Primary immunodeficiencies

Current advances of CRISPR-Cas technology in cell therapy

CRISPR-Cas is a versatile genome editing technology that has been broadly applied in both basic research and translation medicine. Ever since its discovery, the bacterial derived endonucleases have been engineered to a collection of robust genome-editing tools for introducing frameshift mutations or base conversions at site-specific loci. Since the initiation of first-in-human trial in 2016, CRISPR-Cas has been tested in 57 cell therapy trials, 38 of which focusing on engineered CAR-T cells and TCR-T cells for cancer malignancies, 15 trials of engineered hematopoietic stem cells treating hemoglobinopathies, leukemia and AIDS, and 4 trials of engineered iPSCs for diabetes and cancer. Here, we aim to review the recent breakthroughs of CRISPR technology and highlight their applications in cell therapy.

Oral manifestations of human immunodeficiency virus in children: An institutional study at highly active antiretroviral therapy centre in India

CONTEXT

More than 1000 children are newly infected with Human immunodefi ciency virus (HIV) every day, and of these more than half will die as a result of AIDS due to lack of access to HIV treatment. HIV disease varies considerably in children. Among those infected prenatally, some experience few or no symptoms for years, whereas in others the disease progresses rapidly. The risk factors that influence the development of such oral manifestations include, low CD4+ T cell count, xerostomia and lack of highly active antiretroviral therapy (HAART).

AIMS

To identify the oral manifestations of HIV in children receiving HAART.

MATERIALS AND METHODS

The study comprised 95 children receiving HAART. 95 HIV +ve children not receiving HAART and 95 HIV -ve children were also included for comparing the manifestations of HIV.

STATISTICAL ANALYSIS USED

Statistical analysis was done using Fisher's Chi-square test. Probability value (P value) was obtained for the three groups.

RESULTS

The manifestations of HIV that were observed in children receiving HAART include dental caries (26%), periodontal diseases (23%), candidiasis (19%), hyperpigmentation (17%), ulcerative stomatitis (9%) and one case of mucocele. These manifestations were compared with HIV +ve children not receiving HAART and HIV -ve children to find manifestations with statistical significance.

CONCLUSIONS

We conclude that HAART had increased the disease-free states in HIV +ve children on HAART promising them better life span. The incidence of oral lesions can further come down with adequate oral hygiene measures in HIV-infected children.

Early-onset chronic inflammatory disease associated with maternal microchimerism

Maternal microchimerism (mMc) refers to the presence of a small population of cells originating from the mother. Whether mMc leads to autoimmune responses in children remains controversial. We describe here an 11-year-old boy with persistent fever and elevated levels of C-reactive protein from infancy onward. During infancy, the patient presented with high fever, skin rashes, and hepatic dysfunction. Careful examination including a liver biopsy failed to reveal the cause. At 4 years old, petechiae developed associated with thrombocytopenia and positive anti-dsDNA autoantibodies. Steroid pulse therapy was effective, but the effect of low-dose prednisone was insufficient. At age 9, an extensive differential diagnosis was considered especially for infantile onset autoinflammatory disorders but failed to make a definitive diagnosis. On admission, the patient exhibited short stature, hepatosplenomegaly, generalized superficial lymphadenopathy, and rashes. Laboratory findings revealed anemia, elevated levels of inflammation markers, and hypergammaglobulinemia. Serum complement levels were normal. Serum levels of IL-6 and B-cell activating factor were elevated. Viral infections were not identified. Although HLA typing revealed no noninherited maternal antigens in lymphocytes, female cells were demonstrated in the patient's skin and lymph nodes, suggesting that maternal microchimerism might be involved in the pathogenesis of fever without source in infants.

[Anesthetic considerations in primary immunodeficiencies]

Primary immunodeficiencies are a group of mostly hereditary, or congenital, disorders. Some cases, however, show no hereditary pattern despite an evident familial distribution. The incidence of these cases is variable and the most frequent of them is immunoglobulin A deficiency. Many are pediatric disorders that are occasionally so serious that the patient does not survive the first year of life due to the development of systemic infections. In other cases, survival is much longer and it is possible to find adult carriers in routine clinical practice. These are less aggressive cases that form part of specific clinical syndromes that must be recognized so that appropriate anesthetic management can be planned. We review the clinical characteristics of primary immunodeficiencies that may be relevant to anesthetic management in these patients.

Immune suppression and considerations for dental care

Immunocompromised individuals present a challenge to oral health care providers. As the spectrum of patients with dysfunctional immune responses continues to broaden, practitioners should be able to identify these patients, understand the potential for complications, and manage their dental care safely and effectively. This article reviews various immune deficiencies, addresses complications that may result from an individual's immune status, and discusses dental considerations for these patients.

Conservative management of infections in cochlear implant recipients

OBJECTIVE

The goal of this study was to evaluate a conservative management strategy of postoperative infection after cochlear implantation.

METHODS

A retrospective review of the medical records of 108 cochlear implant patients operated on at the University of California, San Francisco between 1991 and 2000 and 133 cochlear implant patients from the University of Iowa between 1997 and 2000 showed 4 patients with evidence of postoperative infections. The clinical presentation, intervention, laboratory results, and outcome are analyzed in each case.

RESULTS

Minimal surgical intervention with limited incision and drainage with prolonged postoperative antibiotics was effective in treating postoperative cochlear implant infections without the need for device removal. Implant function remained unaffected after surgery.

CONCLUSION

Postoperative cochlear implant infections can be effectively controlled with limited surgical and prolonged medical management. Chronic implant infections may be explained by a primary immunodeficiency. With appropriate treatment leading to infection control, a conservative management strategy is advocated before consideration of device explantation.