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Roncareggi S, Girardi K, Fioredda F, Pedace L, Arcuri L, Badolato R, Bonanomi S, Borlenghi E, Cirillo E, Coliva T, Consonni F, Conti F, Farruggia P, Gambineri E, Guerra F, Locatelli F, Mancuso G, Marzollo A, Masetti R, Micalizzi C, Onofrillo D, Piccini M, Pignata C, Raddi MG, Santini V, Vendemini F, Biondi A, Saettini F. A Nationwide Study of GATA2 Deficiency in Italy Reveals Novel Symptoms and Genotype-phenotype Association. J Clin Immunol 2023; 43:2192-2207. [PMID: 37837580 DOI: 10.1007/s10875-023-01583-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/10/2023] [Indexed: 10/16/2023]
Abstract
GATA2 deficiency is a rare disorder encompassing a broadly variable phenotype and its clinical picture is continuously evolving. Since it was first described in 2011, up to 500 patients have been reported. Here, we describe a cohort of 31 Italian patients (26 families) with molecular diagnosis of GATA2 deficiency. Patients were recruited contacting all the Italian Association of Pediatric Hematology and Oncology (AIEOP) centers, the Hematology Department in their institution and Italian societies involved in the field of vascular anomalies, otorhinolaryngology, dermatology, infectious and respiratory diseases. Median age at the time of first manifestation, molecular diagnosis and last follow-up visit was 12.5 (age-range, 2-52 years), 18 (age-range, 7-64 years) and 22 years (age-range, 3-64), respectively. Infections (39%), hematological malignancies (23%) and undefined cytopenia (16%) were the most frequent symptoms at the onset of the disease. The majority of patients (55%) underwent hematopoietic stem cell transplantation. During the follow-up rarer manifestations emerged. The clinical penetrance was highly variable, with the coexistence of severely affected pediatric patients and asymptomatic adults in the same pedigree. Two individuals remained asymptomatic at the last follow-up visit. Our study highlights new (pilonidal cyst/sacrococcygeal fistula, cholangiocarcinoma and gastric adenocarcinoma) phenotypes and show that lymphedema may be associated with null/regulatory mutations. Countrywide studies providing long prospective follow-up are essential to unveil the exact burden of rarer manifestations and the natural history in GATA2 deficiency.
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Affiliation(s)
- Samuele Roncareggi
- Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
- Dipartimento Di Medicina E Chirurgia, Università Degli Studi Milano-Bicocca, Monza, Italy
| | - Katia Girardi
- Department of Pediatric Onco-Haematology and Cell and Gene Therapy, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | | | - Lucia Pedace
- Department of Pediatric Onco-Haematology and Cell and Gene Therapy, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Luca Arcuri
- U.O.C. Ematologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Raffaele Badolato
- Paediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, Department of Clinical and Experimental Sciences, ASST- Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | | | - Erika Borlenghi
- U.O.C. Ematologia, ASST Spedali Civili Di Brescia, Brescia, Italy
| | - Emilia Cirillo
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Naples, Italy
| | | | - Filippo Consonni
- Department of Health Sciences, University of Florence, Florence, Italy
- Centre of Excellence, Division of Pediatric Oncology/Hematology, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Francesca Conti
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Piero Farruggia
- Pediatric Hematology and Oncology Unit, Pediatric Department, ARNAS Civico, Di Cristina and Benfratelli Hospitals, Palermo, Italy
| | - Eleonora Gambineri
- Centre of Excellence, Division of Pediatric Oncology/Hematology, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Fabiola Guerra
- Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
- Dipartimento Di Medicina E Chirurgia, Università Degli Studi Milano-Bicocca, Monza, Italy
| | - Franco Locatelli
- Department of Pediatric Onco-Haematology and Cell and Gene Therapy, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Gaia Mancuso
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Marzollo
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, Padua University Hospital, Via Giustiniani 3, 35128, Padua, Italy
| | - Riccardo Masetti
- Pediatric Oncology and Hematology Unit, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Pediatric Hematology-Oncology Unit, Department of Medical and Surgical Sciences DIMEC, University of Bologna, Bologna, Italy
| | - Concetta Micalizzi
- U.O.S.D. Centro Trapianto Di Midollo Osseo, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Daniela Onofrillo
- UOSD Oncoematologia Pediatrica, Ospedale Civile Santo Spirito, Pescara, Italia
| | - Matteo Piccini
- Ematologia, DMSC, AOU Careggi, Università Di Firenze, Florence, Italy
| | - Claudio Pignata
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Naples, Italy
| | | | - Valeria Santini
- Ematologia, DMSC, AOU Careggi, Università Di Firenze, Florence, Italy
| | | | - Andrea Biondi
- Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
- Dipartimento Di Medicina E Chirurgia, Università Degli Studi Milano-Bicocca, Monza, Italy
- Centro Tettamanti, Fondazione IRCCS San Gerardo Dei Tintori, Via Cadore, Monza, Italy
| | - Francesco Saettini
- Centro Tettamanti, Fondazione IRCCS San Gerardo Dei Tintori, Via Cadore, Monza, Italy.
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Chiunti-Andrade P, Gallardo-Hernández CA, González-Herrera SL. [Development of autoimmunity in patients with primary immunodeficiencies]. Rev Med Inst Mex Seguro Soc 2023; 61:189-195. [PMID: 37200522 PMCID: PMC10395887] [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] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 08/31/2022] [Indexed: 05/20/2023]
Abstract
The autoimmune diseases include many in which the immune system is directed against the host, leading to life-threatening destruction of organs. The origin of autoimmune disorders can be multifactorial and, there are no specific therapy for these diseases. Primary immunodeficiencies are a group of immune disorders that affect different components of the innate and adaptive responses. Interestingly, patients with primary immunodeficiencies have an increased susceptibility to infectious diseases and non-infectious complications including allergies, malignancies, and autoimmune diseases. The molecular mechanism for development of autoimmunity in immunodeficiencies is unclear. The study of the complex immune regulatory and signaling mechanisms is revealing the relationships between primary immunodeficiency syndromes and autoimmune diseases. Newly, it has been demonstrated that a deficient maturation of immune cells; the deficiency of proteins important for T and B lymphocyte function and impaired signally pathways that include key molecules in regulation and activation of immune cells are associated with the development of autoimmunity in patients with primary immunodeficiencies. The aim of the present work is to review the evidence available to date regarding the cellular and molecular mechanisms involved in the development of autoimmunity in patients with primary immunodeficiencies.
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Affiliation(s)
- Práxedes Chiunti-Andrade
- Universidad Veracruzana, Unidad Académica de Ciencias de la Salud, Facultad de Bioanálisis. Xalapa, Veracruz, México
| | | | - Sandra Luz González-Herrera
- Universidad Veracruzana, Unidad Académica de Ciencias de la Salud, Facultad de Bioanálisis. Xalapa, Veracruz, México
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Castano-Jaramillo LM, Yamazaki-Nakashimada MA, O'Farrill-Romanillos PM, Muzquiz Zermeño D, Scheffler Mendoza SC, Venegas Montoya E, García Campos JA, Sánchez-Sánchez LM, Gámez González LB, Ramírez López JM, Bustamante Ogando JC, Vásquez-Echeverri E, Medina Torres EA, Lopez-Herrera G, Blancas Galicia L, Berrón Ruiz L, Staines-Boone AT, Espinosa-Padilla SE, Segura Mendez NH, Lugo Reyes SO. COVID-19 in the Context of Inborn Errors of Immunity: a Case Series of 31 Patients from Mexico. J Clin Immunol 2021; 41:1463-1478. [PMID: 34114122 PMCID: PMC8191444 DOI: 10.1007/s10875-021-01077-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [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: 03/16/2021] [Accepted: 05/25/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Patients with inborn errors of immunity (IEI) have a compromised or inappropriate immune response. Although they might be considered a high-risk group for severe SARS-CoV-2 infection, the reported impact of COVID-19 in these patients has been reassuring, while the differential susceptibility of distinct types of IEI remains unclear. OBJECTIVE We aimed to describe the findings and outcomes of our known patients with IEI who were diagnosed with COVID-19. METHODS In a retrospective study from March 2020 to February 2021, four centers in Mexico collected clinical, laboratory, and genetic data from pediatric and adult patients with known diagnoses of IEI who presented with COVID-19, based on compatible symptoms and positive SARS-CoV-2 testing or known household exposure. RESULTS We report 31 patients with known IEI from Mexico who presented with SARS-CoV-2 infection. Seventy-four percent were male, 52% were pediatric, and 81% survived. Their ages ranged from 5 months to 56 years, with a median of 17 years. Sixty-five percent had predominant antibody deficiencies, 48% were hospitalized, and 26% required ICU. Pediatric patients had a higher hospital admission rate than adults. Inpatient mortality was 40%, and ICU mortality rate was 63%. Forty-eight percent developed pneumonia, while 36% had evidence of hyperinflammation (4 adults and 7 children). Predominant laboratory features were lymphopenia and thrombocytopenia, seen in 70 and 44% of patients, respectively. The serum D-dimer median value was 2.6 (0.5-20.6) μg/mL, and the median highest ferritin value was 1015 (32-10,303) ng/mL. Intravenous immunoglobulin was used in 80% of patients. Other treatments included macrolides (39%) and corticosteroids (29%). Six patients died from secondary infection or uncontrolled systemic inflammation. DISCUSSION Although impaired immunity due to IEI may be a predisposing factor for severe COVID-19, most of our patients with IEI who acquired the SARS-CoV-2 infection developed a well-tolerated infection and survived, as have more than 80% of worldwide reported patients to date. An impaired immune or inflammatory response may be a predisposing factor for some and a protective factor for others. A systematic review of the literature could help identify those patients at risk of severe disease and complications. Healthcare-associated infections should be aggressively prevented.
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Affiliation(s)
| | | | - Patricia M O'Farrill-Romanillos
- Allergy and Immunology Department, Hospital de Especialidades, National Medical Center, Siglo XXI" IMSS, Mexico City, Mexico
| | | | | | - Edna Venegas Montoya
- Immunology Service, Hospital de Especialidades UMAE 25 IMSS, Monterrey, NL, Mexico
| | | | | | - Luisa B Gámez González
- Clinical Immunology Service, Hospital Infantil Especialidades de Chihuahua, Chihuahua, Mexico
| | | | - Juan Carlos Bustamante Ogando
- Immune Deficiencies Lab., National Institute of Pediatrics, Av Iman 1, Torre de Investigacion Piso 9, Insurgentes Cuicuilco, Coyoacan, 04530, Mexico City, Mexico
| | - Estefanía Vásquez-Echeverri
- Immune Deficiencies Lab., National Institute of Pediatrics, Av Iman 1, Torre de Investigacion Piso 9, Insurgentes Cuicuilco, Coyoacan, 04530, Mexico City, Mexico
| | - Edgar Alejandro Medina Torres
- Immune Deficiencies Lab., National Institute of Pediatrics, Av Iman 1, Torre de Investigacion Piso 9, Insurgentes Cuicuilco, Coyoacan, 04530, Mexico City, Mexico
| | - Gabriela Lopez-Herrera
- Immune Deficiencies Lab., National Institute of Pediatrics, Av Iman 1, Torre de Investigacion Piso 9, Insurgentes Cuicuilco, Coyoacan, 04530, Mexico City, Mexico
| | - Lizbeth Blancas Galicia
- Immune Deficiencies Lab., National Institute of Pediatrics, Av Iman 1, Torre de Investigacion Piso 9, Insurgentes Cuicuilco, Coyoacan, 04530, Mexico City, Mexico
| | - Laura Berrón Ruiz
- Immune Deficiencies Lab., National Institute of Pediatrics, Av Iman 1, Torre de Investigacion Piso 9, Insurgentes Cuicuilco, Coyoacan, 04530, Mexico City, Mexico
| | | | - Sara Elva Espinosa-Padilla
- Immune Deficiencies Lab., National Institute of Pediatrics, Av Iman 1, Torre de Investigacion Piso 9, Insurgentes Cuicuilco, Coyoacan, 04530, Mexico City, Mexico
| | - Nora Hilda Segura Mendez
- Allergy and Immunology Department, Hospital de Especialidades, National Medical Center, Siglo XXI" IMSS, Mexico City, Mexico
| | - Saul O Lugo Reyes
- Immune Deficiencies Lab., National Institute of Pediatrics, Av Iman 1, Torre de Investigacion Piso 9, Insurgentes Cuicuilco, Coyoacan, 04530, Mexico City, Mexico.
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Momtazmanesh S, Rayzan E, Zoghi S, Shahkarami S, Molatefi R, Mohammadzadeh I, Ghaffari J, Mahmoudi H, Dmytrus J, Segarra-Roca A, Somekh I, Witzel M, Hauck F, Boztug K, Klein C, Rezaei N. Novel Variants of DOCK8 Deficiency in a Case Series of Iranian Patients. Endocr Metab Immune Disord Drug Targets 2021; 22:159-168. [PMID: 33634762 DOI: 10.2174/1871530321666210226143912] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Dedicator of Cytokinesis 8 (DOCK8) deficiency, the most frequent cause of autosomal recessive hyper immunoglobulin (Ig)E syndrome, is a rare combined immunodeficiency. OBJECTIVE In this study, we report seven patients with consanguineous parents with five novel variants within the DOCK8 gene. METHODS For genetic analysis, we performed Whole Exome Sequencing (WES), or targeted sequencing by means of Next-generation sequencing (NGS) for some of the patients. For others, Sanger sequencing, Fluorescence-activated cell sorting (FACS), or polymerase chain reaction (PCR) was used. RESULTS We report five novel variants within the DOCK8 gene: three deletions (deletion of exons 4-12, 24-30, and 22-27), one frameshift (LRG_196:g.189315dup;p.(Leu1052Profs*7)), and a splice region variant (LRG_196t1:c.741+5G>T). Patients presented with skin lesions, food allergy, candidiasis, otitis, recurrent respiratory infections, short stature, aortic aneurism, gynecomastia, and coarse facial features. Patients had leukocytosis, eosinophilia, lymphopenia, and monocytosis, elevated IgE, IgG, IgA , reduced IgM and IgA levels. Patients had a low percentage of CD3+ and CD4+ cells, and a high percentage of CD19+, CD27+CD19+, and recent thymic emigrants T cells. The percentage of natural killer cells was increased in one of the patients while it was decreased in another patient. One patient died due to disseminated intravascular coagulation after hematopoietic stem cell transplantation. CONCLUSION We reported novel variants within the DOCK8 gene and highlighted risk of aneurysms in these patients, which have been rarely reported in these patients.
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Affiliation(s)
- Sara Momtazmanesh
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran. Iran
| | - Elham Rayzan
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran. Iran
| | - Samaneh Zoghi
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran. Iran
| | - Sepideh Shahkarami
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran. Iran
| | - Rasol Molatefi
- Pediatric department of Bou-Ali educational Hospital, Ardabil university of medical sciences, Ardabil. Iran
| | - Iraj Mohammadzadeh
- Noncommunicable Pediatric Diseases Research Center, Amirkola Hospital, Babol University of Medical Sciences, Babol. Iran
| | - Javad Ghaffari
- Department of Allergy and Clinical Immunology, Bou Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Mazandaran. Iran
| | - Hamidreza Mahmoudi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran. Iran
| | - Jasmin Dmytrus
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna. Austria
| | - Anna Segarra-Roca
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna. Austria
| | - Ido Somekh
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich. Germany
| | - Maximilian Witzel
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich. Germany
| | - Fabian Hauck
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich. Germany
| | - Kaan Boztug
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna. Austria
| | - Christoph Klein
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich. Germany
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran. Iran
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