Long-term follow-up of autoimmune polyendocrine syndrome type 1 in Norway
Year: 2026
Type: article
Study design: Observational Study
Abstract: CONTEXT: Autoimmune polyendocrine syndrome type 1 (APS-1) is a rare yet severe multiorgan autoimmune disease caused by mutations in the autoimmune regulator (AIRE) gene. Classical APS-1 arises from biallelic recessive AIRE mutations, whereas dominant negative mutations cause a milder, nonclassical phenotype with variable clinical presentation. Due to its rarity, long-term, population-based data are limited, underscoring the need for extended follow-up to guide lifelong care and research. OBJECTIVE: To characterize the clinical profiles of APS-1 and explore associations between disease manifestations, autoantibody profiles, and AIRE mutations over an extended follow-up (1996-2025). PATIENTS: All known Norwegian patients with APS-1. METHODS: We analyzed longitudinal clinical and laboratory data of 71 APS-1 patients (49 classical, 22 nonclassical) from the Norwegian Registry of Organ-specific Autoimmune Diseases. Data included clinical progression, autoantibody and cytokine profiles, and AIRE genotypes. Additionally, we compared age at diagnosis of primary adrenal insufficiency (PAI) in patients with and without (n = 999) APS-1. RESULTS: In classical APS-1, the most frequent clinical manifestations were chronic mucocutaneous candidiasis, enamel hypoplasia, and PAI, while for nonclassical APS-1 vitiligo, hypothyroidism, and PAI were most common. A broad proinflammatory cytokine signature was observed in classical APS-1, along with increased levels of the soluble form of the interferon (IFN)-α/β receptor. CONCLUSION: APS-1 should be considered in patients diagnosed with PAI before age 20, and AIRE sequencing is recommended for diagnostic confirmation. The presence of IFN-ω autoantibodies, a proinflammatory cytokine profile, and increased soluble IFN receptor levels further support the role of dysregulated interferon responses in APS-1 pathogenesis.
Authors: Isil Kucuka, Anette S B Wolff, Lars Breivik, Thea Sjøgren, Eirik Bratland, Marianne Grytaas, Kari Lima, Anders P Jørgensen, Ingrid Nermoen, Åsne Bakke, Hallvard Singsås, Margrethe Svendsen, Trine E Finnes, Bjørn Gunnar Nedrebø, Thor Haug, Guri Grimnes, Marthe Landsverk Rensvik, Cecilie G Gjerde, Mihaela C Marthinussen, Marianne Øksnes, Bergithe E Oftedal, Eystein S Husebye
Institutions: University of Bergen, Haukeland University Hospital, Akershus University Hospital, Oslo University Hospital, University of Oslo, Stavanger University Hospital, St Olav's University Hospital, Østfold Hospital Trust, Innlandet Hospital Trust, Inland Hospital, Molde Hospital, University Hospital of North Norway, UiT The Arctic University of Norway, Ålesund Hospital
Language: English
Subfield: Immunology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: hybrid
Estimated APC paid: $3,750
OpenAlex ID: W7128699167