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Ascunce M, Coccolo A, Mozo Y, Baquero-Artigao F, Rodriguez-Molino P, Toro-Rueda C, García-Clemente P, Sánchez-Zapardiel E, López-Granados E, Corral-Sánchez D, Bueno D, Sisinni L, Pérez-Martínez A, Calvo C, Del Rosal T. Severe Impairment of T-cell Immunity and Pulmonary GvHD Are Major Risk Factors for Nontuberculous Mycobacterial Infection After Pediatric Allogeneic Hematopoietic Stem Cell Transplantation. Pediatr Infect Dis J 2024:00006454-990000000-00857. [PMID: 38713829 DOI: 10.1097/inf.0000000000004380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
Hematopoietic stem cell transplant recipients are prone to infectious complications. Infections caused by nontuberculous mycobacteria have increased in adults but literature in children is scarce. We report 6 episodes of disseminated or pulmonary nontuberculous mycobacteria infection among 5 pediatric hematopoietic stem cell transplant recipients. All but one were caused by Mycobacterium avium complex. Four patients died, 2 related to nontuberculous mycobacteria infection.
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Affiliation(s)
- Marina Ascunce
- From the Pediatrics Department, La Paz University Hospital
| | | | - Yasmina Mozo
- Pediatric Hemato-Oncology Department, La Paz University Hospital
| | - Fernando Baquero-Artigao
- Pediatrics and Infectious Disease Department, La Paz University Hospital
- Hospital La Paz Institute for Health Research (IdiPAZ)
- Translational Research Network of Pediatric Infectious Diseases (RITIP)
- Center for Biomedical Research Network on Infectious Diseases (CIBERINFEC), Carlos III Health Institute
| | - Paula Rodriguez-Molino
- Pediatrics and Infectious Disease Department, La Paz University Hospital
- Hospital La Paz Institute for Health Research (IdiPAZ)
- Translational Research Network of Pediatric Infectious Diseases (RITIP)
- Center for Biomedical Research Network on Infectious Diseases (CIBERINFEC), Carlos III Health Institute
| | | | | | - Elena Sánchez-Zapardiel
- Hospital La Paz Institute for Health Research (IdiPAZ)
- Immunology Department, La Paz University Hospital
| | - Eduardo López-Granados
- Hospital La Paz Institute for Health Research (IdiPAZ)
- Immunology Department, La Paz University Hospital
- Center for Biomedical Research Network on Rare Diseases (CIBERER U767), Carlos III Health Institute
| | | | - David Bueno
- Pediatric Hemato-Oncology Department, La Paz University Hospital
- Hospital La Paz Institute for Health Research (IdiPAZ)
| | - Luisa Sisinni
- Pediatric Hemato-Oncology Department, La Paz University Hospital
| | - Antonio Pérez-Martínez
- Pediatric Hemato-Oncology Department, La Paz University Hospital
- Hospital La Paz Institute for Health Research (IdiPAZ)
- Universidad Autónoma de Madrid, Madrid, Spain
| | - Cristina Calvo
- Pediatrics and Infectious Disease Department, La Paz University Hospital
- Hospital La Paz Institute for Health Research (IdiPAZ)
- Translational Research Network of Pediatric Infectious Diseases (RITIP)
- Center for Biomedical Research Network on Infectious Diseases (CIBERINFEC), Carlos III Health Institute
- Universidad Autónoma de Madrid, Madrid, Spain
| | - Teresa Del Rosal
- Pediatrics and Infectious Disease Department, La Paz University Hospital
- Hospital La Paz Institute for Health Research (IdiPAZ)
- Translational Research Network of Pediatric Infectious Diseases (RITIP)
- Center for Biomedical Research Network on Rare Diseases (CIBERER U767), Carlos III Health Institute
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2
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Valdivieso-Shephard JL, Matas-Pérez E, García-Bujalance S, Mirones-Aguilar I, González-Martínez B, Pérez-Martínez A, López-Granados E, Martínez-Feito A, Sánchez-Zapardiel E. The challenge of standardizing CAR-T cell monitoring: A comparison of two flow-cytometry methods and correlation with qPCR technique. Cytometry A 2024; 105:368-375. [PMID: 38327134 DOI: 10.1002/cyto.a.24825] [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: 05/19/2023] [Revised: 01/10/2024] [Accepted: 01/24/2024] [Indexed: 02/09/2024]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy is a breakthrough in hematologic malignancies, such as acute B lymphoblastic leukemia (B-ALL). Monitoring this treatment is recommended, although standardized protocols have not been developed yet. This work compares two flow cytometry monitoring strategies and correlates this technique with qPCR method. CAR-T cells were detected by two different flow-cytometry protocols (A and B) in nine blood samples from one healthy donor and five B-ALL patients treated with Tisagenlecleucel (Kymriah®, USA). HIV-1 viral load allowed CAR detection by qPCR, using samples from seven healthy donors and nine B-ALL patients. CAR detection by protocol A and B did not yield statistically significant differences (1.9% vs. 11.8% CD3 + CAR+, p = 0.07). However, protocol B showed a better discrimination of the CD3 + CAR+ population. A strong correlation was observed between protocol B and qPCR (r = 0.7, p < 0.0001). CD3 + CAR+ cells were detected by flow cytometry only when HIV-1 viral load was above 104 copies/mL. In conclusion, protocol B was the most specific flow-cytometry procedure for the identification of CAR-T cells and showed a high correlation with qPCR. Further efforts are needed to achieve a standardized monitoring approach.
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Affiliation(s)
| | | | | | - Isabel Mirones-Aguilar
- Advanced Therapy Medicinal Products Production Unit, Haemato-Oncology Service, La Paz University Hospital, Madrid, Spain
| | - Berta González-Martínez
- Translational Research Unit in Paediatric Haemato-Oncology, Hematopoietic Stem Cell Transplantation and Cell Therapy, La Paz University Hospital, Madrid, Spain
- Paediatric Haemato-Oncology Department, La Paz University Hospital, Madrid, Spain
| | - Antonio Pérez-Martínez
- Translational Research Unit in Paediatric Haemato-Oncology, Hematopoietic Stem Cell Transplantation and Cell Therapy, La Paz University Hospital, Madrid, Spain
- Paediatric Haemato-Oncology Department, La Paz University Hospital, Madrid, Spain
| | - Eduardo López-Granados
- Immunology Department, La Paz University Hospital, Madrid, Spain
- CIBERER U767, Center for Biomedical Network Research on Rare Diseases, Madrid, Spain
- Lymphocyte Pathophysiology in Immunodeficiencies Group, La Paz Institute of Biomedical Research (IdiPAZ), Madrid, Spain
| | - Ana Martínez-Feito
- Immunology Department, La Paz University Hospital, Madrid, Spain
- Lymphocyte Pathophysiology in Immunodeficiencies Group, La Paz Institute of Biomedical Research (IdiPAZ), Madrid, Spain
| | - Elena Sánchez-Zapardiel
- Immunology Department, La Paz University Hospital, Madrid, Spain
- Lymphocyte Pathophysiology in Immunodeficiencies Group, La Paz Institute of Biomedical Research (IdiPAZ), Madrid, Spain
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3
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Calvo-Apalategi A, Nevado ML, Bravo-Gallego LY, González-Granado LI, Allende LM, Pena RR, López-Granados E, Reyburn HT. The lack of either IRF9, or STAT2, has surprisingly little effect on human natural killer cell development and function. Immunology 2024. [PMID: 38514903 DOI: 10.1111/imm.13779] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 03/01/2024] [Indexed: 03/23/2024] Open
Abstract
Analysis of genetically defined immunodeficient patients allows study of the effect of the absence of specific proteins on human immune function in real-world conditions. Here we have addressed the importance of type I interferon signalling for human NK cell development by studying the phenotype and function of circulating NK cells isolated from patients suffering primary immunodeficiency disease due to mutation of either the human interferon regulatory factor 9 (IRF9) or the signal transducer and activator of transcription 2 (STAT2) genes. IRF9, together with phosphorylated STAT1 and STAT2, form a heterotrimer called interferon stimulated gene factor 3 (ISGF3) which promotes the expression of hundreds of IFN-stimulated genes that mediate antiviral function triggered by exposure to type I interferons. IRF9- and STAT2-deficient patients are unable to respond efficiently to stimulation by type I interferons and so our experiments provide insights into the importance of type I interferon signalling and the consequences of its impairment on human NK cell biology. Surprisingly, the NK cells of these patients display essentially normal phenotype and function.
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Affiliation(s)
| | - Marta López Nevado
- Immunology Department, University Hospital 12 de Octubre, Madrid, Spain
- Hospital 12 Octubre Research Institute (Imas12), Madrid, Spain
| | | | - Luis Ignacio González-Granado
- Immunology Department, University Hospital 12 de Octubre, Madrid, Spain
- Immunodeficiency Unit, Department of Pediatrics, University Hospital 12 de Octubre, Madrid, Spain
| | - Luis M Allende
- Immunology Department, University Hospital 12 de Octubre, Madrid, Spain
- Hospital 12 Octubre Research Institute (Imas12), Madrid, Spain
- School of Medicine, Complutense University of Madrid, Madrid, Spain
| | | | - Eduardo López-Granados
- Department of Immunology, La Paz University Hospital, Madrid, Spain
- Lymphocyte Pathophysiology Group, La Paz Institute of Biomedical Research, IdiPAZ, Madrid, Spain
| | - Hugh T Reyburn
- Department of Immunology and Oncology, CNB-CSIC, Madrid, Spain
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4
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Donà D, Bravo-Gallego LY, Remacha EF, Cananzi M, Gastaldi A, Canizalez JT, Stephenne X, Lacaille F, Lindemans C, Calore E, Galea N, Benetti E, Nachbaur E, Sandes AR, Teixeira A, Ferreira S, Klaudel-Dreszler M, Ackermann O, Boyer O, Espinosa L, Guereta LG, Sciveres M, Fischler B, Schwerk N, Neland M, Nicastro E, Dello Strologo L, Toporski J, Vainumae I, Rascon J, Urbonas V, Del Rosal T, López-Granados E, Perilongo G, Baker A, Vega PJ. Vaccination practices in pediatric transplantation: A survey among member centers of the European reference network TransplantChild. Pediatr Transplant 2023; 27:e14589. [PMID: 37543721 DOI: 10.1111/petr.14589] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/24/2023] [Accepted: 07/16/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND There is considerable variation in vaccination practices between pediatric transplant centers. This study aims to evaluate active immunization attitudes and practices among ERN-TransplantChild centers and identify potential areas of improvement that could be addressed by shared evidence-based protocols. METHODS A cross-sectional questionnaire of attitudes and practices toward immunization of pediatric SOT and HSCT candidates and recipients was sent to a representative member of multidisciplinary teams from 27 European centers belonging to the ERN-TransplantChild. RESULTS A total of 28/62 SOT programs and 6/12 HSCT programs across 21 European centers participated. A quarter of centers did not have an on-site protocol for the immunizations. At the time of transplantation, pediatric candidates were fully immunized (80%-100%) in 57% and 33% of the SOT and HSCT programs. Variations in the time between vaccine administration and admission to the waiting list were reported between the centers, with 2 weeks for inactivated vaccines and variable time (2-4 weeks) for live-attenuated vaccines (LAVs). Almost all sites recommended immunization in the post-transplant period, with a time window of 4-8 months for the inactivated vaccines and 16-24 months for MMR and Varicella vaccines. Only five sites administer LAVs after transplantation, with seroconversion evaluated in 80% of cases. CONCLUSIONS The immunization coverage of European pediatric transplant recipients is still inconsistent and far from adequate. This survey is a starting point for developing shared evidence-based immunization protocols for safe vaccination among pediatric transplant centers and generating new research studies.
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Affiliation(s)
- Daniele Donà
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Luz Yadira Bravo-Gallego
- Lymphocyte Pathophysiology in Immunodeficiencies Group, La Paz Institute of Biomedical Research (IdiPAZ), Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain
| | - Esteban Frauca Remacha
- Pediatric Hepatology Department, La Paz University Hospital, Molecular Hepatology Group, La Paz Institute of Biomedical Research (IdiPAZ), Madrid, Spain
| | - Mara Cananzi
- Unit of Paediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child with Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Andrea Gastaldi
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
- Department of Pediatrics, Woman and Child Hospital, University of Verona, Verona, Italy
| | - Juan Torres Canizalez
- Lymphocyte Pathophysiology in Immunodeficiencies Group, La Paz Institute of Biomedical Research (IdiPAZ), Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain
| | - Xavier Stephenne
- Laboratoire d'Hépatologie Pédiatrique et Thérapie Cellulaire, Unité PEDI, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Florence Lacaille
- Service de Gastroentérologie-Hépatologie-Nutrition Pédiatriques, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France
| | - Caroline Lindemans
- Princess Maxima Center for Pediatric Oncology, Pediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Elisabetta Calore
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, Department of Women's and Children's Health, Padua University Hospital, Padua, Italy
| | - Nathalie Galea
- Paediatric Department of Mater Dei Hospital, Msida, Malta
| | - Elisa Benetti
- Pediatric Nephrology, Dialysis and Transplant Unit, Department of Women's and Children's Health, Azienda Ospedaliera di Padova, Padua, Italy
| | - Edith Nachbaur
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Ana Rita Sandes
- Unidade de Nefrologia e Transplantação Renal, Serviço de Pediatria Médica, Departamento de Pediatria, Hospital de Santa Maria, Centro Académico de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Teixeira
- Department of Pediatric Nephrology, Pediatric Service, Centro Materno-Infantil do Norte, Centro Hospitalar do Porto, Porto, Portugal
| | - Sandra Ferreira
- Hepatology and Pediatric Liver Transplantation Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Maja Klaudel-Dreszler
- Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Oanez Ackermann
- Hepatologie et Transplantation Hepatique Pediatriques, Centre de reference de l'atresie des voies biliaires et des cholestases genetiques, FSMR FILFOIE, ERN RARE LIVER, Hôpital Bicêtre, AP-HP, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Olivia Boyer
- Service de Néphrologie Pédiatrique, AP-HP, Centre de Référence de maladies rénales rares de l'enfant et de l'adulte (MARHEA), Hôpital Necker-Enfants Malades, Paris, France
- Institut Imagine, Laboratoire des maladies rénales héréditaires, INSERM UMR 1163, Université de Paris, Paris, France
| | - Laura Espinosa
- Pediatric Nephrology Department, La Paz University Hospital, Diagnosis and Treatment of Diseases Associated with Abnormalities of the Complement System Group, La Paz Institute of Biomedical Research (IdiPAZ), Madrid, Spain
| | | | - Marco Sciveres
- Pediatric Hepatology and Liver Transplantation, ISMETT-University of Pittsburgh Medical Center Italy, Palermo, Italy
| | - Björn Fischler
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Nicolaus Schwerk
- Paediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, Hannover, Germany
| | - Mette Neland
- Department of Paediatrics and Adolescence Medicine, Odense University Hospital, Odense, Denmark
| | - Emanuele Nicastro
- Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Luca Dello Strologo
- Nephrology Unit, Bambino Gesù Children's Research Hospital, IRCCS, Rome, Italy
| | - Jacek Toporski
- Department of Pediatrics, Section of Pediatric Oncology, Hematology, Immunology and Nephrology, Skåne University Hospital, Lund, Sweden
- Center of Allogenic Stem Cell Transplantation and Cellular Therapy, Karolinska University Hospital, Stockholm, Sweden
| | - Inga Vainumae
- Department of Pediatrics, Tartu University Hospital, Tartu, Estonia
| | - Jelena Rascon
- Centre for Paediatric Oncology and Haematology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Vaidotas Urbonas
- Department of Paediatric Gastroenterology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Teresa Del Rosal
- Paediatric Infectious and Tropical Diseases Department, La Paz University Hospital, Translational Research Network in Paediatric Infectious Diseases (RITIP), La Paz Institute of Biomedical Research (IdiPAZ), and Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain
| | - Eduardo López-Granados
- Lymphocyte Pathophysiology in Immunodeficiencies Group, La Paz Institute of Biomedical Research (IdiPAZ), Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain
- Clinical Immunology Department, La Paz University Hospital, Madrid, Spain
| | - Giorgio Perilongo
- Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Alastair Baker
- Paediatric Liver, Gastrointestinal and Nutrition Centre, King's College London School of Medicine at King's College Hospital, London, UK
| | - Paloma Jara Vega
- Pediatric Hepatology Department, La Paz University Hospital, Molecular Hepatology Group, La Paz Institute of Biomedical Research (IdiPAZ), ERN TransplantChild Coordinator, Madrid, Spain
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Plasencia-Rodríguez C, Martínez-Feito A, Hernández M, Del Pino-Molina L, Novella-Navarro M, Serrano Y, González-Muñoz M, Peiteado D, Bonilla G, Monjo I, Nuño L, Tornero C, López-Granados E, Balsa A, Nozal P. Immune response after SARS-CoV-2 vaccination in patients with inflammatory immune-mediated diseases receiving immunosuppressive treatment. Allergy Asthma Clin Immunol 2023; 19:71. [PMID: 37598192 PMCID: PMC10439605 DOI: 10.1186/s13223-023-00832-0] [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] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/06/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Real world data on the response to the SARS-CoV-2 vaccine in patients with immunomediated diseases (IMIDs) treated with immunesuppressants is of great interest because vaccine response may be impaired. The main aim was to study the humoral and cellular immune response after SARS-CoV-2 vaccination in patients with IMIDs treated with immunosuppressants. The secondary aim was to describe the frequency of SARS-CoV-2 infections after vaccination in these patients. MATERIAL AND METHODS This is an observational study including 86 patients with IMIDs. All patients were treated with biologic or targeted synthetic disease-modifying antirheumatic drugs [b/tsDMARDs: TNF inhibitors (TNFi), rituximab, anti-interleukin 6 receptor (anti-IL6R) or JAK inhibitors (JAKi)]. Demographic and clinical information were collected. After 4-6 weeks of 2nd and 3rd vaccine doses, humoral response was assessed using the Thermo Scientific ELiA SARS-CoV-2-Sp1 IgG Test. Also, in patients with serum SARS-CoV-2 antibody levels under 100UI/ml, cellular response was analyzed using the QuantiFERON SARS-CoV-2 Starter Pack. RESULTS A total of 86 patients under b/tsDMARDs and 38 healthy controls were included. Most patients received TNFi (45 with TNFi, 31 with rituximab, 5 with anti-IL6R and 5 with JAKi). SARS-CoV-2 antibodies (Ab) were present in an 86% of patients with IMIDs and in 100% healthy controls (p = 0.017). However, 12 (14%) patients had undetectable SARS-CoV-2 Ab levels, all treated with rituximab. In addition, SARS-CoV-2 Ab (IU/ml) were statistically lower in patients (Mdn (IQR): 59.5 (17-163) in patients vs 625 (405-932) in controls, p < 0.001). Patients treated with rituximab had lower Ab levels than those treated with TNFi and controls (p < 0.001). The cellular response to SARS-CoV-2 vaccine was evaluated in 30 patients. Eleven patients had a positive cellular response, being more frequent in patients treated with rituximab (p = 0.03). SARS-CoV-2 infection was reported in 43% of patients and 34% of controls after vaccination. Only 6 (7%) patients required hospitalization, most of whom treated with rituximab (67%). CONCLUSION SARS-CoV-2 antibody levels were lower in patients than in controls, especially in patients treated with rituximab. A cellular response can be detected despite having a poor humoral response. Severe infections in vaccinated patients with IMIDs are rare, and are observed mainly in patients treated with rituximab.
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Affiliation(s)
| | | | | | - Lucia Del Pino-Molina
- Center for Biomedical Network Research on Rare Diseases, ISCIII (CIBERER U767), Madrid, Spain
- Lymphocyte Pathophysiology in Immunodeficiencies Group, La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | - Marta Novella-Navarro
- Rheumatology Unit, La Paz University Hospital, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Yolanda Serrano
- Lymphocyte Pathophysiology in Immunodeficiencies Group, La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | | | - Diana Peiteado
- Rheumatology Unit, La Paz University Hospital, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Gema Bonilla
- Rheumatology Unit, La Paz University Hospital, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Irene Monjo
- Rheumatology Unit, La Paz University Hospital, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Laura Nuño
- Rheumatology Unit, La Paz University Hospital, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Carolina Tornero
- Rheumatology Unit, La Paz University Hospital, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Eduardo López-Granados
- Immunology, La Paz University Hospital, Madrid, Spain
- Center for Biomedical Network Research on Rare Diseases, ISCIII (CIBERER U767), Madrid, Spain
- Lymphocyte Pathophysiology in Immunodeficiencies Group, La Paz Institute for Health Research (IdiPaz), Madrid, Spain
| | - Alejandro Balsa
- Rheumatology Unit, La Paz University Hospital, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Pilar Nozal
- Immunology, La Paz University Hospital, Madrid, Spain
- Center for Biomedical Network Research on Rare Diseases, ISCIII (CIBERER U754), Madrid, Spain
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6
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Marín-Candón A, García-García I, Arias P, Carcas AJ, Díaz-García L, Feltes Ochoa R, Hernández Cano N, Herranz Pinto P, Jiménez González M, López-Granados E, Martínez-Feito A, Mayor-Ibarguren A, Rosas-Alonso R, Seco-Meseguer E, Borobia AM. Identifying biomarkers of treatment response to ciclosporin in atopic dermatitis through multiomic predictive modelling: DERMATOMICS study protocol. BMJ Open 2023; 13:e072350. [PMID: 37429687 DOI: 10.1136/bmjopen-2023-072350] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
INTRODUCTION There is a need to optimise the management of atopic dermatitis (AD), improving the efficacy of treatments and reducing the toxicity associated with them. Although the efficacy of ciclosporine (CsA) in the treatment of AD has been thoroughly documented in the literature, the optimal dose has not been yet established. The use of multiomic predictive models of treatment response could optimise CsA therapy in AD. METHODS AND ANALYSIS The study is a low-intervention phase 4 trial to optimise the treatment of patients with moderate-severe AD requiring systemic treatment. The primary objectives are to identify biomarkers that could allow for the selection of responders and non-responders to first-line treatment with CsA and to develop a response prediction model to optimise the CsA dose and treatment regimen in responding patients based on these biomarkers. The study is divided into two cohorts: the first comprised of patients starting treatment with CsA (cohort 1), and the second, of patients already receiving or who have received CsA therapy (cohort 2). ETHICS AND DISSEMINATION The study activities began following authorisation by the Spanish Regulatory Agency (AEMPS) and the Clinical Research Ethics Committee of La Paz University Hospital approval. Trial results will be submitted for publication in an open access peer-reviewed medical speciality-specific publication.Trial registration of this study can be located at the EU Clinical Trials Register, available from https://euclinicaltrials.eu/search-for-clinical-trials/?lang=en. Our clinical trial was registered in the website before the enrolment of the first patient complying with European regulations. EU Clinical Trials Register is a primary registry according the WHO. Once our trial was included in a primary and official registry, in order to extend the accessibility to our research, we also registered it retrospectively in clinicaltrials.gov; however, this is not mandatory as per our regulation. TRIAL REGISTRATION NUMBER NCT05692843.
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Affiliation(s)
- Alicia Marín-Candón
- Clinical Pharmacology Department, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - Irene García-García
- Clinical Pharmacology Department, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - Pedro Arias
- Genetic Department, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - Antonio J Carcas
- Clinical Pharmacology Department, La Paz University Hospital, IdiPAZ, Madrid, Spain
- Pharmacology Department, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Lucía Díaz-García
- Clinical Pharmacology Department, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - Rosa Feltes Ochoa
- Dermatology Department, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | | | | | | | | | - Ana Martínez-Feito
- Immunology Department, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | | | | | | | - Alberto M Borobia
- Clinical Pharmacology Department, La Paz University Hospital, IdiPAZ, Madrid, Spain
- Pharmacology Department, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
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7
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Sánchez-Zapardiel E, Alós M, Nozal P, González-Muñoz M, Frauca-Remacha E, Gavilán LB, Quiles MJ, Hierro L, López-Granados E. Humoral and cellular immune responses to Pfizer-BioNTech BNT162b2 SARS-CoV-2 vaccine in adolescents with liver transplantation: Single center experience. Front Immunol 2022; 13:1049188. [PMID: 36505469 PMCID: PMC9727154 DOI: 10.3389/fimmu.2022.1049188] [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: 09/20/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background Immune responses to vaccines against severe acute respiratory syndrome (SARS)-coronavirus (CoV)-2 are variable. In the absence of disease, youngsters are expected to better react to vaccines than adults. Nevertheless, chronic immunosuppression in transplant recipients may impair their capability to generate protection. We aim to explore immune responses after BNT162b2 SARS-CoV-2 vaccination in our cohort of young liver-transplanted patients. Methods A prospective study of adolescent liver-transplanted patients (n=33) in the long-term follow-up was performed. Immune responses after receiving Pfizer-BioNTech BNT162b2 vaccine were analyzed at two time-points: baseline and 30 days after the second dose. Humoral responses were measured by fluoroenzyme-immunoassay and T-cell responses by interferon-γ-release assay. Post-vaccine coronavirus disease (COVID-19) events were recorded by a survey. Results Pre-vaccine SARS-CoV-2-specific antibodies were undetectable in 27/32 (84.4%), negative/indeterminate in 3/32 (9.4%) and positive in 2/32 (6.3%) patients. Cellular responses at baseline were negative in 12/18 (66.6%), positive in 3/18 (16.6%) and indeterminate in 3/18 (16.6%) recipients. None of the baseline positives recalled any symptoms. Post-vaccine antibodies were detected in all patients and 92.6% showed levels >816 BAU/mL. Twenty (71.4%) recipients had positive T-cell responses. Regarding post-vaccine SARS-Cov-2 infection, 10 (30.3%) patients reported COVID-19 without hospitalization and 21 (63.6%) did not notify any infection. Negative and positive cell-response groups after vaccination showed statistically significant differences regarding COVID-19 cases (62.5% vs 22.2%, respectively; p=0.046). Conclusions Adolescents and young adults with liver transplantation responded to SARS-Cov-2 vaccine, generating both humoral and cellular responses. Recipients developing cellular responses after vaccination had a lower incidence of COVID-19.
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Affiliation(s)
- Elena Sánchez-Zapardiel
- Department of Immunology, La Paz University Hospital, Madrid, Spain,Lymphocyte Pathophysiology in Immunodeficiency Group, La Paz Biomedical Research Institute (IdiPAZ), La Paz University Hospital, Madrid, Spain,European Reference Network (ERN) Transplant-Child, Madrid, Spain,*Correspondence: Elena Sánchez-Zapardiel,
| | - María Alós
- European Reference Network (ERN) Transplant-Child, Madrid, Spain,Department of Pediatric Hepatology, La Paz University Hospital, Madrid, Spain
| | - Pilar Nozal
- Department of Immunology, La Paz University Hospital, Madrid, Spain,Diagnosis and Treatment of Pathologies Associated with Alterations of the Complement System Group, La Paz Biomedical Research Institute (IdiPAZ), La Paz University Hospital, Madrid, Spain,Rare Diseases Networking Biomedical Research Centre (CIBERER U754), Madrid, Spain
| | - Miguel González-Muñoz
- Department of Immunology, La Paz University Hospital, Madrid, Spain,Patient Safety and Quality Research Group, La Paz Biomedical Research Institute (IdiPAZ), La Paz University Hospital, Madrid, Spain
| | - Esteban Frauca-Remacha
- European Reference Network (ERN) Transplant-Child, Madrid, Spain,Department of Pediatric Hepatology, La Paz University Hospital, Madrid, Spain
| | | | - María José Quiles
- Department of Pediatric Hepatology, La Paz University Hospital, Madrid, Spain
| | - Loreto Hierro
- European Reference Network (ERN) Transplant-Child, Madrid, Spain,Department of Pediatric Hepatology, La Paz University Hospital, Madrid, Spain
| | - Eduardo López-Granados
- Department of Immunology, La Paz University Hospital, Madrid, Spain,Lymphocyte Pathophysiology in Immunodeficiency Group, La Paz Biomedical Research Institute (IdiPAZ), La Paz University Hospital, Madrid, Spain,European Reference Network (ERN) Transplant-Child, Madrid, Spain,Rare Diseases Networking Biomedical Research Centre (CIBERER U767), Madrid, Spain
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8
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Davalos V, García-Prieto CA, Ferrer G, Aguilera-Albesa S, Valencia-Ramos J, Rodríguez-Palmero A, Ruiz M, Planas-Serra L, Jordan I, Alegría I, Flores-Pérez P, Cantarín V, Fumadó V, Viadero MT, Rodrigo C, Méndez-Hernández M, López-Granados E, Colobran R, Rivière JG, Soler-Palacín P, Pujol A, Esteller M. Epigenetic profiling linked to multisystem inflammatory syndrome in children (MIS-C): A multicenter, retrospective study. EClinicalMedicine 2022; 50:101515. [PMID: 35770252 PMCID: PMC9233426 DOI: 10.1016/j.eclinm.2022.101515] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Most children and adolescents infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remain asymptomatic or develop a mild coronavirus disease 2019 (COVID-19) that usually does not require medical intervention. However, a small proportion of pediatric patients develop a severe clinical condition, multisystem inflammatory syndrome in children (MIS-C). The involvement of epigenetics in the control of the immune response and viral activity prompted us to carry out an epigenomic study to uncover target loci regulated by DNA methylation that could be altered upon the appearance of MIS-C. METHODS Peripheral blood samples were recruited from 43 confirmed MIS-C patients. 69 non-COVID-19 pediatric samples and 15 COVID-19 pediatric samples without MIS-C were used as controls. The cases in the two groups were mixed and divided into discovery (MIS-C = 29 and non-MIS-C = 56) and validation (MIS-C = 14 and non-MIS-C = 28) cohorts, and balanced for age, gender and ethnic background. We interrogated 850,000 CpG sites of the human genome for DNA methylation variants. FINDINGS The DNA methylation content of 33 CpG loci was linked with the presence of MIS-C. Of these sites, 18 (54.5%) were located in described genes. The top candidate gene was the immune T-cell mediator ZEB2; and others highly ranked candidates included the regulator of natural killer cell functional competence SH2D1B; VWA8, which contains a domain of the Von Willebrand factor A involved in the pediatric hemostasis disease; and human leukocyte antigen complex member HLA-DRB1; in addition to pro-inflammatory genes such as CUL2 and AIM2. The identified loci were used to construct a DNA methylation profile (EPIMISC) that was associated with MIS-C in both cohorts. The EPIMISC signature was also overrepresented in Kawasaki disease patients, a childhood pathology with a possible viral trigger, that shares many of the clinical features of MIS-C. INTERPRETATION We have characterized DNA methylation loci that are associated with MIS-C diagnosis. The identified genes are likely contributors to the characteristic exaggerated host inflammatory response observed in these patients. The described epigenetic signature could also provide new targets for more specific therapies for the disorder. FUNDING Unstoppable campaign of Josep Carreras Leukaemia Foundation, Fundació La Marató de TV3, Cellex Foundation and CERCA Programme/Generalitat de Catalunya.
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Affiliation(s)
- Veronica Davalos
- Josep Carreras Leukaemia Research Institute (IJC), Badalona, Barcelona, Catalonia, Spain
| | - Carlos A. García-Prieto
- Josep Carreras Leukaemia Research Institute (IJC), Badalona, Barcelona, Catalonia, Spain
- Life Sciences Department, Barcelona Supercomputing Center (BSC), Barcelona, Catalonia, Spain
| | - Gerardo Ferrer
- Josep Carreras Leukaemia Research Institute (IJC), Badalona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Cancer (CIBERONC), Spain
| | | | | | - Agustí Rodríguez-Palmero
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain
- Germans Trias i Pujol Research Institute (IGTP), Universitat Autònoma de Barcelona (UAB), Badalona, Barcelona, Spain
| | - Montserrat Ruiz
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain
| | - Laura Planas-Serra
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain
| | - Iolanda Jordan
- Pediatric Critical Care Unit, Hospital Universitari Sant Joan de Deu, Barcelona, Catalonia, Spain
| | | | | | - Verónica Cantarín
- Pediatrics Department, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Victoria Fumadó
- Unitat de Malalties Infeccioses i Importades, Servei de Pediatría, Infectious and Imported Diseases, Pediatric Unit, Hospital Universitari Sant Joan de Deú, Barcelona, Catalonia, Spain
| | - Maria Teresa Viadero
- Servicio de Pediatría del Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Carlos Rodrigo
- Germans Trias i Pujol Research Institute (IGTP), Universitat Autònoma de Barcelona (UAB), Badalona, Barcelona, Spain
| | - Maria Méndez-Hernández
- Germans Trias i Pujol Research Institute (IGTP), Universitat Autònoma de Barcelona (UAB), Badalona, Barcelona, Spain
| | - Eduardo López-Granados
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain
- Department of Immunology, La Paz University Hospital, Madrid, Spain; La Paz Institute of Biomedical Research, Madrid, Spain
| | - Roger Colobran
- Immunology Division, Department of Clinical and Molecular Genetics, Hospital Universitari Vall d'Hebron (HUVH), Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Jacques G. Rivière
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron (HUVH), Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron (HUVH), Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Aurora Pujol
- Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Catalonia, Spain
- Corresponding author at: Neurometabolic Diseases Laboratory, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08908 Barcelona, Catalonia, Spain.
| | - Manel Esteller
- Josep Carreras Leukaemia Research Institute (IJC), Badalona, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red de Cancer (CIBERONC), Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Catalonia, Spain
- Physiological Sciences Department, School of Medicine and Health Sciences, University of Barcelona (UB), Catalonia, Spain
- Corresponding author at: Josep Carreras Leukaemia Research Institute (IJC), Carretera de Can Ruti, Camí de les Escoles s/n, 08916 Badalona, Barcelona, Catalonia, Spain.
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9
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Bravo García-Morato M, Padilla-Merlano B, Matas Pérez E, Shephard JLV, Marhuenda ÁR, Santos Simarro F, López-Granados E, Pena RR. Hypomorphic Variant in TRNT1 Induces a Milder Autoinflammatory Disease with Congenital Cataracts and Impaired Sexual Development. Rheumatology (Oxford) 2021; 61:e114-e116. [PMID: 34864912 DOI: 10.1093/rheumatology/keab903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/12/2021] [Accepted: 11/05/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- María Bravo García-Morato
- Department of Clinical Immunology, La Paz University Hospital, Madrid, Spain.,Lymphocyte Pathophysiology Group, La Paz Institute of Biomedical Research, IdiPAZ.,Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain
| | | | | | | | - Ángel Robles Marhuenda
- Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain.,Department of Internal Medicine, La Paz University Hospital, Madrid, Spain
| | - Fernando Santos Simarro
- Clinical Genetics Section, Institute of Medical and Molecular Genetics (INGEMM), La Paz University Hospital, La Paz Institute of Biomedical Research, IdiPAZ, Madrid, Spain
| | - Eduardo López-Granados
- Department of Clinical Immunology, La Paz University Hospital, Madrid, Spain.,Lymphocyte Pathophysiology Group, La Paz Institute of Biomedical Research, IdiPAZ.,Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain
| | - Rebeca Rodríguez Pena
- Department of Clinical Immunology, La Paz University Hospital, Madrid, Spain.,Lymphocyte Pathophysiology Group, La Paz Institute of Biomedical Research, IdiPAZ.,Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain
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10
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Cordero E, Goycochea-Valdivia W, Mendez-Echevarria A, Allende LM, Alsina L, Bravo García-Morato M, Gil-Herrera J, Gudiol C, Len-Abad O, López-Medrano F, Moreno-Pérez D, Muñoz P, Olbrich P, Sánchez-Ramón S, Soler-Palacín P, Aguilera Cros C, Arostegui JI, Badell Serra I, Carbone J, Fortún J, Gonzalez-Granado LI, López-Granados E, Lucena JM, Parody R, Ramakers J, Regueiro JR, Rivière JG, Roca-Oporto C, Rodríguez Pena R, Santos-Pérez JL, Rodríguez-Gallego C, Neth O. Executive Summary of the Consensus Document on the Diagnosis and Management of Patients with Primary Immunodeficiencies. Enferm Infecc Microbiol Clin 2021; 38:438-443. [PMID: 33161954 DOI: 10.1016/j.eimc.2020.07.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/01/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Abstract
Primary immunodeficiencies (PIDs) are rare, undiagnosed and potentially fatal diseases. Clinical manifestations of PID can be fatal or leave sequelae that worsen the quality of life of patients. Traditionally, the treatment of PIDs has been largely supportive, with the exception of bone marrow transplantation and, more recently, gene therapy. The discovering of new affected pathways, the development of new molecules and biologics, and the increasing understanding of the molecular basis of these disorders have created opportunities in PIDs therapy. This document aims to review current knowledge and to provide recommendations about the diagnosis and clinical management of adults and children with PIDs based on the available scientific evidence taking in to account current practice and future challenges. A systematic review was conducted, and evidence levels based on the available literature are given for each recommendation where available.
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Affiliation(s)
- Elisa Cordero
- Clinical Unit of Infectious Diseases University Hospital Virgen del Rocio, Institute of Biomedicine, CSIC, University of Seville, Seville, Spain; Department of Medicine, University of Seville, Seville, Spain.
| | - Walter Goycochea-Valdivia
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, University Hospital Virgen del Rocio, Institute of Biomedicine, Seville, Spain
| | - Ana Mendez-Echevarria
- Servicio de Pediatría y Enfermedades Infecciosas, Hospital Universitario La Paz, Madrid, Spain
| | - Luis M Allende
- Servicio de Inmunología, Hospital Universitario 12 de Octubre, Instituto de Investigación i+12, Universidad Complutense de Madrid, Madrid, Spain
| | - Laia Alsina
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Institut de Recerca Sant Joan de Déu, Clinical Immunology Unit Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - Maria Bravo García-Morato
- Servicio de Inmunología, Hospital Universitario La Paz, Instituto de Investigación Biomédica del Hospital La Paz (IdiPAZ), Centro de Investigación en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Juana Gil-Herrera
- Department of Immunology, Hospital General Universitario and Health Research Institute Gregorio Marañón, School of Medicine, Univerisdad Complutense, Madrid, Spain
| | - Carlota Gudiol
- Infectious Diseases Department, Hospital Universitari de Bellvitge and Institut Català d'Oncologia (ICO), Hospital Duran i Reynals, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Oscar Len-Abad
- Infectious Diseases Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Francisco López-Medrano
- Infectious Diseases University Unit, Hospital 12 de Octubre, Instituto de Investigación Biomédica i+12, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - David Moreno-Pérez
- Pediatric Infectology and Immunodeficiencies Unit, Department of Pediatrics, Hospital Regional Universitario de Málaga, IBIMA, RECLIP, University of Malaga, Málaga, Spain
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Peter Olbrich
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, University Hospital Virgen del Rocio, Institute of Biomedicine, Seville, Spain
| | - Silvia Sánchez-Ramón
- Department of Immunology, IML and IdSSC, Hospital Clínico San Carlos, Madrid, Spain
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona (UAB), Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain
| | - Clara Aguilera Cros
- Department of Rheumatology, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Juan Ignacio Arostegui
- Department of Immunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Isabel Badell Serra
- Unidad de Hematología, Oncología y Trasplante Hematopoyético, Servicio de Pediatría, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier Carbone
- Servicio de Inmunología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jesús Fortún
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Luis I Gonzalez-Granado
- Primary Immunodeficiencies Unit, Pediatrics, Hospital 12 de Octubre, Research Institute Hospital 12 octubre (i+12), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Eduardo López-Granados
- Servicio de Inmunología, Instituto de Investigación Biomédica del Hospital La Paz (IdiPAZ), Hospital Universitario La Paz, Centro de Investigación en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | | | - Rocío Parody
- Servicio de Hematología Clínica, Institut Català d'Oncologia H. Duran i Reynals, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jan Ramakers
- Department of Pediatrics, Pediatric Rheumatology and Immunology, Son Espases University Hospital, Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - José R Regueiro
- Department of Immunology, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Jacques G Rivière
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona (UAB), Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain
| | - Cristina Roca-Oporto
- Clinical Unit of Infectious Diseases University Hospital Virgen del Rocio, Institute of Biomedicine, CSIC, University of Seville, Seville, Spain
| | - Rebeca Rodríguez Pena
- Servicio de Inmunología, Instituto de Investigación Biomédica del Hospital La Paz (IdiPAZ), Hospital Universitario La Paz, Centro de Investigación en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Juan Luis Santos-Pérez
- Infectious Diseases and Immunodeficiencies Unit, Service of Pediatrics, University Hospital Virgen de las Nieves, Granada, Spain
| | - Carlos Rodríguez-Gallego
- Department of Immunology, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain; University Fernando Pessoa Canarias, Las Palmas de Gran Canaria, Spain.
| | - Olaf Neth
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, University Hospital Virgen del Rocio, Institute of Biomedicine, Seville, Spain
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11
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Matas Pérez E, Valdivieso Shephard JL, Bravo García-Morato M, Robles Marhuenda Á, Martinez-Ojinaga Nodal E, Prieto Bozano G, González Casado I, Salamanca Fresno L, Méndez Echevarria A, Del Rosal Rabes T, Allende Martínez L, López-Granados E, Rodríguez Pena R. Variants in CASP10, a diagnostic challenge: Single center experience and review of the literature. Clin Immunol 2021; 230:108812. [PMID: 34329798 DOI: 10.1016/j.clim.2021.108812] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/21/2021] [Accepted: 07/25/2021] [Indexed: 11/27/2022]
Abstract
Autoimmune lymphoproliferative syndrome is a primary immunodeficiency caused by variants in FAS-mediated apoptosis related genes and is characterized by lymphadenopathy, splenomegaly and autoimmunity. A total of six different variants in CASP10 have been described as potential causative of disease, although two of them have recently been considered polymorphisms. The high allele frequency of these variants in healthy population in addition to the broad clinical spectrum of the disease difficult the interpretation of their pathogenicity. Here, we describe the clinical and analytical findings of three new patients carrying variants in CASP10 and summarize 12 more cases from the literature. Autoimmune cytopenias, adenopathies and increment of TCRαβ+CD4-CD8- cells have been the most common findings, being possibly the FAS-mediated apoptosis pathway the pathogenic mechanism of this disease. The clinical impact and the consequences of CASP10 variants are not fully elucidated, therefore the description of new cases will contribute to solve this issue.
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Affiliation(s)
| | | | - María Bravo García-Morato
- Department of Immunology, La Paz University Hospital, Madrid, Spain; Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain; La Paz Institute of Biomedical Research, Madrid, Spain.
| | - Ángel Robles Marhuenda
- Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain; La Paz Institute of Biomedical Research, Madrid, Spain; Department of Internal Medicine, La Paz University Hospital, Madrid, Spain.
| | | | - Gerardo Prieto Bozano
- Department of Pediatric Gastroenterology, La Paz University Hospital, Madrid, Spain.
| | | | | | - Ana Méndez Echevarria
- Department of Pediatric Infectious Diseases, La Paz University Hospital, Madrid, Spain.
| | | | - Luis Allende Martínez
- Department of Immunology, 12 de Octubre University Hospital, Madrid, Spain; Research Institute Hospital 12 Octubre (I+12), Madrid, Spain.
| | - Eduardo López-Granados
- Department of Immunology, La Paz University Hospital, Madrid, Spain; Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain; La Paz Institute of Biomedical Research, Madrid, Spain.
| | - Rebeca Rodríguez Pena
- Department of Immunology, La Paz University Hospital, Madrid, Spain; Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain; La Paz Institute of Biomedical Research, Madrid, Spain.
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12
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Ramos-Ruperto L, Busca-Arenzana C, Valdivieso J, López-Granados E, Robles-Marhuenda Á. COVID-19 and Pembrolizumab-Induced Secondary Hemophagocytic Lymphohistiocytosis: a Case Report. SN Compr Clin Med 2021; 3:1412-1415. [PMID: 33824942 PMCID: PMC8017431 DOI: 10.1007/s42399-021-00882-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 01/19/2023]
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13
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Valdivieso Shephard JL, Plasencia Rodríguez C, Suárez Ferrer C, Peiteado López D, Balsa Criado A, López-Granados E, Bravo García-Morato M. Colitis expands the phenotype of PAAND patients: new case report and review of the literature. Rheumatology (Oxford) 2021; 60:keab215. [PMID: 33829260 DOI: 10.1093/rheumatology/keab215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/30/2021] [Accepted: 02/16/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | | | - Eduardo López-Granados
- Department of Immunology
- Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain
| | - María Bravo García-Morato
- Department of Immunology
- Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain
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14
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Rodríguez-Rubio M, Menéndez-Suso JJ, Cámara-Hijón C, Río-García M, Laplaza-González M, Amores-Hernández I, Romero-Gómez MP, Álvarez-Rojas E, Salas-Mera D, López-Granados E, de la Oliva P. Cytokine Profile in Children with Severe Multisystem Inflammatory Syndrome Related to the Coronavirus Disease 2019. J Pediatr Intensive Care 2021; 11:259-264. [DOI: 10.1055/s-0041-1724101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/07/2021] [Indexed: 10/22/2022] Open
Abstract
AbstractThe multisystem inflammatory syndrome in children (MIS-C) is a novel and concerning entity related to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. Although MIS-C has been the subject of intensive research efforts, its pathophysiology and optimal treatment remain elusive. We studied the clinical features, laboratory findings, and immunoinflammatory profiles of seven children prospectively admitted to a pediatric intensive care unit (PICU) during the first wave of the pandemic. All patients had immunoglobulin (Ig)-G against SARS-CoV-2, four of seven patients had both IgM and IgG, and in one of the 7 SARS-CoV-2 was detected in a respiratory sample. All patients received intravenous fluid boluses (median: 15 mL/kg) and norepinephrine. The most common form of respiratory support was supplemental oxygen via nasal cannula. None of the patients needed mechanical ventilation. The cardiovascular system was frequently involved. All patients had an elevated troponin-I (median: 107.3 ng/L). Four out of seven patients had coronary artery abnormalities, and two of seven had both abnormal electrocardiogram (EKG) findings and evidence of left ventricular dysfunction on echocardiogram. Ig levels and complement function were normal. Peripheral blood phenotyping with flow cytometry showed decreased T-cell numbers at the expense of CD8+ T-cells. Cytokine profiling showed a heterogeneous increase in interleukin (IL)-6, tumor necrosis factor (TNF)-α, interferon (IFN)-γ, IL-18, IL-2Ra, IL-10, and IL-1Ra that tended to normalize after treatment. Our study shows that children with MIS-C have elevated plasma levels of pro- and anti-inflammatory cytokines in the acute phase of the disease without other relevant immunologic disturbances. These findings suggest the presence of a mixed antagonist response syndrome (MARS) similar to that present in pediatric sepsis. Combining a meticulous differential diagnosis with cautiously coordinated immunomodulatory therapy and high-quality supportive care can help clinicians avoid causing iatrogenic harm in patients with MIS-C.
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Affiliation(s)
- Miguel Rodríguez-Rubio
- Department of Pediatric Intensive Care, Hospital Universitario La Paz, Madrid, Spain
- Department of Pediatrics, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Juan J. Menéndez-Suso
- Department of Pediatric Intensive Care, Hospital Universitario La Paz, Madrid, Spain
- Department of Pediatrics, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Carmen Cámara-Hijón
- Department of Clinical Immunology, Hospital Universitario La Paz, Madrid, Spain
| | - Miguel Río-García
- Department of Pediatric Intensive Care, Hospital Universitario La Paz, Madrid, Spain
- Department of Pediatrics, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Laplaza-González
- Department of Pediatric Intensive Care, Hospital Universitario La Paz, Madrid, Spain
- Department of Pediatrics, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Irene Amores-Hernández
- Department of Pediatric Intensive Care, Hospital Universitario La Paz, Madrid, Spain
- Department of Pediatrics, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Elena Álvarez-Rojas
- Department of Pediatric Intensive Care, Hospital Universitario La Paz, Madrid, Spain
- Department of Pediatrics, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Diana Salas-Mera
- Department Pediatric Cardiology, Hospital Universitario La Paz, Madrid, Spain
| | - Eduardo López-Granados
- Department of Clinical Immunology, Hospital Universitario La Paz, Madrid, Spain
- Lymphocyte Pathophysiology Group, La Paz Biomedical Research Institute (IdiPAZ), Madrid, Spain
- Rare Disease Network Research Center (CIBERER)
| | - Pedro de la Oliva
- Department of Pediatric Intensive Care, Hospital Universitario La Paz, Madrid, Spain
- Department of Pediatrics, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
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15
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Del Pino-Molina L, López-Granados E, Lecrevisse Q, Torres Canizales J, Pérez-Andrés M, Blanco E, Wentink M, Bonroy C, Nechvatalova J, Milota T, Kienzler AK, Philippé J, Sousa AE, van der Burg M, Kalina T, van Dongen JJM, Orfao A. Dissection of the Pre-Germinal Center B-Cell Maturation Pathway in Common Variable Immunodeficiency Based on Standardized Flow Cytometric EuroFlow Tools. Front Immunol 2021; 11:603972. [PMID: 33679693 PMCID: PMC7925888 DOI: 10.3389/fimmu.2020.603972] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/29/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction Common Variable Immunodeficiency (CVID) is characterized by defective antibody production and hypogammaglobulinemia. Flow cytometry immunophenotyping of blood lymphocytes has become of great relevance for the diagnosis and classification of CVID, due to an impaired differentiation of mature post-germinal-center (GC) class-switched memory B-cells (MBC) and severely decreased plasmablast/plasma cell (Pb) counts. Here, we investigated in detail the pre-GC B-cell maturation compartment in blood of CVID patients. Methods In this collaborative multicentric study the EuroFlow PID 8-color Pre-GC B-cell tube, standardized sample preparation procedures (SOPs) and innovative data analysis tools, were used to characterize the maturation profile of pre-GC B-cells in 100 CVID patients, vs 62 age-matched healthy donors (HD). Results The Pre-GC B-cell tube allowed identification within pre-GC B-cells of three subsets of maturation associated immature B-cells and three subpopulations of mature naïve B-lymphocytes. CVID patients showed overall reduced median absolute counts (vs HD) of the two more advanced stages of maturation of both CD5+ CD38+/++ CD21het CD24++ (2.7 vs 5.6 cells/µl, p=0.0004) and CD5+ CD38het CD21+ CD24+ (6.5 vs 17 cells/µl, p<0.0001) immature B cells (below normal HD levels in 22% and 37% of CVID patients). This was associated with an expansion of CD21-CD24- (6.1 vs 0.74 cells/µl, p<0.0001) and CD21-CD24++ (1.8 vs 0.4 cells/µl, p<0.0001) naïve B-cell counts above normal values in 73% and 94% cases, respectively. Additionally, reduced IgMD+ (21 vs 32 cells/µl, p=0.03) and IgMD- (4 vs 35 cells/µl, p<0.0001) MBC counts were found to be below normal values in 25% and 77% of CVID patients, respectively, always together with severely reduced/undetectable circulating blood pb. Comparison of the maturation pathway profile of pre-GC B cells in blood of CVID patients vs HD using EuroFlow software tools showed systematically altered patterns in CVID. These consisted of: i) a normally-appearing maturation pathway with altered levels of expression of >1 (CD38, CD5, CD19, CD21, CD24, and/or smIgM) phenotypic marker (57/88 patients; 65%) for a total of 3 distinct CVID patient profiles (group 1: 42/88 patients, 48%; group 2: 8/88, 9%; and group 3: 7/88, 8%) and ii) CVID patients with a clearly altered pre-GC B cell maturation pathway in blood (group 4: 31/88 cases, 35%). Conclusion Our results show that maturation of pre-GC B-cells in blood of CVID is systematically altered with up to four distinctly altered maturation profiles. Further studies, are necessary to better understand the impact of such alterations on the post-GC defects and the clinical heterogeneity of CVID.
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Affiliation(s)
- Lucía Del Pino-Molina
- Clinical Immunology Department, La Paz University Hospital and Lymphocyte Pathophysiology in Immunodeficiencies Group, La Paz Institute for Health Research (IdiPAZ) and Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain
| | - Eduardo López-Granados
- Clinical Immunology Department, La Paz University Hospital and Lymphocyte Pathophysiology in Immunodeficiencies Group, La Paz Institute for Health Research (IdiPAZ) and Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain
| | - Quentin Lecrevisse
- Clinical and Translation Research Program, Cancer Research Centre (IBMCC, USAL-CSIC), Department of Medicine, Cytometry Service (NUCLEUS), University of Salamanca (USAL), Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Biomedical Research Networking Centre Consortium of Oncology (CIBERONC) Instituto de salud Carlos III, Madrid, Spain
| | - Juan Torres Canizales
- Clinical Immunology Department, La Paz University Hospital and Lymphocyte Pathophysiology in Immunodeficiencies Group, La Paz Institute for Health Research (IdiPAZ) and Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain
| | - Martín Pérez-Andrés
- Clinical and Translation Research Program, Cancer Research Centre (IBMCC, USAL-CSIC), Department of Medicine, Cytometry Service (NUCLEUS), University of Salamanca (USAL), Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Biomedical Research Networking Centre Consortium of Oncology (CIBERONC) Instituto de salud Carlos III, Madrid, Spain
| | - Elena Blanco
- Clinical and Translation Research Program, Cancer Research Centre (IBMCC, USAL-CSIC), Department of Medicine, Cytometry Service (NUCLEUS), University of Salamanca (USAL), Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Biomedical Research Networking Centre Consortium of Oncology (CIBERONC) Instituto de salud Carlos III, Madrid, Spain
| | - Marjolein Wentink
- Department of Immunology, Erasmus University Medical Center (Erasmus MC), Rotterdam, Netherlands
| | - Carolien Bonroy
- Department of Laboratory Medicine, University Hospital Ghent, Ghent, Belgium
| | - Jana Nechvatalova
- Department of Allergology and Clinical Immunology, Faculty of Medicine, Masaryk University and St Anne's University Hospital in Brno, Brno, Czechia
| | - Tomas Milota
- Department of Immunology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czechia
| | - Anne-Kathrin Kienzler
- Nuffield Department of Medicine, Experimental Medicine Division, University of Oxford, Oxford, United Kingdom
| | - Jan Philippé
- Department of Laboratory Medicine, University Hospital Ghent, Ghent, Belgium
| | - Ana E Sousa
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Mirjam van der Burg
- Department of Pediatrics, Laboratory for Immunology, Leiden University Medical Center, Leiden, Netherlands
| | - Tomas Kalina
- CLIP - Childhood Leukemia Investigation Prague, Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Jacques J M van Dongen
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Alberto Orfao
- Clinical and Translation Research Program, Cancer Research Centre (IBMCC, USAL-CSIC), Department of Medicine, Cytometry Service (NUCLEUS), University of Salamanca (USAL), Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Biomedical Research Networking Centre Consortium of Oncology (CIBERONC) Instituto de salud Carlos III, Madrid, Spain
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16
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Alonso L, Méndez-Echevarría A, Rudilla F, Mozo Y, Soler-Palacin P, Sisinni L, Bueno D, Riviere J, de Paz R, Sánchez-Zapardiel E, Querol S, Rodriguez-Pena R, López-Granados E, Gimeno R, Díaz de Heredia C, Pérez-Martínez A. Failure of Viral-Specific T Cells Administered in Pre-transplant Settings in Children with Inborn Errors of Immunity. J Clin Immunol 2021; 41:748-755. [PMID: 33462728 DOI: 10.1007/s10875-020-00961-w] [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: 05/17/2020] [Accepted: 12/29/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Use of adoptive immunotherapy with virus-specific T cells (VST) in patients with inborn errors of immunity prior to hematopoietic stem cell transplantation (HSCT) has been reported in few patients. We report our experience, reviewing all the cases previously reported. METHODS We report four children with inborn errors of immunity who received VST infusion in a pre-HSCT setting in two reference centers in Spain and review all inborn errors of immunity cases previously reported. RESULTS Taking into account our four cases, nine children have been reported to receive VST prior to HSCT to date: 3 severe combined immunodeficiency, 2 CTPS1 deficiency, 1 dyskeratosis congenital, 1 ORAI1 deficiency, 1 Rothmund-Thomson syndrome, and 1 combined immunodeficiency without confirmed genetic defect. In four patients, immunotherapy resulted in clinical improvement, allowing to proceed to HSCT. In these cases, the infusion was started closely to viral diagnosis [mean time 28 days (IQR; 17-52 days)], and the VST was followed shortly thereafter by HSCT [mean time 28 days (IQR; 10-99 days)]. Viremia was controlled after HSCT in two cases (performed 7 and 36 days after the infusion). Multiple infusions were required in many cases. Five out of nine patients died before receiving HSCT. These patients presented with a prolonged and uncontrolled infection before VST administration [mean time from viral diagnosis to VST infusion was 176 days (IQR; 54-1687)]. CONCLUSIONS In patients with inborn errors of immunity, the efficacy of VST for treating disseminated viral infections in pre-transplant settings seems to have a limited efficacy. However, this therapy could be used in a pre-emptive setting before severe viral disease occurs or closely to HSCT.
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Affiliation(s)
- Laura Alonso
- HSCT Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Ana Méndez-Echevarría
- Paediatric Infectious Diseases Department, La Paz University Hospital, Madrid, Spain. .,Translational Research Network in Pediatric Infectious Diseases (RITIP), Paseo de la Castellana 261, 28046, Madrid, Spain.
| | - Francesc Rudilla
- Immunogenetics and Histocompatibility Laboratory, Banc de Sang i Teixits, Barcelona, Spain
| | - Yasmina Mozo
- Paediatric Hemato-Oncology Department, La Paz University Hospital, Madrid, Spain.,Translational Research in Pediatric Oncology, Hematopoietic Transplantation and Cell Therapy, La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Pere Soler-Palacin
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron Research Institute, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Jeffrey Model Foundation Excellence Center, Barcelona, Spain
| | - Luisa Sisinni
- Paediatric Hemato-Oncology Department, La Paz University Hospital, Madrid, Spain.,Translational Research in Pediatric Oncology, Hematopoietic Transplantation and Cell Therapy, La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - David Bueno
- Paediatric Hemato-Oncology Department, La Paz University Hospital, Madrid, Spain.,Translational Research in Pediatric Oncology, Hematopoietic Transplantation and Cell Therapy, La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Jacques Riviere
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron Research Institute, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Jeffrey Model Foundation Excellence Center, Barcelona, Spain
| | - Raquel de Paz
- Hematology Department, La Paz University Hospital, Madrid, Spain
| | - Elena Sánchez-Zapardiel
- Immunology Department, La Paz University Hospital, Madrid, Spain.,IdiPAZ Institute for Health Research, Madrid, Spain
| | - Sergi Querol
- Cellular Therapy Unit, Cord Blood Bank, Centre Frederic Duran i Jordà, Barcelona, Spain
| | - Rebeca Rodriguez-Pena
- Immunology Department, La Paz University Hospital, Madrid, Spain.,IdiPAZ Institute for Health Research, Madrid, Spain
| | - Eduardo López-Granados
- Immunology Department, La Paz University Hospital, Madrid, Spain.,IdiPAZ Institute for Health Research, Madrid, Spain
| | - Ramón Gimeno
- Laboratory of Immunology, Department of Pathology, Hospital del Mar, Barcelona, Spain
| | | | - Antonio Pérez-Martínez
- Paediatric Hemato-Oncology Department, La Paz University Hospital, Madrid, Spain.,Translational Research in Pediatric Oncology, Hematopoietic Transplantation and Cell Therapy, La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
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17
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Colmenero-Velázquez A, Esteso G, Del Rosal T, Calvo Apalategui A, Reyburn H, López-Granados E. Marked changes in innate immunity associated with a mild course of COVID-19 in identical twins with athymia and absent circulating T cells. J Allergy Clin Immunol 2020; 147:567-568. [PMID: 33309039 PMCID: PMC7713636 DOI: 10.1016/j.jaci.2020.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/08/2020] [Accepted: 11/12/2020] [Indexed: 11/18/2022]
Affiliation(s)
| | - Gloria Esteso
- Department of Immunology and Oncology, CNB-CSIC, Madrid, Spain
| | - Teresa Del Rosal
- Pediatric Infectious Diseases Department, La Paz University Hospital, Madrid, Spain; Pediatric Respiratory, Systemic and Neurological Infections & Host Immune Response Group, La Paz Institute of Biomedical Research, IdiPAZ, Madrid, Spain; Rare Disease Network Research Center (CIBERER U767), Madrid, Spain
| | | | - Hugh Reyburn
- Department of Immunology and Oncology, CNB-CSIC, Madrid, Spain
| | - Eduardo López-Granados
- Department of Immunology, La Paz University Hospital, Madrid, Spain; Rare Disease Network Research Center (CIBERER U767), Madrid, Spain; Lymphocyte Pathophysiology Group, La Paz Institute of Biomedical Research, IdiPAZ, Madrid, Spain.
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18
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Martin Saborido C, Borobia AM, Cobas J, D'Antiga L, Frauca E, Hernández-Oliveros F, Jara P, López-Granados E, Muñoz JM, Nicastro E, Ojeda JJ, Pérez-Martínez A, Torres JM, Carcas A. Effectiveness of immunosuppression minimisation, conversion or withdrawal strategies in paediatric solid organ and haematopoietic stem cell transplantation: a protocol of a systematic review and meta-analysis. BMJ Open 2020; 10:e037721. [PMID: 33273046 PMCID: PMC7716658 DOI: 10.1136/bmjopen-2020-037721] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Paediatric transplantation is the only curative therapeutic procedure for several end-stage rare diseases affecting different organs and body systems, causing altogether great impact in European children's health and quality of life. Transplanted children shift their primary disease to a chronic condition of immunosuppression to avoid rejection. Longer life expectancy in children poses a greater risk of prolonged and severe side effects related to long-term immunosuppressive (IS) disabilities and secondary cancer susceptibility. The goal remains to find the best combination of IS agents that optimises allograft survival by preventing acute rejection while limiting drug toxicities. This systematic review will aim to determine the optimal IS strategy within the so-called minimisation, conversion or withdrawal strategies. METHODS AND ANALYSIS We will search the following databases with no language restrictions: Cochrane Central Register of Controlled Trials in the Cochrane Library, OvidSP Medline and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily; OvidSP Embase Classic+Embase; Ebsco CINAHL Plus, complete database; WHO International Clinical Trials Registry Platform search portal. We will include controlled and uncontrolled clinical trials along with any prospective or retrospective study that includes a universal cohort (all participants from a centre/region/city over a certain period). Cases series and cross-sectional studies are excluded. Two review authors will independently assess the trial eligibility, risk of bias and extract appropriate data points. The outcomes included in this review are: patient survival, acute graft rejection, chronic graft rejection, diabetes, graft function, graft loss, chronic graft versus host disease, acute graft versus host disease, surgical complications, infusion complications, post-transplant lymphoproliferative disease, liver function, renal function, cognition, depression, health-related quality of life, hospitalisation, high blood pressure, low blood pressure, cancer-other, cancer-skin, cardiovascular disease, bacterial infection, Epstein-Barr infection, cytomegalovirus infection, other viral infections and growth.
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Affiliation(s)
- Carlos Martin Saborido
- Institute for Health Research (IdiPAZ), La Paz University Hospital Biomedical Research Foundation, Madrid, Spain
| | - Alberto M Borobia
- Clinical Pharmacology Department, Hospital Universitario La Paz, Madrid, Spain
- Pharmacology Department, Autonomous University of Madrid, Madrid, Spain
| | - Javier Cobas
- Children's Hospital Manager, La Paz University Hospital, Madrid, Spain
| | - Lorenzo D'Antiga
- Centre for Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Esteban Frauca
- Department of Pediatric Hepatology, La Paz University Hospital, Madrid, Spain
| | | | - Paloma Jara
- Department of Pediatric Hepatology, La Paz University Hospital, Madrid, Spain
| | | | - Jose María Muñoz
- General Hospital Medical Director, La Paz University Hospital, Madrid, Spain
| | - Emanuele Nicastro
- Centre for Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Juan Manuel Torres
- Institute for Health Research (IdiPAZ), La Paz University Hospital Biomedical Research Foundation, Madrid, Spain
| | - Antonio Carcas
- Clinical Pharmacology Department, Hospital Universitario La Paz, Madrid, Spain
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19
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Martínez-Fleta P, Alfranca A, González-Álvaro I, Casasnovas JM, Fernández-Soto D, Esteso G, Cáceres-Martell Y, Gardeta S, López-Sanz C, Prat S, Mateu-Albero T, Gabrie L, López-Granados E, Sánchez-Madrid F, Reyburn HT, Rodríguez Frade JM, Valés-Gómez M. SARS-CoV-2 Cysteine-like Protease Antibodies Can Be Detected in Serum and Saliva of COVID-19-Seropositive Individuals. J Immunol 2020; 205:3130-3140. [PMID: 33148714 DOI: 10.4049/jimmunol.2000842] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/29/2020] [Indexed: 11/19/2022]
Abstract
Currently, there is a need for reliable tests that allow identification of individuals that have been infected with SARS-CoV-2 even if the infection was asymptomatic. To date, the vast majority of the serological tests for SARS-CoV-2-specific Abs are based on serum detection of Abs to either the viral spike glycoprotein (the major target for neutralizing Abs) or the viral nucleocapsid protein that is known to be highly immunogenic in other coronaviruses. Conceivably, exposure of Ags released from infected cells could stimulate Ab responses that might correlate with tissue damage and, hence, they may have some value as a prognostic indicator. We addressed whether other nonstructural viral proteins, not incorporated into the infectious viral particle, specifically the viral cysteine-like protease, might also be potent immunogens. Using ELISA tests, coating several SARS-CoV-2 proteins produced in vitro, we describe that COVID-19 patients make high titer IgG, IgM, and IgA Ab responses to the Cys-like protease from SARS-CoV-2, also known as 3CLpro or Mpro, and it can be used to identify individuals with positive serology against the coronavirus. Higher Ab titers in these assays associated with more-severe disease, and no cross-reactive Abs against prior betacoronavirus were found. Remarkably, IgG Abs specific for Mpro and other SARS-CoV-2 Ags can also be detected in saliva. In conclusion, Mpro is a potent Ag in infected patients that can be used in serological tests, and its detection in saliva could be the basis for a rapid, noninvasive test for COVID-19 seropositivity.
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Affiliation(s)
- Pedro Martínez-Fleta
- Immunology Department, University Teaching Hospital "La Princesa," La Princesa Health Research Institute, Madrid 28006, Spain
| | - Arantzazu Alfranca
- Immunology Department, University Teaching Hospital "La Princesa," La Princesa Health Research Institute, Madrid 28006, Spain.,Cardiovascular Centre for Biomedical Research Network, Health Institute Carlos III, Madrid 28029, Spain
| | - Isidoro González-Álvaro
- Immunology Department, University Teaching Hospital "La Princesa," La Princesa Health Research Institute, Madrid 28006, Spain.,Rheumatology Department, University Teaching Hospital "La Princesa," Madrid 28006, Spain
| | - Jose M Casasnovas
- Department of Macromolecular Structures, National Centre for Biotechnology-Spanish National Research Council, Madrid 28049, Spain
| | - Daniel Fernández-Soto
- Department of Immunology and Oncology, National Centre for Biotechnology, National Centre for Biotechnology-Spanish National Research Council, Madrid 28049, Spain; and
| | - Gloria Esteso
- Department of Immunology and Oncology, National Centre for Biotechnology, National Centre for Biotechnology-Spanish National Research Council, Madrid 28049, Spain; and
| | - Yaiza Cáceres-Martell
- Department of Immunology and Oncology, National Centre for Biotechnology, National Centre for Biotechnology-Spanish National Research Council, Madrid 28049, Spain; and
| | - Sofía Gardeta
- Department of Immunology and Oncology, National Centre for Biotechnology, National Centre for Biotechnology-Spanish National Research Council, Madrid 28049, Spain; and
| | - Celia López-Sanz
- Immunology Department, University Teaching Hospital "La Princesa," La Princesa Health Research Institute, Madrid 28006, Spain
| | - Salomé Prat
- Department of Macromolecular Structures, National Centre for Biotechnology-Spanish National Research Council, Madrid 28049, Spain
| | - Tamara Mateu-Albero
- Immunology Department, University Teaching Hospital "La Princesa," La Princesa Health Research Institute, Madrid 28006, Spain
| | - Ligia Gabrie
- Immunology Department, University Teaching Hospital "La Princesa," La Princesa Health Research Institute, Madrid 28006, Spain
| | | | - Francisco Sánchez-Madrid
- Immunology Department, University Teaching Hospital "La Princesa," La Princesa Health Research Institute, Madrid 28006, Spain.,Cardiovascular Centre for Biomedical Research Network, Health Institute Carlos III, Madrid 28029, Spain
| | - Hugh T Reyburn
- Department of Immunology and Oncology, National Centre for Biotechnology, National Centre for Biotechnology-Spanish National Research Council, Madrid 28049, Spain; and
| | - José M Rodríguez Frade
- Department of Immunology and Oncology, National Centre for Biotechnology, National Centre for Biotechnology-Spanish National Research Council, Madrid 28049, Spain; and
| | - Mar Valés-Gómez
- Department of Immunology and Oncology, National Centre for Biotechnology, National Centre for Biotechnology-Spanish National Research Council, Madrid 28049, Spain; and
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20
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Cordero E, Goycochea-Valdivia W, Mendez-Echevarria A, Allende LM, Alsina L, Bravo García-Morato M, Gil-Herrera J, Gudiol C, Len-Abad O, López-Medrano F, Moreno-Pérez D, Muñoz P, Olbrich P, Sánchez-Ramón S, Soler-Palacín P, Aguilera Cros C, Arostegui JI, Badell Serra I, Carbone J, Fortún J, Gonzalez-Granado LI, López-Granados E, Lucena JM, Parody R, Ramakers J, Regueiro JR, Rivière JG, Roca-Oporto C, Rodríguez Pena R, Santos-Pérez JL, Rodríguez-Gallego C, Neth O. Executive Summary of the Consensus Document on the Diagnosis and Management of Patients with Primary Immunodeficiencies. J Allergy Clin Immunol Pract 2020; 8:3342-3347. [PMID: 33161963 DOI: 10.1016/j.jaip.2020.05.008] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 10/23/2022]
Abstract
Primary immunodeficiencies (PIDs) are rare, undiagnosed and potentially fatal diseases. Clinical manifestations of PID can be fatal or leave sequelae that worsen the quality of life of patients. Traditionally, the treatment of PIDs has been largely supportive, with the exception of bone marrow transplantation and, more recently, gene therapy. The discovering of new affected pathways, the development of new molecules and biologics, and the increasing understanding of the molecular basis of these disorders have created opportunities in PIDs therapy. This document aims to review current knowledge and to provide recommendations about the diagnosis and clinical management of adults and children with PIDs based on the available scientific evidence taking in to account current practice and future challenges. A systematic review was conducted, and evidence levels based on the available literature are given for each recommendation where available.
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Affiliation(s)
- Elisa Cordero
- Clinical Unit of Infectious Diseases University Hospital Virgen del Rocio, Institute of Biomedicine, CSIC, University of Seville, Seville, Spain; Department of Medicine, University of Seville, Seville, Spain.
| | - Walter Goycochea-Valdivia
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, University Hospital Virgen del Rocio, Institute of Biomedicine, Seville, Spain
| | - Ana Mendez-Echevarria
- Servicio de Pediatría y Enfermedades Infecciosas, Hospital Universitario La Paz, Madrid, Spain
| | - Luis M Allende
- Servicio de Inmunología, Hospital Universitario 12 de Octubre, Instituto de Investigación i+12, Universidad Complutense de Madrid, Madrid, Spain
| | - Laia Alsina
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Institut de Recerca Sant Joan de Déu, Clinical Immunology Unit Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - Maria Bravo García-Morato
- Servicio de Inmunología, Hospital Universitario La Paz, Instituto de Investigación Biomédica del Hospital La Paz (IdiPAZ), Centro de Investigación en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Juana Gil-Herrera
- Department of Immunology, Hospital General Universitario and Health Research Institute Gregorio Marañón, School of Medicine, Univerisdad Complutense, Madrid, Spain
| | - Carlota Gudiol
- Infectious Diseases Department, Hospital Universitari de Bellvitge and Institut Català d'Oncologia (ICO), Hospital Duran i Reynals, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Oscar Len-Abad
- Infectious Diseases Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Francisco López-Medrano
- Infectious Diseases University Unit, Hospital 12 de Octubre, Instituto de Investigación Biomédica i+12, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - David Moreno-Pérez
- Pediatric Infectology and Immunodeficiencies Unit, Department of Pediatrics, Hospital Regional Universitario de Málaga, IBIMA, RECLIP, University of Malaga, Málaga, Spain
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Peter Olbrich
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, University Hospital Virgen del Rocio, Institute of Biomedicine, Seville, Spain
| | - Silvia Sánchez-Ramón
- Department of Immunology, IML and IdSSC, Hospital Clínico San Carlos, Madrid, Spain
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona (UAB), Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain
| | - Clara Aguilera Cros
- Department of Rheumatology, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Juan Ignacio Arostegui
- Department of Immunology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Isabel Badell Serra
- Unidad de Hematología, Oncología y Trasplante Hematopoyético, Servicio de Pediatría, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier Carbone
- Servicio de Inmunología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jesús Fortún
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Luis I Gonzalez-Granado
- Primary Immunodeficiencies Unit, Pediatrics, Hospital 12 de Octubre, Research Institute Hospital 12 octubre (i+12), School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Eduardo López-Granados
- Servicio de Inmunología, Instituto de Investigación Biomédica del Hospital La Paz (IdiPAZ), Hospital Universitario La Paz, Centro de Investigación en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | | | - Rocío Parody
- Servicio de Hematología Clínica, Institut Català d'Oncologia H. Duran i Reynals, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jan Ramakers
- Department of Pediatrics, Pediatric Rheumatology and Immunology, Son Espases University Hospital, Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - José R Regueiro
- Department of Immunology, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Jacques G Rivière
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona (UAB), Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain
| | - Cristina Roca-Oporto
- Clinical Unit of Infectious Diseases University Hospital Virgen del Rocio, Institute of Biomedicine, CSIC, University of Seville, Seville, Spain
| | - Rebeca Rodríguez Pena
- Servicio de Inmunología, Instituto de Investigación Biomédica del Hospital La Paz (IdiPAZ), Hospital Universitario La Paz, Centro de Investigación en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Juan Luis Santos-Pérez
- Infectious Diseases and Immunodeficiencies Unit, Service of Pediatrics, University Hospital Virgen de las Nieves, Granada, Spain
| | - Carlos Rodríguez-Gallego
- Department of Immunology, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain; University Fernando Pessoa Canarias, Las Palmas de Gran Canaria, Spain.
| | - Olaf Neth
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, University Hospital Virgen del Rocio, Institute of Biomedicine, Seville, Spain
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21
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Feito-Rodríguez M, Mayor-Ibarguren A, Cámara-Hijón C, Montero-Vega D, Servera-Negre G, Ruiz-Bravo E, Nozal P, Rodríguez-Peralto JL, Enguita AB, Bravo-Gallego LY, Granados-Fernández M, Fernández-Alcalde C, Fernández-Heredero Á, Alonso-Riaño M, Jiménez-Yuste V, Nuño-González A, De Lucas-Laguna R, López-Granados E, Herranz-Pinto P. Chilblain-like lesions and COVID-19 infection: A prospective observational study at Spain's ground zero. J Am Acad Dermatol 2020; 84:507-509. [PMID: 33022305 PMCID: PMC7831642 DOI: 10.1016/j.jaad.2020.09.086] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 09/23/2020] [Accepted: 09/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Carmen Cámara-Hijón
- Department of Clinical Immunology, La Paz University Hospital, Madrid, Spain
| | | | | | - Elena Ruiz-Bravo
- Department of Pathology, La Paz University Hospital, Madrid, Spain
| | - Pilar Nozal
- Department of Clinical Immunology, La Paz University Hospital, Madrid, Spain
| | | | - Ana Belén Enguita
- Department of Pathology, Doce de Octubre University Hospital, Madrid, Spain
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22
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Bravo García-Morato M, Del Pino Molina L, Torres Canizales JM, Del Rosal Rabes T, Méndez Echevarría A, González Martínez B, López-Granados E, Rodríguez Pena R. A mutation in the promoter region of BTK causes atypical XLA. Heliyon 2020; 6:e04914. [PMID: 32995611 PMCID: PMC7501425 DOI: 10.1016/j.heliyon.2020.e04914] [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: 06/25/2020] [Revised: 07/28/2020] [Accepted: 09/08/2020] [Indexed: 11/30/2022] Open
Abstract
X-linked Agammaglobulinemia is a primary immunodeficiency caused by mutations in BTK, a tyrosine kinase essential for B lymphocytes differentiation. Patients usually have very low or absent B lymphocytes and are not able to develop humoral specific responses. Here we present a boy, diagnosed with XLA due to a mutation on the promoter region of the gene, whose phenotype is characterised by low percentage of B cells, hypogammaglobulinemia, oscillating neutropenia, antibodies responses to some antigens after vaccination and IgE-mediated allergy. Additional technology as flow cytometry was needed to demonstrate the pathological status of the variant. We focus on the idea that XLA should be suspected in males with B lymphopenia and hypogammaglobulinemia, even if they make humoral specific responses. We also highlight the importance of sequencing BTK's promoter region, as mutations on it can be disease-causing.
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Affiliation(s)
- María Bravo García-Morato
- Clinical Immunology Department, La Paz University Hospital and Lymphocyte Pathophysiology in Immunodeficiencies Group, La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain
| | - Lucía Del Pino Molina
- Clinical Immunology Department, La Paz University Hospital and Lymphocyte Pathophysiology in Immunodeficiencies Group, La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain
| | - Juan Manuel Torres Canizales
- Clinical Immunology Department, La Paz University Hospital and Lymphocyte Pathophysiology in Immunodeficiencies Group, La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain
| | - Teresa Del Rosal Rabes
- Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain.,Department of Pediatrics, La Paz University Hospital, Madrid, Spain
| | - Ana Méndez Echevarría
- Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain.,Department of Pediatrics, La Paz University Hospital, Madrid, Spain
| | | | - Eduardo López-Granados
- Clinical Immunology Department, La Paz University Hospital and Lymphocyte Pathophysiology in Immunodeficiencies Group, La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain
| | - Rebeca Rodríguez Pena
- Clinical Immunology Department, La Paz University Hospital and Lymphocyte Pathophysiology in Immunodeficiencies Group, La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Madrid, Spain
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23
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Robles-Marhuenda A, Álvarez-Troncoso J, Rodríguez-Pena R, Busca-Arenzana C, López-Granados E, Arnalich-Fernández F. Chronic granulomatous disease: Single-center Spanish experience. Clin Immunol 2020; 211:108323. [DOI: 10.1016/j.clim.2019.108323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 12/07/2019] [Indexed: 11/15/2022]
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24
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Pérez-Portilla A, Moraru M, Blázquez-Moreno A, Kolb P, Bravo García-Morato M, Ranganath T, Esteso G, Gianelli C, Rodríguez-Pena R, Lozano-Rodríguez R, Torres-Canizales JM, Blish CA, Vales-Gomez M, Hengel H, Vilches C, López-Granados E, Reyburn HT. Identification of the first cases of complete CD16A deficiency: Association with persistent EBV infection. J Allergy Clin Immunol 2020; 145:1288-1292. [PMID: 31953104 DOI: 10.1016/j.jaci.2019.11.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 10/31/2019] [Accepted: 11/27/2019] [Indexed: 10/25/2022]
Affiliation(s)
- A Pérez-Portilla
- Department of Immunology and Oncology, National Centre for Biotechnology (CNB-CSIC), Madrid, Spain
| | - M Moraru
- Department of Immunology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Alfonso Blázquez-Moreno
- Department of Immunology and Oncology, National Centre for Biotechnology (CNB-CSIC), Madrid, Spain
| | - Philipp Kolb
- Institute of Virology, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - María Bravo García-Morato
- Clinical Immunology Department, University Hospital La Paz and Lymphocyte Pathophysiology in Immunodeficiencies Group, IdiPAZ Institute for Health Research, Madrid, Spain
| | - Thanmayi Ranganath
- Department of Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Gloria Esteso
- Department of Immunology and Oncology, National Centre for Biotechnology (CNB-CSIC), Madrid, Spain
| | - Carla Gianelli
- Clinical Immunology Department, University Hospital La Paz and Lymphocyte Pathophysiology in Immunodeficiencies Group, IdiPAZ Institute for Health Research, Madrid, Spain
| | - Rebeca Rodríguez-Pena
- Clinical Immunology Department, University Hospital La Paz and Lymphocyte Pathophysiology in Immunodeficiencies Group, IdiPAZ Institute for Health Research, Madrid, Spain
| | - Roberto Lozano-Rodríguez
- Department of Immunology and Oncology, National Centre for Biotechnology (CNB-CSIC), Madrid, Spain
| | - Juan Manuel Torres-Canizales
- Clinical Immunology Department, University Hospital La Paz and Lymphocyte Pathophysiology in Immunodeficiencies Group, IdiPAZ Institute for Health Research, Madrid, Spain
| | - Catherine A Blish
- Department of Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Mar Vales-Gomez
- Department of Immunology and Oncology, National Centre for Biotechnology (CNB-CSIC), Madrid, Spain
| | - Hartmut Hengel
- Institute of Virology, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Carlos Vilches
- Department of Immunology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
| | - Eduardo López-Granados
- Clinical Immunology Department, University Hospital La Paz and Lymphocyte Pathophysiology in Immunodeficiencies Group, IdiPAZ Institute for Health Research, Madrid, Spain.
| | - Hugh T Reyburn
- Department of Immunology and Oncology, National Centre for Biotechnology (CNB-CSIC), Madrid, Spain.
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25
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Blanco E, Perez-Andres M, Sanoja-Flores L, Wentink M, Pelak O, Martín-Ayuso M, Grigore G, Torres-Canizales J, López-Granados E, Kalina T, van der Burg M, Arriba-Méndez S, Santa Cruz S, Puig N, van Dongen JJ, Orfao A. Selection and validation of antibody clones against IgG and IgA subclasses in switched memory B-cells and plasma cells. J Immunol Methods 2019; 475:112372. [DOI: 10.1016/j.jim.2017.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 07/18/2017] [Accepted: 09/15/2017] [Indexed: 11/27/2022]
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26
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Del Pino-Molina L, Rodríguez-Ubreva J, Torres Canizales J, Coronel-Díaz M, Kulis M, Martín-Subero JI, van der Burg M, Ballestar E, López-Granados E. Impaired CpG Demethylation in Common Variable Immunodeficiency Associates With B Cell Phenotype and Proliferation Rate. Front Immunol 2019; 10:878. [PMID: 31105700 PMCID: PMC6492528 DOI: 10.3389/fimmu.2019.00878] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 12/03/2018] [Accepted: 04/05/2019] [Indexed: 01/01/2023] Open
Abstract
Common Variable Immunodeficiency (CVID) is characterized by impaired antibody production and poor terminal differentiation of the B cell compartment, yet its pathogenesis is still poorly understood. We first reported the occurrence of epigenetic alterations in CVID by high-throughput methylation analysis in CVID-discordant monozygotic twins. Data from a recent whole DNA methylome analysis throughout different stages of normal B cell differentiation allowed us to design a new experimental approach. We selected CpG sites for analysis based on two criteria: one, CpGs with potential association with the transcriptional status of relevant genes for B cell activation and differentiation; and two, CpGs that undergo significant demethylation from naïve to memory B cells in healthy individuals. DNA methylation was analyzed by bisulfite pyrosequencing of specific CpG sites in sorted naïve and memory B cell subsets from CVID patients and healthy donors. We observed impaired demethylation in two thirds of the selected CpGs in CVID memory B cells, in genes that govern B cell-specific processes or participate in B cell signaling. The degree of demethylation impairment associated with the extent of the memory B cell reduction. The impaired demethylation in such functionally relevant genes as AICDA in switched memory B cells correlated with a lower proliferative rate. Our new results reinforce the hypothesis of altered demethylation during B cell differentiation as a contributing pathogenic mechanism to the impairment of B cell function and maturation in CVID. In particular, deregulated epigenetic control of AICDA could play a role in the defective establishment of a post-germinal center B cell compartment in CVID.
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Affiliation(s)
- Lucía Del Pino-Molina
- Lymphocyte Pathophysiology in Immunodeficiencies Group, Department of Clinical Immunology, IdiPAZ Institute for Health Research, University Hospital La Paz, Madrid, Spain
| | - Javier Rodríguez-Ubreva
- Chromatin and Disease Group, Cancer Epigenetics and Biology Programme (PEBC), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Juan Torres Canizales
- Lymphocyte Pathophysiology in Immunodeficiencies Group, Department of Clinical Immunology, IdiPAZ Institute for Health Research, University Hospital La Paz, Madrid, Spain
| | - María Coronel-Díaz
- Lymphocyte Pathophysiology in Immunodeficiencies Group, Department of Clinical Immunology, IdiPAZ Institute for Health Research, University Hospital La Paz, Madrid, Spain
| | - Marta Kulis
- Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain
| | - José I Martín-Subero
- Departamento de Fundamentos Clínicos, Centro de Investigación Biomédica en Red de Cáncer, CIBERONC, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Mirjam van der Burg
- Laboratory for Immunology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Esteban Ballestar
- Chromatin and Disease Group, Cancer Epigenetics and Biology Programme (PEBC), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Eduardo López-Granados
- Lymphocyte Pathophysiology in Immunodeficiencies Group, Department of Clinical Immunology, IdiPAZ Institute for Health Research, University Hospital La Paz, Madrid, Spain
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27
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Campos-Sanchez E, Martínez-Cano J, Del Pino Molina L, López-Granados E, Cobaleda C. Epigenetic Deregulation in Human Primary Immunodeficiencies. Trends Immunol 2018; 40:49-65. [PMID: 30509895 DOI: 10.1016/j.it.2018.11.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 10/11/2018] [Revised: 11/02/2018] [Accepted: 11/07/2018] [Indexed: 12/20/2022]
Abstract
Primary immunodeficiencies (PIDs) are immune disorders resulting from defects in genes involved in immune regulation, and manifesting as an increased susceptibility to infections, autoimmunity, and cancer. However, the molecular basis of some prevalent entities remains poorly understood. Epigenetic control is essential for immune functions, and epigenetic alterations have been identified in different PIDs, including syndromes such as immunodeficiency-centromeric-instability-facial-anomalies, Kabuki, or Wolf-Hirschhorn, among others. Although the epigenetic changes may differ among these PIDs, the reversibility of epigenetic modifications suggests that they might become potential therapeutic targets. Here, we review recent mechanistic advances in our understanding of epigenetic alterations associated with certain PIDs, propose that a fully epigenetically driven mechanism might underlie some PIDs, and discuss the possible prophylactic and therapeutic implications.
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Affiliation(s)
- Elena Campos-Sanchez
- Department of Cell Biology and Immunology, Centro de Biología Molecular Severo Ochoa (CBMSO), CSIC/UAM, Madrid 28049, Spain; These authors contributed equally to this work
| | - Jorge Martínez-Cano
- Department of Cell Biology and Immunology, Centro de Biología Molecular Severo Ochoa (CBMSO), CSIC/UAM, Madrid 28049, Spain; These authors contributed equally to this work
| | - Lucía Del Pino Molina
- Clinical Immunology Department, Hospital Universitario, La Paz Institute of Biomedical Research, 28046, Madrid, Spain; Lymphocyte Pathophysiology Group, La Paz Institute of Biomedical Research, 28046 Madrid, Spain
| | - Eduardo López-Granados
- Clinical Immunology Department, Hospital Universitario, La Paz Institute of Biomedical Research, 28046, Madrid, Spain; Lymphocyte Pathophysiology Group, La Paz Institute of Biomedical Research, 28046 Madrid, Spain.
| | - Cesar Cobaleda
- Department of Cell Biology and Immunology, Centro de Biología Molecular Severo Ochoa (CBMSO), CSIC/UAM, Madrid 28049, Spain.
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28
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Mensa-Vilaró A, Bravo García-Morato M, de la Calle-Martin O, Franco-Jarava C, Martínez-Saavedra MT, González-Granado LI, González-Roca E, Fuster JL, Alsina L, Mutchinick OM, Balderrama-Rodríguez A, Ramos E, Modesto C, Mesa-Del-Castillo P, Ortego-Centeno N, Clemente D, Souto A, Palmou N, Remesal A, Leslie KS, Gómez de la Fuente E, Yadira Bravo Gallego L, Campistol JM, Dhouib NG, Bejaoui M, Dutra LA, Terreri MT, Mosquera C, González T, Cañellas J, García-Ruiz de Morales JM, Wouters CH, Bosque MT, Cham WT, Jiménez-Treviño S, de Inocencio J, Bloomfield M, Pérez de Diego R, Martínez-Pomar N, Rodríguez-Pena R, González-Santesteban C, Soler-Palacín P, Casals F, Yagüe J, Allende LM, Rodríguez-Gallego JC, Colobran R, Martínez-Martínez L, López-Granados E, Aróstegui JI. Unexpected relevant role of gene mosaicism in patients with primary immunodeficiency diseases. J Allergy Clin Immunol 2018; 143:359-368. [PMID: 30273710 DOI: 10.1016/j.jaci.2018.09.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [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: 02/27/2018] [Revised: 08/21/2018] [Accepted: 09/08/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Postzygotic de novo mutations lead to the phenomenon of gene mosaicism. The 3 main types are called somatic, gonadal, and gonosomal mosaicism, which differ in terms of the body distribution of postzygotic mutations. Mosaicism has been reported occasionally in patients with primary immunodeficiency diseases (PIDs) since the early 1990s, but its real involvement has not been systematically addressed. OBJECTIVE We sought to investigate the incidence of gene mosaicism in patients with PIDs. METHODS The amplicon-based deep sequencing method was used in the 3 parts of the study that establish (1) the allele frequency of germline variants (n = 100), (2) the incidence of parental gonosomal mosaicism in families with PIDs with de novo mutations (n = 92), and (3) the incidence of mosaicism in families with PIDs with moderate-to-high suspicion of gene mosaicism (n = 36). Additional investigations evaluated body distribution of postzygotic mutations, their stability over time, and their characteristics. RESULTS The range of allele frequency (44.1% to 55.6%) was established for germline variants. Those with minor allele frequencies of less than 44.1% were assumed to be postzygotic. Mosaicism was detected in 30 (23.4%) of 128 families with PIDs, with a variable minor allele frequency (0.8% to 40.5%). Parental gonosomal mosaicism was detected in 6 (6.5%) of 92 families with de novo mutations, and a high incidence of mosaicism (63.9%) was detected among families with moderate-to-high suspicion of gene mosaicism. In most analyzed cases mosaicism was found to be both uniformly distributed and stable over time. CONCLUSION This study represents the largest performed to date to investigate mosaicism in patients with PIDs, revealing that it affects approximately 25% of enrolled families. Our results might have serious consequences regarding treatment and genetic counseling and reinforce the use of next-generation sequencing-based methods in the routine analyses of PIDs.
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Affiliation(s)
- Anna Mensa-Vilaró
- Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Barcelona, Spain.
| | | | | | - Clara Franco-Jarava
- Department of Immunology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain; Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain
| | | | - Luis I González-Granado
- Primary Immunodeficiencies Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain; Universidad Complutense, Madrid, Spain
| | - Eva González-Roca
- Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Jose Luis Fuster
- Department of Hematology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Laia Alsina
- Department of Allergy and Clinical Immunology, Hospital Sant Joan de Deu, Esplugues, Spain; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Esplugues, Spain
| | - Osvaldo M Mutchinick
- Department of Genetics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Eduardo Ramos
- Department of Pediatrics, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Consuelo Modesto
- Department of Pediatric Rheumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Pablo Mesa-Del-Castillo
- Department of Pediatric Rheumatology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | - Daniel Clemente
- Department of Pediatric Rheumatology, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Alejandro Souto
- Department of Rheumatology, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain
| | - Natalia Palmou
- Department of Rheumatology, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Agustín Remesal
- Department of Pediatric Rheumatology, Hospital Universitario La Paz, Madrid, Spain
| | - Kieron S Leslie
- Department of Dermatology, University of California San Francisco, San Francisco, Calif
| | | | | | | | - Naouel Guirat Dhouib
- Pediatric Immuno-Hematology Unit, Bone Marrow Transplantation Center, Tunis, Tunisia
| | - Mohamed Bejaoui
- Pediatric Immuno-Hematology Unit, Bone Marrow Transplantation Center, Tunis, Tunisia
| | - Lívia Almeida Dutra
- Division of General Neurology, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Maria Teresa Terreri
- Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Catalina Mosquera
- Department of Pediatric Rheumatology, Universidad El Bosque, Bogota, Colombia
| | - Tatiana González
- Department of Pediatric Rheumatology, Universidad de Cartagena, Cartagena, Colombia
| | - Jerónima Cañellas
- Department of Rheumatology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Carine H Wouters
- Departments of Pediatric Rheumatology, Microbiology and Immunology, University Hospitals Leuven, KU University of Leuven, Leuven, Belgium
| | - María Teresa Bosque
- Department of Rheumatology, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain
| | - Weng Tarng Cham
- Department of Pediatric Rheumatology, Sunway Medical Centre, Kuala Lumpur, Malaysia
| | | | - Jaime de Inocencio
- Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Pediatric Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Markéta Bloomfield
- Department of Immunology, 2(nd) Faculty of Medicine, Charles University and University Hospital in Motol, Prague, Czech Republic
| | - Rebeca Pérez de Diego
- Laboratory of Immunogenetics of Diseases, IdiPAZ Institute for Health Research, Hospital Universitario La Paz, Madrid, Spain; Innate Immunity Group, IdiPAZ Institute for Health Research, Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | - Pere Soler-Palacín
- Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain; Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Ferran Casals
- Department of Genomics, Universitat Pompeu Fabra, Barcelona, Spain
| | - Jordi Yagüe
- Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Luis M Allende
- Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, Spain; Universidad Complutense, Madrid, Spain; Department of Immunology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Roger Colobran
- Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain; Immunology Division, Department of Clinical and Molecular Genetics, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain; Department of Cell Biology, Physiology and Immunology, Autonomous University of Barcelona, Barcelona, Spain
| | | | | | - Juan I Aróstegui
- Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Barcelona, Spain.
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29
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Blanco E, Pérez-Andrés M, Arriba-Méndez S, Contreras-Sanfeliciano T, Criado I, Pelak O, Serra-Caetano A, Romero A, Puig N, Remesal A, Torres Canizales J, López-Granados E, Kalina T, Sousa AE, van Zelm M, van der Burg M, van Dongen JJ, Orfao A. Age-associated distribution of normal B-cell and plasma cell subsets in peripheral blood. J Allergy Clin Immunol 2018; 141:2208-2219.e16. [DOI: 10.1016/j.jaci.2018.02.017] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 12/15/2017] [Accepted: 02/05/2018] [Indexed: 01/12/2023]
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30
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de Valles-Ibáñez G, Esteve-Solé A, Piquer M, González-Navarro EA, Hernandez-Rodriguez J, Laayouni H, González-Roca E, Plaza-Martin AM, Deyà-Martínez Á, Martín-Nalda A, Martínez-Gallo M, García-Prat M, Del Pino-Molina L, Cuscó I, Codina-Solà M, Batlle-Masó L, Solís-Moruno M, Marquès-Bonet T, Bosch E, López-Granados E, Aróstegui JI, Soler-Palacín P, Colobran R, Yagüe J, Alsina L, Juan M, Casals F. Evaluating the Genetics of Common Variable Immunodeficiency: Monogenetic Model and Beyond. Front Immunol 2018; 9:636. [PMID: 29867916 PMCID: PMC5960686 DOI: 10.3389/fimmu.2018.00636] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/14/2018] [Indexed: 12/16/2022] Open
Abstract
Common variable immunodeficiency (CVID) is the most frequent symptomatic primary immunodeficiency characterized by recurrent infections, hypogammaglobulinemia and poor response to vaccines. Its diagnosis is made based on clinical and immunological criteria, after exclusion of other diseases that can cause similar phenotypes. Currently, less than 20% of cases of CVID have a known underlying genetic cause. We have analyzed whole-exome sequencing and copy number variants data of 36 children and adolescents diagnosed with CVID and healthy relatives to estimate the proportion of monogenic cases. We have replicated an association of CVID to p.C104R in TNFRSF13B and reported the second case of homozygous patient to date. Our results also identify five causative genetic variants in LRBA, CTLA4, NFKB1, and PIK3R1, as well as other very likely causative variants in PRKCD, MAPK8, or DOCK8 among others. We experimentally validate the effect of the LRBA stop-gain mutation which abolishes protein production and downregulates the expression of CTLA4, and of the frameshift indel in CTLA4 producing expression downregulation of the protein. Our results indicate a monogenic origin of at least 15–24% of the CVID cases included in the study. The proportion of monogenic patients seems to be lower in CVID than in other PID that have also been analyzed by whole exome or targeted gene panels sequencing. Regardless of the exact proportion of CVID monogenic cases, other genetic models have to be considered for CVID. We propose that because of its prevalence and other features as intermediate penetrancies and phenotypic variation within families, CVID could fit with other more complex genetic scenarios. In particular, in this work, we explore the possibility of CVID being originated by an oligogenic model with the presence of heterozygous mutations in interacting proteins or by the accumulation of detrimental variants in particular immunological pathways, as well as perform association tests to detect association with rare genetic functional variation in the CVID cohort compared to healthy controls.
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Affiliation(s)
- Guillem de Valles-Ibáñez
- Institut de Biologia Evolutiva (UPF-CSIC), Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
| | - Ana Esteve-Solé
- Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain.,Functional Unit of Clinical Immunology Hospital Sant Joan de Déu-Hospital Clinic, Barcelona, Spain
| | - Mònica Piquer
- Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain.,Functional Unit of Clinical Immunology Hospital Sant Joan de Déu-Hospital Clinic, Barcelona, Spain
| | - E Azucena González-Navarro
- Functional Unit of Clinical Immunology Hospital Sant Joan de Déu-Hospital Clinic, Barcelona, Spain.,Servei d'Immunologia, Centre de Diagnòstic Biomèdic, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | - Jessica Hernandez-Rodriguez
- Institut de Biologia Evolutiva (UPF-CSIC), Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
| | - Hafid Laayouni
- Institut de Biologia Evolutiva (UPF-CSIC), Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain.,Bioinformatics Studies, ESCI-UPF, Barcelona, Spain
| | - Eva González-Roca
- Functional Unit of Clinical Immunology Hospital Sant Joan de Déu-Hospital Clinic, Barcelona, Spain.,Servei d'Immunologia, Centre de Diagnòstic Biomèdic, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | - Ana María Plaza-Martin
- Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain.,Functional Unit of Clinical Immunology Hospital Sant Joan de Déu-Hospital Clinic, Barcelona, Spain
| | - Ángela Deyà-Martínez
- Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain.,Functional Unit of Clinical Immunology Hospital Sant Joan de Déu-Hospital Clinic, Barcelona, Spain
| | - Andrea Martín-Nalda
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron (HUVH), Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain
| | - Mónica Martínez-Gallo
- Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain.,Immunology Division, Department of Clinical and Molecular Genetics, Hospital Universitari Vall d'Hebron (HUVH), Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.,Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marina García-Prat
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron (HUVH), Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain
| | - Lucía Del Pino-Molina
- Clinical Immunology Department, University Hospital La Paz and Physiopathology of Lymphocytes in Immunodeficiencies Group, IdiPAZ Institute for Health Research, Madrid, Spain
| | - Ivón Cuscó
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER), Madrid, Spain
| | - Marta Codina-Solà
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBER-ER), Madrid, Spain
| | - Laura Batlle-Masó
- Institut de Biologia Evolutiva (UPF-CSIC), Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain.,Servei de Genòmica, Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
| | - Manuel Solís-Moruno
- Institut de Biologia Evolutiva (UPF-CSIC), Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain.,Servei de Genòmica, Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
| | - Tomàs Marquès-Bonet
- Institut de Biologia Evolutiva (UPF-CSIC), Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain.,Catalan Institution of Research and Advanced Studies (ICREA), Barcelona, Spain.,CNAG-CRG, Centre for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
| | - Elena Bosch
- Institut de Biologia Evolutiva (UPF-CSIC), Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
| | - Eduardo López-Granados
- Clinical Immunology Department, University Hospital La Paz and Physiopathology of Lymphocytes in Immunodeficiencies Group, IdiPAZ Institute for Health Research, Madrid, Spain
| | - Juan Ignacio Aróstegui
- Functional Unit of Clinical Immunology Hospital Sant Joan de Déu-Hospital Clinic, Barcelona, Spain.,Servei d'Immunologia, Centre de Diagnòstic Biomèdic, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron (HUVH), Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain
| | - Roger Colobran
- Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain.,Immunology Division, Department of Clinical and Molecular Genetics, Hospital Universitari Vall d'Hebron (HUVH), Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.,Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Yagüe
- Functional Unit of Clinical Immunology Hospital Sant Joan de Déu-Hospital Clinic, Barcelona, Spain.,Servei d'Immunologia, Centre de Diagnòstic Biomèdic, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | - Laia Alsina
- Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain.,Functional Unit of Clinical Immunology Hospital Sant Joan de Déu-Hospital Clinic, Barcelona, Spain
| | - Manel Juan
- Functional Unit of Clinical Immunology Hospital Sant Joan de Déu-Hospital Clinic, Barcelona, Spain.,Servei d'Immunologia, Centre de Diagnòstic Biomèdic, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | - Ferran Casals
- Servei de Genòmica, Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
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31
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Bravo García-Morato M, Aracil Santos FJ, Briones AC, Blázquez Moreno A, Del Pozo Maté Á, Domínguez-Soto Á, Beato Merino MJ, Del Pino Molina L, Torres Canizales J, Marin AV, Vallespín García E, Feito Rodríguez M, Plaza López Sabando D, Jiménez-Reinoso A, Mozo Del Castillo Y, Sanz Santaeufemia FJ, de Lucas-Laguna R, Cárdenas PP, Casamayor Polo L, Coronel Díaz M, Valés-Gómez M, Roldán Santiago E, Ferreira Cerdán A, Nevado Blanco J, Corbí ÁL, Reyburn HT, Regueiro JR, López-Granados E, Rodríguez Pena R. New human combined immunodeficiency caused by interferon regulatory factor 4 (IRF4) deficiency inherited by uniparental isodisomy. J Allergy Clin Immunol 2018; 141:1924-1927.e18. [PMID: 29408330 DOI: 10.1016/j.jaci.2017.12.995] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 12/01/2017] [Accepted: 12/27/2017] [Indexed: 01/01/2023]
Affiliation(s)
- María Bravo García-Morato
- Department of Immunology, Hospital Universitario La Paz, Madrid, Spain; Lymphocyte Pathophysiology Group, La Paz Institute of Biomedical Research, IdiPAZ, Madrid, Spain.
| | | | - Alejandro Contreras Briones
- Department of Microbiology I (Immunology), School of Medicine, Universidad Complutense de Madrid, 12 de Octubre Health Research Institute (imas12), Madrid, Spain
| | - Alfonso Blázquez Moreno
- Department of Immunology and Oncology, Centro Nacional de Biotecnología-Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Ángela Del Pozo Maté
- Institute of Medical and Molecular Genetics (INGEMM), Centro de Investigaciones Biológicas, CSIC, Madrid, Spain
| | | | | | - Lucía Del Pino Molina
- Department of Immunology, Hospital Universitario La Paz, Madrid, Spain; Lymphocyte Pathophysiology Group, La Paz Institute of Biomedical Research, IdiPAZ, Madrid, Spain
| | - Juan Torres Canizales
- Department of Immunology, Hospital Universitario La Paz, Madrid, Spain; Lymphocyte Pathophysiology Group, La Paz Institute of Biomedical Research, IdiPAZ, Madrid, Spain
| | - Ana Victoria Marin
- Department of Microbiology I (Immunology), School of Medicine, Universidad Complutense de Madrid, 12 de Octubre Health Research Institute (imas12), Madrid, Spain
| | - Elena Vallespín García
- Institute of Medical and Molecular Genetics (INGEMM), Centro de Investigaciones Biológicas, CSIC, Madrid, Spain
| | | | | | - Anaïs Jiménez-Reinoso
- Department of Microbiology I (Immunology), School of Medicine, Universidad Complutense de Madrid, 12 de Octubre Health Research Institute (imas12), Madrid, Spain
| | | | | | | | - Paula P Cárdenas
- Department of Microbiology I (Immunology), School of Medicine, Universidad Complutense de Madrid, 12 de Octubre Health Research Institute (imas12), Madrid, Spain
| | | | | | - Mar Valés-Gómez
- Department of Immunology and Oncology, Centro Nacional de Biotecnología-Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | | | - Antonio Ferreira Cerdán
- Department of Immunology, Hospital Universitario La Paz, Madrid, Spain; Lymphocyte Pathophysiology Group, La Paz Institute of Biomedical Research, IdiPAZ, Madrid, Spain
| | - Julián Nevado Blanco
- Institute of Medical and Molecular Genetics (INGEMM), Centro de Investigaciones Biológicas, CSIC, Madrid, Spain
| | - Ángel L Corbí
- Myeloid Cell Laboratory, Centro de Investigaciones Biológicas, CSIC, Madrid, Spain
| | - Hugh T Reyburn
- Department of Immunology and Oncology, Centro Nacional de Biotecnología-Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - José Ramón Regueiro
- Department of Microbiology I (Immunology), School of Medicine, Universidad Complutense de Madrid, 12 de Octubre Health Research Institute (imas12), Madrid, Spain
| | - Eduardo López-Granados
- Department of Immunology, Hospital Universitario La Paz, Madrid, Spain; Lymphocyte Pathophysiology Group, La Paz Institute of Biomedical Research, IdiPAZ, Madrid, Spain
| | - Rebeca Rodríguez Pena
- Department of Immunology, Hospital Universitario La Paz, Madrid, Spain; Lymphocyte Pathophysiology Group, La Paz Institute of Biomedical Research, IdiPAZ, Madrid, Spain
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32
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Bravo García-Morato M, García-Miñaúr S, Molina Garicano J, Santos Simarro F, Del Pino Molina L, López-Granados E, Ferreira Cerdán A, Rodríguez Pena R. Mutations in PIK3R1 can lead to APDS2, SHORT syndrome or a combination of the two. Clin Immunol 2017; 179:77-80. [PMID: 28302518 DOI: 10.1016/j.clim.2017.03.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [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: 01/12/2017] [Revised: 03/06/2017] [Accepted: 03/10/2017] [Indexed: 01/04/2023]
Abstract
Mutations in PIK3R1 gene have been associated to two different conditions: a primary immunodeficiency, called APDS2, of recent description and SHORT syndrome. 47 patients with APDS2 have been reported to date, only one of them sharing both PIK3R1-related phenotypes. Here we describe two more patients affected by APDS2 and SHORT syndrome, which highlights that this association may not be so infrequent. We recommend that patients with mutations in PIK3R1 gene should be assessed by both clinical immunologists and clinical geneticists.
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Affiliation(s)
- M Bravo García-Morato
- Department of Clinical Immunology, IdiPAZ, La Paz University Hospital, Madrid, Spain; Lymphocyte Pathophysiology Group, La Paz Institute of Biomedical Research, IdiPAZ, Madrid, Spain.
| | - S García-Miñaúr
- Clinical Genetics Section, Institute of Medical and Molecular Genetics (INGEMM), IdiPAZ, La Paz University Hospital, Madrid, Spain; Unit 753, Biomedical Research Networking Center on Rare Diseases, (CIBERER), Health Institute Carlos III, Madrid, Spain
| | - J Molina Garicano
- Department of Pediatrics, Pediatrics Oncology Unit, Navarra Hospital Center, Pamplona, Spain
| | - F Santos Simarro
- Clinical Genetics Section, Institute of Medical and Molecular Genetics (INGEMM), IdiPAZ, La Paz University Hospital, Madrid, Spain; Unit 753, Biomedical Research Networking Center on Rare Diseases, (CIBERER), Health Institute Carlos III, Madrid, Spain
| | - L Del Pino Molina
- Department of Clinical Immunology, IdiPAZ, La Paz University Hospital, Madrid, Spain; Lymphocyte Pathophysiology Group, La Paz Institute of Biomedical Research, IdiPAZ, Madrid, Spain
| | - E López-Granados
- Department of Clinical Immunology, IdiPAZ, La Paz University Hospital, Madrid, Spain; Lymphocyte Pathophysiology Group, La Paz Institute of Biomedical Research, IdiPAZ, Madrid, Spain
| | - A Ferreira Cerdán
- Department of Clinical Immunology, IdiPAZ, La Paz University Hospital, Madrid, Spain; Lymphocyte Pathophysiology Group, La Paz Institute of Biomedical Research, IdiPAZ, Madrid, Spain
| | - R Rodríguez Pena
- Department of Clinical Immunology, IdiPAZ, La Paz University Hospital, Madrid, Spain; Lymphocyte Pathophysiology Group, La Paz Institute of Biomedical Research, IdiPAZ, Madrid, Spain
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33
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López-Rodríguez M, Herrera-Ramos E, Solé-Violán J, Ruíz-Hernández JJ, Borderías L, Horcajada JP, Lerma-Chippirraz E, Rajas O, Briones M, Pérez-González MC, García-Bello MA, López-Granados E, Rodriguez de Castro F, Rodríguez-Gallego C. IFITM3 and severe influenza virus infection. No evidence of genetic association. Eur J Clin Microbiol Infect Dis 2016; 35:1811-1817. [PMID: 27492307 PMCID: PMC7100079 DOI: 10.1007/s10096-016-2732-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 07/11/2016] [Indexed: 11/20/2022]
Abstract
Influenza virus infection (IVI) is typically subclinical or causes a self-limiting upper respiratory disease. However, in a small subset of patients IVI rapidly progresses to primary viral pneumonia (PVP) with respiratory failure; a minority of patients require intensive care unit admission. Inherited and acquired variability in host immune responses may influence susceptibility and outcome of IVI. However, the molecular basis of such human factors remains largely elusive. It has been proposed that homozygosity for IFITM3 rs12252-C is associated with a population-attributable risk of 5.4 % for severe IVI in Northern Europeans and 54.3 % for severe H1N1pdm infection in Chinese. A total of 148 patients with confirmed IVI were considered for recruitment; 118 Spanish patients (60 of them hospitalized with PVP) and 246 healthy Spanish individuals were finally included in the statistical analysis. PCR-RFLP was used with confirmation by Sanger sequencing. The allele frequency for rs12252-C was found to be 3.5 % among the general Spanish population. We found no rs12252-C homozygous individuals in our control group. The only Spanish patient homozygous for rs12252-C had a neurological disorder (a known risk factor for severe IVI) and mild influenza. Our data do not suggest a role of rs12252-C in the development of severe IVI in our population. These data may be relevant to recognize whether patients homozygous for rs12252-C are at risk of severe influenza, and hence require individualized measures in the case of IVI.
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Affiliation(s)
- M López-Rodríguez
- Department of Immunology, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, 35010, Spain.,Department of Clinical Sciences, School of Medicine, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, 35016, Spain
| | - E Herrera-Ramos
- Department of Immunology, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, 35010, Spain.,Department of Medical and Surgical Sciences, School of Medicine, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, 35016, Spain
| | - J Solé-Violán
- Intensive Care Unit, Hospital Universitario de Gran Canaria Dr. Negrín, CIBERES, Las Palmas de Gran Canaria, 35010, Spain
| | - J J Ruíz-Hernández
- Department of Internal Medicine, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas Gran Canaria, 35010, Spain
| | - L Borderías
- Department of Respiratory Diseases, Hospital San Jorge, Huesca, 22004, Spain
| | - J P Horcajada
- Department of Infectious Diseases, Hospital Universitari del Mar, Barcelona, 08003, Spain.,Hospital del Mar de Investigaciones Médicas (IMIM), CIBERES, Barcelona, 08003, Spain
| | - E Lerma-Chippirraz
- Department of Infectious Diseases, Hospital Universitari del Mar, Barcelona, 08003, Spain
| | - O Rajas
- Department of Respiratory Diseases, Hospital Universitario de la Princesa, Madrid, 28005, Spain
| | - M Briones
- Department of Respiratory Diseases, Hospital Clínico y Universitario de Valencia, Valencia, 46010, Spain
| | - M C Pérez-González
- Department of Microbiology, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, 35010, Spain
| | - M A García-Bello
- Department of Statistics, Research Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, 35010, Spain
| | - E López-Granados
- Department of Immunology, Hospital La Paz, La Paz Institute of Biomedical Research, IdiPAZ, Madrid, 28046, Spain
| | - F Rodriguez de Castro
- Department of Medical and Surgical Sciences, School of Medicine, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, 35016, Spain.,Department of Respiratory Diseases, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, 35010, Spain
| | - C Rodríguez-Gallego
- Department of Immunology, Hospital Universitario Son Espases, Palma de Mallorca, 07120, Spain. .,Department of Immunology, Hospital Universitario Son Espases, Carretera de Valldemossa 79, 07120, Palma de Mallorca, Spain.
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34
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Rodríguez-Cortez VC, Del Pino-Molina L, Rodríguez-Ubreva J, López-Granados E, Ballestar E. Dissecting Epigenetic Dysregulation of Primary Antibody Deficiencies. J Clin Immunol 2016; 36 Suppl 1:48-56. [PMID: 26984849 DOI: 10.1007/s10875-016-0267-4] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/07/2016] [Indexed: 01/04/2023]
Abstract
Primary antibody deficiencies (PADs), the most prevalent inherited primary immunodeficiencies (PIDs), are associated with a wide range of genetic alterations (both monogenic or polygenic) in B cell-specific genes. However, correlations between the genotype and clinical manifestations are not evident in all cases indicating that genetic interactions, environmental and epigenetic factors may have a role in PAD pathogenesis. The recent identification of key defects in DNA methylation in common variable immunodeficiency as well as the multiple evidences on the role of epigenetic control during B cell differentiation, activation and during antibody formation highlight the importance of investing research efforts in dissecting the participation of epigenetic defects in this group of diseases. This review focuses on the role of epigenetic control in B cell biology which can provide clues for the study of potential novel pathogenic defects involved in PADs.
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Affiliation(s)
- Virginia C Rodríguez-Cortez
- Chromatin and Disease Group, Cancer Epigenetics and Biology Programme (PEBC), Bellvitge Biomedical Research Institute (IDIBELL), 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lucia Del Pino-Molina
- Clinical Immunology Department, University Hospital La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
- Physiopathology of Lymphocytes in Immunodeficiencies Group, IdiPAZ Institute for Health Research, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Javier Rodríguez-Ubreva
- Chromatin and Disease Group, Cancer Epigenetics and Biology Programme (PEBC), Bellvitge Biomedical Research Institute (IDIBELL), 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Eduardo López-Granados
- Clinical Immunology Department, University Hospital La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
- Physiopathology of Lymphocytes in Immunodeficiencies Group, IdiPAZ Institute for Health Research, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Esteban Ballestar
- Chromatin and Disease Group, Cancer Epigenetics and Biology Programme (PEBC), Bellvitge Biomedical Research Institute (IDIBELL), 08908 L'Hospitalet de Llobregat, Barcelona, Spain.
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Tenorio J, Mansilla A, Valencia M, Martínez-Glez V, Romanelli V, Arias P, Castrejón N, Poletta F, Guillén-Navarro E, Gordo G, Mansilla E, García-Santiago F, González-Casado I, Vallespín E, Palomares M, Mori MA, Santos-Simarro F, García-Miñaur S, Fernández L, Mena R, Benito-Sanz S, del Pozo Á, Silla JC, Ibañez K, López-Granados E, Martín-Trujillo A, Montaner D, Heath KE, Campos-Barros Á, Dopazo J, Nevado J, Monk D, Ruiz-Pérez VL, Lapunzina P. A new overgrowth syndrome is due to mutations in RNF125. Hum Mutat 2015; 35:1436-41. [PMID: 25196541 DOI: 10.1002/humu.22689] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 06/04/2014] [Accepted: 08/26/2014] [Indexed: 11/08/2022]
Abstract
Overgrowth syndromes (OGS) are a group of disorders in which all parameters of growth and physical development are above the mean for age and sex. We evaluated a series of 270 families from the Spanish Overgrowth Syndrome Registry with no known OGS. We identified one de novo deletion and three missense mutations in RNF125 in six patients from four families with overgrowth, macrocephaly, intellectual disability, mild hydrocephaly, hypoglycemia, and inflammatory diseases resembling Sjögren syndrome. RNF125 encodes an E3 ubiquitin ligase and is a novel gene of OGS. Our studies of the RNF125 pathway point to upregulation of RIG-I-IPS1-MDA5 and/or disruption of the PI3K-AKT and interferon signaling pathways as the putative final effectors.
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Affiliation(s)
- Jair Tenorio
- CIBERER, Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII, Madrid, Spain; Molecular Endocrinology Unit - Overgrowth Syndromes Laboratory, INGEMM, Instituto de Genética Médica y Molecular, IdiPAZ, Hospital Universitario La Paz, Universidad Autónoma de Madrid (UAM), Madrid, Spain
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Torres JM, Martinez-Barricarte R, García-Gómez S, Mazariegos MS, Itan Y, Boisson B, Rholvarez R, Jiménez-Reinoso A, del Pino L, Rodríguez-Pena R, Ferreira A, Hernández-Jiménez E, Toledano V, Cubillos-Zapata C, Díaz-Almirón M, López-Collazo E, Unzueta-Roch JL, Sánchez-Ramón S, Regueiro JR, López-Granados E, Casanova JL, Pérez de Diego R. Inherited BCL10 deficiency impairs hematopoietic and nonhematopoietic immunity. J Clin Invest 2014; 124:5239-48. [PMID: 25365219 DOI: 10.1172/jci77493] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 10/02/2014] [Indexed: 12/12/2022] Open
Abstract
Heterotrimers composed of B cell CLL/lymphoma 10 (BCL10), mucosa-associated lymphoid tissue lymphoma translocation protein 1 (MALT1), and caspase recruitment domain-containing (CARD) family adaptors play a role in NF-κB activation and have been shown to be involved in both the innate and the adaptive arms of immunity in murine models. Moreover, individuals with inherited defects of MALT1, CARD9, and CARD11 present with immunological and clinical phenotypes. Here, we characterized a case of autosomal-recessive, complete BCL10 deficiency in a child with a broad immunodeficiency, including defects of both hematopoietic and nonhematopoietic immunity. The patient died at 3 years of age and was homozygous for a loss-of-expression, loss-of-function BCL10 mutation. The effect of BCL10 deficiency was dependent on the signaling pathway, and, for some pathways, the cell type affected. Despite the noted similarities to BCL10 deficiency in mice, including a deficient adaptive immune response, human BCL10 deficiency in this patient resulted in a number of specific features within cell populations. Treatment of the patient's myeloid cells with a variety of pathogen-associated molecular pattern molecules (PAMPs) elicited a normal response; however, NF-κB-mediated fibroblast functions were dramatically impaired. The results of this study indicate that inherited BCL10 deficiency should be considered in patients with combined immunodeficiency with B cell, T cell, and fibroblast defects.
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Herrera-Ramos E, López-Rodríguez M, Ruíz-Hernández JJ, Horcajada JP, Borderías L, Lerma E, Blanquer J, Pérez-González MC, García-Laorden MI, Florido Y, Mas-Bosch V, Montero M, Ferrer JM, Sorlí L, Vilaplana C, Rajas O, Briones M, Aspa J, López-Granados E, Solé-Violán J, de Castro FR, Rodríguez-Gallego C. Surfactant protein A genetic variants associate with severe respiratory insufficiency in pandemic influenza A virus infection. Crit Care 2014; 18:R127. [PMID: 24950659 PMCID: PMC4229788 DOI: 10.1186/cc13934] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 06/04/2014] [Indexed: 11/26/2022]
Abstract
Introduction Inherited variability in host immune responses influences susceptibility and outcome of Influenza A virus (IAV) infection, but these factors remain largely unknown. Components of the innate immune response may be crucial in the first days of the infection. The collectins surfactant protein (SP)-A1, -A2, and -D and mannose-binding lectin (MBL) neutralize IAV infectivity, although only SP-A2 can establish an efficient neutralization of poorly glycosylated pandemic IAV strains. Methods We studied the role of polymorphic variants at the genes of MBL (MBL2), SP-A1 (SFTPA1), SP-A2 (SFTPA2), and SP-D (SFTPD) in 93 patients with H1N1 pandemic 2009 (H1N1pdm) infection. Results Multivariate analysis showed that two frequent SFTPA2 missense alleles (rs1965708-C and rs1059046-A) and the SFTPA2 haplotype 1A0 were associated with a need for mechanical ventilation, acute respiratory failure, and acute respiratory distress syndrome. The SFTPA2 haplotype 1A1 was a protective variant. Kaplan-Meier analysis and Cox regression also showed that diplotypes not containing the 1A1 haplotype were associated with a significantly shorter time to ICU admission in hospitalized patients. In addition, rs1965708-C (P = 0.0007), rs1059046-A (P = 0.0007), and haplotype 1A0 (P = 0.0004) were associated, in a dose-dependent fashion, with lower PaO2/FiO2 ratio, whereas haplotype 1A1 was associated with a higher PaO2/FiO2 ratio (P = 0.001). Conclusions Our data suggest an effect of genetic variants of SFTPA2 on the severity of H1N1pdm infection and could pave the way for a potential treatment with haplotype-specific (1A1) SP-A2 for future IAV pandemics.
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Ramírez E, Romero-Garrido JA, López-Granados E, Borobia AM, Pérez T, Medrano N, Rueda C, Tong HY, Herrero A, Frías J. Symptomatic thromboembolic events in patients treated with intravenous-immunoglobulins: Results from a retrospective cohort study. Thromb Res 2014; 133:1045-51. [DOI: 10.1016/j.thromres.2014.03.046] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/24/2014] [Accepted: 03/27/2014] [Indexed: 01/18/2023]
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Muñoz-Ruiz M, Pérez-Flores V, Garcillán B, Guardo AC, Mazariegos MS, Takada H, Allende LM, Kilic SS, Sanal O, Roifman CM, López-Granados E, Recio MJ, Martínez-Naves E, Fernández-Malavé E, Regueiro JR. Human CD3γ, but not CD3δ, haploinsufficiency differentially impairs γδ versus αβ surface TCR expression. BMC Immunol 2013; 14:3. [PMID: 23336327 PMCID: PMC3585704 DOI: 10.1186/1471-2172-14-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 01/16/2013] [Indexed: 01/19/2023] Open
Abstract
Background The T cell antigen receptors (TCR) of αβ and γδ T lymphocytes are believed to assemble in a similar fashion in humans. Firstly, αβ or γδ TCR chains incorporate a CD3δε dimer, then a CD3γε dimer and finally a ζζ homodimer, resulting in TCR complexes with the same CD3 dimer stoichiometry. Partial reduction in the expression of the highly homologous CD3γ and CD3δ proteins would thus be expected to have a similar impact in the assembly and surface expression of both TCR isotypes. To test this hypothesis, we compared the surface TCR expression of primary αβ and γδ T cells from healthy donors carrying a single null or leaky mutation in CD3G (γ+/−) or CD3D (δ+/−, δ+/leaky) with that of normal controls. Results Although the partial reduction in the intracellular availability of CD3γ or CD3δ proteins was comparable as a consequence of the mutations, surface TCR expression measured with anti-CD3ε antibodies was significantly more decreased in γδ than in αβ T lymphocytes in CD3γ+/− individuals, whereas CD3δ+/− and CD3δ+/leaky donors showed a similar decrease of surface TCR in both T cell lineages. Therefore, surface γδ TCR expression was more dependent on available CD3γ than surface αβ TCR expression. Conclusions The results support the existence of differential structural constraints in the two human TCR isotypes regarding the incorporation of CD3γε and CD3δε dimers, as revealed by their discordant surface expression behaviour when confronted with reduced amounts of CD3γ, but not of the homologous CD3δ chain. A modified version of the prevailing TCR assembly model is proposed to accommodate these new data.
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Affiliation(s)
- Miguel Muñoz-Ruiz
- Inmunología, Facultad de Medicina, Universidad Complutense, Madrid, 28040, Spain
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Hernando H, Shannon-Lowe C, Islam AB, Al-Shahrour F, Rodríguez-Ubreva J, Rodríguez-Cortez VC, Javierre BM, Mangas C, Fernández AF, Parra M, Delecluse HJ, Esteller M, López-Granados E, Fraga MF, López-Bigas N, Ballestar E. The B cell transcription program mediates hypomethylation and overexpression of key genes in Epstein-Barr virus-associated proliferative conversion. Genome Biol 2013; 14:R3. [PMID: 23320978 PMCID: PMC3663113 DOI: 10.1186/gb-2013-14-1-r3] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 01/15/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Epstein-Barr virus (EBV) infection is a well characterized etiopathogenic factor for a variety of immune-related conditions, including lymphomas, lymphoproliferative disorders and autoimmune diseases. EBV-mediated transformation of resting B cells to proliferating lymphoblastoid cells occurs in early stages of infection and is an excellent model for investigating the mechanisms associated with acquisition of unlimited growth. RESULTS We investigated the effects of experimental EBV infection of B cells on DNA methylation profiles by using high-throughput analysis. Remarkably, we observed hypomethylation of around 250 genes, but no hypermethylation. Hypomethylation did not occur at repetitive sequences, consistent with the absence of genomic instability in lymphoproliferative cells. Changes in methylation only occurred after cell divisions started, without the participation of the active demethylation machinery, and were concomitant with acquisition by B cells of the ability to proliferate. Gene Ontology analysis, expression profiling, and high-throughput analysis of the presence of transcription factor binding motifs and occupancy revealed that most genes undergoing hypomethylation are active and display the presence of NF-κB p65 and other B cell-specific transcription factors. Promoter hypomethylation was associated with upregulation of genes relevant for the phenotype of proliferating lymphoblasts. Interestingly, pharmacologically induced demethylation increased the efficiency of transformation of resting B cells to lymphoblastoid cells, consistent with productive cooperation between hypomethylation and lymphocyte proliferation. CONCLUSIONS Our data provide novel clues on the role of the B cell transcription program leading to DNA methylation changes, which we find to be key to the EBV-associated conversion of resting B cells to proliferating lymphoblasts.
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Gil J, Busto EM, Garcillán B, Chean C, García-Rodríguez MC, Díaz-Alderete A, Navarro J, Reiné J, Mencía A, Gurbindo D, Beléndez C, Gordillo I, Duchniewicz M, Höhne K, García-Sánchez F, Fernández-Cruz E, López-Granados E, Schamel WWA, Moreno-Pelayo MA, Recio MJ, Regueiro JR. A leaky mutation in CD3D differentially affects αβ and γδ T cells and leads to a Tαβ-Tγδ+B+NK+ human SCID. J Clin Invest 2011; 121:3872-6. [PMID: 21926461 DOI: 10.1172/jci44254] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 08/03/2011] [Indexed: 01/26/2023] Open
Abstract
T cells recognize antigens via their cell surface TCR and are classified as either αβ or γδ depending on the variable chains in their TCR, α and β or γ and δ, respectively. Both αβ and γδ TCRs also contain several invariant chains, including CD3δ, which support surface TCR expression and transduce the TCR signal. Mutations in variable chains would be expected to affect a single T cell lineage, while mutations in the invariant chains would affect all T cells. Consistent with this, all CD3δ-deficient patients described to date showed a complete block in T cell development. However, CD3δ-KO mice have an αβ T cell-specific defect. Here, we report 2 unrelated cases of SCID with a selective block in αβ but not in γδ T cell development, associated with a new splicing mutation in the CD3D gene. The patients' T cells showed reduced CD3D transcripts, CD3δ proteins, surface TCR, and early TCR signaling. Their lymph nodes showed severe T cell depletion, recent thymus emigrants in peripheral blood were strongly decreased, and the scant αβ T cells were oligoclonal. T cell-dependent B cell functions were also impaired, despite the presence of normal B cell numbers. Strikingly, despite the specific loss of αβ T cells, surface TCR expression was more reduced in γδ than in αβ T cells. Analysis of individuals with this CD3D mutation thus demonstrates the contrasting CD3δ requirements for αβ versus γδ T cell development and TCR expression in humans and highlights the diagnostic and clinical relevance of studying both TCR isotypes when a T cell defect is suspected.
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Affiliation(s)
- Juana Gil
- Gregorio Maranon University Hospital, Madrid, Spain
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Pérez de Diego R, López-Granados E, Rivera J, Ferreira A, Fontán G, Bravo J, García Rodríguez MC, Bolland S. Naturally occurring Bruton's tyrosine kinase mutations have no dominant negative effect in an X-linked agammaglobulinaemia cellular model. Clin Exp Immunol 2008; 152:33-8. [PMID: 18241233 DOI: 10.1111/j.1365-2249.2008.03589.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
X-linked agammaglobulinaemia (XLA) is characterized by absence of mature B cells because of mutations in the Bruton's tyrosine kinase (Btk) gene. Btk-deficient early B cell precursors experience a block in their differentiation potentially reversible by the addition of an intact Btk gene. Btk expression was measured in 69 XLA patients with 47 different mutations and normal expression was detected in seven. We characterized these Btk mutant forms functionally by transfection into a lymphoma cell line that lacks endogenous Btk expression (Btk-/- DT40 cells) and analysed the calcium flux in response to B cell receptor stimulation. To test whether co-expression of a mutated form could compromise the function of the intact Btk transfection, studies in wild-type (WT) DT40 cells were also performed. Study reveals that none of the seven Btk mutants analysed was able to revert the absence of calcium mobilization upon IgM engagement in Btk-/- DT40 cells, as does intact Btk. In addition, calcium mobilization by anti-IgM stimulation in DT40 Btk+/+ cells was unaffected by co-expression with Btk mutants. These results suggest that gene addition would be feasible not only for patients with XLA and mutations that prevent Btk expression, but for those with expression of a mutant Btk.
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Affiliation(s)
- R Pérez de Diego
- Signal Transduction Group, Spanish National Cancer Research Centre (CNIO), Madrid, and Immunology Unit, Unviersity Hospital La Paz, Madrid, Spain.
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Pérez de Diego R, Bravo J, Allende LM, López-Granados E, Rivera J, Ferreira A, Fontán G, García Rodríguez MC. Identification of novel non-pathogenic mutation in SH3 domain of Btk in an XLA patient. Mol Immunol 2008; 45:301-3. [PMID: 17707910 DOI: 10.1016/j.molimm.2007.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Revised: 07/04/2007] [Accepted: 07/10/2007] [Indexed: 11/18/2022]
Abstract
A first report of an XLA patient with a polymorphism in Btk SH3 domain has been identified after sequencing of the entire gene. SH3 domain variants might not be detected due to well characterized mutations outside the domain.
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Pérez de Diego R, López-Granados E, Pozo M, Rodríguez C, Sabina P, Ferreira A, Fontan G, García-Rodríguez MC, Alemany S. Bruton's tyrosine kinase is not essential for LPS-induced activation of human monocytes. J Allergy Clin Immunol 2006; 117:1462-9. [PMID: 16751014 DOI: 10.1016/j.jaci.2006.01.037] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [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: 11/21/2005] [Revised: 01/18/2006] [Accepted: 01/24/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND X-linked agammaglobulinemia (XLA) is characterized by impaired B-cell differentiation caused by mutations in the Bruton's tyrosine kinase (Btk) gene. The natural disease model, the X-linked immunodeficiency mouse, shows a less severe phenotype, indicating a different requirement of Btk in human and mouse B cells. Btk is also expressed in the myeloid line and participates in LPS signaling. Deficient oxidative burst and myeloid differentiation have been reported in the X-linked immunodeficiency mouse, but the precise mechanism and relevance of Btk activity in human monocytes is poorly understood. OBJECTIVE The apparent absence in XLA of clinical manifestations of myeloid deficiency prompted us to explore the relevance of complete Btk absence in human myeloid cells. METHODS Seven patients with XLA with BTK mutations conditioning a null protein expression were included in the study. Monocyte LPS-induced mitogen-activated protein kinase activation, TNF-alpha and IL-6 production in monocytes, and oxidative burst in monocytes and granulocytes were analyzed by means of flow cytometry. RESULTS We show that in response to LPS, Btk-null monocytes from patients with XLA induce early mitogen-activated protein kinase activation and intracellular TNF-alpha and IL-6 production with the same intensity as cells from age- and sex-matched control subjects. In addition, the oxidative burst in response to LPS and other stimulants was completely normal in Btk-null monocytes and neutrophils. CONCLUSION Our results indicate that Btk is not essential for early LPS signaling in human monocytes and that different Btk dependency might exist between human and mouse myeloid cells. CLINICAL IMPLICATIONS These findings provide a better understanding of XLA, and they show the differences between human XLA and murine Xid models.
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López-Granados E, Pérez de Diego R, Ferreira Cerdán A, Fontán Casariego G, García Rodríguez MC. A genotype-phenotype correlation study in a group of 54 patients with X-linked agammaglobulinemia. J Allergy Clin Immunol 2005; 116:690-7. [PMID: 16159644 DOI: 10.1016/j.jaci.2005.04.043] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [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: 11/02/2004] [Revised: 04/13/2005] [Accepted: 04/28/2005] [Indexed: 12/29/2022]
Abstract
BACKGROUND X-linked (Bruton's) agammaglobulinemia (XLA) is a rare immunodeficiency caused by a block in B-cell development caused by mutations in the Bruton's tyrosine kinase (BTK) gene. Many aspects of XLA and BTK function remain unresolved; atypical presentations have been reported, and no clear genotype-phenotype correlation has been established. OBJECTIVES We sought to contribute to the understanding of XLA through the phenotypic and biochemical characterization of a large group of Spanish patients with agammaglobulinemia. We also sought to classify the mutations according to their severity to analyze a genotype-phenotype correlation. METHODS Clinical and analytic data were collected from the clinical records. We studied the BTK gene, protein expression, and function, and the findings were correlated with the phenotypic information. RESULTS Fifty-four patients were given diagnoses of XLA. We identified 38 different mutations in BTK, 26 not described in other patients, and several uncommon clinical phenotypes or analytic characteristics were found. The statistical analysis shows that less severe mutations or minimal detection of protein by means of flow cytometry are associated with decreased severity in clinical and analytic data, demonstrating a clear relation between the type of mutation and the disease expressivity. However, some exemptions to this rule were noted. CONCLUSIONS XLA is a variable disease. Globally, a genotype-phenotype correlation is observed, but individual discrepancies between the severity of the mutation and the clinical and analytic phenotype suggest that other loci or ambient factors significantly influence the disease presentation and evolution.
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López-Granados E, Cambronero R, Ferreira A, Fontán G, García-Rodríguez MC. Three novel mutations reflect the variety of defects causing phenotypically diverse X-linked hyper-IgM syndrome. Clin Exp Immunol 2003; 133:123-31. [PMID: 12823286 PMCID: PMC1808739 DOI: 10.1046/j.1365-2249.2003.02184.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [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] [Indexed: 12/11/2022] Open
Abstract
X-linked hyper-IgM syndrome (HIGM1) (MIM musical sharp 308230), is a severe primary immunodeficiency caused by mutations in the gene coding for CD40 ligand (CD40L or CD154), a member of the tumour necrosis factor (TNF) superfamily. The interaction of this protein with its ligand, CD40, mediates crucial processes in the immune response. The variety of defects that have been described in HIGM1 patients range from a complete lack of CD40L protein expression to missense mutations that interfere with its interaction with CD40L. In this study we describe three families - a total of seven HIGM1 patients and carriers, presenting a spectrum of severity in clinical evolution. In two of these families, patient DNA samples were available for genetic studies. In the third, carrier detection was performed on female family members. The results of immunological studies - the different patterns of CD40L expression and binding capacity as measured by flow cytometry - and molecular diagnosis are presented. Three novel mutations were identified: an intron mutation that partially interferes with the splicing process (intron 3, position + 5 G/T); a missense mutation (Ser222 Phe) located in the molecular region which interacts with the receptor and which abrogates binding capacity; and a 14 base pair deletion leading to a frameshift and a premature truncated mutation (del I 171 X 195). An attempt to correlate protein expression and function of the CD40L mutants with clinical disease evolution is described.
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Cambronero R, Cámara C, López-Granados E, Ferreira A, Fontán G, García Rodríguez MC. [Autoimmune lymphoproliferative syndrome: molecular diagnosis in two families]. Med Clin (Barc) 2003; 120:622-5. [PMID: 12732128 DOI: 10.1016/s0025-7753(03)73790-7] [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] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE The autoimmune lymphoproliferative syndrome (ALPS) is a disorder caused by a defect in lymphocytes' apoptosis and characterized by non malignant lymphoproliferation, autoimmune features and increased TCR alpha + CD4CD8 cells. Most patients have a mutation in the TNFRSF6 gene, which encodes the Fas protein. Our aim was to identify mutations in this gene in two families with possible ALPS cases. PATIENTS AND METHOD Two patients with suspicion of ALPS, belonging to two unrelated families, were studied. To confirm such a diagnosis, immunoglobulin quantification, cellular phenotypic analysis by flow cytometry, IL-10 quantification, an apoptosis study, and molecular analysis were performed. RESULTS Both patients showed hypergammaglobulinemia and an increased percentage of TCR alpha + CD4CD8 cells (family A patient: 14%; family B patient: 4.25%). In family A, in vitro Fas-mediated apoptosis was absent in the patient and markedly reduced in his father. In this family, both the patient and his father were heterozygous for the Fas mutation T1045C (Leu 268 Pro). The family B patient and her mother showed the Fas mutation G943T (Arg 234 Leu), both being heterozygous for it too. Both mutations are located in exon 9 of TNFRSF6 gene, affecting the death domain of the Fas protein. CONCLUSIONS The molecular study of these families confirms a diagnosis of ALPS and suggests that the causing defect of this syndrome is compatible with an autosomal dominant inheritance with incomplete penetrance.
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Blanch A, Roche O, López-Granados E, Fontán G, López-Trascasa M. Erratum: Detection of C1 inhibitor (SERPING1/C1NH) mutations in exon 8 in patients with hereditary angioedema: evidence for 10 novel mutations. Hum Mutat 2002. [DOI: 10.1002/humu.9105] [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: 11/10/2022]
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Blanch A, Roche O, López-Granados E, Fontán G, López-Trascasa M. Detection of C1 inhibitor (SERPING1/C1NH) mutations in exon 8 in patients with hereditary angioedema: evidence for 10 novel mutations. Hum Mutat 2002; 20:405-6. [PMID: 12402344 DOI: 10.1002/humu.9073] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hereditary angioedema (HAE) is caused by mutations in the C1 inhibitor gene (SERPING1, C1NH) and the result is C1 inhibitor deficiency, either in levels or function. We have searched exon 8 for mutations by direct sequencing and analyzed the rest of the exons by SSCP in 87 Spanish families affected by HAE. Out of 87 screened families, we have detected exon 8 mutations in 26. Among these, 17 different mutations were identified: 14 point mutations and 3 frameshift. Seven of the point mutations and the three frameshift were not previously reported. Mutations were: S438P; R444P; V451G; W460X; V468D; G471E; X479R; S417fsX427; I440fsX450; E429fsX450. The rest of the families presented previously reported mutations, 5 missense and two nonsense. In none of the 26 families was an additional change identified in the rest of the exons by SSCP, and, in 20 out of the 22 families with point mutation, we verified that the mutation did not affect a healthy relative. Seven of these families had no history of the disease, and in five of them we were able to verify that the progenitors did not have the mutation. Therefore, they were de novo mutations.
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Affiliation(s)
- Alvaro Blanch
- Unidad de Inmunología, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain
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Larrucea S, González-Rubio C, Cambronero R, Ballou B, Bonay P, López-Granados E, Bouvet P, Fontán G, Fresno M, López-Trascasa M. Cellular adhesion mediated by factor J, a complement inhibitor. Evidence for nucleolin involvement. J Biol Chem 1998; 273:31718-25. [PMID: 9822633 DOI: 10.1074/jbc.273.48.31718] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Factor J (FJ) is a complement inhibitor that acts on the classical and the alternative pathways. We demonstrated FJ-cell interactions in fluid phase by flow cytometry experiments using the cell lines Jurkat, K562, JY, and peripheral blood lymphocytes. FJ bound to plastic plates was able to induce in vitro adhesion of these cells with potency equivalent to fibronectin. As evidence for the specificity of this reaction, the adhesion was blocked by MAJ2, an anti-FJ monoclonal antibody, and by soluble FJ. Attachment of the cells required active metabolism and cytoskeletal integrity. The glycosaminoglycans heparin, heparan sulfate, or chondroitin sulfates A, B, and C inhibited to varying degrees the binding of FJ to cells, as did treatment with chondroitinase ABC. In the search for a putative receptor, a protein of 110 kDa was isolated by affinity chromatography, and microsequence analysis identified this protein as nucleolin. Confocal microscopy evidenced the presence of nucleolin in cell membrane by immunofluorescence with monoclonal (D3) and polyclonal anti-nucleolin antibodies in Jurkat cells. The interaction FJ-nucleolin was evidenced by Western blot and enzyme-linked immunosorbent assay. Furthermore, purified nucleolin and D3 inhibited adhesion of Jurkat cells to immobilized FJ, suggesting that the interaction was specific and that nucleolin mediated the binding.
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Affiliation(s)
- S Larrucea
- Unidad de Inmunología, Hospital La Paz, Paseo de la Castellana, 261-28046 Madrid, Spain
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