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Zamani R, Zoghi S, Shahkarami S, Seyedpour S, Jimenez Heredia R, Boztug K, Rezaei N. Novel CARMIL2 (RLTPR) Mutation Presenting with Hyper-IgE and Eosinophilia: A Case Report. Endocr Metab Immune Disord Drug Targets 2024; 24:596-605. [PMID: 37855284 DOI: 10.2174/0118715303263327230922043929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/28/2023] [Accepted: 08/07/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Inborn errors of immunity are a growing group of disorders with a wide spectrum of genotypic and phenotypic profiles. CARMIL2 (previously named RLTPR) deficiency is a recently described cause of immune dysregulation, mainly presenting with allergy, mucocutaneous infections, and inflammatory bowel disease. CARMIL2 deficiency is categorized under diseases of immune dysregulation with susceptibility to lymphoproliferative conditions. CASE PRESENTATION Here we describe a 29-years-old male from a consanguineous family, with food and sting allergy, allergic rhinitis, facial molluscum contagiosum (viral infection of the skin in the form of umbilicated papules), eosinophilia and highly elevated serum IgE level. Whole exome sequencing revealed numerous homozygous variants, including a CARMIL2 nonsense mutation, a gene regulating actin polymerization, and promoting cell protrusion formation. CONCLUSION The selective role of CARMIL2 in T cell activation and maturation through cytoskeletal organization is proposed to be the cause of immune dysregulation in individuals with CARMIL2 deficiency. CARMIL2 has an important role in immune pathways regulation, through cell maturation and differentiation, giving rise to a balance between Th1, Th2, and Th17 immune response. This case can improve the understanding of the different impacts of CARMIL2 mutations on immune pathways and further guide the diagnosis of patients with similar phenotypes.
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Affiliation(s)
- Raha Zamani
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Samaneh Zoghi
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Sepideh Shahkarami
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians- Universität München (LMU), Munich, Germany
| | - Simin Seyedpour
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Raúl Jimenez Heredia
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Kaan Boztug
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
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Sams L, Wijetilleka S, Ponsford M, Gennery A, Jolles S. Atopic manifestations of inborn errors of immunity. Curr Opin Allergy Clin Immunol 2023; 23:478-490. [PMID: 37755421 PMCID: PMC10621644 DOI: 10.1097/aci.0000000000000943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
PURPOSE OF REVIEW Allergy and atopic features are now well recognized manifestations of many inborn errors of immunity (IEI), and indeed may be the hallmark in some, such as DOCK8 deficiency. In this review, we describe the current IEI associated with atopy, using a comprehensive literature search and updates from the IUIS highlighting clinical clues for underlying IEI such as very early onset of atopic disease or treatment resistance to enable early and accurate genetic diagnosis. RECENT FINDINGS We focus on recently described genes, their categories of pathogenic mechanisms and the expanding range of potential therapies. SUMMARY We highlight in this review that patients with very early onset or treatment resistant atopic disorders should be investigated for an IEI, as targeted and effective therapies exist. Early and accurate genetic diagnosis is crucial in this cohort to reduce the burden of disease and mortality.
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Affiliation(s)
- Laura Sams
- Paediatric Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital (GNCH), Royal Victoria Infirmary, Queen Victoria Road
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne
| | - Sonali Wijetilleka
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Mark Ponsford
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Andrew Gennery
- Paediatric Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital (GNCH), Royal Victoria Infirmary, Queen Victoria Road
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne
| | - Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
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Of Mycelium and Men: Inherent Human Susceptibility to Fungal Diseases. Pathogens 2023; 12:pathogens12030456. [PMID: 36986378 PMCID: PMC10058615 DOI: 10.3390/pathogens12030456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Abstract
In medical mycology, the main context of disease is iatrogenic-based disease. However, historically, and occasionally, even today, fungal diseases affect humans with no obvious risk factors, sometimes in a spectacular fashion. The field of “inborn errors of immunity” (IEI) has deduced at least some of these previously enigmatic cases; accordingly, the discovery of single-gene disorders with penetrant clinical effects and their immunologic dissection have provided a framework with which to understand some of the key pathways mediating human susceptibility to mycoses. By extension, they have also enabled the identification of naturally occurring auto-antibodies to cytokines that phenocopy such susceptibility. This review provides a comprehensive update of IEI and autoantibodies that inherently predispose humans to various fungal diseases.
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Vahidnezhad H, Youssefian L, Harvey N, Tavasoli AR, Saeidian AH, Sotoudeh S, Varghaei A, Mahmoudi H, Mansouri P, Mozafari N, Zargari O, Zeinali S, Uitto J. Mutation update: The spectra of PLEC sequence variants and related plectinopathies. Hum Mutat 2022; 43:1706-1731. [PMID: 35815343 PMCID: PMC9771971 DOI: 10.1002/humu.24434] [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: 05/02/2022] [Revised: 06/23/2022] [Accepted: 07/07/2022] [Indexed: 01/24/2023]
Abstract
Plectin, encoded by PLEC, is a cytoskeletal linker of intermediate filaments expressed in many cell types. Plectin consists of three main domains that determine its functionality: the N-terminal domain, the Rod domain, and the C-terminal domain. Molecular defects of PLEC correlating with the functional aspects lead to a group of rare heritable disorders, plectinopathies. These multisystem disorders include an autosomal dominant form of epidermolysis bullosa simplex (EBS-Ogna), limb-girdle muscular dystrophy (LGMD), aplasia cutis congenita (ACC), and an autosomal recessive form of EBS, which may associate with muscular dystrophy (EBS-MD), pyloric atresia (EBS-PA), and/or congenital myasthenic syndrome (EBS-MyS). In this study, genotyping of over 600 Iranian patients with epidermolysis bullosa by next-generation sequencing identified 15 patients with disease-causing PLEC variants. This mutation update analyzes the clinical spectrum of PLEC in our cohort and in the literature and demonstrates the relationship between PLEC genotype and phenotypic manifestations. This study has integrated our seven novel PLEC variants and phenotypic findings with previously published data totaling 116 variants to provide the most complete overview of pathogenic PLEC variants and related disorders.
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Affiliation(s)
- Hassan Vahidnezhad
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Leila Youssefian
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Nailah Harvey
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Ali Reza Tavasoli
- Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA
- Pediatric Neurology Division, Children’s Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Saeidian
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Soheila Sotoudeh
- Department of Dermatology, Children’s Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Aida Varghaei
- Department of Dermatology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Hamidreza Mahmoudi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvin Mansouri
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nikoo Mozafari
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Jouni Uitto
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA
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Kolukisa B, Baser D, Akcam B, Danielson J, Eltan SB, Haliloglu Y, Sefer AP, Babayeva R, Akgun G, Charbonnier LM, Schmitz-Abe K, Demirkol YK, Zhang Y, Gonzaga-Jauregui C, Heredia RJ, Kasap N, Kiykim A, Yucel EO, Gok V, Unal E, Kisaarslan AP, Nepesov S, Baysoy G, Onal Z, Yesil G, Celkan TT, Cokugras H, Camcioglu Y, Eken A, Boztug K, Lo B, Karakoc-Aydiner E, Su HC, Ozen A, Chatila TA, Baris S. Evolution and long-term outcomes of combined immunodeficiency due to CARMIL2 deficiency. Allergy 2022; 77:1004-1019. [PMID: 34287962 PMCID: PMC9976932 DOI: 10.1111/all.15010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/05/2021] [Accepted: 07/01/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Biallelic loss-of-function mutations in CARMIL2 cause combined immunodeficiency associated with dermatitis, inflammatory bowel disease (IBD), and EBV-related smooth muscle tumors. Clinical and immunological characterizations of the disease with long-term follow-up and treatment options have not been previously reported in large cohorts. We sought to determine the clinical and immunological features of CARMIL2 deficiency and long-term efficacy of treatment in controlling different disease manifestations. METHODS The presenting phenotypes, long-term outcomes, and treatment responses were evaluated prospectively in 15 CARMIL2-deficient patients, including 13 novel cases. Lymphocyte subpopulations, protein expression, regulatory T (Treg), and circulating T follicular helper (cTFH ) cells were analyzed. Three-dimensional (3D) migration assay was performed to determine T-cell shape. RESULTS Mean age at disease onset was 38 ± 23 months. Main clinical features were skin manifestations (n = 14, 93%), failure to thrive (n = 10, 67%), recurrent infections (n = 10, 67%), allergic symptoms (n = 8, 53%), chronic diarrhea (n = 4, 27%), and EBV-related leiomyoma (n = 2, 13%). Skin manifestations ranged from atopic and seborrheic dermatitis to psoriasiform rash. Patients had reduced proportions of memory CD4+ T cells, Treg, and cTFH cells. Memory B and NK cells were also decreased. CARMIL2-deficient T cells exhibited reduced T-cell proliferation and cytokine production following CD28 co-stimulation and normal morphology when migrating in a high-density 3D collagen gel matrix. IBD was the most severe clinical manifestation, leading to growth retardation, requiring multiple interventional treatments. All patients were alive with a median follow-up of 10.8 years (range: 3-17 years). CONCLUSION This cohort provides clinical and immunological features and long-term follow-up of different manifestations of CARMIL2 deficiency.
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Affiliation(s)
- Burcu Kolukisa
- Marmara University, Faculty of Medicine, Pediatric Allergy
and Immunology, Istanbul, Turkey,Istanbul Jeffrey Modell Diagnostic and Research Center for
Primary Immunodeficiencies, Istanbul, Turkey,The Isil Berat Barlan Center for Translational
Medicine
| | - Dilek Baser
- Marmara University, Faculty of Medicine, Pediatric Allergy
and Immunology, Istanbul, Turkey,Istanbul Jeffrey Modell Diagnostic and Research Center for
Primary Immunodeficiencies, Istanbul, Turkey,The Isil Berat Barlan Center for Translational
Medicine
| | - Bengu Akcam
- Marmara University, Faculty of Medicine, Pediatric Allergy
and Immunology, Istanbul, Turkey,Istanbul Jeffrey Modell Diagnostic and Research Center for
Primary Immunodeficiencies, Istanbul, Turkey,The Isil Berat Barlan Center for Translational
Medicine
| | - Jeffrey Danielson
- Human Immunological Diseases Section, Laboratory of
Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, MD, USA,Clinical Genomics Program, NIAID, NIH, Bethesda, MD,
USA
| | - Sevgi Bilgic Eltan
- Marmara University, Faculty of Medicine, Pediatric Allergy
and Immunology, Istanbul, Turkey,Istanbul Jeffrey Modell Diagnostic and Research Center for
Primary Immunodeficiencies, Istanbul, Turkey,The Isil Berat Barlan Center for Translational
Medicine
| | - Yesim Haliloglu
- Erciyes University School of Medicine, Department of
Medical Biology, Kayseri, Turkey
| | - Asena Pinar Sefer
- Marmara University, Faculty of Medicine, Pediatric Allergy
and Immunology, Istanbul, Turkey,Istanbul Jeffrey Modell Diagnostic and Research Center for
Primary Immunodeficiencies, Istanbul, Turkey,The Isil Berat Barlan Center for Translational
Medicine
| | - Royale Babayeva
- Marmara University, Faculty of Medicine, Pediatric Allergy
and Immunology, Istanbul, Turkey,Istanbul Jeffrey Modell Diagnostic and Research Center for
Primary Immunodeficiencies, Istanbul, Turkey,The Isil Berat Barlan Center for Translational
Medicine
| | - Gamze Akgun
- Marmara University, Faculty of Medicine, Pediatric Allergy
and Immunology, Istanbul, Turkey,Istanbul Jeffrey Modell Diagnostic and Research Center for
Primary Immunodeficiencies, Istanbul, Turkey,The Isil Berat Barlan Center for Translational
Medicine
| | - Louis-Marie Charbonnier
- Boston Children’s Hospital and Department of
Pediatrics, Harvard Medical School, Division of Immunology, Boston, MA, USA
| | - Klaus Schmitz-Abe
- Boston Children’s Hospital, Division of Immunology
and Newborn Medicine, Harvard Medical School, Boston, MA, USA
| | - Yasemin Kendir Demirkol
- Genomic Laboratory (GLAB), Umraniye Teaching and Research
Hospital, University of Health Sciences, Istanbul, Turkey
| | - Yu Zhang
- Human Immunological Diseases Section, Laboratory of
Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, MD, USA,Clinical Genomics Program, NIAID, NIH, Bethesda, MD,
USA
| | | | - Raul Jimenez Heredia
- Ludwig Boltzmann Institute for Rare and Undiagnosed
Diseases, Vienna, Austria,St. Anna Children’s Cancer Research Institute
(CCRI), Vienna, Austria
| | - Nurhan Kasap
- Marmara University, Faculty of Medicine, Pediatric Allergy
and Immunology, Istanbul, Turkey,Istanbul Jeffrey Modell Diagnostic and Research Center for
Primary Immunodeficiencies, Istanbul, Turkey,The Isil Berat Barlan Center for Translational
Medicine
| | - Ayca Kiykim
- Istanbul University-Cerrahpasa, Faculty of Medicine,
Pediatric Allergy and Immunology, Istanbul, Turkey
| | - Esra Ozek Yucel
- Istanbul University, Istanbul Faculty of Medicine,
Pediatric Allergy and Immunology, Istanbul, Turkey
| | - Veysel Gok
- Erciyes University School of Medicine, Pediatric
Hematology and Oncology, Kayseri, Turkey
| | - Ekrem Unal
- Erciyes University School of Medicine, Pediatric
Hematology and Oncology, Kayseri, Turkey
| | | | - Serdar Nepesov
- Medipol University Medical Faculty, Department of
Pediatric Allergy and Immunology, Istanbul, Turkey
| | - Gokhan Baysoy
- Medipol University Medical Faculty, Department of
Pediatric Gastroenterology, Istanbul, Turkey
| | - Zerrin Onal
- Istanbul University, Istanbul Faculty of Medicine,
Department of Pediatric Gastroenterology, Hepatology and Nutrition, Istanbul,
Turkey
| | - Gozde Yesil
- Istanbul University, Istanbul Faculty of Medicine,
Department of Medical Genetics, Istanbul, Turkey
| | - Tulin Tiraje Celkan
- Istanbul University-Cerrahpasa, Faculty of Medicine,
Division of Pediatric Hematology and Oncology, Istanbul, Turkey
| | - Haluk Cokugras
- Istanbul University-Cerrahpasa, Faculty of Medicine,
Pediatric Allergy and Immunology, Istanbul, Turkey
| | - Yildiz Camcioglu
- Istanbul University-Cerrahpasa, Faculty of Medicine,
Pediatric Allergy and Immunology, Istanbul, Turkey
| | - Ahmet Eken
- Erciyes University School of Medicine, Department of
Medical Biology, Kayseri, Turkey
| | - Kaan Boztug
- Ludwig Boltzmann Institute for Rare and Undiagnosed
Diseases, Vienna, Austria,St. Anna Children’s Cancer Research Institute
(CCRI), Vienna, Austria
| | - Bernice Lo
- Sidra Medicine, Research Branch, Division of
Translational Medicine, Doha, Qatar,College of Health and Life Sciences, Hamad Bin Khalifa
University, Doha, Qatar
| | - Elif Karakoc-Aydiner
- Marmara University, Faculty of Medicine, Pediatric Allergy
and Immunology, Istanbul, Turkey,Istanbul Jeffrey Modell Diagnostic and Research Center for
Primary Immunodeficiencies, Istanbul, Turkey,The Isil Berat Barlan Center for Translational
Medicine
| | - Helen C. Su
- Human Immunological Diseases Section, Laboratory of
Clinical Immunology and Microbiology, NIAID, NIH, Bethesda, MD, USA,Clinical Genomics Program, NIAID, NIH, Bethesda, MD,
USA
| | - Ahmet Ozen
- Marmara University, Faculty of Medicine, Pediatric Allergy
and Immunology, Istanbul, Turkey,Istanbul Jeffrey Modell Diagnostic and Research Center for
Primary Immunodeficiencies, Istanbul, Turkey,The Isil Berat Barlan Center for Translational
Medicine
| | - Talal A. Chatila
- Boston Children’s Hospital and Department of
Pediatrics, Harvard Medical School, Division of Immunology, Boston, MA, USA
| | - Safa Baris
- Marmara University, Faculty of Medicine, Pediatric Allergy
and Immunology, Istanbul, Turkey,Istanbul Jeffrey Modell Diagnostic and Research Center for
Primary Immunodeficiencies, Istanbul, Turkey,The Isil Berat Barlan Center for Translational
Medicine
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6
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Zhu Y, Ye L, Huang H, Xu X, Liu Y, Wang J, Jin Y. Case report: Primary immunodeficiency due to a novel mutation in CARMIL2 and its response to combined immunomodulatory therapy. Front Pediatr 2022; 10:1042302. [PMID: 36727012 PMCID: PMC9884805 DOI: 10.3389/fped.2022.1042302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/06/2022] [Indexed: 01/18/2023] Open
Abstract
Capping protein regulator and myosin 1 linker 2 (CARMIL2) is necessary for invadopodia formation, cell polarity, lamellipodial assembly, membrane ruffling, acropinocytosis, and collective cell migration. CARMIL2 deficiency is a rare autosomal recessive disease characterized by dysfunction in naïve T-cell activation, proliferation, differentiation, and effector function and insufficient responses in T-cell memory. In this paper, we report a 9-year-old female patient with a novel pathogenic variant in CARMIL2 (c.2063C > G:p.Thr688Arg) who presented with various symptoms of primary immunodeficiencies including recurrent upper and lower respiratory infections, perioral and perineum papules, reddish impetiginized atopic dermatitis, oral ulcer, painful urination and vaginitis, otitis media, and failure to thrive. A missense mutation leading to insufficient CARMIL2 protein expression, reduced absolute T-cell and natural killer cell (NK cell) counts, and marked skewing to the naïve T-cell form was identified and indicated defective maturation of T cells and B cells. Following 1 year of multitargeted treatment with corticosteroids, hydroxychloroquine, mycophenolate mofetil, and thymosin, the patient presented with significant regression in rashes. CD4+ T-cell, CD8+ T-cell, and NK cell counts were significantly improved.
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Affiliation(s)
- Yu Zhu
- Department of Rheumatology & Immunology, Shanghai Children's Medical Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Lili Ye
- Department of Rheumatology & Immunology, Shanghai Children's Medical Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Hua Huang
- Department of Rheumatology & Immunology, Shanghai Children's Medical Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xuemei Xu
- Department of Rheumatology & Immunology, Shanghai Children's Medical Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yu Liu
- Department of Rheumatology & Immunology, Shanghai Children's Medical Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jian Wang
- Department of Medical Genetics and Molecular Diagnostic Laboratory, Shanghai Children's Medical Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yanliang Jin
- Department of Rheumatology & Immunology, Shanghai Children's Medical Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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7
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Redmond MT, Scherzer R, Prince BT. Novel Genetic Discoveries in Primary Immunodeficiency Disorders. Clin Rev Allergy Immunol 2022; 63:55-74. [PMID: 35020168 PMCID: PMC8753955 DOI: 10.1007/s12016-021-08881-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 01/12/2023]
Abstract
The field of Immunology is one that has undergone great expansion in recent years. With the advent of new diagnostic modalities including a variety of genetic tests (discussed elsewhere in this journal), the ability to diagnose a patient with a primary immunodeficiency disorder (PIDD) has become a more streamlined process. With increased availability of genetic testing for those with suspected or known PIDD, there has been a significant increase in the number of genes associated with this group of disorders. This is of great importance as a misdiagnosis of these rare diseases can lead to a delay in what can be critical treatment options. At times, those options can include life-saving medications or procedures. Presentation of patients with PIDD can vary greatly based on the specific genetic defect and the part(s) of the immune system that is affected by the variation. PIDD disorders lead to varying levels of increased risk of infection ranging from a mild increase such as with selective IgA deficiency to a profound risk with severe combined immunodeficiency. These diseases can also cause a variety of other clinical findings including autoimmunity and gastrointestinal disease.
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Affiliation(s)
- Margaret T. Redmond
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH USA
| | - Rebecca Scherzer
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH USA
| | - Benjamin T. Prince
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH USA
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8
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Lino CNR, Ghosh S. Epstein-Barr Virus in Inborn Immunodeficiency-More Than Infection. Cancers (Basel) 2021; 13:cancers13194752. [PMID: 34638238 PMCID: PMC8507541 DOI: 10.3390/cancers13194752] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 12/18/2022] Open
Abstract
Simple Summary Epstein–Barr Virus (EBV) is a common virus that is readily controlled by a healthy immune system and rarely causes serious problems in infected people. However, patients with certain genetic defects of their immune system might have difficulties controlling EBV and often develop severe and life-threatening conditions, such as severe inflammation and malignancies. In this review, we provide a summary of inherited immune diseases that lead to a high susceptibility to EBV infection and discuss how this infection is associated with cancer development. Abstract Epstein–Barr Virus (EBV) is a ubiquitous virus affecting more than 90% of the world’s population. Upon infection, it establishes latency in B cells. It is a rather benign virus for immune-competent individuals, in whom infections usually go unnoticed. Nevertheless, EBV has been extensively associated with tumorigenesis. Patients suffering from certain inborn errors of immunity are at high risk of developing malignancies, while infection in the majority of immune-competent individuals does not seem to lead to immune dysregulation. Herein, we discuss how inborn mutations in TNFRSF9, CD27, CD70, CORO1A, CTPS1, ITK, MAGT1, RASGRP1, STK4, CARMIL2, SH2D1A, and XIAP affect the development, differentiation, and function of key factors involved in the immunity against EBV, leading to increased susceptibility to lymphoproliferative disease and lymphoma.
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Affiliation(s)
| | - Sujal Ghosh
- Correspondence: ; Tel.: +49-211-811-6224; Fax: +49-211-811-6191
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9
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Zrelski MM, Kustermann M, Winter L. Muscle-Related Plectinopathies. Cells 2021; 10:2480. [PMID: 34572129 PMCID: PMC8466646 DOI: 10.3390/cells10092480] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 12/23/2022] Open
Abstract
Plectin is a giant cytoskeletal crosslinker and intermediate filament stabilizing protein. Mutations in the human plectin gene (PLEC) cause several rare diseases that are grouped under the term plectinopathies. The most common disorder is autosomal recessive disease epidermolysis bullosa simplex with muscular dystrophy (EBS-MD), which is characterized by skin blistering and progressive muscle weakness. Besides EBS-MD, PLEC mutations lead to EBS with nail dystrophy, EBS-MD with a myasthenic syndrome, EBS with pyloric atresia, limb-girdle muscular dystrophy type R17, or EBS-Ogna. In this review, we focus on the clinical and pathological manifestations caused by PLEC mutations on skeletal and cardiac muscle. Skeletal muscle biopsies from EBS-MD patients and plectin-deficient mice revealed severe dystrophic features with variation in fiber size, degenerative myofibrillar changes, mitochondrial alterations, and pathological desmin-positive protein aggregates. Ultrastructurally, PLEC mutations lead to a disorganization of myofibrils and sarcomeres, Z- and I-band alterations, autophagic vacuoles and cytoplasmic bodies, and misplaced and degenerating mitochondria. We also summarize a variety of genetically manipulated mouse and cell models, which are either plectin-deficient or that specifically lack a skeletal muscle-expressed plectin isoform. These models are powerful tools to study functional and molecular consequences of PLEC defects and their downstream effects on the skeletal muscle organization.
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Affiliation(s)
| | | | - Lilli Winter
- Center for Anatomy and Cell Biology, Neuromuscular Research Department, Medical University of Vienna, 1090 Vienna, Austria; (M.M.Z.); (M.K.)
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10
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Chaudhry IUH, Alshaer A, Al Jassas B, Alkhunizi A, Alsaiary M, AlMubayaedh TA, AlMalki AA, Almesfer A. Bronchopleural fistula in a 5- years old child with novel CARMIL 2 mutation: A rare disease and a rare case. Ann Med Surg (Lond) 2021; 66:102443. [PMID: 34150204 PMCID: PMC8193081 DOI: 10.1016/j.amsu.2021.102443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/19/2021] [Accepted: 05/23/2021] [Indexed: 11/24/2022] Open
Abstract
A five year girl had eczema and allergic rhinitis in the past, presented with a history of cough, shortness of breath for the last one month. Her chest -X-ray showed a left side pleural effusion, and a computed tomographic scan (CT) of the chest showed left side hydropneumothorax. Left side 21 Fr drain was inserted. Her clinical condition deteriorated despite antimicrobial therapy, and she required mechanical ventilatory support due to respiratory distress. She also developed a right-sided pneumothorax that was managed by inserting a 21 Fr chest drain. A video-assisted thoracoscopic VATS procedure was done to staple the lung bullae and drain the empyema. Her post-operative chest X-ray showed good lung expansion. Pleural fluid culture report was positive for candida. She was commenced on antifungal microbial therapy. Two days later, she developed again left side pneumothorax, which was again managed by left intercostal drain. We were unable to wean her off from mechanical ventilatory support due to a significant air leak due to bronchopleural fistula. A posterolateral thoracotomy was performed, and the bronchopleural fistula was closed. She was extubated the next day, and intercostal drains were removed on the 4th post-operative day.
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Affiliation(s)
- Ikram ul Haq Chaudhry
- Department of Pediatric Thoracic Surgery and Intensive Care Medicine, Infectious Disease, and Immunology, Maternity and Children Hospital, Dammam, Saudi Arabia
| | - Ahmed Alshaer
- Department of Pediatric Thoracic Surgery and Intensive Care Medicine, Infectious Disease, and Immunology, Maternity and Children Hospital, Dammam, Saudi Arabia
| | - Burair Al Jassas
- Department of Pediatric Thoracic Surgery and Intensive Care Medicine, Infectious Disease, and Immunology, Maternity and Children Hospital, Dammam, Saudi Arabia
| | - Amal Alkhunizi
- Department of Pediatric Thoracic Surgery and Intensive Care Medicine, Infectious Disease, and Immunology, Maternity and Children Hospital, Dammam, Saudi Arabia
| | - Mohammad Alsaiary
- Department of Pediatric Thoracic Surgery and Intensive Care Medicine, Infectious Disease, and Immunology, Maternity and Children Hospital, Dammam, Saudi Arabia
| | - Tasneem A. AlMubayaedh
- Department of Pediatric Thoracic Surgery and Intensive Care Medicine, Infectious Disease, and Immunology, Maternity and Children Hospital, Dammam, Saudi Arabia
| | - Abass A. AlMalki
- Department of Pediatric Thoracic Surgery and Intensive Care Medicine, Infectious Disease, and Immunology, Maternity and Children Hospital, Dammam, Saudi Arabia
| | - Ahmed Almesfer
- Department of Pediatric Thoracic Surgery and Intensive Care Medicine, Infectious Disease, and Immunology, Maternity and Children Hospital, Dammam, Saudi Arabia
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11
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Abstract
Epidermolysis bullosa (EB) is a group of rare genetic disorders for which significant progress has been achieved in the development of molecular therapies in the last few decades. Such therapies require knowledge of mutant genes and specific mutations, some of them being allele specific. A relatively large number of clinical trials are ongoing and ascertaining the clinical efficacy of gene, protein or cell therapies or of repurposed drugs, mainly in recessive dystrophic EB. It is expected that some new drugs may emerge in the near future and that combinations of different approaches may result in improved treatment outcomes for individuals with EB.
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12
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Shayegan LH, Garzon MC, Morel KD, Borlack R, Vuguin PM, Margolis KG, Demirdag YY, Pereira EM, Lauren CT. CARMIL2-related immunodeficiency manifesting with photosensitivity. Pediatr Dermatol 2020; 37:695-697. [PMID: 32342551 PMCID: PMC7599087 DOI: 10.1111/pde.14173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
We report a case of a newly recognized primary immunodeficiency due to biallelic mutations in CARMIL2 manifesting as an actinic prurigo-like photodermatitis, allergic diathesis and recurrent infections in a child. We present this case to highlight a rare phenotype seen in this T-cell immunodeficiency and provide an overview of other dermatologic manifestations among published reports of this condition.
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Affiliation(s)
- Leila H Shayegan
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Maria C Garzon
- Departments of Dermatology and Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Kimberly D Morel
- Departments of Dermatology and Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Rachel Borlack
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Patricia M Vuguin
- Division of Pediatric Endocrinology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Kara G Margolis
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Yesim Y Demirdag
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Elaine M Pereira
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Christine T Lauren
- Departments of Dermatology and Pediatrics, Columbia University Irving Medical Center, New York, New York
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13
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Yonkof JR, Gupta A, Rueda CM, Mangray S, Prince BT, Rangarajan HG, Alshahrani M, Varga E, Cripe TP, Abraham RS. A Novel Pathogenic Variant in CARMIL2 ( RLTPR) Causing CARMIL2 Deficiency and EBV-Associated Smooth Muscle Tumors. Front Immunol 2020; 11:884. [PMID: 32625199 PMCID: PMC7314954 DOI: 10.3389/fimmu.2020.00884] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/16/2020] [Indexed: 12/16/2022] Open
Abstract
CARMIL2 deficiency is a rare combined immunodeficiency (CID) characterized by defective CD28-mediated T cell co-stimulation, altered cytoskeletal dynamics, and susceptibility to Epstein Barr Virus smooth muscle tumors (EBV-SMTs). Case reports associated with EBV-SMTs are limited. We describe herein a novel homozygous CARMIL2 variant (c.1364_1393del) in two Saudi Arabian male siblings born to consanguineous parents who developed EBV-SMTs. CARMIL2 protein expression was significantly reduced in CD4+ T cells and CD8+ T cells. T cell proliferation on stimulation with soluble (s) anti-CD3 or (s) anti-CD3 plus anti-CD28 antibodies was close to absent in the proband, confirming altered CD28-mediated co-signaling. CD28 expression was substantially reduced in the proband's T cells, and was diminished to a lesser degree in the T cells of the younger sibling, who has a milder clinical phenotype. Defects in both T and B cell compartments were observed, including absent central memory CD8+ T cells, and decreased frequencies of total and class-switched memory B cells. FOXP3+ regulatory T cells (Treg) were also quantitatively decreased, and furthermore CD25 expression within the Treg subset was substantially reduced. These data confirm the pathogenicity of this novel loss-of-function (LOF) variant in CARMIL2 and expand the genotypic and phenotypic spectrum of CIDs associated with EBV-SMTs.
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Affiliation(s)
- Jennifer R Yonkof
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, United States
| | - Ajay Gupta
- Division of Hematology, Oncology and Blood and Marrow Transplant, Nationwide Children's Hospital, Columbus, OH, United States
| | - Cesar M Rueda
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, United States
| | - Shamlal Mangray
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, United States
| | - Benjamin T Prince
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, United States
| | - Hemalatha G Rangarajan
- Division of Hematology and Oncology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, United States
| | - Mohammad Alshahrani
- Department of Pediatric Hematology-Oncology, Riyadh Military Hospital, Riyadh, Saudi Arabia
| | - Elizabeth Varga
- Division of Hematology, Oncology and Blood and Marrow Transplant, Nationwide Children's Hospital, Columbus, OH, United States
| | - Timothy P Cripe
- Division of Hematology, Oncology and Blood and Marrow Transplant, Nationwide Children's Hospital, Columbus, OH, United States
| | - Roshini S Abraham
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, United States
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14
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Shamriz O, Simon AJ, Lev A, Megged O, Ledder O, Picard E, Joseph L, Molho-Pessach V, Tal Y, Millman P, Slae M, Somech R, Toker O, Berger M. Exogenous interleukin-2 can rescue in-vitro T cell activation and proliferation in patients with a novel capping protein regulator and myosin 1 linker 2 mutation. Clin Exp Immunol 2020; 200:215-227. [PMID: 32201938 PMCID: PMC7232008 DOI: 10.1111/cei.13432] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/04/2020] [Accepted: 03/16/2020] [Indexed: 12/27/2022] Open
Abstract
Capping protein regulator and myosin 1 linker 2 (CARMIL2) deficiency is characterized by impaired T cell activation, which is attributed to defective CD28-mediated co-signaling. Herein, we aimed to analyze the effect of exogenous interleukin (IL)-2 on in-vitro T cell activation and proliferation in a family with CARMIL2 deficiency. This study included four children (one male and three females; aged 2·5-10 years at presentation). The patients presented with inflammatory bowel disease and recurrent viral infections. Genetic analysis revealed a novel homozygous 25-base pairs deletion in CARMIL2. Immunoblotting demonstrated the absence of CARMIL2 protein in all four patients and confirmed the diagnosis of CARMIL2 deficiency. T cells were activated in-vitro with the addition of IL-2 in different concentrations. CD25 and interferon (IFN)-γ levels were measured after 48 h and 5 days of activation. CD25 surface expression on activated CD8+ and CD4+ T cells was significantly diminished in all patients compared to healthy controls. Additionally, CD8+ T cells from all patients demonstrated significantly reduced IFN-γ production. When cells derived from CARMIL2-deficient patients were treated with IL-2, CD25 and IFN-γ production increased in a dose-dependent manner. T cell proliferation, as measured by Cell Trace Violet, was impaired in one patient and it was also rescued with IL-2. In conclusion, we found that IL-2 rescued T cell activation and proliferation in CARMIL2-deficient patients. Thus, IL-2 should be further studied as a potential therapeutic modality for these patients.
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Affiliation(s)
- O. Shamriz
- The Lautenberg Center for Immunology and Cancer ResearchInstitute of Medical Research Israel‐CanadaHebrew University‐Hadassah Medical SchoolJerusalemIsrael
- Allergy and Clinical Immunology UnitDepartment of MedicineHadassah‐Hebrew University Medical CenterJerusalemIsrael
| | - A. J. Simon
- Sheba Cancer Research Center and Institute of HematologySheba Medical CenterTel HaShomerRamat‐GanIsrael
| | - A. Lev
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- Pediatric Department A and Immunology ServiceJeffrey Modell Foundation CenterEdmond and Lily Safra Children’s HospitalSheba Medical CenterAffiliated with Tel Aviv UniversityTel AvivIsrael
| | - O. Megged
- Pediatric Infectious diseases UnitShaare Zedek Medical CenterJerusalemIsrael
| | - O. Ledder
- Juliet Keidan Institute of Pediatric Gastroenterology and NutritionShaare Zedek Medical CenterJerusalemIsrael
| | - E. Picard
- Pediatric pulmonology UnitShaare Zedek Medical CenterJerusalemIsrael
| | - L. Joseph
- Pediatric pulmonology UnitShaare Zedek Medical CenterJerusalemIsrael
| | - V. Molho-Pessach
- Department of DermatologyHadassah‐Hebrew University Medical CenterJerusalemIsrael
| | - Y. Tal
- Allergy and Clinical Immunology UnitDepartment of MedicineHadassah‐Hebrew University Medical CenterJerusalemIsrael
| | - P. Millman
- Pediatric Gastroenterology UnitHadassah‐Hebrew University Medical CenterJerusalemIsrael
| | - M. Slae
- Pediatric Gastroenterology UnitHadassah‐Hebrew University Medical CenterJerusalemIsrael
| | - R. Somech
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- Pediatric Department A and Immunology ServiceJeffrey Modell Foundation CenterEdmond and Lily Safra Children’s HospitalSheba Medical CenterAffiliated with Tel Aviv UniversityTel AvivIsrael
| | - O. Toker
- Faculty of MedicineHebrew University of JerusalemJerusalemIsrael
- Allergy and Clinical Immunology UnitShaare Zedek Medical CenterJerusalemIsrael
| | - M. Berger
- The Lautenberg Center for Immunology and Cancer ResearchInstitute of Medical Research Israel‐CanadaHebrew University‐Hadassah Medical SchoolJerusalemIsrael
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15
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Human genetic dissection of papillomavirus-driven diseases: new insight into their pathogenesis. Hum Genet 2020; 139:919-939. [PMID: 32435828 DOI: 10.1007/s00439-020-02183-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/11/2020] [Indexed: 02/07/2023]
Abstract
Human papillomaviruses (HPVs) infect mucosal or cutaneous stratified epithelia. There are 5 genera and more than 200 types of HPV, each with a specific tropism and virulence. HPV infections are typically asymptomatic or result in benign tumors, which may be disseminated or persistent in rare cases, but a few oncogenic HPVs can cause cancers. This review deals with the human genetic and immunological basis of interindividual clinical variability in the course of HPV infections of the skin and mucosae. Typical epidermodysplasia verruciformis (EV) is characterized by β-HPV-driven flat wart-like and pityriasis-like cutaneous lesions and non-melanoma skin cancers in patients with inborn errors of EVER1-EVER2-CIB1-dependent skin-intrinsic immunity. Atypical EV is associated with other infectious diseases in patients with inborn errors of T cells. Severe cutaneous or anogenital warts, including anogenital cancers, are also driven by certain α-, γ-, μ or ν-HPVs in patients with inborn errors of T lymphocytes and antigen-presenting cells. The genetic basis of HPV diseases at other mucosal sites, such as oral multifocal epithelial hyperplasia or juvenile recurrent respiratory papillomatosis (JRRP), remains poorly understood. The human genetic dissection of HPV-driven lesions will clarify the molecular and cellular basis of protective immunity to HPVs, and should lead to novel diagnostic, preventive, and curative approaches in patients.
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16
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Has C, Bauer JW, Bodemer C, Bolling MC, Bruckner-Tuderman L, Diem A, Fine JD, Heagerty A, Hovnanian A, Marinkovich MP, Martinez AE, McGrath JA, Moss C, Murrell DF, Palisson F, Schwieger-Briel A, Sprecher E, Tamai K, Uitto J, Woodley DT, Zambruno G, Mellerio JE. Consensus reclassification of inherited epidermolysis bullosa and other disorders with skin fragility. Br J Dermatol 2020; 183:614-627. [PMID: 32017015 DOI: 10.1111/bjd.18921] [Citation(s) in RCA: 370] [Impact Index Per Article: 92.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several new genes and clinical subtypes have been identified since the publication in 2014 of the report of the last International Consensus Meeting on Epidermolysis Bullosa (EB). OBJECTIVES We sought to reclassify disorders with skin fragility, with a focus on EB, based on new clinical and molecular data. METHODS This was a consensus expert review. RESULTS In this latest consensus report, we introduce the concept of genetic disorders with skin fragility, of which classical EB represents the prototype. Other disorders with skin fragility, where blisters are a minor part of the clinical picture or are not seen because skin cleavage is very superficial, are classified as separate categories. These include peeling skin disorders, erosive disorders, hyperkeratotic disorders, and connective tissue disorders with skin fragility. Because of the common manifestation of skin fragility, these 'EB-related' disorders should be considered under the EB umbrella in terms of medical and socioeconomic provision of care. CONCLUSIONS The proposed classification scheme should be of value both to clinicians and researchers, emphasizing both clinical and genetic features of EB. What is already known about this topic? Epidermolysis bullosa (EB) is a group of genetic disorders with skin blistering. The last updated recommendations on diagnosis and classification were published in 2014. What does this study add? We introduce the concept of genetic disorders with skin fragility, of which classical EB represents the prototype. Clinical and genetic aspects, genotype-phenotype correlations, disease-modifying factors and natural history of EB are reviewed. Other disorders with skin fragility, e.g. peeling skin disorders, erosive disorders, hyperkeratotic disorders, and connective tissue disorders with skin fragility are classified as separate categories; these 'EB-related' disorders should be considered under the EB umbrella in terms of medical and socioeconomic provision of care. Linked Comment: Pope. Br J Dermatol 2020; 183:603.
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Affiliation(s)
- C Has
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - J W Bauer
- Department of Dermatology and Allergology and EB Haus Austria University Hospital of the Paracelsus Medical University Salzburg, Austria
| | - C Bodemer
- Department of Dermatology, Necker Hospital des Enfants Malades, University Paris-Centre APHP 5, Paris, France
| | - M C Bolling
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - L Bruckner-Tuderman
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - A Diem
- Department of Dermatology and Allergology and EB Haus Austria University Hospital of the Paracelsus Medical University Salzburg, Austria
| | - J-D Fine
- Vanderbilt University School of Medicine, Nashville, TN, USA; National Epidermolysis Bullosa Registry, Nashville, TN, USA
| | - A Heagerty
- Heart of England Foundation Trust, Birmingham, UK
| | - A Hovnanian
- INSERM UMR1163, Imagine Institute, Department of Genetics, Necker hospital for sick children, Paris University, Paris, France
| | - M P Marinkovich
- Stanford University School of Medicine, Stanford, Palo Alto Veterans Affairs Medical Center CA, USA
| | - A E Martinez
- Dermatology Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - J A McGrath
- St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - C Moss
- Birmingham Children's Hospital and University of Birmingham, UK
| | - D F Murrell
- St George Hospital and University of New South Wales, Sydney, Australia
| | - F Palisson
- DEBRA Chile, Facultad de Medicina Clinica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - A Schwieger-Briel
- Department of Pediatric Dermatology, University Children's Hospital Zürich, Zürich, Switzerland
| | - E Sprecher
- Division of Dermatology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - K Tamai
- Dermatology Department, University of Osaka, Osaka, Japan
| | - J Uitto
- Thomas Jefferson University, Philadelphia, PA, USA
| | - D T Woodley
- University of Southern California, Los Angeles, CA, USA
| | - G Zambruno
- Dermatology Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - J E Mellerio
- St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
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