- Interstitial lung disease and neurodegeneration in FINCA syndrome: new knowledge changes old judgments
Interstitial lung disease and neurodegeneration in FINCA syndrome: new knowledge changes old judgments
Modern Pediatrics. Ukraine. (2022). 5(125): 103-107. doi 10.15574/SP.2022.125.103
Boyarchuk O. R.
I. Horbachevsky Ternopil National Medical University, Ukraine
For citation: Boyarchuk OR. (2022). Interstitial lung disease and neurodegeneration in FINCA syndrome: new knowledge changes old judgments. Modern Pediatrics. Ukraine. 5(125): 103-107. doi 10.15574/SP.2022.125.103.
Article received: Jun 10, 2022. Accepted for publication: Sep 17, 2022.
FINCA (Fibrosis, Neurodegeneration, Cerebral Angiomatosis) syndrome is a new genetic multiorgan disease caused by a mutation in NHLRC2 (NHL repeat-containing protein 2). Disease manifests at an early age by interstitial lung disease, neurodegenerative disorders, hemolytic anemia, gastrointestinal disorders, liver dysfunction and other multiorgan changes. The syndrome was first described in 2018 in three children who died before the age of two. Studies in recent years have significantly expanded the range of clinical symptoms of FINCA syndrome, and also showed great variability in the severity of the symptomes, especially respiratory lesions. Taking into account the neurological problems in all described patients, NHLRC2 should be included in the sequencing panels of neurological diseases (neurodegenerative, neurodevelopmental disorders, epilepsy). Recurrent respiratory infections and episodic diarrhea, as well as hypogammaglobulinemia in most patients require study of the role of NHLRC2 protein in the functioning of the immune system.
No conflict of interests was declared by the authors.
Keywords: FINCA syndrome, interstitial lung disease, neurodegenerative disorders, hemolytic anemia, episodic diarrhea.
REFERENCES
1. Badura-Stronka M, Śmigiel R, Rutkowska K et al. (2022). FINCA syndrome-Defining neurobehavioral phenotype in survivors into late childhood. Mol Genet Genomic Med. 10 (4): e1899. https://doi.org/10.1002/mgg3.1899; PMid:35255187 PMCid:PMC9000936
2. Biterova E, Ignatyev A, Uusimaa J, Hinttala R, Ruddock LW. (2018). Structural analysis of human NHLRC2, mutations of which are associated with FINCA disease. PLoS One. 13 (8): e0202391. https://doi.org/10.1371/journal.pone.0202391; PMid:30138417 PMCid:PMC6107167
3. Boyarchuk O, Dmytrash L. (2019). Clinical Manifestations in the Patients with Primary Immunodeficiencies: Data from One Regional Center. Turkish Journal of Immunology. 7 (3): 113-119. https://doi.org/10.25002/tji.2019.1168
4. Boyarchuk O, Kinash M, Hariyan T, Bakalyuk T. (2019). Evaluation of knowledge about primary immunodeficiencies among postgraduate medical students. Archives of the Balkan Medical Union. 54 (1): 11-19. https://doi.org/10.31688/ABMU.2019.54.1.18
5. Boyarchuk O, Lewandowicz-Uszyńska A, Kinash M, Haliyash N, Sahal I, Kovalchuk T. (2018). Physicians' awareness concerning primary immunodeficiencies in the Ternopil Region of Ukraine. Pediatria Polska. 93 (3): 221-228. https://doi.org/10.5114/polp.2018.77435
6. Brodsky NN, Boyarchuk O, Kovalchuk T et al. (2020). Novel compound heterozygous variants in NHLRC2 in a patient with FINCA syndrome. J Hum Genet. 65 (10): 911-915. https://doi.org/10.1038/s10038-020-0776-0; PMid:32435055
7. Bush A, Cunningham S, de Blic J et al. (2015). European protocols for the diagnosis and initial treatment of interstitial lung disease in children. Thorax. 70 (11): 1078-1084. https://doi.org/10.1136/thoraxjnl-2015-207349; PMid:26135832
8. Distler O, Highland KB, Gahlemann M et al. (2019). Nintedanib for Systemic Sclerosis-Associated Interstitial Lung Disease. N Engl J Med. 380 (26): 2518-2528. https://doi.org/10.1056/NEJMoa1903076; PMid:31112379
9. Flaherty KR, Wells AU, Cottin V et al. (2019). Nintedanib in Progressive Fibrosing Interstitial Lung Diseases. N Engl J Med. 381 (18): 1718-1727. https://doi.org/10.1056/NEJMoa1908681; PMid:31566307
10. Hiltunen AE, Kangas SM, Ohlmeier S et al. (2020). Variant in NHLRC2 leads to increased hnRNP C2 in developing neurons and the hippocampus of a mouse model of FINCA disease. Mol Med. 26 (1): 123. https://doi.org/10.1186/s10020-020-00245-4; PMid:33297935 PMCid:PMC7724728
11. Horvath B, Kloesel B. (2022). FINCA syndrome, a novel interstitial lung and multiorgan disease. Paediatr Anaesth. https://doi.org/10.1111/pan.14475; PMid:35557017
12. Maher TM, Corte TJ, Fischer A et al. (2020). Pirfenidone in patients with unclassifiable progressive fibrosing interstitial lung disease: a double-blind, randomised, placebo-controlled, phase 2 trial. Lancet Respir Med. 8 (2): 147-157. https://doi.org/10.1016/S2213-2600(19)30341-8
13. Marunchyn TA, Volokha AP. (2019). Management of children with primary and secondary hypogammaglobulinemia (literature review). Modern Pediatrics.Ukraine. 5(101): 123132. https://doi.org/10.15574/SP.2019.101.123
14. Nishi K, Iwaihara Y, Tsunoda T et al. (2017). ROS-induced cleavage of NHLRC2 by caspase-8 leads to apoptotic cell death in the HCT116 human colon cancer cell line. Cell Death & Disease. 8: 3218. https://doi.org/10.1038/s41419-017-0006-7; PMid:29242562 PMCid:PMC5870588
15. Paakkola T, Salokas K, Miinalainen I et al. (2018). Biallelic mutations in human NHLRC2 enhance myofibroblast differentiation in FINCA disease. Hum Mol Genet. 27 (24): 4288-4302. https://doi.org/10.1093/hmg/ddy298; PMid:30239752
16. Rapp CK, Van Dijck I, Laugwitz L et al. (2021). Expanding the phenotypic spectrum of FINCA (fibrosis, neurodegeneration, and cerebral angiomatosis) syndrome beyond infancy. Clin Genet. 100 (4): 453-461. https://doi.org/10.1111/cge.14016; PMid:34165204
17. Thalhammer J, Kindle G, Nieters A et al. (2021). European Society for Immunodeficiencies Registry Working Party. Initial presenting manifestations in 16,486 patients with inborn errors of immunity include infections and noninfectious manifestations. J Allergy Clin Immunol. 148 (5): 1332-1341.e5. https://doi.org/10.1016/j.jaci.2021.04.015; PMid:33895260
18. Uusimaa J, Kaarteenaho R, Paakkola T et al. (2018). NHLRC2 variants identified in patients with fibrosis, neurodegeneration, and cerebral angiomatosis (FINCA): characterisation of a novel cerebropulmonary disease. Acta Neuropathol. 135 (5): 727-742. https://doi.org/10.1007/s00401-018-1817-z; PMid:29423877