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Khanbabaee G, Khazaii F, Chavoshzadeh Z, Rekabi M, Ghomi Z, Zeinali V, Pourghasem M, Soflaee M, Ghadrdan M. Interstitial lung diseases (ILD) in common variable immunodeficiency (CVID) patients: a study from Iran. BMC Immunol 2024; 25:45. [PMID: 39014337 PMCID: PMC11251223 DOI: 10.1186/s12865-024-00640-0] [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: 04/09/2024] [Accepted: 07/05/2024] [Indexed: 07/18/2024] Open
Abstract
INTRODUCTION Interstitial lung disease (ILD) is a prevalent complication in patients with common variable immunodeficiency (CVID) and is often related to other characteristics such as bronchiectasis and autoimmunity. Because the term ILD encompasses a variety of acute and chronic pulmonary conditions, diagnosis is usually based on imaging features. Histopathology is less available. This study was conducted with the aim of investigating the ILD in patients with CVID. MATERIALS AND METHODS In this retrospective cross-sectional study, sixty CVID patients who referred to the pulmonology and immunodeficiency clinics of Mofid Children's Hospital between 2013 and 2022 were included. The diagnosis of ILD were based on transbronchial lung biopsy (TBB) or clinical and radiological symptoms. The prevalence of ILD in CVID patients was determined. Also, the CVID patients with and without ILD were compared in terms of demographic characteristics, clinical, laboratory and radiologic findings. RESULTS Among all patients, ten patients had ILD (16.6%). In terms of laboratory parameters, there was a significant difference between platelets in the two groups of CVID patients with and without ILD, and the level of platelets was higher in the group of patients with ILD. Moreover, in terms of clinical symptoms, pneumonia, diarrhea and hepatomegaly were significantly different between the two groups and were statistically higher in the group of patients with ILD (P < 0.05). Autoimmunity and malignancy were not significantly different in two groups. There was a significant difference in, hyperinflation between the two groups of CVID patients with and without ILD, and the frequency of, hyperinflation was higher in the patients without ILD (P = 0.040). CONCLUSION Understanding the pathogenesis of ILD plays an essential role in revealing non-infectious pulmonary complications that occur in CVID patients. Increasing efforts to understand ILD not only shed light on its hidden pathogenesis and clinical features, but also enhance our understanding of CVID in a broader sense.
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Affiliation(s)
- Ghamartaj Khanbabaee
- Department of Pediatric Pulmonology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Khazaii
- Department of Pediatric Pulmonology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Zahra Chavoshzadeh
- Department of Immunology and allergy, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Rekabi
- Department of Immunology and allergy, Masih daneshvari Hospital, Shahid beheshti university of medical sciences, Tehran, Iran
| | - Zahra Ghomi
- Department of clinical radiology, Mofid Children's Hospital, ShahidBeheshti University of Medical Sciences, Tehran, Iran
| | - Vahide Zeinali
- Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Matin Pourghasem
- Department of Pediatric Pulmonology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maedeh Soflaee
- Department of Pediatric Pulmonology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Ghadrdan
- Department of Pediatric Pulmonology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Smits B, Goldacker S, Seneviratne S, Malphettes M, Longhurst H, Mohamed OE, Witt-Rautenberg C, Leeman L, Schwaneck E, Raymond I, Meghit K, Uhlmann A, Winterhalter C, van Montfrans J, Klima M, Workman S, Fieschi C, Lorenzo L, Boyle S, Onyango-Odera S, Price S, Schmalzing M, Aurillac V, Prasse A, Hartmann I, Meerburg JJ, Kemner-van de Corput M, Tiddens H, Grimbacher B, Kelleher P, Patel SY, Korganow AS, Viallard JF, Tony HP, Bethune C, Schulze-Koops H, Witte T, Huissoon A, Baxendale H, Grigoriadou S, Oksenhendler E, Burns SO, Warnatz K. The efficacy and safety of systemic corticosteroids as first line treatment for granulomatous lymphocytic interstitial lung disease. J Allergy Clin Immunol 2023; 152:528-537. [PMID: 36587851 DOI: 10.1016/j.jaci.2022.12.813] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/13/2022] [Accepted: 12/21/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Granulomatous and lymphocytic interstitial lung disease (gl-ILD) is a major cause of morbidity and mortality among patients with common variable immunodeficiency. Corticosteroids are recommended as first-line treatment for gl-ILD, but evidence for their efficacy is lacking. OBJECTIVES This study analyzed the effect of high-dose corticosteroids (≥0.3 mg/kg prednisone equivalent) on gl-ILD, measured by high-resolution computed tomography (HRCT) scans, and pulmonary function test (PFT) results. METHODS Patients who had received high-dose corticosteroids but no other immunosuppressive therapy at the time (n = 56) and who underwent repeated HRCT scanning or PFT (n = 39) during the retrospective and/or prospective phase of the Study of Interstitial Lung Disease in Primary Antibody Deficiency (STILPAD) were included in the analysis. Patients without any immunosuppressive treatment were selected as controls (n = 23). HRCT scans were blinded, randomized, and scored using the Hartman score. Differences between the baseline and follow-up HRCT scans and PFT were analyzed. RESULTS Treatment with high-dose corticosteroids significantly improved HRCT scores and forced vital capacity. Carbon monoxide diffusion capacity significantly improved in both groups. Of 18 patients, for whom extended follow-up data was available, 13 achieved a long-term, maintenance therapy independent remission. All patients with relapse were retreated with corticosteroids, but only one-fifth of them responded. Two opportunistic infections were found in the corticosteroid treatment group, while overall infection rate was similar between cohorts. CONCLUSIONS Induction therapy with high-dose corticosteroids improved HRCT scans and PFT results of patients with gl-ILD and achieved long-term remission in 42% of patients. It was not associated with major side effects. Low-dose maintenance therapy provided no benefit and efficacy was poor in relapsing disease.
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Affiliation(s)
- Bas Smits
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sigune Goldacker
- Division of Immunodeficiency, Department of Rheumatology and Clinical Immunology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | | | - Hilary Longhurst
- Department of Immunology and Department of Haemato-Oncology, Barts Health National Health Service Trust, The Royal London Hospital, London, United Kingdom
| | - Omar E Mohamed
- West Midlands Primary Immunodeficiency Centre, Birmingham Heartlands Hospital, Birmingham, United Kingdom
| | - Carla Witt-Rautenberg
- Division of Rheumatology and Clinical Immunology, Department of Medicine IV, University of Munich, Munich, Germany
| | - Lucy Leeman
- Peninsula Immunology and Allergy Service, University Hospitals Plymouth, Plymouth, United Kingdom
| | - Eva Schwaneck
- Rheumatology/Clinical Immunology, University Hospital of Wuerzburg, Wuerzburg, Germany; Rheumatology/Clinical Immunology Asklepios Klinik Altona, Hamburg, Germany
| | - Isabelle Raymond
- Department of Internal Medicine, Centre Hospitalier Universitaire of Bordeaux, Bordeaux, France
| | - Kilifa Meghit
- Department of Clinical Immunology and Internal Medicine, National Reference Center for Autoimmune Diseases, University Hospitals of Strasbourg, Strasbourg, France
| | - Annette Uhlmann
- Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Clinical Trials Unit, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christine Winterhalter
- Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Clinical Trials Unit, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Joris van Montfrans
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marion Klima
- Division of Immunodeficiency, Department of Rheumatology and Clinical Immunology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sarita Workman
- Department of Clinical Immunology, Royal Free Hospital, London, United Kingdom
| | - Claire Fieschi
- Département d'Immunologie, Hôpital Saint-Louis, Paris, France
| | - Lorena Lorenzo
- Department of Immunology and Department of Haemato-Oncology, Barts Health National Health Service Trust, The Royal London Hospital, London, United Kingdom
| | - Sonja Boyle
- Clinical Immunology, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Shamin Onyango-Odera
- West Midlands Primary Immunodeficiency Centre, Birmingham Heartlands Hospital, Birmingham, United Kingdom
| | - Suzanne Price
- Peninsula Immunology and Allergy Service, University Hospitals Plymouth, Plymouth, United Kingdom
| | - Marc Schmalzing
- Rheumatology/Clinical Immunology, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Valerie Aurillac
- Department of Internal Medicine, Centre Hospitalier Universitaire of Bordeaux, Bordeaux, France
| | - Antje Prasse
- Department of Respiratory Medicine, Medizinische Hochschule Hannover, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease, Deutsches Zentrum für Lungenforschung, Hannover, Germany
| | - Ieneke Hartmann
- Department of Pediatric Respiratory Medicine, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Radiology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Jennifer J Meerburg
- Department of Pediatric Respiratory Medicine, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Radiology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Mariette Kemner-van de Corput
- Department of Pediatric Respiratory Medicine, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Radiology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Harm Tiddens
- Department of Pediatric Respiratory Medicine, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Radiology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Bodo Grimbacher
- Division of Immunodeficiency, Department of Rheumatology and Clinical Immunology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Center for Infection Research, Satellite Center Freiburg, Freiburg, Germany; Resolving Infection Susceptibility, Cluster of Excellence 2155 to Hanover Medical School, Satellite Center Freiburg, Freiburg, Germany; Centre for Integrative Biological Signalling Studies, Albert-Ludwigs University, Freiburg, Germany
| | - Peter Kelleher
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Smita Y Patel
- Department of Clinical Immunology, Oxford University Hospitals National Health Service Foundation Trust, United Kingdom; National Institute for Health and Care Research Biomedical Research Unit, University of Oxford, United Kingdom
| | - Anne-Sophie Korganow
- Department of Clinical Immunology and Internal Medicine, National Reference Center for Autoimmune Diseases, University Hospitals of Strasbourg, Strasbourg, France
| | - Jean-Francois Viallard
- Department of Internal Medicine, Centre Hospitalier Universitaire of Bordeaux, Bordeaux, France
| | - Hans-Peter Tony
- Rheumatology/Clinical Immunology, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Claire Bethune
- Peninsula Immunology and Allergy Service, University Hospitals Plymouth, Plymouth, United Kingdom
| | | | - Torsten Witte
- Department for Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Aarnoud Huissoon
- West Midlands Primary Immunodeficiency Centre, Birmingham Heartlands Hospital, Birmingham, United Kingdom
| | - Helen Baxendale
- Clinical Immunology, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Sofia Grigoriadou
- Department of Immunology and Department of Haemato-Oncology, Barts Health National Health Service Trust, The Royal London Hospital, London, United Kingdom
| | - Eric Oksenhendler
- Département d'Immunologie, Hôpital Saint-Louis, Paris, France; Department of Clinical Immunology and Université de Paris, Paris, France
| | - Siobhan O Burns
- Department of Clinical Immunology, Royal Free Hospital, London, United Kingdom; Institute of Immunity and Transplantation, University College London, London, United Kingdom
| | - Klaus Warnatz
- Division of Immunodeficiency, Department of Rheumatology and Clinical Immunology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Fevang B. Treatment of inflammatory complications in common variable immunodeficiency (CVID): current concepts and future perspectives. Expert Rev Clin Immunol 2023; 19:627-638. [PMID: 36996348 DOI: 10.1080/1744666x.2023.2198208] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
INTRODUCTION Patients with Common variable immunodeficiency (CVID) have a high frequency of inflammatory complications like autoimmune cytopenias, interstitial lung disease and enteropathy. These patients have poor prognosis and effective, timely and safe treatment of inflammatory complications in CVID are essential, but guidelines and consensus on therapy are often lacking. AREAS COVERED This review will focus on current medical treatment of inflammatory complications in CVID and point out some future perspectives based on literature indexed in PubMed. There are a number of good observational studies and case reports on treatment of specific complications but randomized controlled trials are scarce. EXPERT OPINION In clinical practice, the most urgent issues that need to be addressed are the preferred treatment of GLILD, enteropathy and liver disease. Treating the underlying immune dysregulation and immune exhaustion in CVID is an alternative approach that potentially could alleviate these and other organ-specific inflammatory complications. Therapies of potential interest and wider use in CVID include mTOR-inhibitors like sirolimus, JAK-inhibitors like tofacitinib, the monoclonal IL-12/23 antibody ustekinumab, the anti-BAFF antibody belimumab and abatacept. For all inflammatory complications, there is a need for prospective therapeutic trials, preferably randomized controlled trials, and multi-center collaborations with larger cohorts of patients will be essential.
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Affiliation(s)
- Børre Fevang
- Centre for Rare Disorders, Oslo University Hospital, Oslo, Norway
- Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Oslo, Norway
- Research Institute for Internal Medicine, Oslo University Hospital, Oslo, Norway
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Gao X, Michel K, Griese M. Interstitial Lung Disease in Immunocompromised Children. Diagnostics (Basel) 2022; 13:diagnostics13010064. [PMID: 36611354 PMCID: PMC9818431 DOI: 10.3390/diagnostics13010064] [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] [Received: 11/21/2022] [Revised: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The range of pulmonary complications beyond infections in pediatric immunocompromised patients is broad but not well characterized. Our goal was to assess the spectrum of disorders with a focus on interstitial lung diseases (ILD) in immunodeficient patients. METHODS We reviewed 217 immunocompromised children attending a specialized pneumology service during a period of 23 years. We assigned molecular diagnoses where possible and categorized the underlying immunological conditions into inborn errors of immunity or secondary immunodeficiencies according to the IUIS and the pulmonary conditions according to the chILD-EU classification system. RESULTS Among a wide array of conditions, opportunistic and chronic infections were the most frequent. ILD had a 40% prevalence. Of these children, 89% had a CT available, and 66% had a lung biopsy, which supported the diagnosis of ILD in 95% of cases. Histology was often lymphocyte predominant with the histo-pattern of granulomatous and lymphocytic interstitial lung disease (GLILD), follicular bronchiolitis or lymphocytic interstitial pneumonitis. Of interest, DIP, PAP and NSIP were also diagnosed. ILD was detected in several immunological disorders not yet associated with ILD. CONCLUSIONS Specialized pneumological expertise is necessary to manage the full spectrum of respiratory complications in pediatric immunocompromised patients.
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Affiliation(s)
| | | | - Matthias Griese
- Correspondence: ; Tel.: +49-89-4400-57870; Fax: +49-89-4400-57872
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Hurst JR, Abbas SH, Bintalib HM, Alfaro TM, Baumann U, Burns SO, Condliffe A, Davidsen JR, Fevang B, Gennery AR, Haerynck F, Jacob J, Jolles S, Lamers O, Bergeron A, Malphettes M, Meignin V, Milito C, Milota T, Pergent M, Prasse A, Quinti I, Renzoni E, Sediva A, Stolz D, Smits B, Strauss F, van de Ven AA, van Montfrans J, Warnatz K. Granulomatous-lymphocytic interstitial lung disease: an international research prioritisation. ERJ Open Res 2021; 7:00467-2021. [PMID: 34881327 PMCID: PMC8646000 DOI: 10.1183/23120541.00467-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/18/2021] [Indexed: 11/17/2022] Open
Abstract
The first ever research prioritisation exercise in GLILD: this survey identified areas of interest in the diagnosis, treatment and management of GLILD, which can be used as a roadmap for future research https://bit.ly/3nVuzti.
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Affiliation(s)
- John R. Hurst
- UCL Respiratory, University College London, London, UK
| | | | | | - Tiago M. Alfaro
- Unit of Pneumology, Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - Ulrich Baumann
- Paediatric Pulmonology, Allergy and Neonatology, Hanover Medical School, Hannover, Germany
| | - Siobhan O. Burns
- Institute of Immunity and Transplantation, University College London, London, UK
- Dept of Immunology, Royal Free London NHS Foundation Trust, London, UK
| | - Alison Condliffe
- Dept of Infection, Immunity and Cardiovascular Diseases, University of Sheffield, Sheffield, UK
| | - Jesper R. Davidsen
- South Danish Centre for Interstitial Lung Diseases (SCILS), Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Børre Fevang
- Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Oslo, Norway
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Andrew R. Gennery
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Paediatric Immunology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Filomeen Haerynck
- Dept of Pediatric Pulmonology and Immunology, Jeffrey Modell Foundation Diagnostic and Research Centre, PID Research lab, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Joseph Jacob
- UCL Respiratory, University College London, London, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Olivia Lamers
- Dept of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne Bergeron
- Université de Paris, Hôpital Saint-Louis, AP-HP, Pulmonology Dept, Paris, France
| | - Marion Malphettes
- Immunology Dept, Inserm U1126, Hôpital Saint-Louis, APHP, Paris, France
| | | | - Cinzia Milito
- Dept of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Tomas Milota
- Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Motol University Hospital, Prague, Czech Republic
| | - Martine Pergent
- International Patient Organisation for Primary Immunodeficiencies, Brussels, Belgium
| | - Antje Prasse
- Dept of Pulmonology, Hannover Medical School, Hannover, Germany
- DZL BREATH, Hannover, Germany
- Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Isabella Quinti
- Dept of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Elisabetta Renzoni
- Interstitial Lung Disease Unit, Royal Brompton Hospital/Imperial College London, London, UK
| | - Anna Sediva
- Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Motol University Hospital, Prague, Czech Republic
| | - Daiana Stolz
- University Hospital Basel, Clinic of Respiratory Medicine and Pulmonary Cell Research, Basel, Switzerland
| | - Bas Smits
- Dept of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Friedolin Strauss
- dsai e.V. Patientenorganisation fuer angeborene Immundefekte, Schnaitsee, Germany
| | - Annick A.J.M. van de Ven
- Dept of Internal Medicine and Allergology, University Medical Centre Groningen, Groningen, The Netherlands
- Dept of Rheumatology and Clinical Immunology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Joris van Montfrans
- Dept of Internal Medicine and Allergology, University Medical Centre Groningen, Groningen, The Netherlands
- Dept of Rheumatology and Clinical Immunology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Klaus Warnatz
- Dept of Rheumatology and Clinical Immunology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Chronic Immunodeficiency, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Pulmonary Manifestations of Immunodeficiency and Immunosuppressive Diseases Other than Human Immunodeficiency Virus. Pediatr Clin North Am 2021; 68:103-130. [PMID: 33228927 DOI: 10.1016/j.pcl.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Immune deficiencies may alter normal lung function and protective mechanisms, resulting in a myriad of pulmonary manifestations. Primary immunodeficiencies involve multiple branches of the immune system, and defects may predispose to recurrent upper and lower respiratory infections by common pathogens; opportunistic infections; and autoimmune, inflammatory, and malignant processes that may result in interstitial pneumonias. Secondary immunodeficiencies may result from neoplasms or their treatment, organ transplant and immunosuppression, and from autoimmune diseases and their treatments. Primary and secondary immunodeficiencies and their pulmonary manifestations may be difficult to diagnose and treat. A multidisciplinary approach to evaluation is essential.
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van de Ven AAJM, Alfaro TM, Robinson A, Baumann U, Bergeron A, Burns SO, Condliffe AM, Fevang B, Gennery AR, Haerynck F, Jacob J, Jolles S, Malphettes M, Meignin V, Milota T, van Montfrans J, Prasse A, Quinti I, Renzoni E, Stolz D, Warnatz K, Hurst JR. Managing Granulomatous-Lymphocytic Interstitial Lung Disease in Common Variable Immunodeficiency Disorders: e-GLILDnet International Clinicians Survey. Front Immunol 2020; 11:606333. [PMID: 33324422 PMCID: PMC7726128 DOI: 10.3389/fimmu.2020.606333] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/27/2020] [Indexed: 12/15/2022] Open
Abstract
Background Granulomatous-lymphocytic interstitial lung disease (GLILD) is a rare, potentially severe pulmonary complication of common variable immunodeficiency disorders (CVID). Informative clinical trials and consensus on management are lacking. Aims The European GLILD network (e-GLILDnet) aims to describe how GLILD is currently managed in clinical practice and to determine the main uncertainties and unmet needs regarding diagnosis, treatment and follow-up. Methods The e-GLILDnet collaborators developed and conducted an online survey facilitated by the European Society for Immunodeficiencies (ESID) and the European Respiratory Society (ERS) between February-April 2020. Results were analyzed using SPSS. Results One hundred and sixty-one responses from adult and pediatric pulmonologists and immunologists from 47 countries were analyzed. Respondents treated a median of 27 (interquartile range, IQR 82-maximum 500) CVID patients, of which a median of 5 (IQR 8-max 200) had GLILD. Most respondents experienced difficulties in establishing the diagnosis of GLILD and only 31 (19%) had access to a standardized protocol. There was little uniformity in diagnostic or therapeutic interventions. Fewer than 40% of respondents saw a definite need for biopsy in all cases or performed bronchoalveolar lavage for diagnostics. Sixty-six percent used glucocorticosteroids for remission-induction and 47% for maintenance therapy; azathioprine, rituximab and mycophenolate mofetil were the most frequently prescribed steroid-sparing agents. Pulmonary function tests were the preferred modality for monitoring patients during follow-up. Conclusions These data demonstrate an urgent need for clinical studies to provide more evidence for an international consensus regarding management of GLILD. These studies will need to address optimal procedures for definite diagnosis and a better understanding of the pathogenesis of GLILD in order to provide individualized treatment options. Non-availability of well-established standardized protocols risks endangering patients.
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Affiliation(s)
- Annick A. J. M. van de Ven
- Departments of Internal Medicine and Allergology, Rheumatology and Clinical Immunology, University Medical Center Groningen, Netherlands
| | - Tiago M. Alfaro
- Pneumology Unit, Centro Hospital e Universitário de Coimbra, Coimbra, Portugal and Centre of Pneumology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | | | - Ulrich Baumann
- Department of Paediatric Pulmonology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Anne Bergeron
- Université de Paris, Assistance Publique Hôpitaux de Paris (APHP), Hôpital Saint Louis, Paris, France
| | - Siobhan O. Burns
- Institute of Immunity and Transplantation, University College London, Dept of Immunology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Alison M. Condliffe
- Department of Infection, Immunity and Cardiovascular Diseases, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Børre Fevang
- Centre for Rare Disorders and Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Andrew R. Gennery
- Translational and Clinical Research Institute, Newcastle University and Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom
| | - Filomeen Haerynck
- Department of Pediatric Pulmonology and Immunology, Centre for Primary Immune deficiency Ghent, PID research lab, Ghent University Hospital, Belgium
| | - Joseph Jacob
- UCL Respiratory, University College London, London, United Kingdom
- Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, United Kingdom
| | - Marion Malphettes
- Department of Clinical Immunology, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP), Université Paris Diderot, Paris, France
| | - Véronique Meignin
- Department of Pathology, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - Tomas Milota
- Department of Immunology, Second Faculty of Medicine Charles University and Motol University Hospital, Prague, Czech Republic
| | - Joris van Montfrans
- Department of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, Netherlands
| | - Antje Prasse
- Department of Pulmonology, Hannover Medical School and DZL BREATH, and Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Elisabetta Renzoni
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, United Kingdom
| | - Daiana Stolz
- Clinic for Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
| | - Klaus Warnatz
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Chronic Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - John R. Hurst
- UCL Respiratory, University College London, London, United Kingdom
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Dhalla F, Lochlainn DJM, Chapel H, Patel SY. Histology of Interstitial Lung Disease in Common Variable Immune Deficiency. Front Immunol 2020; 11:605187. [PMID: 33329602 PMCID: PMC7718002 DOI: 10.3389/fimmu.2020.605187] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/26/2020] [Indexed: 12/16/2022] Open
Abstract
Interstitial lung disease (ILD) is an important non-infectious complication in several primary immune deficiencies. In common variable immune deficiency (CVID) it is associated with complex clinical phenotypes and adverse outcomes. The histology of ILD in CVID is heterogeneous and mixed patterns are frequently observed within a single biopsy, including non-necrotising granulomatous inflammation, lymphoid interstitial pneumonitis, lymphoid hyperplasia, follicular bronchiolitis, organizing pneumonia, and interstitial fibrosis; ILD has to be differentiated from lymphoma. The term granulomatous-lymphocytic interstitial lung disease (GLILD), coined to describe the histopathological findings within the lungs of patients with CVID with or without multisystem granulomata, is somewhat controversial as pulmonary granulomata are not always present on histology and the nature of infiltrating lymphocytes is variable. In this mini review we summarize the literature on the histology of CVID-related ILD and discuss some of the factors that may contribute to the inter- and intra- patient variability in the histological patterns reported. Finally, we highlight areas for future development. In particular, there is a need for standardization of histological assessments and reporting, together with a better understanding of the immunopathogenesis of CVID-related ILD to resolve the apparent heterogeneity of ILD in this setting and guide the selection of rational targeted therapies in different patients.
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Affiliation(s)
- Fatima Dhalla
- Department of Clinical Immunology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Developmental Immunology, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Dylan J Mac Lochlainn
- Department of Clinical Immunology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Helen Chapel
- Department of Clinical Immunology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Primary Immunodeficiency Unit, Nuffield Department of Medicine and National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Smita Y Patel
- Department of Clinical Immunology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Primary Immunodeficiency Unit, Nuffield Department of Medicine and National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
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New developments in respiratory medicine: a primary immunodeficiency perspective. Curr Opin Allergy Clin Immunol 2020; 20:549-556. [PMID: 32941317 DOI: 10.1097/aci.0000000000000690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To consider recent developments in respiratory medicine that are of relevance to clinicians caring for adults affected by primary immunodeficiency disorders. RECENT FINDINGS We consider impulse oscillometry, new bronchoscopic techniques for sampling, MRI and PET, the concept of the human airway microbiome, and new treatment approaches for bronchiectasis and interstitial lung disease to better understand the future of respiratory care for people with PID. SUMMARY New approaches to the diagnosis and management of respiratory manifestations of PID have been driven by better understanding of the lung in health and disease, progress in imaging and sampling modalities, and new therapeutics.
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