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Wlodarski MW, Vlachos A, Farrar JE, Da Costa LM, Kattamis A, Dianzani I, Belendez C, Unal S, Tamary H, Pasauliene R, Pospisilova D, de la Fuente J, Iskander D, Wolfe L, Liu JM, Shimamura A, Albrecht K, Lausen B, Bechensteen AG, Tedgard U, Puzik A, Quarello P, Ramenghi U, Bartels M, Hengartner H, Farah RA, Al Saleh M, Hamidieh AA, Yang W, Ito E, Kook H, Ovsyannikova G, Kager L, Gleizes PE, Dalle JH, Strahm B, Niemeyer CM, Lipton JM, Leblanc TM. Diagnosis, treatment, and surveillance of Diamond-Blackfan anaemia syndrome: international consensus statement. Lancet Haematol 2024; 11:e368-e382. [PMID: 38697731 DOI: 10.1016/s2352-3026(24)00063-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/08/2024] [Accepted: 02/16/2024] [Indexed: 05/05/2024]
Abstract
Diamond-Blackfan anaemia (DBA), first described over 80 years ago, is a congenital disorder of erythropoiesis with a predilection for birth defects and cancer. Despite scientific advances, this chronic, debilitating, and life-limiting disorder continues to cause a substantial physical, psychological, and financial toll on patients and their families. The highly complex medical needs of affected patients require specialised expertise and multidisciplinary care. However, gaps remain in effectively bridging scientific discoveries to clinical practice and disseminating the latest knowledge and best practices to providers. Following the publication of the first international consensus in 2008, advances in our understanding of the genetics, natural history, and clinical management of DBA have strongly supported the need for new consensus recommendations. In 2014 in Freiburg, Germany, a panel of 53 experts including clinicians, diagnosticians, and researchers from 27 countries convened. With support from patient advocates, the panel met repeatedly over subsequent years, engaging in ongoing discussions. These meetings led to the development of new consensus recommendations in 2024, replacing the previous guidelines. To account for the diverse phenotypes including presentation without anaemia, the panel agreed to adopt the term DBA syndrome. We propose new simplified diagnostic criteria, describe the genetics of DBA syndrome and its phenocopies, and introduce major changes in therapeutic standards. These changes include lowering the prednisone maintenance dose to maximum 0·3 mg/kg per day, raising the pre-transfusion haemoglobin to 9-10 g/dL independent of age, recommending early aggressive chelation, broadening indications for haematopoietic stem-cell transplantation, and recommending systematic clinical surveillance including early colorectal cancer screening. In summary, the current practice guidelines standardise the diagnostics, treatment, and long-term surveillance of patients with DBA syndrome of all ages worldwide.
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Affiliation(s)
- Marcin W Wlodarski
- Department of Hematology, St Jude Children's Research Hospital, Memphis, TN, USA; Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Adrianna Vlachos
- Cohen Children's Medical Center, Hematology/Oncology and Stem Cell Transplantation, Hew Hyde Park, NY, USA; Feinstein Institutes for Medical Research, Manhasset, NY, USA; Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Jason E Farrar
- Arkansas Children's Research Institute and Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lydie M Da Costa
- Hôpital R. DEBRE, Groupe Hospitalier Universitaire, Assistance Publique-Hôpitaux de Paris Nord, Université de Paris Cité, Paris, France; HEMATIM, EA4666, UPJV, Amiens, France; Le LabEx Gr-Ex - Biogénèse et Pathologies du Globule Rouge, Paris, France
| | - Antonis Kattamis
- First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Irma Dianzani
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Cristina Belendez
- Pediatric Hematology and Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Instituto Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Instituto Nacional de Investigación Biomédica en Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Sule Unal
- Hacettepe University, Department of Pediatric Hematology and Research Center for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes, Ankara, Turkey
| | - Hannah Tamary
- The Rina Zaizov Hematology-Oncology Division, Schneider Children's Medical Center of Israel, Peta Tikvah, Israel; Felsenstein Medical Research Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | | | - Dagmar Pospisilova
- Department of Pediatrics, Faculty Hospital of Palacky University, Olomouc, Czech Republic
| | - Josu de la Fuente
- Department of Paediatrics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Deena Iskander
- Department of Paediatrics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK; Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Lawrence Wolfe
- Cohen Children's Medical Center, Hematology/Oncology and Stem Cell Transplantation, Hew Hyde Park, NY, USA; Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Johnson M Liu
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA
| | - Akiko Shimamura
- Dana Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Katarzyna Albrecht
- Department of Oncology, Paediatric Haematology, Clinical Transplantology and Paediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Birgitte Lausen
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Ulf Tedgard
- Department of Pediatric Hematology and Oncology, Skåne University Hospital, Lund, Sweden
| | - Alexander Puzik
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Paola Quarello
- Department of Pediatric and Public Health Sciences, University of Turin, Turin, Italy
| | - Ugo Ramenghi
- Department of Pediatric and Public Health Sciences, University of Turin, Turin, Italy
| | - Marije Bartels
- Pediatric Hematology Department, University Medical Center Utrecht, Utrecht, Netherlands
| | - Heinz Hengartner
- Pediatric Hospital of Eastern Switzerland St Gallen, St Gallen, Switzerland
| | - Roula A Farah
- Department of Pediatrics, LAU Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Mahasen Al Saleh
- King Faisal Hospital and Research Center Riyadh, Riyadh, Saudi Arabia
| | - Amir Ali Hamidieh
- Pediatric Cell and Gene Therapy Research Center, Gene, Cell & Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Wan Yang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Etsuro Ito
- Department of Pediatrics, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hoon Kook
- Chonnam National University Hwasun Hospital, Gwangju, South Korea
| | - Galina Ovsyannikova
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Leo Kager
- St. Anna Children's Hospital, Department of Pediatrics, Medical University Vienna, Vienna, Austria; Children's Cancer Research Institute, Vienna, Austria
| | | | - Jean-Hugues Dalle
- Pediatric Immunology and Hematology Department and CRMR aplasies médullaires, Robert Debré Hospital, Groupe Hospitalier Universitaire, Assistance Publique-Hôpitaux de Paris Nord, Université de Paris Cité, Paris, France
| | - Brigitte Strahm
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Charlotte M Niemeyer
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium, Freiburg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - Jeffrey M Lipton
- Cohen Children's Medical Center, Hematology/Oncology and Stem Cell Transplantation, Hew Hyde Park, NY, USA; Feinstein Institutes for Medical Research, Manhasset, NY, USA; Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Thierry M Leblanc
- Pediatric Immunology and Hematology Department and CRMR aplasies médullaires, Robert Debré Hospital, Groupe Hospitalier Universitaire, Assistance Publique-Hôpitaux de Paris Nord, Université de Paris Cité, Paris, France
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Iskander D, Roy NBA, Payne E, Drasar E, Hennessy K, Harrington Y, Christodoulidou C, Karadimitris A, Batkin L, de la Fuente J. Diamond-Blackfan anemia in adults: In pursuit of a common approach for a rare disease. Blood Rev 2023; 61:101097. [PMID: 37263874 DOI: 10.1016/j.blre.2023.101097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/19/2023] [Accepted: 05/07/2023] [Indexed: 06/03/2023]
Abstract
Diamond-Blackfan anemia (DBA) is a rare bone marrow failure syndrome, usually caused by loss-of function variants in genes encoding ribosomal proteins. The hallmarks of DBA are anemia, congenital anomalies and cancer predisposition. Although DBA usually presents in childhood, the prevalence in later life is increasing due to an expanding repertoire of implicated genes, improvements in genetic diagnosis and increasing life expectancy. Adult patients uniquely suffer the manifestations of end-organ damage caused by the disease and its treatment, and transition to adulthood poses specific issues in disease management. To standardize and optimize care for this rare disease, in this review we provide updated guidance on the diagnosis and management of DBA, with a specific focus on older adolescents and adults. Recommendations are based upon published literature and our pooled clinical experience from three centres in the United Kingdom (U·K.). Uniquely we have also solicited and incorporated the views of affected families, represented by the independent patient organization, DBA U.K.
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Affiliation(s)
- Deena Iskander
- Centre for Haematology, Department of Immunology & Inflammation, Imperial College London, London W12 0NN, UK.
| | - Noémi B A Roy
- Oxford University Hospitals NHS Foundation Trust and University of Oxford, OX3 9DU, UK
| | - Elspeth Payne
- UCL Cancer Institute, Dept of Hematology, London WC1 E6BT, UK; Dept of Hematology, University College Hospital London, NW1 2BU, UK
| | - Emma Drasar
- Whittington Health NHS Trust and University College Hospital London, N19 5NF, UK
| | - Kelly Hennessy
- Department of Paediatrics, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Yvonne Harrington
- Department of Paediatrics, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Chrysi Christodoulidou
- Centre for Haematology, Department of Immunology & Inflammation, Imperial College London, London W12 0NN, UK
| | - Anastasios Karadimitris
- Centre for Haematology, Department of Immunology & Inflammation, Imperial College London, London W12 0NN, UK
| | - Leisa Batkin
- DBA, UK 71-73 Main Street, Palterton, Chesterfield, S44 6UR, UK
| | - Josu de la Fuente
- Department of Paediatrics, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London W2 1NY, UK.
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易 美, 万 扬, 程 思, 巩 晓, 尹 梓, 李 俊, 高 洋, 吴 超, 宗 苏, 常 丽, 陈 玉, 郑 荣, 竺 晓. [Prevalence and risk factors of obesity in children with Diamond-Blackfan anemia]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:1143-1148. [PMID: 36305116 PMCID: PMC9627996 DOI: 10.7499/j.issn.1008-8830.2206070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/30/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To investigate the distribution of body mass index (BMI) and risk factors for obesity in children with Diamond-Blackfan Anemia (DBA). METHODS The children with DBA who attended National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, from January 2003 to December 2020 were enrolled as subjects. The related clinical data and treatment regimens were recorded. The height and weight data measured within 1 week before or after follow-up time points were collected to calculate BMI. The risk factors for obesity were determined by multivariate regression analysis in children with DBA. RESULTS A total of 129 children with DBA were enrolled, among whom there were 80 boys (62.0%) and 49 girls (38.0%), with a median age of 49 months (range 3-189 months). The prevalence rate of obesity was 14.7% (19/129). The multivariate logistic regression analysis showed that the absence of ribosomal protein gene mutation was closely associated with obesity in children with DBA (adjusted OR=3.63, 95%CI: 1.16-11.38, adjusted P=0.027). In children with glucocorticoid-dependent DBA, obesity was not associated with age of initiation of glucocorticoid therapy, duration of glucocorticoid therapy, and maintenance dose of glucocorticoids (P>0.05). CONCLUSIONS There is a high prevalence rate of obesity in children with DBA, and the absence of ribosomal protein gene mutation is closely associated with obesity in children with DBA.
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Kubickova A, Maceckova Z, Vojta P, Ondra M, Volejnikova J, Koralkova P, Jungova A, Jahoda O, Mojzikova R, Hadacova I, Cermak J, Horvathova M, Pospisilova D, Hajduch M. Missense mutation in RPS7 causes Diamond-Blackfan anemia via alteration of erythrocyte metabolism, protein translation and induction of ribosomal stress. Blood Cells Mol Dis 2022; 97:102690. [DOI: 10.1016/j.bcmd.2022.102690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 11/17/2022]
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Effect of Glucocorticosteroids in Diamond-Blackfan Anaemia: Maybe Not as Elusive as It Seems. Int J Mol Sci 2022; 23:ijms23031886. [PMID: 35163808 PMCID: PMC8837118 DOI: 10.3390/ijms23031886] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/01/2022] [Accepted: 02/05/2022] [Indexed: 12/22/2022] Open
Abstract
Diamond-Blackfan anaemia (DBA) is a red blood cell aplasia that in the majority of cases is associated with ribosomal protein (RP) aberrations. However, the mechanism by which this disorder leads to such a specific phenotype remains unclear. Even more elusive is the reason why non-specific agents such as glucocorticosteroids (GCs), also known as glucocorticoids, are an effective therapy for DBA. In this review, we (1) explore why GCs are successful in DBA treatment, (2) discuss the effect of GCs on erythropoiesis, and (3) summarise the GC impact on crucial pathways deregulated in DBA. Furthermore, we show that GCs do not regulate DBA erythropoiesis via a single mechanism but more likely via several interdependent pathways.
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Short Stature in Patients with Diamond-Blackfan Anemia: A Cross-Sectional Study. J Pediatr 2022; 240:177-185. [PMID: 34543620 DOI: 10.1016/j.jpeds.2021.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/26/2021] [Accepted: 09/10/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To systematically describe the short stature of patients with Diamond-Blackfan anemia and to explore factors affecting the height development of patients with Diamond-Blackfan anemia. STUDY DESIGN This cross-sectional study was conducted at the Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, and the height, weight, and clinical data of 129 patients with Diamond-Blackfan anemia were collected from June 2020 to September 2020. RESULTS The median height-age-z score (HAZ) of children affected by Diamond-Blackfan anemia was -1.54 (-6.36-1.96). Short stature was found in 37.98% of the patients. Specific Diamond-Blackfan anemia growth curves were developed for weight, height, and body mass index, separately for male and female patients. Multivariable logistic regression models showed that female sex (aOR 4.92; 95% CI 1.29-18.71; P = .0195), underweight (aOR 10.41, 95% CI 1.41-76.98, P = .0217), cardiovascular malformations (aOR 216.65; 95% CI 3.29-14279.79; P = .0118), and RPL11(aOR 29.14; 95% CI 1.18-719.10; P = .0392) or RPS26 (aOR 53.49; 95% CI 1.40-2044.30; P = .0323) mutations were independent risk factors for short stature. In the subgroup of patients who were steroid-dependent, patients with a duration of steroid therapy over 2 years (OR 2.95; 95% CI 1.00-8.66; P = .0494) or maintenance dose of prednisone >0.1 mg/kg per day (OR 3.30; 95% CI 1.02-10.72; P = .0470) had a higher incidence of short stature. CONCLUSIONS Patients with Diamond-Blackfan anemia had a high prevalence of short stature. The risk of short stature increased with age and was associated with sex, underweight, congenital malformations, and RPL11 or RPS26 mutations. The duration of steroid therapy and maintenance dose of steroid was significantly associated with the incidence of short stature in steroid-dependent patients with Diamond-Blackfan anemia.
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Pediatric bone marrow failure: Clinical, hematological and targeted next generation sequencing data. Blood Cells Mol Dis 2020; 87:102510. [PMID: 33197791 DOI: 10.1016/j.bcmd.2020.102510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/14/2020] [Accepted: 10/18/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE In this study, clinico-hematological, genetic and outcome profile of children with BMF was evaluated to delineate the underlying genotype and phenotype. DESIGN Cases were evaluated as two groups: Group 1 (n = 56; DBA-23, FA-18, DC-2, UBMFS-13) included children with suspected IBMFS based on clinical phenotype and accessible lab investigations and Group 2 (n = 53) included children with IAA treated with IST. Targeted NGS was carried out in a subset of these children (n = 42) and supplemented with WES wherever required. RESULTS We identified causative mutation in overall 15 of 27 tested children (55.5%) in group 1 and 2 of 15 tested children (13.3%) in group 2. In DBA, a mutation was noted in 50% cases with involvement of RPS 19 (75%) and RPL5 (25%) genes. Phenotypic abnormalities were present in 69.5% and response to steroids in 68.4% of cases at a median follow up of 33 months. In children with IAA, overall response (complete + partial) was present in 51% at a median follow up of 23 months. The 3-year OS and FFS for the cohort of IAA were 68% and 48% respectively. Targeted sequencing could also pick up germline mutations in 50% of UBMFS cases and nearly 19% of IAA cases.
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Jahan D, Al Hasan MM, Haque M. Diamond-Blackfan anemia with mutation in RPS19: A case report and an overview of published pieces of literature. J Pharm Bioallied Sci 2020; 12:163-170. [PMID: 32742115 PMCID: PMC7373105 DOI: 10.4103/jpbs.jpbs_234_19] [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: 10/20/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Diamond-Blackfan anemia (DBA), one of a rare group of inherited bone marrow failure syndromes, is characterized by red cell failure, the presence of congenital anomalies, and cancer predisposition. It can be caused by mutations in the RPS19 gene (25% of the cases). Methods This case report describes a 10-month-old boy who presented with 2 months' history of gradually increasing weakness and pallor. Results The patient was diagnosed as a case of DBA based on peripheral blood finding, bone marrow aspiration with trephine biopsy reports, and genetic mutation analysis of the RPS19 gene. His father refused hematopoietic stem cell transplantation for financial constraints. Patient received prednisolone therapy with oral folic acid and iron supplements. Conclusion Hemoglobin raised from 6.7 to 9.8g/dL after 1 month of therapeutic intervention.
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Affiliation(s)
- Dilshad Jahan
- Department of Hematology, Apollo Hospitals, Dhaka, Bangladesh
| | | | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
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Nonsense Suppression Therapy: New Hypothesis for the Treatment of Inherited Bone Marrow Failure Syndromes. Int J Mol Sci 2020; 21:ijms21134672. [PMID: 32630050 PMCID: PMC7369780 DOI: 10.3390/ijms21134672] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 12/13/2022] Open
Abstract
Inherited bone marrow failure syndromes (IBMFS) are a group of cancer-prone genetic diseases characterized by hypocellular bone marrow with impairment in one or more hematopoietic lineages. The pathogenesis of IBMFS involves mutations in several genes which encode for proteins involved in DNA repair, telomere biology and ribosome biogenesis. The classical IBMFS include Shwachman–Diamond syndrome (SDS), Diamond–Blackfan anemia (DBA), Fanconi anemia (FA), dyskeratosis congenita (DC), and severe congenital neutropenia (SCN). IBMFS are associated with high risk of myelodysplastic syndrome (MDS), acute myeloid leukemia (AML), and solid tumors. Unfortunately, no specific pharmacological therapies have been highly effective for IBMFS. Hematopoietic stem cell transplantation provides a cure for aplastic or myeloid neoplastic complications. However, it does not affect the risk of solid tumors. Since approximately 28% of FA, 24% of SCN, 21% of DBA, 20% of SDS, and 17% of DC patients harbor nonsense mutations in the respective IBMFS-related genes, we discuss the use of the nonsense suppression therapy in these diseases. We recently described the beneficial effect of ataluren, a nonsense suppressor drug, in SDS bone marrow hematopoietic cells ex vivo. A similar approach could be therefore designed for treating other IBMFS. In this review we explain in detail the new generation of nonsense suppressor molecules and their mechanistic roles. Furthermore, we will discuss strengths and limitations of these molecules which are emerging from preclinical and clinical studies. Finally we discuss the state-of-the-art of preclinical and clinical therapeutic studies carried out for IBMFS.
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Quarello P, Garelli E, Carando A, Cillario R, Brusco A, Giorgio E, Ferrante D, Corti P, Zecca M, Luciani M, Pierri F, Putti MC, Cantarini ME, Farruggia P, Barone A, Cesaro S, Russo G, Fagioli F, Dianzani I, Ramenghi U. A 20-year long term experience of the Italian Diamond-Blackfan Anaemia Registry: RPS and RPL genes, different faces of the same disease? Br J Haematol 2020; 190:93-104. [PMID: 32080838 DOI: 10.1111/bjh.16508] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/03/2020] [Indexed: 12/24/2022]
Abstract
Diamond-Blackfan anaemia (DBA) is a rare and heterogeneous disease characterised by hypoplastic anaemia, congenital anomalies and a predisposition for malignancies. The aim of this paper is to report the findings from the Italian DBA Registry, and to discuss the Registry's future challenges in tackling this disease. Our 20-year long work allowed the connection of 50 Italian Association of Paediatric Haematology and Oncology (AIEOP) centres and the recruitment of 283 cases. Almost all patients have been characterised at a molecular level (96%, 271/283), finding a causative mutation in 68% (184/271). We confirm the importance of determination of erythrocyte adenosine deaminase activity (eADA) and of ribosomal RNA assay in the diagnostic pipeline and characterisation of a remission state. Patients with mutations in large ribosomal subunit protein (RPL) genes had a significant correlation with the incidence of malformations, higher eADA levels and more severe outcomes, compared to patients with mutations in small ribosomal subunit protein (RPS) genes. Furthermore, as a consequence of our findings, particularly the incidence of malignancies and the high percentage of patients aged >18 years, we stress the importance of collaboration with adult clinicians to guarantee regular multi-specialist follow-up. In conclusion, this study highlights the importance of national registries to increase our understanding and improve management of this complex disease.
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Affiliation(s)
- Paola Quarello
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Turin, Italy
| | - Emanuela Garelli
- Department of Public Health and Paediatric Sciences, University of Torino, Turin, Italy
| | - Adriana Carando
- Department of Public Health and Paediatric Sciences, University of Torino, Turin, Italy
| | - Rebecca Cillario
- Department of Public Health and Paediatric Sciences, University of Torino, Turin, Italy
| | - Alfredo Brusco
- Department of Medical Sciences, University of Torino, Turin, Italy.,Medical Genetics Unit, "Città della Salute e della Scienza" Hospital, Turin, Italy
| | - Elisa Giorgio
- Department of Medical Sciences, University of Torino, Turin, Italy
| | - Daniela Ferrante
- Department of Translational Medicine, Unit of Cancer Epidemiology, CPO-Piemonte, University of Eastern Piedmont, Novara, Italy
| | - Paola Corti
- Paediatric Haematology, Fondazione MBBM, Monza, Italy
| | - Marco Zecca
- Department of Paediatric Haematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Matteo Luciani
- Haemostasis and Thrombosis Center, Onco-Haematology Department, Bambino Gesù Paediatric Hospital, Rome, Italy
| | - Filomena Pierri
- Clinical and Experimental Unit, G. Gaslini Children's Hospital, Genoa, Italy
| | - Maria C Putti
- Department of Women's and Children's Health, Paediatric Haematology-Oncology Unit, University of Padova, Padua, Italy
| | - Maria E Cantarini
- Paediatric Oncology and Haematology, U.O. Pediatria, Department of Women's and Children's Health, Policlinico Azienda Ospedaliera Universitaria Sant'Orsola Malpighi, Bologna, Italy
| | - Piero Farruggia
- Paediatric Haematology and Oncology Unit, A.R.N.A. S. Ospedale Civico, Palermo, Italy
| | - Angelica Barone
- Department of Paediatric Onco-Haematology, University Hospital, Parma, Italy
| | - Simone Cesaro
- Paediatric Haematology Oncology, Ospedale Donna Bambino, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giovanna Russo
- Paediatric Haematology and Oncology Unit, Azienda Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - Franca Fagioli
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Turin, Italy.,Department of Public Health and Paediatric Sciences, University of Torino, Turin, Italy
| | - Irma Dianzani
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Ugo Ramenghi
- Department of Public Health and Paediatric Sciences, University of Torino, Turin, Italy
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Volejnikova J, Vojta P, Urbankova H, Mojzíkova R, Horvathova M, Hochova I, Cermak J, Blatny J, Sukova M, Bubanska E, Feketeova J, Prochazkova D, Horakova J, Hajduch M, Pospisilova D. Czech and Slovak Diamond-Blackfan Anemia (DBA) Registry update: Clinical data and novel causative genetic lesions. Blood Cells Mol Dis 2019; 81:102380. [PMID: 31855845 DOI: 10.1016/j.bcmd.2019.102380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/08/2019] [Accepted: 11/08/2019] [Indexed: 12/23/2022]
Abstract
Diamond-Blackfan anemia (DBA) is a rare congenital erythroid aplasia, underlied by haploinsufficient mutations in genes coding for ribosomal proteins (RP) in approximately 70% of cases. DBA is frequently associated with somatic malformations, endocrine dysfunction and with an increased predisposition to cancer. Here we present clinical and genetic characteristics of 62 patients from 52 families enrolled in the Czech and Slovak DBA Registry. Whole exome sequencing (WES) and array comparative genomic hybridization (aCGH) were employed to identify causative mutations in newly diagnosed patients and in cases with previously unrecognized molecular pathology. RP mutation detection rate was 81% (50/62 patients). This included 8 novel point mutations and 4 large deletions encompassing some of the RP genes. Malignant or predisposing condition developed in 8/62 patients (13%): myelodysplastic syndrome in 3 patients; breast cancer in 2 patients; colorectal cancer plus ocular tumor, diffuse large B-cell lymphoma and multiple myeloma each in one case. These patients exclusively harbored RPL5, RPL11 or RPS19 mutations. Array CGH is beneficial for detection of novel mutations in DBA due to its capacity to detect larger chromosomal aberrations. Despite the importance of genotype-phenotype correlation in DBA, phenotypic differences among family members harboring an identical mutation were observed.
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Affiliation(s)
- Jana Volejnikova
- Department of Pediatrics, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc, I. P. Pavlova 6, 77900 Olomouc, Czech Republic; Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 1333/5, 77900 Olomouc, Czech Republic
| | - Petr Vojta
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 1333/5, 77900 Olomouc, Czech Republic
| | - Helena Urbankova
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc, I. P. Pavlova 6, 77900 Olomouc, Czech Republic
| | - Renata Mojzíkova
- Department of Biology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 77900 Olomouc, Czech Republic
| | - Monika Horvathova
- Department of Biology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 77900 Olomouc, Czech Republic
| | - Ivana Hochova
- Department of Hematology, Second Faculty of Medicine, Charles University and University Hospital Motol Prague, V Uvalu 84, 15006 Prague, Czech Republic
| | - Jaroslav Cermak
- Institute of Hematology and Blood Transfusion, U Nemocnice 2094/1, 12820 Prague, Czech Republic
| | - Jan Blatny
- Department of Pediatric Hematology, Masaryk University and University Hospital Brno, Jihlavská 20, 62500 Brno, Czech Republic
| | - Martina Sukova
- Department of Pediatric Hematology and Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol Prague, V Uvalu 84, 15006 Prague, Czech Republic
| | - Eva Bubanska
- Department of Pediatric Oncology and Hematology, Children's Faculty Hospital Banska Bystrica, Ludovit Svoboda Square 4, 97409 Banska Bystrica, Slovakia
| | - Jaroslava Feketeova
- Department of Pediatric Oncology and Hematology, Children Teaching Hospital Kosice, Trieda SNP 457/1, 04011 Kosice, Slovakia
| | - Daniela Prochazkova
- Department of Pediatrics, Masaryk Hospital Usti nad Labem, Socialni pece 3316/12A, 40113 Usti nad Labem, Czech Republic
| | - Julia Horakova
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Comenius University and University Hospital Bratislava, Limbova 1, 83340 Bratislava, Slovakia
| | - Marian Hajduch
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 1333/5, 77900 Olomouc, Czech Republic
| | - Dagmar Pospisilova
- Department of Pediatrics, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc, I. P. Pavlova 6, 77900 Olomouc, Czech Republic.
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12
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Abstract
Diamond-Blackfan anaemia (DBA) is a rare inherited marrow failure disorder, characterized by hypoplastic anaemia, congenital anomalies and a predisposition to cancer as a result of ribosomal dysfunction. Historically, treatment is based on glucocorticoids and/or blood transfusions, which is accompanied by significant toxicity and long-term sequelae. Currently, stem cell transplantation is the only curative option for the haematological DBA phenotype. Whereas this procedure has been quite successful in the last decade in selected patients, novel therapies and biological insights are still warranted to improve clinical care for all DBA patients. In addition to paediatric haematologists, other physicians (e.g. endocrinologist, gynaecologist) should ideally be involved in the care of this chronic condition from an early age, to improve lifelong management of haematological and non-haematological symptoms, and screen for DBA-associated malignancies. Here we provide an overview of current knowledge and recommendations for the day-to-day care of DBA patients.
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Affiliation(s)
- Marije Bartels
- Paediatric Haematology DepartmentWilhelmina Children's HospitalUniversity Medical Centre Utrecht Utrechtthe Netherlands
| | - Marc Bierings
- Department of Stem cell transplantationPrincess Maxima Centre for Paediatric OncologyWilhelmina Children's HospitalUniversity Medical Centre UtrechtUtrechtthe Netherlands
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13
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Aspesi A, Betti M, Sculco M, Actis C, Olgasi C, Wlodarski MW, Vlachos A, Lipton JM, Ramenghi U, Santoro C, Follenzi A, Ellis SR, Dianzani I. A functional assay for the clinical annotation of genetic variants of uncertain significance in Diamond-Blackfan anemia. Hum Mutat 2018; 39:1102-1111. [PMID: 29766597 PMCID: PMC6055729 DOI: 10.1002/humu.23551] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/21/2018] [Accepted: 05/09/2018] [Indexed: 12/03/2022]
Abstract
Diamond-Blackfan anemia (DBA) is a rare genetic hypoplasia of erythroid progenitors characterized by mild to severe anemia and associated with congenital malformations. Clinical manifestations in DBA patients are quite variable and genetic testing has become a critical factor in establishing a diagnosis of DBA. The majority of DBA cases are due to heterozygous loss-of-function mutations in ribosomal protein (RP) genes. Causative mutations are fairly straightforward to identify in the case of large deletions and frameshift and nonsense mutations found early in a protein coding sequence, but diagnosis becomes more challenging in the case of missense mutations and small in-frame indels. Our group recently characterized the phenotype of lymphoblastoid cell lines established from DBA patients with pathogenic lesions in RPS19 and observed that defective pre-rRNA processing, a hallmark of the disease, was rescued by lentiviral vectors expressing wild-type RPS19. Here, we use this complementation assay to determine whether RPS19 variants of unknown significance are capable of rescuing pre-rRNA processing defects in these lymphoblastoid cells as a means of assessing the effects of these sequence changes on the function of the RPS19 protein. This approach will be useful in differentiating pathogenic mutations from benign polymorphisms in identifying causative genes in DBA patients.
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Affiliation(s)
- Anna Aspesi
- Department of Health SciencesUniversità del Piemonte OrientaleNovaraItaly
| | - Marta Betti
- Department of Health SciencesUniversità del Piemonte OrientaleNovaraItaly
| | - Marika Sculco
- Department of Health SciencesUniversità del Piemonte OrientaleNovaraItaly
| | - Chiara Actis
- Department of Health SciencesUniversità del Piemonte OrientaleNovaraItaly
| | - Cristina Olgasi
- Department of Health SciencesUniversità del Piemonte OrientaleNovaraItaly
| | - Marcin W. Wlodarski
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Adrianna Vlachos
- Feinstein Institute for Medical ResearchManhassetNew York
- Division of Hematology/Oncology and Stem Cell TransplantationCohen Children's Medical Center of New YorkNew Hyde ParkNew York
| | - Jeffrey M. Lipton
- Feinstein Institute for Medical ResearchManhassetNew York
- Division of Hematology/Oncology and Stem Cell TransplantationCohen Children's Medical Center of New YorkNew Hyde ParkNew York
| | - Ugo Ramenghi
- Department of Public Health and Pediatric SciencesUniversity of TorinoTorinoItaly
| | - Claudio Santoro
- Department of Health SciencesUniversità del Piemonte OrientaleNovaraItaly
| | - Antonia Follenzi
- Department of Health SciencesUniversità del Piemonte OrientaleNovaraItaly
| | - Steven R. Ellis
- Department of Biochemistry and Molecular GeneticsUniversity of LouisvilleLouisvilleKentucky
| | - Irma Dianzani
- Department of Health SciencesUniversità del Piemonte OrientaleNovaraItaly
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14
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Arbiv OA, Cuvelier G, Klaassen RJ, Fernandez CV, Robitaille N, Steele M, Breakey V, Abish S, Wu J, Sinha R, Silva M, Goodyear L, Jardine L, Lipton JH, Corriveau-Bourque C, Brossard J, Michon B, Ghemlas I, Waespe N, Zlateska B, Sung L, Cada M, Dror Y. Molecular analysis and genotype-phenotype correlation of Diamond-Blackfan anemia. Clin Genet 2017; 93:320-328. [PMID: 29044489 DOI: 10.1111/cge.13158] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/11/2017] [Accepted: 10/13/2017] [Indexed: 02/03/2023]
Abstract
Diamond-Blackfan anemia (DBA) features hypoplastic anemia and congenital malformations, largely caused by mutations in various ribosomal proteins. The aim of this study was to characterize the spectrum of genetic lesions causing DBA and identify genotypes that correlate with phenotypes of clinical significance. Seventy-four patients with DBA from across Canada were included. Nucleotide-level mutations or large deletions were identified in 10 ribosomal genes in 45 cases. The RPS19 mutation group was associated with higher requirement for chronic treatment for anemia than other DBA groups. Patients with RPS19 mutations, however, were more likely to maintain long-term corticosteroid response without requirement for further chronic transfusions. Conversely, patients with RPL11 mutations were less likely to need chronic treatment. Birth defects, including cardiac, skeletal, hand, cleft lip or palate and genitourinary malformations, also varied among the various genetic groups. Patients with RPS19 mutations had the fewest number of defects, while patients with RPL5 had the greatest number of birth defects. This is the first study to show differences between DBA genetic groups with regards to treatment. Previously unreported differences in the rate and types of birth defects were also identified. These data allow better patient counseling, a more personalized monitoring plan, and may also suggest differential functions of DBA genes on ribosome and extra-ribosomal functions.
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Affiliation(s)
- O A Arbiv
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - G Cuvelier
- Division of Haematology/Oncology, CancerCare Manitoba, Winnipeg, Canada
| | - R J Klaassen
- Division of Haematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - C V Fernandez
- Division of Haematology/Oncology, IWK Health Centre, Halifax, Canada
| | - N Robitaille
- Division of Haematology/Oncology, CHU Sainte Justine, Montreal, Canada
| | - M Steele
- Division of Haematology/Oncology, Alberta Children's Hospital, Calgary, Canada
| | - V Breakey
- Division of Haematology/Oncology, McMaster Children's Hospital, Hamilton, Canada
| | - S Abish
- Division of Haematology/Oncology, Montreal Children's Hospital, Montreal, Canada
| | - J Wu
- Division of Haematology/Oncology, British Columbia Children's Hospital, Vancouver, Canada
| | - R Sinha
- Division of Haematology/Oncology, University of Saskatchewan, Saskatoon, Canada
| | - M Silva
- Division of Haematology/Oncology, Queen's University, Kingston, Canada
| | - L Goodyear
- Division of Haematology/Oncology, Janeway Child Health Centre, St. John's, Canada
| | - L Jardine
- Division of Haematology/Oncology, Children's Hospital of Western Ontario, London, Canada
| | - J H Lipton
- Department of Haematology and Internal Medicine, Princess Margaret Hospital, Toronto, Canada
| | - C Corriveau-Bourque
- Division of Haematology/Oncology, University of Alberta Health Sciences Centre, Edmonton, Canada
| | - J Brossard
- Division of Haematology/Oncology, Centre Y Sante L'Estrie-Fleur, Sherbrooke, Canada
| | - B Michon
- Division of Haematology/Oncology, Centre Hospitalier de l'Université Laval, Quebec City, Canada
| | - I Ghemlas
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada.,Division of Haematology/Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - N Waespe
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada.,The Marrow Failure and Myelodysplasia Program, Haematology Section, Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - B Zlateska
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada.,The Marrow Failure and Myelodysplasia Program, Haematology Section, Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - L Sung
- Program in Child Health and Evaluative Medicine, Research Institute, The Hospital for Sick Children, Toronto, Canada.,Lymphoma Leukemia Section, Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - M Cada
- The Marrow Failure and Myelodysplasia Program, Haematology Section, Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Y Dror
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada.,The Marrow Failure and Myelodysplasia Program, Haematology Section, Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Canada
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15
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Da Costa L, O'Donohue MF, van Dooijeweert B, Albrecht K, Unal S, Ramenghi U, Leblanc T, Dianzani I, Tamary H, Bartels M, Gleizes PE, Wlodarski M, MacInnes AW. Molecular approaches to diagnose Diamond-Blackfan anemia: The EuroDBA experience. Eur J Med Genet 2017; 61:664-673. [PMID: 29081386 DOI: 10.1016/j.ejmg.2017.10.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/28/2017] [Accepted: 10/22/2017] [Indexed: 11/19/2022]
Abstract
Diamond-Blackfan anemia (DBA) is a rare congenital erythroblastopenia and inherited bone marrow failure syndrome that affects approximately seven individuals in every million live births. In addition to anemia, about 50% of all DBA patients suffer from various physical malformations of the face, hands, heart, or urogenital region. The disorder is almost exclusively driven by haploinsufficient mutations in one of several ribosomal protein (RP) genes, although for ∼30% of diagnosed patients no mutation is found in any of the known DBA-linked genes. Because DBA is such a rare disease with a particularly wide range of clinical phenotypes and molecular signatures, the development of collaborative efforts such as the ERARE-funded European DBA consortium (EuroDBA) has become imperative for DBA research. EuroDBA was founded in 2012 and brings together dedicated clinical and biological researchers of DBA from France, Italy, the Netherlands, Germany, Israel, Poland, and Turkey to achieve a number of goals including the consolidation of data in patient registries, establishment of minimal diagnostic criteria, and projects aimed at more fully describing the different mutations linked to DBA. This review will cover the history of the EuroDBA registries, the methods used by EuroDBA in the diagnosis of DBA, and how the consortium has successfully worked together towards the discovery of new DBA-linked genes and the better understanding their pathophysiological effects.
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Affiliation(s)
- Lydie Da Costa
- University Paris VII Denis DIDEROT, Faculté de Médecine Xavier Bichat, F-75019 Paris, France; Laboratory of Excellence for Red Cell, LABEX GR-Ex, F-75015 Paris, France; Inserm Unit 1134, INTS, F-75015 Paris, France; Service d'onco-hématologie pédiatrique, Robert Debré Hospital, F-75019 Paris, France
| | - Marie-Françoise O'Donohue
- Laboratoire de Biologie Moléculaire Eucaryote, Centre de Biologie Intégrative, Université de Toulouse, CNRS, UPS, 31000 Toulouse, France
| | - Birgit van Dooijeweert
- Department of Pediatric Hematology and Stem Cell Transplantation, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Katarzyna Albrecht
- Medical University of Warsaw, Department of Pediatric Hematology and Oncology, Ul. Żwirki I Wigury 61, 02-091 Warsaw, Poland
| | - Sule Unal
- Hacettepe University, Center of Research, Diagnosis and Treatment for Fanconi Anemia and Other Inherited Bone Marrow Failure Syndromes, Ankara 06100, Turkey
| | - Ugo Ramenghi
- Department of Pediatric and Public Health Sciences, University of Torino, 10126 Torino, Italy
| | - Thierry Leblanc
- Service d'onco-hématologie pédiatrique, Robert Debré Hospital, F-75019 Paris, France
| | - Irma Dianzani
- Department of Health Sciences, Università Del Piemonte Orientale, 28100 Novara, Italy
| | - Hannah Tamary
- Pediatric Hematology/Oncology Department, Soroka Medical Center, Faculty of Medicine, Ben-Gurion University, 84101 Beer Sheva, Israel
| | - Marije Bartels
- Department of Pediatric Hematology and Stem Cell Transplantation, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Pierre-Emmanuel Gleizes
- Laboratoire de Biologie Moléculaire Eucaryote, Centre de Biologie Intégrative, Université de Toulouse, CNRS, UPS, 31000 Toulouse, France
| | - Marcin Wlodarski
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, D-79106 Freiburg, Germany
| | - Alyson W MacInnes
- Laboratory Genetic Metabolic Diseases, Academic Medical Center, 1105 AZ Amsterdam, The Netherlands.
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16
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Carlston CM, Afify ZA, Palumbos JC, Bagley H, Barbagelata C, Wooderchak-Donahue WL, Mao R, Carey JC. Variable expressivity and incomplete penetrance in a large family with non-classical Diamond-Blackfan anemia associated with ribosomal protein L11 splicing variant. Am J Med Genet A 2017; 173:2622-2627. [PMID: 28742285 DOI: 10.1002/ajmg.a.38360] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/18/2017] [Accepted: 06/21/2017] [Indexed: 12/31/2022]
Abstract
Diamond-Blackfan anemia (DBA) is a group of clinically and genetically heterogeneous bone marrow failure disorders with or without congenital anomalies. Variable expressivity and incomplete penetrance have been observed within affected families. Diamond-Blackfan anemia-7 (DBA7), caused by heterozygous mutations in ribosomal protein L11 (RPL11), accounts for approximately 5% of DBA. DBA7 is usually characterized by early-onset bone marrow failure often accompanied by congenital malformations, especially thumb defects. Here, we present the case of a 2-year-old boy with chronic mild normocytic anemia, short stature, bilateral underdevelopment of the thumbs, atrial septal defect, and hypospadias. Hematological testing revealed slightly decreased hematocrit and hemoglobin, normal HbF, and elevated eADA. Family history included maternal relatives with thumb defects, but the mother's thumbs were normal. Clinical exome sequencing detected a maternally-inherited RPL11 variant, c.396+3A>G, that is predicted to affect splicing. A family correlation study of the identified variant demonstrates segregation with thumb anomalies in the mother's family. RNA studies suggest that the variant produces an alternative transcript that is likely susceptible to nonsense-mediated decay. This report summarizes the prevalence of non-anemia findings in DBA7 and describes a non-classical familial presentation of DBA7 more associated with thumb anomalies than with anemia.
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Affiliation(s)
- Colleen M Carlston
- Department of Pathology, University of Utah, Salt Lake City, Utah.,ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, Utah
| | - Zeinab A Afify
- Department of Pediatrics, Hematology & Oncology, University of Utah, Salt Lake City, Utah
| | - Janice C Palumbos
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Salt Lake City, Utah
| | | | - Carlos Barbagelata
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Salt Lake City, Utah
| | - Whitney L Wooderchak-Donahue
- Department of Pathology, University of Utah, Salt Lake City, Utah.,ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, Utah
| | - Rong Mao
- Department of Pathology, University of Utah, Salt Lake City, Utah.,ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, Utah
| | - John C Carey
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Salt Lake City, Utah
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17
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Whole exome sequencing in the differential diagnosis of Diamond-Blackfan anemia: Clinical and molecular study of three patients with novel RPL5 and mosaic RPS19 mutations. Blood Cells Mol Dis 2017; 64:38-44. [PMID: 28376382 PMCID: PMC7129236 DOI: 10.1016/j.bcmd.2017.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/04/2017] [Accepted: 03/05/2017] [Indexed: 11/20/2022]
Abstract
Diamond-Blackfan anemia (DBA) is a rare congenital disorder presenting remarkable phenotypic overlap with other inherited bone marrow failure syndromes, making differential diagnosis challenging and its confirmation often reached with great delay. By whole exome sequencing, we unraveled the presence of pathogenic variants affecting genes already known to be involved in DBA pathogenesis (RPL5 and RPS19) in three patients with otherwise uncertain clinical diagnosis, and provided new insights on DBA genotype-phenotype correlations. Remarkably, the RPL5 c.482del frameshift mutation has never been reported before, whereas the RPS19 c.3G>T missense mutation, although previously described in a 2-month-old DBA patient without malformations and refractory to steroid therapy, was detected here in the mosaic state in different bodily tissues for the first time in DBA patients.
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18
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Clinical features, mutations and treatment of 104 patients of Diamond-Blackfan anemia in China: a single-center retrospective study. Int J Hematol 2016; 104:430-9. [PMID: 27329125 DOI: 10.1007/s12185-016-2044-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 06/16/2016] [Accepted: 06/16/2016] [Indexed: 10/21/2022]
Abstract
Diamond-Blackfan anemia (DBA) is an inherited bone marrow failure syndrome characterized by a paucity of erythroid progenitors. We summarized the clinical and genetic features of 104 DBA patients in a single-center retrospective study in China. Data of DBA patients who received consultations at our center from 2003 to 2015 were analyzed retrospectively. Genes encoding 10 ribosomal proteins (RPs) and GATA1 were sequenced for mutation detection. Our cohort was composed of 65 males and 39 females. Congenital malformations were observed in 19 patients. Mutations of the RP genes were detected in 58.3 % patients. Twenty different mutations were first reported. Thirty-four patients received prednisone combined with CsA therapy, and improvement was observed in 20 cases. During follow-up for a median 39 months, 33.7 % of the patients achieved remission, 41.3 % of the patients were persistently transfusion independent, 21.7 % of the patients were transfusion dependent, and three patients died. The patient group with detected mutations had a younger age of disease onset, a higher malformation rate, and tended to have a lower remission rate and a higher transfusion-dependence rate. Prednisone in combination with cyclosporine A can be a second-line choice for DBA patients. Differences were detected between DBA patients with and without detectable mutations in the genes studied.
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19
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Zhang J, Barbaro P, Guo Y, Alodaib A, Li J, Gold W, Adès L, Keating BJ, Xu X, Teo J, Hakonarson H, Christodoulou J. Utility of next-generation sequencing technologies for the efficient genetic resolution of haematological disorders. Clin Genet 2015; 89:163-72. [PMID: 25703294 DOI: 10.1111/cge.12573] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 02/01/2015] [Accepted: 02/12/2015] [Indexed: 12/22/2022]
Abstract
Next-generation sequencing (NGS) has now evolved to be a relatively affordable and efficient means of detecting genetic mutations. Whole genome sequencing (WGS) or whole exome sequencing (WES) offers the opportunity for rapid diagnosis in many paediatric haematological conditions, where phenotypes are variable and either a large number of genes are involved, or the genes are large making sanger sequencing expensive and labour-intensive. NGS offers the potential for gene discovery in patients who do not have mutations in currently known genes. This report shows how WES was used in the diagnosis of six paediatric haematology cases. In four cases (Diamond-Blackfan anaemia, congenital neutropenia (n = 2), and Fanconi anaemia), the diagnosis was suspected based on classical phenotype, and NGS confirmed those suspicions. Mutations in RPS19, ELANE and FANCD2 were found. The final two cases (MYH9 associated macrothrombocytopenia associated with multiple congenital anomalies; atypical juvenile myelomonocytic leukaemia associated with a KRAS mutation) highlight the utility of NGS where the diagnosis is less certain, or where there is an unusual phenotype. We discuss the advantages and limitations of NGS in the setting of these cases, and in haematological conditions more broadly, and discuss where NGS is most efficiently used.
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Affiliation(s)
- J Zhang
- T-Life Research Center, Fudan University, Shanghai, 200433, China.,Department of BioMedical Research, BGI-Shenzhen, Shenzhen, 518083, China
| | - P Barbaro
- Haematology Department, The Children's Hospital at Westmead, Sydney, Australia.,Cancer Research Unit, Children's Medical Research Institute, Westmead, Australia
| | - Y Guo
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - A Alodaib
- Genetic Metabolic Disorders Research Unit, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - J Li
- Department of BioMedical Research, BGI-Shenzhen, Shenzhen, 518083, China
| | - W Gold
- Genetic Metabolic Disorders Research Unit, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - L Adès
- Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Clinical Genetics Department, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Genetic Medicine, Sydney Medical School, University of Sydney, Sydney, Australia
| | - B J Keating
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Human Genetics Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - X Xu
- Department of BioMedical Research, BGI-Shenzhen, Shenzhen, 518083, China.,Shenzhen Key Laboratory of Genomics, Shenzhen, China.,The Guangdong Enterprise Key Laboratory of Human Disease Genomics, Shenzhen, China
| | - J Teo
- Haematology Department, The Children's Hospital at Westmead, Sydney, Australia
| | - H Hakonarson
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Human Genetics Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - J Christodoulou
- Genetic Metabolic Disorders Research Unit, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Discipline of Genetic Medicine, Sydney Medical School, University of Sydney, Sydney, Australia
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Howell JC, Joshi SA, Hornung L, Khoury J, Harris RE, Rose SR. Growth hormone improves short stature in children with Diamond-Blackfan anemia. Pediatr Blood Cancer 2015; 62:402-8. [PMID: 25492299 DOI: 10.1002/pbc.25341] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 10/10/2014] [Indexed: 01/25/2023]
Abstract
BACKGROUND Diamond-Blackfan anemia (DBA), an inherited marrow failure syndrome, has severe hypoplastic anemia in infancy and association with aplastic anemia, MDS/leukemia, and other malignancies. Short stature is present in most patients. Isolated cases have demonstrated improved growth on growth hormone (GH) therapy. PROCEDURES GH treatment data were obtained from 19 children with DBA (6 at our site and 13 from Genentech). Control data from 44 non-GH treated children were provided by Diamond Blackfan Anemia Registry. Annual growth velocity (GV) and height-for-age Z-scores (HAZ) were compared between groups and for up to 4y of GH treatment. RESULTS Constructed DBA-specific male and female height-for-age charts for non-GH treated patients revealed short stature compared to CDC norms. GH-treated patients had significantly lower HAZ prior to treatment initiation compared to non-GH-treated controls. Among GH-treated patients, GV significantly improved in the first two years relative to pre-treatment. HAZ significantly improved in each of 4y of GH therapy compared to baseline. After 2y of therapy, HAZ for GH-treated patients were not significantly different from controls, demonstrating successful catch-up growth. CONCLUSIONS GH treatment in children with DBA improves both GV and HAZ during treatment sustained for up to 4y. Very short children with DBA can be treated successfully with GH to restore stature to levels comparable to less affected patients. DBA height charts are useful tools for assessing age-specific growth in this typically short population. Careful consideration of individualized benefit of GH therapy versus risk is important in view of long-term underlying ∼5% malignancy risk in DBA.
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Affiliation(s)
- Jonathan C Howell
- Divisions of Endocrinology, Bone Marrow Transplantation and Immune Deficiency, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
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Nakhoul H, Ke J, Zhou X, Liao W, Zeng SX, Lu H. Ribosomopathies: mechanisms of disease. PLASMATOLOGY 2014; 7:7-16. [PMID: 25512719 PMCID: PMC4251057 DOI: 10.4137/cmbd.s16952] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/03/2014] [Accepted: 07/16/2014] [Indexed: 01/05/2023]
Abstract
Ribosomopathies are diseases caused by alterations in the structure or function of ribosomal components. Progress in our understanding of the role of the ribosome in translational and transcriptional regulation has clarified the mechanisms of the ribosomopathies and the relationship between ribosomal dysfunction and other diseases, especially cancer. This review aims to discuss these topics with updated information.
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Affiliation(s)
- Hani Nakhoul
- Department of Biochemistry and Molecular Biology and Cancer Center, Tulane University, School of Medicine, New Orleans, Louisiana, LA, USA
| | - Jiangwei Ke
- Department of Biochemistry and Molecular Biology and Cancer Center, Tulane University, School of Medicine, New Orleans, Louisiana, LA, USA. ; Department of Laboratory Medicine, Jiangxi Children's Hospital, Nanchang, Jiangxi, China
| | - Xiang Zhou
- Department of Biochemistry and Molecular Biology and Cancer Center, Tulane University, School of Medicine, New Orleans, Louisiana, LA, USA
| | - Wenjuan Liao
- Department of Biochemistry and Molecular Biology and Cancer Center, Tulane University, School of Medicine, New Orleans, Louisiana, LA, USA
| | - Shelya X Zeng
- Department of Biochemistry and Molecular Biology and Cancer Center, Tulane University, School of Medicine, New Orleans, Louisiana, LA, USA
| | - Hua Lu
- Department of Biochemistry and Molecular Biology and Cancer Center, Tulane University, School of Medicine, New Orleans, Louisiana, LA, USA
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Pospisilova D, Holub D, Zidova Z, Sulovska L, Houda J, Mihal V, Hadacova I, Radova L, Dzubak P, Hajduch M, Divoky V, Horvathova M. Hepcidin levels in Diamond-Blackfan anemia reflect erythropoietic activity and transfusion dependency. Haematologica 2014; 99:e118-21. [PMID: 24727814 DOI: 10.3324/haematol.2014.104034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Dagmar Pospisilova
- Department of Pediatrics, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc
| | - Dusan Holub
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Olomouc
| | - Zuzana Zidova
- Department of Biology, Faculty of Medicine and Dentistry, Palacky University
| | - Lucie Sulovska
- Department of Pediatrics, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc
| | - Jiri Houda
- Department of Pediatrics, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc
| | - Vladimir Mihal
- Department of Pediatrics, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc
| | - Ivana Hadacova
- Department of Pediatric Hematology and Oncology, Charles University, 2 Faculty of Medicine, Prague
| | - Lenka Radova
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Petr Dzubak
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Olomouc
| | - Marian Hajduch
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Olomouc
| | - Vladimir Divoky
- Department of Biology, Faculty of Medicine and Dentistry, Palacky University
| | - Monika Horvathova
- Department of Biology, Faculty of Medicine and Dentistry, Palacky University
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Vlachos A, Blanc L, Lipton JM. Diamond Blackfan anemia: a model for the translational approach to understanding human disease. Expert Rev Hematol 2014; 7:359-72. [PMID: 24665981 DOI: 10.1586/17474086.2014.897923] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Diamond Blackfan anemia (DBA) is an inherited bone marrow failure syndrome. As with the other rare inherited bone marrow failure syndromes, the study of these disorders provides important insights into basic biology and, in the case of DBA, ribosome biology; the disruption of which characterizes the disorder. Thus DBA serves as a paradigm for translational medicine in which the efforts of clinicians to manage DBA have informed laboratory scientists who, in turn, have stimulated clinical researchers to utilize scientific discovery to provide improved care. In this review we describe the clinical syndrome Diamond Blackfan anemia and, in particular, we demonstrate how the study of DBA has allowed scientific inquiry to create opportunities for progress in its understanding and treatment.
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