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Akbar NU, Ahmad S, Khan TA, Tayyeb M, Akhter N, Shafiq L, Khan SN, Alam MM, Abdullah AM, Rehman MFU, Bajaber MA, Akram MS. Consanguineous marriages increase the incidence of recurrent tuberculosis: Evidence from whole exome sequencing. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2024; 118:105559. [PMID: 38266757 DOI: 10.1016/j.meegid.2024.105559] [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: 10/14/2023] [Revised: 01/13/2024] [Accepted: 01/18/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND In this study, we have identified multiple mutations in the IL-12R1 gene among Pakistani patients who have inherited them through consanguineous marriages. These patients have experienced severe Bacille-Calmette-Guérin (BCG) infection as well as recurrent tuberculosis. We will demonstrate the pivotal role of interleukin (IL)-12/interferon (IFN)-γ axis in the regulation of mycobacterial diseases. METHODOLOGY First, we checked the patients' medical records, and then afterward, we assessed interferon-gamma (IFN-γ) production through ELISA. Following that, DNA was extracted to investigate IL-12/IFN- abnormalities. Whole exome sequencing was conducted through Sanger sequencing. Secretory cytokine levels were compared from healthy control of the same age groups and they were found to be considerably less in the disease cohort. To evaluate the probable functional impact of these alterations, an in silico study was performed. RESULTS The study found that the patients' PBMCs produced considerably less IFN-γ than expected. Analysis using flow cytometry showed that activated T cells lacked surface expression of IL-12Rβ1. Exon 7 of the IL-12Rβ1 gene, which encodes a portion of the cytokine binding region (CBR), and exon 10, which encodes the fibronectin-type III (FNIII) domain, were found to have the mutations c.641 A > G; p.Q214R and c.1094 T > C; p.M365T, respectively. In silico analysis showed that these mutations likely to have a deleterious effect on protein function. CONCLUSION Our findings indicate the significant contribution of the IL-12/IFN-γ is in combating infections due to mycobacterium. Among Pakistani patients born to consanguineous marriages, the identified mutations in the IL-12Rβ-1 gene provide insights into the genetic basis of severe BCG infections and recurrent tuberculosis. The study highlights the potential utility of newborn screening in regions with mandatory BCG vaccination, enabling early detection and intervention for primary immunodeficiencies associated with mycobacterial infections. Moreover, the study suggests at the potential role of other related genes such as IL-23Rβ1, TYK2, or JAK2 in IFN-γ production, warranting further investigation.
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Affiliation(s)
- Noor Ul Akbar
- Department of Zoology, Kohat University of Science and Technology, Kohat 26000, Khyber Pakhtunkhwa, Pakistan
| | - Sajjad Ahmad
- Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar 25160, Pakistan
| | - Taj Ali Khan
- Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar 25160, Pakistan; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Muhammad Tayyeb
- Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar 25160, Pakistan
| | - Naheed Akhter
- Department of Biochemistry, Faculty of life Sciences, Government College University, Faisalabad 38000, Pakistan
| | - Laraib Shafiq
- Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar 25160, Pakistan
| | - Shahid Niaz Khan
- Department of Zoology, Kohat University of Science and Technology, Kohat 26000, Khyber Pakhtunkhwa, Pakistan.
| | - Mohammad Mahtab Alam
- Department of Basic Medical Sciences, College of Applied Medical Science, King Khalid University, Abha 61421, Saudi Arabia
| | - Alduwish Manal Abdullah
- Department of Biology, College of Science and Humanities in Al-Kharj, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
| | | | - Majed A Bajaber
- Department of Chemistry, Faculty of Science, King Khalid University, Abha 61413, Saudi Arabia
| | - Muhammad Safwan Akram
- School of Health and Life Sciences, Teesside University, Middlesbrough TS1 3BX, UK; National Horizons Centre, Teesside University, Darlington DL1 1HG, UK.
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Ahmad S, Ahmed J, Khalifa EH, Khattak FA, Khan AS, Farooq SU, Osman SMA, Salih MM, Ullah N, Khan TA. Novel mutations in genes of the IL-12/IFN-γ axis cause susceptibility to tuberculosis. J Infect Public Health 2023; 16:1368-1378. [PMID: 37437430 DOI: 10.1016/j.jiph.2023.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/15/2023] [Accepted: 06/06/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND The IL-12/23/ISG15-IFN-γ pathway is the main immunological pathway for controlling intra-macrophagic microorganisms such as Mycobacteria, Salmonella, and Leishmania spp. Consequently, upon mutations in genes of the IL-12/23/ISG15-IFN-γ pathway cause increased susceptibility to intra-macrophagic pathogens, particularly to Mycobacteria. Therefore, the purpose of this study was to characterize the mutations in genes of the IL-12/23/ISG15-IFN-γ pathway in severe tuberculosis (TB) patients. METHODS Clinically suspected TB was initially confirmed in four patients (P) (P1, P2, P3, and P4) using the GeneXpert MTB/RIF and culturing techniques. The patients' Peripheral blood mononuclear cells (PBMCs) were then subjected to ELISA to measure Interleukin 12 (IL-12) and interferon gamma (IFN-γ). Flow cytometry was used to detect the surface expressions of IFN-γR1 and IFN-γR2 as well as IL-12Rβ1and IL-12Rβ2 on monocytes and T lymphocytes, respectively.The phosphorylation of signal transducer and activator of transcription 1(STAT1) on monocytes and STAT4 on T lymphocytes were also detected by flow cytometry. Sanger sequencing was used to identify mutations in the IL-12Rβ1, STAT1, NEMO, and CYBB genes. RESULTS P1's PBMCs exhibited reduced IFN-γ production, while P2's and P3's PBMCs exhibited impaired IL-12 induction. Low IL-12Rβ1 surface expression and reduced STAT4 phosphorylation were demonstrated by P1's T lymphocytes, while impaired STAT1 phosphorylation was detected in P2's monocytes. The impaired IκB-α degradation and abolished H2O2 production in monocytes and neutrophils of P3 and P4 were observed, respectively. Sanger sequencing revealed novel nonsense homozygous mutation: c.191 G>A/p.W64 * in exon 3 of the IL-12Rβ1 gene in P1, novel missense homozygous mutation: c.107 A>T/p.Q36L in exon 3 of the STAT1 gene in P2, missense hemizygous mutation:: c.950 A>C/p.Q317P in exon 8 of the NEMO gene in P3, and nonsense hemizygous mutation: c.868 C>T/p.R290X in exon 8 of CYBB gene in P4. CONCLUSION Our findings broaden the clinical and genetic spectra associated with IL-12/23/ISG15-IFN-γ axis anomalies. Additionally, our data suggest that TB patients in Pakistan should be investigated for potential genetic defects due to high prevalence of parental consanguinity and increased incidence of TB in the country.
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Affiliation(s)
- Sajjad Ahmad
- Institute of Basic Medical Science, Khyber Medical University, Peshawar, KP, Pakistan
| | - Jawad Ahmed
- Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar, Pakistan
| | - Eman H Khalifa
- Al Baha University Faculty of Applied Medical Sciences, Saudi Arabia
| | - Farhad Ali Khattak
- Research & development Cell, Khyber College of Dentistry (KCD), Peshawar, Pakistan
| | - Anwar Sheed Khan
- Provincial TB Reference laboratory, Hayatabad Medical Complex, Peshawar, PK, Pakistan
| | - Syed Umar Farooq
- Department of oral pathology, Khyber College of Dentistry, Peshawar. Pakistan
| | | | | | - Nadeem Ullah
- Department of Clinical Microbiology, Umeå University, 90185 Umeå, Sweden.
| | - Taj Ali Khan
- Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar, Pakistan; Division of Infectious Diseases & Global Medicine,Department of Medicine,University of Florida, Gainesville, FL,United States.
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ul Akbar N, Khan SN, Amin MU, Ishfaq M, Cabral-Marques O, Schimke LF, Iqbal A, Ullah I, Hussain M, Ali I, Khan N, El Khawanky N, Rahman H, Khan TA. Novel nonsense IL-12Rβ1 mutation associated with recurrent tuberculosis. Immunol Res 2019; 67:408-415. [DOI: 10.1007/s12026-019-09094-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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de Albuquerque JAT, de Oliveira Junior EB, Zurro NB, Vendramini P, Ishizuka EK, Borgli DDSP, de Souza MS, Condino-Neto A. A C126R de novo Mutation in CYBB Leads to X-linked Chronic Granulomatous Disease With Recurrent Pneumonia and BCGitis. Front Pediatr 2018; 6:248. [PMID: 30255005 PMCID: PMC6141742 DOI: 10.3389/fped.2018.00248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/20/2018] [Indexed: 11/24/2022] Open
Abstract
Chronic granulomatous disease (CGD) is an innate immune deficiency of phagocytic cells caused by mutations that affect components of the NADPH oxidase system, with resulting impairment in reactive oxygen species production. Patients with CGD are susceptible to recurrent infections and hyperinflammatory responses. Mutations in CYBB lead to the X-linked form of CGD and are responsible for ~ 70% of cases. In this study, we report the case of a 2.5-year-old male patient with recurrent pneumonia and Bacillus Calmette-Guérin infection (BCGitis). As his first clinical manifestation, he presented with bullous impetigo at 18 days of age, which was followed by recurrent pneumonia and regional BCGitis. Genetic analysis revealed a de novo mutation in exon 5 of the CYBB gene: a single-nucleotide substitution, c.376T > C, leading to a C126R change.
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Affiliation(s)
- Jose Antonio Tavares de Albuquerque
- Immunogenic Assessoria e Diagnóstico em Saúde LTDA, São Paulo, Brazil.,PENSI Institute, José Luiz Egídio Setúbal Foundation, Sabará Hospital, São Paulo, Brazil
| | - Edgar Borges de Oliveira Junior
- Immunogenic Assessoria e Diagnóstico em Saúde LTDA, São Paulo, Brazil.,PENSI Institute, José Luiz Egídio Setúbal Foundation, Sabará Hospital, São Paulo, Brazil
| | - Nuria Bengala Zurro
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Paola Vendramini
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Edson Kiyotaka Ishizuka
- Immunogenic Assessoria e Diagnóstico em Saúde LTDA, São Paulo, Brazil.,PENSI Institute, José Luiz Egídio Setúbal Foundation, Sabará Hospital, São Paulo, Brazil
| | | | | | - Antonio Condino-Neto
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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Pereira NMD, Shah I. Familial Chronic Granulomatous Disease Affecting Three Siblings and Causing Recurrent Tuberculosis. J Clin Immunol 2016; 36:743-746. [PMID: 27699569 DOI: 10.1007/s10875-016-0338-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/20/2016] [Indexed: 01/12/2023]
Affiliation(s)
- Noella Maria Delia Pereira
- Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai, 400012, India. .,, 'Torrefiel', 127, Carter Road, Opp. Joggers Park, Bandra West, Mumbai, 400050, India.
| | - Ira Shah
- Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai, 400012, India
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Khan TA, Kalsoom K, Iqbal A, Asif H, Rahman H, Farooq SO, Naveed H, Nasir U, Amin MU, Hussain M, Tipu HN, Florea A. A novel missense mutation in the NADPH binding domain of CYBB abolishes the NADPH oxidase activity in a male patient with increased susceptibility to infections. Microb Pathog 2016; 100:163-169. [PMID: 27666509 DOI: 10.1016/j.micpath.2016.09.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/11/2016] [Accepted: 09/21/2016] [Indexed: 01/26/2023]
Abstract
Chronic granulomatous disease (CGD) is a primary immunodeficiency caused by mutations in the five structural genes (CYBB, CYBA, NCF1, NCF2, and NCF4) that typically results in a decrease in function or inability to generate a respiratory burst, leading to defective killing of pathogens, including fungi and intracellular bacteria. Mutations in CYBB, encoding the gp91phox (also known as NOX2) result in X-linked CGD account for approximately 65% of CGD cases. Here, we aimed the characterization of a novel missense mutation c.1226C > A/p.A409E in the CYBB gene in a patient with X-linked CGD. Relevant clinical data of a male patient whose family was positive for XCGD was reviewed. Oxidative burst and NADPH protein expression was evaluated by flow cytometry, while Genetic analysis was performed by Sanger sequencing. Monocyte-derived macrophages (MDMs) were evaluated for their capacity for phagocytosis and growth suppression of the intracellular Mycobacterium tuberculosis (M. tuberculosis). We thus report the absence of an oxidative burst in the phagocytes of the patient. Flow cytometry evaluation revealed a normal expression of NADPH oxidase components in neutrophils and genetic analysis proved the existence of a novel missense c.1226C > A mutation in the CYBB gene resulting in p.A409E. Further, we have showed that the patient's MDMs were unhindered in their ability to take up mycobacteria normally. Instead, the MDMs failed to control the intracellular proliferation of M. tuberculosis, a phenotype that improved in the presence of recombinant human interferon-gamma (rhIFN-γ). This work expands the genetic spectrum of X-linked CGD and demonstrates improvement in macrophage function in X91+CGD patient by rhIFN-γ.
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Affiliation(s)
- Taj Ali Khan
- Department of Microbiology, Kohat University of Science and Technology, Kohat, Pakistan.
| | - Kalsoom Kalsoom
- Department of Food Science & Technology, University of Agriculture, Peshawar, Pakistan
| | - Asif Iqbal
- Laboratory of Biochemistry and Biophysics, Butantan Institute, Sao Paulo, Brazil
| | - Huma Asif
- Laboratory of Biochemistry and Biophysics, Butantan Institute, Sao Paulo, Brazil
| | - Hazir Rahman
- Department of Microbiology, Kohat University of Science and Technology, Kohat, Pakistan
| | - Syed Omar Farooq
- Khyber Medical University, Institute of Medical Sciences, Kohat, Pakistan
| | - Hassan Naveed
- Department of Microbiology, Kohat University of Science and Technology, Kohat, Pakistan
| | - Umar Nasir
- Khyber Medical University, Institute of Medical Sciences, Kohat, Pakistan
| | | | - Mubashir Hussain
- Department of Microbiology, Kohat University of Science and Technology, Kohat, Pakistan
| | - Hamid Nawaz Tipu
- Department of Immunology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan
| | - Andrei Florea
- The Department of Chemistry, University of Oxford, Oxford, United Kingdom
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Interferon-Gamma Improves Macrophages Function against M. tuberculosis in Multidrug-Resistant Tuberculosis Patients. CHEMOTHERAPY RESEARCH AND PRACTICE 2016; 2016:7295390. [PMID: 27478636 PMCID: PMC4960331 DOI: 10.1155/2016/7295390] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 06/14/2016] [Indexed: 01/04/2023]
Abstract
Background. Mycobacterium tuberculosis (M. tuberculosis) that causes tuberculosis (TB) kills millions of infected people annually especially multidrug-resistant tuberculosis (MDR-TB). On infection, macrophages recognize the mycobacteria by toll-like receptor (TLR) followed by phagocytosis and control of mycobacteria. In addition, macrophages also secrete IL-12 to induce IFN-γ production by T, which, in turn, increases the phagocytosis and oxidative burst. Individuals with defects in innate or adaptive immunity exhibit increased susceptibility to M. tuberculosis. Understanding these immunologic mechanisms will help in TB control. We aimed to investigate the immunopathologic mechanisms in MDR-TB and role of recombinant human interferon-gamma (rhIFN-γ). Study Design and Methods. Monocyte-derived macrophages (MDMs) were generated from peripheral blood mononuclear cells of MDR-TB patients and healthy subjects and were investigated for immunologic response by ELISA and flow cytometry. Results. Different functional and molecular anomalies were observed in macrophages. In addition, a defective immune response to M. tuberculosis from the patient's MDMs was characterized, which in turn improved by pretreatment with rhIFN-γ. Conclusion. This work highlights the fact that rhIFN-γ improves macrophages function against M. tuberculosis and treatment of patients with poor responsiveness to TB therapy may be needed in future to include IFN-γ as adjuvant therapy after the full characterization of pathological and molecular mechanisms in these and in other more multidrug-resistant TB patients.
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