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Feng Y, Yao S, Li S, Peng Z, Feng G, Ma Y, Guo B, Liu H. Autoimmune regulator (Aire) deficiency results in reduced memory CD8 + T cells after Listeria monocytogenes infection in a murine model. FEBS Lett 2023; 597:2185-2195. [PMID: 37418594 DOI: 10.1002/1873-3468.14696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/15/2023] [Accepted: 06/23/2023] [Indexed: 07/09/2023]
Abstract
Homozygous mutations in the autoimmune regulator (AIRE) gene that cripple thymic negative selection of autoreactive T cells result in autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED). However, how AIRE regulates the T-cell response against foreign pathogens is not well understood. Here, we observed comparable primary CD8+ T cells but a markedly reduced memory T-cell population and protective function in Aire-/- mice compared with wild-type after infection with a strain of recombinant Listeria monocytogenes. In adoptive transfer models, exogenous congenic CD8+ T cells transferred into Aire-/- mice also showed a reduction in the memory T-cell population, indicating an important role for extrathymic Aire-expressing cells in shaping or sustaining memory T cells. Moreover, using a bone marrow chimeric model, we found that Aire expressed in radioresistant cells plays an important role in maintaining the memory phenotype. These results provide important insights into the role of extrathymic Aire in the T-cell response to infection.
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Affiliation(s)
- Yi Feng
- Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Shu Yao
- Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Shan Li
- Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Zuxiang Peng
- Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Guoying Feng
- Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Yan Ma
- Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Bo Guo
- Maternal & Child Health Research Institute, Baoan Womens's and Children's Hospital, Jinan University, Shenzhen, China
| | - Hongming Liu
- Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, Chongqing, China
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2
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Freen-van Heeren JJ, Opstelten R. Age is just a number: long-lasting T-cell immunity can span several lifetimes. Immunol Cell Biol 2023; 101:374-376. [PMID: 36798971 DOI: 10.1111/imcb.12632] [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: 02/15/2023] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 02/18/2023]
Abstract
T-cell memory is considered long-lasting, but new evidence recently published in Nature by Soerens et al. shows that, under certain conditions, mouse memory T-cell immunity can span several mouse lifetimes.
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Affiliation(s)
- Julian J Freen-van Heeren
- Immunomonitoring Services, Pharma & Biotech Services, Sanquin Health Solutions, Amsterdam, The Netherlands
| | - Rianne Opstelten
- Immunomonitoring Services, Pharma & Biotech Services, Sanquin Health Solutions, Amsterdam, The Netherlands
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3
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Lee WC, Cheng CH, Lee CF, Hsu HY, Hsu PY, Wu TJ, Chan KM. Enhancement of dendritic cell immunotherapy by recalling antigens for hepatocellular carcinoma in mice. Immunotherapy 2022; 14:1225-1236. [PMID: 36097695 DOI: 10.2217/imt-2021-0254] [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] [Indexed: 11/21/2022] Open
Abstract
Background: The therapeutic efficacy of dendritic cell (DC)-immunotherapy for large hepatoma in mice is unsatisfactory. Materials & methods: DC-based immunotherapy was used to treat Hepa1-6 tumors measuring 6 ± 1 mm in diameter, enhanced by boosting tumor antigens. Results: CD4+ and CD8+ T-cells were contracted and transformed into memory phenotypic cells after DC-based vaccination. When T-cells were re-stimulated, T-cells obtained from mice boosted by tumor antigen injection showed highest proliferation capacity. When mice with large tumors were treated, DC-based vaccination boosted by tumor antigen and an additional DC-infusion yielded curative rates of 50% and 23.1%, respectively. Conclusion: DC vaccination induced effector memory cells. Antigen presentation recalled by DC or tumor antigens increased the curative rate in mice with large tumors.
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Affiliation(s)
- Wei-Chen Lee
- Division of Liver & Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Linkou, Taiwan. Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Chih-Hsien Cheng
- Division of Liver & Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Linkou, Taiwan. Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Chen-Fang Lee
- Division of Liver & Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Linkou, Taiwan. Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsiu-Ying Hsu
- Division of Liver & Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Linkou, Taiwan. Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Pao-Yueh Hsu
- Division of Liver & Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Linkou, Taiwan. Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Ting-Jung Wu
- Division of Liver & Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Linkou, Taiwan. Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Kun-Ming Chan
- Division of Liver & Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Linkou, Taiwan. Chang-Gung University College of Medicine, Taoyuan, Taiwan
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Glazer N, Akerman O, Louzoun Y. Naive and memory T cells TCR-HLA-binding prediction. Oxf Open Immunol 2022; 3:iqac001. [PMID: 36846560 PMCID: PMC9914496 DOI: 10.1093/oxfimm/iqac001] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/01/2022] [Accepted: 05/17/2022] [Indexed: 11/12/2022] Open
Abstract
T cells recognize antigens through the interaction of their T cell receptor (TCR) with a peptide-major histocompatibility complex (pMHC) molecule. Following thymic-positive selection, TCRs in peripheral naive T cells are expected to bind MHC alleles of the host. Peripheral clonal selection is expected to further increase the frequency of antigen-specific TCRs that bind to the host MHC alleles. To check for a systematic preference for MHC-binding T cells in TCR repertoires, we developed Natural Language Processing-based methods to predict TCR-MHC binding independently of the peptide presented for Class I MHC alleles. We trained a classifier on published TCR-pMHC binding pairs and obtained a high area under curve (AUC) of over 0.90 on the test set. However, when applied to TCR repertoires, the accuracy of the classifier dropped. We thus developed a two-stage prediction model, based on large-scale naive and memory TCR repertoires, denoted TCR HLA-binding predictor (CLAIRE). Since each host carries multiple human leukocyte antigen (HLA) alleles, we first computed whether a TCR on a CD8 T cell binds an MHC from any of the host Class-I HLA alleles. We then performed an iteration, where we predict the binding with the most probable allele from the first round. We show that this classifier is more precise for memory than for naïve cells. Moreover, it can be transferred between datasets. Finally, we developed a CD4-CD8 T cell classifier to apply CLAIRE to unsorted bulk sequencing datasets and showed a high AUC of 0.96 and 0.90 on large datasets. CLAIRE is available through a GitHub at: https://github.com/louzounlab/CLAIRE, and as a server at: https://claire.math.biu.ac.il/Home.
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Affiliation(s)
- Neta Glazer
- Department of Mathematics, Bar-Ilan University, Ramat Gan, Israel
| | - Ofek Akerman
- Department of Mathematics, Bar-Ilan University, Ramat Gan, Israel
| | - Yoram Louzoun
- Correspondence address. Department of Mathematics, Bar-Ilan University, Ramat Gan, Israel. E-mail:
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5
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Lin F, Sun X, Lei J, Xu AE. Altered circulating memory T cells in vitiligo cases followed NB-UVB therapy. Photodermatol Photoimmunol Photomed 2021; 38:76-82. [PMID: 34265118 PMCID: PMC9292791 DOI: 10.1111/phpp.12719] [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] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/11/2021] [Accepted: 07/10/2021] [Indexed: 11/28/2022]
Abstract
Background Vitiligo represents a commonly diagnosed autoimmune disease caused by the depletion of epidermal melanocytes. Many subsets of T cells contribute to vitiligo pathogenesis, including resident and circulating memory T cells. Objectives To analyze the amounts of CD4+ and CD8+memory T‐cell subsets in peripheral blood specimens from vitiligo patients and alterations caused by narrowband ultraviolet B (NB‐UVB) phototherapy. Methods Circulating CD4+ and CD8+ central memory T (TCM) and effector memory T (TEM) cell frequencies in 33 patients with non‐segmental vitiligo and 16 healthy donors were evaluated by flow cytometry. Related chemokine levels were also detected. Results Peripheral blood CD4+ TCM and CD8+ TCM counts were markedly reduced in vitiligo cases while they were higher in active vitiligo compared with stable vitiligo cases. Circulating CD8+ TCM frequency in vitiligo was closely related to disease duration. Interestingly, CD4+ TCM and CD8+ TCM frequencies, alongside CXCL9 and CXCL10 amounts in peripheral blood of patients with vitiligo, were significantly decreased after NB‐UVB phototherapy. Conclusions Decreased frequencies of circulating CD4+ TCM and CD8+ TCM by NB‐UVB suggest a possible immunosuppressive effect of phototherapy. The chemokines CXCL9 and CXCL10 are the bridge between circulating and skin resident memory T cells. NB‐UVB blocks the homing of circulating memory T cells into vitiligo lesions by down‐regulating CXCL9 and CXCL10. Targeting the above proteins could provide novel, durable treatment options to cure and prevent flares of this disease.
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Affiliation(s)
- Fuquan Lin
- Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiukun Sun
- Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiehao Lei
- Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ai-E Xu
- Department of Dermatology, Hangzhou Third People's Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
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6
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Gupta A, Saqib M, Singh B, Pal L, Nishikanta A, Bhaskar S. Mycobacterium indicus pranii Induced Memory T-Cells in Lung Airways Are Sentinels for Improved Protection Against M.tb Infection. Front Immunol 2019; 10:2359. [PMID: 31681272 PMCID: PMC6813244 DOI: 10.3389/fimmu.2019.02359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/19/2019] [Indexed: 12/24/2022] Open
Abstract
The lungs are the most vulnerable site for air-borne infections. Immunologic compartmentalization of the lungs into airway lumen and interstitium has paved the way to determine the immune status of the site of pathogen entry, which is crucial for the outcome of any air-borne infections. Vaccination via the nasal route with Mycobacterium indicus pranii (MIP), a prospective candidate vaccine against tuberculosis (TB), has been reported to confer superior protection as compared to the subcutaneous (s.c.) route in small-animal models of TB. However, the immune mechanism remains only partly understood. Here, we showed that intranasal (i.n.) immunization of mice with MIP resulted in a significant recruitment of CD4+ and CD8+ T-cells expressing activation markers in the lung airway lumen. A strong memory T-cell response was observed in the lung airway lumen after i.n. MIP vaccination, compared with s.c. vaccination. The recruitment of these T-cells was regulated primarily by CXCR3–CXCL11 axis in “MIP i.n.” group. MIP-primed T-cells in the lung airway lumen effectively transferred protective immunity into naïve mice against Mycobacterium tuberculosis (M.tb) infection and helped reducing the pulmonary bacterial burden. These signatures of protective immune response were virtually absent or very low in unimmunized and subcutaneously immunized mice, respectively, before and after M.tb challenge. Our study provides mechanistic insights for MIP-elicited protective response against M.tb infection.
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Affiliation(s)
- Ananya Gupta
- National Institute of Immunology, Product Development Cell-I, New Delhi, India
| | - Mohd Saqib
- National Institute of Immunology, Product Development Cell-I, New Delhi, India.,Department of Immunology and Microbial Disease, Albany Medical College, Albany, NY, United States
| | - Bindu Singh
- National Institute of Immunology, Product Development Cell-I, New Delhi, India
| | - Lalit Pal
- National Institute of Immunology, Product Development Cell-I, New Delhi, India
| | - Akoijam Nishikanta
- National Institute of Immunology, Product Development Cell-I, New Delhi, India
| | - Sangeeta Bhaskar
- National Institute of Immunology, Product Development Cell-I, New Delhi, India
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7
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Loschinski R, Böttcher M, Stoll A, Bruns H, Mackensen A, Mougiakakos D. IL-21 modulates memory and exhaustion phenotype of T-cells in a fatty acid oxidation-dependent manner. Oncotarget 2018; 9:13125-13138. [PMID: 29568345 PMCID: PMC5862566 DOI: 10.18632/oncotarget.24442] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [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: 07/19/2017] [Accepted: 02/01/2018] [Indexed: 11/25/2022] Open
Abstract
T-cell-based therapies represent a promising strategy for cancer treatment. In this context, cytokines are discussed as a bona fide instrument for fine-tuning T- cell biology. One promising candidate is the pleiotropic interleukin-21 (IL-21) with only little being known regarding its direct effects on human T-cells. Thus, we sought out to characterize the impact of IL-21 on T-cell metabolism, fitness, and differentiation. Culturing T-cells in presence of IL-21 elicited a metabolic skewing away from aerobic glycolysis towards fatty acid oxidation (FAO). These changes of the metabolic framework were paralleled by increased mitochondrial fitness and biogenesis. However, oxidative stress levels were not increased but rather decreased. Furthermore, elevated FAO and mitochondrial biomass together with enhanced antioxidative properties are linked to formation of longer lasting memory responses and less PD-1 expression. We similarly observed an IL-21-triggered induction of central memory-like T-cells and reduced levels of PD-1 on the cell surface. Taken together, IL-21 shifts T-cells towards an immunometabolic phenotype that has been associated with increased survivability and enhanced anti-tumor efficacy. In addition, our data reveals a novel interconnection between fatty acid metabolism and immune function regulated by IL 21.
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Affiliation(s)
- Romy Loschinski
- Department of Internal Medicine 5, Hematology and Oncology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Martin Böttcher
- Department of Internal Medicine 5, Hematology and Oncology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Andrej Stoll
- Department of Internal Medicine 5, Hematology and Oncology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Heiko Bruns
- Department of Internal Medicine 5, Hematology and Oncology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Andreas Mackensen
- Department of Internal Medicine 5, Hematology and Oncology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Dimitrios Mougiakakos
- Department of Internal Medicine 5, Hematology and Oncology, University of Erlangen-Nuremberg, Erlangen, Germany
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Seledtsova GV, Ivanova IP, Shishkov AA, Seledtsov VI. Immune responses to polyclonal T-cell vaccination in patients with progressive multiple sclerosis. J Immunotoxicol 2016; 13:879-884. [PMID: 27602793 DOI: 10.1080/1547691x.2016.1223767] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 01/10/2023] Open
Abstract
The overall objective of disease management in autoimmune diseases is to suppress chronic inflammation and prevent organ damage. Therapies often revolve around five drug classes: non-steroidal anti-inflammatory drugs (NSAIDS), anti-malarials, steroids, immunosuppressants, and bio-therapies. However, none of these is a 'cure' and each displays a potential for adverse events. In particular, while all of them suppress harmful autoimmune responses, they also impact on useful protective immune responses. T-Cell receptor (TCR) immunogenicity provides a rationale for T-cell vaccinations to induce anti-idiotypic immune responses with the purpose of down-regulating functionality of idiotype-bearing self-reactive T-cells. To explore this, in this study, 39 patients with progressive (chronic) multiple sclerosis (MS) were multiply immunized with autological polyclonal T-cell vaccines (TCVs). None of the TCV-treated patients experienced any significant side-effects during the entire follow-up period (2 years). T-Cell vaccination had no significant effects on T-cell sub-population contents in the blood of MS patients after 2 years of immunotherapy initiation. However, a substantial reduction in the frequency of CD4+ and CD8+ memory T-cells able to produce interferon (IFN)-γ following activation were noted in the blood of TCV-treated patients. Moreover, significant and sustained reduction in plasma IFNγ levels and concomitant increases in interleukin (IL)-4 levels were documented in these samples. The TCV-treated subjects, however, exhibited no significant changes in plasma IL-17 and IL-18. More importantly was a significant decline in proliferative T-cell responses to myelin antigens in the TCV-treated patients, indicating attenuation of myelin-specific T-cell activity. Collectively, the results suggest that polyclonal T-cell vaccination is safe to use, able to induce measurable, long-lasting, anti-inflammatory immune effects in patients with advanced MS.
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Affiliation(s)
- Galina V Seledtsova
- a State Research Institute for Fundamental and Clinical Immunology , Novosibirsk , Russia
| | - Irina P Ivanova
- a State Research Institute for Fundamental and Clinical Immunology , Novosibirsk , Russia
| | - Alexey A Shishkov
- a State Research Institute for Fundamental and Clinical Immunology , Novosibirsk , Russia
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Nemoto S, Mailloux AW, Kroeger J, Mulé JJ. OMIP-031: Immunologic checkpoint expression on murine effector and memory T-cell subsets. Cytometry A 2016; 89:427-9. [PMID: 26859685 DOI: 10.1002/cyto.a.22808] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/25/2015] [Accepted: 12/04/2015] [Indexed: 01/10/2023]
Affiliation(s)
- Satoshi Nemoto
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, Florida.,Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Adam W Mailloux
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, Florida.,Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Jodi Kroeger
- Flow Cytometry Core Facility, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - James J Mulé
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, Florida.,Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida
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10
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Lin JL, Lee WI, Huang JL, Chen PKT, Chan KC, Lo LJ, You YJ, Shih YF, Tseng TY, Wu MC. Immunologic assessment and KMT2D mutation detection in Kabuki syndrome. Clin Genet 2014; 88:255-60. [PMID: 25142838 DOI: 10.1111/cge.12484] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 08/14/2014] [Accepted: 08/16/2014] [Indexed: 12/31/2022]
Abstract
Kabuki or Niikawa-Kuroki syndrome (KS) is a rare disorder with multiple malformations and recurrent infections, especially otitis media. This study aimed to investigate the genetic defects in Kabuki syndrome and determine if immune status is related to recurrent otitis media. Fourteen patients from 12 unrelated families were enrolled in the 9-year study period (2005-2013). All had Kabuki faces, cleft palate, developmental delay, mental retardation, and the short fifth finger. Recurrent otitis media (12/14) and hearing impairment (8/14) were also more common features. Immunologic analysis revealed lower memory CD19+ cells (11/13), lower memory CD4+ cells (8/13), undetectable anti-HBs antibodies (7/13), and antibody deficiency (7/13), including lower IgA (4), IgG (2), and IgG2 (1). Naïve emigrant lymphocytes, lymphocyte proliferation function, complement activity, and superoxide production in polymorphonuclear cells were all normal. All the patients had KMT2D mutations and 10 novel mutations of R1252X, R1757X,Y1998C, P2550R fs2604X, Q4013X, G5379X, E5425K, R5432X, R5432W, and R5500W. Resembling the phenotype of common variable immunodeficiency, KS patients with antibody deficiency, decreased memory cells, and poor vaccine response increased susceptibility to recurrent otitis media. Large-scale prospective studies are warranted to determine if regular immunoglobulin supplementation decreases the frequency of otitis media and severity of hearing impairment.
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Affiliation(s)
- J-L Lin
- Division of Genetics and Endocrinology
| | - W-I Lee
- Primary Immunodeficiency Care and Research (PICAR) Institute.,Division of Allergy, Asthma and Rheumatology, Department of Pediatrics
| | - J-L Huang
- Primary Immunodeficiency Care and Research (PICAR) Institute.,Division of Allergy, Asthma and Rheumatology, Department of Pediatrics
| | - P K-T Chen
- Division of Plasty, Department of Surgery
| | - K-C Chan
- Division of Ear, Nose and Throat, Department of Surgery, Chang Gung University College of Medicine and Chang Gung Children's and Memorial Hospital, Taoyuan, Taiwan
| | - L-J Lo
- Division of Plasty, Department of Surgery
| | - Y-J You
- Division of Genetics and Endocrinology
| | - Y-F Shih
- Primary Immunodeficiency Care and Research (PICAR) Institute
| | - T-Y Tseng
- Primary Immunodeficiency Care and Research (PICAR) Institute
| | - M-C Wu
- Division of Genetics and Endocrinology
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