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Lam T, Saso A, Torres Ortiz A, Hatcher J, Woodman M, Chandran S, Thistlethwayte R, Best T, Johnson M, Wagstaffe H, Mai A, Buckland M, Gilmour K, Goldblatt D, Grandjean L. Socioeconomic and Demographic Risk Factors for SARS-CoV-2 Seropositivity Among Healthcare Workers in a UK Hospital: A Prospective Cohort Study. Clin Infect Dis 2024; 78:594-602. [PMID: 37647517 PMCID: PMC10954340 DOI: 10.1093/cid/ciad522] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/26/2023] [Accepted: 08/29/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND To protect healthcare workers (HCWs) from the consequences of disease due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), it is necessary to understand the risk factors that drive exposure and infection within hospitals. Insufficient consideration of key socioeconomic variables is a limitation of existing studies that can lead to bias and residual confounding of proposed risk factors for infection. METHODS The Co-STARs study prospectively enrolled 3679 HCWs between April 2020 and September 2020. We used multivariate logistic regression to comprehensively characterize the demographic, occupational, socioeconomic, and environmental risk factors for SARS-CoV-2 seropositivity. RESULTS After adjusting for key confounders, relative household overcrowding (odds ratio [OR], 1.4 [95% confidence interval {CI}, 1.1-1.9]; P = .006), Black, Black British, Caribbean, or African ethnicity (OR, 1.7 [95% CI, 1.2-2.3]; P = .003), increasing age (ages 50-60 years: OR, 1.8 [95% CI, 1.3-2.4]; P < .001), lack of access to sick pay (OR, 1.8 [95% CI, 1.3-2.4]; P < .001). CONCLUSIONS Socioeconomic and demographic factors outside the hospital were the main drivers of infection and exposure to SARS-CoV-2 during the first wave of the pandemic in an urban pediatric referral hospital. Overcrowding and out-of-hospital SARS-CoV-2 contact are less amenable to intervention. However, lack of access to sick pay among externally contracted staff is more easily rectifiable. Our findings suggest that providing easier access to sick pay would lead to a decrease in SARS-CoV-2 transmission and potentially that of other infectious diseases in hospital settings. CLINICAL TRIALS REGISTRATION NCT04380896.
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Affiliation(s)
- Tanya Lam
- Department of Infectious Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Anja Saso
- Department of Infectious Diseases, Great Ormond Street Hospital, London, United Kingdom
- Department of Tropical and Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Medical Research Council Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Arturo Torres Ortiz
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, United Kingdom
| | - James Hatcher
- Department of Microbiology, Great Ormond Street Hospital, London, United Kingdom
| | - Marc Woodman
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, United Kingdom
| | - Shruthi Chandran
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, United Kingdom
| | | | - Timothy Best
- Department of Microbiology, Great Ormond Street Hospital, London, United Kingdom
| | - Marina Johnson
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, United Kingdom
| | - Helen Wagstaffe
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, United Kingdom
| | - Annabelle Mai
- Clinical Immunology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, United Kingdom
| | - Matthew Buckland
- Clinical Immunology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, United Kingdom
| | - Kimberly Gilmour
- Clinical Immunology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, United Kingdom
| | - David Goldblatt
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, United Kingdom
| | - Louis Grandjean
- Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, United Kingdom
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Soomann M, Gilmour K, Güngör T, Pachlopnik Schmid J, Spyropoulou V, Trück J, Prader S. Fevers and ulcers in a newborn-Think genetics and act quickly. Pediatr Allergy Immunol 2024; 35:e14102. [PMID: 38445565 DOI: 10.1111/pai.14102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Maarja Soomann
- Division of Immunology and the Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kimberly Gilmour
- Immunology Department, Great Ormond Street Hospital for Children National Health Service (NHS) Foundation Trust, NIHR, London, UK
| | - Tayfun Güngör
- Division of Stem Cell Transplantation and the Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jana Pachlopnik Schmid
- Division of Immunology and the Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Vasiliki Spyropoulou
- Division of Gastroenterology and the Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Johannes Trück
- Division of Immunology and the Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Seraina Prader
- Division of Immunology and the Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
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3
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Ghorashian S, Lucchini G, Richardson R, Nguyen K, Terris C, Guvenel A, Oporto-Espuelas M, Yeung J, Pinner D, Chu J, Williams L, Ko KY, Walding C, Watts K, Inglott S, Thomas R, Connor C, Adams S, Gravett E, Gilmour K, Lal A, Kunaseelan S, Popova B, Lopes A, Ngai Y, Hackshaw A, Kokalaki E, Carulla MB, Mullanfiroze K, Lazareva A, Pavasovic V, Rao A, Bartram J, Vora A, Chiesa R, Silva J, Rao K, Bonney D, Wynn R, Pule M, Hough R, Amrolia PJ. CD19/CD22 targeting with cotransduced CAR T cells to prevent antigen-negative relapse after CAR T-cell therapy for B-cell ALL. Blood 2024; 143:118-123. [PMID: 37647647 DOI: 10.1182/blood.2023020621] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 03/31/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 09/01/2023] Open
Abstract
ABSTRACT CD19-negative relapse is a leading cause of treatment failure after chimeric antigen receptor (CAR) T-cell therapy for acute lymphoblastic leukemia. We investigated a CAR T-cell product targeting CD19 and CD22 generated by lentiviral cotransduction with vectors encoding our previously described fast-off rate CD19 CAR (AUTO1) combined with a novel CD22 CAR capable of effective signaling at low antigen density. Twelve patients with advanced B-cell acute lymphoblastic leukemia were treated (CARPALL [Immunotherapy with CD19/22 CAR Redirected T Cells for High Risk/Relapsed Paediatric CD19+ and/or CD22+ Acute Lymphoblastic Leukaemia] study, NCT02443831), a third of whom had failed prior licensed CAR therapy. Toxicity was similar to that of AUTO1 alone, with no cases of severe cytokine release syndrome. Of 12 patients, 10 (83%) achieved a measurable residual disease (MRD)-negative complete remission at 2 months after infusion. Of 10 responding patients, 5 had emergence of MRD (n = 2) or relapse (n = 3) with CD19- and CD22-expressing disease associated with loss of CAR T-cell persistence. With a median follow-up of 8.7 months, there were no cases of relapse due to antigen-negative escape. Overall survival was 75% (95% confidence interval [CI], 41%-91%) at 6 and 12 months. The 6- and 12-month event-free survival rates were 75% (95% CI, 41%-91%) and 60% (95% CI, 23%-84%), respectively. These data suggest dual targeting with cotransduction may prevent antigen-negative relapse after CAR T-cell therapy.
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Affiliation(s)
- Sara Ghorashian
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
- Department of Developmental Biology and Cancer, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Giovanna Lucchini
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Rachel Richardson
- Molecular and Cellular Immunology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Kyvi Nguyen
- Molecular and Cellular Immunology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Craig Terris
- Molecular and Cellular Immunology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Aleks Guvenel
- Molecular and Cellular Immunology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Macarena Oporto-Espuelas
- Molecular and Cellular Immunology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jenny Yeung
- Molecular and Cellular Immunology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Danielle Pinner
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Jan Chu
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Lindsey Williams
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Ka-Yuk Ko
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Chloe Walding
- Department of Haematology, University College London Hospital Trust, London, United Kingdom
| | - Kelly Watts
- Department of Blood and Marrow Transplant, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Sarah Inglott
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Rebecca Thomas
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Christopher Connor
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Stuart Adams
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Emma Gravett
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Kimberly Gilmour
- Cell Therapy and Immunology Laboratory, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Alka Lal
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | | | - Bilyana Popova
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Andre Lopes
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Yenting Ngai
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | | | - Milena Balasch Carulla
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Khushnuma Mullanfiroze
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Arina Lazareva
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Vesna Pavasovic
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Anupama Rao
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Jack Bartram
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Ajay Vora
- Department of Haematology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Robert Chiesa
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Juliana Silva
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Kanchan Rao
- Molecular and Cellular Immunology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Denise Bonney
- Department of Blood and Marrow Transplant, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Robert Wynn
- Department of Blood and Marrow Transplant, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | | | - Rachael Hough
- Department of Haematology, University College London Hospital Trust, London, United Kingdom
| | - Persis J Amrolia
- Department of Bone Marrow Transplantation, Great Ormond Street Children's Hospital, London, United Kingdom
- Molecular and Cellular Immunology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
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4
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Gargano MA, Matentzoglu N, Coleman B, Addo-Lartey EB, Anagnostopoulos A, Anderton J, Avillach P, Bagley AM, Bakštein E, Balhoff JP, Baynam G, Bello SM, Berk M, Bertram H, Bishop S, Blau H, Bodenstein DF, Botas P, Boztug K, Čady J, Callahan TJ, Cameron R, Carbon S, Castellanos F, Caufield JH, Chan LE, Chute C, Cruz-Rojo J, Dahan-Oliel N, Davids JR, de Dieuleveult M, de Souza V, de Vries BBA, de Vries E, DePaulo JR, Derfalvi B, Dhombres F, Diaz-Byrd C, Dingemans AJM, Donadille B, Duyzend M, Elfeky R, Essaid S, Fabrizzi C, Fico G, Firth HV, Freudenberg-Hua Y, Fullerton JM, Gabriel DL, Gilmour K, Giordano J, Goes FS, Moses RG, Green I, Griese M, Groza T, Gu W, Guthrie J, Gyori B, Hamosh A, Hanauer M, Hanušová K, He Y(O, Hegde H, Helbig I, Holasová K, Hoyt CT, Huang S, Hurwitz E, Jacobsen JOB, Jiang X, Joseph L, Keramatian K, King B, Knoflach K, Koolen DA, Kraus M, Kroll C, Kusters M, Ladewig MS, Lagorce D, Lai MC, Lapunzina P, Laraway B, Lewis-Smith D, Li X, Lucano C, Majd M, Marazita ML, Martinez-Glez V, McHenry TH, McInnis MG, McMurry JA, Mihulová M, Millett CE, Mitchell PB, Moslerová V, Narutomi K, Nematollahi S, Nevado J, Nierenberg AA, Čajbiková NN, Nurnberger JI, Ogishima S, Olson D, Ortiz A, Pachajoa H, Perez de Nanclares G, Peters A, Putman T, Rapp CK, Rath A, Reese J, Rekerle L, Roberts A, Roy S, Sanders SJ, Schuetz C, Schulte EC, Schulze TG, Schwarz M, Scott K, Seelow D, Seitz B, Shen Y, Similuk MN, Simon ES, Singh B, Smedley D, Smith CL, Smolinsky JT, Sperry S, Stafford E, Stefancsik R, Steinhaus R, Strawbridge R, Sundaramurthi JC, Talapova P, Tenorio Castano JA, Tesner P, Thomas RH, Thurm A, Turnovec M, van Gijn ME, Vasilevsky NA, Vlčková M, Walden A, Wang K, Wapner R, Ware JS, Wiafe AA, Wiafe SA, Wiggins LD, Williams AE, Wu C, Wyrwoll MJ, Xiong H, Yalin N, Yamamoto Y, Yatham LN, Yocum AK, Young AH, Yüksel Z, Zandi PP, Zankl A, Zarante I, Zvolský M, Toro S, Carmody LC, Harris NL, Munoz-Torres MC, Danis D, Mungall CJ, Köhler S, Haendel MA, Robinson PN. The Human Phenotype Ontology in 2024: phenotypes around the world. Nucleic Acids Res 2024; 52:D1333-D1346. [PMID: 37953324 PMCID: PMC10767975 DOI: 10.1093/nar/gkad1005] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/12/2023] [Accepted: 10/19/2023] [Indexed: 11/14/2023] Open
Abstract
The Human Phenotype Ontology (HPO) is a widely used resource that comprehensively organizes and defines the phenotypic features of human disease, enabling computational inference and supporting genomic and phenotypic analyses through semantic similarity and machine learning algorithms. The HPO has widespread applications in clinical diagnostics and translational research, including genomic diagnostics, gene-disease discovery, and cohort analytics. In recent years, groups around the world have developed translations of the HPO from English to other languages, and the HPO browser has been internationalized, allowing users to view HPO term labels and in many cases synonyms and definitions in ten languages in addition to English. Since our last report, a total of 2239 new HPO terms and 49235 new HPO annotations were developed, many in collaboration with external groups in the fields of psychiatry, arthrogryposis, immunology and cardiology. The Medical Action Ontology (MAxO) is a new effort to model treatments and other measures taken for clinical management. Finally, the HPO consortium is contributing to efforts to integrate the HPO and the GA4GH Phenopacket Schema into electronic health records (EHRs) with the goal of more standardized and computable integration of rare disease data in EHRs.
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Affiliation(s)
| | | | - Ben Coleman
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | | | | | - Joel Anderton
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Anita M Bagley
- Shriners Children's Northern California, Sacramento, CA, USA
| | - Eduard Bakštein
- National Institute of Mental Health, Klecany, Czech Republic
| | - James P Balhoff
- Renaissance Computing Institute, University of North Carolina, Chapel Hill, NC 27517, USA
| | - Gareth Baynam
- Rare Care Centre, Perth Children's Hospital, Perth, Australia
| | | | - Michael Berk
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Holli Bertram
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Somer Bishop
- Department of Psychiatry and Behavioral Sciences, UCSF Weil Institute for Neuroscience, San Francisco, CA, USA
| | - Hannah Blau
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - David F Bodenstein
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | | | - Kaan Boztug
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Jolana Čady
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Tiffany J Callahan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, NY, NY, USA
| | | | - Seth J Carbon
- Division of Environmental Genomics and Systems Biology, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | | | - J Harry Caufield
- Division of Environmental Genomics and Systems Biology, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Lauren E Chan
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA
| | - Christopher G Chute
- Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Jaime Cruz-Rojo
- UDISGEN (Dysmorphology and Genetics Unit), 12 de Octubre Hospital, Madrid, Spain
| | - Noémi Dahan-Oliel
- Department of Clinical Research, Shriners Hospitals for Children, Montreal, Quebec, Canada
| | - Jon R Davids
- Shriners Children's Northern California, Sacramento, CA, USA
| | - Maud de Dieuleveult
- Département I&D, AP-HP, Banque Nationale de Données Maladies Rares, Paris, France
| | - Vinicius de Souza
- European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton CB10 1SD, UK
| | - Bert B A de Vries
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - J Raymond DePaulo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Beata Derfalvi
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Ferdinand Dhombres
- Fetal Medicine Department, Armand Trousseau Hospital, Sorbonne University, GRC26, INSERM, Limics, Paris, France
| | - Claudia Diaz-Byrd
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Alexander J M Dingemans
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bruno Donadille
- St Antoine Hospital, Reference Center for Rare Growth Endocrine Disorders, Sorbonne University, AP-HP, INSERM, US14 - Orphanet, Plateforme Maladies Rares, Paris, France
| | | | - Reem Elfeky
- Department of Immunology, GOS Hospital for Children NHS Foundation Trust, University College London, London, UK
| | - Shahim Essaid
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | | | - Giovanna Fico
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Helen V Firth
- Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Yun Freudenberg-Hua
- Department of Psychiatry, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | | | - Davera L Gabriel
- School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | | | - Jessica Giordano
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Fernando S Goes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Rachel Gore Moses
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ian Green
- SNOMED International, London W2 6BD, UK
| | - Matthias Griese
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, German center for Lung research (DZL), Munich, Germany
| | - Tudor Groza
- Rare Care Centre, Perth Children's Hospital, Perth, Australia
| | | | - Julia Guthrie
- Department of Structural and Computational Biology, University of Vienna; Max Perutz Labs, Vienna, Austria
| | - Benjamin Gyori
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, USA
| | - Ada Hamosh
- Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Marc Hanauer
- INSERM, US14 - Orphanet, Plateforme Maladies Rares, Paris, France
| | - Kateřina Hanušová
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | | | - Harshad Hegde
- Division of Environmental Genomics and Systems Biology, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Ingo Helbig
- Neurology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Kateřina Holasová
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Charles Tapley Hoyt
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, USA
| | | | - Eric Hurwitz
- University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Julius O B Jacobsen
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | - Lisa Joseph
- Neurodevelopmental and Behavioral Phenotyping Service, National Institute of Mental Health, Bethesda, MD, USA
| | - Kamyar Keramatian
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Bryan King
- Department of Psychiatry and Behavioral Sciences, UCSF Weil Institute for Neuroscience, San Francisco, CA, USA
| | - Katrin Knoflach
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, German center for Lung research (DZL), Munich, Germany
| | - David A Koolen
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Megan L Kraus
- University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Carlo Kroll
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Maaike Kusters
- Immunology, NIHR Great Ormond Street Hospital BRC, London, UK
| | - Markus S Ladewig
- Department of Ophthalmology, University Clinic Marburg - Campus Fulda, Fulda, Germany
| | - David Lagorce
- INSERM, US14 - Orphanet, Plateforme Maladies Rares, Paris, France
| | - Meng-Chuan Lai
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Pablo Lapunzina
- Institute of Medical and Molecular Genetics, Hospital Univ. La Paz, Madrid, Spain
| | - Bryan Laraway
- University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - David Lewis-Smith
- Translational and Clinical Research Institute, Henry Wellcome Building, Framlington Place, Newcastle University, Newcastle-Upon-Tyne NE14LP, UK
| | | | - Caterina Lucano
- INSERM, US14 - Orphanet, Plateforme Maladies Rares, Paris, France
| | - Marzieh Majd
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mary L Marazita
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Victor Martinez-Glez
- Center for Genomic Medicine, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
| | - Toby H McHenry
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Melvin G McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Julie A McMurry
- University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Michaela Mihulová
- Department of Biology and Medical Genetics, 2nd Medical Faculty of Charles University and University Hospital Motol, Prague, Czech Republic
| | - Caitlin E Millett
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Philip B Mitchell
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Veronika Moslerová
- Department of Biology and Medical Genetics, 2nd Medical Faculty of Charles University and University Hospital Motol, Prague, Czech Republic
| | - Kenji Narutomi
- Okinawa Prefectural Nanbu Medical Center & Children's Medical Center
| | - Shahrzad Nematollahi
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Julian Nevado
- Institute of Medical and Molecular Genetics, Hospital Univ. La Paz, Madrid, Spain
| | - Andrew A Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, MA, USA
| | - Nikola Novák Čajbiková
- Department of Biology and Medical Genetics, 2nd Medical Faculty of Charles University and University Hospital Motol, Prague, Czech Republic
| | - John I Nurnberger
- Stark Neurosciences Research Institute, Departments of Psychiatry and Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Daniel Olson
- Data Collaboration Center, Data Science, Critical Path Institute, Tucson, AZ, USA
| | - Abigail Ortiz
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Harry Pachajoa
- Centro de Investigaciones en Anomalías Congénitas y Enfermedades Raras (CIACER), Universidad Icesi, Cali, Colombia
| | - Guiomar Perez de Nanclares
- Molecular (epi) genetics lab, Bioaraba Health Research Institute, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Amy Peters
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Tim Putman
- University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Christina K Rapp
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, German center for Lung research (DZL), Munich, Germany
| | - Ana Rath
- INSERM, US14 - Orphanet, Plateforme Maladies Rares, Paris, France
| | - Justin Reese
- Division of Environmental Genomics and Systems Biology, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Lauren Rekerle
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Angharad M Roberts
- National Heart & Lung Institute & MRC London Institute of Medical Sciences, Imperial College London, London W12 0HS, UK
| | - Suzy Roy
- SNOMED International, London W2 6BD, UK
| | - Stephan J Sanders
- Department of Paediatrics, Institute of Developmental and Regenerative Medicine, University of Oxford, Oxford, UK
| | - Catharina Schuetz
- Universitätsklinikum Carl Gustav Carus, Medizinische Fakultät, TU, Dresden, Germany
| | - Eva C Schulte
- Institute of Psychiatric Phenomics and Genomics (IPPG), LMU University Hospital, LMU Munich, Munich, Germany
| | - Thomas G Schulze
- Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Martin Schwarz
- Department of Biology and Medical Genetics, 2nd Medical Faculty of Charles University and University Hospital Motol, Prague, Czech Republic
| | - Katie Scott
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Dominik Seelow
- Exploratory Diagnostic Sciences, Berliner Institut für Gesundheitsforschung - Charité, Berlin, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center UKS, Homburg/Saar, Germany
| | | | - Morgan N Similuk
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Eric S Simon
- Eisenberg Family Depression Center, University of Michigan, Ann Arbor, MI, USA
| | - Balwinder Singh
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Damian Smedley
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | | | - Jake T Smolinsky
- Human Genetics Institute of New Jersey, Rutgers University, Piscataway, NJ, USA
| | - Sarah Sperry
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | | | - Ray Stefancsik
- European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton CB10 1SD, UK
| | - Robin Steinhaus
- Exploratory Diagnostic Sciences, Berliner Institut für Gesundheitsforschung - Charité, Berlin, Germany
| | - Rebecca Strawbridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Polina Talapova
- Institute for Research and Health Policy Studies, Tufts Medicine, Boston, MA 2111, USA
| | | | - Pavel Tesner
- Department of Biology and Medical Genetics, 2nd Medical Faculty of Charles University and University Hospital Motol, Prague, Czech Republic
| | - Rhys H Thomas
- Translational and Clinical Research Institute, Henry Wellcome Building, Framlington Place, Newcastle University, Newcastle-Upon-Tyne NE14LP, UK
| | - Audrey Thurm
- Neurodevelopmental and Behavioral Phenotyping Service, National Institute of Mental Health, Bethesda, MD, USA
| | - Marek Turnovec
- Department of Biology and Medical Genetics, 2nd Medical Faculty of Charles University and University Hospital Motol, Prague, Czech Republic
| | - Marielle E van Gijn
- Department of Genetics, University Medical Center Groningen, Groningen, Netherlands
| | | | - Markéta Vlčková
- Department of Biology and Medical Genetics, 2nd Medical Faculty of Charles University and University Hospital Motol, Prague, Czech Republic
| | - Anita Walden
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Kai Wang
- Chinese HPO Consortium, Beijing, China
| | - Ron Wapner
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - James S Ware
- National Heart & Lung Institute & MRC London Institute of Medical Sciences, Imperial College London, London W12 0HS, UK
| | | | | | - Lisa D Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrew E Williams
- Institute for Research and Health Policy Studies, Tufts Medicine, Boston, MA 2111, USA
| | - Chen Wu
- Chinese HPO Consortium, Beijing, China
| | - Margot J Wyrwoll
- Centre for Regenerative Medicine, Institute for Regeneration and Repair, Institute for Stem Cell Research, University of Edinburgh, Edinburgh, UK
| | - Hui Xiong
- Chinese HPO Consortium, Beijing, China
| | - Nefize Yalin
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Yasunori Yamamoto
- Database Center for Life Science, Joint Support-Center for Data Science Research, Research Organization of Information and Systems, Japan
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Anastasia K Yocum
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Allan H Young
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London & South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, London SE5 8AF, UK
| | - Zafer Yüksel
- Department of Human Genetics, Bioscientia Healthcare GmbH, Ingelheim, Germany
| | - Peter P Zandi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Andreas Zankl
- Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Ignacio Zarante
- Institute of Human Genetics, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Miroslav Zvolský
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Sabrina Toro
- University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Leigh C Carmody
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Nomi L Harris
- Division of Environmental Genomics and Systems Biology, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Monica C Munoz-Torres
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Daniel Danis
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Christopher J Mungall
- Division of Environmental Genomics and Systems Biology, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | | | - Melissa A Haendel
- University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Peter N Robinson
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
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5
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Chiesa R, Georgiadis C, Syed F, Zhan H, Etuk A, Gkazi SA, Preece R, Ottaviano G, Braybrook T, Chu J, Kubat A, Adams S, Thomas R, Gilmour K, O'Connor D, Vora A, Qasim W. Base-Edited CAR7 T Cells for Relapsed T-Cell Acute Lymphoblastic Leukemia. N Engl J Med 2023; 389:899-910. [PMID: 37314354 DOI: 10.1056/nejmoa2300709] [Citation(s) in RCA: 45] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cytidine deamination that is guided by clustered regularly interspaced short palindromic repeats (CRISPR) can mediate a highly precise conversion of one nucleotide into another - specifically, cytosine to thymine - without generating breaks in DNA. Thus, genes can be base-edited and rendered inactive without inducing translocations and other chromosomal aberrations. The use of this technique in patients with relapsed childhood T-cell leukemia is being investigated. METHODS We used base editing to generate universal, off-the-shelf chimeric antigen receptor (CAR) T cells. Healthy volunteer donor T cells were transduced with the use of a lentivirus to express a CAR with specificity for CD7 (CAR7), a protein that is expressed in T-cell acute lymphoblastic leukemia (ALL). We then used base editing to inactivate three genes encoding CD52 and CD7 receptors and the β chain of the αβ T-cell receptor to evade lymphodepleting serotherapy, CAR7 T-cell fratricide, and graft-versus-host disease, respectively. We investigated the safety of these edited cells in three children with relapsed leukemia. RESULTS The first patient, a 13-year-old girl who had relapsed T-cell ALL after allogeneic stem-cell transplantation, had molecular remission within 28 days after infusion of a single dose of base-edited CAR7 (BE-CAR7). She then received a reduced-intensity (nonmyeloablative) allogeneic stem-cell transplant from her original donor, with successful immunologic reconstitution and ongoing leukemic remission. BE-CAR7 cells from the same bank showed potent activity in two other patients, and although fatal fungal complications developed in one patient, the other patient underwent allogeneic stem-cell transplantation while in remission. Serious adverse events included cytokine release syndrome, multilineage cytopenia, and opportunistic infections. CONCLUSIONS The interim results of this phase 1 study support further investigation of base-edited T cells for patients with relapsed leukemia and indicate the anticipated risks of immunotherapy-related complications. (Funded by the Medical Research Council and others; ISRCTN number, ISRCTN15323014.).
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Affiliation(s)
- Robert Chiesa
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Christos Georgiadis
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Farhatullah Syed
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Hong Zhan
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Annie Etuk
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Soragia Athina Gkazi
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Roland Preece
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Giorgio Ottaviano
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Toni Braybrook
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Jan Chu
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Agnieszka Kubat
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Stuart Adams
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Rebecca Thomas
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Kimberly Gilmour
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - David O'Connor
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Ajay Vora
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
| | - Waseem Qasim
- From Great Ormond Street Hospital for Children NHS Trust (R.C., G.O., T.B., J.C., S.A., R.T., K.G., D.O., A.V., W.Q.) and the UCL Great Ormond Street Institute of Child Health (C.G., F.S., H.Z., A.E., S.A.G., R.P., A.K., W.Q.) - both in London
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6
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Gilmour K, Hoggarth C, Williams C, Baulch HM. Cold spots and cold moments: The potential for sediment freezing to depress denitrification in wetland sediments. J Environ Qual 2022; 51:990-1002. [PMID: 35819079 DOI: 10.1002/jeq2.20384] [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] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
Within the north-temperate zone, winters can be long and are associated with conditions of low temperature and potential for sediment freezing. There are critical gaps in our knowledge of biogeochemical cycling during winter and inadequate knowledge of how warming winters and changing snowpack might affect biogeochemistry. Here, we assessed the impacts of sediment freeze-thaw cycling and nitrate amendment on denitrification rates in the littoral fringe of four urban wetlands. We demonstrate the potential for experimental sediment freezing to suppress denitrification, although freezing effects were not observed at all sites. Multiple freeze-thaw cycles were assessed, and, although subsequent cycles may affect denitrification, the first instance of our experimental freezing seems the most critical. Although this work demonstrates potential sensitivity of wetland denitrification rates to changing winter conditions, we note nitrate availability has a larger impact upon denitrification rates. This suggests nitrification rates and changing nitrate loads may be more important determinants of nitrate retention than sediment freeze-thaw history. Although there has been great interest in hot spots and moments for biogeochemical cycling, we suggest there is similar need to understand cold spots and moments, as evidenced here. This is particularly important where cold moments may correspond with critical periods of nitrate transport, such as snowmelt.
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Affiliation(s)
- Kimberly Gilmour
- Dep. of Biology, Univ. of Saskatchewan, 112 Science Place, Saskatoon, SK, S7N 5E2, Canada
- Global Institute for Water Security National Hydrology Research Centre, 11 Innovation Blvd, Saskatoon, SK, S7N 3H5, Canada
| | - Cameron Hoggarth
- Global Institute for Water Security National Hydrology Research Centre, 11 Innovation Blvd, Saskatoon, SK, S7N 3H5, Canada
| | - Clayton Williams
- Dep. of Environmental Studies and Science, Saint Michael's College, One Winooski Park, Colchester, VT 05439, USA
| | - Helen M Baulch
- Global Institute for Water Security National Hydrology Research Centre, 11 Innovation Blvd, Saskatoon, SK, S7N 3H5, Canada
- School of Environment and Sustainability, Univ. of Saskatchewan, 117 Science Place, Saskatoon, SK, S7N 5C8, Canada
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7
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Torres Ortiz A, Fenn Torrente F, Twigg A, Hatcher J, Saso A, Lam T, Johnson M, Wagstaffe H, Dhillon R, Mai AL, Goldblatt D, Still R, Buckland M, Gilmour K, Grandjean L. The influence of time on the sensitivity of SARS-CoV-2 serological testing. Sci Rep 2022; 12:10517. [PMID: 35732870 PMCID: PMC9214469 DOI: 10.1038/s41598-022-14351-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 01/22/2022] [Accepted: 06/06/2022] [Indexed: 11/11/2022] Open
Abstract
Sensitive serological testing is essential to estimate the proportion of the population exposed or infected with SARS-CoV-2, to guide booster vaccination and to select patients for treatment with anti-SARS-CoV-2 antibodies. The performance of serological tests is usually evaluated at 14–21 days post infection. This approach fails to take account of the important effect of time on test performance after infection or exposure has occurred. We performed parallel serological testing using 4 widely used assays (a multiplexed SARS-CoV-2 Nucleoprotein (N), Spike (S) and Receptor Binding Domain assay from Meso Scale Discovery (MSD), the Roche Elecsys-Nucleoprotein (Roche-N) and Spike (Roche-S) assays and the Abbott Nucleoprotein assay (Abbott-N) on serial positive monthly samples collected as part of the Co-STARs study (www.clinicaltrials.gov, NCT04380896) up to 200 days following infection. Our findings demonstrate the considerable effect of time since symptom onset on the diagnostic sensitivity of different assays. Using a time-to-event analysis, we demonstrated that 50% of the Abbott nucleoprotein assays will give a negative result after 175 days (median survival time 95% CI 168–185 days), compared to the better performance over time of the Roche Elecsys nucleoprotein assay (93% survival probability at 200 days, 95% CI 88–97%). Assays targeting the spike protein showed a lower decline over the follow-up period, both for the MSD spike assay (97% survival probability at 200 days, 95% CI 95–99%) and the Roche Elecsys spike assay (95% survival probability at 200 days, 95% CI 93–97%). The best performing quantitative Roche Elecsys Spike assay showed no evidence of waning Spike antibody titers over the 200-day time course of the study. We have shown that compared to other assays evaluated, the Abbott-N assay fails to detect SARS-CoV-2 antibodies as time passes since infection. In contrast the Roche Elecsys Spike Assay and the MSD assay maintained a high sensitivity for the 200-day duration of the study. These limitations of the Abbott assay should be considered when quantifying the immune correlates of protection or the need for SARS-CoV-2 antibody therapy. The high levels of maintained detectable neutralizing spike antibody titers identified by the quantitative Roche Elecsys assay is encouraging and provides further evidence in support of long-lasting SARS-CoV-2 protection following natural infection.
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Affiliation(s)
- Arturo Torres Ortiz
- Department of Infection, Inflammation and Immunity, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.,Department of Infectious Diseases, Imperial College London, Paddington, London, W2 1NY, UK
| | - Fernanda Fenn Torrente
- Department of Infection, Inflammation and Immunity, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.,UCL Medical School, University College London, 74 Huntley Street, London, WC1E 6DE, UK
| | - Adam Twigg
- Department of Infectious Diseases, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK.,School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Box 111, Cambridge, CB2 0SP, UK
| | - James Hatcher
- Department of Microbiology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Anja Saso
- Department of Infectious Diseases, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK.,Department of Tropical and Infectious Diseases, LSHTM, Keppel St, Bloomsbury, London, WC1E 7HT, UK.,MRC Gambia at LSHTM, PO Box 273, Fajara, The Gambia
| | - Tanya Lam
- Department of Infectious Diseases, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Marina Johnson
- Department of Infection, Inflammation and Immunity, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Helen Wagstaffe
- Department of Infection, Inflammation and Immunity, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Rishi Dhillon
- Public Health Wales Microbiology, University Hospital of Wales, Heath Park Way, Cardiff, CF14 4XW, UK
| | - Anabelle Lea Mai
- Clinical Immunology, Camelia Botnar Laboratories, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - David Goldblatt
- Department of Infection, Inflammation and Immunity, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Rachel Still
- Laboratory Medicine Service Swansea, Bay University Health Board Morriston Hospital, Swansea, SA6 6NL, UK
| | - Matthew Buckland
- Clinical Immunology, Camelia Botnar Laboratories, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Kimberly Gilmour
- Clinical Immunology, Camelia Botnar Laboratories, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Louis Grandjean
- Department of Infection, Inflammation and Immunity, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK. .,Department of Infectious Diseases, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK.
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8
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Ellis S, Burleigh A, Way R, Kembou-Ringert J, Masonou T, Gilmour K, Grandjean L, Smith C. Longevity and neutralisation activity of secretory IgA following SARS-CoV-2 infection. Access Microbiol 2022. [DOI: 10.1099/acmi.ac2021.po0434] [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] [Indexed: 11/18/2022] Open
Abstract
The mucosal barrier is a primary defence against inhaled pathogens, comprising secretory antibodies which have the potential to block viral entry and neutralise infection. There is an ongoing need for greater understanding of the mucosal immunity to SARS-CoV-2 infection. In this study, we investigated mucosal IgA through non-invasive saliva sampling of healthcare workers.
A total of 551 saliva samples were collected from staff at Great Ormond Street Children’s Hospital who previously tested positive for COVID-19. Participant metadata included age, gender, ethnicity and symptoms. IgA titres were measured by ELISA against viral antigens spike protein, nucleocapsid protein, and spike receptor-binding domain. SARS-CoV-2 neutralisation was measured using a VERO E6 cell culture infection assay.
We found that approximately 30% of saliva samples contained detectable IgA specific for at least one of the SARS-CoV-2 antigens. IgA levels in saliva decreased with the time post-infection, and were largely undetectable after six months. IgA titres specific to SARS-CoV-2 were lowest in participants over 60 years old. Specific saliva samples were identified which effectively neutralised SARS-CoV-2 virus infection of epithelial cells.
Our results suggest secretory IgA specific to SARS-CoV-2 can be detected in saliva following infection, an accessible sample type for testing, although titres decreased over time. Some saliva samples were able to neutralise SARS-CoV-2 infectivity against cultured epithelial cells. This data could be used to assess the risk of re-infection with SARS-CoV-2, as well as accelerate efforts to develop effective mucosal vaccination with longer lasting protection.
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Affiliation(s)
| | | | - Rosie Way
- University College London, United Kingdom
| | | | | | | | - Louis Grandjean
- Great Ormond Street Hospital, United Kingdom
- University College London, United Kingdom
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9
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Sherlaw-Sturrock C, Austin T, Baptista J, Gilmour K, Naik S. Dysmorphism and immunodeficiency - One of the differential diagnoses is PAX1 related otofaciocervical syndrome type 2. Eur J Med Genet 2022; 65:104523. [PMID: 35595062 DOI: 10.1016/j.ejmg.2022.104523] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/04/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022]
Abstract
Otofaciocervical syndrome (OTFCS) is a rare condition associated with short stature, abnormal facial features and conductive hearing loss. OTFCS type 2 (OTFCS) is an autosomal recessive form of this condition with associated T cell deficiency due to biallelic variants in PAX1. We report a female child born to a consanguineous couple with homozygous PAX1 variant. She was diagnosed with T cell immunodeficiency as a neonate and underwent haematopoietic stem cell transplant with cord blood at the age of 5 months. She had facial dysmorphism including ear abnormalities and spinal deformity. We present longitudinal follow-up of the proband who has responded well to the bone marrow transplant to add to the otherwise limited description of this rare condition. This case report expands on the limited literature available on this condition, with only five families reported to date and it further highlights the clinical utility of a rapid gene-agnostic trio exome analysis in identifying a genetic diagnosis in patients who previously underwent genomic testing by gene panel analysis.
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Affiliation(s)
| | - Thomas Austin
- Department of Clinical Genetics, Birmingham Women's and Children's Hospital, UK
| | - Julia Baptista
- Faculty of Health, University of Plymouth, UK; Exeter Genomics Laboratory, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Kimberly Gilmour
- Immunology, Camelia Botnar Laboratories, Great Ormond Street Hospital for Children NHS Foundation Trust, UK
| | - Swati Naik
- Department of Clinical Genetics, Birmingham Women's and Children's Hospital, UK
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10
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Ralph E, Evans J, Booth C, Gilmour K. Patients with XLP type 1 have variable numbers of NKT cells. Br J Haematol 2022; 198:151-154. [PMID: 35355252 DOI: 10.1111/bjh.18159] [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: 01/05/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 11/27/2022]
Abstract
X-linked lymphoproliferative disease (XLP1) is a rare primary immunodeficiency that usually presents in early childhood. Patients with XLP1 have been reported to have absent NKT cells, and it has been suggested that this can be diagnostic for the disorder. Whilst NKT frequency in adults is variable, little is known about their frequency in children. Therefore, we established a paediatric reference range for these cells. In contrast to previous reports, in our cohort of XLP1 patients, NKT cell numbers were found to be variable, and we would advise against using the finding of NKT cells to exclude a diagnosis of XLP1.
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Affiliation(s)
- Elizabeth Ralph
- Immunology Laboratory, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Josie Evans
- Immunology Laboratory, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Claire Booth
- Department of Paediatric Immunology and Gene Therapy, Great Ormond Street Hospital, London, UK
| | - Kimberly Gilmour
- Immunology Laboratory, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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11
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Ortiz AT, Torrente FF, Twigg A, Hatcher J, Saso A, Lam T, Johnson M, Wagstaffe H, Dhillon R, Mai AL, Goldblatt D, Still R, Buckland M, Gilmour K, Grandjean L. The Influence of Time on the Sensitivity of SARS-CoV-2 Serological Testing. Res Sq 2022:rs.3.rs-1286644. [PMID: 35194596 PMCID: PMC8863153 DOI: 10.21203/rs.3.rs-1286644/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: Serological testing is used to quantify SARS-CoV-2 seroprevalence, guide booster vaccination and select patients for anti-SARS-CoV-2 antibodies therapy. However, our understanding of how serological tests perform as time passes after infection is limited. Methods: Four assays were compared in parallel: 1) the multiplexed spike, nucleoprotein and receptor binding domain Meso Scale Discovery (MSD) assay 2) the Roche Elecsys-Nucleoprotein assay (Roche-N) 3) the Roche Spike assay (Roche-S) and 4) the Abbott Nucleoprotein assay (Abbott-N) on serial positive monthly samples from hospital staff up to 200 days following infection as part of the Co-Stars study. Results: We demonstrate that 50% of the Abbott-N assays give a negative result after 175 days (median survival time 95% CI 168-185 days) while the Roche-N assay (93% survival probability at 200 days, 95% CI 88-97%) maintained seropositivity. The MSD spike (97% survival probability at 200 days, 95% CI 95-99%) and the Roche-S assay (95% survival probability at 200 days, 95% CI 93-97%) also remained seropositive. The best performing quantitative Roche-S assay showed no evidence of waning Spike antibody titres over 200-days. Conclusions: The Abbott-N assay fails to detect SARS-CoV-2 antibodies as time passes since infection. In contrast the Roche and the MSD assays maintained high sensitivity. The limitations of the Abbott assay must be considered in clinical decision making. The long duration of detectable neutralizing spike antibody titres by the quantitative Roche-S assay provides further evidence in support of long-lasting SARS-CoV-2 protection to pre-existing strains of SARS-CoV-2 following natural infection. Trial registration : Co-STARs study was registered with ClinicalTrials.gov on May 8th, 2020, with trial number NCT04380896 (www.clinicaltrials.gov, NCT04380896).
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Affiliation(s)
| | | | | | | | - Anja Saso
- London School of Hygiene & Tropical Medicine
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12
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Awuah A, Zamani A, Tahami F, Davis M, Grandjean L, Buckland M, Gilmour K. T cell responses to SARS-CoV-2 in healthy controls and primary immunodeficiency patients. Clin Exp Immunol 2022; 207:uxac001. [PMID: 35020892 PMCID: PMC8807284 DOI: 10.1093/cei/uxac001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/03/2021] [Accepted: 01/05/2022] [Indexed: 01/03/2023] Open
Abstract
Understanding the T cell response to SARS-CoV-2 is key in patients who lack antibody production. We demonstrate the applicability of a functional assay to measure the T cell response in a cohort of patients with immunodeficiency.
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Affiliation(s)
- Arnold Awuah
- Department of Immunology, Great Ormond Street Hospital (GOSH), London, UK
| | - Ava Zamani
- Affiliate of Department of Immunology, Great Ormond Street Hospital (GOSH), London, UK
| | - Fariba Tahami
- Department of Immunology, Great Ormond Street Hospital (GOSH), London, UK
| | - Mark Davis
- Department of Immunology, Great Ormond Street Hospital (GOSH), London, UK
| | - Louis Grandjean
- Department of Infectious Diseases, Great Ormond Street Hospital (GOSH), London, UK
| | - Matthew Buckland
- Department of Immunology, Great Ormond Street Hospital (GOSH), London, UK
| | - Kimberly Gilmour
- Department of Immunology, Great Ormond Street Hospital (GOSH), London, UK
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13
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McCreary D, Omoyinmi E, Hong Y, Jensen B, Burleigh A, Price-Kuehne F, Gilmour K, Eleftheriou D, Brogan P. A rapid turnaround gene panel for severe autoinflammation: Genetic results within 48 hours. Front Immunol 2022; 13:998967. [PMID: 36203604 PMCID: PMC9531256 DOI: 10.3389/fimmu.2022.998967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/05/2022] [Indexed: 11/30/2022] Open
Abstract
There is an important unmet clinical need for fast turnaround next generation sequencing (NGS) to aid genetic diagnosis of patients with acute and sometimes catastrophic inflammatory presentations. This is imperative for patients who require precise and targeted treatment to prevent irreparable organ damage or even death. Acute and severe hyper- inflammation may be caused by primary immunodeficiency (PID) with immune dysregulation, or more typical autoinflammatory diseases in the absence of obvious immunodeficiency. Infectious triggers may be present in either immunodeficiency or autoinflammation. We compiled a list of 25 genes causing monogenetic immunological diseases that are notorious for their acute first presentation with fulminant inflammation and which may be amenable to specific treatment, including hemophagocytic lymphohistiocytosis (HLH); and autoinflammatory diseases that can present with early-onset stroke or other irreversible neurological inflammatory complications. We designed and validated a pipeline that enabled return of clinically actionable results in hours rather than weeks: the Rapid Autoinflammation Panel (RAP). We demonstrated accuracy of this new pipeline, with 100% sensitivity and 100% specificity. Return of results to clinicians was achieved within 48-hours from receiving the patient's blood or saliva sample. This approach demonstrates the potential significant diagnostic impact of NGS in acute medicine to facilitate precision medicine and save "life or limb" in these critical situations.
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Affiliation(s)
- Dara McCreary
- Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Ebun Omoyinmi
- Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.,National Amyloidosis Centre, Royal Free Hospital, London, United Kingdom
| | - Ying Hong
- Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Barbara Jensen
- Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Alice Burleigh
- Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.,Centre for Adolescent Rheumatology, University College London, London, United Kingdom
| | - Fiona Price-Kuehne
- Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Kimberly Gilmour
- Camelia Botnar Laboratory, Great Ormond Street Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Despina Eleftheriou
- Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.,Centre for Adolescent Rheumatology, University College London, London, United Kingdom.,Rheumatology Department, Great Ormond Street Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Paul Brogan
- Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.,Rheumatology Department, Great Ormond Street Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
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14
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Escaron C, Ralph E, Bibi S, Visser J, Aricò M, Rao K, Veys P, Gilmour K. Diagnosis of HLH: two siblings, two distinct genetic causes. Clin Exp Immunol 2021; 207:205-207. [PMID: 35020838 PMCID: PMC8982960 DOI: 10.1093/cei/uxab019] [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: 09/14/2021] [Revised: 11/08/2021] [Accepted: 11/18/2021] [Indexed: 02/03/2023] Open
Abstract
This report highlights case of two siblings who developed haemophagocytic lymphohystiocytosis due to distinct genetic abnormalities. Though their presentation was clinically similar, the cases demonstrate that a shared genetic diagnosis among siblings cannot be assumed.
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Affiliation(s)
- Claire Escaron
- Immunology Laboratory, Great Ormond Street Hospital, London, UK
| | - Elizabeth Ralph
- Immunology Laboratory, Great Ormond Street Hospital, London, UK,Correspondence: Elizabeth Ralph, Immunology Laboratory, Great Ormond Street Hospital, London, UK.
| | - Shahnaz Bibi
- Genetics Laboratory, Great Ormond Street Hospital, London, UK
| | - Johannes Visser
- Department of Paediatric Oncology, Addenbrookes Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Maurizio Aricò
- Azienda Ospedaliero-Universitaria Consorziale Policlinico Bari, Children Hospital 13 Giovanni XXIII, Bari, Italy
| | - Kanchan Rao
- Department of Bone Marrow Transplant, Great Ormond Street Hospital for Children, London, UK
| | - Paul Veys
- Department of Bone Marrow Transplant, Great Ormond Street Hospital for Children, London, UK
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15
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Malik P, Antonini L, Mannam P, Aboobacker FN, Merve A, Gilmour K, Rao K, Kumar S, Mani SE, Eleftheriou D, Rao A, Hemingway C, Sudhakar SV, Bartram J, Mankad K. MRI Patterns in Pediatric CNS Hemophagocytic Lymphohistiocytosis. AJNR Am J Neuroradiol 2021; 42:2077-2085. [PMID: 34620587 DOI: 10.3174/ajnr.a7292] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/19/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Neuroimaging has an important role in detecting CNS involvement in children with systemic or CNS isolated hemophagocytic lymphohistiocytosis. We characterized a cohort of pediatric patients with CNS hemophagocytic lymphohistiocytosis focusing on neuroradiologic features and assessed whether distinct MR imaging patterns and genotype correlations can be recognized. MATERIALS AND METHODS We retrospectively enrolled consecutive pediatric patients diagnosed with hemophagocytic lymphohistiocytosis with CNS involvement treated at 2 pediatric neurology centers between 2010 and 2018. Clinical and MR imaging data were analyzed. RESULTS Fifty-seven children (40 primary, 70%) with a median age of 36 months (interquartile range, 5.5-80.8 months) were included. One hundred twenty-three MR imaging studies were assessed, and 2 broad imaging patterns were identified. Pattern 1 (significant parenchymal disease, 32/57, 56%) was seen in older children (P = .004) with worse clinical profiles. It had 3 onset subpatterns: multifocal white matter lesions (21/32, 66%), brainstem predominant disease (5, 15%), and cerebellitis (6, 19%). All patients with the brainstem pattern failed to meet the radiologic criteria for chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids. An attenuated imaging phenotype (pattern 2) was seen in 25 patients (44%, 30 studies) and was associated with younger age. CONCLUSIONS Distinct MR imaging patterns correlating with clinical phenotypes and possible genetic underpinnings were recognized in this cohort of pediatric CNS hemophagocytic lymphohistiocytosis. Disruptive mutations and missense mutations with absent protein expression correlate with a younger onset age. Children with brainstem and cerebellitis patterns and a negative etiologic work-up require directed assessment for CNS hemophagocytic lymphohistiocytosis.
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Affiliation(s)
- P Malik
- From the Departments of Diagnostic Imaging (P. Malik, P. Mannam, S.E.M.)
| | - L Antonini
- Department of Paediatric Hemato-Oncology (L.A.), G. Salesi Hospital, Ancona, Italy
| | - P Mannam
- From the Departments of Diagnostic Imaging (P. Malik, P. Mannam, S.E.M.)
| | | | - A Merve
- Department of Histopathology (A.M.)
| | | | - K Rao
- Bone Marrow Transplant Unit (K.R.)
| | - S Kumar
- Child Heath (S.K.), Christian Medical College, Vellore, India
| | - S E Mani
- From the Departments of Diagnostic Imaging (P. Malik, P. Mannam, S.E.M.)
| | - D Eleftheriou
- Paediatric Rheumatology (D.E.), Great Ormond Street Hospital for Children and University College, London, UK
| | - A Rao
- Department of Pediatric Hematology (A.R., J.B.)
| | | | | | - J Bartram
- Department of Pediatric Hematology (A.R., J.B.)
| | - K Mankad
- Pediatric Neuroradiology Unit (S.V.S., K.M.)
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16
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Keller B, Strohmeier V, Harder I, Unger S, Payne KJ, Andrieux G, Boerries M, Felixberger PT, Landry JJM, Nieters A, Rensing-Ehl A, Salzer U, Frede N, Usadel S, Elling R, Speckmann C, Hainmann I, Ralph E, Gilmour K, Wentink MWJ, van der Burg M, Kuehn HS, Rosenzweig SD, Kölsch U, von Bernuth H, Kaiser-Labusch P, Gothe F, Hambleton S, Vlagea AD, Garcia Garcia A, Alsina L, Markelj G, Avcin T, Vasconcelos J, Guedes M, Ding JY, Ku CL, Shadur B, Avery DT, Venhoff N, Thiel J, Becker H, Erazo-Borrás L, Trujillo-Vargas CM, Franco JL, Fieschi C, Okada S, Gray PE, Uzel G, Casanova JL, Fliegauf M, Grimbacher B, Eibel H, Ehl S, Voll RE, Rizzi M, Stepensky P, Benes V, Ma CS, Bossen C, Tangye SG, Warnatz K. The expansion of human T-bet highCD21 low B cells is T cell dependent. Sci Immunol 2021; 6:eabh0891. [PMID: 34623902 DOI: 10.1126/sciimmunol.abh0891] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Accumulation of human CD21low B cells in peripheral blood is a hallmark of chronic activation of the adaptive immune system in certain infections and autoimmune disorders. The molecular pathways underpinning the development, function, and fate of these CD21low B cells remain incompletely characterized. Here, combined transcriptomic and chromatin accessibility analyses supported a prominent role for the transcription factor T-bet in the transcriptional regulation of these T-bethighCD21low B cells. Investigating essential signals for generating these cells in vitro established that B cell receptor (BCR)/interferon-γ receptor (IFNγR) costimulation induced the highest levels of T-bet expression and enabled their differentiation during cell cultures with Toll-like receptor (TLR) ligand or CD40L/interleukin-21 (IL-21) stimulation. Low proportions of CD21low B cells in peripheral blood from patients with defined inborn errors of immunity (IEI), because of mutations affecting canonical NF-κB, CD40, and IL-21 receptor or IL-12/IFNγ/IFNγ receptor/signal transducer and activator of transcription 1 (STAT1) signaling, substantiated the essential roles of BCR- and certain T cell–derived signals in the in vivo expansion of T-bethighCD21low B cells. Disturbed TLR signaling due to MyD88 or IRAK4 deficiency was not associated with reduced CD21low B cell proportions. The expansion of human T-bethighCD21low B cells correlated with an expansion of circulating T follicular helper 1 (cTfh1) and T peripheral helper (Tph) cells, identifying potential sources of CD40L, IL-21, and IFNγ signals. Thus, we identified important pathways to target autoreactive T-bethighCD21low B cells in human autoimmune conditions, where these cells are linked to pathogenesis and disease progression.
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Affiliation(s)
- Baerbel Keller
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Valentina Strohmeier
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- University of Freiburg, Faculty of Biology, Freiburg, Germany
| | - Ina Harder
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Susanne Unger
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kathryn J Payne
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, Sydney, New South Wales, Australia
| | - Geoffroy Andrieux
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK) partner site, Freiburg, Germany
- German Cancer Research Center (DKFZ), partner site Freiburg, 79106 Freiburg, Germany
| | - Melanie Boerries
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK) partner site, Freiburg, Germany
- German Cancer Research Center (DKFZ), partner site Freiburg, 79106 Freiburg, Germany
| | - Peter Tobias Felixberger
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jonathan J M Landry
- Genomics Core Facility, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Alexandra Nieters
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- FREEZE-Biobank-Zentrum für Biobanking, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anne Rensing-Ehl
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ulrich Salzer
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Natalie Frede
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Susanne Usadel
- Department of Infection Medicine, Medical Service Centre Clotten, Freiburg, Germany
| | - Roland Elling
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Pediatrics and Adolescent Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Carsten Speckmann
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Pediatrics, Department of Pediatric Hematology and Oncology, University Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ina Hainmann
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | | | | | | | - Mirjam van der Burg
- Department of Pediatrics, Laboratory for Pediatric Immunology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, Netherlands
| | - Hye Sun Kuehn
- Immunology Service, Department of Laboratory Medicine (DLM), National Institutes of Health (NIH) Clinical Center (CC), Bethesda, MD, USA
| | - Sergio D Rosenzweig
- Immunology Service, Department of Laboratory Medicine (DLM), National Institutes of Health (NIH) Clinical Center (CC), Bethesda, MD, USA
| | - Uwe Kölsch
- Department of Immunology, Labor Berlin-Charité Vivantes GmbH, Berlin, Germany
| | - Horst von Bernuth
- Department of Immunology, Labor Berlin-Charité Vivantes GmbH, Berlin, Germany
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Petra Kaiser-Labusch
- Prof. Hess Children's Hospital, Klinikum Bremen-Mitte, Gesundheit Nord gGmbH, Bremen, Germany
| | - Florian Gothe
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Dr. von Hauner Children's Hospital, Department of Paediatrics, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sophie Hambleton
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Alexandru Daniel Vlagea
- Immunology Department, Biomedic Diagnostic Center (CDB), Hospital Clínic de Barcelona, Barcelona, Spain
- Clinical Immunology Unit Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - Ana Garcia Garcia
- Clinical Immunology Unit Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Laia Alsina
- Clinical Immunology Unit Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Gašper Markelj
- Department of Allergology, Rheumatology and Clinical Immunology, Children's Hospital, University Medical Center Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, Children's Hospital, University Medical Center Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - Julia Vasconcelos
- Serviço de Imunologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Margarida Guedes
- Pediatric Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Jing-Ya Ding
- Laboratory of Human Immunology and Infectious Disease, Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Lung Ku
- Laboratory of Human Immunology and Infectious Disease, Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
- Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Bella Shadur
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, Sydney, New South Wales, Australia
- Department of Bone Marrow Transplantation and Cancer Immunotherapy, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
- St. Vincent's Clinical School, UNSW Sydney, Sydney, New South Wales, Australia
| | - Danielle T Avery
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, Sydney, New South Wales, Australia
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jens Thiel
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Heiko Becker
- German Cancer Consortium (DKTK) partner site, Freiburg, Germany
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lucía Erazo-Borrás
- Group of Primary Immunodeficiencies and CCBB, University of Antioquia UDEA, Medellin, Colombia
| | - Claudia Milena Trujillo-Vargas
- Group of Primary Immunodeficiencies, Department of Microbiology and Parasitology, School of Medicine, University of Antioquia UDEA, Medellin, Colombia
| | - José Luis Franco
- Group of Primary Immunodeficiencies, Department of Microbiology and Parasitology, School of Medicine, University of Antioquia UDEA, Medellin, Colombia
| | - Claire Fieschi
- Clinical Immunology Department, Saint Louis Hospital, AP-HP Université de Paris, Paris, France
- INSERM UMR1126, Institut de Recherche Saint-Louis, Université de Paris, Paris, France
| | - Satoshi Okada
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Paul E Gray
- University of New South Wales School of Women's and Children's Health, Sydney, New South Wales, Australia
| | - Gulbu Uzel
- Laboratory of Clinical Infectious Diseases, NIAID, NIH, Bethesda, MD, USA
| | - Jean-Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Imagine Institute, Necker Medical School, Paris Descartes University, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
- Pediatric Hematology and Immunology Unit, Necker Hospital for Sick Children, AP-HP, Paris, France
- Howard Hughes Medical Institute, New York, NY, USA
| | - Manfred Fliegauf
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- CIBSS-Centre for Integrative Biological Signalling Studies, Albert-Ludwigs University, Freiburg, Germany
| | - Bodo Grimbacher
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- CIBSS-Centre for Integrative Biological Signalling Studies, Albert-Ludwigs University, Freiburg, Germany
- DZIF-German Center for Infection Research, Satellite Center Freiburg, Freiburg, Germany
- RESIST-Cluster of Excellence 2155 to Hannover Medical School, Satellite Center Freiburg, Freiburg, Germany
| | - Hermann Eibel
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stephan Ehl
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marta Rizzi
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Polina Stepensky
- Department of Bone Marrow Transplantation and Cancer Immunotherapy, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
| | - Vladimir Benes
- Institute of Medical Bioinformatics and Systems Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cindy S Ma
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, UNSW Sydney, Sydney, New South Wales, Australia
| | - Claudia Bossen
- Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stuart G Tangye
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, UNSW Sydney, Sydney, New South Wales, Australia
| | - Klaus Warnatz
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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17
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Blom M, Zetterström RH, Stray-Pedersen A, Gilmour K, Gennery AR, Puck JM, van der Burg M. Recommendations for uniform definitions used in newborn screening for severe combined immunodeficiency. J Allergy Clin Immunol 2021; 149:1428-1436. [PMID: 34537207 DOI: 10.1016/j.jaci.2021.08.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 07/05/2021] [Revised: 08/06/2021] [Accepted: 08/23/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Public health newborn screening (NBS) programs continuously evolve, taking advantage of international shared learning. NBS for severe combined immunodeficiency (SCID) has recently been introduced in many countries. However, comparison of screening outcomes has been hampered by use of disparate terminology and imprecise or variable case definitions for non-SCID conditions with T-cell lymphopenia. OBJECTIVES This study sought to determine whether standardized screening terminology could overcome a Babylonian confusion and whether improved case definitions would promote international exchange of knowledge. METHODS A systematic literature review highlighted the diverse terminology in SCID NBS programs internationally. While, as expected, individual screening strategies and tests were tailored to each program, we found uniform terminology to be lacking in definitions of disease targets, sensitivity, and specificity required for comparisons across programs. RESULTS The study's recommendations reflect current evidence from literature and existing guidelines coupled with opinion of experts in public health screening and immunology. Terminologies were aligned. The distinction between actionable and nonactionable T-cell lymphopenia among non-SCID cases was clarified, the former being infants with T-cell lymphopenia who could benefit from interventions such as protection from infections, antibiotic prophylaxis, and live-attenuated vaccine avoidance. CONCLUSIONS By bringing together the previously unconnected public health screening community and clinical immunology community, these SCID NBS deliberations bridged the gaps in language and perspective between these disciplines. This study proposes that international specialists in each disorder for which NBS is performed join forces to hone their definitions and recommend uniform registration of outcomes of NBS. Standardization of terminology will promote international exchange of knowledge and optimize each phase of NBS and follow-up care, advancing health outcomes for children worldwide.
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Affiliation(s)
- Maartje Blom
- Department of Pediatrics, Laboratory for Pediatric Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rolf H Zetterström
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Asbjørg Stray-Pedersen
- Norwegian National Unit for Newborn Screening, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Department of Pediatrics, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Kimberly Gilmour
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom; Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom; National Institute for Health Research-Great Ormond Street Hospital Biomedical Research Center, London, United Kingdom
| | - Andrew R Gennery
- Children's Bone Marrow Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, United Kingdom; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jennifer M Puck
- Division of Allergy, Immunology, and Blood and Marrow Transplantation, Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, Calif; University of California, San Francisco Benioff Children's Hospital San Francisco, San Francisco, Calif
| | - Mirjam van der Burg
- Department of Pediatrics, Laboratory for Pediatric Immunology, Leiden University Medical Center, Leiden, The Netherlands.
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18
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Milsom WK, Kinkead R, Hedrick MS, Gilmour K, Perry S, Gargaglioni L, Wang T. Evolution of vertebrate respiratory central rhythm generators. Respir Physiol Neurobiol 2021; 295:103781. [PMID: 34481078 DOI: 10.1016/j.resp.2021.103781] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/03/2021] [Accepted: 08/29/2021] [Indexed: 12/01/2022]
Abstract
Tracing the evolution of the central rhythm generators associated with ventilation in vertebrates is hindered by a lack of information surrounding key transitions. To begin with, central rhythm generation has been studied in detail in only a few species from four vertebrate groups, lamprey, anuran amphibians, turtles, and mammals (primarily rodents). Secondly, there is a lack of information regarding the transition from water breathing fish to air breathing amniotes (reptiles, birds, and mammals). Specifically, the respiratory rhythm generators of fish appear to be single oscillators capable of generating both phases of the respiratory cycle (expansion and compression) and projecting to motoneurons in cranial nerves innervating bucco-pharyngeal muscles. In the amniotes we find oscillators capable of independently generating separate phases of the respiratory cycle (expiration and inspiration) and projecting to pre-motoneurons in the ventrolateral medulla that in turn project to spinal motoneurons innervating thoracic and abdominal muscles (reptiles, birds, and mammals). Studies of the one group of amphibians that lie at this transition (the anurans), raise intriguing possibilities but, for a variety of reasons that we explore, also raise unanswered questions. In this review we summarize what is known about the rhythm generating circuits associated with breathing that arise from the different rhombomeric segments in each of the different vertebrate classes. Assuming oscillating circuits form in every pair of rhombomeres in every vertebrate during development, we trace what appears to be the evolutionary fate of each and highlight the questions that remain to be answered to properly understand the evolutionary transitions in vertebrate central respiratory rhythm generation.
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Affiliation(s)
- W K Milsom
- Department of Zoology, University of British Columbia, Canada.
| | - R Kinkead
- Département de Pédiatrie, Université Laval, Canada
| | - M S Hedrick
- Department of Biological Sciences, California State University, Hayward, CA, USA
| | - K Gilmour
- Department of Biology, University of Ottawa, Canada
| | - S Perry
- Department of Biology, University of Ottawa, Canada
| | - L Gargaglioni
- Departamento de Morfologia e Fisiologia Animal, UNESP, Jaboticabal, Brazil
| | - T Wang
- Department of Zoophysiology, Aarhus University, Denmark
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19
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Lamikanra A, Nguyen D, Simmonds P, Williams S, Bentley EM, Rowe C, Otter AD, Brooks T, Gilmour K, Mai A, Dadhra J, Csatari M, Ziyenge S, Oliveira M, Ploeg R, Tsang P, Zambon M, Gopal R, Xiao JH, Townsend A, Roberts D, Harvala H. Comparability of six different immunoassays measuring SARS-CoV-2 antibodies with neutralizing antibody levels in convalescent plasma: From utility to prediction. Transfusion 2021; 61:2837-2843. [PMID: 34342366 PMCID: PMC8447482 DOI: 10.1111/trf.16600] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 05/02/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Convalescent plasma (CP) therapy for coronavirus disease (COVID-19) provides virus-neutralizing antibodies that may ameliorate the outcome of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. The effectiveness of CP likely depends on its antiviral neutralizing potency and is determined using in vitro neutralizing antibody assays. STUDY DESIGN AND METHODS We evaluated abilities of three immunoassays for anti-spike antibodies (EUROimmun, Ortho, Roche), a pseudotype-based neutralization assay, and two assays that quantify ACE2 binding of spike protein (GenScript and hemagglutination test [HAT]-based assay) to predict neutralizing antibody titers in 113 CP donations. Assay outputs were analyzed through linear regression and calculation of sensitivities and specificities by receiver operator characteristic (ROC) analysis. RESULTS Median values of plasma samples containing neutralizing antibodies produced conversion factors for assay unitage of ×6.5 (pseudotype), ×19 (GenScript), ×3.4 (HAT assay), ×0.08 (EUROimmun), ×1.64 (Roche), and ×0.10 (Ortho). All selected assays were sufficient in identifying the high titer donations based on ROC analysis; area over curve ranged from 91.7% for HAT and GenScript assay to 95.6% for pseudotype assay. However, their ability to predict the actual neutralizing antibody levels varied substantially as shown by linear regression correlation values (from 0.27 for Ortho to 0.61 for pseudotype assay). DISCUSSION Overall, the study data demonstrate that all selected assays were effective in identifying donations with high neutralizing antibody levels and are potentially suitable as surrogate assays for donation selection for CP therapy.
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Affiliation(s)
- Abigail Lamikanra
- Clinical, Research and Development Departments, NHS Blood and Transplant, Oxford, UK
| | - Dung Nguyen
- Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK
| | - Peter Simmonds
- Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK
| | - Sarah Williams
- Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK
| | - Emma M Bentley
- National Institute for Biological Standards and Control (NIBSC), South Mimms, UK
| | - Cathy Rowe
- Rare and Imported Pathogens Laboratory, Public Health England, Porton Down, UK
| | - Ashley David Otter
- Rare and Imported Pathogens Laboratory, Public Health England, Porton Down, UK
| | - Tim Brooks
- Rare and Imported Pathogens Laboratory, Public Health England, Porton Down, UK
| | - Kimberly Gilmour
- Laboratory Services and NIHR BRC Departments, Great Ormond Street Hospital, London, UK
| | - Annabelle Mai
- Laboratory Services and NIHR BRC Departments, Great Ormond Street Hospital, London, UK
| | - Jusvinder Dadhra
- Laboratory Services and NIHR BRC Departments, Great Ormond Street Hospital, London, UK
| | - Mabel Csatari
- Laboratory Services and NIHR BRC Departments, Great Ormond Street Hospital, London, UK
| | - Sheba Ziyenge
- Nuffield Department of Surgical Sciences and BRC Surgical Theme, University of Oxford, Oxford, UK
| | - Marta Oliveira
- Nuffield Department of Surgical Sciences and BRC Surgical Theme, University of Oxford, Oxford, UK.,Research Laboratory Department, NHS Blood and Transplant, Oxford, UK
| | - Rutger Ploeg
- Nuffield Department of Surgical Sciences and BRC Surgical Theme, University of Oxford, Oxford, UK.,Research Laboratory Department, NHS Blood and Transplant, Oxford, UK
| | - Pat Tsang
- Clinical, Research and Development Departments, NHS Blood and Transplant, Oxford, UK
| | - Maria Zambon
- Virology Reference Department, National Infection Service, Public Health England, London, UK
| | - Robin Gopal
- High Containment Microbiology Department, National Infection Service, Public Health England, London, UK
| | - Julie Huiyuan Xiao
- MRC Human Immunology Unit, MRC Weatherall Institute, Radcliffe Department of Medicine, John Radcliffe Hospital, Oxford, UK
| | - Alain Townsend
- MRC Human Immunology Unit, MRC Weatherall Institute, Radcliffe Department of Medicine, John Radcliffe Hospital, Oxford, UK.,Chinese Academy of Medical Science Oxford Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - David Roberts
- Clinical, Research and Development Departments, NHS Blood and Transplant, Oxford, UK.,Radcliffe Department of Medicine and BRC Haematology Theme, University of Oxford, Oxford, UK
| | - Heli Harvala
- Microbiology Services, NHS Blood and Transplant, London, UK
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20
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Mengrelis K, Kucera F, Shahid N, Watt E, Ross S, Lau CI, Adams S, Gilmour K, Pils D, Crompton T, Burch M, Davies EG. T cell phenotype in paediatric heart transplant recipients. Pediatr Transplant 2021; 25:e13930. [PMID: 33326675 DOI: 10.1111/petr.13930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 11/01/2020] [Accepted: 11/03/2020] [Indexed: 01/31/2023]
Abstract
Paediatric heart transplantation recipients suffer an increased incidence of infectious, autoimmune and allergic problems. The relative roles of thymus excision and immunosuppressive treatments in contributing to these sequelae are not clear. We compared the immunological phenotypes of 25 heart transplant recipients (Tx), 10 children who underwent thymus excision during non-transplantation cardiac surgery (TE) and 25 age range-matched controls, in two age bands: 1-9 and 10-16 years. Significant differences from controls were seen mainly in the younger age band with Tx showing lower CD3 and CD4 cell counts whilst TE showed lower CD8 cell counts. Naïve T cell and recent thymic emigrant proportions and counts were significantly lower than controls in both groups in the lower age band. T cell recombination excision circle (TREC) levels were lower than controls in both groups in both age bands. There were no differences in regulatory T cells, but in those undergoing thymus excision in infancy, their proportions were higher in TE than Tx, a possible direct effect of immunosuppression. T cell receptor V beta spectratyping showed fewer peaks in both groups than in controls (predominantly in the older age band). Thymus excision in infancy was associated with lower CD8 cell counts and higher proportions of Tregs in TE compared to Tx. These data are consistent with thymus excision, particularly in infancy, being the most important influence on immunological phenotype after heart transplantation.
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Affiliation(s)
- Konstantinos Mengrelis
- UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Filip Kucera
- Department of Cardiology, Great Ormond Street Hospital, London, UK
| | - Nadia Shahid
- Department of Immunology, Great Ormond Street Hospital, London, UK
| | - Eleanor Watt
- Department of Haematology, Great Ormond Street Hospital, London, UK
| | - Susan Ross
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Ching-In Lau
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Stuart Adams
- Department of Haematology, Great Ormond Street Hospital, London, UK
| | - Kimberly Gilmour
- Department of Immunology, Great Ormond Street Hospital, London, UK
| | - Dietmar Pils
- Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Tessa Crompton
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Michael Burch
- Department of Cardiology, Great Ormond Street Hospital, London, UK
| | - E Graham Davies
- UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Immunology, Great Ormond Street Hospital, London, UK
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21
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Grandjean L, Saso A, Ortiz AT, Lam T, Hatcher J, Thistlethwayte R, Harris M, Best T, Johnson M, Wagstaffe H, Ralph E, Mai A, Colijn C, Breuer J, Buckland M, Gilmour K, Goldblatt D. Long-Term Persistence of Spike Antibody and Predictive Modeling of Antibody Dynamics Following Infection with SARS-CoV-2. Clin Infect Dis 2021; 74:1220-1229. [PMID: 34218284 PMCID: PMC8994590 DOI: 10.1093/cid/ciab607] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Indexed: 01/08/2023] Open
Abstract
Background Antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been shown to neutralize the virus in vitro and prevent disease in animal challenge models on reexposure. However, the current understanding of SARS-CoV-2 humoral dynamics and longevity is conflicting. Methods The COVID-19 Staff Testing of Antibody Responses Study (Co-Stars) prospectively enrolled 3679 healthcare workers to comprehensively characterize the kinetics of SARS-CoV-2 spike protein (S), receptor-binding domain, and nucleoprotein (N) antibodies in parallel. Participants screening seropositive had serial monthly serological testing for a maximum of 7 months with the Meso Scale Discovery Assay. Survival analysis determined the proportion of seroreversion, while 2 hierarchical gamma models predicted the upper and lower bounds of long-term antibody trajectory. Results A total of 1163 monthly samples were provided from 349 seropositive participants. At 200 days after symptoms, >95% of participants had detectable S antibodies, compared with 75% with detectable N antibodies. S antibody was predicted to remain detectable in 95% of participants until 465 days (95% confidence interval, 370–575 days) using a “continuous-decay” model and indefinitely using a “decay-to-plateau” model to account for antibody secretion by long-lived plasma cells. S-antibody titers were correlated strongly with surrogate neutralization in vitro (R2 = 0.72). N antibodies, however, decayed rapidly with a half-life of 60 days (95% confidence interval, 52–68 days). Conclusions The Co-Stars data presented here provide evidence for long-term persistence of neutralizing S antibodies. This has important implications for the duration of functional immunity after SARS-CoV-2 infection. In contrast, the rapid decay of N antibodies must be considered in future seroprevalence studies and public health decision-making. This is the first study to establish a mathematical framework capable of predicting long-term humoral dynamics after SARS-CoV-2 infection. Clinical Trials Registration NCT04380896.
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Affiliation(s)
- Louis Grandjean
- Department of Infection, Inflammation and Immunity, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, UK.,Department of Infectious Diseases, Great Ormond Street Hospital, Great Ormond Street, London
| | - Anja Saso
- Department of Infectious Diseases, Great Ormond Street Hospital, Great Ormond Street, London.,Department of Tropical and Infectious diseases; LSHTM, Keppel St, Bloomsbury, London.,MRC Gambia at LSHTM, PO Box 273, Fajara, The Gambia
| | - Arturo Torres Ortiz
- Department of Infection, Inflammation and Immunity, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, UK.,Department of Medicine, Imperial College, Paddington, London
| | - Tanya Lam
- Department of Infectious Diseases, Great Ormond Street Hospital, Great Ormond Street, London
| | - James Hatcher
- Department of Microbiology, Great Ormond Street Hospital, Great Ormond Street, London
| | | | - Mark Harris
- Quality Improvement, Great Ormond Street Hospital, Great Ormond Street, London
| | - Timothy Best
- Department of Medicine, Imperial College, Paddington, London
| | - Marina Johnson
- Department of Infection, Inflammation and Immunity, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, UK
| | - Helen Wagstaffe
- Department of Infection, Inflammation and Immunity, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, UK
| | - Elizabeth Ralph
- Clinical Immunology, Camelia Botnar Laboratories, Great Ormond Street Hospital, Great Ormond Street, London
| | - Annabelle Mai
- Clinical Immunology, Camelia Botnar Laboratories, Great Ormond Street Hospital, Great Ormond Street, London
| | - Caroline Colijn
- Department of Mathematics, Simon Fraser University, Vancouver, British Colombia, Canada
| | - Judith Breuer
- Department of Infection, Inflammation and Immunity, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, UK
| | - Matthew Buckland
- Clinical Immunology, Camelia Botnar Laboratories, Great Ormond Street Hospital, Great Ormond Street, London
| | - Kimberly Gilmour
- Clinical Immunology, Camelia Botnar Laboratories, Great Ormond Street Hospital, Great Ormond Street, London
| | - David Goldblatt
- Department of Infection, Inflammation and Immunity, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, UK
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22
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Izotova N, Rivat C, Baricordi C, Blanco E, Pellin D, Watt E, Gkazi AS, Adams S, Gilmour K, Bayford J, Booth C, Gaspar HB, Thrasher AJ, Biasco L. Long-term lymphoid progenitors independently sustain naïve T and NK cell production in humans. Nat Commun 2021; 12:1622. [PMID: 33712608 PMCID: PMC7954865 DOI: 10.1038/s41467-021-21834-9] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 02/06/2021] [Indexed: 12/01/2022] Open
Abstract
Our mathematical model of integration site data in clinical gene therapy supported the existence of long-term lymphoid progenitors capable of surviving independently from hematopoietic stem cells. To date, no experimental setting has been available to validate this prediction. We here report evidence of a population of lymphoid progenitors capable of independently maintaining T and NK cell production for 15 years in humans. The gene therapy patients of this study lack vector-positive myeloid/B cells indicating absence of engineered stem cells but retain gene marking in both T and NK. Decades after treatment, we can still detect and analyse transduced naïve T cells whose production is likely maintained by a population of long-term lymphoid progenitors. By tracking insertional clonal markers overtime, we suggest that these progenitors can support both T and NK cell production. Identification of these long-term lymphoid progenitors could be utilised for the development of next generation gene- and cancer-immunotherapies.
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Affiliation(s)
- Natalia Izotova
- Great Ormond Street Institute of Child Health Faculty of Population Health Sciences, London, UK
| | - Christine Rivat
- Great Ormond Street Institute of Child Health Faculty of Population Health Sciences, London, UK
- Orchard Therapeutics, University College of London (UCL), London, UK
| | - Cristina Baricordi
- Gene Therapy Program, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Elena Blanco
- Great Ormond Street Institute of Child Health Faculty of Population Health Sciences, London, UK
| | - Danilo Pellin
- Gene Therapy Program, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | | | - Athina S Gkazi
- Great Ormond Street Institute of Child Health Faculty of Population Health Sciences, London, UK
| | | | | | | | - Claire Booth
- Great Ormond Street Institute of Child Health Faculty of Population Health Sciences, London, UK
- Great Ormond Street Hospital, London, UK
| | - H Bobby Gaspar
- Great Ormond Street Institute of Child Health Faculty of Population Health Sciences, London, UK
- Orchard Therapeutics, University College of London (UCL), London, UK
| | - Adrian J Thrasher
- Great Ormond Street Institute of Child Health Faculty of Population Health Sciences, London, UK.
- Great Ormond Street Hospital, London, UK.
| | - Luca Biasco
- Great Ormond Street Institute of Child Health Faculty of Population Health Sciences, London, UK.
- Gene Therapy Program, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA.
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23
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Straathof K, Flutter B, Wallace R, Jain N, Loka T, Depani S, Wright G, Thomas S, Cheung GWK, Gileadi T, Stafford S, Kokalaki E, Barton J, Marriott C, Rampling D, Ogunbiyi O, Akarca AU, Marafioti T, Inglott S, Gilmour K, Al-Hajj M, Day W, McHugh K, Biassoni L, Sizer N, Barton C, Edwards D, Dragoni I, Silvester J, Dyer K, Traub S, Elson L, Brook S, Westwood N, Robson L, Bedi A, Howe K, Barry A, Duncan C, Barone G, Pule M, Anderson J. Antitumor activity without on-target off-tumor toxicity of GD2-chimeric antigen receptor T cells in patients with neuroblastoma. Sci Transl Med 2020; 12:eabd6169. [PMID: 33239386 DOI: 10.1126/scitranslmed.abd6169] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/23/2020] [Indexed: 12/16/2022]
Abstract
The reprogramming of a patient's immune system through genetic modification of the T cell compartment with chimeric antigen receptors (CARs) has led to durable remissions in chemotherapy-refractory B cell cancers. Targeting of solid cancers by CAR-T cells is dependent on their infiltration and expansion within the tumor microenvironment, and thus far, fewer clinical responses have been reported. Here, we report a phase 1 study (NCT02761915) in which we treated 12 children with relapsed/refractory neuroblastoma with escalating doses of second-generation GD2-directed CAR-T cells and increasing intensity of preparative lymphodepletion. Overall, no patients had objective clinical response at the evaluation point +28 days after CAR-T cell infusion using standard radiological response criteria. However, of the six patients receiving ≥108/meter2 CAR-T cells after fludarabine/cyclophosphamide conditioning, two experienced grade 2 to 3 cytokine release syndrome, and three demonstrated regression of soft tissue and bone marrow disease. This clinical activity was achieved without on-target off-tumor toxicity. Targeting neuroblastoma with GD2 CAR-T cells appears to be a valid and safe strategy but requires further modification to promote CAR-T cell longevity.
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Affiliation(s)
- Karin Straathof
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 1EH, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Barry Flutter
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 1EH, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Rebecca Wallace
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 1EH, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Neha Jain
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Thalia Loka
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Sarita Depani
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Gary Wright
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Simon Thomas
- UCL Cancer Institute, London WC1E 6DD, UK
- Autolus Ltd., London W12 7FP, UK
| | | | - Talia Gileadi
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 1EH, UK
| | - Sian Stafford
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 1EH, UK
| | | | - Jack Barton
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 1EH, UK
| | - Clare Marriott
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Dyanne Rampling
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Olumide Ogunbiyi
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | | | | | - Sarah Inglott
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Kimberly Gilmour
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | | | | | - Kieran McHugh
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Lorenzo Biassoni
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Natalie Sizer
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Claire Barton
- Centre for Drug Development, Cancer Research UK, London E20 1JQ, UK
| | - David Edwards
- Centre for Drug Development, Cancer Research UK, London E20 1JQ, UK
| | - Ilaria Dragoni
- Centre for Drug Development, Cancer Research UK, London E20 1JQ, UK
| | - Julie Silvester
- Centre for Drug Development, Cancer Research UK, London E20 1JQ, UK
| | - Karen Dyer
- Centre for Drug Development, Cancer Research UK, London E20 1JQ, UK
| | - Stephanie Traub
- Centre for Drug Development, Cancer Research UK, London E20 1JQ, UK
| | - Lily Elson
- Centre for Drug Development, Cancer Research UK, London E20 1JQ, UK
| | - Sue Brook
- Centre for Drug Development, Cancer Research UK, London E20 1JQ, UK
| | - Nigel Westwood
- Centre for Drug Development, Cancer Research UK, London E20 1JQ, UK
| | - Lesley Robson
- Centre for Drug Development, Cancer Research UK, London E20 1JQ, UK
| | - Ami Bedi
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Karen Howe
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Ailish Barry
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Catriona Duncan
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Giuseppe Barone
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | | | - John Anderson
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 1EH, UK.
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
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Mackenzie S, Low R, Brown M, Sanchez E, Gilmour K, Youngstein T, Tatersall R, Carpenter B, Patel A, Mcnamara C, Manson J. P82 Multi-centre cross-specialty recommendations for the investigation of suspected adult onset secondary haemophagocytic lymphohistiocytosis (HLH). Rheumatology (Oxford) 2020. [DOI: 10.1093/rheumatology/keaa111.080] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Secondary HLH (sHLH) in adults is a paradigm of a disorder with multiple challenges. It is rare and under-recognised, clinical features are non-specific and heterogeneous, it may present to a broad range of specialties and there is no single test which can unambiguously diagnose the condition. The investigation of such patients often occurs in a piecemeal fashion, which causes delays in establishing diagnosis leading to missed opportunities to start treatment early. Treatment protocols are extrapolated from mostly paediatric data from the primary, genetic form of HLH with insufficient clinical trials in adults to provide robust evidence-based management approaches. There is a resultant wide range in clinical practice and sHLH has a high mortality rate. Addressing these issues and improving knowledge about the disorder therefore requires cross-speciality, multi-centre working. Within the UK, these challenges have begun to be addressed over the past 24 months, resulting in the creation of local and regional HLH MDTs, the formation of a national network of interested specialists (HASC: the HLH across-specialty collaboration) as well as the creation of a national HLH registry as part of the UK Histiocytosis Registry (UKHR).
Methods
The aim of this project was to create a national guideline for the diagnosis and investigation of adult patients with suspected sHLH in order to start to standardise practice across the UK. Over 30 clinicians from a broad range of specialties, from both paediatric and adult practice, were consulted. These included sub-specialist input from rheumatology, haematology, infectious diseases, virology, nephrology, intensive care and immunology with collaborations from 15 centres around the UK. The HASC meetings were used as a forum to collaborate and develop the guidance.
Results
We created an investigation algorithm dividing tests for work-up into 3 sections: 1. Routine initial work 2. HLH-specific testing, comprehensive infection work-up, guidance on tissue biopsy 3. Identification and work-up of suspected adult cases of familial/genetic HLH (fHLH).
The guidance also uses HASC multi-professional expertise to provide approaches to controversial areas including ferritin and sCD25 thresholds in adults, deep skin biopsies for suspected intravascular lymphoma and specific scenarios such as neurological presentations and CAR-T therapy. Clinicians from different specialties across the UK and specialist laboratories with an interest in HLH have been identified in order to make the HLH network more accessible. The aim is to have the guideline hosted by Histio UK, and freely available on their website.
Conclusion
This guideline is based on cross-specialty consensus expert opinion with reference to published literature in order to develop best practice. The coordinated investigation of patients with sHLH is key to improving early diagnosis and treatment and is just one part of the collaborative multi-faceted approach that is required to improve overall outcomes for patients with sHLH.
Disclosures
S. Mackenzie None. R. Low None. M. Brown None. E. Sanchez None. K. Gilmour None. T. Youngstein None. R. Tatersall None. B. Carpenter None. A. Patel None. C. Mcnamara None. J. Manson None.
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Affiliation(s)
- Strachan Mackenzie
- Dept of Haematology, University College London Hospital, London, UNITED KINGDOM
| | - Ryan Low
- Dept of Haematology, University College London Hospital, London, UNITED KINGDOM
| | - Michael Brown
- Divison of Infection & Immunity, University College London Hospital, London, UNITED KINGDOM
- Dept of Infectious and tropical diseases, Hospital for Tropical Diseases, London, UNITED KINGDOM
| | - Emilie Sanchez
- Dept of Virology, University College London Hospital, London, UNITED KINGDOM
| | - Kimberly Gilmour
- Dept of Immunology, Great Ormond Street Hospital for Children, London, UNITED KINGDOM
| | - Taryn Youngstein
- Dept of Rheumatology, Imperial College Healthcare NHS Trust, London, UNITED KINGDOM
| | - Rachel Tatersall
- Dept of Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UNITED KINGDOM
- Dept of Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Benjamin Carpenter
- Dept of Haematology, University College London Hospital, London, UNITED KINGDOM
| | - Amit Patel
- Dept of Haematology, University of Liverpool, Liverpool, UNITED KINGDOM
| | | | - Jessica Manson
- Dept of Rheumatology, University College London Hospital, London, UNITED KINGDOM
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25
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Hong Y, Capitani M, Murphy C, Pandey S, Cavounidis A, Takeshita H, Nanthapisal S, Yasuda T, Bader-Meunier B, McCreary D, Omoyinmi E, Rao A, Booth C, Gilmour K, Sebire N, Shah N, Klein N, Bullock AN, Eleftheriou D, Uhlig HH, Brogan P. Janus kinase inhibition for autoinflammation in patients with DNASE2 deficiency. J Allergy Clin Immunol 2020; 145:701-705.e8. [DOI: 10.1016/j.jaci.2019.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/13/2019] [Accepted: 11/15/2019] [Indexed: 01/11/2023]
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26
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Kohn DB, Booth C, Kang EM, Pai SY, Shaw KL, Santilli G, Armant M, Buckland KF, Choi U, De Ravin SS, Dorsey MJ, Kuo CY, Leon-Rico D, Rivat C, Izotova N, Gilmour K, Snell K, Dip JXB, Darwish J, Morris EC, Terrazas D, Wang LD, Bauser CA, Paprotka T, Kuhns DB, Gregg J, Raymond HE, Everett JK, Honnet G, Biasco L, Newburger PE, Bushman FD, Grez M, Gaspar HB, Williams DA, Malech HL, Galy A, Thrasher AJ. Lentiviral gene therapy for X-linked chronic granulomatous disease. Nat Med 2020; 26:200-206. [PMID: 31988463 PMCID: PMC7115833 DOI: 10.1038/s41591-019-0735-5] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 12/10/2019] [Indexed: 12/24/2022]
Abstract
Chronic granulomatous disease (CGD) is a rare inherited disorder of phagocytic cells1,2. We report the initial results of nine severely affected X-linked CGD (X-CGD) patients who received ex vivo autologous CD34+ hematopoietic stem and progenitor cell-based lentiviral gene therapy following myeloablative conditioning in first-in-human studies (trial registry nos. NCT02234934 and NCT01855685). The primary objectives were to assess the safety and evaluate the efficacy and stability of biochemical and functional reconstitution in the progeny of engrafted cells at 12 months. The secondary objectives included the evaluation of augmented immunity against bacterial and fungal infection, as well as assessment of hematopoietic stem cell transduction and engraftment. Two enrolled patients died within 3 months of treatment from pre-existing comorbidities. At 12 months, six of the seven surviving patients demonstrated stable vector copy numbers (0.4-1.8 copies per neutrophil) and the persistence of 16-46% oxidase-positive neutrophils. There was no molecular evidence of either clonal dysregulation or transgene silencing. Surviving patients have had no new CGD-related infections, and six have been able to discontinue CGD-related antibiotic prophylaxis. The primary objective was met in six of the nine patients at 12 months follow-up, suggesting that autologous gene therapy is a promising approach for CGD patients.
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Affiliation(s)
| | - Claire Booth
- Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Elizabeth M Kang
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Sung-Yun Pai
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kit L Shaw
- University of California, Los Angeles, CA, USA
| | - Giorgia Santilli
- Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Myriam Armant
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Karen F Buckland
- Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Uimook Choi
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Suk See De Ravin
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | | | - Diego Leon-Rico
- Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Christine Rivat
- Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Natalia Izotova
- Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Kimberly Gilmour
- Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Katie Snell
- Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Jinhua Xu-Bayford Dip
- Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Jinan Darwish
- Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Emma C Morris
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Leo D Wang
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- City of Hope, Beckman Research Institute, Duarte, CA, USA
| | | | | | - Douglas B Kuhns
- Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - John Gregg
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - Luca Biasco
- Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | | | | | | | - H Bobby Gaspar
- Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
- Orchard Therapeutics, London, UK
| | - David A Williams
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Harry L Malech
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Anne Galy
- Genethon, Evry, France
- Inserm, University of Evry, Université Paris Saclay Genethon, Evry, France
| | - Adrian J Thrasher
- Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK.
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Hong Y, Nanthapisal S, Omoyinmi E, Olbrich P, Neth O, Speckmann C, Lucena JM, Gilmour K, Worth A, Klein N, Eleftheriou D, Brogan P. Secondary C1q Deficiency in Activated PI3Kδ Syndrome Type 2. Front Immunol 2019; 10:2589. [PMID: 31781101 PMCID: PMC6859795 DOI: 10.3389/fimmu.2019.02589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/18/2019] [Indexed: 11/13/2022] Open
Abstract
Monogenic forms of vasculitis are rare but increasingly recognized. Furthermore, genetic immunodeficiency is increasingly associated with inflammatory immune dysregulatory features, including vasculitis. This case report describes a child of non-consanguineous parents who presented with chronic digital vasculitis early in life, is of short stature, has facial dysmorphia, immunodeficiency (low serum IgA, high serum IgM), recurrent bacterial infections, lymphoproliferation, absence of detectable serum C1q, and low classical complement pathway activity. We identified a previously reported de novo heterozygous pathogenic splice mutation in PIK3R1 (c.1425 + 1G > A), resulting in the skipping of exon 11 of the p85α subunit of phosphatidylinositol 3-kinase and causing activated PI3Kδ syndrome type II (APDS2). This explained the phenotype, with the exception of digital vasculitis and C1q deficiency, which have never been described in association with APDS2. No mutations were identified in C1QA, B, or C, their promoter regions, or in any other complement component. Functional studies indicated normal monocytic C1q production and release, suggesting that the observed C1q deficiency was caused by peripheral consumption of C1q. Since C1q deficiency has never been associated with APDS2, we assessed C1q levels in two unrelated patients with genetically confirmed APDS2 and confirmed C1q deficiency in those two cases as well. This observation suggests C1q deficiency to be an inherent but previously unrecognized feature of APDS2. We speculate that the consumption of C1q is driven by increased apoptotic bodies derived from immune cellular senescence, combined with elevated IgM production (both inherent features of APDS2). Secondary C1q deficiency in APDS2 may further contribute to immunodeficiency and could also be associated with inflammatory immune dysregulatory phenotypes, such as the digital vasculitis observed in our case.
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Affiliation(s)
- Ying Hong
- Infection, Immunology and Inflammation Research & Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Sira Nanthapisal
- Infection, Immunology and Inflammation Research & Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
- Department of Pediatrics, Thammasat University, Bangkok, Thailand
| | - Ebun Omoyinmi
- Infection, Immunology and Inflammation Research & Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Peter Olbrich
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, Institut of Biomedicine of Seville, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Olaf Neth
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, Institut of Biomedicine of Seville, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Carsten Speckmann
- Faculty of Medicine, Center for Chronic Immunodeficiency, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Jose Manuel Lucena
- Unidad de Inmunología, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - Kimberly Gilmour
- Clinical Immunology Laboratory, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Austen Worth
- Clinical Immunology Laboratory, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Nigel Klein
- Infection, Immunology and Inflammation Research & Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Despina Eleftheriou
- Infection, Immunology and Inflammation Research & Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
- ARUK Centre for Adolescent Rheumatology, UCL, London, United Kingdom
| | - Paul Brogan
- Infection, Immunology and Inflammation Research & Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
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Al Shehri T, Gilmour K, Gothe F, Loughlin S, Bibi S, Rowan AD, Grainger A, Mohanadas T, Cant AJ, Slatter MA, Hambleton S, Lilic D, Leahy TR. Novel Gain-of-Function Mutation in Stat1 Sumoylation Site Leads to CMC/CID Phenotype Responsive to Ruxolitinib. J Clin Immunol 2019; 39:776-785. [PMID: 31512162 DOI: 10.1007/s10875-019-00687-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 09/02/2019] [Indexed: 10/26/2022]
Abstract
Mutations in the coiled-coil and DNA-binding domains of STAT1 lead to delayed STAT1 dephosphorylation and subsequently gain-of-function. The associated clinical phenotype is broad and can include chronic mucocutaneous candidiasis (CMC) and/or combined immunodeficiency (CID). We report a case of CMC/CID in a 10-year-old boy due to a novel mutation in the small ubiquitin molecule (SUMO) consensus site at the C-terminal region of STAT1 leading to gain-of-function by impaired sumoylation. Immunodysregulatory features of disease improved after Janus kinase inhibitor (jakinib) treatment. Functional testing after treatment confirmed reversal of the STAT1 hyper-phosphorylation and downstream transcriptional activity. IL-17 and IL-22 production was, however, not restored with jakinib therapy (ruxolitinib), and the patient remained susceptible to opportunistic infection. In conclusion, a mutation in the SUMO consensus site of STAT1 can lead to gain-of-function that is reversible with jakinib treatment. However, full immunocompetence was not restored, suggesting that this treatment strategy might serve well as a bridge to definitive therapy such as hematopoietic stem cell transplant rather than a long-term treatment option.
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Affiliation(s)
- Tariq Al Shehri
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Department of Pathology & Laboratory Medicine, Immunology Lab, King Faisal Specialist Hospital & Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Kimberly Gilmour
- Department of Immunology, Camelia Botnar Laboratories, Great Ormond Street Hospital for Children, London, UK
| | - Florian Gothe
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Sam Loughlin
- Regional Molecular Genetics Laboratory, Great Ormond Street Hospital for Children, London, UK
| | - Shahnaz Bibi
- Regional Molecular Genetics Laboratory, Great Ormond Street Hospital for Children, London, UK
| | - Andrew D Rowan
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Angela Grainger
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Thivytra Mohanadas
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew J Cant
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Department of Paediatric Immunology and BMT, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Mary A Slatter
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Department of Paediatric Immunology and BMT, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Sophie Hambleton
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Department of Paediatric Immunology and BMT, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Desa Lilic
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Timothy R Leahy
- Department of Paediatric Immunology and Infectious Diseases, Children's Health Ireland, Crumlin, Dublin, D12 N512, Ireland.
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29
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McCreary D, Omoyinmi E, Hong Y, Mulhern C, Papadopoulou C, Casimir M, Hacohen Y, Nyanhete R, Ahlfors H, Cullup T, Lim M, Gilmour K, Mankad K, Wassmer E, Berg S, Hemingway C, Brogan P, Eleftheriou D. Development and Validation of a Targeted Next-Generation Sequencing Gene Panel for Children With Neuroinflammation. JAMA Netw Open 2019; 2:e1914274. [PMID: 31664448 PMCID: PMC6824223 DOI: 10.1001/jamanetworkopen.2019.14274] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Neuroinflammatory disorders are a range of severe neurological disorders causing brain and spinal inflammation and are now increasingly recognized in the pediatric population. They are often characterized by marked genotypic and phenotypic heterogeneity, complicating diagnostic work in clinical practice and molecular diagnosis. OBJECTIVE To develop and evaluate a next-generation sequencing panel targeting genes causing neuroinflammation or mimicking neuroinflammation. DESIGN, SETTING, AND PARTICIPANTS Cohort study in which a total of 257 genes associated with monogenic neuroinflammation and/or cerebral vasculopathy, including monogenic noninflammatory diseases mimicking these entities, were selected. A customized enrichment capture array, the neuroinflammation gene panel (NIP), was created. Targeted high-coverage sequencing was applied to DNA samples taken from eligible patients referred to Great Ormond Street Hospital in London, United Kingdom, between January 1, 2017, and January 30, 2019, because of onset of disease early in life, family history, and/or complex neuroinflammatory phenotypes. MAIN OUTCOMES AND MEASURES The main outcome was the percentage of individuals with definitive molecular diagnoses, variant classification, and clinical phenotyping of patients with pathogenic variants identified using the NIP panel. The NIP panel was initially validated in 16 patients with known genetic diagnoses. RESULTS The NIP was both sensitive (95%) and specific (100%) for detection of known mutations, including gene deletions, copy number variants, small insertions and deletions, and somatic mosaicism with allele fraction as low as 3%. Prospective testing of 60 patients (30 [50%] male; median [range] age, 9.8 [0.8-20] years) presenting with heterogeneous neuroinflammatory phenotypes revealed at least 1 class 5 (clearly pathogenic) variant in 9 of 60 patients (15%); 18 of 60 patients (30%) had at least 1 class 4 (likely pathogenic) variant. Overall, a definitive molecular diagnosis was established in 12 of 60 patients (20%). CONCLUSIONS AND RELEVANCE The NIP was associated with molecular diagnosis in this cohort and complemented routine laboratory and radiological workup of patients with neuroinflammation. Unexpected genotype-phenotype associations in patients with pathogenic variants deviating from the classic phenotype were identified. Obtaining an accurate molecular diagnosis in a timely fashion informed patient management, including successful targeted treatment in some instances and early institution of hematopoietic stem cell transplantation in others.
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Affiliation(s)
- Dara McCreary
- Infection, Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Ebun Omoyinmi
- Infection, Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Ying Hong
- Infection, Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Ciara Mulhern
- Infection, Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Charalampia Papadopoulou
- Infection, Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Marina Casimir
- Infection, Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Yael Hacohen
- Paediatric Neurology Department, Children NHS Foundation Trust, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Rodney Nyanhete
- North East Thames Regional Genetics Laboratory, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Helena Ahlfors
- North East Thames Regional Genetics Laboratory, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Thomas Cullup
- North East Thames Regional Genetics Laboratory, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Ming Lim
- Children’s Neurosciences Unit, Evelina London Children’s Hospital, Women’s and Children’s Department, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Kimberly Gilmour
- Immunology Department, Great Ormond Street Hospital NHS Foundations Trust, London, United Kingdom
| | - Kshitij Mankad
- Paediatric Neuroradiology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Evangeline Wassmer
- Paediatric Neurology Department, Birmingham Children’s Hospital, Birmingham, United Kingdom
| | - Stefan Berg
- Paediatric Rheumatology Department, University of Gothenburg, Gothenburg, Sweden
| | - Cheryl Hemingway
- Paediatric Neurology Department, Children NHS Foundation Trust, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Paul Brogan
- Infection, Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Despina Eleftheriou
- Infection, Inflammation and Rheumatology Section, University College London Great Ormond Street Institute of Child Health, London, United Kingdom
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, United Kingdom
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30
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Cinar OK, Foley C, Al-Hussaini A, Gilmour K, Buckland M, Al-Obaidi M. P24 Can high ANA titre combined with clinical features predict developing autoimmune conditions in children? Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez414.005] [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] [Indexed: 11/13/2022] Open
Abstract
Poster presentation Tuesday 8 October
Background
Antinuclear antibodies (ANA) are autoantibodies that recognise cellular antigens found predominantly in the cell nucleus. They are associated with numerous autoimmune diseases such as systemic lupus erythematosus, but may also be found in infectious diseases, malignancies and healthy individuals.
ANA is requested as part of an initial work-up for autoimmune conditions. In healthy children (5-18%), positive ANA titres of 1/80 to 1/320 have been reported. A prospective study of healthy children with positive ANA found that children who developed autoimmune disease had clinical features at presentation that were suspicious for such an outcome. Therefore, the usefulness of a positive ANA result for diagnosing autoimmune conditions is limited without clinical correlation. The aim of our study was to assess whether high ANA titre and clinical features at presentation could predict final diagnosis.
Methods
Single centre retrospective study at Great Ormond Street Hospital for Children (GOSH). The immunology laboratory provided a list of positive ANA results (using indirect immunofluorescence technique) from January 2013 to July 2018. A retrospective chart review was performed to ascertain presence of clinical features at presentation under the five following titles: arthritis, skin involvement, eyes, CNS involvement and Raynaud’s phenomenon. We then reviewed the last clinical contact to document confirmed diagnosis.
Results
We performed a retrospective chart review on 1,354 children (67% female; median age 7.5 years (0.1-17.5); median follow-up 4.8 years (0-18)) with positive ANA results (titres 1/160, 1/320, 1/640, 1/1280, 1/2560 and >1/2560). Table 1 reports ANA titres at first presentation in relation to final diagnosis. A titre of 1/640 or above was most commonly seen (>50%) in children with an autoimmune rheumatology condition. In fact, children with the highest titre (>1:2560) were significantly more likely to be diagnosed with one of these conditions. Finally, we looked at the number of presenting features and correlated with final diagnosis. Those diagnosed with a CTD were most likely to present with 2-5 clinical features (p < 0.0001).
P24 Table 1: Percentage of patients grouped according to their diagnosis and ANA titres Final Diagnoses ANA Titres >1: 2560 1: 2560 1: 1280 1: 640 1: 320 1: 160 Connective Tissue Diseases 24% 9% 13% 16% 16% 22% JIA and Uveitis 8% 11% 15% 22% 22% 22% JIA 6% 8% 13% 24% 24% 25% Autoimmune (other) 4% 5% 11% 19% 32% 29% Unidentified autoimmune/ autoinflammatory 8% 12% - 24% 12% 44% Vasculitis - - 5% 26% 16% 53% Sarcoidosis - 20% - 20% - 60% Autoinflammatory 7% - - 43% - 50% Malignancy - - - 25% - 75% Other 3% 2% 3% 17% 28% 47% Non-inflammatory MSK 3% - 9% 18% 27% 43%
Conclusion
This study suggests that, patients presenting with higher ANA titres and a combination of clinical features should be assessed systemically and followed-up as they may have increased risk of developing an autoimmune rheumatological conditions.
Conflicts of Interest
The authors declare no conflicts of interest.
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Affiliation(s)
- Ovgu Kul Cinar
- Rheumatology Department, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Charlene Foley
- Centre for Adolescent Rheumatology, University College London, London, United Kingdom
| | - Ali Al-Hussaini
- Rheumatology, Imperial College London School of Medicine, London, United Kingdom
| | - Kimberly Gilmour
- Great Ormond Street Hospital for Children NHS Trust Department of Immunology Octav Bognar Laboratories, London, United Kingdom
| | - Matthew Buckland
- Great Ormond Street Hospital for Children NHS Trust Department of Immunology Octav Bognar Laboratories, London, United Kingdom
| | - Muthana Al-Obaidi
- Rheumatology Department, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
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31
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Johnson SM, Gilmour K, Samarasinghe S, Bamford A. Haemophagocytic lymphohistiocytosis complicating visceral leishmaniasis in the UK: a case for detailed travel history, a high index of suspicion and timely diagnostics. BMJ Case Rep 2019; 12:12/7/e228307. [PMID: 31296633 DOI: 10.1136/bcr-2018-228307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 4-month-old male infant presented acutely unwell with fever. He was initially treated for sepsis but failed to improve with IV broad spectrum antibiotics. Haemophagocytic lymphohistiocytosis (HLH) was diagnosed due to his fever, pancytopenia, splenomegaly, hypertriglyceridaemia, hypofibrinogenaemia and significant hyperferritinaemia. An array of differentials for HLH including both immunological and infectious causes were considered and excluded. He had travelled to Madrid, and hence visceral leishmaniasis (VL) was suspected, but was not confirmed on the initial bone marrow aspirate (BMA) microscopy or culture. He improved with empirical treatment with dexamethasone and liposomal amphotericin B. VL was later confirmed on BMA PCR. He made a good recovery and remained well at 12 month follow-up. Non-endemic countries need rapid and sensitive VL diagnostics. A thorough travel history and high clinical index of suspicion are necessary to avoid the pitfall of treatment with intense immunosuppression recommended in treatment guidelines for HLH.
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Affiliation(s)
- Sarah May Johnson
- Paediatric Infectious Diseases, Great Ormond Street Hospital, London, UK.,Paediatric Infectious Diseases, Royal Free London NHS Foundation Trust, London, UK
| | - Kimberly Gilmour
- Immunology, Great Ormond Street Hospital, London, UK.,Infection, Immunity, Inflammation, Great Ormond Street Institute of Child Health, London, UK
| | | | - Alasdair Bamford
- Paediatric Infectious Diseases, Great Ormond Street Hospital, London, UK.,Infection, Immunity, Inflammation, Great Ormond Street Institute of Child Health, London, UK
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32
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Tometten I, Felgentreff K, Hönig M, Hauck F, Albert MH, Niehues T, Perez R, Ghosh S, Picard C, Stary J, Formankova R, Worth A, Soler-Palacín P, García-Prat M, Allende LM, Gonzalez-Granado LI, Stepensky P, Di Cesare S, Scarselli A, Cancrini C, Speckmann C, Gilmour K, Notarangelo L, Ehl S, Rohr JC. Increased proportions of γδ T lymphocytes in atypical SCID associate with disease manifestations. Clin Immunol 2019; 201:30-34. [PMID: 30776520 DOI: 10.1016/j.clim.2018.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 08/13/2018] [Revised: 10/31/2018] [Accepted: 11/11/2018] [Indexed: 10/27/2022]
Abstract
Severe combined immunodeficiencies (SCID) comprise a group of genetic diseases characterized by abrogated development of T lymphocytes. In some case reports of atypical SCID patients elevated proportions of γδ T lymphocytes have been reported. However, it is unknown whether these γδ T cells modulate or reflect the patient's clinical phenotype. We investigated the frequency of elevated γδ T cell proportions and associations with clinical disease manifestations in a cohort of 76 atypical SCID patients. Increased proportions of γδ T lymphocytes were present in approximately 60% of these patients. Furthermore, we identified positive correlations between elevated proportions of γδ T cells and the occurrence of CMV infections and autoimmune cytopenias. We discuss that CMV infections might trigger an expansion of γδ T lymphocytes, which could drive the development of autoimmune cytopenias. We advocate that atypical SCID patients should be screened for elevated proportions of γδ T lymphocytes, CMV infection and autoimmune cytopenias.
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Affiliation(s)
- Inga Tometten
- Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kerstin Felgentreff
- Department of Pediatrics and Adolescent Medicine, Ulm University, Ulm, Germany
| | - Manfred Hönig
- Department of Pediatrics and Adolescent Medicine, Ulm University, Ulm, Germany
| | - Fabian Hauck
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Michael H Albert
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU, Munich, Germany
| | - Tim Niehues
- HELIOS Children's Hospital Krefeld, Pediatric Immunology and Rheumatology, Krefeld, Germany
| | - Ruy Perez
- HELIOS Children's Hospital Krefeld, Pediatric Immunology and Rheumatology, Krefeld, Germany
| | - Sujal Ghosh
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Center of Child and Adolescent Health, Heinrich-Heine-University, Dusseldorf, Germany
| | - Capucine Picard
- Paris Descartes-Sorbonne Paris Cité University, Imagine Institute Paris, Paris, France; Paediatric Haematology-Immunology and Rheumatology Unit, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France; Center for Primary Immunodeficiencies, Necker-Enfants Malades Hospital, APHP, Paris, France; Laboratory of Lymphocyte Activation and Susceptibility to EBV Infection, INSERM UMR 1163, Imagine Institute, University Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Jan Stary
- Department of Pediatric Hematology and Oncology, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Renata Formankova
- Department of Pediatric Hematology and Oncology, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Austen Worth
- Great Ormond Street Hospital NHS Trust, London, United Kingdom
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit (UPIIP), Hospital Universitari Vall d'Hebron (HUVH), Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Jeffrey Model Foundation Excellence Center, Barcelona, Spain
| | - Marina García-Prat
- Pediatric Infectious Diseases and Immunodeficiencies Unit (UPIIP), Hospital Universitari Vall d'Hebron (HUVH), Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Jeffrey Model Foundation Excellence Center, Barcelona, Spain
| | - Luis M Allende
- Immunology Department, Hospital Universitario 12 de Octubre, Research Institute (i+12). Madrid, Spain
| | - Luis Ignacio Gonzalez-Granado
- Immunodeficiencies Unit, Department of Pediatrics, University Hospital 12 de Octubre, Research Institute Hospital 12 Octubre (i+12), Madrid, Spain; Complutense University of Madrid, Madrid, Spain
| | - Polina Stepensky
- Department of Bone Marrow Transplantation, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Silvia Di Cesare
- University Department of Pediatrics, Unit of Immune and Infectious Diseases, Children's Hospital Bambino Gesù, Rome, Italy
| | - Alessia Scarselli
- University Department of Pediatrics, Unit of Immune and Infectious Diseases, Children's Hospital Bambino Gesù, Rome, Italy
| | - Caterina Cancrini
- University Department of Pediatrics, Unit of Immune and Infectious Diseases, Children's Hospital Bambino Gesù, Rome, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Carsten Speckmann
- Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Luigi Notarangelo
- Laboratory of Clinical Immunology and Microbiology, LCIM, National Institute of Allergy and Infectious Diseases, NIAID, National Institutes of Health, NIH, Bethesda, MD, USA
| | - Stephan Ehl
- Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jan C Rohr
- Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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33
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Elfeky R, Shah RM, Unni MNM, Ottaviano G, Rao K, Chiesa R, Amrolia P, Worth A, Flood T, Abinun M, Hambleton S, Cant AJ, Gilmour K, Adams S, Ahsan G, Barge D, Gennery AR, Qasim W, Slatter M, Veys P. New graft manipulation strategies improve the outcome of mismatched stem cell transplantation in children with primary immunodeficiencies. J Allergy Clin Immunol 2019; 144:280-293. [PMID: 30731121 DOI: 10.1016/j.jaci.2019.01.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 06/10/2018] [Revised: 01/11/2019] [Accepted: 01/17/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Mismatched stem cell transplantation is associated with a high risk of graft loss, graft-versus-host disease (GvHD), and transplant-related mortality. Alternative graft manipulation strategies have been used over the last 11 years to reduce these risks. OBJECTIVE We investigated the outcome of using different graft manipulation strategies among children with primary immunodeficiencies. METHODS Between 2006 and 2017, 147 patients with primary immunodeficiencies received 155 mismatched grafts: 30 T-cell receptor (TCR) αβ/CD19-depleted grafts, 43 cord blood (CB) grafts (72% with no serotherapy), 17 CD34+ selection with T-cell add-back grafts, and 65 unmanipulated grafts. RESULTS The estimated 8-year survival of the entire cohort was 79%, transplant-related mortality was 21.7%, and the graft failure rate was 6.7%. Posttransplantation viral reactivation, grade II to IV acute graft-versus-host disease (aGvHD), and chronic graft-versus-host disease (cGvHD) complicated 49.6%, 35%, and 15% of transplantations, respectively. Use of TCRαβ/CD19 depletion was associated with a significantly lower incidence of grade II to IV aGvHD (11.5%) and cGvHD (0%), although with a greater incidence of viral reactivation (70%) in comparison with other grafts. T-cell immune reconstitution was robust among CB transplants, although with a high incidence (56.7%) of grade II to IV aGvHD. Stable full donor engraftment was significantly greater at 80% among TCRαβ+/CD19+-depleted and CB transplants versus 40% to 60% among the other groups. CONCLUSIONS Rapidly accessible CB and haploidentical grafts are suitable alternatives for patients with no HLA-matched donor. Cord transplantation without serotherapy and TCRαβ+/CD19+-depleted grafts produced comparable survival rates of around 80%, although with a high rate of aGvHD with the former and a high risk of viral reactivation with the latter that need to be addressed.
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Affiliation(s)
- Reem Elfeky
- Molecular and Cellular Immunology Unit, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom; Department of Paediatric Allergy and Immunology, Ain Shams University, Cairo, Egypt.
| | - Ravi M Shah
- Blood and Bone Marrow Transplant Unit, Great Ormond Street Hospital, London, United Kingdom; Department of Paediatric Oncology and BMT, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Mohamed N M Unni
- Host Defence Unit, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | - Giorgio Ottaviano
- Department of Paediatrics, Fondazione MBBM University of Milan-Bicocca, Monza, Italy
| | - Kanchan Rao
- Blood and Bone Marrow Transplant Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Robert Chiesa
- Blood and Bone Marrow Transplant Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Persis Amrolia
- Molecular and Cellular Immunology Unit, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom; Blood and Bone Marrow Transplant Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Austen Worth
- Blood and Bone Marrow Transplant Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Terry Flood
- Host Defence Unit, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | - Mario Abinun
- Host Defence Unit, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | - Sophie Hambleton
- Host Defence Unit, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | - Andrew J Cant
- Host Defence Unit, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | - Kimberly Gilmour
- Blood and Bone Marrow Transplant Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Stuart Adams
- Blood and Bone Marrow Transplant Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Gul Ahsan
- Blood and Bone Marrow Transplant Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Dawn Barge
- Host Defence Unit, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | - Andrew R Gennery
- Host Defence Unit, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | - Waseem Qasim
- Molecular and Cellular Immunology Unit, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Mary Slatter
- Host Defence Unit, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | - Paul Veys
- Molecular and Cellular Immunology Unit, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom; Blood and Bone Marrow Transplant Unit, Great Ormond Street Hospital, London, United Kingdom
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34
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Papadopoulou C, Omoyinmi E, Standing A, Pain CE, Booth C, D’Arco F, Gilmour K, Buckland M, Eleftheriou D, Brogan PA. Monogenic mimics of Behçet’s disease in the young. Rheumatology (Oxford) 2019; 58:1227-1238. [DOI: 10.1093/rheumatology/key445] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 12/13/2018] [Indexed: 12/19/2022] Open
Affiliation(s)
- C Papadopoulou
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - E Omoyinmi
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - A Standing
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - C E Pain
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - C Booth
- Infection, Immunity, Inflammation, Molecular and Cellular Immunology Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - F D’Arco
- Neuroradiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - K Gilmour
- Immunology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - M Buckland
- Immunology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - D Eleftheriou
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
- Arthritis Research UK Centre for Adolescent Rheumatology, UCL, UCLH and GOSH, London, UK
| | - P A Brogan
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
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35
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Payne H, Chain G, Adams S, Hunter P, Luckhurst N, Gilmour K, Lewis J, Babiker A, Cotton M, Violari A, Gibb D, Callard R, Klein N. Naive B Cell Output in HIV-Infected and HIV-Uninfected Children. AIDS Res Hum Retroviruses 2019; 35:33-39. [PMID: 30298747 PMCID: PMC6863188 DOI: 10.1089/aid.2018.0170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 01/03/2023] Open
Abstract
In this study, we aimed to quantify KREC (kappa-deleting recombination excision circle) levels and naive B cell output in healthy HIV-uninfected children, compared with HIV-infected South African children, before and after starting ART (antiretroviral therapy). Samples were acquired from a Child Wellness Clinic (n = 288 HIV-uninfected South African children, 2 weeks-12 years) and the Children with HIV Early Antiretroviral Therapy (CHER) trial (n = 153 HIV-infected South African children, 7 weeks-8 years). Naive B cell output was estimated using a mathematical model combining KREC levels to reflect B cell emigration into the circulation, flow cytometry measures of naive unswitched B cells to quantify total body naive B cells, and their rates of proliferation using the intracellular marker Ki67. Naive B cell output increases from birth to 1 year, followed by a decline and plateau into late childhood. HIV-infected children on or off ART had higher naive B cell outputs than their uninfected counterparts (p = .01 and p = .04). This is the first study to present reference ranges for measurements of KRECs and naive B cell output in healthy and HIV-infected children. Comparison between HIV-uninfected healthy children and HIV-infected children suggests that HIV may increase naive B cell output. Further work is required to fully understand the mechanisms involved and clinical value of measuring naive B cell output in children.
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Affiliation(s)
- Helen Payne
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Clinical Trials Unit, Medical Research Council, London, United Kingdom
| | - Gabriel Chain
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Stuart Adams
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Patricia Hunter
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Natasha Luckhurst
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Department of Immunology, Kingston University, London, United Kingdom
| | - Kimberly Gilmour
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Joanna Lewis
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- CoMPLEX, UCL, London, United Kingdom
| | - Abdel Babiker
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Mark Cotton
- Children's Infectious Diseases Clinical Research Unit, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Avy Violari
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Diana Gibb
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Robin Callard
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Nigel Klein
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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36
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Perocheau DP, Cunningham SC, Lee J, Antinao Diaz J, Waddington SN, Gilmour K, Eaglestone S, Lisowski L, Thrasher AJ, Alexander IE, Gissen P, Baruteau J. Age-Related Seroprevalence of Antibodies Against AAV-LK03 in a UK Population Cohort. Hum Gene Ther 2019; 30:79-87. [PMID: 30027761 PMCID: PMC6343184 DOI: 10.1089/hum.2018.098] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 06/28/2018] [Indexed: 12/16/2022] Open
Abstract
Recombinant adeno-associated virus (rAAV) vectors are a promising platform for in vivo gene therapy. The presence of neutralizing antibodies (Nab) against AAV capsids decreases cell transduction efficiency and is a common exclusion criterion for participation in clinical trials. Novel engineered capsids are being generated to improve gene delivery to the target cells and facilitate success of clinical trials; however, the prevalence of antibodies against such capsids remains largely unknown. We therefore assessed the seroprevalence of antibodies against a novel synthetic liver-tropic capsid AAV-LK03. We measured seroprevalence of immunoglobulin (Ig)G (i.e., neutralizing and nonneutralizing) antibodies and Nab to AAV-LK03 in a cohort of 323 UK patients (including 260 pediatric) and 52 juvenile rhesus macaques. We also performed comparative analysis of seroprevalence of Nab against wild-type AAV8 and AAV3B capsids. Overall IgG seroprevalence for AAV-LK03 was 39% in human samples. The titer increased with age. Prevalence of Nab was 23%, 35%, and 18% for AAV-LK03, AAV3B, and AAV8, respectively, with the lowest seroprevalence between 3 and 17 years of age for all serotypes. Presence of Nab against AAV-LK03 decreased from 36% in the youngest cohort (birth to 6 months) to 7% in older primary school-age children (9-11 years) and then progressively increased to 54% in late adulthood. Cross-reactivity between serotypes was >60%. Nab seroprevalence in macaques was 62%, 85%, and 40% for AAV-LK03, AAV3B, and AAV8, respectively. When planning for AAV gene therapy clinical trials, knowing the seropositivity of the target population is critical. In the population studied, AAV seroprevalence for AAV serotypes tested was low. However, high cross-reactivity between AAV serotypes remains a barrier for re-injection. Shifts in Nab seroprevalence during the first decade need to be confirmed by longitudinal studies. This possibility suggests that pediatric patients could respond differently to AAV therapy according to age. If late childhood is an ideal age window, intervention at an early age when maternal Nab levels are high may be challenging. Nab-positive children excluded from trials could be rescreened for eligibility at regular intervals because this status may change.
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Affiliation(s)
- Dany P. Perocheau
- Genetics and Genomic Medicine Programme, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- Gene Transfer Technology Group, Institute for Women's Health, University College London, London, United Kingdom
| | - Sharon C. Cunningham
- Gene Therapy Research Unit, Children's Medical Research Institute, Faculty of Medicine and Health, University of Sydney and Sydney Children's Hospital Network, Westmead, Australia
| | - Juhee Lee
- Genetics and Genomic Medicine Programme, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- Gene Transfer Technology Group, Institute for Women's Health, University College London, London, United Kingdom
| | - Juan Antinao Diaz
- Gene Transfer Technology Group, Institute for Women's Health, University College London, London, United Kingdom
| | - Simon N. Waddington
- Gene Transfer Technology Group, Institute for Women's Health, University College London, London, United Kingdom
- Antiviral Gene Therapy Research Unit, Faculty of Health Sciences, University of the Witswatersrand, Johannesburg, South Africa
| | - Kimberly Gilmour
- Clinical Immunology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Simon Eaglestone
- Translational Research Office, University College London, London, United Kingdom
| | - Leszek Lisowski
- Gene Therapy Research Unit, Children's Medical Research Institute, Faculty of Medicine and Health, University of Sydney and Sydney Children's Hospital Network, Westmead, Australia
- Translational Vectorology Group, Children's Medical Research Institute, Faculty of Medicine and Health, University of Sydney, Westmead, Australia
- Military Institute of Hygiene and Epidemiology, The Biological Threats Identification and Countermeasure Centre, Puławy, Poland
| | - Adrian J. Thrasher
- Clinical Immunology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- Infection, Immunity and Inflammation Programme, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Ian E. Alexander
- Gene Therapy Research Unit, Children's Medical Research Institute, Faculty of Medicine and Health, University of Sydney and Sydney Children's Hospital Network, Westmead, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Westmead, Australia
| | - Paul Gissen
- Genetics and Genomic Medicine Programme, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- MRC Laboratory for Molecular Biology, University College London, London, United Kingdom
- Metabolic Medicine Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Julien Baruteau
- Genetics and Genomic Medicine Programme, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- Gene Transfer Technology Group, Institute for Women's Health, University College London, London, United Kingdom
- Metabolic Medicine Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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37
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Elfeky RA, Furtado-Silva JM, Chiesa R, Rao K, Amrolia P, Lucchini G, Gilmour K, Adams S, Bibi S, Worth A, Thrasher AJ, Qasim W, Veys P. One hundred percent survival after transplantation of 34 patients with Wiskott-Aldrich syndrome over 20 years. J Allergy Clin Immunol 2018; 142:1654-1656.e7. [DOI: 10.1016/j.jaci.2018.06.042] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 06/24/2018] [Accepted: 06/29/2018] [Indexed: 11/16/2022]
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38
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Omoyinmi E, Mohamoud I, Gilmour K, Brogan PA, Eleftheriou D. Cutaneous Vasculitis and Digital Ischaemia Caused by Heterozygous Gain-of-Function Mutation in C3. Front Immunol 2018; 9:2524. [PMID: 30443255 PMCID: PMC6221951 DOI: 10.3389/fimmu.2018.02524] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 08/22/2018] [Accepted: 10/12/2018] [Indexed: 12/22/2022] Open
Abstract
It is now increasingly recognized that some monogenic autoinflammatory diseases and immunodeficiencies cause vasculitis, although genetic causes of vasculitis are extremely rare. We describe a child of non-consanguineous parents who presented with cutaneous vasculitis, digital ischaemia and hypocomplementaemia. A heterozygous p.R1042G gain-of-function mutation (GOF) in the complement component C3 gene was identified as the cause, resulting in secondary C3 consumption and complete absence of alternative complement pathway activity, decreased classical complement activity, and low levels of serum C3 with normal C4 levels. The same heterozygous mutation and immunological defects were also identified in another symptomatic sibling and his father. C3 deficiency due GOF C3 mutations is thus now added to the growing list of monogenic causes of vasculitis and should always be considered in vasculitis patients found to have persistently low levels of C3 with normal C4.
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Affiliation(s)
- Ebun Omoyinmi
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Iman Mohamoud
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Kimberly Gilmour
- Clinical Immunology Laboratory, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Paul A Brogan
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Despina Eleftheriou
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom.,Centre for Adolescent Rheumatology, Arthritis Research UK, University College London (UCL), University College London Hospital (UCLH) and Great Ormond Street Hospital (GOSH), London, United Kingdom
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Almeida B, Jordan EJ, Palman J, Bale P, Ralph E, Heard C, Robinson E, Ursu S, Gilmour K, Wedderburn LR. R08 Real-life use of MRP8/14 serum level measurement in clinical practice as a predictor of outcome after stopping methotrexate in patients with juvenile idiopathic arthritis. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key273.058] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
- Beverley Almeida
- Infection, Inflammation & Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UNITED KINGDOM
- Department of Rheumatology, Great Ormond Street Hospital for Children NHS Trust, London, UNITED KINGDOM
| | - Emma J Jordan
- Infection, Inflammation & Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UNITED KINGDOM
| | - Jason Palman
- Infection, Inflammation & Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UNITED KINGDOM
| | - Peter Bale
- Department of Rheumatology, Great Ormond Street Hospital for Children NHS Trust, London, UNITED KINGDOM
| | - Elizabeth Ralph
- Immunology Laboratory, Great Ormond Street Hospital for Children NHS Trust, London, UNITED KINGDOM
| | - Clare Heard
- Infection, Inflammation & Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UNITED KINGDOM
| | - Emily Robinson
- Infection, Inflammation & Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UNITED KINGDOM
| | - Simona Ursu
- Infection, Inflammation & Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UNITED KINGDOM
| | - Kimberly Gilmour
- Immunology Laboratory, Great Ormond Street Hospital for Children NHS Trust, London, UNITED KINGDOM
| | - Lucy R Wedderburn
- Infection, Inflammation & Rheumatology Section, UCL Great Ormond Street Institute of Child Health, London, UNITED KINGDOM
- Department of Rheumatology, Great Ormond Street Hospital for Children NHS Trust, London, UNITED KINGDOM
- ARUK Centre for Adolescent Rheumatology, University College London, London, UNITED KINGDOM
- National Institute for Health Research, Biomedical Research Centre, Great Ormond Street Hospital, London, UNITED KINGDOM
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Harris S, Braggins H, van Leeuwen K, Gilmour K, Buckland MS, Roos D, Lowe DM. Male X-chromosome mosaicism leading to carrier phenotype and inheritance of chronic granulomatous disease. The Journal of Allergy and Clinical Immunology: In Practice 2018; 6:1775-1777.e1. [DOI: 10.1016/j.jaip.2018.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/21/2018] [Accepted: 01/26/2018] [Indexed: 01/12/2023]
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Duignan S, Wright S, Rossor T, Cazabon J, Gilmour K, Ciccarelli O, Wassmer E, Lim M, Hemingway C, Hacohen Y. Myelin oligodendrocyte glycoprotein and aquaporin-4 antibodies are highly specific in children with acquired demyelinating syndromes. Dev Med Child Neurol 2018; 60:958-962. [PMID: 29468668 DOI: 10.1111/dmcn.13703] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [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] [Accepted: 01/03/2018] [Indexed: 12/13/2022]
Abstract
AIM Our objectives were to evaluate the utility of measuring myelin oligodendrocyte glycoprotein (MOG) and aquaporin-4 (AQP4) antibodies (Ab) in clinical practice and describe their associated neurological phenotypes in children. METHOD Between 2012 and 2017, 371 children with suspected acquired demyelinating syndromes (ADS) seen in three tertiary centres were tested for MOG-Ab and AQP4-Ab. Medical notes were retrospectively reviewed, and clinical and demographic data compiled. Clinical phenotyping was performed blinded to the antibody results. RESULTS After review, 237 of the 371 were diagnosed with ADS. Of these, 76 out of 237 (32.1%) were MOG-Ab positive and 14 out of 237 (5.9%) were AQP4-Ab positive. None were positive for both autoantibodies. All 134 patients with non-ADS were negative for MOG-Ab. MOG-Ab were identified in 45 out of 70 (64.3%) patients presenting with acute disseminated encephalomyelitis (ADEM) and in 24 out of 25 patients with relapsing ADEM. Thirty-six out of 75 (48%) MOG-Ab positive patients relapsed. Of the 33 children with neuromyelitis optic spectrum disorder, 14 were AQP4-Ab positive, 13 were MOG-Ab positive, and 6 were seronegative. Of the children with longitudinal samples, 8 out of 13 AQP4-Ab remained positive during the disease course compared to 35 out of 43 MOG-Ab (13/16 monophasic and 22/27 relapsing). INTERPRETATION Myelin oligodendrocyte glycoprotein antibodies were identified in a third of children with ADS. Almost half of the MOG-Ab positive children relapsed and the majority of them remained antibody positive over 4-years follow-up. WHAT THIS PAPER ADDS Myelin oligodendrocyte glycoprotein antibodies (MOG-Ab) are highly specific for acquired demyelinating syndromes (ADS). Myelin oligodendrocyte glycoprotein antibodies are not identified in children with peripheral demyelination or genetic leukodystrophies/hypomyelination. Up to 48% of MOG-Ab ADS paediatric patients relapse, higher than previously thought. Seroconversion to MOG-Ab negative status is infrequent; patients may test MOG-Ab positive at follow-up sampling even when asymptomatic. Myelin oligodendrocyte glycoprotein antibodies status should only be used in conjunction with the clinical information to guide maintenance therapy.
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Affiliation(s)
- Sophie Duignan
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Sukhvir Wright
- Department of Paediatric Neurology, Birmingham Children's Hospital, Birmingham, UK
| | - Tom Rossor
- Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London, UK
| | - John Cazabon
- Immunology Department, King's College Hospital, London, UK
| | - Kimberly Gilmour
- Immunology Department, Great Ormond Street Hospital for Children, London, UK
| | - Olga Ciccarelli
- Department of Neuroinflammation, Queen Square MS Centre, UCL Institute of Neurology, London, UK.,National Institute for Health Research (NIHR), University College London Hospitals (UCLH), Biomedical Research Centre (BRC), London, UK
| | - Evangeline Wassmer
- Department of Paediatric Neurology, Birmingham Children's Hospital, Birmingham, UK
| | - Ming Lim
- Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London, UK.,Faculty of Life Sciences and Medicine, Kings College, London, UK
| | - Cheryl Hemingway
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Yael Hacohen
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK.,Department of Neuroinflammation, Queen Square MS Centre, UCL Institute of Neurology, London, UK
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Quaranta M, Wilson R, Gonçalves Serra E, Pandey S, Schwerd T, Gilmour K, Klenerman P, Powrie F, Keshav S, Travis SPL, Anderson CA, Uhlig HH. Consequences of Identifying XIAP Deficiency in an Adult Patient With Inflammatory Bowel Disease. Gastroenterology 2018; 155:231-234. [PMID: 29894681 DOI: 10.1053/j.gastro.2018.03.069] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 03/26/2018] [Indexed: 12/02/2022]
Affiliation(s)
- Maria Quaranta
- Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Rachel Wilson
- Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | | | - Sumeet Pandey
- Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Tobias Schwerd
- Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | | | - Paul Klenerman
- Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Fiona Powrie
- Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital and Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Satish Keshav
- Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Simon P L Travis
- Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | | | - Holm H Uhlig
- Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Oxford, UK; Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
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Nanthapisal S, Eleftheriou D, Gilmour K, Leone V, Ramnath R, Omoyinmi E, Hong Y, Klein N, Brogan PA. Cutaneous Vasculitis and Recurrent Infection Caused by Deficiency in Complement Factor I. Front Immunol 2018; 9:735. [PMID: 29696024 PMCID: PMC5904195 DOI: 10.3389/fimmu.2018.00735] [Citation(s) in RCA: 12] [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: 02/14/2018] [Accepted: 03/26/2018] [Indexed: 11/23/2022] Open
Abstract
Cutaneous leukocytoclastic vasculitis arises from immune complex deposition and dysregulated complement activation in small blood vessels. There are many causes, including dysregulated host response to infection, drug reactions, and various autoimmune conditions. It is increasingly recognised that some monogenic autoinflammatory diseases cause vasculitis, although genetic causes of vasculitis are extremely rare. We describe a child of consanguineous parents who presented with chronic cutaneous leukocytoclastic vasculitis, recurrent upper respiratory tract infection, and hypocomplementaemia. A homozygous p.His380Arg mutation in the complement factor I (CFI) gene CFI was identified as the cause, resulting in complete absence of alternative complement pathway activity, decreased classical complement activity, and low levels of serum factor I, C3, and factor H. C4 and C2 levels were normal. The same homozygous mutation and immunological defects were also identified in an asymptomatic sibling. CFI deficiency is thus now added to the growing list of monogenic causes of vasculitis and should always be considered in vasculitis patients found to have persistently low levels of C3 with normal C4.
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Affiliation(s)
- Sira Nanthapisal
- Infection Inflammation and Rheumatology Section, Great Ormond Street Institute of Child Health, University College London, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom.,Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Despina Eleftheriou
- Infection Inflammation and Rheumatology Section, Great Ormond Street Institute of Child Health, University College London, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Kimberly Gilmour
- Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Valentina Leone
- Department of Paediatric Rheumatology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Radhika Ramnath
- Department of Histopathology, St. James University Hospital, Leeds, United Kingdom
| | - Ebun Omoyinmi
- Infection Inflammation and Rheumatology Section, Great Ormond Street Institute of Child Health, University College London, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Ying Hong
- Infection Inflammation and Rheumatology Section, Great Ormond Street Institute of Child Health, University College London, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Nigel Klein
- Infection Inflammation and Rheumatology Section, Great Ormond Street Institute of Child Health, University College London, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Paul A Brogan
- Infection Inflammation and Rheumatology Section, Great Ormond Street Institute of Child Health, University College London, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
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Qasim W, Zhan H, Samarasinghe S, Adams S, Amrolia P, Stafford S, Butler K, Rivat C, Wright G, Somana K, Ghorashian S, Pinner D, Ahsan G, Gilmour K, Lucchini G, Inglott S, Mifsud W, Chiesa R, Peggs KS, Chan L, Farzeneh F, Thrasher AJ, Vora A, Pule M, Veys P. Molecular remission of infant B-ALL after infusion of universal TALEN gene-edited CAR T cells. Sci Transl Med 2018; 9:9/374/eaaj2013. [PMID: 28123068 DOI: 10.1126/scitranslmed.aaj2013] [Citation(s) in RCA: 609] [Impact Index Per Article: 101.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/13/2016] [Accepted: 01/03/2017] [Indexed: 12/17/2022]
Abstract
Autologous T cells engineered to express chimeric antigen receptor against the B cell antigen CD19 (CAR19) are achieving marked leukemic remissions in early-phase trials but can be difficult to manufacture, especially in infants or heavily treated patients. We generated universal CAR19 (UCART19) T cells by lentiviral transduction of non-human leukocyte antigen-matched donor cells and simultaneous transcription activator-like effector nuclease (TALEN)-mediated gene editing of T cell receptor α chain and CD52 gene loci. Two infants with relapsed refractory CD19+ B cell acute lymphoblastic leukemia received lymphodepleting chemotherapy and anti-CD52 serotherapy, followed by a single-dose infusion of UCART19 cells. Molecular remissions were achieved within 28 days in both infants, and UCART19 cells persisted until conditioning ahead of successful allogeneic stem cell transplantation. This bridge-to-transplantation strategy demonstrates the therapeutic potential of gene-editing technology.
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Affiliation(s)
- Waseem Qasim
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK. .,Great Ormond Street Hospital National Health Service Trust, London WC1N 1LE, UK
| | - Hong Zhan
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Sujith Samarasinghe
- Great Ormond Street Hospital National Health Service Trust, London WC1N 1LE, UK
| | - Stuart Adams
- Great Ormond Street Hospital National Health Service Trust, London WC1N 1LE, UK
| | - Persis Amrolia
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK.,Great Ormond Street Hospital National Health Service Trust, London WC1N 1LE, UK
| | - Sian Stafford
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Katie Butler
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Christine Rivat
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Gary Wright
- Great Ormond Street Hospital National Health Service Trust, London WC1N 1LE, UK
| | - Kathy Somana
- Great Ormond Street Hospital National Health Service Trust, London WC1N 1LE, UK
| | - Sara Ghorashian
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Danielle Pinner
- Great Ormond Street Hospital National Health Service Trust, London WC1N 1LE, UK
| | - Gul Ahsan
- Great Ormond Street Hospital National Health Service Trust, London WC1N 1LE, UK
| | - Kimberly Gilmour
- Great Ormond Street Hospital National Health Service Trust, London WC1N 1LE, UK
| | - Giovanna Lucchini
- Great Ormond Street Hospital National Health Service Trust, London WC1N 1LE, UK
| | - Sarah Inglott
- Great Ormond Street Hospital National Health Service Trust, London WC1N 1LE, UK
| | - William Mifsud
- Great Ormond Street Hospital National Health Service Trust, London WC1N 1LE, UK
| | - Robert Chiesa
- Great Ormond Street Hospital National Health Service Trust, London WC1N 1LE, UK
| | - Karl S Peggs
- Cancer Institute, University College London, London WC1E 6DD, UK
| | - Lucas Chan
- Division of Cancer Studies, Department of Haematological Medicine, King's College London, London SE5 9NU, UK
| | - Farzin Farzeneh
- Division of Cancer Studies, Department of Haematological Medicine, King's College London, London SE5 9NU, UK
| | - Adrian J Thrasher
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Ajay Vora
- Sheffield Children's Hospital, Sheffield S10 2TH, UK
| | - Martin Pule
- Cancer Institute, University College London, London WC1E 6DD, UK
| | - Paul Veys
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
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Omoyinmi E, Standing A, Keylock A, Price-Kuehne F, Melo Gomes S, Rowczenio D, Nanthapisal S, Cullup T, Nyanhete R, Ashton E, Murphy C, Clarke M, Ahlfors H, Jenkins L, Gilmour K, Eleftheriou D, Lachmann HJ, Hawkins PN, Klein N, Brogan PA. Clinical impact of a targeted next-generation sequencing gene panel for autoinflammation and vasculitis. PLoS One 2017; 12:e0181874. [PMID: 28750028 PMCID: PMC5531484 DOI: 10.1371/journal.pone.0181874] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/07/2017] [Indexed: 12/27/2022] Open
Abstract
Background Monogenic autoinflammatory diseases (AID) are a rapidly expanding group of genetically diverse but phenotypically overlapping systemic inflammatory disorders associated with dysregulated innate immunity. They cause significant morbidity, mortality and economic burden. Here, we aimed to develop and evaluate the clinical impact of a NGS targeted gene panel, the “Vasculitis and Inflammation Panel” (VIP) for AID and vasculitis. Methods The Agilent SureDesign tool was used to design 2 versions of VIP; VIP1 targeting 113 genes, and a later version, VIP2, targeting 166 genes. Captured and indexed libraries (QXT Target Enrichment System) prepared for 72 patients were sequenced as a multiplex of 16 samples on an Illumina MiSeq sequencer in 150bp paired-end mode. The cohort comprised 22 positive control DNA samples from patients with previously validated mutations in a variety of the genes; and 50 prospective samples from patients with suspected AID in whom previous Sanger based genetic screening had been non-diagnostic. Results VIP was sensitive and specific at detecting all the different types of known mutations in 22 positive controls, including gene deletion, small INDELS, and somatic mosaicism with allele fraction as low as 3%. Six/50 patients (12%) with unclassified AID had at least one class 5 (clearly pathogenic) variant; and 11/50 (22%) had at least one likely pathogenic variant (class 4). Overall, testing with VIP resulted in a firm or strongly suspected molecular diagnosis in 16/50 patients (32%). Conclusions The high diagnostic yield and accuracy of this comprehensive targeted gene panel validate the use of broad NGS-based testing for patients with suspected AID.
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Affiliation(s)
- Ebun Omoyinmi
- UCL Great Ormond Street Institute of Child Health (ICH), London, United Kingdom
- * E-mail:
| | - Ariane Standing
- UCL Great Ormond Street Institute of Child Health (ICH), London, United Kingdom
| | - Annette Keylock
- UCL Great Ormond Street Institute of Child Health (ICH), London, United Kingdom
| | - Fiona Price-Kuehne
- UCL Great Ormond Street Institute of Child Health (ICH), London, United Kingdom
| | - Sonia Melo Gomes
- UCL Great Ormond Street Institute of Child Health (ICH), London, United Kingdom
| | - Dorota Rowczenio
- National Amyloidosis Centre (NAC), UCL, Royal Free Campus, London, United Kingdom
| | - Sira Nanthapisal
- UCL Great Ormond Street Institute of Child Health (ICH), London, United Kingdom
| | - Thomas Cullup
- NE Thames Regional Genetics laboratory, GOSH NHS Foundation Trust, London, United Kingdom
| | - Rodney Nyanhete
- NE Thames Regional Genetics laboratory, GOSH NHS Foundation Trust, London, United Kingdom
| | - Emma Ashton
- NE Thames Regional Genetics laboratory, GOSH NHS Foundation Trust, London, United Kingdom
| | - Claire Murphy
- UCL Great Ormond Street Institute of Child Health (ICH), London, United Kingdom
| | - Megan Clarke
- UCL Great Ormond Street Institute of Child Health (ICH), London, United Kingdom
| | - Helena Ahlfors
- NE Thames Regional Genetics laboratory, GOSH NHS Foundation Trust, London, United Kingdom
| | - Lucy Jenkins
- NE Thames Regional Genetics laboratory, GOSH NHS Foundation Trust, London, United Kingdom
| | - Kimberly Gilmour
- Immunology, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Despina Eleftheriou
- UCL Great Ormond Street Institute of Child Health (ICH), London, United Kingdom
- Arthritis Research UK Centre for Adolescent Rheumatology, UCL, UCLH and GOSH, London, United Kingdom
| | - Helen J. Lachmann
- National Amyloidosis Centre (NAC), UCL, Royal Free Campus, London, United Kingdom
| | - Philip N. Hawkins
- National Amyloidosis Centre (NAC), UCL, Royal Free Campus, London, United Kingdom
| | - Nigel Klein
- UCL Great Ormond Street Institute of Child Health (ICH), London, United Kingdom
| | - Paul A. Brogan
- UCL Great Ormond Street Institute of Child Health (ICH), London, United Kingdom
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Lomakina O, Alekseeva E, Valieva S, Bzarova T, Nikishina I, Zholobova E, Rodionovskaya S, Kaleda M, Nakagishi Y, Shimizu M, Mizuta M, Yachie A, Sugita Y, Okamoto N, Shabana K, Murata T, Tamai H, Smith EM, Yin P, Jorgensen AL, Beresford MW, Smith EM, Eleuteri A, Goilav B, Lewandowski L, Phuti A, Wahezi D, Rubinstein T, Jones C, Newland P, Marks S, Corkhill R, Ekdawy D, Pilkington C, Tullus K, Putterman C, Scott C, Fisher AC, Beresford MW, Smith EM, Lewandowski L, Phuti A, Jorgensen A, Scott C, Beresford MW, Batu ED, Kosukcu C, Taskiran E, Akman S, Ozturk K, Sozeri B, Unsal E, Ekinci Z, Bilginer Y, Alikasifoglu M, Ozen S, Lythgoe H, Beresford MW, Brunner HI, Gulati G, Jones JT, Altaye M, Eaton J, Difrancesco M, Yeo JG, Leong J, Bathi LDT, Arkachaisri T, Albani S, Abdelrahman N, Beresford MW, Leone V, Groot N, Shaikhani D, Bultink IEM, Bijl M, Dolhain RJEM, Teng YKO, Zirkzee E, de Leeuw K, Fritsch-Stork R, Kamphuis SSM, Wright RD, Smith EM, Beresford MW, Abdawani R, Al Shaqshi L, Al Zakwani I, Gormezano NW, Kern D, Pereira OL, Esteves GCC, Sallum AM, Aikawa NE, Pereira RM, Silva CA, Bonfa E, Beckmann J, Bartholomä N, Foeldvari I, Bohnsack J, Milojevic D, Rabinovich C, Kingsbury D, Marzan K, Quartier P, Minden K, Chalom E, Horneff G, Venhoff N, Kuester RM, Dare J, Heinrich M, Kupper H, Kalabic J, Martini A, Brunner HI, Consolaro A, Horneff G, Burgos-Vargas R, Henneke P, Constantin T, Foeldvari I, Vojinovic J, Dehoorne J, Panaviene V, Susic G, Stanevica V, Kobusinska K, Zuber Z, Mouy R, Salzer U, Rumba-Rozenfelde I, Dolezalova P, Job-Deslandre C, Wulffraat N, Pederson R, Bukowski J, Hinnershitz T, Vlahos B, Martini A, Ruperto N, Janda A, Keskitalo P, Kangas S, Vähäsalo P, Valencia RAC, Martino D, Munro J, Ponsonby AL, Chiaroni-Clarke R, Meyer B, Allen RC, Boteanu AL, Akikusa JD, Craig JM, Saffrey R, Ellis JA, Davì S, Minoia F, Horne A, Wulffraat N, Wouters C, Wallace C, Corral SG, Uziel Y, Sterba G, Schneider R, Russo R, Ramanan AV, Schmid JP, Ozen S, Nichols KE, Miettunen P, Lovell DJ, Giraldo AS, Lehmberg K, Kitoh T, Khubchandani R, Ilowite NT, Henter JI, Grom AA, De Benedetti F, Behrens EM, Avcin T, Aricò M, Gámir MG, Martini A, Ruperto N, Cron RQ, Ravelli A, Grevich S, Lee P, Ringold S, Leroux B, Leahey H, Yuasa M, Mendoza AZ, Foster J, Sokolove J, Lahey L, Robinson W, Newson J, Stevens A, Shoop SJW, Hyrich KL, Verstappen SMM, Thomson W, Adrovic A, McDonagh JE, Beukelman T, Kimura Y, Natter M, Ilowite N, Mieszkalski K, Burrell G, Best B, Bristow H, Carr S, Dedeoglu R, Dennos A, Kaufmann R, Schanberg L, Parissenti I, Insalaco A, Taddio A, Mauro A, Pardeo M, Ricci F, Simonini G, Sahin S, Cattalini M, Montesano P, Parissenti I, Ricci F, Bonafini B, Medeghini V, Lancini F, Cattalini M, Gerbaux M, Lê PQ, Barut K, Goffin L, Badot V, La C, Caspers L, Willermain F, Ferster A, Ceci M, Licciardi F, Turco M, Santarelli F, Koka A, Montin D, Toppino C, Maggio MC, Alizzi C, Papia B, Vergara B, Corpora U, Messina L, Corsello G, Tsinti M, Oztunc F, Dermentzoglou V, Tziavas P, Tsitsami E, Perica M, Vidović M, Lamot L, Harjaček M, Bukovac LT, Çakan M, Ayaz NA, Kasapcopur O, Keskindemirci G, Miettunen P, Lang M, Laing C, Benseler S, Gerschman T, Luca N, Schmeling H, Dropol A, Taiani J, Rodriguez-Lozano AL, Johnson N, Rusted B, Nalbanti P, Trachana M, Pratsidou P, Pardalos G, Tzimouli V, Taparkou A, Stavrakidou M, Papachristou F, Rivas-Larrauri F, Kanakoudi-Tsakalidou F, Bale P, Robinson E, Palman J, Pilkington C, Ralph E, Gilmour K, Heard C, Wedderburn LR, Carlomagno R, de la Puente SG, Barrense-Dias Y, Gregory A, Amira D, Paolo S, Sylviane H, Michaël H, Panko N, Shokry S, Rakovska L, Pino S, Alves AGF, Diaz-Maldonado A, Guarnizo P, Torreggiani S, Cressoni P, Garagiola U, Di Landro G, Farronato G, Corona F, Filocamo G, Shenoi S, Giacomin MFDA, Bell S, Bhatti P, Nelson L, Mueller BA, Simon TA, Baheti A, Ray N, Guo Z, Ruperto N, Brunner HI, Farhat J, Hazra A, Stock T, Wang R, Mebus C, Alvey C, Lamba M, Krishnaswami S, Conte U, Wang M, 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Sundberg E, Horne A, Ehl S, Ammann S, Lehmberg K, De Benedetti F, Beutel K, Foell D, Minoia F, Horne A, Bovis F, Davì S, Pagani L, Espada G, Gao YJ, Insalaco A, Lehmberg K, Sanner H, Shenoi S, Weitzman S, Ruperto N, Martini A, Cron RQ, Ravelli A, Prencipe G, Caiello I, Pascarella A, Bracaglia C, Ferlin WG, Chatel L, Strippoli R, de Min C, De Benedetti F, Jacqmin P, De Graaf K, Ballabio M, Nelson R, Johnson Z, Ferlin W, Lapeyre G, de Benedetti F, Cristina DM, Wakiguchi H, Hasegawa S, Hirano R, Okazaki F, Nakamura T, Kaneyasu H, Ohga S, Yamazaki K, Nozawa T, Kanetaka T, Ito S, Yokota S, McLellan K, MacGregor I, Martin N, Davidson J, Kuemmerle-Deschner J, Hansmann S, Wulffraat N, Eikelberg A, Haug I, Schuller S, Benseler SM, Nazarova LS, Danilko KV, Malievsky VA, Viktorova TV, Mauro A, Omoyinmi E, Barnicoat A, Brogan P, Foley C, Killeen O, MacDermott E, Veale D, Foley C, Killeen O, MacDermott E, Veale D, Gomes SM, Omoyinmi E, Hurst J, Canham N, Eleftheriou D, Klein N, Lacassagne S, Brogan P, Wiener A, Hügle B, Denecke B, Costa-Filho I, Haas JP, Tenbrock K, Popp D, Boltjes A, Rühle F, Herresthal S, de Jager W, van Wijk F, Schultze J, Stoll M, Klotz L, Vogl T, Roth J, Quesada-Masachs E, de la Sierra DÁ, Prat MG, Sánchez AMM, Borrell RP, Barril SM, Gallo MM, Caballero CM, Chyzheuskaya I, Byelyaeva LM, Filonovich RM, Khrustaleva HK, Zajtseva LI, Yuraga TM, Chyzheuskaya I, Byelyaeva LM, Filonovich RM, Khrustaleva HK, Zajtseva LI, Yuraga TM, Giner T, Hackl L, Albrecht J, Würzner R, Brunner J, Pastore S, Minute M, Parentin F, Tesser A, Nocerino A, Taddio A, Tommasini A, Nørgaard M, Herlin T, Alberdi-Saugstrup M, Zak MS, Nielsen SM, Herlin T, Nordal E, Berntson L, Fasth A, Rygg M, Müller KG, Avramovič MZ, Dolžan V, Toplak N, Avčin T, Ruperto N, Lovell DJ, Wallace C, Toth M. Proceedings of the 23rd Paediatric Rheumatology European Society Congress: part two. Pediatr Rheumatol Online J 2017. [PMCID: PMC5461533 DOI: 10.1186/s12969-017-0142-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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SM, Hanaya A, Miyamae T, Kawamoto M, Tani Y, Hara T, Kawaguchi Y, Nagata S, Yamanaka H, Ćosićkić A, Skokić F, Čolić B, Suljendić S, Kozlova A, Mersiyanova I, Panina M, Hachtryan L, Burlakov V, Raikina E, Maschan A, Shcherbina A, Acar B, Albayrak M, Sozeri B, Sahin S, Barut K, Adrovic A, Inan N, Sevgi S, Kasapcopur O, Andreasen CM, Jurik AG, Glerup MB, Høst C, Mahler BT, Hauge EM, Herlin T, Lazea C, Damian L, Lazar C, Manasia R, Stephenson CM, Prajapati V, Miettunen PM, Yılmaz D, Tokgöz Y, Bulut Y, Çakmak H, Sönmez F, Comak E, Aksoy GK, Koyun M, Akman S, Arıkan Y, Terzioğlu E, Özdeş ON, Keser İ, Koçak H, Bingöl A, Yılmaz A, Artan R, De Benedetti F, Anton J, Gattorno M, Lachmann H, Kone-Paut I, Ozen S, Frenkel J, Simon A, Zeft A, Ben-Chetrit E, Hoffman HM, Joubert Y, Lheritier K, Speziale A, Guido J, Xu X, Mehregan FF, Ziaee V, Moradinejad MH, Ferrara G, Pastore S, Insalaco A, Pardeo M, Tommasini A, La Torre F, Alizzi C, Cimaz R, Finetti M, Gattorno M, D’Adamo P, Taddio A, Lachmann H, Simon A, Anton J, Gattorno M, Kone-Paut I, Ozen S, Frenkel J, Ben-Chetrit E, Hoffman H, Zeft A, Joubert Y, Lheritier K, Speziale A, Junge G, Gregson J, De Benedetti F, Sargsyan H, Sargsyan H, Zengin H, Fidanci BE, Kaymakamgil C, Konukbay D, Simsek D, Batu ED, Yildiz D, Gok F, Ozen S, Demirkaya E, Stoler I, Freytag J, Orak B, Seib C, Esmann L, Seipelt E, Gohar F, Foell D, Wittkowski H, Kallinich T, Dursun I, Tulpar S, Yel S, Kartal D, Borlu M, Bastug F, Poyrazoglu H, Gunduz Z, Kose K, Yuksel ME, Calıskan A, Cekgeloglu AB, Dusunsel R, Bouchalova K, Franova J, Schuller M, Macku M, Theodoropoulou K, Carlomagno R, von Scheven-Gête A, Poloni C, Hofer M, Damian LO, Cosma D, Radulescu A, Vasilescu D, Rogojan L, Lazar C, Rednic S, Lupse M, De Somer L, Moens P, Wouters C, Zavala RG, Pedraz LM, Cuadros EN, Rego GDC, Cardona ALU, Zavala RG, Pedraz LM, Cuadros EN, Rego GDC, Cardona ALU, Forno ID, Pieropan S, Viapiana O, Gatti D, Dallagiacoma G, Caramaschi P, Biasi D, Windschall D, Trauzeddel R, Lehmann H, Ganser G, Berendes R, Haller M, Krumrey-Langkammerer M, Nimtz-Talaska A, Schoof P, Trauzeddel RF, Nirschl C, Quesada-Masachs E, Blancafort CA, Barril SM, Caballero CM, Aguiar F, Fonseca R, Alves D, Vieira A, Vieira A, Dias JA, Brito I, Susic G, Milic V, Radunovic G, Boricic I, Marteau P, Adamsbaum C, Rossi-Semerano L, De Bandt M, Lemelle I, Deslandre C, Tran TA, Lohse A, Solau-Gervais E, Pillet P, Bader-Meunier B, Wipff J, Gaujoux-Viala C, Breton S, Devauchelle-Pensec V, Gran S, Fehler O, Zenker S, Schäfers M, Roth J, Vogl T, Czitrom SG, Foell D, Holzinger D, Lanni S, Van Dijkhuizen EHP, Manzoni SM, Marafon DP, Magnaguagno F, de Horatio LT, Ter Haar NM, Littooij AS, Vastert SJ, De Benedetti F, Ravelli A, Martini A, Malattia C, Teixeira VA, Campanilho-Marques R, Mourão AF, Ramos FO, Costa M, Madan WA, Killeen OG, Vidal AR, Delgado DS, Fernandez MIG, Montesinos BL, Penades IC, Kozhevnikov A, Pozdeeva N, Konev M, Melchenko E, Kenis V, Novik G, Sozeri B, Kısaarslan AP, Gunduz Z, Poyrazoglu H, Dusunsel R, Lerkvaleekul B, Jaovisidha S, Sungkarat W, Chitrapazt N, Fuangfa P, Ruangchaijatuporn T, Vilaiyuk S, Pradsgaard DØ, Hørlyck A, Spannow AH, Heuck CW, Herlin T, Diaz T, Garcia F, De La Cruz L, Rubio N, Świdrowska-Jaros J, Smolewska E, Lamot M, Lamot L, Vidovic M, Bosak EP, Rados I, Harjacek M, Tzaribachev N, Louka P, Hagoug R, Trentin C, Kubassova O, Hinton M, Boesen M, Oshlianska OA, Chaikovsky IA, Mjasnikov G, Kazmirchyk A, Garagiola U, Borzani I, Cressoni P, Corona F, Dzsida E, Farronato G, Garagiola U, Cressoni P, Corona F, Petaccia A, Dzsida E, Farronato G, Gagro A, Pasini AM, Roic G, Vrdoljak O, Lujic L, Zutelija-Fattorini M, Esser MM, Abraham DR, Kinnear C, Durrheim G, Urban M, Hoal E, Crow Y, Oshlianska OA. Proceedings of the 23rd Paediatric Rheumatology European Society Congress: part one. Pediatr Rheumatol Online J 2017. [PMCID: PMC5461530 DOI: 10.1186/s12969-017-0141-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Davies EG, Cheung M, Gilmour K, Maimaris J, Curry J, Furmanski A, Sebire N, Halliday N, Mengrelis K, Adams S, Bernatoniene J, Bremner R, Browning M, Devlin B, Erichsen HC, Gaspar HB, Hutchison L, Ip W, Ifversen M, Leahy TR, McCarthy E, Moshous D, Neuling K, Pac M, Papadopol A, Parsley KL, Poliani L, Ricciardelli I, Sansom DM, Voor T, Worth A, Crompton T, Markert ML, Thrasher AJ. Thymus transplantation for complete DiGeorge syndrome: European experience. J Allergy Clin Immunol 2017; 140:1660-1670.e16. [PMID: 28400115 PMCID: PMC5716670 DOI: 10.1016/j.jaci.2017.03.020] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 03/03/2017] [Accepted: 03/15/2017] [Indexed: 12/17/2022]
Abstract
Background Thymus transplantation is a promising strategy for the treatment of athymic complete DiGeorge syndrome (cDGS). Methods Twelve patients with cDGS underwent transplantation with allogeneic cultured thymus. Objective We sought to confirm and extend the results previously obtained in a single center. Results Two patients died of pre-existing viral infections without having thymopoiesis, and 1 late death occurred from autoimmune thrombocytopenia. One infant had septic shock shortly after transplantation, resulting in graft loss and the need for a second transplant. Evidence of thymopoiesis developed from 5 to 6 months after transplantation in 10 patients. Median circulating naive CD4 counts were 44 × 106/L (range, 11-440 × 106/L) and 200 × 106/L (range, 5-310 × 106/L) at 12 and 24 months after transplantation and T-cell receptor excision circles were 2,238/106 T cells (range, 320-8,807/106 T cells) and 4,184/106 T cells (range, 1,582-24,596/106 T cells). Counts did not usually reach normal levels for age, but patients were able to clear pre-existing infections and those acquired later. At a median of 49 months (range, 22-80 months), 8 have ceased prophylactic antimicrobials, and 5 have ceased immunoglobulin replacement. Histologic confirmation of thymopoiesis was seen in 7 of 11 patients undergoing biopsy of transplanted tissue, including 5 showing full maturation through to the terminal stage of Hassall body formation. Autoimmune regulator expression was also demonstrated. Autoimmune complications were seen in 7 of 12 patients. In 2 patients early transient autoimmune hemolysis settled after treatment and did not recur. The other 5 experienced ongoing autoimmune problems, including thyroiditis (3), hemolysis (1), thrombocytopenia (4), and neutropenia (1). Conclusions This study confirms the previous reports that thymus transplantation can reconstitute T cells in patients with cDGS but with frequent autoimmune complications in survivors.
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Affiliation(s)
- E Graham Davies
- Infection, Immunity and Inflammation Theme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Department of Immunology, Great Ormond Street Hospital, London, United Kingdom.
| | - Melissa Cheung
- Infection, Immunity and Inflammation Theme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Kimberly Gilmour
- Department of Immunology, Great Ormond Street Hospital, London, United Kingdom
| | - Jesmeen Maimaris
- Infection, Immunity and Inflammation Theme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Joe Curry
- Department of Immunology, Great Ormond Street Hospital, London, United Kingdom
| | - Anna Furmanski
- Infection, Immunity and Inflammation Theme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; School of Life Sciences, University of Bedfordshire, Luton, United Kingdom
| | - Neil Sebire
- Department of Immunology, Great Ormond Street Hospital, London, United Kingdom
| | - Neil Halliday
- Institute of Immunity and Transplantation, Division of Infection & Immunity, School of Life and Medical Sciences, Royal Free Hospital, University College London, London, United Kingdom
| | - Konstantinos Mengrelis
- Infection, Immunity and Inflammation Theme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Stuart Adams
- Department of Immunology, Great Ormond Street Hospital, London, United Kingdom
| | - Jolanta Bernatoniene
- Department of Paediatric Immunology and Infectious Diseases, Bristol Children's Hospital, Bristol, United Kingdom
| | - Ronald Bremner
- Department of Gastroenterology, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Michael Browning
- Department of Immunology, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Blythe Devlin
- Division of Allergy and Immunology, Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Hans Christian Erichsen
- Division of Paediatric and Adolescent Medicine, Section of Paediatric Medicine and Transplantation, Oslo University Hospital, Oslo, Norway
| | - H Bobby Gaspar
- Infection, Immunity and Inflammation Theme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Department of Immunology, Great Ormond Street Hospital, London, United Kingdom
| | - Lizzie Hutchison
- Department of Paediatric Immunology and Infectious Diseases, Bristol Children's Hospital, Bristol, United Kingdom
| | - Winnie Ip
- Infection, Immunity and Inflammation Theme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Department of Immunology, Great Ormond Street Hospital, London, United Kingdom
| | - Marianne Ifversen
- Paediatric Clinic II, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - T Ronan Leahy
- Department of Paediatric Immunology and Infectious Diseases, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - Elizabeth McCarthy
- Division of Allergy and Immunology, Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Despina Moshous
- Paediatric Immunology, Haematology and Rheumatology Unit, Hopital Necker, Paris, France
| | - Kim Neuling
- Department of Paediatrics, University Hospital, Coventry, United Kingdom
| | - Malgorzata Pac
- Department of Immunology, Children's Memorial Health Institute, Warsaw, Poland
| | - Alina Papadopol
- Paediatric Clinic, Polyclinic Regina Maria Baneasa, Bucharest, Romania
| | - Kathryn L Parsley
- Infection, Immunity and Inflammation Theme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Department of Immunology, Great Ormond Street Hospital, London, United Kingdom
| | - Luigi Poliani
- Institute of Immunity and Translational Medicine, University of Brescia, Brescia, Italy
| | - Ida Ricciardelli
- Infection, Immunity and Inflammation Theme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - David M Sansom
- Institute of Immunity and Transplantation, Division of Infection & Immunity, School of Life and Medical Sciences, Royal Free Hospital, University College London, London, United Kingdom
| | - Tiia Voor
- The Children's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Austen Worth
- Infection, Immunity and Inflammation Theme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Department of Immunology, Great Ormond Street Hospital, London, United Kingdom
| | - Tessa Crompton
- Infection, Immunity and Inflammation Theme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - M Louise Markert
- Department of Immunology, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Adrian J Thrasher
- Infection, Immunity and Inflammation Theme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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Kammermeier J, Dziubak R, Pescarin M, Drury S, Godwin H, Reeve K, Chadokufa S, Huggett B, Sider S, James C, Acton N, Cernat E, Gasparetto M, Noble-Jamieson G, Kiparissi F, Elawad M, Beales PL, Sebire NJ, Gilmour K, Uhlig HH, Bacchelli C, Shah N. Phenotypic and Genotypic Characterisation of Inflammatory Bowel Disease Presenting Before the Age of 2 years. J Crohns Colitis 2017; 11:60-69. [PMID: 27302973 PMCID: PMC5885808 DOI: 10.1093/ecco-jcc/jjw118] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [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: 12/15/2022]
Abstract
OBJECTIVES Inflammatory bowel disease [IBD] presenting in early childhood is extremely rare. More recently, progress has been made to identify children with monogenic forms of IBD predominantly presenting very early in life. In this study, we describe the heterogeneous phenotypes and genotypes of patients with IBD presenting before the age of 2 years and establish phenotypic features associated with underlying monogenicity. METHODS Phenotype data of 62 children with disease onset before the age of 2 years presenting over the past 20 years were reviewed. Children without previously established genetic diagnosis were prospectively recruited for next-generation sequencing. RESULTS In all, 62 patients [55% male] were identified. The median disease onset was 3 months of age (interquartile range [IQR]: 1 to 11). Conventional IBD classification only applied to 15 patients with Crohn's disease [CD]-like [24%] and three with ulcerative colitis [UC]-like [5%] phenotype; 44 patients [71%] were diagnosed with otherwise unclassifiable IBD. Patients frequently required parenteral nutrition [40%], extensive immunosuppression [31%], haematopoietic stem-cell transplantation [29%], and abdominal surgery [19%]. In 31% of patients, underlying monogenic diseases were established [EPCAM, IL10, IL10RA, IL10RB, FOXP3, LRBA, SKIV2L, TTC37, TTC7A]. Phenotypic features significantly more prevalent in monogenic IBD were: consanguinity, disease onset before the 6th month of life, stunting, extensive intestinal disease and histological evidence of epithelial abnormalities. CONCLUSIONS IBD in children with disease onset before the age of 2 years is frequently unclassifiable into Crohn's disease and ulcerative colitis, particularly treatment resistant, and can be indistinguishable from monogenic diseases with IBD-like phenotype.
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Affiliation(s)
- Jochen Kammermeier
- Genetics and Genomic Medicine, Institute of Child Health, University College London, London, UK,Department of Gastroenterology, Great Ormond Street Hospital, London, UK
| | - Robert Dziubak
- Department of Gastroenterology, Great Ormond Street Hospital, London, UK
| | - Matilde Pescarin
- Department of Gastroenterology, Great Ormond Street Hospital, London, UK
| | - Suzanne Drury
- Genetics and Genomic Medicine, Institute of Child Health, University College London, London, UK,NE Thames Regional Genetics Laboratory, Great Ormond Street Hospital, London, UK
| | - Heather Godwin
- Department of Gastroenterology, Great Ormond Street Hospital, London, UK
| | - Kate Reeve
- Department of Gastroenterology, Great Ormond Street Hospital, London, UK
| | | | - Bonita Huggett
- Department of Gastroenterology, Great Ormond Street Hospital, London, UK
| | - Sara Sider
- Department of Gastroenterology, Great Ormond Street Hospital, London, UK
| | - Chela James
- Genetics and Genomic Medicine, Institute of Child Health, University College London, London, UK
| | - Nikki Acton
- Department of Gastroenterology, Great Ormond Street Hospital, London, UK
| | - Elena Cernat
- Department of Gastroenterology, Great Ormond Street Hospital, London, UK
| | - Marco Gasparetto
- Department of Paediatric Gastroenterology, Addenbrookes Hospital, Cambridge, UK
| | - Gabi Noble-Jamieson
- Department of Paediatric Gastroenterology, Addenbrookes Hospital, Cambridge, UK
| | - Fevronia Kiparissi
- Department of Gastroenterology, Great Ormond Street Hospital, London, UK
| | - Mamoun Elawad
- Department of Gastroenterology, Great Ormond Street Hospital, London, UK
| | - Phil L. Beales
- Genetics and Genomic Medicine, Institute of Child Health, University College London, London, UK
| | - Neil J. Sebire
- Department of Histopathology, Great Ormond Street Hospital, London, UK
| | - Kimberly Gilmour
- Department of Immunology, Great Ormond Street Hospital, London, UK
| | - Holm H. Uhlig
- Transitional Gastroenterology Unit, Nuffield Department of Medicine and Department of Paediatrics, University of Oxford, UK
| | - Chiara Bacchelli
- Genetics and Genomic Medicine, Institute of Child Health, University College London, London, UK
| | - Neil Shah
- Department of Gastroenterology, Great Ormond Street Hospital, London, UK
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Engelhardt KR, Xu Y, Grainger A, Germani Batacchi MGC, Swan DJ, Willet JDP, Abd Hamid IJ, Agyeman P, Barge D, Bibi S, Jenkins L, Flood TJ, Abinun M, Slatter MA, Gennery AR, Cant AJ, Santibanez Koref M, Gilmour K, Hambleton S. Identification of Heterozygous Single- and Multi-exon Deletions in IL7R by Whole Exome Sequencing. J Clin Immunol 2016; 37:42-50. [PMID: 27807805 PMCID: PMC5226981 DOI: 10.1007/s10875-016-0343-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 12/16/2015] [Accepted: 10/10/2016] [Indexed: 12/30/2022]
Abstract
Purpose We aimed to achieve a retrospective molecular diagnosis by applying state-of-the-art genomic sequencing methods to past patients with T-B+NK+ severe combined immunodeficiency (SCID). We included identification of copy number variations (CNVs) by whole exome sequencing (WES) using the CNV calling method ExomeDepth to detect gene alterations for which routine Sanger sequencing analysis is not suitable, such as large heterozygous deletions. Methods Of a total of 12 undiagnosed patients with T-B+NK+ SCID, we analyzed eight probands by WES, using GATK to detect single nucleotide variants (SNVs) and small insertions and deletions (INDELs) and ExomeDepth to detect CNVs. Results We found heterozygous single- or multi-exon deletions in IL7R, a known disease gene for autosomal recessive T-B+NK+ SCID, in four families (seven patients). In three families (five patients), these deletions coexisted with a heterozygous splice site or nonsense mutation elsewhere in the same gene, consistent with compound heterozygosity. In our cohort, about a quarter of T-B+NK+ SCID patients (26%) had such compound heterozygous IL7R deletions. Conclusions We show that heterozygous IL7R exon deletions are common in T-B+NK+ SCID and are detectable by WES. They should be considered if Sanger sequencing fails to detect homozygous or compound heterozygous IL7R SNVs or INDELs. Electronic supplementary material The online version of this article (doi:10.1007/s10875-016-0343-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karin R Engelhardt
- Primary Immunodeficiency Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
| | - Yaobo Xu
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Angela Grainger
- Primary Immunodeficiency Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Mila G C Germani Batacchi
- Primary Immunodeficiency Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - David J Swan
- Primary Immunodeficiency Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Joseph D P Willet
- Primary Immunodeficiency Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Intan J Abd Hamid
- Primary Immunodeficiency Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Philipp Agyeman
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Dawn Barge
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Shahnaz Bibi
- NE Thames Regional Genetics Service, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Lucy Jenkins
- NE Thames Regional Genetics Service, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Terence J Flood
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mario Abinun
- Primary Immunodeficiency Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mary A Slatter
- Primary Immunodeficiency Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew R Gennery
- Primary Immunodeficiency Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew J Cant
- Primary Immunodeficiency Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Kimberly Gilmour
- Immunology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Sophie Hambleton
- Primary Immunodeficiency Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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