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Activated PI3K Delta Syndrome (APDS)

Activated PI3K Delta Syndrome (APDS) is a rare, genetic primary immunodeficiency

Prevalence

< 1 / 1,000,000

< 331

US Estimated

< 514

Europe Estimated

Age of Onset

ICD-10

D81.8

Inheritance

Autosomal dominant

Caregiver Corner

Access the latest tools and resources for patients and caregivers living with APDS

Rare View

Activated PI3K delta syndrome, known as APDS (previously known as PASLI* Disease) is a rare primary immunodeficiency, first discovered in 2013. APDS is caused by genetic variants in either one of two genes known as PIK3CD or PIK3R1, which encode proteins that are vital to the normal development and function of immune cells. Signs and symptoms of APDS start in childhood, and patients are vulnerable to repeat infections and immune dysregulation such as lymphadenopathy, splenomegaly, autoimmune cytopenias, and even lymphoma.

5 Facts you should know

FACT

1

Since APDS was only recently fully characterized and shares many features of other immune disorders, patients with APDS may have been previously misdiagnosed with other conditions.

FACT

2

Signs and symptoms of APDS start in childhood, and patients are vulnerable to repeat infections and immune dysregulation such as severe respiratory tract infections, sinusitis, swollen lymph nodes, like tonsilitis and nodules in the air ways.

FACT

3

Recurrent respiratory infections affect virtually all APDS patients.

FACT

4

Bronchiectasis is a severe and common complication - lung infections affect up to 60% of APDS1 patients.

FACT

5

Genetic testing is the only way to definitively diagnose APDS and other primary immunodeficiencies.

Activated PI3K Delta Syndrome (APDS)

Activated PI3K Delta Syndrome (APDS) is also known as

PASLI disease, p110 delta-activating mutation causing senescent T cells, lymphadenopathy, and immunodeficiency

What’s your rare IQ?

Typically, patients with Activated PI3K Delta Syndrome APDS will present to a hospital within the first 5 years of life with a predominant and recurring respiratory tract infection. Which of the following is not usually characteristic of APDS?

Common Signs & Symptoms

Bronchiectasis

Permanent enlargement of the airways of the lungs

Decreased circulating IgG2 level

Decreased proportion of class-switched memory B cells

Decreased specific pneumococcal antibody level

Increased circulating IgM level

Increased proportion of transitional B cells

Lymphadenopathy

Swollen lymph nodes

Recurrent ear infections

Frequent ear infections

Top clinical studies

TitleDescriptionPhasesStatusInterventionsLocationsMore Information
Extension to the Study of Efficacy of CDZ173 in Patients With APDS/PASLIThis study is designed to provide long-term CDZ173 treatment, a selective PI3Kδ inhibitor, to the patients with genetically activated PI3Kδ, i.e., patients with APDS/PASLI who participated in the CCDZ173X2201 study or who were treated previously with PI3Kδ inhibitors other than CDZ173. The study is open-label designed to establish the long-term safety, tolerability, efficay and pharmacokinetics of CDZ173 in the target population.PI3K with immunomodulating and potentially anti-neoplastic activities. Leniolisib inhibits the
production of phosphatidylinositol-3-4-5-trisphosphate (PIP3). PIP3 serves as an important cellular
messenger specifically activating AKT (via PDK1) and regulates a multitude of cell functions such as
proliferation, differentiation, cytokine production, cell survival, angiogenesis, and metabolism. Unlike
PI3Kα and PI3Kβ which are ubiquitously expressed, PI3Kẟ and PI3Kγ are expressed primarily in cells of hematopoietic origin. The central role of PI3Kẟ in regulating numerous cellular functions of the adaptive immune system (B-cells and to a lesser extent T cells) as well as the innate immune system (neutrophil, mast cells, and macrophages) strongly indicates that PI3Kẟ is a valid and potentially effective therapeutic target for several immune diseases. To date, leniolisib has proven to be safe and well tolerated in healthy subjects as well as the APDS patients during the Phase 1 first-in-human trial and an ongoing open label extension trial.
Phase 2
Phase 3
RecruitingDrug: CDZ173Novartis Investigative Site, Bethesda, Maryland, United States|Novartis Investigative Site, Minsk, Belarus|Novartis Investigative Site, Prague 5, CZE, Czechia|Novartis Investigative Site, Dublin, Ireland|Novartis Investigative Site, Palermo, PA, Italy|Novartis Investigative Site, Brescia, Italy|Novartis Investigative Site, Rotterdam, NetherlandsMore Info
Safety, Pharmacokinetic (PK) and Pharmacodynamic (PD) Study of Repeat Doses of Inhaled Nemiralisib in Patients With APDS/PASLIThis is an open-label study conducted to investigate safety, pharmacokinetics and pharmacodynamics of repeat doses of inhaled nemiralisib (NEMI) in participants with activated phosphoinositide 3-kinase (PI3K) delta syndrome /p110 delta-activating mutation causing senescent T Cells, lymphadenopathy and immunodeficiency (APDS/PASLI)Phase 2CompletedDrug: NemiralisibGSK Investigational Site, Cambridge, United KingdomMore Info
Study of Efficacy of CDZ173 in Patients With APDS/PASLIThis study is designed to explore CDZ173, a selective PI3Kδ inhibitor, in patients with genetically activated PI3Kδ, i.e., patients with APDS/PASLI. The study consists of two parts. Part I is the open label part designed to establish the safety and pharmacokinetics of CDZ173 in the target population, as well as to select the optimal dose to be tested in part II. Part II is designed to assess efficacy and safety of CDZ173 in this population.Phase 2
Phase 3
RecruitingDrug: CDZ173National Institute of Health NIH, Bethesda, Maryland, United States|Novartis Investigative Site, Minsk, Belarus|Novartis Investigative Site, Prague 5, Czechia|Novartis Investigative Site, Paris cedex 15, France|Novartis Investigative Site, Dresden, Germany|Novartis Investigative Site, Dublin, Ireland|Novartis Investigative Site, Palermo, PA, Italy|Novartis Investigative Site, Brescia, Italy|Novartis Investigative Site, Rotterdam, Netherlands|Novartis Investigative Site, Moscow, Russian Federation|Novartis Investigative Site, Belfast, United Kingdom|Novartis Investigative Site, London, United KingdomMore Info

Top treatments in development

AgentClass/Mechanism of ActionDevelopment StatusCompanyCompany ContactClinical StudiesMore Information
leniolisibLeniolisib is a small molecule inhibitor of the delta isoform of the 110 kDa catalytic subunit of class IA
PI3K with immunomodulating and potentially anti-neoplastic activities. Leniolisib inhibits the
production of phosphatidylinositol-3-4-5-trisphosphate (PIP3). PIP3 serves as an important cellular
messenger specifically activating AKT (via PDK1) and regulates a multitude of cell functions such as
proliferation, differentiation, cytokine production, cell survival, angiogenesis, and metabolism. Unlike
PI3Kα and PI3Kβ which are ubiquitously expressed, PI3Kẟ and PI3Kγ are expressed primarily in cells of hematopoietic origin. The central role of PI3Kẟ in regulating numerous cellular functions of the adaptive immune system (B-cells and to a lesser extent T cells) as well as the innate immune system (neutrophil, mast cells, and macrophages) strongly indicates that PI3Kẟ is a valid and potentially effective therapeutic target for several immune diseases. To date, leniolisib has proven to be safe and well tolerated in healthy subjects as well as the APDS patients during the Phase 1 first-in-human trial and an ongoing open label extension trial.
Phase 3Pharming Group N.V.Anurag Relan, MD
Chief Medical Officer
More InfoMore Info
Sirolimus (Rapamycin)The mTOR inhibitor, Sirolimus (Rapamycin) has been found to decrease in non-neoplastic lymphoproliferation. mTOR (mammalian target of rapamycin) is activated downstream of PI3K and has a prominent role in T cell metabolism and the regulation of immune responses. Previously Sirolimus therapy had been reported in a case of APDS to reduce hepatosplenomegaly and lymphadenopathy, increase naïve T cell frequencies, and restore T cell proliferation and IL-2 secretion. Recently Maccari et al. published the initial findings of the ESID APDS registry.Phase 1/2This agent is being studied by Children's Hospital of Fudan Universityn/aMore InfoMore Info
NemiralisibThe inhaled PI3Kδ inhibitor, GSK2269557 or Nemiralisib, is also currently being studied in APDS sponsored by GlaxoSmithKline (NCT02593539). Though an oral inhibitor maybe more effective for lymphoproliferation; it is proposed an inhaled inhibitor could benefit patients primarily affected by airway infection and bronchiectasis. The GSK2269557 clinical trial has not as yet reported results, but is described as a “multi-center, non-randomized, open-label, uncontrolled, single group study to investigate the safety and pharmacokinetics during 84 days repeat dosing treatment with 1,000 micrograms of inhaled in addition to standard of care, in subjects with APDS.” GSK2269557 is also currently being investigated as an anti-inflammatory treatment in Chronic Obstructive Pulmonary Disease (COPD).Phase 2GSKn/aMore InfoMore Info

† All About APDS https://allaboutapds.com

Caregiver Corner

Tools and resources for your patients living with LGS

Comprehensive Care Centers

If you or someone you care for suspects they may have APDS, or you’ve been given an APDS diagnosis, it’s important to find a physician who is familiar with diagnosing and managing patients with APDS. This tool features experts who can support patients through diagnosis, disease management and genetic testing. Click below to find a physician in your area.

Featured Resources

Understanding The APDS Patient Experience Video - This video highlights the variety and severity of symptoms that each person with APDS may experience and the importance of genetic testing.
APDS – Mechanism Of Disease Video - What is happening in my body? Learn how APDS affects the body
An overview of Activated PI3K Delta Syndrome (APDS) and primary immunodeficiencies

Help your patients learn about APDS and primary immunodeficiencies. Get years of knowledge and experience condensed into a simple report.

Symptom history

Experience with various treatments

Challenges, frustrations, and suppport needs

Valued sources of information

Impact of the disease on daily life

Seizure triggers and control

Other resources

Click the drop-down to see info on Patient Advocacy Groups and a Glossary of common terms

  • Immune Deficiency Foundation (IDF) IDF is a national nonprofit organization dedicated to improving the diagnosis, treatment, and quality of life of individuals affected by primary immunodeficiency diseases through advocacy, education, and research.
  • Jeffrey Modell Foundation (JMF) - JMF is a global nonprofit organization dedicated to early diagnosis, meaningful treatments, and ultimately cures for primary immunodeficiency diseases. The foundation provides support, education, and advocacy for patients and families affected by these conditions.
  • Foundation for Primary Immunodeficiency Diseases (FPID) - Established in the United States to support the education, early diagnosis, genetic counseling, therapy, and research of PID in both India and the United States.
  • Advocacy & Awareness for Immune Disorders Association (AAIDA) - Dedicated to patients living with immune dysregulation and overlapping conditions with a focus on advocacy campaigns, educational initiatives, and research opportunities. AAIDA also provides patients and healthcare providers assistance with insurance denials and medication assistance programs available across the United States.
  • American Partnership for Eosinophilic Disorders (APFED) - While not exclusively focused on primary immunodeficiencies, APFED provides support, education, and advocacy for individuals with eosinophilic disorders, which can sometimes occur alongside primary immunodeficiency conditions.
  • Activated PI3K Delta Syndrome (APDS): A rare primary immunodeficiency that affects approximately 1 to 2 people per million. It occurs when there are variations to the PIK3CD or PIK3R1 genes.
  • Primary Immunodeficiency (PID): A group of disorders characterized by defects in the immune system present from birth, leading to increased susceptibility to infections.
  • Innate Immunity: The first line of defense against pathogens, involving physical barriers (eg., skin), cellular responses (eg., macrophages, neutrophils), and soluble factors (eg., complement proteins).
  • Adaptive Immunity: The immune response mediated by lymphocytes (T and B cells) that specifically targets pathogens and develops memory for future encounters.
  • T-Cell Deficiency: A primary immunodeficiency characterized by defects in T lymphocytes, leading to impaired cell-mediated immunity and increased susceptibility to viral, fungal, and certain bacterial infections.
  • B-Cell Deficiency: A primary immunodeficiency characterized by defects in B lymphocytes, leading to impaired humoral immunity and increased susceptibility to bacterial infections, particularly encapsulated bacteria.
  • Combined Immunodeficiency: A primary immunodeficiency characterized by defects affecting both T and B lymphocytes, leading to severe immunodeficiency and susceptibility to a wide range of infections.
  • Severe Combined Immunodeficiency (SCID): A rare and severe form of combined immunodeficiency characterized by profound defects in both T and B lymphocytes, often resulting in life-threatening infections within the first few months of life.
  • Antibody Deficiency: A primary immunodeficiency characterized by defects in antibody production, leading to impaired humoral immunity and increased susceptibility to bacterial infections, especially extracellular pathogens.
  • Common Variable Immunodeficiency (CVID): A primary immunodeficiency characterized by low levels of serum immunoglobulins (particularly IgG and IgA), leading to recurrent bacterial infections, autoimmune disorders, and an increased risk of malignancy.
  • Complement Deficiency: A primary immunodeficiency characterized by defects in components of the complement system, leading to impaired opsonization, chemotaxis, and lysis of pathogens, resulting in increased susceptibility to bacterial infections, particularly Neisseria species.
  • Phagocytic Defects: A primary immunodeficiency characterized by defects in phagocytes (eg., neutrophils, macrophages), leading to impaired clearance of pathogens and increased susceptibility to bacterial and fungal infections.
  • Hyper IgM Syndrome: A primary immunodeficiency characterized by defective class switching of immunoglobulins, resulting in low levels of IgG and IgA but normal or elevated levels of IgM, leading to increased susceptibility to bacterial infections.
  • X-linked Agammaglobulinemia (XLA): A primary immunodeficiency caused by mutations in the gene encoding Bruton’s tyrosine kinase (BTK), resulting in the absence of mature B cells and low levels of immunoglobulins, leading to recurrent bacterial infections.
  • Autoimmune Lymphoproliferative Syndrome (ALPS): A primary immunodeficiency characterized by defective apoptosis of lymphocytes, leading to lymphoproliferation, autoimmune manifestations, and an increased risk of lymphoma.
  • Hematopoietic Stem Cell Transplantation (HSCT): A procedure in which hematopoietic stem cells are infused into a patient to restore bone marrow function and immune system competence often used as a treatment for severe primary immunodeficiencies.