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Acquired Thrombotic Thrombocytopenic Purpura in a 5-Year-old Child With Wiskott-Aldrich Syndrome. J Pediatr Hematol Oncol 2022; 44:e434-e437. [PMID: 33769392 DOI: 10.1097/mph.0000000000002150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 02/09/2021] [Indexed: 11/26/2022]
Abstract
Thrombocytopenia is often seen as a laboratory finding during childhood. A supposed idiopathic thrombocytopenic purpura patient who was later diagnosed as Wiskott-Aldrich syndrome (WAS) and developed acquired thrombotic thrombocytopenic purpura (aTTP). Although autoimmune manifestations in WAS described, aTTP was reported just once. Five-year-old-boy was initially brought with cough, bloody stool (diarrhea), oral mucosal bleeding at 12th months of age. Following diagnosed with idiopathic thrombocytopenic purpura and receiving intravenous immunoglobulin, platelet count raised from 20,000 to 50,000/µL. One year after WAS diagnosis by mutation analysis, he presented with complaints of resistant fever, epistaxis, and melena. Hemoglobin decreased from 10 to 5.9 g/dL. Schistocytes in peripheral blood smear and high anti-ADAMTS-13 antibody level indicated development of aTTP.
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Exploring genetic defects in adults who were clinically diagnosed as severe combined immune deficiency during infancy. Immunol Res 2021; 69:145-152. [PMID: 33599911 DOI: 10.1007/s12026-021-09179-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/03/2021] [Indexed: 12/16/2022]
Abstract
Genetic diagnostic tools including whole-exome sequencing (WES) have advanced our understanding in human diseases and become common practice in diagnosing patients with suspected primary immune deficiencies. Establishing a genetic diagnosis is of paramount importance for tailoring adequate therapeutic regimens, including identifying the need for hematopoietic stem cell transplantation (HSCT) and genetic-based therapies. Here, we genetically studied two adult patients who were clinically diagnosed during infancy with severe combined immune deficiency (SCID). Two unrelated patients, both of consanguineous kindred, underwent WES in adulthood, 2 decades after their initial clinical manifestations. Upon clinical presentation, immunological workup was performed, which led to a diagnosis of SCID. The patients presented during infancy with failure to thrive, generalized erythematous rash, and recurrent gastrointestinal and respiratory tract infections, including episodes of Pneumocystis pneumonia infection and Candida albicans fungemia. Hypogammaglobulinemia and T-cell lymphopenia were detected. Both patients were treated with a 10/10 HLA matched sibling donor unconditioned HSCT. Retrospective genetic workup revealed homozygous bi-allelic mutations in IL7RA in one patient and in RAG2 in the other. Our study exemplifies the impact of retrospectively establishing a genetic diagnosis. Pinpointing the genetic cause raises several issues including optimized surveillance and treatment, understanding disease mechanisms and outcomes, future family planning, and social and psychological considerations.
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Muñoz P, Tristán-Manzano M, Sánchez-Gilabert A, Santilli G, Galy A, Thrasher AJ, Martin F. WAS Promoter-Driven Lentiviral Vectors Mimic Closely the Lopsided WASP Expression during Megakaryocytic Differentiation. MOLECULAR THERAPY-METHODS & CLINICAL DEVELOPMENT 2020; 19:220-235. [PMID: 33102615 PMCID: PMC7558809 DOI: 10.1016/j.omtm.2020.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/11/2020] [Indexed: 01/10/2023]
Abstract
Transplant of gene-modified autologous hematopoietic progenitors cells has emerged as a new therapeutic approach for Wiskott-Aldrich syndrome (WAS), a primary immunodeficiency with microthrombocytopenia and abnormal lymphoid and myeloid functions. Despite the clinical benefits obtained in ongoing clinical trials, platelet restoration is suboptimal. The incomplete restoration of platelets in these patients can be explained either by a low number of corrected cells or by insufficient or inadequate WASP expression during megakaryocyte differentiation and/or in platelets. We therefore used in vitro models to study the endogenous WASP expression pattern during megakaryocytic differentiation and compared it with the expression profiles achieved by different therapeutic lentiviral vectors (LVs) driving WAS cDNA through different regions of the WAS promoter. Our data showed that all WAS promoter-driven LVs mimic very closely the endogenous WAS expression kinetic during megakaryocytic differentiation. However, LVs harboring the full-length (1.6-kb) WAS-proximal promoter (WW1.6) or a combination of the WAS alternative and proximal promoters (named AW) had the best behavior. Finally, all WAS-driven LVs restored the WAS knockout (WASKO) mice phenotype and functional defects of hematopoietic stem and progenitor cells (HSPCs) from a WAS patient with similar efficiency. In summary, our data back up the use of WW1.6 and AW LVs as physiological gene transfer tools for WAS therapy.
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Affiliation(s)
- Pilar Muñoz
- Genomic Medicine Department, GENYO, Centre for Genomics and Oncological Research, Pfizer-University of Granada-Andalusian Regional Government, Parque Tecnológico Ciencias de la Salud (PTS), Avenida de la Ilustracion 114, 18016 Granada, Spain.,University College London (UCL) Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, WC1N 1EH London, UK
| | - María Tristán-Manzano
- Genomic Medicine Department, GENYO, Centre for Genomics and Oncological Research, Pfizer-University of Granada-Andalusian Regional Government, Parque Tecnológico Ciencias de la Salud (PTS), Avenida de la Ilustracion 114, 18016 Granada, Spain
| | - Almudena Sánchez-Gilabert
- Genomic Medicine Department, GENYO, Centre for Genomics and Oncological Research, Pfizer-University of Granada-Andalusian Regional Government, Parque Tecnológico Ciencias de la Salud (PTS), Avenida de la Ilustracion 114, 18016 Granada, Spain
| | - Giorgia Santilli
- University College London (UCL) Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, WC1N 1EH London, UK
| | - Anne Galy
- Genethon, 91000 Evry, France.,Université Paris-Saclay, Univ Evry, Inserm, Genethon, Integrare research unit UMR_S951, 91000 Evry, France
| | - Adrian J Thrasher
- University College London (UCL) Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, WC1N 1EH London, UK
| | - Francisco Martin
- Genomic Medicine Department, GENYO, Centre for Genomics and Oncological Research, Pfizer-University of Granada-Andalusian Regional Government, Parque Tecnológico Ciencias de la Salud (PTS), Avenida de la Ilustracion 114, 18016 Granada, Spain
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Bhattacharya A, Ghosh P, Prasad R, Ghosh A, Das K, Roy A, Mallik S, Sinha DK, Sen P. MAP Kinase driven actomyosin rearrangement is a crucial regulator of monocyte to macrophage differentiation. Cell Signal 2020; 73:109691. [PMID: 32531262 DOI: 10.1016/j.cellsig.2020.109691] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 06/05/2020] [Accepted: 06/06/2020] [Indexed: 12/31/2022]
Abstract
Rearrangement of actin cytoskeleton correlates significantly with the immune responses as the perturbation of cytoskeletal dynamics leads to many immune deficiencies. Mechanistic insights into this correlation remain unknown. Cellular spreading, the most characteristic phenotype associated with monocyte to macrophage differentiation, led us to investigate the contribution of actomyosin dynamics in monocyte differentiation. Our observation revealed that actomyosin reorganization intrinsically governs the process of monocyte to macrophage differentiation. Further, we established that the MAPK-driven signaling pathways regulate the cellular actomyosin dynamics that direct monocyte to macrophage differentiation. We also identified P42/44 Mitogen-Activated Protein Kinase (P42/44 MAPK), P38 Mitogen-Activated Protein Kinase (P38 MAPK), MAP Kinase Activated Protein Kinase 2 (MK-2), Heat Shock Protein 27 (Hsp-27), Lim Kinase (Lim K), non-muscle cofilin (n-cofilin), Myosin Light Chain Kinase (MLCK) and Myosin Light Chain (MLC) as critical components of the signaling network. Moreover, we have shown the involvement of the same signaling cascade in 3D gel-like microenvironment induced spontaneous monocyte to macrophage differentiation and in human blood-derived PBMC differentiation. Our study reveals new mechanistic insights into the process of monocyte to macrophage differentiation.
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Affiliation(s)
- Anindita Bhattacharya
- Department of Biological Chemistry, Indian Association for the Cultivation of Science, Jadavpur, Kolkata 700032, India
| | - Purnam Ghosh
- Department of Biological Chemistry, Indian Association for the Cultivation of Science, Jadavpur, Kolkata 700032, India
| | - Ramesh Prasad
- Department of Biological Chemistry, Indian Association for the Cultivation of Science, Jadavpur, Kolkata 700032, India
| | - Arnab Ghosh
- Department of Biological Chemistry, Indian Association for the Cultivation of Science, Jadavpur, Kolkata 700032, India
| | - Kaushik Das
- Department of Biological Chemistry, Indian Association for the Cultivation of Science, Jadavpur, Kolkata 700032, India
| | - Abhishek Roy
- Department of Biological Chemistry, Indian Association for the Cultivation of Science, Jadavpur, Kolkata 700032, India
| | - Suman Mallik
- Department of Biological Chemistry, Indian Association for the Cultivation of Science, Jadavpur, Kolkata 700032, India
| | - Deepak Kumar Sinha
- Department of Biological Chemistry, Indian Association for the Cultivation of Science, Jadavpur, Kolkata 700032, India
| | - Prosenjit Sen
- Department of Biological Chemistry, Indian Association for the Cultivation of Science, Jadavpur, Kolkata 700032, India.
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Abstract
Certain rashes and cutaneous lesions in a newborn can be clues to more concerning diseases and conditions if recognized and evaluated promptly. Langerhans cell histiocytosis, cutaneous forms of cancer (such as leukemia cutis, neuroblastoma, and rhabdomyosarcoma), developmental abnormalities such as neural tube or spinal dysraphism, and aplasia cutis congenita, nutritional deficiency, and immunodeficiency all have a range of cutaneous findings that will be reviewed herein to guide diagnosis and management. [Pediatr Ann. 2019;48(1):e30-e35.].
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Baharin MF, Dhaliwal JS, Sarachandran SVV, Idris SZ, Yeoh SL. A rare case of Wiskott-Aldrich Syndrome with normal platelet size: a case report. J Med Case Rep 2016; 10:188. [PMID: 27356510 PMCID: PMC4928304 DOI: 10.1186/s13256-016-0944-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 05/10/2016] [Indexed: 11/12/2022] Open
Abstract
Background Wiskott-Aldrich syndrome is a rare X-linked disorder characterized by microthrombocytopenia, eczema, and recurrent infections. It is caused by mutations of the WAS gene. Microthrombocytopenia has been regarded as the key criteria in diagnosing this rare condition. However, in this case report, we describe a case of Wiskott-Aldrich syndrome with normal platelet size. Case presentation We report the case of a 9-month-old Malay boy who presented with persistent thrombocytopenia from birth. Serial blood investigations at birth showed he had normal platelet size. His family history revealed two early neonatal deaths in maternal uncles. Spontaneous bleeding was only seen at the age of 3 months. He was initially treated for immune thrombocytopenic purpura and was started on intravenously administered immunoglobulin. His clinical deterioration and poor response to the immunoglobulin raised suspicion for a different underlying pathology. Molecular analysis of the WAS gene revealed a missense mutation in exon 10. His parents refused further interventions and defaulted on subsequent follow-up appointments. Conclusions A diagnosis of Wiskott-Aldrich syndrome should be considered in any male infant who presents with early onset thrombocytopenia despite an absence of small platelet size, a characteristic feature of Wiskott-Aldrich syndrome.
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Affiliation(s)
- Mohd Farid Baharin
- Allergy and Immunology Research Centre, Institute for Medical Research, Jalan Pahang, 50588, Kuala Lumpur, Malaysia.
| | | | - Smrdhi V V Sarachandran
- Department of Pediatrics, Hospital Sultanah Bahiyah, KM 6, Jalan Langgar, 05460, Alor Setar, Kedah, Malaysia
| | - Siti Zaharah Idris
- Department of Pathology, Hospital Sultanah Bahiyah, KM 6, Jalan Langgar, 05460, Alor Setar, Kedah, Malaysia
| | - Seoh Leng Yeoh
- Department of Pediatrics, Hospital Pulau Pinang, Jalan Residensi, 10450, George Town, Pulau Pinang, Malaysia
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Tsilifis C, Gennery AR, Cant A. Presenting features and platelet anomalies in WAS: one centre's experience. J Clin Immunol 2016; 36:354-6. [PMID: 26951488 DOI: 10.1007/s10875-016-0259-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 02/28/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Christo Tsilifis
- Newcastle University School of Medical Education, Framlington Place, Newcastle-upon-Tyne, UK.
| | - Andrew R Gennery
- Primary Immunodeficiency Group, Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
- Paediatric Haematopoietic Stem Cell Unit, Great North Childrens' Hospital, Newcastle upon Tyne, UK
| | - Andrew Cant
- Primary Immunodeficiency Group, Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, UK
- Paediatric Haematopoietic Stem Cell Unit, Great North Childrens' Hospital, Newcastle upon Tyne, UK
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Abstract
Immune thrombocytopenia is an autoimmune-mediated disorder and the treatment strategies were directed mainly to suppression of the immune system or to removal of the spleen as a place of thrombocyte destruction. In last years, it was shown that other mechanisms are responsible for development of immune thrombocytopenia: reduced thrombocyte lifespan and ineffective marrow platelet production. New treatment strategies, such as thrombopoietin receptor agonists, were developed to overcome this mechanism. Still there are a difficult minority of patients unresponsive to multiple treatments, whose have severe bleeding and another group of patients with extensive morbidity from therapy, not restricted to steroids. In this review, focused on adult patients, we discuss newer results of therapies and consider newer treatment strategies.
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Affiliation(s)
- Marina Izak
- 1NY Presbyterian Hospital and Weill Cornell Medical College, Division of Pediatric Hematology Oncology, 525 East 68th Street, Payson Pavilion 695, New York, NY 10065, USA
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Liu CH, Wu KH, Lin TY, Wei CC, Lin CY, Chen XX, Lee WI. Wiskott–Aldrich syndrome with IgA nephropathy: a case report and literature review. Int Urol Nephrol 2012; 45:1495-500. [DOI: 10.1007/s11255-012-0178-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 04/05/2012] [Indexed: 11/28/2022]
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Ramoutar DN, Tang SW, Rodrigues J, Holdsworth BJ. Infective myositis: a rare but important cause of elbow pain in the immunocompromised patient. J Shoulder Elbow Surg 2010; 19:e14-6. [PMID: 20452248 DOI: 10.1016/j.jse.2010.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 02/04/2010] [Accepted: 02/15/2010] [Indexed: 02/01/2023]
Affiliation(s)
- Darryl N Ramoutar
- Department of Trauma and Orthopaedics, Queens Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, UK.
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Huang KY, Lai MW, Lee WI, Huang YC. Fatal Cytomegalovirus Gastrointestinal Disease in an Infant with Wiskott-Aldrich Syndrome. J Formos Med Assoc 2008; 107:64-7. [DOI: 10.1016/s0929-6646(08)60009-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Binder V, Albert MH, Kabus M, Bertone M, Meindl A, Belohradsky BH. The genotype of the original Wiskott phenotype. N Engl J Med 2006; 355:1790-3. [PMID: 17065640 DOI: 10.1056/nejmoa062520] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The Wiskott-Aldrich syndrome is an X-linked hereditary disorder associated with combined immunodeficiency, thrombocytopenia, small platelets, eczema, and increased susceptibility to autoimmune disorders and cancers. It is caused by mutations in the gene (WAS) for the Wiskott-Aldrich syndrome protein (WASP). We investigated family members of the patients originally described by Wiskott in 1937 and identified a new frame shift mutation in exon 1 of WAS. This mutation is likely to be the hypothesized genotype that caused the severe form of the Wiskott-Aldrich syndrome in the three brothers described by Wiskott.
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Affiliation(s)
- Vera Binder
- Department of Hematology and Oncology, Dr. von Haunersches Children's Hospital, Ludwig Maximilians University, Munich, Germany
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Abstract
Atopic is the most common of the dermatitides seen in infancy and childhood, but there are numerous other diseases that can mimic the skin findings. These include seborrheic dermatitis, immunodeficiency, and psoriasis in infancy; scabies, tinea corporis infection, perioral, nummular, contact, and molluscum dermatitis in childhood. It is sometimes extremely difficult to differentiate between ichthyosis and AD, and it is also important to differentiate AD from erythrodermic conditions including acrodermatitis enteropathica, biotin deficiency, and Netherton syndrome. A rare condition in children that may mimic AD is mycosis fungoides.
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Affiliation(s)
- Alfons Krol
- Oregon Health and Sciences University, Portland, 97239, USA.
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Notarangelo LD, Notarangelo LD, Ochs HD. WASP and the phenotypic range associated with deficiency. Curr Opin Allergy Clin Immunol 2006; 5:485-90. [PMID: 16264326 DOI: 10.1097/01.all.0000191243.25757.ce] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review reports on the range of clinical phenotypes that are caused by mutations in the Wiskott-Aldrich Syndrome Protein (WASP) gene. The basis of genotype-phenotype correlation in Wiskott-Aldrich syndrome (WAS) is discussed, with regard to expression of the WAS protein (WASp) and of the effects of WASP mutations on WASp function. Advances in preclinical models of gene therapy for WAS are presented. RECENT FINDINGS Two recent studies have supported genotype-phenotype correlation in WAS and in related X-linked thrombocytopenia. Expression of the WASp was found to be the best predictor of clinical phenotype. Investigation of autoimmune manifestations associated with WAS has shown that autoimmune hemolytic anemia and elevated serum IgM associate with a more severe clinical course. Finally, while results of hematopoietic stem cell transplantation for WAS continue to improve, several studies have shown the potential benefit of novel therapeutic approaches based on gene transfer. In particular, use of lentiviral vector-driven expression of the WASP gene under autologous promoter sequences has been found to result in increased targeting of hematopoietic stem cells, higher levels of WASp expression, and improved reconstitution of immune function. SUMMARY Availability of tools that allow analysis of WASp expression has provided evidence for a genotype-phenotype correlation in patients with WASP gene defects. Protein expression is an important prognostic indicator. The molecular and cellular abnormalities of WAS-associated defects are being identified, and significant advances in vector-mediated gene transfer have opened possibilities for the treatment of WAS based on gene therapy.
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Affiliation(s)
- Luigi D Notarangelo
- Department of Pediatrics and Angelo Nocivelli Institute for Molecular Medicine, University of Brescia, Spedali Civili, Brescia, Italy.
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Friedrich W, Müller SM. Allogeneic stem cell transplantation for treatment of immunodeficiency. ACTA ACUST UNITED AC 2004; 26:109-18. [PMID: 15368077 DOI: 10.1007/s00281-004-0158-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2004] [Accepted: 04/18/2004] [Indexed: 11/28/2022]
Abstract
Primary immunodeficiencies constitute a group of highly complex congenital disorders commonly characterized by an extremely poor prognosis. Allogeneic hematopoietic stem cell transplantation has the potential to establish a permanently functioning immune system and represents a curative approach in many of these disorders. In this review several aspects of stem cell transplantation are presented, with an emphasis on the mechanism of immune reconstitution in severe combined immunodeficiency diseases. In this disorder transplant modalities vary, and also include transplantation without cytoreductive conditioning. Clinical results are summarized based on recent analysis performed in large patient cohorts, which have shown steady improvements and have led to a marked change in the prognosis of patients with primary immunodeficiencies.
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Affiliation(s)
- Wilhelm Friedrich
- Department of Pediatrics, University of Ulm, Prittwitzstrasse 43, 89075 Ulm, Germany.
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Matsukura H, Kanegane H, Miya K, Ohtsubo K, Higuchi A, Tanizawa T, Miyawaki T. IgA nephropathy associated with X-linked thrombocytopenia. Am J Kidney Dis 2004; 43:e7-12. [PMID: 14981635 DOI: 10.1053/j.ajkd.2003.11.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
X-Linked thrombocytopenia (XLT) is characterized by congenital thrombocytopenia with small platelets and absence of immunodeficiency; XLT is an allelic variant of Wiskott-Aldrich syndrome (WAS). Both entities are caused by mutations in the same gene. This study presents the case of an 8-year-old boy with XLT. He developed immunoglobulin A (IgA) nephropathy at the age of 4 years. Genetic analysis confirmed the XLT diagnosis. His maternal uncle also had thrombocytopenia from early infancy and developed end-stage renal failure as a result of IgA nephropathy. The maternal uncle was inferred to be affected with XLT because of the carrier status of the patient's mother. Abnormal glycosylation has a role in pathogenesis in IgA nephropathy; moreover, sialophorin glycosylation is defective in WAS. Altered glycosylation may contribute to renal involvement in patients with WAS/XLT despite different defective glycosylation patterns in IgA nephropathy and WAS/XLT.
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Affiliation(s)
- Hiro Matsukura
- Department of Pediatrics, Saiseikai Toyama Hospital, Toyama, Japan.
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Snyder KM, Rubin MA, Shulkin BL, Hutchinson RJ, Wechsler DS. Mediastinal seminoma in a patient with Wiskott-Aldrich syndrome. J Pediatr Hematol Oncol 2002; 24:672-6. [PMID: 12439043 DOI: 10.1097/00043426-200211000-00015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Shortness of breath developed in an 18-year-old man with Wiskott-Aldrich syndrome, and he was found to have a large mediastinal mass. The gallium scan was positive, and biopsy indicated a seminoma. After treatment with four cycles of chemotherapy, the mass completely resolved. Despite severe thrombocytopenia, he required only two platelet transfusions during therapy. Although lymphomas make up the vast majority of mediastinal tumors in patients with Wiskott-Aldrich syndrome, a positive gallium scan should not preclude the diagnosis of seminoma or the need for confirmatory tissue diagnosis. This report shows the possibility of uneventful and successful treatment of malignancy in a patient with Wiskott-Aldrich syndrome and severe thrombocytopenia.
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Affiliation(s)
- Kristen M Snyder
- Department of Pediatrics, Section of Pediatric Hematology-Oncology, The University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0938, USA
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Affiliation(s)
- B Grimbacher
- Department of Rheumatology and Clinical Immunology, Medical Center, University of Freiburg, Hugstetterstrasse 55, 79106 Freiburg, Germany
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21
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Longhurst HJ, Taussig D, Haque T, Syndercombe-Court D, Cavenagh J, Edgar JD, Helbert MR. Non-myeloablative bone marrow transplantation in an adult with Wiskott-Aldrich syndrome. Br J Haematol 2002; 116:497-9. [PMID: 11841458 DOI: 10.1046/j.1365-2141.2002.03269.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Early bone marrow transplant is now standard treatment for infants with severe immunodeficiencies such as Wiskott-Aldrich Syndrome (WAS), but results in older children and adults are poor. Non-myeloablative transplant has shown promise in the treatment of older children, who are likely to have active infections and organ damage. We describe a non-myeloablative transplant of a 26-year-old man with WAS, undertaken because of severe infections and vasculitis. Partial engraftment and immunorestoration were achieved. The patient is well 1 year post transplantation.
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Canning MO, Grotenhuis K, De Haan-Meulman M, De Wit HJ, Berghout A, Drexhage HA. An abnormal adherence of monocytes to fibronectin in thyroid autoimmunity has consequences for cell polarization and the development of veiled cells. Clin Exp Immunol 2001; 125:10-8. [PMID: 11472420 PMCID: PMC1906102 DOI: 10.1046/j.1365-2249.2001.01583.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Blood monocytes of patients with thyroid autoimmune disease (TAID) display defects in rearranging their cortical actomyosin cytoskeleton ('polarize') in response to chemoattractants. Such rearrangements also take place after the adherence of monocytes to the extracellular matrix (ECM). It is therefore not surprising that monocytes are primed after fibronectin (FN) adherence, displaying an enhanced polarization toward chemoattractants. We investigated the integrin expression and chemoattractant-induced polarization of monocytes of TAID patients before and after FN adherence. Since cytoskeletal rearrangements are also required during the transition of monocytes into veiled antigen-presenting cells (VCs), we investigated such transition of FN-adherent monocytes of TAID patients. Adherent and nonadherent monocyte populations from TAID patients and healthy controls were subjected to a polarization test with the chemoattractant fMLP (or MCP-1), FACS analyses (FITC-labelled FN, CD29, CD49e, d, b and a) and tested for their capability to develop into veiled APC. Monocytes of healthy individuals showed an improved chemoattractant-induced cell polarization after FN adherence, not reflected by TAID monocytes, in which chemoattractant-induced polarization worsened. Monocytes of healthy individuals up-regulated CD49e and d integrins and their capability to bind FITC-labelled FN after adherence to a FN-coated plate, as well as enhancing their capability to generate T cell-stimulatory VCs. Monocytes of TAID patients did not. These data indicate that integrin- (and chemokine-) mediated functions are hampered in monocytes of TAID patients. Because integrin action is pivotal to processes such as monocyte adherence to endothelial cells, uropod formation, migration into tissues and differentiation into APC and macrophages, these defects might underly immune dysbalances important in thyroid autoimmune development.
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Affiliation(s)
- M O Canning
- Department of Immunology, Erasmus University Rotterdam, The Netherlands
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Depiero A, Kaminski DA, Halsey JF, Briles D, Burrows PD, Hostoffer RW. Immunologic compensation in a patient with a large IgH constant region deletion. J Allergy Clin Immunol 2001; 107:1051-5. [PMID: 11398084 DOI: 10.1067/mai.2001.115094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Deficiencies of serum Ig of the IgG isotype typically predispose individuals to recurrent infections in some but not all cases. Patients with large deletions of the Ig heavy chain genes are free of recurrent and severe infections. OBJECTIVE We sought to determine a mechanism of immunologic compensation that would possibly explain the reason for this patient's paucity of infection despite lacking several classes of serum Ig. METHODS The patient is a 50-year-old white man. Serum Ig levels and specific antibody titers were measured by using various methods, including nephelometry, enzyme immunoassay, and radial immunodiffusion. The status of the Ig heavy chain genes was examined by means of Southern blotting of genomic DNA isolated from EBV-transformed B cells. RESULTS The patient's serum lacked detectable IgG1, IgG2, IgG4, and IgA1 levels. Southern blot analysis demonstrated a large heavy chain constant (C) region gene deletion that included Cgamma1, Calpha1, psiCgamma, Cgamma2, and Cgamma4. Antibody responses to capsular pneumococcal and hemophilus polysaccharide antigens were essentially absent. However, IgG3 antibodies against the protein antigen tetanus toxoid were present. Relatively high antibody titers were found against pneumococcal surface proteins as well. CONCLUSION We conclude that our patient's relative freedom from serious infection may be as a result of production of IgG3 antibodies to pneumococcal capsular proteins.
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Affiliation(s)
- A Depiero
- Case Western Reserve University, Cleveland, Ohio, USA
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Qasim W, Gilmour KC, Heath S, Ashton E, Cranston T, Thomas A, Finn A, Davies EG, Thrasher AJ, Kinnon C, Jones A, Gaspar HB. Protein assays for diagnosis of Wiskott-Aldrich syndrome and X-linked thrombocytopenia. Br J Haematol 2001; 113:861-5. [PMID: 11442475 DOI: 10.1046/j.1365-2141.2001.02832.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Mutations in the gene encoding the Wiskott-Aldrich syndrome protein (WASp) give rise to Wiskott-Aldrich syndrome (WAS), a condition that exhibits a wide spectrum of clinical severity. Patients may develop mild thrombocytopenia or suffer from a wide range of associated disorders including eczema, immune dysfunction, autoimmune disease and malignancy. The clinical diagnosis of Wiskott-Aldrich syndrome (WAS) can be difficult and is usually supported by the detection of WASp gene mutations using genetic analysis. Recently, protein-based assays have been used to demonstrate the absence of WASp in patients known to have WASp gene mutations. We have now reversed this approach and report on the use of immunoblot assays to rapidly diagnose WAS in 13 patients. There was a complete absence of WASp in 10 out of 13 patients and an abnormal protein form was detected in the remaining three patients. In all cases, subsequent genetic analysis confirmed the presence of a WASp gene mutation. We believe that protein-based assays should be employed as the first line of investigation in the diagnosis of WAS spectrum disorders.
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Affiliation(s)
- W Qasim
- Molecular Immunology Unit, Institute of Child Health, University College London, UK
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