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Marin AV, Jiménez-Reinoso A, Mazariegos MS, Román-Ortiz E, Regueiro JR. T-cell receptor signaling in Schimke immuno-osseous dysplasia is SMARCAL1-independent. Front Immunol 2022; 13:979722. [PMID: 36330520 PMCID: PMC9623027 DOI: 10.3389/fimmu.2022.979722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/27/2022] [Accepted: 09/22/2022] [Indexed: 11/26/2022] Open
Abstract
Schimke immuno-osseous dysplasia (SIOD) caused by mutations in SMARCAL1 is an ultra-rare disease characterized by specific facial features, skeletal dysplasia, and steroid-resistant nephrotic syndrome, which often leads to kidney failure and requires transplantation. Cellular (T-cell) deficiency, lymphopenia, and infections have been frequently reported, but whether they are due to T-cell-intrinsic defects in T-cell receptor (TCR) signaling associated with SMARCAL1 deficiency or to T-cell-extrinsic effects such as the impaired proliferation of hematopoietic precursors or T-cell-specific immunosuppression after renal transplantation remains unknown. We have explored the effects of SMARCAL1 deficiency on T-cell receptor signaling in primary and immortalized T cells from a 9-year-old SIOD patient under immunosuppression treatment when compared to healthy donors. Immortalized T cells recapitulated the SMARCAL1 deficiency of the patient, as judged by their impaired response to gamma irradiation. The results indicated that TCR-mediated signaling was normal in SIOD-derived immortalized T cells but strongly impaired in the primary T cells of the patient, although rescued with TCR-independent stimuli such as PMA + ionomycin, suggesting that SIOD-associated T-cell signaling is not intrinsically defective but rather the result of the impaired proliferation of hematopoietic precursors or of T-cell-specific immunosuppression. The lack of early thymic emigrants in our patients may support the former hypothesis.
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Affiliation(s)
- Ana V. Marin
- Department of Immunology, Ophthalmology and Ear, Nose and Throat (ENT), Complutense University School of Medicine and 12 de Octubre Health Research Institute (imas12), Madrid, Spain
| | - Anaïs Jiménez-Reinoso
- Department of Immunology, Ophthalmology and Ear, Nose and Throat (ENT), Complutense University School of Medicine and 12 de Octubre Health Research Institute (imas12), Madrid, Spain
| | - Marina S. Mazariegos
- Department of Immunology, Ophthalmology and Ear, Nose and Throat (ENT), Complutense University School of Medicine and 12 de Octubre Health Research Institute (imas12), Madrid, Spain
| | - Elena Román-Ortiz
- Pediatric Nephrology, Hospital Universitari i Politècnic la Fe, Valencia, Spain
| | - José R. Regueiro
- Department of Immunology, Ophthalmology and Ear, Nose and Throat (ENT), Complutense University School of Medicine and 12 de Octubre Health Research Institute (imas12), Madrid, Spain
- *Correspondence: José R. Regueiro,
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Greenbaum LA, Licht C, Nikolaou V, Al-Dakkak I, Green J, Haas CS, Román-Ortiz E, Cheong HI, Sartz L, Swinford R, Tomazos I, Miller B, Cataland S. Functional Assessment of Fatigue and Other Patient-Reported Outcomes in Patients Enrolled in the Global aHUS Registry. Kidney Int Rep 2020; 5:1161-1171. [PMID: 32775815 PMCID: PMC7403628 DOI: 10.1016/j.ekir.2020.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/19/2019] [Revised: 04/20/2020] [Accepted: 05/07/2020] [Indexed: 12/27/2022] Open
Abstract
Introduction Atypical hemolytic uremic syndrome (aHUS) is a progressive and potentially life-threatening disease characterized by complement-mediated thrombotic microangiopathy. Patients with aHUS may experience fatigue, which can negatively impact their lives, but there is a knowledge gap regarding disease burden in these patients. Methods In this longitudinal study, patients with aHUS from the Global aHUS Registry who completed patient-reported outcome assessments (Functional Assessment of Chronic Illness Therapy-Fatigue scale [FACIT-Fatigue], general health status, and work status) at ≥2 time points were assessed relative to treatment status: (i) never treated with eculizumab; (ii) on eculizumab at registry enrollment and continued therapy; and (iii) started eculizumab after registry enrollment. Results Patients who started eculizumab after the baseline visit (n = 23) exhibited improvements in fatigue (nearly 75% achieved clinically meaningful improvement), improved general health status (55%), and 25% to 30% rate reduction in symptoms of fatigue, weakness, irritability, nausea/vomiting, and swelling at last follow-up. Among patients already on eculizumab at registry enrollment (n = 295) and those never treated (n = 233), these parameters changed minimally relative to the baseline. Emergency room visits and hospital admissions were similar between groups. The number of health care provider visits and work days missed were higher in patients who started eculizumab after registry enrollment. Conclusion These real-world findings confirm the detrimental effects of aHUS on patients’ daily lives, including high levels of fatigue and impairments in general health status. The results suggest clinically meaningful improvement in fatigue, other patient-reported outcomes, and symptoms with eculizumab initiation after enrollment into the aHUS registry.
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Affiliation(s)
- Larry A Greenbaum
- Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | | | - Imad Al-Dakkak
- Alexion Pharmaceuticals, Inc., Boston, Massachusetts, USA
| | | | - Christian Stefan Haas
- Department of Internal Medicine, Nephrology and Intensive Care Medicine, Philipps-University, Marburg, Germany
| | | | - Hae Il Cheong
- Seoul National University Children's Hospital, Seoul, Korea
| | - Lisa Sartz
- Lund University, Skåne University Hospital, Lund, Sweden
| | - Rita Swinford
- McGovern Medical School at UTHealth, University of Texas-Houston, Houston, Texas, USA
| | | | | | - Spero Cataland
- The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
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Román-Ortiz E, Mendizábal-Oteiza S, Codoñer-Franch P. Nutrition in Pediatric Kidney Disease. JCS 2018. [DOI: 10.1055/s-0038-1669379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AbstractNutrition has a major impact on the health of children with chronic kidney disease (CKD). Special diets and additional replacement therapies may be chosen according to the specific renal disease. Persistent low-grade inflammation, which contributes to CKD-associated cardiovascular and all-cause mortality, protein-energy wasting, oxidative stress, acidosis, chronic and recurrent infections, and altered metabolism of adipose tissue may result from dietary deficits and are important targets for nutritive intervention. Therefore, many guidelines have been developed regarding nutrient intake adequation to assist pediatricians treating these children. Acute kidney injury (AKI) has multifactorial etiology and complicated clinical course that may ultimately necessitate renal replacement. AKI presents unique treatment challenges because of associated metabolic derangements, difficulties in nutrient requirement estimation, the negative effects of renal replacement therapy, and the complex effects on nutrient balances. Maintenance of protein balance in such conditions requires adequate energy and protein intake, especially during acute illnesses. Malnutrition in pediatric AKI has been linked to increased morbidity and mortality. However, the recommended nutritional requirements for this condition are less precise than for CKD. A complete assessment of pediatric kidney disease requires evaluation of growth, body composition, abnormal sodium loss, acid-base status, and dietary intake, particularly for children with renal insufficiency. Nutritional support should also provide adequate amounts of energy, macronutrients, and micronutrients for normal growth and development.
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Affiliation(s)
- Elena Román-Ortiz
- Department of Pediatrics, Dr. Peset University Hospital, Valencia, Spain
| | | | - Pilar Codoñer-Franch
- Department of Pediatrics, Dr. Peset University Hospital, Valencia, Spain
- Department of Pediatrics, Obstetrics, and Gynecology, University of Valencia, Valencia, Spain
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Sartz L, Greenbaum L, Haas C, Román-Ortiz E, Cheong HI, Al-Dakkak I, Ogawa M, Cataland S, Licht C. FP250FACIT-FATIGUE SCORES IN ADULT PATIENTS AT ENROLLMENT INTO THE GLOBAL AHUS REGISTRY. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fp250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lisa Sartz
- Barnkliniken, Dept of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Larry Greenbaum
- Pediatric Nephrology, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Christian Haas
- Nephrologie und Internistische Intensivmedizin, Klinik für Innere Medizin, Marburg, Germany
| | - Elena Román-Ortiz
- Divison of Pediatric Nephrology, Hospital Universitario La Fe, Valencia, Spain
| | - Hae Il Cheong
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea, Republic of
| | - Imad Al-Dakkak
- Global Epidemiology, Alexion Pharmaceuticals, Inc., New Haven, CT, United States
| | - Masayo Ogawa
- Medical Sciences, Alexion Pharmaceuticals, Inc., New Haven, CT, United States
| | - Spero Cataland
- Division of Hematology, The Ohio State University, Wexner Medical Center, Columbus, OH, United States
| | - Christoph Licht
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
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Jiménez-Reinoso A, Marin AV, Subias M, López-Lera A, Román-Ortiz E, Payne K, Ma CS, Arbore G, Kolev M, Freeley SJ, Kemper C, Tangye SG, Fernández-Malavé E, Rodríguez de Córdoba S, López-Trascasa M, Regueiro JR. Human plasma C3 is essential for the development of memory B, but not T, lymphocytes. J Allergy Clin Immunol 2017; 141:1151-1154.e14. [PMID: 29113906 DOI: 10.1016/j.jaci.2017.09.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 08/06/2017] [Accepted: 09/08/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Anaïs Jiménez-Reinoso
- Department of Immunology, Complutense University School of Medicine and 12 de Octubre Health Research Institute (imas12), Madrid, Spain
| | - Ana V Marin
- Department of Immunology, Complutense University School of Medicine and 12 de Octubre Health Research Institute (imas12), Madrid, Spain
| | - Marta Subias
- Centro de Investigaciones Biológicas (CSIC), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Alberto López-Lera
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain; Immunology Unit, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | | | - Kathryn Payne
- Immunology Research Program, Garvan Institute of Medical Research, Darlinghurst, Australia
| | - Cindy S Ma
- Immunology Research Program, Garvan Institute of Medical Research, Darlinghurst, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Giuseppina Arbore
- MRC Centre for Transplantation, Division of Transplant Immunology and Mucosal Biology, King's, College London, London, United Kingdom
| | - Martin Kolev
- MRC Centre for Transplantation, Division of Transplant Immunology and Mucosal Biology, King's, College London, London, United Kingdom
| | - Simon J Freeley
- MRC Centre for Transplantation, Division of Transplant Immunology and Mucosal Biology, King's, College London, London, United Kingdom
| | - Claudia Kemper
- MRC Centre for Transplantation, Division of Transplant Immunology and Mucosal Biology, King's, College London, London, United Kingdom
| | - Stuart G Tangye
- Immunology Research Program, Garvan Institute of Medical Research, Darlinghurst, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Edgar Fernández-Malavé
- Department of Immunology, Complutense University School of Medicine and 12 de Octubre Health Research Institute (imas12), Madrid, Spain
| | - Santiago Rodríguez de Córdoba
- Centro de Investigaciones Biológicas (CSIC), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Margarita López-Trascasa
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain; Immunology Unit, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - José R Regueiro
- Department of Immunology, Complutense University School of Medicine and 12 de Octubre Health Research Institute (imas12), Madrid, Spain.
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Román-Ortiz E, Mendizabal S. SP894ECULIZUMAB IN ANTIBODY-MEDIATED REJECTION OF PAEDIATRIC RENAL TRANSPLANTATION. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv203.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Román-Ortiz E, Mendizábal S, Anter J, López-Trascasa M, Sánchez-Corral P, Rodríguez de Córdoba S. SP837ECULIZUMAB TREATMENT IN DE NOVO ATYPICAL HAEMOLYTIC URAEMIC SYNDROME AFTER RENAL TRANSPLANTATION ASSOCIATED WITH COMPLETE DEFICIENCY OF FACTOR-H RELATED PROTEINS 1 AND 3. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv202.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Román-Ortiz E, Mendizabal Oteiza S, Pinto S, López-Trascasa M, Sánchez-Corral P, Rodríguez de Cordoba S. Eculizumab long-term therapy for pediatric renal transplant in aHUS with CFH/CFHR1 hybrid gene. Pediatr Nephrol 2014; 29:149-53. [PMID: 23982707 DOI: 10.1007/s00467-013-2591-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 07/17/2013] [Accepted: 07/25/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Atypical hemolytic uremic syndrome (aHUS) is a form of thrombotic microangiopathy (TMA) caused by dysregulation of the complement system. Outcomes of kidney transplantation are poor owing to aHUS recurrence and loss of graft. Patients carrying CFH mutations or CFH/CFHR1 hybrid genes present a very high risk of recurrence despite preventive plasmapheresis. Evaluation of recent data suggests that prophylactic eculizumab pretransplant might be the preferred therapy if available. CASE-DIAGNOSIS/TREATMENT We report 3-year follow-up data in a 9-year-old boy with aHUS and successful renal transplant treated with prophylactic eculizumab without recurrence. He presented with aHUS at age 3, irreversible renal failure and uncontrolled severe hypertension with concentric left ventricular hypertrophy, recurrent acute pulmonary edema, and congestive heart failure despite five hypotensive agents and bilateral nephrectomy. Complement analysis demonstrated the presence of a CFH/CFHR1 hybrid gene inherited from his mother and a SNP risk CFH haplotype inherited from his father. Kidney transplant was performed with prophylactic eculizumab and subsequent fortnightly administration. Three years post-transplant, graft function remains stable (serum creatinine 0.9 mg/dl), hypertension is controlled, no left ventricular hypertrophy, no opportunistic infections, and negative clinical chemistry parameters for hemolysis. CONCLUSION Eculizumab is a safe and effective therapy for preventing TMA recurrence and provides long-term graft function in aHUS with the CFH/CFHR1 hybrid gene.
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Affiliation(s)
- Elena Román-Ortiz
- Pediatric Nephrology Unit, Hospital La Fe, Bulevar sur s/n, 46026, Valencia, Spain,
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