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Haskologlu S, Kostel Bal S, Islamoglu C, Aytekin C, Guner S, Sevinc S, Keles S, Kendirli T, Ceylaner S, Dogu F, Ikinciogullari A. Clinical, immunological features and follow up of 20 patients with dedicator of cytokinesis 8 (DOCK8) deficiency. Pediatr Allergy Immunol 2020; 31:515-527. [PMID: 32108967 PMCID: PMC7228270 DOI: 10.1111/pai.13236] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 01/27/2020] [Accepted: 02/19/2020] [Indexed: 12/19/2022]
Abstract
Biallelic mutations in the dedicator of cytokinesis 8 gene (DOCK8) cause a progressive combined immunodeficiency (CID) characterized by susceptibility to severe viral skin infections, atopic diseases, recurrent respiratory infections, and malignancy. Hematopoietic stem cell transplantation (HSCT) is only curative treatment for the disease. However, there is limited information about long-term outcome of HSCT and its effect to protect against cancer development in DOCK8-deficient patients. In this study, we retrospectively evaluated clinical and immunologic characteristics of 20 DOCK8-deficient patients and outcome of 11 patients who underwent HSCT. We aimed to report the experience of our center and the result of the largest transplantation series of DOCK8 deficiency in our country. Median follow-up time is 71 months (min-max: 16-172) in all patients and 48 months (min-max: 5-84) in transplanted patients. Atopic dermatitis (18/20), recurrent respiratory tract infections (17/20), and food allergy (14/20) were the most frequent clinical manifestations. Failure to thrive (13/20), liver problems (12/20), bronchiectasis (11/20), chronic diarrhea (10/21), and autism spectrum disorders (3/20) were remarkable findings in our series. Elevated IgE level (20/20) and eosinophilia (17/20), low IgM level (15/20), and decreased CD3+ T (10/20) and CD4+ T (11/20) cell count were prominent laboratory findings. HSCT was performed in 11 patients. All patients achieved adequate engraftment and showed improvement in their clinical and immunologic findings. Atopic dermatitis and food allergies improved in all patients, and their dietary restriction was stopped except one patient who was transplanted recently. The frequency of infections was decreased. The overall survival is 91% in HSCT-received patients and 80% in all. HSCT at the earliest possible period with most suitable donor- and patient-specific appropriate conditioning regimen and GvHD prophylaxis is lifesaving for DOCK8 deficiency cases.
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Affiliation(s)
- Sule Haskologlu
- Department of Pediatrics, Division of Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Sevgi Kostel Bal
- Department of Pediatrics, Division of Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Candan Islamoglu
- Department of Pediatrics, Division of Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Caner Aytekin
- Department of Pediatric Immunology, Dr.Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Sukru Guner
- Department of Pediatrics, Division of Immunology and Allergy, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Selin Sevinc
- Department of Pediatrics, Division of Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Sevgi Keles
- Department of Pediatrics, Division of Immunology and Allergy, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Tanil Kendirli
- Pediatric Intensive Care Unit, Ankara University School of Medicine, Ankara, Turkey
| | | | - Figen Dogu
- Department of Pediatrics, Division of Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Aydan Ikinciogullari
- Department of Pediatrics, Division of Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Turkey
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2
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Lehman H, Gordon C. The Skin as a Window into Primary Immune Deficiency Diseases: Atopic Dermatitis and Chronic Mucocutaneous Candidiasis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 7:788-798. [PMID: 30832893 DOI: 10.1016/j.jaip.2018.11.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/19/2018] [Accepted: 11/25/2018] [Indexed: 12/19/2022]
Abstract
Primary immune deficiency diseases characteristically present with recurrent, severe, or unusual infections. These infections may often involve the skin, with mucocutaneous candidal infections seen in a variety of different primary immune deficiencies. Primary immune deficiencies may also present with noninfectious cutaneous complications, of which eczema is the most common. In a patient with suspected primary immune deficiency, the presence of eczema or candidal skin infections offers critical information about the underlying immune defect, either the presence of atopy or defect in the TH17 pathway, respectively. These skin manifestations also are often early or heralding findings of the underlying immunologic disease. Therefore, awareness of associations between these skin findings and specific immune deficiencies may aide in the early detection and treatment of serious or life-threatening immunologic defects. This review specifically will focus on the primary immune deficiencies commonly associated with eczema or mucocutaneous candidiasis.
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Affiliation(s)
- Heather Lehman
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY.
| | - Christopher Gordon
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
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3
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Fan M, Wang J, Wang S, Li T, Pan H, Liu H, Xu H, Zhernakova DV, O'Brien SJ, Feng Z, Chang L, Dai E, Lu J, Xi H, Yu Y, Zhang J, Wang B, Zeng Z. New Gene Variants Associated with the Risk of Chronic HBV Infection. Virol Sin 2020; 35:378-387. [PMID: 32297155 DOI: 10.1007/s12250-020-00200-x] [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: 03/05/2019] [Accepted: 01/16/2020] [Indexed: 12/16/2022] Open
Abstract
Some patients with chronic hepatitis B virus (HBV) infection failed to clear HBV, even persistently continue to produce antibodies to HBV. Here we performed a two stage genome wide association study in a cohort of Chinese patients designed to discover single nucleotide variants that associate with HBV infection and clearance of HBV. The first stage involved genome wide exome sequencing of 101 cases (HBsAg plus anti-HBs positive) compared with 102 control patients (anti-HBs positive, HBsAg negative). Over 80% of individual sequences displayed 20 × sequence coverage. Adapters, uncertain bases > 10% or low-quality base calls (> 50%) were filtered and compared to the human reference genome hg19. In the second stage, 579 chronic HBV infected cases and 439 HBV clearance controls were sequenced with selected genes from the first stage. Although there were no significant associated gene variants in the first stage, two significant gene associations were discovered when the two stages were assessed in a combined analysis. One association showed rs506121-"T" allele [within the dedicator of cytokinesis 8 (DOCK8) gene] was higher in chronic HBV infection group than that in clearance group (P = 0.002, OR = 0.77, 95% CI [0.65, 0.91]). The second association involved rs2071676-A allele within the Carbonic anhydrase (CA9) gene that was significantly elevated in chronic HBV infection group compared to the clearance group (P = 0.0003, OR = 1.35, 95% CI [1.15, 1.58]). Upon replication these gene associations would suggest the influence of DOCK8 and CA9 as potential risk genetic factors in the persistence of HBV infection.
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Affiliation(s)
- Mengjie Fan
- Department of Infectious Diseases, Peking University First Hospital, Beijing, 100034, China
| | - Jing Wang
- Department of Medical Genetics and Development Biology, School of Medical Basic, Capital Medical University, Beijing, 100069, China.,Center for Genetics, National Research Institute for Family Planning, Beijing, 100081, China
| | - Sa Wang
- Department of Infectious Diseases, Peking University First Hospital, Beijing, 100034, China
| | - Tengyan Li
- Center for Genetics, National Research Institute for Family Planning, Beijing, 100081, China
| | - Hong Pan
- Center for Genetics, National Research Institute for Family Planning, Beijing, 100081, China
| | - Hankui Liu
- BGI-Shenzhen, Shenzhen, 518083, China.,BGI Genomics, BGI-Shenzhen, Shenzhen, 518083, China
| | - Huifang Xu
- BGI-Shenzhen, Shenzhen, 518083, China.,BGI Genomics, BGI-Shenzhen, Shenzhen, 518083, China
| | - Daria V Zhernakova
- Laboratory of Genomic Diversity, Center for Computer Technologies, ITMO University, St. Petersburg, Russia, 197101
| | - Stephen J O'Brien
- Laboratory of Genomic Diversity, Center for Computer Technologies, ITMO University, St. Petersburg, Russia, 197101.,Guy Harvey Oceanographic Center, Halmos College of Natural Sciences and Oceanography, Nova Southeastern University, Ft Lauderdale, FL, 33004, USA
| | - Zhenru Feng
- Department of Laboratory Medicine, Peking University First Hospital, Beijing, 100034, China
| | - Le Chang
- Department of Laboratory Medicine, Peking University First Hospital, Beijing, 100034, China
| | - Erhei Dai
- The Fifth Hospital of Shijiazhuang, Shijiazhuang, 050024, China
| | - Jianhua Lu
- The Fifth Hospital of Shijiazhuang, Shijiazhuang, 050024, China
| | - Hongli Xi
- Department of Infectious Diseases, Peking University First Hospital, Beijing, 100034, China
| | - Yanyan Yu
- Department of Infectious Diseases, Peking University First Hospital, Beijing, 100034, China
| | - Jianguo Zhang
- BGI-Shenzhen, Shenzhen, 518083, China. .,BGI Genomics, BGI-Shenzhen, Shenzhen, 518083, China.
| | - Binbin Wang
- Center for Genetics, National Research Institute for Family Planning, Beijing, 100081, China.
| | - Zheng Zeng
- Department of Infectious Diseases, Peking University First Hospital, Beijing, 100034, China.
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4
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Keller MD, Bollard CM. Virus-specific T-cell therapies for patients with primary immune deficiency. Blood 2020; 135:620-628. [PMID: 31942610 PMCID: PMC7046606 DOI: 10.1182/blood.2019000924] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 09/23/2019] [Indexed: 02/07/2023] Open
Abstract
Viral infections are common and are potentially life-threatening in patients with moderate to severe primary immunodeficiency disorders. Because T-cell immunity contributes to the control of many viral pathogens, adoptive immunotherapy with virus-specific T cells (VSTs) has been a logical and effective way of combating severe viral disease in immunocompromised patients in multiple phase 1 and 2 clinical trials. Common viral targets include cytomegalovirus, Epstein-Barr virus, and adenovirus, though recent published studies have successfully targeted additional pathogens, including HHV6, BK virus, and JC virus. Though most studies have used VSTs derived from allogenic stem cell donors, the use of banked VSTs derived from partially HLA-matched donors has shown efficacy in multicenter settings. Hence, this approach could shorten the time for patients to receive VST therapy thus improving accessibility. In this review, we discuss the usage of VSTs for patients with primary immunodeficiency disorders in clinical trials, as well as future potential targets and methods to broaden the applicability of virus-directed T-cell immunotherapy for this vulnerable patient population.
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Affiliation(s)
- Michael D Keller
- Center for Cancer and Immunology Research and
- Division of Allergy and Immunology, Children's National Health System, Washington, DC
- GW Cancer Center, George Washington University, Washington, DC; and
| | - Catherine M Bollard
- Center for Cancer and Immunology Research and
- GW Cancer Center, George Washington University, Washington, DC; and
- Division of Blood and Marrow Transplantation, Children's National Health System, Washington, DC
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5
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Kuloglu Z, Balcı D, Haskoloğlu ZŞ, Kendirli T, Bingöl-Koloğlu M, Tuna-Kırsaçlıoğlu C, Bal S, Selbuz S, Kırımker O, Savaş B, Altuntaş C, Güner ŞN, Can ÖS, Karayalçın K, Doğu F, Kansu Tanca A, İkincioğulları A. Allogeneic hematopoietic stem cell and liver transplantation in a young girl with dedicator of cytokinesis 8 protein deficiency. Pediatr Transplant 2019; 23:e13545. [PMID: 31297914 DOI: 10.1111/petr.13545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 05/14/2019] [Accepted: 06/08/2019] [Indexed: 11/28/2022]
Abstract
DOCK8 deficiency is a rare inherited combined immunodeficiency, caused by mutations in the DOCK8 gene. We describe a case with DOCK8 deficiency associated with severe CLD in whom orthotopic LT was performed successfully after allogeneic HSCT. A 5 year-old girl with DOCK8 deficiency presented with mild direct hyperbilirubinemia and abnormal GGT level and without a previous history of jaundice. She had severe growth retardation, hepatosplenomegaly and generalized eczema. Progressive worsening of CLD was observed within 4 months. Investigations for etiology of liver disease were negative. Liver biopsy showed bridging necrosis, cholestasis and, cirrhosis. Recurrent immune hemolytic crisis and several viral infections developed in follow-up. She underwent whole cadaveric LT for end-stage liver disease (ESLD) 1 year after allogenic HSCT from a full matched related donor. The postoperative course was uneventful. The patient is alive with normal liver function and moderate skin graft versus host disease for 36 months after LT. In conclusion DOCK8 deficiency can be associated with severe CLD. Successful LT following HSCT is possible in patients with ESLD in DOCK8 deficiency. The timing of LT is challenging in patients requiring both HSCT and LT since conditioning regimens for HSCT can be highly hepatotoxic and the patients with suboptimal liver function can become decompensated during HSCT.
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Affiliation(s)
- Zarife Kuloglu
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara University School of Medicine, Ankara, Turkey
| | - Deniz Balcı
- Deparment of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Zehra Şule Haskoloğlu
- Division of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Division of Pediatric Intensive Care, Ankara University School of Medicine, Ankara, Turkey
| | - Meltem Bingöl-Koloğlu
- Deparment of Pediatric Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Ceyda Tuna-Kırsaçlıoğlu
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara University School of Medicine, Ankara, Turkey
| | - Sevgi Bal
- Division of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Suna Selbuz
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara University School of Medicine, Ankara, Turkey
| | - Onur Kırımker
- Deparment of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Berna Savaş
- Deparment of Pathology, Ankara University School of Medicine, Ankara, Turkey
| | - Cansu Altuntaş
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara University School of Medicine, Ankara, Turkey
| | - Şükrü Nail Güner
- Division of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Özlem Selvi Can
- Department of Anesthesiology and Reanimation, Ankara University School of Medicine, Ankara, Turkey
| | - Kaan Karayalçın
- Deparment of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Figen Doğu
- Division of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Aydan Kansu Tanca
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara University School of Medicine, Ankara, Turkey
| | - Aydan İkincioğulları
- Division of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
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6
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Pillay BA, Avery DT, Smart JM, Cole T, Choo S, Chan D, Gray PE, Frith K, Mitchell R, Phan TG, Wong M, Campbell DE, Hsu P, Ziegler JB, Peake J, Alvaro F, Picard C, Bustamante J, Neven B, Cant AJ, Uzel G, Arkwright PD, Casanova JL, Su HC, Freeman AF, Shah N, Hickstein DD, Tangye SG, Ma CS. Hematopoietic stem cell transplant effectively rescues lymphocyte differentiation and function in DOCK8-deficient patients. JCI Insight 2019; 5:127527. [PMID: 31021819 DOI: 10.1172/jci.insight.127527] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Bi-allelic inactivating mutations in DOCK8 cause a combined immunodeficiency characterised by severe pathogen infections, eczema, allergies, malignancy and impaired humoral responses. These clinical features result from functional defects in most lymphocyte lineages. Thus, DOCK8 plays a key role in immune cell function. Hematopoietic stem cell transplantation (HSCT) is curative for DOCK8 deficiency. While previous reports have described clinical outcomes for DOCK8 deficiency following HSCT, the effect on lymphocyte reconstitution and function has not been investigated. Our study determined whether defects in lymphocyte differentiation and function in DOCK8-deficient patients were restored following HSCT. DOCK8-deficient T and B lymphocytes exhibited aberrant activation and effector function in vivo and in vitro. Frequencies of αβ T and MAIT cells were reduced while γδT cells were increased in DOCK8-deficient patients. HSCT improved, abnormal lymphocyte function in DOCK8-deficient patients. Elevated total and allergen-specific IgE in DOCK8-deficient patients decreased over time following HSCT. Our results document the extensive catalogue of cellular defects in DOCK8-deficient patients, and the efficacy of HSCT to correct these defects, concurrent with improvements in clinical phenotypes. Overall, our findings provide mechanisms at a functional cellular level for improvements in clinical features of DOCK8 deficiency post-HSCT, identify biomarkers that correlate with improved clinical outcomes, and inform the general dynamics of immune reconstitution in patients with monogenic immune disorders following HSCT.
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Affiliation(s)
- Bethany A Pillay
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia.,St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Danielle T Avery
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Joanne M Smart
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Theresa Cole
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Sharon Choo
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Damien Chan
- Women and Children's Hosp==ital, Adelaide, South Australia, Australia
| | - Paul E Gray
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Clinical Immunogenomics Research Consortium of Australia (CIRCA), Sydney, New South Wales, Australia
| | - Katie Frith
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Richard Mitchell
- School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales Australia
| | - Tri Giang Phan
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia.,St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Clinical Immunogenomics Research Consortium of Australia (CIRCA), Sydney, New South Wales, Australia
| | - Melanie Wong
- Clinical Immunogenomics Research Consortium of Australia (CIRCA), Sydney, New South Wales, Australia.,Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Dianne E Campbell
- Clinical Immunogenomics Research Consortium of Australia (CIRCA), Sydney, New South Wales, Australia.,Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Peter Hsu
- Clinical Immunogenomics Research Consortium of Australia (CIRCA), Sydney, New South Wales, Australia.,Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - John B Ziegler
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Clinical Immunogenomics Research Consortium of Australia (CIRCA), Sydney, New South Wales, Australia
| | - Jane Peake
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Frank Alvaro
- Pediatric Hematology, John Hunter Hospital, New Lambton, New South Wales, Australia
| | - Capucine Picard
- Laboratory of Lymphocyte Activation and Susceptibility to EBV Infection, INSERM UMR 1163, Imagine institut, Paris, France.,Study Center for Primary Immunodeficiencies, Assistance Publique-Hôpitaux de Paris (AP-HP), Necker Hospital for Sick Children, Paris, France.,Pediatric Hematology and Immunology Unit, Necker Hospital for Sick Children, AP-HP, Paris, France
| | - Jacinta Bustamante
- Laboratory of Lymphocyte Activation and Susceptibility to EBV Infection, INSERM UMR 1163, Imagine institut, Paris, France.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Institut IMAGINE, Necker Medical School, University Paris Descartes Paris, France.,St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, New York, USA
| | - Benedicte Neven
- Pediatric Hematology-Immunology Unit, Necker Hospital for Sick Children, AP-HP, Paris, France
| | - Andrew J Cant
- Great North Children's Hospital, Newcastle upon Tyne Hospitals, NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.,Primary Immunodeficiency Group, Institute of Cellular Medicine, Newcastle upon Tyne University, Newcastle upon Tyne, United Kingdom
| | - Gulbu Uzel
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Peter D Arkwright
- Lydia Becker Institute of Immunology & Inflammation, University of Manchester, Manchester, United Kingdom
| | - Jean-Laurent Casanova
- Pediatric Hematology and Immunology Unit, Necker Hospital for Sick Children, AP-HP, Paris, France.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Institut IMAGINE, Necker Medical School, University Paris Descartes Paris, France.,St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, New York, USA.,Howard Hughes Medical Institute, New York, New York, USA
| | - Helen C Su
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Alexandra F Freeman
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | | | - Dennis D Hickstein
- Experimental Transplantation and Immunology Branch, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Stuart G Tangye
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia.,St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Clinical Immunogenomics Research Consortium of Australia (CIRCA), Sydney, New South Wales, Australia
| | - Cindy S Ma
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia.,St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia.,Clinical Immunogenomics Research Consortium of Australia (CIRCA), Sydney, New South Wales, Australia
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7
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Tang W, Dou Y, Qin T, Ding Y, Tang X, Zhao X, An Y. Skewed B cell receptor repertoire and reduced antibody avidity in patients with DOCK8 deficiency. Scand J Immunol 2019; 89:e12759. [PMID: 30793341 DOI: 10.1111/sji.12759] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/28/2019] [Accepted: 02/13/2019] [Indexed: 01/31/2023]
Abstract
DOCK8 immunodeficiency syndrome (DIDS) is a combined immunodeficiency characterized by recurrent viral infections, severe atopy and early onset malignancy. Immunological abnormalities include lymphopenia, CD8+ T-cell cytoskeleton dysfunction, defective B cell memory and variable serum immunoglobulin levels. Here, we analyse the B cell receptor repertoire (BCR) characteristics and antibody avidity of four DIDS patients, attempt to understand the dysregulated humoral immunity in DIDS patients with a normal antibody titre and suggest a scientific basis for intravenous immunoglobulin (IVIG) replacement therapy for these patients. We analysed BCR characteristics, including somatic hypermutation (SHM) frequency, using deep sequencing of multiplex PCR products derived from BCR heavy chain CDR3 regions from DIDS patients and controls. The antibody avidity of human tetanus and hemophilus influenza B antibodies was determined by ELISA using thiocyanate elution. IVIG replacement treatment and infection conditions were investigated retrospectively. We found skewing of the BCR repertoire and decreased antibody avidity in patients with DIDS. DIDS patients had fewer negatively charged amino acids than healthy controls. The SHM frequency of the IGHV3 gene was lower in patients with DIDS. Patients received regular IVIG therapy, resulting in fewer and less severe infections. We conclude that although IgG levels are normal in most DIDS patients, IVIG replacement therapy is still necessary.
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Affiliation(s)
- Wenjing Tang
- Division of Immunology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Child Infection and Immunity, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Dou
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Child Infection and Immunity, Children's Hospital of Chongqing Medical University, Chongqing, China.,Division of Hematology and Oncology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Tao Qin
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Child Infection and Immunity, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yuan Ding
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Child Infection and Immunity, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xuemei Tang
- Division of Immunology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Child Infection and Immunity, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaodong Zhao
- Division of Immunology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Child Infection and Immunity, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yunfei An
- Division of Immunology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Child Infection and Immunity, Children's Hospital of Chongqing Medical University, Chongqing, China
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8
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Castagnoli R, Delmonte OM, Calzoni E, Notarangelo LD. Hematopoietic Stem Cell Transplantation in Primary Immunodeficiency Diseases: Current Status and Future Perspectives. Front Pediatr 2019; 7:295. [PMID: 31440487 PMCID: PMC6694735 DOI: 10.3389/fped.2019.00295] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/03/2019] [Indexed: 12/29/2022] Open
Abstract
Primary immunodeficiencies (PID) are disorders that for the most part result from mutations in genes involved in immune host defense and immunoregulation. These conditions are characterized by various combinations of recurrent infections, autoimmunity, lymphoproliferation, inflammatory manifestations, atopy, and malignancy. Most PID are due to genetic defects that are intrinsic to hematopoietic cells. Therefore, replacement of mutant cells by healthy donor hematopoietic stem cells (HSC) represents a rational therapeutic approach. Full or partial ablation of the recipient's marrow with chemotherapy is often used to allow stable engraftment of donor-derived HSCs, and serotherapy may be added to the conditioning regimen to reduce the risks of graft rejection and graft versus host disease (GVHD). Initially, hematopoietic stem cell transplantation (HSCT) was attempted in patients with severe combined immunodeficiency (SCID) as the only available curative treatment. It was a challenging procedure, associated with elevated rates of morbidity and mortality. Overtime, outcome of HSCT for PID has significantly improved due to availability of high-resolution HLA typing, increased use of alternative donors and new stem cell sources, development of less toxic, reduced-intensity conditioning (RIC) regimens, and cellular engineering techniques for graft manipulation. Early identification of infants affected by SCID, prior to infectious complication, through newborn screening (NBS) programs and prompt genetic diagnosis with Next Generation Sequencing (NGS) techniques, have also ameliorated the outcome of HSCT. In addition, HSCT has been applied to treat a broader range of PID, including disorders of immune dysregulation. Yet, the broad spectrum of clinical and immunological phenotypes associated with PID makes it difficult to define a universal transplant regimen. As such, integration of knowledge between immunologists and transplant specialists is necessary for the development of innovative transplant protocols and to monitor their results during follow-up. Despite the improved outcome observed after HSCT, patients with severe forms of PID still face significant challenges of short and long-term transplant-related complications. To address this issue, novel HSCT strategies are being implemented aiming to improve both survival and long-term quality of life. This article will discuss the current status and latest developments in HSCT for PID, and present data regarding approach and outcome of HSCT in recently described PID, including disorders associated with immune dysregulation.
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Affiliation(s)
- Riccardo Castagnoli
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States.,Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Ottavia Maria Delmonte
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Enrica Calzoni
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States.,Department of Molecular and Translational Medicine, A. Nocivelli Institute for Molecular Medicine, University of Brescia, Brescia, Italy
| | - Luigi Daniele Notarangelo
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
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Aydin SE, Freeman AF, Al-Herz W, Al-Mousa HA, Arnaout RK, Aydin RC, Barlogis V, Belohradsky BH, Bonfim C, Bredius RG, Chu JI, Ciocarlie OC, Doğu F, Gaspar HB, Geha RS, Gennery AR, Hauck F, Hawwari A, Hickstein DD, Hoenig M, Ikinciogullari A, Klein C, Kumar A, Ifversen MRS, Matthes S, Metin A, Neven B, Pai SY, Parikh SH, Picard C, Renner ED, Sanal Ö, Schulz AS, Schuster F, Shah NN, Shereck EB, Slatter MA, Su HC, van Montfrans J, Woessmann W, Ziegler JB, Albert MH. Hematopoietic Stem Cell Transplantation as Treatment for Patients with DOCK8 Deficiency. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:848-855. [PMID: 30391550 DOI: 10.1016/j.jaip.2018.10.035] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/21/2018] [Accepted: 10/22/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Biallelic variations in the dedicator of cytokinesis 8 (DOCK8) gene cause a combined immunodeficiency with eczema, recurrent bacterial and viral infections, and malignancy. Natural disease outcome is dismal, but allogeneic hematopoietic stem cell transplantation (HSCT) can cure the disease. OBJECTIVE To determine outcome of HSCT for DOCK8 deficiency and define possible outcome variables. METHODS We performed a retrospective study of the results of HSCT in a large international cohort of DOCK8-deficient patients. RESULTS We identified 81 patients from 22 centers transplanted at a median age of 9.7 years (range, 0.7-27.2 years) between 1995 and 2015. After median follow-up of 26 months (range, 3-135 months), 68 (84%) patients are alive. Severe acute (III-IV) or chronic graft versus host disease occurred in 11% and 10%, respectively. Causes of death were infections (n = 5), graft versus host disease (5), multiorgan failure (2), and preexistent lymphoma (1). Survival after matched related (n = 40) or unrelated (35) HSCT was 89% and 81%, respectively. Reduced-toxicity conditioning based on either treosulfan or reduced-dose busulfan resulted in superior survival compared with fully myeloablative busulfan-based regimens (97% vs 78%; P = .049). Ninety-six percent of patients younger than 8 years at HSCT survived, compared with 78% of those 8 years and older (P = .06). Of the 73 patients with chimerism data available, 65 (89%) had more than 90% donor T-cell chimerism at last follow-up. Not all disease manifestations responded equally well to HSCT: eczema, infections, and mollusca resolved quicker than food allergies or failure to thrive. CONCLUSIONS HSCT is curative in most DOCK8-deficient patients, confirming this approach as the treatment of choice. HSCT using a reduced-toxicity regimen may offer the best chance for survival.
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Affiliation(s)
- Susanne E Aydin
- Dr von Hauner University Children's Hospital, Ludwig Maximilians Universität, Munich, Germany
| | - Alexandra F Freeman
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Waleed Al-Herz
- Department of Pediatrics, Al-Sabah Hospital, Kuwait, Kuwait
| | - Hamoud A Al-Mousa
- Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Rand K Arnaout
- Department of Medicine, Allergy & Immunology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Roland C Aydin
- Dr von Hauner University Children's Hospital, Ludwig Maximilians Universität, Munich, Germany
| | - Vincent Barlogis
- Pediatric Hematology, Assistance publique des Hopitaux de Marseille, Marseille, France
| | | | - Carmem Bonfim
- Pediatric Blood and Marrow Transplantation Program, Hospital de Clinicas, Federal University of Parana, Curitiba, Brazil
| | | | - Julia I Chu
- Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | - Oana C Ciocarlie
- Department of Bone Marrow Transplantation, Great Ormond Street Hospital NHS Trust, London, United Kingdom
| | - Figen Doğu
- Department of Pediatric Immunology & Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Hubert B Gaspar
- Molecular Immunology Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Raif S Geha
- Department of Immunology, Boston Children's Hospital, Boston, Mass
| | - Andrew R Gennery
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fabian Hauck
- Dr von Hauner University Children's Hospital, Ludwig Maximilians Universität, Munich, Germany
| | - Abbas Hawwari
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | | | - Manfred Hoenig
- Department of Pediatrics, University Medical Center Ulm, Ulm, Germany
| | - Aydan Ikinciogullari
- Department of Pediatric Immunology & Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Christoph Klein
- Dr von Hauner University Children's Hospital, Ludwig Maximilians Universität, Munich, Germany
| | - Ashish Kumar
- BMT/Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Marianne R S Ifversen
- Department for Children and Adolescents, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Matthes
- Stem Cell Transplantation, St Anna Children's Hospital, Vienna, Austria
| | - Ayse Metin
- Pediatric Immunology, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Benedicte Neven
- Department for Pediatric Immuno-Hematology and Rheumatology, Necker Hospital, Paris, France
| | - Sung-Yun Pai
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Mass
| | - Suhag H Parikh
- Pediatric Blood and Marrow Transplant Program, Duke University Medical Center, Durham, NC
| | - Capucine Picard
- Study Center of Primary Immunodeficiency, Necker Children's Hospital, Paris, France
| | | | - Özden Sanal
- Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Ansgar S Schulz
- Department of Pediatrics, University Medical Center Ulm, Ulm, Germany
| | - Friedhelm Schuster
- Department of Pediatrics, Düsseldorf University Hospital, Düsseldorf, Germany
| | - Nirali N Shah
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Md
| | - Evan B Shereck
- Pediatric Hematology/Oncology, Oregon & Health Science University, Portland, Ore
| | - Mary A Slatter
- Paediatric BMT, Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
| | - Helen C Su
- Laboratory of Clinical Immunology and Microbiology, NIAID, National Institutes of Health, Bethesda, Md
| | - Joris van Montfrans
- Pediatric Immunology and Infectious Diseases, UMC Utrecht, Utrecht, The Netherlands
| | - Wilhelm Woessmann
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - John B Ziegler
- Immunology & Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Michael H Albert
- Dr von Hauner University Children's Hospital, Ludwig Maximilians Universität, Munich, Germany.
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Slatter MA, Gennery AR. Hematopoietic cell transplantation in primary immunodeficiency - conventional and emerging indications. Expert Rev Clin Immunol 2018; 14:103-114. [PMID: 29300535 DOI: 10.1080/1744666x.2018.1424627] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Hematopoietic stem cell transplantation (HSCT) is an established curative treatment for many primary immunodeficiencies. Advances in donor selection, graft manipulation, conditioning and treatment of complications, mean that survival for many conditions is now around 90%. Next generation sequencing is identifying new immunodeficiencies, many of which are treatable with HSCT. Challenges remain however with short and long-term sequalae. This article reviews latest developments in HSCT for conventional primary immunodeficiencies and presents data on outcome for emerging diseases, Areas covered: This article reviews recently published literature detailing advances, particularly in conditioning regimens and new methods of T-lymphocyte depletion, as well as new information regarding approach and out come of transplanting patients with conventional primary immunodeficiencies. The article reviews data regarding transplant outcomes for newly described primary immunodeficiencies, particularly those associated with gain-of-function mutations. Expert commentary: New methods of graft manipulation have had significant impact on HSCT outcomes, with the range of PIDs treated using T-lymphocyte depletion significantly expanded. Outcomes for newly described diseases with variable phenotypes and clinical features, transplanted when the diagnosis was unknown are beginning to be described, and will improve as patients are identified earlier, and targeted therapies such as JAK inhibitors are used as a bridge to transplantation.
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Affiliation(s)
- Mary A Slatter
- a Institute of Cellular Medicine , Newcastle University , Newcastle Upon Tyne , UK.,b Paediatric Immunology and HSCT , Great North Children's Hospital , Newcastle Upon Tyne , UK
| | - Andrew R Gennery
- a Institute of Cellular Medicine , Newcastle University , Newcastle Upon Tyne , UK.,b Paediatric Immunology and HSCT , Great North Children's Hospital , Newcastle Upon Tyne , UK
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11
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Successful hematopoietic stem cell transplantation after myeloablative conditioning in three patients with dedicator of cytokinesis 8 deficiency (DOCK8) related Hyper IgE syndrome. Bone Marrow Transplant 2017; 53:339-343. [PMID: 29269803 DOI: 10.1038/s41409-017-0040-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 11/11/2017] [Accepted: 11/19/2017] [Indexed: 11/08/2022]
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12
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Uygun DFK, Uygun V, Reisli İ, Keleş S, Özen A, Yılmaz M, Sayar EH, Daloğlu H, Öztürkmen SI, Çakı S, Karasu GT, Yeşilipek A. Hematopoietic stem cell transplantation from unrelated donors in children with DOCK8 deficiency. Pediatr Transplant 2017; 21. [PMID: 28664550 DOI: 10.1111/petr.13015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2017] [Indexed: 01/01/2023]
Abstract
DIDS is a unique form of combined immune deficiency characterized by an unusual susceptibility to cutaneous viral infections, severe allergies with eosinophilia and elevated immunoglobulin E titers, autoimmunity, and cancer. HSCT is considered the standard of care for this deadly disease. We have retrospectively analyzed the outcome of allogeneic HSCT from unrelated donors in patients with DIDS. Data from four patients, with five transplants, are presented. All patients received transplants from unrelated donors' BM, except for one patient who received a cord blood transplant. The conditioning regimens were based on myeloablative protocols for BM derived transplants; a NM regimen was pursued for the patient who received a cord blood transplant, which resulted in graft rejection. Although recurrent pneumonia and skin infections resolved immediately after transplantation, all patients subsequently developed human herpesvirus infection, including cutaneous herpetic lesions, cytomegalovirus reactivation, and zona zoster, which could be attributed to the use of ATG. Despite the presence of serious morbidities prior to transplantation, all patients recovered successfully. DIDS can be successfully treated with allogeneic HSCT from unrelated donors following a myeloablative conditioning regimen, with a reasonable safety profile.
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Affiliation(s)
- Dilara Fatma K Uygun
- Department of Pediatric Immunology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Vedat Uygun
- Faculty of Medicine, Department of Pediatric Bone Marrow Transplantation Unit, MedicalPark Antalya Hospital, Bahçeşehir University, Antalya, Turkey
| | - İsmail Reisli
- Meram Medical Faculty, Division of Pediatric Immunology and Allergy, Necmettin Erbakan University, Konya, Turkey
| | - Sevgi Keleş
- Meram Medical Faculty, Division of Pediatric Immunology and Allergy, Necmettin Erbakan University, Konya, Turkey
| | - Ahmet Özen
- Faculty of Medicine, Division of Pediatric Allergy and Immunology, Marmara University, İstanbul, Turkey
| | - Mustafa Yılmaz
- Faculty of Medicine, Division of Pediatric Allergy and Immunology, Cukurova University, Adana, Turkey
| | - Esra H Sayar
- Meram Medical Faculty, Division of Pediatric Immunology and Allergy, Necmettin Erbakan University, Konya, Turkey
| | - Hayriye Daloğlu
- Faculty of Medicine, Department of Pediatric Bone Marrow Transplantation Unit, MedicalPark Antalya Hospital, Bahçeşehir University, Antalya, Turkey
| | - Seda I Öztürkmen
- Faculty of Medicine, Department of Pediatric Bone Marrow Transplantation Unit, MedicalPark Antalya Hospital, Bahçeşehir University, Antalya, Turkey
| | - Suar Çakı
- Faculty of Medicine, Department of Pediatric Bone Marrow Transplantation Unit, MedicalPark Göztepe Hospital, Bahçeşehir University, İstanbul, Turkey
| | - Gülsün T Karasu
- Faculty of Medicine, Department of Pediatric Bone Marrow Transplantation Unit, MedicalPark Göztepe Hospital, Bahçeşehir University, İstanbul, Turkey
| | - Akif Yeşilipek
- Faculty of Medicine, Department of Pediatric Bone Marrow Transplantation Unit, MedicalPark Antalya Hospital, Bahçeşehir University, Antalya, Turkey
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13
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Biggs CM, Keles S, Chatila TA. DOCK8 deficiency: Insights into pathophysiology, clinical features and management. Clin Immunol 2017. [PMID: 28625885 DOI: 10.1016/j.clim.2017.06.003] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Dedicator of cytokinesis 8 (DOCK8) deficiency is a combined immunodeficiency that exemplifies the broad clinical features of primary immunodeficiencies (PIDs), extending beyond recurrent infections to include atopy, autoimmunity and cancer. It is caused by loss of function mutations in DOCK8, encoding a guanine nucleotide exchange factor highly expressed in lymphocytes that regulates the actin cytoskeleton. Additional roles of DOCK8 have also emerged, including regulating MyD88-dependent Toll-like receptor signaling and the activation of the transcription factor STAT3. DOCK8 deficiency impairs immune cell migration, function and survival, and it impacts both innate and adaptive immune responses. Clinically, DOCK8 deficiency is characterized by allergic inflammation as well as susceptibility towards infections, autoimmunity and malignancy. This review details the pathophysiology, clinical features and management of DOCK8 deficiency. It also surveys the recently discovered combined immunodeficiency due to DOCK2 deficiency, highlighting in the process the emerging spectrum of PIDs resulting from DOCK protein family abnormalities.
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Affiliation(s)
- Catherine M Biggs
- Division of Immunology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Sevgi Keles
- Division of Pediatric Allergy and Immunology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Talal A Chatila
- Division of Immunology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
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14
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Shah NN, Freeman AF, Su H, Cole K, Parta M, Moutsopoulos NM, Baris S, Karakoc-Aydiner E, Hughes TE, Kong HH, Holland SM, Hickstein DD. Haploidentical Related Donor Hematopoietic Stem Cell Transplantation for Dedicator-of-Cytokinesis 8 Deficiency Using Post-Transplantation Cyclophosphamide. Biol Blood Marrow Transplant 2017; 23:980-990. [PMID: 28288951 PMCID: PMC5757872 DOI: 10.1016/j.bbmt.2017.03.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 03/09/2017] [Indexed: 01/02/2023]
Abstract
Dedicator-of-cytokinesis 8 (DOCK8) deficiency, a primary immunodeficiency disease, can be reversed by allogeneic hematopoietic stem cell transplantation (HSCT); however, there are few reports describing the use of alternative donor sources for HSCT in DOCK8 deficiency. We describe HSCT for patients with DOCK8 deficiency who lack a matched related or unrelated donor using bone marrow from haploidentical related donors and post-transplantation cyclophosphamide (PT/Cy) for graft-versus-host disease (GVHD) prophylaxis. Seven patients with DOCK8 deficiency (median age, 20 years; range, 7 to 25 years) received a haploidentical related donor HSCT. The conditioning regimen included 2 days of low-dose cyclophosphamide, 5 days of fludarabine, 3 days of busulfan, and 200 cGy total body irradiation. GVHD prophylaxis consisted of PT/Cy 50 mg/kg/day on days +3 and +4 and tacrolimus and mycophenolate mofetil starting at day +5. The median times to neutrophil and platelet engraftment were 15 and 19 days, respectively. All patients attained >90% donor engraftment by day +30. Four subjects developed acute GVHD (1 with maximum grade 3). No patient developed chronic GVHD. With a median follow-up time of 20.6 months (range, 9.5 to 31.7 months), 6 of 7 patients are alive and disease free. Haploidentical related donor HSCT with PT/Cy represents an effective therapeutic approach for patients with DOCK8 deficiency who lack a matched related or unrelated donor.
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Affiliation(s)
- Nirali N Shah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Alexandra F Freeman
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Helen Su
- Laboratory of Host Defense, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Kristen Cole
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mark Parta
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Niki M Moutsopoulos
- Oral Immunity and Inflammation Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland
| | - Safa Baris
- Division of Pediatric Allergy and Immunology, Ministry of Health, Marmara University, Training and Research Hospital, Istanbul, Turkey
| | - Elif Karakoc-Aydiner
- Division of Pediatric Allergy and Immunology, Ministry of Health, Marmara University, Training and Research Hospital, Istanbul, Turkey
| | - Thomas E Hughes
- Clinical Center Pharmacy Department, National Institutes of Health, Bethesda, Maryland
| | - Heidi H Kong
- Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Steve M Holland
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Dennis D Hickstein
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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15
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Dimitrova D, Freeman AF. Current Status of Dedicator of Cytokinesis-Associated Immunodeficiency: DOCK8 and DOCK2. Dermatol Clin 2017; 35:11-19. [PMID: 27890234 DOI: 10.1016/j.det.2016.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
DOCK8 deficiency is an autosomal recessive combined immunodeficiency disease associated with elevated IgE, atopy, recurrent sinopulmonary and cutaneous viral infections, and malignancy. The DOCK8 protein is critical for cytoskeletal organization, and deficiency impairs dendritic cell transmigration, T-cell survival, and NK cell cytotoxicity. Early hematopoietic stem cell transplantation is gaining prominence as a definitive treatment given the potential for severe complications and mortality in this disease. Recently, DOCK2 deficiency has been identified in several patients with early-onset invasive bacterial and viral infections.
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Affiliation(s)
- Dimana Dimitrova
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
| | - Alexandra F Freeman
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA.
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16
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Tangye SG, Pillay B, Randall KL, Avery DT, Phan TG, Gray P, Ziegler JB, Smart JM, Peake J, Arkwright PD, Hambleton S, Orange J, Goodnow CC, Uzel G, Casanova JL, Lugo Reyes SO, Freeman AF, Su HC, Ma CS. Dedicator of cytokinesis 8-deficient CD4 + T cells are biased to a T H2 effector fate at the expense of T H1 and T H17 cells. J Allergy Clin Immunol 2017; 139:933-949. [PMID: 27554822 PMCID: PMC10500883 DOI: 10.1016/j.jaci.2016.07.016] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 07/01/2016] [Accepted: 07/12/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Dedicator of cytokinesis 8 (DOCK8) deficiency is a combined immunodeficiency caused by autosomal recessive loss-of-function mutations in DOCK8. This disorder is characterized by recurrent cutaneous infections, increased serum IgE levels, and severe atopic disease, including food-induced anaphylaxis. However, the contribution of defects in CD4+ T cells to disease pathogenesis in these patients has not been thoroughly investigated. OBJECTIVE We sought to investigate the phenotype and function of DOCK8-deficient CD4+ T cells to determine (1) intrinsic and extrinsic CD4+ T-cell defects and (2) how defects account for the clinical features of DOCK8 deficiency. METHODS We performed in-depth analysis of the CD4+ T-cell compartment of DOCK8-deficient patients. We enumerated subsets of CD4+ T helper cells and assessed cytokine production and transcription factor expression. Finally, we determined the levels of IgE specific for staple foods and house dust mite allergens in DOCK8-deficient patients and healthy control subjects. RESULTS DOCK8-deficient memory CD4+ T cells were biased toward a TH2 type, and this was at the expense of TH1 and TH17 cells. In vitro polarization of DOCK8-deficient naive CD4+ T cells revealed the TH2 bias and TH17 defect to be T-cell intrinsic. Examination of allergen-specific IgE revealed plasma IgE from DOCK8-deficient patients is directed against staple food antigens but not house dust mites. CONCLUSION Investigations into the DOCK8-deficient CD4+ T cells provided an explanation for some of the clinical features of this disorder: the TH2 bias is likely to contribute to atopic disease, whereas defects in TH1 and TH17 cells compromise antiviral and antifungal immunity, respectively, explaining the infectious susceptibility of DOCK8-deficient patients.
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Affiliation(s)
- Stuart G Tangye
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, Australia; St Vincent's Clinical School, University of New South Wales, Darlinghurst, Australia.
| | - Bethany Pillay
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, Australia; St Vincent's Clinical School, University of New South Wales, Darlinghurst, Australia
| | - Katrina L Randall
- Department of Immunology, John Curtin School of Medical Research, Acton, Australia; Australian National University Medical School, Australian National University, Acton, Australia
| | - Danielle T Avery
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, Australia
| | - Tri Giang Phan
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, Australia; St Vincent's Clinical School, University of New South Wales, Darlinghurst, Australia
| | - Paul Gray
- University of New South Wales School of Women's and Children's Health, Randwick, Australia
| | - John B Ziegler
- University of New South Wales School of Women's and Children's Health, Randwick, Australia
| | - Joanne M Smart
- Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Australia
| | - Jane Peake
- University of Queensland and Lady Cilento Children's Hospital, Brisbane, Australia
| | - Peter D Arkwright
- University of Manchester, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Sophie Hambleton
- Institute of Cellular Medicine, Newcastle University and Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
| | - Jordan Orange
- Center for Human Immunobiology of Texas Children's Hospital/Department of Pediatrics, Baylor College of Medicine; the Department of Pediatrics, Division of Immunology, Allergy, and Rheumatology, and the Department of Pediatrics, Baylor College of Medicine, and Texas Children's Hospital, Houston, Tex
| | - Christopher C Goodnow
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, Australia; St Vincent's Clinical School, University of New South Wales, Darlinghurst, Australia
| | - Gulbu Uzel
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Jean-Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Institut IMAGINE, Necker Medical School, University Paris Descartes, Paris, France; Pediatric Hematology and Immunology Unit, Necker Hospital for Sick Children, AP-HP, Paris, France; St Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, Rockefeller University, New York, NY; Howard Hughes Medical Institute, New York, NY
| | | | - Alexandra F Freeman
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Helen C Su
- Laboratory of Host Defenses, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Cindy S Ma
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, Australia; St Vincent's Clinical School, University of New South Wales, Darlinghurst, Australia.
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Early Diagnosis in Dedicator of Cytokinesis 8 (DOCK8) Deficiency. J Pediatr 2016; 179:33-35. [PMID: 27671117 DOI: 10.1016/j.jpeds.2016.08.081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 08/01/2016] [Accepted: 08/24/2016] [Indexed: 01/08/2023]
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Al Shekaili L, Sheikh F, Al Gazlan S, Al Dhekri H, Al Mousa H, Al Ghonaium A, Al Saud B, Al Mohsen S, Rehan Khaliq AM, Al Sumayli S, Al Zahrani M, Dababo A, AlKawi A, Hawwari A, Arnaout R. Novel mutation in DOCK8-HIES with severe phenotype and successful transplantation. Clin Immunol 2016; 178:39-44. [PMID: 27890707 DOI: 10.1016/j.clim.2016.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 08/01/2016] [Accepted: 08/01/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hyper-IgE syndrome (HIES) due to DOCK8 deficiency is an autosomal recessive (AR) primary combined immunodeficiency which results in significant morbidity and mortality at a young age. Different mutations in the DOCK8 gene can lead to variable severity of the disease. OBJECTIVE We evaluated the genetic mutations in three related patients with severe clinical manifestations suggestive of AR HIES. We also explored whether treatment with stem cell transplantation could lead to complete disease resolution. METHOD We examined the clinical manifestations and immunological workup of these patients. Their DNA was also screened for causative mutation. Post transplantation, clinical and immunological data for the transplanted patient was also collected. RESULTS All patients had a severe course of the disease with rarely reported severe complications in HIES. One patient died with lymphoma while another died with progressive multifocal leukoencephalopathy (PML) due to a slow virus. All our patients had two novel mutations in the DOCK8 gene. One of these mutations was a novel pathogenic mutation and explains the severity of the disease (homozygous splice site mutation at position 5 after the end of exon 45), while the other mutation was mostly non-pathogenic. Hematopoietic stem cell transplantation (HSCT) was performed in the youngest patient with excellent engraftment and full reversibility of the clinical manifestations. CONCLUSION We report 3 patients from a consanguineous family diagnosed with AR-HIES due to a novel pathogenic mutation in DOCK8 gene leading to fatal outcome in 2 patients and complete resolution of the clinical and immunological features in the third patient by HSCT.
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Affiliation(s)
- Latifa Al Shekaili
- King Faisal Specialist Hospital and Research Center, Department of Medicine, Allergy and Immunology section, P.O Box 3354, Riyadh 11211, MBC 46, Saudi Arabia.
| | - Farrukh Sheikh
- King Faisal Specialist Hospital and Research Center, Department of Medicine, Allergy and Immunology section, P.O Box 3354, Riyadh 11211, MBC 46, Saudi Arabia.
| | - Sulaiman Al Gazlan
- King Faisal Specialist Hospital and Research Center, Department of Medicine, Allergy and Immunology section, P.O Box 3354, Riyadh 11211, MBC 46, Saudi Arabia.
| | - Hasan Al Dhekri
- King Faisal Specialist Hospital and Research Center, Department of Pediatric, Allergy and Immunology section, P.O Box 3354, Riyadh 11211, MBC 58, Saudi Arabia.
| | - Hamoud Al Mousa
- King Faisal Specialist Hospital and Research Center, Department of Pediatric, Allergy and Immunology section, P.O Box 3354, Riyadh 11211, MBC 58, Saudi Arabia.
| | - Abdulaziz Al Ghonaium
- King Faisal Specialist Hospital and Research Center, Department of Pediatric, Allergy and Immunology section, P.O Box 3354, Riyadh 11211, MBC 58, Saudi Arabia.
| | - Bander Al Saud
- King Faisal Specialist Hospital and Research Center, Department of Pediatric, Allergy and Immunology section, P.O Box 3354, Riyadh 11211, MBC 58, Saudi Arabia.
| | - Saleh Al Mohsen
- King Faisal Specialist Hospital and Research Center, Department of Pediatric, Allergy and Immunology section, P.O Box 3354, Riyadh 11211, MBC 58, Saudi Arabia.
| | - Agha M Rehan Khaliq
- King Faisal Specialist Hospital and Research Center, Department of Medicine, Allergy and Immunology section, P.O Box 3354, Riyadh 11211, MBC 46, Saudi Arabia; Alfaisal University, Saudi Arabia.
| | - Safiah Al Sumayli
- King Faisal Specialist Hospital and Research Center, Department of Medicine, Allergy and Immunology section, P.O Box 3354, Riyadh 11211, MBC 46, Saudi Arabia.
| | - Mufarreh Al Zahrani
- King Fahad medical city, Department of Medicine, Riyadh 11525, P.O. Box 59046, Saudi Arabia.
| | - Anas Dababo
- King Faisal Specialist Hospital and Research Center, Department of Pathology and Lab Medicine, P.O Box 3354, Riyadh 11211, MBC 10, Saudi Arabia.
| | - Ammar AlKawi
- King Faisal Specialist Hospital and Research Center, Department of Neuroscience, P.O Box 3354, Riyadh 11211, MBC 76, Saudi Arabia.
| | - Abbas Hawwari
- King Faisal Specialist Hospital and Research Center, Department of genetics, P.O Box 3354, Riyadh 11211, MBC 3, Saudi Arabia.
| | - Rand Arnaout
- King Faisal Specialist Hospital and Research Center, Department of Medicine, Allergy and Immunology section, P.O Box 3354, Riyadh 11211, MBC 46, Saudi Arabia; Alfaisal University, Saudi Arabia.
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Abstract
Elevated serum IgE has many etiologies including parasitic infection, allergy and asthma, malignancy, and immune dysregulation. The hyper-IgE syndromes caused by mutations in STAT3, DOCK8, and PGM3 are monogenic primary immunodeficiencies associated with high IgE, eczema, and recurrent infections. These primary immunodeficiencies are associated with recurrent pneumonias leading to bronchiectasis; however, each has unique features and genetic diagnosis is essential in guiding therapy, discussing family planning, and defining prognosis. This article discusses the clinical features of these primary immunodeficiencies with a particular focus on the pulmonary manifestations and discussion of the genetics, pathogenesis, and approaches to therapy.
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Affiliation(s)
- Alexandra F Freeman
- Laboratory of Clinical Infectious Diseases, NIAID, NHLBI, National Institutes of Health, Bethesda, MD, USA.
| | - Kenneth N Olivier
- Laboratory of Clinical Infectious Diseases, NIAID, NHLBI, National Institutes of Health, Bethesda, MD, USA
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20
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Happel CS, Stone KD, Freeman AF, Shah NN, Wang A, Lyons JJ, Guerrerio PA, Hickstein DD, Su HC. Food allergies can persist after myeloablative hematopoietic stem cell transplantation in dedicator of cytokinesis 8-deficient patients. J Allergy Clin Immunol 2016; 137:1895-1898.e5. [PMID: 26827248 PMCID: PMC4899149 DOI: 10.1016/j.jaci.2015.11.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 11/11/2015] [Accepted: 11/17/2015] [Indexed: 11/23/2022]
Affiliation(s)
- Corinne S Happel
- Laboratory of Host Defenses, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Kelly D Stone
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Alexandra F Freeman
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Nirali N Shah
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md
| | - Angela Wang
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Frederick National Laboratory for Cancer Research, Frederick, Md
| | - Jonathan J Lyons
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Pamela A Guerrerio
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Dennis D Hickstein
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md
| | - Helen C Su
- Laboratory of Host Defenses, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.
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21
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Recent Advances in DOCK8 Immunodeficiency Syndrome. J Clin Immunol 2016; 36:441-9. [PMID: 27207373 DOI: 10.1007/s10875-016-0296-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/05/2016] [Indexed: 10/21/2022]
Abstract
Since the discovery of the genetic basis of DOCK8 immunodeficiency syndrome (DIDS) in 2009, several hundred patients worldwide have been reported, validating and extending the initial clinical descriptions. Importantly, the beneficial role of hematopoietic stem cell transplantation for this disease has emerged, providing impetus for improved diagnosis. Additionally, several groups have further elucidated the biological functions of DOCK8 in the immune system that help explain disease pathogenesis. Here, we summarize these recent developments.
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22
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Williams KW, Milner JD, Freeman AF. Eosinophilia Associated with Disorders of Immune Deficiency or Immune Dysregulation. Immunol Allergy Clin North Am 2016. [PMID: 26209898 DOI: 10.1016/j.iac.2015.05.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Increased serum eosinophil levels have been associated with multiple disorders of immune deficiency or immune dysregulation. Although primary immunodeficiency diseases are rare, it is important to consider these in the differential diagnosis of patients with eosinophilia. In this review, the clinical features, laboratory findings, diagnosis, and genetic basis of disease of several disorders of immune deficiency or dysregulation are discussed. The article includes autosomal dominant hyper IgE syndrome, DOCK8 deficiency, phosphoglucomutase 3 deficiency, ADA-SCID, Omenn syndrome, Wiskott-Aldrich syndrome, Loeys-Dietz syndrome, autoimmune lymphoproliferative syndrome, immunodysregulation, polyendocrinopathy, enteropathy, X-linked syndrome, Comel-Netherton syndrome, and severe dermatitis, multiple allergies, and metabolic wasting syndrome.
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Affiliation(s)
- Kelli W Williams
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 33 North Drive, Building 33, Room 2W10A, Bethesda, MD 20892, USA
| | - Joshua D Milner
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 10 Center Drive, Building 10/CRC, Room 5-3950, Bethesda, MD 20892, USA
| | - Alexandra F Freeman
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 10 Center Drive, Building 10/CRC, Room 12C103, Bethesda, MD 20892, USA.
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23
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Al-Herz W, Chu JI, van der Spek J, Raghupathy R, Massaad MJ, Keles S, Biggs CM, Cockerton L, Chou J, Dbaibo G, Elisofon SA, Hanna-Wakim R, Kim HB, Lehmann LE, McDonald DR, Notarangelo LD, Veys P, Chatila TA, Geha RS, Gaspar HB, Pai SY. Hematopoietic stem cell transplantation outcomes for 11 patients with dedicator of cytokinesis 8 deficiency. J Allergy Clin Immunol 2016; 138:852-859.e3. [PMID: 27130861 DOI: 10.1016/j.jaci.2016.02.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 02/13/2016] [Accepted: 02/26/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dedicator of cytokinesis 8 (DOCK8) deficiency can be cured by allogeneic hematopoietic stem cell transplantation (HSCT). Reports of outcomes are still limited. OBJECTIVE We sought to analyze the results of HSCT in patients with DOCK8 deficiency and report whether approaches resulting in mixed chimerism result in clinically relevant immune reconstitution. METHODS We performed a retrospective chart review of 11 patients with DOCK8 deficiency and measured DOCK8 expression and cytokine production. RESULTS Of 11 patients, 7 received HSCT from related and 4 from unrelated donors; 9 patients received busulfan-based conditioning regimens. Survival was excellent (10 [91%] of 11 patients alive), including a patient who had undergone liver transplantation. Patients showed significant improvements in the frequency and severity of infections. Although eczema resolved in all, food allergies and high IgE levels persisted in some patients. Lymphopenia, eosinophilia, low numbers of naive CD8(+) T cells and switched memory B cells, and TH1/TH2 cytokine imbalance improved in most patients. Although the 8 matched related or unrelated donor recipients had full donor chimerism, all 3 recipients of mismatched unrelated donor HSCT had high levels of donor T-cell chimerism and low B-cell and myeloid cell chimerism (0% to 46%). Almost all switched memory B cells were of donor origin. All patients, including those with mixed chimerism, mounted robust antibody responses to vaccination. CONCLUSION Allogeneic HSCT ameliorated the infectious and atopic symptoms of patients with DOCK8 deficiency. In patients with mixed chimerism, selective advantage for donor-derived T cells and switched memory B cells promoted restoration of cellular and humoral immunity and protection against opportunistic infection.
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Affiliation(s)
- Waleed Al-Herz
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait; Department of Pediatrics, Al-Sabah Hospital, Kuwait City, Kuwait
| | - Julia I Chu
- Division of Hematology-Oncology, Boston Children's Hospital, Boston, Mass; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Mass
| | - Jet van der Spek
- Division of Hematology-Oncology, Boston Children's Hospital, Boston, Mass
| | - Raj Raghupathy
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Michel J Massaad
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Sevgi Keles
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | | | - Lucinda Cockerton
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Janet Chou
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Ghassan Dbaibo
- Division of Pediatric Infectious Diseases, American University of Beirut, Beirut, Lebanon
| | - Scott A Elisofon
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Mass
| | - Rima Hanna-Wakim
- Division of Pediatric Infectious Diseases, American University of Beirut, Beirut, Lebanon
| | - Heung Bae Kim
- Department of Surgery, Boston Children's Hospital, Boston, Mass
| | - Leslie E Lehmann
- Division of Hematology-Oncology, Boston Children's Hospital, Boston, Mass; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Mass
| | | | | | - Paul Veys
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Talal A Chatila
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Raif S Geha
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - H Bobby Gaspar
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom; UCL Institute of Child Health, London, United Kingdom
| | - Sung-Yun Pai
- Division of Hematology-Oncology, Boston Children's Hospital, Boston, Mass; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Mass.
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24
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Pichard DC, Freeman AF, Cowen EW. Primary immunodeficiency update: Part I. Syndromes associated with eczematous dermatitis. J Am Acad Dermatol 2015; 73:355-64; quiz 365-6. [PMID: 26282794 DOI: 10.1016/j.jaad.2015.01.054] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/20/2015] [Accepted: 01/21/2015] [Indexed: 01/26/2023]
Abstract
In the past decade, the availability of powerful molecular techniques has accelerated the pace of discovery of several new primary immunodeficiencies (PIDs) and revealed the biologic basis of other established PIDs. These genetic advances, in turn, have facilitated more precise phenotyping of associated skin and systemic manifestations and provide a unique opportunity to better understand the complex human immunologic response. These continuing medical education articles will provide an update of recent advances in PIDs that may be encountered by dermatologists through their association with eczematous dermatitis, infectious, and non-infectious cutaneous manifestations. Part I will discuss new primary immunodeficiencies that have an eczematous dermatitis. Part II will focus on primary immunodeficiencies that greatly increase susceptibility to fungal infection and the noninfectious presentations of PIDs.
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Affiliation(s)
- Dominique C Pichard
- National Institutes of Health, National Cancer Institute, Bethesda, Maryland
| | | | - Edward W Cowen
- National Institutes of Health, National Cancer Institute, Bethesda, Maryland.
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25
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Cuellar-Rodriguez J, Freeman AF, Grossman J, Su H, Parta M, Murdock H, Shah N, Bollard C, Kong HH, Moutsopoulos N, Stone K, Gea-Banacloche J, Holland SM, Hickstein DD. Matched related and unrelated donor hematopoietic stem cell transplantation for DOCK8 deficiency. Biol Blood Marrow Transplant 2015; 21:1037-45. [PMID: 25636378 PMCID: PMC4426076 DOI: 10.1016/j.bbmt.2015.01.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/21/2015] [Indexed: 10/24/2022]
Abstract
We performed allogeneic hematopoietic stem cell transplantation in 6 patients with mutations in the dedicator-of-cytokinesis-8 (DOCK8) gene using a myeloablative conditioning regimen consisting of busulfan 3.2 mg/kg/day i.v. for 4 days and fludarabine 40 mg/m(2)/day for 4 days. Three patients received allografts from matched related donors and 3 patients from matched unrelated donors. Two patients received peripheral blood stem cells and 4 patients bone marrow hematopoietic stem cells. Tacrolimus and short-course methotrexate on days 1, 3, 6, and 11 were used for graft-versus-host-disease (GVHD) prophylaxis. All 6 patients are alive at a median follow-up of 22.5 months (range, 14 to 35). All patients achieved rapid and high levels of donor engraftment and complete reversal of the clinical and immunologic phenotype. Adverse events consisted of acute skin GVHD in 2 patients and post-transplant pulmonary infiltrates in a patient with extensive bronchiectasis pretransplant. Thus, a uniform myeloablative conditioning regimen followed by allogeneic hematopoietic stem cell transplantation in DOCK8 deficiency results in reconstitution of immunologic function and reversal of the clinical phenotype with a low incidence of regimen-related toxicity.
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Affiliation(s)
- Jennifer Cuellar-Rodriguez
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Alexandra F Freeman
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jennifer Grossman
- Division of Hematology and Hematologic Malignancies, Alberta Health Services, Calgary, Alberta, Canada
| | - Helen Su
- Laboratory of Host Defense, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Mark Parta
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc. (formerly SAIC-Frederick, Inc.), Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Heardley Murdock
- Laboratory of Host Defense, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Nirali Shah
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Catherine Bollard
- Center for Cancer and Immunology Research at the Children's Research Institute, Children's National Medical Center, Washington, DC
| | - Heidi H Kong
- Dermatology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Niki Moutsopoulos
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland
| | - Kelly Stone
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Juan Gea-Banacloche
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Steven M Holland
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Dennis D Hickstein
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
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DOCK8 deficiency: clinical and immunological phenotype and treatment options - a review of 136 patients. J Clin Immunol 2015; 35:189-98. [PMID: 25627830 DOI: 10.1007/s10875-014-0126-0] [Citation(s) in RCA: 199] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 12/26/2014] [Indexed: 01/06/2023]
Abstract
Mutations in DOCK8 result in autosomal recessive Hyper-IgE syndrome with combined immunodeficiency (CID). However, the natural course of disease, long-term prognosis, and optimal therapeutic management have not yet been clearly defined. In an international retrospective survey of patients with DOCK8 mutations, focused on clinical presentation and therapeutic measures, a total of 136 patients with a median follow-up of 11.3 years (1.3-47.7) spanning 1693 patient years, were enrolled. Eczema, recurrent respiratory tract infections, allergies, abscesses, viral infections and mucocutaneous candidiasis were the most frequent clinical manifestations. Overall survival probability in this cohort [censored for hematopoietic stem cell transplantation (HSCT)] was 87 % at 10, 47 % at 20, and 33 % at 30 years of age, respectively. Event free survival was 44, 18 and 4 % at the same time points if events were defined as death, life-threatening infections, malignancy or cerebral complications such as CNS vasculitis or stroke. Malignancy was diagnosed in 23/136 (17 %) patients (11 hematological and 9 epithelial cancers, 5 other malignancies) at a median age of 12 years. Eight of these patients died from cancer. Severe, life-threatening infections were observed in 79/136 (58 %); severe non-infectious cerebral events occurred in 14/136 (10 %). Therapeutic measures included antiviral and antibacterial prophylaxis, immunoglobulin replacement and HSCT. This study provides a comprehensive evaluation of the clinical phenotype of DOCK8 deficiency in the largest cohort reported so far and demonstrates the severity of the disease with relatively poor prognosis. Early HSCT should be strongly considered as a potential curative measure.
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28
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Janssen E, Morbach H, Ullas S, Bannock JM, Massad C, Menard L, Barlan I, Lefranc G, Su H, Dasouki M, Al-Herz W, Keles S, Chatila T, Geha RS, Meffre E. Dedicator of cytokinesis 8-deficient patients have a breakdown in peripheral B-cell tolerance and defective regulatory T cells. J Allergy Clin Immunol 2014; 134:1365-1374. [PMID: 25218284 PMCID: PMC4261031 DOI: 10.1016/j.jaci.2014.07.042] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 07/11/2014] [Accepted: 07/15/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND Dedicator of cytokinesis 8 (DOCK8) deficiency is typified by recurrent infections, increased serum IgE levels, eosinophilia, and a high incidence of allergic and autoimmune manifestations. OBJECTIVE We sought to determine the role of DOCK8 in the establishment and maintenance of human B-cell tolerance. METHODS Autoantibodies were measured in the plasma of DOCK8-deficient patients. The antibody-coding genes from new emigrant/transitional and mature naive B cells were cloned and assessed for their ability to bind self-antigens. Regulatory T (Treg) cells in the blood were analyzed by means of flow cytometry, and their function was tested by examining their capacity to inhibit the proliferation of CD4(+)CD25(-) effector T cells. RESULTS DOCK8-deficient patients had increased levels of autoantibodies in their plasma. We determined that central B-cell tolerance did not require DOCK8, as evidenced by the normally low frequency of polyreactive new emigrant/transitional B cells in DOCK8-deficient patients. In contrast, autoreactive B cells were enriched in the mature naive B-cell compartment, revealing a defective peripheral B-cell tolerance checkpoint. In addition, we found that Treg cells were decreased and exhibited impaired suppressive activity in DOCK8-deficient patients. CONCLUSIONS Our data support a critical role for DOCK8 in Treg cell homeostasis and function and the enforcement of peripheral B-cell tolerance.
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Affiliation(s)
- Erin Janssen
- Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Henner Morbach
- Department of Immunobiology, Yale University School of Medicine, New Haven, Conn
| | - Sumana Ullas
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Jason M Bannock
- Department of Immunobiology, Yale University School of Medicine, New Haven, Conn
| | - Christopher Massad
- Department of Immunobiology, Yale University School of Medicine, New Haven, Conn
| | - Laurence Menard
- Department of Immunobiology, Yale University School of Medicine, New Haven, Conn
| | | | - Gerard Lefranc
- IMGT, University Montpellier, and CNRS Institute of Human Genetics, Montpellier, France
| | - Helen Su
- Human Immunological Diseases Unit, National Institutes of Health, Bethesda, Md
| | - Majed Dasouki
- Department of Pediatrics and Department of Internal Medicine, Division of Genetics, Endocrinology & Metabolism, University of Kansas Medical Center, Kansas City, Kan
| | - Waleed Al-Herz
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Sevgi Keles
- Division of Immunology, Boston Children's Hospital, Boston, Mass; Division of Pediatric Immunology and Allergy, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Talal Chatila
- Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Raif S Geha
- Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
| | - Eric Meffre
- Department of Immunobiology, Yale University School of Medicine, New Haven, Conn.
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29
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Abstract
Allogeneic hematopoietic stem cell transplantation has been shown to be curative for well-described as well as newly discovered immunodeficiencies. However, it is difficulty to define a universal transplant regimen given the rarity of these disorders and the varied pathophysiology these disorders encompass. This article discusses those primary immunodeficiencies most commonly treated by hematopoietic stem cell transplant and describes the transplant issues specific to these disorders.
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Affiliation(s)
- Elizabeth Kang
- Hematotherapeutics Unit, Laboratory of Host Defenses, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 10-CRC Room 6-3752, 10 Centre Drive, Bethesda, MD 20892, USA.
| | - Andrew Gennery
- Paediatric Immunology Department, Institute of Cellular Medicine, Great North Children's Hospital, c/o Ward 3, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
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30
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Jing H, Zhang Q, Zhang Y, Hill BJ, Dove CG, Gelfand EW, Atkinson TP, Uzel G, Matthews HF, Mustillo PJ, Lewis DB, Kavadas FD, Hanson IC, Kumar AR, Geha RS, Douek DC, Holland SM, Freeman AF, Su HC. Somatic reversion in dedicator of cytokinesis 8 immunodeficiency modulates disease phenotype. J Allergy Clin Immunol 2014; 133:1667-75. [PMID: 24797421 DOI: 10.1016/j.jaci.2014.03.025] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 03/21/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Autosomal recessive loss-of-function mutations in dedicator of cytokinesis 8 (DOCK8) cause a combined immunodeficiency characterized by atopy, recurrent infections, and cancer susceptibility. A genotype-phenotype explanation for the variable disease expression is lacking. OBJECTIVE We investigated whether reversions contributed to the variable disease expression. METHODS Patients followed at the National Institutes of Health's Clinical Center were studied. We performed detailed genetic analyses and intracellular flow cytometry to detect DOCK8 protein expression within lymphocyte subsets. RESULTS We identified 17 of 34 DOCK8-deficient patients who had germline mutations with variable degrees of reversion caused by somatic repair. Somatic repair of the DOCK8 mutations resulted from second-site mutation, original-site mutation, gene conversion, and intragenic crossover. Higher degrees of reversion were associated with recombination-mediated repair. DOCK8 expression was restored primarily within antigen-experienced T cells or natural killer cells but less so in naive T or B cells. Several patients exhibited multiple different repair events. Patients who had reversions were older and had less severe allergic disease, although infection susceptibility persisted. No patients were cured without hematopoietic cell transplantation. CONCLUSIONS In patients with DOCK8 deficiency, only certain combinations of germline mutations supported secondary somatic repair. Those patients had an ameliorated disease course with longer survival but still had fatal complications or required hematopoietic cell transplantation. These observations support the concept that some DOCK8-immunodeficient patients have mutable mosaic genomes that can modulate disease phenotype over time.
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Affiliation(s)
- Huie Jing
- Laboratory of Host Defenses, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, Md
| | - Qian Zhang
- Laboratory of Host Defenses, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, Md
| | - Yu Zhang
- Laboratory of Host Defenses, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, Md
| | - Brenna J Hill
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, Md
| | - Christopher G Dove
- Laboratory of Host Defenses, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, Md
| | - Erwin W Gelfand
- Division of Allergy and Immunology, Department of Pediatrics, Division of Cell Biology, National Jewish Health, Denver, Colo
| | - T Prescott Atkinson
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Ala
| | - Gulbu Uzel
- Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, Md
| | - Helen F Matthews
- Laboratory of Immunology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, Md
| | - Peter J Mustillo
- Division of Infectious Diseases and Immunology, Nationwide Children's Hospital, Columbus, Ohio
| | - David B Lewis
- Department of Pediatrics, Division of Immunology, Allergy, and Rheumatology, Stanford University, Stanford, Calif
| | - Fotini D Kavadas
- Section of Clinical Immunology and Allergy, Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - I Celine Hanson
- Section of Allergy and Immunology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Tex
| | - Ashish R Kumar
- Cancer and Blood Diseases Institute, Division of Bone Marrow Transplantation and Immune Deficiency and Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Raif S Geha
- Division of Immunology and Department of Pediatrics, Children's Hospital and Harvard Medical School, Boston, Mass
| | - Daniel C Douek
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, Md
| | - Steven M Holland
- Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, Md
| | - Alexandra F Freeman
- Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, Md
| | - Helen C Su
- Laboratory of Host Defenses, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, Md.
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Janssen E, Tsitsikov E, Al-Herz W, Lefranc G, Megarbane A, Dasouki M, Bonilla FA, Chatila T, Schneider L, Geha RS. Flow cytometry biomarkers distinguish DOCK8 deficiency from severe atopic dermatitis. Clin Immunol 2013; 150:220-4. [PMID: 24440647 DOI: 10.1016/j.clim.2013.12.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 12/18/2013] [Indexed: 11/17/2022]
Abstract
DOCK8 deficiency is a primary immunodeficiency characterized by recurrent sinopulmonary infections, dermatitis with cutaneous infections, elevated serum IgE levels, eosinophilia, and a high incidence of food allergy. Given the seriousness of DOCK8 deficiency, it is important to recognize it early and initiate appropriate therapy. Diagnosis relies on examining DOCK8 protein expression and sequencing of the 48 exons in the DOCK8 gene, but these assays are not always readily available. A major problem facing clinicians is that DOCK8 deficiency shares many clinical and laboratory features with severe atopic dermatitis. Here, we have identified biomarkers routinely measured by flow cytometry on whole blood in clinical immunology laboratories that may be used in distinguishing DOCK8 deficiency from severe atopic dermatitis. The use of these biomarkers may help the clinician identify those patients who are most likely to have DOCK8 mutations and would benefit from further specialized diagnostic testing.
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Affiliation(s)
- Erin Janssen
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Erdyni Tsitsikov
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Waleed Al-Herz
- Department of Pediatrics, Kuwait University, Kuwait City, Kuwait
| | - Gerard Lefranc
- University Montpellier 2 and CNRS Institute of Human Genetics, Montpellier, France
| | - Andre Megarbane
- Unit of Medical Genetics, Saint Joseph University, Beirut, Lebanon
| | - Majed Dasouki
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA; Department of Internal Medicine, Division of Genetics, Endocrinology & Metabolism, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Talal Chatila
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Lynda Schneider
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Raif S Geha
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA.
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Al-Mousa H, Hawwari A, Alsum Z. In DOCK8 deficiency donor cell engraftment post–genoidentical hematopoietic stem cell transplantation is possible without conditioning. J Allergy Clin Immunol 2013; 131:1244-5. [DOI: 10.1016/j.jaci.2012.12.663] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Revised: 12/03/2012] [Accepted: 12/10/2012] [Indexed: 11/28/2022]
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Matthes-Martin S, Lawitschka A, Fritsch G, Lion T, Grimm B, Breuer S, Boztug H, Karlhuber S, Holter W, Peters C, Minkov M. Stem cell transplantation after reduced-intensity conditioning for sickle cell disease. Eur J Haematol 2013; 90:308-12. [PMID: 23369103 DOI: 10.1111/ejh.12082] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2013] [Indexed: 11/29/2022]
Abstract
Sickle cell disease (SCD) is still associated with substantial morbidity and reduced life expectancy. Disease-related mortality rises to 14% in adolescents and young adults. Overall and disease-free survival following haematopoietic stem cell transplantation (HSCT) is 90% and 95%, respectively. To reduce transplant-associated late effects, the feasibility of a highly immunosuppressive reduced-intensity conditioning (RIC) regimen was explored in children with SCD and a matched sibling donor. Eight patients (median age, 9 yr) and symptomatic SCD were included. The conditioning regimen consisted of fludarabine, melphalan and either thiotepa or total lymphoid irradiation plus antithymocyte globuline or alemtuzumab. The graft was bone marrow in seven and cord blood in one case. The conditioning regimen was well tolerated and no severe infectious complications occurred. All patients displayed mixed chimaerism on day +28. After a median follow-up of 4 yr, 3/8 patients have mixed leucocyte chimaerism and 8/8 patients have 100% donor erythropoiesis. HSCT from matched sibling donors following a RIC regimen was well tolerated and resulted in cure in all patients studied. If confirmed in larger patient cohorts, these observations will have important implications for the indications of HSCT in children with SCD.
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Affiliation(s)
- Susanne Matthes-Martin
- Department of Paediatrics, St. Anna Children's Hospital, Medical University, Kinderspitalgasse 6, Vienna, Austria.
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