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Hagl B, Heinz V, Schlesinger A, Spielberger BD, Sawalle-Belohradsky J, Senn-Rauh M, Magg T, Boos AC, Hönig M, Schwarz K, Dückers G, von Bernuth H, Pache C, Karitnig-Weiss C, Belohradsky BH, Frank J, Niehues T, Wahn V, Albert MH, Wollenberg A, Jansson AF, Renner ED. Key findings to expedite the diagnosis of hyper-IgE syndromes in infants and young children. Pediatr Allergy Immunol 2016; 27:177-84. [PMID: 26592211 DOI: 10.1111/pai.12512] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Hyper-IgE syndromes (HIES) are primary immunodeficiency disorders characterized by elevated serum IgE, eczema, and recurrent infections. Despite the availability of confirmatory molecular diagnosis of several distinct HIES entities, the differentiation of HIES particularly from severe forms of atopic dermatitis remains a challenge. The two most common forms of HIES are caused by mutations in the genes STAT3 and DOCK8. METHODS Here, we assess the clinical and immunologic phenotype of DOCK8- and STAT3-HIES patients including the cell activation, proliferation, and cytokine release after stimulation. RESULTS Existing HIES scoring systems are helpful to identify HIES patients. However, those scores may fail in infants and young children due to the age-related lack of clinical symptoms. Furthermore, our long-term observations showed a striking variation of laboratory results over time in the individual patient. Reduced memory B-cell counts in concert with low specific antibody production are the most consistent findings likely contributing to the high susceptibility to bacterial and fungal infection. In DOCK8-HIES, T-cell lymphopenia and low IFN-gamma secretion after stimulation were common, likely promoting viral infections. In contrast to STAT3-HIES, DOCK8-HIES patients showed more severe inflammation with regard to allergic manifestations, elevated activation markers (HLA-DR, CD69, CD86, and CD154), and significantly increased inflammatory cytokines (IL1-beta, IL4, IL6, and IFN-gamma). CONCLUSION Differentiating HIES from other diseases such as atopic dermatitis early in life is essential for patients because treatment modalities differ. To expedite the diagnosis process, we propose here a diagnostic workflow.
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Affiliation(s)
- Beate Hagl
- Dr. von Hauner Children's Hospital, Ludwig Maximilian University, Munich, Germany
| | - Valerie Heinz
- Dr. von Hauner Children's Hospital, Ludwig Maximilian University, Munich, Germany
| | - Anne Schlesinger
- Dr. von Hauner Children's Hospital, Ludwig Maximilian University, Munich, Germany.,Dermatology Hospital, Ludwig Maximilian University, Munich, Germany
| | | | | | - Monika Senn-Rauh
- Dr. von Hauner Children's Hospital, Ludwig Maximilian University, Munich, Germany
| | - Thomas Magg
- Dr. von Hauner Children's Hospital, Ludwig Maximilian University, Munich, Germany
| | - Annette C Boos
- Dr. von Hauner Children's Hospital, Ludwig Maximilian University, Munich, Germany.,Dermatology Hospital, Ludwig Maximilian University, Munich, Germany
| | - Manfred Hönig
- University Children's Hospital, University Ulm, Ulm, Germany
| | - Klaus Schwarz
- Institute for Transfusion Medicine, University of Ulm and Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Service, Ulm, Germany
| | | | | | - Christoph Pache
- Oral and Maxillofacial Surgery, Ludwig Maximilian University, Munich, Germany
| | | | - Bernd H Belohradsky
- Dr. von Hauner Children's Hospital, Ludwig Maximilian University, Munich, Germany
| | - Josef Frank
- Department of Transfusion Medicine, Cell Therapeutics and Haemostaseology, Ludwig Maximilian University, Munich, Germany
| | - Tim Niehues
- HELIOS Children's Hospital, Krefeld, Germany
| | - Volker Wahn
- University Children's Hospital, Charité, Berlin, Germany
| | - Michael H Albert
- Dr. von Hauner Children's Hospital, Ludwig Maximilian University, Munich, Germany
| | | | - Annette F Jansson
- Dr. von Hauner Children's Hospital, Ludwig Maximilian University, Munich, Germany
| | - Ellen D Renner
- Dr. von Hauner Children's Hospital, Ludwig Maximilian University, Munich, Germany
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Liu L, Okada S, Kong XF, Kreins AY, Cypowyj S, Abhyankar A, Toubiana J, Itan Y, Audry M, Nitschke P, Masson C, Toth B, Flatot J, Migaud M, Chrabieh M, Kochetkov T, Bolze A, Borghesi A, Toulon A, Hiller J, Eyerich S, Eyerich K, Gulácsy V, Chernyshova L, Chernyshov V, Bondarenko A, María Cortés Grimaldo R, Blancas-Galicia L, Madrigal Beas IM, Roesler J, Magdorf K, Engelhard D, Thumerelle C, Burgel PR, Hoernes M, Drexel B, Seger R, Kusuma T, Jansson AF, Sawalle-Belohradsky J, Belohradsky B, Jouanguy E, Bustamante J, Bué M, Karin N, Wildbaum G, Bodemer C, Lortholary O, Fischer A, Blanche S, Al-Muhsen S, Reichenbach J, Kobayashi M, Rosales FE, Lozano CT, Kilic SS, Oleastro M, Etzioni A, Traidl-Hoffmann C, Renner ED, Abel L, Picard C, Maródi L, Boisson-Dupuis S, Puel A, Casanova JL. Gain-of-function human STAT1 mutations impair IL-17 immunity and underlie chronic mucocutaneous candidiasis. J Exp Med 2011; 208:1635-48. [PMID: 21727188 PMCID: PMC3149226 DOI: 10.1084/jem.20110958] [Citation(s) in RCA: 588] [Impact Index Per Article: 45.2] [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: 05/11/2011] [Accepted: 06/22/2011] [Indexed: 01/14/2023] Open
Abstract
Chronic mucocutaneous candidiasis disease (CMCD) may be caused by autosomal dominant (AD) IL-17F deficiency or autosomal recessive (AR) IL-17RA deficiency. Here, using whole-exome sequencing, we identified heterozygous germline mutations in STAT1 in 47 patients from 20 kindreds with AD CMCD. Previously described heterozygous STAT1 mutant alleles are loss-of-function and cause AD predisposition to mycobacterial disease caused by impaired STAT1-dependent cellular responses to IFN-γ. Other loss-of-function STAT1 alleles cause AR predisposition to intracellular bacterial and viral diseases, caused by impaired STAT1-dependent responses to IFN-α/β, IFN-γ, IFN-λ, and IL-27. In contrast, the 12 AD CMCD-inducing STAT1 mutant alleles described here are gain-of-function and increase STAT1-dependent cellular responses to these cytokines, and to cytokines that predominantly activate STAT3, such as IL-6 and IL-21. All of these mutations affect the coiled-coil domain and impair the nuclear dephosphorylation of activated STAT1, accounting for their gain-of-function and dominance. Stronger cellular responses to the STAT1-dependent IL-17 inhibitors IFN-α/β, IFN-γ, and IL-27, and stronger STAT1 activation in response to the STAT3-dependent IL-17 inducers IL-6 and IL-21, hinder the development of T cells producing IL-17A, IL-17F, and IL-22. Gain-of-function STAT1 alleles therefore cause AD CMCD by impairing IL-17 immunity.
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Affiliation(s)
- Luyan Liu
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Necker Medical School, Institut National de la Santé et de la Recherche Médicale U980 and University Paris Descartes, 75015 Paris, France
| | - Satoshi Okada
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY 10065
| | - Xiao-Fei Kong
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY 10065
| | - Alexandra Y. Kreins
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY 10065
| | - Sophie Cypowyj
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY 10065
| | - Avinash Abhyankar
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY 10065
| | - Julie Toubiana
- Department of Pediatrics, Bioinformatics Unit, Department of Dermatology, Department of Infectious Diseases, Pediatric Hematology-Immunology Unit, and Center for Immunodeficiency, Necker Hospital, AP-HP, and University Paris Descartes, 75015 Paris, France
| | - Yuval Itan
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY 10065
| | - Magali Audry
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY 10065
| | - Patrick Nitschke
- Department of Pediatrics, Bioinformatics Unit, Department of Dermatology, Department of Infectious Diseases, Pediatric Hematology-Immunology Unit, and Center for Immunodeficiency, Necker Hospital, AP-HP, and University Paris Descartes, 75015 Paris, France
| | - Cécile Masson
- Department of Pediatrics, Bioinformatics Unit, Department of Dermatology, Department of Infectious Diseases, Pediatric Hematology-Immunology Unit, and Center for Immunodeficiency, Necker Hospital, AP-HP, and University Paris Descartes, 75015 Paris, France
| | - Beata Toth
- Department of Infectious and Pediatric Immunology, Medical and Health Science Center, University of Debrecen, 4032 Debrecen, Hungary
| | - Jérome Flatot
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Necker Medical School, Institut National de la Santé et de la Recherche Médicale U980 and University Paris Descartes, 75015 Paris, France
| | - Mélanie Migaud
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Necker Medical School, Institut National de la Santé et de la Recherche Médicale U980 and University Paris Descartes, 75015 Paris, France
| | - Maya Chrabieh
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Necker Medical School, Institut National de la Santé et de la Recherche Médicale U980 and University Paris Descartes, 75015 Paris, France
| | - Tatiana Kochetkov
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY 10065
| | - Alexandre Bolze
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Necker Medical School, Institut National de la Santé et de la Recherche Médicale U980 and University Paris Descartes, 75015 Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY 10065
| | - Alessandro Borghesi
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Necker Medical School, Institut National de la Santé et de la Recherche Médicale U980 and University Paris Descartes, 75015 Paris, France
| | - Antoine Toulon
- Department of Pediatrics, Bioinformatics Unit, Department of Dermatology, Department of Infectious Diseases, Pediatric Hematology-Immunology Unit, and Center for Immunodeficiency, Necker Hospital, AP-HP, and University Paris Descartes, 75015 Paris, France
| | - Julia Hiller
- Center for Allergy and Environment, Helmholtz Center/TUM, 80802 Munich, Germany
| | - Stefanie Eyerich
- Center for Allergy and Environment, Helmholtz Center/TUM, 80802 Munich, Germany
| | - Kilian Eyerich
- Center for Allergy and Environment, Helmholtz Center/TUM, 80802 Munich, Germany
- Department of Dermatology, Technische Universitat, 80802 Munich, Germany
| | - Vera Gulácsy
- Department of Infectious and Pediatric Immunology, Medical and Health Science Center, University of Debrecen, 4032 Debrecen, Hungary
| | - Ludmyla Chernyshova
- Department of Pediatric Infectious Diseases and Clinical Immunology, National Medical Academy for Post-Graduate Education, 01024 Kiev, Ukraine
| | - Viktor Chernyshov
- Laboratory of Immunology, Institute of Pediatrics, Obstetrics, and Gynecology, National Academy of Medical Sciences, 01024 Kiev, Ukraine
| | - Anastasia Bondarenko
- Department of Pediatric Infectious Diseases and Clinical Immunology, National Medical Academy for Post-Graduate Education, 01024 Kiev, Ukraine
| | | | | | | | - Joachim Roesler
- Department of Pediatrics, University Hospital Carl Gustav Carus, 01307 Dresden, Germany
| | - Klaus Magdorf
- Department of Pediatric Pneumology and Immunology, Charité Medical School of Berlin, 11117 Berlin, Germany
| | - Dan Engelhard
- Department of Pediatrics, Hadassah University Hospital, 91120 Jerusalem, Israel
| | - Caroline Thumerelle
- Pneumology and Allergology Unit, Hospital Jeanne de Flandres, 59037 Lille, France
| | | | - Miriam Hoernes
- Division of Immunology, Hematology, and BMT, Children’s Research Center, Children’s Hospital, University of Zurich, 8032 Zurich, Switzerland
| | - Barbara Drexel
- Division of Immunology, Hematology, and BMT, Children’s Research Center, Children’s Hospital, University of Zurich, 8032 Zurich, Switzerland
| | - Reinhard Seger
- Division of Immunology, Hematology, and BMT, Children’s Research Center, Children’s Hospital, University of Zurich, 8032 Zurich, Switzerland
| | - Theresia Kusuma
- University Children’s Hospital at Dr. von Haunersches Kinderspital, Ludwig Maximilian University, 80337 Munich, Germany
| | - Annette F. Jansson
- University Children’s Hospital at Dr. von Haunersches Kinderspital, Ludwig Maximilian University, 80337 Munich, Germany
| | - Julie Sawalle-Belohradsky
- University Children’s Hospital at Dr. von Haunersches Kinderspital, Ludwig Maximilian University, 80337 Munich, Germany
| | - Bernd Belohradsky
- University Children’s Hospital at Dr. von Haunersches Kinderspital, Ludwig Maximilian University, 80337 Munich, Germany
| | - Emmanuelle Jouanguy
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Necker Medical School, Institut National de la Santé et de la Recherche Médicale U980 and University Paris Descartes, 75015 Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY 10065
| | - Jacinta Bustamante
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Necker Medical School, Institut National de la Santé et de la Recherche Médicale U980 and University Paris Descartes, 75015 Paris, France
| | - Mélanie Bué
- University Hospital Center of Brest, 29609 Brest, France
| | - Nathan Karin
- Rappaport Faculty of Medicine, Technion, 31096 Haifa, Israel
| | - Gizi Wildbaum
- Rappaport Faculty of Medicine, Technion, 31096 Haifa, Israel
| | - Christine Bodemer
- Department of Infectious and Pediatric Immunology, Medical and Health Science Center, University of Debrecen, 4032 Debrecen, Hungary
| | - Olivier Lortholary
- Department of Infectious and Pediatric Immunology, Medical and Health Science Center, University of Debrecen, 4032 Debrecen, Hungary
| | - Alain Fischer
- Department of Infectious and Pediatric Immunology, Medical and Health Science Center, University of Debrecen, 4032 Debrecen, Hungary
| | - Stéphane Blanche
- Department of Infectious and Pediatric Immunology, Medical and Health Science Center, University of Debrecen, 4032 Debrecen, Hungary
| | - Saleh Al-Muhsen
- Rappaport Faculty of Medicine, Technion, 31096 Haifa, Israel
| | - Janine Reichenbach
- Division of Immunology, Hematology, and BMT, Children’s Research Center, Children’s Hospital, University of Zurich, 8032 Zurich, Switzerland
| | - Masao Kobayashi
- Division of Immunology, Hematology, and BMT, Children’s Research Center, Children’s Hospital, University of Zurich, 8032 Zurich, Switzerland
| | | | | | - Sara Sebnem Kilic
- Department of Pediatrics, Uludag University School of Medicine, 16059 Bursa, Turkey
| | - Matias Oleastro
- National Children’s Hospital Prof. Dr. Juan P. Garrahan, 12049 Buenos Aires, Argentina
| | - Amos Etzioni
- Rappaport Faculty of Medicine, Technion, 31096 Haifa, Israel
| | - Claudia Traidl-Hoffmann
- Center for Allergy and Environment, Helmholtz Center/TUM, 80802 Munich, Germany
- Department of Dermatology, Technische Universitat, 80802 Munich, Germany
| | - Ellen D. Renner
- University Children’s Hospital at Dr. von Haunersches Kinderspital, Ludwig Maximilian University, 80337 Munich, Germany
| | - Laurent Abel
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Necker Medical School, Institut National de la Santé et de la Recherche Médicale U980 and University Paris Descartes, 75015 Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY 10065
| | - Capucine Picard
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Necker Medical School, Institut National de la Santé et de la Recherche Médicale U980 and University Paris Descartes, 75015 Paris, France
- Department of Pediatrics, Bioinformatics Unit, Department of Dermatology, Department of Infectious Diseases, Pediatric Hematology-Immunology Unit, and Center for Immunodeficiency, Necker Hospital, AP-HP, and University Paris Descartes, 75015 Paris, France
| | - László Maródi
- Department of Infectious and Pediatric Immunology, Medical and Health Science Center, University of Debrecen, 4032 Debrecen, Hungary
| | - Stéphanie Boisson-Dupuis
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Necker Medical School, Institut National de la Santé et de la Recherche Médicale U980 and University Paris Descartes, 75015 Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY 10065
| | - Anne Puel
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Necker Medical School, Institut National de la Santé et de la Recherche Médicale U980 and University Paris Descartes, 75015 Paris, France
| | - Jean-Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Necker Medical School, Institut National de la Santé et de la Recherche Médicale U980 and University Paris Descartes, 75015 Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY 10065
- Department of Pediatrics, Bioinformatics Unit, Department of Dermatology, Department of Infectious Diseases, Pediatric Hematology-Immunology Unit, and Center for Immunodeficiency, Necker Hospital, AP-HP, and University Paris Descartes, 75015 Paris, France
- Prince Naif Center for Immunology Research, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, 11461Saudi Arabia
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