1
|
Donkó Á, Sharapova SO, Kabat J, Ganesan S, Hauck FH, Bergerson JRE, Marois L, Abbott J, Moshous D, Williams KW, Campbell N, Martin PL, Lagresle-Peyrou C, Trojan T, Kuzmenko NB, Deordieva EA, Raykina EV, Abers MS, Abolhassani H, Barlogis V, Milla C, Hall G, Mousallem T, Church J, Kapoor N, Cros G, Chapdelaine H, Franco-Jarava C, Lopez-Lerma I, Miano M, Leiding JW, Klein C, Stasia MJ, Fischer A, Hsiao KC, Martelius T, Sepännen MRJ, Barmettler S, Walter J, Masmas TN, Mukhina AA, Falcone EL, Kracker S, Shcherbina A, Holland SM, Leto TL, Hsu AP. Clinical and functional spectrum of RAC2-related immunodeficiency. Blood 2024; 143:1476-1487. [PMID: 38194689 PMCID: PMC11033590 DOI: 10.1182/blood.2023022098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/01/2023] [Accepted: 12/12/2023] [Indexed: 01/11/2024] Open
Abstract
ABSTRACT Mutations in the small Rho-family guanosine triphosphate hydrolase RAC2, critical for actin cytoskeleton remodeling and intracellular signal transduction, are associated with neonatal severe combined immunodeficiency (SCID), infantile neutrophilic disorder resembling leukocyte adhesion deficiency (LAD), and later-onset combined immune deficiency (CID). We investigated 54 patients (23 previously reported) from 37 families yielding 15 novel RAC2 missense mutations, including one present only in homozygosity. Data were collected from referring physicians and literature reports with updated clinical information. Patients were grouped by presentation: neonatal SCID (n = 5), infantile LAD-like disease (n = 5), or CID (n = 44). Disease correlated to RAC2 activity: constitutively active RAS-like mutations caused neonatal SCID, dominant-negative mutations caused LAD-like disease, whereas dominant-activating mutations caused CID. Significant T- and B-lymphopenia with low immunoglobulins were seen in most patients; myeloid abnormalities included neutropenia, altered oxidative burst, impaired neutrophil migration, and visible neutrophil macropinosomes. Among 42 patients with CID with clinical data, upper and lower respiratory infections and viral infections were common. Twenty-three distinct RAC2 mutations, including 15 novel variants, were identified. Using heterologous expression systems, we assessed downstream effector functions including superoxide production, p21-activated kinase 1 binding, AKT activation, and protein stability. Confocal microscopy showed altered actin assembly evidenced by membrane ruffling and macropinosomes. Altered protein localization and aggregation were observed. All tested RAC2 mutant proteins exhibited aberrant function; no single assay was sufficient to determine functional consequence. Most mutants produced elevated superoxide; mutations unable to support superoxide formation were associated with bacterial infections. RAC2 mutations cause a spectrum of immune dysfunction, ranging from early onset SCID to later-onset combined immunodeficiencies depending on RAC2 activity. This trial was registered at www.clinicaltrials.gov as #NCT00001355 and #NCT00001467.
Collapse
Affiliation(s)
- Ágnes Donkó
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Svetlana O. Sharapova
- Research Department, Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Belarus
| | - Juraj Kabat
- Research Technologies Branch, Biological Imaging Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Sundar Ganesan
- Research Technologies Branch, Biological Imaging Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Fabian H. Hauck
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Jenna R. E. Bergerson
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Louis Marois
- Department of Medicine, Centre Hospitalier Universitaire de Montréal and Institut de Recherches Cliniques de Montréal, Université de Montréal, Montreal, QC, Canada
- Department of Medecine, Centre Hospitalier Universitaire de Québec, Université de Laval, Québec, QC, Canada
| | - Jordan Abbott
- University of Colorado School of Medicine, Department of Pediatrics, Section of Allergy and Immunology, Children’s Hospital of Colorado, Aurora, CO
| | - Despina Moshous
- Pediatric Hematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, Assistance Publique – Hôpitaux de Paris Centre Université de Paris, Paris, France
- Université de Paris, Imagine Institute, Laboratory of Genome Dynamics in the Immune System, INSERM UMR 1163, Paris, France
| | - Kelli W. Williams
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | | | - Paul L. Martin
- Division of Transplant and Cellular Therapy, Duke University Medical School, Durham, NC
| | - Chantal Lagresle-Peyrou
- Université Paris Cité, Imagine Institute, INSERM UMR 1163, Paris, France
- Biotherapy Clinical Investigation Center, Groupe Hospitalier Universitaire Ouest, Assistance Publique–Hôpitaux de Paris, INSERM, Paris, France
| | | | - Natalia B. Kuzmenko
- D. Rogachev National Medical and Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Ekaterina A. Deordieva
- D. Rogachev National Medical and Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Elena V. Raykina
- D. Rogachev National Medical and Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Michael S. Abers
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Hassan Abolhassani
- Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vincent Barlogis
- Pediatric Hematology Unit, La Timone University Hospital, Marseille, France
| | - Carlos Milla
- Center for Excellence in Pulmonary Biology, Stanford University School of Medicine, Stanford, CA
| | - Geoffrey Hall
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Duke University Medical Center, Durham, NC
| | - Talal Mousallem
- Department of Pediatrics, Division of Allergy and Immunology, Duke University Medical Center, Durham, NC
| | - Joseph Church
- Pediatric Allergy/Immunology, Children’s Hospital Los Angeles, Los Angeles, CA
- Clinical Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Neena Kapoor
- Division of Hematology, Oncology and Blood and Marrow Transplant, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Guilhem Cros
- Department of Medicine, Université de Montreal, Montreal, QC, Canada
- Institut de Recherches Cliniques de Montréal, Montreal, QC, Canada
| | - Hugo Chapdelaine
- Department of Medicine, Université de Montreal, Montreal, QC, Canada
- Institut de Recherches Cliniques de Montréal, Montreal, QC, Canada
| | - Clara Franco-Jarava
- Department of Immunology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Ingrid Lopez-Lerma
- Department of Immunology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Maurizio Miano
- Haematology Unit, Scientific Institute for Research, Hospitalization and Healthcare Istituto Giannina Gaslini, Genoa, Italy
| | - Jennifer W. Leiding
- Division of Allergy and Immunology, Department of Pediatrics, Johns Hopkins University, Baltimore, MD
- Institute for Clinical and Translational Research, Johns Hopkins All Children’s Hospital, St. Petersburg, FL
| | - Christoph Klein
- Department of Pediatrics, Dr. von Hauner Children’s Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Marie José Stasia
- Centre Hospitalier Universitaire Grenoble Alpes, Pôle de Biologie, Centre Diagnostic et Recherche sur la Granulomatose Septique Chronique, Grenoble, France
- Université Grenoble Alpes, Centre National de le Recherche Scientifique, CEA, UMR5075, Institut de Biologie Structurale, Grenoble, France
| | - Alain Fischer
- Université Paris Cité, Imagine Institute, Laboratory of Human Lymphohematopoiesis, INSERM UMR 1163, Paris, France
| | - Kuang-Chih Hsiao
- Department of Immunology, Starship Child Health, Te Whatu Ora, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Timi Martelius
- Inflammation Center/Infectious Diseases, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Mikko R. J. Sepännen
- Adult Immunodeficiency Unit, Infectious Diseases, Inflammation Center, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
- ERN-RITA Core Center Member, RITAFIN, Helsinki, Finland
- Rare Disease Center and Pediatric Research Center, Children and Adolescents, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
- Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Sara Barmettler
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, MA
| | - Jolan Walter
- University of South Florida at Johns Hopkins All Children’s Hospital, St. Petersburg, FL
| | - Tania N. Masmas
- Pediatric Hematopoietic Stem Cell Transplantation and Immunodeficiency, The Child and Adolescent Department, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anna A. Mukhina
- D. Rogachev National Medical and Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Emilia Liana Falcone
- Center for Inflammation, Immunity and Infectious Diseases, Montreal Clinical Research Institute, Montreal, QC, Canada
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montreal, QC, Canada
| | - Sven Kracker
- Université Paris Cité, Imagine Institute, Laboratory of Human Lymphohematopoiesis, INSERM UMR 1163, Paris, France
| | - Anna Shcherbina
- D. Rogachev National Medical and Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Steven M. Holland
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Thomas L. Leto
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Amy P. Hsu
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| |
Collapse
|
2
|
Brillant-Marquis F, Proulx É, Ratnarajah K, Lavoie A, Gauthier A, Gagnon R, Boursiquot JN, Verreault N, Marois L, Bédard MA, Boivin M, Bédard PM, Ouakki M, De Serres G, Drolet JP. Safety of Direct Drug Provocation for the Evaluation of Penicillin Allergy in Low-Risk Adults. J Allergy Clin Immunol Pract 2024; 12:451-457.e2. [PMID: 38572700 DOI: 10.1016/j.jaip.2023.10.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/08/2023] [Accepted: 10/17/2023] [Indexed: 04/05/2024]
Abstract
BACKGROUND About 10% of patients have a penicillin allergy label, but less than 5% of them are actually allergic. Unnecessary penicillin avoidance is associated with serious medical consequences. Given the growing number of these labels, it is imperative that our diagnostic strategy for penicillin allergy be as efficient as possible. The validity of traditionally used skin tests (STs) has been questioned, whereas drug provocation testing (DPT), the criterion standard, without previous ST appears very safe in most cases. OBJECTIVE To evaluate the safety of direct DPT without consideration for ST results and the validity of ST in the diagnosis of penicillin allergy. METHODS In this prospective cohort study without a control group, we recruited patients consulting an allergist for penicillin allergy. Patients underwent ST followed by DPT regardless of ST results. Patients with anaphylaxis to penicillin within the past 5 years or a severe delayed reaction were excluded, as were those with significant cardiorespiratory comorbidity. RESULTS None of the 1002 recruited patients had a serious reaction to DPT. Ten (1.0%) had a mild immediate reaction, of whom only 1 (0.1%) was considered likely IgE-mediated. The positive and negative predictive values of ST for an immediate reaction were 3.6% and 99.1%, respectively. CONCLUSIONS In a low-risk adult population reporting penicillin allergy, ST has very poor positive predictive value. Direct DPT without ST is safe and appears to be an ideal diagnostic strategy to remove penicillin allergy labels that could be implemented in first-line practice.
Collapse
Affiliation(s)
- Frédéric Brillant-Marquis
- Division of Allergy and Clinical Immunology, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Québec, Canada
| | - Émilie Proulx
- Division of Allergy and Clinical Immunology, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Québec, Canada
| | - Kayadri Ratnarajah
- Division of Allergy and Clinical Immunology, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Québec, Canada
| | - Aubert Lavoie
- Division of Allergy and Clinical Immunology, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Québec, Canada
| | - Amélie Gauthier
- Division of Allergy and Clinical Immunology, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Québec, Canada
| | - Rémi Gagnon
- Division of Allergy and Clinical Immunology, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Québec, Canada
| | - Jean-Nicolas Boursiquot
- Division of Allergy and Clinical Immunology, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Québec, Canada
| | - Nina Verreault
- Division of Allergy and Clinical Immunology, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Québec, Canada
| | - Louis Marois
- Division of Allergy and Clinical Immunology, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Québec, Canada
| | - Marc-Antoine Bédard
- Division of Allergy and Clinical Immunology, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Québec, Canada
| | - Martine Boivin
- Division of Allergy and Clinical Immunology, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Québec, Canada
| | - Pierre-Michel Bédard
- Division of Allergy and Clinical Immunology, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Québec, Canada
| | - Manale Ouakki
- Institut National de Santé Publique du Québec, Québec City, Québec, Canada
| | - Gaston De Serres
- Institut National de Santé Publique du Québec, Québec City, Québec, Canada
| | - Jean-Philippe Drolet
- Division of Allergy and Clinical Immunology, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Québec City, Québec, Canada.
| |
Collapse
|
3
|
Borna Š, Lee E, Nideffer J, Ramachandran A, Wang B, Baker J, Mavers M, Lakshmanan U, Narula M, Garrett AKH, Schulze J, Olek S, Marois L, Gernez Y, Bhatia M, Chong HJ, Walter J, Kitcharoensakkul M, Lang A, Cooper MA, Bertaina A, Roncarolo MG, Meffre E, Bacchetta R. Identification of unstable regulatory and autoreactive effector T cells that are expanded in patients with FOXP3 mutations. Sci Transl Med 2023; 15:eadg6822. [PMID: 38117899 PMCID: PMC11070150 DOI: 10.1126/scitranslmed.adg6822] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 11/17/2023] [Indexed: 12/22/2023]
Abstract
Studies of the monogenic autoimmune disease immunodysregulation polyendocrinopathy enteropathy X-linked syndrome (IPEX) have elucidated the essential function of the transcription factor FOXP3 and thymic-derived regulatory T cells (Tregs) in controlling peripheral tolerance. However, the presence and the source of autoreactive T cells in IPEX remain undetermined. Here, we investigated how FOXP3 deficiency affects the T cell receptor (TCR) repertoire and Treg stability in vivo and compared T cell abnormalities in patients with IPEX with those in patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy syndrome (APECED). To study Tregs independently of their phenotype and to analyze T cell autoreactivity, we combined Treg-specific demethylation region analyses, single-cell multiomic profiling, and bulk TCR sequencing. We found that patients with IPEX, unlike patients with APECED, have expanded autoreactive T cells originating from both autoreactive effector T cells (Teffs) and Tregs. In addition, a fraction of the expanded Tregs from patients with IPEX lost their phenotypic and functional markers, including CD25 and FOXP3. Functional experiments with CRISPR-Cas9-mediated FOXP3 knockout Tregs and Tregs from patients with IPEX indicated that the patients' Tregs gain a TH2-skewed Teff-like function, which is consistent with immune dysregulation observed in these patients. Analyses of FOXP3 mutation-carrier mothers and a patient with IPEX after hematopoietic stem cell transplantation indicated that Tregs expressing nonmutated FOXP3 prevent the accumulation of autoreactive Teffs and unstable Tregs. These findings could be directly used for diagnostic and prognostic purposes and for monitoring the effects of immunomodulatory treatments.
Collapse
Affiliation(s)
- Šimon Borna
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Esmond Lee
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jason Nideffer
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Akshaya Ramachandran
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Bing Wang
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jeanette Baker
- Department of Medicine, Division of Blood and Marrow Transplantation, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Melissa Mavers
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Uma Lakshmanan
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Mansi Narula
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Amy Kang-hee Garrett
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | | | - Sven Olek
- Ivana Turbachova Laboratory for Epigenetics, Precision for Medicine GmbH, Berlin, 12489, Germany
| | - Louis Marois
- Department of Medicine, Immunology and Allergy Service, CHU de Québec – Laval University, Quebec, G1V 4G2, Canada
| | - Yael Gernez
- Department of Pediatrics, Division of Allergy, Rheumatology and Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Monica Bhatia
- Columbia University Irving Medical Center, NY, NY 10032, USA
| | - Hey Jin Chong
- Division of Allergy and Immunology, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, 15224, Pa, USA
| | - Jolan Walter
- Division of Allergy and Immunology, Department of Pediatrics, Johns Hopkins All Children’s Hospital, University of South Florida, St. Petersburg, 33701, FL, USA
| | - Maleewan Kitcharoensakkul
- Divisions of Rheumatology/Immunology, and Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
| | - Abigail Lang
- Department of Pediatrics, Division of Allergy and Immunology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 60611, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Megan A. Cooper
- Department of pediatrics, division of Rheumatology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, 63110, USA
| | - Alice Bertaina
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Center for Definitive and Curative Medicine (CDCM), Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Maria Grazia Roncarolo
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Center for Definitive and Curative Medicine (CDCM), Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Eric Meffre
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, 269 Campus Drive West, Stanford, CA 94305, USA
| | - Rosa Bacchetta
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Center for Definitive and Curative Medicine (CDCM), Stanford University School of Medicine, Stanford, CA 94305, USA
| |
Collapse
|
4
|
Doré-Brabant G, Bouchard J, Marois L, Lavoie A. Pinus halepensis (Aleppo pine) nuts induced anaphylaxis: A case series. Pediatr Allergy Immunol 2023; 34:e14016. [PMID: 37747747 DOI: 10.1111/pai.14016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/15/2023] [Indexed: 09/26/2023]
Affiliation(s)
| | - Joëlle Bouchard
- Department of Allergy and Immunology, CHU de Québec - Université Laval, Québec City, Canada
| | - Louis Marois
- Department of Allergy and Immunology, CHU de Québec - Université Laval, Québec City, Canada
| | - Aubert Lavoie
- Department of Allergy and Immunology, CHU de Québec - Université Laval, Québec City, Canada
| |
Collapse
|
5
|
Marois L, Drouin D, Leduc C, Fernandez I, Manganas H, Gosse G, Chapdelaine H, Cros G, Falcone EL. Chronic granulomatous disease presenting at age 52 with fulminant mulch pneumonitis. J Allergy Clin Immunol Glob 2022; 1:322-324. [PMID: 37779538 PMCID: PMC10509940 DOI: 10.1016/j.jacig.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/12/2022] [Accepted: 06/07/2022] [Indexed: 10/03/2023]
Abstract
Chronic granulomatous disease should be considered in adults of any age in the presence of refractory and/or atypical or fulminant pulmonary infections. This case of new large deletions in NCF1 was presented with mulch pneumonitis without a significant history of infections.
Collapse
Affiliation(s)
- Louis Marois
- Department of Medicine, Université de Montreal, Montreal, Québec, Canada
- Institut de recherches cliniques de Montréal, Montreal, Québec, Canada
| | - David Drouin
- Department of Medicine, Université de Montreal, Montreal, Québec, Canada
| | - Charles Leduc
- Department of Pathology and Molecular Biology, Université de Montreal, Montreal, Québec, Canada
| | - Isabel Fernandez
- Department of Microbiology, Infectiology and Immunology, Université de Montreal, Montreal, Québec, Canada
| | - Hélène Manganas
- Department of Medicine, Université de Montreal, Montreal, Québec, Canada
| | - Géraldine Gosse
- Institut de recherches cliniques de Montréal, Montreal, Québec, Canada
| | - Hugo Chapdelaine
- Department of Medicine, Université de Montreal, Montreal, Québec, Canada
- Institut de recherches cliniques de Montréal, Montreal, Québec, Canada
| | - Guilhem Cros
- Institut de recherches cliniques de Montréal, Montreal, Québec, Canada
| | - Emilia Liana Falcone
- Department of Medicine, Université de Montreal, Montreal, Québec, Canada
- Institut de recherches cliniques de Montréal, Montreal, Québec, Canada
| |
Collapse
|
6
|
Marois L, Touzot F, Haddad E, Fernandez I, Morin MP, De Bruycker JJ, Duval M, Cellot S, Teira P, Bittencourt H, Decaluwe H. Successful management of familial hemophagocytic lymphohistiocytosis by the JAK 1/2 inhibitor ruxolitinib. Pediatr Blood Cancer 2021; 68:e28954. [PMID: 33694335 DOI: 10.1002/pbc.28954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 12/27/2022]
Affiliation(s)
- Louis Marois
- Immunology and Rheumatology Division, Department of Pediatrics, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Fabien Touzot
- Immunology and Rheumatology Division, Department of Pediatrics, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Elie Haddad
- Immunology and Rheumatology Division, Department of Pediatrics, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Isabel Fernandez
- Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montréal, Québec, Canada
| | - Marie-Paule Morin
- Immunology and Rheumatology Division, Department of Pediatrics, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Jean Jacques De Bruycker
- Immunology and Rheumatology Division, Department of Pediatrics, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Michel Duval
- Hematology-Oncology Division, Department of Pediatrics, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Sonia Cellot
- Hematology-Oncology Division, Department of Pediatrics, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Pierre Teira
- Hematology-Oncology Division, Department of Pediatrics, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Henrique Bittencourt
- Hematology-Oncology Division, Department of Pediatrics, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Hélène Decaluwe
- Immunology and Rheumatology Division, Department of Pediatrics, CHU Sainte-Justine, Montréal, Québec, Canada
| |
Collapse
|
7
|
Alipour Tehrany Y, Marois L, Colmant C, Marchand V, Kokta V, Coulombe J, Marcoux D, Haddad E, McCuaig C. Refractory pruritus responds to dupilumab in a patient with TTC7A mutation. JAAD Case Rep 2020; 8:9-12. [PMID: 33457482 PMCID: PMC7797900 DOI: 10.1016/j.jdcr.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Louis Marois
- Division of Immunology, Centre Hospitalier Universitaire Ste-Justine, Montréal, Québec, Canada
| | - Caroline Colmant
- Division of Dermatology, Centre Hospitalier Universitaire Ste-Justine, Montréal, Québec, Canada
| | - Valérie Marchand
- Division of Gastroenterology, Department of Pediatrics, Centre Hospitalier Universitaire Ste-Justine, Montréal, Québec, Canada
| | - Victor Kokta
- Department of Pathology, Centre Hospitalier Universitaire Ste-Justine, Montréal, Québec, Canada
| | - Jérôme Coulombe
- Division of Dermatology, Centre Hospitalier Universitaire Ste-Justine, Montréal, Québec, Canada
| | - Danielle Marcoux
- Division of Dermatology, Centre Hospitalier Universitaire Ste-Justine, Montréal, Québec, Canada
| | - Elie Haddad
- Division of Immunology, Centre Hospitalier Universitaire Ste-Justine, Montréal, Québec, Canada
| | - Catherine McCuaig
- Division of Dermatology, Centre Hospitalier Universitaire Ste-Justine, Montréal, Québec, Canada
| |
Collapse
|
8
|
Alipour Tehrany Y, Marois L, Colmant C, Marchand V, Kokta V, Coulombe J, Marcoux D, Haddad E, McCuaig C. Prurit chronique récalcitrant et lésions eczématiformes chez une patiente de 5 ans avec mutation du TTC7A traitée avec succès par dupilumab. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.262] [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: 10/22/2022]
|
9
|
Yea C, Bitnun A, Branson HM, Ciftci-Kavaklioglu B, Rafay MF, Fortin O, Moresoli P, Sébire G, Srour M, Decaluwe H, Marois L, Pelletier F, Barton M, Nouri MN, Brophy J, Venkateswaran S, Pohl D, Selby K, Jones K, Robinson J, Mineyko A, Licht C, Ertl-Wagner B, Yeh EA. Association of outcomes in acute flaccid myelitis with identification of enterovirus at presentation: a Canadian, nationwide, longitudinal study. Lancet Child Adolesc Health 2020; 4:828-836. [PMID: 33068549 DOI: 10.1016/s2352-4642(20)30176-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/21/2020] [Accepted: 05/27/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute flaccid myelitis (AFM) is characterised by rapid onset of limb weakness with spinal cord grey-matter abnormalities on MRI scan. We aimed to assess whether detection of enterovirus in respiratory or other specimens can help predict prognosis in children with AFM. METHODS In this nationwide, longitudinal study, we evaluated the significance of detection of enterovirus in any sample in predicting outcomes in a cohort of Canadian children younger than 18 years presenting with AFM to tertiary paediatric hospitals in Canada in 2014 and 2018. All patients fulfilled the 2015 US Centers for Disease Control and Prevention case definition for definite AFM or probable AFM. Clinical data, laboratory findings, treatment, and neuroimaging results were collected (follow up period up to 5 years). We assessed neurological function and motor outcomes using Kurtzke's Expanded Disability Status Scale (EDSS) and a Weakest Limb Score. FINDINGS 58 children with AFM (median age 5·1 years, IQR 3·8-8·3) were identified across five of Canada's ten provinces and three territories. 25 (43%) children had enterovirus detected in at least one specimen: 16 (64%) with EV-D68, two (8%) with EV-A71, two (8%) with coxsackievirus, 10 (40%) with untyped enterovirus. Children who were enterovirus positive were more likely than those that were negative to have had quadriparesis (12 [48%] of 25 vs four [13%] of 30; p=0·028), bulbar weakness (11 [44%] of 25 vs two [7%] of 30; p=0·028), bowel or bladder dysfunction (14 [56%] of 25 vs seven [23%] of 30; p=0·040), cardiovascular instability (nine [36%] of 25 vs one [3%] of 30; p=0·028), and were more likely to require intensive care unit admission (13 [52%] of 25 vs 5 [17%] of 30; p=0·028). On MRI, most children who were enterovirus positive showed brainstem pontine lesions (14 [61%] of 23), while other MRI parameters did not correlate with enterovirus status. Median EDSS of enterovirus positive (EV+) and enterovirus negative (EV-) groups was significantly different at all timepoints: baseline (EDSS 8·5, IQR 4·1-9·5 vs EDSS 4·0, IQR 3·0-6·0; p=0·0067), 3 months (EDSS 4·0, IQR 3·0-7·4 vs EDSS 3·0, IQR 1·5-4·3; p=0·0067), 6 months (EDSS 3·5, IQR 3·0-7·0 vs EDSS 3·0, IQR 1·0-4·0; p=0·029), and 12 months (EDSS 3·0, IQR 3·0-6·9 vs EDSS 2·5 IQR 0·3-3·0; p=0·0067). Kaplan-Meier survival analysis of a subgroup of patients showed significantly poorer motor recovery among children who tested positive for enterovirus than for those who tested negative (p=0·037). INTERPRETATION Detection of enterovirus in specimens from non-sterile sites at presentation correlated with more severe acute motor weakness, worse overall outcomes and poorer trajectory for motor recovery. These results have implications for rehabilitation planning as well as counselling of families of children with these disorders. The findings of this study support the need for early testing for enterovirus in non-CNS sites in all cases of AFM. FUNDING None.
Collapse
Affiliation(s)
- Carmen Yea
- SickKids Research Institute, Neuroscience and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ari Bitnun
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Helen M Branson
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Mubeen F Rafay
- Department of Pediatric and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Olivier Fortin
- McGill University Health Centre, Montreal Children's Hospital, Montréal, QC, Canada
| | - Paola Moresoli
- McGill University Health Centre, Montreal Children's Hospital, Montréal, QC, Canada
| | - Guillaume Sébire
- McGill University Health Centre, Montreal Children's Hospital, Montréal, QC, Canada
| | - Myriam Srour
- McGill University Health Centre, Montreal Children's Hospital, Montréal, QC, Canada
| | - Hélène Decaluwe
- Division of Immunology and Rheumatology, Department of Pediatrics, Sainte-Justine University Hospital Center, Université de Montréal, Montréal, QC, Canada
| | - Louis Marois
- Division of Immunology and Rheumatology, Department of Pediatrics, Sainte-Justine University Hospital Center, Université de Montréal, Montréal, QC, Canada
| | - Félixe Pelletier
- Division of Neurology, Department of Pediatrics, Sainte-Justine University Hospital Center, Université de Montréal, Montréal, QC, Canada
| | - Michelle Barton
- Department of Pediatrics, London Health Sciences Centre, London, ON, Canada
| | | | - Jason Brophy
- Division of Infectious Diseases, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Sunita Venkateswaran
- Division of Neurology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Daniela Pohl
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Kathryn Selby
- Division of Pediatric Neurology, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Kevin Jones
- Division of Neurology, Department of Pediatrics McMaster Children's Hospital, Hamilton, ON, Canada
| | - Joan Robinson
- Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Aleksandra Mineyko
- Section of Neurology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Christoph Licht
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Birgit Ertl-Wagner
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - E Ann Yeh
- SickKids Research Institute, Neuroscience and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada; Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
10
|
Paradis N, Marois L, Paradis L, Graham F, Bégin P, Des Roches A. Anaphylaxis to clindamycin following cutaneous exposure. Allergy Asthma Clin Immunol 2020; 16:51. [PMID: 32577121 PMCID: PMC7304217 DOI: 10.1186/s13223-020-00452-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background The role and importance of skin barrier as an immunologic organ and as a potent way of sensitization is well known. However, antibiotics anaphylaxis following skin sensitization has not been reported. Case presentation We describe the first case of intravenous clindamycin anaphylaxis, with likely sensitization due to previous topical exposure to clindamycin gel for acne in a 14-year-old boy with history of atopy and mild atopic dermatitis. Conclusion This case highlights the potential sensitization to drug allergens, including antibiotics, via the skin.
Collapse
Affiliation(s)
- N Paradis
- Pediatric Allergy and Clinical Immunology, CHU Sainte-Justine, 3175 chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1C5 Canada
| | - L Marois
- Pediatric Allergy and Clinical Immunology, CHU Sainte-Justine, 3175 chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1C5 Canada
| | - L Paradis
- Pediatric Allergy and Clinical Immunology, CHU Sainte-Justine, 3175 chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1C5 Canada.,Allergy and Clinical Immunology, Centre Hospitalier de l'Universite de Montreal (CHUM), Montreal, Canada
| | - F Graham
- Pediatric Allergy and Clinical Immunology, CHU Sainte-Justine, 3175 chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1C5 Canada.,Allergy and Clinical Immunology, Centre Hospitalier de l'Universite de Montreal (CHUM), Montreal, Canada
| | - P Bégin
- Pediatric Allergy and Clinical Immunology, CHU Sainte-Justine, 3175 chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1C5 Canada.,Allergy and Clinical Immunology, Centre Hospitalier de l'Universite de Montreal (CHUM), Montreal, Canada.,Applied Clinical Research Unit, CHU Sainte-Justine, Montreal, Canada
| | - A Des Roches
- Pediatric Allergy and Clinical Immunology, CHU Sainte-Justine, 3175 chemin de la Côte-Sainte-Catherine, Montreal, QC H3T 1C5 Canada.,Applied Clinical Research Unit, CHU Sainte-Justine, Montreal, Canada
| |
Collapse
|
11
|
Rollet-Labelle E, Vaillancourt M, Marois L, Newkirk MM, Poubelle PE, Naccache PH. Cross-linking of IgGs bound on circulating neutrophils leads to an activation of endothelial cells: possible role of rheumatoid factors in rheumatoid arthritis-associated vascular dysfunction. J Inflamm (Lond) 2013; 10:27. [PMID: 23902799 PMCID: PMC3734015 DOI: 10.1186/1476-9255-10-27] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 07/25/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis is characterized by the presence of circulating auto-antibodies, including rheumatoid factors, which recognize the Fc portion of IgGs. The neutrophil is the most abundant circulating leukocyte and it expresses high levels of FcγRs on its surface. The aim of the present study was to examine the capacity of circulating human neutrophils to be activated by rheumatoid factors and the consequences of these events on endothelium. METHODS Neutrophil-bound IgGs were cross-linked with anti-human IgGs to mimick the presence of circulating rheumatoid factors and FcγRs-dependent signalling events and functions were examined. The IgG and IgM composition of rheumatoid factors isolated from the serum of RA patients was characterized. Adhesion of neutrophils to endothelial cells was quantified in response to the addition of rheumatoid factors. RESULTS Cross-linking of IgGs bound on neutrophils leads to FcγRs-dependent tyrosine phosphorylation, mobilisation of intracellular calcium and the extracellular release of superoxide anions and lysozyme. Incubation of endothelial cells with the supernatant of activated neutrophils increases ICAM-1 expression and IL-8 production by endothelial cells. Finally, rheumatoid factors enhance neutrophil adhesion to endothelial cells. CONCLUSIONS Our results show that activation of neutrophils' FcγRs by rheumatoid factors could participate in rheumatoid arthritis-associated vascular damage.
Collapse
Affiliation(s)
- Emmanuelle Rollet-Labelle
- Départements de Microbiologie-Infectiologie et Immunologie et de Médecine, Centre de recherche en rhumatologie et immunologie, Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada
| | - Myriam Vaillancourt
- Départements de Microbiologie-Infectiologie et Immunologie et de Médecine, Centre de recherche en rhumatologie et immunologie, Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada
| | - Louis Marois
- Départements de Microbiologie-Infectiologie et Immunologie et de Médecine, Centre de recherche en rhumatologie et immunologie, Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada
| | - Marianna M Newkirk
- Department of Medicine, Division of Rheumatology, Research Institute of McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Patrice E Poubelle
- Départements de Microbiologie-Infectiologie et Immunologie et de Médecine, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Paul H Naccache
- Départements de Microbiologie-Infectiologie et Immunologie et de Médecine, Centre de recherche en rhumatologie et immunologie, Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada
| |
Collapse
|
12
|
Gagné V, Marois L, Levesque JM, Galarneau H, Lahoud MH, Caminschi I, Naccache PH, Tessier P, Fernandes MJG. Modulation of monosodium urate crystal-induced responses in neutrophils by the myeloid inhibitory C-type lectin-like receptor: potential therapeutic implications. Arthritis Res Ther 2013; 15:R73. [PMID: 23837669 PMCID: PMC3978892 DOI: 10.1186/ar4250] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 07/09/2013] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Monosodium urate crystals (MSU), the etiological agent of gout, are one of the most potent proinflammatory stimuli for neutrophils. The modulation of MSU-induced neutrophil activation by inhibitory receptors remains poorly characterized. The expression of the myeloid inhibitory C-type lectin-like receptor (MICL) in neutrophils is downregulated by several proinflammatory stimuli, suggestive of a role for this receptor in neutrophil function. We thus investigated the potential role of MICL in MSU-induced neutrophil activation. METHODS The expression of MICL was monitored in human neutrophils by flow cytometry and Western blot analysis after stimulation with MSU. Protein tyrosine phosphorylation was also assessed by Western blot analysis and the production of IL-1 and IL-8 by enzyme-linked immunosorbent assay. Changes in the concentration of cytoplasmic free calcium were monitored with the Fura-2-acetoxymethyl ester calcium indicator. MICL expression was modulated with an anti-MICL antibody in neutrophils and siRNA in the PLB-985 neutrophil-like cell line. RESULTS MSU induced the downregulation of MICL expression in neutrophils. A diminution in the expression of MICL induced by antibody cross-linking or siRNA enhanced the MSU-dependent increase in cytoplasmic calcium levels, protein tyrosine phosphorylation and IL-8 but not IL-1 production. Pretreatment of neutrophils with colchicine inhibited the MSU-induced downregulation of MICL expression. CONCLUSIONS Our findings strongly suggest that MICL acts as an inhibitory receptor in human neutrophils since the downregulation of MICL expression enhances MSU-induced neutrophil activation. Since MSU downregulates the expression of MICL, MICL may play a pathogenic role in gout by enhancing neutrophil effector functions. In support of this notion, colchicine counteracts the MSU-induced loss of MICL expression. Our findings thus also provide further insight into the potential molecular mechanisms behind the anti-inflammatory properties of this drug.
Collapse
|
13
|
Marois L, Vaillancourt M, Paré G, Gagné V, Fernandes MJG, Rollet-Labelle E, Naccache PH. CIN85 modulates the down-regulation of Fc gammaRIIa expression and function by c-Cbl in a PKC-dependent manner in human neutrophils. J Biol Chem 2011; 286:15073-84. [PMID: 21372129 PMCID: PMC3083175 DOI: 10.1074/jbc.m110.213660] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [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: 12/17/2010] [Revised: 02/21/2011] [Indexed: 01/04/2023] Open
Abstract
We previously described a non-classical mechanism that arrests FcγRIIa signaling in human neutrophils once engaged by immune complexes or opsonized pathogens. The engagement of FcγRIIa leads to its ubiquitination by the ubiquitin ligase c-Cbl and degradation by the proteasome. Herein, we further examined some of the events regulating this novel pathway. The adaptor protein CIN85 was described in other systems to be involved in the regulation of the c-Cbl-dependent pathway. We found that CIN85 is expressed in human neutrophils and that it translocates like c-Cbl from the cytosol to the plasma membrane following receptor cross-linking. CIN85 was also recruited to the same subset of high density detergent-resistant membrane fractions in which stimulated FcγRIIa partitioned with c-Cbl. The integrity of these microdomains is essential to the FcγRIIa degradation process because the cholesterol-depleting agent methyl-β-cyclodextrin inhibits this event. Silencing the expression of CIN85 by siRNA in dibutyryl cyclic AMP-differentiated PLB 985 cells prevented FcγRIIa degradation and increased IgG-mediated phagocytosis. Confocal microscopy revealed that the presence of CIN85 is essential to the proper sorting of FcγRIIa during endocytosis. We also provide direct evidence that CIN85 is a substrate of serine/threonine kinase PKCs. Classical PKCs positively regulate FcγRIIa ubiquitination and degradation because these events were inhibited by Gö6976, a classical PKC inhibitor. We conclude that the ubiquitination and degradation of stimulated FcγRIIa mediated by c-Cbl are positively regulated by the adaptor protein CIN85 in a PKC-dependent manner and that these events contribute to the termination of FcγRIIa signaling.
Collapse
Affiliation(s)
- Louis Marois
- From the Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHUQ, Département de Microbiologie-Infectiologie et Immunologie, Faculté de Médecine, Université Laval, Québec, Québec G1V 4G2, Canada
| | - Myriam Vaillancourt
- From the Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHUQ, Département de Microbiologie-Infectiologie et Immunologie, Faculté de Médecine, Université Laval, Québec, Québec G1V 4G2, Canada
| | - Guillaume Paré
- From the Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHUQ, Département de Microbiologie-Infectiologie et Immunologie, Faculté de Médecine, Université Laval, Québec, Québec G1V 4G2, Canada
| | - Valérie Gagné
- From the Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHUQ, Département de Microbiologie-Infectiologie et Immunologie, Faculté de Médecine, Université Laval, Québec, Québec G1V 4G2, Canada
| | - Maria J. G. Fernandes
- From the Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHUQ, Département de Microbiologie-Infectiologie et Immunologie, Faculté de Médecine, Université Laval, Québec, Québec G1V 4G2, Canada
| | - Emmanuelle Rollet-Labelle
- From the Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHUQ, Département de Microbiologie-Infectiologie et Immunologie, Faculté de Médecine, Université Laval, Québec, Québec G1V 4G2, Canada
| | - Paul H. Naccache
- From the Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHUQ, Département de Microbiologie-Infectiologie et Immunologie, Faculté de Médecine, Université Laval, Québec, Québec G1V 4G2, Canada
| |
Collapse
|
14
|
Marois L, Paré G, Vaillancourt M, Rollet-Labelle E, Naccache PH. Fc gammaRIIIb triggers raft-dependent calcium influx in IgG-mediated responses in human neutrophils. J Biol Chem 2010; 286:3509-19. [PMID: 21123174 DOI: 10.1074/jbc.m110.169516] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Human neutrophils constitutively express a unique combination of FcγRs, namely FcγRIIa and FcγRIIIb. Numerous lines of evidence support the concept that these FcγRs generate only partially characterized intracellular signals. However, despite the fact that both receptors are likely to be engaged simultaneously in a physiological setting, no recent publications have investigated the distinct, although partially convergent, results of their joint activation in IgG-dependent responses. To examine the significance of the co-expression of FcγRIIa and FcγRIIIb on human neutrophils, we analyzed the neutrophil responses to stimuli that engage these FcγRs, namely the phagocytosis of human IgG-opsonized zymosan and the responses to heat-aggregated IgGs. Blocking antibodies to either FcγR significantly decreased the phagocytic index and the stimulated production of superoxide anions. Both receptors are required for optimal IgG-dependent responses by human neutrophils. On the other hand, only blocking antibodies to FcγRIIIb, but not to FcγRIIa, inhibited the mobilization of calcium in response to heat-aggregated IgGs. Furthermore, phagocytosis of IgG-opsonized zymosan by human neutrophils required an extracellular influx of calcium that was blocked only by antibodies against FcγRIIIb. We also observed that this calcium influx as well as the IgG-dependent phagocytosis were dependent on the integrity of the plasma membrane detergent-resistant microdomains to which both isoforms were recruited following stimulation by heat-aggregated IgGs. These data clarify the mechanisms that regulate the FcγRs constitutively expressed on human neutrophils, describe a specific contribution of FcγRIIIb at the level of the mobilization of calcium, and provide evidence for a crucial role of detergent-resistant microdomains in this process.
Collapse
Affiliation(s)
- Louis Marois
- Centre de Recherche du Centre Hospitalier Universitaire de Québec, Department of Microbiology-Infectiology and Immunology, Faculty of Medicine, Laval University, Québec City, Québec G1V 4G2, Canada
| | | | | | | | | |
Collapse
|
15
|
St-Onge M, Lagarde S, Laflamme C, Rollet-Labelle E, Marois L, Naccache PH, Pouliot M. Proteinase-activated receptor-2 up-regulation by Fcgamma-receptor activation in human neutrophils. FASEB J 2010; 24:2116-25. [PMID: 20154268 DOI: 10.1096/fj.09-146167] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We shed new light on the expression and function of the proteinase-activated receptor (PAR) family, associated with inflammation and hyperalgesia, in human granulocytes. Resting cells expressed constitutive levels of PAR-2 and PAR-3 mRNA but not PAR-1 or PAR-4. Based on flow cytometry, stimulation with opsonized bacteria (Bop) specifically up-regulated cell surface expression of PAR-2 in a concentration-dependent and time-dependent manner, independent of transcription or de novo protein synthesis. Primary granules were identified as a source of preformed PAR-2 that can readily be mobilized at the surface on fusion with the plasma membrane. Cellular response to PAR-2 activation, measured as changes in intracellular calcium concentration, was enhanced in PAR-2 up-regulated cells. Increase of cell-surface PAR-2 and of cell responsiveness were dependent specifically on the engagement of immunoglobulin (Ig)-binding receptors. Together, our results reveal that mobilization of intracellular granules, in response to Ig-receptor activation, up-regulates PAR-2 surface expression and makes neutrophils more responsive to proteinase activity. This enhanced response to PAR-2 activation indicates that molecular communication between pain and inflammation may be more important than previously believed.
Collapse
Affiliation(s)
- Mireille St-Onge
- Centre de Recherche en Rhumatologie et Immunologie du Centre Hospitalier Universitaire de Québec, Department of Microbiology-Infectiology and Immunology, Faculty of Medicine, Laval University, Quebec, Canada
| | | | | | | | | | | | | |
Collapse
|
16
|
Marois L, Paré G, Vaillancourt M, Rollet-Labelle E, Naccache PH. Functional cooperation between Fc gamma RIIa and Fc gamma RIIIb on human neutrophils. Cytokine 2009. [DOI: 10.1016/j.cyto.2009.07.107] [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: 10/20/2022]
|
17
|
Vaillancourt M, Marois L, Rollet-Labelle E, Naccache PH. Regulation of Fc gamma RIIa functions by src homology 2-containing inositol 5-phosphatase 1 on human neutrophils. Cytokine 2009. [DOI: 10.1016/j.cyto.2009.07.289] [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: 10/20/2022]
|
18
|
Marois L, Vaillancourt M, Marois S, Proulx S, Paré G, Rollet-Labelle E, Naccache PH. The ubiquitin ligase c-Cbl down-regulates FcgammaRIIa activation in human neutrophils. J Immunol 2009; 182:2374-84. [PMID: 19201892 DOI: 10.4049/jimmunol.0801420] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Little is known about the mechanisms that arrest FcgammaRIIa signaling in human neutrophils once engaged by immune complexes or opsonized pathogens. In our previous studies, we observed a loss of immunoreactivity of Abs directed against FcgammaRIIa following its cross-linking. In this study, we report on the mechanisms involved in this event. A stimulated internalization of FcgammaRIIa leading to the down-regulation of its surface expression was observed by flow cytometry and confocal microscopy. Immunoprecipitation of the receptor showed that FcgammaRIIa is ubiquitinated after stimulation. MG132 and clasto-lactacystin beta-lactone inhibited the loss of immunoreactivity of FcgammaRIIa, suggesting that this receptor was down-regulated via the proteasomal pathway. The E3 ubiquitin ligase c-Cbl was found to translocate from the cytosol to the plasma membrane following receptor cross-linking. Furthermore, c-Cbl was recruited to the same subset of high-density, detergent-resistant membrane fractions as stimulated FcgammaRIIa itself. Silencing the expression of c-Cbl by small interfering RNA decreased FcgammaRIIa ubiquitination and prevented its degradation without affecting the internalisation process. It also prolonged the stimulation of the tyrosine phosphorylation response to the cross-linking of the receptor. We conclude that c-Cbl mediates the ubiquitination of stimulated FcgammaRIIa and thereby contributes to the termination of FcgammaRIIa signaling via its proteasomal degradation, thus leading to the down-regulation of neutrophil signalisation and function (phagocytosis) through this receptor.
Collapse
Affiliation(s)
- Louis Marois
- Centre de recherche en rhumatologie et immunologie, Centre de recherche du Centre hospitalier universitaire de Québec, Department of Medicine, Faculty of Medicine, Laval University, Quebec, Canada
| | | | | | | | | | | | | |
Collapse
|
19
|
Guiet R, Poincloux R, Castandet J, Marois L, Labrousse A, Le Cabec V, Maridonneau-Parini I. Hematopoietic cell kinase (Hck) isoforms and phagocyte duties – From signaling and actin reorganization to migration and phagocytosis. Eur J Cell Biol 2008; 87:527-42. [DOI: 10.1016/j.ejcb.2008.03.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Revised: 03/06/2008] [Accepted: 03/11/2008] [Indexed: 01/21/2023] Open
|
20
|
Popa-Nita O, Marois L, Paré G, Naccache PH. Crystal-induced neutrophil activation: X. Proinflammatory role of the tyrosine kinase Tec. ACTA ACUST UNITED AC 2008; 58:1866-76. [PMID: 18512796 DOI: 10.1002/art.23801] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Monosodium urate monohydrate (MSU) crystals are among the most potent proinflammatory stimuli, and an innate immune inflammatory response to the crystal surface is involved in the pathogenesis of gouty arthritis. Release of the crystals into the joint cavity promotes an acute inflammation characterized by massive infiltration of neutrophils, which leads to tissue damage. The aim of the present study was to assess the involvement of the tyrosine kinase Tec in MSU crystal-initiated transduction events in human neutrophils. METHODS Immunoprecipitation and immunoblotting techniques were used for the cellular signaling studies. Chemotaxis and enzyme-linked immunosorbent assay techniques were used for the functional studies. Silencing of Tec expression using specific small interfering RNA was also performed. RESULTS MSU crystals induced the phosphorylation and activation of Tec in a Src-dependent manner. This activation was necessary for the MSU crystal-induced secretion of interleukin-1beta (IL-1beta) and IL-8 and for the generation of chemotactic activity in supernatants of MSU crystal-stimulated neutrophils. In addition, colchicine, an effective drug for the treatment of gout, inhibited the MSU crystal-induced tyrosine phosphorylation of Tec, thus modulating its kinase activity. CONCLUSION Our findings show that Tec is the principal kinase of the Tec family that plays a major role in the responses of human neutrophils to MSU crystals, which are likely to be involved in the initiation and perpetuation of gout. Our results suggest that the specific inhibition of Tec during the acute phase of MSU crystal-induced inflammation may be considered for the treatment of gouty arthritis.
Collapse
|
21
|
Vaillancourt M, Levasseur S, Tremblay ML, Marois L, Rollet-Labelle E, Naccache PH. The Src Homology 2-Containing Inositol 5-Phosphatase 1 (SHIP1) is involved in CD32a signaling in human neutrophils. Cell Signal 2006; 18:2022-32. [PMID: 16682172 DOI: 10.1016/j.cellsig.2006.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Revised: 03/22/2006] [Accepted: 03/23/2006] [Indexed: 01/05/2023]
Abstract
Phosphatidylinositol(3,4,5)triphosphate (PtdIns(3,4,5)P(3)) plays important signaling roles in immune cells, particularly in the control of activating pathways and of survival. It is formed by a family of phosphatidylinositol 3'-kinases (PI3Ks) which phosphorylate PtdIns(4,5)P(2) in vivo. In human neutrophils, the levels of PtdIns(3,4,5)P(3) increase rapidly at the leading edge of locomoting cells and at the base of the phagocytic cup during FcgammaR-mediated particle ingestion. Even though these, and other, data indicate that PtdIns(3,4,5)P(3) is involved in the control of chemotaxis and phagocytosis in human neutrophils, the mechanisms that regulate its levels have yet to be fully elucidated in these cells. We evaluated the potential implication of SHIP1 and PTEN, two lipid phosphatases that utilize PtdIns(3,4,5)P(3) as substrate, in the signaling pathways called upon in response to CD32a cross-linking. We observed that the cross-linking of CD32a resulted in a transient accumulation of PtdIns(3,4,5)P(3). CD32a cross-linking also induced the tyrosine phosphorylation of SHIP1, its translocation to the plasma membrane and its co-immunoprecipitation with CD32a. CD32a cross-linking had no effect on the level of serine/threonine phosphorylation of PTEN and did not stimulate its translocation to the plasma membrane. PP2, a Src kinase inhibitor, inhibited the tyrosine phosphorylation of SHIP1 as well as its translocation to the plasma membrane. Wortmannin, a PI3K inhibitor, had no effect on either of these two indices of activation of SHIP1. Our results indicate that SHIP1 is involved, in a Src kinase-dependent manner, in the early signaling events observed upon the cross-linking of CD32a in human neutrophils.
Collapse
Affiliation(s)
- Myriam Vaillancourt
- Centre de Recherche en Rhumatologie et Immunologie, Centre de Recherche du CHUL, Room T1-49, 2705, Boulevard Laurier and Department of Medicine, Faculty of Medicine, Laval University, Sainte-Foy, QC, Canada
| | | | | | | | | | | |
Collapse
|
22
|
Poirier P, Bogaty P, Garneau C, Marois L, Dumesnil JG. Diastolic dysfunction in normotensive men with well-controlled type 2 diabetes: importance of maneuvers in echocardiographic screening for preclinical diabetic cardiomyopathy. Diabetes Care 2001; 24:5-10. [PMID: 11194240 DOI: 10.2337/diacare.24.1.5] [Citation(s) in RCA: 407] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Because a pseudonormal pattern of ventricular filling has never been considered in studies that reported a prevalence of left ventricular diastolic dysfunction (LVDD) between 20 and 40%, our aim was to more completely evaluate the prevalence of LVDD in subjects with diabetes. RESEARCH DESIGN AND METHODS We studied 46 men with type 2 diabetes who were aged 38-67 years; without evidence of diabetic complications, hypertension, coronary artery disease, congestive heart failure, or thyroid or overt renal disease; and with a maximal treadmill exercise test showing no ischemia. LVDD was evaluated by Doppler echocardiography, which included the use of the Valsalva maneuver and pulmonary venous recordings to unmask a pseudonormal pattern of left ventricular filling. RESULTS LVDD was found in 28 subjects (60%), of whom 13 (28%) had a pseudonormal pattern of ventricular filling and 15 (32%) had impaired relaxation. Systolic function was normal in all subjects, and there was no correlation between LVDD and indexes of metabolic control. CONCLUSIONS LVDD is much more common than previously reported in subjects with well-controlled type 2 diabetes who are free of clinically detectable heart disease. The high prevalence of this phenomenon in this high-risk population suggests that screening for LVDD in type 2 diabetes should include procedures such as the Valsalva maneuver and pulmonary venous recordings to unmask a pseudonormal pattern of ventricular filling.
Collapse
Affiliation(s)
- P Poirier
- Quebec Heart Institute and Laval Hospital, Sainte-Foy, Canada.
| | | | | | | | | |
Collapse
|
23
|
Poirier P, Garneau C, Bogaty P, Nadeau A, Marois L, Brochu C, Gingras C, Fortin C, Jobin J, Dumesnil JG. Impact of left ventricular diastolic dysfunction on maximal treadmill performance in normotensive subjects with well-controlled type 2 diabetes mellitus. Am J Cardiol 2000; 85:473-7. [PMID: 10728953 DOI: 10.1016/s0002-9149(99)00774-2] [Citation(s) in RCA: 114] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Patients with type 2 diabetes often have impaired exercise capacity compared with nondiabetic subjects. Left ventricular (LV) diastolic dysfunction has been shown to limit exercise performance in nondiabetic subjects. Men with well-controlled type 2 diabetes were divided into 2 groups: normal LV diastolic function (group 1, n = 9) or LV diastolic dysfunction (group 2, n = 10) based on standard echocardiographic criteria using pulmonary veins and transmitral flow recordings. They were matched for age and had no evidence of systemic hypertension, macroalbuminuria, coronary artery disease, congestive heart failure, clinical diabetic complications, and thyroid disease. Good metabolic control was demonstrated by glycated hemoglobin levels of 6.7+/-1.6% and 6.6+/-2.5% (means +/- SD) in patients with LV diastolic dysfunction and in controls, respectively. Each subject performed a symptom-limited modified Bruce protocol treadmill exercise test. Maximal treadmill performance was higher in subjects with normal diastolic function compared with subjects with LV diastolic dysfunction when expressed in time (803+/-29 vs. 662+/-44 seconds, respectively, p<0.02) or in METs (11.4+/-1.2 vs. 9.5+/-1.9 METs, respectively, p<0.02). Moreover, there was a correlation between E/A ratio and exercise duration (r = 0.64, p = 0.004) or E/A ratio and METs (r = 0.658, p = 0.003). There were no significant differences in maximal heart rate, maximal systolic and diastolic blood pressure, or maximal rate-pressure product attained during the exercise test. In conclusion, this study demonstrated that LV diastolic dysfunction influences maximal treadmill performance and could explain lower maximal performance observed in patients with type 2 diabetes.
Collapse
Affiliation(s)
- P Poirier
- Quebec Heart Institute, Laval Hospital, Diabetes Research Unit, Laval University, Ste-Foy, Quebec, Canada.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Poirier P, Garneau C, Marois L, Jobin J, Dumesnil JG. IMPACT OF DIASTOLIC DYSFUNCTION ON MAXIMAL TREADMILL PERFORMANCE IN TYPE 2 DIABETIC SUBJECTS WITHOUT CLINICAL HEART DISEASE. Med Sci Sports Exerc 1999. [DOI: 10.1097/00005768-199905001-01824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
25
|
Pernot C, Marçon F, Worms AM, Cloez JL, Gilgenkrantz S, Marois L. [Cardiovascular dysplasia in Noonan's syndrome. Apropos of 64 cases]. Arch Mal Coeur Vaiss 1987; 80:434-43. [PMID: 3113364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The multiple malformation syndrome with characteristic facies described by Jacqueline Noonan in 1963 is one of the most commonly encountered syndromes in paediatric cardiology. The series presented here comprises 64 cases, almost a quarter of which were familial (6 families). The morphotype (Turner phenotype with hypertelorism) can easily be recognized, but the variations, progressivity and resemblance to some similar syndromes imply a detailed analysis of a wide range of discriminant features. Short stature and webbed neck are less frequent than in Turner's syndrome, while mental debility and, mostly, cardiovascular lesions are much more frequent (the latter are present in 50-60% of the cases). The most typical cardiovascular lesion is pulmonary valve stenosis with dysplastic leaflets, or "atypical pulmonary stenosis syndrome", characterized by a curious electrical axis and above all, by left ventricular myocardiopathy with very peculiar deformations at ventriculography and 2D-echocardiography. In our series, myocardiopathy was even more frequent than dysplastic pulmonary valve stenosis (71.8% versus 64%). The dissemination of dysplastic lesions must be emphasized. They involve the aorta much more often than is usually reported (one-third of the cases); lesions of the lymphatic system are less frequent but may be severe. Occasionally, entirely different heart diseases, such as Fallot's tetralogy, are encountered. Owing to the relationship between its lesions and those of other multiple malformation syndromes, notably those of the phakomatosis group, and to the possibility of borderline cases with these syndromes, or even with other dystrophies, such as Williams-Beuren dystrophia, the cardiovascular dysplasia of Noonan's syndrome must be classified within the vast group of histodysplasias which are embryonic diseases of the "layers" or "neuro-ecto-mesodermoses" of unknown genetic mechanism.
Collapse
|