Abstract
Deficiency of adenosine deaminase 2 (DADA2) is a recently described autoinflammatory disorder. Genetic analysis is required to confirm the diagnosis. We aimed to describe the identifying symptoms and genotypes of patients referred to our reference centres and to improve the indications for genetic testing. DNA from 66 patients with clinically suspected DADA2 were sequenced by Sanger or next-generation sequencing. Detailed epidemiological, clinical and biological features were collected by use of a questionnaire and were compared between patients with and without genetic confirmation of DADA2. We identified 13 patients (19.6%) carrying recessively inherited mutations in ADA2 that were predicted to be deleterious. Eight patients were compound heterozygous for mutations. Seven mutations were novel (4 missense variants, 2 predicted to affect mRNA splicing and 1 frameshift). The mean age of the 13 patients with genetic confirmation was 12.7 years at disease onset and 20.8 years at diagnosis. Phenotypic manifestations included fever (85%), vasculitis (85%) and neurological disorders (54%). Features best associated with a confirmatory genotype included fever with neurologic or cutaneous attacks (odds ratio [OR] 10.71, p = 0.003 and OR 10.9, p < 0.001), fever alone (OR 8.1, p = 0.01), and elevated C-reactive protein (CRP) level with neurologic involvement (OR 6.63, p = 0.017). Our proposed decision tree may help improve obtaining genetic confirmation of DADA2 in the context of autoinflammatory symptoms. Prerequisites for quick and low-cost Sanger analysis include one typical cutaneous or neurological sign, one marker of inflammation (fever or elevated CRP level), and recurrent or chronic attacks in adults.
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Acknowledgements
We thank Mrs Cécile Rittore and M. Bruno Dumont for excellent technical contribution. We thank Laura Smales (http://www.biomedediting.com), for editing the manuscript for English language. The French Ministry of Health and the University Hospital of Montpellier supported this work.
Author contributions
MR, IT and GS conceived and designed the study. CD provided help for statistical analysis and design of the study. IM, DB, AB, HM, DD, SV, DR, EC, DG, KH, AI, NF, VQM, NT, JL, FU, SGL, AB, IKP and VH recruited and phenotyped the patients. MR and GS conducted the analyses and interpreted the results. MR, GB and GS drafted, the manuscript. MR, GB and IT edited and prepared the final version of the manuscript.
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Rama, M., Duflos, C., Melki, I. et al. A decision tree for the genetic diagnosis of deficiency of adenosine deaminase 2 (DADA2): a French reference centres experience. Eur J Hum Genet 26, 960–971 (2018). https://doi.org/10.1038/s41431-018-0130-6
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DOI: https://doi.org/10.1038/s41431-018-0130-6
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