Clinical, immunological and genetic findings in patients with UNC13D deficiency (FHL3): A systematic review

Amirifar, P. and Ranjouri, M.R. and Abolhassani, H. and Moeini Shad, T. and Almasi-Hashiani, A. and Azizi, G. and Moamer, S. and Aghamohammadi, A. and Yazdani, R. (2021) Clinical, immunological and genetic findings in patients with UNC13D deficiency (FHL3): A systematic review. Pediatric Allergy and Immunology, 32 (1). pp. 186-197.

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Background: Familial hemophagocytic lymphohistiocytosis (FHL) is a rare autosomal recessive immune disorder that is caused by mutations in 6 different genes related to the formation and function of secretory lysosomes within cytotoxic T lymphocytes and natural killer (NK) cells. Thus, defect in these genes is associated with the accumulation of antigens due to defective cytotoxic function. FHL type 3 (FHL3) accounts for nearly 30-40 of FHL, and its underlying reason is mutation in UNC13D gene which encodes Munc13-4 protein. Methods: For the first time, we aimed to systematically review clinical features, immunologic data, and genetic findings of patients with FHL3. We conducted electronic searches for English-language articles in PubMed, Web of Science, EMBASE, and Scopus databases to collect comprehensive records related to patients with UNC13D mutations. Results: A total of 279 abstracts were initially reviewed for inclusion. Among them, 57 articles corresponding to 322 individual FHL3 patients fulfilled our selection criteria. Finally, 73 and 249 patients were considered as severe and mild feature groups, respectively. Our results confirmed that fever, hepatosplenomegaly, and hemophagocytosis are common clinical features in the disease. Moreover, reduced fibrinogen and NK cell activity, as well as increased ferritin and triglycerides, are important markers for early diagnosis of the FHL3 disease. Investigation of genotype showed that the most prevalent type and zygosity of UNC13D are splice-site errors and compound heterozygous, respectively. Conclusion: FHL3 patients have a wide range of clinical manifestations, which makes it difficult to diagnose. Therefore, it seems that the sequencing of the entire UNC13D gene (coding and non-coding regions) is the most appropriate way to accurate diagnosis of FHL3 patients. © 2020 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

Item Type: Article
Additional Information: cited By 1
Uncontrolled Keywords: ferritin; fibrinogen; triacylglycerol, adult; Article; chemotherapy; child; clinical feature; consanguinity; cytopenia; Epstein Barr virus infection; erythrophagocytosis; familial hemophagocytic lymphohistiocytosis type 3; female; ferritin blood level; fever; fibrinogen blood level; gait disorder; gene; gene mutation; genetic analysis; genotype phenotype correlation; hemophagocytic syndrome; hepatosplenomegaly; heterozygote; human; human cell; indel mutation; infection; leukemia; leukopenia; lymphadenopathy; male; malignant neoplasm; missense mutation; natural killer cell; neurologic disease; neutropenia; onset age; pain; pancytopenia; priority journal; protein domain; respiratory distress; respiratory system; respiratory tract infection; skin manifestation; splenomegaly; systematic review; thrombocytopenia; triacylglycerol blood level; unc13d gene; virus infection; zygosity
Subjects: QZ Pathology
Depositing User: eprints admin
Date Deposited: 21 Apr 2021 09:12
Last Modified: 21 Apr 2021 09:12

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