| Abstract
Background: The inborn errors of immunity (IEIs) are a group of heterogeneous disorders mainly characterized by severe and recurrent infections besides other complications including autoimmune and inflammatory diseases. In this study, we aim to
evaluate clinical, immunologic, and molecular data of monogenic IEI patients with and
without autoimmune manifestations.
Methods: We have retrospectively screened cases of monogenic IEI in the Iranian PID
registry for the occurrence of autoimmunity and immune dysregulation. A questionnaire was filled for all qualified patients with monogenic defects to evaluate demographic, laboratory, clinical, and molecular data.
Results: A total of 461 monogenic IEI patients (290 male and 171 female) with a median (IQR) age of 11.0 (6.0-20.0) years were enrolled in this study. Overall, 331 patients (72.1%) were born to consanguineous parents. At the time of the study, 330
individuals (75.7%) were alive and 106 (24.3%) were deceased. Autoimmunity was
reported in 92 (20.0%) patients with a median (IQR) age at autoimmune diagnosis of
4.0 (2.0-7.0) years. Sixteen patients (3.5%) showed autoimmune complications (mostly
autoimmune cytopenia) as the first presentation of the disease. Most of the patients
with autoimmunity were diagnosed clinically with common variable immunodeficiency (42.4%). The frequency of sinusitis and splenomegaly was significantly higher
in patients with autoimmunity than patients without autoimmunity. In patients with
autoimmunity, the most common pathogenic variants were identified in LRBA (in 21
patients, 23.0%), ATM (in 13 patients, 14.0%), and BTK (in 9 patients, 10.0%) genes.
In the evaluation of autoimmunity by different genes, 4 of 4 IL10RB (100%), 3 of 3
AIRE (100%), and 21 of 30 LRBA (70.0%) mutated genes had the highest prevalence
of autoimmunity.
Conclusions: Autoimmune phenomena are common features among patients with
monogenic IEI and are associated with a more complicated course of the disease.
Therefore, when encountering autoimmune disorders, especially in the setting of dysgammaglobulinemia, it would be appropriate to conduct next-generation sequencing
to discover responsible genes for the immune dysregulation at an early stage of the
disease.
KEYWORDS
autoimmunity, inborn errors of immunity, inflammation, primary immunodeficiencies |