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Familial chilblain lupus due to a gain-of-function mutation in STING
  1. Nadja König1,
  2. Christoph Fiehn2,
  3. Christine Wolf1,
  4. Max Schuster1,
  5. Emanuel Cura Costa3,
  6. Victoria Tüngler1,
  7. Hugo Ariel Alvarez3,
  8. Osvaldo Chara3,4,
  9. Kerstin Engel1,
  10. Raphaela Goldbach-Mansky5,
  11. Claudia Günther6,
  12. Min Ae Lee-Kirsch1
  1. 1Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
  2. 2ACURA Akutklinik für Rheumatologie Baden-Baden, Baden-Baden, Germany
  3. 3System Biology Group (SysBio), Institute of Physics of Liquids and Biological Systems (IFLYSIB) CONICET, University of La Plata, La Plata, Argentina
  4. 4Center for Information Services and High Performance Computing, Technische Universität Dresden, Dresden, Germany
  5. 5Translational Autoinflammatory Disease Section, NIAMS, NIH, Bethesda, Maryland, USA
  6. 6Department of Dermatology, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
  1. Correspondence to Professor Min Ae Lee-Kirsch, Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, Dresden 01307, Germany; minae.lee-kirsch{at}uniklinikum-dresden.de

Abstract

Objectives Familial chilblain lupus is a monogenic form of cutaneous lupus erythematosus caused by loss-of-function mutations in the nucleases TREX1 or SAMHD1. In a family without TREX1 or SAMHD1 mutation, we sought to determine the causative gene and the underlying disease pathology.

Methods Exome sequencing was used for disease gene identification. Structural analysis was performed by homology modelling and docking simulations. Type I interferon (IFN) activation was assessed in cells transfected with STING cDNA using an IFN-β reporter and Western blotting. IFN signatures in patient blood in response to tofacitinib treatment were measured by RT-PCR of IFN-stimulated genes.

Results In a multigenerational family with five members affected with chilblain lupus, we identified a heterozygous mutation of STING, a signalling molecule in the cytosolic DNA sensing pathway. Structural and functional analyses indicate that mutant STING enhances homodimerisation in the absence of its ligand cGAMP resulting in constitutive type I IFN activation. Treatment of two affected family members with the Janus kinase (JAK) inhibitor tofacitinib led to a marked suppression of the IFN signature.

Conclusions A heterozygous gain-of-function mutation in STING can cause familial chilblain lupus. These findings expand the genetic spectrum of type I IFN-dependent disorders and suggest that JAK inhibition may be of therapeutic value.

  • Autoimmunity
  • Inflammation
  • Cytokines
  • Systemic Lupus Erythematosus

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