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Nassar R, Hougui O, Zerem M, Omary M, Assi Z, Ling G, Yerushalmi B. Esophageal Atresia with Tracheoesophageal Fistula Is Associated with Consanguinity. J Pediatr 2024; 275:114242. [PMID: 39151598 DOI: 10.1016/j.jpeds.2024.114242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/17/2024] [Accepted: 08/12/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVE To examine the association between nonsyndromic esophageal atresia with tracheoesophageal fistula (EA-TEF) and consanguinity. STUDY DESIGN A retrospective study comparing the incidence of EA-TEF between a low-consanguineous Jewish population and a high-consanguineous Bedouin population. All patients were treated at Soroka University Medical Center, the only tertiary medical center in southern Israel. RESULTS From 2000 to 2022, 579 130 children were born in southern Israel, and 386 915 (66.8%) were Jewish, and 192 215 were Bedouin Muslims. A total of 96 patients were diagnosed with EA-TEF; 83 of them were nonsyndromic. The incidence of EA-TEF was 1.66 cases per 10 000 live births and was statistically higher among the Bedouin population (3 vs 0.95 cases per 10 000 live births; P < .001). The consanguinity rate among the Bedouin group was higher compared with the Jewish (67.8% vs 0%; P < .001). There were no differences in other risk factors. CONCLUSIONS The incidence of EA-TEF is higher among the Bedouin population that lives in the same geographic region and has the same medical access as the Jewish population, proposing consanguinity as a risk factor for EA-TEF.
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Affiliation(s)
- Raouf Nassar
- Pediatric Gastrointestinal Unit, Soroka University Medical Center, Beer-Sheva, Israel; Pediatrics Department A, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Ohad Hougui
- Pediatric Gastrointestinal Unit, Soroka University Medical Center, Beer-Sheva, Israel; Pediatrics Department A, Soroka University Medical Center, Beer-Sheva, Israel
| | - Matan Zerem
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Maha Omary
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Zaki Assi
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Pediatric Surgery Department, Soroka University Medical Center, Beer-Sheva, Israel
| | - Galina Ling
- Pediatric Gastrointestinal Unit, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Baruch Yerushalmi
- Pediatric Gastrointestinal Unit, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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2
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Slaton D, Chang A, Ahluwalia T, Alfaro S, Javed B, Greer R. Zellweger's Syndrome With PEX6 Gene Mutation in Mixteco Neonates Due to Possible Founder Effect. Cureus 2023; 15:e45162. [PMID: 37842507 PMCID: PMC10573658 DOI: 10.7759/cureus.45162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
Zellweger spectrum disorder (ZSD) is a group of autosomal recessive peroxisomal disorders caused by PEX gene mutations that commonly present with symptoms of severe hypotonia, epileptic seizures, failure to thrive, hepatomegaly, craniofacial dysmorphisms, and sensorineural hearing loss. This article highlights three patients born with ZSD in Central California. All three patients were born to Mixteco mothers. Patients were genetically analyzed, which revealed mutations that correspond to ZSD. They presented with hypotonia at birth, abnormal hepatic panels, and increased fatty acid levels, findings consistent with Zellweger syndrome (ZS). However, only two of three patients displayed sensorineural hearing loss. Two of the patients failed to survive more than one year of age, which reflects the average life expectancy of an infant presenting with ZS. Observed and recorded cases of ZS in the Mixteco population have been postulated to be related to consanguinity and/or a founder effect. Studies have shown that autosomal recessive diseases are more prevalent in consanguineous populations. Consanguinity has been denied by patient 1 and is unknown for patients 2 and 3. Founder mutations have been implicated in areas with high rates of autosomal recessive diseases. All three of our Mixteco patients share a distinct lineage as well as a mutation at PEX6, leading us to believe that they suffered from an inherited founder mutation. The Mixteco population is not studied well enough to come to a definitive conclusion; however, the recognition of the relationship between ZS and Mixteco background is important, as it allows parents to plan accordingly and increases awareness in the community.
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Affiliation(s)
- Daniel Slaton
- School of Osteopathic Medicine, Andrew Taylor (AT) Still University, Mesa, USA
| | - Ashley Chang
- School of Osteopathic Medicine, Andrew Taylor (AT) Still University, Mesa, USA
| | - Tamanna Ahluwalia
- School of Osteopathic Medicine, Andrew Taylor (AT) Still University, Mesa, USA
| | - Sophie Alfaro
- School of Osteopathic Medicine, Andrew Taylor (AT) Still University, Mesa, USA
| | - Britani Javed
- Clinical Science Education, Andrew Taylor (AT) Still University, Mesa, USA
| | - Rocky Greer
- Neonatal Medicine, Marian Regional Medical Center, Santa Maria, USA
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3
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Hyper IgM in tricho-hepato-enteric syndrome due to TTC37 mutation. Immunol Res 2022; 70:775-780. [PMID: 35776314 DOI: 10.1007/s12026-022-09305-9] [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: 03/30/2022] [Accepted: 06/27/2022] [Indexed: 11/05/2022]
Abstract
Tricho-hepato-enteric syndrome (THES) (OMIM #222,470) is a rare autosomal recessive syndromic enteropathy whose primary manifestations are dysmorphism, intractable diarrhea, failure to thrive, hair abnormalities, liver disease, and immunodeficiency with low serum IgG concentrations. THES is caused by mutations of either Tetratricopeptide Repeat Domain 37 (TTC37) or Ski2 like RNA Helicase (SKIV2L), genes that encode two components of the human SKI complex. Here, we report a patient with a TTC37 homozygous mutation phenotypically typical for tricho-hepato-enteric syndrome in whom extremely elevated IgM with low IgG was present at the time of diagnosis. These manifestations were not previously described in THES patients and this raised our index of suspicion towards "atypical" hyper IgM syndrome. Although the pathogenesis of immunoglobulin production dysfunction in THES is still elusive, this disorder should be considered in the differential diagnosis in patients with elevated IgM and syndromic features.
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4
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Bistritzer J, Mijalovsky A, Nissenkorn A, Flusser H, Levy J, Nahum A, Broides A. Phenotypic variability in patients with unique double homozygous mutations causing variant ataxia telangiectasia. Eur J Paediatr Neurol 2021; 32:36-39. [PMID: 33743388 DOI: 10.1016/j.ejpn.2021.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/06/2021] [Accepted: 03/02/2021] [Indexed: 11/17/2022]
Abstract
Ataxia-Telangiectasia (A-T) is a neurodegenerative disease caused by bi-allelic mutations in the Ataxia-Telangiectasia-Mutated (ATM) gene. Complete lack of ATM activity leads to severe A-T and mutations allowing for residual activity cause a milder phenotype, termed variant A-T. There are only sparse data on the variability in phenotypes of variant A-T patients carrying the same mutations. A retrospective study of 15 patients with variant A-T, all double homozygous for the same mutations was conducted. The age of first symptom ranged from 4-180 months, including: truncal ataxia at <18 months of age in 9 patients, ataxia and instability only during fever in one patient, dystonia in one patient and malignancy in 4 patients. Global developmental delay and occulo-motor apraxia were recorded in 4/14 patients. Variant A-T patients with the same mutations in ATM, have variable phenotypes. Environmental, epigenetic, and post translational factors are likely to play a role in creation of the phenotype in variant A-T patients.
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Affiliation(s)
- Jacob Bistritzer
- Zusman Child Development Center, Soroka University Medical Center, Beer-Sheva, Israel; Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel.
| | - Analia Mijalovsky
- Zusman Child Development Center, Soroka University Medical Center, Beer-Sheva, Israel; Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Andreea Nissenkorn
- Pediatric Neurology Unit, Edith Wolfson Medical Center, Holon, Israel; National AT Center, Chaim Sehba Medical Center, Ramat-Gan, Israel; The Sackler School of Medicine, Tel Aviv Univerity. Tel Aviv, Israel
| | - Hagit Flusser
- Zusman Child Development Center, Soroka University Medical Center, Beer-Sheva, Israel; Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Jacov Levy
- Pediatric Immunology, Soroka University Medical Center, Beer-Sheva, Israel; Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Amit Nahum
- Department of Pediatrics A, Soroka University Medical Center, Beer-Sheva, Israel; Pediatric Immunology, Soroka University Medical Center, Beer-Sheva, Israel; Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Arnon Broides
- Pediatric Immunology, Soroka University Medical Center, Beer-Sheva, Israel; Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
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5
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Exploring genetic defects in adults who were clinically diagnosed as severe combined immune deficiency during infancy. Immunol Res 2021; 69:145-152. [PMID: 33599911 DOI: 10.1007/s12026-021-09179-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/03/2021] [Indexed: 12/16/2022]
Abstract
Genetic diagnostic tools including whole-exome sequencing (WES) have advanced our understanding in human diseases and become common practice in diagnosing patients with suspected primary immune deficiencies. Establishing a genetic diagnosis is of paramount importance for tailoring adequate therapeutic regimens, including identifying the need for hematopoietic stem cell transplantation (HSCT) and genetic-based therapies. Here, we genetically studied two adult patients who were clinically diagnosed during infancy with severe combined immune deficiency (SCID). Two unrelated patients, both of consanguineous kindred, underwent WES in adulthood, 2 decades after their initial clinical manifestations. Upon clinical presentation, immunological workup was performed, which led to a diagnosis of SCID. The patients presented during infancy with failure to thrive, generalized erythematous rash, and recurrent gastrointestinal and respiratory tract infections, including episodes of Pneumocystis pneumonia infection and Candida albicans fungemia. Hypogammaglobulinemia and T-cell lymphopenia were detected. Both patients were treated with a 10/10 HLA matched sibling donor unconditioned HSCT. Retrospective genetic workup revealed homozygous bi-allelic mutations in IL7RA in one patient and in RAG2 in the other. Our study exemplifies the impact of retrospectively establishing a genetic diagnosis. Pinpointing the genetic cause raises several issues including optimized surveillance and treatment, understanding disease mechanisms and outcomes, future family planning, and social and psychological considerations.
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6
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Ling E, Broides A, Ling G, Shubinsky G, Hadad N, Nahum A, Simon AJ, Lev A, Somech R. A novel zeta-associated protein 70 homozygous mutation causing combined immunodeficiency presenting as neonatal autoimmune hemolytic anemia. Immunol Res 2021; 69:100-106. [PMID: 33484432 DOI: 10.1007/s12026-021-09172-w] [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: 09/25/2020] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
Biallelic mutations in the zeta-associated protein 70 (ZAP70) gene cause combined immunodeficiency (CID). Neonatal screening for severe CID in Israel is implemented since 2015. We report on clinical, flow cytometry, and genetic data of an unusual ZAP70 deficiency patient. A 10-week-old Bedouin female presented with severe autoimmune hemolytic anemia. Cytomegalovirus (CMV) negative packed cell therapy was given without improvement; indexes of hemolysis worsened. At this time, thrombocytopenia was noted. The patient was treated with single dose of 1 g/kg intravenous immunoglobulin with rapid resolution of hemolysis. Serum immunoglobulin concentrations were normal; flow cytometry revealed severe CD8 lymphocytopenia. Lymphocyte proliferation test demonstrated reduced response to concanavalin A and phytohemagglutinin. Gated T cells were negative for intracellular ZAP70. A genetic analysis revealed a missense homozygous c.1388C > T (p.A463V) mutation, confirming the diagnosis of ZAP70 deficiency. She later on developed urinary tract infection due to ESBL producing E. coli treated with amikacin and severe CMV infection that partially responded to ganciclovir therapy and at 7 months of age, she successfully underwent allogeneic hematopoietic stem cell transplantation. Neonatal screening by T cell receptor excision circles (TRECs) for SCID was normal, yet very low TRECs were recorded at the time of CID diagnosis. Normal neonatal screening for SCID does not rule out the diagnosis of CID due to ZAP70 deficiency. This type of CID can present with autoimmunity as the sole initial manifestation of the disease.
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Affiliation(s)
- Eduard Ling
- Department of Pediatrics B and Pediatric Rheumatology Clinic, Soroka University Medical Center, Rager Avenue, Beer Sheva, Israel. .,Soroka University Medical Center, Beer Sheva, Israel. .,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Arnon Broides
- Soroka University Medical Center, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Pediatric Immunology Clinic, Beer Sheva, Israel
| | - Galina Ling
- Soroka University Medical Center, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Pediatric Gastroenterology and Nutrition Unit and Pediatric Ambulatory Service, Tel Aviv, Israel
| | - George Shubinsky
- Soroka University Medical Center, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Flow Cytometry Unit, Beer Sheva, Israel
| | - Nurit Hadad
- Soroka University Medical Center, Beer Sheva, Israel.,Infectious Disease Laboratory, Tel Aviv, Israel
| | - Amit Nahum
- Soroka University Medical Center, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Pediatric Immunology Clinic, Beer Sheva, Israel
| | - Amos J Simon
- Pediatric Immunology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Atar Lev
- Pediatric Immunology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Raz Somech
- Pediatric Immunology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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7
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Marcus N, Frizinsky S, Hagin D, Ovadia A, Hanna S, Farkash M, Maoz-Segal R, Agmon-Levin N, Broides A, Nahum A, Rosenberg E, Kuperman AA, Dinur-Schejter Y, Berkun Y, Toker O, Goldberg S, Confino-Cohen R, Scheuerman O, Badarneh B, Epstein-Rigbi N, Etzioni A, Dalal I, Somech R. Minor Clinical Impact of COVID-19 Pandemic on Patients With Primary Immunodeficiency in Israel. Front Immunol 2021; 11:614086. [PMID: 33519822 PMCID: PMC7840610 DOI: 10.3389/fimmu.2020.614086] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/01/2020] [Indexed: 12/13/2022] Open
Abstract
In the last few months the world has witnessed a global pandemic due to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection causing coronavirus disease 2019 (COVID-19). Obviously, this pandemic affected individuals differently, with a significant impact on populations considered to be at high-risk. One such population, was assumed to be patients with primary genetic defect involving components or pathways of the immune system. While human immunity against COVID-19 is not fully understood, it is, so far, well documented, that both adaptive and innate cells have a critical role in protection against SARS-CoV-2. Here, we aimed to summarize the clinical and laboratory data on primary immunodeficiency (PID) patients in Israel, who were tested positive for SARS-CoV-2, in order to estimate the impact of COVID-19 on such patients. Data was collected from mid-February to end-September. During this time Israel experienced two “waves” of COVID-19 diseases; the first, from mid-February to mid-May and the second from mid-June and still ongoing at the end of data collection. A total of 20 PID patients, aged 4 months to 60 years, were tested positive for SARS-CoV-2, all but one, were detected during the second wave. Fourteen of the patients were on routine monthly IVIG replacement therapy at the time of virus detection. None of the patients displayed severe illness and none required hospitalization; moreover, 7/20 patients were completely asymptomatic. Possible explanations for the minimal clinical impact of COVID-19 pandemic observed in our PID patients include high level of awareness, extra-precautions, and even self-isolation. It is also possible that only specific immune pathways (e.g. type I interferon signaling), may increase the risk for a more severe course of disease and these are not affected in many of the PID patients. In some cases, lack of an immune response actually may be a protective measure against the development of COVID-19 sequelae.
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Affiliation(s)
- Nufar Marcus
- Allergy and Immunology Unit, Schneider Children's Medical Center of Israel, Felsenstein Medical Research Center, Kipper Institute of Immunology, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States
| | - Shirly Frizinsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Pediatric Department A and the Immunology Service, Jeffrey Modell Foundation Center, "Edmond and Lily Safra" Children's Hospital, Sheba Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.,Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - David Hagin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Department of Medicine, Allergy and Clinical Immunology Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Adi Ovadia
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Pediatric Allergy Unit, E. Wolfson Medical Center, Holon, Israel.,Pediatric Department, E. Wolfson Medical Center, Holon, Israel
| | - Suhair Hanna
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Ruth Children Hospital, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Michael Farkash
- Allergy and Immunology Unit, Schneider Children's Medical Center of Israel, Felsenstein Medical Research Center, Kipper Institute of Immunology, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States
| | - Ramit Maoz-Segal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Nancy Agmon-Levin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Arnon Broides
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Immunology Clinic, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Amit Nahum
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Immunology Clinic, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Elli Rosenberg
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Immunology Clinic, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Amir Asher Kuperman
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.,Blood Coagulation Service and Pediatric Hematology Clinic, Galilee Medical Center, Nahariya, Israel
| | - Yael Dinur-Schejter
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Bone Marrow Transplantation Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yackov Berkun
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Department of Pediatrics, Mount Scopus Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ori Toker
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,The Allergy and Immunology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Shmuel Goldberg
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Pediatric Pulmonary Unit, Pediatric Division, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ronit Confino-Cohen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Allergy and Clinical Immunology Unit, Meir Medical Center, Kfar-Saba, Israel
| | - Oded Scheuerman
- Pediatrics B, Schneider Children Medical Center Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Basel Badarneh
- Allergy and Immunology Unit, Schneider Children's Medical Center of Israel, Felsenstein Medical Research Center, Kipper Institute of Immunology, Petach Tikva, Israel.,Pediatric Department, Allergy and Immunology Clinic, Carmel Medical Center, Technion Faculty of Medicine, Haifa, Israel
| | - Na'ama Epstein-Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Former Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Amos Etzioni
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Ruth Children Hospital, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ilan Dalal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Pediatric Allergy Unit, E. Wolfson Medical Center, Holon, Israel.,Pediatric Department, E. Wolfson Medical Center, Holon, Israel
| | - Raz Somech
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Pediatric Department A and the Immunology Service, Jeffrey Modell Foundation Center, "Edmond and Lily Safra" Children's Hospital, Sheba Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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8
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Hazan G, Hershkovitz E, Staretz-Chacham O. Incidence of inherited metabolic disorders in southern Israel: a comparison between consanguinity and non-consanguinity communities. Orphanet J Rare Dis 2020; 15:331. [PMID: 33239050 PMCID: PMC7687810 DOI: 10.1186/s13023-020-01578-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/13/2020] [Indexed: 11/29/2022] Open
Abstract
Background Inherited metabolic disorders (IMDs) are group of rare monogenic diseases, usually derived from reduced or absent activity in a single metabolic pathway. Most of the IMDs are inherited in an autosomal recessive manner. The incidence of IMDs varies from country to country and within different ethnic groups, but data is still scarce. Consanguinity rate among populations is highly contributor factor for IMDs incidence. There are no reports comparing the incidence of IMD in consanguineous and non-consanguineous populations from the same geographic region with the same diagnostic capabilities. Our study objective is to compare the incidence of IMDs between between the relatively low consanguineous Jewish population and the consanguineous Bedouin population, both living in the southern of Israel. Results During 1990–2017 there were 393,772 live births in the Negev district, of Southern of Israel. Among them 187,049 were of Jewish origin while 206,723 were of Bedouin-Muslim origin. A total of 223 children were diagnosed in this study period with IMDs. Among those 223 children with IMD, 33 were of Jewish origin while the other 190 children were of Bedouin-Muslim origin. The overall incidence for IMDs of the overall Negev population was 56.6/100,000 live birth. The incidence for IMD's among the Bedouin population was significantly higher than among Jewish population. Conclusions IMDs are extremely more common in the consanguineous Bedouin compared with the relatively non-consanguineous Jewish population of Southern Israel. Health policy makers should consider these data and prepare educational and genetic counselling problems accordingly.
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Affiliation(s)
- G Hazan
- Division of Pediatrics, Soroka University Medical Center, Ben Gurion University, Beer Sheva, Israel
| | - E Hershkovitz
- Division of Pediatrics, Soroka University Medical Center, Ben Gurion University, Beer Sheva, Israel.,Metabolic Clinic, Soroka University Medical Center, Ben Gurion University, 151 Rager Ave., Beer Sheva, Israel
| | - O Staretz-Chacham
- Metabolic Clinic, Soroka University Medical Center, Ben Gurion University, 151 Rager Ave., Beer Sheva, Israel. .,Neonatlogy Unit, Soroka University Medical Center, Ben Gurion University, Beer Sheva, Israel.
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9
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Goldberg L, Simon AJ, Lev A, Barel O, Stauber T, Kunik V, Rechavi G, Somech R. Atypical immune phenotype in severe combined immunodeficiency patients with novel mutations in IL2RG and JAK3. Genes Immun 2020; 21:326-334. [PMID: 32921793 DOI: 10.1038/s41435-020-00111-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/14/2020] [Accepted: 09/02/2020] [Indexed: 11/09/2022]
Abstract
Mutations in the common gamma chain of the interleukin 2 receptor (IL2RG) or the associated downstream signaling enzyme Janus kinase 3 (JAK3) genes are typically characterized by a T cell-negative, B cell-positive, natural killer (NK) cell-negative (T-B+NK-) severe combined immunodeficiency (SCID) immune phenotype. We report clinical course, immunological, genetic and proteomic work-up of two patients with different novel mutations in the IL-2-JAK3 pathway with a rare atypical presentation of T-B+NK- SCID. Lymphocyte subpopulation revealed significant T cells lymphopenia, normal B cells, and NK cells counts (T-B+NK+SCID). Despite the presence of B cells, IgG levels were low and IgA and IgM levels were undetectable. T-cell proliferation in response to mitogens in patient 1 was very low and T-cell receptor V-beta chain repertoire in patient 2 was polyclonal. Whole-exome sequencing revealed novel mutations in both patients (patient 1-c.923delC frame-shift mutation in the IL2RG gene, patient 2-c.G172A a homozygous missense mutation in the JAK3 gene). Bioinformatic analysis of the JAK3 mutation indicated deleterious effect and 3D protein modeling located the mutation to a surface exposed alpha-helix structure. Our findings help to link between genotype and phenotype, which is a key factor for the diagnosis and treatment of SCID patients.
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Affiliation(s)
- Lior Goldberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Department A, Pediatric Immunology Service, Jeffrey Modell Foundation (JMF) Center, Sheba Medical Center, Tel HaShomer, Israel
| | - Amos J Simon
- Pediatric Department A, Pediatric Immunology Service, Jeffrey Modell Foundation (JMF) Center, Sheba Medical Center, Tel HaShomer, Israel.,Sheba Cancer Research Center, Sheba Medical Center, Tel HaShomer, Israel
| | - Atar Lev
- Pediatric Department A, Pediatric Immunology Service, Jeffrey Modell Foundation (JMF) Center, Sheba Medical Center, Tel HaShomer, Israel
| | - Ortal Barel
- Sheba Cancer Research Center, Sheba Medical Center, Tel HaShomer, Israel.,The Wohl Institute for Translational Medicine, Sheba Medical Center, Tel HaShomer, Israel
| | - Tali Stauber
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Department A, Pediatric Immunology Service, Jeffrey Modell Foundation (JMF) Center, Sheba Medical Center, Tel HaShomer, Israel
| | - Vered Kunik
- Bioinformatics Consulting, Gat Rimon, Israel
| | - Gideon Rechavi
- Sheba Cancer Research Center, Sheba Medical Center, Tel HaShomer, Israel.,The Wohl Institute for Translational Medicine, Sheba Medical Center, Tel HaShomer, Israel
| | - Raz Somech
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Pediatric Department A, Pediatric Immunology Service, Jeffrey Modell Foundation (JMF) Center, Sheba Medical Center, Tel HaShomer, Israel.
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10
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El-Sayed ZA, Radwan N. Newborn Screening for Primary Immunodeficiencies: The Gaps, Challenges, and Outlook for Developing Countries. Front Immunol 2020; 10:2987. [PMID: 32082296 PMCID: PMC7002357 DOI: 10.3389/fimmu.2019.02987] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 12/05/2019] [Indexed: 01/04/2023] Open
Abstract
Primary immunodeficiency diseases (PIDs) are genetically inherited diseases characterized by an increased susceptibility to infections, autoimmunity, lymphoproliferation, and malignancies. PIDs are under-diagnosed and the registered cases and reported prevalence are far below the estimated numbers especially in countries with large population and high consanguinity rates. Delays in diagnosis yield major morbidities and mortalities with resultant increased economic burden. Newborn screening using TRECs and KRECs, currently being implemented in some countries, is aimed through early diagnosis, to overcome the delays in the diagnosis and hence the poor outcome of some of the severe PIDs. However, the limited resources in developing countries challenges the implementation of newborn PID screening programs. There are considerable gaps in our knowledge that must be bridged. Setting the norms of TRECs and KRECs for each country is needed. Furthermore, some PIDs that might present in the neonatal period could not be detected by the current screening programs, and their diagnosis requires clinical expertise. Not to mention, local guidelines for the management of patients diagnosed by NBS should be set forth. Also, in the absence of NBS, clinicians should be aware of the early manifestations of PID. All these mandate conducting studies genuine to each country, developing programs for raising public awareness and clinical training of physicians to attain the required immunological skills.
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Affiliation(s)
- Zeinab A El-Sayed
- Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Nesrine Radwan
- Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
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11
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Greenberg-Kushnir N, Lee YN, Simon AJ, Lev A, Marcus N, Abuzaitoun O, Somech R, Stauber T. A Large Cohort of RAG1/2-Deficient SCID Patients—Clinical, Immunological, and Prognostic Analysis. J Clin Immunol 2019; 40:211-222. [DOI: 10.1007/s10875-019-00717-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 11/01/2019] [Indexed: 12/13/2022]
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12
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Lev A, Simon AJ, Barel O, Eyal E, Glick-Saar E, Nayshool O, Birk O, Stauber T, Hochberg A, Broides A, Almashanu S, Hendel A, Lee YN, Somech R. Reduced Function and Diversity of T Cell Repertoire and Distinct Clinical Course in Patients With IL7RA Mutation. Front Immunol 2019; 10:1672. [PMID: 31379863 PMCID: PMC6650764 DOI: 10.3389/fimmu.2019.01672] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/04/2019] [Indexed: 01/01/2023] Open
Abstract
The alpha subunit of IL-7 receptor (IL7R7α) is critical for the differentiation of T cells, specifically for the development and maintenance of γδT cells. Mutations in IL7RA are associated with Severe Combined Immunodeficiency (SCID). Infants with IL7RA deficiency can be identified through newborn screening program. We aimed at defining the immunological and genetic parameters that are directly affected by the IL7RA mutation on the immune system of five unrelated patients which were identified by our newborn screening program for SCID. The patients were found to have a novel identical homozygote mutation in IL7RA (n.c.120 C>G; p.F40L). Both surface expression of IL7Rα and functionality of IL-7 signaling were impaired in patients compared to controls. Structural modeling demonstrated instability of the protein structure due to the mutation. Lastly the TRG immune repertoire of the patients showed reduced diversity, increased clonality and differential CDR3 characteristics. Interestingly, the patients displayed significant different clinical outcome with two displaying severe clinical picture of immunodeficiency and three had spontaneous recovery. Our data supports that the presented IL7RA mutation affects the IL-7 signaling and shaping of the TRG repertoire, reinforcing the role of IL7RA in the immune system, while non-genetic factors may exist that attribute to the ultimate clinical presentation and disease progression.
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Affiliation(s)
- Atar Lev
- The National Lab for Diagnosing SCID - The Israeli Newborn Screening Program, Pediatric Department A and the Immunology Service, Jeffrey Modell Foundation Center, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Israel Ministry of Health, Tel HaShomer, Israel.,The Mina and Everard Goodman Faculty of Life Sciences, Advanced Materials and Nanotechnology Institute, Bar-Ilan University, Ramat-Gan, Israel
| | - Amos J Simon
- Sheba Cancer Research Center and Institute of Hematology, Sheba Medical Center, Tel HaShomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ortal Barel
- Sheba Cancer Research Center and Institute of Hematology, Sheba Medical Center, Tel HaShomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Eyal
- Sheba Cancer Research Center and Institute of Hematology, Sheba Medical Center, Tel HaShomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Wohl Institute for Translational Medicine, Sheba Medical Center, Tel HaShomer, Israel
| | - Efrat Glick-Saar
- Sheba Cancer Research Center and Institute of Hematology, Sheba Medical Center, Tel HaShomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Wohl Institute for Translational Medicine, Sheba Medical Center, Tel HaShomer, Israel
| | - Omri Nayshool
- Sheba Cancer Research Center and Institute of Hematology, Sheba Medical Center, Tel HaShomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Wohl Institute for Translational Medicine, Sheba Medical Center, Tel HaShomer, Israel
| | - Ohad Birk
- Soroka Medical Center, Genetics Institute, The National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Tali Stauber
- The National Lab for Diagnosing SCID - The Israeli Newborn Screening Program, Pediatric Department A and the Immunology Service, Jeffrey Modell Foundation Center, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Israel Ministry of Health, Tel HaShomer, Israel
| | - Amit Hochberg
- Department of Pediatrics, Hillel Yaffe Medical Center, Hadera, Israel
| | - Arnon Broides
- Faculty of Health Sciences, Soroka University Medical Center, Pediatric Immunology Clinic, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Shlomo Almashanu
- The National Center for Newborn Screening, Israel Ministry of Health, Tel HaShomer, Israel
| | - Ayal Hendel
- The Mina and Everard Goodman Faculty of Life Sciences, Advanced Materials and Nanotechnology Institute, Bar-Ilan University, Ramat-Gan, Israel
| | - Yu Nee Lee
- The National Lab for Diagnosing SCID - The Israeli Newborn Screening Program, Pediatric Department A and the Immunology Service, Jeffrey Modell Foundation Center, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Israel Ministry of Health, Tel HaShomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raz Somech
- The National Lab for Diagnosing SCID - The Israeli Newborn Screening Program, Pediatric Department A and the Immunology Service, Jeffrey Modell Foundation Center, Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Israel Ministry of Health, Tel HaShomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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13
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Thrasher PR, Scofield SLC, Dalal S, Crawford CC, Singh M, Singh K. Ataxia telangiectasia mutated kinase deficiency impairs the autophagic response early during myocardial infarction. Am J Physiol Heart Circ Physiol 2018; 315:H48-H57. [PMID: 29652546 PMCID: PMC6087781 DOI: 10.1152/ajpheart.00042.2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/29/2018] [Accepted: 04/09/2018] [Indexed: 12/19/2022]
Abstract
Ataxia telangiectasia mutated kinase (ATM) is activated in response to DNA damage. We have previously shown that ATM plays a critical role in myocyte apoptosis and cardiac remodeling after myocardial infarction (MI). Here, we tested the hypothesis that ATM deficiency results in autophagic impairment in the heart early during MI. MI was induced in wild-type (WT) and ATM heterozygous knockout (hKO) mice by ligation of the left anterior descending artery. Structural and biochemical parameters of the heart were measured 4 h after left anterior descending artery ligation. M-mode echocardiography revealed that MI worsens heart function, as evidenced by reduced percent ejection fraction and fractional shortening in both groups. However, MI-induced increase in left ventricular end-diastolic and end-systolic diameters and volumes were significantly lower in hKO hearts. ATM deficiency resulted in autophagic impairment during MI, as evidenced by decreased microtubule-associated protein light chain 3-II increased p62, decreased cathepsin D protein levels, and increased aggresome accumulation. ERK1/2 activation was only observed in WT-MI hearts. Activation of Akt and AMP-activated protein kinase (AMPK) was lower, whereas activation of glycogen synthase kinase (GSK)-3β and mammalian target of rapamycin (mTOR) was higher in hKO-MI hearts. Inhibition of ATM using KU-55933 resulted in autophagic impairment in cardiac fibroblasts, as evidenced by decreased light chain 3-II protein levels and formation of acidic vesicular organelles. This impairment was associated with decreased activation of Akt and AMPK but enhanced activation of GSK-3β and mTOR in KU-55933-treated fibroblasts. Thus, ATM deficiency results in autophagic impairment in the heart during MI and cardiac fibroblasts. This autophagic impairment may occur via the activation of GSK-3β and mTOR and inactivation of Akt and AMPK. NEW & NOTEWORTHY Ataxia telangiectasia mutated kinase (ATM) plays a critical role in myocyte apoptosis and cardiac remodeling after myocardial infarction (MI). Here, we provide evidence that ATM deficiency results in autophagic impairment during MI. Further investigation of the role of ATM in autophagy post-MI may provide novel therapeutic targets for patients with ataxia telangiectasia suffering from heart disease.
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Affiliation(s)
- Patsy R Thrasher
- Department of Biomedical Sciences, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
| | - Stephanie L C Scofield
- Department of Biomedical Sciences, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
| | - Suman Dalal
- Department of Biomedical Sciences, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
| | - Claire C Crawford
- Department of Biomedical Sciences, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
| | - Mahipal Singh
- Department of Biomedical Sciences, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
| | - Krishna Singh
- Department of Biomedical Sciences, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
- Center for Inflammation, Infectious Disease, and Immunity, East Tennessee State University, Johnson City, Tennessee
- James H. Quillen Veterans Affairs Medical Center, Mountain Home, Tennessee
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14
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Rechavi E, Lev A, Simon AJ, Stauber T, Daas S, Saraf-Levy T, Broides A, Nahum A, Marcus N, Hanna S, Stepensky P, Toker O, Dalal I, Etzioni A, Almashanu S, Somech R. First Year of Israeli Newborn Screening for Severe Combined Immunodeficiency-Clinical Achievements and Insights. Front Immunol 2017; 8:1448. [PMID: 29167666 PMCID: PMC5682633 DOI: 10.3389/fimmu.2017.01448] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/17/2017] [Indexed: 11/29/2022] Open
Abstract
Severe combined immunodeficiency (SCID), the most severe form of T cell immunodeficiency, is detectable through quantification of T cell receptor excision circles (TRECs) in dried blood spots obtained at birth. Herein, we describe the results of the first year of the Israeli SCID newborn screening (NBS) program. This important, life-saving screening test is available at no cost for every newborn in Israel. Eight SCID patients were diagnosed through the NBS program in its first year, revealing an incidence of 1:22,500 births in the Israeli population. Consanguine marriages and Muslim ethnic origin were found to be a risk factor in affected newborns, and a founder effect was detected for both IL7Rα and DCLRE1C deficiency SCID. Lymphocyte subset analysis and TREC quantification in the peripheral blood appear to be sufficient for confirmation of typical and leaky SCID and ruling out false positive (FP) results. Detection of secondary targets (infants with non-SCID lymphopenia) did not significantly affect the management or outcomes of these infants in our cohort. In the general, non-immunodeficient population, TREC rises along with gestational age and birth weight, and is significantly higher in females and the firstborn of twin pairs. Low TREC correlates with both gestational age and birth weight in extremely premature newborns. Additionally, the rate of TREC increase per week consistently accelerates with gestational age. Together, these findings mandate a lower cutoff or a more lenient screening algorithm for extremely premature infants, in order to reduce the high rate of FPs within this group. A significant surge in TREC values was observed between 28 and 30 weeks of gestation, where median TREC copy numbers rise by 50% over 2 weeks. These findings suggest a maturational step in T cell development around week 29 gestation, and imply moderate to late preterms should be screened with the same cutoff as term infants. The SCID NBS program is still in its infancy, but is already bearing fruit in the early detection and improved outcomes of children with SCID in Israel and other countries.
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Affiliation(s)
- Erez Rechavi
- Pediatric Department A and the Immunology Service, Jeffrey Modell Foundation Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Atar Lev
- Pediatric Department A and the Immunology Service, Jeffrey Modell Foundation Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos J Simon
- Pediatric Department A and the Immunology Service, Jeffrey Modell Foundation Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tali Stauber
- Pediatric Department A and the Immunology Service, Jeffrey Modell Foundation Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Suha Daas
- The National Center for Newborn Screening, Israel Ministry of Health, Tel-HaShomer, Israel
| | - Talia Saraf-Levy
- The National Center for Newborn Screening, Israel Ministry of Health, Tel-HaShomer, Israel
| | - Arnon Broides
- Pediatric Immunology Clinic, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States
| | - Amit Nahum
- Pediatric Immunology Clinic, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States
| | - Nufar Marcus
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Allergy and Immunology Unit, Schneider Children's Medical Center of Israel, Felsenstein Medical Research Center, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Suhair Hanna
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Ruth Children Hospital, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Polina Stepensky
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Bone Marrow Transplantation Department, Hadassah Hebrew University Medical Center, Hadassah-Hebrew University Medical School, Jerusalem, Israel
| | - Ori Toker
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Allergy and Clinical Immunology Clinic, Department of Pediatrics, Shaare Zedek Medical Center, Hadassah-Hebrew University Medical School, Jerusalem, Israel
| | - Ilan Dalal
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Pediatric Allergy Unit, Wolfson Medical Center, Holon, Israel.,Pediatric Department, Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Etzioni
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Ruth Children Hospital, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Shlomo Almashanu
- The National Center for Newborn Screening, Israel Ministry of Health, Tel-HaShomer, Israel
| | - Raz Somech
- Pediatric Department A and the Immunology Service, Jeffrey Modell Foundation Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,The National Lab for Diagnosing SCID - The Israeli Newborn Screening Program, Israel Ministry of Health, Tel-Hashomer, Israel
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15
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Berger M, Geng B, Cameron DW, Murphy LM, Schulman ES. Primary immune deficiency diseases as unrecognized causes of chronic respiratory disease. Respir Med 2017; 132:181-188. [PMID: 29229095 DOI: 10.1016/j.rmed.2017.10.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 09/13/2017] [Accepted: 10/20/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND More than half of all primary immune deficiency diseases (PIDD) affect antibody production and are well known as causes of recurrent sinusitis and lung infections. Chronic and recurrent infections of the upper and/or lower airways can contribute to inflammatory and obstructive processes in the lower airways which are initially reversible and considered "asthma", but can eventually cause irreversible remodeling and chronic obstructive pulmonary disease (COPD). Conversely, several lines of evidence suggest that many patients who present with a diagnosis of asthma have an increased incidence of infection, suggesting underlying host-defense defects. Asthma and respiratory infections in the first decades of life are recognized as risk factors for development of COPD, but when patients present with COPD as adults, underlying primary immune deficiency disease may be unrecognized. MAIN FINDINGS AND CONCLUSIONS Detection of PIDD as a potentially treatable underlying contributor to recurrent/acute exacerbations and morbidity of COPD, and provision of immunoglobulin (Ig) G replacement therapy, when appropriate, may decrease the progression of COPD. Decreasing the severity and rate of exacerbations and admissions should improve the quality of life and longevity of an important subset of patients with COPD, while decreasing costs. Major steps toward achieving these goals include developing a high index of suspicion, more frequent use and appropriate interpretation of screening tests such as quantitative immunoglobulins and vaccine responses, and prompt institution of IgG replacement therapy when antibody deficiency has been diagnosed.
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Affiliation(s)
- Melvin Berger
- CSL Behring, 1020 First Avenue, King of Prussia, PA 19406, USA.
| | - Bob Geng
- Department of Medicine, University of California at San Diego, 200W Arbor Dr Frnt, San Diego, CA 92103, USA.
| | - D William Cameron
- Department of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada.
| | | | - Edward S Schulman
- Department of Medicine, Drexel University College of Medicine, 219 N. Broad Street, The Arnold T. Berman MD Building, 9th Floor, Philadelphia 19107, USA.
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16
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Thomas RJ, Chang AB. Improving the management of people with bronchiectasis in Saudi: A new beginning. Ann Thorac Med 2017; 12:133-134. [PMID: 28808485 PMCID: PMC5541961 DOI: 10.4103/atm.atm_183_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- R J Thomas
- Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Brisbane, Australia
| | - Anne B Chang
- Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Brisbane, Australia.,Children's Centre of Health Research, Queensland University of Technology, Queensland.,Brisbane and Child Health Division, Menzies School of Health Research, Darwin, Australia
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