ROSAH syndrome

ROSAH syndrome is a genetic disease of innate immune activation.[1] ROSAH stands for Retinal dystrophy, Optic nerve edema, Splenomegaly, Anhidrosis and Headache and the name emphasizes some, but not all, of the features that can be associated with the syndrome.[2] The disease is inherited in an autosomal dominant manner and caused by heterozygous missense mutations in the ALPK1 gene, an innate immune sensor for bacterial sugars. [3]

ROSAH syndrome
ROSAH syndrome is inherited via an autosomal dominant manner
CausesMutation in ALPK1 gene

Signs and symptoms

While the initial descriptions of ROSAH syndrome emphasized the ocular manifestations of the disease, it is now clear that ROSAH syndrome can also present with a range of systemic features including recurrent fever, uveitis, deforming arthritis, AA amyloidosis, meningeal enhancement and premature mineralisation of the basal ganglia, substantia nigra and red nuclei on MRI. [2] [1] Additionally, clinical features not conventionally attributed to inflammation have also been reported and included short dental roots, enamel defects and decreased salivary flow.[1]

Pathophysiology

ALPK1’s role in human physiology and immune regulation is still under investigation but the protein is known to act as a sensor for bacterial sugars.[3] ROSAH syndrome patients’ primary samples and in vitro assays with mutated ALPK1 constructs have shown immune activation with increased NF-κB signaling, STAT1 phosphorylation and interferon gene expression signature.[1]

Genetics

This condition is caused by mutations in the ɑ-kinase gene (ALPK1) gene. This gene is located on the long arm of chromosome 4 (4q25). The inheritance of this condition is autosomal dominant.

Diagnosis

Currently, screening for ROSAH syndrome is initiated upon a physician's judgement. Genetic testing for ROSAH syndrome can be performed as either targeted, single-gene testing through Sanger sequencing or a multi-gene test through whole exome sequencing or whole genome sequencing.[2] [1]

Management

Some features of the disease are amenable to immunomodulatory therapy.[1] However, additional studies will be need to determine if immunomodulation can mitigate the risk of progressive vision loss in this disease.

Epidemiology

The prevalence is not known. To date, less than 50 individuals with ROSAH syndrome have been described in the medical literature. [1] [2]

History

This condition was first described in 2012 prior to the discovery of the genetics and naming of the condition.[4] The genetic basis of this condition was first published in an ARVO abstract in 2013 and in a complete article in 2019.[2] In 2022, ROSAH Syndrome Foundation was established to serve patients with ROSAH syndrome by providing information and connecting them to other individuals living with ROSAH syndrome.[5]

References
  1. Kozycki CT, Kodati S, Huryn L, et al. (2022). "Gain-of-function mutations in ALPK1 cause an NF-κB-mediated autoinflammatory disease: functional assessment, clinical phenotyping and disease course of patients with ROSAH syndrome". Annals of the Rheumatic Diseases. doi:10.1136/annrheumdis-2022-222629. ISSN 0003-4967.
  2. Williams LB, Javed A, Sabri A, Morgan DJ, Huff CD, Grigg JR, Heng XT, Khng AJ, Hollink IHIM, Morrison MA, Owen LA, Anderson K, Kinard K, Greenlees R, Novacic D, Nida Sen H, Zein WM, Rodgers GM, Vitale AT, Haider NB, Hillmer AM, Ng PC, Shankaracharya, Cheng A, Zheng L, Gillies MC, van Slegtenhorst M, van Hagen PM, Missotten TOAR, Farley GL, Polo M, Malatack J, Curtin J, Martin F, Arbuckle S, Alexander SI, Chircop M, Davila S, Digre KB, Jamieson RV, DeAngelis MM (2019) ALPK1 missense pathogenic variant in five families leads to ROSAH syndrome, an ocular multisystem autosomal dominant disorder. Genet Med doi: 10.1038/s41436-019-0476-3
  3. Zhou, Ping; She, Yang; Dong, Na; Li, Peng; He, Huabin; Borio, Alessio; Wu, Qingcui; Lu, Shan; Ding, Xiaojun; Cao, Yong; Xu, Yue; Gao, Wenqing; Dong, Mengqiu; Ding, Jingjin; Wang, Da-Cheng; Zamyatina, Alla; Shao, Feng (September 2018). "Alpha-kinase 1 is a cytosolic innate immune receptor for bacterial ADP-heptose". Nature. 561 (7721): 122–126. doi:10.1038/s41586-018-0433-3. ISSN 1476-4687.
  4. Tantravahi, Srinivas (March 2012). "An Inherited disorder with splenomegaly, cytopenias, and vision loss". American Journal of Medical Genetics. 158A (3): 475–481. doi:10.1002/ajmg.a.34437. PMC 4242507. PMID 22307799.
  5. "ROSAH Syndrome Foundation". rosahsyndrome.org.
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