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Zahran AM, El-Badawy OH, Mahran H, Gad E, Saad K, Morsy SG, Makboul A, Zahran ZAM, Elhoufey A, Dailah HG, Elsayh KI. Detection and characterization of autoreactive memory stem T-cells in children with acute immune thrombocytopenia. Clin Exp Med 2024; 24:158. [PMID: 39004660 PMCID: PMC11247050 DOI: 10.1007/s10238-024-01386-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/28/2024] [Indexed: 07/16/2024]
Abstract
Primary immune thrombocytopenia (ITP) is an acquired autoimmune disorder characterized by an isolated decrease in platelets below 100 × 109/l after the exclusion of other conditions associated with thrombocytopenia. We investigated the role of different memory T-cell subsets, including T stem cell memory (TSCM), in children diagnosed with primary ITP and its association with therapeutic duration. This case-control study included 39 pediatric patients with acute ITP admitted to the Children's Hospital at Assiut University. Using a FACSCanto flow cytometer, CD8 + and CD4 + T-lymphocytes were gated. Five different subsets were characterized in each of these cells according to CD45RO and CD45RA expression. Afterward, gating was performed based on CCR7, CD95, and CD27. Examination of the CD8 + T cells subpopulation showed that Central memory T (TCM) and CD8+ Naïve T (TN) cells were significantly lower in ITP patients than in healthy children (p < 0.0001) and (p = 0.01), respectively. In addition, CD8 + TEMRA was significantly higher in ITP children than in controls (p = 0.001). CD4 + TCM cells were significantly lower in the ITP patient group (p = 0.04). However, CD4 + TEM was significantly higher in patients than controls (p = 0.04). Our research found that ITP patients had an imbalance in the ratio of CD4+ to CD8+ T cells in the peripheral blood and that TCM cells may be involved in the pathogenetic mechanism of ITP. TCMs could help in prediction of patients with higher risk of developing ITP.
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Affiliation(s)
- Asmaa M Zahran
- Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Omnia H El-Badawy
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
| | - Hayam Mahran
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Eman Gad
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Khaled Saad
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Salma G Morsy
- Department of Cancer Biology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Ahmed Makboul
- Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | | | - Amira Elhoufey
- Department of Community Health Nursing, Alddrab University College, Jazan University, 45142, Jazan, Saudi Arabia
| | - Hamad Ghaleb Dailah
- Research and Scientific Studies Unit, College of Nursing, Jazan University, Jazan, Saudi Arabia
| | - Khalid I Elsayh
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
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Boyarchuk O, Kostyuchenko L, Akopyan H, Bondarenko A, Volokha A, Hilfanova A, Savchak I, Nazarenko L, Yarema N, Urbas O, Hrabovska I, Lysytsia O, Budzyn A, Tykholaz O, Ivanchuk M, Bastanohova O, Patskun E, Vasylenko N, Stepanovskyy Y, Chernyshova L, Makukh H. Nijmegen breakage syndrome: 25-year experience of diagnosis and treatment in Ukraine. Front Immunol 2024; 15:1428724. [PMID: 39007137 PMCID: PMC11239363 DOI: 10.3389/fimmu.2024.1428724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 06/17/2024] [Indexed: 07/16/2024] Open
Abstract
Introduction Nijmegen breakage syndrome (NBS) is an autosomal recessive disorder, characterized by microcephaly, immunodeficiency, and impaired DNA repair. NBS is most prevalent among Slavic populations, including Ukraine. Our study aimed to comprehensively assess the prevalence, diagnosis, clinical data, immunological parameters, and treatment of NBS patients in Ukraine. Methods We conducted a retrospective review that included 84 NBS patients from different regions of Ukraine who were diagnosed in 1999-2023. Data from the Ukrainian Registry of NBS and information from treating physicians, obtained using a developed questionnaire, were utilized for analysis. Results Among 84 NBS patients, 55 (65.5%) were alive, 25 (29.8%) deceased, and 4 were lost to follow-up. The median age of patients was 11 years, ranging from 1 to 34 years. Most patients originate from western regions of Ukraine (57.8%), although in recent years, there has been an increase in diagnoses from central and southeastern regions, expanding our knowledge of NBS prevalence. The number of diagnosed patients per year averaged 3.4 and increased from 2.7 to 4.8 in recent years. The median age of NBS diagnosis was 4.0 years (range 0.1-16) in 1999-2007 and decreased to 2.7 in the past 6 years. Delayed physical development was observed in the majority of children up to the age of ten years. All children experienced infections, and 41.3% of them had recurrent infections. Severe infections were the cause of death in 12%. The second most common clinical manifestation of NBS was malignancies (37.5%), with the prevalence of lymphomas (63.3%). Malignancies have been the most common cause of death in NBS patients (72% of cases). Decreased levels of CD4+ and CD19+ were observed in 89.6%, followed by a reduction of CD3+ (81.8%) and CD8+ (62.5%). The level of NK cells was elevated at 62.5%. IgG concentration was decreased in 72.9%, and IgA - in 56.3%. Immunoglobulin replacement therapy was administered to 58.7% of patients. Regular immunoglobulin replacement therapy has helped reduce the frequency and severity of severe respiratory tract infections. Conclusion Improvements in diagnosis, including prenatal screening, newborn screening, monitoring, and expanding treatment options, will lead to better outcomes for NBS patients.
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Affiliation(s)
- Oksana Boyarchuk
- Department of Children’s Diseases and Pediatric Surgery, I.Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Larysa Kostyuchenko
- Clinic of Pediatric Immunology and Rheumatology, Western Ukrainian Specialized Children’s Medical Centre, Lviv, Ukraine
| | - Hayane Akopyan
- Department of Diagnostic of Hereditary Pathology, Institute of Hereditary Pathology of the National Academy of Medical Sciences of Ukraine, Lviv, Ukraine
| | - Anastasiia Bondarenko
- Department of Pediatrics, Immunology, Infectious and Rare Diseases, European Medical School, International European University, Kyiv, Ukraine
| | - Alla Volokha
- Department of Pediatrics, Pediatric Infectious Diseases, Immunology and Allergology, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Anna Hilfanova
- Department of Pediatrics, Immunology, Infectious and Rare Diseases, European Medical School, International European University, Kyiv, Ukraine
| | - Ihor Savchak
- Clinic of Pediatric Immunology and Rheumatology, Western Ukrainian Specialized Children’s Medical Centre, Lviv, Ukraine
| | - Liliia Nazarenko
- Department of Pediatrics, Cherkasy Regional Children’s Hospital, Cherkasy, Ukraine
| | - Nataliia Yarema
- Department of Children’s Diseases and Pediatric Surgery, I.Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Olha Urbas
- Department of Pediatrics, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Iryna Hrabovska
- Department of Pediatrics Oncohematology, Volyn Regional Territorial Mother and Child Health Care Center, Lutsk, Ukraine
| | - Oleksandr Lysytsia
- Department of Bone Marrow Transplantation and Intensive Megadose Chemotherapy and Immunotherapy, National Specialized Children’s Hospital “OHMATDYT”, Kyiv, Ukraine
| | - Andrii Budzyn
- Department of Bone Marrow Transplantation and Intensive Megadose Chemotherapy and Immunotherapy, National Specialized Children’s Hospital “OHMATDYT”, Kyiv, Ukraine
| | - Oksana Tykholaz
- Department of Propedeutics of Pediatric Diseases with Patient Care, National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Mariana Ivanchuk
- Department of Pediatrics Oncohematology, Volyn Regional Territorial Mother and Child Health Care Center, Lutsk, Ukraine
| | - Olha Bastanohova
- Center of Specialized Pediatric Care, Poltava Regional Clinical Hospital named after M. V. Sklifosovsky, Poltava, Ukraine
| | - Erika Patskun
- Department of Faculty Therapy, Uzhhorod National University, Uzhhorod, Ukraine
| | - Nataliia Vasylenko
- Outpatient Department, Kherson Regional Children’s Hospital, Kherson, Ukraine
| | - Yuriy Stepanovskyy
- Department of Pediatrics, Immunology, Infectious and Rare Diseases, European Medical School, International European University, Kyiv, Ukraine
| | - Liudmyla Chernyshova
- Department of Pediatrics, Pediatric Infectious Diseases, Immunology and Allergology, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Halyna Makukh
- Department of the Research and Biotechnology, Scientific Medical Genetic Center LeoGENE, Lviv, Ukraine
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Hopkins G, Gomez N, Tucis D, Bartlett L, Steers G, Burns E, Brown M, Harvey-Cowlishaw T, Santos R, Lauder SN, Scurr M, Capitani L, Burnell S, Rees T, Smart K, Somerville M, Gallimore A, Perera M, Potts M, Metaxaki M, Krishna B, Jackson H, Tighe P, Onion D, Godkin A, Wills M, Fairclough L. Lower Humoral and Cellular Immunity Following Asymptomatic SARS-CoV-2 Infection Compared to Symptomatic Infection in Education (The ACE Cohort). J Clin Immunol 2024; 44:147. [PMID: 38856804 PMCID: PMC11164737 DOI: 10.1007/s10875-024-01739-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/20/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE Asymptomatic SARS-CoV-2 infections were widely reported during the COVID-19 pandemic, acting as a hidden source of infection. Many existing studies investigating asymptomatic immunity failed to recruit true asymptomatic individuals. Thus, we conducted a longitudinal cohort study to evaluate humoral- and cell-mediated responses to infection and vaccination in well-defined asymptomatic young adults (the Asymptomatic COVID-19 in Education [ACE] cohort). METHODS Asymptomatic testing services located at three UK universities identified asymptomatic young adults who were subsequently recruited with age- and sex-matched symptomatic and uninfected controls. Blood and saliva samples were collected after SARS-CoV-2 Wuhan infection, and again after vaccination. 51 participant's anti-spike antibody titres, neutralizing antibodies, and spike-specific T-cell responses were measured, against both Wuhan and Omicron B.1.1.529.1. RESULTS Asymptomatic participants exhibited reduced Wuhan-specific neutralization antibodies pre- and post-vaccination, as well as fewer Omicron-specific neutralization antibodies post-vaccination, compared to symptomatic participants. Lower Wuhan and Omicron-specific IgG titres in asymptomatic individuals were also observed pre- and post-vaccination, compared to symptomatic participants. There were no differences in salivary IgA levels. Conventional flow cytometry analysis and multi-dimensional clustering analysis indicated unvaccinated asymptomatic participants had significantly fewer Wuhan-specific IL-2 secreting CD4+ CD45RA+ T cells and activated CD8+ T cells than symptomatic participants, though these differences dissipated after vaccination. CONCLUSIONS Asymptomatic infection results in decreased antibody and T cell responses to further exposure to SARS-CoV-2 variants, compared to symptomatic infection. Post-vaccination, antibody responses are still inferior, but T cell immunity increases to match symptomatic subjects, emphasising the importance of vaccination to help protect asymptomatic individuals against future variants.
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Affiliation(s)
- Georgina Hopkins
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Nancy Gomez
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Davis Tucis
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Laura Bartlett
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Graham Steers
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Ellie Burns
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Michaela Brown
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | | | - Rute Santos
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | | | - Martin Scurr
- School of Medicine, Cardiff University, Cardiff, UK
- ImmunoServ Ltd, Cardiff, UK
| | | | | | - Tara Rees
- School of Medicine, Cardiff University, Cardiff, UK
| | | | | | | | - Marianne Perera
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Martin Potts
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Marina Metaxaki
- Department of Medicine, University of Cambridge, Cambridge, UK
| | | | - Hannah Jackson
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Paddy Tighe
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - David Onion
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Andrew Godkin
- School of Medicine, Cardiff University, Cardiff, UK
- ImmunoServ Ltd, Cardiff, UK
| | - Mark Wills
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Lucy Fairclough
- School of Life Sciences, University of Nottingham, Nottingham, UK.
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Genetic Disorders with Predisposition to Paediatric Haematopoietic Malignancies—A Review. Cancers (Basel) 2022; 14:cancers14153569. [PMID: 35892827 PMCID: PMC9329786 DOI: 10.3390/cancers14153569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/26/2022] [Accepted: 07/11/2022] [Indexed: 02/04/2023] Open
Abstract
The view of paediatric cancer as a genetic disease arises as genetic research develops. Germline mutations in cancer predisposition genes have been identified in about 10% of children. Paediatric cancers are characterized by heterogeneity in the types of genetic alterations that drive tumourigenesis. Interactions between germline and somatic mutations are a key determinant of cancer development. In 40% of patients, the family history does not predict the presence of inherited cancer predisposition syndromes and many cases go undetected. Paediatricians should be aware of specific symptoms, which highlight the need of evaluation for cancer syndromes. The quickest possible identification of such syndromes is of key importance, due to the possibility of early detection of neoplasms, followed by presymptomatic genetic testing of relatives, implementation of appropriate clinical procedures (e.g., avoiding radiotherapy), prophylactic surgical resection of organs at risk, or searching for donors of hematopoietic stem cells. Targetable driver mutations and corresponding signalling pathways provide a novel precision medicine strategy.Therefore, there is a need for multi-disciplinary cooperation between a paediatrician, an oncologist, a geneticist, and a psychologist during the surveillance of families with an increased cancer risk. This review aimed to emphasize the role of cancer-predisposition gene diagnostics in the genetic surveillance and medical care in paediatric oncology.
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