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Simons BD, Karin O. Tuning of plasma cell lifespan by competition explains the longevity and heterogeneity of antibody persistence. Immunity 2024; 57:600-611.e6. [PMID: 38447570 DOI: 10.1016/j.immuni.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/12/2024] [Accepted: 02/07/2024] [Indexed: 03/08/2024]
Abstract
Plasma cells that emerge after infection or vaccination exhibit heterogeneous lifespans; most survive for days to months, whereas others persist for decades, providing antigen-specific long-term protection. We developed a mathematical framework to explore the dynamics of plasma cell removal and its regulation by survival factors. Analyses of antibody persistence following hepatitis A and B and HPV vaccination revealed specific patterns of longevity and heterogeneity within and between responses, implying that this process is fine-tuned near a critical "flat" state between two dynamic regimes. This critical state reflects the tuning of rates of the underlying regulatory network and is highly sensitive to variation in parameters, which amplifies lifespan differences between cells. We propose that fine-tuning is the generic outcome of competition over shared survival signals, with a competition-based mechanism providing a unifying explanation for a wide range of experimental observations, including the dynamics of plasma cell accumulation and the effects of survival factor deletion. Our theory is testable, and we provide specific predictions.
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Affiliation(s)
- Benjamin D Simons
- Department of Applied Mathematics and Theoretical Physics, Centre for Mathematical Sciences, University of Cambridge, Cambridge CB3 0WA, UK; Wellcome Trust, Cancer Research UK Gurdon Institute, University of Cambridge, Cambridge CB2 1QN, UK; Wellcome Trust-MRC Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, University of Cambridge, Cambridge CB2 0AW, UK
| | - Omer Karin
- Department of Mathematics, Imperial College London, London SW7 2AZ, UK.
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2
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Kose H, Karali Z, Bodur M, Cekic S, Kilic SS. Neurological involvement in patients with primary immunodeficiency. Allergol Immunopathol (Madr) 2024; 52:85-92. [PMID: 38186198 DOI: 10.15586/aei.v52i1.961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/29/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Primary immunodeficiency diseases (PID) are defined by recurrent infections, allergies, autoimmunity, and malignancies. Neurologic symptoms are one of the major components of some immunodeficiency syndromes, such as Ataxia-Telangiectasia (AT), Nijmegen breakage syndrome (NBS), and Purine Nucleoside Phosphorylase (PNP) deficiency, which are considered as the primary involvement. Various pathological mechanisms, DNA repair disorders, metabolic abnormalities, and autoimmune phenomena have also been linked with neurological conditions. MATERIALS AND METHOD We retrospectively assessed the neurological involvement in 108 patients out of 6000 with PID in this study. RESULTS The female/male ratio of the cases was 49/59, and the median age was 13 years (min = 1; max = 60). Neurological problems were detected at a median age of 7 years (min = 0.5; max = 30). Di George Syndrome (DGS) and CVID (common variable immunodeficiency) were the most common diseases in our cohort (n = 31, 30% and n = 30, 27%, respectively). The most frequent outcomes were cognitive delay (n = 63, 58%), epilepsy (n = 25, 23%), and ataxia (n = 20, 18%). Central nervous system involvement was found in 99% of the patients (n = 107), and peripheral nervous system complication was found in only one patient with CVID and chronic inflammatory demyelinating polyneuropathy (CDIP). Cranial MRI was found to be abnormal in 74% (n = 80) of the patients. MRI findings included cerebellar atrophy (n = 33, 34%), white matter lesion (n = 27, 28.4%), cerebral atrophy (n = 21, 22.3%), gray matter lesion (n = 6, 6.3%), hydrocephalus (n = 5, 5,3%), and pituitary gland lesion (n = 3, 3.2%), intracranial hemorrhage (n = 3, 3%), intracranial vasculitis (n = 3, 2.7%), and arterio-venous malformation (n = 1, 0,9%). Primary involvement (a component of the disease) was 60% (n = 65), and secondary (infection or autoimmunity) and tertiary involvements (structural or incidental lesions) contributed 20% (n = 20) each in the patients. CONCLUSION In this study, we describe the various neurologic findings of patients with PID. The neurologic presentation may represent the initial manifestation of certain types of PID. Early diagnosis and treatment are essential to prevent or reduce further neurologic damages.
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Affiliation(s)
- Hulya Kose
- Department of Pediatric Immunology and Rheumatology, Bursa Uludag University, Turkey
| | - Zuhal Karali
- Department of Pediatric Immunology and Rheumatology, Bursa Uludag University, Turkey
| | - Muhittin Bodur
- Department of Pediatric Neurology Bursa Uludag University, Turkey
| | - Sukru Cekic
- Department of Pediatric Immunology and Rheumatology, Bursa Uludag University, Turkey
| | - Sara Sebnem Kilic
- Department of Pediatric Immunology and Rheumatology, Bursa Uludag University, Turkey;
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Yang JH, Scanlon N, Woo W, LaBuzetta JN, Gonzalez C, Broderick L, Doherty T, Riedl M, Dunn-Pirio A. Refractory Status Epilepticus Associated With a Pathogenic Variant in TNFRSF13B. Cureus 2023; 15:e48222. [PMID: 38054159 PMCID: PMC10694393 DOI: 10.7759/cureus.48222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 12/07/2023] Open
Abstract
Febrile infection-related epilepsy syndrome (FIRES) is a rare epileptic syndrome characterized by new-onset refractory status epilepticus preceded by a febrile illness. Limited literature exists regarding the relationship between primary immunodeficiencies and immune-mediated epilepsy, and the relationship between new-onset refractory status epilepticus and common variable immunodeficiency (CVID) is not well-understood. We present a case of a 21-year-old female with a history of recurrent sinus infections, asthma, thrombocytopenia, atrioventricular nodal reentrant tachycardia, and neonatal seizures who presented with fever and new-onset status epilepticus. She was ultimately diagnosed with a heterozygous variant in TNFRSF13B c.311G>A (p.Cys104Tyr), which encodes for a tumor necrosis factor receptor implicated in CVID.
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Affiliation(s)
- Jennifer H Yang
- Neurosciences, University of California San Diego, San Diego, USA
- Pediatric Neurology, Rady Children's Hospital San Diego, San Diego, USA
| | - Nicholas Scanlon
- Allergy and Immunology, University of California San Diego, San Diego, USA
| | - Wonhee Woo
- Allergy and Immunology, Kaiser Permanente San Jose Medical Center, San Jose, USA
| | | | - Cynthia Gonzalez
- Neurosciences, University of California San Diego, San Diego, USA
| | - Lori Broderick
- Allergy and Immunology, University of California San Diego, San Diego, USA
| | - Taylor Doherty
- Allergy and Immunology, University of California San Diego, San Diego, USA
| | - Marc Riedl
- Allergy and Immunology, University of California San Diego, San Diego, USA
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Sgrulletti M, Costagliola G, Giardino G, Graziani S, Del Duca E, Di Cesare S, Di Matteo G, Consolini R, Pignata C, Moschese V. The Evolutionary Scenario of Pediatric Unclassified Primary Antibody Deficiency to Adulthood. J Clin Med 2023; 12:4206. [PMID: 37445241 DOI: 10.3390/jcm12134206] [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: 05/17/2023] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Unclassified primary antibody deficiency (unPAD) is a relatively novel inborn error of immunity (IEI) condition that can vary with time to more defined entities. Since long-term follow-up (FU) studies are scarce, we aimed to provide insight into the evolutionary clinical and immunological scenario of unPAD children to adulthood and identification of biomarkers of primary immune deficiency (PID) persistence. METHODS A total of 23 pediatric unPAD patients underwent clinical and immunological FU for a mean time of 14 years (range 3-32 years, median 16 years). RESULTS UnPAD diagnosis may change over time. At the last FU, 10/23 (44%) children matched the diagnosis of transient hypogammaglobulinemia of infancy and 13/23 (56%) suffered from a persistent PID. In detail, an unPAD condition was confirmed in 7/23 (30%) patients, whereas 3/23 (13%), 2/23 (9%), and 1/23 (4%) were reclassified as common variable immunodeficiency, selective IgA deficiency, and isolated IgM deficiency, respectively. Low IgA, low specific antibody response to pneumococcus, and lower respiratory tract infections at diagnosis were independently associated with IEI persistence. CONCLUSIONS Long-term monitoring of unPAD patients is required to define their outcome and possible evolution towards a definitive IEI diagnosis.
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Affiliation(s)
- Mayla Sgrulletti
- Pediatric Immunopathology and Allergology Unit, Policlinico Tor Vergata, University of Tor Vergata, 00133 Rome, Italy
- Ph.D. Program in Immunology, Molecular Medicine and Applied Biotechnology, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Giorgio Costagliola
- Section of Clinical and Laboratory Immunology, Division of Pediatrics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Giuliana Giardino
- Pediatric Section, Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy
| | - Simona Graziani
- Pediatric Immunopathology and Allergology Unit, Policlinico Tor Vergata, University of Tor Vergata, 00133 Rome, Italy
| | - Elisabetta Del Duca
- Pediatric Immunopathology and Allergology Unit, Policlinico Tor Vergata, University of Tor Vergata, 00133 Rome, Italy
| | - Silvia Di Cesare
- Department of Systems Medicine, University of Tor Vergata, 00133 Rome, Italy
| | - Gigliola Di Matteo
- Department of Systems Medicine, University of Tor Vergata, 00133 Rome, Italy
| | - Rita Consolini
- Section of Clinical and Laboratory Immunology, Division of Pediatrics, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Claudio Pignata
- Pediatric Section, Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy
| | - Viviana Moschese
- Pediatric Immunopathology and Allergology Unit, Policlinico Tor Vergata, University of Tor Vergata, 00133 Rome, Italy
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Kakkas I, Tsinti G, Kalala F, Farmaki E, Kourakli A, Kapousouzi A, Dimou M, Kalaitzidou V, Sevdali E, Peristeri AM, Tsiouma G, Patiou P, Papadimitriou E, Vassilakopoulos TP, Panayiotidis P, Kioumi A, Symeonidis A, Speletas M. TACI Mutations in Primary Antibody Deficiencies: A Nationwide Study in Greece. ACTA ACUST UNITED AC 2021; 57:medicina57080827. [PMID: 34441032 PMCID: PMC8401742 DOI: 10.3390/medicina57080827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 11/16/2022]
Abstract
Background and objectives: Monoallelic (heterozygous) or biallelic (homozygous or compound heterozygous) TACI mutations have been reported as the most common genetic defects in patients with common variable immunodeficiency (CVID), which is the most common clinically significant primary immunodeficiency in humans. The aim of our study was to evaluate the prevalence and any correlations of TACI defects in Greek patients with primary antibody deficiencies. Materials and Methods: 117 patients (male/female: 53/64) with CVID (110) and a combined IgA and IgG subclass deficiency (7) with a CVID-like clinical phenotype were enrolled in the study. Genomic DNA was extracted from peripheral blood and the molecular analysis of the TACI gene was performed by PCR (Polymerase Chain Reaction) and sequencing of all 5 exons, including exon–intron boundaries. Results: Seventeen patients (14.5%) displayed TACI defects, four (23.5%) carried combined heterozygous mutations and 13 (76.5%) carried single heterozygous mutations. The most frequently detected mutation was C104R (58.8%), followed by I87N (23.5%) and A181E (11.8%), while R20C, C62Y, P151L, K188M and E236X mutations were present in only one patient each. Patients with TACI defects were more frequently male (p = 0.011) and displayed a benign lymphoproliferation (splenomegaly and lymph node enlargement, p = 0.047 and p = 0.002, respectively), had a history of tonsillectomy (p = 0.015) and adenoidectomy (p = 0.031) and more frequently exhibited autoimmune cytopenias (p = 0.046). Conclusions: Considering that accumulating evidence suggests several CVID patients have a complex rather than a monogenic inheritance, our data further support the notion that TACI mutations, particularly as monoallelic defects, should be primarily considered as susceptibility co-factors and/or modifiers of primary antibody deficiencies.
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Affiliation(s)
- Ioannis Kakkas
- Immunology and Histocompatibility Department, “Evaggelismos” General Hospital, 106 76 Athens, Greece;
| | - Gerasimina Tsinti
- Department of Immunology & Histocompatibility, Faculty of Medicine, University of Thessaly, 415 00 Larissa, Greece; (G.T.); (A.K.); (E.S.); (A.-M.P.)
| | - Fani Kalala
- Hematology Department, Henry Dunant Hospital, 115 26 Athens, Greece;
| | - Evangelia Farmaki
- Pediatric Immunology and Rheumatology Referral Center, First Department of Pediatrics, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (E.F.); (E.P.)
| | - Alexandra Kourakli
- Department of Internal Medicine, Hematology Division, Medical School—University Hospital, University of Patras, 265 04 Patras, Greece; (A.K.); (P.P.); (A.S.)
| | - Androniki Kapousouzi
- Department of Immunology & Histocompatibility, Faculty of Medicine, University of Thessaly, 415 00 Larissa, Greece; (G.T.); (A.K.); (E.S.); (A.-M.P.)
| | - Maria Dimou
- Hematology Section, First Department of Propedeutic Internal Medicine, “Laikon” General Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece; (M.D.); (P.P.)
| | - Vassiliki Kalaitzidou
- Department of Hematology, Papageorgiou General Hospital, 564 29 Thessaloniki, Greece; (V.K.); (A.K.)
| | - Eirini Sevdali
- Department of Immunology & Histocompatibility, Faculty of Medicine, University of Thessaly, 415 00 Larissa, Greece; (G.T.); (A.K.); (E.S.); (A.-M.P.)
| | - Athanasia-Marina Peristeri
- Department of Immunology & Histocompatibility, Faculty of Medicine, University of Thessaly, 415 00 Larissa, Greece; (G.T.); (A.K.); (E.S.); (A.-M.P.)
| | - Georgia Tsiouma
- ENT Department, “Achillopoulion” General Hospital of Volos, 382 21 Volos, Greece;
| | - Peristera Patiou
- Department of Internal Medicine, Hematology Division, Medical School—University Hospital, University of Patras, 265 04 Patras, Greece; (A.K.); (P.P.); (A.S.)
| | - Eleni Papadimitriou
- Pediatric Immunology and Rheumatology Referral Center, First Department of Pediatrics, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (E.F.); (E.P.)
| | - Theodoros P. Vassilakopoulos
- Department of Haematology and Bone Marrow Transplantation, “Laikon” General Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece;
| | - Panayiotis Panayiotidis
- Hematology Section, First Department of Propedeutic Internal Medicine, “Laikon” General Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece; (M.D.); (P.P.)
| | - Anna Kioumi
- Department of Hematology, Papageorgiou General Hospital, 564 29 Thessaloniki, Greece; (V.K.); (A.K.)
| | - Argiris Symeonidis
- Department of Internal Medicine, Hematology Division, Medical School—University Hospital, University of Patras, 265 04 Patras, Greece; (A.K.); (P.P.); (A.S.)
| | - Matthaios Speletas
- Department of Immunology & Histocompatibility, Faculty of Medicine, University of Thessaly, 415 00 Larissa, Greece; (G.T.); (A.K.); (E.S.); (A.-M.P.)
- Correspondence: ; Tel.: +30-241-350-2173; Fax: +30-241-068-5687
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Salzer U, Grimbacher B. TACI deficiency - a complex system out of balance. Curr Opin Immunol 2021; 71:81-88. [PMID: 34247095 DOI: 10.1016/j.coi.2021.06.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/25/2021] [Accepted: 06/06/2021] [Indexed: 12/29/2022]
Abstract
TACI promotes T-cell independent antibody responses and plasma cell differentiation and counteracts BAFF driven B-cell activation. Mutations in TNFRSF13B (encoding TACI) are associated with common variable immunodeficiency (CVID) but are also found in 1-2% of the general population. Although not diseases causing, certain TNFRSF13B mutations predispose CVID patients to autoimmunity and lymphoproliferation. Recently, studies of TACI-deficient humans and murine models revealed novel aspects of TACI, especially its crosstalk with the TLR pathways, differential expression of TACI isoforms, and its role in the generation of autoreactive B-cells. Vice versa, these studies are instrumental for a better understanding of TACI deficiency in humans and suggest that gene dosage, mutation type, and additional clinical or laboratory abnormalities influence the relevance of TNFRSF13B variants in individual CVID patients. TACI is embedded in a complex and well-balanced system, which is vulnerable to genetic and possibly also environmental hits.
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Affiliation(s)
- Ulrich Salzer
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Bodo Grimbacher
- Institute for Immunodeficiency, Center for Chronic Immunodeficiencies, Medical Center - University Hospital Freiburg, Faculty of Medicine, Albert-Ludwigs-University, Freiburg, Germany; DZIF - German Center for Infection Research, Satellite Center Freiburg, Germany; CIBSS - Centre for Integrative Biological Signalling Studies, Albert-Ludwigs University, Freiburg, Germany; RESIST - Cluster of Excellence 2155 to Hanover Medical School, Satellite Center Freiburg, Germany
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Kemme S, Stahl M, Brigham D, Lovell MA, Nakano T, Feldman AG, Mack C. Outcomes of Severe Seronegative Hepatitis-associated Aplastic Anemia: A Pediatric Case Series. J Pediatr Gastroenterol Nutr 2021; 72:194-201. [PMID: 32925550 PMCID: PMC7856235 DOI: 10.1097/mpg.0000000000002940] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Hepatitis-associated aplastic anemia (HAAA) is a potentially life-threatening diagnosis without clear treatment guidelines. The goal of the study was to characterize the presentation, evaluation, histopathology, and outcomes of therapy in children with HAAA to guide future research and to develop standardized care guidelines for this rare disease. METHODS Retrospective chart review of 4 patients with HAAA who presented to Children's Hospital Colorado between 2016 and 2019 was conducted. Patient presentation, evaluation, bone marrow and liver pathology, interventions, and clinical course were collected. Immunohistochemistry of liver biopsies was performed. RESULTS We treated 4 patients with HAAA without liver failure. All had evidence of systemic hyperinflammation and CD8+ T cell predominant liver tissue infiltration. One had a genetic mutation predisposing him to immune-mediated disease, but all other genetic testing was negative. In 3 of the 4 patients, hepatitis was poorly responsive to standard therapy with steroids, azathioprine, or tacrolimus; however, sustained biochemical remission of hepatitis was induced after more aggressive immunosuppressive therapies including Anti-Thymocyte Globulin (ATG) at standard immunosuppressive therapy (IST) dosing for severe Aplastic Anemia (sAA). Two patients underwent hematopoietic stem cell transplant (HSCT); 1 as first line therapy and 1 for refractory sAA. CONCLUSIONS We found that ATG-based IST induced remission of hepatitis in patients with steroid-refractory HAAA. This is also an appropriate initial treatment for severe Aplastic Anemia, though may not prevent the need for HSCT. We propose that equine ATG based IST at standard dosing regimen for sAA is a therapy that in select cases can be considered early on in the treatment course and could lead to a sustained remission of both hepatitis and sAA. This should be considered in collaboration with a pediatric hematologist.
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Affiliation(s)
- Sarah Kemme
- Section of Gastroenterology, Hepatology and Nutrition, and the Digestive Health Institute, Children's Hospital Colorado, University of Colorado Denver School of Medicine
| | - Marisa Stahl
- Section of Gastroenterology, Hepatology and Nutrition, and the Digestive Health Institute, Children's Hospital Colorado, University of Colorado Denver School of Medicine
| | - Dania Brigham
- Section of Gastroenterology, Hepatology and Nutrition, and the Digestive Health Institute, Children's Hospital Colorado, University of Colorado Denver School of Medicine
| | - Mark A Lovell
- Section of Pathology and Lab Services, Children's Hospital Colorado, University of Colorado Denver School of Medicine
| | - Taizo Nakano
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - Amy G Feldman
- Section of Gastroenterology, Hepatology and Nutrition, and the Digestive Health Institute, Children's Hospital Colorado, University of Colorado Denver School of Medicine
| | - Cara Mack
- Section of Gastroenterology, Hepatology and Nutrition, and the Digestive Health Institute, Children's Hospital Colorado, University of Colorado Denver School of Medicine
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Mauracher AA, Gujer E, Bachmann LM, Güsewell S, Pachlopnik Schmid J. Patterns of Immune Dysregulation in Primary Immunodeficiencies: A Systematic Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:792-802.e10. [PMID: 33186766 DOI: 10.1016/j.jaip.2020.10.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/18/2020] [Accepted: 10/27/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Immune dysregulation is as important as susceptibility to infection in defining primary immunodeficiencies (PIDs). Because of the variability and nonspecificity of the symptoms of PIDs, diagnosis can be delayed-especially if a patient presents with immune dysregulation. Diagnosis is then based on certain combinations of symptoms and relies on the clinician's ability to recognize a pattern. So far there is no large report linking patterns of immune dysregulations to the underlying genetic defects. OBJECTIVE To identify immune dysregulatory patterns associated with PIDs and to help clinicians to detect an underlying PID in certain patients with noninfectious inflammatory diseases. METHOD A systematic literature review was performed. RESULTS We included 186 articles that reported on n = 745 patients. The most common immune dysregulation category was "autoimmunity" (62%, n = 463), followed by "intestinal disease" (38%, n = 283) and "lymphoproliferation" (36%, n = 268). Most patients (67%) had 1 or more symptoms of immune dysregulation. Autoimmune hemolytic anemia, the most common autoimmune phenotype, was most frequently reported in patients with LPS responsive beige-like anchor protein deficiency (when combined with hypogammaglobulinemia or gastrointestinal symptoms), activation-induced cytidine deaminase deficiency (when combined with autoimmune hepatitis), or RAG1 deficiency (when it was the only symptom of immune dysregulation). Eczema, allergies, and asthma were reported in 34%, 4%, and 4% of the patients, respectively. CONCLUSION Patterns of immune dysregulation may help the physician to recognize specific PIDs. This systematic review provides clinicians with an overview to better assess patients with immune dysregulation.
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Affiliation(s)
- Andrea A Mauracher
- Division of Immunology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Esther Gujer
- Division of Immunology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Lucas M Bachmann
- Medignition Inc., Medical Research Consultants, Zurich, Switzerland
| | - Sabine Güsewell
- Clinical Trials Unit, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Jana Pachlopnik Schmid
- Division of Immunology, University Children's Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland.
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Moschese V, Chini L, Graziani S, Sgrulletti M, Gallo V, Di Matteo G, Ferrari S, Di Cesare S, Cirillo E, Pession A, Pignata C, Specchia F. Follow-up and outcome of symptomatic partial or absolute IgA deficiency in children. Eur J Pediatr 2019; 178:51-60. [PMID: 30269248 DOI: 10.1007/s00431-018-3248-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/07/2018] [Accepted: 09/10/2018] [Indexed: 12/18/2022]
Abstract
Selective IgA deficiency is defined as absolute or partial when serum IgA level is < 7 mg/dl or 2 SD below normal for age, respectively. Few data are available on partial selective IgA deficiency, as probably most children with low serum IgA are seldom referred to a specialist clinic in common pediatric practice. The aim of our study was to better define the profile of both symptomatic forms and their clinical outcome in a pediatric immunology setting. Thus, clinical and immunological data from 103 symptomatic patients with selective IgA deficiency (53 absolute and 50 partial), 4-18 years of age, were collected at diagnosis and 80 patients (44 absolute and 36 partial) were monitored for a mean period of 5 years. Also, the prevalence of TNFRSF13B mutations has been assessed in 56 patients. The most common clinical features were infections (86/103; 83%), allergy (39/103; 38%), and autoimmunity (13/103; 13%). No significative differences were observed between absolute and partial selective IgA deficiency patients. However, a significative difference in the rate of IgA normalization between partial and absolute selective IgA deficiency patients (33 vs 9%, p = 0.01) was detected. Furthermore, a lower incidence of infections was associated to a normalization reversal compared to a final absolute or partial defect status (12 vs 53 and 64% respectively, p < 0.01).Conclusions: Regardless of a diagnosis of absolute or partial defect, monitoring of symptomatic patients with selective IgA deficiency is recommended overtime for prompt identification and treatment of associated diseases. Further, diagnostic workup protocols should be revisited in children with IgA deficiency. What is Known: ● Selective IgA Deficiency is the most common primary immunodeficiency and is usually asymptomatic. ● Symptomatic pediatric patients with selective IgA deficiency mostly suffer with respiratory and gastrointestinal infections. What is New: ● Symptomatic children with partial IgA defect may have similar clinical, immunological, and genetic features than symptomatic children with absolute IgA deficiency. ● Symptomatic children with partial IgA deficiency deserve accurate monitoring for associated diseases as per children with absolute IgA deficiency.
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Affiliation(s)
- Viviana Moschese
- Pediatric Immunopathology and Allergology Unit, University of Rome Tor Vergata, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy.
| | - Loredana Chini
- Pediatric Immunopathology and Allergology Unit, University of Rome Tor Vergata, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Simona Graziani
- Pediatric Immunopathology and Allergology Unit, University of Rome Tor Vergata, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Mayla Sgrulletti
- Pediatric Immunopathology and Allergology Unit, University of Rome Tor Vergata, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Vera Gallo
- Department of Translational Medical Sciences- Section of Pediatrics, Federico II University, Naples, Italy
| | - Gigliola Di Matteo
- Pediatric Immunopathology and Allergology Unit, University of Rome Tor Vergata, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Simona Ferrari
- Medical Genetics Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Silvia Di Cesare
- Pediatric Immunopathology and Allergology Unit, University of Rome Tor Vergata, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
| | - Emilia Cirillo
- Department of Translational Medical Sciences- Section of Pediatrics, Federico II University, Naples, Italy
| | - Andrea Pession
- Pediatric Unit, Department of Woman, Child and Urologic Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Claudio Pignata
- Department of Translational Medical Sciences- Section of Pediatrics, Federico II University, Naples, Italy
| | - Fernando Specchia
- Pediatric Unit, Department of Woman, Child and Urologic Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
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Mahdaviani SA, Rezaei N. Pulmonary Manifestations of Predominantly Antibody Deficiencies. PULMONARY MANIFESTATIONS OF PRIMARY IMMUNODEFICIENCY DISEASES 2019. [PMCID: PMC7123456 DOI: 10.1007/978-3-030-00880-2_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Predominantly antibody deficiencies (PADs) are the most frequent forms of primary immunodeficiency diseases (PIDs). Commonly accompanied with complications involving several body systems, immunoglobulin substitution therapy along with prophylactic antibiotics remained the cornerstone of treatment for PADs and related complications. Patients with respiratory complications should be prescribed an appropriate therapy as soon as possible and have to be adhering to more and longer medical therapies. Recent studies identified a gap for screening protocols to monitor respiratory manifestations in patients with PADs. In the present chapter, the pulmonary manifestations of different PADs for each have been discussed. The chapter is mainly focused on X-linked agammaglobulinemia, common variable immunodeficiency, activated PI3K-δ syndrome, LRBA deficiency, CD19 complex deficiencies, CD20 deficiency, other monogenic defects associated with hypogammaglobulinemia, immunoglobulin class switch recombination deficiencies affecting B-cells, transient hypogammaglobulinemia of infancy, and selective IgA deficiency.
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Affiliation(s)
- Seyed Alireza Mahdaviani
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies Children’s Medical Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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11
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Ma T, Xu L, Wang H, Guo X, Li Z, Wan F, Chen J, Liu L, Liu X, Chang G, Chen G. Identification of the crucial genes in the elimination and survival process of Salmonella enterica ser. Pullorum in the chicken spleen. Anim Genet 2017; 48:303-314. [PMID: 28176342 DOI: 10.1111/age.12533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2016] [Indexed: 12/11/2022]
Abstract
Salmonella enterica ser. Pullorum is one of the most easily re-infecting pathogens in poultry production because of its mechanism of escaping from immune elimination. We used the transcriptome method to investigate the variation in gene expression in chicken spleen resulting from the interaction between hosts and S. Pullorum in the survival process. The expression of various genes related to the maturation and activation of B cells was activated before S. Pullorum was eliminated, which might help S. Pullorum escape from the elimination process. The suppression of some genes involved in the fusion of autophagosomes and lysosomes, such as MYO6, was identified and may be regulated by the secretion systems of S. Pullorum. In addition, a large proportion of these differentially expressed genes could be localized in the identified quantitative trait loci regions associated with the antibody response to bacteria. Collectively, these identified genes provided an outline for further understanding the interaction between chicken immune cells and S. Pullorum in chicken spleen.
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Affiliation(s)
- T Ma
- Animal Genetic Resources Laboratory, College of Animal Science and Technology, Yangzhou University, Yangzhou, Jiangsu, 225009, China
| | - L Xu
- Animal Genetic Resources Laboratory, College of Animal Science and Technology, Yangzhou University, Yangzhou, Jiangsu, 225009, China
| | - H Wang
- Animal Genetic Resources Laboratory, College of Animal Science and Technology, Yangzhou University, Yangzhou, Jiangsu, 225009, China
| | - X Guo
- Animal Genetic Resources Laboratory, College of Animal Science and Technology, Yangzhou University, Yangzhou, Jiangsu, 225009, China
| | - Z Li
- Animal Genetic Resources Laboratory, College of Animal Science and Technology, Yangzhou University, Yangzhou, Jiangsu, 225009, China
| | - F Wan
- Animal Genetic Resources Laboratory, College of Animal Science and Technology, Yangzhou University, Yangzhou, Jiangsu, 225009, China
| | - J Chen
- Animal Genetic Resources Laboratory, College of Animal Science and Technology, Yangzhou University, Yangzhou, Jiangsu, 225009, China
| | - L Liu
- Animal Genetic Resources Laboratory, College of Animal Science and Technology, Yangzhou University, Yangzhou, Jiangsu, 225009, China
| | - X Liu
- Poultry Institute, Chinese Academy of Agricultural Sciences, Yangzhou, Jiangsu, 225125, China
| | - G Chang
- Animal Genetic Resources Laboratory, College of Animal Science and Technology, Yangzhou University, Yangzhou, Jiangsu, 225009, China
| | - G Chen
- Animal Genetic Resources Laboratory, College of Animal Science and Technology, Yangzhou University, Yangzhou, Jiangsu, 225009, China
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Clinical Associations of Biallelic and Monoallelic TNFRSF13B Variants in Italian Primary Antibody Deficiency Syndromes. J Immunol Res 2016; 2016:8390356. [PMID: 27123465 PMCID: PMC4829724 DOI: 10.1155/2016/8390356] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 01/26/2016] [Accepted: 02/29/2016] [Indexed: 11/17/2022] Open
Abstract
We assessed the prevalence of TNFRSF13B mutations and the clinical correlates in an Italian cohort of 189 CVID, 67 IgAD patients, and 330 healthy controls to substantiate the role of TACI genetic testing in diagnostic workup. We found that 11% of CVID and 13% of IgAD carried at least one mutated TNFRSF13B allele. Seven per cent of CVID had monoallelic-mutations and 4% had biallelic-mutations. The frequency of C104R monoallelic-mutations was not higher than that found in healthy controls. Biallelic-mutations were exclusively found in CVID. CVID patients carrying monoallelic-mutations had an increased prevalence of lymphadenopathy, granulomata, and autoimmune cytopenias. CVID carrying biallelic-mutations had a low prevalence of autoimmunity in comparison with TACI wild-type CVID. Moreover, biallelic-mutated CVID had higher frequency of switched memory B-cells and higher IgM and IgA antibodies to polysaccharide antigens than TACI wild-type and monoallelic-mutated CVID. TACI-mutated IgAD patients had only monoallelic-mutations and did not display clinical difference from IgAD wild-type patients. In conclusion, TNFRSF13B genetic screening of antibody deficiencies may allow the identification of mutational patterns. However, as with counseling for risk assessment, geneticists should be aware that the interpretation of genetic testing for TACI mutations is difficult and the potential impact on clinical management is still limited.
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The crossroads of autoimmunity and immunodeficiency: Lessons from polygenic traits and monogenic defects. J Allergy Clin Immunol 2016; 137:3-17. [DOI: 10.1016/j.jaci.2015.11.004] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 11/16/2015] [Accepted: 11/16/2015] [Indexed: 01/16/2023]
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Kompoti M, Michopoulos A, Michalia M, Clouva-Molyvdas PM, Germenis AE, Speletas M. Genetic polymorphisms of innate and adaptive immunity as predictors of outcome in critically ill patients. Immunobiology 2014; 220:414-21. [PMID: 25454804 DOI: 10.1016/j.imbio.2014.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 09/12/2014] [Accepted: 10/12/2014] [Indexed: 01/23/2023]
Abstract
Sepsis and septic shock frequently cause the admission or complicate the clinical course of critically ill patients admitted in the intensive care units (ICU). Genetic variations disrupting the immune sensing of infectious organisms, could affect the ability of the immune system to respond to infection, and may influence both the genetic predisposition to infection and the diversity of the clinical presentation of sepsis. The aim of this study was to uncover possible associations between common functional immune gene polymorphisms (of both innate and adaptive immunity) and ICU-acquired sepsis and mortality. The TLR4-D299G (rs4986790), TLR4-T399I (rs4986791), C2-c.841_849+19del28 (rs9332736), TACI-C104R (rs34557412), BAFFR-P21R (rs77874543), and BAFFR-H159Y (rs61756766) polymorphisms were detected in a cohort of 215 critically ill patients, admitted in an 8-bed medical/surgical ICU. Interestingly, TLR4-D299G, TLR4-T399I and BAFFR-P21R carriage was associated with a lower risk of ICU-acquired sepsis. This association applied particularly in medical patients, while in trauma and surgical patients no significant associations were observed. Moreover, carriers of TACI-C104R displayed an undiagnosed mild to moderate hypogammaglobulinemia along with a significantly lower survival rate in the ICU, although lethal events were not attributed to sepsis. These findings further elucidate the role that host immune genetic variations may play in the susceptibility to ICU-acquired sepsis and ICU mortality.
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Affiliation(s)
- Maria Kompoti
- Intensive Care Unit, Thriassion General Hospital of Eleusis, Athens, Greece
| | - Alexandros Michopoulos
- Department of Immunology and Histocompatibility, University of Thessaly, School of Health Sciences, Faculty of Medicine, Larissa, Greece
| | - Martha Michalia
- Intensive Care Unit, Thriassion General Hospital of Eleusis, Athens, Greece
| | | | - Anastasios E Germenis
- Department of Immunology and Histocompatibility, University of Thessaly, School of Health Sciences, Faculty of Medicine, Larissa, Greece
| | - Matthaios Speletas
- Department of Immunology and Histocompatibility, University of Thessaly, School of Health Sciences, Faculty of Medicine, Larissa, Greece.
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Bellacchio E, Palma A, Corrente S, Di Girolamo F, Helen Kemp E, Di Matteo G, Comelli L, Carsetti R, Cascioli S, Cancrini C, Fierabracci A. The possible implication of the S250C variant of the autoimmune regulator protein in a patient with autoimmunity and immunodeficiency: in silico analysis suggests a molecular pathogenic mechanism for the variant. Gene 2014; 549:286-94. [PMID: 25068407 DOI: 10.1016/j.gene.2014.07.064] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 07/14/2014] [Accepted: 07/24/2014] [Indexed: 12/12/2022]
Abstract
Autoimmunity can develop from an often undetermined interplay of genetic and environmental factors. Rare forms of autoimmune conditions may also result from single gene mutations as for autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy, an autosomal recessive disease associated with mutated forms of the autoimmune regulator gene. It was proposed that genetic variability in the autoimmune regulator locus, in particular heterozygous loss-of-function mutations, might favor the development of organ-specific autoimmunity by affecting the presentation of self-antigens in the thymus. Indeed, heterozygous mutations of the autoimmune regulator gene were reported in patients with organ-specific autoimmunity. Also, in primary immunodeficiencies, a breakdown in central/peripheral tolerance frequently produces association with autoimmunity. The causative link may involve a common genetic background and several gene defects have been identified as putative culprits. We report a unique patient, a 14 year old male from Lazio region, affected by common variable immunodeficiency associated with autoimmune manifestations (alopecia, onychodystrophy) and heterozygote for the S250C variant located in the SAND domain of the autoimmune regulator gene protein. To our knowledge this is the first report of the S250C variant in a patient bearing this unusual combination of autoimmunity and immunodeficiency. To obtain insights into the possible molecular effects of the S250C variant, we have carried out an in silico analysis of the SAND domain structure of the autoimmune regulator protein. In particular, homology modeling has allowed us to observe that the cysteine introduced by the S250C variant is surrounded by cationic residues, and by means of molecular dynamics simulations together with pKa calculations, we have shown that these residues remain stably proximal to cysteine-250 lowering its pKa and thus conferring high chemical reactivity to the mutated residue. We propose that the enhanced reactivity of cysteine-250, which is likely to impair the protein function but probably insufficient to produce alone a phenotype as a heterozygous S250C variant due to compensation mechanisms, might become manifest when combined with other genetic/environmental factors. These results can provide the rationale for the patient's unusual phenotype, shedding new light into the pathogenesis of the clinical association of autoimmunity and immunodeficiency.
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Affiliation(s)
- Emanuele Bellacchio
- Research Laboratories, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Alessia Palma
- Immunology and Pharmacotherapy Area, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Stefania Corrente
- University Department of Paediatrics, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Francesco Di Girolamo
- Department of Laboratory Medicine, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - E Helen Kemp
- Department of Human Metabolism, The Medical School, University of Sheffield, Sheffield S10 2RX, United Kingdom
| | - Gigliola Di Matteo
- Department of Systems Medicine, Tor Vergata University of Rome, Viale Oxford 81, 00133 Rome, Italy
| | - Laura Comelli
- Proteomics Laboratory Istituto di Fisiologia Clinica, CNR Via Moruzzi, 1, 56124 Pisa, Italy
| | - Rita Carsetti
- Immunology and Pharmacotherapy Area, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Simona Cascioli
- Immunology and Pharmacotherapy Area, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Caterina Cancrini
- University Department of Paediatrics, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Alessandra Fierabracci
- Immunology and Pharmacotherapy Area, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy.
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Heterozygous alterations of TNFRSF13B/TACI in tonsillar hypertrophy and sarcoidosis. Clin Dev Immunol 2013; 2013:532437. [PMID: 23956760 PMCID: PMC3727192 DOI: 10.1155/2013/532437] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 06/12/2013] [Accepted: 06/19/2013] [Indexed: 12/02/2022]
Abstract
TNFRSF13B/TACI defects have been associated with CVID pathogenesis and/or phenotype, especially the development of benign lymphoproliferation and autoimmunity. Our purpose was to investigate the role of TNFRSF13B/TACI defects in the pathogenesis of two common lymphoproliferative disorders, namely, sarcoidosis and tonsillar hypertrophy (TH). 105 patients (71 with sarcoidosis and 34 with TH, including 19 without infectious causative and 15 due to Haemophilus influenzae) were analyzed for TNFRSF13B/TACI defects. Two out of 19 TH patients without infectious cause (10.5%) and 2 patients with sarcoidosis (2.8%) displayed rare TNFRSF13B/TACI defects (I87N, L69TfsX12, E36L, and R202H, resp.). Both mutations identified in TH patients have been assessed as deleterious for protein function, while the patient with the R202H mutation and sarcoidosis exhibited also sIgG4D. Our study further supports the notion that TNFRSF13B/TACI defects alone do not result in CVID but may be also found frequently in distinct clinical phenotypes, including benign lymphoproliferation and IgG subclass deficiencies.
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