Cited by 170Autoimmune and Inflammatory Disorders ResearchInfluenza Virus Research StudiesInflammasome and immune disorders

Whole-Exome Sequencing Reveals Mutations in Genes Linked to Hemophagocytic Lymphohistiocytosis and Macrophage Activation Syndrome in Fatal Cases of H1N1 Influenza

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Schulert, Grant S., Zhang, Mingce, Fall, Ndate, Husami, Ammar, Kissell, Diane, Hanosh, Andrew, Zhang, Kejian, Davis, Kristina +7 more·2016·Journal of Infectious Diseases

Abstract

BACKGROUND: Severe H1N1 influenza can be lethal in otherwise healthy individuals and can have features of reactive hemophagocytic lymphohistiocytosis (HLH). HLH is associated with mutations in lymphocyte cytolytic pathway genes, which have not been previously explored in H1N1 influenza. METHODS: Sixteen cases of fatal influenza A(H1N1) infection, 81% with histopathologic hemophagocytosis, were identified and analyzed for clinical and laboratory features of HLH, using modified HLH-2004 and macrophage activation syndrome (MAS) criteria. Fourteen specimens were subject to whole-exome sequencing. Sequence alignment and variant filtering detected HLH gene mutations and potential disease-causing variants. Cytolytic function of the PRF1 p.A91V mutation was tested in lentiviral-transduced NK-92 natural killer (NK) cells. RESULTS: Despite several lacking variables, cases of influenza A(H1N1) infection met 44% and 81% of modified HLH-2004 and MAS criteria, respectively. Five subjects (36%) carried one of 3 heterozygous LYST mutations, 2 of whom also possessed the p.A91V PRF1 mutation, which was shown to decrease NK cell cytolytic function. Several patients also carried rare variants in other genes previously observed in MAS. CONCLUSIONS: This cohort of fatal influenza A(H1N1) infections confirms the presence of hemophagocytosis and HLH pathology. Moreover, the high percentage of HLH gene mutations suggests they are risk factors for mortality among individuals with influenza A(H1N1) infection.

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  • The pattern of cytokine elevations varies on the basis of such factors as the microbiome, genetic features, and underlying disorders.

    “The pattern of cytokine elevations varies on the basis of such factors as the microbiome, genetic features, and underlying disorders.”

    From Cytokine storm (2020) · cites this paper as [30]

  • Retrospective analyses of persons who died from coagulopathies and hemophagocytosis during the 2009 H1N1 influenza pandemic revealed germline mutations previously associated with HLH-associated cytokine storm.

    “Furthermore, retrospective analyses of data from persons who died from coagulopathies and hemophagocytosis during the H1N1 influenza pandemic of 2009 revealed germline mutations previously associated with HLH-associated cytokine storm.30”

    From Cytokine storm (2020) · cites this paper as [30]

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  1. Schulert GS, Bove K, McMasters R, Campbell K, Leslie N, Grom AA. Mevalonate kinase deficiency associated with recurrent liver dysfunction, macrophage activation syndrome and perforin gene polymorphism. Arthritis Care Res 2014; 67:1173-9.

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Authors
Schulert, G. S., Zhang, M., Fall, N., Husami, A., Kissell, D., Hanosh, A., Zhang, K., Davis, K., Jentzen, J. M., Napolitano, L., Siddiqui, J., Smith, L. B., Harms, P. W., Grom, A. A., & Cron, R. Q.
Affiliations
  • Cincinnati Children's Hospital Medical Center (US)
  • University of Alabama at Birmingham (US)
  • University of Michigan (US)
Corresponding author
Cron, Randy Q.
Venue
Journal of Infectious Diseases
Published
2015-11-23
Volume
213
Issue
7
Pages
1180-1188
ISSN
  • 0022-1899 (ISSN-L)
  • 1537-6613
OpenAlex
W2273799513
Cited by
170
References
52
Citations by year
2026: 6 · 2025: 11 · 2024: 14 · 2023: 15 · 2022: 15 · 2021: 25 · 2020: 42 · 2019: 15 · 2018: 9 · 2017: 13 · 2016: 3 · 2015: 1
FWCI
6.80
Type
journal article
Language
en
Open access
Locations
  • The Journal of Infectious Diseases (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • National Institutes of Health (R01-AR059049, K12-HL119986 to G. S. S.)
  • the Kaul Pediatric Research Institute
  • the American College of Rheumatology Rheumatology Research Foundation (scientist development award to G. S. S.)
Topics
  • Health Sciences › Medicine › Hematology › Autoimmune and Inflammatory Disorders Research
  • Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Inflammasome and immune disorders
Keywords
hemophagocytic lymphohistiocytosis, macrophage activation syndrome, H1N1 influenza, fatal influenza, NK cell cytotoxicity
MeSH terms
Female, Genotype, Humans, Influenza, Human, Killer Cells, Natural, Male, Mutation, Cohort Studies, Sequence Analysis, DNA, Genetic Predisposition to Disease, Lymphohistiocytosis, Hemophagocytic, Influenza A Virus, H1N1 Subtype, Perforin, Macrophage Activation Syndrome, HEK293 Cells, Exome

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