Activated PI3K delta syndrome

Activated PI3K delta syndrome (APDS) is a primary immunodeficiency disease caused by activating gain of function mutations in the PIK3CD gene.[7][8][2] Which encodes the p110δ catalytic subunit of PI3Kδ, APDS-2 (PASLI-R1) is caused by exon-skipping mutations in PIK3R1 which encodes for the regulatory subunit p85α. APDS and APDS-2 affected individuals present with similar symptoms, which include increased susceptibility to airway infections, bronchiectasis and lymphoproliferation.

Activated PI3K delta syndrome
Other namesimmunodeficiency 14, p110δ-activating mutation causing senescent T cells, PASLI
Activated PI3K Delta Syndrome is autosomal dominant
SymptomsImmunodeficiency, Lymphadenopathy[1]
CausesMutation in phosphatidylinositol 4,5-bisphosphate 3-kinase catalytic subunit delta isoform[2][3]
Diagnostic methodGenetic testing[4]
TreatmentAntiviral therapy[5][6]

Symptoms and signs

The signs and symptoms of activated PI3K Delta Syndrome are consistent with the following:[1]

Cause

In terms of genetics, activated PI3K Delta Syndrome is autosomal dominant, a mutation in phosphatidylinositol 4,5-bisphosphate 3-kinase catalytic subunit delta isoform is the reason for this condition (located at chromosome 1p36.) [2][3]

Mechanism
PI3kinase

The pathophysiology of activated PI3K delta syndrome has several aspects.[2] The normal function has P110δ (PI3K) involved in immune system regulation.[9]

P110δ effect is not limited to the immune system; P110δ has a presence in transformed epithelial cells and cell adhesion molecules (airway inflammation), and research has been done on the possibility of P110δ in the nervous system.[10]

Activated PI3K delta syndrome effect indicates affected individuals are likely to have activation-induced cell death.[2] Normally, PI3K-delta signaling assists B cells and T cells to mature; however, overactive PI3K-delta has an effect on the B and T cell differentiation (the process by which cells eventually are different from one another[11]).

Consequently, there is an inability to confront an infection, as well as early cell death. Furthermore, overproduction of said signal can cause lymphadenopathy (which is an enlargement of lymph nodes[12]) due to excess white blood cells.[7]

Diagnosis

In order to ascertain if an individual has activated PI3K delta syndrome, usually one finds atypical levels of immunoglobulins. Methods to determine the condition are the following:[4]

Treatment
Amoxicillin(antibiotic)

Infections for this condition, are treated or prevented in the following general ways:[5][6]

Leniolisib (Joenja) was approved for medical use in the United States in March 2023.[13][14][15] It is the first approved drug in the US for activated PI3K delta syndrome.[13]

References
  1. "PASLI disease | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program". rarediseases.info.nih.gov. Archived from the original on 2 January 2018. Retrieved 9 June 2017.
  2. "IMMUNODEFICIENCY 14A WITH LYMPHOPROLIFERATION, AUTOSOMAL DOMINANT; IMD14A". Online Mendelian Inheritance in Man (OMIM). Archived from the original on 4 July 2017. Retrieved 10 June 2017.
  3. "PIK3CD gene". MedlinePlus. Archived from the original on 31 May 2022. Retrieved 10 June 2017.
  4. "PI3 Kinase Disease". National Institute of Allergy and Infectious Diseases. Archived from the original on 28 June 2017. Retrieved 10 June 2017.
  5. "Immunodeficiency (Primary and Secondary). Information". patient.info. Archived from the original on 21 December 2022. Retrieved 11 June 2017.
  6. "Bronchiectasis Treatment & Management: Approach Considerations, Supportive Treatment, Antibiotic Therapy". 17 February 2017. Archived from the original on 8 June 2017. Retrieved 11 June 2017.
  7. "Activated PI3K-delta syndrome". MedlinePlus. Archived from the original on 28 November 2022. Retrieved 9 June 2017.
  8. Collard, Harold R.; Richeldi, Luca (18 February 2017). Interstitial Lung Disease E-Book. Elsevier Health Sciences. p. 9. ISBN 9780323480253. Archived from the original on 26 March 2023. Retrieved 27 November 2021.
  9. "PIK3CD phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit delta [Homo sapiens (human)]". National Library of Medicine. Archived from the original on 6 November 2018. Retrieved 11 June 2017.
  10. Schoenberger, Stephen P.; Katsikis, Peter D.; Pulendran, Bali (31 August 2015). Crossroads Between Innate and Adaptive Immunity V. Springer. p. 121. ISBN 9783319157740. Archived from the original on 26 March 2023. Retrieved 27 November 2021.
  11. Prasad, Keder N. (6 December 2012). Regulation of Differentiation in Mammalian Nerve Cells. Springer Science & Business Media. p. 2. ISBN 9781468481129. Archived from the original on 26 March 2023. Retrieved 27 November 2021.
  12. Fleisher, Gary R.; Ludwig, Stephen (2010). Textbook of Pediatric Emergency Medicine. Lippincott Williams & Wilkins. p. 378. ISBN 9781605471594. Archived from the original on 26 March 2023. Retrieved 27 November 2021.
  13. "FDA approves first treatment for activated phosphoinositide 3-kinase delta syndrome". U.S. Food and Drug Administration (FDA) (Press release). 24 March 2023. Archived from the original on 25 March 2023. Retrieved 24 March 2023.
  14. "US FDA approves Pharming's immune disorder drug". Reuters. Archived from the original on 24 March 2023. Retrieved 24 March 2023.
  15. "Pharming announces US FDA approval of Joenja (leniolisib) as the first and only treatment indicated for APDS" (PDF). Pharming Group N.V. (Press release). 24 March 2023. Archived (PDF) from the original on 26 March 2023. Retrieved 25 March 2023.

Further reading
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