displayed autoantibodies against interleukin-22 and/or interferon-α4, of which nine were known APS1 cases. Four patients previously undiagnosed with APS1 fulfilled clinical, genetic, and serological criteria. Hence, we identified four patients with undiagnosed APS1 with this screening procedure.

Conclusion: We propose that patients with Addison disease should be routinely screened for cytokine autoantibodies. Clinical or serological support for APS1 should warrant DNA sequencing and copy number analysis of AIRE to enable early diagnosis and prevention of lethal complications.

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@article{8cc764f5-b3d8-4bf5-b77f-cb43d5c39d57,
  abstract     = {<p>Context: Autoimmune polyendocrine syndrome type 1 (APS1) is a monogenic disorder that features autoimmune Addison disease as a major component. Although APS1 accounts for only a small fraction of all patients with Addison disease, early identification of these individuals is vital to prevent the potentially lethal complications of APS1.</p><p>Objective: To determine whether available serological and genetic markers are valuable screening tools for the identification of APS1 among patients diagnosed with Addison disease.</p><p>Design: We systematically screened 677 patients with Addison disease enrolled in the Swedish Addison Registry for autoantibodies against interleukin-22 and interferon-α4. Autoantibody-positive patients were investigated for clinical manifestations of APS1, additional APS1-specific autoantibodies, and DNA sequence and copy number variations of AIRE.</p><p>Results: In total, 17 patients (2.5%) displayed autoantibodies against interleukin-22 and/or interferon-α4, of which nine were known APS1 cases. Four patients previously undiagnosed with APS1 fulfilled clinical, genetic, and serological criteria. Hence, we identified four patients with undiagnosed APS1 with this screening procedure.</p><p>Conclusion: We propose that patients with Addison disease should be routinely screened for cytokine autoantibodies. Clinical or serological support for APS1 should warrant DNA sequencing and copy number analysis of AIRE to enable early diagnosis and prevention of lethal complications.</p>},
  author       = {Eriksson, Daniel and Dalin, Frida and Eriksson, Gabriel Nordling and Landegren, Nils and Bianchi, Matteo and Hallgren, Åsa and Dahlqvist, Per and Wahlberg, Jeanette and Ekwall, Olov and Winqvist, Ola and Catrina, Sergiu-Bogdan and Rönnelid, Johan and Hulting, Anna-Lena and Lindblad-Toh, Kerstin and Alimohammadi, Mohammad and Husebye, Eystein S and Knappskog, Per Morten and Rosengren Pielberg, Gerli and Bensing, Sophie and Kämpe, Olle and , },
  issn         = {1945-7197},
  keyword      = {Addison Disease/blood,Autoantibodies/blood,Biomarkers/blood,Case-Control Studies,Cytokines/immunology,Follow-Up Studies,Humans,Mass Screening,Polyendocrinopathies, Autoimmune/blood,Prognosis,Registries,Sweden},
  language     = {eng},
  month        = {01},
  number       = {1},
  pages        = {179--186},
  publisher    = {The Endocrine Society},
  series       = {The Journal of clinical endocrinology and metabolism},
  title        = {Cytokine Autoantibody Screening in the Swedish Addison Registry Identifies Patients With Undiagnosed APS1},
  url          = {http://dx.doi.org/10.1210/jc.2017-01957},
  volume       = {103},
  year         = {2018},
}