1
|
Wang YB, Wang O, Nie M, Jiang Y, Li M, Xia WB, Xing XP. Characterization of the clinical and genetic spectrum of autoimmune polyendocrine syndrome type 1 in Chinese case series. Orphanet J Rare Dis 2021; 16:296. [PMID: 34217342 PMCID: PMC8254246 DOI: 10.1186/s13023-021-01933-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/27/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Autoimmune polyendocrine syndrome type 1 (APS1) is a hereditary disease caused by mutations in the AIRE gene with both endocrine and non-endocrine organ involvement. The existing data from China are limited, and this study aims to describe the phenotypes and genetic characterization in Chinese APS1 patients. In this single-center, retrospective, observational study, comprehensive endocrine and extra-endocrine manifestations were collected, and genetic analysis in AIRE was conducted in patients with APS1 between the years of 1984 and 2018 at Peking Union Medical College Hospital. RESULTS In total, 13 patients from 12 unrelated families were enrolled, seven of whom were female, with hypoparathyroidism, chronic mucocutaneous candidiasis, and Addison's disease being the most frequently observed manifestations. Up to 84.7% presented with two or three of the above-mentioned manifestations, and nearly 4.9 ± 1.8 components presented in patients aged 21.2 ± 7.9 years old. Several less common phenotypes, such as myeloproliferative disease, pure red cell aplasia, renal tubular acidosis, asplenia, autoimmune hepatitis, and ankylosing spondylitis, were also observed in patients. Altogether, seven different AIRE mutations were found in six patients, four of which (K161fs, G208V, A246fs, and L308F) had not been previously reported in patients with APS1. CONCLUSION We have provided a comprehensive profile of Chinese patients with APS1, with less commonly observed features being observed in addition to more regularly seen manifestations. Additionally, different AIRE mutations that were observed have expanded the genetic spectrum, which will help with future understanding of the molecular pathogenesis of APS1.
Collapse
Affiliation(s)
- Ya-Bing Wang
- Department of Endocrinology, Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Dongcheng District, Shuaifuyuan No.1, Beijing, 100730 China
- Department of Endocrinology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100730 China
| | - Ou Wang
- Department of Endocrinology, Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Dongcheng District, Shuaifuyuan No.1, Beijing, 100730 China
| | - Min Nie
- Department of Endocrinology, Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Dongcheng District, Shuaifuyuan No.1, Beijing, 100730 China
| | - Yan Jiang
- Department of Endocrinology, Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Dongcheng District, Shuaifuyuan No.1, Beijing, 100730 China
| | - Mei Li
- Department of Endocrinology, Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Dongcheng District, Shuaifuyuan No.1, Beijing, 100730 China
| | - Wei-Bo Xia
- Department of Endocrinology, Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Dongcheng District, Shuaifuyuan No.1, Beijing, 100730 China
| | - Xiao-Ping Xing
- Department of Endocrinology, Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Dongcheng District, Shuaifuyuan No.1, Beijing, 100730 China
| |
Collapse
|
2
|
Pizzi M, Friziero A, Vianello F, Binotto G, Da Dalt G, Zoletto S, Carraro E, Fassan M, Sbaraglia M, Sperti C, Baldan N, D'Amore F, Bertozzi I, Righi S, Pierobon ES, Moletta L, Capovilla G, Grego A, Sabattini E, Fabris F, Merigliano S, Dei Tos AP. Histology of the spleen in immune thrombocytopenia: clinical-pathological characterization and prognostic implications. Eur J Haematol 2020; 106:281-289. [PMID: 33190299 DOI: 10.1111/ejh.13547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Immune thrombocytopenia (ITP) is an acquired disorder, characterized by immune-mediated platelet destruction. The spleen plays a key pathogenic role in ITP and splenectomy is a valuable second-line therapy for this disease. Little is known on ITP spleen histology and response to splenectomy is unpredictable. This study aims to characterize ITP spleen histology and assess possible predictors of splenectomy outcome. METHODS A series of 23 ITP spleens were retrospectively assessed for the following histological parameters: density of lymphoid follicles (LFs), marginal zones (MZs), T helper and cytotoxic T cells; presence of reactive germinal centers (GCs); width of perivascular T cell sheaths; and red pulp features. Clinical and histological data were matched with postsplenectomy platelet counts to assess their prognostic relevance. RESULTS Three histological patterns were documented: a hyperplastic white pulp pattern, a non-activated white pulp pattern (lacking GCs), and a white pulp-depleted pattern. Poor surgical responses were associated with presplenectomy high-dose steroid administration, autoimmune comorbidities and low T follicular helper cell density. The combination of such parameters stratified patients into different splenectomy response groups. The removal of accessory spleens was also associated with better outcome. CONCLUSION ITP spleens are histologically heterogeneous and clinical-pathological parameters may help predict the splenectomy outcome.
Collapse
Affiliation(s)
- Marco Pizzi
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Alberto Friziero
- 3rd Surgical Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Fabrizio Vianello
- Hematology and Clinical Immunology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Gianni Binotto
- Hematology and Clinical Immunology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Gianfranco Da Dalt
- 3rd Surgical Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Simone Zoletto
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Elisa Carraro
- Oncohematology Unit, Department of Women and Children's Health, University of Padova, Padova, Italy
| | - Matteo Fassan
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Marta Sbaraglia
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Cosimo Sperti
- 3rd Surgical Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Nicola Baldan
- 3rd Surgical Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Fabio D'Amore
- Hematology and Clinical Immunology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Irene Bertozzi
- 1st Medical Clinic, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Simona Righi
- Haematopathology Unit, Sant'Orsola Hospital, Bologna, Italy
| | - Elisa Sefora Pierobon
- 3rd Surgical Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Lucia Moletta
- 3rd Surgical Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Giovanni Capovilla
- 3rd Surgical Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Andrea Grego
- 3rd Surgical Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | | | - Fabrizio Fabris
- 1st Medical Clinic, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Stefano Merigliano
- 3rd Surgical Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Angelo Paolo Dei Tos
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy
| |
Collapse
|
3
|
Balaceanu A, Omer S, Stirban R, Zara O, Dina I. Hyposplenism, Hashimoto's Autoimmune Thyroiditis and Overlap Syndrome (Celiac Disease and Autoimmune Hepatitis Type 1). Am J Med Sci 2020; 360:293-299. [PMID: 32563569 DOI: 10.1016/j.amjms.2020.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/02/2020] [Accepted: 04/18/2020] [Indexed: 01/25/2023]
Abstract
Hyposplenism is associated with autoimmune diseases, inflammatory bowel disease, severe celiac disease, autoimmune thyroiditis, untreated HIV infection and chronic graft-versus-host disease. The aim of this study was to review the existing data on hyposplenism associated with celiac disease and Hashimoto's autoimmune thyroiditis. Our research was based on a clinical case concerning a 41-year-old female who presented with asthenia, fatigue, dyspepsia and chronic diarrhea. The medical history revealed autoimmune Hashimoto's thyroiditis, type 2 diabetes, fatty liver disease, chronic gastritis and thrombocytosis. Multiple investigations showed hyposplenism and complex autoimmune dysfunction with positive serum markers for celiac disease and type 1 autoimmune hepatitis along with minor symptomatology. The intestinal symptomatology of celiac disease is often hid by hypothyroidism-associated autoimmune thyroiditis. Asymptomatic or minimally symptomatic celiac disease associated with Hashimoto's autoimmune thyroiditis is diagnosed by biomarkers. Hyposplenism in celiac disease can occur regardless of the disease stage, latent or symptomatic.
Collapse
Affiliation(s)
- Alice Balaceanu
- "Carol Davila" University of Medicine and Pharmacy, "Sf. Ioan" Clinical Emergency Hospital, Internal Medicine Department, Bucharest, Romania.
| | - Secil Omer
- "Carol Davila" University of Medicine and Pharmacy, "Sf. Ioan" Clinical Emergency Hospital, Gastroenterology Department, Bucharest, Romania
| | - Raluca Stirban
- "Sf. Ioan" Clinical Emergency Hospital, Internal Medicine Department, Bucharest, Romania
| | - Octavian Zara
- "Sf. Ioan" Clinical Emergency Hospital, Interventional Cardiology Department, Bucharest, Romania
| | - Ion Dina
- "Carol Davila" University of Medicine and Pharmacy, "Sf. Ioan" Clinical Emergency Hospital, Gastroenterology Department, Bucharest, Romania
| |
Collapse
|