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Yang X, He J, Peng W, Zheng S, Ma N, Chen Y, Shen J, Kong X. Opening SCID newborn screening for novel exon genetic variants through whole-exome sequencing in China. Int Immunopharmacol 2024; 137:112402. [PMID: 38908084 DOI: 10.1016/j.intimp.2024.112402] [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: 11/08/2023] [Revised: 05/13/2024] [Accepted: 06/02/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Severe combined immunodeficiency (SCID) is the most fatal form of inherited primary immunodeficiency disease. Known molecular defect mutations occur in most children with SCID. METHODS Herein, we report Adenosine Deaminase-SCID (ADA-SCID) using whole-exome sequencing (WES), explore exome mutational landscape and significance for 17 SCID samples, and verify the mutated exon genes using the Gene Expression Omnibus (GEO) datasets. A total of 250 patients, who were hospitalized at the Neonatal Intensive Care Unit (NICU) of The Seventh Medical Center of the PLA General Hospital for 3 years (from 2017 to 2020), were screened for SCID. We collected mutated genes from the WES data of 17 SCID children. GSE609 and GSE99176 cohorts were used to identify the expressions of mutated exon genes and molecular features in SCID. Gene set variation analyses (GSVA) and correlation analyses were performed. RESULTS The detection rate with approximately 6.8 % (17/250) of SCID is high in the NICU. A total of 16 genes were identified among 17 SCID samples, of which the Top 2 genes (MUC6 and RP11-683L23.1) might be crucial in the progression of SCID with 94 % mutation frequency. Furthermore, CNN2 and SCGB1C1 had significant co-mutations and may cooperate to affect SCID development. Importantly, the phylogenetic tree classification results of 17 SCID samples are more correlated to MUC6 with the most significant mutations. Expression profiles of seven mutated genes and five mutated genes were documented in GSE609 and GSE99176 cohorts based on microarray, respectively. Several immune-related pathways were significantly enriched, and Foxd4, differing from the other four mutated genes, was inversely correlated with the GSVA-enriched pathway. CONCLUSION Due to its high detection rate (6.8%) and fatality rate (100%), the inclusion of SCID in newborn screening (NBS) is urgent for children in China. The WES successfully identified several common exonic variants (e.g., MUC6) and depicted the feature of mutations and evolution, which will help develop new diagnostic methods for SCID.
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Affiliation(s)
- Xiao Yang
- Faculty of Pediatrics, the Chinese PLA General Hospital, Beijing, China; Institute of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing, China; National Engineering Laboratory for Birth defects prevention and Control of key technology, Beijing, China; Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - JianHu He
- Department of Information, Women's Hospital School of Medicine Zhejiang University, Zhejiang, China
| | - Wei Peng
- Faculty of Pediatrics, the Chinese PLA General Hospital, Beijing, China; Institute of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing, China; National Engineering Laboratory for Birth defects prevention and Control of key technology, Beijing, China; Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - Sheng Zheng
- ShangHai Z&S Biotechnology Company, Shanghai, China
| | - Ning Ma
- Faculty of Pediatrics, the Chinese PLA General Hospital, Beijing, China; Institute of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing, China; National Engineering Laboratory for Birth defects prevention and Control of key technology, Beijing, China; Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - YuHan Chen
- Faculty of Pediatrics, the Chinese PLA General Hospital, Beijing, China; Institute of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing, China; National Engineering Laboratory for Birth defects prevention and Control of key technology, Beijing, China; Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China
| | - Jian Shen
- Department of Gynecology and Obstetrics, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200003, China.
| | - XiangYong Kong
- Faculty of Pediatrics, the Chinese PLA General Hospital, Beijing, China; Institute of Pediatrics, the Seventh Medical Center of PLA General Hospital, Beijing, China; National Engineering Laboratory for Birth defects prevention and Control of key technology, Beijing, China; Beijing Key Laboratory of Pediatric Organ Failure, Beijing, China.
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2
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Senter J, Wagner K, Gabryszewski SJ, Wolfset N, Reid W, Sun D. Severe Pneumonia in a Previously Healthy Infant. Clin Pediatr (Phila) 2023; 62:1595-1598. [PMID: 36964682 DOI: 10.1177/00099228231163381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Affiliation(s)
- James Senter
- Department of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kristina Wagner
- Department of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stanislaw J Gabryszewski
- Division of Allergy and Immunology, Department of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nicole Wolfset
- Division of Allergy and Immunology, Department of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Whitney Reid
- Division of Allergy and Immunology, Department of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Di Sun
- Division of Allergy and Immunology, Department of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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3
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Schober S, Huber S, Braun N, Döring M, Lang P, Hofbeck M, Neunhoeffer F, Renk H. Prognostic factors and predictive scores for 6-months mortality of hematopoietic stem cell transplantation recipients admitted to the pediatric intensive care unit. Front Oncol 2023; 13:1161573. [PMID: 37810960 PMCID: PMC10552149 DOI: 10.3389/fonc.2023.1161573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/28/2023] [Indexed: 10/10/2023] Open
Abstract
Objective Despite advances in hematopoietic stem cell transplantation (HSCT), a considerable number of pediatric HSCT patients develops post-transplant complications requiring admission to the pediatric intensive care unit (PICU). The objective of this study was to evaluate clinical findings, PICU supportive therapy and outcome as well as predictive factors for 6-months survival after discharge of HSCT patients from PICU. Study design This retrospective single-center analysis investigated patient characteristics, microbiological findings, reasons for admission and death of 54 cases accounting for 94 admissions to the PICU of the University Children's Hospital Tuebingen from 2002 to 2017. We compared clinical characteristics between children with and without 6-months survival after discharge from PICU following HSCT. Finally, we assessed the potential prognostic value of the oncological Pediatric Risk of Mortality Score (O-PRISM), the Pediatric Sequential Organ Failure Assessment Score (pSOFA) and the pRIFLE Criteria for Acute Kidney Injury for 6-months survival using Generalized Estimating Equations (GEE) and Receiver Operating Characteristic curves. Results Respiratory insufficiency, gastroenterological problems and sepsis were the most common reasons for PICU admission. Out of 54 patients, 38 (70%) died during or after their last PICU admission, 30% survived for at least six months. When considering only first PICU admissions, we could not determine prognostic factors for 6-months mortality. In contrast, under consideration of all PICU admissions in the GEE model, ventilation (p=0.03) and dialysis (p=0.007) were prognostic factors for 6-months mortality. Furthermore, pSOFA (p=0.04) and O-PRISM (p=0.02) were independent risk factors for 6-months mortality considering all PICU admissions. Conclusion Admission of HSCT patients to PICU is still associated with poor outcome and 69% of patients died within 6 months. Need for respiratory support and dialysis are associated with poor outcome. Prediction of 6-months survival is difficult, especially during a first PICU admission. However, on subsequent PICU admissions pSOFA and O-PRISM scores might be useful to predict mortality. These scores should be prospectively evaluated in further studies to verify whether they can identify pediatric HSCT recipients profiting most from transferal to the PICU.
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Affiliation(s)
- Sarah Schober
- University Children’s Hospital Tuebingen, Department I – General Pediatrics, Hematology/Oncology, Tuebingen, Germany
| | - Silke Huber
- University Children’s Hospital Tuebingen, Department II – Pediatric Cardiology, Pulmonology and Intensive Care Medicine, Tuebingen, Germany
| | - Norbert Braun
- University Children’s Hospital Tuebingen, Department II – Pediatric Cardiology, Pulmonology and Intensive Care Medicine, Tuebingen, Germany
| | - Michaela Döring
- University Children’s Hospital Tuebingen, Department I – General Pediatrics, Hematology/Oncology, Tuebingen, Germany
| | - Peter Lang
- University Children’s Hospital Tuebingen, Department I – General Pediatrics, Hematology/Oncology, Tuebingen, Germany
| | - Michael Hofbeck
- University Children’s Hospital Tuebingen, Department II – Pediatric Cardiology, Pulmonology and Intensive Care Medicine, Tuebingen, Germany
| | - Felix Neunhoeffer
- University Children’s Hospital Tuebingen, Department II – Pediatric Cardiology, Pulmonology and Intensive Care Medicine, Tuebingen, Germany
| | - Hanna Renk
- University Children’s Hospital Tuebingen, Department I – General Pediatrics, Hematology/Oncology, Tuebingen, Germany
- University Children’s Hospital Tuebingen, Department II – Pediatric Cardiology, Pulmonology and Intensive Care Medicine, Tuebingen, Germany
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4
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Öztürk M, Botan E, Gün E, Baskin AK, İslamoğlu C, Erkol GH, Havan M, Çakmak FH, Haskoloğlu Ş, İleri T, İnce E, Doğu F, Ertem M, İkinciogullari A, Kendirli T. The Determining Factors for Outcome of Pediatric Intensive Care Admitted Children After Stem Cell Transplantation. J Pediatr Hematol Oncol 2023; 45:e768-e772. [PMID: 36706283 DOI: 10.1097/mph.0000000000002610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/07/2022] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Requiring pediatric intensive care unit (PICU) admission relates to high mortality and morbidity in patients who received hematopoietic stem cell transplantation (HSCT). In this study, we aimed to evaluate the indications for PICU admission, treatments, and the determining risk factors for morbidity and mortality in patients who had allogeneic HSCT from various donors. MATERIALS AND METHODS In this retrospective study, we enrolled to patients who required the PICU after receiving allogeneic HSCT at our Pediatric Bone Marrow Transplantation Unit between 2005 and 2020. We evaluated to indication to PICU admission, applications, mortality rate, and the determining factors to outcomes. RESULTS Thirty-three (7%) patients had 47 PICU admissions and 471 patients underwent bone marrow transplantation during 16-year study period. Also, 14 repeated episodes were registered in 9 different patients. The median age of PICU admitted patients was 4 (0.3 to 18) years and 29 (62%) were male. The main reasons for PICU admission were a respiratory failure, sepsis, and neurological event in 20, 8, and 7 patients, respectively. The average length of PICU stay was 14.5 (1 to 80) days, 14 (43%) of patients survived and the mortality rate was 57%. Multiple organ failure ( P =0.001), need for respiratory support ( P =0.007), inotrope agents ( P =0.001), and renal replacement therapy ( P =0.013) were found as significant risk factors for mortality. CONCLUSIONS Allogeneic HSCT recipients need PICU admission because of its related different life-threatening complications. But there is a good chance of survival with quality PICU care and different advanced organ support methods.
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Affiliation(s)
| | - Edin Botan
- Division of Pediatric Critical Care Medicine
| | - Emrah Gün
- Division of Pediatric Critical Care Medicine
| | | | | | - Gül Hatice Erkol
- Department of Pediatric Hematology and Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Merve Havan
- Division of Pediatric Critical Care Medicine
| | - Fatih Hasan Çakmak
- Department of Pediatric Hematology and Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Talia İleri
- Department of Pediatric Hematology and Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Elif İnce
- Department of Pediatric Hematology and Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Figen Doğu
- Department of Pediatric Allergy and Immunology
| | - Mehmet Ertem
- Department of Pediatric Hematology and Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
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5
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Cirillo E, Cancrini C, Azzari C, Martino S, Martire B, Pession A, Tommasini A, Naviglio S, Finocchi A, Consolini R, Pierani P, D'Alba I, Putti MC, Marzollo A, Giardino G, Prencipe R, Esposito F, Grasso F, Scarselli A, Di Matteo G, Attardi E, Ricci S, Montin D, Specchia F, Barzaghi F, Cicalese MP, Quaremba G, Lougaris V, Giliani S, Locatelli F, Rossi P, Aiuti A, Badolato R, Plebani A, Pignata C. Clinical, Immunological, and Molecular Features of Typical and Atypical Severe Combined Immunodeficiency: Report of the Italian Primary Immunodeficiency Network. Front Immunol 2019; 10:1908. [PMID: 31456805 PMCID: PMC6700292 DOI: 10.3389/fimmu.2019.01908] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/29/2019] [Indexed: 12/22/2022] Open
Abstract
Severe combined immunodeficiencies (SCIDs) are a group of inborn errors of the immune system, usually associated with severe or life-threatening infections. Due to the variability of clinical phenotypes, the diagnostic complexity and the heterogeneity of the genetic basis, they are often difficult to recognize, leading to a significant diagnostic delay (DD). Aim of this study is to define presenting signs and natural history of SCID in a large cohort of patients, prior to hematopoietic stem cell or gene therapies. To this purpose, we conducted a 30-year retro-prospective multicenter study within the Italian Primary Immunodeficiency Network. One hundred eleven patients, diagnosed as typical or atypical SCID according to the European Society for Immune Deficiencies criteria, were included. Patients were subsequently classified based on the genetic alteration, pathogenic mechanism and immunological classification. A positive relationship between the age at onset and the DD was found. SCID patients with later onset were identified only in the last decade of observation. Syndromic SCIDs represented 28% of the cohort. Eight percent of the subjects were diagnosed in Intensive Care Units. Fifty-three percent had an atypical phenotype and most of them exhibited a discordant genotype-immunophenotype. Pre-treatment mortality was higher in atypical and syndromic patients. Our study broadens the knowledge of clinical and laboratory manifestations and genotype/phenotype correlation in patients with SCID and may facilitate the diagnosis of both typical and atypical forms of the disease in countries where newborn screening programs have not yet been implemented.
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Affiliation(s)
- Emilia Cirillo
- Pediatric Section, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Caterina Cancrini
- Department of System of Medicine University of Rome Tor Vergata, Rome, Italy.,Unit of Immune and Infectious Disease, University Department of Pediatrics DPUO, Children's Hospital Bambino Gesù, Rome, Italy
| | - Chiara Azzari
- Pediatric Immunology Unit, Anna Meyer Hospital, University of Florence, Florence, Italy
| | - Silvana Martino
- Department of Public Health and Pediatrics, Regina Margherita Children Hospital, University of Turin, Turin, Italy
| | - Baldassarre Martire
- Paediatric Hematology Oncology Unit, Policlinico-Giovanni XXII Hospital, University of Bari, Bari, Italy
| | - Andrea Pession
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alberto Tommasini
- Pediatric Hematology Oncology, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Samuele Naviglio
- Pediatric Hematology Oncology, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Andrea Finocchi
- Department of System of Medicine University of Rome Tor Vergata, Rome, Italy.,Unit of Immune and Infectious Disease, University Department of Pediatrics DPUO, Children's Hospital Bambino Gesù, Rome, Italy
| | - Rita Consolini
- Section of Pediatrics Immunology and Rheumatology, Department of Pediatrics, University of Pisa, Pisa, Italy
| | - Paolo Pierani
- Division of Pediatric Hematology and Oncology, Ospedale G. Salesi, Ancona, Italy
| | - Irene D'Alba
- Division of Pediatric Hematology and Oncology, Ospedale G. Salesi, Ancona, Italy
| | - Maria Caterina Putti
- Department of Child's and Woman's Health, Pediatric Oncology and Hematology, University of Padova, Padova, Italy
| | - Antonio Marzollo
- Department of Child's and Woman's Health, Pediatric Oncology and Hematology, University of Padova, Padova, Italy
| | - Giuliana Giardino
- Pediatric Section, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Rosaria Prencipe
- Pediatric Section, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Federica Esposito
- Pediatric Section, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Fiorentino Grasso
- Pediatric Section, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Alessia Scarselli
- Department of System of Medicine University of Rome Tor Vergata, Rome, Italy.,Unit of Immune and Infectious Disease, University Department of Pediatrics DPUO, Children's Hospital Bambino Gesù, Rome, Italy
| | - Gigliola Di Matteo
- Department of System of Medicine University of Rome Tor Vergata, Rome, Italy.,Unit of Immune and Infectious Disease, University Department of Pediatrics DPUO, Children's Hospital Bambino Gesù, Rome, Italy
| | - Enrico Attardi
- Department of System of Medicine University of Rome Tor Vergata, Rome, Italy
| | - Silvia Ricci
- Pediatric Immunology Unit, Anna Meyer Hospital, University of Florence, Florence, Italy
| | - Davide Montin
- Department of Public Health and Pediatrics, Regina Margherita Children Hospital, University of Turin, Turin, Italy
| | - Fernando Specchia
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Federica Barzaghi
- Pediatric Immunohematology and Bone Marrow Transplantation Unit, San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Pia Cicalese
- Pediatric Immunohematology and Bone Marrow Transplantation Unit, San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Quaremba
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Vassilios Lougaris
- Department of Clinical and Experimental Sciences, Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, University of Brescia, Brescia, Italy
| | - Silvia Giliani
- A. Nocivelli Institute for Molecular Medicine, Department of Molecular and Translational Medicine, University of Brescia, and ASST Spedali Civili, Brescia, Italy
| | - Franco Locatelli
- Department of Pediatric Hematology and Oncology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Paolo Rossi
- Department of System of Medicine University of Rome Tor Vergata, Rome, Italy.,Unit of Immune and Infectious Disease, University Department of Pediatrics DPUO, Children's Hospital Bambino Gesù, Rome, Italy
| | - Alessandro Aiuti
- Pediatric Immunohematology and Bone Marrow Transplantation Unit, San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaele Badolato
- Department of Clinical and Experimental Sciences, Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, University of Brescia, Brescia, Italy
| | - Alessandro Plebani
- Department of Clinical and Experimental Sciences, Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, University of Brescia, Brescia, Italy
| | - Claudio Pignata
- Pediatric Section, Department of Translational Medical Sciences, Federico II University, Naples, Italy
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6
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Al-Herz W, Essa S. Spectrum of Viral Infections Among Primary Immunodeficient Children: Report From a National Registry. Front Immunol 2019; 10:1231. [PMID: 31191561 PMCID: PMC6549382 DOI: 10.3389/fimmu.2019.01231] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/14/2019] [Indexed: 12/11/2022] Open
Abstract
Objective: To present the frequency and spectrum of viral infections in primary immunodeficient children. Methods: The data was obtained from the Kuwait National Primary Immunodeficiency Disorders (PIDs) Registry during the period of 2004-2018. Results: A total of 274 PID children were registered in KNPIDR during the study period with predominance of immunodeficiencies affecting cellular and humoral immunity, followed by combined immunodeficiencies with associated syndromic features and diseases of immune dysregulation. Overall infectious complications affected 82.4% of the patients, and viral infections affected 31.7% of the registered patients. Forty-five patients (16.4%) developed viral infections caused by at least 2 organisms, among those 20 patients were affected by three or more viral infections. There was a statistically significant association between viral infections and PID category. However, there was no statistically significant association between viral infections and gender or the patients' onset age. There was a total of 170 viral infections during the study period and the causes of these infections were predominated by CMV (22.2%), adenovirus (11.7%), EBV (11.1%), and enteroviruses (7.4%). CMV and parainfluenza infections were more common in the group of immunodeficiencies affecting cellular and humoral immunity while EBV and human papilloma virus (HPV) were more common in the immune dysregulation group and combined immunodeficiencies with associated syndromic features, respectively. The most common presentation was viremia (28.8%) followed by pneumonia (28.2%) and skin infections (17.6%). The most common causes of viremia were CMV followed by adenovirus and EBV, while the most common organisms causing pneumonia were CMV followed by rhinovirus and parainfluenza. There were 80 deaths among the registered patients, 10% were caused by viral infections. Conclusions: Viral infections are common in PIDs and result into a wide-range of clinical manifestations causing significant morbidity and mortality.
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Affiliation(s)
- Waleed Al-Herz
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.,Allergy and Clinical Immunology Unit, Pediatric Department, Al-Sabah Hospital, Kuwait City, Kuwait
| | - Sahar Essa
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
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7
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Kulkarni, AP, Sengar, M, Chinnaswamy, G, Hegde, A, Rodrigues, C, Soman, R, Khilnani, GC, Ramasubban, S, Desai, M, Pandit, R, Khasne, R, Shetty, A, Gilada, T, Bhosale, S, Kothekar, A, Dixit, S, Zirpe, K, Mehta, Y, Pulinilkunnathil, JG, Bhagat, V, Khan, MS, Narkhede, AM, Baliga, N, Ammapalli, S, Bamne, S, Turkar, S, K, VB, Choudhary, J, Kumar, R, Divatia JV. Indian Antimicrobial Prescription Guidelines in Critically Ill Immunocompromised Patients. Indian J Crit Care Med 2019; 23:S64-S96. [PMID: 31516212 PMCID: PMC6734470 DOI: 10.5005/jp-journals-10071-23102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
How to cite this article: Kulkarni AP, Sengar M, Chinnaswamy G, Hegde A, Rodrigues C, Soman R, Khilnani GC, Ramasubban S, Desai M, Pandit R, Khasne R, Shetty A, Gilada T, Bhosale S, Kothekar A, Dixit S, Zirpe K, Mehta Y, Pulinilkunnathil JG, Bhagat V, Khan MS, Narkhede AM, Baliga N, Ammapalli S, Bamne S, Turkar S, Bhat KV, Choudhary J, Kumar R, Divatia JV. Indian Journal of Critical Care Medicine 2019;23(Suppl 1): S64-S96.
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Affiliation(s)
- Atul P Kulkarni,
- Division of Critical Care Medicine, Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Dr Ernest Borges Road, Parel, Mumbai, Maharashtra, India
| | - Manju Sengar,
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Dr Ernest Borges Road, Parel, Mumbai, Maharashtra, India
| | - Girish Chinnaswamy,
- Department of Paediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Dr Ernest Borges Road, Parel, Mumbai, Maharashtra, India
| | - Ashit Hegde,
- Consultant in Medicine and Critical Care, PD Hinduja National Hospital, Mahim, Mumbai, Maharashtra, India
| | - Camilla Rodrigues,
- Consultant Microbiologist and Chair Infection Control, Hinduja Hospital, Mahim, Mumbai, Maharashtra, India
| | - Rajeev Soman,
- Consultant ID Physician, Jupiter Hospital, Pune, DeenanathMangeshkar Hospital, Pune, BharatiVidyapeeth, Deemed University Hospital, Pune, Courtsey Visiting Consultant, Hinduja Hospital Mumbai, Maharashtra, India
| | - Gopi C Khilnani,
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Suresh Ramasubban,
- Pulmomary and Critical Care Medicine, Apollo Gleneagles Hospital, 58, Canal Circular Road, Kolkata, West Bengal, India
| | - Mukesh Desai,
- Department of Immunology, Prof of Pediatric Hematology and Oncology, Bai Jerbaiwadia Hospital for Children, Consultant, Hematologist, Nanavati Superspeciality Hospital, Director of Pediatric Hematology, Surya Hospitals, Mumbai, Maharashtra, India
| | - Rahul Pandit,
- Intensive Care Unit, Fortis Hospital, Mulund Goregaon Link Road, Mulund (W), Mumbai, Maharashtra, India
| | - Ruchira Khasne,
- Critical Care Medicine, Ashoka - Medicover Hospital, Indira Nagar, Wadala Nashik, Maharashtra, India
| | - Anjali Shetty,
- Microbiology Section, 5th Floor, S1 Building, PD Hinduja Hospital, Veer Savarkar Marg, Mahim, Mumbai, Maharashtra, India
| | - Trupti Gilada,
- Consultant Physician in Infectious Disease, Unison Medicare and Research Centre and Prince Aly Khan Hospital, Maharukh Mansion, Alibhai Premji Marg, Grant Road, Mumbai, Maharashtra, India
| | - Shilpushp Bhosale,
- Intensive Care Medicine, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Center, Homi Bhabha National Institute, Dr. E. Borges Road, Parel, Mumbai, Maharashtra, India
| | - Amol Kothekar,
- Division of Critical Care Medicine, Departemnt of Anaesthesia, Critical Care and Pain, Tata Memorial Center, Homi Bhabha National Institute, Dr. E. Borges Road, Parel, Mumbai, Maharashtra, India
| | - Subhal Dixit,
- Consultant in Critical Care, Director, ICU Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Kapil Zirpe,
- Neuro-Trauma Unit, Grant Medical Foundation, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Yatin Mehta,
- Institute of Critical Care and Anesthesiology, Medanta The Medicity, Gurgaon, Haryana, India
| | - Jacob George Pulinilkunnathil,
- Division of Critical Care Medicine, Department of Anesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Dr E Borges Road, Mumbai, Maharashtra, India
| | - Vikas Bhagat,
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Center, HomiBhabha National Institute, Dr. E. Borges Road, Parel, Mumbai, Maharashtra, India
| | - Mohammad Saif Khan,
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Center, Homi Bhabha National Institute, Dr. E. Borges Road, Parel, Mumbai, Maharashtra, India
| | - Amit M Narkhede,
- Division of Critical Care Medicine, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Center, Homi Bhabha National Institute, Dr. E. Borges Road, Parel, Mumbai, Maharashtra, India
| | - Nishanth Baliga,
- Division of Critical Care Medicine, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Center, Homi Bhabha National Institute, Dr. E. Borges Road, Parel, Mumbai, Maharashtra, India
| | - Srilekha Ammapalli,
- Division of Critical Care Medicine, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Center, Homi Bhabha National Institute, Dr. E. Borges Road, Parel, Mumbai, Maharashtra, India
| | - Shrirang Bamne,
- Division of Critical Care Medicine, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Center, Homi Bhabha National Institute, Dr. E. Borges Road, Parel, Mumbai, Maharashtra, India
| | - Siddharth Turkar,
- Department of Medical Oncology, Tata Memorial Hospital, HomiBhabha National Institute, Mumbai, Maharashtra, India
| | - Vasudeva Bhat K,
- Department of Pediatric Oncology, Tata Memorial Hospital, HomiBhabha National Institute, Dr E. Borges Marg, Parel, Mumbai, Maharashtra, India
| | - Jitendra Choudhary,
- Critical Care, Fortis Hospital, 102, Nav Sai Shakti CHS, Near Bhoir Gymkhana, M Phule Road, Dombivali West Mumbai, Maharashtra, India
| | - Rishi Kumar,
- Critical Care Medicine, PD Hinduja National Hospital and MRC, Mumbai, Maharashtra, India
| | - Jigeeshu V Divatia
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Dr. E. Borges Road, Parel, Mumbai, Maharashtra, India
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8
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Harris KM, Davila BJ, Bollard CM, Keller MD. Virus-Specific T Cells: Current and Future Use in Primary Immunodeficiency Disorders. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:809-818. [PMID: 30581131 DOI: 10.1016/j.jaip.2018.10.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 12/28/2022]
Abstract
Viral infections are common and can be potentially fatal in patients with primary immunodeficiency disorders (PIDDs). Because viral susceptibility stems from poor to absent T-cell function in most patients with moderate to severe forms of PIDD, adoptive immunotherapy with virus-specific T cells (VSTs) has been used to combat viral infections in the setting of hematopoietic stem cell transplantation in multiple clinical trials. Most trials to date have targeted cytomegalovirus, EBV, and adenovirus either alone or in combination, although newer trials have expanded the number of targeted pathogens. Use of banked VSTs produced from third-party donors has also been studied as a method of expanding access to this therapy. Here we review the clinical experience with VST therapy for patients with PIDDs as well as future potential targets and approaches for the use of VSTs to improve clinical outcomes for this specific patient population.
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Affiliation(s)
- Katherine M Harris
- Center for Cancer and Immunology Research, Children's National Health System, Washington, DC
| | - Blachy J Davila
- Center for Cancer and Immunology Research, Children's National Health System, Washington, DC; Division of Blood and Marrow Transplantation, Children's National Health System, Washington, DC
| | - Catherine M Bollard
- Center for Cancer and Immunology Research, Children's National Health System, Washington, DC; Division of Blood and Marrow Transplantation, Children's National Health System, Washington, DC
| | - Michael D Keller
- Center for Cancer and Immunology Research, Children's National Health System, Washington, DC; Division of Allergy and Immunology, Children's National Health System, Washington, DC.
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9
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McLaughlin LP, Bollard CM, Keller MD. Adoptive T Cell Therapy for Epstein-Barr Virus Complications in Patients With Primary Immunodeficiency Disorders. Front Immunol 2018; 9:556. [PMID: 29616044 PMCID: PMC5867312 DOI: 10.3389/fimmu.2018.00556] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/05/2018] [Indexed: 12/28/2022] Open
Abstract
Patients with primary immunodeficiency disorders (PID) have an increased risk from acute and chronic Epstein–Barr Virus (EBV) viral infections and EBV-associated malignancies. Hematopoietic stem cell transplantation (HSCT) is a curative strategy for many patients with PID, but EBV-related complications are common in the immediate post-transplant period due to delayed reconstitution of T cell immunity. Adoptive T cell therapy with EBV-specific T cells is a promising therapeutic strategy for patients with PID both before and after HSCT. Here we review the methods used to manufacture EBV-specific T cells, the clinical outcomes, and the ongoing challenges for future development of the strategy.
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Affiliation(s)
- Lauren P McLaughlin
- Center for Cancer and Immunology Research, Children's National Health System, The George Washington University, Washington, DC, United States.,Division of Oncology, Children's National Health System, Washington, DC, United States
| | - Catherine M Bollard
- Center for Cancer and Immunology Research, Children's National Health System, The George Washington University, Washington, DC, United States.,Division of Allergy and Immunology, Children's National Health System, Washington, DC, United States.,Division of Blood and Marrow Transplantation, Children's National Health System, Washington, DC, United States
| | - Michael D Keller
- Center for Cancer and Immunology Research, Children's National Health System, The George Washington University, Washington, DC, United States.,Division of Allergy and Immunology, Children's National Health System, Washington, DC, United States
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10
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Yıldıran A, Çeliksoy MH, Borte S, Güner ŞN, Elli M, Fışgın T, Özyürek E, Sancak R, Oğur G. Hematopoietic Stem Cell Transplantation in Primary Immunodeficiency Patients in the Black Sea Region of Turkey. Turk J Haematol 2017; 34:345-349. [PMID: 28404538 PMCID: PMC5774364 DOI: 10.4274/tjh.2016.0477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Hematopoietic stem cell transplantation is a promising curative therapy for many combined primary immunodeficiencies and phagocytic disorders. We retrospectively reviewed pediatric cases of patients diagnosed with primary immunodeficiencies and scheduled for hematopoietic stem cell transplantation. We identified 22 patients (median age, 6 months; age range, 1 month to 10 years) with various diagnoses who received hematopoietic stem cell transplantation. The patient diagnoses included severe combined immunodeficiency (n=11), Chediak-Higashi syndrome (n=2), leukocyte adhesion deficiency (n=2), MHC class 2 deficiency (n=2), chronic granulomatous syndrome (n=2), hemophagocytic lymphohistiocytosis (n=1), Wiskott-Aldrich syndrome (n=1), and Omenn syndrome (n=1). Of the 22 patients, 7 received human leukocyte antigen-matched related hematopoietic stem cell transplantation, 12 received haploidentical hematopoietic stem cell transplantation, and 2 received matched unrelated hematopoietic stem cell transplantation. The results showed that 5 patients had graft failure. Fourteen patients survived, yielding an overall survival rate of 67%. Screening newborn infants for primary immunodeficiency diseases may result in timely administration of hematopoietic stem cell transplantation.
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Affiliation(s)
- Alişan Yıldıran
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Allergy and Immunology, Samsun, Turkey
| | - Mehmet Halil Çeliksoy
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Allergy and Immunology, Samsun, Turkey
| | - Stephan Borte
- Leipzig University, Translational Centre for Regenerative Medicine, Leipzig, Germany
| | - Şükrü Nail Güner
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Allergy and Immunology, Samsun, Turkey
| | - Murat Elli
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Hematology and Oncology, Samsun, Turkey
| | - Tunç Fışgın
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Hematology and Oncology, Samsun, Turkey
| | - Emel Özyürek
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Hematology and Oncology, Samsun, Turkey
| | - Recep Sancak
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Allergy and Immunology, Samsun, Turkey
| | - Gönül Oğur
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Genetic, Samsun, Turkey
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11
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Adoptive T Cell Immunotherapy for Patients with Primary Immunodeficiency Disorders. Curr Allergy Asthma Rep 2017; 17:3. [PMID: 28116637 DOI: 10.1007/s11882-017-0669-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Primary immunodeficiency disorders (PID) are a group of inborn errors of immunity with a broad range of clinical severity but often associated with recurrent and serious infections. While hematopoietic stem cell transplantation (HSCT) can be curative for some forms of PID, chronic and/or refractory viral infections remain a cause of morbidity and mortality both before and after HSCT. Although antiviral pharmacologic agents exist for many viral pathogens, these are associated with significant costs and toxicities and may not be effective for increasingly drug-resistant pathogens. Thus, the emergence of adoptive immunotherapy with virus-specific T lymphocytes (VSTs) is an attractive option for addressing the underlying impaired T cell immunity in many PID patients. VSTs have been utilized for PID patients following HSCT in many prior phase I trials, and may potentially be beneficial before HSCT in patients with chronic viral infections. We review the various methods of generating VSTs, clinical experience using VSTs for PID patients, and current limitations as well as potential ways to broaden the clinical applicability of adoptive immunotherapy for PID patients.
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12
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Naik S, Nicholas SK, Martinez CA, Leen AM, Hanley PJ, Gottschalk SM, Rooney CM, Hanson IC, Krance RA, Shpall EJ, Cruz CR, Amrolia P, Lucchini G, Bunin N, Heimall J, Klein OR, Gennery AR, Slatter MA, Vickers MA, Orange JS, Heslop HE, Bollard CM, Keller MD. Adoptive immunotherapy for primary immunodeficiency disorders with virus-specific T lymphocytes. J Allergy Clin Immunol 2016; 137:1498-1505.e1. [PMID: 26920464 PMCID: PMC4860050 DOI: 10.1016/j.jaci.2015.12.1311] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 11/27/2015] [Accepted: 12/14/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Viral infections are a leading fatal complication for patients with primary immunodeficiencies (PIDs) who require hematopoietic stem cell transplantation (HSCT). Use of virus-specific T lymphocytes (VSTs) has been successful for the treatment and prevention of viral infections after HSCT for malignant and nonmalignant conditions. Here we describe the clinical use of VSTs in patients with PIDs at 4 centers. OBJECTIVE We sought to evaluate the safety and efficacy of VSTs for treatment of viral infections in patients with PIDs. METHODS Patients with PIDs who have received VST therapy on previous or current protocols were reviewed in aggregate. Clinical information, including transplantation details, viral infections, and use of antiviral and immunosuppressive pharmacotherapy, were evaluated. Data regarding VST production, infusions, and adverse reactions were compared. RESULTS Thirty-six patients with 12 classes of PID diagnoses received 37 VST products before or after HSCT. Twenty-six (72%) patients had received a diagnosis of infection with cytomegalovirus, EBV, adenovirus, BK virus, and/or human herpesvirus 6. Two patients were treated before HSCT because of EBV-associated lymphoproliferative disease. Partial or complete responses against targeted viruses occurred in 81% of patients overall. Time to response varied from 2 weeks to 3 months (median, 28 days). Overall survival at 6 months after therapy was 80%. Four patients had graft-versus-host disease in the 45 days after VST infusion, which in most cases was therapy responsive. CONCLUSION VSTs derived from either stem cell donors or third-party donors are likely safe and effective for the treatment of viral infections in patients with PIDs.
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Affiliation(s)
- Swati Naik
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston Methodist Hospital, Houston, Tex; Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Sarah K Nicholas
- Department of Pediatrics, Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Houston, Tex; Center for Human Immunobiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex
| | - Caridad A Martinez
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston Methodist Hospital, Houston, Tex; Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Ann M Leen
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston Methodist Hospital, Houston, Tex
| | - Patrick J Hanley
- Center for Cancer and Immunology Research, Children's National Medical Center, Washington, DC; Division of Blood and Marrow Transplantation, Children's National Medical Center, Washington, DC
| | - Steven M Gottschalk
- Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Cliona M Rooney
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston Methodist Hospital, Houston, Tex
| | - I Celine Hanson
- Department of Pediatrics, Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Houston, Tex
| | - Robert A Krance
- Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Conrad R Cruz
- Sheikh Zayed Institute, Children's National Medical Center, Washington, DC
| | - Persis Amrolia
- Bone Marrow Transplantation Department, Great Ormond Street Hospital, London, United Kingdom
| | - Giovanna Lucchini
- Bone Marrow Transplantation Department, Great Ormond Street Hospital, London, United Kingdom
| | - Nancy Bunin
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Jennifer Heimall
- Division of Allergy & Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Orly R Klein
- Department of Oncology, Division of Pediatric Hematology/Oncology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Andrew R Gennery
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mary A Slatter
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mark A Vickers
- Scottish National Blood Transfusion Service, Aberdeen, United Kingdom; University of Aberdeen, Aberdeen, United Kingdom
| | - Jordan S Orange
- Department of Pediatrics, Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Houston, Tex; Center for Human Immunobiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex
| | - Helen E Heslop
- Center for Cell and Gene Therapy, Baylor College of Medicine, Texas Children's Hospital, Houston Methodist Hospital, Houston, Tex; Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Catherine M Bollard
- Center for Cancer and Immunology Research, Children's National Medical Center, Washington, DC; Division of Blood and Marrow Transplantation, Children's National Medical Center, Washington, DC
| | - Michael D Keller
- Center for Cancer and Immunology Research, Children's National Medical Center, Washington, DC; Division of Allergy and Immunology, Children's National Medical Center, Washington, DC.
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