1
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Kimizu T, Nozaki M, Okada Y, Sawada A, Morisaki M, Fujita H, Irie A, Matsuda K, Hasegawa Y, Nishi E, Okamoto N, Kawai M, Imai K, Suzuki Y, Wada K, Mitsuda N, Ida S. Multiplex Real-Time PCR-Based Newborn Screening for Severe Primary Immunodeficiency and Spinal Muscular Atrophy in Osaka, Japan: Our Results after 3 Years. Genes (Basel) 2024; 15:314. [PMID: 38540372 PMCID: PMC10970021 DOI: 10.3390/genes15030314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 06/14/2024] Open
Abstract
In newborn screening (NBS), it is important to consider the availability of multiplex assays or other tests that can be integrated into existing systems when attempting to implement NBS for new target diseases. Recent developments in innovative testing technology have made it possible to simultaneously screen for severe primary immunodeficiency (PID) and spinal muscular atrophy (SMA) using quantitative real-time polymerase chain reaction (qPCR) assays. We describe our experience of optional NBS for severe PID and SMA in Osaka, Japan. A multiplex TaqMan qPCR assay was used for the optional NBS program. The assay was able to quantify the levels of T-cell receptor excision circles and kappa-deleting recombination excision circles, which is useful for severe combined immunodeficiency and B-cell deficiency screening, and can simultaneously detect the homozygous deletion of SMN1 exon 7, which is useful for NBS for SMA. In total, 105,419 newborns were eligible for the optional NBS program between 1 August 2020 and 31 August 2023. A case each of X-linked agammaglobulinemia and SMA were diagnosed through the optional NBS and treated at early stages (before symptoms appeared). Our results show how multiplex PCR-based NBS can benefit large-scale NBS implementation projects for new target diseases.
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Affiliation(s)
- Tomokazu Kimizu
- Department of Pediatric Neurology, Osaka Women’s and Children’s Hospital, Izumi 594-1101, Japan;
| | - Masatoshi Nozaki
- Department of Neonatal Medicine, Osaka Women’s and Children’s Hospital, Izumi 594-1101, Japan;
- Department of Perinatal and Pediatric Infectious Diseases, Osaka Women’s and Children’s Hospital, Izumi 594-1101, Japan
| | - Yousuke Okada
- Department of Hematology/Oncology, Osaka Women’s and Children’s Hospital, Izumi 594-1101, Japan; (Y.O.); (A.S.)
| | - Akihisa Sawada
- Department of Hematology/Oncology, Osaka Women’s and Children’s Hospital, Izumi 594-1101, Japan; (Y.O.); (A.S.)
| | - Misaki Morisaki
- Department of Laboratory Medicine, Osaka Women’s and Children’s Hospital, Izumi 594-1101, Japan; (M.M.); (H.F.); (A.I.); (S.I.)
| | - Hiroshi Fujita
- Department of Laboratory Medicine, Osaka Women’s and Children’s Hospital, Izumi 594-1101, Japan; (M.M.); (H.F.); (A.I.); (S.I.)
| | - Akemi Irie
- Department of Laboratory Medicine, Osaka Women’s and Children’s Hospital, Izumi 594-1101, Japan; (M.M.); (H.F.); (A.I.); (S.I.)
| | - Keiko Matsuda
- Department of Medical Genetics, Osaka Women’s and Children’s Hospital, Izumi 594-1101, Japan; (K.M.); (Y.H.); (E.N.); (N.O.)
| | - Yuiko Hasegawa
- Department of Medical Genetics, Osaka Women’s and Children’s Hospital, Izumi 594-1101, Japan; (K.M.); (Y.H.); (E.N.); (N.O.)
| | - Eriko Nishi
- Department of Medical Genetics, Osaka Women’s and Children’s Hospital, Izumi 594-1101, Japan; (K.M.); (Y.H.); (E.N.); (N.O.)
| | - Nobuhiko Okamoto
- Department of Medical Genetics, Osaka Women’s and Children’s Hospital, Izumi 594-1101, Japan; (K.M.); (Y.H.); (E.N.); (N.O.)
| | - Masanobu Kawai
- Department of Pediatric Gastroenterology, Nutrition, and Endocrinology, Osaka Women’s and Children’s Hospital, Izumi 594-1101, Japan;
| | - Kohsuke Imai
- Department of Pediatrics, National Defense Medical College, Saitama 359-0042, Japan;
| | - Yasuhiro Suzuki
- Department of Pediatric Neurology, Osaka Women’s and Children’s Hospital, Izumi 594-1101, Japan;
| | - Kazuko Wada
- Department of Neonatal Medicine, Osaka Women’s and Children’s Hospital, Izumi 594-1101, Japan;
| | - Nobuaki Mitsuda
- Department of Maternal Fetal Medicine, Osaka Women’s and Children’s Hospital, Izumi 594-1101, Japan;
| | - Shinobu Ida
- Department of Laboratory Medicine, Osaka Women’s and Children’s Hospital, Izumi 594-1101, Japan; (M.M.); (H.F.); (A.I.); (S.I.)
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2
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Eissa E, Afifi HH, Abo-Shanab AM, Thomas MM, Taher MB, Kandil R, Kholoussi NM. Importance of TREC and KREC as molecular markers for immunological evaluation of down syndrome children. Sci Rep 2023; 13:15445. [PMID: 37723211 PMCID: PMC10507011 DOI: 10.1038/s41598-023-42370-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/09/2023] [Indexed: 09/20/2023] Open
Abstract
Recurrent and severe infections occurred in children with Down Syndrome (DS) due to immunological parameter defects have been reported. The aim of the study is to evaluate the importance of using T-cell receptor excision circle (TREC) and kappa-deleting recombination excision circle (KREC) as molecular markers for immunological investigation of children with DS. The study included 40 non-disjunction trisomy 21 confirmed DS children, and 25 healthy controls. Peripheral blood (PB) was analyzed for lymphocyte subpopulations by flow cytometry, serum immunoglobulin levels, and TREC and KREC copy numbers using quantitative real-time PCR. DS patients showed significantly lower absolute counts of PB T lymphocytes, T helper lymphocytes, T cytotoxic lymphocytes, B lymphocytes, and Natural killer cells, and lower serum IgA, IgG, and IgM levels compared to healthy controls. Copy number of TREC and KREC showed no significant differences between DS patients and healthy controls. There is a significant positive correlation between TREC copy number with a percentage and absolute count of helper T lymphocytes in patients. Also, the KREC copy number was significantly negatively correlated with the age of patients. These findings suggest that copy numbers of TREC and KREC could be useful as molecular markers for immunological evaluation of patients with DS.
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Affiliation(s)
- Eman Eissa
- Department of Immunogenetics, Human Genetics and Genome Research Institute, National Research Centre, Cairo, Egypt.
| | - Hanan H Afifi
- Department of Clinical Genetics, Developmental Assessment and Genetic Disorders Clinic, Human Genetics and Genome Research Institute, National Research Centre, Cairo, Egypt
| | - Assem M Abo-Shanab
- Department of Immunogenetics, Human Genetics and Genome Research Institute, National Research Centre, Cairo, Egypt
| | - Manal M Thomas
- Department of Clinical Genetics, Developmental Assessment and Genetic Disorders Clinic, Human Genetics and Genome Research Institute, National Research Centre, Cairo, Egypt
| | - Mohamed B Taher
- Department of Clinical Genetics, Developmental Assessment and Genetic Disorders Clinic, Human Genetics and Genome Research Institute, National Research Centre, Cairo, Egypt
| | - Rania Kandil
- Department of Immunogenetics, Human Genetics and Genome Research Institute, National Research Centre, Cairo, Egypt
| | - Naglaa M Kholoussi
- Department of Immunogenetics, Human Genetics and Genome Research Institute, National Research Centre, Cairo, Egypt
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3
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Makukh HV, Boyarchuk OR, Kravets VS, Yarema NM, Shimanska IE, Kinash MI, Tyrkus MY, Shulhai OM. Determining the Number of TREC and KREC Copies for Screening of Inborn Errors of Immunity. CYTOL GENET+ 2023. [DOI: 10.3103/s009545272301005x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
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4
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Medova V, Hulinkova I, Laiferova N, Urdova V, Ciznar P, Dolnikova D, Krasnanova V, Fabri O, Ficek A, Soltysova A. The importance of defining the age-specific TREC/KREC levels for detection of various inborn errors of immunity in pediatric and adult patients. Clin Immunol 2022; 245:109155. [DOI: 10.1016/j.clim.2022.109155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/01/2022] [Accepted: 10/07/2022] [Indexed: 11/26/2022]
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5
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Şentürk G, Ng YY, Eltan SB, Başer D, Ogulur I, Altındirek D, Fırtına S, Yılmaz H, Kocamış B, Kıykım A, Camcıoğlu Y, Ar MC, Sudutan T, Beken S, Temel ŞG, Alanay Y, Karakoc-Aydiner E, Barış S, Özen A, Özbek U, Sayitoğlu M, Hatırnaz Ng Ö. Determining T and B Cell development by TREC/KREC analysis in primary immunodeficiency patients and healthy controls. Scand J Immunol 2021; 95:e13130. [PMID: 34951041 DOI: 10.1111/sji.13130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/07/2021] [Accepted: 12/15/2021] [Indexed: 01/26/2023]
Abstract
T cell receptor excision circles (TRECs) and kappa-deleting excision circles (KRECs) are DNA fragments potentially indicative of T and B cell development, respectively. Recent thymic emigrants (RTEs) are a subset of peripheral cells that may also represent thymic function. Here, we investigated TREC/KREC copy numbers by quantitative real-time PCR in the peripheral blood of patients with primary immunodeficiencies (PIDs, n = 145) and that of healthy controls (HCs, n = 86) and assessed the correlation between RTEs and TREC copy numbers. We found that TREC copy numbers were significantly lower in children and adults with PIDs (P < .0001 and P < .002, respectively) as compared with their respective age-matched HCs. A moderate correlation was observed between TREC copies and RTE numbers among children with PID (r = .5114, P < .01), whereas no significant correlation was detected between RTE values and TREC content in the HCs (r = .0205, P = .9208). Additionally, we determined TREC and KREC copy numbers in DNA isolated from the Guthrie cards of 200 newborns and showed that this method is applicable to DNA isolated from both peripheral blood samples and dried blood spots, with the two sample types showing comparable TREC and KREC values. We further showed that RTE values are not always reliable markers of T cell output. Although additional confirmatory studies with larger cohorts are needed, our results provide thresholds for TREC/KREC copy numbers for different age groups.
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Affiliation(s)
- Gizem Şentürk
- Department of Genetics, Health Sciences Institute, Istanbul University, Istanbul, Turkey.,Department of Medical Biology, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey.,Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Yuk Yin Ng
- Department of Genetics and Bioengineering, Istanbul Bilgi University, Istanbul, Turkey
| | - Sevgi Bilgiç Eltan
- The Isıl Berat Barlan Center for Translational Medicine, Istanbul, Turkey.,Division of Pediatric Allergy and Immunology, Pendik Research and Training Hospital, Marmara University, Istanbul, Turkey
| | - Dilek Başer
- The Isıl Berat Barlan Center for Translational Medicine, Istanbul, Turkey.,Division of Pediatric Allergy and Immunology, Pendik Research and Training Hospital, Marmara University, Istanbul, Turkey
| | - Ismail Ogulur
- The Isıl Berat Barlan Center for Translational Medicine, Istanbul, Turkey.,Division of Pediatric Allergy and Immunology, Marmara University School of Medicine, Istanbul, Turkey
| | - Didem Altındirek
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Sinem Fırtına
- Department of Bioinformatics and Genetics, Faculty of Engineering and Natural Science, Istanbul Istinye University, Istanbul, Turkey
| | - Hülya Yılmaz
- Division of Hematology, Ankara Medical Faculty, Ankara University, Ankara, Turkey
| | - Burcu Kocamış
- The Isıl Berat Barlan Center for Translational Medicine, Istanbul, Turkey.,Division of Pediatric Allergy and Immunology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ayça Kıykım
- Division of Allergy, and Immunology, Department of Children's Health and Disease, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Yıldız Camcıoğlu
- Division of Allergy, and Immunology, Department of Children's Health and Disease, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Muhlis Cem Ar
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Tuğçe Sudutan
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Serdar Beken
- Department of Pediatrics, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Şehime G Temel
- Department of Medical Genetics, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey.,Department of Histology and Embryology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey.,Department of Translational Medicine, Institute of Health Sciences, Bursa Uludag University, Bursa, Turkey
| | - Yasemin Alanay
- Department of Pediatrics, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey.,Rare Diseases and Orphan Drugs Application and Research Center, Acıbadem University, Istanbul, Turkey
| | - Elif Karakoc-Aydiner
- The Isıl Berat Barlan Center for Translational Medicine, Istanbul, Turkey.,Division of Pediatric Allergy and Immunology, Marmara University School of Medicine, Istanbul, Turkey
| | - Safa Barış
- The Isıl Berat Barlan Center for Translational Medicine, Istanbul, Turkey.,Division of Pediatric Allergy and Immunology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ahmet Özen
- The Isıl Berat Barlan Center for Translational Medicine, Istanbul, Turkey.,Division of Pediatric Allergy and Immunology, Marmara University School of Medicine, Istanbul, Turkey
| | - Uğur Özbek
- Rare Diseases and Orphan Drugs Application and Research Center, Acıbadem University, Istanbul, Turkey.,Department of Medical Genetics, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Müge Sayitoğlu
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Özden Hatırnaz Ng
- Department of Medical Biology, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey.,Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.,Rare Diseases and Orphan Drugs Application and Research Center, Acıbadem University, Istanbul, Turkey
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6
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Rhim JW. Importance of neonatal screening for primary immunodeficiencies. Clin Exp Pediatr 2021; 64:519-520. [PMID: 33957033 PMCID: PMC8498010 DOI: 10.3345/cep.2021.00283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/22/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Jung Woo Rhim
- Departments of Pediatrics, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
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7
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Blom M, Zetterström RH, Stray-Pedersen A, Gilmour K, Gennery AR, Puck JM, van der Burg M. Recommendations for uniform definitions used in newborn screening for severe combined immunodeficiency. J Allergy Clin Immunol 2021; 149:1428-1436. [PMID: 34537207 DOI: 10.1016/j.jaci.2021.08.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/06/2021] [Accepted: 08/23/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Public health newborn screening (NBS) programs continuously evolve, taking advantage of international shared learning. NBS for severe combined immunodeficiency (SCID) has recently been introduced in many countries. However, comparison of screening outcomes has been hampered by use of disparate terminology and imprecise or variable case definitions for non-SCID conditions with T-cell lymphopenia. OBJECTIVES This study sought to determine whether standardized screening terminology could overcome a Babylonian confusion and whether improved case definitions would promote international exchange of knowledge. METHODS A systematic literature review highlighted the diverse terminology in SCID NBS programs internationally. While, as expected, individual screening strategies and tests were tailored to each program, we found uniform terminology to be lacking in definitions of disease targets, sensitivity, and specificity required for comparisons across programs. RESULTS The study's recommendations reflect current evidence from literature and existing guidelines coupled with opinion of experts in public health screening and immunology. Terminologies were aligned. The distinction between actionable and nonactionable T-cell lymphopenia among non-SCID cases was clarified, the former being infants with T-cell lymphopenia who could benefit from interventions such as protection from infections, antibiotic prophylaxis, and live-attenuated vaccine avoidance. CONCLUSIONS By bringing together the previously unconnected public health screening community and clinical immunology community, these SCID NBS deliberations bridged the gaps in language and perspective between these disciplines. This study proposes that international specialists in each disorder for which NBS is performed join forces to hone their definitions and recommend uniform registration of outcomes of NBS. Standardization of terminology will promote international exchange of knowledge and optimize each phase of NBS and follow-up care, advancing health outcomes for children worldwide.
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Affiliation(s)
- Maartje Blom
- Department of Pediatrics, Laboratory for Pediatric Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rolf H Zetterström
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Asbjørg Stray-Pedersen
- Norwegian National Unit for Newborn Screening, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Department of Pediatrics, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Kimberly Gilmour
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom; Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom; National Institute for Health Research-Great Ormond Street Hospital Biomedical Research Center, London, United Kingdom
| | - Andrew R Gennery
- Children's Bone Marrow Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jennifer M Puck
- Division of Allergy, Immunology, and Blood and Marrow Transplantation, Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, Calif; University of California, San Francisco Benioff Children's Hospital San Francisco, San Francisco, Calif
| | - Mirjam van der Burg
- Department of Pediatrics, Laboratory for Pediatric Immunology, Leiden University Medical Center, Leiden, The Netherlands.
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8
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Currier R, Puck JM. SCID newborn screening: What we've learned. J Allergy Clin Immunol 2021; 147:417-426. [PMID: 33551023 PMCID: PMC7874439 DOI: 10.1016/j.jaci.2020.10.020] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/15/2020] [Accepted: 10/19/2020] [Indexed: 12/15/2022]
Abstract
Newborn screening for severe combined immunodeficiency, the most profound form of primary immune system defects, has long been recognized as a measure that would decrease morbidity and improve outcomes by helping patients avoid devastating infections and receive prompt immune-restoring therapy. The T-cell receptor excision circle test, developed in 2005, proved to be successful in pilot studies starting in the period 2008 to 2010, and by 2019 all states in the United States had adopted versions of it in their public health programs. Introduction of newborn screening for severe combined immunodeficiency, the first immune disorder accepted for population-based screening, has drastically changed the presentation of this disorder while providing important lessons for public health programs, immunologists, and transplanters.
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Affiliation(s)
- Robert Currier
- Division of Allergy, Immunology and Blood and Marrow Transplantation, Department of Pediatrics, University of California San Francisco School of Medicine and UCSF Benioff Children's Hospital San Francisco, San Francisco, Calif
| | - Jennifer M Puck
- Division of Allergy, Immunology and Blood and Marrow Transplantation, Department of Pediatrics, University of California San Francisco School of Medicine and UCSF Benioff Children's Hospital San Francisco, San Francisco, Calif.
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9
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Giżewska M, Durda K, Winter T, Ostrowska I, Ołtarzewski M, Klein J, Blankenstein O, Romanowska H, Krzywińska-Zdeb E, Patalan MF, Bartkowiak E, Szczerba N, Seiberling S, Birkenfeld B, Nauck M, von Bernuth H, Meisel C, Bernatowska EA, Walczak M, Pac M. Newborn Screening for SCID and Other Severe Primary Immunodeficiency in the Polish-German Transborder Area: Experience From the First 14 Months of Collaboration. Front Immunol 2020; 11:1948. [PMID: 33178177 PMCID: PMC7596351 DOI: 10.3389/fimmu.2020.01948] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/20/2020] [Indexed: 12/22/2022] Open
Abstract
In 2017, in the Polish-German transborder area of West Pomerania, Mecklenburg-Western Pomerania, and Brandenburg, in collaboration with two centers in Warsaw, a partnership in the field of newborn screening (NBS) for severe primary immunodeficiency diseases (PID), mainly severe combined immunodeficiency (SCID), was initiated. SCID, but also some other severe PID, is a group of disorders characterized by the absence of T and/or B and NK cells. Affected infants are susceptible to life-threatening infections, but early detection gives a chance for effective treatment. The prevalence of SCID in the Polish and German populations is unknown but can be comparable to other countries (1:50,000–100,000). SCID NBS tests are based on real-time polymerase chain reaction (qPCR) and the measurement of a number of T cell receptor excision circles (TREC), kappa-deleting recombination excision circles (KREC), and beta-actin (ACTB) as a quality marker of DNA. This method can also be effective in NBS for other severe PID with T- and/or B-cell lymphopenia, including combined immunodeficiency (CID) or agammaglobulinemia. During the 14 months of collaboration, 44,287 newborns were screened according to the ImmunoIVD protocol. Within 65 positive samples, seven were classified to immediate recall and 58 requested a second sample. Examination of the 58 second samples resulted in recalling one newborn. Confirmatory tests included immunophenotyping of lymphocyte subsets with extension to TCR repertoire, lymphoproliferation tests, radiosensitivity tests, maternal engraftment assays, and molecular tests. Final diagnosis included: one case of T-BlowNK+ SCID, one case of atypical Tlow BlowNK+ CID, one case of autosomal recessive agammaglobulinemia, and one case of Nijmegen breakage syndrome. Among four other positive results, three infants presented with T- and/or B-cell lymphopenia due to either the mother's immunosuppression, prematurity, or unknown reasons, which resolved or almost normalized in the first months of life. One newborn was classified as truly false positive. The overall positive predictive value (PPV) for the diagnosis of severe PID was 50.0%. This is the first population screening study that allowed identification of newborns with T and/or B immunodeficiency in Central and Eastern Europe.
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Affiliation(s)
- Maria Giżewska
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology, Pomeranian Medical University, Szczecin, Poland.,Independent Public Clinical Hospital nr 1 PUM, Szczecin, Poland
| | - Katarzyna Durda
- Independent Public Clinical Hospital nr 1 PUM, Szczecin, Poland
| | - Theresa Winter
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.,Integrated Research Biobank (IRB), University Medicine Greifswald, Greifswald, Germany
| | - Iwona Ostrowska
- Independent Public Clinical Hospital nr 1 PUM, Szczecin, Poland
| | - Mariusz Ołtarzewski
- Department of Screening and Metabolic Diagnostics, Institute of Mother and Child, Warsaw, Poland
| | - Jeannette Klein
- Newbornscreening Laboratory, Charité Universitaetsmedizin, Berlin, Germany
| | | | - Hanna Romanowska
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology, Pomeranian Medical University, Szczecin, Poland.,Independent Public Clinical Hospital nr 1 PUM, Szczecin, Poland
| | - Elżbieta Krzywińska-Zdeb
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology, Pomeranian Medical University, Szczecin, Poland.,Independent Public Clinical Hospital nr 1 PUM, Szczecin, Poland
| | - Michał Filip Patalan
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology, Pomeranian Medical University, Szczecin, Poland.,Independent Public Clinical Hospital nr 1 PUM, Szczecin, Poland
| | | | | | - Stefan Seiberling
- Research Support Center, University of Greifswald, Greifswald, Germany
| | - Bożena Birkenfeld
- Independent Public Clinical Hospital nr 1 PUM, Szczecin, Poland.,Department of Nuclear Medicine, Pomeranian Medical University, Szczecin, Poland
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine Greifswald, Greifswald, Germany
| | - Horst von Bernuth
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Labor Berlin - Charité Vivantes Services GmbH, Berlin, Germany.,BIH Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Meisel
- Labor Berlin - Charité Vivantes Services GmbH, Berlin, Germany.,Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ewa Anna Bernatowska
- Department of Immunology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Mieczysław Walczak
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology, Pomeranian Medical University, Szczecin, Poland.,Independent Public Clinical Hospital nr 1 PUM, Szczecin, Poland
| | - Małgorzata Pac
- Department of Immunology, The Children's Memorial Health Institute, Warsaw, Poland
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10
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Barmettler S, Coffey K, Smith MJ, Chong HJ, Pozos TC, Seroogy CM, Walter J, Abraham RS. Functional Confirmation of DNA Repair Defect in Ataxia Telangiectasia (AT) Infants Identified by Newborn Screening for Severe Combined Immunodeficiency (NBS SCID). THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:723-732.e3. [PMID: 32818697 DOI: 10.1016/j.jaip.2020.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/24/2020] [Accepted: 08/03/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The introduction of newborn screening for severe combined immunodeficiencies (NBS SCID) in 2010 was a significant public health milestone. Although SCID was the primary target, several other conditions associated with severe T-cell lymphopenia have subsequently been identified as secondary targets. The differential diagnosis in infants with an abnormal T-cell receptor excision circle result on NBS SCID who do not meet criteria for typical SCID is often broad, and often the evaluation of these conditions requires immunological and functional testing, in conjunction with genetic analysis, to obtain an accurate diagnosis and develop an appropriate management and treatment plan. OBJECTIVE We describe here 3 infants identified by NBS SCID, who required additional workup as they did not have a typical SCID phenotype and meet the relevant diagnostic criteria. Genetic testing identified pathogenic variants in ATM in all 3 patients, and the pathogenicity of the variants was confirmed by a functional flow cytometry assay. METHODS The patients underwent immunological and genetic workup to identify an underlying cause of their abnormal NBS SCID. Ataxia telangiectasia (AT) was suspected based on clinical and family history, and immunological analyses. The diagnosis was confirmed in all patients with a rapid functional flow cytometric assay and genetic testing. RESULTS A rapid functional flow cytometry assay was used as a diagnostic and confirmatory tool, in conjunction with genetic testing, to make a diagnosis of AT. Experimental validation of the causal relationship between genotype and phenotype allowed for expeditious diagnosis, which facilitated early discussions with families regarding prognosis, treatment, and management. CONCLUSIONS Even with increased rapidity and access to genetic results, functional testing is required for clinical diagnosis in infants identified by NBS SCID who do not fit into the classic categories or have novel genetic variants to confirm the diagnosis. Consideration should be given to the use of functional assays as an essential component of an integrated evaluation to characterize the genetics and mechanisms of inborn errors of immunity.
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Affiliation(s)
- Sara Barmettler
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Mass.
| | - Kara Coffey
- Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Matthew J Smith
- Department of Pathology and Laboratory Medicine, Division of Hematology Research, Mayo Clinic, Rochester, Minn
| | - Hey Jin Chong
- Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Tamara C Pozos
- Department of Clinical Immunology, Children's Minnesota Minneapolis, Minneapolis, Minn
| | - Christine M Seroogy
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Jolan Walter
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Mass; Division of Pediatric Allergy and Immunology, University of South Florida, Tampa, Fla; Division of Pediatric Allergy and Immunology, Johns Hopkins All Children's Hospital, St. Petersburg, Fla
| | - Roshini S Abraham
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio
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11
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Shinwari K, Bolkov M, Tuzankina IA, Chereshnev VA. Newborn Screening through TREC, TREC/KREC System for Primary Immunodeficiency with limitation of TREC/KREC. Comprehensive Review. Antiinflamm Antiallergy Agents Med Chem 2020; 20:132-149. [PMID: 32748762 DOI: 10.2174/1871523019999200730171600] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/11/2020] [Accepted: 06/21/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Newborn screening (NBS) by quantifying T cell receptor excision circles (TRECs) and Kappa receptor excision circles in neonatal dried blood spots (DBS) enables early diagnosis of different types of primary immune deficiencies. Global newborn screening for PID, using an assay to detect T-cell receptor excision circles (TREC) in dried blood spots (DBS), is now being performed in all states in the United States. In this review, we discuss the development and outcomes of TREC, TREC/KREC combines screening, and continued challenges to implementation. OBJECTIVE To review the diagnostic performance of published articles for TREC and TREC/ KREC based NBS for PID and its different types. METHODS Different research resources were used to get an approach for the published data of TREС and KREC based NBS for PID like PubMed, Scopus, Google Scholar, Research gate EMBASE. We extracted TREC and KREC screening Publisher with years of publication, content and cut-off values, and a number of retests, repeat DBS, and referrals from the different published pilot, pilot cohort, Case series, and cohort studies. RESULTS We included the results of TREC, combined TREC/KREC system based NBS screening from different research articles, and divided these results between the Pilot studies, case series, and cohort. For each of these studies, different parameter data are excluded from different articles. Thirteen studies were included, re-confirming 89 known SCID cases in case series and reporting 53 new SCID cases in 3.15 million newborns. Individual TREC contents in all SCID patients were <25 TRECs/μl (except in those evaluated with the New York State assay). CONCLUSION TREC and KREC sensitivity for typical SCID and other types of PID was 100 %. It shows its importance and anticipating the significance of implementation in different undeveloped and developed countries in the NBS program in upcoming years. Data adapting the screening algorithm for pre-term/ill infants reduce the amount of false-positive test results.
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Affiliation(s)
- Khyber Shinwari
- Department of Immunochemistry, Institute of Chemical Engineering, Ural Federal University, Yekaterinburg, Russian Federation
| | - Mikhail Bolkov
- Department of Immunochemistry, Institute of Chemical Engineering, Ural Federal University, Yekaterinburg, Russian Federation
| | - Irina A Tuzankina
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russian Federation
| | - Valery A Chereshnev
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russian Federation
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12
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Knight V, Heimall JR, Wright N, Dutmer CM, Boyce TG, Torgerson TR, Abraham RS. Follow-Up for an Abnormal Newborn Screen for Severe Combined Immunodeficiencies (NBS SCID): A Clinical Immunology Society (CIS) Survey of Current Practices. Int J Neonatal Screen 2020; 6:ijns6030052. [PMID: 33239578 PMCID: PMC7569936 DOI: 10.3390/ijns6030052] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/15/2020] [Accepted: 06/26/2020] [Indexed: 12/20/2022] Open
Abstract
Severe combined immunodeficiency (SCID) includes a group of monogenic disorders presenting with severe T cell lymphopenia (TCL) and high mortality, if untreated. The newborn screen (NBS) for SCID, included in the recommended universal screening panel (RUSP), has been widely adopted across the US and in many other countries. However, there is a lack of consensus regarding follow-up testing to confirm an abnormal result. The Clinical Immunology Society (CIS) membership was surveyed for confirmatory testing practices for an abnormal NBS SCID result, which included consideration of gestational age and birth weight, as well as flow cytometry panels. Considerable variability was observed in follow-up practices for an abnormal NBS SCID with 49% confirming by flow cytometry, 39% repeating TREC analysis, and the remainder either taking prematurity into consideration for subsequent testing or proceeding directly to genetic analysis. More than 50% of respondents did not take prematurity into consideration when determining follow-up. Confirmation of abnormal NBS SCID in premature infants continues to be challenging and is handled variably across centers, with some choosing to repeat NBS SCID testing until normal or until the infant reaches an adjusted gestational age of 37 weeks. A substantial proportion of respondents included naïve and memory T cell analysis with T, B, and NK lymphocyte subset quantitation in the initial confirmatory panel. These results have the potential to influence the diagnosis and management of an infant with TCL as illustrated by the clinical cases presented herein. Our data indicate that there is clearly a strong need for harmonization of follow-up testing for an abnormal NBS SCID result.
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Affiliation(s)
- Vijaya Knight
- Division of Allergy and Immunology, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, CO 80045, USA;
- Correspondence:
| | - Jennifer R. Heimall
- Division of Allergy and Immunology, Children’s Hospital of Philadelphia, Perlman School of Medicine at University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Nicola Wright
- Department of Pediatrics, Alberta Children’s Hospital, University of Calgary, Calgary, AB T3B 6A8, Canada;
| | - Cullen M. Dutmer
- Division of Allergy and Immunology, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, CO 80045, USA;
| | - Thomas G. Boyce
- Division of Pediatric Infectious Diseases, Marshfield Clinic, WI 54449, USA;
| | | | - Roshini S. Abraham
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital, Columbus, OH 43205, USA;
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13
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Amirifar P, Mozdarani H, Yazdani R, Kiaei F, Moeini Shad T, Shahkarami S, Abolhassani H, Delavari S, Sohani M, Rezaei A, Hassanpour G, Akrami SM, Aghamohammadi A. Effect of Class Switch Recombination Defect on the Phenotype of Ataxia-Telangiectasia Patients. Immunol Invest 2020; 50:201-215. [PMID: 32116070 DOI: 10.1080/08820139.2020.1723104] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objectives: Ataxia-telangiectasia (A-T) is an autosomal recessive neurodegenerative disorder with multisystem involvement caused by homozygous or compound heterozygous mutations in the ataxia telangiectasia mutated (ATM) gene which encodes a serine/threonine protein kinase. The aims of this study were to investigate class switch recombination (CSR) and to review the clinical and immunologic phenotypes of 3 groups of A-T patients, including A-T patients with CSR defects (CSR-D), A-T patients with selective immunoglobulin A deficiency (IgA-D) and A-T patients with normal Ig level. Methods: In this study, 41 patients with confirmed diagnosis of A-T (16 A-T patients with HIgM, 15 A-T patients with IgA-D, and 10 A-T patients with normal Ig levels) from Iranian immunodeficiency registry center were enrolled. B-cell proliferation, in vitro CSR toward IgE and IgA were compared between three groups as well as G2 radiosensitivity assay. Results: Earliest presentation of telangiectasia was a significant hallmark in A-T patients with CSR-D (p = .036). In this investigation, we found that the frequency of respiratory infection (p = .002), pneumonia (p = .02), otitis media (p = .008), chronic fever (p < .001), autoimmunity (p = .02) and hepatosplenomegaly (p = .03) in A-T patients with HIgM phenotype were significantly higher than the other groups. As expected IgE production stimulation and IgA CSR were perturbed in HIgM patients that were aligned with the higher readiosenstivity scores in this group. Conclusion: A-T patients with HIgM compared to other A-T patients presenting more infections and noninfectious complications, therefore, early detection and careful management of these patients is necessary.
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Affiliation(s)
- Parisa Amirifar
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences , Tehran, Iran.,Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, University of Medical Science , Tehran, Iran
| | - Hossein Mozdarani
- Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University , Terhran, Iran
| | - Reza Yazdani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, University of Medical Science , Tehran, Iran
| | - Fatemeh Kiaei
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, University of Medical Science , Tehran, Iran
| | - Tannaz Moeini Shad
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, University of Medical Science , Tehran, Iran
| | - Sepideh Shahkarami
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, University of Medical Science , Tehran, Iran.,Medical Genetics Network (Megene), Universal Scientific Education and Research Network (USERN) , Tehran, Iran
| | - Hassan Abolhassani
- Research Center for Primary Immunodeficiencies, Iran University of Medical Sciences , Tehran, Iran.,Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institute at Karolinska University Hospital Huddinge , Stockholm, Sweden
| | - Samaneh Delavari
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, University of Medical Science , Tehran, Iran
| | - Mahsa Sohani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, University of Medical Science , Tehran, Iran
| | - Arezou Rezaei
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, University of Medical Science , Tehran, Iran
| | - Gholamreza Hassanpour
- Center for Research of Endemic Parasites of Iran, Tehran University of Medical Sciences , Tehran, Iran
| | - Seyed Mohammad Akrami
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences , Tehran, Iran
| | - Asghar Aghamohammadi
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, University of Medical Science , Tehran, Iran
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14
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Yaz I, Ozbek B, Ng YY, Cetinkaya PG, Halacli SO, Tan C, Kasikci M, Kosukcu C, Tezcan I, Cagdas D. Lymphocyte Subgroups and KREC Numbers in Common Variable Immunodeficiency: A Single Center Study. J Clin Immunol 2020; 40:494-502. [PMID: 32056073 DOI: 10.1007/s10875-020-00761-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/30/2020] [Indexed: 01/10/2023]
Abstract
Common variable immunodeficiency (CVID) results in defective B cell differentiation and impaired antibody production and is the most common symptomatic primary immunodeficiency. Our aim was to evaluate the correlation among B cell subgroups, κ-deleting recombination excision circle (KREC) copy numbers, and clinical and immunological data of the patients with CVID, and evaluate the patients according to classifications currently available to define the role of KREC copy numbers in the diagnosis of CVID. KREC analysis was performed using a quantitative real-time polymerase chain reaction assay, and B cell subgroups were measured by flow cytometry. The median age of the patients (n = 30) was 25 (6-69) years. Parental consanguinity ratio was 33%. The median age at diagnosis was 15 (4-59), and follow-up period was 6 (1-37) years. CD19+ and CD4+ cell counts at the time of diagnosis were low in 66.7% and 46.7% of the patients, respectively. CD19+ cell counts were positively correlated with KREC copy numbers in patients and healthy controls. CD19+ cell counts and KREC copy numbers were significantly reduced in CVID patients compared to healthy controls as expected. KRECs are quantitative markers for B cell defects. We found low CD4+ cell numbers, recent thymic emigrants, and lymphopenia in some of the patients at diagnosis, which reminds the heterogeneity of CVID's etiology. In this study, a positive correlation was shown between CD19+ cell counts and KREC copy numbers. Low KREC copy numbers indicated B cell deficiency; however, high KREC copy numbers were not sufficient to rule out CVID.
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Affiliation(s)
- Ismail Yaz
- Institute of Child Health, Section of Pediatric Immunology, Hacettepe University Institute of Health Sciences, Ihsan Dogramaci Children's Hospital, Altındağ, 06100, Ankara, Turkey
| | - Begum Ozbek
- Institute of Child Health, Section of Pediatric Immunology, Hacettepe University Institute of Health Sciences, Ihsan Dogramaci Children's Hospital, Altındağ, 06100, Ankara, Turkey
| | - Yuk Yin Ng
- Department of Genetics and Bioengineering, Faculty of Engineering and Natural Sciences, İstanbul Bilgi University, İstanbul, Turkey
| | - Pinar Gur Cetinkaya
- Institute of Child Health, Section of Pediatric Immunology, Hacettepe University Institute of Health Sciences, Ihsan Dogramaci Children's Hospital, Altındağ, 06100, Ankara, Turkey
| | - Sevil Oskay Halacli
- Institute of Child Health, Section of Pediatric Immunology, Hacettepe University Institute of Health Sciences, Ihsan Dogramaci Children's Hospital, Altındağ, 06100, Ankara, Turkey
| | - Cagman Tan
- Institute of Child Health, Section of Pediatric Immunology, Hacettepe University Institute of Health Sciences, Ihsan Dogramaci Children's Hospital, Altındağ, 06100, Ankara, Turkey
| | - Merve Kasikci
- Department of Biostatistics, Institute of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Can Kosukcu
- Department of Bioinformatics, Institute of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Ilhan Tezcan
- Institute of Child Health, Section of Pediatric Immunology, Hacettepe University Institute of Health Sciences, Ihsan Dogramaci Children's Hospital, Altındağ, 06100, Ankara, Turkey.,Division of Pediatric Immunology, Department of Pediatrics, Hacettepe University Medical School , 06100, Altındağ, Ankara, Turkey
| | - Deniz Cagdas
- Institute of Child Health, Section of Pediatric Immunology, Hacettepe University Institute of Health Sciences, Ihsan Dogramaci Children's Hospital, Altındağ, 06100, Ankara, Turkey. .,Division of Pediatric Immunology, Department of Pediatrics, Hacettepe University Medical School , 06100, Altındağ, Ankara, Turkey.
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15
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El-Sayed ZA, Radwan N. Newborn Screening for Primary Immunodeficiencies: The Gaps, Challenges, and Outlook for Developing Countries. Front Immunol 2020; 10:2987. [PMID: 32082296 PMCID: PMC7002357 DOI: 10.3389/fimmu.2019.02987] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 12/05/2019] [Indexed: 01/04/2023] Open
Abstract
Primary immunodeficiency diseases (PIDs) are genetically inherited diseases characterized by an increased susceptibility to infections, autoimmunity, lymphoproliferation, and malignancies. PIDs are under-diagnosed and the registered cases and reported prevalence are far below the estimated numbers especially in countries with large population and high consanguinity rates. Delays in diagnosis yield major morbidities and mortalities with resultant increased economic burden. Newborn screening using TRECs and KRECs, currently being implemented in some countries, is aimed through early diagnosis, to overcome the delays in the diagnosis and hence the poor outcome of some of the severe PIDs. However, the limited resources in developing countries challenges the implementation of newborn PID screening programs. There are considerable gaps in our knowledge that must be bridged. Setting the norms of TRECs and KRECs for each country is needed. Furthermore, some PIDs that might present in the neonatal period could not be detected by the current screening programs, and their diagnosis requires clinical expertise. Not to mention, local guidelines for the management of patients diagnosed by NBS should be set forth. Also, in the absence of NBS, clinicians should be aware of the early manifestations of PID. All these mandate conducting studies genuine to each country, developing programs for raising public awareness and clinical training of physicians to attain the required immunological skills.
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Affiliation(s)
- Zeinab A El-Sayed
- Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Nesrine Radwan
- Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
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16
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Sharma R, Lewis S, Wlodarski MW. DNA Repair Syndromes and Cancer: Insights Into Genetics and Phenotype Patterns. Front Pediatr 2020; 8:570084. [PMID: 33194896 PMCID: PMC7644847 DOI: 10.3389/fped.2020.570084] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/18/2020] [Indexed: 12/15/2022] Open
Abstract
DNA damage response is essential to human physiology. A broad spectrum of pathologies are displayed by individuals carrying monoallelic or biallelic loss-of-function mutations in DNA damage repair genes. DNA repair syndromes with biallelic disturbance of essential DNA damage response pathways manifest early in life with multi-systemic involvement and a high propensity for hematologic and solid cancers, as well as bone marrow failure. In this review, we describe classic biallelic DNA repair cancer syndromes arising from faulty single- and double-strand DNA break repair, as well as dysfunctional DNA helicases. These clinical entities include xeroderma pigmentosum, constitutional mismatch repair deficiency, ataxia telangiectasia, Nijmegen breakage syndrome, deficiencies of DNA ligase IV, NHEJ/Cernunnos, and ERCC6L2, as well as Bloom, Werner, and Rothmund-Thompson syndromes. To give an in-depth understanding of these disorders, we provide historical overview and discuss the interplay between complex biology and heterogeneous clinical manifestations.
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Affiliation(s)
- Richa Sharma
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, United States.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Sara Lewis
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Marcin W Wlodarski
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, United States.,Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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17
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Mandola AB, Reid B, Sirror R, Brager R, Dent P, Chakroborty P, Bulman DE, Roifman CM. Ataxia Telangiectasia Diagnosed on Newborn Screening-Case Cohort of 5 Years' Experience. Front Immunol 2019; 10:2940. [PMID: 31921190 PMCID: PMC6932992 DOI: 10.3389/fimmu.2019.02940] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/29/2019] [Indexed: 11/28/2022] Open
Abstract
Ataxia telangiectasia (AT) is a genetic condition caused by mutations involving ATM (Ataxia Telangiectasia Mutated). This gene is responsible for the expression of a DNA double stranded break repair kinase, the ATM protein kinase. The syndrome encompasses combined immunodeficiency and various degrees of neurological abnormalities and increased risk of malignancy. Typically, patients present early in life with delay in neurological milestones, but very infrequently, with life threatening infections typical of a profound T cell deficiency. It would therefore be unexpected to identify this condition immediately after birth using T cell receptor excision circle (TREC)-based newborn screening (NBS) for SCID. We sought to evaluate the frequency of AT detected by NBS, and to assess immunity as well as the genetic aberrations associated with this early presentation. Here, we describe the clinical, laboratory, and genetic features of patients diagnosed with AT through the Ontario NBS program for SCID, and followed in our center since its inception in 2013. Four patients were diagnosed with AT as a result of low TRECs on NBS. In each case, whole exome sequencing was diagnostic. All of our patients had compound heterozygous mutations involving the FRAP-ATM-TRRAP (FAT) domain of the ATM gene, which appears critical for kinase activity and is highly sensitive to mutagenesis. Our patients presented with profound lymphopenia involving both B and T cells. The ratio of naïve/memory CD45+RA/RO T cells population was variable. T cell repertoire showed decreased T cell diversity. Two out of four patients had decreased specific antibody response to vaccination and hypogammaglobulinemia requiring IVIG replacement. In two patients, profound decreased responses to phytohemagglutinin stimulation was observed. In the other two patients, the initial robust response declined with time. In summary, the rate of detection of AT through NBS had been surprisingly high at our center. One case was identified per year, while the total rate for SCID has been five new cases per year. This early detection may allow for better prospective evaluation of AT shortly after birth, and may assist in formulating early and more effective interventions both for the neurological as well as the immune abnormalities in this syndrome.
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Affiliation(s)
- Amarilla B Mandola
- Division of Immunology and Allergy, Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada.,The Canadian Centre for Primary Immunodeficiency and the Jeffrey Modell Research Laboratory for the Diagnosis of Primary Immunodeficiency, the Hospital for Sick Children, Toronto, ON, Canada
| | - Brenda Reid
- Division of Immunology and Allergy, Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada.,The Canadian Centre for Primary Immunodeficiency and the Jeffrey Modell Research Laboratory for the Diagnosis of Primary Immunodeficiency, the Hospital for Sick Children, Toronto, ON, Canada
| | - Raga Sirror
- Paediatric Allergy/Immunology, Thunder Bay Regional Health Sciences Center, North Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Rae Brager
- Division of Rheumatology, Immunology, and Allergy, Department of Paediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Peter Dent
- Division of Rheumatology, Immunology, and Allergy, Department of Paediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Pranesh Chakroborty
- Department of Pediatrics, CHEO Research Institute and Newborn Screening Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Dennis E Bulman
- Department of Pediatrics, CHEO Research Institute and Newborn Screening Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Chaim M Roifman
- Division of Immunology and Allergy, Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada.,The Canadian Centre for Primary Immunodeficiency and the Jeffrey Modell Research Laboratory for the Diagnosis of Primary Immunodeficiency, the Hospital for Sick Children, Toronto, ON, Canada
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18
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Development of a Multiplex Real-Time PCR Assay for the Newborn Screening of SCID, SMA, and XLA. Int J Neonatal Screen 2019; 5:39. [PMID: 33072998 PMCID: PMC7510252 DOI: 10.3390/ijns5040039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 10/31/2019] [Indexed: 01/21/2023] Open
Abstract
Numerous studies have shown evidence supporting the benefits of universal newborn screening for primary immunodeficiencies (PID) and for Spinal Muscular Atrophy (SMA). We have developed a four-plex, real-time PCR assay to screen for Severe Combined Immune Deficiencies (SCID), X-linked agammaglobulinemia (XLA), and SMA in DNA extracted from a single 3.2 mm punch of a dried blood spot (DBS). A simple, high-throughput, semi-automated DNA extraction method was developed for a Janus liquid handler that can process 384 DBS punches in four 96-well plates in just over one hour with sample tracking capability. The PCR assay identifies the absence of exon 7 in the SMN1 gene, while simultaneously evaluating the copy number of T-cell receptor excision circles (TREC) and Kappa-deleting recombination excision circles (KREC) molecules. Additionally, the amplification of a reference gene, RPP30, was included in the assay as a quality/quantity indicator of DNA isolated from the DBS. The assay performance was demonstrated on over 3000 DNA samples isolated from punches of putative normal newborn DBS. The reliability and analytical accuracy were further evaluated using DBS controls, and contrived and confirmed positive samples. The results from this study demonstrate the potential of future molecular DBS assays, and highlight how a multiplex assay could benefit newborn screening programs.
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19
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Argudo-Ramírez A, Martín-Nalda A, Marín-Soria JL, López-Galera RM, Pajares-García S, González de Aledo-Castillo JM, Martínez-Gallo M, García-Prat M, Colobran R, Riviere JG, Quintero Y, Collado T, García-Villoria J, Ribes A, Soler-Palacín P. First Universal Newborn Screening Program for Severe Combined Immunodeficiency in Europe. Two-Years' Experience in Catalonia (Spain). Front Immunol 2019; 10:2406. [PMID: 31695692 PMCID: PMC6818460 DOI: 10.3389/fimmu.2019.02406] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/25/2019] [Indexed: 12/20/2022] Open
Abstract
Severe combined immunodeficiency (SCID), the most severe form of T-cell immunodeficiency, can be screened at birth by quantifying T-cell receptor excision circles (TRECs) in dried blood spot (DBS) samples. Early detection of this condition speeds up the establishment of appropriate treatment and increases the patient's life expectancy. Newborn screening for SCID started in January 2017 in Catalonia, the first Spanish and European region to universally include this testing. The results obtained in the first 2 years of experience are evaluated here. All babies born between January 2017 and December 2018 were screened. TREC quantification in DBS (1.5 mm diameter) was performed with the Enlite Neonatal TREC kit from PerkinElmer (Turku, Finland). In 2018, the retest cutoff in the detection algorithm was updated based on the experience gained in the first year, and changed from 34 to 24 copies/μL. This decreased the retest rate from 3.34 to 1.4% (global retest rate, 2.4%), with a requested second sample rate of 0.23% and a positive detection rate of 0.02%. Lymphocyte phenotype (T, B, NK populations), expression of CD45RA/RO isoforms, percentage and intensity of TCR αβ and TCR γδ, presence of HLA-DR+ T lymphocytes, and in vitro lymphocyte proliferation were studied in all patients by flow cytometry. Of 130,903 newborns screened, 30 tested positive, 15 of which were male. During the study period, one patient was diagnosed with SCID: incidence, 1 in 130,903 births in Catalonia. Thirteen patients had clinically significant T-cell lymphopenia (non-SCID) with an incidence of 1 in 10,069 newborns (43% of positive detections). Nine patients were considered false-positive cases because of an initially normal lymphocyte count with normalization of TRECs between 3 and 6 months of life, four infants had transient lymphopenia due to an initially low lymphocyte count with recovery in the following months, and three patients are still under study. The results obtained provide further evidence of the benefits of including this disease in newborn screening programs. Longer follow-up is needed to define the exact incidence of SCID in Catalonia.
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Affiliation(s)
- Ana Argudo-Ramírez
- Newborn Screening Laboratory, Inborn Errors of Metabolism Division, Biochemistry and Molecular Genetics Department, Hospital Clínic, Barcelona, Spain
| | - Andrea Martín-Nalda
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jose L Marín-Soria
- Newborn Screening Laboratory, Inborn Errors of Metabolism Division, Biochemistry and Molecular Genetics Department, Hospital Clínic, Barcelona, Spain
| | - Rosa M López-Galera
- Newborn Screening Laboratory, Inborn Errors of Metabolism Division, Biochemistry and Molecular Genetics Department, Hospital Clínic, Barcelona, Spain
| | - Sonia Pajares-García
- Newborn Screening Laboratory, Inborn Errors of Metabolism Division, Biochemistry and Molecular Genetics Department, Hospital Clínic, Barcelona, Spain
| | - Jose M González de Aledo-Castillo
- Newborn Screening Laboratory, Inborn Errors of Metabolism Division, Biochemistry and Molecular Genetics Department, Hospital Clínic, Barcelona, Spain
| | - Mónica Martínez-Gallo
- Immunology Division, Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marina García-Prat
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Roger Colobran
- Immunology Division, Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Clinical and Molecular Genetics, Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jacques G Riviere
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Yania Quintero
- Newborn Screening Laboratory, Inborn Errors of Metabolism Division, Biochemistry and Molecular Genetics Department, Hospital Clínic, Barcelona, Spain
| | - Tatiana Collado
- Newborn Screening Laboratory, Inborn Errors of Metabolism Division, Biochemistry and Molecular Genetics Department, Hospital Clínic, Barcelona, Spain
| | - Judit García-Villoria
- Newborn Screening Laboratory, Inborn Errors of Metabolism Division, Biochemistry and Molecular Genetics Department, Hospital Clínic, Barcelona, Spain
| | - Antonia Ribes
- Newborn Screening Laboratory, Inborn Errors of Metabolism Division, Biochemistry and Molecular Genetics Department, Hospital Clínic, Barcelona, Spain
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Wolska-Kuśnierz B, Gennery AR. Hematopoietic Stem Cell Transplantation for DNA Double Strand Breakage Repair Disorders. Front Pediatr 2019; 7:557. [PMID: 32010653 PMCID: PMC6974535 DOI: 10.3389/fped.2019.00557] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/20/2019] [Indexed: 11/25/2022] Open
Abstract
The ubiquitous presence of enzymes required for repair of DNA double strand breaks renders patients with defects in these pathways susceptible to immunodeficiency, an increased risk of infection, autoimmunity, bone marrow failure and malignancies, which are commonly associated with Epstein Barr virus (EBV) infection. Treatment of malignancies is particularly difficult, as the nature of the systemic defect means that patients are sensitive to chemotherapy and radiotherapy. Increasing numbers of patients with Nijmegen Breakage syndrome, Ligase 4 deficiency and Cernunnos-XLF deficiency have been successfully transplanted. Best results are obtained with the use of reduced intensity conditioning. Patients with ataxia-telangiectasia have particularly poor outcomes and the best treatment approach for these patients is still to be determined.
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Affiliation(s)
| | - Andrew R Gennery
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.,Paediatric Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
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