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Venugopal P, Arts P, Fox LC, Simons A, Hiwase DK, Bardy PG, Swift A, Ross DM, van Vulpen LFD, Buijs A, Bolton KL, Getta B, Furlong E, Carter T, Krapels I, Hoeks M, Al Kindy A, Al Kindy F, de Munnik S, Evans P, Frank MSB, Bournazos AM, Cooper ST, Ha TT, Jackson MR, Arriola-Martinez L, Phillips K, Brennan Y, Bakshi M, Ambler K, Gao S, Kassahn KS, Kenyon R, Hung K, Babic M, McGovern A, Rawlings L, Vakulin C, Dejong L, Fathi R, McRae S, Myles N, Ladon D, Jongmans M, Kuiper RP, Poplawski NK, Barbaro P, Blombery P, Brown AL, Hahn CN, Scott HS. Unraveling facets of MECOM-associated syndrome: somatic genetic rescue, clonal hematopoiesis, and phenotype expansion. Blood Adv 2024; 8:3437-3443. [PMID: 38662475 PMCID: PMC11259931 DOI: 10.1182/bloodadvances.2023012331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/22/2024] [Indexed: 06/28/2024] Open
Affiliation(s)
- Parvathy Venugopal
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
- Centre for Cancer Biology, an alliance between SA Pathology and University of South Australia, Adelaide, SA, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Peer Arts
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
- Centre for Cancer Biology, an alliance between SA Pathology and University of South Australia, Adelaide, SA, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Lucy C. Fox
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Clinical Haematology at Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, Parkville, VIC, Australia
| | - Annet Simons
- Department of Human Genetics, Nijmegen Center for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Institute for Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Devendra K. Hiwase
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Peter G. Bardy
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- Department of Clinical Haematology and Bone Marrow Transplantation, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Annette Swift
- Department of Paediatric Haematology, Queensland Children’s Hospital, South Brisbane, QLD, Australia
| | - David M. Ross
- Centre for Cancer Biology, an alliance between SA Pathology and University of South Australia, Adelaide, SA, Australia
- Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Department of Clinical Haematology and Bone Marrow Transplantation, Royal Adelaide Hospital, Adelaide, SA, Australia
- Department of Haematology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Lize F. D. van Vulpen
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arjan Buijs
- Department of Genetics, University Medical Center, Utrecht, The Netherlands
| | - Kelly L. Bolton
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Bartlomiej Getta
- Department of Haematology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Eliska Furlong
- Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, WA, Australia
| | - Tina Carter
- Department of Clinical Haematology, Oncology, Blood and Marrow Transplantation, Perth Children's Hospital, Perth, WA, Australia
| | - Ingrid Krapels
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marlijn Hoeks
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Adila Al Kindy
- Genetic and Developmental Medicine Clinic, Sultan Qaboos University Hospital and Department of Genetics, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Farah Al Kindy
- Genetic and Developmental Medicine Clinic, Sultan Qaboos University Hospital and Department of Genetics, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Sonja de Munnik
- Department of Human Genetics, Nijmegen Center for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Pamela Evans
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Mahalia S. B. Frank
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
- Centre for Cancer Biology, an alliance between SA Pathology and University of South Australia, Adelaide, SA, Australia
| | - Adam M. Bournazos
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Westmead, NSW, Australia
- The Children's Medical Research Institute, Westmead, NSW, Australia
| | - Sandra T. Cooper
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Westmead, NSW, Australia
- The Children's Medical Research Institute, Westmead, NSW, Australia
- School of Medicine, Faculty of Health and Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Thuong Thi Ha
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
- ACRF Genomics Facility, Centre for Cancer Biology, an alliance between SA Pathology and University of South Australia, Adelaide, SA, Australia
| | - Matilda R. Jackson
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
- Centre for Cancer Biology, an alliance between SA Pathology and University of South Australia, Adelaide, SA, Australia
- Australian Genomics, Parkville, VIC, Australia
| | - Luis Arriola-Martinez
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
- ACRF Genomics Facility, Centre for Cancer Biology, an alliance between SA Pathology and University of South Australia, Adelaide, SA, Australia
| | - Kerry Phillips
- Adult Genetics Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Yvonne Brennan
- Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Madhura Bakshi
- Department of Clinical Genetics, Liverpool Hospital, Liverpool, NSW, Australia
| | - Karen Ambler
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
| | - Song Gao
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
| | - Karin S. Kassahn
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Rosalie Kenyon
- ACRF Genomics Facility, Centre for Cancer Biology, an alliance between SA Pathology and University of South Australia, Adelaide, SA, Australia
| | - Kevin Hung
- Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Milena Babic
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
| | - Alan McGovern
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
| | - Lesley Rawlings
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
| | - Cassandra Vakulin
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
| | - Lucas Dejong
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
| | - Rema Fathi
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
| | - Simon McRae
- Western Haematology and Oncology Clinics, West Perth, WA, Australia
| | - Nicholas Myles
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- Department of Clinical Haematology and Bone Marrow Transplantation, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Dariusz Ladon
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
| | - Marjolijn Jongmans
- Department of Genetics, University Medical Center, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Roland P. Kuiper
- Department of Genetics, University Medical Center, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Nicola K. Poplawski
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- Adult Genetics Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Pasquale Barbaro
- Department of Paediatric Haematology, Queensland Children’s Hospital, South Brisbane, QLD, Australia
| | - Piers Blombery
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Clinical Haematology at Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, Parkville, VIC, Australia
| | - Anna L. Brown
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
- Centre for Cancer Biology, an alliance between SA Pathology and University of South Australia, Adelaide, SA, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Christopher N. Hahn
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
- Centre for Cancer Biology, an alliance between SA Pathology and University of South Australia, Adelaide, SA, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Hamish S. Scott
- Department of Genetics and Molecular Pathology, SA Pathology, Adelaide, SA, Australia
- Centre for Cancer Biology, an alliance between SA Pathology and University of South Australia, Adelaide, SA, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- ACRF Genomics Facility, Centre for Cancer Biology, an alliance between SA Pathology and University of South Australia, Adelaide, SA, Australia
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
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Rafii H, Volt F, Bierings M, Dalle JH, Ayas M, Rihani R, Faraci M, de Simone G, Sengeloev H, Passweg J, Cavazzana M, Costello R, Maertens J, Biffi A, Johansson JE, Montoro J, Guepin GR, Diaz MA, Sirvent A, Kenzey C, Rivera Franco MM, Cappelli B, Scigliuolo GM, Rocha V, Ruggeri A, Risitano A, De Latour RP, Gluckman E. Umbilical Cord Blood Transplantation for Fanconi Anemia With a Special Focus on Late Complications: a Study on Behalf of Eurocord and SAAWP-EBMT. Transplant Cell Ther 2024; 30:532.e1-532.e16. [PMID: 38452872 DOI: 10.1016/j.jtct.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/20/2024] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Abstract
Hematopoietic cell transplantation (HCT) remains the sole available curative treatment for Fanconi anemia (FA), with particularly favorable outcomes reported after matched sibling donor (MSD) HCT. This study aimed to describe outcomes, with a special focus on late complications, of FA patients who underwent umbilical cord blood transplantation (UCBT). In this retrospective analysis of allogeneic UCBT for FA performed between 1988 and 2021 in European Society for Blood and Marrow Transplantation (EBMT)-affiliated centers, a total of 205 FA patients underwent UCBT (55 related and 150 unrelated) across 77 transplant centers. Indications for UCBT were bone marrow failure in 190 patients and acute leukemia/myelodysplasia in 15 patients. The median age at transplantation was 9 years (range, 1.2 to 43 years), with only 20 patients aged >18 years. Among the donor-recipient pairs, 56% (n = 116) had a 0 to 1/6 HLA mismatch. Limited-field radiotherapy was administered to 28% (n = 58) and 78% (n = 160) received a fludarabine (Flu)-based conditioning regimen. Serotherapy consisted of antithymocyte globulin (n = 159; 78%) or alemtuzumab (n = 12; 6%). The median follow-up was 10 years for related UCBT and 7 years for unrelated UCBT. Excellent outcomes were observed in the setting of related UCBT, including a 60-day cumulative incidence (CuI) of neutrophil recovery of 98.1% (95% confidence interval [CI], 93.9% to 100%), a 100-day CuI of grade II-IV acute graft-versus-host disease (GVHD) of 17.3% (95% CI, 9.5% to 31.6%), and a 5-year CuI of chronic GVHD (cGVHD) of 22.7% (95% CI, 13.3% to 38.7%; 13% extensive). Five-year overall survival (OS) was 88%. In multivariate analysis, none of the factors included in the model predicted a better OS. In unrelated UCBT, the 60-day CuI of neutrophil recovery was 78.7% (95% CI, 71.9% to 86.3%), the 100-day CuI of grade II-IV aGVHD was 31.4% (95% CI, 24.6% to 40.2%), and the 5-year CuI of cGVHD was 24.3% (95% CI, 17.8% to 32.2%; 12% extensive). Five-year OS was 44%. In multivariate analysis, negative recipient cytomegalovirus serology, Flu-based conditioning, age <9 years at UCBT, and 0 to 1/6 HLA mismatch were associated with improved OS. A total of 106 patients, including 5 with acute leukemia/myelodysplasia, survived for >2 years after UCBT. Nine of these patients developed subsequent neoplasms (SNs), including 1 donor-derived acute myelogenous leukemia and 8 solid tumors, at a median of 9.7 years (range, 2.3 to 21.8 years) post-UCBT (1 related and 8 unrelated UCBT). In a subset of 49 patients with available data, late nonmalignant complications affecting various organ systems were observed at a median of 8.7 years (range, 2.7 to 28.8 years) post-UCBT. UCB is a valid source of stem cells for transplantation in patients with FA, with the best results observed after related UCBT. After unrelated UCBT, improved survival was observed in patients who underwent transplantation at a younger age, with Flu-based conditioning, and with better HLA parity. The incidence of organ-specific complications and SNs was relatively low. The incidence of SNs, mostly squamous cell carcinoma, increases with time. Rigorous follow-up and lifelong screening are crucial in survivors of UCBT for FA.
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Affiliation(s)
- Hanadi Rafii
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - Fernanda Volt
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - Marc Bierings
- Princess Maxima Center, University Hospital for Children, Utrecht, Netherlands
| | - Jean-Hugues Dalle
- Pediatric Hematology and Immunology Department, Robert Debré Hospital, Université Paris Cité, APHP, Paris, France
| | - Mouhab Ayas
- Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Rawad Rihani
- Pediatric Blood, Marrow and Cellular Therapy Program, King Hussein Cancer Centre, Amman, Jordan
| | - Maura Faraci
- Hematopoetic Stem Cell Unit, Department of Hematology-Oncology, IRCCS Istituto G. Gaslini, Genova, Italy
| | - Giuseppina de Simone
- Hematology and Stem Cell Transplant Unit, Azienda Ospedaliera di Rilievo Nazionale Santobono-Pausilipon, Napoli, Italy
| | - Henrik Sengeloev
- Bone Marrow Transplant Unit L 4043, National University Hospital, Copenhagen, Denmark
| | - Jakob Passweg
- Hematology Department, University Hospital of Basel, Basel, Switzerland
| | | | - Regis Costello
- Centre Hospitalier Universitaire La Conception, Marseille, France
| | - Johan Maertens
- Departement of Hematology,University Hospital Gasthuisberg, Leuven, Belgium
| | - Alessandra Biffi
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, Padua University Hospital, Padua, Italy
| | | | | | | | | | - Anne Sirvent
- Pediatric Onco-Hematology Unit, CHU A de Villeneuve, Montpellier, France
| | - Chantal Kenzey
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - Monica M Rivera Franco
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - Barbara Cappelli
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco
| | - Graziana Maria Scigliuolo
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco
| | - Vanderson Rocha
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France; Hematology, Transfusion, and Cell Therapy Service and Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Hospital das Clínicas, Faculty of Medicine, São Paulo University, São Paulo, Brazil
| | - Annalisa Ruggeri
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France; Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Risitano
- University of Naples, Avellino, Italy; AORN San Giuseppe Moscati, Avellino, Italy
| | - Regis Peffault De Latour
- Bone Marrow Transplant Unit, Hôpital Saint Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Eliane Gluckman
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco.
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3
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Iskander D, Roy NBA, Payne E, Drasar E, Hennessy K, Harrington Y, Christodoulidou C, Karadimitris A, Batkin L, de la Fuente J. Diamond-Blackfan anemia in adults: In pursuit of a common approach for a rare disease. Blood Rev 2023; 61:101097. [PMID: 37263874 DOI: 10.1016/j.blre.2023.101097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/19/2023] [Accepted: 05/07/2023] [Indexed: 06/03/2023]
Abstract
Diamond-Blackfan anemia (DBA) is a rare bone marrow failure syndrome, usually caused by loss-of function variants in genes encoding ribosomal proteins. The hallmarks of DBA are anemia, congenital anomalies and cancer predisposition. Although DBA usually presents in childhood, the prevalence in later life is increasing due to an expanding repertoire of implicated genes, improvements in genetic diagnosis and increasing life expectancy. Adult patients uniquely suffer the manifestations of end-organ damage caused by the disease and its treatment, and transition to adulthood poses specific issues in disease management. To standardize and optimize care for this rare disease, in this review we provide updated guidance on the diagnosis and management of DBA, with a specific focus on older adolescents and adults. Recommendations are based upon published literature and our pooled clinical experience from three centres in the United Kingdom (U·K.). Uniquely we have also solicited and incorporated the views of affected families, represented by the independent patient organization, DBA U.K.
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Affiliation(s)
- Deena Iskander
- Centre for Haematology, Department of Immunology & Inflammation, Imperial College London, London W12 0NN, UK.
| | - Noémi B A Roy
- Oxford University Hospitals NHS Foundation Trust and University of Oxford, OX3 9DU, UK
| | - Elspeth Payne
- UCL Cancer Institute, Dept of Hematology, London WC1 E6BT, UK; Dept of Hematology, University College Hospital London, NW1 2BU, UK
| | - Emma Drasar
- Whittington Health NHS Trust and University College Hospital London, N19 5NF, UK
| | - Kelly Hennessy
- Department of Paediatrics, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Yvonne Harrington
- Department of Paediatrics, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Chrysi Christodoulidou
- Centre for Haematology, Department of Immunology & Inflammation, Imperial College London, London W12 0NN, UK
| | - Anastasios Karadimitris
- Centre for Haematology, Department of Immunology & Inflammation, Imperial College London, London W12 0NN, UK
| | - Leisa Batkin
- DBA, UK 71-73 Main Street, Palterton, Chesterfield, S44 6UR, UK
| | - Josu de la Fuente
- Department of Paediatrics, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London W2 1NY, UK.
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4
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Zlotogora J, Harel T, Meiner V. Explanations for the discrepancy between variant frequency and homozygous disease occurrence: Lessons from Ashkenazi Jewish data. Eur J Med Genet 2023; 66:104765. [PMID: 37028505 DOI: 10.1016/j.ejmg.2023.104765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/28/2022] [Accepted: 04/03/2023] [Indexed: 04/09/2023]
Abstract
Ample data on recessive disorders among Ashkenazi Jews has been gathered and published through the years. The opportunity to integrate molecular records analyzed in actual affected individuals with data derived from population-documented frequencies enables to compare these figures. We reviewed assumed pathogenic variants reported among patients in the Israeli medical genetic database (IMGD) with a carrier frequency of 1% or more among Ashkenazi Jews in gnomAD. Among the 60 assumed pathogenic variants recorded in IMGD, 15 (25%) had either a disease incidence considerably lower than expected by the calculated carrier frequency (12 variants), or the variant was not characterized in Ashkenazi Jewish patients (three variants). Possible explanations for the rarity or absence of affected individuals despite high carrier frequency include embryonic lethality, clinical variability, and incomplete and age-related penetrance, in addition to the existence of additional assumed pathogenic variants on the founder haplotype, hypomorphic variants or digenic inheritance. The discrepancy in actual versus expected number of patients calls for caution upon designing and choosing targeted genes and recessive mutations for carrier screening.
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Affiliation(s)
- Joël Zlotogora
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, 9112001, Israel.
| | - Tamar Harel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, 9112001, Israel; Department of Genetics, Hadassah Medical Organization, Jerusalem, 9112001, Israel
| | - Vardiella Meiner
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, 9112001, Israel; Department of Genetics, Hadassah Medical Organization, Jerusalem, 9112001, Israel
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Fiesco-Roa MÓ, García-de Teresa B, Leal-Anaya P, van ‘t Hek R, Wegman-Ostrosky T, Frías S, Rodríguez A. Fanconi anemia and dyskeratosis congenita/telomere biology disorders: Two inherited bone marrow failure syndromes with genomic instability. Front Oncol 2022; 12:949435. [PMID: 36091172 PMCID: PMC9453478 DOI: 10.3389/fonc.2022.949435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Inherited bone marrow failure syndromes (IBMFS) are a complex and heterogeneous group of genetic diseases. To date, at least 13 IBMFS have been characterized. Their pathophysiology is associated with germline pathogenic variants in genes that affect hematopoiesis. A couple of these diseases also have genomic instability, Fanconi anemia due to DNA damage repair deficiency and dyskeratosis congenita/telomere biology disorders as a result of an alteration in telomere maintenance. Patients can have extramedullary manifestations, including cancer and functional or structural physical abnormalities. Furthermore, the phenotypic spectrum varies from cryptic features to patients with significantly evident manifestations. These diseases require a high index of suspicion and should be considered in any patient with abnormal hematopoiesis, even if extramedullary manifestations are not evident. This review describes the disrupted cellular processes that lead to the affected maintenance of the genome structure, contrasting the dysmorphological and oncological phenotypes of Fanconi anemia and dyskeratosis congenita/telomere biology disorders. Through a dysmorphological analysis, we describe the phenotypic features that allow to make the differential diagnosis and the early identification of patients, even before the onset of hematological or oncological manifestations. From the oncological perspective, we analyzed the spectrum and risks of cancers in patients and carriers.
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Affiliation(s)
- Moisés Ó. Fiesco-Roa
- Laboratorio de Citogenética, Instituto Nacional de Pediatría, Ciudad de México, Mexico
- Maestría y Doctorado en Ciencias Médicas, Universidad Nacional Autónoma de México (UNAM), Ciudad Universitaria, Ciudad de México, Mexico
| | | | - Paula Leal-Anaya
- Departamento de Genética Humana, Instituto Nacional de Pediatría, Ciudad de México, Mexico
| | - Renée van ‘t Hek
- Facultad de Medicina, Universidad Nacional Autoínoma de Meíxico (UNAM), Ciudad Universitaria, Ciudad de México, Mexico
| | - Talia Wegman-Ostrosky
- Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Ciudad de México, Mexico
| | - Sara Frías
- Laboratorio de Citogenética, Instituto Nacional de Pediatría, Ciudad de México, Mexico
- Departamento de Medicina Genómica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, Mexico
- *Correspondence: Alfredo Rodríguez, ; Sara Frías,
| | - Alfredo Rodríguez
- Departamento de Medicina Genómica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, Mexico
- Unidad de Genética de la Nutrición, Instituto Nacional de Pediatría, Ciudad de México, Mexico
- *Correspondence: Alfredo Rodríguez, ; Sara Frías,
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6
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Telkar N, Stewart GL, Pewarchuk ME, Cohn DE, Robinson WP, Lam WL. Small Non-Coding RNAs in the Human Placenta: Regulatory Roles and Clinical Utility. Front Genet 2022; 13:868598. [PMID: 35432451 PMCID: PMC9006164 DOI: 10.3389/fgene.2022.868598] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/11/2022] [Indexed: 12/26/2022] Open
Abstract
The placenta is a vital organ formed during pregnancy, and being the interface between the mother and fetus, it is paramount that placental functioning is strictly controlled. Gene expression in the placenta is finely tuned-with aberrant expression causing placental pathologies and inducing stress on both mother and fetus. Gene regulation is brought upon by several mechanisms, and small non-coding RNAs (sncRNAs) have recently been appreciated for their contribution in gene repression. Their dysregulation has been implicated in a range of somatic and inherited disorders, highlighting their importance in maintaining healthy organ function. Their specific roles within the placenta, however, are not well understood, and require further exploration. To this end, we summarize the mechanisms of microRNAs (miRNAs), Piwi-interacting RNAs (piRNAs), small nuclear RNAs (snRNAs), small nucleolar RNAs (snoRNAs), and transfer RNAs (tRNAs), their known contributions to human placental health and disease, the relevance of sncRNAs as promising biomarkers throughout pregnancy, and the current challenges faced by placental sncRNA studies.
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Affiliation(s)
- Nikita Telkar
- British Columbia Children’s Hospital Research Institute, Vancouver, BC, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
- British Columbia Cancer Research Centre, Vancouver, BC, Canada
| | - Greg L. Stewart
- British Columbia Cancer Research Centre, Vancouver, BC, Canada
| | | | - David E. Cohn
- British Columbia Cancer Research Centre, Vancouver, BC, Canada
| | - Wendy P. Robinson
- British Columbia Children’s Hospital Research Institute, Vancouver, BC, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Wan L. Lam
- British Columbia Cancer Research Centre, Vancouver, BC, Canada
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Niewisch MR, Giri N, McReynolds LJ, Alsaggaf R, Bhala S, Alter BP, Savage SA. Disease progression and clinical outcomes in telomere biology disorders. Blood 2022; 139:1807-1819. [PMID: 34852175 PMCID: PMC8952184 DOI: 10.1182/blood.2021013523] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/11/2021] [Indexed: 11/20/2022] Open
Abstract
Dyskeratosis congenita related telomere biology disorders (DC/TBDs) are characterized by very short telomeres caused by germline pathogenic variants in telomere biology genes. Clinical presentations can affect all organs, and inheritance patterns include autosomal dominant (AD), autosomal recessive (AR), X-linked (XLR), or de novo. This study examined the associations between mode of inheritance with phenotypes and long-term clinical outcomes. Two hundred thirty-one individuals with DC/TBDs (144 male, 86.6% known genotype, median age at diagnosis 19.4 years [range 0 to 71.6]), enrolled in the National Cancer Institute's Inherited Bone Marrow Failure Syndrome Study, underwent detailed clinical assessments and longitudinal follow-up (median follow-up 5.2 years [range 0 to 36.7]). Patients were grouped by inheritance pattern, considering AD-nonTINF2, AR/XLR, and TINF2 variants separately. Severe bone marrow failure (BMF), severe liver disease, and gastrointestinal telangiectasias were more prevalent in AR/XLR or TINF2 disease, whereas pulmonary fibrosis developed predominantly in adults with AD disease. After adjusting for age at DC/TBD diagnosis, we observed the highest cancer risk in AR/XLR individuals. At last follow-up, 42% of patients were deceased with a median overall survival (OS) of 52.8 years (95% confidence interval [CI] 45.5-57.6), and the hematopoietic cell or solid organ transplant-free median survival was 45.3 years (95% CI 37.4-52.1). Significantly better OS was present in AD vs AR/XLR/TINF2 disease (P < .01), while patients with AR/XLR and TINF2 disease had similar survival probabilities. This long-term study of the clinical manifestations of DC/TBDs creates a foundation for incorporating the mode of inheritance into evidence-based clinical care guidelines and risk stratification in patients with DC/TBDs. This trial was registered at www.clinicaltrials.gov as #NCT00027274.
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Affiliation(s)
- Marena R Niewisch
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Neelam Giri
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Lisa J McReynolds
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Rotana Alsaggaf
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Sonia Bhala
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Blanche P Alter
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Sharon A Savage
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Carneiro-Sampaio M, de Jesus AA, Bando SY, Moreira-Filho CA. Inborn Errors of Immunity With Fetal or Perinatal Clinical Manifestations. Front Pediatr 2022; 10:891343. [PMID: 35601409 PMCID: PMC9121170 DOI: 10.3389/fped.2022.891343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/18/2022] [Indexed: 11/28/2022] Open
Abstract
In this article we revised the literature on Inborn Errors of Immunity (IEI) keeping our focus on those diseases presenting with intrauterine or perinatal clinical manifestations. We opted to describe our findings according to the IEI categories established by the International Union of Immunological Societies, predominantly addressing the immunological features of each condition or group of diseases. The main finding is that such precocious manifestations are largely concentrated in the group of primary immune regulatory disorders (PIRDs) and not in the group of classical immunodeficiencies. The IEI categories with higher number of immunological manifestations in utero or in perinatal period are: (i) diseases of immune dysregulation (HLH, IPEX and other Tregopathies, autosomal recessive ALPS with complete lack of FAS protein expression) and (ii) autoinflammatory diseases (NOMID/CINCA, DIRA and some interferonopathies, such as Aicardi-Goutières syndrome, AGS, and USP18 deficiency). Regarding the other IEI categories, some patients with Omenn syndrome (an atypical form of SCID), and a few X-linked CGD patients present with clinical manifestations at birth associated to immune dysregulation. The most frequent clinical features were hydrops fetalis, intrauterine growth retardation leading to fetal loss, stillbirths, and prematurity, as in HLH and IPEX. Additionally, pseudo-TORCH syndrome was observed in AGS and in USP18 deficiency. The main goal of our review was to contribute to increasing the medical awareness of IEI with intrauterine and perinatal onset, which has obvious implications for diagnosis, treatment, and genetic counseling.
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Affiliation(s)
- Magda Carneiro-Sampaio
- Department of Pediatrics, Faculdade de Medicina, Universidade de São Paulo, Sao-Paulo, Brazil
| | - Adriana Almeida de Jesus
- Translational Autoinflammatory Disease Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Silvia Yumi Bando
- Department of Pediatrics, Faculdade de Medicina, Universidade de São Paulo, Sao-Paulo, Brazil
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Functional profiling of single CRISPR/Cas9-edited human long-term hematopoietic stem cells. Nat Commun 2019; 10:4730. [PMID: 31628330 PMCID: PMC6802205 DOI: 10.1038/s41467-019-12726-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/29/2019] [Indexed: 12/20/2022] Open
Abstract
In the human hematopoietic system, rare self-renewing multipotent long-term hematopoietic stem cells (LT-HSCs) are responsible for the lifelong production of mature blood cells and are the rational target for clinical regenerative therapies. However, the heterogeneity in the hematopoietic stem cell compartment and variable outcomes of CRISPR/Cas9 editing make functional interrogation of rare LT-HSCs challenging. Here, we report high efficiency LT-HSC editing at single-cell resolution using electroporation of modified synthetic gRNAs and Cas9 protein. Targeted short isoform expression of the GATA1 transcription factor elicit distinct differentiation and proliferation effects in single highly purified LT-HSC when analyzed with functional in vitro differentiation and long-term repopulation xenotransplantation assays. Our method represents a blueprint for systematic genetic analysis of complex tissue hierarchies at single-cell resolution. Previous gene editing in haematopoietic stem cells (HSCs) has focussed on a heterogeneous CD34+ population. Here, the authors demonstrate high efficiency CRISPR/Cas9-based editing of purified long-term HSCs using non-homologous end joining and homology-directed repair, by directing isoform-specific expression of GATA1.
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