ROSAH syndrome mimicking chronic uveitis

Abstract

To suggest a unique missense variant candidate based on long-term ophthalmological changes and associated systemic signs described in five patients from two unrelated families affected by an autosomal dominant multi-systemic disorder including Retinal dystrophy, Optic nerve oedema, Splenomegaly, Anhidrosis and migraine Headaches, called ROSAH syndrome, related to a unique missense variant in ALPK1 gene.Observational longitudinal follow-up study of unrelated families. Clinical analysis of ophthalmological and systemic examinations was performed, followed by genetic analysis, including targeted Next Generation Sequencing (NGS) and Whole-Genome Sequencing (WGS). The ophthalmological phenotype showed extensive optic nerve swelling associated with early macular oedema and vascular leakage. The main associated systemic manifestations were recurrent fever, splenomegaly, anhidrosis, mild cytopenia, anicocytosis and hypersegmented polynuclear cells. WGS, shortened in the second family by the gene candidate suggestion, revealed in all patients the heterozygous missense variant c.710C>T; p.(Thr237Met) in ALPK1. The primary morbidity in ROSAH syndrome in this cohort appeared ophthalmological. Comprehensive, detailed phenotype changes aided by the advancement in genetic testing could allow an early genetic diagnosis of ROSAH syndrome and targeted treatment. The unique missense variant may be suggested as a target of gene correction therapy.

Update on autoinflammatory diseases

“…ALPK1 activation leads to the activation of NF-κB, a pathway known to be altered in other autoinflammatory diseases, including haploinsufficiency of A20 (HA20), haploinsufficiency of RELA, Blau syndrome, and Behcet disease. Interestingly, uveitis is associated with several of these conditions [36,37 ▪ ]. Anti-TNF therapy and other biologics, including anti-IL-1 and anti-IL-6 therapies, have shown partial efficacy [35 ▪ ].…”