A new syndrome characterized by mental retardation, epilepsy, palpebral conjunctival telangiectasias and IgA deficiency

Mental retardation, epilepsy, palpebral conjunctival telangiectasias and diminished serum IgA, with a particular facies and shortened fifth finger were found in a 12-year-old Mexican girl. She has six siblings, of whom five have the same characteristics. The parents and the elder sister were not affected, and there was no history of consanguinity. This seems to be a new syndrome, and as both sexes are affected, the parents are normal and several siblings have the same syndrome, we postulate an autosomal recessive mode of inheritance.

Molecular basis of familial and acquired phagocytosis deficiency involving the tetrapeptide, thr-lys-pro-arg, tuftsin

The biological activity and metabolism of the phagocytosis stimulating tetrapeptide (Thr-Lys-Pro-Arg) tuftsin, are discussed. Its effect is shown to be highly specific. It stimulates the phagocytic activity of the blood polymorphonuclear leukocyte. A unique familial deficiency of the tetrapeptide is described. In such patients, moderate to severe infections occur at high frequency. These are most pronounced in children. Biochemical and symptomatic evidence can readily be obtained in one or more children. At least one parent of either sex shows clinical signs or laboratory evidence of defective phagocytosis. Another type of deficiency results from removal of the spleen or from loss of specific function due to leukemic infiltration or embolism.

Antibody response to the streptococcal group A-variant polysaccharide in BASILEA rabbits lacking kappa-polypeptide chains

Rabbits from a variant strain called BASILEA, in which homozygotes express only lambda-type chains and heterozygotes have normal kappa/lambda ratios, were hyperimmunized with a streptococcal group A variant vaccine. Homozygotes (bas/bas) produced antibodies with lambda-chains, heterozygotes, however, produced predominantly antibodies with kappa-chains. The incidence of restricted high responders in the BASILEA strain was high; it was probably introduced by the original mutant rather than by the loss of kappa-chains (founder effect). The degree of heterogeneity of homozygotes is similar to the heterogeneity of heterozygotes, and to that of rabbits expressing kappa-chains. This suggests that in the rabbit, the repertoire of lambda-chain genes is of similar size to that of kappa-chain genes.

[Familial IgM deficiency and type II hyperlipoproteinemia]

It is reported on the common appearance of a hyperlipoproteinaemia type II after Fredrickson and of a selective insufficiency of IgM in a family. The two generations of a family which have been observed since three years show these disturbances in a 42-year-old patient and all his four children. The diminution and the lack of a stimulation of B-cells under antihuman-IgM in the transformation test of lymphocytes refer to an isolated disturbance of the IgM-synthesis. Cellular immune reactions and haematologically cytological findings were normal. A connection between the lack of IgM and hypercholesterolaemia is not excluded, since experimental investigations of Alderson and Green show an influence of cholesterol on the function of the lymphocyte membrane. The necessity of systematic investigations on patients with immune defects and hyperlipoproteinaemias is emphasized for the exclusion of an accidental coincidence.

Selective IgA deficiency. Immunologic and cytogenetic studies

24 cases of selective IgA deficiency were found among 2,650 children studied in an immuno-Allergy service. The population studied must therefore be considered highly selected. The Amman and Hong criteria were used as a basis for diagnosis (Table 1). Even though they are currently being revised, they are still on some practical value. Statistically, the incidence of selective IgA deficiency in this study is higher (0.905%) than in other publications. Respiratory symptoms were the most important. Only one case presented digestive symptoms (resembling coeliac disease), and no cases with autoimmune disease were found, although the possibility of its occurrence later on cannot be dismissed. A cytogentic analysis was performed in 8 cases and interesting results were found. Five cases showed an increase in heterochromatic material in the paracentric region (1qh+, 2qh+, 16qh+ and Yqh+). These polymorphic variations are present in the general population without any apparent clinical significance, even though their presence in several clinical has been described. However, in this study the frequency seems higher than in the general population. In 2,051 cases studied for other reasons, the frequency of occurrence of polymorphic traits was 3.12%, while in the cases studied by us the incidence amounted to 62.5%, a highly significant proportion. Our data do not try to establish a relationship between the chromosomal alterations and the etiology of the IgA deficiency, even through some relationship may in the future be found to exist.

Frequency of IgA deficiency in blood donors and Rh negative women in Iceland

Sera from 6,842 individuals were tested for IgA deficiency, using double and radial immunodiffusion. Sera containing less than 1 mg/100 ml of IgA were classified as deficient. The frequency of selective IgA deficiency among 4,799 blood donors investigated was 1:533, but 1:340 among 1,017 Rh negative women screened and 1:485 for both groups combined. One of the nine IgA deficient blood donors detected belonged to a 1st cousin marriage family previously investigated, in which the mother also was deficient in IgA. One IgA deficient recipient was found among 704 hospital patients screened for this abnormality.

A case report of a presumptive +i(18p) associated with serum IgA deficiency

The case of a 4-month-old male infant with retarded psychomotor development and multiple anomalies is presented. Cytogenetic studies on peripheral blood and skin cultures revealed a normal male complement with a supernumerary small metacentric chromosome. According to its size and its banding patterns, the metacentric chromosome was postulated to be an isochromosome for the short arm of number 18. A deficiency of serum IgA was observed in this patient.

Selective deficiency of IgG and IgA as a first stage defect in B cell differentiation

A case of selective deficiency of IgG and IgA, in a 13-year old girl, is described. Immunologic investigations, showing an almost complete absence of IgG- and IgA-bearing lymphocytes and significant amounts of IgD and IgM positive cells, suggest the possibility of a block in the shift from IgM to IgG synthesis at the B lymphocyte level.

Combined immunodeficiency in foals in Arabian breeding: evaluation of mode of inheritance and estimation of prevalence of affected foals and carrier mares and stallions

Combined immunodeficiency (CID), a defect in both B- and T-lymphocytes, was found to occur in 2.3% of 257 foals of Arabian breeding. All affected foals died by 5 months of age. The belief that CID is transmitted as an autosomal recessive genetic defect was supported by results from matings of dams and sires that had previously produced affected foals. Based on a prevalence of 2.3%, the proportion of carriers of the CID trait among the adult population surveyed was estimated to be 25.7%. Recent descriptions of other immunologic defects in foals emphasized the need for careful differential diagnosis. Disorders that could be confused with CID include failure in passive transfer of immunoglobulins from dam to foal, via colostrum; transient hypogammaglobulinemia; agammaglobulinemia (associated with B-lymphocyte deficiency and normal T-lymphocytes), and selective IgM deficiency.

A syndrome of immunoglobulin A deficiency, diabetes mellitus, malabsorption, a common HLA haplotype. Immunologic and genetic studies of forty-three family members

Three persons in a kindred of 43 had variable expression of a syndrome consisting of immunoglobulin A deficiency, diabetes mellitus, malabsorption, and a common HLA haplotype. Findings from the proband included life-threatening malabsorption; idiopathic intestinal mucosal atrophy with infalmmation; IgA deficiency and antibodies to multiple endocrine organs; insulin-dependent diabetes mellitus; and the major histocomptability antigens HLA-A2, B8, and DW3. In addition to the described syndrome other conditions present in the family include Graves' disease, vitiligo, hypocomplementemia, rheumatic fever, multiple sclerosis, and a high frequency of antibodies to endocrine tissue. Since Graves' disease, diabetes mellitus, and idiopathic Addison's disease have all been described in association with HLS-B8 and DW3, we believe that the occurrence of these diseases in this family suggests that a single immune response gene or gene complex is linked with HLA-B8 and DW3.

Kappa-chain deficiency. An immunoglobulin disorder

Since kappa-chain deficiency is an unusual condition, we studied the clinical and laboratory findings in a patient with this deficiency. The patient had cystic fibrosis with concurrent malabsorption, diabetes mellitus and IgA deficiency. The serum levels of IgM and IgG were 0.85 and 7.22 mg per milliliter, respectively. Kappa type IgM and IgG was not present in serum and external secretions; gamma, mu and lambda chains were probably polyclonal in character. Antibodies against kappa chains were not detected in either the patient or the mother. Plasma cells containing kappa-type immunoglobulins were absent in jejunum samples and bone marrow; kappa-chainbearing B lymphocytes could not be detected in blood and bone marrow. The serum of one of the patient's sisters contained trace amounts of kappa-type immunoglobulins. The patient displays a complete absence of kappa-type immunoglobulins, probably owing to a genetic defect.

Hereditary C2 deficiency: association with skin lesions resembling the discoid lesion of systemic lupus erythematosus

Two patients with hereditary homozygous C2 deficiency are described. They showed many similar clinical features. Both had discoid-like skin rashes and serologic abnormalities consistent with SLE, but neither had evidence of involvement of any organ other than skin. Although biopsy of these lesions revealed expected changes by light microscopy, typical immunofluorescent findings were not present. The presence of the HL-A haplotype 10, W18 was seen in both families and was associated with the C2 deficiency gene. The 2 patients were mutually nonreactive in MLC tests and both were found to be homozygous for the LD7a type.

Familial clustering of selective IgA deficiency

Serum IgA levels of 35 healthy IgA-deficient index cases, of their 180 first-degree relatives, and of 31 other family members were studied. IgA deficiency was detected in 7.2% of the first-degree relatives, which is significantly more than the 0.25% frequency of IgA deficiency in healthy Finnish blood donors. Subnormal serum IgA levels were found in additional 13 (7.2%) first-degree relatives. The familial clustering of IgA deficiency seemed to be controlled by multigenic factors. IgA-deficient persons and their family members were tested for antinuclear and antithyroid antibodies, for rheumatoid factor (by latex test) and for other anti-IgG antibodies (by Ripley test). Antibodies against bovine milk were also studied. The relatives of IgA-deficient persons did not have more of these antibodies than the controls. It is suggested that various serological abnormalities are a consequence of the IgA deficiency rather than of genetic defects per se.

Cancer in a familial IgA deficiency patient: abnormal chromosomes and B lymphocytes

Two primary cancers were found in a patient with a familial IgA deficiency. Although cytogenetic studies showed nonconsistent pseudodiploid chromosomal pattern in the peripheral blood lymphocyte cultures, there were two metaphases with a deleted short arm of an E (17-18) chromosome and several metaphases with an abnormally large chromosome, larger than chromosome number 1. Also, there were 37 B lymphocytes per mm3 in her peripheral blood which was much lower than other radiation-treated cancer patients. The absence of IgA, the decrease of peripheral B lymphocytes and the chromosomal abnormality might have played a role in her developing the cancers.

IgA deficiency and autoimmune hemolytic disease

A case of familial selective IgA deficiency associated with autoimmune hemolytic disease is reported that illustrates the therapeutic implications when these two entities coexist. Immunoglobulin screening is recommended for patients with AHD who require blood transfusions, in order to identify IgA-deficient patients who may have anti-IgA anaphylactic reactions.

Primary immunodeficiency with early encephalopathy in two siblings. An anatomo-clinical study

The authors describe two siblings affected by an immunodeficiency state characterized by low IgA and IgM levels in serum, and an early encephalopathy with infantile spasms and hypsarrhythmia. The nosography of this unusual association and the relationship to ataxia telangiectasia and allied disorders are briefly discussed.

Haemochromatosis, active chronic hepatitis, and familial IgA deficiency

A man aged 38 years developed chronic liver disease with characteristics of both haemochromatosis and active chronic hepatitis. Two of his relatives were found to have selective IgA deficiency. It is suggested that this case provides evidence that haemochromatosis may initiate active chronic hepatitis in a genetically susceptible subject.

Anti-IgA antibodies in two brothers with selective serum IgA deficiency

A selective serum IgA deficiency with anti-IgA antibodies at high titer were found in a patient who suffered severe transfusion reactions. The same abnormalities were detected in his brother, a 72-year-old-man in good general condition. Anti-IgA antibodies were found in the IgG fraction and were directed against alpha-chains. A deficiency of isoagglutinins and an absence of heteroagglutinins in the propositus' serum could be shown.

Vitiligo and dysgammaglobulinemia. A case report and family study

This report concerns an 8 year old female with vitiligo and dysgammaglobulinemia characterized by absent IgA, very low IgG, and normal IgM. The t-cell immune system was intact but other family members had low levels or absence of IgA. The possible relationship of dysgammaglobulinemia and vitiligo is discussed along with the classification and inheritance of the immune cell defects.

Chronic infections in a family with hereditary deficiency of IgG2 and IgG4

Two siblings, a girl and a boy, and their mother were abnormally susceptible to infections with bronchopneumonias leading to chronic pulmonary atelectasis in the girl and otitis leading to necrotizing changes with deafness in the mother. The causative micro-organism most often found was Haemophilus influenzae. The serum IgG was within the normal concentration range, but showed restricted electro-phoretic heterogeneity with absence of the anodal component. Serum IgG2 and IgG4 were absent. Absence of antibodies to teichoic acid and haemagglutinating antibodies to Haemophilus influenzae polysaccharide was noted as was the case with isohaemagglutinins and heteroagglutinins against sheep cells. Lymphopenia and poor [³H]thymidine uptake by peripheral lymphocytes after PHA stimulation were demonstrable in the girl and the mother. The girl had developed an epithelial ovarian tumour. The disease was a non-X-linked recessive and expressed selective humoral and selective cellular immunodeficiency. An inherited structural or regulatory gene defect is suggested. Gamma-globulin therapy had a good clinical effect.