Clinical features and genetic analysis of three patients with Immune dysregulation, polyendocrinopathy, enteropathy, X-linked syndrome due to variants of FOXP3 gene
10.3760/cma.j.cn511374-20211102-00872
- VernacularTitle:FOXP3基因变异致X连锁多内分泌腺病肠病伴免疫失调综合征3例患儿的临床及遗传学研究
- Author:
Cuifang ZHENG
1
;
Yingying MENG
;
Zhaohui DENG
;
Jing LIU
;
Gangfeng YAN
;
Ying HUANG
Author Information
1. 复旦大学附属儿科医院消化科，上海 201102
- Keywords:
Immune dysregulation;
Polyendocrinopathy;
Enteropathy, X-linked;
FOXP3 gene;
Very early onset inflammatory bowel disease;
Diabetes
- From:
Chinese Journal of Medical Genetics
2024;41(2):181-186
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the clinical characteristics of three patients with Immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome.Methods:Three patients with IPEX syndrome diagnosed at the Children′s Hospital of Fudan University from January 24, 2013 to July 29, 2019 were selected as the study subjects. Their clinical features, laboratory investigations and results of genetic testing were summarized. Treatment and prognosis were also explored.Results:All of the three children had developed the disorder during infancy. One child had initial features including diabetes and diabetic ketoacidosis, whilst the other two had initiated by diarrhea. All patients had gastrointestinal involvement, and one was diagnosed as very early onset inflammatory bowel disease by colonoscopy and biopsy. Two children also had endocrine glands involvement. One child had manifested type 1 diabetes and positivity for thyroglobulin and thyroid peroxidase antibodies, though his thyroid function had remained normal. Another one had hypothyroidism and was treated by levothyroxine. Genetic testing revealed that all children had harbored missense variants of the FOXP3 gene, including c. 1222G>A (p.V408M), c. 767T>C (p.M256T) and c. 1021A>G (p.T341A). The clinical symptoms of one patient were alleviated following allogeneic hematopoietic stem cell transplantation. One patient was stable after treatment with infliximab plus insulin, and one child had died of refractory septic shock and multiple organ dysfunction syndrome at 3 months old. Conclusion:FOXP3 gene variant-associated IPEX syndrome may have very early onset and diverse clinical manifestations. For male patients with infantile onset chronic diarrhea, multiple endocrine or multiple system involvement, genetic testing is recommended, which may facilitate early diagnosis, treatment and genetic counseling.
