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Tar I, Szegedi M, Krasuska-Sławińska E, Heropolitańska-Pliszka E, Bernatowska EA, Öncü E, Keles S, Guner SN, Reisli I, Gesheva N, Naumova E, Izakovicova-Holla L, Litzman J, Savchak I, Kostyuchenko L, Erdõs M. Intraoral and maxillofacial abnormalities in patients with autosomal dominant hyper-IgE syndrome. Cent Eur J Immunol 2023; 48:228-236. [PMID: 37901871 PMCID: PMC10604639 DOI: 10.5114/ceji.2023.130874] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 05/24/2023] [Indexed: 10/31/2023] Open
Abstract
Autosomal dominant hyper-IgE syndrome (AD-HIES) is an inborn error of immunity (IEI) caused by a dominant-negative mutation in the signal transducer and activator of transcription 3 (STAT 3). This disease is characterized by chronic eczematoid dermatitis, recurrent staphylococcal skin abscesses, pneumonia, pneumatoceles, and extremely high serum IgE levels. Loss-of-function STAT3 mutations may also result in distinct non-immunologic features such as dental, facial, skeletal, and vascular abnormalities, central nervous system malformations and an increased risk for bone fractures. Prophylactic treatment of Candida infections and prophylactic antimicrobial therapy for staphylococcal skin infections and sinopulmonary infections are essential. An awareness of the oral and maxillofacial features of HIES may facilitate early diagnosis with genetic counselling and may improve future patient care. This study describes oral, dental, and maxillofacial manifestations in 14 patients with genetically defined AD-HIES. We also review the literature and propose recommendations for the complex care of patients with this rare primary immunodeficiency.
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Affiliation(s)
- Ildikó Tar
- Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
| | - Márta Szegedi
- Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
| | - Ewa Krasuska-Sławińska
- Dental Surgical Clinic for Children, Children’s Memorial Health Institute, Warsaw, Poland
| | | | - Ewa A. Bernatowska
- Department of Immunology, Children’s Memorial Health Institute, Warsaw, Poland
| | - Elif Öncü
- Department of Periodontology, Lokman Hekim University, Ankara, Turkey
| | - Sevgi Keles
- Division of Pediatric Allergy and Immunology, Necmettin Erbakan University, Konya, Turkey
| | - Sukru N. Guner
- Division of Pediatric Allergy and Immunology, Necmettin Erbakan University, Konya, Turkey
| | - Ismail Reisli
- Division of Pediatric Allergy and Immunology, Necmettin Erbakan University, Konya, Turkey
| | - Nevena Gesheva
- Department of Clinical Immunology and Stem Cell Bank, University Hospital “Aleksandrovska”, Sofia, Bulgaria
| | - Elissaveta Naumova
- Department of Clinical Immunology and Stem Cell Bank, University Hospital “Aleksandrovska”, Sofia, Bulgaria
| | - Lydie Izakovicova-Holla
- Department of Stomatology, St Anne’s University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Litzman
- Department of Clinical Immunology and Allergology, St Anne’s University Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Igor Savchak
- Department of Pediatric Immunology and Rheumatology, Western Ukrainian Specialized Children’s Medical Center, Lviv, Ukraine
| | - Larysa Kostyuchenko
- Department of Pediatric Immunology and Rheumatology, Western Ukrainian Specialized Children’s Medical Center, Lviv, Ukraine
| | - Melinda Erdõs
- J Project Education and Research Network, Debrecen, Hungary
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2
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Leiding JW, Vogel TP, Santarlas VGJ, Mhaskar R, Smith MR, Carisey A, Vargas-Hernández A, Silva-Carmona M, Heeg M, Rensing-Ehl A, Neven B, Hadjadj J, Hambleton S, Ronan Leahy T, Meesilpavikai K, Cunningham-Rundles C, Dutmer CM, Sharapova SO, Taskinen M, Chua I, Hague R, Klemann C, Kostyuchenko L, Morio T, Thatayatikom A, Ozen A, Scherbina A, Bauer CS, Flanagan SE, Gambineri E, Giovannini-Chami L, Heimall J, Sullivan KE, Allenspach E, Romberg N, Deane SG, Prince BT, Rose MJ, Bohnsack J, Mousallem T, Jesudas R, Santos Vilela MMD, O'Sullivan M, Pachlopnik Schmid J, Průhová Š, Klocperk A, Rees M, Su H, Bahna S, Baris S, Bartnikas LM, Chang Berger A, Briggs TA, Brothers S, Bundy V, Chan AY, Chandrakasan S, Christiansen M, Cole T, Cook MC, Desai MM, Fischer U, Fulcher DA, Gallo S, Gauthier A, Gennery AR, Gonçalo Marques J, Gottrand F, Grimbacher B, Grunebaum E, Haapaniemi E, Hämäläinen S, Heiskanen K, Heiskanen-Kosma T, Hoffman HM, Gonzalez-Granado LI, Guerrerio AL, Kainulainen L, Kumar A, Lawrence MG, Levin C, Martelius T, Neth O, Olbrich P, Palma A, Patel NC, Pozos T, Preece K, Lugo Reyes SO, Russell MA, Schejter Y, Seroogy C, Sinclair J, Skevofilax E, Suan D, Suez D, Szabolcs P, Velasco H, Warnatz K, Walkovich K, Worth A, Seppänen MRJ, Torgerson TR, Sogkas G, Ehl S, Tangye SG, Cooper MA, Milner JD, Forbes Satter LR. Monogenic early-onset lymphoproliferation and autoimmunity: Natural history of STAT3 gain-of-function syndrome. J Allergy Clin Immunol 2023; 151:1081-1095. [PMID: 36228738 PMCID: PMC10081938 DOI: 10.1016/j.jaci.2022.09.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [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: 11/03/2021] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND In 2014, germline signal transducer and activator of transcription (STAT) 3 gain-of-function (GOF) mutations were first described to cause a novel multisystem disease of early-onset lymphoproliferation and autoimmunity. OBJECTIVE This pivotal cohort study defines the scope, natural history, treatment, and overall survival of a large global cohort of patients with pathogenic STAT3 GOF variants. METHODS We identified 191 patients from 33 countries with 72 unique mutations. Inclusion criteria included symptoms of immune dysregulation and a biochemically confirmed germline heterozygous GOF variant in STAT3. RESULTS Overall survival was 88%, median age at onset of symptoms was 2.3 years, and median age at diagnosis was 12 years. Immune dysregulatory features were present in all patients: lymphoproliferation was the most common manifestation (73%); increased frequencies of double-negative (CD4-CD8-) T cells were found in 83% of patients tested. Autoimmune cytopenias were the second most common clinical manifestation (67%), followed by growth delay, enteropathy, skin disease, pulmonary disease, endocrinopathy, arthritis, autoimmune hepatitis, neurologic disease, vasculopathy, renal disease, and malignancy. Infections were reported in 72% of the cohort. A cellular and humoral immunodeficiency was observed in 37% and 51% of patients, respectively. Clinical symptoms dramatically improved in patients treated with JAK inhibitors, while a variety of other immunomodulatory treatment modalities were less efficacious. Thus far, 23 patients have undergone bone marrow transplantation, with a 62% survival rate. CONCLUSION STAT3 GOF patients present with a wide array of immune-mediated disease including lymphoproliferation, autoimmune cytopenias, and multisystem autoimmunity. Patient care tends to be siloed, without a clear treatment strategy. Thus, early identification and prompt treatment implementation are lifesaving for STAT3 GOF syndrome.
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Affiliation(s)
- Jennifer W Leiding
- Division of Allergy and Immunology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore; Johns Hopkins All Children's Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St Petersburg.
| | - Tiphanie P Vogel
- Department of Pediatrics, Baylor College of Medicine and William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston
| | | | - Rahul Mhaskar
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa
| | - Madison R Smith
- Department of Pediatrics, Baylor College of Medicine and William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston
| | - Alexandre Carisey
- Department of Cell and Molecular Biology, St Jude Children's Research Hospital, Memphis
| | - Alexander Vargas-Hernández
- Department of Pediatrics, Baylor College of Medicine and William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston
| | - Manuel Silva-Carmona
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston
| | - Maximilian Heeg
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg
| | - Anne Rensing-Ehl
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg
| | - Bénédicte Neven
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163-Institut Imagine, Paris
| | - Jérôme Hadjadj
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163-Institut Imagine, Paris
| | - Sophie Hambleton
- Newcastle University Translational and Clinical Research Institute, Newcastle (United Kingdom)
| | | | - Kornvalee Meesilpavikai
- Department of Internal Medicine, Division of Clinical Immunology and Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Cullen M Dutmer
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora
| | - Svetlana O Sharapova
- Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk
| | - Mervi Taskinen
- New Children's Hospital, Pediatric Research Center, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Turku and Kuopio, Finland
| | - Ignatius Chua
- Department of Rheumatology, Immunology and Allergy, Christchurch Hospital, Christchurch; Clinical Immunogenomics Research Consortium of Australasia (CIRCA)
| | | | - Christian Klemann
- Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover
| | - Larysa Kostyuchenko
- Center of Pediatric Immunology, Western Ukrainian Specialized Children's Medical Centre, Lviv
| | - Tomohiro Morio
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo
| | - Akaluck Thatayatikom
- Division of Pediatric Allergy/Immunology/Rheumatology, Shands Children's Hospital, University of Florida, Gainesville
| | - Ahmet Ozen
- School of Medicine, Pediatric Allergy and Immunology, Marmara University, Istanbul
| | - Anna Scherbina
- Dmitry Rogachev National Medical and Research Center for Pediatric Hematology, Oncology and Immunology, Moscow
| | - Cindy S Bauer
- Division of Allergy and Immunology, Phoenix Children's Hospital, Phoenix
| | - Sarah E Flanagan
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter
| | - Eleonora Gambineri
- Department of NEUROFARBA, Section of Children's Health, University of Florence, Anna Meyer Children's Hospital, Florence
| | | | - Jennifer Heimall
- Perelman School of Medicine at University of Pennsylvania, Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia
| | - Kathleen E Sullivan
- Perelman School of Medicine at University of Pennsylvania, Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia
| | - Eric Allenspach
- Pediatric Immunology/Rheumatology, University of Washington, Seattle; Seattle Children's Hospital, Seattle
| | - Neil Romberg
- Perelman School of Medicine at University of Pennsylvania, Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia
| | - Sean G Deane
- Department of Allergy, The Permanente Medical Group, Sacramento, and the Division of Rheumatology/Allergy and Clinical Immunology, University of California, Davis, School of Medicine, Sacramento
| | - Benjamin T Prince
- Nationwide Children's Hospital Department of Allergy and Immunology, Columbus; College of Medicine, The Ohio State University, Columbus
| | - Melissa J Rose
- College of Medicine, The Ohio State University, Columbus; Division of Pediatric Hematology-Oncology, Nationwide Children's Hospital, Columbus
| | - John Bohnsack
- Department of Pediatrics, University of Utah, Salt Lake City
| | | | - Rohith Jesudas
- Department of Hematology, St Jude Children's Research Hospital, Memphis
| | - Maria Marluce Dos Santos Vilela
- Pediatric Allergy and Immunology/Center of Investigation in Pediatrics, Faculty of Medical Sciences, State University of Campinas-Unicamp, São Paulo
| | - Michael O'Sullivan
- Clinical Immunogenomics Research Consortium of Australasia (CIRCA); Immunology Department, Perth Children's Hospital, Nedlands
| | - Jana Pachlopnik Schmid
- Division of Immunology, University Children's Hospital Zurich, Children's Research Center (CRC), Zurich
| | - Štěpánka Průhová
- Department of Pediatrics, Charles University in Prague, Second Faculty of Medicine and University Hospital Motol, Prague
| | - Adam Klocperk
- Department of Immunology, Second Faculty of Medicine and University Hospital Motol, Charles University in Prague, Prague
| | - Matthew Rees
- Department of Hematology, St Jude Children's Research Hospital, Memphis
| | - Helen Su
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda
| | - Sami Bahna
- Allergy and Immunology Section, Louisiana State University Health Sciences Center, Shreveport
| | - Safa Baris
- School of Medicine, Pediatric Allergy and Immunology, Marmara University, Istanbul
| | - Lisa M Bartnikas
- Division of Immunology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston
| | - Amy Chang Berger
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco
| | - Tracy A Briggs
- Division of Evolution and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester; NW Genomic Laboratory Hub, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester
| | - Shannon Brothers
- Clinical Immunogenomics Research Consortium of Australasia (CIRCA); Starship Children's Hospital, Auckland
| | - Vanessa Bundy
- Allergy and Immunology, University of California, Los Angeles
| | - Alice Y Chan
- Department of Medicine, University of California, San Francisco
| | - Shanmuganathan Chandrakasan
- Division of Bone Marrow Transplant, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta
| | | | - Theresa Cole
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne
| | - Matthew C Cook
- Department of Immunology and Infectious Diseases, John Curtin School of Medical Research, Australian National University, Canberra
| | | | - Ute Fischer
- Department of Pediatric Oncology, Hematology, and Clinical Immunology, Medical Faculty, Heinrich-Heine-University, Düsseldorf
| | - David A Fulcher
- Department of Immunology and Infectious Diseases, John Curtin School of Medical Research, Australian National University, Canberra
| | - Silvanna Gallo
- Department of Pediatrics, Immunology and Rheumatology Section, Puerto Montt Hospital, Puerto Montt
| | - Amelie Gauthier
- Department of Allergy and Immunology, CHU de Québec-CHUL, Laval University Hospital Center, Laval University, Quebec City
| | - Andrew R Gennery
- Newcastle University Translational and Clinical Research Institute, Newcastle (United Kingdom)
| | - José Gonçalo Marques
- Infectious Diseases and Immunodeficiencies Unit, Department of Pediatrics, Hospital de Santa Maria-CHULN and Faculdade de Medicina, Universidade de Lisboa, Lisbon
| | - Frédéric Gottrand
- University Lille, Inserm, CHU Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille
| | - Bodo Grimbacher
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg
| | - Eyal Grunebaum
- Division of Immunology and Allergy, and the Department of Pediatrics, Developmental and Stem Cell Biology Program, Research Institute, Hospital for Sick Children, Toronto
| | - Emma Haapaniemi
- Centre for Molecular Medicine Norway, Oslo; Department of Pediatric Research, Oslo
| | | | - Kaarina Heiskanen
- New Children's Hospital, Pediatric Research Center, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Turku and Kuopio, Finland
| | | | - Hal M Hoffman
- Department of Pediatrics, University of California San Diego, La Jolla; Rady Children's Hospital San Diego, Division of Pediatric Allergy, Immunology, and Rheumatology, San Diego
| | - Luis Ignacio Gonzalez-Granado
- Pediatrics Department, University Hospital 12 de Octubre, Research Institute Hospital, School of Medicine Complutense University, Madrid
| | - Anthony L Guerrerio
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore
| | - Leena Kainulainen
- Department of Pediatrics and Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Ashish Kumar
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati
| | | | - Carina Levin
- Pediatric Hematology Unit, Emek Medical Centre, Afula, and the Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa
| | - Timi Martelius
- Adult Immunodeficiency Unit, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki
| | - Olaf Neth
- Pediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocio, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - Peter Olbrich
- Pediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocio, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - Alejandro Palma
- Servicio de Immunología y Reumatología, Hospital Nacional de Pediatría Prof Dr Juan P. Garrahan, Buenos Aires
| | - Niraj C Patel
- Division of Allergy and Immunology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta
| | - Tamara Pozos
- Department of Clinical Immunology, Children's Minnesota, Minneapolis
| | - Kahn Preece
- Clinical Immunogenomics Research Consortium of Australasia (CIRCA); Department of Paediatric Immunology, John Hunter Children's Hospital, Newcastle (Australia)
| | | | | | - Yael Schejter
- Department of Bone Marrow Transplantation and Cancer Immunotherapy, Hadassah Ein-Kerem Medical Center and Faculty of Medicine, Hebrew University, Jerusalem
| | - Christine Seroogy
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Jan Sinclair
- Clinical Immunogenomics Research Consortium of Australasia (CIRCA); Starship Children's Hospital, Auckland
| | - Effie Skevofilax
- Department of Pediatric Hematology-Oncology (TAO) and First Department of Pediatrics, Aghia Sophia Children's Hospital, Athens
| | - Daniel Suan
- Clinical Immunogenomics Research Consortium of Australasia (CIRCA); Garvan Institute of Medical Research, Darlinghurst; Westmead Clinical School, University of Sydney, Westmead
| | - Daniel Suez
- Allergy, Asthma & Immunology Clinic, PA, Irving
| | - Paul Szabolcs
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh
| | - Helena Velasco
- Division of Allergy and Clinical Immunology, Moinhos de Vento Hospital, Porto Alegre
| | - Klaus Warnatz
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg
| | - Kelly Walkovich
- Department of Pediatrics, C. S. Mott Children's Hospital, Michigan Medicine, Ann Arbor
| | - Austen Worth
- Great Ormond Street Hospital for Children, London
| | - Mikko R J Seppänen
- Rare Disease Center, Children's Hospital, and Adult Primary Immunodeficiency Outpatient Clinic, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki
| | | | - Georgios Sogkas
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, Hanover
| | - Stephan Ehl
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg
| | - Stuart G Tangye
- Clinical Immunogenomics Research Consortium of Australasia (CIRCA); Garvan Institute of Medical Research, Darlinghurst; St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney
| | - Megan A Cooper
- Department of Pediatrics, Division of Rheumatology and Immunology, Washington University School of Medicine, St Louis
| | - Joshua D Milner
- Department of Pediatrics, Division of Allergy and Immunology, Columbia University, New York Presbyterian Hospital, New York
| | - Lisa R Forbes Satter
- Department of Pediatrics, Baylor College of Medicine and William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston.
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3
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Abolhassani H, Avcin T, Bahceciler N, Balashov D, Bata Z, Bataneant M, Belevtsev M, Bernatowska E, Bidló J, Blazsó P, Boisson B, Bolkov M, Bondarenko A, Boyarchuk O, Bundschu A, Casanova JL, Chernishova L, Ciznar P, Csürke I, Erdős M, Farkas H, Fomina DS, Galal N, Goda V, Guner SN, Hauser P, Ilyina NI, Iremadze T, Iritsyan S, Ismaili-Jaha V, Jesenak M, Kelecic J, Keles S, Kindle G, Kondratenko IV, Kostyuchenko L, Kovzel E, Kriván G, Kuli-Lito G, Kumánovics G, Kurjane N, Latysheva EA, Latysheva TV, Lázár I, Markelj G, Markovic M, Maródi L, Mammadova V, Medvecz M, Miltner N, Mironska K, Modell F, Modell V, Mosdósi B, Mukhina AA, Murdjeva M, Műzes G, Nabieva U, Nasrullayeva G, Naumova E, Nagy K, Onozó B, Orozbekova B, Pac M, Pagava K, Pampura AN, Pasic S, Petrosyan M, Petrovic G, Pocek L, Prodeus AP, Reisli I, Ress K, Rezaei N, Rodina YA, Rumyantsev AG, Sciuca S, Sediva A, Serban M, Sharapova S, Shcherbina A, Sitkauskiene B, Snimshchikova I, Spahiu-Konjusha S, Szolnoky M, Szűcs G, Toplak N, Tóth B, Tsyvkina G, Tuzankina I, Vlasova E, Volokha A. Care of patients with inborn errors of immunity in thirty J Project countries between 2004 and 2021. Front Immunol 2022; 13:1032358. [PMID: 36605210 PMCID: PMC9809467 DOI: 10.3389/fimmu.2022.1032358] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/11/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction The J Project (JP) physician education and clinical research collaboration program was started in 2004 and includes by now 32 countries mostly in Eastern and Central Europe (ECE). Until the end of 2021, 344 inborn errors of immunity (IEI)-focused meetings were organized by the JP to raise awareness and facilitate the diagnosis and treatment of patients with IEI. Results In this study, meeting profiles and major diagnostic and treatment parameters were studied. JP center leaders reported patients' data from 30 countries representing a total population of 506 567 565. Two countries reported patients from JP centers (Konya, Turkey and Cairo University, Egypt). Diagnostic criteria were based on the 2020 update of classification by the IUIS Expert Committee on IEI. The number of JP meetings increased from 6 per year in 2004 and 2005 to 44 and 63 in 2020 and 2021, respectively. The cumulative number of meetings per country varied from 1 to 59 in various countries reflecting partly but not entirely the population of the respective countries. Altogether, 24,879 patients were reported giving an average prevalence of 4.9. Most of the patients had predominantly antibody deficiency (46,32%) followed by patients with combined immunodeficiencies (14.3%). The percentages of patients with bone marrow failure and phenocopies of IEI were less than 1 each. The number of patients was remarkably higher that those reported to the ESID Registry in 13 countries. Immunoglobulin (IgG) substitution was provided to 7,572 patients (5,693 intravenously) and 1,480 patients received hematopoietic stem cell therapy (HSCT). Searching for basic diagnostic parameters revealed the availability of immunochemistry and flow cytometry in 27 and 28 countries, respectively, and targeted gene sequencing and new generation sequencing was available in 21 and 18 countries. The number of IEI centers and experts in the field were 260 and 690, respectively. We found high correlation between the number of IEI centers and patients treated with intravenous IgG (IVIG) (correlation coefficient, cc, 0,916) and with those who were treated with HSCT (cc, 0,905). Similar correlation was found when the number of experts was compared with those treated with HSCT. However, the number of patients treated with subcutaneous Ig (SCIG) only slightly correlated with the number of experts (cc, 0,489) and no correlation was found between the number of centers and patients on SCIG (cc, 0,174). Conclusions 1) this is the first study describing major diagnostic and treatment parameters of IEI care in countries of the JP; 2) the data suggest that the JP had tremendous impact on the development of IEI care in ECE; 3) our data help to define major future targets of JP activity in various countries; 4) we suggest that the number of IEI centers and IEI experts closely correlate to the most important treatment parameters; 5) we propose that specialist education among medical professionals plays pivotal role in increasing levels of diagnostics and adequate care of this vulnerable and still highly neglected patient population; 6) this study also provides the basis for further analysis of more specific aspects of IEI care including genetic diagnostics, disease specific prevalence, newborn screening and professional collaboration in JP countries.
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Affiliation(s)
- Hassan Abolhassani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Tadej Avcin
- Children’s Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Nerin Bahceciler
- Division of Pediatric Allergy and Immunology, Near East University, Nicosia, Cyprus
| | - Dmitry Balashov
- Department of Hematopoietic Stem Cell Transplantation, Dmitry Rogachev National Medical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Zsuzsanna Bata
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Mihaela Bataneant
- Department of Immunology, Clinical Emergency Paediatric Hospital Louis Turcanu, Timisoara, Romania
| | - Mikhail Belevtsev
- Immunology Department, Belarussian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Belarus
| | - Ewa Bernatowska
- Department of Immunology, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Judit Bidló
- National Health Insurance Fund Administration, Budapest, Hungary
| | - Péter Blazsó
- Department of Pediatrics, University of Szeged, Szeged, Hungary
| | - Bertrand Boisson
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, United States,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM, Necker Hospital for Sick Children, Paris, France,Paris Cité University, Imagine Institute, Paris, France,Department of Pediatrics, Necker Hospital for Sick Children, Paris, France,Howard Hughes Medical Institute, New York, NY, United States
| | - Mikhail Bolkov
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Anastasia Bondarenko
- Pediatric Infectious Disease and Pediatric Immunology Department, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Oksana Boyarchuk
- Department of Children’s Diseases and Pediatric Surgery, I.Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Anna Bundschu
- National Health Insurance Fund Administration, Budapest, Hungary
| | - Jean-Laurent Casanova
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, United States,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM, Necker Hospital for Sick Children, Paris, France,Paris Cité University, Imagine Institute, Paris, France,Department of Pediatrics, Necker Hospital for Sick Children, Paris, France,Howard Hughes Medical Institute, New York, NY, United States
| | - Liudmyla Chernishova
- Pediatric Infectious Disease and Pediatric Immunology Department, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Peter Ciznar
- Department of Pediatrics, University of Bratislava, Bratislava, Slovakia
| | - Ildikó Csürke
- Department of Pediatrics, Jósa András County Hospital and University Teaching Hospital, Nyíregyháza, Hungary
| | - Melinda Erdős
- Primary Immunodeficiency Clinical Unit and Laboratory, Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Henriette Farkas
- Center for Hereditary Angioedema, Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary
| | - Daria S. Fomina
- Department of Clinical Immunology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Nermeen Galal
- Pediatrics Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Vera Goda
- Department of Pediatric Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest, Budapest, Hungary
| | - Sukru Nail Guner
- Department of Pediatric Immunology, Necmettin Erbakan University, Konya, Turkey
| | - Péter Hauser
- Velkey László Child’s Health Center, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital, Miskolc, Hungary
| | - Natalya I. Ilyina
- Department of Pulmonology, National Research Center Institute of Immunology, Federal Biomedical Agency of Russia, Moscow, Russia
| | - Teona Iremadze
- Department of Pulmonology, Iashvili Children’s Central Hospital, Tbilisi, Georgia
| | - Sevan Iritsyan
- Department of Hematology and Transfusion Medicine, National Institute of Health, Yerevan, Armenia
| | - Vlora Ismaili-Jaha
- Pediatric Clinic, Department of Gastroenterology, University Clinical Center of Kosovo Faculty of Medicine, University of Prishtina “Hasan Prishtina”, Pristina, Kosovo
| | - Milos Jesenak
- Department of Pediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital in Martin, Martin, Slovakia
| | - Jadranka Kelecic
- Department of Pediatrics, Division of Clinical Immunology, Allergology, Respiratory Diseases and Rheumatology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Sevgi Keles
- Department of Pediatric Immunology, Necmettin Erbakan University, Konya, Turkey
| | - Gerhard Kindle
- Institute for Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Irina V. Kondratenko
- Russian Children’s Clinical Hospital of the N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia
| | - Larysa Kostyuchenko
- Department of Pediatric Immunology and Reumatology, Western-Ukrainian Specialized Children’s Medical Centre, Lviv, Ukraine
| | - Elena Kovzel
- Program of Clinical Immunology, Allergology and Pulmonology, University Medical Center, Nazarbaev University, Nur-Sultan, Kazakhstan
| | - Gergely Kriván
- Department of Pediatric Hematology and Stem Cell Transplantation, Central Hospital of Southern Pest, Budapest, Hungary
| | - Georgina Kuli-Lito
- Department of Pediatrics, University Hospital Centre Mother Theresa, Tirana, Albania
| | - Gábor Kumánovics
- Department of Rheumatology and Immunology, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - Natalja Kurjane
- Department of Biology and Microbiology, Rīga Stradiņš University, Riga, Latvia
| | - Elena A. Latysheva
- Department of Pulmonology, National Research Center Institute of Immunology, Federal Biomedical Agency of Russia, Moscow, Russia
| | - Tatiana V. Latysheva
- Department of Pulmonology, National Research Center Institute of Immunology, Federal Biomedical Agency of Russia, Moscow, Russia
| | - István Lázár
- Department of Meteorology, University of Debrecen, Debrecen, Hungary
| | - Gasper Markelj
- Children’s Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Maja Markovic
- Department of Eastern Europe, Octapharma Nordic, Stockholm, Sweden
| | - László Maródi
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, United States,Department of Pediatrics, Jósa András County Hospital and University Teaching Hospital, Nyíregyháza, Hungary,*Correspondence: László Maródi,
| | - Vafa Mammadova
- Research-Immunology Laboratory, Azerbaijan Medical University, Baku, Azerbaijan
| | - Márta Medvecz
- Department of Pediatrics, Jósa András County Hospital and University Teaching Hospital, Nyíregyháza, Hungary
| | - Noémi Miltner
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Kristina Mironska
- University Clinic for Children’s Diseases, Department of Immunology, Faculty of Medicine, University “St.Cyril and Methodius”, Skopje, North Macedonia
| | - Fred Modell
- The Jeffrey Modell Foundation, New York, NY, United States
| | - Vicki Modell
- The Jeffrey Modell Foundation, New York, NY, United States
| | - Bernadett Mosdósi
- Department of Pediatrics, Clinical Center, University of Pécs, Pécs, Hungary
| | - Anna A. Mukhina
- Department of Hematopoietic Stem Cell Transplantation, Dmitry Rogachev National Medical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Marianna Murdjeva
- Department of Microbiology and Immunology, Faculty of Pharmacy, Research Institute, Medical University-Plovdiv, Plovdiv, Bulgaria
| | - Györgyi Műzes
- Department of Internal Medicine and Hematology, Semmelweis University, Budapest, Hungary
| | - Umida Nabieva
- Institute of Immunology and Human Genomics, Academy of Sciences of the Republic of Uzbekistan, Tashkent, Uzbekistan
| | | | - Elissaveta Naumova
- Department of Clinical Immunology, Faculty of Medicine, Alexandrovska Hospital, Medical University, Sofia, Bulgaria
| | - Kálmán Nagy
- Velkey László Child’s Health Center, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital, Miskolc, Hungary
| | - Beáta Onozó
- Velkey László Child’s Health Center, Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital, Miskolc, Hungary
| | - Bubusaira Orozbekova
- Department of Epidemiology and Immunology, Kyrgyz-Russian Slavic University, Bishkek, Kyrgyzstan
| | - Malgorzata Pac
- Department of Immunology, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Karaman Pagava
- Department of Child and Adolescent Medicine, Tbilisi State Medical University, Tbilisi, Georgia
| | - Alexander N. Pampura
- Department of Allergology and Clinical Immunology, Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery of the Pirogov Russian National Research Medical University of the Russian Ministry of Health, Moscow, Russia
| | - Srdjan Pasic
- Department of Pediatric Immunology, Mother and Child Health Institute, Belgrade, Serbia
| | - Mery Petrosyan
- Department of Hematology and Transfusion Medicine, Pediatric Cancer and Blood Disorders Center, Yerevan, Armenia
| | - Gordana Petrovic
- Department of Pediatric Immunology, Mother and Child Health Institute, Belgrade, Serbia
| | - Lidija Pocek
- Department of Allergology, Institute for Children Diseases, Clinical Center of Montenegro, Podgorica, Montenegro
| | - Andrei P. Prodeus
- Department of Pediatrics, Speransky Children’s Municipal Clinical Hospital #9, Moscow, Russia
| | - Ismail Reisli
- Department of Pediatric Immunology, Necmettin Erbakan University, Konya, Turkey
| | - Krista Ress
- Department of Pediatrics, Center of Allergology and Immunology, East-Tallinn Central Hospital, Tallinn, Estonia
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Yulia A. Rodina
- Department of Hematopoietic Stem Cell Transplantation, Dmitry Rogachev National Medical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Alexander G. Rumyantsev
- Department of Hematopoietic Stem Cell Transplantation, Dmitry Rogachev National Medical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Svetlana Sciuca
- Department of Pulmonology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Anna Sediva
- Department of Pulmonology, Motol University Hospital, 2nd Faculty of Medicine, Charles University, Prague, Czechia
| | - Margit Serban
- Academy of Medical Sciences-Research Unit, Clinical Emergency Paediatric Hospital Louis Turcanu, Timisoara, Romania
| | - Svetlana Sharapova
- Immunology Department, Belarussian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Belarus
| | - Anna Shcherbina
- Department of Hematopoietic Stem Cell Transplantation, Dmitry Rogachev National Medical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Brigita Sitkauskiene
- Department of Immunology and Allergology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Irina Snimshchikova
- Medical Institute, Orel State University named after I.S.Turgenev, Orel, Russia
| | - Shqipe Spahiu-Konjusha
- Pediatric Clinic, Genetics Department, University Clinical Center of Kosovo Faculty of Medicine, University of Pristina ”Hasan Prishtina”, Pristina, Kosovo
| | - Miklós Szolnoky
- Primary Immunodeficiency Clinic, Szent János Hospital, Budapest, Hungary
| | - Gabriella Szűcs
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Natasa Toplak
- Children’s Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Beáta Tóth
- Institute of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Galina Tsyvkina
- Department of Territorial Clinical Center of Specialized Types of Medical Care, State Autonomous Health Care Institution, Vladivostok, Russia
| | - Irina Tuzankina
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Elena Vlasova
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Alla Volokha
- Pediatric Infectious Disease and Pediatric Immunology Department, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
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4
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Zielen S, Duecker RP, Woelke S, Donath H, Bakhtiar S, Buecker A, Kreyenberg H, Huenecke S, Bader P, Mahlaoui N, Ehl S, El-Helou SM, Pietrucha B, Plebani A, van der Flier M, van Aerde K, Kilic SS, Reda SM, Kostyuchenko L, McDermott E, Galal N, Pignata C, Pérez JLS, Laws HJ, Niehues T, Kutukculer N, Seidel MG, Marques L, Ciznar P, Edgar JDM, Soler-Palacín P, von Bernuth H, Krueger R, Meyts I, Baumann U, Kanariou M, Grimbacher B, Hauck F, Graf D, Granado LIG, Prader S, Reisli I, Slatter M, Rodríguez-Gallego C, Arkwright PD, Bethune C, Deripapa E, Sharapova SO, Lehmberg K, Davies EG, Schuetz C, Kindle G, Schubert R. Simple Measurement of IgA Predicts Immunity and Mortality in Ataxia-Telangiectasia. J Clin Immunol 2021; 41:1878-1892. [PMID: 34477998 PMCID: PMC8604875 DOI: 10.1007/s10875-021-01090-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/25/2021] [Indexed: 11/29/2022]
Abstract
Patients with ataxia-telangiectasia (A-T) suffer from progressive cerebellar ataxia, immunodeficiency, respiratory failure, and cancer susceptibility. From a clinical point of view, A-T patients with IgA deficiency show more symptoms and may have a poorer prognosis. In this study, we analyzed mortality and immunity data of 659 A-T patients with regard to IgA deficiency collected from the European Society for Immunodeficiencies (ESID) registry and from 66 patients with classical A-T who attended at the Frankfurt Goethe-University between 2012 and 2018. We studied peripheral B- and T-cell subsets and T-cell repertoire of the Frankfurt cohort and survival rates of all A-T patients in the ESID registry. Patients with A-T have significant alterations in their lymphocyte phenotypes. All subsets (CD3, CD4, CD8, CD19, CD4/CD45RA, and CD8/CD45RA) were significantly diminished compared to standard values. Patients with IgA deficiency (n = 35) had significantly lower lymphocyte counts compared to A-T patients without IgA deficiency (n = 31) due to a further decrease of naïve CD4 T-cells, central memory CD4 cells, and regulatory T-cells. Although both patient groups showed affected TCR-ß repertoires compared to controls, no differences could be detected between patients with and without IgA deficiency. Overall survival of patients with IgA deficiency was significantly diminished. For the first time, our data show that patients with IgA deficiency have significantly lower lymphocyte counts and subsets, which are accompanied with reduced survival, compared to A-T patients without IgA deficiency. IgA, a simple surrogate marker, is indicating the poorest prognosis for classical A-T patients. Both non-interventional clinical trials were registered at clinicaltrials.gov 2012 (Susceptibility to infections in ataxia-telangiectasia; NCT02345135) and 2017 (Susceptibility to Infections, tumor risk and liver disease in patients with ataxia-telangiectasia; NCT03357978)
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Affiliation(s)
- Stefan Zielen
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - Ruth Pia Duecker
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany.
| | - Sandra Woelke
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - Helena Donath
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - Sharhzad Bakhtiar
- Division for Stem Cell Transplantation, Immunology and Intensive Care Unit, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - Aileen Buecker
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - Hermann Kreyenberg
- Division for Stem Cell Transplantation, Immunology and Intensive Care Unit, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - Sabine Huenecke
- Division for Stem Cell Transplantation, Immunology and Intensive Care Unit, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - Peter Bader
- Division for Stem Cell Transplantation, Immunology and Intensive Care Unit, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
| | - Nizar Mahlaoui
- Pediatric Immunology-Hematology and Rheumatology Unit, French National Reference Center for Primary Immune Deficiencies (CEREDIH), Necker Children's University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Stephan Ehl
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sabine M El-Helou
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- RESIST - Cluster of Excellence 2155 To Hanover Medical School, Satellite Center Freiburg, Freiburg, Germany
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Barbara Pietrucha
- Department of Immunology, The Children's Memorial Health Institute, Av. Dzieci Polskich 20, 04-730, Warsaw, Poland
| | - Alessandro Plebani
- Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, Department of Clinical and Experimental Sciences, University of Brescia and ASST-Spedali Civili di Brescia, Brescia, Italy
| | - Michiel van der Flier
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Koen van Aerde
- Department of Pediatrics, Amalia's Children Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sara S Kilic
- Department of Pediatric Immunology and Rheumatology, the School of Medicine, Uludag University, Bursa, Turkey
| | - Shereen M Reda
- Department of Pediatrics, Children's Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Larysa Kostyuchenko
- Center of Pediatric Immunology, Western Ukrainian Specialized Children's Medical Centre, Lviv, Ukraine
| | - Elizabeth McDermott
- Clinical Immunology and Allergy Unit, Nottingham University Hospitals, Nottingham, UK
| | - Nermeen Galal
- Department of Pediatrics, Cairo University Specialized Pediatric Hospital, Cairo, Egypt
| | - Claudio Pignata
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Naples, Italy
| | - Juan Luis Santos Pérez
- Infectious Diseases and Immunodeficiencies Unit, Service of Pediatrics, Hospital Universitario Virgen de Las Nieves, Granada, Spain
| | - Hans-Juergen Laws
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine University, Duesseldorf, Germany
| | - Tim Niehues
- Centre for Child and Adolescent Health, Helios Klinikum Krefeld, Krefeld, Germany
| | - Necil Kutukculer
- Faculty of Medicine, Department of Pediatric Immunology, Ege University, Izmir, Turkey
| | - Markus G Seidel
- Research Unit for Pediatric Hematology and Immunology, Division of Pediatric Hemato-Oncology, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria
| | - Laura Marques
- Pediatric Department, Infectious Diseases and Immunodeficiencies Unit, Porto Hospital Center, Porto, Portugal
| | - Peter Ciznar
- Pediatric Department, Faculty of Medicine, Children University Hospital in Bratislava, Comenius University in Bratislava, Bratislava, Slovakia
| | | | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall D'Hebron Research Institute, Hospital Universitari Vall D'Hebron, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Horst von Bernuth
- Department of Pediatric Pneumology, Immunology and Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Immunology, Labor Berlin Charité - Vivantes GmbH, Berlin, Germany
- Berlin Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Renate Krueger
- Department of Pediatric Pneumology, Immunology and Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Isabelle Meyts
- Department of Pediatrics, University Hospitals Leuven, and the Laboratory for Inborn Errors of Immunity, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Ulrich Baumann
- Department of Paediatric Pulmonology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Maria Kanariou
- Department of Immunology and Histocompatibility, Centre for Primary Immunodeficiencies, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Bodo Grimbacher
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- RESIST - Cluster of Excellence 2155 To Hanover Medical School, Satellite Center Freiburg, Freiburg, Germany
- DZIF-German Center for Infection Research, Satellite Center Freiburg, Freiburg, Germany; Centre for Integrative Biological Signalling Studies, Albert-Ludwigs University, Freiburg, Germany
| | - Fabian Hauck
- Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Dagmar Graf
- MVZ Dr. Reising-Ackermann Und Kollegen, Leipzig, Germany
| | - Luis Ignacio Gonzalez Granado
- Primary Immunodeficiencies Unit, Pediatrics, Hospital 12 Octubre, Complutense University School of Medicine, Madrid, Spain
| | - Seraina Prader
- Division of Immunology and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ismail Reisli
- Department of Pediatrics, Division of Pediatric Immunology and Allergy, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Mary Slatter
- Primary Immunodeficiency Group, Paediatric Immunology and Haematopoietic Stem Cell Transplantation, Translational and Clinical Research Institute, Great North Childrens' Hospital, Newcastle University, Newcastle upon Tyne, UK
| | - Carlos Rodríguez-Gallego
- Department of Immunology, Dr. Negrin University Hospital of Gran Canaria, University Fernando Pessoa Canarias, Las Palmas de Gran Canaria, Spain
| | - Peter D Arkwright
- Lydia Becker Institute of Immunology and Inflammation, University of Manchester and Royal Manchester Children's Hospital, Manchester, UK
| | | | - Elena Deripapa
- National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Svetlana O Sharapova
- Research Department, Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk region, Minsk, Belarus
| | - Kai Lehmberg
- Division for Pediatric Stem Cell Transplantation and Immunology, Clinic for Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E Graham Davies
- Great Ormond Street Hospital and UCL Great Ormond Street Institute of Child Health, London, UK
| | - Catharina Schuetz
- Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Gerhard Kindle
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- FREEZE Biobank, Center for Biobanking, Medical Center and Faculty of Medicine, University of Freiburg, Breisacher Str. 115, 79106, Freiburg, Germany
| | - Ralf Schubert
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, Goethe University, Frankfurt, Germany
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5
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Boyarchuk O, Makukh H, Kostyuchenko L, Yarema N, Haiboniuk I, Kravets V, Shulhai O, Tretyak B. TREC/KREC levels in children with ataxia-telangiectasia. Immunol Res 2021; 69:436-444. [PMID: 34427868 DOI: 10.1007/s12026-021-09216-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/20/2021] [Accepted: 07/14/2021] [Indexed: 11/29/2022]
Abstract
The aim of the study was to determine the TREC/KREC levels in the patients diagnosed with ataxia-telangiectasia (AT) and to establish their informative value for early diagnosis of this pathology. TRECs and KREC assay was performed using real-time polymerase chain reaction on the DNA of 25 patients diagnosed with AT aged 3 to 14 years and of 173 healthy individuals of the control group aged 1 to 12 years. Clinical and laboratory characteristics of patients were ascertained using their medical records. In the patients with AT, the mean level of TRECs was 542.84 per 106 cells, ranging from 4 to 4720, while mean level of KRECs was 1317.64 per 106 cells, ranging from 146 to 9300. In 84% of the patients, TREC levels were less than 1000, which was significantly lower than in the control group, while KREC levels were reduced in 48% of the patients. A correlation was found between the levels of TREC and the absolute values of CD4 (r = 0.5455). Measurement of TREC/KREC levels opens new opportunities for early AT detection in children as a part of the newborn screening. Reduced time to diagnosis will allow to carry out timely in-depth immunological and genetic testing, prevent the development of severe infections, and improve quality of life.
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Affiliation(s)
- Oksana Boyarchuk
- Department of Children's Diseases and Pediatric Surgery, I.Horbachevsky Ternopil National Medical University, 1, Maidan Voli, Ternopil, 46001, Ukraine.
| | - Halyna Makukh
- Institute of Hereditary Pathology of the Ukrainian National Academy of Medical Sciences, Lviv, Ukraine.,Scientific Medical Genetic Center LeoGENE, LTD, Lviv, Ukraine
| | | | - Nataliya Yarema
- Department of Children's Diseases and Pediatric Surgery, I.Horbachevsky Ternopil National Medical University, 1, Maidan Voli, Ternopil, 46001, Ukraine
| | - Ivanna Haiboniuk
- Institute of Hereditary Pathology of the Ukrainian National Academy of Medical Sciences, Lviv, Ukraine
| | | | - Oleksandra Shulhai
- Department of Children's Diseases and Pediatric Surgery, I.Horbachevsky Ternopil National Medical University, 1, Maidan Voli, Ternopil, 46001, Ukraine
| | - Bohdan Tretyak
- Institute of Hereditary Pathology of the Ukrainian National Academy of Medical Sciences, Lviv, Ukraine
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6
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Volokha A, Bondarenko A, Chernyshova L, Hilfanova A, Stepanovskiy Y, Boyarchuk O, Kostyuchenko L. Impact of the J Project on progress of primary immunodeficiency care in Ukraine. Cent Eur J Immunol 2021; 46:250-257. [PMID: 34764795 PMCID: PMC8568034 DOI: 10.5114/ceji.2021.108183] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/16/2020] [Indexed: 11/17/2022] Open
Abstract
The J Project is a Central-Eastern European collaborative program in the field of physician education and clinical research aimed at improving the clinical care and diagnosis of primary immunodeficiency disorders (PIDs). Ukraine was one of the first to participate in the project, which allowed us to join the whole European PID community. Since 2004, the country has been holding annual J Project meetings with the involvement of new regions. The spread of the J Project impact has contributed to significantly improved early PID diagnosis in Ukraine. Progress has been made not only in identifying patients but also in arranging the treatment. The assistance in genetic diagnosis made it possible to detect PIDs, study their features, and improve approaches to the management. This also gave an impetus to the development of regional PID centers and participation in scientific research. Of utmost importance is the cooperation with colleagues from Poland, Hungary, and Belarus, who are active members of the J Project.
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Affiliation(s)
- Alla Volokha
- Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | | | | | - Anna Hilfanova
- Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Yuriy Stepanovskiy
- Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | | | - Larysa Kostyuchenko
- Danylo Halyckyy Lviv Medical University, Western Ukrainian Specialized Children’s Medical Center, Ukraine
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7
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Wolska-Kusnierz B, Pastorczak A, Fendler W, Wakulinska A, Dembowska-Baginska B, Heropolitanska-Pliszka E, Piątosa B, Pietrucha B, Kałwak K, Ussowicz M, Pieczonka A, Drabko K, Lejman M, Koltan S, Gozdzik J, Styczynski J, Fedorova A, Miakova N, Deripapa E, Kostyuchenko L, Krenova Z, Hlavackova E, Gennery AR, Sykora KW, Ghosh S, Albert MH, Balashov D, Eapen M, Svec P, Seidel MG, Kilic SS, Tomaszewska A, Wiesik-Szewczyk E, Kreins A, Greil J, Buechner J, Lund B, Gregorek H, Chrzanowska K, Mlynarski W. Hematopoietic Stem Cell Transplantation Positively Affects the Natural History of Cancer in Nijmegen Breakage Syndrome. Clin Cancer Res 2021; 27:575-584. [PMID: 33082212 DOI: 10.1158/1078-0432.ccr-20-2574] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/26/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Nijmegen breakage syndrome (NBS) is a DNA repair disorder with a high predisposition to hematologic malignancies. EXPERIMENTAL DESIGN We describe the natural history of NBS, including cancer incidence, risk of death, and the potential effectiveness of hematopoietic stem cell transplantation (HSCT) in preventing both pathologies: malignancy and immunodeficiency. RESULTS Among 241 patients with NBS enrolled in the study from 11 countries, 151 (63.0%) patients were diagnosed with cancer. Incidence rates for primary and secondary cancer, tumor characteristics, and risk factors affecting overall survival (OS) were estimated. The cumulative cancer incidence was 40.21% ± 3.5% and 77.78% ± 3.4% at 10 years and 20 years of follow-up, respectively. Most of the tumors n = 95 (62.9%) were non-Hodgkin lymphomas. Overall, 20 (13.2%) secondary malignancies occurred at a median age of 18 (interquartile range, 13.7-21.5) years. The probability of 20-year overall survival (OS) for the whole cohort was 44.6% ± 4.5%. Patients who developed cancer had a shorter 20-year OS than those without malignancy (29.6% vs. 86.2%; P < 10-5). A total of 49 patients with NBS underwent HSCT, including 14 patients transplanted before malignancy. Patients with NBS with diagnosed cancer who received HSCT had higher 20-year OS than those who did not (42.7% vs. 30.3%; P = 0.038, respectively). In the group of patients who underwent preemptive transplantation, only 1 patient developed cancer, which is 6.7 times lower as compared with nontransplanted patients [incidence rate ratio 0.149 (95% confidence interval, 0.138-0.162); P < 0.0001]. CONCLUSIONS There is a beneficial effect of HSCT on the long-term survival of patients with NBS transplanted in their first complete remission of cancer.
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Affiliation(s)
| | - Agata Pastorczak
- Department Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | - Wojciech Fendler
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland.,Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anna Wakulinska
- Department of Oncology, Children's Memorial Health Institute, Warsaw, Poland
| | | | | | - Barbara Piątosa
- Histocompatibility Laboratory, Children's Memorial Health Institute, Warsaw, Poland
| | - Barbara Pietrucha
- Department of Immunology, Children's Memorial Health Institute, Warsaw, Poland
| | - Krzysztof Kałwak
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Marek Ussowicz
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Pieczonka
- Department of Pediatric Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Katarzyna Drabko
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Poland
| | - Monika Lejman
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Poland
| | - Sylwia Koltan
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Jolanta Gozdzik
- Department of Transplantation, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Jan Styczynski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - Alina Fedorova
- Belarusian Research Center for Pediatric Oncology and Hematology, Minsk, Belarus
| | - Natalia Miakova
- Department of Pediatric Oncology and Hematology, Federal Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Elena Deripapa
- Department of Immunology and Hematopoietic Stem Cell Transplantation, Federal Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Larysa Kostyuchenko
- Department of Pediatric Immunology, Western Ukrainian Specialized Children's Medical Centre, Lviv, Ukraine
| | - Zdenka Krenova
- Department of Pediatric Oncology, University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Eva Hlavackova
- Department of Pediatric Oncology, University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Clinical Immunology and Allergology, St. Anne's University Hospital in Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Andrew R Gennery
- Translational and Clinical Research Institute, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Karl-Walter Sykora
- Department of Pediatrics, Hannover Medical School (MHH), Hannover, Germany
| | - Sujal Ghosh
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine-University, Düsseldorf, Germany
| | - Michael H Albert
- Dr. von Hauner University Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Dmitry Balashov
- Department of Hematopoietic Stem Cell Transplantation, Dmitriy Rogachev National Center for Pediatric Hematology, Oncology, and Immunology, Moscow, Russia
| | - Mary Eapen
- Center for International Blood and Marrow Transplant, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Peter Svec
- Department of Pediatric Hematology and Oncology, Comenius University and National Institute of Children's Diseases, Bratislava, Slovakia
| | - Markus G Seidel
- Research Unit Pediatric Hematology and Immunology, Division of Pediatric Hematology-Oncology, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria
| | - Sara S Kilic
- Pediatric Immunology Division, Department of Pediatrics, Uludag University Medical Faculty, Bursa, Turkey
| | - Agnieszka Tomaszewska
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Wiesik-Szewczyk
- Department of Internal Medicine, Pneumonology, Allergology and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine, Warsaw, Poland
| | - Alexandra Kreins
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Johann Greil
- Department of Pediatric Hematology and Oncology, University Hospital, Heidelberg, Germany
| | - Jochen Buechner
- Department of Pediatric Hematology and Oncology, Oslo University Hospital, Oslo, Norway
| | - Bendik Lund
- Pediatric Department, St Olav University Hospital, Trondheim, Norway
| | - Hanna Gregorek
- Department of Microbiology and Clinical Immunology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Krystyna Chrzanowska
- Department of Medical Genetics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Wojciech Mlynarski
- Department Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland.
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8
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Jägle S, Heeg M, Grün S, Rensing-Ehl A, Maccari ME, Klemann C, Jones N, Lehmberg K, Bettoni C, Warnatz K, Grimbacher B, Biebl A, Schauer U, Hague R, Neth O, Mauracher A, Pachlopnik Schmid J, Fabre A, Kostyuchenko L, Führer M, Lorenz MR, Schwarz K, Rohr J, Ehl S. Distinct molecular response patterns of activating STAT3 mutations associate with penetrance of lymphoproliferation and autoimmunity. Clin Immunol 2019; 210:108316. [PMID: 31770611 DOI: 10.1016/j.clim.2019.108316] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/16/2019] [Accepted: 11/20/2019] [Indexed: 01/12/2023]
Abstract
Germline STAT3 gain-of-function (GOF) mutations have been linked to poly-autoimmunity and lymphoproliferation with variable expressivity and incomplete penetrance. Here we studied the impact of 17 different STAT3 GOF mutations on the canonical STAT3 signaling pathway and correlated the molecular results with clinical manifestations. The mutations clustered in three groups. Group 1 mutants showed altered STAT3 phosphorylation kinetics and strong basal transcriptional activity. They were associated with the highest penetrance of lymphoproliferation and autoimmunity. Group 2 mutants showed a strongly inducible transcriptional reporter activity and were clinically less penetrant. Group 3 mutants were mostly located in the DNA binding domain and showed the strongest DNA binding affinity despite a poor transcriptional reporter response. Thus, the GOF effect of STAT3 mutations is determined by a heterogeneous response pattern at the molecular level. The correlation of response pattern and clinical penetrance indicates a significant contribution of mutation-determined effects on disease manifestations.
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Affiliation(s)
- Sabine Jägle
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maximilian Heeg
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for Pediatrics, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sarah Grün
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anne Rensing-Ehl
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maria Elena Maccari
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for Pediatrics, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christian Klemann
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Neil Jones
- Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria
| | - Kai Lehmberg
- Division of Pediatric Stem Cell Transplantation and Immunology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Claudia Bettoni
- Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Klaus Warnatz
- Divivion Immunodeficiency (CCI), Department of Rheumatology and Clinical Immunology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bodo Grimbacher
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; DZIF, German Center for Infection Research, Satellite Center, Freiburg, Germany; Resist - Cluster of Excellence 2155 to Hanover Medical School, Satellite Center Freiburg, Germany; CIBSS - Centre for Integrative Biological Signalling Studies, University of Freiburg, Freiburg, Germany
| | - Ariane Biebl
- Department of Paediatric and Adolescent Medicine, Kepler University Hospital Linz, Linz, Austria
| | - Uwe Schauer
- University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Rosie Hague
- Paediatric Infectious Diseases and Immunology, Royal Hospital for Children, Glasgow, UK
| | - Olaf Neth
- Paediatric Infectious Diseases, Rheumatology and Immunology, Hospital Universitario Virgen del Rocío, Instituto de Bioinvestigacion (IBIS), Sevilla, Spain
| | - Andrea Mauracher
- Division of Immunology, University Children's Hospital Zurich, Children's Research Center (CRC), Zurich, Switzerland
| | - Jana Pachlopnik Schmid
- Division of Immunology, University Children's Hospital Zurich, Children's Research Center (CRC), Zurich, Switzerland
| | - Alexandre Fabre
- Service de Pédiatrie Multidisciplinaire, Hôpital de la Timone, APHM, Marseille, France; Aix Marseille Univ, INSERM, MMG, Marseille, France
| | - Larysa Kostyuchenko
- Center of Pediatric Immunology, Western Ukrainian Specialized Children's Medical Centre, Lviv, Ukraine
| | - Marita Führer
- Institute for Transfusion Medicine, University of Ulm, Ulm, Germany
| | | | - Klaus Schwarz
- Institute for Transfusion Medicine, University of Ulm, Ulm, Germany; Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Service Baden-Wuerttemberg, Hessen, Ulm, Germany
| | - Jan Rohr
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for Pediatrics, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stephan Ehl
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for Pediatrics, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; CIBSS - Centre for Integrative Biological Signalling Studies, University of Freiburg, Freiburg, Germany.
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9
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Wolska-Kuśnierz B, Gregorek H, Chrzanowska K, Piątosa B, Pietrucha B, Heropolitańska-Pliszka E, Pac M, Klaudel-Dreszler M, Kostyuchenko L, Pasic S, Marodi L, Belohradsky BH, Čižnár P, Shcherbina A, Kilic SS, Baumann U, Seidel MG, Gennery AR, Syczewska M, Mikołuć B, Kałwak K, Styczyński J, Pieczonka A, Drabko K, Wakulińska A, Gathmann B, Albert MH, Skarżyńska U, Bernatowska E. Nijmegen Breakage Syndrome: Clinical and Immunological Features, Long-Term Outcome and Treatment Options - a Retrospective Analysis. J Clin Immunol 2015; 35:538-49. [PMID: 26271390 DOI: 10.1007/s10875-015-0186-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [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: 02/13/2015] [Accepted: 07/27/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Nijmegen Breakage Syndrome (NBS) is a rare inherited condition, characterized by microcephaly, chromosomal instability, immunodeficiency, and predisposition to malignancy. This retrospective study, characterizing the clinical and immunological status of patients with NBS at time of diagnosis, was designed to assess whether any parameters were useful in disease prognosis, and could help determine patients qualified for hematopoietic stem cell transplantation. METHODS The clinical and immunological characteristics of 149 NBS patients registered in the online database of the European Society for Immune Deficiencies were analyzed. RESULTS Of the 149 NBS patients, 91 (61%), of median age 14.3 years, remained alive at the time of analysis. These patients were clinically heterogeneous, with variable immune defects, ranging from negligible to severe dysfunction. Humoral deficiencies predisposed NBS patients to recurrent/chronic respiratory tract infections and worsened long-term clinical prognosis. Eighty malignancies, most of lymphoid origin (especially non-Hodgkin's lymphomas), were diagnosed in 42% of patients, with malignancy being the leading cause of death in this cohort. Survival probabilities at 5, 10, 20 and 30 years of age were 95, 85, 50 and 35%, respectively, and were significantly lower in patients with than without malignancies. CONCLUSIONS The extremely high incidence of malignancies, mostly non-Hodgkin's lymphomas, was the main risk factor affecting survival probability in NBS patients. Because treatment of NBS is very difficult and frequently unsuccessful, the search for an alternative medical intervention such as hematopoietic stem cell transplantation is of great clinical importance.
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Affiliation(s)
- Beata Wolska-Kuśnierz
- Department of Immunology, Children's Memorial Health Institute, 04-730 Av. Dzieci Polskich 20, Warsaw, Poland.
| | - Hanna Gregorek
- Department of Microbiology and Clinical Immunology, Children's Memorial Health Institute, 04-730 Av. Dzieci Polskich 20, Warsaw, Poland
| | - Krystyna Chrzanowska
- Department of Medical Genetics, Children's Memorial Health Institute, 04-730 Av. Dzieci Polskich 20, Warsaw, Poland
| | - Barbara Piątosa
- Histocompatibility Laboratory, Children's Memorial Health Institute, 04-730 Av. Dzieci Polskich 20, Warsaw, Poland
| | - Barbara Pietrucha
- Department of Immunology, Children's Memorial Health Institute, 04-730 Av. Dzieci Polskich 20, Warsaw, Poland
| | | | - Małgorzata Pac
- Department of Immunology, Children's Memorial Health Institute, 04-730 Av. Dzieci Polskich 20, Warsaw, Poland
| | - Maja Klaudel-Dreszler
- Gastrology, Hepatology Department, Children's Memorial Health Institute, 04-730 Av. Dzieci Polskich 20, Warsaw, Poland
| | - Larysa Kostyuchenko
- Western-Ukrainian Centre of Paediatric Immunology, Western Ukrainian Specialized Children's Medical Centre, Dnisterska Street, 27, Lviv, 79035, Ukraine
| | - Srdjan Pasic
- Pediatric Immunology, Mother and Child Health Institute, Medical School, University of Belgrade, Radoja Dakica 6-8, 11070, Belgrade, Serbia
| | - Laszlo Marodi
- Department of Infectious and Pediatric Immunology, Medical and Health Science Center, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
| | - Bernd H Belohradsky
- University Childrens Hospital, Ludwig Maximilians University, Lindwurmstrasse 4, 80337, Munich, Germany
| | - Peter Čižnár
- 1st Pediatric Department, Comenius University Medical Faculty, Children University Hospital, Mickiewiczova 13th, Bratislava, 813 69, Slovakia
| | - Anna Shcherbina
- Department of Сlinical Immunology and Allergy, Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, 1 Samori Mashela Str., Moscow, 117917, Russia
| | - Sara Sebnem Kilic
- Department of Paediatric Immunology, Uludag University School of Medicine, Özlüce Mh., 16120, Bursa, Turkey
| | - Ulrich Baumann
- Department of Pediatric Pulmonology and Neonatology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Markus G Seidel
- Department of Pediatrics and Adolescent Medicine, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria.,Division of Pediatric Hematology-Oncology, Department of Pediatric and Adolescent Medicine, Medical University Graz, Auenbruggerplatz 38, 8036, Graz, Austria
| | - Andrew R Gennery
- Institute of Cellular Medicine, Child Health, University of Newcastle upon Tyne, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Małgorzata Syczewska
- Department of Paediatric Rehabilitation, Children's Memorial Health Institute, 04-730 Av. Dzieci Polskich 20, Warsaw, Poland
| | - Bożena Mikołuć
- Department of Pediatrics and Developmental Disorders of Children and Adolescents, Medical University Bialystok, 15-089 Jana Kilinskiego str. 1, Białystok, Poland
| | - Krzysztof Kałwak
- Department of Pediatric Hematology, Oncology and BMT, Wroclaw Medical University, 50-368 Bujwida Str. 44, Wroclaw, Poland
| | - Jan Styczyński
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, 85-094 Curie-Skłodowskiej 9 str., Bydgoszcz, Poland
| | - Anna Pieczonka
- Department of Pediatric Hematology, Oncology and Haematopoietic Stem Cell Transplantation, University of Medical Sciences, Poznań, 60-572 Szpitalna str. 27/33, Poznań, Poland
| | - Katarzyna Drabko
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University, Lublin, 20-093 W. Chodźki str. 2, Lublin, Poland
| | - Anna Wakulińska
- Department of Oncology, Children's Memorial Health Institute, 04-730 Av. Dzieci Polskich 20, Warsaw, Poland
| | - Benjamin Gathmann
- Centre of Chronic Immunodeficiency, University Medical Center Freiburg and University of Freiburg, Robert-Koch-Str. 1, 79106, Freiburg, Germany
| | - Michael H Albert
- Department of Pediatric Hematology/Oncology, Dr. von Hauner University Children's Hospital, Lindwurmstraße 4, 80337, Munich, Germany
| | - Urszula Skarżyńska
- Department of Immunology, Children's Memorial Health Institute, 04-730 Av. Dzieci Polskich 20, Warsaw, Poland
| | - Ewa Bernatowska
- Department of Immunology, Children's Memorial Health Institute, 04-730 Av. Dzieci Polskich 20, Warsaw, Poland
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10
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Gulácsy V, Freiberger T, Shcherbina A, Pac M, Chernyshova L, Avcin T, Kondratenko I, Kostyuchenko L, Prokofjeva T, Pasic S, Bernatowska E, Kutukculer N, Rascon J, Iagaru N, Mazza C, Tóth B, Erdos M, van der Burg M, Maródi L. Genetic characteristics of eighty-seven patients with the Wiskott-Aldrich syndrome. Mol Immunol 2010; 48:788-92. [PMID: 21185603 DOI: 10.1016/j.molimm.2010.11.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Accepted: 11/17/2010] [Indexed: 12/29/2022]
Abstract
The Wiskott-Aldrich syndrome (WAS) is an X-linked recessive immune deficiency disorder characterized by thrombocytopenia, small platelet size, eczema, recurrent infections, and increased risk of autoimmune disorders and malignancies. WAS is caused by mutations in the WASP gene which encodes WASP, a 502-amino acid protein. WASP plays a critical role in actin cytoskeleton organization and signalling, and functions of immune cells. We present here the results of genetic analysis of patients with WAS from eleven Eastern and Central European (ECE) countries and Turkey. Clinical and haematological information of 87 affected males and 48 carrier females from 77 WAS families were collected. The WASP gene was sequenced from genomic DNA of patients with WAS, as well as their family members to identify carriers. In this large cohort, we identified 62 unique mutations including 17 novel sequence variants. The mutations were scattered throughout the WASP gene and included single base pair changes (17 missense and 11 nonsense mutations), 7 small insertions, 18 deletions, and 9 splice site defects. Genetic counselling and prenatal diagnosis were applied in four affected families. This study was part of the J Project aimed at identifying genetic basis of primary immunodeficiency disease in ECE countries. This report provides the first comprehensive overview of the molecular genetic and demographic features of WAS in ECE.
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Affiliation(s)
- Vera Gulácsy
- Department of Infectious and Pediatric Immunology, Medical and Health Science Center, University of Debrecen, Nagyerdei krt. 98, 4032 Debrecen, Hungary
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11
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Kitsera NI, Akopyan H, Polishchuk R, Kostyuchenko L, Markevych N. Cancer incidence among first-degree relatives in families with Nijmegen breakage syndrome. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.22052] [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: 11/20/2022] Open
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