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Somatic NLRP3 mosaicism in patients with “mutation-negative” CAPS: insights from a single centre UK cohort

Melo Gomes, Sonia; Arostegui, Juan I; Mensa-Vilaro, Ana; Omoyinmi, Ebun; Hong, Ying; McCreary, Dara; Rowczenio, Dorota; ... Brogan, Paul; + view all (2025) Somatic NLRP3 mosaicism in patients with “mutation-negative” CAPS: insights from a single centre UK cohort. Frontiers in Pediatrics , 13 , Article 1598748. 10.3389/fped.2025.1598748. Green open access

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Abstract

Introduction: Knowledge about mosaicism in cryopyrin-associated periodic syndromes (CAPS) has expanded significantly with the use of next generation sequencing technologies. The aim of this study was to assess the contribution of mosaicism in a paediatric cohort of patients with a clinical diagnosis of CAPS and no NLRP3 mutations identified through conventional DNA sequencing. / / Methods: Mosaicism was assessed by amplicon-based deep sequencing (ADS) on DNA extracted from different tissues over time. Targeted gene panels (TGPs) and whole-exome sequencing (WES) were used for comparison of detection methods. / / Results: In 40% (4/10) of the cohort a post-zygotic NLRP3 mutation leading to somatic mosaicism was found by ADS. Three of the detected NLRP3 mutations had been previously described only in somatic form and one both as germline and somatic. Mean mutant allelic frequencies (MAF) at diagnosis varied between 3.1–14.5% in whole blood, with all mutations being present in other tissues tested. In 3 patients, mosaicism was evaluated over time in whole blood, with results confirming mosaicism stability in 2 patients, and a MAF increase in 1 patient (from 1.9% to 5%). TGPs identified 4/4 cases of mosaicism whilst WES detected only 1/3. / / Discussion: Somatic NLRP3 mosaicism was present in 40% of this paediatric cohort, confirming the key role of this phenomenon in disease pathogenesis and in genetic confirmation of CAPS diagnosis. MAFs can be extremely low, which warrants caution regarding lower detection limits of the sequencing techniques utilized. Mosaicism level may vary over time in some patients, with diagnostic and potential therapeutic implications.

Type: Article
Title: Somatic NLRP3 mosaicism in patients with “mutation-negative” CAPS: insights from a single centre UK cohort
Location: Switzerland
Open access status: An open access version is available from UCL Discovery
DOI: 10.3389/fped.2025.1598748
Publisher version: https://doi.org/10.3389/fped.2025.1598748
Language: English
Additional information: © 2025 Melo Gomes, Arostegui, Mensa-Vilaro, Omoyinmi, Hong, McCreary, Rowczenio, Hawkins and Brogan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. http://creativecommons.org/licenses/by/4.0/
Keywords: CAPS, NGS—next generation sequencing, NLRP3, mosaicism, mosaicism distribution, mosaicism stability
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Infection, Immunity and Inflammation Dept
URI: https://discovery.ucl.ac.uk/id/eprint/10210497
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