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Proteasome-associated autoinflammatory syndrome 6(PRAAS6)

MedGen UID:
1857440
Concept ID:
C5935614
Disease or Syndrome
Synonyms: PRAAS6; PROTEASOME-ASSOCIATED AUTOINFLAMMATORY SYNDROME 6
 
Gene (location): PSMB9 (6p21.32)
 
Monarch Initiative: MONDO:0968983
OMIM®: 620796

Definition

Proteasome-associated autoinflammatory syndrome-6 (PRAAS6) is characterized by a proteasome-associated autoinflammatory syndrome with immunodeficiency (Kanazawa et al., 2021). [from OMIM]

Clinical features

From HPO
Cardiomegaly
MedGen UID:
5459
Concept ID:
C0018800
Finding
Increased size of the heart, clinically defined as an increased transverse diameter of the cardiac silhouette that is greater than or equal to 50% of the transverse diameter of the chest (increased cardiothoracic ratio) on a posterior-anterior projection of a chest radiograph or a computed tomography.
Portal hypertension
MedGen UID:
9375
Concept ID:
C0020541
Disease or Syndrome
Increased pressure in the portal vein.
Cardiogenic shock
MedGen UID:
48650
Concept ID:
C0036980
Pathologic Function
Severely decreased cardiac output with evidence of inadequate end-organ perfusion (i.e., tissue hypoxia) in the presence of adequate intravascular volume.
Pulmonary arterial hypertension
MedGen UID:
425404
Concept ID:
C2973725
Disease or Syndrome
Pulmonary hypertension is defined mean pulmonary artery pressure of 25mmHg or more and pulmonary capillary wedge pressure of 15mmHg or less when measured by right heart catheterisation at rest and in a supine position.
Increased circulating troponin T concentration
MedGen UID:
1634809
Concept ID:
C4703661
Finding
An increased concentration of tropnin T in the blood, which is a cardiac regulatory protein that controls the calcium mediated interaction between actin and myosin. Raised cardiac troponin concentrations are now accepted as the standard biochemical marker for the diagnosis of myocardial infarction.
Cirrhosis of liver
MedGen UID:
7368
Concept ID:
C0023890
Disease or Syndrome
A chronic disorder of the liver in which liver tissue becomes scarred and is partially replaced by regenerative nodules and fibrotic tissue resulting in loss of liver function.
Seizure
MedGen UID:
20693
Concept ID:
C0036572
Sign or Symptom
A seizure is an intermittent abnormality of nervous system physiology characterized by a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.
Simple febrile seizure
MedGen UID:
101773
Concept ID:
C0149886
Disease or Syndrome
A short generalized seizure, of a duration of <15 min, not recurring within 24 h, occurring during a febrile episode not caused by an acute disease of the nervous system intracranial infection or severe metabolic disturbance.
Increased CSF protein concentration
MedGen UID:
329971
Concept ID:
C1806780
Finding
Increased concentration of protein in the cerebrospinal fluid.
Pancytopenia
MedGen UID:
18281
Concept ID:
C0030312
Disease or Syndrome
An abnormal reduction in numbers of all blood cell types (red blood cells, white blood cells, and platelets).
Elevated circulating D-dimer concentration
MedGen UID:
677042
Concept ID:
C0742969
Finding
An increased concentration of D-dimers, a marker of fibrin degradation, in the blood circulation.
Prolonged prothrombin time
MedGen UID:
208879
Concept ID:
C0853225
Finding
Increased time to coagulation in the prothrombin time test, which is a measure of the extrinsic pathway of coagulation. The results of the prothrombin time test are often expressed in terms of the International normalized ratio (INR), which is calculated as a ratio of the patient's prothrombin time (PT) to a control PT standardized for the potency of the thromboplastin reagent developed by the World Health Organization (WHO) using the formula
Basal ganglia calcification
MedGen UID:
234651
Concept ID:
C1389280
Pathologic Function
The presence of calcium deposition affecting one or more structures of the basal ganglia.
Leukocytosis
MedGen UID:
9736
Concept ID:
C0023518
Disease or Syndrome
An abnormal increase in the number of leukocytes in the blood.
Lymphopenia
MedGen UID:
7418
Concept ID:
C0024312
Disease or Syndrome
A reduced number of lymphocytes in the blood.
Myositis disease
MedGen UID:
44564
Concept ID:
C0027121
Disease or Syndrome
Idiopathic inflammatory myopathy is a group of disorders characterized by inflammation of the muscles used for movement (skeletal muscles). Idiopathic inflammatory myopathy usually appears in adults between ages 40 and 60 or in children between ages 5 and 15, though it can occur at any age.\n\nThe primary symptom of idiopathic inflammatory myopathy is muscle weakness, which develops gradually over a period of weeks to months or even years. Other symptoms include joint pain and general tiredness (fatigue).\n\nThere are several forms of idiopathic inflammatory myopathy, including polymyositis, dermatomyositis, and sporadic inclusion body myositis.\n\nPolymyositis and dermatomyositis involve weakness of the muscles closest to the center of the body (proximal muscles), such as the muscles of the hips and thighs, upper arms, and neck. People with these forms of idiopathic inflammatory myopathy may find it difficult to climb stairs, get up from a seated position, or lift items above their head. In some cases, muscle weakness may make swallowing or breathing difficult.\n\nPolymyositis and dermatomyositis have similar symptoms, but dermatomyositis is distinguished by a reddish or purplish rash on the eyelids, elbows, knees, or knuckles. Sometimes, abnormal calcium deposits form hard, painful bumps under the skin (calcinosis).\n\nIn sporadic inclusion body myositis, the muscles most affected are those of the wrists and fingers and the front of the thigh. Affected individuals may frequently stumble while walking and find it difficult to grasp items. As in dermatomyositis and polymyositis, swallowing can be difficult.
Pneumonia
MedGen UID:
10813
Concept ID:
C0032285
Disease or Syndrome
Inflammation of any part of the lung parenchyma.
Splenomegaly
MedGen UID:
52469
Concept ID:
C0038002
Finding
Abnormal increased size of the spleen.
Reduced natural killer cell count
MedGen UID:
383765
Concept ID:
C1855767
Finding
Less than normal number of natural killer cells, a type of lymphocyte in the innate immune system with an ability to mediate cytotoxicity and produce cytokines after the ligation of a germline-encoded activation receptor.
Increased circulating interferon-gamma concentration
MedGen UID:
892529
Concept ID:
C4072900
Finding
An elevation in the concentration of interferon gamma measured in the blood circulation.
Increased circulating interleukin 6 concentration
MedGen UID:
901461
Concept ID:
C4280771
Finding
The concentration of interleukin-6 in the blood circulation is above the upper limit of normal.
Abnormally low T cell receptor excision circle level
MedGen UID:
1611921
Concept ID:
C4531052
Finding
Reduced level of T cell receptor excision circle (TRECs) as measured by the TREC assay. Late in maturation, 70% of thymocytes that will ultimately express alpha/beta-T cell receptors form a circular DNA TREC from the excised TCRdelta gene that lies within the TCRalpha genetic locus. The circles are stable but do not increase following cell division and, therefore, become diluted as T cells proliferate. A quantitative polymerase chain reaction (PCR) reaction across the joint of the circular DNA provides the TREC copy number, a marker of newly-formed, antigenically-naïve thymic emigrant T cells.
Decreased circulating IgG concentration
MedGen UID:
1720114
Concept ID:
C5234937
Finding
An abnormally decreased level of immunoglobulin G (IgG) in blood.
Decreased proportion of gamma-delta T cells
MedGen UID:
1713360
Concept ID:
C5398020
Finding
Decreased proportion of gamma-delta T cells relative to the total number of T cells.
Increased circulating interleukin 10 concentration
MedGen UID:
1735742
Concept ID:
C5421678
Finding
An elevation of the concentration of interleukin 10 in the blood circulation.
Skin rash
MedGen UID:
1830322
Concept ID:
C5779628
Sign or Symptom
A red eruption of the skin.
Increased circulating interleukin 18 concentration
MedGen UID:
1841761
Concept ID:
C5826400
Finding
An increased concentration of interleukin-18 in the blood circulation.
Elevated circulating tumor necrosis factor alpha concentration
MedGen UID:
1864198
Concept ID:
C5937062
Finding
The concentration of tumor necrosis factor alpha in the blood circulation is above the upper limit of normal.
Increased circulating interleukin 1beta concentration
MedGen UID:
1864063
Concept ID:
C5937166
Finding
An increased concentration of interleukin-1beta in the blood circulation.
Fever
MedGen UID:
5169
Concept ID:
C0015967
Sign or Symptom
Body temperature elevated above the normal range.
Elevated circulating aspartate aminotransferase concentration
MedGen UID:
57497
Concept ID:
C0151904
Finding
The concentration of aspartate aminotransferase (AST) in the blood circulation is above the upper limit of normal.
Elevated circulating alanine aminotransferase concentration
MedGen UID:
57740
Concept ID:
C0151905
Finding
An abnormally high concentration in the circulation of alanine aminotransferase (ALT).
Elevated circulating creatine kinase concentration
MedGen UID:
69128
Concept ID:
C0241005
Finding
An elevation of the level of the enzyme creatine kinase (also known as creatine phosphokinase (CK; EC 2.7.3.2) in the blood. CK levels can be elevated in a number of clinical disorders such as myocardial infarction, rhabdomyolysis, and muscular dystrophy.
Increased circulating ferritin concentration
MedGen UID:
69130
Concept ID:
C0241013
Finding
Increased concentration of ferritin in the blood circulation.
Elevated circulating C-reactive protein concentration
MedGen UID:
892906
Concept ID:
C4023452
Finding
An abnormal elevation of the C-reactive protein level in the blood circulation.
Increased circulating NT-proBNP concentration
MedGen UID:
1385064
Concept ID:
C4477024
Finding
An elevated level of circulating N-terminal part of the prohormone of B-type natriuretic peptide (BNP).
Increased circulating lactate dehydrogenase concentration
MedGen UID:
1377250
Concept ID:
C4477095
Finding
An elevated level of the enzyme lactate dehydrogenase in the blood circulation.
Elevated circulating myoglobin concentration
MedGen UID:
1787040
Concept ID:
C5539591
Finding
An increased blood concentration of myoglobin.
Elevated circulating soluble CD25 concentration
MedGen UID:
1784407
Concept ID:
C5539839
Finding
Increased concentration of the interleukin-2 receptor alpha-chain (CD25) in the blood circulation. CD25 is shed upon immune activation. Increased levels of soluble CD25, therefore, are an indication of an on-going immune response.

Recent clinical studies

Etiology

Ebstein F, Poli Harlowe MC, Studencka-Turski M, Krüger E
Front Immunol 2019;10:2756. Epub 2019 Nov 26 doi: 10.3389/fimmu.2019.02756. PMID: 31827472Free PMC Article
Almeida de Jesus A, Goldbach-Mansky R
Clin Immunol 2013 Jun;147(3):155-74. Epub 2013 Apr 9 doi: 10.1016/j.clim.2013.03.016. PMID: 23711932Free PMC Article

Diagnosis

Guo W, Lozeau D, Tonnesen M, Schuval S, de Jesus A, Miller D, Alehashemi S, Kristal L
Pediatr Dermatol 2024 Nov-Dec;41(6):1162-1165. Epub 2024 Jun 16 doi: 10.1111/pde.15667. PMID: 38881047
Dafun AS, Živković D, Leon-Icaza SA, Möller S, Froment C, Bonnet D, de Jesus AA, Alric L, Quaranta-Nicaise M, Ferrand A, Cougoule C, Meunier E, Burlet-Schiltz O, Ebstein F, Goldbach-Mansky R, Krüger E, Bousquet MP, Marcoux J
Cells 2023 Mar 8;12(6) doi: 10.3390/cells12060844. PMID: 36980185Free PMC Article
Kone-Paut I, Georgin-Laviallec S, Galeotti C, Rossi-Semerano L, Hentgen V, Savey L, Saadoun D, Sarrabay G, Touitou I
Joint Bone Spine 2019 Oct;86(5):554-561. Epub 2018 Nov 22 doi: 10.1016/j.jbspin.2018.11.003. PMID: 30471422

Therapy

Guo W, Lozeau D, Tonnesen M, Schuval S, de Jesus A, Miller D, Alehashemi S, Kristal L
Pediatr Dermatol 2024 Nov-Dec;41(6):1162-1165. Epub 2024 Jun 16 doi: 10.1111/pde.15667. PMID: 38881047

Prognosis

Ayaki T, Murata K, Kanazawa N, Uruha A, Ohmura K, Sugie K, Kasagi S, Li F, Mori M, Nakajima R, Sasai T, Nishino I, Ueno S, Urushitani M, Furukawa F, Ito H, Takahashi R
Neuropathol Appl Neurobiol 2020 Oct;46(6):579-587. Epub 2020 Mar 25 doi: 10.1111/nan.12614. PMID: 32144790

Clinical prediction guides

Ebstein F, Poli Harlowe MC, Studencka-Turski M, Krüger E
Front Immunol 2019;10:2756. Epub 2019 Nov 26 doi: 10.3389/fimmu.2019.02756. PMID: 31827472Free PMC Article

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