title: A nationwide survey of Aicardi-Goutières syndrome patients identifies a strong association between dominant TREX1 mutations and chilblain lesions: Japanese cohort study.
abstract: OBJECTIVE
  Aicardi-Goutières syndrome (AGS) is a rare, genetically determined, early onset progressive encephalopathy associated with autoimmune manifestations. AGS is usually inherited in an autosomal recessive manner. The disease is rare, therefore the clinical manifestations and genotype-phenotype correlations, particularly with regard to autoimmune diseases, are still unclear. Here we performed a nationwide survey of AGS patients in Japan and analysed the genetic and clinical data.
  
  
  METHODS
  Patients were recruited via questionnaires sent to paediatric or adult neurologists in Japanese hospitals and institutions. Genetic analysis was performed and clinical data were collected.
  
  
  RESULTS
  Fourteen AGS patients were identified from 13 families; 10 harboured genetic mutations. Three patients harboured dominant-type TREX1 mutations. These included two de novo cases: one caused by a novel heterozygous p.His195Tyr mutation and the other by a novel somatic mosaicism resulting in a p.Asp200Asn mutation. Chilblain lesions were observed in all patients harbouring dominant-type TREX1 mutations. All three patients harbouring SAMHD1 mutations were diagnosed with autoimmune diseases, two with SLE and one with SS. The latter is the first reported case.
  
  
  CONCLUSIONS
  This study is the first to report a nationwide AGS survey, which identified more patients with sporadic AGS carrying de novo dominant-type TREX1 mutations than expected. There was a strong association between the dominant-type TREX1 mutations and chilblain lesions, and between SAMHD1 mutations and autoimmunity. These findings suggest that rheumatologists should pay attention to possible sporadic AGS cases presenting with neurological disorders and autoimmune manifestations.
authors.affiliation: Department of Pediatrics, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan. rnishiko@kuhp.kyoto-u.ac.jp.
authors.forename: Junya
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authors.forename: Ryuta
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authors.forename: Mitsuhiro
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authors.lastname: Kato
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authors.forename: Kazushi
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authors.lastname: Yasumi
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authors.lastname: Toyoshima
authors.forename: Kazuko
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authors.lastname: Hasegawa
authors.forename: Yusei
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authors.lastname: Ohshima
authors.forename: Toru
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authors.lastname: Hiragi
authors.forename: Yoji
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authors.lastname: Sasahara
authors.forename: Yasuhiro
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authors.lastname: Suzuki
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authors.lastname: Kikuchi
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authors.lastname: Osaka
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authors.lastname: Ohya
authors.forename: Shinya
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authors.lastname: Ninomiya
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authors.lastname: Fujikawa
authors.forename: Manami
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authors.lastname: Akasaka
authors.forename: Naomi
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authors.lastname: Iwata
authors.forename: Akiko
authors.initials: A
authors.lastname: Kawakita
authors.forename: Makoto
authors.initials: M
authors.lastname: Funatsuka
authors.forename: Haruo
authors.initials: H
authors.lastname: Shintaku
authors.forename: Osamu
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authors.lastname: Ohara
authors.forename: Hiroshi
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authors.lastname: Ichinose
authors.forename: Toshio
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authors.lastname: Heike
mesh_terms: D000293:Adolescent; D044466:Asian People / Q000235:genetics*; D001327:Autoimmune Diseases / Q000235:genetics; D020274:Autoimmune Diseases of the Nervous System / Q000453:epidemiology / Q000235:genetics*; D002647:Chilblains / Q000453:epidemiology / Q000235:genetics*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005090:Exodeoxyribonucleases / Q000235:genetics*; D005260:Female; D005838:Genotype; D006306:Health Surveys; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D020559:Monomeric GTP-Binding Proteins / Q000235:genetics; D009154:Mutation / Q000235:genetics*; D009421:Nervous System Malformations / Q000453:epidemiology / Q000235:genetics*; D010641:Phenotype; D010750:Phosphoproteins / Q000235:genetics*; D000076106:SAM Domain and HD Domain-Containing Protein 1; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D010750:Phosphoproteins; D005090:Exodeoxyribonucleases; C429526:three prime repair exonuclease 1; D000076106:SAM Domain and HD Domain-Containing Protein 1; C484280:SAMHD1 protein, human; D020559:Monomeric GTP-Binding Proteins
keywords: Aicardi–Goutières syndrome; SAMHD1; TREX1; autoimmunity; chilblain; dominant-type; mosaicism