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Westers TM, Alhan C, Visser-Wisselaar HA, Chitu DA, van de Loosdrecht AA. Dysplasia and PNH-type cells in bone marrow aspirates of myelodysplastic syndromes. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2023; 104:162-172. [PMID: 34806840 DOI: 10.1002/cyto.b.22038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/01/2021] [Accepted: 11/01/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Flow cytometry is increasingly applied in cytopenic patients suspected for myelodysplastic syndromes (MDS). Analysis includes evaluation of antigen expression patterns in granulocytes of which, for example, partial lack of CD16 may indicate dysplasia, but presence of paroxysmal nocturnal hemoglobinuria (PNH)-type cells should be considered. However, diagnostic bone marrow (BM) samples hamper PNH analysis because immature stages in the granulo-/monocytic compartment lack expression of certain glycophosphatidyl-inositol-anchored proteins. In this prospective study, we evaluated the presence of PNH-type cells in BM next to aberrancies from routine MDS immunophenotyping. METHODS We combined antibodies defining maturation trajectories with FLAER. Validation of the designed method against routine PNH analysis and parallel analysis of BM and blood samples revealed similar results (granulocytes: Wilcoxon p = 0.25 and p = 0.82, respectively). We analyzed BM samples from 134 MDS, 17 chronic myelomonocytic leukemia, 15 aplastic anemia (AA), 1 PNH, 51 non-clonal cytopenic controls, and 12 normal controls. RESULTS Most AA/PNH-BM samples showed clear PNH clones: median 1.1% (0%-35%); CD16 loss on mature neutrophils paralleled PNH-clone sizes. In MDS-BM, only 3.7% of cases showed ≥0.1% PNH-type cells, whereas partial CD16 loss was more frequent and abundant. CONCLUSIONS Our findings confirm that dysplastic features in MDS-BM may point to presence of PNH-type cells, though only few cases displayed FLAER-negative cells. We showed that identification of these cells in the granulocyte compartment of BM specimen is feasible, but-according to international guidelines-results need to be confirmed in peripheral blood.
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Affiliation(s)
- Theresia M Westers
- Department of Hematology, Amsterdam University Medical Centers, Location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Canan Alhan
- Department of Hematology, Amsterdam University Medical Centers, Location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Heleen A Visser-Wisselaar
- Department of Hematology, HOVON Data Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Dana A Chitu
- Department of Hematology, HOVON Data Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Arjan A van de Loosdrecht
- Department of Hematology, Amsterdam University Medical Centers, Location VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
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Lima M. Laboratory studies for paroxysmal nocturnal hemoglobinuria, with emphasis on flow cytometry. Pract Lab Med 2020; 20:e00158. [PMID: 32195308 PMCID: PMC7078534 DOI: 10.1016/j.plabm.2020.e00158] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 01/28/2020] [Accepted: 02/28/2020] [Indexed: 12/15/2022] Open
Abstract
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired clonal hematopoietic stem cell disorder caused by somatic mutations in the PIG-A gene, leading to the production of blood cells with absent or decreased expression of glycosylphosphatidylinositol-anchored proteins, including CD55 and CD59. Clinically, PNH is classified into three variants: classic (hemolytic), in the setting of another specified bone marrow disorder (such as aplastic anemia or myelodysplastic syndrome) and subclinical (asymptomatic). PNH testing is recommended for patients with intravascular hemolysis, acquired bone marrow failure syndromes and thrombosis with unusual features. Despite the availability of consensus guidelines for PNH diagnosis and monitoring, there are still discrepancies on how PNH tests are carried out, and these technical variations may lead to an incorrect diagnosis. Herein, we provide a brief historical overview of PNH, focusing on the laboratory tests available and on the current recommendations for PNH diagnosis and monitoring based in flow cytometry.
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Affiliation(s)
- Margarida Lima
- Laboratório de Citometria, Unidade de Diagnóstico Hematológico, Serviço de Hematologia Clínica, Hospital de Santo António (HSA), Centro Hospitalar Universitário do Porto (CHUP), Porto, Portugal
- Unidade Multidisciplinar de Investigação Biomédica, Instituto de Ciências Biomédicas da Universidade do Porto (UMIB/ICBAS/UP), Porto, Portugal
- Laboratório de Citometria, Hospital de Santo António (HSA), Centro Hospitalar Universitário do Porto (CHUP), Ex-CICAP, Rua D. Manuel II, s/n, 4099-001, Porto, Portugal.
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Dulau-Florea A, Maric I, Calvo KR, Braylan RC. Detection of paroxysmal nocturnal hemoglobinuria (PNH) in bone marrow aspirates☆. Semin Hematol 2019; 56:65-68. [DOI: 10.1053/j.seminhematol.2018.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/16/2018] [Indexed: 11/11/2022]
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Payne D, Johansson U, Bloxham D, Couzens S, Carter A, Holtom P, Baker B, Hughes M, Knill T, Milne T, Morilla A, Morilla R, O'Brien D, Thomas L. Inter-laboratory validation of a harmonized PNH flow cytometry assay. CYTOMETRY PART B-CLINICAL CYTOMETRY 2018; 94:580-587. [DOI: 10.1002/cyto.b.21726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 06/22/2018] [Accepted: 07/23/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Daniel Payne
- University Hospitals of Leicester; Leicester Royal Infirmary, Infirmary Square; Leicester Leicestershire LE1 5WW United Kingdom
| | - Ulrika Johansson
- Bristol Royal Infirmary; Upper Maudlin St Bristol BS2 8HW United Kingdom
| | - David Bloxham
- Cambridge University Hospitals NHS Foundation Trust; Addenbrooke's Hospital; Hills Rd Cambridge CB2 0QQ United Kingdom
| | - Stephen Couzens
- University Hospital of Wales; Heath Park; Cardiff CF14 4XW United Kingdom
| | - Anthony Carter
- The Royal Liverpool University Hospital Prescot St; Liverpool L7 8XP United Kingdom
| | - Pamela Holtom
- Heart of England NHS Foundation Trust; Birmingham Heartlands Hospital; Birmingham B9 5SS West Midlands United Kingdom
| | - Bronia Baker
- Royal Victoria Infirmary Queen Victoria Road; Newcastle upon Tyne NE1 4LP United Kingdom
| | - Mark Hughes
- Bristol Royal Infirmary; Upper Maudlin St Bristol BS2 8HW United Kingdom
| | - Tara Knill
- Plymouth Hospitals NHS Trust; Plymouth Devon PL6 8DH United Kingdom
| | - Tim Milne
- King's College Hospital NHS Foundation Trust; Denmark Hill London SE5 9RS United Kingdom
| | | | | | | | - Lisa Thomas
- Royal Victoria Infirmary Queen Victoria Road; Newcastle upon Tyne NE1 4LP United Kingdom
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Dulau-Florea AE, Young NS, Maric I, Calvo KR, Dunbar CE, Townsley DM, Winkler T, Monreal M, Jiang C, Jordan EK, Braylan RC. Bone Marrow as a Source of Cells for Paroxysmal Nocturnal Hemoglobinuria Detection. Am J Clin Pathol 2018; 150:273-282. [PMID: 29982419 PMCID: PMC7263309 DOI: 10.1093/ajcp/aqy053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objectives To determine fluorescently labeled aerolysin (FLAER) binding and glycophosphatidylinositol–anchored protein expression in bone marrow (BM) cells of healthy volunteers and patients with paroxysmal nocturnal hemoglobinuria (PNH) detected in peripheral blood (PB); compare PNH clone size in BM and PB; and detect PNH in BM by commonly used antibodies. Methods Flow cytometry analysis of FLAER binding to leukocytes and expression of CD55/CD59 in erythrocytes. Analysis of CD16 in neutrophils and CD14 in monocytes in BM. Results FLAER binds to all normal BM leukocytes, and binding increases with cell maturation. In PNH, lymphocytic clones are consistently smaller than clones of other BM cells. PNH clones are detectable in mature BM leukocytes with high specificity and sensitivity using common antibodies. Conclusions PNH clone sizes measured in mature BM leukocytes and in PB are comparable, making BM suitable for PNH assessment. We further demonstrate that commonly used reagents (not FLAER or CD55/CD59) can reliably identify abnormalities of BM neutrophils and monocytes consistent with PNH cells.
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Affiliation(s)
- Alina E Dulau-Florea
- Hematology Laboratory, Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD
| | - Neal S Young
- Cell Biology Section, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Irina Maric
- Hematology Laboratory, Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD
| | - Katherine R Calvo
- Hematology Laboratory, Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD
| | - Cynthia E Dunbar
- Cell Biology Section, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Danielle M Townsley
- Cell Biology Section, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Thomas Winkler
- Cell Biology Section, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | - Chunjie Jiang
- Hematology Laboratory, Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD
| | - Elaine K Jordan
- Hematology Laboratory, Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD
| | - Raul C Braylan
- Hematology Laboratory, Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD
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Ng BG, Freeze HH. Human genetic disorders involving glycosylphosphatidylinositol (GPI) anchors and glycosphingolipids (GSL). J Inherit Metab Dis 2015; 38:171-8. [PMID: 25164783 PMCID: PMC4373530 DOI: 10.1007/s10545-014-9752-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 07/14/2014] [Accepted: 07/17/2014] [Indexed: 12/27/2022]
Abstract
Glycosylation - enabling genes are thought to comprise approximately 1-2 % of the human genome, thus, it is not surprising that more than 100 genetic disorders have been identified in this complex multi-pathway cellular process. Recent advances in next generation sequencing technology (NGS) have led to the discovery of genetic causes of many new disorders and importantly highlighted the broad phenotypes that occur. Here we will focus on two glycosylation pathways that involve lipids; glycosylphosphatidylinositol (GPI) anchors and glycosphingolipids (GSL) with emphasis on the specific gene defects, their biochemical properties, and their expanding clinical spectra. These disorders involve the intersection of two pathways: lipids and carbohydrates. Studies of both pathways were founded on structural biochemistry. Those methods and their more refined and sensitive descendants can both identify the specific genes that cause the disorders and validate the importance of the specific mutations.
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Affiliation(s)
- Bobby G Ng
- Human Genetics Program, Sanford Children's Health Research Center, Sanford-Burnham Medical Research Institute, La Jolla, CA, 92037, USA
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Freeze HH, Chong JX, Bamshad MJ, Ng BG. Solving glycosylation disorders: fundamental approaches reveal complicated pathways. Am J Hum Genet 2014; 94:161-75. [PMID: 24507773 DOI: 10.1016/j.ajhg.2013.10.024] [Citation(s) in RCA: 190] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Indexed: 11/30/2022] Open
Abstract
Over 100 human genetic disorders result from mutations in glycosylation-related genes. In 2013, a new glycosylation disorder was reported every 17 days. This trend will probably continue given that at least 2% of the human genome encodes glycan-biosynthesis and -recognition proteins. Established biosynthetic pathways provide many candidate genes, but finding unanticipated mutated genes will offer new insights into glycosylation. Simple glycobiomarkers can be used in narrowing the candidates identified by exome and genome sequencing, and those can be validated by glycosylation analysis of serum or cells from affected individuals. Model organisms will expand the understanding of these mutations' impact on glycosylation and pathology. Here, we highlight some recently discovered glycosylation disorders and the barriers, breakthroughs, and surprises they presented. We predict that some glycosylation disorders might occur with greater frequency than current estimates of their prevalence. Moreover, the prevalence of some disorders differs substantially between European and African Americans.
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Affiliation(s)
- Hudson H Freeze
- Human Genetics Program, Sanford Children's Health Research Center, Sanford Burnham Medical Research Institute, La Jolla, CA 92037, USA.
| | - Jessica X Chong
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
| | - Michael J Bamshad
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
| | - Bobby G Ng
- Human Genetics Program, Sanford Children's Health Research Center, Sanford Burnham Medical Research Institute, La Jolla, CA 92037, USA
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