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Vosughimotlagh A, Rasouli SE, Rafiemanesh H, Safarirad M, Sharifinejad N, Madanipour A, Dos Santos Vilela MM, Heropolitańska-Pliszka E, Azizi G. Clinical manifestation for immunoglobulin A deficiency: a systematic review and meta-analysis. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:75. [PMID: 37641141 PMCID: PMC10463351 DOI: 10.1186/s13223-023-00826-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 07/17/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES Immunoglobulin A deficiency (IgAD) is a common disease with an unknown genetic defect, characterized by the decreased or absent IgA with other isotypes normal, normal subclasses, and specific antibodies. Patients with this disorder represent a spectrum of clinical manifestations including infections, autoimmune disorders, malignancy, and allergic diseases. The current study aimed to evaluate their prevalence and categorized them. METHODS We searched PubMed, Web of Science, and Scopus databases to find eligible studies from the earliest available date to January 2022 with standard keywords. Pooled estimates of clinical manifestations prevalence and the corresponding 95% confidence intervals were calculated using random-effects models. RESULTS The most prevalent clinical manifestations belonged to infection (64.8%) followed by allergic diseases (26.16%) and autoimmunity (22.0%), respectively. In selective IgA deficiency patients as the largest group of IgAD in current study, celiac disease (6.57%), Inflammatory bowel disease (4.01%), and rheumatoid arthritis (3.80%) were the most prevalent autoimmunity. Meanwhile, the most frequent infection was respiratory tract infection, fungal infection, and gastrointestinal infection at 50.74%, 18.48%, and 15.79%, respectively. In addition, the pooled prevalence of asthma, allergic rhinitis, and allergic conjunctivitis were 19.06%, 15.46%, and 11.68%, respectively which were reported as the most widespread allergic diseases. CONCLUSIONS Our results showed that apart from undiagnosed IgAD patients, IgAD patients represent a wide range of clinical manifestations. Infection, allergy, and autoimmunity are the most common clinical manifestations. The concurrent presence of IgA and IgG subtypes deficiency could be associated with increased susceptibility to infection. Considering the probability of developing new clinical complications during follow-up, periodic assessments of IgAD patients should be inspected.
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Affiliation(s)
- Ahmad Vosughimotlagh
- Department of Pediatrics, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Seyed Erfan Rasouli
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
| | - Hosein Rafiemanesh
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Molood Safarirad
- Department of Pediatrics, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Niusha Sharifinejad
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Atossa Madanipour
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | - Maria Marluce Dos Santos Vilela
- Center for Investigation in Pediatrics, Pediatrics Department, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | | | - Gholamreza Azizi
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
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Çölkesen F, Kepenek Kurt E, Vatansev H, Korkmaz C, Çölkesen F, Yücel F, Yıldız E, Evcen R, Aykan FS, Kılınç M, Aytekin G, Feyzioğlu B, Doğan M, Arslan Ş, Teke T, Keleş S, Reisli İ. Memory B cells and serum immunoglobulins are associated with disease severity and mortality in patients with COVID-19. Postgrad Med J 2022; 98:765-771. [PMID: 37062997 PMCID: PMC8783971 DOI: 10.1136/postgradmedj-2021-140540] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 01/06/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE OF THE STUDY The aim of this study was to investigate the relationship of B cell-mediated immunity with disease severity and mortality in patients with COVID-19. STUDY DESIGN In this retrospective cohort and single-centre study, 208 patients with laboratory-confirmed COVID-19 were recruited. A COVID-19 severity score, ranging from 0 to 10, was used to evaluate associations between various factors. Serum immunoglobulin levels and the number of cells in B lymphocyte subsets were measured and their association with disease severity and mortality in patients with COVID-19 examined. RESULTS The median age of the patients was 50 (35-63) years and 88 (42%) were female. The number of deceased patients was 17. The median COVID-19 severity score was 8 (6-8) in deceased patients and 1 (0-2) in survivors. Deceased patients had significantly lower levels of total B lymphocytes, naive B cells, switched memory B cells, and serum IgA, IgG, IgG1 and IgG2 than recovered patients (all p<0.05). In addition, a significant negative correlation was found between the number of these parameters and COVID-19 severity scores. Decrease in the number of total B cells and switched memory B cells as well as lower serum IgA, IgG and IgG1 levels were independent risk factors for mortality in patients with COVID-19. CONCLUSION In the present study, the prognosis of patients with COVID-19 was shown to be associated with the B cell subset and serum immunoglobulin levels.
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Affiliation(s)
- Fatih Çölkesen
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Esma Kepenek Kurt
- Department of Infectious Diseases and Clinical Microbiology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Hülya Vatansev
- Department of Chest Diseases, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Celalettin Korkmaz
- Department of Chest Diseases, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Fatma Çölkesen
- Department of Infectious Diseases and Clinical Microbiology, Konya Training and Research Hospital, Konya, Turkey
| | - Fatih Yücel
- Department of General Intensive Care Unit, Konya Training and Research Hospital, Konya, Turkey
| | - Eray Yıldız
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Recep Evcen
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Filiz Sadi Aykan
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Mehmet Kılınç
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Gökhan Aytekin
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, Konya Training and Research Hospital, Konya, Turkey
| | - Bahadır Feyzioğlu
- Division of Medical Virology, Department of Medical Microbiology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Metin Doğan
- Department of Medical Microbiology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Şevket Arslan
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Turgut Teke
- Department of Chest Diseases, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Sevgi Keleş
- Division of Pediatric Allergy and Immunology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - İsmail Reisli
- Division of Pediatric Allergy and Immunology, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
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Dong Z, Zhang B, Rong J, Yang X, Wang Y, Zhang Q, Su Z. The aberrant expression of CD45 isoforms and levels of sex hormones in systemic lupus erythematosus. Clin Rheumatol 2022; 41:1087-1093. [PMID: 35064423 DOI: 10.1007/s10067-021-05934-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/30/2021] [Accepted: 09/21/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Systemic lupus erythematosus (SLE) is a common autoimmune disease with significant gender bias in women, and sex hormones are considered to play an important role in the regulation of immune activity. The CD45 isoforms generated through alternative splicing of mRNA identify different functional status of lymphocytes and also are suggested as a biomarker for assessing the progression of SLE, while the modulation of CD45 expression in SLE patients is not clear. METHODS In this study, the peripheral blood sera of 46 SLE patients and 15 health individuals were collected for detecting the levels of sex hormones and immune associated factors. The expression of CD45 isoforms and the status of CD45 DNA methylation of the peripheral mononuclear blood cells were detected by flow cytometry and bisulfite sequencing PCR, respectively. RESULTS The levels of complement C3 and IgA decreased, especially decline of the serum IgA to the level of selective immunoglobulin A deficiency, and the C-reactive protein increased in SLE patients when compared with healthy controls, which manifested the abnormal immune activity of the SLE patients. Sex hormones detection showed a decreased testosterone and increased prolactin in SLE. An accelerated expression of CD45RO, reduced CD45RA and CD45RB, and a relative hypermethylation of CD45 DNA in SLE were also identified that provided a clue to explain the possible regulatory mechanism for the immune function in SLE. CONCLUSION The results indicated that the aberrant CD45 isoforms, DNA methylation and hormone levels might be correlated with the imbalanced immune activity of SLE patients. Key Points • Selective immunoglobulin A deficiency was significantly higher in SLE than in healthy individuals. • SLE patients had decreased testosterone and increased prolactin in the sera. • An aberrant expression of CD45 isoforms and CD45 DNA methylation were identified in SLE.
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Affiliation(s)
- Zhaoxia Dong
- Department of Histology and Embryology, Shantou University Medical College, Shantou, 515041, Guangdong Province, China
| | - Bin Zhang
- Department of Histology and Embryology, Shantou University Medical College, Shantou, 515041, Guangdong Province, China
| | - Ju Rong
- Department of Internal Medicine, The First Affiliated Hospital of Shantou University Medical College, 57 Changping Road, Shantou, 515041, Guangdong Province, China
| | - Xinran Yang
- Department of Clinical Laboratory, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong Province, China
| | - Yongni Wang
- Department of Clinical Laboratory, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong Province, China
| | - Qiaoxin Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong Province, China
| | - Zhongjing Su
- Department of Histology and Embryology, Shantou University Medical College, Shantou, 515041, Guangdong Province, China
- Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou University Medical College, 22 Xinling Road, Shantou, 515041, Guangdong Province, China
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Çölkesen F, Kandemir B, Arslan Ş, Çölkesen F, Yıldız E, Korkmaz C, Vatansev H, Evcen R, Sadi Aykan F, Kılınç M, Aytekin G, Feyzioğlu B, Doğan M, Teke T. Relationship between selective IgA deficiency and COVID-19 prognosis. Jpn J Infect Dis 2021; 75:228-233. [PMID: 34588364 DOI: 10.7883/yoken.jjid.2021.281] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The prevalence and mortality rates of coronavirus disease 2019 (COVID-19) vary widely among populations. Mucosal immunity is the first barrier to pathogens' entry into the body. Immunoglobulin A (IgA) is the main antibody of mucosal immunity. We explored the relationship between selective immunoglobulin A deficiency (SIgAD) and the severity of COVID-19. We included 424 patients (203 females) with COVID-19. Eleven patients had SIgAD. Laboratory data on patients with SIgAD and normal IgA levels were compared. The relationship between SIgAD and severe COVID-19 infection was explored by logistic regression analysis. In univariate logistic regression analysis, the risk of severe disease in COVID-19 patients with SIgAD was approximately 7.7-fold higher than in the other patients (odds ratio [OR], 7.789; 95% confidence interval [CI], 1.665-36.690, p = 0.008), while it was 4-fold (OR, 4.053; 95% CI, 1.182-13.903, p = 0.026) higher in multivariate logistic regression analysis. Serum IgA levels were positively correlated with total lymphocyte counts, and negatively correlated with C-reactive protein (CRP) levels, which were found as a risk factor for severe COVID-19.In SIgAD patients, the number of SARS-CoV-2 viruses that pass through mucosal membranes may be increased, leading to complications such as cytokine storm syndrome and acute respiratory distress syndrome.
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Affiliation(s)
- Fatih Çölkesen
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, Meram Faculty of Medicine, Necmettin Erbakan University, Turkey
| | - Bahar Kandemir
- Department of Infectious Diseases and Clinical Microbiology, Meram Faculty of Medicine, Necmettin Erbakan University, Turkey
| | - Şevket Arslan
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, Meram Faculty of Medicine, Necmettin Erbakan University, Turkey
| | - Fatma Çölkesen
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Konya Training and Research Hospital, Turkey
| | - Eray Yıldız
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, Meram Faculty of Medicine, Necmettin Erbakan University, Turkey
| | - Celalettin Korkmaz
- Department of Chest Diseases, Meram Faculty of Medicine, Necmettin Erbakan University, Turkey
| | - Hülya Vatansev
- Department of Chest Diseases, Meram Faculty of Medicine, Necmettin Erbakan University, Turkey
| | - Recep Evcen
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, Meram Faculty of Medicine, Necmettin Erbakan University, Turkey
| | - Filiz Sadi Aykan
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, Meram Faculty of Medicine, Necmettin Erbakan University, Turkey
| | - Mehmet Kılınç
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, Meram Faculty of Medicine, Necmettin Erbakan University, Turkey
| | - Gökhan Aytekin
- Division of Clinical Immunology and Allergy, Department of Internal Medicine, University of Health Sciences, Konya City Training and Research Hospital, Turkey
| | - Bahadır Feyzioğlu
- Division of Medical Virology, Department of Medical Microbiology, Meram Faculty of Medicine, Necmettin Erbakan University, Turkey
| | - Metin Doğan
- Department of Medical Microbiology, Meram Faculty of Medicine, Necmettin Erbakan University, Turkey
| | - Turgut Teke
- Department of Chest Diseases, Meram Faculty of Medicine, Necmettin Erbakan University, Turkey
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Zhang J, Kong W, Ni J, Guo Z, Yang X, Cao Q, Wang S, Feng Y, Zhou Y, Weng W, Liang S, Li S, Chen Y, Liu J. The epidemiology and clinical feature of selective immunoglobulin a deficiency of Zhejiang Province in China. J Clin Lab Anal 2020; 34:e23440. [PMID: 32715518 PMCID: PMC7595911 DOI: 10.1002/jcla.23440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 12/23/2022] Open
Abstract
Background Selective immunoglobulin A deficiency (SIgAD) is the most common primary antibody deficiency disease and frequently reported in the Western countries. However, large‐scale epidemiologic studies on SIgAD in China are still lacking. Methods The clinical information of 555 180 subjects (age >4 years) including the outpatient, inpatient, and healthy subjects who had ordered serum immunoglobulin A, G, M in 9 hospitals of Zhejiang Province in China was collected. The SIgAD individuals were defined as IgA level <0.07 g/L with normal levels of serum IgG and IgM, whose age should be over 4 years, and any other secondary diseases causing SIgAD were also excluded. Then, the geographical and prevalence distribution of SIgAD individuals in Zhejiang Province and patients' clinical characteristics at the time of diagnosis were also reviewed. Result Among these 555 180 subjects who had ordered the immunoglobulin evaluation, the prevalence of SIgAD was 109/555180 (0.02%). The ratio of male to female of these SIgAD individuals was 1:1.37, which also included 87 adults (≥18 years) and 22 children (18 > age >4 years). For adults, the common clinical features were infections (43/87, 49.43%), autoimmune disorders (31/87, 35.63%), allergic cases (5/87, 5.75%), and tumor cases (4/87, 4.60%). Additionally, infectious diseases (20/22, 90.91%), autoimmune disorders (4/22, 18.18%), and allergic cases (1/22, 4.55%) were found in 22 children. Conclusion We first describe a large cohort of SIgAD individuals of Zhejiang Province in China. The incidence was 0.020%. The common clinical features were infection, autoimmune disorders, tumor, and allergy, and the infection rate was higher in children than the adults.
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Affiliation(s)
- Junwu Zhang
- Department of Clinical Laboratory, Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Wenzhou, China
| | - Wanzhong Kong
- Department of Clinical Laboratory, Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Wenzhou, China
| | - Jinyao Ni
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhen Guo
- Department of Clinical Laboratory, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xunjun Yang
- Department of Clinical Laboratory, The Second Affiliated Hospital and Yuying Children's Hospital of WMU, Wenzhou, China
| | - Qun Cao
- Department of Clinical Laboratory, The First Hospital of Jiaxing, Jiaxing, China
| | - Sheliang Wang
- Department of Clinical Laboratory, Shaoxing Second Hospital, Jiaxing, China
| | - Yijun Feng
- Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province, Linhai, China
| | - Ying Zhou
- Department of Clinical Laboratory, Lishui City People's Hospital, Lishui, China
| | - Wei Weng
- Department of Clinical Laboratory, Jinhua People's hospital, Jinhua, China
| | - Shanyan Liang
- Department of Clinical Laboratory, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Shuang Li
- Department of Clinical Laboratory, Ningbo Traditional Chinese Medicine Hospital, Ningbo, China
| | - Yanxia Chen
- Department of Rheumatology, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Jinlin Liu
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China.,Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang Province, hangzhou, China
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