L’esofagite eosinofila: quando deglutire diventa difficile

Knowledge in the genetic field of autoinflammatory diseases has progressively increased over the last decade. Starting from the genetic knowledge on a few initially known diseases (Familial Mediterranean Fever, Periodic Syndrome Associated with Tumor Necrosis Factor Receptor 1, Mevalonate Kinase Deficiency, Cryopyrinopathies), at least 40 genes associated with these conditions have been identified, and more than 100 genes are currently being tested with Next Generation Sequencing (NGS) technologies. Indeed, starting recommendations for the genetic diagnosis of autoinflammatory diseases were limited to a gene-by-gene diagnosis strategy, based on the Sanger method, and restricted to a few prototypic recurrent fevers. More recently, improvement of genetic technologies, in particular NGS, allowed identification of genetic variants among involved genes in an easier and more rapid way. Detection of more and more genetic variants made interpretation of results more complicated, and often a genetic diagnosis is not achieved. On the other hand, other mechanisms, namely somatic mosaicisms, epigenetic modifications, digenic inheritance, allow to explain some not genetically defined cases. Eventually, further genetic and non-genetic mechanisms will be probably identified in near future to explain underlying basis of autoinflammatory diseases, especially in a still large part of patients without a clearcut genetic basis.