1
|
Shu Z, Deng M, Han T, Mao H. De Novo Deep Intron ELANE Mutation Resulting in Severe Congenital Neutropenia. J Clin Immunol 2024; 44:183. [PMID: 39172268 DOI: 10.1007/s10875-024-01783-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/31/2024] [Indexed: 08/23/2024]
Abstract
Severe congenital neutropenia (SCN) comprises a diverse range of rare hematological disorders characterized by recurrent, often life-threatening infections that manifest within the first months of life. Mutations in the ELANE gene are the most prevalent cause of SCN. While over 230 mutations in ELANE have been documented, including substitutions, frameshifts, nonsense mutations, and splice site alterations, the occurrence of deep intronic mutations has not been previously reported. Herein, we present the case of a young girl who exhibited recurrent fever, respiratory infections, skin abscesses, and gingivitis shortly after birth. Laboratory analysis revealed markedly diminished neutrophil levels alongside elevated monocyte and eosinophil counts. Bone marrow examination disclosed a halt in myelopoiesis maturation. ELANE gene full-length sequencing identified a novel de novo deep intron mutation in ELANE (c.598 + 79G > T), subsequently confirmed by Sanger sequencing. cDNA sequencing of the patient demonstrated aberrant gene splicing. Utilizing a mini-gene splicing assay for ELANE intronic variants, we identified a mutant ELANE allele (c.597 + 1_597 + 83ins) leading to the creation of a premature termination codon (p.Gly200ValfsTer40). Confocal microscopy revealed heightened expression of myeloperoxidase and neutrophil elastase in the patient, suggesting a potential role for the unfolded protein response in the pathogenesis of the deep intron ELANE mutation. In summary, our findings illustrate the first reported instance of de novo deep intron ELANE mutations associated with SCN, underscoring the importance of exploring deep intronic regions in SCN patients lacking identifiable disease-causing gene mutations.
Collapse
Affiliation(s)
- Zhou Shu
- Department of Immunology, Ministry of Education Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, No. 56 Nanlishi Road, Beijing, 100045, China
| | - Mengyue Deng
- Department of Immunology, Ministry of Education Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, No. 56 Nanlishi Road, Beijing, 100045, China
| | - Tongxin Han
- Department of Immunology, Ministry of Education Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, No. 56 Nanlishi Road, Beijing, 100045, China
| | - Huawei Mao
- Department of Immunology, Ministry of Education Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, No. 56 Nanlishi Road, Beijing, 100045, China.
- Beijing Key Laboratory for Genetics of Birth Defects, No. 56 Nanlishi Road, Beijing, 100045, China.
| |
Collapse
|
2
|
Katsaras G, Koutsi S, Psaroulaki E, Gouni D, Tsitsani P. Neutropenia in Childhood-A Narrative Review and Practical Diagnostic Approach. Hematol Rep 2024; 16:375-389. [PMID: 38921186 PMCID: PMC11203312 DOI: 10.3390/hematolrep16020038] [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: 08/28/2023] [Revised: 05/24/2024] [Accepted: 06/14/2024] [Indexed: 06/27/2024] Open
Abstract
Neutropenia refers to a decrease in the absolute neutrophil count according to age and race norms and poses a common concern in pediatric practice. Neutrophils serve as host defenders and act crucially in acute inflammation procedures. In this narrative review, we systematically present causes of neutropenia in childhood, mainly adopting the pathophysiological classification of Frater, thereby studying (1) neutropenia with reduced bone marrow reserve, (2) secondary neutropenia with reduced bone marrow reserve, and (3) neutropenia with normal bone marrow reserve. Different conditions in each category are thoroughly discussed and practically approached from the clinician's point of view. Secondary mild to moderate neutropenia is usually benign due to childhood viral infections and is expected to resolve in 2-4 weeks. Bacterial and fungal agents are also associated with transient neutropenia, although fever with severe neutropenia constitutes a medical emergency. Drug-induced and immune neutropenias should be suspected following a careful history and a detailed clinical examination. Cytotoxic chemotherapies treating malignancies are responsible for severe neutropenia and neutropenic shock. Rare genetic neutropenias usually manifest with major infections early in life. Our review of taxonomies clinical findings and associates them to specific neutropenia disorders. We consequently propose a practical diagnostic algorithm for managing neutropenic children.
Collapse
Affiliation(s)
- Georgios Katsaras
- Paediatric Department, General Hospital of Pella—Hospital Unit of Edessa, 58200 Edessa, Greece; (S.K.); (E.P.); (D.G.); (P.T.)
| | - Silouani Koutsi
- Paediatric Department, General Hospital of Pella—Hospital Unit of Edessa, 58200 Edessa, Greece; (S.K.); (E.P.); (D.G.); (P.T.)
| | - Evdokia Psaroulaki
- Paediatric Department, General Hospital of Pella—Hospital Unit of Edessa, 58200 Edessa, Greece; (S.K.); (E.P.); (D.G.); (P.T.)
| | - Dimitra Gouni
- Paediatric Department, General Hospital of Pella—Hospital Unit of Edessa, 58200 Edessa, Greece; (S.K.); (E.P.); (D.G.); (P.T.)
- Paediatric Outpatient Department, Health Care Center of Aridaia, 58400 Aridaia, Greece
| | - Pelagia Tsitsani
- Paediatric Department, General Hospital of Pella—Hospital Unit of Edessa, 58200 Edessa, Greece; (S.K.); (E.P.); (D.G.); (P.T.)
| |
Collapse
|
3
|
Zhang H, Villar-Prados A, Bussel JB, Zehnder JL. The highs and lows of cyclic thrombocytopenia. Br J Haematol 2024; 204:56-67. [PMID: 38083878 PMCID: PMC10906350 DOI: 10.1111/bjh.19239] [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: 09/16/2023] [Revised: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 01/11/2024]
Abstract
Cyclic thrombocytopenia (CTP) is characterized by periodic platelet oscillation with substantial amplitude. Most CTP cases have a thrombocytopenic background and are often misdiagnosed as immune thrombocytopenia with erratically effective treatment choices. CTP also occurs during hydroxyurea treatment in patients with myeloproliferative diseases. While the aetiology of CTP remains uncertain, here we evaluate historical, theoretical and clinical findings to provide a framework for understanding CTP pathophysiology. CTP retains the intrinsic oscillatory factors defined by the homeostatic regulation of platelet count, presenting as reciprocal platelet/thrombopoietin oscillations and stable oscillation periodicity. Moreover, CTP patients possess pathogenic factors destabilizing the platelet homeostatic system thereby creating opportunities for external perturbations to initiate and sustain the exaggerated platelet oscillations. Beyond humoral and cell-mediated autoimmunity, we propose recently uncovered germline and somatic genetic variants, such as those of MPL, STAT3 or DNMT3A, as pathogenic factors in thrombocytopenia-related CTP. Likewise, the JAK2 V617F or BCR::ABL1 translocation that drives underlying myeloproliferative diseases may also play a pathogenic role in hydroxyurea-induced CTP, where hydroxyurea treatment can serve as both a trigger and a pathogenic factor of platelet oscillation. Elucidating the pathogenic landscape of CTP provides an opportunity for targeted therapeutic approaches in the future.
Collapse
Affiliation(s)
- Haiyu Zhang
- Department of Pathology. Stanford University School of Medicine, Stanford, California, 94305
| | - Alejandro Villar-Prados
- Department of Medicine, Division of Hematology and Oncology. Stanford University School of Medicine, Stanford, California, 94305
| | - James B. Bussel
- Department of Pediatrics. Division of Oncology/Hematology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, NY, 10065
| | - James L. Zehnder
- Department of Pathology and Department of Medicine, Division of Hematology. Stanford University School of Medicine, Stanford, California, 94305
| |
Collapse
|
4
|
Komvilaisak P, Yudhasompop N, Kanchanakamhaeng K, Hongeng S, Pakakasama S, Anurathapan U, Pongphitcha P, Songdej D, Sasanakul W, Sirachainan N. Screening for ELANE, HAX1 and GFI1 gene mutations in children with neutropenia and clinical characterization of two novel mutations in ELANE gene. BMC Pediatr 2023; 23:592. [PMID: 37993852 PMCID: PMC10666431 DOI: 10.1186/s12887-023-04428-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 11/17/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Congenital neutropenia is a rare disease. Recurrent infections since young age are the presentation. The most common mutation causing severe congenital neutropenia (SCN) and cyclic neutropenia (CyN) is the ELANE gene. The objectives of this study were to screen the three common genetic mutations of ELANE, HAX1 and GFI1 in children with chronic neutropenia and to describe the clinical characteristics of children who had the mutations. METHODS Infants having ANC < 1,000/cu mm or children aged > 1 year having ANC < 1,500/cu mm at least 3 times in 3 months were enrolled in the study. Patients who had acquired neutropenia due to infection, immune deficiency, or drugs were excluded. The ELANE gene was first studied; and if mutations were not identified, the HAX1 and GFI1 genes were further examined. RESULTS A total of 60 patients were enrolled in the study. The median (range) age, ratio of female to male, ANC, and last follow-up age were 9.2 (0.5-45.2) months, 1:1.2, 248 (0-1,101) /cu mm, and 19.9 (3.5-202.3) months, respectively. Infections were noted in 67.3% of all patients. ELANE gene mutation was found in only four patients (6.7%), and the rest (56 patients) showed no mutations in the HAX1 and GFI1 genes. In patients without mutations, 66.0% had normal ANC during the follow-up, with a median (range) age for normal ANC of 19.8 (4.0-60.0) months. Two novel mutations p. Ala79del (c.234_236del) and p. Val197GlufsTer18 (c.589_590insAGGCCGGC) were identified, and they respectively cause SCN and CyN. Patients with the two novel mutations presented with several episodes of infection, including pneumonia, sepsis, abscess, otitis media, and gum infection. CONCLUSION The genetic screening for ELANE, HAX1, and GFI1 gene mutations in 60 patients with chronic neutropenia could identify four patients (6.7%) with ELANE gene mutation and two novel mutations, p. Ala79del in exon 3 and p. Val197GlufsTer18 in exon 4 causing SCN; and CyN, respectively.
Collapse
Affiliation(s)
- Patcharee Komvilaisak
- Departments of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Najwa Yudhasompop
- Department of Pediatrics, Hatyai Hospital, Hatyai, Songkhla, Thailand
| | - Kittima Kanchanakamhaeng
- Departments of Pediatrics, Sawanpracharak Hospital, Sawanpracharak Hospital, Nakhon Sawan, Thailand
| | - Suradej Hongeng
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Samart Pakakasama
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Usanarat Anurathapan
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Pongpak Pongphitcha
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Duantida Songdej
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Werasak Sasanakul
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Nongnuch Sirachainan
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi District, Bangkok, 10400, Thailand.
| |
Collapse
|
5
|
Guarino AD, Luglio G, Imperatore N, Cerciello G, Pugliese N, Castiglione F, Tropeano FP, Testa A, Olmo O, Rispo A. Cyclic Neutropenia Mimicking Crohn's Disease: Two Case Reports and a Narrative Review. J Clin Med 2023; 12:6323. [PMID: 37834967 PMCID: PMC10573598 DOI: 10.3390/jcm12196323] [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: 08/11/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Cyclic neutropenia is a rare hematological condition characterized by periodic fluctuations in neutrophil counts, with a 21-day periodicity. Clinical presentation varies from mild to severe forms of the disease, with the onset of recurrent fever, painful oral ulcers, recurrent bacterial infections, peritonitis, and septic shock. The availability of granulocyte colony-stimulating factor (G-CSF) has revolutionized the management and natural history of this disease, regulating the proliferation, differentiation, and maturation of the progenitor cells, and reducing the duration of neutropenia. Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is a group of chronic pathologies that affect the gastrointestinal tract. The onset of both diseases may be at a young age (even during childhood or adolescence), and clinical manifestations may lead to misdiagnosis, due to similar characteristics such as recurrent infections, oral ulcers, perianal abscesses, and infertility. Moreover, the two pathologies are rarely associated, with different management and therapeutic options. Here, we describe two case reports of patients who underwent surgery because of diagnosis of complicated CD. After surgery, due to persistent neutropenia, the hematologist consultant confirmed suspicions of cyclic neutropenia, and G-CSF therapy was started with benefits, underlining the crucial importance of proper differential diagnosis.
Collapse
Affiliation(s)
- Alessia Dalila Guarino
- Gastroenterology, Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy; (A.D.G.)
| | - Gaetano Luglio
- Endoscopic Surgery, Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy
| | - Nicola Imperatore
- Gastroenterology,“Santa Maria Delle Grazie” Hospital, 80078 Pozzuoli, Italy
| | | | - Novella Pugliese
- Hematology, Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy; (A.D.G.)
| | - Francesca Paola Tropeano
- Endoscopic Surgery, Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy
| | - Anna Testa
- Gastroenterology, Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy; (A.D.G.)
| | - Oriana Olmo
- Gastroenterology, Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy; (A.D.G.)
| | - Antonio Rispo
- Gastroenterology, Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy; (A.D.G.)
| |
Collapse
|
6
|
Núñez-Núñez ME, Lona-Reyes JC, López-Barragán B, Cruz-Osorio RM, Gutiérrez-Zepeda BM, Quintero-Ramos A, Becerra-Loaiza DS. Case Report: Characterization of known (c.607G>C) and novel (c.416C>G) ELANE mutations in two Mexican families with congenital neutropenia. Front Immunol 2023; 14:1194262. [PMID: 37795094 PMCID: PMC10547563 DOI: 10.3389/fimmu.2023.1194262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023] Open
Abstract
The most common causes of congenital neutropenia are mutations in the ELANE (Elastase, Neutrophil Expressed) gene (19p13.3), mostly in exon 5 and the distal portion of exon 4, which result in different clinical phenotypes of neutropenia. Here, we report two pathogenic mutations in ELANE, namely, c.607G>C (p.Gly203Arg) and a novel variant c.416C>G (p.Pro139Arg), found in two Mexican families ascertained via patients with congenital neutropenia who responded positively to the granulocyte colony-stimulating factor (G-CSF) treatment. These findings highlight the usefulness of identifying variants in patients with inborn errors of immunity for early clinical management and the need to rule out mosaicism in noncarrier parents with more than one case in the family.
Collapse
Affiliation(s)
- María Enriqueta Núñez-Núñez
- Departamento de Alergia e Inmunología Clínica Pediátrica, Nuevo Hospital Civil de Guadalajara “Dr. Juan I. Menchaca”, Guadalajara, Mexico
| | - Juan Carlos Lona-Reyes
- Departamento de Infectología, Nuevo Hospital Civil de Guadalajara “Dr. Juan I. Menchaca”, Guadalajara, Mexico
- Clínicas de Pediatría, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Brenda López-Barragán
- Departamento de Pediatría, Nuevo Hospital Civil de Guadalajara “Dr. Juan I. Menchaca”, Guadalajara, Mexico
| | - Rosa Margarita Cruz-Osorio
- Clínicas de Pediatría, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
- Departamento de Hemato-Oncología Pediátrica, Nuevo Hospital Civil de Guadalajara “Dr. Juan I. Menchaca”, Guadalajara, Mexico
| | - Bricia Melissa Gutiérrez-Zepeda
- Laboratorio de Inmunología, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
- Doctorado en Genética Humana, Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Antonio Quintero-Ramos
- Laboratorio de Inmunología, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Mexico
| | - Denisse Stephania Becerra-Loaiza
- Laboratorio de Inmunología, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
- Doctorado en Genética Humana, Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| |
Collapse
|
7
|
Kapogiannis C, Zaggogianni T, Stergiou N, Kakleas K, Kapogiannis A, Gakiopoulou H, Kanaka-Gantenbein C. Cyclic neutropenia and concomitant IgA nephropathy: a case report. BMC Nephrol 2023; 24:124. [PMID: 37138249 PMCID: PMC10157981 DOI: 10.1186/s12882-023-03179-1] [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: 08/28/2022] [Accepted: 04/20/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND IgA nephropathy (IgAN) is universally recognized as one of the most common primary glomerular diseases in all ages. Cyclic neutropenia (CN) is a rare haematologic disorder that is associated with mutations of the ELANE gene. The co-occurrence of IgAN and CN is extremely rare. This is the first case report of a patient with IgAN and genetically confirmed CN. CASE PRESENTATION We report a case of a 10-year-old boy who presented with recurrent viral upper respiratory tract infections accompanied by several episodes of febrile neutropenia, haematuria, proteinuria and acute kidney injury. Upon first admission, his physical examination was unremarkable. His kidney function was impaired, whereas his urine microscopy showed evidence of macroscopic haematuria and proteinuria. Further workup showed elevated IgA. The renal histology was consistent with mesangial and endocapillary hypercellularity with mild crescentic lesions, while immunofluorescence microscopy showed IgA-positive staining, which was characteristic of IgAN. Moreover, genetic testing confirmed the clinical diagnosis of CN, therefore Granulocyte colony-stimulating factor (G-CSF) was initiated to stabilize the neutrophil count. Regarding proteinuria control, the patient was initially treated with an Angiotensin-converting-enzyme inhibitor for approximately 28 months. However, due to progressive proteinuria (> 1 g/24 h), Corticosteroids (CS) were added for a period of 6 months according to the revised 2021 KDIGO guidelines with favorable outcome. CONCLUSIONS Patients with CN are more susceptible to recurrent viral infections, which can trigger IgAN attacks. In our case CS induced remarkable proteinuria remission. The use of G-CSF contributed to the resolution of severe neutropenic episodes, viral infections and concomitant AKI episodes, contributing to better prognosis of IgAN. Further studies are mandatory to determine whether there is a genetical predisposition for IgAN in children with CN.
Collapse
Affiliation(s)
- C Kapogiannis
- Renal Unit, First Department of Paediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece.
- Renal Unit, Great Ormond Street Hospital, London, UK.
| | - T Zaggogianni
- First Department of Paediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - N Stergiou
- Renal Unit, First Department of Paediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - K Kakleas
- First Department of Paediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - A Kapogiannis
- Renal Unit, First Department of Paediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - H Gakiopoulou
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - C Kanaka-Gantenbein
- First Department of Paediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| |
Collapse
|
8
|
|
9
|
Rahul M, Gowthaman K, Tewari N, Mathur V. Dental manifestations of pseudo-vitamin-D deficiency rickets in a paediatric patient. BMJ Case Rep 2021; 14:e244517. [PMID: 34969788 PMCID: PMC8719130 DOI: 10.1136/bcr-2021-244517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2021] [Indexed: 11/03/2022] Open
Abstract
Vitamin D-resistant rickets shows the resistance to vitamin D (Vit-D) therapy, which traditionally works well in cases with deficiency rickets. The signs start appearing as early as in the first month of life and are characterised by the defective mineralisation at the ends of cartilage and bones despite having normal Vit-D levels in the serum. This case report highlights the dental and maxillofacial manifestations in a 3-year-old girl diagnosed with pseudo-Vit-D deficiency rickets. The report also highlights the variations in the dental manifestations of the condition reported in the literature.
Collapse
Affiliation(s)
- Morankar Rahul
- Division of Pedodontics and Preventive Dentistry, Center for Dental Education and Research, AIIMS, New Delhi, Delhi, India
| | - Keerthana Gowthaman
- Division of Pedodontics and Preventive Dentistry, Center for Dental Education and Research, AIIMS, New Delhi, Delhi, India
| | - Nitesh Tewari
- Division of Pedodontics and Preventive Dentistry, Center for Dental Education and Research, AIIMS, New Delhi, Delhi, India
| | - Vijay Mathur
- Division of Pedodontics and Preventive Dentistry, Center for Dental Education and Research, AIIMS, New Delhi, Delhi, India
| |
Collapse
|
10
|
Ilonze C, Galipp KM, Scordino T, Meyer WH, Baker A. A Case of Cyclic Neutropenia and Associated Amyloidosis. J Pediatr Hematol Oncol 2021; 43:e1115-e1117. [PMID: 34224518 DOI: 10.1097/mph.0000000000002217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 03/26/2021] [Indexed: 11/25/2022]
Abstract
Cyclic neutropenia has been rarely associated with chronic inflammation and development of reactive AA amyloidosis. We report a family with cyclic neutropenia with associated renal and thyroid amyloid. A 12-year-old female presented with thyromegaly, recurrent aphthous ulcers, severe neutropenia, and renal failure. Renal and thyroid biopsies revealed abundant amyloid deposition. Presence of a heterozygous ELANE c.358 A>T gene mutation p.I120F variant with autosomal dominant inheritance confirmed the diagnosis of cyclic neutropenia. The patient's father also had neutropenia and amyloidosis with renal failure. We started filgrastim to attenuate neutropenia and thereby reduce chronic inflammation and minimize further amyloid deposition.
Collapse
Affiliation(s)
- Chibuzo Ilonze
- Department of Pediatrics, Jimmy Everest Section of Pediatric Hematology/Oncology
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of South Alabama, Mobile, AL
| | - Kari M Galipp
- Department of Pediatrics, Jimmy Everest Section of Pediatric Hematology/Oncology
| | - Teresa Scordino
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - William H Meyer
- Department of Pediatrics, Jimmy Everest Section of Pediatric Hematology/Oncology
| | - Ashley Baker
- Department of Pediatrics, Jimmy Everest Section of Pediatric Hematology/Oncology
| |
Collapse
|
11
|
Rydzynska Z, Pawlik B, Krzyzanowski D, Mlynarski W, Madzio J. Neutrophil Elastase Defects in Congenital Neutropenia. Front Immunol 2021; 12:653932. [PMID: 33968054 PMCID: PMC8100030 DOI: 10.3389/fimmu.2021.653932] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/06/2021] [Indexed: 12/21/2022] Open
Abstract
Severe congenital neutropenia (SCN) is a rare hematological condition with heterogenous genetic background. Neutrophil elastase (NE) encoded by ELANE gene is mutated in over half of the SCN cases. The role of NE defects in myelocytes maturation arrest in bone marrow is widely investigated; however, the mechanism underlying this phenomenon has still remained unclear. In this review, we sum up the studies exploring mechanisms of neutrophil deficiency, biological role of NE in neutrophil and the effects of ELANE mutation and neutropenia pathogenesis. We also explain the hypotheses presented so far and summarize options of neutropenia therapy.
Collapse
Affiliation(s)
- Zuzanna Rydzynska
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | - Bartlomiej Pawlik
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland.,Postgraduate School of Molecular Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Damian Krzyzanowski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland.,Laboratory of Epigenetics, Institute of Medical Biology, Polish Academy of Sciences, Lodz, Poland
| | - Wojciech Mlynarski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | - Joanna Madzio
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| |
Collapse
|
12
|
Frater JL. How I investigate neutropenia. Int J Lab Hematol 2021; 42 Suppl 1:121-132. [PMID: 32543073 DOI: 10.1111/ijlh.13210] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/20/2020] [Accepted: 03/25/2020] [Indexed: 01/24/2023]
Abstract
Neutropenia is a common laboratory finding in adults and children. Its underlying causes are extremely heterogeneous and include benign conditions, autoimmune disorders, infections, and malignancies. The clinical laboratory plays a central role in the diagnosis of these disorders, including data derived from hematology, microbiology, molecular biology/cytogenetics, and clinical chemistry. The purpose of this review is to (a) highlight the clinical, hematologic, and molecular genetic features of the major entities resulting in neutropenia and (b) outline an algorithm-based approach to permit the classification of neutropenias.
Collapse
Affiliation(s)
- John L Frater
- Department of Pathology and Immunology, Washington University, St. Louis, MO, USA
| |
Collapse
|
13
|
Lahlimi FE, Khalil K, Lahiaouni S, Tazi I. Neutropenic Enterocolitis Disclosing an Underlying Cyclic Neutropenia. Case Rep Pediatr 2020; 2020:8858764. [PMID: 33343958 PMCID: PMC7725567 DOI: 10.1155/2020/8858764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/09/2020] [Accepted: 11/25/2020] [Indexed: 01/09/2023] Open
Abstract
Neutropenic enterocolitis is a syndrome characterized by fever and abdominal pain in a neutropenic patient. It is often reported in children treated for leukemia and rarely reported in patients with other diseases. Herein, we report the case of a 9-year-old patient with a medical history of recurrent fever and mouth ulcers since the age of 4, who presented with neutropenic enterocolitis complicated with intestinal perforation which all leaded to disclose cyclic neutropenia. The patient was successfully treated by aggressive supportive care combined with surgical intervention. Neutropenic enterocolitis with possible complications should be considered and promptly managed in every neutropenic patient and may reveal a rare cause of neutropenia as cyclic neutropenia.
Collapse
Affiliation(s)
- Fatima Ezzahra Lahlimi
- Hematology Department, University Hospital Mohamed VI, Faculty of Medicine, Cadi Ayyad University, Marrakech, Morocco
| | - Khawla Khalil
- Hematology Department, University Hospital Mohamed VI, Faculty of Medicine, Cadi Ayyad University, Marrakech, Morocco
| | - Soumia Lahiaouni
- Hematology Department, University Hospital Mohamed VI, Faculty of Medicine, Cadi Ayyad University, Marrakech, Morocco
| | - Illias Tazi
- Hematology Department, University Hospital Mohamed VI, Faculty of Medicine, Cadi Ayyad University, Marrakech, Morocco
| |
Collapse
|
14
|
Lehman HK, Segal BH. The role of neutrophils in host defense and disease. J Allergy Clin Immunol 2020; 145:1535-1544. [PMID: 32283205 DOI: 10.1016/j.jaci.2020.02.038] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/15/2020] [Accepted: 02/05/2020] [Indexed: 12/21/2022]
Abstract
Neutrophils, the most abundant circulating leukocyte, are critical for host defense. Granulopoiesis is under the control of transcriptional factors and culminates in mature neutrophils with a broad armamentarium of antimicrobial pathways. These pathways include nicotinamide adenine dinucleotide phosphate oxidase, which generates microbicidal reactive oxidants, and nonoxidant pathways that target microbes through several mechanisms. Activated neutrophils can cause or worsen tissue injury, underscoring the need for calibration of activation and resolution of inflammation when infection has been cleared. Acquired neutrophil disorders are typically caused by cytotoxic chemotherapy or immunosuppressive agents. Primary neutrophil disorders typically result from disabling mutations of individual genes that result in impaired neutrophil number or function, and provide insight into basic mechanisms of neutrophil biology. Neutrophils can also be activated by noninfectious causes, including trauma and cellular injury, and can have off-target effects in which pathways that typically defend against infection exacerbate injury and disease. These off-target effects include acute organ injury, autoimmunity, and variable effects on the tumor microenvironment that can limit or worsen tumor progression. A greater understanding of neutrophil plasticity in these conditions is likely to pave the way to new therapeutic approaches.
Collapse
Affiliation(s)
- Heather K Lehman
- Division of Allergy/Immunology & Rheumatology, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Brahm H Segal
- Roswell Park Comprehensive Cancer Center, University at Buffalo, Buffalo, NY.
| |
Collapse
|
15
|
Knauer F, Stiehl T, Marciniak-Czochra A. Oscillations in a white blood cell production model with multiple differentiation stages. J Math Biol 2019; 80:575-600. [DOI: 10.1007/s00285-019-01432-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 07/02/2019] [Indexed: 12/15/2022]
|
16
|
Atallah-Yunes SA, Ready A, Newburger PE. Benign ethnic neutropenia. Blood Rev 2019; 37:100586. [PMID: 31255364 DOI: 10.1016/j.blre.2019.06.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/09/2019] [Accepted: 06/20/2019] [Indexed: 01/30/2023]
Abstract
Benign ethnic neutropenia (BEN) is one of the most common causes of chronic neutropenia seen in individuals of African, Middle Eastern and West Indian descent, affecting many individuals worldwide. Despite its prevalence, many physicians are not familiar with this benign condition, resulting in unnecessary evaluation and testing for neutropenia in otherwise healthy individuals. Clinically, patients with BEN are at no increased risk of infection despite their neutropenia. Implications of this condition are highlighted in those patients receiving therapies that have a known side effect of neutropenia, most commonly chemotherapy agents. Studies have suggested that disparities in survival among those patients receiving chemotherapy between patients of European decent and African decent may be attributed to measured neutropenia in these populations, questioning whether BEN could be an influential factor. This review encompasses all aspects of benign ethnic neutropenia, providing information about this condition and helping to guide clinical decision-making as to when an aggressive work up and referral are indicated and when it is appropriate to monitor. Additionally, we review the role of genetic studies in identifying the genes related to BEN, summarize the theories that offer the most accepted mechanisms behind the condition, and address the importance of pursuing larger studies to assess the implication of BEN in oncology patients as well as patients taking neutropenia-causing medications.
Collapse
Affiliation(s)
- Suheil Albert Atallah-Yunes
- Department of Medicine, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA 01103, USA.
| | - Audrey Ready
- Department of Medicine, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA 01103, USA
| | - Peter E Newburger
- Departments of Pediatrics and Molecular, Cell and Cancer Biology, University of Massachusetts Medical School, Worcester, MA 01655, USA.
| |
Collapse
|
17
|
Walkovich K, Connelly JA. Congenital Neutropenia and Rare Functional Phagocyte Disorders in Children. Hematol Oncol Clin North Am 2019; 33:533-551. [PMID: 31030818 DOI: 10.1016/j.hoc.2019.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Both profound neutropenia and functional phagocyte disorders render patients susceptible to recurrent, unusual, and/or life-threatening infections. Many disorders also have nonhematologic manifestations and a substantial risk of leukemogenesis. Diagnosis relies on clinical suspicion and interrogation of the complete blood count with differential/bone marrow examination coupled with immunologic and genetic analyses. Treatment of the quantitative neutrophil disorders depends on granulocyte colony-stimulating factor, whereas management of functional phagocyte disease is reliant on antimicrobials and/or targeted therapies. Hematopoietic stem cell transplant remains the only curative option for most disorders but is not used on a routine basis.
Collapse
Affiliation(s)
- Kelly Walkovich
- Pediatric Hematology/Oncology, Department of Pediatrics, University of Michigan Medical School, 1500 E. Medical Center Drive, D4202 Medical Professional Building, SPC 5718, Ann Arbor, MI 48109-5718, USA.
| | - James A Connelly
- Pediatric Hematopoietic Stem Cell Transplant, Department of Pediatrics, Vanderbilt University Medical Center, 2220 Pierce Avenue, 397 PRB, Nashville, TN 37232-6310, USA
| |
Collapse
|
18
|
Marques DP, Rocha S, Manso M, Domingos R. Periodic Fever with Pharyngitis, Aphthous Stomatitis and Cervical Adenitis Syndrome: A Rare Cause of Fever in Adults. Eur J Case Rep Intern Med 2019; 6:001041. [PMID: 30931275 PMCID: PMC6438113 DOI: 10.12890/2019_001041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 01/09/2019] [Indexed: 11/18/2022] Open
Abstract
Periodic fever with pharyngitis, aphthous stomatitis and cervical adenitis (PFAPA syndrome) is a common cause of periodic fever in children and usually manifests as episodes of fever recurring with a clockwork periodicity. Although rare after adolescence, adult patients with PFAPA syndrome may present with a wider range of symptoms and may lack the clockwork periodicity of fever. A 24-year-old patient presented with a 4-year history of periodic fever with pharyngitis and cervical adenitis. She also complained of vomiting, fatigue and sporadically presented with aphthous stomatitis. During crises, laboratory evaluation showed a moderate elevation of inflammatory markers. Blood cultures and ANA titres were negative. Immunoglobulins and serum ferritin levels were normal. After other causes of periodic fever had been excluded, a diagnosis of PFAPA syndrome was made.
Collapse
Affiliation(s)
| | - Sara Rocha
- Internal Medicine Department, Hospital de Egas Moniz, Lisbon, Portugal
| | - Marta Manso
- Internal Medicine Department, Hospital de Egas Moniz, Lisbon, Portugal
| | - Raquel Domingos
- Internal Medicine Department, Hospital de Egas Moniz, Lisbon, Portugal
| |
Collapse
|
19
|
Congenital neutropenia and primary immunodeficiency diseases. Crit Rev Oncol Hematol 2019; 133:149-162. [DOI: 10.1016/j.critrevonc.2018.10.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 10/09/2018] [Accepted: 10/09/2018] [Indexed: 02/06/2023] Open
|
20
|
Arun AK, Senthamizhselvi A, Hemamalini S, Edison ES, Korula A, Fouzia NA, George B, Mathews V, Balasubramanian P. Spectrum of ELANE mutations in congenital neutropenia: a single-centre study in patients of Indian origin. J Clin Pathol 2018; 71:1046-1050. [PMID: 30171085 DOI: 10.1136/jclinpath-2018-205235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/21/2018] [Accepted: 07/25/2018] [Indexed: 01/05/2023]
Abstract
AIMS Congenital and cyclical neutropenia are rare inherited diseases that result in recurrent life-threatening bacterial infections due to a deficiency of mature neutrophils. Cyclical neutropenia is usually caused by heterozygous ELANE mutations while congenital neutropenia is genetically heterogeneous with mutations in genes like ELANE, HAX-1, G6PC3 and GFI1. The presence of ELANE mutation aids in the establishment of diagnosis and rules out other secondary causes of neutropenia such as autoimmune cytopenia and evolving aplasia. Further, patients with ELANE mutations are also at a high risk of developing myelodysplasia or acute myeloid leukaemia. Hence it is important to screen for these mutations in patients presenting with neutropenia early in life. METHODS The study included 52 patients who were evaluated for inherited neutropenia. Genomic DNA was extracted from peripheral blood leucocytes and mutation analysis was done by bidirectional Sanger sequencing. RESULTS Ten different missense, frameshift or splice site variants in ELANE gene were identified in 11 patients: c.125C>T (p.Pro42Leu), c.164G>A (p.Cys55Tyr), c.169G>A (p.Ala57Thr), c.179T>C (p.Ile60Thr), c.770C>T (p.Pro257Leu), c.367-8C>A, c.597+1G>A along with three novel mutations c.302T>A (p.Val101Glu), c.468G>T (p.Try156Cys) and c.596delT (Phe199Ser fs*13). Family studies were available for three patients and, in all three instances, the mutation had a de novo origin. CONCLUSION The widespread distribution of mutations suggests the need to screen all the exons in ELANE gene for proper characterisation of the genotype.
Collapse
Affiliation(s)
- A Kumar Arun
- Department of Haematology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Suresh Hemamalini
- Department of Haematology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Eunice S Edison
- Department of Haematology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anu Korula
- Department of Haematology, Christian Medical College, Vellore, Tamil Nadu, India
| | - N A Fouzia
- Department of Haematology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Biju George
- Department of Haematology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vikram Mathews
- Department of Haematology, Christian Medical College, Vellore, Tamil Nadu, India
| | | |
Collapse
|
21
|
Feng JH, Qian Y. [Advances in research on childhood neutropenia]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:484-489. [PMID: 28407840 PMCID: PMC7389658 DOI: 10.7499/j.issn.1008-8830.2017.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/28/2016] [Indexed: 06/07/2023]
Abstract
Neutrophils, an important type of human immune cells, are involved in host defense against infections. Neutropenia refers to a group of diseases manifesting as a reduction in the absolute value of mature neutrophils and is often accompanied by an increased risk of bacterial infection. According to etiology and pathogenesis, neutropenia is classified into congenital and acquired neutropenia. This article reviews the current research status and advances in the etiology of neutropenia in children. A deep understanding of the etiology of neutropenia helps to improve the diagnosis and treatment of this disease.
Collapse
Affiliation(s)
- Jian-Hua Feng
- Department of Pediatric Hematology/Oncology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China.
| | | |
Collapse
|
22
|
Okolo ON, Katsanis E, Yun S, Reveles CY, Anwer F. Allogeneic Transplant in ELANE and MEFV Mutation Positive Severe Cyclic Neutropenia: Review of Prognostic Factors for Secondary Severe Events. Case Rep Hematol 2017; 2017:5375793. [PMID: 28197346 PMCID: PMC5286543 DOI: 10.1155/2017/5375793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/01/2016] [Accepted: 12/07/2016] [Indexed: 12/15/2022] Open
Abstract
Objective and Importance. Cyclic neutropenia (CyN) is a rare autosomal dominant inherited disorder due to the mutation ELANE primarily affecting bone marrow stem cells and is characterized by recurrent neutropenia every 2 to 4 weeks. Symptoms vary from benign to severe, including death. Postulations on the cause of wide spectrum in symptom presentation include the possibility of other genetic mutations, such as MEFV. Recommended treatment for CyN is G-CSF to keep ANC higher to minimize risk of infection. Case. A 25-year-old male diagnosed with CyN, on G-CSF but worsening quality of life. Pretransplant investigations revealed ELANE mutation positive severe CyN along with familial Mediterranean fever (MEFV) mutation. Intervention. Bone marrow transplantation as treatment for dual mutation (ELANE and MEFV mutation) positive severe CyN. Conclusion. BMT may be considered as an alternative treatment for severe CyN in patients who are refractory to G-CSF. It is postulated that in our patient the combined mutations (CyN and MEFV) may have contributed to the severity of this individual's symptoms. We suggest CyN patients who present with severe symptoms have evaluation with ELANE mutation testing, Periodic Fever Syndromes Panel, and routine marrow assessment with FISH, conventional cytogenetics, and morphological evaluation for MDS/AML.
Collapse
Affiliation(s)
| | - Emmanuel Katsanis
- Department of Medicine, University of Arizona, Tucson, AZ, USA
- Department of Pediatrics, University of Arizona, Tucson, AZ, USA
- Division of Blood & Marrow Transplantation, University of Arizona, Tucson, AZ, USA
- Department of Pathology, University of Arizona, Tucson, AZ, USA
| | - Seongseok Yun
- Department of Medicine, University of Arizona, Tucson, AZ, USA
| | | | - Faiz Anwer
- Department of Pediatrics, University of Arizona, Tucson, AZ, USA
- Division of Hematology and Oncology, University of Arizona, Tucson, AZ, USA
| |
Collapse
|
23
|
Margaroli C, Tirouvanziam R. Neutrophil plasticity enables the development of pathological microenvironments: implications for cystic fibrosis airway disease. Mol Cell Pediatr 2016; 3:38. [PMID: 27868161 PMCID: PMC5136534 DOI: 10.1186/s40348-016-0066-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 11/04/2016] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The pathological course of several chronic inflammatory diseases, including cystic fibrosis, chronic obstructive pulmonary disease, and rheumatoid arthritis, features an aberrant innate immune response dominated by neutrophils. In cystic fibrosis, neutrophil burden and activity of neutrophil elastase in the extracellular fluid have been identified as strong predictors of lung disease severity. REVIEW Although neutrophils are generally considered to be rigid, pre-programmed effector leukocytes, recent studies suggest extensive plasticity in how neutrophil functions unfold upon recruitment to peripheral tissues, and how they choose their ultimate fate. Indeed, upon migration to cystic fibrosis airways, neutrophils display dysregulated lifespan, metabolic activation, and altered effector and regulatory functions, consistent with profound adaptation and phenotypic reprogramming. Licensed by signals present in cystic fibrosis airway microenvironment to survive and develop these novel functions, neutrophils orchestrate, in partnership with the epithelium and with the resident microbiota, the evolution of a pathological microenvironment. This microenvironment is defined by altered proteolytic, redox, and metabolic balance and the presence of stable luminal structures in which neutrophils and microbes coexist. CONCLUSIONS The elucidation of molecular mechanisms driving neutrophil plasticity in vivo will open new treatment opportunities designed to modulate, rather than block, the crucial adaptive functions fulfilled by neutrophils. This review aims to outline emerging mechanisms of neutrophil plasticity and their participation in the building of pathological microenvironments in the context of cystic fibrosis and other diseases with similar features.
Collapse
Affiliation(s)
- Camilla Margaroli
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Center for CF and Airways Disease Research, Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA
- Emory + Children's Center, 2015 Uppergate Dr NE, Rm 344, Atlanta, GA, 30322-1014, USA
| | - Rabindra Tirouvanziam
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, 30322, USA.
- Center for CF and Airways Disease Research, Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA.
- Emory + Children's Center, 2015 Uppergate Dr NE, Rm 344, Atlanta, GA, 30322-1014, USA.
| |
Collapse
|
24
|
Ahangari G, Chavoshzadeh Z, Lari Z, Ramyar A, Farhoudi A. Novel Mutation Detection of an Inflammatory Molecule Elastase ii Gene Encoding Neutrophil Elastase in Kostmann Syndrome. EUR J INFLAMM 2016. [DOI: 10.1177/1721727x0700500202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Severe congenital neutropenia (SCN), often referred to as Kostmann syndrome, is a rare immune deficiency syndrome diagnosed at or soon after birth, characterized by maturation arrest of myeloid cells at the promyelocyte stage of hematopoiesis. In severe congenital neutropenia due to disorder of neutrophil production, patients are predisposed to recurrent bacterial infections. Recently, there have been reports of detected mutations in neutrophil elastase II (ELA2) gene in genomic DNA of severe congenital neutropenia. In this study we attempted to determine whether there is any mutation in elastase II gene encoding. Peripheral blood was collected from five patients with severe congenital neutropenia and 20 healthy individuals. Total RNA was isolated using RNA standard techniques from fresh separated cells by Polymorphoprep. RNA was analyzed by employing PCR amplification of reverse transcribed using a total of ten specific primers. We amplified five exons of ELA2 gene separately and sequenced each exon. Mutational analysis was performed by directed capillary sequencing method. We found mutations in all severe congenital neutropenia patients and no mutation in 20 healthy individuals. The most mutations were in exon 4 and no mutation was found in exons 3 and 5.
Collapse
Affiliation(s)
| | - Z. Chavoshzadeh
- Department of Clinical Immunology, Center for Pediatric Hospital, Teheran University of Medical Sciences, Teheran
| | | | - A. Ramyar
- Department of Hematology and Oncology, Center for Pediatric Hospital, Teheran University of Medical sciences, Tehran, Iran
| | - A. Farhoudi
- Department of Clinical Immunology, Center for Pediatric Hospital, Teheran University of Medical Sciences, Teheran
| |
Collapse
|
25
|
Ahangari G, Farhoudi A, Chavoshzadeh Z, Ramyar A, Jamshidi S. RT-PCR Based Mutation Detection of the Inflammatory Molecules Elastase II Gene Encoding Neutrophil Elastase in Cyclic Neutropenia Patients by Capillary Sequencing. EUR J INFLAMM 2016. [DOI: 10.1177/1721727x0600400105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cyclic neutropenia is characterized by the maturation arrest of myeloid cells at the promyelocyte stage of hematopoiesis. In cyclic neutropenia, due to the disorder of neutrophil production, patients are predisposed to recurrent bacterial infections. Detected mutations in neutrophil elastase (ELA2) gene in genomic DNA of cyclic neutropenia were recently reported. Peripheral blood was obtained from 18 patients with cyclic neutropenia and 20 healthy individuals. Total RNA was isolated using RNA standard techniques from fresh separated cells by polymorphoprep. Elastase II mRNA expression was analyzed by employing reverse transcription PCR amplification using a total of ten specific primers. We amplified five exon of ELA2 gene separately and sequenced each exon. Mutational analysis was performed by directed capillary sequencing method. We found mutations in 15 out of 18 cyclic neutropenia patients (83%) and no mutation in 20 healthy individuals. Most of the mutations were in exon 4 and fewer mutation were found in exon 1.
Collapse
Affiliation(s)
| | - A. Farhoudi
- Department of Clinical Immunology, Center for Pediatric hospital, Tehran University of Medical Sciences, Tehran
| | - Z. Chavoshzadeh
- Department of Clinical Immunology, Center for Pediatric hospital, Tehran University of Medical Sciences, Tehran
| | - A. Ramyar
- Department of Hematology and Oncology, Center for Pediatric hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | |
Collapse
|
26
|
A novel mechanism for NETosis provides antimicrobial defense at the oral mucosa. Blood 2015; 126:2128-37. [DOI: 10.1182/blood-2015-04-641142] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/20/2015] [Indexed: 12/18/2022] Open
Abstract
Key Points
Saliva induces bactericidal and DNase resistant NETs in the oral cavity via sialyl LewisX- L-selectin signaling. Disordered homeostasis in the oral cavity may lead to deficient saliva-mediated NETosis.
Collapse
|
27
|
Glavan N, Roganović J, Glavan-Gačanin L, Jonjić N. Appendectomy in a child with cyclic neutropenia in profound neutropenic episode. Ther Clin Risk Manag 2015; 11:1217-9. [PMID: 26316766 PMCID: PMC4544725 DOI: 10.2147/tcrm.s89488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Our experience in the treatment of a 4-year-old boy with cyclic neutropenia who was admitted for urgent appendectomy is described. The postoperative course was uneventful with high daily doses of granulocyte colony-stimulating factor and antimicrobial therapy. The purpose of this report is to highlight the importance of immediate appendectomy in neutropenic patients, wherein low absolute neutrophil count should not be considered as a contraindication for urgent surgical procedure.
Collapse
Affiliation(s)
- Nedeljka Glavan
- Department of Pediatrics Surgery, University Hospital Centre Rijeka, Rijeka, Croatia
| | - Jelena Roganović
- Department of Pediatrics Hematology and Oncology, University Hospital Centre Rijeka, Rijeka, Croatia
| | - Lana Glavan-Gačanin
- Department of Obstetrics and Gynecology, University Hospital Centre Rijeka, Rijeka, Croatia
| | - Nives Jonjić
- Department of Pathology, School of Medicine, University of Rijeka, Rijeka, Croatia
| |
Collapse
|
28
|
The diversity of mutations and clinical outcomes for ELANE-associated neutropenia. Curr Opin Hematol 2015; 22:3-11. [PMID: 25427142 DOI: 10.1097/moh.0000000000000105] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Mutations in the gene for neutrophil elastase, ELANE, cause cyclic neutropenia (CyN) and severe congenital neutropenia (SCN). This study summarized data from the Severe Chronic Neutropenia International Registry (SCNIR) on genotype-phenotype relationships of ELANE mutations to important clinical outcomes. We also summarize findings for ELANE mutations not observed in SCNIR patients. RECENT FINDINGS There were 307 SCNIR patients with 104 distinctive ELANE mutations who were followed longitudinally for up to 27 years. The ELANE mutations were diverse; there were 65 single amino acid substitutions; 61 of these mutations (94%) were 'probably' or 'possibly damaging' by PolyPhen-2 analysis, and one of the 'benign' mutations was associated with two cases of acute myeloid leukemia (AML). All frame-shift mutations (19/19) were associated with the SCN. The pattern of mutations in the SCN versus CyN was significantly different (P < 10), but some mutations were observed in both groups (overlapping mutations). The cumulative incidence of severe adverse events, that is, myelodysplasia, AML, stem cell transplantation, or deaths was significantly greater for patients with SCN versus those with CyN or overlapping mutations. Specific mutations (i.e. G214R or C151Y) had a high risk for evolution to AML. SUMMARY Sequencing is useful for predicting outcomes of ELANE-associated neutropenia.
Collapse
|
29
|
Baird JH, Minniti CP, Lee JM, Tian X, Wu C, Jackson M, Alam S, Taylor JG, Kato GJ. Oscillatory haematopoiesis in adults with sickle cell disease treated with hydroxycarbamide. Br J Haematol 2015; 168:737-46. [PMID: 25377027 PMCID: PMC4323880 DOI: 10.1111/bjh.13203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 09/15/2014] [Indexed: 11/28/2022]
Abstract
Hydroxycarbamide therapy has been associated with significant oscillations in peripheral blood counts from myeloid, lymphoid and erythroid lineages in patients with polycythaemia vera and chronic myeloid leukaemia. We retrospectively evaluated serial blood counts over an 8-year period from 44 adult patients with sickle cell disease receiving hydroxycarbamide. Platelet counts, leucocyte counts, haemoglobin values and reticulocyte counts, apportioned by hydroxycarbamide status, were analysed using a Lomb-Scargle periodogram algorithm. Significant periodicities were present in one or more counts in 38 patients receiving hydroxycarbamide for a mean duration of 4·81 years. Platelet and leucocyte counts oscillated in 56·8% and 52·3% of patients, respectively. These oscillations generally became detectable within days of initiating therapy. During hydroxycarbamide therapy, the predominant periods of oscillation were 27 ± 1 d for platelet counts and 15 ± 1 d for leucocyte counts. Despite an absolute decrease in leucocyte and platelet counts during hydroxycarbamide treatment, the amplitudes between nadirs and zeniths remained similar regardless of exposure. Our observations appear consistent with previously proposed models of cyclic haematopoiesis, and document that hydroxycarbamide-induced oscillations in blood counts are innocuous phenomena not limited to myeloproliferative disorders as described previously. We speculate the known cell cycle inhibitory properties of hydroxycarbamide may accentuate otherwise latent constitutive oscillatory haematopoiesis.
Collapse
Affiliation(s)
- John H. Baird
- Hematology Branch, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Jung-Min Lee
- Medical Oncology Branch, National Cancer Institute; National Institutes of Health, Bethesda, Maryland, USA
| | - Xin Tian
- Office of Biostatistics Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Colin Wu
- Office of Biostatistics Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Mary Jackson
- Hematology Branch, National Institutes of Health, Bethesda, Maryland, USA
| | - Shoaib Alam
- Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute; National Institutes of Health, Bethesda, Maryland, USA
| | - James G. Taylor
- Hematology Branch, National Institutes of Health, Bethesda, Maryland, USA
| | - Gregory J. Kato
- Division of Hematology-Oncology, Department of Medicine and the Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
30
|
Affiliation(s)
- Liza Köster
- Department of Companion Animal Clinical StudiesFaculty of Veterinary ScienceUniversity of PretoriaOnderstepoortGautengSouth Africa
- Department of Small Animal Internal MedicineRoss University School of Veterinary MedicineBasseterreSaint Kitts and Nevis
| | - Cindy Harper
- Veterinary Genetics LaboratoryFaculty of Veterinary ScienceUniversity of PretoriaOnderstepoortGautengSouth Africa
| | - Amelia Goddard
- Department of Clinical PathologyFaculty of Veterinary ScienceUniversity of PretoriaOnderstepoortGautengSouth Africa
| |
Collapse
|
31
|
Alonso Quintela P, Mora Matilla M, Gautreaux Minaya S, Rodríguez Blanco S, Rodríguez Fernández L. Aftas orales recurrentes como manifestación clínica en un caso de neutropenia cíclica con mutación en el gen ELA 2. An Pediatr (Barc) 2014; 81:e68-9. [DOI: 10.1016/j.anpedi.2014.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/14/2014] [Accepted: 04/22/2014] [Indexed: 11/28/2022] Open
|
32
|
Grassinger J, Khomenko A, Hart C, Baldaranov D, Johannesen SW, Mueller G, Schelker R, Schulte-Mattler W, Andreesen R, Bogdahn U. Safety and feasibility of long term administration of recombinant human granulocyte-colony stimulating factor in patients with amyotrophic lateral sclerosis. Cytokine 2014; 67:21-8. [PMID: 24680478 DOI: 10.1016/j.cyto.2014.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 01/26/2014] [Accepted: 02/02/2014] [Indexed: 01/08/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neuronal disease resulting in a loss of the upper and lower motor neurons and subsequent death within three to four years after diagnosis. Mouse models and preliminary human exposure data suggest that the treatment with granulocyte-colony stimulating factor (G-CSF) has neuro-protective effects and may delay ALS progression. As data on long-term administration of G-CSF in patients with normal bone marrow (BM) function are scarce, we initiated a compassionate use program including 6 ALS patients with monthly G-CSF treatment cycles. Here we demonstrate that G-CSF injection was safe and feasible throughout our observation period up to three years. Significant decrease of mobilization efficiency occurred in one patient and a loss of immature erythroid progenitors was observed in all six patients. These data imply that follow-up studies analyzing BM function during long-term G-CSF stimulation are required.
Collapse
Affiliation(s)
- Jochen Grassinger
- University Hospital Regensburg, Department of Internal Medicine III, Regensburg, Germany.
| | - Andrei Khomenko
- University Hospital Regensburg, Department of Neurology, Regensburg, Germany
| | - Christina Hart
- University Hospital Regensburg, Department of Internal Medicine III, Regensburg, Germany
| | - Dobri Baldaranov
- University Hospital Regensburg, Department of Neurology, Regensburg, Germany
| | - Siw W Johannesen
- University Hospital Regensburg, Department of Neurology, Regensburg, Germany
| | - Gunnar Mueller
- University Hospital Regensburg, Department of Internal Medicine III, Regensburg, Germany
| | - Roland Schelker
- University Hospital Regensburg, Department of Internal Medicine III, Regensburg, Germany
| | | | - Reinhard Andreesen
- University Hospital Regensburg, Department of Internal Medicine III, Regensburg, Germany
| | - Ulrich Bogdahn
- University Hospital Regensburg, Department of Neurology, Regensburg, Germany
| |
Collapse
|
33
|
Parvaneh N, Ziaee V, Moradinejad MH, Touitou I. Intermittent neutropenia as an early feature of mild mevalonate kinase deficiency. J Clin Immunol 2013; 34:123-6. [PMID: 24177804 DOI: 10.1007/s10875-013-9955-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 10/14/2013] [Indexed: 11/27/2022]
Abstract
A 15-month-old boy, born to Iranian consanguineous parents presented with intermittent neutropenia interspersed with episodes of fever and leukocytosis since early infancy. No ELA2 mutations were found and the bone marrow study was normal. At age 4 years he progressed to more typical attacks of periodic attacks of fever, abdominal pain, oral aphthous ulcers, cutaneous rash and leukocytosis. The clinical and laboratory features were compatible with the mild form of mevalonate kinase deficiency, usually named "Hyper-IgD and periodic fever syndrome" (HIDS). Genomic sequencing of the mevalonate kinase (MVK) gene revealed homozygous missense mutation (p.Val377Ile). On demand dexamethasone resulted in a rapid amelioration of febrile episodes. The presentation of intermittent neutropenia has not been reported in HIDS and deserves more attention in large patient cohorts.
Collapse
Affiliation(s)
- Nima Parvaneh
- Pediatric Infectious Diseases Research Center, Children's Medical Center, Tehran University of Medical Sciences, 62 Gharib St, 14194, Tehran, Iran,
| | | | | | | |
Collapse
|
34
|
Romero-Weaver AL, Wan XS, Diffenderfer ES, Lin L, Kennedy AR. Effect of SPE-like proton or photon radiation on the kinetics of mouse peripheral blood cells and radiation biological effectiveness determinations. ASTROBIOLOGY 2013; 13:570-7. [PMID: 23980767 PMCID: PMC3689168 DOI: 10.1089/ast.2012.0916] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Exploration missions outside low-Earth orbit are being planned; therefore, it is critical to understand the risk astronauts would be exposed to in the space environment, especially during extravehicular activities (EVAs). Reductions in white blood cell (WBC) numbers can occur as a result of exposure to solar particle event (SPE) radiation. The aim of the present study was to determine the duration of the effects on blood cell numbers from exposure to a single whole-body dose of SPE-like proton radiation or photon radiation as well as to determine the radiation biological effectiveness (RBE) values at those times when radiation exposure causes blood cell numbers to experience the most critical effects when using mice as a model. Our results indicate that both types of radiation cause significant reductions in the numbers of all blood cell types at different times post-irradiation. The RBE values were not significantly different from 1.0. These results indicate that the risk estimations for astronauts from exposure of mice to SPE-like proton radiation are comparable to those previously made for doses of standard reference radiations, suggesting that countermeasures should be developed for the decreases in blood cell counts observed following the exposure of mice to SPE radiation.
Collapse
Affiliation(s)
- A L Romero-Weaver
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | | | | | | | | |
Collapse
|
35
|
Germeshausen M, Deerberg S, Peter Y, Reimer C, Kratz CP, Ballmaier M. The Spectrum ofELANEMutations and their Implications in Severe Congenital and Cyclic Neutropenia. Hum Mutat 2013; 34:905-14. [DOI: 10.1002/humu.22308] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 02/27/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Manuela Germeshausen
- Department of Pediatric Hematology and Oncology; Hannover Medical School; Hannover; Germany
| | - Sabine Deerberg
- Department of Pediatric Hematology and Oncology; Hannover Medical School; Hannover; Germany
| | - Yvonne Peter
- Department of Pediatric Hematology and Oncology; Hannover Medical School; Hannover; Germany
| | - Christina Reimer
- Research Facility Cell Sorting; Hannover Medical School; Hannover; Germany
| | - Christian P. Kratz
- Department of Pediatric Hematology and Oncology; Hannover Medical School; Hannover; Germany
| | - Matthias Ballmaier
- Department of Pediatric Hematology and Oncology; Hannover Medical School; Hannover; Germany
| |
Collapse
|
36
|
Kallinich T, Gattorno M, Grattan CE, de Koning HD, Traidl-Hoffmann C, Feist E, Krause K, Lipsker D, Navarini AA, Maurer M, Lachmann HJ, Simon A. Unexplained recurrent fever: when is autoinflammation the explanation? Allergy 2013; 68:285-96. [PMID: 23330689 DOI: 10.1111/all.12084] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2012] [Indexed: 11/29/2022]
Abstract
Recurrent fever can be the sole or leading manifestation of a variety of diseases including malignancies, autoimmune diseases and infections. Because the differential diagnoses are manifold, no formal guidelines for the approach of patients with recurrent fever exists. The newly recognized group of autoinflammatory diseases are often accompanied by repetitive fever attacks. As these episodes are frequently associated by a variety of divergent presentations, the differentiation of other causes for febrile illnesses can be difficult. In this article, we first review disease entities, which frequently present with the symptom of recurrent fever. In a next step, we summarize their characteristic pattern of disease presentation. Finally, we analyse key features of autoinflammatory diseases, which are helpful to distinguish this group of diseases from the other causes of recurrent fever. Recognizing these symptom patterns can provide the crucial clues and, thus, lead to the initiation of targeted specific diagnostic tests and therapies.
Collapse
Affiliation(s)
| | - M. Gattorno
- UO Pediatria II; G. Gaslini Institute; Genova; Italy
| | - C. E. Grattan
- St John's Institute of Dermatology; St Thomas' Hospital; London; UK
| | - H. D. de Koning
- Department of Dermatology; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| | | | | | | | - D. Lipsker
- Faculté de Médecine; Université de Strasbourg et Clinique Dermatologique; Hôpitaux universitaires de Strasbourg; Strasbourg, France
| | - A. A. Navarini
- Department of Dermatology; University Hospital of Zurich; Zurich; Switzerland
| | | | - H. J. Lachmann
- National Amyloidosis Centre; University College London Medical School; London; UK
| | - A. Simon
- Department of General Internal Medicine; Nijmegen Institute for Infection, Inflammation and Immunology (N4i); Centre for Immunodeficiency and Autoinflammation (NCIA); Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| |
Collapse
|
37
|
Abstract
PURPOSE OF REVIEW Neutropenia is a feature of several primary immunodeficiency diseases (PIDDs). Because of the diverse pathophysiologies of the PIDDs and the rarity of each disorder, data are often lacking, leading to the necessity of empiric treatment. Recent developments in the understanding of neutropenia in several of the PIDDs make a review of the data timely. RECENT FINDINGS The category of severe congenital neutropenia continues to expand. Mutations in G6PC3 have been identified as the cause of neutropenia in a minority of previously molecularly undefined cases. Recent advances have broadened our understanding of the pathophysiology and the clinical expression of this disorder. A possible function of the C16orf57 gene has been hypothesized that may explain the clinical overlap between Clerucuzio-type poikiloderma with neutropenia and other marrow diseases. Plerixafor has been shown to be a potentially useful treatment in the warts, hypogammaglobulinemia, infection, and myelokathexis syndrome. Investigations of patients with adenosine deaminase deficient severe combined immunodeficiency have identified neutropenia, and particularly susceptibility to myelotoxins, as a feature of this disorder. Granulocyte-colony stimulating factor is the treatment of choice for neutropenia in PIDD, whereas hematopoietic cell transplantation is the only curative option. SUMMARY The number of PIDDs associated with neutropenia has increased, as has our understanding of the range of phenotypes. Additional data and hypotheses have been generated helping to explain the diversity of presentations of neutropenia in PIDDs.
Collapse
Affiliation(s)
- Robert Sokolic
- Disorders of Immunity Section, Genetics and Molecular Biology Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland 20892-1611, USA.
| |
Collapse
|
38
|
Lee MJ, Yoo JJ, Kang EH, Lee SG, Shin K, Lee EY, Lee EB, Song YW, Lee YJ. Adult-onset Cyclic Neutropenia Diagnosed in a Patient with Acute Arthritis. JOURNAL OF RHEUMATIC DISEASES 2013. [DOI: 10.4078/jrd.2013.20.1.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Myung Jin Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jong Jin Yoo
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Ha Kang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Guk Lee
- Department of Laboratory Medicine, Armed Forces Capital Hospital, Seongnam, Korea
| | - Kichul Shin
- Department of Internal Medicine, Seoul National University Borame Hospital, Seoul, Korea
| | - Eun Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Bong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yeong-Wook Song
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yun Jong Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
39
|
Lee WI, Chen SH, Huang JL, Jaing TH, Chung HT, Yeh KW, Chen LC, Yao TC, Hsieh MY, Lin SJ, Kuo ML. Identifying patients with neutrophil elastase (ELANE) mutations from patients with a presumptive diagnosis of autoimmune neutropenia. Immunobiology 2012. [PMID: 23206890 DOI: 10.1016/j.imbio.2012.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To differentiate severe congenital neutropenia (SCN) from autoimmune neutropenia (AIN) in patients with persistent neutropenia ≤1000/mm(3) over three months, we evaluated anti-neutrophil auto-antibodies, candidate genes of ELANA, HAX1 and GCSFR, and neutrophil elastase (NE) activity in 38 patients (21 females; average onset age 14.12 ± 2.49 months) in a primary immunodeficiency disease center between 2004 and 2011. In 30 patients, detectable anti-neutrophil auto-antibodies were HNA1a in 16 patients, HNA1c in 15, MHC Class I in 14, HNA1b in eight, MHC Class II in five, and HNA2a in three. Their average neutropenia duration was 27.04 ± 2.08 months. Of eight patients without detectable auto-antibodies, three had ELANE mutations [Ser126Pro, Arg170Phe and Cys223stop] and recurrent muco-cutaneous infections and sepsis. The patient with nonsense ELANE mutation [Cys223stop] had the lowest NE activity (16.8). Thus, patients with ELANE mutations have undetectable antibodies and more severe and younger-onset muco-cutaneous infections, prolonged healing and decreased serum NE activity that require prompt intervention.
Collapse
Affiliation(s)
- Wen-I Lee
- Primary Immunodeficiency Care And Research (PICAR) Institute, Chang Gung University, College of Medicine and Memorial Hospital Taoyuan, Taiwan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Maruthappu T, Tharakaram S, Calonje E, Shirlaw PJ, Setterfield J. Erythema elevatum diutinum with oral ulceration. Br J Dermatol 2012; 167:222-4. [PMID: 22284024 DOI: 10.1111/j.1365-2133.2012.10851.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
41
|
Fioredda F, Calvillo M, Bonanomi S, Coliva T, Tucci F, Farruggia P, Pillon M, Martire B, Ghilardi R, Ramenghi U, Renga D, Menna G, Pusiol A, Barone A, Gambineri E, Palazzi G, Casazza G, Lanciotti M, Dufour C. Congenital and acquired neutropenias consensus guidelines on therapy and follow-up in childhood from the Neutropenia Committee of the Marrow Failure Syndrome Group of the AIEOP (Associazione Italiana Emato-Oncologia Pediatrica). Am J Hematol 2012; 87:238-43. [PMID: 22213173 DOI: 10.1002/ajh.22242] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 10/26/2011] [Indexed: 12/12/2022]
Abstract
The management of congenital and acquired neutropenias presents some differences according to the type of the disease. Treatment with recombinant human granulocyte-colony stimulating factor (G-CSF) is not standardized and scanty data are available on the best schedule to apply. The frequency and the type of longitudinal controls in patients affected with neutropenias are not usually discussed in the literature. The Neutropenia Committee of the Marrow Failure Syndrome Group (MFSG) of the Associazione Italiana di Emato-Oncologia Pediatrica (AIEOP) elaborated this document following design and methodology formerly approved by the AIEOP board. The panel of experts reviewed the literature on the topic and participated in a conference producing a document that includes recommendations on neutropenia treatment and timing of follow-up.
Collapse
|
42
|
Fioredda F, Calvillo M, Bonanomi S, Coliva T, Tucci F, Farruggia P, Pillon M, Martire B, Ghilardi R, Ramenghi U, Renga D, Menna G, Barone A, Lanciotti M, Dufour C. Congenital and acquired neutropenia consensus guidelines on diagnosis from the Neutropenia Committee of the Marrow Failure Syndrome Group of the AIEOP (Associazione Italiana Emato-Oncologia Pediatrica). Pediatr Blood Cancer 2011; 57:10-7. [PMID: 21448998 DOI: 10.1002/pbc.23108] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 02/07/2011] [Indexed: 12/30/2022]
Abstract
Congenital and acquired neutropenia are rare disorders whose frequency in pediatric age may be underestimated due to remarkable differences in definition or misdiagnosed because of the lack of common practice guidelines. Neutropenia Committee of the Marrow Failure Syndrome Group (MFSG) of the AIEOP (Associazione Italiana Emato-Oncologia Pediatrica) elaborated this document following design and methodology formerly approved by the AIEOP board. The panel of experts reviewed the literature on the topic and participated in a conference producing a document which includes a classification of neutropenia and a comprehensive guideline on diagnosis of neutropenia.
Collapse
|
43
|
Ogoina D. Fever, fever patterns and diseases called 'fever'--a review. J Infect Public Health 2011; 4:108-24. [PMID: 21843857 DOI: 10.1016/j.jiph.2011.05.002] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Revised: 04/21/2011] [Accepted: 05/08/2011] [Indexed: 12/12/2022] Open
Abstract
Fever is a prominent feature of disease since antiquity. The febrile response is orchestrated by the central nervous system through endocrine, neurological, immunological and behavioural mechanisms. Other than a regulated rise in body temperature, fever is often accompanied by various sickness behaviours, changes in metabolic and physiological characteristics of body systems and alterations in immune responses. Fever and the febrile response, therefore, remain significant contributors to the pathogenesis, clinical presentation and outcome of many illnesses and diseases. This review highlights the pathophysiology of the febrile response and describes the fever types and patterns, including their clinical significance. The various medical illnesses called "fever" are also listed and the origins of their appellations discussed.
Collapse
Affiliation(s)
- Dimie Ogoina
- Immunology and Infectious Disease Unit, Department of Medicine, Bingham University Teaching Hospital, Jos Plateau State, Nigeria.
| |
Collapse
|
44
|
Lee H, Han KH, Jung YH, Kang HG, Moon KC, Ha IS, Choi Y, Cheong HI. A case of systemic amyloidosis associated with cyclic neutropenia. Pediatr Nephrol 2011; 26:625-9. [PMID: 21161286 DOI: 10.1007/s00467-010-1715-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 10/10/2010] [Accepted: 11/02/2010] [Indexed: 10/18/2022]
Abstract
Reactive AA amyloidosis is caused by the accumulation of the acute phase reactant, serum amyloid A (SAA), as a complication of chronic inflammatory conditions. Cyclic neutropenia is a rare hereditary disorder characterized by repeated episodes of neutropenia at regular intervals, with or without concurrent infection, and is known to be a rare cause of AA amyloidosis. Here, we report a case of a patient who developed systemic AA amyloidosis following a prolonged course of undiagnosed cyclic neutropenia. The patient had a history of recurrent infections since infancy and developed goiter, proteinuria, and azotemia at age 14 years. Her SAA level was markedly increased (601.8 μg/mL, normal range <8 μg/mL), and a thyroid and kidney biopsy revealed typical lesions of AA amyloidosis. Amyloid deposits were also detected in the myocardium, colon, and gallbladder. She had repeated episodes of neutropenia regularly at 3-week intervals and a pathogenic mutation in the ELA2 gene. After 10 months of treatment with recombinant human granulocyte colony-stimulating factor, her SAA level normalized (<2.5 μg/mL), but her renal function did not recover. This case clearly shows that cyclic neutropenia can be complicated by AA amyloidosis unless it is detected early and treated adequately.
Collapse
Affiliation(s)
- HyunKyung Lee
- Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehang-no, Jongno-Gu, Seoul, 110-744, South Korea
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
Oral manifestations of hematologic and nutritional deficiencies can affect the mucous membranes, teeth, periodontal tissues, salivary glands, and perioral skin. This article reviews common oral manifestations of hematologic conditions starting with disorders of the white blood cells including cyclic hematopoiesis (cyclic neutropenia), leukemias, lymphomas, plasma cell dyscrasias, and mast cell disorders; this is followed by a discussion of the impact of red blood cell disorders including anemias and less common red blood cell dyscrasias (sickle cell disease, hemochromatosis, and congenital erythropoietic porphyria) as well as thrombocytopenia. Several nutritional deficiencies exhibit oral manifestations. The authors specifically discuss the impact of water-soluble vitamins (B2, B3, B6, B9, B12, and C), fat-soluble vitamins (A, D, and K) and the eating disorders anorexia nervosa and bulimia nervosa on the oral mucosa.
Collapse
|
46
|
|
47
|
Rocco R. [Periodic fever, aphthous stomatitis, pharyngitis and adenitis: PFAPA syndrome in Argentina]. An Pediatr (Barc) 2011; 74:161-7. [PMID: 21330226 DOI: 10.1016/j.anpedi.2010.10.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 08/05/2010] [Accepted: 10/03/2010] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION PFAPA syndrome is a benign, non-hereditary condition, of unknown etiology and pathogenesis. There are few reports of it in South America. The purpose of this article is to communicate the experience in a large pediatric hospital in Argentina. PATIENTS AND METHODS A total of 18 patients were diagnosed with PFAPA between 2002 and 2009 at the Medium Risk Clinic, Prof. Dr. Juan P. Garrahan Pediatrics Hospital, Buenos Aires City. The modified criteria reported by Thomas et al were used for diagnosis. The follow up continued with evaluations during new febrile episodes, clinic check ups and telephone calls. RESULTS The mean age at onset of symptoms was 2.5 years (range: 0.4-7.5) and the mean lag time from onset of symptoms and diagnosis was 3.2 years (range: 0.4-10.9). Fever episodes lasted for a mean of 4.5 days (range: 2-8), with a mean interval of 23 days (range: 15-30) between the beginning of the attacks. Febrile episodes were treated with methyl prednisone at a dose of 1mg/kg or betamethasone at a dose of 0.15mg/kg in a single dose. With a mean follow up of 2.6 years (range: 0.5-5.9) 13 patients remain with febrile episodes at a mean interval of 4.6 months (range: 1-12). Five patients did not have febrile crisis for more than a year during the study period and they are considered cured; in this group the disease lasted a mean of 4.7 years (1-9.7). CONCLUSIONS PFAPA syndrome is a sporadic, difficult to diagnose, condition. Both methyl-prednisone and betamethasone have shown to be effective in controlling the symptoms during the febrile crisis. The definitive remission of the syndrome may occur in the first years of onset, although in most patients the febrile episodes continue with an increase of free intervals and attenuated symptoms, and full recovery in prepuberty or adolescence with no sequelae.
Collapse
Affiliation(s)
- R Rocco
- Consultorios de Mediano Riesgo, Área Ambulatoria, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, República Argentina.
| |
Collapse
|
48
|
Abstract
Patients with severe chronic neutropenia have blood neutrophil level <0.5 × 10(9)/L, predisposing them to increased susceptibility to life-threatening bacterial infections. This chapter focuses on cyclic and congenital neutropenia, two very interesting and rare hematological conditions causing severe chronic neutropenia. Both disorders respond well to treatment with the myeloid growth factor, granulocyte colony-stimulating factor (G-CSF). This chapter describes the basic features of these diseases and addresses several current clinical issues regarding their diagnosis and management. Cyclic neutropenia is a rare, inherited autosomal dominant disorder due to mutations in the gene for neutrophil elastase (ELA-2 or ELANE). Usually these patients have regular oscillation of blood neutrophil counts with periods of severe neutropenia occurring every 21 days. During these periods, they have painful mouth ulcers, fevers, and bacterial infections. The most severe consequences are gangrene, bacteremia, and septic shock. Cyclic neutropenia patients respond well to treatment with granulocyte colony-stimulating factor (G-CSF) given by subcutaneous injections on a daily or alternate-day basis. Severe congenital neutropenia is also a rare hematological disease, but it is probably more common than cyclic neutropenia. Blood neutrophils are extremely low on a continuing basis; the levels may be <0.2 × 10(9)/L, and the risk of severe bacterial infections is even greater than in cyclic neutropenia. The majority of cases are due to autosomal dominant inheritance of mutations in the ELA-2 or ELANE gene. Less commonly, mutations in HAX-1, G6PC3, and other genes cause this disorder. Treatment with G-CSF is usually effective, but the dose of G-CSF required to normalize blood neutrophils varies greatly. Ten to thirty percent of severe congenital neutropenia patients evolve to develop acute myeloid leukemia, necessitating careful clinical monitoring.
Collapse
Affiliation(s)
- David C Dale
- Department of Medicine, University of Washington, Seattle, WA 98195, USA.
| | | |
Collapse
|
49
|
Martin J, Audrain M, Durant C, Rimbert M, Fromont P, Hamidou M. Neutropénies auto-immunes. Rev Med Interne 2011; 32:26-32. [DOI: 10.1016/j.revmed.2010.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 03/05/2010] [Accepted: 04/11/2010] [Indexed: 11/30/2022]
|
50
|
Affiliation(s)
- Victoria M Wurster
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University school of Medicine
| | | | | |
Collapse
|