Impaired STING Activation Due to a Variant in the E3 Ubiquitin Ligase AMFR in a Patient with Severe VZV Infection and Hemophagocytic Lymphohistiocytosis.

Varicella zoster virus (VZV) is a neurotropic alphaherpesvirus exclusively infecting humans, causing two distinct pathologies: varicella (chickenpox) upon primary infection and herpes zoster (shingles) following reactivation. In susceptible individuals, VZV can give rise to more severe clinical manifestations, including disseminated infection, pneumonitis, encephalitis, and vasculopathy with stroke. Here, we describe a 3-year-old boy in whom varicella followed a complicated course with thrombocytopenia, hemorrhagic and necrotic lesions, pneumonitis, and intermittent encephalopathy. Hemophagocytic lymphohistiocytosis (HLH) was strongly suspected and as the condition deteriorated, HLH therapy was initiated. Although the clinical condition improved, longstanding hemophagocytosis followed despite therapy. We found that the patient carries a rare monoallelic variant in autocrine motility factor receptor (AMFR), encoding a ubiquitin ligase involved in innate cytosolic DNA sensing and interferon (IFN) production through the cyclic GMP-AMP synthase-stimulator of IFN genes (cGAS-STING) pathway. Peripheral blood mononuclear cells (PBMCs) from the patient exhibited impaired signaling downstream of STING in response dsDNA and 2'3'-cGAMP, agonists of cGAS and STING, respectively, and fibroblasts from the patient showed impaired type I IFN responses and significantly increased VZV replication. Overexpression of the variant AMFR R594C resulted in decreased K27-linked STING ubiquitination compared to WT AMFR. Moreover, ImageStream technology revealed reduced STING trafficking from ER to Golgi in cells expressing the patient AMFR R594C variant. This was supported by a dose-dependent dominant negative effect of expression of the patient AMFR variant as measured by IFN-ß reporter gene assay. Finally, lentiviral transduction with WT AMFR partially reconstituted 2'3'-cGAMP-induced STING-mediated signaling and ISG expression in patient PBMCs. This work links defective AMFR-STING signaling to severe VZV disease and hyperinflammation and suggests a direct role for cGAS-STING in the control of viral infections in humans. In conclusion, we describe a novel genetic etiology of severe VZV disease in childhood, also representing the first inborn error of immunity related to a defect in the cGAS-STING pathway.

Resistance to vincristine in DLBCL by disruption of p53-induced cell cycle arrest and apoptosis mediated by KIF18B and USP28.

The frontline therapy R-CHOP for patients with diffuse large B-cell lymphoma (DLBCL) has remained unchanged for two decades despite numerous Phase III clinical trials investigating new alternatives. Multiple large studies have uncovered genetic subtypes of DLBCL enabling a targeted approach. To further pave the way for precision oncology, we perform genome-wide CRISPR screening to uncover the cellular response to one of the components of R-CHOP, vincristine, in the DLBCL cell line SU-DHL-5. We discover important pathways and subnetworks using gene-set enrichment analysis and protein-protein interaction networks and identify genes related to mitotic spindle organization that are essential during vincristine treatment. The inhibition of KIF18A, a mediator of chromosome alignment, using the small molecule inhibitor BTB-1 causes complete cell death in a synergistic manner when administered together with vincristine. We also identify the genes KIF18B and USP28 of which CRISPR/Cas9-directed knockout induces vincristine resistance across two DLBCL cell lines. Mechanistic studies show that lack of KIF18B or USP28 counteracts a vincristine-induced p53 response suggesting that resistance to vincristine has origin in the mitotic surveillance pathway (USP28-53BP1-p53). Collectively, our CRISPR screening data uncover potential drug targets and mechanisms behind vincristine resistance, which may support the development of future drug regimens.

Suspected immune-mediated myositis in horses.

BACKGROUND: Although immune-mediated myositis (IMM) is commonly reported in other species, this condition is poorly described in horses. HYPOTHESIS: IMM occurs in horses. ANIMALS: Thirty-seven horses with suspected IMM were included in the study. METHODS: The database of the Neuromuscular Diagnostic Laboratory was reviewed to identify 37 horses with muscle biopsies characterized by lymphocytic infiltrates. A retrospective standardized questionnaire regarding clinical signs and response to treatment was answered by horse owners. RESULTS: Horses with suspected IMM were predominantly of Quarter Horse bloodlines (33/37 horses) and primarily either < or =8 years or > or =17 years of age. Clinical signs included rapid atrophy, particularly of the epaxial and gluteal muscles, depression, and stiffness. Creatine kinase (CK) activity (mean 9746; range 260-139,183 U/L: reference range 119-287 U/L) and aspartate transaminase (AST) activity (mean 2880; range 350-9009 U/L: reference range 138-409 U/L) were high. Exposure to horses with infectious respiratory disease occurred in 39% (9/23) of horses before clinical signs and 47% (9/19) had recurrence of atrophy. Variation in dosage and time elapsed before administration of corticosteroids confounded assessment of treatment efficacy. Macrophages and CD4+ T lymphocytes were the prominent mononuclear cellular infiltrates with lesser numbers of CD8+ cells and small clusters of B lymphocytes in some samples. Myofibers did not stain for equine immunoglobulin G (IgG). CONCLUSIONS AND CLINICAL IMPORTANCE: IMM appears to be a distinct cause of rapid muscle atrophy, particularly in Quarter Horses that may be amenable to treatment with corticosteroids. Diagnosis is best achieved by identifying lymphocytic infiltrates in atrophied muscles.