クリオピリン関連周期熱症候群の経時的解析~成人期以降の発症にクローン性造血が関与~

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2025-07-29 京都大学

クリオピリン関連周期熱症候群(CAPS)はNLRP3遺伝子の体細胞モザイク変異により発症するが、変異率(VAF)の経時的推移や発症時期との関係は不明だった。加藤健太郎氏らの研究グループは、CAPS患者15名を対象に血液・乾燥臍帯などからVAFを解析。幼少期発症例ではVAFは安定していたが、成人期発症例ではミエロイド系でVAFが上昇し、クローン性造血の関与が示唆された。単一細胞解析ではTET2変異との共在も確認され、クローン性造血がCAPSの発症に影響する可能性が初めて示された。

クリオピリン関連周期熱症候群の経時的解析~成人期以降の発症にクローン性造血が関与~
本研究の概要図

<関連情報>

クリオピリン関連周期熱症候群における体細胞モザイクおよびクローン性造血の経時的解析 Longitudinal Analysis of Somatic Mosaicism and Clonal Hematopoiesis in Cryopyrin-Associated Periodic Syndrome

Kentaro Kato MD, Yoshitaka Honda MD PhD, Takashi Kamatani MD PhD, Kosaku Murakami MD PhD, Masaki Shimizu MD PhD, Toshihiko Komai MD PhD, Hiroko Kanda MD PhD …
Arthritis & Rheumatology  Published: 22 July 2025
DOI:https://doi.org/10.1002/art.43329

Abstract

Objective

Cryopyrin-associated periodic syndrome (CAPS) is an autoinflammatory disease caused by gain-of-function mutations in NLRP3. Although somatic NLRP3 mosaicism is increasingly recognized, it remains unclear how variant allele frequency (VAF) changes over time and whether disease onset age reflects differences in somatic mutation dynamics. This study aimed to analyze the longitudinal VAF trends and their correlation with clonal hematopoiesis (CH) in patients with CAPS mosaicism.

Methods

We analyzed NLRP3 VAF in blood and various tissues, including dried umbilical cord (DUC) using digital PCR and deep amplicon sequencing. Whole-exome and single-cell genome sequencing were performed to evaluate CH-related mutations.

Results

We included 15 patients with VAFs of 4.3% to 34.9%. In the 12 early-onset cases, VAFs were generally consistent across various tissues and did not increase over time, including the DUC. Conversely, in the three late-onset cases, VAFs were particularly high in myeloid cells. Notably, in one late-onset case, no mutations were detected in DUC. After disease onset, VAFs exhibited 2.9%-to-10.6% and 6.2%-to-16.4% increase in the whole blood and neutrophils over 6.4 and 4.4 years, respectively, showing a clonal expansion of NLRP3-mutant cells. Single-cell genome sequencing revealed frequent co-occurrence of NLRP3 and TET2 mutations in the same cells, with a gradual increase in both VAFs over 3 years, in one late-onset case.

Conclusion

In early-onset cases, the VAFs were comparable across various tissues and did not increase over time. Mutations in late-onset cases were enriched in myeloid cells, and VAFs were increased, suggesting a link to CH.

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