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O'Hora KP, Amir CM, Chiem E, Schleifer CH, Grigoryan V, Kushan-Wells L, Chiang JJ, Cole S, Irwin MR, Bearden CE. Differential inflammatory profiles in carriers of reciprocal 22q11.2 copy number variants. Psychoneuroendocrinology 2024; 169:107135. [PMID: 39116521 DOI: 10.1016/j.psyneuen.2024.107135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/10/2024] [Accepted: 07/12/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Genetic copy number variants (CNVs; i.e., a deletion or duplication) at the 22q11.2 locus confer increased risk of neuropsychiatric disorders and immune dysfunction. Inflammatory profiles of 22q11.2 CNV carriers can shed light on gene-immune relationships that may be related to neuropsychiatric symptoms. However, little is known about inflammation and its relationship to clinical phenotypes in 22q11.2 CNV carriers. Here, we investigate differences in peripheral inflammatory markers in 22q11.2 CNV carriers and explore their relationship with psychosis risk symptoms and sleep disturbance. METHODS Blood samples and clinical assessments were collected from 22q11.2 deletion (22qDel) carriers (n=45), 22q11.2 duplication (22qDup) carriers (n=29), and typically developing (TD) control participants (n=92). Blood plasma levels of pro-inflammatory cytokines, including interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ), and anti-inflammatory cytokine interleukin-10 (IL-10) were measured using a MesoScale Discovery multiplex immunoassay. Plasma levels of C-reactive protein (CRP) were measured using Enzyme-linked Immunosorbent Assay (ELISA). Linear mixed effects models controlling for age, sex, and body mass index were used to: a) examine group differences in inflammatory markers between 22qDel, 22qDup, and TD controls, b) test differences in inflammatory markers between 22qDel carriers with psychosis risk symptoms (22qDelPS+) and those without (22qDelPS-), and c) conduct an exploratory analysis testing the effect of sleep disturbance on inflammation in 22qDel and 22qDup carriers. A false discovery rate correction was used to correct for multiple comparisons. RESULTS 22qDup carriers exhibited significantly elevated levels of IL-8 relative to TD controls (q<0.001) and marginally elevated IL-8 levels relative to 22qDel carriers (q=0.08). There were no other significant differences in inflammatory markers between the three groups (q>0.13). 22qDelPS+ exhibited increased levels of IL-8 relative to both 22qDelPS- (q=0.02) and TD controls (p=0.002). There were no relationships between sleep and inflammatory markers that survived FDR correction (q>0.14). CONCLUSION Our results suggest that CNVs at the 22q11.2 locus may have differential effects on inflammatory processes related to IL-8, a key mediator of inflammation produced by macrophages and microglia. Further, these IL-8-mediated inflammatory processes may be related to psychosis risk symptoms in 22qDel carriers. Additional research is required to understand the mechanisms contributing to these differential levels of IL-8 between 22q11.2 CNV carriers and IL-8's association with psychosis risk.
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Affiliation(s)
- Kathleen P O'Hora
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA; Neuroscience Interdepartmental Program, University of California Los Angeles, Los Angeles, CA, USA
| | - Carolyn M Amir
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Emily Chiem
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA; Molecular, Cellular, and Integrative Physiology Program, University of California Los Angeles, Los Angeles, CA, USA
| | - Charles H Schleifer
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA; Neuroscience Interdepartmental Program, University of California Los Angeles, Los Angeles, CA, USA
| | - Vardui Grigoryan
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Leila Kushan-Wells
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | | | - Steven Cole
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA; Norman Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Michael R Irwin
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA; Norman Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA; Department of Psychology, University of California, Los Angeles, CA, USA.
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Kreins AY, Dhalla F, Flinn AM, Howley E, Ekwall O, Villa A, Staal FJT, Anderson G, Gennery AR, Holländer GA, Davies EG. European Society for Immunodeficiencies guidelines for the management of patients with congenital athymia. J Allergy Clin Immunol 2024:S0091-6749(24)00980-1. [PMID: 39303894 DOI: 10.1016/j.jaci.2024.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 07/06/2024] [Accepted: 07/15/2024] [Indexed: 09/22/2024]
Abstract
Congenital athymia is a life-limiting disorder due to rare inborn errors of immunity causing impaired thymus organogenesis or abnormal thymic stromal cell development and function. Athymic infants have a T-lymphocyte-negative, B-lymphocyte-positive, natural killer cell-positive immunophenotype with profound T-lymphocyte deficiency and are susceptible to severe infections and autoimmunity. Patients variably display syndromic features. Expanding access to newborn screening for severe combined immunodeficiency and T lymphocytopenia and broad genetic testing, including next-generation sequencing technologies, increasingly facilitate their timely identification. The recommended first-line treatment is allogeneic thymus transplantation, which is a specialized procedure available in Europe and the United States. Outcomes for athymic patients are best with early diagnosis and thymus transplantation before the development of infectious and inflammatory complications. These guidelines on behalf of the European Society for Immunodeficiencies provide a comprehensive review for clinicians who manage patients with inborn thymic stromal cell defects; they offer clinical practice recommendations focused on the diagnosis, investigation, risk stratification, and management of congenital athymia with the aim of improving patient outcomes.
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Affiliation(s)
- Alexandra Y Kreins
- Department of Immunology and Gene Therapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; Infection Immunity and Inflammation Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.
| | - Fatima Dhalla
- Department of Paediatrics and Institute of Developmental and Regenerative Medicine, University of Oxford, Oxford, United Kingdom; Department of Clinical Immunology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Aisling M Flinn
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; Paediatric Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, United Kingdom; Department of Paediatric Immunology, Children's Health Ireland at Crumlin, Crumlin, Ireland
| | - Evey Howley
- Department of Immunology and Gene Therapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Olov Ekwall
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Villa
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Hospital, Milan, Italy; Istituto di Ricerca Genetica e Biomedica, Consiglio Nazionale Delle Ricerche (IRGB-CNR), Milan, Italy
| | - Frank J T Staal
- Department of Pediatrics, Pediatric Stem Cell Transplantation Program, Willem-Alexander Children's Hospital, Leiden, The Netherlands; Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Graham Anderson
- Institute of Immunology and Immunotherapy, Medical School, University of Birmingham, Birmingham, United Kingdom
| | - Andrew R Gennery
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom; Paediatric Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
| | - Georg A Holländer
- Department of Paediatrics and Institute of Developmental and Regenerative Medicine, University of Oxford, Oxford, United Kingdom; Paediatric Immunology, Department of Biomedicine, University of Basel and University Children's Hospital Basel, Basel, Switzerland; Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland
| | - E Graham Davies
- Department of Immunology and Gene Therapy, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; Infection Immunity and Inflammation Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
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Cilio Arroyuelo M, Tenorio-Castano J, García-Moya LF, Parra A, Cazalla M, Gallego N, Miranda L, Mori MÁ, García-Gueretta L, Labrandero C, Mansilla E, Rikeros E, García-Santiago F, Vallcorba I, Arias P, Silván C, Deiros Bronte L, Nevado J, Lapunzina P. Mortality in Patients with 22q11.2 Rearrangements. Genes (Basel) 2024; 15:1146. [PMID: 39336737 PMCID: PMC11431692 DOI: 10.3390/genes15091146] [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] [Received: 07/17/2024] [Revised: 08/16/2024] [Accepted: 08/19/2024] [Indexed: 09/30/2024] Open
Abstract
The 22q11.2 region is highly susceptible to genomic rearrangements leading to multiple genomic disorders, including 22q11.2 microdeletion syndrome (22q11.2 DS) (MIM# 188400), 22q11.2 microduplication syndrome (MIM# 608363), supernumerary der(22)t(11;22) syndrome (also known as Emanuel Syndrome; MIM# 609029), and Cat Eye Syndrome (MIM# 115470). In this study, we present data on causes of mortality, average age of death, and the existing associated risk factors in patients with 22q11.2 rearrangements. Our cohort included 223 patients (120 males and 103 females) with confirmed diagnoses of 22q11.2 rearrangements diagnosed through molecular techniques (FISH, MLPA, and CMA). Relatives from patients who have been molecularly confirmed with 22q11.2 rearrangements have also been added to the study, regardless of the presence or absence of symptoms. Of these 223 individuals, 21 (9.4%) died. Deceased patients' rearrangements include 19 microdeletions, 1 microduplication, and 1 patient with a marker chromosome. The median age of death was 3 months and 18 days (ranging from 3 days to 34 years). There were 17 patients who died at pediatric age (80.95%), 3 died at adult age (14.28%), and for 1 of whom, the age of death is unknown (4.76%). Eighteen patients were White Mediterranean (European non-Finnish) (85.71%) whereas three were Amerindian (South American) (14.28%). Mortality from cardiac causes accounted for 71.42%. The second most frequent cause of death was sepsis in two patients (9.52%). One patient died from respiratory failure (4.76%) and one from renal failure (4.76%). Information regarding the cause of death was not available in two patients (9.52%). Most patients who died were diagnosed within the first week of life, the majority on the first day. This study adds additional information on mortality in one of the largest cohorts of patients with 22q11.2 rearrangements in more than 30 years of follow-up.
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Affiliation(s)
- Melisa Cilio Arroyuelo
- Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, INGEMM-IdIPAZ, 28046 Madrid, Spain (J.T.-C.); (L.F.G.-M.); (A.P.); (M.C.); (N.G.); (L.M.); (M.Á.M.); (E.M.); (E.R.); (F.G.-S.); (I.V.); (P.A.); (C.S.); (J.N.)
| | - Jair Tenorio-Castano
- Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, INGEMM-IdIPAZ, 28046 Madrid, Spain (J.T.-C.); (L.F.G.-M.); (A.P.); (M.C.); (N.G.); (L.M.); (M.Á.M.); (E.M.); (E.R.); (F.G.-S.); (I.V.); (P.A.); (C.S.); (J.N.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras, CIBERER, 28029 Madrid, Spain
- European Reference Network, ITHACA, 1070 Brussels, Belgium
| | - Luis Fernández García-Moya
- Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, INGEMM-IdIPAZ, 28046 Madrid, Spain (J.T.-C.); (L.F.G.-M.); (A.P.); (M.C.); (N.G.); (L.M.); (M.Á.M.); (E.M.); (E.R.); (F.G.-S.); (I.V.); (P.A.); (C.S.); (J.N.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras, CIBERER, 28029 Madrid, Spain
- European Reference Network, ITHACA, 1070 Brussels, Belgium
| | - Alejandro Parra
- Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, INGEMM-IdIPAZ, 28046 Madrid, Spain (J.T.-C.); (L.F.G.-M.); (A.P.); (M.C.); (N.G.); (L.M.); (M.Á.M.); (E.M.); (E.R.); (F.G.-S.); (I.V.); (P.A.); (C.S.); (J.N.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras, CIBERER, 28029 Madrid, Spain
- European Reference Network, ITHACA, 1070 Brussels, Belgium
| | - Mario Cazalla
- Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, INGEMM-IdIPAZ, 28046 Madrid, Spain (J.T.-C.); (L.F.G.-M.); (A.P.); (M.C.); (N.G.); (L.M.); (M.Á.M.); (E.M.); (E.R.); (F.G.-S.); (I.V.); (P.A.); (C.S.); (J.N.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras, CIBERER, 28029 Madrid, Spain
- European Reference Network, ITHACA, 1070 Brussels, Belgium
| | - Natalia Gallego
- Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, INGEMM-IdIPAZ, 28046 Madrid, Spain (J.T.-C.); (L.F.G.-M.); (A.P.); (M.C.); (N.G.); (L.M.); (M.Á.M.); (E.M.); (E.R.); (F.G.-S.); (I.V.); (P.A.); (C.S.); (J.N.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras, CIBERER, 28029 Madrid, Spain
- European Reference Network, ITHACA, 1070 Brussels, Belgium
| | - Lucía Miranda
- Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, INGEMM-IdIPAZ, 28046 Madrid, Spain (J.T.-C.); (L.F.G.-M.); (A.P.); (M.C.); (N.G.); (L.M.); (M.Á.M.); (E.M.); (E.R.); (F.G.-S.); (I.V.); (P.A.); (C.S.); (J.N.)
| | - María Ángeles Mori
- Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, INGEMM-IdIPAZ, 28046 Madrid, Spain (J.T.-C.); (L.F.G.-M.); (A.P.); (M.C.); (N.G.); (L.M.); (M.Á.M.); (E.M.); (E.R.); (F.G.-S.); (I.V.); (P.A.); (C.S.); (J.N.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras, CIBERER, 28029 Madrid, Spain
- European Reference Network, ITHACA, 1070 Brussels, Belgium
| | - Luis García-Gueretta
- Department of Pediatric Cardiology, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.G.-G.); (C.L.); (L.D.B.)
| | - Carlos Labrandero
- Department of Pediatric Cardiology, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.G.-G.); (C.L.); (L.D.B.)
| | - Elena Mansilla
- Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, INGEMM-IdIPAZ, 28046 Madrid, Spain (J.T.-C.); (L.F.G.-M.); (A.P.); (M.C.); (N.G.); (L.M.); (M.Á.M.); (E.M.); (E.R.); (F.G.-S.); (I.V.); (P.A.); (C.S.); (J.N.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras, CIBERER, 28029 Madrid, Spain
- European Reference Network, ITHACA, 1070 Brussels, Belgium
| | - Emi Rikeros
- Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, INGEMM-IdIPAZ, 28046 Madrid, Spain (J.T.-C.); (L.F.G.-M.); (A.P.); (M.C.); (N.G.); (L.M.); (M.Á.M.); (E.M.); (E.R.); (F.G.-S.); (I.V.); (P.A.); (C.S.); (J.N.)
| | - Fe García-Santiago
- Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, INGEMM-IdIPAZ, 28046 Madrid, Spain (J.T.-C.); (L.F.G.-M.); (A.P.); (M.C.); (N.G.); (L.M.); (M.Á.M.); (E.M.); (E.R.); (F.G.-S.); (I.V.); (P.A.); (C.S.); (J.N.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras, CIBERER, 28029 Madrid, Spain
- European Reference Network, ITHACA, 1070 Brussels, Belgium
| | - Isabel Vallcorba
- Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, INGEMM-IdIPAZ, 28046 Madrid, Spain (J.T.-C.); (L.F.G.-M.); (A.P.); (M.C.); (N.G.); (L.M.); (M.Á.M.); (E.M.); (E.R.); (F.G.-S.); (I.V.); (P.A.); (C.S.); (J.N.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras, CIBERER, 28029 Madrid, Spain
- European Reference Network, ITHACA, 1070 Brussels, Belgium
| | - Pedro Arias
- Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, INGEMM-IdIPAZ, 28046 Madrid, Spain (J.T.-C.); (L.F.G.-M.); (A.P.); (M.C.); (N.G.); (L.M.); (M.Á.M.); (E.M.); (E.R.); (F.G.-S.); (I.V.); (P.A.); (C.S.); (J.N.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras, CIBERER, 28029 Madrid, Spain
- European Reference Network, ITHACA, 1070 Brussels, Belgium
| | - Cristina Silván
- Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, INGEMM-IdIPAZ, 28046 Madrid, Spain (J.T.-C.); (L.F.G.-M.); (A.P.); (M.C.); (N.G.); (L.M.); (M.Á.M.); (E.M.); (E.R.); (F.G.-S.); (I.V.); (P.A.); (C.S.); (J.N.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras, CIBERER, 28029 Madrid, Spain
- European Reference Network, ITHACA, 1070 Brussels, Belgium
| | - Lucia Deiros Bronte
- Department of Pediatric Cardiology, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.G.-G.); (C.L.); (L.D.B.)
| | - Julián Nevado
- Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, INGEMM-IdIPAZ, 28046 Madrid, Spain (J.T.-C.); (L.F.G.-M.); (A.P.); (M.C.); (N.G.); (L.M.); (M.Á.M.); (E.M.); (E.R.); (F.G.-S.); (I.V.); (P.A.); (C.S.); (J.N.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras, CIBERER, 28029 Madrid, Spain
- European Reference Network, ITHACA, 1070 Brussels, Belgium
| | - Pablo Lapunzina
- Institute of Medical and Molecular Genetics, Hospital Universitario La Paz, INGEMM-IdIPAZ, 28046 Madrid, Spain (J.T.-C.); (L.F.G.-M.); (A.P.); (M.C.); (N.G.); (L.M.); (M.Á.M.); (E.M.); (E.R.); (F.G.-S.); (I.V.); (P.A.); (C.S.); (J.N.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras, CIBERER, 28029 Madrid, Spain
- European Reference Network, ITHACA, 1070 Brussels, Belgium
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Soomann M, Prader S, Lorenzini T, Soulard C, Sayasith K, Haddad E, Pachlopnik Schmid J. Severe T-cell lymphopenia in a patient with microduplication 22q11.2 identified by newborn screening. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:2199-2200.e1. [PMID: 38729303 DOI: 10.1016/j.jaip.2024.04.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 05/12/2024]
Affiliation(s)
- Maarja Soomann
- Division of Immunology and the Children's Research Center, University Children's, Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Seraina Prader
- Division of Immunology and the Children's Research Center, University Children's, Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tiziana Lorenzini
- Division of Immunology and the Children's Research Center, University Children's, Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Clara Soulard
- Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada; Department of Microbiology, Immunology and Infectious Diseases, University of Montreal, Montreal, Quebec, Canada
| | - Khampoun Sayasith
- Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Elie Haddad
- Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada; Department of Microbiology, Immunology and Infectious Diseases, University of Montreal, Montreal, Quebec, Canada; Research Center, Centre hospitalier universitaire (CHU) Sainte-Justine (CHU), Montreal, Quebec, Canada
| | - Jana Pachlopnik Schmid
- Division of Immunology and the Children's Research Center, University Children's, Hospital Zurich, University of Zurich, Zurich, Switzerland
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Bhattarai D, McGinn DE, Crowley TB, Giunta V, Gaiser K, Zackai EH, Emanuel BS, Heimall J, Jyonouchi S, Lee J, Sun D, McDonald-McGinn DM, Sullivan KE. Immunologic, Molecular, and Clinical Profile of Patients with Chromosome 22q11.2 Duplications. J Clin Immunol 2023; 43:794-807. [PMID: 36735193 DOI: 10.1007/s10875-023-01443-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/30/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE Duplication of chromosome 22q11.2 due to meiotic non-allelic homologous recombination results in a distinct syndrome, chromosome 22q11.2 duplication syndrome that has some overlapping phenotypic features with the corresponding 22q11.2 deletion syndrome. Literature on immunologic aspects of the duplication syndrome is limited. We conducted a retrospective study of 216 patients with this syndrome to better define the key features of the duplication syndrome. METHODS Single-center retrospective record review was performed. Data regarding demographics, clinical details, and immunological tests were compiled, extracted into a predetermined data collection form, and analyzed. RESULTS This cohort comprised 113 (52.3%) males and 103 (47.7%) females. The majority (54.6%) of mapped duplications were between low copy repeat regions A-D (LCR22A to -D). Though T cell subsets were relatively preserved, switched memory B cells, immunoglobulins, and specific antibodies were each found to be decreased in a subset of the cohort. One-fifth (17/79, 21.5%) of patients had at least 2 low immunoglobulin values, and panhypogammaglobulinemia was found in 11.7% (9/79) cases. Four children were on regular immunoglobulin replacement therapy. Asthma and eczema were the predominant atopic symptoms in our cohort. CONCLUSION Significant immunodeficiencies were observed in our cohort, particularly in B cells and antibodies. Our study expands the current clinical understanding and emphasizes the need of immunological studies and multidisciplinary approaches for these patients.
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Affiliation(s)
- Dharmagat Bhattarai
- Division of Allergy & Immunology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Daniel E McGinn
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - T Blaine Crowley
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Victoria Giunta
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Kimberly Gaiser
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Elaine H Zackai
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Beverly S Emanuel
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Jennifer Heimall
- Division of Allergy & Immunology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Soma Jyonouchi
- Division of Allergy & Immunology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Juhee Lee
- Division of Allergy & Immunology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Di Sun
- Division of Allergy & Immunology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Donna M McDonald-McGinn
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Kathleen E Sullivan
- Division of Allergy & Immunology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
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Mustillo PJ, Sullivan KE, Chinn IK, Notarangelo LD, Haddad E, Davies EG, de la Morena MT, Hartog N, Yu JE, Hernandez-Trujillo VP, Ip W, Franco J, Gambineri E, Hickey SE, Varga E, Markert ML. Clinical Practice Guidelines for the Immunological Management of Chromosome 22q11.2 Deletion Syndrome and Other Defects in Thymic Development. J Clin Immunol 2023; 43:247-270. [PMID: 36648576 PMCID: PMC9892161 DOI: 10.1007/s10875-022-01418-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/04/2022] [Indexed: 01/18/2023]
Abstract
Current practices vary widely regarding the immunological work-up and management of patients affected with defects in thymic development (DTD), which include chromosome 22q11.2 microdeletion syndrome (22q11.2del) and other causes of DiGeorge syndrome (DGS) and coloboma, heart defect, atresia choanae, retardation of growth and development, genital hypoplasia, ear anomalies/deafness (CHARGE) syndrome. Practice variations affect the initial and subsequent assessment of immune function, the terminology used to describe the condition and immune status, the accepted criteria for recommending live vaccines, and how often follow-up is needed based on the degree of immune compromise. The lack of consensus and widely varying practices highlight the need to establish updated immunological clinical practice guidelines. These guideline recommendations provide a comprehensive review for immunologists and other clinicians who manage immune aspects of this group of disorders.
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Affiliation(s)
- Peter J Mustillo
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, 43205, USA.
| | - Kathleen E Sullivan
- Division of Allergy Immunology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Ivan K Chinn
- Division of Immunology, Allergy, and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, TX, 77030, USA
| | - Luigi D Notarangelo
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Elie Haddad
- Department of Pediatrics, Department of Microbiology, Infectious Diseases and Immunology, CHU Sainte-Justine, University of Montreal, Montreal, QC, H3T 1C5, Canada
| | - E Graham Davies
- Department of Immunology, Great Ormond Street Hospital and UCL Great Ormond Street Institute of Child Health, London, WC1N 3HJ, UK
| | - Maria Teresa de la Morena
- Division of Immunology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, 98105, USA
| | - Nicholas Hartog
- Spectrum Health Helen DeVos Children's Hospital Department of Allergy and Immunology, Michigan State University College of Human Medicine, East Lansing, USA
| | - Joyce E Yu
- Division of Allergy, Immunology & Rheumatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Winnie Ip
- Department of Immunology, Great Ormond Street Hospital and UCL Great Ormond Street Institute of Child Health, London, WC1N 3JH, UK
| | - Jose Franco
- Grupo de Inmunodeficiencias Primarias, Facultad de Medicina, Universidad de Antioquia UdeA, Medellin, Colombia
| | - Eleonora Gambineri
- Department of "NEUROFARBA", Section of Child's Health, University of Florence, Florence, Italy
- Centre of Excellence, Division of Pediatric Oncology/Hematology, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Scott E Hickey
- Division of Genetic & Genomic Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Elizabeth Varga
- Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - M Louise Markert
- Department of Immunology, Duke University Medical Center, Durham, NC, 27710, USA
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7
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Bartik LE, Hughes SS, Tracy M, Feldt MM, Zhang L, Arganbright J, Kaye A. 22q11.2 duplications: Expanding the clinical presentation. Am J Med Genet A 2021; 188:779-787. [PMID: 34845825 DOI: 10.1002/ajmg.a.62577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/06/2021] [Accepted: 11/02/2021] [Indexed: 11/06/2022]
Abstract
22q11.2 duplication syndrome has a frequency of ~1/700 in the intellectual disability population. Despite this frequency, there is limited information on the variable clinical presentation. Although the phenotype and incidence of congenital anomalies are well described for 22q11.2 deletion syndrome, they are not as well understood for individuals with 22q11.2 duplication syndrome. This study is a single-center, retrospective review of patients diagnosed with 22q11.2 duplication syndrome designed to categorize the variable phenotype seen in these individuals. The data suggest that the incidence of congenital anomalies may be higher than previously reported for this syndrome. Affected individuals are at increased risk for a variety of problems including gastrointestinal complications, endocrine dysfunction, ophthalmologic abnormalities, palatal anomalies, congenital heart disease, musculoskeletal differences, and neurologic abnormalities. Individuals with 22q11.2 duplication syndrome would benefit from care coordinated by a multidisciplinary team and managed according to the 22q11.2 deletion syndrome guidelines.
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Affiliation(s)
- Lauren E Bartik
- Division of Clinical Genetics, Children's Mercy Hospital, Kansas City, Missouri, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Susan S Hughes
- Division of Clinical Genetics, Children's Mercy Hospital, Kansas City, Missouri, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Meghan Tracy
- Division of Plastic Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - M Max Feldt
- Division of Pediatric Endocrinology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Lei Zhang
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.,Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Jill Arganbright
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.,Division of Pediatric Otolaryngology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Alison Kaye
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.,Division of Plastic Surgery, Children's Mercy Hospital, Kansas City, Missouri, USA
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