Unexplained fever with consumptive syndrome in the elderly: two cases of VEXAS syndrome with inflammasome dysregulation

Clin Exp Immunol. 2024 Oct 16;218(2):213-220. doi: 10.1093/cei/uxae069.

Abstract

The aim of this study is to investigate the inflammasome dysregulation in peripheral blood leukocytes of VEXAS patients. The constitutive and in vitro triggered activation of inflammasome in PBMC and neutrophils was analyzed in two Brazilian patients with typical UBA1 mutations, and compared with healthy donors. Our findings highlight the constitutive activation of caspase-1 in VEXAS leukocytes, accompanied by increased plasma levels of IL-18. Furthermore, upon stimulation of isolated peripheral blood mononuclear cells (PBMC) and neutrophils, we observed not only the exhaustion of NLRP3 and NLRP1/CARD8 pathways in VEXAS PBMC but also a significant increase in NLRP3-mediated NETs release in VEXAS neutrophils. These findings support previous studies on the contribution of the inflammasome to VEXAS pathogenesis, identifying at least two profoundly affected pathways (NLRP3 and NLRP1/CARD8) in VEXAS peripheral blood.

Keywords: CARD8; NETs; NLRP1; NLRP3; UBA1; VEXAS; inflammasome.

Publication types

  • Case Reports

MeSH terms

  • Adaptor Proteins, Signal Transducing / genetics
  • Aged
  • Apoptosis Regulatory Proteins / genetics
  • Brazil
  • CARD Signaling Adaptor Proteins* / genetics
  • Caspase 1 / genetics
  • Female
  • Fever / immunology
  • Humans
  • Inflammasomes* / genetics
  • Inflammasomes* / immunology
  • Inflammasomes* / metabolism
  • Interleukin-18* / blood
  • Interleukin-18* / genetics
  • Leukocytes, Mononuclear* / immunology
  • Leukocytes, Mononuclear* / metabolism
  • Male
  • Mutation
  • NLR Family, Pyrin Domain-Containing 3 Protein* / genetics
  • NLR Family, Pyrin Domain-Containing 3 Protein* / metabolism
  • NLR Proteins* / genetics
  • Neoplasm Proteins
  • Neutrophils* / immunology
  • Ubiquitin-Activating Enzymes / genetics

Substances

  • Inflammasomes
  • NLR Family, Pyrin Domain-Containing 3 Protein
  • NLRP3 protein, human
  • NLRP1 protein, human
  • Interleukin-18
  • CARD Signaling Adaptor Proteins
  • NLR Proteins
  • CARD8 protein, human
  • Caspase 1
  • UBA1 protein, human
  • Adaptor Proteins, Signal Transducing
  • Apoptosis Regulatory Proteins
  • Ubiquitin-Activating Enzymes
  • IL18 protein, human
  • Neoplasm Proteins