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Onodera M, Uchiyama T, Ariga T, Yamada M, Miyamura T, Arizono H, Morio T. Safety and efficacy of elapegademase in patients with adenosine deaminase deficiency: A multicenter, open-label, single-arm, phase 3, and postmarketing clinical study. Immun Inflamm Dis 2023; 11:e917. [PMID: 37506145 PMCID: PMC10367445 DOI: 10.1002/iid3.917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 05/15/2023] [Accepted: 06/03/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION Adenosine deaminase (ADA) deficiency is an ultrarare inherited purine metabolism disorder characterized by severe combined immunodeficiency. Elapegademase-lvlr is a new pegylated recombinant bovine ADA used in enzyme-replacement therapy (ERT) for ADA deficiency. Therefore, replacement with the new drug may eliminate the infectious risks associated with the currently used bovine intestinal-derived product, pegademase. METHODS We conducted a multicenter, single-arm, open-label, phase 3, and postmarketing clinical study of elapegademase for patients with ADA deficiency. The following biochemical markers were monitored to determine an appropriate dose of elapegademase: the trough deoxyadenosine nucleotide (dAXP) level ≤0.02 μmol/mL in erythrocytes or whole blood and the trough serum ADA activity ≥1100 U/L (equivalent to plasma levels ≥15 μmol/h/mL) indicated sufficient enzyme activity and detoxification as efficacy endpoints and monitored adverse events during the study as safety endpoints. RESULTS A total of four patients (aged 0-25 years) were enrolled. One infant patient died of pneumonia caused by cytomegalovirus infection whereas the other three completed the study and have been observed in the study period over 3 years. The infant patient had received elapegademase at 0.4 mg/kg/week until decease and the others received elapegademase at maximum doses of 0.3 mg/kg/week for 164-169 weeks. As a result, all four patients achieved undetectable levels of dAXPs together with sufficient enzyme activity, increased T and B cell numbers, and slightly elevated and maintained IgM and IgA immunoglobulin levels. Serious adverse events occurred in three patients, all of which were assessed as unrelated to elapegademase. CONCLUSIONS This study showed that elapegademase had comparable safety and efficacy to pegademase as ERT for ADA deficiency by demonstrating stable maintenance of sufficient ADA activity and lowering dAXP to undetectable levels, while no drug-related adverse events were reported (Trial registration: JapicCTI-163204).
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Affiliation(s)
- Masafumi Onodera
- Division of Immunology, National Center for Child Health and Development, Tokyo, Japan
| | - Toru Uchiyama
- Division of Immunology, National Center for Child Health and Development, Tokyo, Japan
| | - Tadashi Ariga
- Department of Pediatrics, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masafumi Yamada
- Department of Pediatrics, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Department of Food and Human Wellness, Rakuno Gakuen University, Ebetsu, Japan
| | - Takako Miyamura
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hironori Arizono
- Pharmaceutical Development & Production Division, Teijin Pharma Limited, Tokyo, Japan
| | - Tomohiro Morio
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
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Ucku D, Armutlu A, Cipe F, Ersoy GZ, Karakaya AD, Arikan C. Hepatocellular Carcinoma in ADA-SCID Patient After Hematopoietic Stem Cell Transplantation. J Pediatr Hematol Oncol 2023; 45:285-289. [PMID: 37027238 DOI: 10.1097/mph.0000000000002661] [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: 11/27/2022] [Accepted: 02/14/2023] [Indexed: 04/08/2023]
Abstract
Adenosine deaminase (ADA) deficiency is one of the most prevalent forms of severe combined immunodeficiency and results in the accumulation of toxic substrates which creates a systemic metabolic disease. It predisposes patients to the development of malignancies, most commonly lymphoma. We report an 8-month-old infant with ADA deficient severe combined immunodeficiency who developed progressive liver dysfunction and hepatocellular carcinoma after successful hematopoietic stem cell transplantation. This is the first case report of an ADA-deficient patient who presented with hepatocellular carcinoma and gives an insight into the complex etiology that can lie behind liver dysfunction in these patients.
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Affiliation(s)
| | | | - Funda Cipe
- Department of Pediatric Allergy and Immunology, Istinye University School of Medicine
| | - Gizem Zengin Ersoy
- Altinbas University School of Medicine, Bahcelievler Medical Park Hospital, Pediatric Hematology-Oncology and Bone Marrow Transplantation Unit, Istanbul, Turkey
| | | | - Cigdem Arikan
- Pediatric Gastroenterology, Hepatology and Nutrition, Koc University School of Medicine
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3
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Murguia-Favela L, Suresh S, Wright NAM, Alvi S, Tehseen S, Hernandez-Trujillo V, Seroogy CM, Haddad E, Nieves D, Hershfield MS, Walter JE, Pettiford L, Kamani NR, Keller MD, Pham-Huy A, Grunebaum E. Long-Term Immune Reconstitution in ADA-Deficient Patients Treated With Elapegademase: A Real-World Experience. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1725-1733. [PMID: 36736953 DOI: 10.1016/j.jaip.2023.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND ADAGEN, a bovine-based enzyme replacement therapy (ERT), has been used to treat adenosine deaminase severe combined immunodeficiency (ADA-SCID). In 2018, ADAGEN was replaced by REVCOVI (elapegademase), a modified bovine recombinant protein. OBJECTIVE To determine the real-life long-term benefits of REVCOVI in ADA-SCID. METHODS Data on ERT, infectious and noninfectious complications, and metabolic and immune evaluations were collected from 17 patients with ADA-SCID treated for 6 months or more with REVCOVI. RESULTS Eleven patients had previously received ADAGEN for 16 to 324 months, whereas 6 patients were ERT-naive. REVCOVI was administered twice weekly at 0.4 mg/kg/wk in ERT-naive patients, whereas patients transitioning to REVCOVI from ADAGEN typically continued at the same frequency and equivalent dosing as ADAGEN, resulting in a significantly lower (P = .007) total REVCOVI dose in the transitioning group. REVCOVI treatment in the ERT-naive group led to the resolution of many clinical and laboratory complications of ADA deficiency, whereas there were no new adverse effects among the transitioning patients. REVCOVI treatment increased plasma ADA activity and decreased dAXP (which included deoxyadenosine mono-, di-, and tri phosphate) among most patients, effects that persisted throughout the 7- to 37-month treatment periods, except in 2 patients with incomplete adherence. Among some patients, after 0.5 to 6 months, injection frequency was reduced to once a week, while maintaining adequate metabolic profiles. All ERT-naive infants treated with REVCOVI demonstrated an increase in the number of CD4+ T and CD19+ B cells, although these counts remained stable but lower than normal in most transitioning patients. CONCLUSIONS REVCOVI is effective for the management of ADA-SCID.
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Affiliation(s)
- Luis Murguia-Favela
- Section of Hematology/Immunology, Department of Pediatrics, Alberta Children's Hospital and the University of Calgary, Calgary, Alberta, Canada
| | - Sneha Suresh
- Division of IHOPE, Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Nicola A M Wright
- Section of Hematology/Immunology, Department of Pediatrics, Alberta Children's Hospital and the University of Calgary, Calgary, Alberta, Canada
| | - Saima Alvi
- Division of Pediatric Hematology/Oncology, Jim Pattison Children's Hospital, Saskatoon, Saskatchewan, Canada
| | - Sarah Tehseen
- Division of Hematology/Oncology and Transfusion Medicine, Jim Pattison Children's Hospital, Saskatoon, Saskatchewan, Canada
| | | | - Christine M Seroogy
- Division of Allergy, Immunology & Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Elie Haddad
- Division of Immunology and Rheumatology, Department of Pediatrics, Centre Hospitalier Universitaire (CHU) Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Daime Nieves
- Division of Pediatric Allergy and Immunology, University of South Florida at Johns Hopkins All Children's Hospital, St Petersburg, Fla
| | - Michael S Hershfield
- Division of Medicine and Biochemistry, Duke University Medical Center, Durham, NC
| | - Jolan E Walter
- Division of Pediatric Allergy and Immunology, University of South Florida at Johns Hopkins All Children's Hospital, St Petersburg, Fla
| | - Leah Pettiford
- Division of Allergy and Immunology, Children's National Hospital, Washington, DC
| | - Naynesh R Kamani
- Division of Allergy and Immunology, Children's National Hospital, Washington, DC
| | - Michael D Keller
- Division of Allergy and Immunology, Children's National Hospital, Washington, DC
| | - Anne Pham-Huy
- Division of Infectious Diseases, Immunology and Allergy, Children's Hospital Eastern Ontario, Ottawa, Ontario, Canada
| | - Eyal Grunebaum
- Division of Immunology and Allergy, The Hospital for Sick Children, Toronto, Ontario, Canada.
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4
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Yin M, Wang J, Zhang J, Wang W, Lu W, Xu F, Ma X, Lyu S, Chen L, Zhang L, Dong Z, Xiao Y. Transcription analyses of differentially expressed mRNAs, lncRNAs, circRNAs, and miRNAs in the growth plate of rats with glucocorticoid-induced growth retardation. PeerJ 2023; 11:e14603. [PMID: 36684670 PMCID: PMC9851049 DOI: 10.7717/peerj.14603] [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: 05/30/2022] [Accepted: 11/29/2022] [Indexed: 01/17/2023] Open
Abstract
Background Glucocorticoids (GCs) are commonly used to treat autoimmune diseases and malignancies in children and adolescents. Growth retardation is a common adverse effect of GC treatment in pediatric patients. Accumulating evidence indicates that non-coding RNAs (ncRNAs) are involved in the pathogenesis of glucocorticoid-induced growth retardation (GIGR), but the roles of specific ncRNAs in growth remain largely unknown. Methods In this study, 2-week-old male Sprague-Dawley rats had been treated with 2 mg/kg/d of dexamethasone for 7 or 14 days, after which the growth plate tissues were collected for high-throughput RNA sequencing to identify differentially expressed mRNAs, lncRNAs, circRNAs, and miRNAs in GIGR rats. Results Transcriptomic analysis identified 1,718 mRNAs, 896 lncRNAs, 60 circRNAs, and 72 miRNAs with different expression levels in the 7d group. In the 14d group, 1,515 mRNAs, 880 lncRNAs, 46 circRNAs, and 55 miRNAs with differential expression were identified. Four mRNAs and four miRNAs that may be closely associated with the development of GIGR were further validated by real-time quantitative fluorescence PCR. Function enrichment analysis indicated that the PI3K-Akt signaling pathway, NF-kappa B signaling pathway, and TGF-β signaling pathway participated in the development of the GIGR. Moreover, the constructed ceRNA networks suggested that several miRNAs (including miR-140-3p and miR-127-3p) might play an important role in the pathogenesis of GIGR. Conclusions These results provide new insights and important clues for exploring the molecular mechanisms underlying GIGR.
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Affiliation(s)
- Mingyue Yin
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Junqi Wang
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Juanjuan Zhang
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Wei Wang
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Wenli Lu
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Fei Xu
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China,Department of Pediatrics, Liqun Hospital, Putuo District, Shanghai, China
| | - Xiaoyu Ma
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Sheng Lyu
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Lifen Chen
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Lidan Zhang
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Zhiya Dong
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yuan Xiao
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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5
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Cuvelier GDE, Logan BR, Prockop SE, Buckley RH, Kuo CY, Griffith LM, Liu X, Yip A, Hershfield MS, Ayoub PG, Moore TB, Dorsey MJ, O'Reilly RJ, Kapoor N, Pai SY, Kapadia M, Ebens CL, Forbes Satter LR, Burroughs LM, Petrovic A, Chellapandian D, Heimall J, Shyr DC, Rayes A, Bednarski JJ, Chandra S, Chandrakasan S, Gillio AP, Madden L, Quigg TC, Caywood EH, Dávila Saldaña BJ, DeSantes K, Eissa H, Goldman FD, Rozmus J, Shah AJ, Vander Lugt MT, Thakar MS, Parrott RE, Martinez C, Leiding JW, Torgerson TR, Pulsipher MA, Notarangelo LD, Cowan MJ, Dvorak CC, Haddad E, Puck JM, Kohn DB. Outcomes following treatment for ADA-deficient severe combined immunodeficiency: a report from the PIDTC. Blood 2022; 140:685-705. [PMID: 35671392 PMCID: PMC9389638 DOI: 10.1182/blood.2022016196] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/21/2022] [Indexed: 11/20/2022] Open
Abstract
Adenosine deaminase (ADA) deficiency causes ∼13% of cases of severe combined immune deficiency (SCID). Treatments include enzyme replacement therapy (ERT), hematopoietic cell transplant (HCT), and gene therapy (GT). We evaluated 131 patients with ADA-SCID diagnosed between 1982 and 2017 who were enrolled in the Primary Immune Deficiency Treatment Consortium SCID studies. Baseline clinical, immunologic, genetic characteristics, and treatment outcomes were analyzed. First definitive cellular therapy (FDCT) included 56 receiving HCT without preceding ERT (HCT); 31 HCT preceded by ERT (ERT-HCT); and 33 GT preceded by ERT (ERT-GT). Five-year event-free survival (EFS, alive, no need for further ERT or cellular therapy) was 49.5% (HCT), 73% (ERT-HCT), and 75.3% (ERT-GT; P < .01). Overall survival (OS) at 5 years after FDCT was 72.5% (HCT), 79.6% (ERT-HCT), and 100% (ERT-GT; P = .01). Five-year OS was superior for patients undergoing HCT at <3.5 months of age (91.6% vs 68% if ≥3.5 months, P = .02). Active infection at the time of HCT (regardless of ERT) decreased 5-year EFS (33.1% vs 68.2%, P < .01) and OS (64.7% vs 82.3%, P = .02). Five-year EFS (90.5%) and OS (100%) were best for matched sibling and matched family donors (MSD/MFD). For patients treated after the year 2000 and without active infection at the time of FDCT, no difference in 5-year EFS or OS was found between HCT using a variety of transplant approaches and ERT-GT. This suggests alternative donor HCT may be considered when MSD/MFD HCT and GT are not available, particularly when newborn screening identifies patients with ADA-SCID soon after birth and before the onset of infections. This trial was registered at www.clinicaltrials.gov as #NCT01186913 and #NCT01346150.
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Affiliation(s)
- Geoffrey D E Cuvelier
- Manitoba Blood and Marrow Transplant Program, CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Brent R Logan
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Susan E Prockop
- Stem Cell Transplant Service, Dana Farber Cancer Institute/Boston Children's Hospital, Boston, MA
| | | | - Caroline Y Kuo
- Division of Allergy, Immunology, Rheumatology, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Linda M Griffith
- Division of Allergy, Immunology and Transplantation, National Institutes of Allergy, National Institutes of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD
| | - Xuerong Liu
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Alison Yip
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA
| | | | - Paul G Ayoub
- Microbiology, Immunology & Molecular Genetics, University of California, Los Angeles, CA
| | - Theodore B Moore
- Department of Pediatric Hematology-Oncology, Mattel Children's Hospital, University of California, Los Angeles, CA
| | - Morna J Dorsey
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA
| | - Richard J O'Reilly
- Stem Cell Transplantation and Cellular Therapy, MSK Kids, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Neena Kapoor
- Division of Hematology, Oncology and Blood and Marrow Transplant, Children's Hospital, Los Angeles, CA
| | - Sung-Yun Pai
- Immune Deficiency Cellular Therapy Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Malika Kapadia
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, MA
| | - Christen L Ebens
- Division of Pediatric Blood and Marrow Transplant and Cellular Therapy, MHealth Fairview Masonic Children's Hospital, Minneapolis, MN
| | - Lisa R Forbes Satter
- Immunology, Allergy and Retrovirology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Lauri M Burroughs
- Fred Hutchinson Cancer Research Center, University of Washington, Department of Pediatrics and Seattle Children's Hospital, Seattle, WA
| | - Aleksandra Petrovic
- Fred Hutchinson Cancer Research Center, University of Washington, Department of Pediatrics and Seattle Children's Hospital, Seattle, WA
| | - Deepak Chellapandian
- Center for Cell and Gene Therapy for Non-Malignant Conditions, Johns Hopkins All Children's Hospital, St Petersburg, FL
| | - Jennifer Heimall
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA
| | - David C Shyr
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Lucile Packard Children's Hospital, Stanford School of Medicine, Palo Alto, CA
| | - Ahmad Rayes
- Primary Children's Hospital, University of Utah, Salt Lake City, UT
| | | | - Sharat Chandra
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | | | - Alfred P Gillio
- Children's Cancer Institute, Hackensack University Medical Center, Hackensack, NJ
| | - Lisa Madden
- Methodist Children's Hospital of South Texas, San Antonio, TX
| | - Troy C Quigg
- Pediatric Blood and Marrow Transplant and Cellular Therapy Program, Helen DeVos Children's Hospital, Michigan State University College of Human Medicine, Grand Rapids, MI
| | - Emi H Caywood
- Nemours Children's Health, Thomas Jefferson University, Wilmington, DE
| | | | - Kenneth DeSantes
- Division of Pediatric Hematology-Oncology & Bone Marrow Transplant, University of Wisconsin, American Family Children's Hospital, Madison, WI
| | - Hesham Eissa
- Division of Pediatric Hematology-Oncology-BMT, Aurora, CO
| | - Frederick D Goldman
- Division of Pediatric Hematology and Oncology and Bone Marrow Transplant, University of Alabama at Birmingham, Birmingham, AL
| | - Jacob Rozmus
- British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Ami J Shah
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Lucile Packard Children's Hospital, Stanford School of Medicine, Palo Alto, CA
| | - Mark T Vander Lugt
- Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, MI
| | - Monica S Thakar
- Fred Hutchinson Cancer Research Center, University of Washington, Department of Pediatrics and Seattle Children's Hospital, Seattle, WA
| | | | - Caridad Martinez
- Hematology/Oncology/BMT, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Jennifer W Leiding
- Division of Allergy and Immunology, Johns Hopkins University, St Petersburg, FL
| | | | - Michael A Pulsipher
- Division of Pediatric Hematology and Oncology, Intermountain Primary Children's Hospital, Huntsman Cancer Institute at the University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT
| | - Luigi D Notarangelo
- Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, MD; and
| | - Morton J Cowan
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA
| | - Christopher C Dvorak
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA
| | - Elie Haddad
- Department of Pediatrics, Centre Hospitalier Universitaire (CHU) Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Jennifer M Puck
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA
| | - Donald B Kohn
- Microbiology, Immunology & Molecular Genetics, University of California, Los Angeles, CA
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6
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Hartog N, Hershfield M, Michniacki T, Moloney S, Holsworth A, Hurden I, Fredrickson M, Kleyn M, Walkovich K, Secord E. Newborn Tandem Mass Spectroscopy Screening for Adenosine Deaminase Deficiency-First Two Years' Experience. Ann Allergy Asthma Immunol 2022; 129:776-783.e2. [PMID: 35914665 DOI: 10.1016/j.anai.2022.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/15/2022] [Accepted: 07/20/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Newborn screening (NBS) via T-cell receptor excision circles (TREC) is now universal in the United States, Puerto Rico, and the Navajo Nation as a strategy to identify severe combined immunodeficiency (SCID) in newborns. Due to the characteristics of adenosine deaminase (ADA) deficiency, small but significant number of cases can be missed by this screening. OBJECTIVE To evaluate the results of the first year of statewide NBS for ADA via dried blood spot newborn screening. METHODS On October 7, 2019, the state of Michigan began screening newborn dried blood spots for ADA deficiency via the Neobase-2 tandem mass spectroscopy (TMS) kit. We report one known case of ADA deficiency in the 18 months prior to screening. We then reviewed the results of the first two years of TMS ADA screening in Michigan. RESULTS There was one ADA deficient patient known to our centers in the 18 months before initiation of TMS ADA screening, this patient died of complications of their disease. In the first two years of TMS ADA NBS, 206,321 infants were screened, and two patients had positive ADA screens. Both patients had ADA deficiency confirmed through biochemical and genetic testing. One patient identified also had a positive TREC screen and was confirmed to have ADA SCID. CONCLUSION In our first two years, TMS NBS for ADA deficiency identified two patients with ADA deficiency at negligible cost; including one patient who would not have been identified by TREC NBS. This report provides initial evidence of the value of specific NBS for ADA deficiency.
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Affiliation(s)
- Nicholas Hartog
- Helen DeVos Children's Hospital and Spectrum Health Division of Allergy and Immunology; Michigan State University College of Human Medicine.
| | - Michael Hershfield
- Department of Medicine, Duke University School of Medicine; Department of Biochemistry, Duke University School of Medicine
| | - Thomas Michniacki
- Pediatric Hematology, Oncology, and Bone Marrow Transplantation C.S. Mott Children's Hospital and University of Michigan
| | | | - Amanda Holsworth
- Helen DeVos Children's Hospital and Spectrum Health Division of Allergy and Immunology; Michigan State University College of Human Medicine
| | | | - Mary Fredrickson
- Division of Allergy and Immunology, Children's Hospital of Michigan
| | - Mary Kleyn
- Michigan Department of Health and Human Services
| | - Kelly Walkovich
- Pediatric Hematology, Oncology, and Bone Marrow Transplantation C.S. Mott Children's Hospital and University of Michigan
| | - Elizabeth Secord
- Wayne State University School of Medicine, Department of Pediatrics, Division of Allergy and Immunology
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7
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Ravendran S, Hernández SS, König S, Bak RO. CRISPR/Cas-Based Gene Editing Strategies for DOCK8 Immunodeficiency Syndrome. Front Genome Ed 2022; 4:793010. [PMID: 35373187 PMCID: PMC8969908 DOI: 10.3389/fgeed.2022.793010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/14/2022] [Indexed: 12/17/2022] Open
Abstract
Defects in the DOCK8 gene causes combined immunodeficiency termed DOCK8 immunodeficiency syndrome (DIDS). DIDS previously belonged to the disease category of autosomal recessive hyper IgE syndrome (AR-HIES) but is now classified as a combined immunodeficiency (CID). This genetic disorder induces early onset of susceptibility to severe recurrent viral and bacterial infections, atopic diseases and malignancy resulting in high morbidity and mortality. This pathological state arises from impairment of actin polymerization and cytoskeletal rearrangement, which induces improper immune cell migration-, survival-, and effector functions. Owing to the severity of the disease, early allogenic hematopoietic stem cell transplantation is recommended even though it is associated with risk of unintended adverse effects, the need for compatible donors, and high expenses. So far, no alternative therapies have been developed, but the monogenic recessive nature of the disease suggests that gene therapy may be applied. The advent of the CRISPR/Cas gene editing system heralds a new era of possibilities in precision gene therapy, and positive results from clinical trials have already suggested that the tool may provide definitive cures for several genetic disorders. Here, we discuss the potential application of different CRISPR/Cas-mediated genetic therapies to correct the DOCK8 gene. Our findings encourage the pursuit of CRISPR/Cas-based gene editing approaches, which may constitute more precise, affordable, and low-risk definitive treatment options for DOCK8 deficiency.
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Affiliation(s)
| | | | | | - Rasmus O. Bak
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
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8
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Kreins AY, Velasco HF, Cheong KN, Rao K, Veys P, Worth A, Gaspar HB, Booth C. Long-Term Immune Recovery After Hematopoietic Stem Cell Transplantation for ADA Deficiency: a Single-Center Experience. J Clin Immunol 2021; 42:94-107. [PMID: 34654999 PMCID: PMC8821083 DOI: 10.1007/s10875-021-01145-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 09/27/2021] [Indexed: 12/15/2022]
Abstract
Unconditioned hematopoietic stem cell transplantation (HSCT) is the recommended treatment for patients with adenosine deaminase (ADA)-deficient severe combined immunodeficiency with an HLA-matched sibling donor (MSD) or family donor (MFD). Improved overall survival (OS) has been reported compared to the use of unrelated donors, and previous studies have demonstrated that adequate cellular and humoral immune recovery can be achieved even in the absence of conditioning. Detailed insight of the long-term outcome is still limited. We aim to address this by studying a large single-center cohort of 28 adenosine deaminase-deficient patients who underwent a total of 31 HSCT procedures, of which more than half were unconditioned. We report an OS of 85.7% and event-free survival of 71% for the entire cohort, with no statistically significant differences after procedures using related or unrelated HLA-matched donors. We find that donor engraftment in the myeloid compartment is significantly diminished in unconditioned procedures, which typically use a MSD or MFD. This is associated with poor metabolic correction and more frequent failure to discontinue immunoglobulin replacement therapy. Approximately one in four patients receiving an unconditioned procedure required a second procedure, whereas the use of reduced intensity conditioning (RIC) prior to allogeneic transplantation improves the long-term outcome by achieving better myeloid engraftment, humoral immune recovery, and metabolic correction. Further longitudinal studies are needed to optimize future management and guidelines, but our findings support a potential role for the routine use of RIC in most ADA-deficient patients receiving an HLA-identical hematopoietic stem cell transplant, even when a MSD or MFD is available.
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Affiliation(s)
- Alexandra Y Kreins
- Department of Immunology and Gene Therapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Helena F Velasco
- Department of Immunology and Gene Therapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Department of Pediatric Allergy and Immunology, Federal University of São Paolo, São Paolo, Brazil
| | - Kai-Ning Cheong
- Department of Immunology and Gene Therapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Department of Paediatric Rheumatology and Immunology, Hong Kong Children's Hospital, Hong Kong, Hong Kong
| | - Kanchan Rao
- UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Bone Marrow Transplantation, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Paul Veys
- UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Bone Marrow Transplantation, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Austen Worth
- Department of Immunology and Gene Therapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - H Bobby Gaspar
- UCL Great Ormond Street Institute of Child Health, London, UK.,Orchard Therapeutics, London, UK
| | - Claire Booth
- Department of Immunology and Gene Therapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK. .,UCL Great Ormond Street Institute of Child Health, London, UK.
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9
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Baloh CH, Borkar SA, Chang KF, Yao J, Hershfield MS, Parikh SH, Kohn DB, Goodenow MM, Sleasman JW, Yin L. Normal IgH Repertoire Diversity in an Infant with ADA Deficiency After Gene Therapy. J Clin Immunol 2021; 41:1597-1606. [PMID: 34184208 PMCID: PMC9906566 DOI: 10.1007/s10875-021-01034-2] [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: 11/14/2020] [Accepted: 04/05/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Adenosine deaminase (ADA) deficiency causes severe combined immunodeficiency (SCID) through an accumulation of toxic metabolites within lymphocytes. Recently, ADA deficiency has been successfully treated using lentiviral-transduced autologous CD34+ cells carrying the ADA gene. T and B cell function appears to be fully restored, but in many patients' B cell numbers remain low, and assessments of the immunoglobulin heavy (IgHV) repertoire following gene therapy are lacking. METHODS We performed deep sequencing of IgHV repertoire in peripheral blood lymphocytes from a child following lentivirus-based gene therapy for ADA deficiency and compared to the IgHV repertoire in healthy infants and adults. RESULTS After gene therapy, Ig diversity increased over time as evidenced by V, D, and J gene usage, N-additions, CDR3 length, extent of somatic hypermutation, and Ig class switching. There was the emergence of predominant IgHM, IgHG, and IgHA CDR3 lengths after gene therapy indicating successful oligoclonal expansion in response to antigens. This provides proof of concept for the feasibility and utility of molecular monitoring in following B cell reconstitution following gene therapy for ADA deficiency. CONCLUSION Based on deep sequencing, gene therapy resulted in an IgHV repertoire with molecular diversity similar to healthy infants.
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Affiliation(s)
- Carolyn H Baloh
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Samiksha A Borkar
- Molecular HIV Host Interaction Section, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Kai-Fen Chang
- Molecular HIV Host Interaction Section, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Jiqiang Yao
- Department of Biostatistics and bioinformatics, Moffitt Cancer Center, Tampa, FL
| | - Michael S Hershfield
- Division of Rheumatology and Immunology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Suhag H Parikh
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Donald B Kohn
- Division of Hematology & Oncology, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA.,Department of Microbiology, Immunology, and Molecular Genetics, University of California Los Angeles, Los Angeles, CA
| | - Maureen M Goodenow
- Molecular HIV Host Interaction Section, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - John W Sleasman
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.
| | - Li Yin
- Molecular HIV Host Interaction Section, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
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10
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Liu J, Deng Y, Yu B, Mo B, Luo L, Yang J, Zhang X, Wang Z, Wang Y, Zhu J, Yang H, Fang S, Cheng Z, Li J, Shu Y, Luo G, Xiong W, Wei J, Li Z. Targeted resequencing showing novel common and rare genetic variants increases the risk of asthma in the Chinese Han population. J Clin Lab Anal 2021; 35:e23813. [PMID: 33969541 DOI: 10.1002/jcla.23813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/16/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Although studies have identified hundreds of genetic variants associated with asthma risk, a large fraction of heritability remains unexplained, especially in Chinese individuals. METHODS To identify genetic risk factors for asthma in a Han Chinese population, 211 asthma-related genes were first selected based on database searches. The genes were then sequenced for subjects in a Discovery Cohort (284 asthma patients and 205 older healthy controls) using targeted next-generation sequencing. Bioinformatics analysis and statistical association analyses were performed to reveal the associations between rare/common variants and asthma, respectively. The identified common risk variants underwent a validation analysis using a Replication Cohort (664 patients and 650 controls). RESULTS First, we identified 18 potentially functional rare loss-of-function (LOF) variants in 21/284 (7.4%) of the asthma cases. Second, using burden tests, we found that the asthma group had nominally significant (p < 0.05) burdens of rare nonsynonymous variants in 10 genes. Third, 23 common single-nucleotide polymorphisms were associated with the risk of asthma, 7/23 (30.4%) and 9/23 (39.1%) of which were modestly significant (p < 9.1 × 10-4 ) in the Replication Cohort and Combined Cohort, respectively. According to our cumulative risk model involving the modestly associated alleles, middle- and high-risk subjects had a 2.0-fold (95% CI: 1.621-2.423, p = 2.624 × 10-11 ) and 6.0-fold (95% CI: 3.623-10.156, p = 7.086 × 10-12 ) increased risk of asthma, respectively, compared with low-risk subjects. CONCLUSION This study revealed novel rare and common genetic risk factors for asthma, and provided a cumulative risk model for asthma risk prediction and stratification in Han Chinese individuals.
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Affiliation(s)
- Juan Liu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Key Cite of National Clinical Research Center for Respiratory Disease, Wuhan Clinical Medical Research Center for Chronic Airway Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, Wuhan, China
| | - Yanhan Deng
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Key Cite of National Clinical Research Center for Respiratory Disease, Wuhan Clinical Medical Research Center for Chronic Airway Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, Wuhan, China
| | - Bo Yu
- Division of Cardiology, Departments of Internal Medicine and Genetic Diagnosis Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Biwen Mo
- Department of Respiratory Medicine, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Liman Luo
- Department of Pediatrics, The 306 Hospital of People's Liberation Army, Beijing, China
| | - Jingping Yang
- Department of Respiratory and Critical Care Medicine, The Third Affiliated Hospital of Inner Mongolia Medical University, Baotou, China
| | - Xiaoju Zhang
- Department of Respiratory Medicine, Henan Provincial People's Hospital & the People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Zheng Wang
- Department of Respiratory Medicine, Henan Provincial People's Hospital & the People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingnan Wang
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Three Gorges University, Yichang, China
| | - Jing Zhu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Three Gorges University, Yichang, China
| | - Hua Yang
- Department of Respiratory Medicine, University Hospital of Hubei University for Nationalities, Enshi, China
| | - Shirong Fang
- Department of Respiratory Medicine, University Hospital of Hubei University for Nationalities, Enshi, China
| | - Zhenshun Cheng
- Department of Respiratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Jingping Li
- Department of Respiratory Medicine, Qianjiang Central Hospital, Qianjiang, China
| | - Ying Shu
- Department of Respiratory Medicine, Qianjiang Central Hospital, Qianjiang, China
| | - Guangwei Luo
- Department of Respiratory Medicine, Wuhan No. 1 Hospital, Wuhan, China
| | - Weining Xiong
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Key Cite of National Clinical Research Center for Respiratory Disease, Wuhan Clinical Medical Research Center for Chronic Airway Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, Wuhan, China.,Department of Respiratory Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianghong Wei
- Department of Respiratory Medicine, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Zongzhe Li
- Division of Cardiology, Departments of Internal Medicine and Genetic Diagnosis Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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11
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Gans MD, Bernstein L, Shliozberg J, Gavrilova T, Rubinstein A. Outcomes of 3 patients with adenosine deaminase deficiency on long-term enzyme replacement therapy. Ann Allergy Asthma Immunol 2021; 126:593-595. [PMID: 33359138 DOI: 10.1016/j.anai.2020.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Melissa D Gans
- Division of Pediatric Pulmonology, Allergy, Immunology, and Sleep Medicine, Westchester Medical Center/Boston Children's Health Physicians, New York Medical College, Hawthorne, New York.
| | - Larry Bernstein
- Division of Allergy and Immunology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Jenny Shliozberg
- Division of Allergy and Immunology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Tatyana Gavrilova
- Division of Allergy and Immunology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Arye Rubinstein
- Division of Allergy and Immunology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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12
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Pajno R, Pacillo L, Recupero S, Cicalese MP, Ferrua F, Barzaghi F, Ricci S, Marzollo A, Pecorelli S, Azzari C, Finocchi A, Cancrini C, Di Matteo G, Russo G, Alfano M, Lesma A, Salonia A, Adams S, Booth C, Aiuti A. Urogenital Abnormalities in Adenosine Deaminase Deficiency. J Clin Immunol 2020; 40:610-618. [PMID: 32307643 PMCID: PMC7253380 DOI: 10.1007/s10875-020-00777-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 03/30/2020] [Indexed: 01/01/2023]
Abstract
Background Improved survival in ADA-SCID patients is revealing new aspects of the systemic disorder. Although increasing numbers of reports describe the systemic manifestations of adenosine deaminase deficiency, currently there are no studies in the literature evaluating genital development and pubertal progress in these patients. Methods We collected retrospective data on urogenital system and pubertal development of 86 ADA-SCID patients followed in the period 2000–2017 at the Great Ormond Street Hospital (UK) and 5 centers in Italy. In particular, we recorded clinical history and visits, and routine blood tests and ultrasound scans were performed as part of patients’ follow-up. Results and Discussion We found a higher frequency of congenital and acquired undescended testes compared with healthy children (congenital, 22% in our sample, 0.5–4% described in healthy children; acquired, 16% in our sample, 1–3% in healthy children), mostly requiring orchidopexy. No urogenital abnormalities were noted in females. Spontaneous pubertal development occurred in the majority of female and male patients with a few cases of precocious or delayed puberty; no patient presented high FSH values. Neither ADA-SCID nor treatment performed (PEG-ADA, BMT, or GT) affected pubertal development or gonadic function. Conclusion In summary, this report describes a high prevalence of cryptorchidism in a cohort of male ADA-SCID patients which could represent an additional systemic manifestation of ADA-SCID. Considering the impact urogenital and pubertal abnormalities can have on patients’ quality of life, we feel it is essential to include urogenital evaluation in ADA-SCID patients to detect any abnormalities, initiate early treatment, and prevent long-term complications. Electronic supplementary material The online version of this article (10.1007/s10875-020-00777-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Roberta Pajno
- Department of Pediatrics, Endocrine Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Lucia Pacillo
- Department of Pediatrics, "Pietro Barilla" Children Hospital, University of Parma, via Gramsci, 14, Parma, Italy.,Unit of Immune and Infectious Diseases, Scientific Institute for Research and Healthcare (IRCCS) Childrens' Hospital Bambino Gesù, University Department of Pediatrics (DPUO), Rome, Italy.,Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Salvatore Recupero
- Pediatric Immunohematology and Stem Cell Program, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.,San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria P Cicalese
- Pediatric Immunohematology and Stem Cell Program, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.,San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Ferrua
- Pediatric Immunohematology and Stem Cell Program, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.,San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Barzaghi
- Pediatric Immunohematology and Stem Cell Program, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.,San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Ricci
- Division of Pediatric Immunology, Department of Health Sciences, University of Florence and Meyer Children's Hospital, Florence, Italy
| | - Antonio Marzollo
- Pediatric Hematology-Oncology Unit, Department of Women's and Children's Health, University of Padova, Via Giustiniani 3, 35128, Padova, Italy
| | - Silvia Pecorelli
- Department of Pediatric Surgery, Ospedale dei Bambini - Spedali Civili, Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Chiara Azzari
- Division of Pediatric Immunology, Department of Health Sciences, University of Florence and Meyer Children's Hospital, Florence, Italy
| | - Andrea Finocchi
- Unit of Immune and Infectious Diseases, Scientific Institute for Research and Healthcare (IRCCS) Childrens' Hospital Bambino Gesù, University Department of Pediatrics (DPUO), Rome, Italy.,Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Caterina Cancrini
- Unit of Immune and Infectious Diseases, Scientific Institute for Research and Healthcare (IRCCS) Childrens' Hospital Bambino Gesù, University Department of Pediatrics (DPUO), Rome, Italy.,Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Gigliola Di Matteo
- Unit of Immune and Infectious Diseases, Scientific Institute for Research and Healthcare (IRCCS) Childrens' Hospital Bambino Gesù, University Department of Pediatrics (DPUO), Rome, Italy.,Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Gianni Russo
- Department of Pediatrics, Endocrine Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Massimo Alfano
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Arianna Lesma
- Unit of Pediatric Surgery, Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Università Vita-Salute San Raffaele, Milan, Italy
| | - Stuart Adams
- SIHMDS-Haematology, Great Ormond Street Hospital for Children, London, UK
| | - Claire Booth
- Department of Paediatric Immunology, Great Ormond Street Hospital, London, UK
| | - Alessandro Aiuti
- Pediatric Immunohematology and Stem Cell Program, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy. .,San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Università Vita-Salute San Raffaele, Milan, Italy.
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13
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Murguia-Favela L, Min W, Loves R, Leon-Ponte M, Grunebaum E. Comparison of elapegademase and pegademase in ADA-deficient patients and mice. Clin Exp Immunol 2020; 200:176-184. [PMID: 31989577 DOI: 10.1111/cei.13420] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2020] [Indexed: 01/08/2023] Open
Abstract
The absence of adenosine deaminase (ADA) causes severe combined immune deficiency (SCID), which has been treated with PEGylated bovine-extracted ADA (ADAGEN). ADAGEN was recently replaced by a PEGylated recombinant bovine ADA, expressed in Escherichia coli (elapegademase, ELA-ADA). Limited information on ELA-ADA is available. ADA enzymatic activity of ELA-ADA and ADAGEN was assessed in vitro at diverse dilutions. ADA activity and immune reconstitution in an ADA-SCID patient treated with ELA-ADA were compared with age-matched patients previously treated with ADAGEN. ADA activity and thymus reconstitution were evaluated in ADA-deficient mice following ELA-ADA or ADAGEN administered from 7 days postpartum. In vitro, ADA activity of ELA-ADA and ADAGEN were similar at all dilutions. In an ADA-SCID patient, ELA-ADA treatment led to a marked increase in trough plasma ADA activity, which was 20% higher than in a patient previously treated with ADAGEN. A marked increase in T cell numbers and generation of naive T cells was evident following 3 months of ELA-ADA treatment, while T cell numbers increased following 4 months in 3 patients previously treated with ADAGEN. T cell proliferations stimulation normalized and thymus shadow became evident following ELA-ADA treatment. ADA activity was significantly increased in the blood of ADA-deficient mice following ELA-ADA compared to ADAGEN, while both treatments improved the mice weights, the weight, number of cells in their thymus and thymocyte subpopulations. ELA-ADA has similar in- vitro and possibly better in-vivo activity than ADAGEN. Future studies will determine whether ELA-ADA results in improved long-term immune reconstitution.
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Affiliation(s)
- L Murguia-Favela
- Section of Hematology and Immunology, Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Canada
| | - W Min
- Developmental and Stem Cell Biology Program, Research Institute, Hospital for Sick Children, Toronto, Canada
| | - R Loves
- Developmental and Stem Cell Biology Program, Research Institute, Hospital for Sick Children, Toronto, Canada
| | - M Leon-Ponte
- Developmental and Stem Cell Biology Program, Research Institute, Hospital for Sick Children, Toronto, Canada
| | - E Grunebaum
- Developmental and Stem Cell Biology Program, Research Institute, Hospital for Sick Children, Toronto, Canada.,Division of Immunology and Allergy, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
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14
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Morbidity in an adenosine deaminase-deficient patient during 27 years of enzyme replacement therapy. Clin Immunol 2020; 211:108321. [DOI: 10.1016/j.clim.2019.108321] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/21/2019] [Accepted: 12/03/2019] [Indexed: 11/30/2022]
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15
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Wilson J. Treating genes and patients. Gene Ther 2019; 27:109-110. [PMID: 31776472 DOI: 10.1038/s41434-019-0111-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 10/27/2019] [Accepted: 11/05/2019] [Indexed: 11/09/2022]
Affiliation(s)
- John Wilson
- Cystic Fibrosis Service, Alfred Health, Melbourne, Australia. .,Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia.
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16
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Xu X, Negandhi J, Min W, Tsui M, Post M, Harrison RV, Grunebaum E. Early Enzyme Replacement Therapy Improves Hearing and Immune Defects in Adenosine Deaminase Deficient-Mice. Front Immunol 2019; 10:416. [PMID: 30918508 PMCID: PMC6424861 DOI: 10.3389/fimmu.2019.00416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/18/2019] [Indexed: 12/24/2022] Open
Abstract
Background: Inherited defects in adenosine deaminase (ADA) cause severe immune deficiency, which can be corrected by ADA enzyme replacement therapy (ERT). Additionally, ADA-deficient patients suffer from hearing impairment. We hypothesized that ADA-deficient (-/-) mice also exhibit hearing abnormalities and that ERT from an early age will improve the hearing and immune defects in these mice. Methods: Auditory brainstem evoked responses, organ weights, thymocytes numbers, and subpopulations, lymphocytes in peripheral blood as well as T lymphocytes in spleen were analyzed in ADA-/- and ADA-proficient littermate post-partum (pp). The cochlea was visualized by scanning electron microscopy (SEM). The effects of polyethylene glycol conjugated ADA (PEG-ADA) ERT or 40% oxygen initiated at 7 days pp on the hearing and immune abnormalities were assessed. Results: Markedly abnormal hearing thresholds responses were found in ADA-/- mice at low and medium tone frequencies. SEM demonstrated extensive damage to the cochlear hair cells of ADA-/- mice, which were splayed, short or missing, correlating with the hearing deficits. The hearing defects were not reversed when hypoxia in ADA-/- mice was corrected. Progressive immune abnormalities were detected in ADA-/- mice from 4 days pp, initially affecting the thymus followed by peripheral lymphocytes and T cells in the spleen. ERT initiated at 7 days pp significantly improved the hearing of ADA-/- mice as well as the number of thymocytes and T lymphocytes, although not all normalized. Conclusions: ADA deficiency is associated with hearing deficits and damage to cochlear hair cells. Early initiation of ERT improves the hearing and immune abnormalities.
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Affiliation(s)
- Xiaobai Xu
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Developmental and Stem Cell Biology Program, Hospital for Sick Children, Toronto, ON, Canada
| | - Jaina Negandhi
- Neuroscience and Mental Health Program, Hospital for Sick Children, Toronto, ON, Canada
| | - Weixian Min
- Developmental and Stem Cell Biology Program, Hospital for Sick Children, Toronto, ON, Canada
| | - Michael Tsui
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Developmental and Stem Cell Biology Program, Hospital for Sick Children, Toronto, ON, Canada
| | - Martin Post
- Translational Medicine Program, Hospital for Sick Children, Toronto, ON, Canada.,Department of Laboratory Medicine & Pathology, Hospital for Sick Children, Toronto, ON, Canada
| | - Robert V Harrison
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Neuroscience and Mental Health Program, Hospital for Sick Children, Toronto, ON, Canada.,Department of Otolaryngology, University of Toronto, Toronto, ON, Canada
| | - Eyal Grunebaum
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Developmental and Stem Cell Biology Program, Hospital for Sick Children, Toronto, ON, Canada.,Division of Immunology and Allergy, Hospital for Sick Children, Toronto, ON, Canada
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17
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Kohn DB, Hershfield MS, Puck JM, Aiuti A, Blincoe A, Gaspar HB, Notarangelo LD, Grunebaum E. Consensus approach for the management of severe combined immune deficiency caused by adenosine deaminase deficiency. J Allergy Clin Immunol 2019; 143:852-863. [PMID: 30194989 PMCID: PMC6688493 DOI: 10.1016/j.jaci.2018.08.024] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/07/2018] [Accepted: 08/28/2018] [Indexed: 12/29/2022]
Abstract
Inherited defects in adenosine deaminase (ADA) cause a subtype of severe combined immunodeficiency (SCID) known as severe combined immune deficiency caused by adenosine deaminase defects (ADA-SCID). Most affected infants can receive a diagnosis while still asymptomatic by using an SCID newborn screening test, allowing early initiation of therapy. We review the evidence currently available and propose a consensus management strategy. In addition to treatment of the immune deficiency seen in patients with ADA-SCID, patients should be followed for specific noninfectious respiratory, neurological, and biochemical complications associated with ADA deficiency. All patients should initially receive enzyme replacement therapy (ERT), followed by definitive treatment with either of 2 equal first-line options. If an HLA-matched sibling donor or HLA-matched family donor is available, allogeneic hematopoietic stem cell transplantation (HSCT) should be pursued. The excellent safety and efficacy observed in more than 100 patients with ADA-SCID who received gammaretrovirus- or lentivirus-mediated autologous hematopoietic stem cell gene therapy (HSC-GT) since 2000 now positions HSC-GT as an equal alternative. If HLA-matched sibling donor/HLA-matched family donor HSCT or HSC-GT are not available or have failed, ERT can be continued or reinstituted, and HSCT with alternative donors should be considered. The outcomes of novel HSCT, ERT, and HSC-GT strategies should be evaluated prospectively in "real-life" conditions to further inform these management guidelines.
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Affiliation(s)
- Donald B Kohn
- Department of Microbiology, Immunology and Molecular Genetics, and the Division of Hematology & Oncology, Department of Pediatrics, David Geffen School of Medicine University of California, Los Angeles, Calif
| | - Michael S Hershfield
- Department of Medicine and Biochemistry, Duke University Medical Center, Durham, NC
| | - Jennifer M Puck
- Department of Pediatrics, Division of Allergy, Immunology, and Bone Marrow Transplantation, University of California San Francisco, San Francisco, Calif
| | - Alessandro Aiuti
- San Raffaele Telethon Institute for Gene Therapy, San Raffaele Scientific Institute, and Università Vita Salute San Raffaele, Milan, Italy
| | - Annaliesse Blincoe
- Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - H Bobby Gaspar
- Infection, Immunity, Inflammation, Molecular and Cellular Immunology Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Luigi D Notarangelo
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Eyal Grunebaum
- Division of Immunology and Allergy, and the Department of Pediatrics, Developmental and Stem Cell Biology Program, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.
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18
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Kim VHD, Pham-Huy A, Grunebaum E. Neutropenia among patients with adenosine deaminase deficiency. J Allergy Clin Immunol 2018; 143:403-405. [PMID: 29753815 DOI: 10.1016/j.jaci.2018.04.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/17/2018] [Accepted: 04/27/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Vy Hong-Diep Kim
- Division of Immunology and Allergy and the Department of Pediatrics, The Hospital for Sick Children, and the University of Toronto, Toronto, Ontario, Canada
| | - Anne Pham-Huy
- Division of Infectious Diseases, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Eyal Grunebaum
- Division of Immunology and Allergy, and the Department of Pediatrics, Developmental and Stem Cell Biology Program, The Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Ferrua F, Aiuti A. Twenty-Five Years of Gene Therapy for ADA-SCID: From Bubble Babies to an Approved Drug. Hum Gene Ther 2018; 28:972-981. [PMID: 28847159 DOI: 10.1089/hum.2017.175] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Twenty-five years have passed since first attempts of gene therapy (GT) in children affected by severe combined immunodeficiency (SCID) due to adenosine deaminase (ADA) defect, also known by the general public as bubble babies. ADA-SCID is fatal early in life if untreated. Unconditioned hematopoietic stem cell (HSC) transplant from matched sibling donor represents a curative treatment but is available for few patients. Enzyme replacement therapy can be life-saving, but its chronic use has many drawbacks. This review summarizes the history of ADA-SCID GT over the last 25 years, starting from first pioneering studies in the early 1990s using gamma-retroviral vectors, based on multiple infusions of genetically corrected autologous peripheral blood lymphocytes. HSC represented the ideal target for gene correction to guarantee production of engineered multi-lineage progeny, but it required a decade to achieve therapeutic benefit with this approach. Introduction of low-intensity conditioning represented a crucial step in achieving stable gene-corrected HSC engraftment and therapeutic levels of ADA-expressing cells. Recent clinical trials demonstrated that gamma-retroviral GT for ADA-SCID has a favorable safety profile and is effective in restoring normal purine metabolism and immune functions in patients >13 years after treatment. No abnormal clonal proliferation or leukemia development have been observed in >40 patients treated experimentally in five different centers worldwide. In 2016, the medicinal product Strimvelis™ received marketing approval in Europe for patients affected by ADA-SCID without a suitable human leukocyte antigen-matched related donor. Positive safety and efficacy results have been obtained in GT clinical trials using lentiviral vectors encoding ADA. The results obtained in last 25 years in ADA-SCID GT development fundamentally contributed to improve patients' prognosis, together with earlier diagnosis thanks to newborn screening. These advances open the way to further clinical development of GT as treatment for broader applications, from inherited diseases to cancer.
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Affiliation(s)
- Francesca Ferrua
- 1 San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), Pediatric Immunohematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute , Milan, Italy.,2 Vita-Salute San Raffaele University , Milan, Italy
| | - Alessandro Aiuti
- 1 San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), Pediatric Immunohematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute , Milan, Italy.,2 Vita-Salute San Raffaele University , Milan, Italy
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Migliavacca M, Assanelli A, Ponzoni M, Pajno R, Barzaghi F, Giglio F, Ferrua F, Frittoli M, Brigida I, Dionisio F, Nicoletti R, Casiraghi M, Roncarolo MG, Doglioni C, Peccatori J, Ciceri F, Cicalese MP, Aiuti A. First Occurrence of Plasmablastic Lymphoma in Adenosine Deaminase-Deficient Severe Combined Immunodeficiency Disease Patient and Review of the Literature. Front Immunol 2018; 9:113. [PMID: 29456531 PMCID: PMC5801298 DOI: 10.3389/fimmu.2018.00113] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 01/15/2018] [Indexed: 12/18/2022] Open
Abstract
Adenosine deaminase-deficient severe combined immunodeficiency disease (ADA-SCID) is a primary immune deficiency characterized by mutations in the ADA gene resulting in accumulation of toxic compounds affecting multiple districts. Hematopoietic stem cell transplantation (HSCT) from a matched donor and hematopoietic stem cell gene therapy are the preferred options for definitive treatment. Enzyme replacement therapy (ERT) is used to manage the disease in the short term, while a decreased efficacy is reported in the medium-long term. To date, eight cases of lymphomas have been described in ADA-SCID patients. Here we report the first case of plasmablastic lymphoma occurring in a young adult with ADA-SCID on long-term ERT, which turned out to be Epstein–Barr virus associated. The patient previously received infusions of genetically modified T cells. A cumulative analysis of the eight published cases of lymphoma from 1992 to date, and the case here described, reveals a high mortality (89%). The most common form is diffuse large B-cell lymphoma, which predominantly occurs in extra nodal sites. Seven cases occurred in patients on ERT and two after haploidentical HSCT. The significant incidence of immunodeficiency-associated lymphoproliferative disorders and poor survival of patients developing this complication highlight the priority in finding a prompt curative treatment for ADA-SCID.
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Affiliation(s)
- Maddalena Migliavacca
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Pediatric Immunohematology and Bone Marrow Transplantation Unit, Scientific Institute San Raffaele (IRCCS), Milan, Italy
| | - Andrea Assanelli
- Hematology and Bone Marrow Transplantation Unit, Scientific Institute San Raffaele (IRCCS), Milan, Italy
| | - Maurilio Ponzoni
- Pathology Unit, Scientific Institute San Raffaele (IRCCS), Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Roberta Pajno
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Pediatric Immunohematology and Bone Marrow Transplantation Unit, Scientific Institute San Raffaele (IRCCS), Milan, Italy
| | - Federica Barzaghi
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Pediatric Immunohematology and Bone Marrow Transplantation Unit, Scientific Institute San Raffaele (IRCCS), Milan, Italy
| | - Fabio Giglio
- Hematology and Bone Marrow Transplantation Unit, Scientific Institute San Raffaele (IRCCS), Milan, Italy
| | - Francesca Ferrua
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Pediatric Immunohematology and Bone Marrow Transplantation Unit, Scientific Institute San Raffaele (IRCCS), Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Marta Frittoli
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Pediatric Immunohematology and Bone Marrow Transplantation Unit, Scientific Institute San Raffaele (IRCCS), Milan, Italy
| | - Immacolata Brigida
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Scientific Institute San Raffaele (IRCCS), Milan, Italy
| | - Francesca Dionisio
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Scientific Institute San Raffaele (IRCCS), Milan, Italy
| | - Roberto Nicoletti
- Department of Radiology, Scientific Institute San Raffaele (IRCCS), Milan, Italy
| | - Miriam Casiraghi
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Pediatric Immunohematology and Bone Marrow Transplantation Unit, Scientific Institute San Raffaele (IRCCS), Milan, Italy
| | - Maria Grazia Roncarolo
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Pediatric Immunohematology and Bone Marrow Transplantation Unit, Scientific Institute San Raffaele (IRCCS), Milan, Italy.,Division of Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Institute for Stem Cell Biology and Regenerative Medicine, Stanford School of Medicine, Stanford, CA, United States
| | - Claudio Doglioni
- Pathology Unit, Scientific Institute San Raffaele (IRCCS), Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Jacopo Peccatori
- Hematology and Bone Marrow Transplantation Unit, Scientific Institute San Raffaele (IRCCS), Milan, Italy
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, Scientific Institute San Raffaele (IRCCS), Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Pia Cicalese
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Pediatric Immunohematology and Bone Marrow Transplantation Unit, Scientific Institute San Raffaele (IRCCS), Milan, Italy
| | - Alessandro Aiuti
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Pediatric Immunohematology and Bone Marrow Transplantation Unit, Scientific Institute San Raffaele (IRCCS), Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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21
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Kim VHD, Murguia-Favela L, Grunebaum E. Adenosine deaminase deficiency: current treatments and emerging therapeutics. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2018.1418660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Vy Hong-Diep Kim
- Division of Immunology and Allergy, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
| | - Luis Murguia-Favela
- Section of Hematology and Immunology, Department of Pediatrics, Alberta Children’s Hospital and University of Calgary, Calgary, Canada
| | - Eyal Grunebaum
- Division of Immunology and Allergy, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
- Developmental and Stem Cell Biology Program, Research Institute, Hospital for Sick Children, Toronto, Canada
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