Polyautoimmunity Reflecting Immune Dysregulation in Common Variable Immunodeficiency

<b>Background</b>: Common variable immunodeficiency (CVID) is the most frequent symptomatic inborn error of immunity (IEI) in adulthood. Other than recurrent infections, CVID may present with non-infectious complications such as enteropathy, lymphoproliferation, malignancy, and autoimmun...

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Main Authors: Maria Giovanna Danieli, Giuseppe Murdaca, Cristina Mezzanotte, Ilaria Claudi, Elena Buti, Matteo Martini, Maria Beatrice Bilò, Sebastiano Gangemi, Gianluca Moroncini
Format: Article
Language:English
Published: MDPI AG 2025-02-01
Series:Biomedicines
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Online Access:https://www.mdpi.com/2227-9059/13/3/552
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author Maria Giovanna Danieli
Giuseppe Murdaca
Cristina Mezzanotte
Ilaria Claudi
Elena Buti
Matteo Martini
Maria Beatrice Bilò
Sebastiano Gangemi
Gianluca Moroncini
author_facet Maria Giovanna Danieli
Giuseppe Murdaca
Cristina Mezzanotte
Ilaria Claudi
Elena Buti
Matteo Martini
Maria Beatrice Bilò
Sebastiano Gangemi
Gianluca Moroncini
author_sort Maria Giovanna Danieli
collection DOAJ
description <b>Background</b>: Common variable immunodeficiency (CVID) is the most frequent symptomatic inborn error of immunity (IEI) in adulthood. Other than recurrent infections, CVID may present with non-infectious complications such as enteropathy, lymphoproliferation, malignancy, and autoimmune diseases. Patients could have a single autoimmune disease (monoautoimmunity) or two or more autoimmune diseases (overt polyautoimmunity). “Latent polyautoimmunity” corresponds to the presence of autoantibodies without a clinically evident autoimmune disease. <b>Methods</b>: The aim of this retrospective study was to describe autoimmunity and polyautoimmunity in a population of 81 CVID adult patients, enrolled from January 2008 to July 2022 (mean follow-up: 8.5 years). <b>Results</b>: We documented at least one autoimmune disorder in 40 patients (49.4%). Moreover, 15 subjects (37.5% of patients with autoimmunity and 18.5% of all CVID population) presented polyautoimmunity. Despite the humoral immune deficiency, we detected different autoantibodies in CVID patients with or without a concomitant autoimmune disease. In both groups with monoautoimmunity and polyautoimmunity, cytopenias were the most common manifestation. Conversely, enteropathy was recorded only in patients with polyautoimmunity (27%, <i>p</i> = 0.006). Patients with polyautoimmunity showed a significantly lower mean age at diagnosis (−12 years, <i>p</i> = 0.018) compared to those with monoautoimmunity. We documented a higher frequency of autoimmunity in CVID patients who had increased diagnostic (+5.6 years) and therapeutic (+7.2 years) delay (<i>p</i> = 0.093 and 0.054, respectively). <b>Conclusions</b>: Polyautoimmunity is a frequent condition in patients affected by CVID. An early start of Ig replacement therapy could help prevent autoimmune complications.
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spelling doaj-art-df46a04990be4f4a9e227dbeef02b3802025-08-20T02:11:04ZengMDPI AGBiomedicines2227-90592025-02-0113355210.3390/biomedicines13030552Polyautoimmunity Reflecting Immune Dysregulation in Common Variable ImmunodeficiencyMaria Giovanna Danieli0Giuseppe Murdaca1Cristina Mezzanotte2Ilaria Claudi3Elena Buti4Matteo Martini5Maria Beatrice Bilò6Sebastiano Gangemi7Gianluca Moroncini8SOS Immunologia delle Malattie Rare e dei Trapianti, SOD Clinica Medica, Dipartimento di Medicina Interna, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, ItalyDepartment of Internal Medicine, University of Genoa, 16132 Genoa, ItalyUO Medicina Interna, Azienda Sanitaria Territoriale Pesaro Urbino, 61032 Fano, ItalyPostgraduate School in Allergology and Clinical Immunology, Università Politecnica delle Marche, 60126 Ancona, ItalyPostgraduate School in Allergology and Clinical Immunology, Università Politecnica delle Marche, 60126 Ancona, ItalySOSD Allergologia, Dipartimento di Medicina Interna, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, ItalyDepartment of Clinical and Molecular Sciences, Marche Polytechnic University, 60126 Ancona, ItalyOperative Unit of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98125 Messina, ItalyDepartment of Clinical and Molecular Sciences, Marche Polytechnic University, 60126 Ancona, Italy<b>Background</b>: Common variable immunodeficiency (CVID) is the most frequent symptomatic inborn error of immunity (IEI) in adulthood. Other than recurrent infections, CVID may present with non-infectious complications such as enteropathy, lymphoproliferation, malignancy, and autoimmune diseases. Patients could have a single autoimmune disease (monoautoimmunity) or two or more autoimmune diseases (overt polyautoimmunity). “Latent polyautoimmunity” corresponds to the presence of autoantibodies without a clinically evident autoimmune disease. <b>Methods</b>: The aim of this retrospective study was to describe autoimmunity and polyautoimmunity in a population of 81 CVID adult patients, enrolled from January 2008 to July 2022 (mean follow-up: 8.5 years). <b>Results</b>: We documented at least one autoimmune disorder in 40 patients (49.4%). Moreover, 15 subjects (37.5% of patients with autoimmunity and 18.5% of all CVID population) presented polyautoimmunity. Despite the humoral immune deficiency, we detected different autoantibodies in CVID patients with or without a concomitant autoimmune disease. In both groups with monoautoimmunity and polyautoimmunity, cytopenias were the most common manifestation. Conversely, enteropathy was recorded only in patients with polyautoimmunity (27%, <i>p</i> = 0.006). Patients with polyautoimmunity showed a significantly lower mean age at diagnosis (−12 years, <i>p</i> = 0.018) compared to those with monoautoimmunity. We documented a higher frequency of autoimmunity in CVID patients who had increased diagnostic (+5.6 years) and therapeutic (+7.2 years) delay (<i>p</i> = 0.093 and 0.054, respectively). <b>Conclusions</b>: Polyautoimmunity is a frequent condition in patients affected by CVID. An early start of Ig replacement therapy could help prevent autoimmune complications.https://www.mdpi.com/2227-9059/13/3/552antinuclear antibodiesautoantibodiesautoimmune diseaseautoimmunitycommon variable immunodeficiencyimmune dysregulation
spellingShingle Maria Giovanna Danieli
Giuseppe Murdaca
Cristina Mezzanotte
Ilaria Claudi
Elena Buti
Matteo Martini
Maria Beatrice Bilò
Sebastiano Gangemi
Gianluca Moroncini
Polyautoimmunity Reflecting Immune Dysregulation in Common Variable Immunodeficiency
Biomedicines
antinuclear antibodies
autoantibodies
autoimmune disease
autoimmunity
common variable immunodeficiency
immune dysregulation
title Polyautoimmunity Reflecting Immune Dysregulation in Common Variable Immunodeficiency
title_full Polyautoimmunity Reflecting Immune Dysregulation in Common Variable Immunodeficiency
title_fullStr Polyautoimmunity Reflecting Immune Dysregulation in Common Variable Immunodeficiency
title_full_unstemmed Polyautoimmunity Reflecting Immune Dysregulation in Common Variable Immunodeficiency
title_short Polyautoimmunity Reflecting Immune Dysregulation in Common Variable Immunodeficiency
title_sort polyautoimmunity reflecting immune dysregulation in common variable immunodeficiency
topic antinuclear antibodies
autoantibodies
autoimmune disease
autoimmunity
common variable immunodeficiency
immune dysregulation
url https://www.mdpi.com/2227-9059/13/3/552
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