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Hildebrandt J, Yalcin E, Bresser HG, Cinel G, Gappa M, Haghighi A, Kiper N, Khalilzadeh S, Reiter K, Sayer J, Schwerk N, Sibbersen A, Van Daele S, Nübling G, Lohse P, Griese M. Characterization of CSF2RA mutation related juvenile pulmonary alveolar proteinosis. Orphanet J Rare Dis 2014; 9:171. [PMID: 25425184 PMCID: PMC4254258 DOI: 10.1186/s13023-014-0171-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 10/27/2014] [Indexed: 12/01/2022] Open
Abstract
Background Juvenile pulmonary alveolar proteinosis (PAP) due to CSF2RA mutations is a rare disorder with only a few cases described worldwide. Methods We identified nine children with severe diffuse interstitial lung disease due to CSF2RA mutations. Clinical course, diagnostic findings and treatment were evaluated and correlated to the genotype. Functional impairment of the intracellular JAK/pStat5 signaling pathway was assessed using flow-cytometry of peripheral mononuclear cells (PBMC) and granulocytes. Results We identified six individuals with homozygous missense/nonsense/frameshift mutations and three individuals homozygous for a deletion of the complete CSF2RA gene locus. Overall, four novel mutations (c.1125 + 1G > A, duplication exon 8, deletion exons 2–13, Xp22.3/Yp11.3) were found. Reduced STAT5 phosphorylation in PBMC and granulocytes was seen in all cases examined (n = 6). Pulmonary symptoms varied from respiratory distress to clinically silent. Early disease onset was associated with a more severe clinical phenotype (p = 0.0092). No association was seen between severity of phenotype at presentation and future clinical course or extent of genetic damage. The clinical course was favorable in all subjects undergoing whole lung lavage (WLL) treatment. Conclusions Our cohort broadens the spectrum of knowledge about the clinical variability and genotype-phenotype correlations of juvenile PAP, and illustrates the favorable outcome of WLL treatment in severely affected patients. Electronic supplementary material The online version of this article (doi:10.1186/s13023-014-0171-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jenna Hildebrandt
- Department of Pediatric Pneumology, Hauner Children's Hospital, Ludwig-Maximilians-University, Member of the German Center for Lung Research (DZL), Munich, Germany.
| | - Ebru Yalcin
- Department of Pediatrics, Hacettepe Üniversitesi Çocuk Göğüs Hastalıkları, Ankara, Turkey.
| | - Hans-Georg Bresser
- Department of Paediatrics, Evangelisches Krankenhaus Bielefeld, Bielefeld, Germany.
| | - Guzin Cinel
- Department of Pediatrics, Hacettepe Üniversitesi Çocuk Göğüs Hastalıkları, Ankara, Turkey.
| | - Monika Gappa
- Children's Hospital, Marien Hospital Wesel, Wesel, Germany.
| | - Alireza Haghighi
- Department of Genetics, Harvard Medical School, Boston, MA, USA.
| | - Nural Kiper
- Department of Pediatrics, Hacettepe Üniversitesi Çocuk Göğüs Hastalıkları, Ankara, Turkey.
| | - Soheila Khalilzadeh
- Pediatric Respiratory Disease Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Teheran, Iran.
| | - Karl Reiter
- Department of Pediatric Pneumology, Hauner Children's Hospital, Ludwig-Maximilians-University, Member of the German Center for Lung Research (DZL), Munich, Germany.
| | - John Sayer
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.
| | - Nicolaus Schwerk
- Clinic for Paediatric Pneumonology and Neonatology, Hannover Medical School, Hannover, Germany.
| | - Anke Sibbersen
- Department of Pediatric Pneumology, Hauner Children's Hospital, Ludwig-Maximilians-University, Member of the German Center for Lung Research (DZL), Munich, Germany.
| | - Sabine Van Daele
- Department of Pediatric Pulmonology, Ghent University Hospital, Ghent, Belgium.
| | - Georg Nübling
- Departments of Neurology and Palliative Care, Klinikum der Universität München, Munich, Germany.
| | - Peter Lohse
- Molecular Genetics Laboratory, Institute of Laboratory Medicine and Human Genetics, Singen, Germany.
| | - Matthias Griese
- Department of Pediatric Pneumology, Hauner Children's Hospital, Ludwig-Maximilians-University, Member of the German Center for Lung Research (DZL), Munich, Germany.
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Griese M, Ripper J, Sibbersen A, Lohse P, Lohse P, Brasch F, Schams A, Pamir A, Schaub B, Muensterer OJ, Schön C, Glöckner-Pagel J, Nicolai T, Reiter K, Hector A. Long-term follow-up and treatment of congenital alveolar proteinosis. BMC Pediatr 2011; 11:72. [PMID: 21849033 PMCID: PMC3175167 DOI: 10.1186/1471-2431-11-72] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 08/17/2011] [Indexed: 11/17/2022] Open
Abstract
Background Clinical presentation, diagnosis, management and outcome of molecularly defined congenital pulmonary alveolar proteinosis (PAP) due to mutations in the GM-CSF receptor are not well known. Case presentation A 2 1/2 years old girl was diagnosed as having alveolar proteinosis. Whole lung lavages were performed with a new catheter balloon technique, feasible in small sized airways. Because of some interstitial inflammation in the lung biopsy and to further improve the condition, empirical therapy with systemic steroids and azathioprin, and inhaled and subcutaneous GMCSF, were used. Based on clinical measures, total protein and lipid recovered by whole lung lavages, all these treatments were without benefit. Conversely, severe respiratory viral infections and an invasive aspergillosis with aspergilloma formation occurred. Recently the novel homozygous stop mutation p.Ser25X of the GMCSF receptor alpha chain was identified in the patient. This mutation leads to a lack of functional GMCSF receptor and a reduced response to GMCSF stimulation of CD11b expression of mononuclear cells of the patient. Subsequently a very intense treatment with monthly lavages was initiated, resulting for the first time in complete resolution of partial respiratory insufficiency and a significant improvement of the overall somato-psychosocial condition of the child. Conclusions The long term management from early childhood into young adolescence of severe alveolar proteinosis due to GMCSF receptor deficiency requires a dedicated specialized team to perform technically demanding whole lung lavages and cope with complications.
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Affiliation(s)
- Matthias Griese
- Dr. von Haunersches Kinderspital, University of Munich, Munich, Germany.
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