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Saettini F, Herriot R, Prada E, Nizon M, Zama D, Marzollo A, Romaniouk I, Lougaris V, Cortesi M, Morreale A, Kosaki R, Cardinale F, Ricci S, Domínguez-Garrido E, Montin D, Vincent M, Milani D, Biondi A, Gervasini C, Badolato R. Prevalence of Immunological Defects in a Cohort of 97 Rubinstein-Taybi Syndrome Patients. J Clin Immunol 2020; 40:851-860. [PMID: 32594341 DOI: 10.1007/s10875-020-00808-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/16/2020] [Indexed: 12/24/2022]
Abstract
Although recurrent infections in Rubinstein-Taybi syndrome (RSTS) are common, and probably multifactorial, immunological abnormalities have not been extensively described with only isolated cases or small case series of immune deficiency and dysregulation having been reported. The objective of this study was to investigate primary immunodeficiency (PID) and immune dysregulation in an international cohort of patients with RSTS. All published cases of RSTS were identified. The corresponding authors and researchers involved in the diagnosis of inborn errors of immunity or genetic syndromes were contacted to obtain up-to-date clinical and immunological information. Ninety-seven RSTS patients were identified. For 45 patients, we retrieved data from the published reports while for 52 patients, a clinical update was provided. Recurrent or severe infections, autoimmune/autoinflammatory complications, and lymphoproliferation were observed in 72.1%, 12.3%, and 8.2% of patients. Syndromic immunodeficiency was diagnosed in 46.4% of individuals. Despite the broad heterogeneity of immunodeficiency disorders, antibody defects were observed in 11.3% of subjects. In particular, these patients presented hypogammaglobulinemia associated with low B cell counts and reduction of switched memory B cell numbers. Immunoglobulin replacement therapy, antibiotic prophylaxis, and immunosuppressive treatment were employed in 16.4%, 8.2%, and 9.8% of patients, respectively. Manifestations of immune dysfunctions, affecting mostly B cells, are more common than previously recognized in patients with RSTS. Full immunological assessment is warranted in these patients, who may require detailed investigation and specific supportive treatment. Graphical Abstract.
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Affiliation(s)
- Francesco Saettini
- Pediatric Hematology Department, Fondazione MBBM, University of Milano Bicocca, via Pergolesi 33, 20900, Monza, Italy.
| | - Richard Herriot
- Immunology Department, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Elisabetta Prada
- Department of Pathophysiology and Transplantation, Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Mathilde Nizon
- Service de Génétique Médicale, CHU de Nantes, 44000, Nantes, France.,Inserm, CNRS, l'institut du thorax, Universite de Nantes, 44000, Nantes, France
| | - Daniele Zama
- Pediatric Oncology and Hematology Unit "Lalla Seràgnoli", Department of Pediatrics, Sant'Orsola Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Antonio Marzollo
- Department of Women's and Children's Health, Pediatric Hemato-Oncology, University Hospital of Padova, Padova, Italy
| | - Igor Romaniouk
- Departamento de Nefrología, Hospital Universitario de Santiago, Santiago de Compostela, Spain
| | - Vassilios Lougaris
- Department of Clinical and Experimental Sciences, Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, ASST-Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Manuela Cortesi
- Department of Clinical and Experimental Sciences, Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, ASST-Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Alessia Morreale
- Department of Clinical and Experimental Sciences, Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, ASST-Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Rika Kosaki
- Division of Medical Genetics, National Center for Child Health and Development, 2-10-1 Okura Setagaya-ku, Tokyo, 157-8535, Japan
| | | | - Silvia Ricci
- Pediatric Immunology, Meyer Children's University Hospital, Florence, Italy
| | | | - Davide Montin
- Division of Immunology and Rheumatology, Department of Paediatric Infectious Diseases, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Marie Vincent
- Service de Génétique Médicale, CHU de Nantes, 44000, Nantes, France.,Inserm, CNRS, l'institut du thorax, Universite de Nantes, 44000, Nantes, France
| | - Donatella Milani
- Department of Pathophysiology and Transplantation, Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Andrea Biondi
- Pediatric Hematology Department, Fondazione MBBM, University of Milano Bicocca, via Pergolesi 33, 20900, Monza, Italy
| | | | - Raffaele Badolato
- Departamento de Nefrología, Hospital Universitario de Santiago, Santiago de Compostela, Spain
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Boot MV, van Belzen MJ, Overbeek LI, Hijmering N, Mendeville M, Waisfisz Q, Wesseling P, Hennekam RC, de Jong D. Benign and malignant tumors in Rubinstein-Taybi syndrome. Am J Med Genet A 2018; 176:597-608. [PMID: 29359884 PMCID: PMC5838508 DOI: 10.1002/ajmg.a.38603] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/11/2017] [Accepted: 12/20/2017] [Indexed: 11/10/2022]
Abstract
Rubinstein–Taybi syndrome (RSTS) is a multiple congenital anomalies syndrome associated with mutations in CREBBP (70%) and EP300 (5–10%). Previous reports have suggested an increased incidence of specific benign and possibly also malignant tumors. We identified all known individuals diagnosed with RSTS in the Netherlands until 2015 (n = 87) and studied the incidence and character of neoplastic tumors in relation to their CREBBP/EP300 alterations. The population–based Dutch RSTS data are compared to similar data of the Dutch general population and to an overview of case reports and series of all RSTS individuals with tumors reported in the literature to date. Using the Nationwide Network and Registry of Histopathology and Cytopathology in the Netherlands (PALGA Foundation), 35 benign and malignant tumors were observed in 26/87 individuals. Meningiomas and pilomatricomas were the most frequent benign tumors and their incidence was significantly elevated in comparison to the general Dutch population. Five malignant tumors were observed in four persons with RSTS (medulloblastoma; diffuse large‐cell B‐cell lymphoma; breast cancer; non‐small cell lung carcinoma; colon carcinoma). No clear genotype–phenotype correlation became evident. The Dutch population‐based data and reported case studies underscore the increased incidence of meningiomas and pilomatricomas in individuals with RSTS. There is no supporting evidence for an increased risk for malignant tumors in individuals with RSTS, however, due to the small numbers this risk may not be fully dismissed.
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Affiliation(s)
- Max V Boot
- Department of Pathology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Martine J van Belzen
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Nathalie Hijmering
- Department of Pathology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Matias Mendeville
- Department of Pathology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Quinten Waisfisz
- Department of Clinical Genetics, VU University Medical Centre, Amsterdam, The Netherlands
| | - Pieter Wesseling
- Department of Pathology, VU University Medical Centre, Amsterdam, The Netherlands.,Department of Pathology, Princess Máxima Centre for Pediatric Oncology, Utrecht and University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Raoul C Hennekam
- Department of Pediatrics, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Daphne de Jong
- Department of Pathology, VU University Medical Centre, Amsterdam, The Netherlands
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Korfi K, Ali S, Heward JA, Fitzgibbon J. Follicular lymphoma, a B cell malignancy addicted to epigenetic mutations. Epigenetics 2017; 12:370-377. [PMID: 28106467 PMCID: PMC5453190 DOI: 10.1080/15592294.2017.1282587] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 01/07/2023] Open
Abstract
While follicular lymphoma (FL) is exquisitely responsive to immuno-chemotherapy, many patients follow a relapsing remitting clinical course driven in part by a common precursor cell (CPC) population. Advances in next generation sequencing have provided valuable insights into the genetic landscape of FL and its clonal evolution in response to therapy, implicating perturbations of epigenetic regulators as a hallmark of the disease. Recurrent mutations of histone modifiers KMT2D, CREBBP, EP300, EZH2, ARIDIA, and linker histones are likely early events arising in the CPC pool, rendering epigenetic based therapies conceptually attractive for treatment of indolent and transformed FL. This review provides a synopsis of the main epigenetic aberrations and the current efforts in development and testing of epigenetic therapies in this B cell malignancy.
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Affiliation(s)
- Koorosh Korfi
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Sara Ali
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - James A. Heward
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Jude Fitzgibbon
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
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