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Wlodarski MW, Da Costa L, O'Donohue MF, Gastou M, Karboul N, Montel-Lehry N, Hainmann I, Danda D, Szvetnik A, Pastor V, Paolini N, di Summa FM, Tamary H, Quider AA, Aspesi A, Houtkooper RH, Leblanc T, Niemeyer CM, Gleizes PE, MacInnes AW. Recurring mutations in RPL15 are linked to hydrops fetalis and treatment independence in Diamond-Blackfan anemia. Haematologica 2018; 103:949-958. [PMID: 29599205 PMCID: PMC6058779 DOI: 10.3324/haematol.2017.177980] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 03/06/2018] [Indexed: 12/18/2022] Open
Abstract
Diamond-Blackfan anemia (DBA) is a rare inherited bone marrow failure disorder linked predominantly to ribosomal protein gene mutations. Here the European DBA consortium reports novel mutations identified in the RPL15 gene in 6 unrelated individuals diagnosed with DBA. Although point mutations have not been previously reported for RPL15, we identified 4 individuals with truncating mutations p.Tyr81* (in 3 of 4) and p.Gln29*, and 2 with missense variants p.Leu10Pro and p.Lys153Thr. Notably, 75% (3 of 4) of truncating mutation carriers manifested with severe hydrops fetalis and required intrauterine transfusions. Even more remarkable is the observation that the 3 carriers of p.Tyr81* mutation became treatment-independent between four and 16 months of life and maintained normal blood counts until their last follow up. Genetic reversion at the DNA level as a potential mechanism of remission was not observed in our patients. In vitro studies revealed that cells carrying RPL15 mutations have pre-rRNA processing defects, reduced 60S ribosomal subunit formation, and severe proliferation defects. Red cell culture assays of RPL15-mutated primary erythroblast cells also showed a severe reduction in cell proliferation, delayed erythroid differentiation, elevated TP53 activity, and increased apoptosis. This study identifies a novel subgroup of DBA with mutations in the RPL15 gene with an unexpected high rate of hydrops fetalis and spontaneous, long-lasting remission.
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Affiliation(s)
- Marcin W Wlodarski
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Germany
- German Cancer Consortium (DKTK), Freiburg, Germany and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lydie Da Costa
- University Paris VII Denis Diderot, Faculté de Médecine Xavier Bichat, Paris, France
- Laboratory of Excellence for Red Cell, LABEX GR-Ex, Paris, France
- Inserm Unit 1149, CRI, Paris, France
- Hematology Laboratory, Robert Debré Hospital, Paris, France
| | | | - Marc Gastou
- University Paris VII Denis Diderot, Faculté de Médecine Xavier Bichat, Paris, France
- Laboratory of Excellence for Red Cell, LABEX GR-Ex, Paris, France
- UMR1170, Gustave Roussy, Villejuif, France
| | - Narjesse Karboul
- University Paris VII Denis Diderot, Faculté de Médecine Xavier Bichat, Paris, France
- Inserm Unit 1149, CRI, Paris, France
| | | | - Ina Hainmann
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | - Dominika Danda
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Germany
- Department of Tumor Pathology, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute, Poland
| | - Amina Szvetnik
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | - Victor Pastor
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Germany
- Faculty of Biology, University of Freiburg, Germany
| | - Nahuel Paolini
- Department of Hematopoiesis, Sanquin and Landsteiner Laboratory, AMC/UvA, CX Amsterdam, the Netherlands
| | - Franca M di Summa
- Department of Hematopoiesis, Sanquin and Landsteiner Laboratory, AMC/UvA, CX Amsterdam, the Netherlands
| | - Hannah Tamary
- Hematology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Israel
| | - Abed Abu Quider
- Pediatric Hematology/Oncology Department, Soroka Medical Center, Faculty of Medicine, Ben-Gurion University, Beer Sheva, Israel
| | - Anna Aspesi
- Dipartimento di Scienze della Salute, Università del Piemonte Orientale, Novara, Italy
| | - Riekelt H Houtkooper
- Laboratory Genetic Metabolic Diseases, Academic Medical Center, Amsterdam, the Netherlands
| | - Thierry Leblanc
- Pediatric Hematology Service, Robert-Debré Hospital and EA-3518, Université Paris Diderot - Institut Universitaire d'Hématologie, Paris, France
| | - Charlotte M Niemeyer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Germany
- German Cancer Consortium (DKTK), Freiburg, Germany and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Alyson W MacInnes
- Laboratory Genetic Metabolic Diseases, Academic Medical Center, Amsterdam, the Netherlands
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Abstract
Hematologic disorders are implicated in approximately 10% to 27% of cases of nonimmune hydrops fetalis. In almost all of these disorders, anemia leading to heart failure, edema, ascites, and anasarca is the final common denominator. The etiology of the anemia in these cases can be conveniently divided into two categories: (1) excessive erythrocyte loss by hemolysis or hemorrhage, and (2) erythrocyte underproduction. The former include intrinsic erythrocyte abnormalities such as alpha-thalassemia and glucose-6-phosphate dehydrogenase deficiency, and conditions with excessive fetal blood loss such as fetomaternal hemorrhage and twin-twin transfusion. The latter include bone marrow replacement syndromes and conditions associated with failure of erythrocyte production. The presentation, diagnosis, and management of hematologic disorders associated with nonimmune hydrops fetalis are reviewed.
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Affiliation(s)
- M O Arcasoy
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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