Chronic arthritis in two children with partial deletion of chromosome 18

We describe 2 children with a partial deletion of chromosome 18 and chronic arthritis. A boy with r(18)(p11.3; q23) lacked serum IgA and had arthritis affecting both knees. A girl with del (18)(q21.2; q22) had arthritis in 5 joints. Her serum IgA was normal. In both children, the arthritis responded to nonsteroidal antiinflammatory drugs.

Molecular analysis of a case of IgA2 deficiency

A family with two members with selective IgA2 deficiency was analysed by direct gene analysis with different probes for the IgCH region. No gross gene deletions or rearrangements were detected. Genetic analysis based on serological and molecular markers did not rule out linkage with the IgCH region. However, a defect of other genes not linked to the Ig heavy chain region and controlling the expression of IgA may be possible as well.

Selective immunoglobulin A deficiency associated with primary biliary cirrhosis in a family with liver disease

A family is described in which multiple members are afflicted with liver disease and primary biliary cirrhosis (PBC). In the third generation, one member died of PBC, and a second individual has both symptomatic PBC and selective immunoglobulin A (IgA) deficiency, an association not previously reported. By culturing this patient's lymphocytes in vitro it was shown that the IgA deficiency was due to a failure of B cells to secrete IgA. Two other siblings of this patient have multiple serum biochemical and serologic abnormalities that are sometimes associated with PBC, but they do not have histopathologically overt PBC or IgA deficiency. All three surviving family members have a diminished autologous mixed lymphocyte reaction, an immunologic abnormality that has previously been found in patients with PBC, selective IgA deficiency, and several autoimmune diseases. As there is an association between selective IgA deficiency and certain autoimmune diseases, it is possible that this immunodeficiency contributed to the development of PBC in the patient in whom the two diseases coexisted. Furthermore, the occurrence of PBC in a patient with selective IgA deficiency indicates that the pathogenesis of PBC does not require IgA-dependent immune mechanisms.

The wasted mutant mouse. I. An animal model of secretory IgA deficiency with normal serum IgA

The wasted (wst) mutation was recently described as a spontaneous, recessive mutation leading to pathologic changes affecting both the neurologic and the immune systems of wst/wst homozygotes, which presented symptoms analogous to those observed in patients with ataxia-telangiectasia (A.T.). We studied the IgA system of wst/wst mutants and their normal littermates to determine whether IgA deficiency commonly found in A.T. patients was also affecting these mutants. Interestingly, although IgA plasma cells were totally absent from their entire (small and large) intestine, their serum contained a normal level of IgA with a normal ratio of monomeric vs polymeric IgA. The absence of gut IgA plasma cells was not due to malnutrition and was not compensated by the appearance of cells secreting any other isotypes. Studies at the precursor cell level showed the absence of IgA-specific B cell precursors in the Peyer's patches, whereas sIgA B cells and IgA plasma cells were found in normal numbers in the spleen of wasted mice. These data suggest that secretory and serum IgA may comprise distinct systems and that the wasted mutant mouse is a potential model for the study of the physiology and regulation of IgA production.

Gm allotypes in IgA deficiency

Gm phenotypes were examined in 90 Swedish IgA-deficient (less than 0.05 g/litre of serum IgA) donors and 40 normal first and second degree relatives of six of these donors. The G1m1,2, G3m5 and Km1 frequency in the group of IgA-deficient donors did not differ from that found in the normal population. Among the relatives, HLA and/or Gm identical normal sibs were observed. Anti-IgA antibodies were present in 29 of the IgA-deficient donors and anti-IgG in seven. No association between the two was found. A statistically significant association between the G1m-2 phenotype and the presence of anti-IgA antibodies was observed. When subdivided according to HLA type, a non-random distribution of Gm phenotypes was seen in HLA-B8/DR3 positive individuals with anti-IgA antibodies (HLA-B8/DR3 being the haplotype associated with IgA deficiency). These data suggest an association between IgA deficiency, anti-IgA and the studied Gm allotypes.

Aberrant recombination events in B cell lines derived from a kappa-deficient human

We have analyzed the structure of Ig kappa chain genes in B cell lines derived from a human individual who cannot synthesize any kappa chains, and whose Igs all contain lambda chains (1). We have characterized secondary DNA recombination events at two kappa alleles which have undergone misaligned V-J recombinations. One such secondary recombination has joined the flanking sequences of a V kappa and a J kappa 2 gene segment as if it were the reciprocal product of a V-J kappa 2 recombination, and resulted in the displacement of the recombined VJ kappa 1 gene segments from the C kappa locus. The non-rearranged form of the V kappa fragment which had recombined with the J kappa 2 flank was cloned. Nucleotide sequencing of this fragment identified a V kappa gene that differed by at least 38% from all previously sequenced human V kappa genes. The other V-J kappa segment analyzed has undergone a secondary recombination at a different site from that described above, at a site within the intervening sequence between the J kappa and C kappa gene segments, similar to the location of secondary recombinations which have occurred in lambda + B cell lines from mice and humans (2,3). These results prove that multiple recombinations can occur at one J kappa-C kappa locus.

Family studies of IgA deficiency

Seventeen immunoglobulin A (IgA)-deficient subjects and other members from 13 families were examined at HLA-A, B and DR, C4A, C4B, and Bf loci. Of the 29 independent haplotypes in the IgA-deficient subjects, 22 included deletions, duplications, or defects at the C4 or 21-hydroxylase loci. It is suggested that there may be a gene regulating serum IgA concentrations in this same region of chromosome 6. Three main supratypes explain most of the previously reported HLA associations with IgA deficiency. These are A1, Cw7, B8, C4AQ0, C4B1, BfS, DR3, Bw65(14), C4A2, C4B1/2, BfS, and Bw57(17), C4A6, C4B1, BfS. All three are proposed to carry a gene for IgA deficiency, while other supratypes carrying the same B allele generally do not. Other supratypes possibly associated with IgA deficiency were also identified. A survey of about 150 individuals with at least 1 of the 3 main supratypes revealed only 2 IgA-deficient subjects, and these were among the 20 that had 2 of these supratypes. This suggests the possibility of a recessive mode of inheritance, with penetrance determined by another factor which is not major histocompatibility complex-linked. All the supratypes found in this group of IgA-deficient subjects would then carry the putative recessive allele for IgA deficiency.

Ataxia-without-telangiectasia. Progressive multisystem degeneration with IgE deficiency and chromosomal instability

Three of five siblings developed a progressive neurological disorder during infancy or early childhood characterized by cerebellar ataxia, choreoathetosis and peripheral neuropathy. Immunological studies revealed a marked selective deficiency of serum IgE in all three affected siblings. There was evidence of chromosomal instability in the three affected siblings and in one of the parents. One of the affected siblings also developed acute lymphoblastic leukaemia. In spite of many resemblances, this syndrome differs from classical or complete ataxia telangiectasia in that oculocutaneous telangiectases were lacking, the serum IgA and alpha-fetoprotein levels in this family were normal, there was no gonadal dysgenesis, and the cytogenetic findings were atypical.

Increased frequency of HLA-A1 and -B8 in association with total lack, but not with deficiency of serum IgA

HLA-A, B, C typing was performed on 37 unrelated healthy blood donors with selective deficiency (less than 0.05 g/l) or total lack (less than 0.00002 g/l) of serum IgA. A significant increase in HLA-B8 and A1 antigen frequency was found in the 15 individuals with lack of serum IgA. This was not observed among those 22, who had only deficiency of serum IgA (0.00002-0.05 g/l). The HLA antigen frequencies were compared to those of 900 randomly selected healthy blood donors. Increased frequency of HLA-A1 and B8 in association with total lack of serum IgA, but not with deficiency has not been demonstrated before. On the basis of this result it seems conceivable that lack of serum IgA may be caused by a different, perhaps genetically determined, mechanism than IgA deficiency.

Significance of immunoglobulin G subclasses

IgG subclasses differ from one another both immunochemically and functionally. An isolated absence of a certain specific subclass may or may not be associated with disease. However, an absence of serum IgG4 as measured by a sensitive radioimmunoassay is usually, if not always, associated with severe recurrent pyogenic infections, usually of the respiratory tract. IgG2 and IgG4 deficiencies tends to occur together, often in association with deficiencies of immunoglobulin A (IgA) and/or immunoglobulin E (IgE). The properties of IgG1 are similar to those of IgG3 and those of IgG2 appear to resemble those of IgG4 in certain respects. Specific combined deficiencies tend to be associated with certain diseases. Some patients with deficiency of an immunoglobulin G (IgG) subclass appear able to compensate and to avoid clinical disease whereas others are not. Overlap zones exist in the lower ranges of serum concentrations in which both healthy and immunoincompetent subjects are found. It is important to consider the concentration of each IgG subclass present in a gamma globulin preparation or in plasma used for replacement therapy. If specific antibody deficiencies exist, it may be critical that the preparation used for replacement contains goodly amounts of the missing antibodies.

Selective deficiency of immunoglobulin A2

A case of familial selective IgA2 deficiency is described. The mother had no detectable IgA2, but a low level of IgA1. She had anti-alpha 2 antibodies of the IgG class. One of her daughters also lacked IgA2 with a normal level of IgA1. The analysis of the immunoglobulin haplotypes of the family suggested the deletion of the alpha 2-gene. In addition, the analysis of B lymphocytes of mother and daughter showed the absence of IgA2-bearing cells. Upon stimulation with pokeweed mitogen, the B cells differentiated into IgA1-containing plasma cells, but IgA2-containing cells were not found. The results suggest a defect in the generation of intraclonal B cell isotype diversity. The molecular basis of this phenomenon is unknown.

Instability of the human immunoglobulin heavy chain constant region locus indicated by different inherited chromosomal deletions

Previously we reported a gross genetic polymorphism of the human immunoglobulin heavy chain locus manifest by a large internal deletion within the constant region gene segment. We now describe a detailed serological and molecular genetic study of a Tunisian family in which members appear to carry two chromosomes 14 with different DNA deletions. The first is similar to that previously described encompassing three gamma subclass genes, a pseudo-epsilon gene and the alpha 1 subclass gene; the second deletion is less complex involving only the pseudo-epsilon gene and the alpha 1 gene.

Association of IgA deficiency with HLA A28 and B14

HLA typing was performed in two groups of individuals with low serum IgA concentrations. These consisted of 44 individuals identified from a blood donor clinic and 37 individuals attending an Immunology clinic with disorders associated with IgA deficiency. Both groups showed an increase in the frequency of HLA B14 (p less than 0.0001), HLA-A28 (P = 0.0007) and the combinations HLA-A1, B14 and HLA-A28, B14. The previously reported increase in HLA-A1, B8 was not apparent in either group. These data suggest that there is a gene within the human major histocompatibility complex which is relevant in IgA deficiency.

Monosomy 22 with humoral immunodeficiency: is there an immunoglobulin chain deficit?

The cytogenetic analysis of a patient with selective deficit of IgA and decrease in IgM, IgE, and IgG is presented. Using trypsin-Giemsa banding the karyotype showed monosomy 22 (45,XX,-22). The interest of this case lies in the rarity of the illness and in the association of monosomy 22 with hypogammaglobulinaemia and selective deficit of IgA, particularly as this chromosome is known to contain genes coding for immunoglobulin chains.

Chromosomal studies in healthy blood donors with IgA deficiency

Chromosomal analysis was performed in 70 asymptomatic blood donors found over a 5-year period in a large screening programme to be IgA deficient. No abnormalities were found in any of these individuals in relation to their chromosomal constitution and, in particular, chromosome 18 was normal in all individuals. A further 10 symptomatic individuals with IgA deficiency also showed a normal chromosomal constitution with no abnormalities of chromosome no. 18.

[Chronic diarrhea with selective IgA deficit associated with Turner's syndrome]

Three cases of selective IgA deficit with chronic diarrhea associated to Turner's syndrome are reported. The first patient presented gluten intolerance (celiac disease), confirmed by intestinal biopsy. The second patient turned out to suffer from cow's milk and gluten intolerance, and in the third an intestinal lambliasis was detected as well as gluten intolerance. Cytogenetic studies revealed in two patients a Turner's syndrome variant with isochromosome X, and the third presented Turner's syndrome associated with chromosome breakage. In all of the patients a history of repetitive upper respiratory infections and otitis was reported. The low incidence found in the literature of this rare association is also remarked, speculating about the role played by chromosome X in IgA synthesis.

Immunoglobulin A deficiency: genetic studies

Immunoglobulin A (IgA) deficiency (less than 0.01 mg/ml) was demonstrated in 155 of 72,296 blood donors. Studies of families of 60 donors revealed IgA deficiency in other members of 12 families. No consistent pattern of inheritance of IgA deficiency was found. HLA typing of 62 unrelated IgA deficient blood donors showed a significant increase in the prevalence of HLA-B8 (p less than 0.005).

Secretory component and serum immunoglobulin A deficiencies with intestinal autoantibody formation and autoimmune disease: a family study

A teenage boy with both secretory component deficiency and selective serum immunoglobulin A deficiency also developed pernicious anemia, insulin-dependent diabetes mellitus, pancreatic insufficiency, lymphopenia, intestinal candidiasis, and anti-intestinal antibody. The patient's father had pernicious anemia and diabetes mellitus while the paternal grandfather also had pernicious anemia. Because the patient had inherited the paternal grandmother's human leukocyte antigen complex, there was no direct association between pernicious anemia and the genetic markers. The presence of multiple immunologic abnormalities in a single patient supports the concept of an underlying defect in immune regulation as a central factor in the pathogenesis of these disorders.

Selective immunoglobulin G4 deficiency and recurrent infections of the respiratory tract

Using a newly developed radioimmunoassay, 4 of 422 subjects tested were found to have an isolated absence of the immunoglobulin subclass IgG4. All had severe recurrent sinopulmonary infection. The association of these disorders with an isolated absence of IgG4 suggested that this immunoglobulin subclass may have a unique role in host respiratory tract defense mechanisms.

Selective IgA deficiency and the HLA-B8 antigen. Report of two cases with familial data

Two patients had IgA deficiency, giardiasis, and the HLA-B8 antigen. The family of patient 1 included members with juvenile-onset diabetes mellitus, adrenal insufficiency, pernicious anemia, and hypothyroidism, a combination of unusual diseases that has been reported previously to occur as a syndrome with IgA deficiency and the HLA-B8 antigen. This coincidence makes it likely that these two patients and the one family previously described have a common pathogenic base, the inheritance of an abnormal immune-response gene that is acquired with the HLA-B8 antigen as a result of genetic dysequilibrium.

Hereditary angioedema: association with IgA deficiency and otolaryngologic disorders

Hereditary angioedema (HAE) is an autosomal dominant disorder characterized by recurrent edema of the oropharynx, the extremities, and by abdominal pain. This disorder is caused by a defect in the C1 esterase inhibitor (C1 INH) which inhibits the first component of complement (C1). Four generations of a family are described and laboratory data of five individuals of this family are given as these individuals presented for general otolaryngologic procedures. The mortality of acute laryngeal edema is described to vary from 6% to 54% and may necessitate a tracheotomy as a life saving measure A deficiency of IgA is also noted in this family, and to our knowledge, this is the first time this has been shown in association with HAE. Present therapy consists of long utilization of danazol, an attenuated androgen. Recently a partially purified C1 INH has been reported for acute episodes of HAE, and preliminary results are promising.

Immunoregulatory defects in a family with selective IgA deficiency

Defects in regulation of the humoral immune system were examined in a family with selective IgA deficiency. Two patients (mother and son) were clinically well and had selective abnormalities of B lymphocytes that can differentiate into IgA plasma cells plus specific T cell suppression of IgA production. One patient (daughter) had several clinical problems and received nine monthly transfusions of normal plasma. Prior to therapy, this patient had abnormal immunoregulation of both B and T lymphocyte population that cooperated in the formation of all cases of immunoglobulin-producing cells. After treatment, her clinical problems were resolved and her cellular abnormalities appeared identical in those in her mother and brother.

Selective IgA deficiency with 18q+ and 18q-- karyotypic anomalies

A case is described of selective immunoglobulin A deficiency in association with an 18q+ anomaly, apparently the result of a break at 18q23 and a de novo translocation. The presentation is compared with the phenotypic and immunological features in an IgA deficient 18q-- patient. The findings in these two patients suggest that gene(s) concerned with regulation of IgA synthesis are located on the distal long arm of chromosome 18 between 18q23 and qter.

Pulmonary alveolar proteinosis in two siblings with decreased immunoglobulin A

A brother and sister with classic, biopsy proved pulmonary alveolar proteinosis are described. Both had low serum and low normal secretory immunoglobulin A (IgA) levels. A tendency for familial occurrence is possible and it is recommended that patients with pulmonary alveolar proteinosis, and their families, be evaluated for immunologic deficiencies.

[Chromosome 18 long-arm deletion. Report of 1 case]

Authors report a ten month old girl with multiple malformations: midfacial hypoplasia, hypertelorism, carp mouth, very marked antihelix, poor muscular tone, spindle-shaped fingers with a high frequency of whirles and low levels of serum immunoglobulin A. In leukocyte culture, patient shows a deletion of the long arm of a 18 chromosome.

Combined immunodeficiency of Arabian horses: confirmation of autosomal recessive mode of inheritance

A 3-year prospective breeding trial was designed to verify the mode of inheritance of combined immunodeficiency (CID) in Arabian horses. Twenty-six mares that had previously produced foals with CID were mated to a stallion that had sired foals with CID. Of 53 foals obtained, 15 (28.3%) had CID. The ratio of female to male foals was 28:25, and the ratio of female CID to male CID foals was 8:7. The results of this trial confirmed a suggestion that CID in Arabian horses is inherited as an autosomal recessive trait.

Acquired alpha-1-antitrypsin deficiency and dysgammaglobulinemia

Alpha-1-antitrypsin (AAT) levels were measured in patients with three types of dysgammaglobulinemia: monoclonal gammopathy, polyclonal hypergammaglobulinemia and hypogammaglobulinemia. A fourth group comprised of subjects with normogammaglobulinemia served as a control. The frequency of hypoalpha-1-antitrypsinemia was significantly higher in those with monoclonal gammopathy compared with controls. The basis for this evaluation is unknown. It was not associated with phenotypic variation nor was it related to sex, age, total protein, albumin and immunoglobulin levels, liver function, bone marrow and bone x-ray findings.

Bloom's syndrome in a Japanese girl

Clinical, cytogenetic, and immunological data of a 5-year-old Japanese girl with Bloom's syndrome are described. Growth deficiency, photosensitivity, and a very mild facial telangiectatic erythema were present. Cytological studies revealed chromosomal aberrations and the characteristic high frequency in sister chromatid exchanges. Immunological studies showed that the serum levels of IgM and IgA, but not IgG, were abnormally low as compared to the age-matched control values and that the generation of cytoplasmic immunoglobulin-producing cells in the peripheral blood lymphocytes, which was evaluated in the in vitro pokeweed mitogen-stimulated cultures, was markedly reduced.

Studies on familial amyloid polyneuropathy in Ogawa Village, Japan

A newly discovered large concentration of familial amyloid polyneuropathy (FAP) in Japan is clinically outlined. The importance of the urinary secretion of IgA in these cases is stressed. Dimethyl sulfoxide administration to these patients induced clinical improvements accompanied by increased excretion of low molecular weight proteins. Amino acid composition of amyloid protein of the Ogawa village-type FAP cases was similar to that of primary amyloidosis.

Karyotype instability with multiple 7/14 and 7/7 rearrangements

Chromosomes were studied in a mentally retarded boy with microcephaly, growth retardation, facial erythema, café-au-lait spots, and IgA deficiency. In the lymphocytes there was a remarkable tendency to exchange parts of the chromosomes Nos. 7 and 14, the translocations almost exclusively taking place in bands 7p13, 7q32 and 14q11. Seven different types of rearrangements between Nos. 7 and 14, and some other chromosomal aberrations were found. No abnormalities could be detected in the bone marrow. The patient somewhat resembles those affected with ataxia-telangiectasia or with Bloom's syndrome, but on clinical and cytogenetic grounds these disorders could be excluded. 7/14 Translocations similar to those found in our patient's lymphocytes have been reported to occur very rarely in the lymphocyte cultures of individuals with apparently normal chromosome constitution. A relationship between these phenomena may exist.

[Selective IgA deficiency, DPH-treated epilepsy and polyarthritis (author's transl)]

A selected IgA deficiency was found in a 66 years old, DPH-treated epileptic female, suffering from polyarthritis. Familial survey brings information for genetic transmission of IgA decreased concentrations in her offspring, unrelated with HLA A, B, C system.

Primary selective deficiency of immunoglobulin M

Selective deficiency of IgM as a primary disorder is seldom encountered1--3, and the syndrome remains ill-defined4. It is generally accepted that for a diagnosis to be made, the serum IgM level should be consistently below 2 SD of normal, no other immunodeficiencies are present, and it is not secondary to other disease processes4. This report of an additional case may provide further insight into this rare disease.

The hypogammaglobulinemias

The immunoglobulin system initially evolved as a defense system to maintain genetic stability during evolution. Studies in the past two decades have resulted in the elucidation of immunoglobulin structure and the definition of their chemical composition. Disorders of immunoglobulin production have led to an enhanced understanding of the functional aspects of immunoglobulin chemistry. The recognition of these disorders has enhanced our knowledge of antibody specificity and led to the development of immunochemical techniques such as radioimmunoassay as well as the development of techniques of transplantation and immune reconstitution in man.

Secretory immunoglobulin deficiency in a family with inflammatory bowel disease

A family with 4 of 10 first-degree relatives affected with inflammatory bowel disease (IBD) was studied to determine whether any distinct immunological abnormalities occur in the affected members, as compared with unaffected members of the family, normal controls, and other unrelated patients with IBD. Red cell blood type and HL-A phenotypes did not distinguish between healthy and affected members, although HL-A2, 32, B27, and B12 were the predominant haplotypes in members with IBD. There was no significant difference between the two groups in the lymphocyte subpopulation counts of T cells, B cells, and cells carrying Fc or complement receptors. The in vitro mitogen response, however, to phytohemagglutinin and pokeweed mitogen were depressed in the affected members. Serum IgA and C3 levels were significantly elevated in members with IBD compared to healthy subjects with values of 232 +/- 69 (mean +/- SD) versus 148 +/- 29 mg per dl for IgA (P less than 0.05) and 173 +/- 32 versus 115 +/- 22 mg per dl for C3 (P less than 0.025), respectively. Plasma and, to a lesser extent, peripheral lymphocytes from 2 affected members who were tested were cytotoxic to allogeneic colonic epithelial cells. Salivary IgA was normal in the affected family members and unrelated patients with IBD. However, the free secretory component of salivary IgA was absent or markedly depressed in family members, as well as in unrelated patients with ulcerative colitis. This deficiency of the secretory immune system appears to characterize more frequently ulcerative colitis than Crohn's disease and may compromise mucosal host defenses in IBD.

Chronic idiopathic thrombocytopenic purpura. A familial immunodeficiency syndrome?

We studied three children with chronic idiopathic thrombocytopenic purpura (ITP) and their immediate families. All three patients and 10/13 family members manifested at least one immunologic defect, eg, decreased numbers of T lymphocytes (1/3, 5/13), diminished in vitro response to phytohemagglutinin (2/3, 6/13), dysgammaglobulinemia (2/3, 4/13), altered autoantibodies (1/3, 5/13), and decreased serum properdin levels (3/3, 2/13). In addition, one parent and two asymptomatic siblings of two of the propositi had shortened platelet life spans with normal platelet counts. The HLA antigens A3 and B7 were identified in all three families. There also appeared to be an association between a familial haplotype and the immunologic defects. Chronic ITP appears to occur in families with underlying immunologic defects, which are genetically related.