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Whole-Exome Sequencing Reveals Mutations in Genes Linked to Hemophagocytic Lymphohistiocytosis and Macrophage Activation Syndrome in Fatal Cases of H1N1 Influenza
Open accessAbstract
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.”
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“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”
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Metadata
- 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.
- ORCID
- Venue
- Journal of Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-11-23
- Volume
- 213
- Issue
- 7
- Pages
- 1180-1188
- ISSN
- 0022-1899 (ISSN-L)
- 1537-6613
- PMC
- PMC4779301
- 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
- bronze
- doi.org
- 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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