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Segura-Tudela A, López-Nevado M, Nieto-López C, García-Jiménez S, Díaz-Madroñero MJ, Delgado Á, Cabrera-Marante O, Pleguezuelo D, Morales P, Paz-Artal E, Gil-Niño J, Marco FM, Serrano C, González-Granado LI, Quesada-Espinosa JF, Allende LM. Enrichment of Immune Dysregulation Disorders in Adult Patients with Human Inborn Errors of Immunity. J Clin Immunol 2024; 44:61. [PMID: 38363452 PMCID: PMC10873437 DOI: 10.1007/s10875-024-01664-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/26/2024] [Indexed: 02/17/2024]
Abstract
Human inborn errors of immunity (IEI) comprise a group of diseases resulting from molecular variants that compromise innate and adaptive immunity. Clinical features of IEI patients are dominated by susceptibility to a spectrum of infectious diseases, as well as autoimmune, autoinflammatory, allergic, and malignant phenotypes that usually appear in childhood, which is when the diagnosis is typically made. However, some IEI patients are identified in adulthood due to symptomatic delay of the disease or other reasons that prevent the request for a molecular study. The application of next-generation sequencing (NGS) as a diagnostic technique has given rise to an ever-increasing identification of IEI-monogenic causes, thus improving the diagnostic yield and facilitating the possibility of personalized treatment. This work was a retrospective study of 173 adults with IEI suspicion that were sequenced between 2005 and 2023. Sanger, targeted gene-panel, and whole exome sequencing were used for molecular diagnosis. Disease-causing variants were identified in 44 of 173 (25.43%) patients. The clinical phenotype of these 44 patients was mostly related to infection susceptibility (63.64%). An enrichment of immune dysregulation diseases was found when cohorts with molecular diagnosis were compared to those without. Immune dysregulation disorders, group 4 from the International Union of Immunological Societies Expert Committee (IUIS), were the most prevalent among these adult patients. Immune dysregulation as a new item in the Jeffrey Model Foundation warning signs for adults significantly increases the sensitivity for the identification of patients with an IEI-producing molecular defect.
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Affiliation(s)
- Alejandro Segura-Tudela
- Department of Immunology, University Hospital, 12 de Octubre, Avda. de Andalucía S/N, 28041, Madrid, Spain
- Research Institute Hospital, 12 Octubre (imas12), Madrid, Spain
| | - Marta López-Nevado
- Department of Immunology, University Hospital, 12 de Octubre, Avda. de Andalucía S/N, 28041, Madrid, Spain
- Research Institute Hospital, 12 Octubre (imas12), Madrid, Spain
| | - Celia Nieto-López
- Department of Immunology, University Hospital, 12 de Octubre, Avda. de Andalucía S/N, 28041, Madrid, Spain
- Research Institute Hospital, 12 Octubre (imas12), Madrid, Spain
| | - Sandra García-Jiménez
- Department of Immunology, University Hospital, 12 de Octubre, Avda. de Andalucía S/N, 28041, Madrid, Spain
- Research Institute Hospital, 12 Octubre (imas12), Madrid, Spain
| | - María J Díaz-Madroñero
- Department of Immunology, University Hospital, 12 de Octubre, Avda. de Andalucía S/N, 28041, Madrid, Spain
| | - Ángeles Delgado
- Department of Immunology, University Hospital, 12 de Octubre, Avda. de Andalucía S/N, 28041, Madrid, Spain
| | - Oscar Cabrera-Marante
- Department of Immunology, University Hospital, 12 de Octubre, Avda. de Andalucía S/N, 28041, Madrid, Spain
- Research Institute Hospital, 12 Octubre (imas12), Madrid, Spain
| | - Daniel Pleguezuelo
- Department of Immunology, University Hospital, 12 de Octubre, Avda. de Andalucía S/N, 28041, Madrid, Spain
- Research Institute Hospital, 12 Octubre (imas12), Madrid, Spain
| | - Pablo Morales
- Department of Immunology, University Hospital, 12 de Octubre, Avda. de Andalucía S/N, 28041, Madrid, Spain
- Research Institute Hospital, 12 Octubre (imas12), Madrid, Spain
| | - Estela Paz-Artal
- Department of Immunology, University Hospital, 12 de Octubre, Avda. de Andalucía S/N, 28041, Madrid, Spain
- Research Institute Hospital, 12 Octubre (imas12), Madrid, Spain
- School of Medicine, Complutense University of Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Jorge Gil-Niño
- Department of Internal Medicine, University Hospital, 12 de Octubre, Madrid, Spain
| | - Francisco M Marco
- Unit of Immunology, University Hospital General Dr Balmis, Alicante, Spain
| | - Cristina Serrano
- Department of Immunology, University Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Luis I González-Granado
- Research Institute Hospital, 12 Octubre (imas12), Madrid, Spain
- School of Medicine, Complutense University of Madrid, Madrid, Spain
- Unit of Immunodeficiencies, Department of Pediatrics, University Hospital, 12 de Octubre, Madrid, Spain
| | - Juan F Quesada-Espinosa
- Research Institute Hospital, 12 Octubre (imas12), Madrid, Spain
- Department of Genetics, University Hospital, 12 de Octubre, Madrid, Spain
| | - Luis M Allende
- Department of Immunology, University Hospital, 12 de Octubre, Avda. de Andalucía S/N, 28041, Madrid, Spain.
- Research Institute Hospital, 12 Octubre (imas12), Madrid, Spain.
- School of Medicine, Complutense University of Madrid, Madrid, Spain.
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2
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Naranjo L, Stojanovich L, Djokovic A, Andreoli L, Tincani A, Maślińska M, Sciascia S, Infantino M, Garcinuño S, Kostyra-Grabczak K, Manfredi M, Regola F, Stanisavljevic N, Milanovic M, Saponjski J, Roccatello D, Cecchi I, Radin M, Benucci M, Pleguezuelo D, Serrano M, Shoenfeld Y, Serrano A. Circulating immune-complexes of IgG/IgM bound to B2-glycoprotein-I associated with complement consumption and thrombocytopenia in antiphospholipid syndrome. Front Immunol 2022; 13:957201. [PMID: 36172349 PMCID: PMC9511106 DOI: 10.3389/fimmu.2022.957201] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background Antiphospholipid syndrome (APS) is a multisystemic autoimmune disorder characterized by thrombotic events and/or gestational morbidity in patients with antiphospholipid antibodies (aPL). In a previous single center study, APS-related clinical manifestations that were not included in the classification criteria (livedo reticularis, thrombocytopenia, leukopenia) were associated with the presence of circulating immune-complexes (CIC) formed by beta-2-glycoprotein-I (B2GP1) and anti-B2GP1 antibodies (B2-CIC). We have performed a multicenter study on APS features associated with the presence of B2-CIC. Methods A multicenter, cross-sectional and observational study was conducted on 303 patients recruited from six European hospitals who fulfilled APS classification criteria: 165 patients had primary APS and 138 APS associated with other systemic autoimmune diseases (mainly systemic lupus erythematosus, N=112). Prevalence of B2-CIC (IgG/IgM isotypes) and its association with clinical manifestations and biomarkers related to the disease activity were evaluated. Results B2-CIC prevalence in APS patients was 39.3%. B2-CIC-positive patients with thrombotic APS presented a higher incidence of thrombocytopenia (OR: 2.32, p=0.007), heart valve thickening and dysfunction (OR: 9.06, p=0.015) and triple aPL positivity (OR: 1.83, p=0.027), as well as lower levels of C3, C4 and platelets (p-values: <0.001, <0.001 and 0.001) compared to B2-CIC-negative patients. B2-CIC of IgM isotype were significantly more prevalent in gestational than thrombotic APS. Conclusions Patients with thrombotic events and positive for B2-CIC had lower platelet count and complement levels than those who were negative, suggesting a greater degree of platelet activation.
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Affiliation(s)
- Laura Naranjo
- Immunology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Aleksandra Djokovic
- Cardiology Department, University Hospital Center Bezanijska Kosa, Belgrade, Serbia
- School of Medicine , University of Belgrade, Belgrade, Serbia
| | - Laura Andreoli
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Angela Tincani
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maria Maślińska
- Early Arthritis Clinic, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Savino Sciascia
- Nephrology and Dialysis Unit (ERK-net Member), Center of Research of Immunopathology and Rare Diseases, Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hospital, Torino, Italy
| | - Maria Infantino
- Immunology and Allergy Laboratory, San Giovanni di Dio Hospital, Florence, Italy
| | - Sara Garcinuño
- Immunology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Kinga Kostyra-Grabczak
- Early Arthritis Clinic, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Mariangela Manfredi
- Immunology and Allergy Laboratory, San Giovanni di Dio Hospital, Florence, Italy
| | - Francesca Regola
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Natasa Stanisavljevic
- Internal Medicine, University Hospital Center Bezanijska Kosa, Belgrade, Serbia
- School of Medicine , University of Belgrade, Belgrade, Serbia
| | - Milomir Milanovic
- Internal Medicine Department, Clinic for Infectious and Tropical Diseases, Military Medical Academy, Belgrade, Serbia
| | - Jovica Saponjski
- Cardiology Department, University Clinical Center of Serbia, Belgrade, Serbia
| | - Dario Roccatello
- Nephrology and Dialysis Unit (ERK-net Member), Center of Research of Immunopathology and Rare Diseases, Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hospital, Torino, Italy
| | - Irene Cecchi
- Nephrology and Dialysis Unit (ERK-net Member), Center of Research of Immunopathology and Rare Diseases, Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hospital, Torino, Italy
| | - Massimo Radin
- Nephrology and Dialysis Unit (ERK-net Member), Center of Research of Immunopathology and Rare Diseases, Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hospital, Torino, Italy
| | - Maurizio Benucci
- Rheumatology Unit, San Giovanni di Dio Hospital, Florence, Italy
| | - Daniel Pleguezuelo
- Immunology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Manuel Serrano
- Immunology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- *Correspondence: Manuel Serrano,
| | - Yehuda Shoenfeld
- Ariel University, Ariel, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - Antonio Serrano
- Immunology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
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3
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Arroyo-Sánchez D, Cabrera-Marante O, Laguna-Goya R, Almendro-Vázquez P, Carretero O, Gil-Etayo FJ, Suàrez-Fernández P, Pérez-Romero P, Rodríguez de Frías E, Serrano A, Allende LM, Pleguezuelo D, Paz-Artal E. Immunogenicity of Anti-SARS-CoV-2 Vaccines in Common Variable Immunodeficiency. J Clin Immunol 2021; 42:240-252. [PMID: 34787773 PMCID: PMC8596355 DOI: 10.1007/s10875-021-01174-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/16/2021] [Indexed: 01/04/2023]
Abstract
Common variable immunodeficiency (CVID) is characterized by hypogammaglobulinemia and/or a defective antibody response to T-dependent and T-independent antigens. CVID response to immunization depends on the antigen type, the vaccine mechanism, and the specific patient immune defect. In CVID patients, humoral and cellular responses to the currently used COVID-19 vaccines remain unexplored. Eighteen CVID subjects receiving 2-dose anti-SARS-CoV-2 vaccines were prospectively studied. S1-antibodies and S1-specific IFN-γ T cell response were determined by ELISA and FluoroSpot, respectively. The immune response was measured before the administration and after each dose of the vaccine, and it was compared to the response of 50 healthy controls (HC). The development of humoral and cellular responses was slower in CVID patients compared with HC. After completing vaccination, 83% of CVID patients had S1-specific antibodies and 83% had S1-specific T cells compared with 100% and 98% of HC (p = 0.014 and p = 0.062, respectively), but neutralizing antibodies were detected only in 50% of the patients. The strength of both humoral and cellular responses was significantly lower in CVID compared with HC, after the first and second doses of the vaccine. Absent or discordant humoral and cellular responses were associated with previous history of autoimmunity and/or lymphoproliferation. Among the three patients lacking humoral response, two had received recent therapy with anti-B cell antibodies. Further studies are needed to understand if the response to COVID-19 vaccination in CVID patients is protective enough. The 2-dose vaccine schedule and possibly a third dose might be especially necessary to achieve full immune response in these patients.
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Affiliation(s)
- Daniel Arroyo-Sánchez
- Department of Immunology, Hospital Universitario, 12 de Octubre, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041, Madrid, Spain
| | - Oscar Cabrera-Marante
- Department of Immunology, Hospital Universitario, 12 de Octubre, Madrid, Spain. .,Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041, Madrid, Spain.
| | - Rocío Laguna-Goya
- Department of Immunology, Hospital Universitario, 12 de Octubre, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041, Madrid, Spain
| | - Patricia Almendro-Vázquez
- Department of Immunology, Hospital Universitario, 12 de Octubre, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041, Madrid, Spain
| | - Octavio Carretero
- National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.,Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Francisco Javier Gil-Etayo
- Department of Immunology, Hospital Universitario, 12 de Octubre, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041, Madrid, Spain
| | - Patricia Suàrez-Fernández
- Department of Immunology, Hospital Universitario, 12 de Octubre, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041, Madrid, Spain
| | - Pilar Pérez-Romero
- National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Edgard Rodríguez de Frías
- Department of Immunology, Hospital Universitario, 12 de Octubre, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041, Madrid, Spain
| | - Antonio Serrano
- Department of Immunology, Hospital Universitario, 12 de Octubre, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041, Madrid, Spain
| | - Luis M Allende
- Department of Immunology, Hospital Universitario, 12 de Octubre, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041, Madrid, Spain.,National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Daniel Pleguezuelo
- Department of Immunology, Hospital Universitario, 12 de Octubre, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041, Madrid, Spain
| | - Estela Paz-Artal
- Department of Immunology, Hospital Universitario, 12 de Octubre, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), Av. de Córdoba, s/n, 28041, Madrid, Spain.,Department of Immunology, Ophthalmology and ENT, Universidad Complutense de Madrid, Madrid, Spain
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4
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Arrieta E, Lalueza A, Ayuso-García B, Trujillo H, Folgueira D, Paredes D, Verdejo MÁ, Camacho J, Caso JM, Heredia C, Cueto-Felgueroso C, Pleguezuelo D, Serrano A, Lumbreras C. Influenza A-Associated In-Hospital Mortality in Very Older People: Does Inflammation Also Play a Role? Gerontology 2021; 68:780-788. [PMID: 34592742 DOI: 10.1159/000519157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/17/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aim of the study was to analyze the clinical manifestations and outcome of the oldest old (people aged ≥85 years) who were admitted to the hospital with a confirmed influenza A virus infection in comparison with younger patients and to assess the role of inflammation in the outcome of influenza infection in this population. METHODS This is an observational prospective study including all adult patients with influenza A virus infection hospitalized in a tertiary teaching hospital in Madrid, in 2 consecutive influenza seasons (2016-17 and 2017-18). RESULTS Five hundred nine hospitalized patients with influenza A infection were included, of whom 117 (23%) were older than 85 years (median age: 89.3 ± 3.2). We compared the clinical characteristics and outcome with those of the rest of the population (median age: 72.8 ± 15.7). Overall, mortality was higher in older patients (10% vs. 4%; p = 0.03) with no differences in clinical presentation. Patients older than 85 years who ultimately died (12 out of 117) showed increased systemic inflammation expressed by higher levels of C-reactive protein (CRP) and ferritin compared to survivors who were discharged (odds ratio [OR] of CRP >20 mg/dL: 5.16, 95% confidence interval [CI]: 1.29-20.57, and OR of ferritin >500 mg: 4.3, 95% CI: 1.04-17.35). CONCLUSIONS Patients aged 85 and older with influenza A virus infection presented a higher in-hospital mortality than younger subjects. CRP and ferritin levels were higher in the oldest old who died, suggesting that inflammation could play a key role in the outcome of this subset of patients.
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Affiliation(s)
- Estibaliz Arrieta
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | - Antonio Lalueza
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain.,Department of Medicine, School of Medicine, Complutense University, Madrid, Spain.,Research Institute of Hospital 12 de Octubre (i + 12), Madrid, Spain
| | - Blanca Ayuso-García
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | - Hernando Trujillo
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | - Dolores Folgueira
- Department of Medicine, School of Medicine, Complutense University, Madrid, Spain.,Research Institute of Hospital 12 de Octubre (i + 12), Madrid, Spain.,Department of Microbiology, University Hospital 12 de Octubre, Madrid, Spain
| | - Diana Paredes
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | - Miguel Ángel Verdejo
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | - Javier Camacho
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | - José María Caso
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | - Carlos Heredia
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | | | - Daniel Pleguezuelo
- Department of Immunology, University Hospital 12 de Octubre, Madrid, Spain
| | - Antonio Serrano
- Research Institute of Hospital 12 de Octubre (i + 12), Madrid, Spain.,Department of Immunology, University Hospital 12 de Octubre, Madrid, Spain
| | - Carlos Lumbreras
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain.,Department of Medicine, School of Medicine, Complutense University, Madrid, Spain.,Research Institute of Hospital 12 de Octubre (i + 12), Madrid, Spain.,Infectious Diseases Unit, University Hospital 12 de Octubre, Madrid, Spain
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5
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López-Nevado M, González-Granado LI, Ruiz-García R, Pleguezuelo D, Cabrera-Marante O, Salmón N, Blanco-Lobo P, Domínguez-Pinilla N, Rodríguez-Pena R, Sebastián E, Cruz-Rojo J, Olbrich P, Ruiz-Contreras J, Paz-Artal E, Neth O, Allende LM. Primary Immune Regulatory Disorders With an Autoimmune Lymphoproliferative Syndrome-Like Phenotype: Immunologic Evaluation, Early Diagnosis and Management. Front Immunol 2021; 12:671755. [PMID: 34447369 PMCID: PMC8382720 DOI: 10.3389/fimmu.2021.671755] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/16/2021] [Indexed: 12/26/2022] Open
Abstract
Primary immune regulatory disorders (PIRD) are associated with autoimmunity, autoinflammation and/or dysregulation of lymphocyte homeostasis. Autoimmune lymphoproliferative syndrome (ALPS) is a PIRD due to an apoptotic defect in Fas-FasL pathway and characterized by benign and chronic lymphoproliferation, autoimmunity and increased risk of lymphoma. Clinical manifestations and typical laboratory biomarkers of ALPS have also been found in patients with a gene defect out of the Fas-FasL pathway (ALPS-like disorders). Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), we identified more than 600 patients suffering from 24 distinct genetic defects described in the literature with an autoimmune lymphoproliferative phenotype (ALPS-like syndromes) corresponding to phenocopies of primary immunodeficiency (PID) (NRAS, KRAS), susceptibility to EBV (MAGT1, PRKCD, XIAP, SH2D1A, RASGRP1, TNFRSF9), antibody deficiency (PIK3CD gain of function (GOF), PIK3R1 loss of function (LOF), CARD11 GOF), regulatory T-cells defects (CTLA4, LRBA, STAT3 GOF, IL2RA, IL2RB, DEF6), combined immunodeficiencies (ITK, STK4), defects in intrinsic and innate immunity and predisposition to infection (STAT1 GOF, IL12RB1) and autoimmunity/autoinflammation (ADA2, TNFAIP3,TPP2, TET2). CTLA4 and LRBA patients correspond around to 50% of total ALPS-like cases. However, only 100% of CTLA4, PRKCD, TET2 and NRAS/KRAS reported patients had an ALPS-like presentation, while the autoimmunity and lymphoproliferation combination resulted rare in other genetic defects. Recurrent infections, skin lesions, enteropathy and malignancy are the most common clinical manifestations. Some approaches available for the immunological study and identification of ALPS-like patients through flow cytometry and ALPS biomarkers are provided in this work. Protein expression assays for NKG2D, XIAP, SAP, CTLA4 and LRBA deficiencies and functional studies of AKT, STAT1 and STAT3 phosphorylation, are showed as useful tests. Patients suspected to suffer from one of these disorders require rapid and correct diagnosis allowing initiation of tailored specific therapeutic strategies and monitoring thereby improving the prognosis and their quality of life.
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Affiliation(s)
- Marta López-Nevado
- Immunology Department, University Hospital 12 de Octubre, Madrid, Spain.,Research Institute Hospital 12 Octubre (imas12), Madrid, Spain
| | - Luis I González-Granado
- Research Institute Hospital 12 Octubre (imas12), Madrid, Spain.,Immunodeficiency Unit, Department of Pediatrics, University Hospital 12 de Octubre, Madrid, Spain
| | - Raquel Ruiz-García
- Immunology Department, Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain
| | - Daniel Pleguezuelo
- Immunology Department, University Hospital 12 de Octubre, Madrid, Spain.,Research Institute Hospital 12 Octubre (imas12), Madrid, Spain
| | - Oscar Cabrera-Marante
- Immunology Department, University Hospital 12 de Octubre, Madrid, Spain.,Research Institute Hospital 12 Octubre (imas12), Madrid, Spain
| | - Nerea Salmón
- Research Institute Hospital 12 Octubre (imas12), Madrid, Spain.,Immunodeficiency Unit, Department of Pediatrics, University Hospital 12 de Octubre, Madrid, Spain
| | - Pilar Blanco-Lobo
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, University Hospital Virgen del Rocío, Institute of Biomedicine, Biomedicine Institute (IBiS)/University of Seville/Superior Council of Scientific Investigations (CSIC), Seville, Spain
| | - Nerea Domínguez-Pinilla
- Research Institute Hospital 12 Octubre (imas12), Madrid, Spain.,Pediatric Hematology and Oncology Unit, Toledo Hospital Complex, Toledo, Spain and University Hospital 12 de Octubre, Madrid, Spain
| | | | - Elena Sebastián
- Hematology and Hemotherapy Unit, University Children's Hospital Niño Jesús, Madrid, Spain
| | - Jaime Cruz-Rojo
- Endocrine Unit, Department of Pediatrics, University Hospital 12 de Octubre, Madrid, Spain
| | - Peter Olbrich
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, University Hospital Virgen del Rocío, Institute of Biomedicine, Biomedicine Institute (IBiS)/University of Seville/Superior Council of Scientific Investigations (CSIC), Seville, Spain
| | - Jesús Ruiz-Contreras
- Research Institute Hospital 12 Octubre (imas12), Madrid, Spain.,Immunodeficiency Unit, Department of Pediatrics, University Hospital 12 de Octubre, Madrid, Spain.,School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Estela Paz-Artal
- Immunology Department, University Hospital 12 de Octubre, Madrid, Spain.,Research Institute Hospital 12 Octubre (imas12), Madrid, Spain.,School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Olaf Neth
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, University Hospital Virgen del Rocío, Institute of Biomedicine, Biomedicine Institute (IBiS)/University of Seville/Superior Council of Scientific Investigations (CSIC), Seville, Spain
| | - Luis M Allende
- Immunology Department, University Hospital 12 de Octubre, Madrid, Spain.,Research Institute Hospital 12 Octubre (imas12), Madrid, Spain.,School of Medicine, Complutense University of Madrid, Madrid, Spain
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6
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Gómez‐Massa E, Talayero P, Utrero‐Rico A, Laguna‐Goya R, Andrés A, Mancebo E, Leivas A, Polanco‐Fernández N, Justo I, Jimenez‐Romero C, Pleguezuelo D, Paz‐Artal E. Number and function of circulatory helper innate lymphoid cells are unaffected by immunosuppressive drugs used in solid organ recipients – a single centre cohort study. Transpl Int 2020; 33:402-413. [DOI: 10.1111/tri.13567] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 10/08/2019] [Accepted: 01/03/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Elena Gómez‐Massa
- Department of Immunology University Hospital 12 de Octubre Madrid Spain
- Imas12 Research Institute University Hospital 12 de Octubre Madrid Spain
| | - Paloma Talayero
- Department of Immunology University Hospital 12 de Octubre Madrid Spain
- Imas12 Research Institute University Hospital 12 de Octubre Madrid Spain
| | | | - Rocío Laguna‐Goya
- Department of Immunology University Hospital 12 de Octubre Madrid Spain
- Imas12 Research Institute University Hospital 12 de Octubre Madrid Spain
- School of Medicine Complutense University Madrid Spain
| | - Amado Andrés
- Imas12 Research Institute University Hospital 12 de Octubre Madrid Spain
- Department of Nephrology University Hospital 12 de Octubre Madrid Spain
| | - Esther Mancebo
- Department of Immunology University Hospital 12 de Octubre Madrid Spain
- Imas12 Research Institute University Hospital 12 de Octubre Madrid Spain
| | - Alejandra Leivas
- H12O‐CNIO Hematological Malignancies Research Unit Madrid Spain
- Department of Hematology University Hospital 12 de Octubre Madrid Spain
| | | | - Iago Justo
- HPB Surgery and Abdominal Transplantation Unit General Surgery Service University Hospital 12 de Octubre Madrid Spain
| | - Carlos Jimenez‐Romero
- Imas12 Research Institute University Hospital 12 de Octubre Madrid Spain
- School of Medicine Complutense University Madrid Spain
- HPB Surgery and Abdominal Transplantation Unit General Surgery Service University Hospital 12 de Octubre Madrid Spain
| | - Daniel Pleguezuelo
- Department of Immunology University Hospital 12 de Octubre Madrid Spain
- Imas12 Research Institute University Hospital 12 de Octubre Madrid Spain
| | - Estela Paz‐Artal
- Department of Immunology University Hospital 12 de Octubre Madrid Spain
- Imas12 Research Institute University Hospital 12 de Octubre Madrid Spain
- School of Medicine Complutense University Madrid Spain
- Section of Immunology San Pablo CEU University Madrid Spain
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7
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Serrano M, Morán L, Martinez-Flores JA, Mancebo E, Pleguezuelo D, Cabrera-Marante O, Delgado J, Serrano A. Immune Complexes of Beta-2-Glycoprotein I and IgA Antiphospholipid Antibodies Identify Patients With Elevated Risk of Thrombosis and Early Mortality After Heart Transplantation. Front Immunol 2019; 10:2891. [PMID: 31921152 PMCID: PMC6935976 DOI: 10.3389/fimmu.2019.02891] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/25/2019] [Indexed: 12/28/2022] Open
Abstract
Background: The presence of anti-Beta 2 glycoprotein antibodies (aB2GP1) of IgA isotype is common in patients with functional impairment of the organs in which B2GP1 is elaborated. Pretransplant IgA aB2GP1 has been associated with increased risk of thrombosis in kidney and heart transplanted patients and has also been related with early mortality after heart transplantation. Circulating immune complexes between IgA and B2GP1 (B2A-CIC) have been described in the blood of patients positive for IgA aB2GP1 with thrombotic clinical symptoms. In kidney transplanted patients, B2A-CIC is a biomarker that predicts which patients IgA aB2GP1 positive are at risk of thrombosis events following kidney transplantation and may lead to early prophylactic treatment. The prevalence of B2A-CIC and its relation with outcomes after heart transplantation is not known. Methods: Follow-up study based on 151 consecutive patients who received a heart transplant. Autoantibodies and B2A-CIC were quantified in pre-transplant serum samples. Three groups of patients were followed-up for 2 years: Group-1, positive for IgA aB2GP1 and B2A-CIC (N = 19). Group-2, only positive for IgA aB2GP1 (N = 28). Group-0 (control group): IgA aB2GP1 negative (N = 104). Results: Kaplan-Meir survival analysis showed that mortality in B2A-CIC positive was higher than group-0 at 3 months (HR:5.08; 95%CI: 1.36–19.01) and at 2 years (HR:3.82; 95%CI: 1.54–12.66). No significant differences were observed between group-2 and group-0. Multivariate analysis identified B2A-CIC as the most important independent risk factor for early mortality (OR = 6.12; 95% CI: 1.93–19.4). Post-transplant incidence of thrombosis was significantly higher in B2A-CIC positive patients than in the control group (OR: 6.42; 95%CI: 2.1–19.63). Multivariate analysis identified the presence of B2A-CIC (OR: 6.13; 95%CI: 2.1–19.63) and the pre-transplant habit of smoking actively (OR: 4.18; 95%CI: 1.35–12.94) as independent risk factor for thrombosis. The proportion of patients who had thrombotic events or died in the first trimester was significantly higher in group-1 (73.7%) than in group-0 (16.3%; p < 0.001) and in group-2 (39.3%; p = 0.02). Multivariate analysis identified B2A-CIC as the main independent risk factor for early outcomes (mortality or thrombosis) in the first 3 months after heart transplant (OR = 11.42, 95% CI: 1.69–9.68). Conclusion: B2A-CIC are a predictor of early mortality and thrombosis after heart transplant.
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Affiliation(s)
- Manuel Serrano
- Immunology Department, Healthcare Research Institute, Hospital "12 de Octubre", Madrid, Spain.,Immunology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Laura Morán
- Cardiology Department, CIBERCV, Facultad de Medicina, Healthcare Research Institute, Hospital "12 de Octubre", Universidad Complutense de Madrid, Madrid, Spain
| | | | - Esther Mancebo
- Immunology Department, Healthcare Research Institute, Hospital "12 de Octubre", Madrid, Spain
| | - Daniel Pleguezuelo
- Immunology Department, Healthcare Research Institute, Hospital "12 de Octubre", Madrid, Spain
| | - Oscar Cabrera-Marante
- Immunology Department, Healthcare Research Institute, Hospital "12 de Octubre", Madrid, Spain
| | - Juan Delgado
- Cardiology Department, CIBERCV, Facultad de Medicina, Healthcare Research Institute, Hospital "12 de Octubre", Universidad Complutense de Madrid, Madrid, Spain
| | - Antonio Serrano
- Immunology Department, Healthcare Research Institute, Hospital "12 de Octubre", Madrid, Spain.,Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
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8
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Pérez D, Gilburd B, Cabrera-Marante Ó, Martínez-Flores JA, Serrano M, Naranjo L, Pleguezuelo D, Morillas L, Shovman O, Paz-Artal E, Shoenfeld Y, Serrano A. Predictive autoimmunity using autoantibodies: screening for anti-nuclear antibodies. Clin Chem Lab Med 2019. [PMID: 28628475 DOI: 10.1515/cclm-2017-0241] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Abstract
Background:
Early detection of antinuclear antibodies (ANA) in asymptomatic subjects is useful to predict autoimmune diseases years before diagnosis. ANA have been determined by indirect immunofluorescence (IIF) using human epithelial type 2 (HEp-2) cells, which is considered the gold standard technique. Multiplex technology (BioPlex ANA Screen) has been introduced for ANA evaluation in recent years. Nevertheless, concordance between BioPlex and IIF is low and there is no harmonization between both methods for detection of autoantibodies. This study has aimed to clarify the clinical significance of autoantibodies detected by BioPlex ANA Screen in subjects with undiagnosed clinical suspicion of autoimmune disease and to determine the predictive value of autoantibodies detected by BioPlex ANA Screen.
Methods:
A 3-year follow-up study was performed of 411 subjects without a clear diagnosis of autoimmune diseases in whom autoantibodies were detected by BioPlex ANA Screen that were negative by IIF on HEp-2 cells.
Results:
At 3 years of follow-up, 312 (76%) subjects were positive for autoantibodies by IIF and 99 subjects continued to be negative. A diagnosis of autoimmune disease was found in most of the subjects (87%).
Conclusions:
BioPlex ANA Screen has greater sensitivity than IIF on HEp-2 cells for autoantibodies detection. Early detection of these antibodies by BioPlex can predict possible development of autoimmune diseases.
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Affiliation(s)
- Dolores Pérez
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel.,Department of Immunology, Instituto de Investigación, Madrid, Spain
| | - Boris Gilburd
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | | | | | - Manuel Serrano
- Department of Immunology, Instituto de Investigación, Madrid, Spain
| | - Laura Naranjo
- Department of Immunology, Instituto de Investigación, Madrid, Spain
| | | | - Luis Morillas
- Department of Rheumatology, Hospital Universitario, Madrid, Spain
| | - Ora Shovman
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Estela Paz-Artal
- Department of Immunology, Instituto de Investigación, Madrid, Spain
| | - Yehuda Shoenfeld
- MaACR, Head of Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer 52621, Israel, Phone: (972) 52-6669020, Fax: (972-3) 5352855; Sackler Faculty of Medicine, Tel-Aviv University, Israel; Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Antonio Serrano
- Department of Immunology, Instituto de Investigación, Madrid, Spain
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Tortosa C, Cabrera-Marante O, Serrano M, Martínez-Flores JA, Pérez D, Lora D, Morillas L, Paz-Artal E, Morales JM, Pleguezuelo D, Serrano A. Incidence of thromboembolic events in asymptomatic carriers of IgA anti ß2 glycoprotein-I antibodies. PLoS One 2017; 12:e0178889. [PMID: 28727732 PMCID: PMC5519006 DOI: 10.1371/journal.pone.0178889] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/19/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The antiphospholipid syndrome (APS) is defined by simultaneous presence of vascular clinical events and antiphospholipid antibodies (aPL). The aPL considered as diagnostics are lupus anticoagulant and antibodies anticardiolipin (aCL) and anti-ß2 glycoprotein-I (aB2GP1). During recent years, IgA aB2GP1 antibodies have been associated with thrombotic events both in patients positive, and mainly negative for other aPL, however its value as a pro-thrombotic risk-factor in asymptomatic patients has not been well defined. OBJECTIVE To test the role of IgA anti B2GP1 as a risk factor for the development of APS-events (thrombosis or pregnancy morbidity) in asymptomatic population with a 5-year follow-up. METHODS 244 patients isolated positive for anti-beta2-glycoprotein I IgA (Group-1 study) and 221 negative patients (Group-2 control) were studied. All the patients were negative for IgG and IgM aCL. RESULTS During the follow-up, 45 patients (9.7%) had APS-events, 38 positive for IgA-aB2GP1 and 7 negative (15.6% vs 3.2%, p<0.001). The incidence rate of APS-events was 3.1% per year in IgA-aB2GP1 positive patients and 0.6% per year in the control group. Arterial thrombosis were the most frequent APS-events (N = 25, 55%) and were mainly observed in Group-1 patients (21 vs 4, p = 0.001). Multivariate analysis were shown as independent risk-factors for the development of APS-events, age, sex (men) and presence of IgA-aB2GP1 (odds ratio 5.25, 95% CI 2.24 to 12.32). CONCLUSION The presence of IgA-aB2GP1 in people with no history of APS-events is the main independent risk factor for the development of these types of events, mainly arterial thrombosis.
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Affiliation(s)
- Carlos Tortosa
- Department of Immunology Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Oscar Cabrera-Marante
- Department of Immunology Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Manuel Serrano
- Department of Immunology Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José A. Martínez-Flores
- Department of Immunology Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Dolores Pérez
- Department of Immunology Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - David Lora
- Department of Epidemiology, Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Luis Morillas
- Department of Rheumatology, Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Estela Paz-Artal
- Department of Immunology Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José M. Morales
- Department of Immunology Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Daniel Pleguezuelo
- Department of Immunology Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Antonio Serrano
- Department of Immunology Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
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