1
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Guan X, Guo H, Guo Y, Han Q, Li Z, Zhang C. Perforin 1 in Cancer: Mechanisms, Therapy, and Outlook. Biomolecules 2024; 14:910. [PMID: 39199299 PMCID: PMC11352983 DOI: 10.3390/biom14080910] [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: 06/13/2024] [Revised: 07/22/2024] [Accepted: 07/24/2024] [Indexed: 09/01/2024] Open
Abstract
PRF1 (perforin 1) is a key cytotoxic molecule that plays a crucial role in the killing function of natural killer (NK) cells and cytotoxic T lymphocytes (CTLs). Recent studies have focused on PRF1's role in cancer development, progression, and prognosis. Studies have shown that aberrant PRF1 expression has a significant role to play in cancer development and progression. In some cancers, high expression of the PRF1 gene is associated with a better prognosis for patients, possibly because it helps enhance the body's immune response to tumors. However, some studies have also shown that the absence of PRF1 may make it easier for tumors to evade the body's immune surveillance, thus affecting patient survival. Furthermore, recent studies have explored therapeutic strategies based on PRF1, such as enhancing the ability of immune cells to kill cancer cells by boosting PRF1 activity. In addition, they have improved the efficacy of immunotherapy by modulating its expression to enhance the effectiveness of the treatment. Based on these findings, PRF1 may be a valuable biomarker both for the treatment of cancer and for its prognosis in the future. To conclude, PRF1 has an important biological function and has clinical potential for the treatment of cancer, which indicates that it deserves more research and development in the future.
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Affiliation(s)
- Xiaoya Guan
- Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China; (H.G.); (Y.G.); (Q.H.); (Z.L.)
- Shanxi Province Clinical Medical Research Center for Precision Medicine of Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Huina Guo
- Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China; (H.G.); (Y.G.); (Q.H.); (Z.L.)
- Shanxi Province Clinical Medical Research Center for Precision Medicine of Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Yujia Guo
- Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China; (H.G.); (Y.G.); (Q.H.); (Z.L.)
- Shanxi Province Clinical Medical Research Center for Precision Medicine of Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Qi Han
- Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China; (H.G.); (Y.G.); (Q.H.); (Z.L.)
- Shanxi Province Clinical Medical Research Center for Precision Medicine of Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Zhongxun Li
- Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China; (H.G.); (Y.G.); (Q.H.); (Z.L.)
- Shanxi Province Clinical Medical Research Center for Precision Medicine of Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Chunming Zhang
- Shanxi Key Laboratory of Otorhinolaryngology Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China; (H.G.); (Y.G.); (Q.H.); (Z.L.)
- Shanxi Province Clinical Medical Research Center for Precision Medicine of Head and Neck Cancer, First Hospital of Shanxi Medical University, Taiyuan 030001, China
- Department of Otolaryngology Head & Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan 030001, China
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2
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Stadermann A, Haar M, Riecke A, Mayer T, Neumann C, Bauer A, Schulz A, Nagarathinam K, Gebauer N, Böhm S, Groß M, Grunert M, Müller M, Witte H. Late Onset of Primary Hemophagocytic Lymphohistiocytosis (HLH) with a Novel Constellation of Compound Heterozygosity Involving Two Missense Variants in the PRF1 Gene. Int J Mol Sci 2024; 25:2762. [PMID: 38474010 DOI: 10.3390/ijms25052762] [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: 12/23/2023] [Revised: 02/12/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare but in most cases life-threatening immune-mediated disease of the hematopoietic system frequently associated with hematologic neoplasms. Here, we report on a case in which we detected a novel constellation of two missense variants affecting the PRF1 gene, leading to de novo primary HLH. Diagnostics included a comprehensive clinical work-up and standard methods of hematopathology as well as extended molecular genomics based on polymerase chain reaction (PCR) reactions and the calculation of three-dimensional molecule reconstructions of PRF1. Subsequently, a comprehensive review of the literature was performed, which showed that this compound heterozygosity has not been previously described. The patient was a 20-year-old female. Molecular diagnostics revealed two heterozygous missense variants in the PRF1 gene (A91V and R104C) on exon 2. Apart from the finding of two inconclusive genetic variants, all clinical criteria defined by the HLH study group of Histiocyte Society were met at initial presentation. The final diagnosis was made in cooperation with the Consortium of German HLH-reference centers. Here, chemotherapy did not lead to sufficient sustained disease control. Therefore, the decision for allogenic hematopoietic stem cell transplantation (alloHSCT) was made. Hitherto, the duration of response was 6 months. Due to severe and unmanageable hepatic graft-versus-host disease (GvHD), the patient died. We report on a novel constellation of a compound heterozygosity containing two missense variants on exon 2 of the PRF1 gene. To the authors' best knowledge, this is the first presentation of a primary HLH case harboring this genomic constellation with late-onset clinical manifestation.
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Affiliation(s)
- Alina Stadermann
- Department of Hematology and Oncology, Bundeswehrkrankemhaus Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
| | - Markus Haar
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Armin Riecke
- Department of Hematology and Oncology, Bundeswehrkrankemhaus Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
| | - Thomas Mayer
- Department of Hematology and Oncology, Bundeswehrkrankemhaus Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
| | - Christian Neumann
- Department of Hematology and Oncology, Bundeswehrkrankemhaus Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
| | - Arthur Bauer
- Department of Hematology and Oncology, Bundeswehrkrankemhaus Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
| | - Ansgar Schulz
- Department of Pediatric Medicine, University Hospital Ulm, Eythstraße 24, 89075 Ulm, Germany
| | - Kumar Nagarathinam
- Institute of Biochemistry, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Niklas Gebauer
- Department of Hematology and Oncology, University Hospital Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Svea Böhm
- Institute for Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 115, 79106 Freiburg, Germany
- Division of Pediatric Stem Cell Transplantation and Immunology, Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Miriam Groß
- Institute for Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 115, 79106 Freiburg, Germany
| | - Michael Grunert
- Department of Nuclear Medicine, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
- Department of Nuclear Medicine, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Matthias Müller
- Department of Hematology and Oncology, Bundeswehrkrankemhaus Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
| | - Hanno Witte
- Department of Hematology and Oncology, Bundeswehrkrankemhaus Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
- Department of Hematology and Oncology, University Hospital Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
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3
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Meyer LK, Huang I, Huang BJ, Chung JH, Pawar A, Hermiston ML, Loh ML, Ohgami RS, Ruiz-Cordero R, Bhargava P, Marinoff AE. Hemophagocytic lymphohistiocytosis and clonally related T-cell malignancies in a pediatric patient. Pediatr Blood Cancer 2023; 70:e30677. [PMID: 37702960 DOI: 10.1002/pbc.30677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/14/2023]
Affiliation(s)
- Lauren K Meyer
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Ingold Huang
- Department of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Benjamin J Huang
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Jong Hee Chung
- Department of Pediatrics, University of California Davis, Davis, California, USA
| | - Anjali Pawar
- Department of Pediatrics, University of California Davis, Davis, California, USA
| | - Michelle L Hermiston
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Mignon L Loh
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Robert S Ohgami
- Department of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Roberto Ruiz-Cordero
- Department of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Pathology and Laboratory Medicine, University of Miami, Miami, Florida, USA
| | - Parul Bhargava
- Department of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Amanda E Marinoff
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
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4
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Reis BCSD, Soares Faccion R, de Carvalho FAA, Moore DCBC, Zuma MCC, Plaça DR, Salerno Filgueiras I, Leandro Mathias Fonseca D, Cabral-Marques O, Bonomo AC, Savino W, Freitas FCDP, Faoro H, Passetti F, Robaina JR, de Oliveira FRC, Novaes Bellinat AP, Zeitel RDS, Salú MDS, de Oliveira MBG, Rodrigues-Santos G, Prata-Barbosa A, de Vasconcelos ZFM. Rare genetic variants involved in multisystem inflammatory syndrome in children: a multicenter Brazilian cohort study. Front Cell Infect Microbiol 2023; 13:1182257. [PMID: 37588055 PMCID: PMC10426286 DOI: 10.3389/fcimb.2023.1182257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/23/2023] [Indexed: 08/18/2023] Open
Abstract
Introduction Despite the existing data on the Multisystem Inflammatory Syndrome in Children (MIS-C), the factors that determine these patients evolution remain elusive. Answers may lie, at least in part, in genetics. It is currently under investigation that MIS-C patients may have an underlying innate error of immunity (IEI), whether of monogenic, digenic, or even oligogenic origin. Methods To further investigate this hypothesis, 30 patients with MIS-C were submitted to whole exome sequencing. Results Analyses of genes associated with MIS-C, MIS-A, severe covid-19, and Kawasaki disease identified twenty-nine patients with rare potentially damaging variants (50 variants were identified in 38 different genes), including those previously described in IFNA21 and IFIH1 genes, new variants in genes previously described in MIS-C patients (KMT2D, CFB, and PRF1), and variants in genes newly associated to MIS-C such as APOL1, TNFRSF13B, and G6PD. In addition, gene ontology enrichment pointed to the involvement of thirteen major pathways, including complement system, hematopoiesis, immune system development, and type II interferon signaling, that were not yet reported in MIS-C. Discussion These data strongly indicate that different gene families may favor MIS- C development. Larger cohort studies with healthy controls and other omics approaches, such as proteomics and RNAseq, will be precious to better understanding the disease dynamics.
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Affiliation(s)
- Bárbara Carvalho Santos Dos Reis
- Programa de Pós Graduação em Pesquisa Aplicada à Saúde da Criança e da Mulher, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- Laboratório de Alta Complexidade (LACIFF), Unidade de Pesquisa Clínica, IFF, FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Departamento de Imunologia, IFF, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Roberta Soares Faccion
- Programa de Pós Graduação em Pesquisa Aplicada à Saúde da Criança e da Mulher, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- Laboratório de Alta Complexidade (LACIFF), Unidade de Pesquisa Clínica, IFF, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Flavia Amendola Anisio de Carvalho
- Programa de Pós Graduação em Pesquisa Aplicada à Saúde da Criança e da Mulher, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- Departamento de Imunologia, IFF, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Daniella Campelo Batalha Cox Moore
- Unidade de Pacientes Graves, Departamento de Pediatria, IFF, FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Faculdade de Medicina, Universidade Federal Fluminense, Niterói, Rio de Janeiro, RJ, Brazil
| | - Maria Celia Chaves Zuma
- Programa de Pós Graduação em Pesquisa Aplicada à Saúde da Criança e da Mulher, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- Laboratório de Alta Complexidade (LACIFF), Unidade de Pesquisa Clínica, IFF, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Desirée Rodrigues Plaça
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas (FCF), Universidade de São Paulo (USP), São Paulo, SP, Brazil
- Programa de Pós-Graduação em Farmácia (Fisiopatologia e Toxicologia), FCF, USP, São Paulo, SP, Brazil
| | - Igor Salerno Filgueiras
- Departamento de Imunologia, Instituto de Ciências Biomédicas (ICB), USP, São Paulo, SP, Brazil
| | - Dennyson Leandro Mathias Fonseca
- Programa Interunidades de Pós-graduação em Bioinformática, Instituto de Matemática e Estatística (IME), USP, São Paulo, SP, Brazil
| | - Otavio Cabral-Marques
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas (FCF), Universidade de São Paulo (USP), São Paulo, SP, Brazil
- Departamento de Imunologia, Instituto de Ciências Biomédicas (ICB), USP, São Paulo, SP, Brazil
- Programa Interunidades de Pós-graduação em Bioinformática, Instituto de Matemática e Estatística (IME), USP, São Paulo, SP, Brazil
- Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), São Paulo, Brazil
- Department of Medicine, Division of Molecular Medicine, University of São Paulo School of Medicine, São Paulo, SP, Brazil
- Laboratory of Medical Investigation 29, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Adriana Cesar Bonomo
- Laboratoírio de Pesquisas Sobre o Timo, Instituto Oswaldo Cruz (IOC), FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Instituto National de Ciencia e Tecnologia em Neuroimunomodulação (INCT/NIM), IOC, FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Rede FAPERJ de Pesquisa em Neuroinflamação, IOC, FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Rede INOVA-IOC em Neuroimunomodulação, IOC, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Wilson Savino
- Laboratoírio de Pesquisas Sobre o Timo, Instituto Oswaldo Cruz (IOC), FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Instituto National de Ciencia e Tecnologia em Neuroimunomodulação (INCT/NIM), IOC, FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Rede FAPERJ de Pesquisa em Neuroinflamação, IOC, FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Rede INOVA-IOC em Neuroimunomodulação, IOC, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | | | - Helisson Faoro
- Laboratório de Regulação da Expressão Gênica, Instituto Carlos Chagas (ICC), FIOCRUZ, Curitiba, PR, Brazil
| | - Fabio Passetti
- Laboratório de Regulação da Expressão Gênica, Instituto Carlos Chagas (ICC), FIOCRUZ, Curitiba, PR, Brazil
| | | | | | | | - Raquel de Seixas Zeitel
- Pediatric Intensive Care Unit, Hospital Universitário Pedro Ernesto (HUPE), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Margarida dos Santos Salú
- Programa de Pós Graduação em Pesquisa Aplicada à Saúde da Criança e da Mulher, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- Laboratório de Alta Complexidade (LACIFF), Unidade de Pesquisa Clínica, IFF, FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Pediatric Intensive Care Unit, Hospital Martagão Gesteira, Salvador, BA, Brazil
| | | | | | - Arnaldo Prata-Barbosa
- Instituto D’Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil
- Pediatric Intensive Care Unit, Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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5
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Lee PY, Cron RQ. The Multifaceted Immunology of Cytokine Storm Syndrome. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2023; 210:1015-1024. [PMID: 37011407 PMCID: PMC10071410 DOI: 10.4049/jimmunol.2200808] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/20/2022] [Indexed: 04/05/2023]
Abstract
Cytokine storm syndromes (CSSs) are potentially fatal hyperinflammatory states that share the underpinnings of persistent immune cell activation and uninhibited cytokine production. CSSs can be genetically determined by inborn errors of immunity (i.e., familial hemophagocytic lymphohistiocytosis) or develop as a complication of infections, chronic inflammatory diseases (e.g., Still disease), or malignancies (e.g., T cell lymphoma). Therapeutic interventions that activate the immune system such as chimeric Ag receptor T cell therapy and immune checkpoint inhibition can also trigger CSSs in the setting of cancer treatment. In this review, the biology of different types of CSSs is explored, and the current knowledge on the involvement of immune pathways and the contribution of host genetics is discussed. The use of animal models to study CSSs is reviewed, and their relevance for human diseases is discussed. Lastly, treatment approaches for CSSs are discussed with a focus on interventions that target immune cells and cytokines.
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Affiliation(s)
- Pui Y. Lee
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Randy Q. Cron
- Division of Pediatric Rheumatology, Children’s of Alabama, University of Alabama Heersink School of Medicine, Birmingham, AL
- Department of Pediatrics, University of Alabama Heersink School of Medicine, Birmingham, AL
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6
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Allain V, Grandin V, Meignin V, Bertinchamp R, Boutboul D, Fieschi C, Galicier L, Gérard L, Malphettes M, Bustamante J, Fusaro M, Lambert N, Rosain J, Lenoir C, Kracker S, Rieux-Laucat F, Latour S, de Villartay JP, Picard C, Oksenhendler E. Lymphoma as an Exclusion Criteria for CVID Diagnosis Revisited. J Clin Immunol 2023; 43:181-191. [PMID: 36155879 DOI: 10.1007/s10875-022-01368-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/14/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE Hypogammaglobulinemia in a context of lymphoma is usually considered as secondary and prior lymphoma remains an exclusion criterion for a common variable immunodeficiency (CVID) diagnosis. We hypothesized that lymphoma could be the revealing symptom of an underlying primary immunodeficiency (PID), challenging the distinction between primary and secondary hypogammaglobulinemia. METHODS Within a French cohort of adult patients with hypogammaglobulinemia, patients who developed a lymphoma either during follow-up or before the diagnosis of hypogammaglobulinemia were identified. These two chronology groups were then compared. For patients without previous genetic diagnosis, a targeted next-generation sequencing of 300 PID-associated genes was performed. RESULTS A total of forty-seven patients had developed 54 distinct lymphomas: non-Hodgkin B cell lymphoma (67%), Hodgkin lymphoma (26%), and T cell lymphoma (7%). In 25 patients, lymphoma developed prior to the diagnosis of hypogammaglobulinemia. In this group of patients, Hodgkin lymphoma was overrepresented compared to the group of patients in whom lymphoma occurred during follow-up (48% versus 9%), whereas MALT lymphoma was absent (0 versus 32%). Despite the histopathological differences, both groups presented with similar characteristics in terms of age at hypogammaglobulinemia diagnosis, consanguinity rate, or severe T cell defect. Overall, genetic analyses identified a molecular diagnosis in 10/47 patients (21%), distributed in both groups and without peculiar gene recurrence. Most of these patients presented with a late onset combined immunodeficiency (LOCID) phenotype. CONCLUSION Prior or concomitant lymphoma should not be used as an exclusion criteria for CVID diagnosis, and these patients should be investigated accordingly.
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Affiliation(s)
- Vincent Allain
- University of Paris, Paris, France.,Department of Clinical Immunology, Saint-Louis Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Virginie Grandin
- Study Center for Primary Immunodeficiencies, Necker Hospital for Sick Children, AP-HP, Paris, France
| | | | - Rémi Bertinchamp
- Department of Clinical Immunology, Saint-Louis Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - David Boutboul
- University of Paris, Paris, France.,Department of Clinical Immunology, Saint-Louis Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France.,Centre de Référence Des Déficits Immunitaires Héréditaires (CEREDIH), Paris, France
| | - Claire Fieschi
- University of Paris, Paris, France.,Department of Clinical Immunology, Saint-Louis Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France.,Centre de Référence Des Déficits Immunitaires Héréditaires (CEREDIH), Paris, France
| | - Lionel Galicier
- Department of Clinical Immunology, Saint-Louis Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France.,Centre de Référence Des Déficits Immunitaires Héréditaires (CEREDIH), Paris, France
| | - Laurence Gérard
- Department of Clinical Immunology, Saint-Louis Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France.,Centre de Référence Des Déficits Immunitaires Héréditaires (CEREDIH), Paris, France
| | - Marion Malphettes
- Department of Clinical Immunology, Saint-Louis Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France.,Centre de Référence Des Déficits Immunitaires Héréditaires (CEREDIH), Paris, France
| | - Jacinta Bustamante
- University of Paris, Paris, France.,Study Center for Primary Immunodeficiencies, Necker Hospital for Sick Children, AP-HP, Paris, France.,Centre de Référence Des Déficits Immunitaires Héréditaires (CEREDIH), Paris, France.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Imagine Institute, Necker Hospital for Sick Children, Paris, France.,St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY, USA
| | - Mathieu Fusaro
- University of Paris, Paris, France.,Study Center for Primary Immunodeficiencies, Necker Hospital for Sick Children, AP-HP, Paris, France
| | - Nathalie Lambert
- Study Center for Primary Immunodeficiencies, Necker Hospital for Sick Children, AP-HP, Paris, France
| | - Jérémie Rosain
- University of Paris, Paris, France.,Study Center for Primary Immunodeficiencies, Necker Hospital for Sick Children, AP-HP, Paris, France
| | - Christelle Lenoir
- University of Paris, Paris, France.,Laboratory of Lymphocyte Activation and Susceptibility to EBV, INSERM UMR 1163, Imagine Institute, Paris, France
| | - Sven Kracker
- University of Paris, Paris, France.,Laboratory of Human Lymphohematopoiesis, INSERM UMR 1163, Imagine Institute, Paris, France
| | - Frédéric Rieux-Laucat
- University of Paris, Paris, France.,Imagine Institute, INSERM UMR 1163, Paris, France
| | - Sylvain Latour
- University of Paris, Paris, France.,Laboratory of Lymphocyte Activation and Susceptibility to EBV, INSERM UMR 1163, Imagine Institute, Paris, France
| | - Jean-Pierre de Villartay
- University of Paris, Paris, France.,Laboratory "Genome Dynamics in the Immune System," INSERM UMR 1163, Imagine Institute, Paris, France
| | - Capucine Picard
- University of Paris, Paris, France.,Study Center for Primary Immunodeficiencies, Necker Hospital for Sick Children, AP-HP, Paris, France.,Centre de Référence Des Déficits Immunitaires Héréditaires (CEREDIH), Paris, France.,Laboratory of Lymphocyte Activation and Susceptibility to EBV, INSERM UMR 1163, Imagine Institute, Paris, France.,Immuno-Hematology Unit, Necker Hospital for Sick Children, AP-HP, Paris, France
| | - Eric Oksenhendler
- University of Paris, Paris, France. .,Department of Clinical Immunology, Saint-Louis Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France. .,Centre de Référence Des Déficits Immunitaires Héréditaires (CEREDIH), Paris, France.
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7
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Nüssing S, Sutton VR, Trapani JA, Parish IA. Beyond target cell death - Granzyme serine proteases in health and disease. Mol Aspects Med 2022; 88:101152. [PMID: 36368281 DOI: 10.1016/j.mam.2022.101152] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 10/06/2022] [Accepted: 10/22/2022] [Indexed: 11/09/2022]
Abstract
Granzymes are a family of small (∼32 kDa) serine proteases with a range of substrate specificities that are stored in, and released from, the cytoplasmic secretory vesicles ('granules') of cytotoxic T lymphocytes and natural killer cells. Granzymes are not digestive proteases but finely tuned processing enzymes that target their substrates in specific ways to activate various signalling pathways, or to inactivate viral proteins and other targets. Great emphasis has been placed on studying the pro-apoptotic functions of granzymes, which largely depend on their synergy with the pore-forming protein perforin, on which they rely for penetration into the target cell cytosol to access their substrates. While a critical role for granzyme B in target cell apoptosis is undisputed, both it and the remaining granzymes also influence a variety of other biological processes (including important immunoregulatory functions), which are discussed in this review. This includes the targeting of many extracellular as well as intracellular substrates, and can also lead to deleterious outcomes for the host if granzyme expression or function are dysregulated or abrogated. A final important consideration is that granzyme repertoire, biochemistry and function vary considerably across species, probably resulting from the pressures applied by viruses and other pathogens across evolutionary time. This has implications for the interpretation of granzyme function in preclinical models of disease.
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Affiliation(s)
- Simone Nüssing
- Peter MacCallum Cancer Centre, Melbourne, Victoria, 3000, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Vivien R Sutton
- Peter MacCallum Cancer Centre, Melbourne, Victoria, 3000, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Joseph A Trapani
- Peter MacCallum Cancer Centre, Melbourne, Victoria, 3000, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, 3052, Australia.
| | - Ian A Parish
- Peter MacCallum Cancer Centre, Melbourne, Victoria, 3000, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, 3052, Australia; John Curtin School of Medical Research, ANU, ACT, Australia.
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8
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Barbosa LV, Prá DMM, Nagashima S, Pereira MRC, Stocco RB, da Silva FDLF, Cruz MR, Dallagassa D, Stupak TJ, da Rosa Götz GWX, Nasimoto GG, Cracco LAF, Silva IB, de Moura KF, Deus MDC, Martins APC, Spitzenbergen BAKV, Amaral ANM, de Paula CBV, Machado-Souza C, de Noronha L. Immune Response Gaps Linked to SARS-CoV-2 Infection: Cellular Exhaustion, Senescence, or Both? Int J Mol Sci 2022; 23:ijms232213734. [PMID: 36430210 PMCID: PMC9696576 DOI: 10.3390/ijms232213734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/26/2022] [Accepted: 11/03/2022] [Indexed: 11/10/2022] Open
Abstract
The COVID-19 pandemic, promoted by the SARS-CoV-2 respiratory virus, has resulted in widespread global morbidity and mortality. The immune response against this pathogen has shown a thin line between protective effects and pathological reactions resulting from the massive release of cytokines and poor viral clearance. The latter is possibly caused by exhaustion, senescence, or both of TCD8+ cells and reduced activity of natural killer (NK) cells. The imbalance between innate and adaptive responses during the early stages of infection caused by SARS-CoV-2 contributes to the ineffective control of viral spread. The present study evaluated the tissue immunoexpression of the tissue biomarkers (Arginase-1, CCR4, CD3, CD4, CD8, CD20, CD57, CD68, CD138, IL-4, INF-α, INF-γ, iNOS, PD-1, Perforin and Sphingosine-1) to understand the cellular immune response triggered in patients who died of COVID-19. We evaluated twenty-four paraffin-embedded lung tissue samples from patients who died of COVID-19 (COVID-19 group) and compared them with ten lung tissue samples from patients who died of H1N1pdm09 (H1N1 group) with the immunohistochemical markers mentioned above. In addition, polymorphisms in the Perforin gene were genotyped through Real-Time PCR. Significantly increased tissue immunoexpression of Arginase, CD4, CD68, CD138, Perforin, Sphingosine-1, and IL-4 markers were observed in the COVID-19 group. A significantly lower immunoexpression of CD8 and CD57 was also found in this group. It is suggested that patients who died from COVID-19 had a poor cellular response concerning viral clearance and adaptive response going through tissue repair.
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Affiliation(s)
- Leonardo Vinicius Barbosa
- Postgraduate in Biotechnology Applied in Health of Children and Adolescent, Faculdades Pequeno Príncipe (FPP), Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), R. Silva Jardim, 1632 Água Verde, Curitiba 80250-060, Brazil
| | - Daniele Margarita Marani Prá
- Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), R. Imaculada Conceição, 1155 Prado Velho, Curitiba 80215-901, Brazil
| | - Seigo Nagashima
- Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), R. Imaculada Conceição, 1155 Prado Velho, Curitiba 80215-901, Brazil
| | - Marcos Roberto Curcio Pereira
- Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), R. Imaculada Conceição, 1155 Prado Velho, Curitiba 80215-901, Brazil
| | - Rebecca Benicio Stocco
- Laboratory of Experimental Pathology, School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), R. Imaculada Conceição, 1155 Prado Velho, Curitiba 80215-901, Brazil
| | - Francys de Luca Fernandes da Silva
- Laboratory of Experimental Pathology, School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), R. Imaculada Conceição, 1155 Prado Velho, Curitiba 80215-901, Brazil
| | - Milena Rueda Cruz
- Laboratory of Experimental Pathology, School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), R. Imaculada Conceição, 1155 Prado Velho, Curitiba 80215-901, Brazil
| | - Djessyka Dallagassa
- Laboratory of Experimental Pathology, School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), R. Imaculada Conceição, 1155 Prado Velho, Curitiba 80215-901, Brazil
| | - Thiago João Stupak
- Laboratory of Experimental Pathology, School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), R. Imaculada Conceição, 1155 Prado Velho, Curitiba 80215-901, Brazil
| | - George Willian Xavier da Rosa Götz
- Laboratory of Experimental Pathology, School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), R. Imaculada Conceição, 1155 Prado Velho, Curitiba 80215-901, Brazil
| | - Georgia Garofani Nasimoto
- Laboratory of Experimental Pathology, School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), R. Imaculada Conceição, 1155 Prado Velho, Curitiba 80215-901, Brazil
| | | | - Isabela Busto Silva
- Hospital Marcelino Champagnat, Av. Presidente Affonso Camargo, 1399 Cristo Rei, Curitiba 80050-370, Brazil
| | - Karen Fernandes de Moura
- Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), R. Imaculada Conceição, 1155 Prado Velho, Curitiba 80215-901, Brazil
| | - Marina de Castro Deus
- Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), R. Imaculada Conceição, 1155 Prado Velho, Curitiba 80215-901, Brazil
| | - Ana Paula Camargo Martins
- Laboratory of Experimental Pathology, School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), R. Imaculada Conceição, 1155 Prado Velho, Curitiba 80215-901, Brazil
| | - Beatriz Akemi Kondo Van Spitzenbergen
- Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), R. Imaculada Conceição, 1155 Prado Velho, Curitiba 80215-901, Brazil
| | - Andréa Novais Moreno Amaral
- Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), R. Imaculada Conceição, 1155 Prado Velho, Curitiba 80215-901, Brazil
| | - Caroline Busatta Vaz de Paula
- Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), R. Imaculada Conceição, 1155 Prado Velho, Curitiba 80215-901, Brazil
- Correspondence: (C.B.V.d.P.); (C.M.-S.)
| | - Cleber Machado-Souza
- Postgraduate in Biotechnology Applied in Health of Children and Adolescent, Faculdades Pequeno Príncipe (FPP), Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), R. Silva Jardim, 1632 Água Verde, Curitiba 80250-060, Brazil
- Correspondence: (C.B.V.d.P.); (C.M.-S.)
| | - Lucia de Noronha
- Postgraduate Program of Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná (PUCPR), R. Imaculada Conceição, 1155 Prado Velho, Curitiba 80215-901, Brazil
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9
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Zanchettin AC, Barbosa LV, Dutra AA, Prá DMM, Pereira MRC, Stocco RB, Martins APC, Vaz de Paula CB, Nagashima S, de Noronha L, Machado-Souza C. Role of Genetic Polymorphism Present in Macrophage Activation Syndrome Pathway in Post Mortem Biopsies of Patients with COVID-19. Viruses 2022; 14:v14081699. [PMID: 36016321 PMCID: PMC9415703 DOI: 10.3390/v14081699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/22/2022] [Accepted: 07/28/2022] [Indexed: 11/30/2022] Open
Abstract
COVID-19 is a viral disease associated with an intense inflammatory response. Macrophage Activation Syndrome (MAS), the complication present in secondary hemophagocytic lymphohistiocytosis (sHLH), shares many clinical aspects observed in COVID-19 patients, and investigating the cytolytic function of the responsible cells for the first line of the immune response is important. Formalin-fixed paraffin-embedded lung tissue samples obtained by post mortem necropsy were accessed for three groups (COVID-19, H1N1, and CONTROL). Polymorphisms in MAS cytolytic pathway (PRF1; STX11; STXBP2; UNC13D and GZMB) were selected and genotyping by TaqMan® assays (Thermo Fisher Scientific, MA, USA) using Real-Time PCR (Applied Biosystems, MA USA). Moreover, immunohistochemistry staining was performed with a monoclonal antibody against perforin, CD8+ and CD57+ proteins. Histopathological analysis showed high perforin tissue expression in the COVID-19 group; CD8+ was high in the H1N1 group and CD57+ in the CONTROL group. An association could be observed in two genes related to the cytolytic pathway (PRF1 rs885822 G/A and STXBP2 rs2303115 G/A). Furthermore, PRF1 rs350947132 was associated with increased immune tissue expression for perforin in the COVID-19 group. The genotype approach could help identify patients that are more susceptible, and for this reason, our results showed that perforin and SNPs in the PRF1 gene can be involved in this critical pathway in the context of COVID-19.
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Affiliation(s)
- Aline Cristina Zanchettin
- Faculdades Pequeno Príncipe, Av. Iguaçu, 333, Curitiba 80230-020, Paraná, Brazil; (A.C.Z.); (L.V.B.)
- Instituto de Pesquisa Pelé Pequeno Príncipe, Av. Silva Jardim, 1632, Curitiba 80250-200, Paraná, Brazil
| | - Leonardo Vinicius Barbosa
- Faculdades Pequeno Príncipe, Av. Iguaçu, 333, Curitiba 80230-020, Paraná, Brazil; (A.C.Z.); (L.V.B.)
- Instituto de Pesquisa Pelé Pequeno Príncipe, Av. Silva Jardim, 1632, Curitiba 80250-200, Paraná, Brazil
| | - Anderson Azevedo Dutra
- School of Medicine, Pontifícia Universidade Católica do Paraná, R. Imaculada Conceição, 1155, Curitiba 80215-901, Paraná, Brazil; (A.A.D.); (D.M.M.P.); (M.R.C.P.); (R.B.S.); (A.P.C.M.); (C.B.V.d.P.); (S.N.); (L.d.N.)
| | - Daniele Margarita Marani Prá
- School of Medicine, Pontifícia Universidade Católica do Paraná, R. Imaculada Conceição, 1155, Curitiba 80215-901, Paraná, Brazil; (A.A.D.); (D.M.M.P.); (M.R.C.P.); (R.B.S.); (A.P.C.M.); (C.B.V.d.P.); (S.N.); (L.d.N.)
| | - Marcos Roberto Curcio Pereira
- School of Medicine, Pontifícia Universidade Católica do Paraná, R. Imaculada Conceição, 1155, Curitiba 80215-901, Paraná, Brazil; (A.A.D.); (D.M.M.P.); (M.R.C.P.); (R.B.S.); (A.P.C.M.); (C.B.V.d.P.); (S.N.); (L.d.N.)
| | - Rebecca Benicio Stocco
- School of Medicine, Pontifícia Universidade Católica do Paraná, R. Imaculada Conceição, 1155, Curitiba 80215-901, Paraná, Brazil; (A.A.D.); (D.M.M.P.); (M.R.C.P.); (R.B.S.); (A.P.C.M.); (C.B.V.d.P.); (S.N.); (L.d.N.)
| | - Ana Paula Camargo Martins
- School of Medicine, Pontifícia Universidade Católica do Paraná, R. Imaculada Conceição, 1155, Curitiba 80215-901, Paraná, Brazil; (A.A.D.); (D.M.M.P.); (M.R.C.P.); (R.B.S.); (A.P.C.M.); (C.B.V.d.P.); (S.N.); (L.d.N.)
| | - Caroline Busatta Vaz de Paula
- School of Medicine, Pontifícia Universidade Católica do Paraná, R. Imaculada Conceição, 1155, Curitiba 80215-901, Paraná, Brazil; (A.A.D.); (D.M.M.P.); (M.R.C.P.); (R.B.S.); (A.P.C.M.); (C.B.V.d.P.); (S.N.); (L.d.N.)
| | - Seigo Nagashima
- School of Medicine, Pontifícia Universidade Católica do Paraná, R. Imaculada Conceição, 1155, Curitiba 80215-901, Paraná, Brazil; (A.A.D.); (D.M.M.P.); (M.R.C.P.); (R.B.S.); (A.P.C.M.); (C.B.V.d.P.); (S.N.); (L.d.N.)
| | - Lucia de Noronha
- School of Medicine, Pontifícia Universidade Católica do Paraná, R. Imaculada Conceição, 1155, Curitiba 80215-901, Paraná, Brazil; (A.A.D.); (D.M.M.P.); (M.R.C.P.); (R.B.S.); (A.P.C.M.); (C.B.V.d.P.); (S.N.); (L.d.N.)
| | - Cleber Machado-Souza
- Faculdades Pequeno Príncipe, Av. Iguaçu, 333, Curitiba 80230-020, Paraná, Brazil; (A.C.Z.); (L.V.B.)
- Instituto de Pesquisa Pelé Pequeno Príncipe, Av. Silva Jardim, 1632, Curitiba 80250-200, Paraná, Brazil
- Correspondence:
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10
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Beliën J, Goris A, Matthys P. Natural Killer Cells in Multiple Sclerosis: Entering the Stage. Front Immunol 2022; 13:869447. [PMID: 35464427 PMCID: PMC9019710 DOI: 10.3389/fimmu.2022.869447] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/14/2022] [Indexed: 11/14/2022] Open
Abstract
Studies investigating the immunopathology of multiple sclerosis (MS) have largely focused on adaptive T and B lymphocytes. However, in recent years there has been an increased interest in the contribution of innate immune cells, amongst which the natural killer (NK) cells. Apart from their canonical role of controlling viral infections, cell stress and malignancies, NK cells are increasingly being recognized for their modulating effect on the adaptive immune system, both in health and autoimmune disease. From different lines of research there is now evidence that NK cells contribute to MS immunopathology. In this review, we provide an overview of studies that have investigated the role of NK cells in the pathogenesis of MS by use of the experimental autoimmune encephalomyelitis (EAE) animal model, MS genetics or through ex vivo and in vitro work into the immunology of MS patients. With the advent of modern hypothesis-free technologies such as single-cell transcriptomics, we are exposing an unexpected NK cell heterogeneity, increasingly blurring the boundaries between adaptive and innate immunity. We conclude that unravelling this heterogeneity, as well as the mechanistic link between innate and adaptive immune cell functions will lay the foundation for the use of NK cells as prognostic tools and therapeutic targets in MS and a myriad of other currently uncurable autoimmune disorders.
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Affiliation(s)
- Jarne Beliën
- Department of Neurosciences, Laboratory for Neuroimmunology, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - An Goris
- Department of Neurosciences, Laboratory for Neuroimmunology, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Patrick Matthys
- Department of Microbiology, Immunology and Transplantation, Laboratory of Immunobiology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
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11
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McCreary D, Omoyinmi E, Hong Y, Jensen B, Burleigh A, Price-Kuehne F, Gilmour K, Eleftheriou D, Brogan P. A rapid turnaround gene panel for severe autoinflammation: Genetic results within 48 hours. Front Immunol 2022; 13:998967. [PMID: 36203604 PMCID: PMC9531256 DOI: 10.3389/fimmu.2022.998967] [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: 07/20/2022] [Accepted: 09/05/2022] [Indexed: 11/30/2022] Open
Abstract
There is an important unmet clinical need for fast turnaround next generation sequencing (NGS) to aid genetic diagnosis of patients with acute and sometimes catastrophic inflammatory presentations. This is imperative for patients who require precise and targeted treatment to prevent irreparable organ damage or even death. Acute and severe hyper- inflammation may be caused by primary immunodeficiency (PID) with immune dysregulation, or more typical autoinflammatory diseases in the absence of obvious immunodeficiency. Infectious triggers may be present in either immunodeficiency or autoinflammation. We compiled a list of 25 genes causing monogenetic immunological diseases that are notorious for their acute first presentation with fulminant inflammation and which may be amenable to specific treatment, including hemophagocytic lymphohistiocytosis (HLH); and autoinflammatory diseases that can present with early-onset stroke or other irreversible neurological inflammatory complications. We designed and validated a pipeline that enabled return of clinically actionable results in hours rather than weeks: the Rapid Autoinflammation Panel (RAP). We demonstrated accuracy of this new pipeline, with 100% sensitivity and 100% specificity. Return of results to clinicians was achieved within 48-hours from receiving the patient's blood or saliva sample. This approach demonstrates the potential significant diagnostic impact of NGS in acute medicine to facilitate precision medicine and save "life or limb" in these critical situations.
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Affiliation(s)
- Dara McCreary
- Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Ebun Omoyinmi
- Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.,National Amyloidosis Centre, Royal Free Hospital, London, United Kingdom
| | - Ying Hong
- Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Barbara Jensen
- Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Alice Burleigh
- Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.,Centre for Adolescent Rheumatology, University College London, London, United Kingdom
| | - Fiona Price-Kuehne
- Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Kimberly Gilmour
- Camelia Botnar Laboratory, Great Ormond Street Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Despina Eleftheriou
- Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.,Centre for Adolescent Rheumatology, University College London, London, United Kingdom.,Rheumatology Department, Great Ormond Street Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Paul Brogan
- Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.,Rheumatology Department, Great Ormond Street Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
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12
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Steen EA, Hermiston ML, Nichols KE, Meyer LK. Digenic Inheritance: Evidence and Gaps in Hemophagocytic Lymphohistiocytosis. Front Immunol 2021; 12:777851. [PMID: 34868048 PMCID: PMC8635482 DOI: 10.3389/fimmu.2021.777851] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/19/2021] [Indexed: 12/26/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory disorder characterized by the inability to properly terminate an immune response. Familial HLH (FHLH) and related immune dysregulation syndromes are associated with mutations in the genes PRF1, UNC13D, STX11, STXBP2, LYST, AP3B1, and RAB27A, all of which are required for the assembly, exocytosis, and function of cytotoxic granules within CD8+ T cells and natural killer (NK) cells. Loss-of-function mutations in these genes render the cytotoxicity pathway ineffective, thereby failing to eradicate immune stimuli, such as infectious pathogens or malignant cells. The resulting persistent immune system stimulation drives hypercytokinemia, ultimately leading to severe tissue inflammation and end-organ damage. Traditionally, a diagnosis of FHLH requires the identification of biallelic loss-of-function mutations in one of these degranulation pathway genes. However, this narrow definition fails to encompass patients with other genetic mechanisms underlying degranulation pathway dysfunction. In particular, mounting clinical evidence supports a potential digenic mode of inheritance of FHLH in which single loss-of-function mutations in two different degranulation pathway genes cooperate to impair pathway activity. Here, we review the functions of the FHLH-associated genes within the degranulation pathway and summarize clinical evidence supporting a model in which cumulative defects along this mechanistic pathway may underlie HLH.
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Affiliation(s)
- Erica A Steen
- University of California, San Diego, San Diego, CA, United States
| | - Michelle L Hermiston
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
| | - Kim E Nichols
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Lauren K Meyer
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
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13
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Cunningham L, Kimber I, Basketter D, Simmonds P, McSweeney S, Tziotzios C, McFadden JP. Perforin, COVID-19 and a possible pathogenic auto-inflammatory feedback loop. Scand J Immunol 2021; 94:e13102. [PMID: 34755902 PMCID: PMC8646999 DOI: 10.1111/sji.13102] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 12/23/2022]
Abstract
During COVID‐19 infection, reduced function of natural killer (NK) cells can lead to both compromised viral clearance and dysregulation of the immune response. Such dysregulation leads to overproduction of cytokines, a raised neutrophil/lymphocyte ratio and monocytosis. This in turn increases IL‐6 expression, which promotes scar and thrombus formation. Excess IL‐6 also leads to a further reduction in NK function through downregulation of perforin expression, therefore forming a pathogenic auto‐inflammatory feedback loop. The perforin/granzyme system of cytotoxicity is the main mechanism through which NK cells and cytotoxic T lymphocytes eliminate virally infected host cells, as well as being central to their role in regulating immune responses to microbial infection. Here, we present epidemiological evidence suggesting an association between perforin expression and resistance to COVID‐19. In addition, we outline the manner in which a pathogenic auto‐inflammatory feedback loop could operate and the relationship of this loop to genes associated with severe COVID‐19. Such an auto‐inflammatory loop may be amenable to synergistic multimodal therapy.
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Affiliation(s)
- Louise Cunningham
- St. John's Institute of Dermatology, Guy's and St Thomas' Hospital, London, UK
| | - Ian Kimber
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | - Peter Simmonds
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sheila McSweeney
- St. John's Institute of Dermatology, Guy's and St Thomas' Hospital, London, UK
| | - Christos Tziotzios
- St. John's Institute of Dermatology, Guy's and St Thomas' Hospital, London, UK
| | - John P McFadden
- St. John's Institute of Dermatology, Guy's and St Thomas' Hospital, London, UK
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14
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Bąbol-Pokora K, Wołowiec M, Popko K, Jaworowska A, Bryceson YT, Tesi B, Henter JI, Młynarski W, Badowska W, Balwierz W, Drabko K, Kałwak K, Maciejka-Kembłowska L, Pieczonka A, Sobol-Milejska G, Kołtan S, Malinowska I. Molecular Genetics Diversity of Primary Hemophagocytic Lymphohistiocytosis among Polish Pediatric Patients. Arch Immunol Ther Exp (Warsz) 2021; 69:31. [PMID: 34677667 PMCID: PMC8536594 DOI: 10.1007/s00005-021-00635-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/10/2021] [Indexed: 06/12/2024]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a clinical syndrome of life-threatening inflammation caused by an excessive, prolonged and ineffective immune response. An increasing number of HLH cases is recognized in Poland, but the genetic causes of familial HLH (FHL) have not been reported. We investigated the molecular genetics and associated outcomes of pediatric patients who met HLH criteria. We studied 54 patients with HLH, 36 of whom received genetic studies. Twenty-five patients were subjected to direct sequencing of the PRF1, UNC13D, STX11, XIAP and SH2D1A genes. Additionally, 11 patients were subjected to targeted next-generation sequencing. In our study group, 17 patients (31%) were diagnosed with primary HLH, with bi-allelic FHL variants identified in 13 (36%) patients whereas hemizygous changes were identified in 4 patients with X-linked lymphoproliferative diseases. In addition, one patient was diagnosed with X-linked immunodeficiency with magnesium defect, Epstein–Barr virus infection and neoplasia due to a hemizygous MAGT1 variant; another newborn was diagnosed with auto-inflammatory syndrome caused by MVK variants. The majority (65%) of FHL patients carried UNC13D pathogenic variants, whereas PRF1 variants occurred in two patients. Novel variants in UNC13D, PRF1 and XIAP were detected. Epstein–Barr virus was the most common trigger noted in 23 (65%) of the patients with secondary HLH. In three patients with secondary HLH, heterozygous variants of FHL genes were found. Overall survival for the entire study group was 74% with a median of 3.6 years of follow-up. Our results highlight the diversity of molecular causes of primary HLH in Poland.
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Affiliation(s)
- Katarzyna Bąbol-Pokora
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | - Magdalena Wołowiec
- Department of Pediatrics, Hematology and Oncology, Medical University of Warsaw, Żwirki i Wigury 63A, 02-091, Warsaw, Poland
| | - Katarzyna Popko
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Jaworowska
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | - Yenan T Bryceson
- Department of Medicine, Centre for Hematology and Regenerative Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Bianca Tesi
- Department of Medicine, Centre for Hematology and Regenerative Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Jan-Inge Henter
- Department of Medicine, Centre for Hematology and Regenerative Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | - Wanda Badowska
- Division of Pediatric Hematology and Oncology, Children Hospital, Olsztyn, Poland
| | - Walentyna Balwierz
- Department of Pediatrics Oncology and Hematology, University Children's Hospital, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - Katarzyna Drabko
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Kałwak
- Department of Pediatric Stem Cell Transplantation, Hematology and Oncology, Medical University, Wroclaw, Poland
| | | | - Anna Pieczonka
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - Grażyna Sobol-Milejska
- Department of Pediatrics, Hematology and Oncology, Medical University of Silesia, Silesia, Poland
| | - Sylwia Kołtan
- Department of Pediatrics, Hematology and Oncology, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Iwona Malinowska
- Department of Pediatrics, Hematology and Oncology, Medical University of Warsaw, Żwirki i Wigury 63A, 02-091, Warsaw, Poland.
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15
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Petley EV, Koay HF, Henderson MA, Sek K, Todd KL, Keam SP, Lai J, House IG, Li J, Zethoven M, Chen AXY, Oliver AJ, Michie J, Freeman AJ, Giuffrida L, Chan JD, Pizzolla A, Mak JYW, McCulloch TR, Souza-Fonseca-Guimaraes F, Kearney CJ, Millen R, Ramsay RG, Huntington ND, McCluskey J, Oliaro J, Fairlie DP, Neeson PJ, Godfrey DI, Beavis PA, Darcy PK. MAIT cells regulate NK cell-mediated tumor immunity. Nat Commun 2021; 12:4746. [PMID: 34362900 PMCID: PMC8346465 DOI: 10.1038/s41467-021-25009-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 07/19/2021] [Indexed: 02/07/2023] Open
Abstract
The function of MR1-restricted mucosal-associated invariant T (MAIT) cells in tumor immunity is unclear. Here we show that MAIT cell-deficient mice have enhanced NK cell-dependent control of metastatic B16F10 tumor growth relative to control mice. Analyses of this interplay in human tumor samples reveal that high expression of a MAIT cell gene signature negatively impacts the prognostic significance of NK cells. Paradoxically, pre-pulsing tumors with MAIT cell antigens, or activating MAIT cells in vivo, enhances anti-tumor immunity in B16F10 and E0771 mouse tumor models, including in the context of established metastasis. These effects are associated with enhanced NK cell responses and increased expression of both IFN-γ-dependent and inflammatory genes in NK cells. Importantly, activated human MAIT cells also promote the function of NK cells isolated from patient tumor samples. Our results thus describe an activation-dependent, MAIT cell-mediated regulation of NK cells, and suggest a potential therapeutic avenue for cancer treatment.
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Affiliation(s)
- Emma V Petley
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Hui-Fern Koay
- Department of Microbiology & Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
- Australian Research Council Centre of Excellence in Advanced Molecular Imaging, University of Melbourne, Melbourne, VIC, Australia
| | - Melissa A Henderson
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Kevin Sek
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Kirsten L Todd
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Simon P Keam
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
- Tumour Suppression and Cancer Sex Disparity Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Junyun Lai
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Imran G House
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Jasmine Li
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Magnus Zethoven
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
- Bioinformatics Core Facility, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Amanda X Y Chen
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Amanda J Oliver
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Jessica Michie
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Andrew J Freeman
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Lauren Giuffrida
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Jack D Chan
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Angela Pizzolla
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Jeffrey Y W Mak
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
- Australian Research Council Centre of Excellence in Advanced Molecular Imaging, The University of Queensland, Brisbane, QLD, Australia
| | - Timothy R McCulloch
- University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
| | | | - Conor J Kearney
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Rosemary Millen
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Robert G Ramsay
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Nicholas D Huntington
- Department of Medical Biology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
- Division of Molecular Immunology, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Biomedicine Discovery Institute and the Department of Biochemistry and Molecular Biology, Monash University, Melbourne, VIC, Australia
| | - James McCluskey
- Department of Microbiology & Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - Jane Oliaro
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
- Department of Immunology, Monash University, Melbourne, VIC, Australia
| | - David P Fairlie
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
- Australian Research Council Centre of Excellence in Advanced Molecular Imaging, The University of Queensland, Brisbane, QLD, Australia
| | - Paul J Neeson
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Dale I Godfrey
- Department of Microbiology & Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia.
- Australian Research Council Centre of Excellence in Advanced Molecular Imaging, University of Melbourne, Melbourne, VIC, Australia.
| | - Paul A Beavis
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia.
- Department of Pathology, University of Melbourne, Melbourne, VIC, Australia.
| | - Phillip K Darcy
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia.
- Biomedicine Discovery Institute and the Department of Biochemistry and Molecular Biology, Monash University, Melbourne, VIC, Australia.
- Department of Pathology, University of Melbourne, Melbourne, VIC, Australia.
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16
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Functional and genetic testing in adults with HLH reveals an inflammatory profile rather than a cytotoxicity defect. Blood 2021; 136:542-552. [PMID: 32356861 DOI: 10.1182/blood.2019003664] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/23/2020] [Indexed: 12/23/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory condition. Primary HLH occurs early in life as a result of monogenic biallelic mutations affecting lymphocyte cytotoxicity. Secondary HLH occurs mostly in adults secondary to infection, lymphoma, or rheumatic disease. In this latter setting, lymphocyte cytotoxicity status is not known. We conducted a systematic evaluation of natural killer (NK) cell cytotoxicity in adult patients with secondary HLH. Adult patients with secondary HLH were prospectively studied ex vivo for total lymphocyte count and subtype, NK cell phenotype, perforin expression and degranulation, and natural or antibody-dependent cell cytotoxicity, in comparison with patients affected by the same underlying disease without HLH (disease controls [DCs]) and with healthy controls (HCs). Screening for variants of cytotoxity genes was systematically performed. 68 patients were included in the HLH group and 34 each in the DC and HC groups. In HLH patients, severe and transient lymphopenia, activated NK cell phenotype (eg, increased CD69, ICAM-1, HLADR, and CCR5 expression), and decreased capacity of interferon γ production were observed; mean perforin expression was normal; and degranulation tests and NK cell cytotoxicity were not different from those in DCs. A monoallelic variant of uncertain significance affecting a lymphocyte cytotoxicity gene or the perforin variant A91V was observed in almost 50% of the patients. We detected no major intrinsic cytotoxicity dysfunction in secondary HLH patients compared with DCs and no predicted pathogenic gene variant. The activated NK phenotype profile associated with decreased interferon γ production seems similar to those of other hyperinflammatory diseases such as sepsis or systemic juvenile idiopathic arthritis.
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17
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Kuitwaard K, van Doorn PA, Bengrine T, van Rijs W, Baas F, Nagelkerke SQ, Kuijpers TW, Fokkink WJR, Bunschoten C, Broers MC, Willemsen SP, Jacobs BC, Huizinga R. Genetic biomarkers for intravenous immunoglobulin response in chronic inflammatory demyelinating polyradiculoneuropathy. Eur J Neurol 2021; 28:1677-1683. [PMID: 33460483 PMCID: PMC8247870 DOI: 10.1111/ene.14742] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/07/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a clinical and electrophysiological heterogeneous immune-mediated polyneuropathy. Intravenous immunoglobulin (IVIg), corticosteroids, and plasma exchange are proven effective treatments for CIDP. The clinical response to IVIg is variable between patients and currently unexplained. Finding biomarkers related to treatment response can help to understand the diversity of CIDP and personalise treatment choice. METHODS We investigated whether genetic variation between patients may explain some of these differences in treatment response. Based on previous publications, we selected six candidate genes that might affect immune and axonal functions, IVIg metabolism, and treatment response in CIDP. Genetic variants were assessed in 172 CIDP patients treated with at least one course of IVIg (2 g/kg). A response to IVIg was defined by ≥1 grade improvement on the modified Rankin Scale. Blood samples were tested for variations in CNTN2, PRF1, FCGRT, FCGR2B, GJB1, and SH2D2A genes. RESULTS In univariate analysis, patients with the FCGR2B promoter variant 2B.4/2B.1 responded more often to IVIg than patients with the 2B.1/2B.1 variant (odds ratio [OR] = 6.9, 95% confidence interval [CI] = 1.6-30; p = 0.003). Patients with the p.(Ala91Val) variant of PRF1 were less often IVIg responsive (OR = 0.34, 95% CI = 0.13-0.91; p = 0.038). In multivariate analysis, both PRF1 and FCGR2B showed discriminative ability to predict the chance of IVIg response (area under the curve = 0.67). CONCLUSIONS Variations in PRF1 and the promoter region of FCGR2B are associated with the response to IVIg in CIDP. These findings, which require validation, are a first step towards the understanding of the heterogeneity in the treatment response in CIDP.
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Affiliation(s)
- Krista Kuitwaard
- Department of Neurology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.,Department of Neurology, Albert Schweitzer hospital, Dordrecht, the Netherlands
| | - Pieter A van Doorn
- Department of Neurology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Thiziri Bengrine
- Department of Neurology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Wouter van Rijs
- Department of Neurology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.,Department of Immunology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Frank Baas
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Sietse Q Nagelkerke
- Department of Blood Cell Research, Landsteiner Laboratory, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.,Department of Pediatric Immunology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Taco W Kuijpers
- Department of Blood Cell Research, Landsteiner Laboratory, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.,Department of Pediatric Immunology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Willem-Jan R Fokkink
- Department of Neurology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.,Department of Immunology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Carina Bunschoten
- Department of Neurology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Merel C Broers
- Department of Neurology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Sten P Willemsen
- Department of Epidemiology and Biostatistics, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Bart C Jacobs
- Department of Neurology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.,Department of Immunology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Ruth Huizinga
- Department of Immunology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
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18
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Cabrera-Marante O, de Frías ER, Pleguezuelo DE, Allende LM, Serrano A, Laguna-Goya R, Mancebo ME, Talayero P, Álvarez-Vallina L, Morales P, Castro-Panete MJ, Paz-Artal E. Perforin gene variant A91V in young patients with severe COVID-19. Haematologica 2020; 105:2844-2846. [PMID: 33256384 PMCID: PMC7716361 DOI: 10.3324/haematol.2020.260307] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Oscar Cabrera-Marante
- Servicio de Inmunología, Instituto de Investigaciones Sanitarias, Hospital 12 de Octubre, Madrid, Spain
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19
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Canna SW, Cron RQ. Highways to hell: Mechanism-based management of cytokine storm syndromes. J Allergy Clin Immunol 2020; 146:949-959. [PMID: 33007328 PMCID: PMC7522622 DOI: 10.1016/j.jaci.2020.09.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 12/12/2022]
Abstract
Since the first textbook devoted to cytokine storm syndromes (CSSs) was published in 2019, the world has changed dramatically and the term’s visibility has broadened. Herein, we define CSSs broadly to include life/organ-threatening systemic inflammation and immunopathology regardless of the context in which it occurs, recognizing that the indistinct borders of such a definition limit its utility. Nevertheless, we are focused on the pathomechanisms leading to CSSs, including impairment of granule-mediated cytotoxicity, specific viral infections, excess IL-18, and chimeric antigen receptor T-cell therapy. These mechanisms are often reflected in distinct clinical features, functional tests, and/or biomarker assessments. Moreover, these mechanisms often indicate specific, definitive treatments. This mechanism-focused organization is vital to both advancing the field and understanding the complexities in individual patients. However, increasing evidence suggests that these mechanisms interact and overlap. Likewise, the utility of a broad term such as “cytokine storm” is that it reflects a convergence on a systemic inflammatory phenotype that, regardless of cause or context, may be amenable to “inflammo-stabilization.” CSS research must improve our appreciation of its various mechanisms and their interactions and treatments, but it must also identify the signs and interventions that may broadly prevent CSS-induced immunopathology.
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Affiliation(s)
- Scott W Canna
- University of Pittsburgh/UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa.
| | - Randy Q Cron
- University of Alabama, Birmingham/Children's of Alabama, Birmingham, Ala
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20
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Unusual Prominent Pulmonary Involvement in a Homozygous PRF1 Gene Variant in a Female Patient. J Clin Immunol 2020; 41:217-220. [PMID: 32986178 PMCID: PMC7521190 DOI: 10.1007/s10875-020-00870-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/16/2020] [Indexed: 10/31/2022]
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21
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Jang HS, Flinsenberg TWH, Lacaze P, Thia KYT, Noori T, Fernando SL, Kerridge I, Riaz M, McNeil JJ, Blombery PA, Trapani JA, Voskoboinik I. Recovery of natural killer cell cytotoxicity in a p.A91V perforin homozygous patient following severe haemophagocytic lymphohistiocytosis. Br J Haematol 2020; 190:458-461. [PMID: 32342501 DOI: 10.1111/bjh.16660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/22/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Helena S Jang
- Immunorheumatology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, Australia.,Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia
| | - Thijs W H Flinsenberg
- Cancer Immunology Program, Killer Cell Biology Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Paul Lacaze
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Kevin Y T Thia
- Cancer Immunology Program, Cancer Cell Death Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Tahereh Noori
- Cancer Immunology Program, Killer Cell Biology Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Suran L Fernando
- Immunorheumatology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, Australia.,Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - Ian Kerridge
- Department of Haematology, Royal North Shore Hospital, Sydney, Australia
| | - Moeen Riaz
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Piers A Blombery
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia.,Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Joseph A Trapani
- Cancer Immunology Program, Cancer Cell Death Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - Ilia Voskoboinik
- Cancer Immunology Program, Killer Cell Biology Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
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22
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The genetics of macrophage activation syndrome. Genes Immun 2020; 21:169-181. [PMID: 32291394 DOI: 10.1038/s41435-020-0098-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/13/2020] [Accepted: 03/27/2020] [Indexed: 12/12/2022]
Abstract
Macrophage activation syndrome (MAS), or secondary hemophagocytic lymphohistiocytosis (HLH), is a cytokine storm syndrome associated with multi-organ system dysfunction and high mortality rates. Laboratory and clinical features resemble primary HLH, which arises in infancy (1 in 50,000 live births) from homozygous mutations in various genes critical to the perforin-mediated cytolytic pathway employed by NK cells and cytotoxic CD8 T lymphocytes. MAS/secondary HLH is about ten times more common and typically presents beyond infancy extending into adulthood. The genetics of MAS are far less defined than for familial HLH. However, the distinction between familial HLH and MAS/secondary HLH is blurred by the finding of heterozygous perforin-pathway mutations in MAS patients, which may function as hypomorphic or partial dominant-negative alleles and contribute to disease pathogenesis. In addition, mutations in a variety of other pathogenic pathways have been noted in patients with MAS/secondary HLH. Many of these genetically disrupted pathways result in a similar cytokine storm syndrome, and can be broadly categorized as impaired viral control (e.g., SH2P1A), dysregulated inflammasome activity (e.g., NLRC4), other immune defects (e.g., IKBKG), and dysregulated metabolism (e.g., LIPA). Collectively these genetic lesions likely combine with states of chronic inflammation, as seen in various rheumatic diseases (e.g., still disease), with or without identified infections, to result in MAS pathology as explained by the threshold model of disease. This emerging paradigm may ultimately support genetic risk stratification for high-risk chronic and even acute inflammatory disorders. Moving forward, continued whole-exome and -genome sequencing will likely identify novel MAS gene associations, as well as noncoding mutations altering levels of gene expression.
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23
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Verrinder AE, Marsden JLS, Slatter MA, McDonald L, Bacon CM, Majo J, Gennery AR. Late relapse of primary hemophagocytic lymphohistiocytosis after hematopoietic stem cell transplantation: a consequence of low-level chimerism from a carrier donor? Immunol Res 2019; 67:261-264. [PMID: 31264179 DOI: 10.1007/s12026-019-09085-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Amy E Verrinder
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Joanna L S Marsden
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Mary A Slatter
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne Hospital NHS Foundation Trust, Clinical Resource Building, Floor 4, Block 2, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Leigh McDonald
- Department of Radiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Chris M Bacon
- Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Joaquim Majo
- Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew R Gennery
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK. .,Children's Haematopoietic Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne Hospital NHS Foundation Trust, Clinical Resource Building, Floor 4, Block 2, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
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24
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Abstract
Hyperferritinemia and pronounced hemophagocytosis help distinguish a subset of patients with a particularly inflammatory and deadly systemic inflammatory response syndrome. Two clinically similar disorders typify these hyperferritinemic syndromes: hemophagocytic lymphohistiocytosis (HLH) and macrophage activation syndrome (MAS). HLH is canonically associated with a complete disturbance of perforin/granzyme-mediated cytotoxicity, whereas MAS occurs in the context of the related rheumatic diseases systemic juvenile idiopathic arthritis and adult-onset Still's disease, with associated IL-1 family cytokine activation. In practice, however, there are accumulating lines of evidence for innate immune dysregulation in HLH as well as partial impairments of cytotoxicity in MAS, and these mechanisms likely represent only a fraction of the host and environmental factors driving hyperferritinemic inflammation. Herein, we present new findings that highlight the pathogenic differences between HLH and MAS, two conditions that present with life-threatening hyperinflammation, hyperferritinemia and hemophagocytosis.
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Affiliation(s)
- Grant S Schulert
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Scott W Canna
- RK Mellon Institute for Pediatric Research, Pittsburgh, PA, USA
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25
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Löfstedt A, Ahlm C, Tesi B, Bergdahl IA, Nordenskjöld M, Bryceson YT, Henter JI, Meeths M. Haploinsufficiency of UNC13D increases the risk of lymphoma. Cancer 2019; 125:1848-1854. [PMID: 30758854 PMCID: PMC6593970 DOI: 10.1002/cncr.32011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/10/2018] [Accepted: 12/27/2018] [Indexed: 12/19/2022]
Abstract
Background Experimental models have demonstrated that immune surveillance by cytotoxic lymphocytes can protect from spontaneous neoplasms and cancer. In humans, defective lymphocyte cytotoxicity is associated with the development of hemophagocytic lymphohistiocytosis, a hyperinflammatory syndrome. However, to the best of the authors’ knowledge, the degree to which human lymphocyte cytotoxicity protects from cancer remains unclear. In the current study, the authors examined the risk of lymphoma attributable to haploinsufficiency in a gene required for lymphocyte cytotoxicity. Methods The authors exploited a founder effect of an UNC13D inversion, which abolishes Munc13‐4 expression and causes hemophagocytic lymphohistiocytosis in an autosomal recessive manner. Within 2 epidemiological screening programs in northern Sweden, an area demonstrating a founder effect of this specific UNC13D mutation, all individuals with a diagnosis of lymphoma (487 patients) and matched controls (1844 controls) were assessed using polymerase chain reaction for carrier status. Results Among 487 individuals with lymphoma, 15 (3.1%) were heterozygous carriers of the UNC13D inversion, compared with 18 controls (1.0%) (odds ratio, 3.0; P = .002). It is interesting to note that a higher risk of lymphoma was attributed to female carriers (odds ratio, 3.7; P = .004). Conclusions Establishing a high regional prevalence of the UNC13D inversion, the authors have reported an overrepresentation of this mutation in individuals with lymphoma. Therefore, the results of the current study indicate that haploinsufficiency of a gene required for lymphocyte cytotoxicity can predispose patients to lymphoma, suggesting the importance of cytotoxic lymphocyte‐mediated surveillance of cancer. Furthermore, the results of the current study suggest that female carriers are more susceptible to lymphoma. In the current study, the authors examine the risk of lymphoma attributable to an inversion disrupting UNC13D, a gene associated with familial hemophagocytic lymphohistiocytosis. The results demonstrate that haploinsufficiency of this gene, which is required for normal lymphocyte cytotoxicity, may predispose patients to lymphoma, signifying the importance of cytotoxic lymphocyte‐mediated surveillance of cancer development.
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Affiliation(s)
- Alexandra Löfstedt
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden.,Clinical Genetics Unit, Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Clas Ahlm
- Infectious Diseases, Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - Bianca Tesi
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden.,Clinical Genetics Unit, Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | | | - Magnus Nordenskjöld
- Clinical Genetics Unit, Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Yenan T Bryceson
- Center for Hematology and Regenerative Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Jan-Inge Henter
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden.,Theme of Children's and Women's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Meeths
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden.,Clinical Genetics Unit, Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Theme of Children's and Women's Health, Karolinska University Hospital, Stockholm, Sweden
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26
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Michie J, Beavis PA, Freeman AJ, Vervoort SJ, Ramsbottom KM, Narasimhan V, Lelliott EJ, Lalaoui N, Ramsay RG, Johnstone RW, Silke J, Darcy PK, Voskoboinik I, Kearney CJ, Oliaro J. Antagonism of IAPs Enhances CAR T-cell Efficacy. Cancer Immunol Res 2019; 7:183-192. [DOI: 10.1158/2326-6066.cir-18-0428] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/06/2018] [Accepted: 01/10/2019] [Indexed: 11/16/2022]
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27
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Mitrovič M, Patsopoulos NA, Beecham AH, Dankowski T, Goris A, Dubois B, D’hooghe MB, Lemmens R, Van Damme P, Søndergaard HB, Sellebjerg F, Sorensen PS, Ullum H, Thørner LW, Werge T, Saarela J, Cournu-Rebeix I, Damotte V, Fontaine B, Guillot-Noel L, Lathrop M, Vukusik S, Gourraud PA, Andlauer TF, Pongratz V, Buck D, Gasperi C, Bayas A, Heesen C, Kümpfel T, Linker R, Paul F, Stangel M, Tackenberg B, Bergh FT, Warnke C, Wiendl H, Wildemann B, Zettl U, Ziemann U, Tumani H, Gold R, Grummel V, Hemmer B, Knier B, Lill CM, Luessi F, Dardiotis E, Agliardi C, Barizzone N, Mascia E, Bernardinelli L, Comi G, Cusi D, Esposito F, Ferrè L, Comi C, Galimberti D, Leone MA, Sorosina M, Mescheriakova J, Hintzen R, van Duijn C, Teunissen CE, Bos SD, Myhr KM, Celius EG, Lie BA, Spurkland A, Comabella M, Montalban X, Alfredsson L, Stridh P, Hillert J, Jagodic M, Piehl F, Jelčić I, Martin R, Sospedra M, Ban M, Hawkins C, Hysi P, Kalra S, Karpe F, Khadake J, Lachance G, Neville M, Santaniello A, Caillier SJ, Calabresi PA, Cree BA, Cross A, Davis MF, Haines JL, de Bakker PI, Delgado S, Dembele M, Edwards K, Fitzgerald KC, Hakonarson H, Konidari I, Lathi E, Manrique CP, Pericak-Vance MA, Piccio L, Schaefer C, McCabe C, Weiner H, Goldstein J, Olsson T, Hadjigeorgiou G, Taylor B, Tajouri L, Charlesworth J, Booth DR, Harbo HF, Ivinson AJ, Hauser SL, Compston A, Stewart G, Zipp F, Barcellos LF, Baranzini SE, Martinelli-Boneschi F, D’Alfonso S, Ziegler A, Oturai A, McCauley JL, Sawcer SJ, Oksenberg JR, De Jager PL, Kockum I, Hafler DA, Cotsapas C. Low-Frequency and Rare-Coding Variation Contributes to Multiple Sclerosis Risk. Cell 2018; 175:1679-1687.e7. [PMID: 30343897 PMCID: PMC6269166 DOI: 10.1016/j.cell.2018.09.049] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 08/08/2018] [Accepted: 09/24/2018] [Indexed: 12/21/2022]
Abstract
Multiple sclerosis is a complex neurological disease, with ∼20% of risk heritability attributable to common genetic variants, including >230 identified by genome-wide association studies. Multiple strands of evidence suggest that much of the remaining heritability is also due to additive effects of common variants rather than epistasis between these variants or mutations exclusive to individual families. Here, we show in 68,379 cases and controls that up to 5% of this heritability is explained by low-frequency variation in gene coding sequence. We identify four novel genes driving MS risk independently of common-variant signals, highlighting key pathogenic roles for regulatory T cell homeostasis and regulation, IFNγ biology, and NFκB signaling. As low-frequency variants do not show substantial linkage disequilibrium with other variants, and as coding variants are more interpretable and experimentally tractable than non-coding variation, our discoveries constitute a rich resource for dissecting the pathobiology of MS.
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28
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Kearney CJ, Vervoort SJ, Hogg SJ, Ramsbottom KM, Freeman AJ, Lalaoui N, Pijpers L, Michie J, Brown KK, Knight DA, Sutton V, Beavis PA, Voskoboinik I, Darcy PK, Silke J, Trapani JA, Johnstone RW, Oliaro J. Tumor immune evasion arises through loss of TNF sensitivity. Sci Immunol 2018; 3:3/23/eaar3451. [DOI: 10.1126/sciimmunol.aar3451] [Citation(s) in RCA: 165] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 03/29/2018] [Indexed: 12/11/2022]
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29
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Jaworowska A, Pastorczak A, Trelinska J, Wypyszczak K, Borowiec M, Fendler W, Sedek L, Szczepanski T, Ploski R, Młynarski W. Perforin gene variation influences survival in childhood acute lymphoblastic leukemia. Leuk Res 2018; 65:29-33. [PMID: 29304394 DOI: 10.1016/j.leukres.2017.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 11/05/2017] [Accepted: 12/31/2017] [Indexed: 10/18/2022]
Abstract
Although a growing body of data links mutations in the perforin gene with increased susceptibility to hematologic malignancies, no studies discuss their influence on the clinical course of such diseases. The present study examines the impact of perforin gene variation on the clinical outcome in acute lymphoblastic leukemia (ALL) patients. The study enrolled 312 children aged 1-18 years, treated for ALL. PRF1 gene variants were analyzed through direct DNA sequencing. Variation in rs885822 was found to be associated with overall survival: patients carrying the GG genotype demonstrated a significantly increased risk of death compared to those carrying the A allele, independently of ALL risk groups (HR 3.13, 95%CI 1.16-7.8, p = 0.014). The effect was even more pronounced in high-risk ALL patients (p = 0.006). On the other hand, the presence of the rs35947132 minor A allele was slightly protective with regard to overall prognosis (p = 0.047). No differences in relapse-free survival were observed with regard to genotypes. The results of the study may imply that perforin gene variation has a role in modifying mortality in childhood ALL.
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Affiliation(s)
- Aleksandra Jaworowska
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland
| | - Agata Pastorczak
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland
| | - Joanna Trelinska
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland
| | - Kamila Wypyszczak
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland
| | - Maciej Borowiec
- Department of Clinical Genetics, Medical University of Lodz, Lodz, Poland
| | - Wojciech Fendler
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland; Department of Biostatistics & Translational Medicine, Medical University of Lodz, Poland
| | - Lukasz Sedek
- Department of Pediatric Hematology and Oncology, Zabrze, Medical University of Silesia, Katowice, Poland
| | - Tomasz Szczepanski
- Department of Pediatric Hematology and Oncology, Zabrze, Medical University of Silesia, Katowice, Poland
| | - Rafal Ploski
- Department of Clinical Genetics, Medical University of Warsaw, Poland
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland.
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30
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Kearney CJ, Vervoort SJ, Ramsbottom KM, Freeman AJ, Michie J, Peake J, Casanova JL, Picard C, Tangye SG, Ma CS, Johnstone RW, Randall KL, Oliaro J. DOCK8 Drives Src-Dependent NK Cell Effector Function. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2017; 199:ji1700751. [PMID: 28794229 DOI: 10.4049/jimmunol.1700751] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/12/2017] [Indexed: 01/05/2023]
Abstract
Mutations in the dedicator of cytokinesis 8 (DOCK8) gene cause an autosomal recessive form of hyper-IgE syndrome, characterized by chronic immunodeficiency with persistent microbial infection and increased incidence of malignancy. These manifestations suggest a defect in cytotoxic lymphocyte function and immune surveillance. However, how DOCK8 regulates NK cell-driven immune responses remains unclear. In this article, we demonstrate that DOCK8 regulates NK cell cytotoxicity and cytokine production in response to target cell engagement or receptor ligation. Genetic ablation of DOCK8 in human NK cells attenuated cytokine transcription and secretion through inhibition of Src family kinase activation, particularly Lck, downstream of target cell engagement or NKp30 ligation. PMA/Ionomycin treatment of DOCK8-deficient NK cells rescued cytokine production, indicating a defect proximal to receptor ligation. Importantly, NK cells from DOCK8-deficient patients had attenuated production of IFN-γ and TNF-α upon NKp30 stimulation. Taken together, we reveal a novel molecular mechanism by which DOCK8 regulates NK cell-driven immunity.
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Affiliation(s)
- Conor J Kearney
- Immune Defence Laboratory, Cancer Immunology Division, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria 3052, Australia
| | - Stephin J Vervoort
- Gene Regulation Laboratory, Cancer Therapeutics Division, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Kelly M Ramsbottom
- Immune Defence Laboratory, Cancer Immunology Division, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Andrew J Freeman
- Immune Defence Laboratory, Cancer Immunology Division, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Jessica Michie
- Immune Defence Laboratory, Cancer Immunology Division, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Jane Peake
- University of Queensland and Lady Cilento Children's Hospital, Brisbane, Queensland 4006, Australia
| | - Jean-Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Imagine Institute, Necker Medical School, University Paris Descartes, 75015 Paris, France
- Pediatric Hematology and Immunology Unit, Necker Hospital for Sick Children, AP-HP, Paris, France
- St. Giles Laboratory of Human Genetics and Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY 10065
- Howard Hughes Medical Institute, New York, NY 10065
| | - Capucine Picard
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Imagine Institute, Necker Medical School, University Paris Descartes, 75015 Paris, France
- St. Giles Laboratory of Human Genetics and Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY 10065
- Study Center for Primary Immunodeficiencies, Necker Hospital for Sick Children, AP-HP, 75015 Paris, France
| | - Stuart G Tangye
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales 2010, Australia
- St. Vincent's Clinical School, University of New South Wales, New South Wales 2052, Australia
| | - Cindy S Ma
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales 2010, Australia
- St. Vincent's Clinical School, University of New South Wales, New South Wales 2052, Australia
| | - Ricky W Johnstone
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria 3052, Australia
- Gene Regulation Laboratory, Cancer Therapeutics Division, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Katrina L Randall
- Department of Immunology and Infectious Disease, The John Curtin School of Medical Research, Australian National University, Acton, Australian Capital Territory 2601, Australia; and
- Australian National University Medical School, Australian National University, Acton, Australian Capital Territory 2601, Australia
| | - Jane Oliaro
- Immune Defence Laboratory, Cancer Immunology Division, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia;
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria 3052, Australia
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31
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Gray PE, Shadur B, Russell S, Mitchell R, Buckley M, Gallagher K, Andrews I, Thia K, Trapani JA, Kirk EP, Voskoboinik I. Late-Onset Non-HLH Presentations of Growth Arrest, Inflammatory Arachnoiditis, and Severe Infectious Mononucleosis, in Siblings with Hypomorphic Defects in UNC13D. Front Immunol 2017; 8:944. [PMID: 28848550 PMCID: PMC5552658 DOI: 10.3389/fimmu.2017.00944] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 07/24/2017] [Indexed: 12/13/2022] Open
Abstract
Bi-allelic null mutations affecting UNC13D, STXBP2, or STX11 result in defects of lymphocyte cytotoxic degranulation and commonly cause familial hemophagocytic lymphohistiocytosis (FHL) in early life. Patients with partial loss of function are increasingly being diagnosed after presenting with alternative features of this disease, or with HLH later in life. Here, we studied two sisters with lymphocyte degranulation defects secondary to compound heterozygote missense variants in UNC13D. The older sibling presented aged 11 with linear growth arrest and delayed puberty, 2 years prior to developing transient ischemic attacks secondary to neuroinflammation and hypogammaglobulinemia, but no FHL symptoms. Her geno-identical younger sister was initially asymptomatic but then presented at the same age with severe EBV-driven infectious mononucleosis, which was treated aggressively and did not progress to HLH. The sisters had similar natural killer cell degranulation; however, while cytotoxic activity was moderately reduced in the asymptomatic patient, it was completely absent in both siblings during active disease. Following allogeneic bone marrow transplantation at the age of 15, the older child has completely recovered NK cell cytotoxicity, is asymptomatic, and has experienced an exceptional compensatory growth spurt. Her younger sister was also successfully transplanted and is currently disease free. The current study reveals previously unappreciated manifestations of FHL in patients who inherited hypomorphic gene variants and also raises the important question of whether a threshold of minimum NK function can be defined that should protect a patient from serious disease manifestations such as HLH.
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Affiliation(s)
- Paul Edgar Gray
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Bella Shadur
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Susan Russell
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Richard Mitchell
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Michael Buckley
- Genetics Laboratory, South Eastern Area Laboratory Services, Randwick, NSW, Australia
| | - Kerri Gallagher
- Department of Immunology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ian Andrews
- Department of Neurology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Kevin Thia
- Cancer Cell Death Laboratory, Cancer Immunology Research, Peter MacCallum Cancer Centre, Melbourne VIC, Australia
| | - Joseph A Trapani
- Cancer Cell Death Laboratory, Cancer Immunology Research, Peter MacCallum Cancer Centre, Melbourne VIC, Australia
| | - Edwin Philip Kirk
- Centre for Clinical Genetics, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Ilia Voskoboinik
- Killer Cell Biology Laboratory, Cancer Immunology Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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32
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Omoyinmi E, Standing A, Keylock A, Price-Kuehne F, Melo Gomes S, Rowczenio D, Nanthapisal S, Cullup T, Nyanhete R, Ashton E, Murphy C, Clarke M, Ahlfors H, Jenkins L, Gilmour K, Eleftheriou D, Lachmann HJ, Hawkins PN, Klein N, Brogan PA. Clinical impact of a targeted next-generation sequencing gene panel for autoinflammation and vasculitis. PLoS One 2017; 12:e0181874. [PMID: 28750028 PMCID: PMC5531484 DOI: 10.1371/journal.pone.0181874] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/07/2017] [Indexed: 12/27/2022] Open
Abstract
Background Monogenic autoinflammatory diseases (AID) are a rapidly expanding group of genetically diverse but phenotypically overlapping systemic inflammatory disorders associated with dysregulated innate immunity. They cause significant morbidity, mortality and economic burden. Here, we aimed to develop and evaluate the clinical impact of a NGS targeted gene panel, the “Vasculitis and Inflammation Panel” (VIP) for AID and vasculitis. Methods The Agilent SureDesign tool was used to design 2 versions of VIP; VIP1 targeting 113 genes, and a later version, VIP2, targeting 166 genes. Captured and indexed libraries (QXT Target Enrichment System) prepared for 72 patients were sequenced as a multiplex of 16 samples on an Illumina MiSeq sequencer in 150bp paired-end mode. The cohort comprised 22 positive control DNA samples from patients with previously validated mutations in a variety of the genes; and 50 prospective samples from patients with suspected AID in whom previous Sanger based genetic screening had been non-diagnostic. Results VIP was sensitive and specific at detecting all the different types of known mutations in 22 positive controls, including gene deletion, small INDELS, and somatic mosaicism with allele fraction as low as 3%. Six/50 patients (12%) with unclassified AID had at least one class 5 (clearly pathogenic) variant; and 11/50 (22%) had at least one likely pathogenic variant (class 4). Overall, testing with VIP resulted in a firm or strongly suspected molecular diagnosis in 16/50 patients (32%). Conclusions The high diagnostic yield and accuracy of this comprehensive targeted gene panel validate the use of broad NGS-based testing for patients with suspected AID.
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Affiliation(s)
- Ebun Omoyinmi
- UCL Great Ormond Street Institute of Child Health (ICH), London, United Kingdom
- * E-mail:
| | - Ariane Standing
- UCL Great Ormond Street Institute of Child Health (ICH), London, United Kingdom
| | - Annette Keylock
- UCL Great Ormond Street Institute of Child Health (ICH), London, United Kingdom
| | - Fiona Price-Kuehne
- UCL Great Ormond Street Institute of Child Health (ICH), London, United Kingdom
| | - Sonia Melo Gomes
- UCL Great Ormond Street Institute of Child Health (ICH), London, United Kingdom
| | - Dorota Rowczenio
- National Amyloidosis Centre (NAC), UCL, Royal Free Campus, London, United Kingdom
| | - Sira Nanthapisal
- UCL Great Ormond Street Institute of Child Health (ICH), London, United Kingdom
| | - Thomas Cullup
- NE Thames Regional Genetics laboratory, GOSH NHS Foundation Trust, London, United Kingdom
| | - Rodney Nyanhete
- NE Thames Regional Genetics laboratory, GOSH NHS Foundation Trust, London, United Kingdom
| | - Emma Ashton
- NE Thames Regional Genetics laboratory, GOSH NHS Foundation Trust, London, United Kingdom
| | - Claire Murphy
- UCL Great Ormond Street Institute of Child Health (ICH), London, United Kingdom
| | - Megan Clarke
- UCL Great Ormond Street Institute of Child Health (ICH), London, United Kingdom
| | - Helena Ahlfors
- NE Thames Regional Genetics laboratory, GOSH NHS Foundation Trust, London, United Kingdom
| | - Lucy Jenkins
- NE Thames Regional Genetics laboratory, GOSH NHS Foundation Trust, London, United Kingdom
| | - Kimberly Gilmour
- Immunology, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Despina Eleftheriou
- UCL Great Ormond Street Institute of Child Health (ICH), London, United Kingdom
- Arthritis Research UK Centre for Adolescent Rheumatology, UCL, UCLH and GOSH, London, United Kingdom
| | - Helen J. Lachmann
- National Amyloidosis Centre (NAC), UCL, Royal Free Campus, London, United Kingdom
| | - Philip N. Hawkins
- National Amyloidosis Centre (NAC), UCL, Royal Free Campus, London, United Kingdom
| | - Nigel Klein
- UCL Great Ormond Street Institute of Child Health (ICH), London, United Kingdom
| | - Paul A. Brogan
- UCL Great Ormond Street Institute of Child Health (ICH), London, United Kingdom
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33
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Souza BMB, De Vito FB, Calado ML, Silva MV, Oliveira LR, Rodrigues-Júnior V, Moraes-Souza H. Evaluation of the cytotoxic response mediated by perforin and granzyme B in patients with non-Hodgkin lymphoma. Leuk Lymphoma 2017; 59:214-220. [PMID: 28679297 DOI: 10.1080/10428194.2017.1341978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
This study quantified the perforin and granzyme B in patients with non-Hodgkin lymphoma (NHL) at the time of diagnosis. Protein quantification was performed by flow cytometry. NHL patients had a higher number of cytotoxic T lymphocytes (CTLs) expressing perforin as well as a greater number of activated CTLs than the control group. However, intracellular perforin levels in natural killer cells were lower in the NHL patients compared to the control group. Quantitative real time PCR showed that patients had more expression of perforin and granzyme B transcripts compared to the control group. In addition, patients who had expression of both genes below the median found for the NHL group had lower survival rates. Considering this, we believe that perforin and granzyme B are potential prognostic markers in NHL and thus it is fundamental to pay attention to their expressions in these patients.
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Affiliation(s)
- Bruna Maria Bereta Souza
- a Disciplina de Hematologia e Hemoterapia , Universidade Federal do Triangulo Mineiro , Uberaba , Brazil
| | | | - Marianna Licati Calado
- a Disciplina de Hematologia e Hemoterapia , Universidade Federal do Triangulo Mineiro , Uberaba , Brazil
| | - Marcos Vinícius Silva
- b Disciplina de Imunologia , Universidade Federal do Triangulo Mineiro , Uberaba , Brazil
| | | | | | - Helio Moraes-Souza
- a Disciplina de Hematologia e Hemoterapia , Universidade Federal do Triangulo Mineiro , Uberaba , Brazil
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34
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Willenbring RC, Jin F, Hinton DJ, Hansen M, Choi DS, Pavelko KD, Johnson AJ. Modulatory effects of perforin gene dosage on pathogen-associated blood-brain barrier (BBB) disruption. J Neuroinflammation 2016; 13:222. [PMID: 27576583 PMCID: PMC5006384 DOI: 10.1186/s12974-016-0673-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 08/17/2016] [Indexed: 11/12/2022] Open
Abstract
Background CD8 T cell-mediated blood-brain barrier (BBB) disruption is dependent on the effector molecule perforin. Human perforin has extensive single nucleotide variants (SNVs), the significance of which is not fully understood. These SNVs can result in reduced, but not ablated, perforin activity or expression. However, complete loss of perforin expression or activity results in the lethal disease familial hemophagocytic lymphohistiocytosis type 2 (FHL 2). In this study, we address the hypothesis that a single perforin allele can alter the severity of BBB disruption in vivo using a well-established model of CNS vascular permeability in C57Bl/6 mice. The results of this study provide insight into the significance of perforin SNVs in the human population. Methods We isolated the effect a single perforin allele has on CNS vascular permeability through the use of perforin-heterozygous (perforin+/−) C57BL/6 mice in the peptide-induced fatal syndrome (PIFS) model of immune-mediated BBB disruption. Seven days following Theiler’s murine encephalomyelitis virus (TMEV) CNS infection, neuroinflammation and TMEV viral control were assessed through flow cytometric analysis and quantitative real-time PCR of the viral genome, respectively. Following immune-mediated BBB disruption, gadolinium-enhanced T1-weighted MRI, with 3D volumetric analysis, and confocal microscopy were used to define CNS vascular permeability. Finally, the open field behavior test was used to assess locomotor activity of mice following immune-mediated BBB disruption. Results Perforin-null mice had negligible CNS vascular permeability. Perforin-WT mice have extensive CNS vascular permeability. Interestingly, perforin-heterozygous mice had an intermediate level of CNS vascular permeability as measured by both gadolinium-enhanced T1-weighted MRI and fibrinogen leakage in the brain parenchyma. Differences in BBB disruption were not a result of increased CNS immune infiltrate. Additionally, TMEV was controlled in a perforin dose-dependent manner. Furthermore, a single perforin allele is sufficient to induce locomotor deficit during immune-mediated BBB disruption. Conclusions Perforin modulates BBB disruption in a dose-dependent manner. This study demonstrates a potentially advantageous role for decreased perforin expression in reducing BBB disruption. This study also provides insight into the effect SNVs in a single perforin allele could have on functional deficit in neurological disease.
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Affiliation(s)
- Robin C Willenbring
- Mayo Graduate School, Mayo Clinic, Rochester, MN, USA.,Department of Immunology, Mayo Clinic, Rochester, MN, USA
| | - Fang Jin
- Department of Immunology, Mayo Clinic, Rochester, MN, USA
| | - David J Hinton
- Mayo Graduate School, Mayo Clinic, Rochester, MN, USA.,Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Mike Hansen
- Department of Immunology, Mayo Clinic, Rochester, MN, USA
| | - Doo-Sup Choi
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Aaron J Johnson
- Department of Immunology, Mayo Clinic, Rochester, MN, USA. .,Department of Neurology, Mayo Clinic, Rochester, MN, USA.
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Chaudhry MS, Gilmour KC, House IG, Layton M, Panoskaltsis N, Sohal M, Trapani JA, Voskoboinik I. Missense mutations in the perforin (PRF1) gene as a cause of hereditary cancer predisposition. Oncoimmunology 2016; 5:e1179415. [PMID: 27622035 PMCID: PMC5006901 DOI: 10.1080/2162402x.2016.1179415] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/10/2016] [Accepted: 04/11/2016] [Indexed: 01/08/2023] Open
Abstract
Perforin, a pore-forming toxin released from secretory granules of NK cells and CTLs, is essential for their cytotoxic activity against infected or cancerous target cells. Bi-allelic loss-of-function mutations in the perforin gene are invariably associated with a fatal immunoregulatory disorder, familial haemophagocytic lymphohistiocytosis type 2 (FHL2), in infants. More recently, it has also been recognized that partial loss of perforin function can cause disease in later life, including delayed onset FHL2 and haematological malignancies. Herein, we report a family in which a wide range of systemic inflammatory and neoplastic manifestations have occurred across three generations. We found that disease was linked to two missense perforin gene mutations (encoding A91V, R410W) that cause protein misfolding and partial loss of activity. These cases link the partial loss of perforin function with some solid tumors that are known to be controlled by the immune system, as well as haematological cancers. Our findings also demonstrate that perforin gene mutations can contribute to hereditary cancer predisposition.
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Affiliation(s)
| | | | - Imran G. House
- Cancer Immunology Program, Peter MacCallum Cancer Center, East Melbourne, Victoria, Australia
| | - Mark Layton
- Department of Haematology, Imperial College London, London, UK
| | | | - Mamta Sohal
- Department of Haematology, Ealing Hospital, London, UK
| | - Joseph A. Trapani
- Cancer Immunology Program, Peter MacCallum Cancer Center, East Melbourne, Victoria, Australia
| | - Ilia Voskoboinik
- Cancer Immunology Program, Peter MacCallum Cancer Center, East Melbourne, Victoria, Australia
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Schulert GS, Zhang M, Fall N, Husami A, Kissell D, Hanosh A, Zhang K, Davis K, Jentzen JM, Napolitano L, Siddiqui J, Smith LB, Harms PW, Grom AA, Cron RQ. Whole-Exome Sequencing Reveals Mutations in Genes Linked to Hemophagocytic Lymphohistiocytosis and Macrophage Activation Syndrome in Fatal Cases of H1N1 Influenza. J Infect Dis 2016; 213:1180-8. [PMID: 26597256 PMCID: PMC4779301 DOI: 10.1093/infdis/jiv550] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/12/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Severe H1N1 influenza can be lethal in otherwise healthy individuals and can have features of reactive hemophagocytic lymphohistiocytosis (HLH). HLH is associated with mutations in lymphocyte cytolytic pathway genes, which have not been previously explored in H1N1 influenza. METHODS Sixteen cases of fatal influenza A(H1N1) infection, 81% with histopathologic hemophagocytosis, were identified and analyzed for clinical and laboratory features of HLH, using modified HLH-2004 and macrophage activation syndrome (MAS) criteria. Fourteen specimens were subject to whole-exome sequencing. Sequence alignment and variant filtering detected HLH gene mutations and potential disease-causing variants. Cytolytic function of the PRF1 p.A91V mutation was tested in lentiviral-transduced NK-92 natural killer (NK) cells. RESULTS Despite several lacking variables, cases of influenza A(H1N1) infection met 44% and 81% of modified HLH-2004 and MAS criteria, respectively. Five subjects (36%) carried one of 3 heterozygous LYST mutations, 2 of whom also possessed the p.A91V PRF1 mutation, which was shown to decrease NK cell cytolytic function. Several patients also carried rare variants in other genes previously observed in MAS. CONCLUSIONS This cohort of fatal influenza A(H1N1) infections confirms the presence of hemophagocytosis and HLH pathology. Moreover, the high percentage of HLH gene mutations suggests they are risk factors for mortality among individuals with influenza A(H1N1) infection.
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Affiliation(s)
- Grant S Schulert
- Division of Pediatric Rheumatology, Cincinnati Children's Hospital Medical Center, Ohio
| | - Mingce Zhang
- Division of Pediatric Rheumatology, Children's Hospital of Alabama/University of Alabama at Birmingham
| | - Ndate Fall
- Division of Pediatric Rheumatology, Cincinnati Children's Hospital Medical Center, Ohio
| | - Ammar Husami
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Ohio
| | - Diane Kissell
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Ohio
| | - Andrew Hanosh
- Department of Pathology, University of Michigan Medical School, Ann Arbor
| | - Kejian Zhang
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Ohio
| | - Kristina Davis
- Department of Pathology, University of Michigan Medical School, Ann Arbor
| | - Jeffrey M Jentzen
- Department of Pathology, University of Michigan Medical School, Ann Arbor
| | - Lena Napolitano
- Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - Javed Siddiqui
- Department of Pathology, University of Michigan Medical School, Ann Arbor Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor
| | - Lauren B Smith
- Department of Pathology, University of Michigan Medical School, Ann Arbor
| | - Paul W Harms
- Department of Pathology, University of Michigan Medical School, Ann Arbor Department of Dermatology, University of Michigan Medical School, Ann Arbor Michigan Center for Translational Pathology, University of Michigan Medical School, Ann Arbor
| | - Alexei A Grom
- Division of Pediatric Rheumatology, Cincinnati Children's Hospital Medical Center, Ohio
| | - Randy Q Cron
- Division of Pediatric Rheumatology, Children's Hospital of Alabama/University of Alabama at Birmingham
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Voss M, Bryceson YT. Natural killer cell biology illuminated by primary immunodeficiency syndromes in humans. Clin Immunol 2015; 177:29-42. [PMID: 26592356 DOI: 10.1016/j.clim.2015.11.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/22/2015] [Accepted: 11/14/2015] [Indexed: 12/21/2022]
Abstract
Natural killer (NK) cells are innate immune cytotoxic effector cells well known for their role in antiviral immunity and tumor immunosurveillance. In parts, this knowledge stems from rare inherited immunodeficiency disorders in humans that abrogate NK cell function leading to immune impairments, most notably associated with a high susceptibility to viral infections. Phenotypically, these disorders range from deficiencies selectively affecting NK cells to complex general immune defects that affect NK cells but also other immune cell subsets. Moreover, deficiencies may be associated with reduced NK cell numbers or rather impair specific NK cell effector functions. In recent years, genetic defects underlying the various NK cell deficiencies have been uncovered and have triggered investigative efforts to decipher the molecular mechanisms underlying these disorders. Here we review the associations between inherited human diseases and NK cell development as well as function, with a particular focus on defects in NK cell exocytosis and cytotoxicity. Furthermore we outline how reports of diverse genetic defects have shaped our understanding of NK cell biology.
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Affiliation(s)
- Matthias Voss
- Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Yenan T Bryceson
- Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Broegelmann Research Laboratory, Institute of Clinical Sciences, University of Bergen, Bergen, Norway.
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Nikiforow S. The Role of Hematopoietic Stem Cell Transplantation in Treatment of Hemophagocytic Lymphohistiocytosis. Hematol Oncol Clin North Am 2015; 29:943-59. [DOI: 10.1016/j.hoc.2015.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nikiforow S, Berliner N. The unique aspects of presentation and diagnosis of hemophagocytic lymphohistiocytosis in adults. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2015; 2015:183-189. [PMID: 26637719 DOI: 10.1182/asheducation-2015.1.183] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) was initially described as an inflammatory condition affecting young children but is increasingly diagnosed in adults. Presenting features such as fever, cytopenias, phagocytosis, elevated ferritin, and increased levels of soluble IL-2 receptor are common in both age groups, but the prevalence of several clinical and biochemical criteria differ between pediatric and adult patients. Specifically, an elevated ferritin level does not have the same specificity for HLH in adults, and many other inflammatory conditions need to be considered in the differential. In contrast to the high incidence of infectious triggers seen in pediatric HLH, HLH in adults is often precipitated by a hematologic malignancy. Malignancy-associated HLH has unique manifestations and a uniformly very poor prognosis. Given these differences, diagnostic scoring systems unique to adult HLH have been proposed, and additional prognostic clinical and immunologic parameters are being explored. Although a genetic predisposition is increasingly found to underlie cases of adult-onset HLH, the mutations are less likely to be bi-allelic and differ slightly from those seen in pediatric cases of familial HLH. The facilitating genetic and environmental factors governing presentation of HLH in adults remain elusive. Understanding the clinical aspects and pathophysiology specific to adults with HLH is necessary to tailor therapies derived in pediatric disease to this under-recognized population.
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