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Wang D, Cassady K, Zou Z, Zhang X, Feng Y. Progress on the efficacy and potential mechanisms of rapamycin in the treatment of immune thrombocytopenia. Hematology 2022; 27:1282-1289. [DOI: 10.1080/16078454.2022.2151230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Dan Wang
- Medical Center of Hematology, The Xinqiao Hospital of Army Medical University, Chongqing, People’s Republic of China
- Department of Hematology, Affiliated Hospital of North Sichuan Medical College, Nanchong, People’s Republic of China
| | | | - Zhongmin Zou
- Department of Chemical Defense Medicine, School of Military Preventive Medicine, Army Medical University, Chongqing, People’s Republic of China
| | - Xi Zhang
- Medical Center of Hematology, The Xinqiao Hospital of Army Medical University, Chongqing, People’s Republic of China
| | - Yimei Feng
- Medical Center of Hematology, The Xinqiao Hospital of Army Medical University, Chongqing, People’s Republic of China
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Luo H, Liu D, Liu W, Jin J, Bi X, Zhang P, Gu J, Zheng M, Xiao M, Liu X, Zhou J, Wang QF. Clinical and genetic characterization of Epstein-Barr virus-associated T/NK-cell lymphoproliferative diseases. J Allergy Clin Immunol 2022; 151:1096-1109. [PMID: 36423698 DOI: 10.1016/j.jaci.2022.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 11/10/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Epstein-Barr virus (EBV)-associated T-/natural killer (T/NK)-cell lymphoproliferative diseases clinically take on various forms, ranging from an indolent course to an aggressive condition. OBJECTIVE Clinically, failure to establish precise diagnosis and provide proper treatment makes it difficult to help patients. We sought to better understand the underlying pathogenesis and to identify genetic prognostic factors to achieve better treatment efficacy. METHODS In this study, 119 cases of EBV-associated lymphoproliferative diseases, including EBV-associated hemophagocytic lymphohistiocytosis (n = 46) and chronic active EBV disease of T/NK cell type (n = 73), were retrospectively examined. RESULTS Adults aged >20 years at onset accounted for 71.4% of our cohort. About 54.6% patients with unfavorable overall survival developed hemophagocytic lymphohistiocytosis and had higher plasma EBV load. Allogenic hematopoietic stem-cell transplantation was the sole independent favorable factor. We systematically screened germline and somatic aberrations by whole-exome and targeted sequencing. Among 372 antiviral immunity genes, germline variants of 8 genes were significantly enriched. From a panel of 24 driver genes, somatic mutations were frequently identified in dominant EBV-infected T/NK cells. Patients carrying any germline/somatic aberrations in epigenetic modifiers and RIG-I-like receptor (RLR) pathway had worse overall survival than those without 2 type aberrations. Importantly, patients with IFIH1 and/or DDX3X aberrations in the RLR pathway had higher plasma and NK-cell EBV load. Knockdown of DDX3X in NKYS cells downregulated RLR signaling activities and elevated the expression of EBV-encoded oncogenes such as LMP1 and EBNA1. CONCLUSION Genetic defects were prevalent in adult EBV-associated hemophagocytic lymphohistiocytosis patients and patients with chronic active EBV disease of T/NK cell type; these defects were associated with unfavorable prognosis. These findings can help clinicians work out more precise staging of the condition and provide new insights into these EBV-associated diseases.
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Affiliation(s)
- Hui Luo
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, China
| | - Dan Liu
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences and China National Center for Bioinformation, Beijing, China
| | - Wenbing Liu
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences and China National Center for Bioinformation, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Jin Jin
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, China
| | - Xiaoman Bi
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences and China National Center for Bioinformation, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Peiling Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, China
| | - Jia Gu
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, China
| | - Miao Zheng
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, China
| | - Min Xiao
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, China
| | - Xin Liu
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences and China National Center for Bioinformation, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Jianfeng Zhou
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Immunotherapy Research Center for Hematologic Diseases of Hubei Province, Wuhan, China
| | - Qian-Fei Wang
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences and China National Center for Bioinformation, Beijing, China; University of Chinese Academy of Sciences, Beijing, China.
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Yao J, Gu H, Mou W, Chen Z, Ma J, Ma H, Li N, Zhang R, Wang T, Jiang J, Wu R. Various phenotypes of LRBA gene with compound heterozygous variation: A case series report of pediatric cytopenia patients. Int J Immunopathol Pharmacol 2022; 36:3946320221125591. [PMID: 36074705 PMCID: PMC9465590 DOI: 10.1177/03946320221125591] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: LPS-responsive beige-like anchor (LRBA) deficiency is one of the most common
monogenic disorders causing common variable immunodeficiency (CVID) and
CVID-like disorders. However, the clinical spectrum of compound heterozygous
(CHZ) LRBA variation should be extended. In this study, we presented five
cases of compound heterozygous LRBA with various refractory cytopenias. Materials and Methods: Retrospective analysis of the clinical manifestations, management, and
outcomes of five cases (from five pedigrees) with LRBA gene
CHZ variants which initially manifested as single/multilineage immune
cytopenias was performed. Results: 1. Gene variations: All five patients inherited the compound heterozygous
LRBA variations from their parents which were thought to be pathogenic.
BEACH, DUF4704, and LamG were the main affected domains of LRBA gene in this
case series. 2. Immune dysregulation of clinic: (1) Hypogammaglobulinemia
were recorded in four patients, and the proportion of Treg was decreased in
two patients. Only one patient had been with increased TCRαβ+CD4/CD8
double-negative T cells (DNT). (2) Lymphoproliferative manifestations were
seen in three patients. (3) All five patients were complained with
cytopenia, although they showed different clinical manifestations. None of
the parents was asymptomatic. (4) Other immune disorders: P5 also had
relapsed infections and autoimmune endocrinopathy. 3. Management and
outcomes: P1 and P5 responded well to immunomodulatory therapy and P3 was
effectively treated with hemophagocytic lymphohistiocytosis (HLH) first-line
regimen chemotherapy. P4 showed no responses to steroids and IVIG. However,
TPO-R agonist was effective. Conclusion: Unlike homozygous mutations, compound heterozygous LRBA variation should
always be kept in mind for the various phenotypes and different treatment
responses.
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Affiliation(s)
- Jiafeng Yao
- Hematology Center, National Center for Children`s Health, 117984Beijing Children`s Hospital, Capital Medical University, Beijing, China
| | - Hao Gu
- Hematologic Disease Laboratory, National Center for Children's Health, 117984Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Wenjun Mou
- Laboratory of Tumor Immunology, National Center for Children's Health, 117984Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Zhenping Chen
- Laboratory of Tumor Immunology, National Center for Children's Health, 117984Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jie Ma
- Hematology Center, National Center for Children`s Health, 117984Beijing Children`s Hospital, Capital Medical University, Beijing, China
| | - Honghao Ma
- Hematology Center, National Center for Children`s Health, 117984Beijing Children`s Hospital, Capital Medical University, Beijing, China
| | - Nan Li
- Hematology Center, National Center for Children`s Health, 117984Beijing Children`s Hospital, Capital Medical University, Beijing, China
| | - Rui Zhang
- Hematology Center, National Center for Children`s Health, 117984Beijing Children`s Hospital, Capital Medical University, Beijing, China
| | - Tianyou Wang
- Hematologic Disease Laboratory, National Center for Children's Health, 117984Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jin Jiang
- Hematologic Disease Laboratory, National Center for Children's Health, 117984Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Runhui Wu
- Hematology Center, National Center for Children`s Health, 117984Beijing Children`s Hospital, Capital Medical University, Beijing, China
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