Ruxolitinib treatment of a patient with steroid-dependent severe autoimmunity due to STAT1 gain-of-function mutation

Kunihiko Moriya, Tasuku Suzuki, Nao Uchida, Tomohiro Nakano, Saori Katayama, Masahiro Irie, Takeshi Rikiishi, Hidetaka Niizuma, Satoshi Okada, Kohsuke Imai, Yoji Sasahara, Shigeo Kure

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

Signal transducer and activator of transcription 1 gain-of-function (STAT1 GOF) mutations are the most common cause of chronic mucocutaneous candidiasis (CMC). We report the effect of oral ruxolitinib, an inhibitor of Janus kinase (JAK) family tyrosine kinases, on the clinical and immune status of a 3-year-old male with steroid-dependent severe autoimmunity due to a STAT1 GOF T385M mutation. The patient’s susceptibility to infection improved with antimicrobial prophylaxis and immunoglobulin replacement therapy, but he continued to exhibit severely disabling symptoms of autoimmunity. More than one-third of patients with STAT1 GOF mutations present with autoimmune manifestations, and this patient’s mutation was reported to cause CMC with autoimmunity. We analyzed the interleukin (IL)-17A and IFN-γ levels and immunophenotype by flow cytometry before and during treatment with ruxolitinib. The peripheral IL-17A level did not increase, but the IFN-γ level decreased after 4 months of therapy. The STAT1 phosphorylation level decreased significantly upon stimulation of patient cells with IFN-γ. Clinically, cytomegalovirus reactivation occurred, but was controlled. No other adverse effect was noted. We report the potential of JAK1/2 inhibition with ruxolitinib for both CMC and steroid-dependent autoimmunity. However, long-term administration is necessary, as the effect is not sustained after treatment is discontinued.

Original languageEnglish
Pages (from-to)258-262
Number of pages5
JournalInternational journal of hematology
Volume112
Issue number2
DOIs
Publication statusPublished - 2020 Aug 1

Keywords

  • Autoimmunity
  • Ruxolitinib
  • STAT1 GOF

ASJC Scopus subject areas

  • Hematology

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