How Protein Ubiquitination Can Influence Cytokine Expression-Updated Review on Autoinflammatory VEXAS Syndrome

VEXAS syndrome is a new disease entity with symptoms that can mimic hematological, rheumatic and dermatological diseases. It is important to take a multidisciplinary approach to patient care, taking into account genetic testing, in which the presence of mutations in the UBA1 gene can confirm the diagnosis. UBA1 mutation has been shown to be involved in the induction of the inflammatory response through many different mechanisms. NF-kappa B and TNF-alpha pathways appear to be the most important in VEXAS syndrome. There are many different UBA1 mutations which can result in different outcomes, suggesting it is a possible prognostic factor. Furthermore, mutations differ in how they impair UBA1 function. Cytokines have been shown to be significantly altered in VEXAS patients; however, their exact expression and importance were not clearly defined. Interleukins, such as interleukin (IL)-6, IL-1, IL-2R and others, were reported to be expressed at an altered level, similarly to other cytokines, such as IFN-gamma or TNF-alpha. It is worth noting that the expression of certain cytokines can vary between patients, which poses therapeutic difficulties in selecting the right drug. Therefore, the aim of this review was to describe the cytokines involved in VEXAS syndrome and associate their expression with UBA1 mutation.