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Krzyzanowski D, Oszer A, Madzio J, Zdunek M, Kolodrubiec J, Urbanski B, Mlynarski W, Janczar S. The paradox of autoimmunity and autoinflammation in inherited neutrophil disorders - in search of common patterns. Front Immunol 2023; 14:1128581. [PMID: 37350970 PMCID: PMC10283154 DOI: 10.3389/fimmu.2023.1128581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/18/2023] [Indexed: 06/24/2023] Open
Abstract
Congenital defects of neutrophil number or function are associated with a severe infectious phenotype that may require intensive medical attention and interventions to be controlled. While the infectious complications in inherited neutrophil disorders are easily understood much less clear and explained are autoimmune and autoinflammatory phenomena. We survey the clinical burden of autoimmunity/autoinflammation in this setting, search for common patterns, discuss potential mechanisms and emerging treatments.
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Affiliation(s)
- Damian Krzyzanowski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
- Laboratory of Epigenetics, Institute of Medical Biology, Polish Academy of Sciences, Lodz, Poland
| | - Aleksandra Oszer
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | - Joanna Madzio
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | - Maciej Zdunek
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | - Julia Kolodrubiec
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | - Bartosz Urbanski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | - Wojciech Mlynarski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | - Szymon Janczar
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
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Kaczor M, Greczan M, Kierus K, Ehmke vel Emczyńska‐Seliga E, Ciara E, Piątosa B, Rokicki D, Książyk J, Wesół‐Kucharska D. Sodium‐glucose cotransporter type 2 channel inhibitor: Breakthrough in the treatment of neutropenia in patients with glycogen storage disease type 1b? JIMD Rep 2022; 63:199-206. [PMID: 35433171 PMCID: PMC8995836 DOI: 10.1002/jmd2.12278] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/07/2022] [Accepted: 02/17/2022] [Indexed: 01/23/2023] Open
Abstract
Glycogen storage disease type 1b (GSD 1b) is an inherited metabolic defect caused by biallelic mutations in the SLC37A4 gene encoding microsomal glucose‐6‐phosphate (G6P) transporter in the endoplasmic reticulum (ER) membrane. Ineffective G6P transport into the ER leads to hypoglycaemia, hyperlactatemia, hyperuricemia, hypertriglyceridemia, hepato‐ and/or nephromegaly. Clinical manifestations of the disease include recurrent, severe infections and inflammatory bowel (Crohn‐like) caused by neutropenia and diminished bactericidal and fungicidal activity of neutrophils. Granulocyte colony‐stimulating factor (G‐CSF) administration is currently a standard therapy to prevent adverse effects of neutropenia, but the treatment is associated with a high risk of severe side effects. On the other hand, short‐treatment with sodium‐glucose cotransporter type 2 inhibitor – empagliflozin (EMPA) was reported to act directly on the mechanism of neutropenia and neutrophil dysfunction in GSD 1b. We observed significant improvement in clinical and laboratory parameters after introducing EMPA to treatment, that is reduced frequency of infections, lower number of bowel movements, and improved postoperative wound healing. EMPA is effective in the treatment of neutropenia in our GSD 1b patients, which allows for dose reduction and even withdrawal of G‐CSF. We did not observe any significant side effects of EMPA treatment in our patients.
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Affiliation(s)
- Magdalena Kaczor
- Department of Paediatrics, Nutrition and Metabolic Diseases Children's Memorial Health Institute Warsaw Poland
| | - Milena Greczan
- Department of Paediatrics, Nutrition and Metabolic Diseases Children's Memorial Health Institute Warsaw Poland
| | - Karolina Kierus
- Department of Paediatrics, Rheumatology, Immunology and Metabolic Bone Diseases Medical University of Bialystok Białystok Poland
| | | | - Elżbieta Ciara
- Department of Medical Genetics Children's Memorial Health Institute Warsaw Poland
| | - Barbara Piątosa
- Histocompatibility Laboratory Children's Memorial Health Institute Warsaw Poland
| | - Dariusz Rokicki
- Department of Paediatrics, Nutrition and Metabolic Diseases Children's Memorial Health Institute Warsaw Poland
| | - Janusz Książyk
- Department of Paediatrics, Nutrition and Metabolic Diseases Children's Memorial Health Institute Warsaw Poland
| | - Dorota Wesół‐Kucharska
- Department of Paediatrics, Nutrition and Metabolic Diseases Children's Memorial Health Institute Warsaw Poland
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Iwanicka-Pronicka K, Trubicka J, Szymanska E, Ciara E, Rokicki D, Pollak A, Pronicki M. Sensorineural hearing loss in GSD type I patients. A newly recognized symptomatic association of potential clinical significance and unclear pathomechanism. Int J Pediatr Otorhinolaryngol 2021; 151:110970. [PMID: 34775139 DOI: 10.1016/j.ijporl.2021.110970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 10/15/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Glycogen storage disease (GSD) type I is an inborn error of carbohydrates metabolism characterized by inability to convert glucose-6-phosphate to glucose. It presents with serious liver and metabolic complications, as well as in type Ib with severe infections due to neutropenia. So far, the sensorineural hearing impairment has not been reported in these patients. Bilateral, sensorineural hearing impairment was diagnosed in four unrelated GSDI patients. Congenital origin of hearing loss and descending audiometric curves warranted the need for future investigations. METHODS Hearing status was assessed in entire group of 40 children with GSD type I. Then, molecular testing, massive parallel sequencing was performed in the four probands and their parents in order to find possible genetic background of auditory dysfunction in these patients. RESULTS Pathogenic variants in G6PC and SLC37A4 related to the phenotypes of GSDI subtype Ia and subtype Ib were detected, each in two probands, respectively. No change in the genes involved in auditory pathway dysfunction was found. CONCLUSIONS Sensorineural hearing loss appears to be associated with GSDI in approximately one out of ten cases. Careful assessment and monitoring of auditory functions of patients with GSDI is recommended.
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Affiliation(s)
- Katarzyna Iwanicka-Pronicka
- Department of Audiology and Phoniatrics, The Children's Memorial Health Institute, Al. Dzieci Polskich 20; 04-730, Warsaw, Poland; Department of Medical Genetics, The Children's Memorial Health Institute, Al. Dzieci Polskich 20; 04-730, Warsaw, Poland.
| | - Joanna Trubicka
- Department of Medical Genetics, The Children's Memorial Health Institute, Al. Dzieci Polskich 20; 04-730, Warsaw, Poland; Department of Pathology, The Children's Memorial Health Institute, Al. Dzieci Polskich 20; 04-730, Warsaw, Poland
| | - Edyta Szymanska
- Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, The Childrens' Memorial Health Institute, Warsaw, Poland, Al. Dzieci Polskich 20; 04-730, Warsaw, Poland; Department of Pediatrics, Nutrition and Metabolic Diseases, The Children's Memorial Health Institute, Al. Dzieci Polskich 20; 04-730, Warsaw, Poland
| | - Elżbieta Ciara
- Department of Medical Genetics, The Children's Memorial Health Institute, Al. Dzieci Polskich 20; 04-730, Warsaw, Poland
| | - Dariusz Rokicki
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children's Memorial Health Institute, Al. Dzieci Polskich 20; 04-730, Warsaw, Poland
| | - Agnieszka Pollak
- Department of Medical Genetics, Medical University of Warsaw, A. Pawinskiego 3c, 02-106, Warszaw, Poland
| | - Maciej Pronicki
- Department of Pathology, The Children's Memorial Health Institute, Al. Dzieci Polskich 20; 04-730, Warsaw, Poland
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5
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Khalaf D, Bell H, Dale D, Gupta V, Faghfoury H, Morel CF, Tierens A, Weinstein DA, Yan J, Thyagu S, Maze D. A case of secondary acute myeloid leukemia on a background of glycogen storage disease with chronic neutropenia treated with granulocyte colony stimulating factor. JIMD Rep 2019; 49:37-42. [PMID: 31788408 PMCID: PMC6875697 DOI: 10.1002/jmd2.12069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/12/2019] [Accepted: 07/01/2019] [Indexed: 12/16/2022] Open
Abstract
Congenital neutropenias due to mutations in ELANE, SBDS or HAX1 or in the setting of glycogen storage disease (GSD) which is caused by SLC37A4 mutation, often require prolonged granulocyte colony stimulating factor (G-CSF) therapy to prevent recurrent infections and hospital admission. There has been emerging evidence that prolonged exposure to G-CSF in cases with congenital neutropenia other than GSD is associated with transformation to myelodysplastic syndrome/acute myeloid leukemia.
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Affiliation(s)
- Dina Khalaf
- Department of Medical Oncology and Hematology, Princess Margaret Hospital Cancer CentreUniversity Health NetworkTorontoOntarioCanada
| | - Heather Bell
- Fred A. Litwin Family Centre in Genetic MedicineUniversity Health Network and Mount Sinai HospitalTorontoOntarioCanada
| | - David Dale
- Department of MedicineUniversity of WashingtonSeattleWashington
| | - Vikas Gupta
- Department of Medical Oncology and Hematology, Princess Margaret Hospital Cancer CentreUniversity Health NetworkTorontoOntarioCanada
| | - Hanna Faghfoury
- Fred A. Litwin Family Centre in Genetic MedicineUniversity Health Network and Mount Sinai HospitalTorontoOntarioCanada
| | - Chantal F. Morel
- Department of Medical Oncology and Hematology, Princess Margaret Hospital Cancer CentreUniversity Health NetworkTorontoOntarioCanada
- Fred A. Litwin Family Centre in Genetic MedicineUniversity Health Network and Mount Sinai HospitalTorontoOntarioCanada
| | - Anne Tierens
- Department of Pathology, Toronto General HospitalUniversity Health NetworkTorontoOntarioCanada
| | - David A. Weinstein
- Glycogen Storage Disease ProgramUniversity of Connecticut and Connecticut Children's Medical CenterHartfordConnecticut
| | - Jiong Yan
- Department of Pathology, Toronto General HospitalUniversity Health NetworkTorontoOntarioCanada
| | - Santhosh Thyagu
- Department of Medical Oncology and Hematology, Princess Margaret Hospital Cancer CentreUniversity Health NetworkTorontoOntarioCanada
| | - Dawn Maze
- Department of Medical Oncology and Hematology, Princess Margaret Hospital Cancer CentreUniversity Health NetworkTorontoOntarioCanada
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Kanungo S, Wells K, Tribett T, El-Gharbawy A. Glycogen metabolism and glycogen storage disorders. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:474. [PMID: 30740405 DOI: 10.21037/atm.2018.10.59] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Glucose is the main energy fuel for the human brain. Maintenance of glucose homeostasis is therefore, crucial to meet cellular energy demands in both - normal physiological states and during stress or increased demands. Glucose is stored as glycogen primarily in the liver and skeletal muscle with a small amount stored in the brain. Liver glycogen primarily maintains blood glucose levels, while skeletal muscle glycogen is utilized during high-intensity exertion, and brain glycogen is an emergency cerebral energy source. Glycogen and glucose transform into one another through glycogen synthesis and degradation pathways. Thus, enzymatic defects along these pathways are associated with altered glucose metabolism and breakdown leading to hypoglycemia ± hepatomegaly and or liver disease in hepatic forms of glycogen storage disorder (GSD) and skeletal ± cardiac myopathy, depending on the site of the enzyme defects. Overall, defects in glycogen metabolism mainly present as GSDs and are a heterogenous group of inborn errors of carbohydrate metabolism. In this article we review the genetics, epidemiology, clinical and metabolic findings of various types of GSD, and glycolysis defects emphasizing current treatment and implications for future directions.
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Affiliation(s)
- Shibani Kanungo
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Kimberly Wells
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Taylor Tribett
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Areeg El-Gharbawy
- Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Raggi F, Pissavino AL, Resaz R, Segalerba D, Puglisi A, Vanni C, Antonini F, Del Zotto G, Gamberucci A, Marcolongo P, Bosco MC, Grillo F, Mastracci L, Eva A. Development and characterization of an inducible mouse model for glycogen storage disease type Ib. J Inherit Metab Dis 2018; 41:1015-1025. [PMID: 29967951 DOI: 10.1007/s10545-018-0211-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/23/2018] [Accepted: 05/30/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Glycogen storage disease type Ib (GSD1b) is a rare metabolic and immune disorder caused by a deficiency in the glucose-6-phosphate transporter (G6PT) and characterized by impaired glucose homeostasis, myeloid dysfunction, and long-term risk of hepatocellular adenomas. Despite maximal therapy, based on a strict diet and on granulocyte colony-stimulating factor treatment, long-term severe complications still develop. Understanding the pathophysiology of GSD1b is a prerequisite to develop new therapeutic strategies and depends on the availability of animal models. The G6PT-KO mouse mimics the human disease but is very fragile and rarely survives weaning. We generated a conditional G6PT-deficient mouse as an alternative model for studying the long-term pathophysiology of the disease. We utilized this conditional mouse to develop an inducible G6PT-KO model to allow temporally regulated G6PT deletion by the administration of tamoxifen (TM). METHODS We generated a conditional G6PT-deficient mouse utilizing the CRElox strategy. Histology, histochemistry, and phenotype analyses were performed at different times after TM-induced G6PT inactivation. Neutrophils and monocytes were isolated and analyzed for functional activity with standard techniques. RESULTS The G6PT-inducible KO mice display the expected disturbances of G6P metabolism and myeloid dysfunctions of the human disorder, even though with a milder intensity. CONCLUSIONS TM-induced inactivation of G6PT in these mice leads to a phenotype which mimics that of human GSD1b patients. The conditional mice we have generated represent an excellent tool to study the tissue-specific role of the G6PT gene and the mechanism of long-term complications in GSD1b.
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Affiliation(s)
- Federica Raggi
- Laboratory of Molecular Biology, Department of Translational Research, Laboratory Medicine, Diagnosis and Services, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy
| | - Anna Livia Pissavino
- Laboratory of Molecular Biology, Department of Translational Research, Laboratory Medicine, Diagnosis and Services, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy
| | - Roberta Resaz
- Laboratory of Molecular Biology, Department of Translational Research, Laboratory Medicine, Diagnosis and Services, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy
| | - Daniela Segalerba
- Laboratory of Molecular Biology, Department of Translational Research, Laboratory Medicine, Diagnosis and Services, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy
| | - Andrea Puglisi
- Laboratory of Molecular Biology, Department of Translational Research, Laboratory Medicine, Diagnosis and Services, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy
| | - Cristina Vanni
- Laboratory of Molecular Biology, Department of Translational Research, Laboratory Medicine, Diagnosis and Services, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy
| | - Francesca Antonini
- Core Facilities Laboratory, Department of Translational Research, Laboratory Medicine, Diagnosis and Services, Istituto Giannina Gaslini, Genoa, Italy
| | - Genny Del Zotto
- Core Facilities Laboratory, Department of Translational Research, Laboratory Medicine, Diagnosis and Services, Istituto Giannina Gaslini, Genoa, Italy
| | - Alessandra Gamberucci
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Paola Marcolongo
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Maria Carla Bosco
- Laboratory of Molecular Biology, Department of Translational Research, Laboratory Medicine, Diagnosis and Services, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy
| | - Federica Grillo
- Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics, University of Genova, Genoa, Italy
- IRCCS AOU San Martino IST Genova, Genoa, Italy
| | - Luca Mastracci
- Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics, University of Genova, Genoa, Italy
- IRCCS AOU San Martino IST Genova, Genoa, Italy
| | - Alessandra Eva
- Laboratory of Molecular Biology, Department of Translational Research, Laboratory Medicine, Diagnosis and Services, Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy.
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Glycogen Storage Disease Ib and Severe Periodontal Destruction: A Case Report. Dent J (Basel) 2018; 6:dj6040053. [PMID: 30282931 PMCID: PMC6313740 DOI: 10.3390/dj6040053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 12/14/2022] Open
Abstract
Background: Glycogen storage diseases (GSDs) are genetic disorders that result from defects in the processing of glycogen synthesis or breakdown within muscles, liver, and other cell types. It also manifests with impaired neutrophil chemotaxis and neutropenic episodes which results in severe destruction of the supporting dental tissues, namely the periodontium. Although GSD Type Ib cannot be cured, associated symptoms and debilitating oral manifestations of the disease can be managed through collaborative medical and dental care where early detection and intervention is of key importance. This objective of the case report was to describe a child with GSD Ib and its associated oral manifestations with microbial, immunological and histological appearances. Case Presentation: An eight-year-old Hispanic male with a history of GSD type Ib presented with extensive intraoral generalized inflammation of the gingiva, ulcerations and bleeding, and intraoral radiographic evidence of bone loss. Tannerella forsythia was readily identifiable from the biofilm samples. Peripheral blood neutrophils were isolated and a deficient host response was observed by impaired neutrophil migration. Histological evaluation of the soft and hard tissues of the periodontally affected primary teeth showed unaffected dentin and cementum. Conclusions: This case illustrates the association between GSD Ib and oral manifestations of the disease. A multi-disciplinary treatment approach was developed in order to establish healthy intraoral conditions for the patient. Review of the literature identified several cases describing GSD and its clinical and radiographic oral manifestations; however, none was identified where also microbial, immunological, and histological appearances were described.
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9
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Weinstein DA, Steuerwald U, De Souza CFM, Derks TGJ. Inborn Errors of Metabolism with Hypoglycemia: Glycogen Storage Diseases and Inherited Disorders of Gluconeogenesis. Pediatr Clin North Am 2018; 65:247-265. [PMID: 29502912 DOI: 10.1016/j.pcl.2017.11.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Although hyperinsulinism is the predominant inherited cause of hypoglycemia in the newborn period, inborn errors of metabolism are the primary etiologies after 1 month of age. Disorders of carbohydrate metabolism often present with hypoglycemia when fasting occurs. The presentation, diagnosis, and management of the hepatic glycogen storage diseases and disorders of gluconeogenesis are reviewed.
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Affiliation(s)
- David A Weinstein
- University of Connecticut School of Medicine, Farmington, CT, USA; Glycogen Storage Disease Program, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA.
| | | | - Carolina F M De Souza
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Terry G J Derks
- Section of Metabolic Diseases, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
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Peacock ME, Arce RM, Cutler CW. Periodontal and other oral manifestations of immunodeficiency diseases. Oral Dis 2017; 23:866-888. [PMID: 27630012 PMCID: PMC5352551 DOI: 10.1111/odi.12584] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 08/31/2016] [Accepted: 09/08/2016] [Indexed: 12/14/2022]
Abstract
The list of immunodeficiency diseases grows each year as novel disorders are discovered, classified, and sometimes reclassified due to our ever-increasing knowledge of immune system function. Although the number of patients with secondary immunodeficiencies (SIDs) greatly exceeds those with primary immunodeficiencies (PIDs), the prevalence of both appears to be on the rise probably because of scientific breakthroughs that facilitate earlier and more accurate diagnosis. Primary immunodeficiencies in adults are not as rare as once thought. Globally, the main causes of secondary immunodeficiency are HIV infection and nutritional insufficiencies. Persons with acquired immune disorders such as AIDS caused by the human immunodeficiency virus (HIV) are now living long and fulfilling lives as a result of highly active antiretroviral therapy (HAART). Irrespective of whether the patient's immune-deficient state is a consequence of a genetic defect or is secondary in nature, dental and medical practitioners must be aware of the constant potential for infections and/or expressions of autoimmunity in these individuals. The purpose of this review was to study the most common conditions resulting from primary and secondary immunodeficiency states, how they are classified, and the detrimental manifestations of these disorders on the periodontal and oral tissues.
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Affiliation(s)
- Mark E Peacock
- Associate Professor, Departments of Periodontics, Oral Biology
| | - Roger M. Arce
- Assistant Professor, Departments of Periodontics, Oral Biology
| | - Christopher W Cutler
- Professor, Departments of Periodontics, Oral Biology; Chair, Department of Periodontics, Associate Dean for Research, The Dental College of Georgia at Augusta University
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11
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Abstract
Neutropenia, usually defined as a blood neutrophil count <1·5 × 109 /l, is a common medical problem for children and adults. There are many causes for neutropenia, and at each stage in life the clinical pattern of causes and consequences differs significantly. I recommend utilizing the age of the child and clinical observations for the preliminary diagnosis and primary management. In premature infants, neutropenia is quite common and contributes to the risk of sepsis with necrotizing enterocolitis. At birth and for the first few months of life, neutropenia is often attributable to isoimmune or alloimmune mechanisms and predisposes to the risk of severe bacterial infections. Thereafter when a child is discovered to have neutropenia, often associated with relatively minor symptoms, it is usually attributed to autoimmune disorder or viral infection. The congenital neutropenia syndromes are usually recognized when there are recurrent infections, the neutropenia is severe and there are congenital anomalies suggesting a genetic disorder. This review focuses on the key clinical finding and laboratory tests for diagnosis with commentaries on treatment, particularly the use of granulocyte colony-stimulating factor to treat childhood neutropenia.
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Affiliation(s)
- David C Dale
- Department of Medicine, University of Washington, Seattle, WA, USA
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12
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Letkemann R, Wittkowski H, Antonopoulos A, Podskabi T, Haslam SM, Föll D, Dell A, Marquardt T. Partial correction of neutrophil dysfunction by oral galactose therapy in glycogen storage disease type Ib. Int Immunopharmacol 2017; 44:216-225. [PMID: 28126686 DOI: 10.1016/j.intimp.2017.01.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 01/06/2017] [Accepted: 01/10/2017] [Indexed: 01/30/2023]
Abstract
Glycogen storage disease type Ib (GSD-Ib) is characterized by impaired glucose homeostasis, neutropenia and neutrophil dysfunction. Mass spectrometric glycomic profiling of GSD-Ib neutrophils showed severely truncated N-glycans, lacking galactose. Experiments indicated the hypoglycosylation of the electron transporting subunit of NADPH oxidase, which is crucial for the defense against bacterial infections. In phosphoglucomutase 1 (PGM1) deficiency, an inherited disorder with an enzymatic defect just one metabolic step ahead, hypogalactosylation can be successfully treated by dietary galactose. We hypothesized the same pathomechanism in GSD-Ib and started a therapeutic trial with oral galactose and uridine. The aim was to improve neutrophil dysfunction through the correction of hypoglycosylation in neutrophils. The GSD-Ib patient was treated for 29weeks. Monitoring included glycomics analysis of the patient's neutrophils and neutrophil function tests including respiratory burst activity, phagocytosis and migration. Although no substantial restoration of neutrophil glycosylation was found, there was partial improvement of respiratory burst activity.
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Affiliation(s)
- Rudolf Letkemann
- Department of General Pediatrics, Metabolic Diseases, University Children's Hospital Muenster, Germany.
| | - Helmut Wittkowski
- Department of Pediatric Rheumatology and Imunology, University Children's Hospital Muenster, Germany.
| | | | - Teodor Podskabi
- Molecular Genetics and Metabolism Laboratory, Munich, Germany.
| | - Stuart M Haslam
- Department of Life Sciences, Imperial College London, SW7 2AZ, UK.
| | - Dirk Föll
- Department of Pediatric Rheumatology and Imunology, University Children's Hospital Muenster, Germany.
| | - Anne Dell
- Department of Life Sciences, Imperial College London, SW7 2AZ, UK.
| | - Thorsten Marquardt
- Department of General Pediatrics, Metabolic Diseases, University Children's Hospital Muenster, Germany.
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13
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Bartels M, Murphy K, Rieter E, Bruin M. Understanding chronic neutropenia: life is short. Br J Haematol 2015; 172:157-69. [PMID: 26456767 DOI: 10.1111/bjh.13798] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The pathophysiological mechanisms underlying chronic neutropenia are extensive, varying from haematopoietic stem cell disorders resulting in defective neutrophil production, to accelerated apoptosis of neutrophil progenitors or circulating mature neutrophils. While the knowledge concerning genetic defects associated with congenital neutropenia or bone marrow failure is increasing rapidly, the functional role and consequences of these genetic alterations is often not well understood. In addition, there is a large group of diseases, including primary immunodeficiencies and metabolic diseases, in which chronic neutropenia is one of the symptoms, while there is no clear bone marrow pathology or haematopoietic stem cell dysfunction. Altogether, these disease entities illustrate the complexity of normal neutrophil development, the functional role of the (bone marrow) microenvironment and the increased propensity to undergo apoptosis, which is typical for neutrophils. The large variety of disorders associated with chronic neutropenia makes classification almost impossible and possibly not desirable, based on the clinical phenotypes. However, a better understanding of the regulation of normal myeloid differentiation and neutrophil development is of great importance in the diagnostic evaluation of unexplained chronic neutropenia. In this review we propose insights in the pathophysiology of chronic neutropenia in the context of the functional role of key players during normal neutrophil development, neutrophil release and neutrophil survival.
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Affiliation(s)
- Marije Bartels
- Department of Paediatric Haematology and Stem Cell Transplantation, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Kate Murphy
- Department of Paediatric Haematology and Stem Cell Transplantation, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Ester Rieter
- Department of Paediatric Haematology and Stem Cell Transplantation, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marrie Bruin
- Department of Paediatric Haematology and Stem Cell Transplantation, University Medical Centre Utrecht, Utrecht, the Netherlands
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14
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Vitamin E Improves Clinical Outcome of Patients Affected by Glycogen Storage Disease Type Ib. JIMD Rep 2015; 25:39-45. [PMID: 26122627 DOI: 10.1007/8904_2015_461] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 04/09/2015] [Accepted: 05/17/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND It has been suggested, on a few GSD1b patients, that vitamin E improves neutrophil count and reduces frequency and severity of infections.The main objective of the present study was to investigate the efficacy of vitamin E on the neutropenia, neutrophil dysfunction and IBD in the entire Italian caseload of GSD1b patients. PATIENTS AND METHODS Eighteen GSD1b patients, median age at the time of the study protocol 14.5 (range, 0.6-42 years), were enrolled from four Italian referral centres for metabolic diseases. For the evaluation of the efficacy of vitamin E, neutrophil count and function, frequency of infections needing hospitalization and inflammatory bowel activity were evaluated periodically all over one year before and during vitamin E therapy. RESULTS Frequency (1.5 ± 0.1 vs. 6.0 ± 0.6, p = 0.003) and severity of infections (2.2 ± 0.2 vs. 3.7 ± 0.4, p = 0.003) were lower and mean value of neutrophil count (1,583 ± 668 vs. 941 ± 809, p = 0.03) higher during vitamin E supplementation. Neutrophil function results improved during vitamin supplementation. PCDAI showed a significant reduction in the inflammatory activity during vitamin E supplementation (9 ± 1.4 vs. 13 ± 1.2, p = 0.006). In seven patients G-CSF requirement decreased and the dose was reduced after the end of the study.In conclusion, our study demonstrated the efficacy of vitamin E supplementation. Vitamin E has evident advantages as compared to G-CSF, as it can be assumed orally, and it has not been associated with severe side effects.
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Boers SJB, Visser G, Smit PGPA, Fuchs SA. Liver transplantation in glycogen storage disease type I. Orphanet J Rare Dis 2014; 9:47. [PMID: 24716823 PMCID: PMC4113191 DOI: 10.1186/1750-1172-9-47] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/01/2014] [Indexed: 12/17/2022] Open
Abstract
Glycogen storage disease type I (GSDI), an inborn error of carbohydrate metabolism, is caused by defects in the glucose-6-transporter/glucose-6-phosphatase complex, which is essential in glucose homeostasis. Two types exist, GSDIa and GSDIb, each caused by different defects in the complex. GSDIa is characterized by fasting intolerance and subsequent metabolic derangements. In addition to these clinical manifestations, patients with GSDIb suffer from neutropenia with neutrophil dysfunction and inflammatory bowel disease. With the feasibility of novel cell-based therapies, including hepatocyte transplantations and liver stem cell transplantations, it is essential to consider long term outcomes of liver replacement therapy. We reviewed all GSDI patients with liver transplantation identified in literature and through personal communication with treating physicians. Our review shows that all 80 GSDI patients showed improved metabolic control and normal fasting tolerance after liver transplantation. Although some complications might be caused by disease progression, most complications seemed related to the liver transplantation procedure and subsequent immune suppression. These results highlight the potential of other therapeutic strategies, like cell-based therapies for liver replacement, which are expected to normalize liver function with a lower risk of complications of the procedure and immune suppression.
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Affiliation(s)
| | | | | | - Sabine A Fuchs
- Department of Metabolic Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA Utrecht, The Netherlands.
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Satoh D, Maeda T, Ito T, Nakajima Y, Ohte M, Ukai A, Nakamura K, Enosawa S, Toyota M, Miyagawa Y, Okita H, Kiyokawa N, Akutsu H, Umezawa A, Matsunaga T. Establishment and directed differentiation of induced pluripotent stem cells from glycogen storage disease type Ib patient. Genes Cells 2013; 18:1053-69. [PMID: 24581426 DOI: 10.1111/gtc.12101] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 08/22/2013] [Indexed: 12/16/2022]
Abstract
Glycogen storage disease type Ib (GSDIb) is caused by a deficiency in the glucose-6-phosphate transporter (G6PT), which leads to neutrophil dysfunction. However, the underlying causes of these dysfunctions and their relationship with glucose homeostasis are unclear. Induced pluripotent stem cells (iPSCs) hold a great promise for advances in developmental biology, cell-based therapy and modeling of human disease. Here, we examined the use of iPSCs as a model for GSDIb. In this study, one 2-year-old patient was genetically screened and diagnosed with GSDIb. We established iPSCs and differentiated these cells into hepatocytes and neutrophils, which comprise the main pathological components of GSDIb. Cells that differentiated into hepatocytes exhibited characteristic albumin secretion and indocyanine green uptake. Moreover, iPSC-derived cells generated from patients with GSDIb metabolic abnormalities recapitulated key pathological features of the diseases affecting the patients from whom they were derived, such as glycogen, lactate, pyruvate and lipid accumulation. Cells that were differentiated into neutrophils also showed the GSDIb pathology. In addition to the expression of neutrophil markers, we showed increased superoxide anion production, increased annexin V binding and activation of caspase-3 and caspase-9, consistent with the GSDIb patient's neutrophils. These results indicate valuable tools for the analysis of this pathology and the development of future treatments.
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Affiliation(s)
- Daisuke Satoh
- Department of Clinical Pharmacy, Graduate School of Pharmaceutical Sciences, Nagoya City University, 3-1 Tanabe-dori, Mizuho-ku, Nagoya, 467-8603, Japan
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Vinh DC, Behr MA. Crohn's as an immune deficiency: from apparent paradox to evolving paradigm. Expert Rev Clin Immunol 2013; 9:17-30. [PMID: 23256761 DOI: 10.1586/eci.12.87] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Crohn's disease is often considered an autoimmune condition, based on the observations of a histopathological inflammatory process in the absence of identifiable causal microorganism(s) and that immune-modulating therapeutics result in diminished host-directed inflammatory pathology. However, the evidence for a self-targeted immune response is unproven; thus, the instigating and perpetuating forces that drive this chronic inflammation remain unknown. In recent years, a convergence of findings from different fields of investigation has led to a new paradigm, where Crohn's disease appears to be the consequence of an intrinsic innate immune deficiency. While genomic/postgenomic studies and functional immunologic investigations offer a common perspective, critical details of the processes involved require further elaboration. In this review, we place this new model in the context of the emerging literature on non-HIV immune deficiencies, to compare and contrast what is known about proven intrinsic (primary) immune deficiencies to the nascent understanding of Crohn's disease. We then re-evaluate postgenomic research, looking at the functional importance of Crohn's disease-associated mutations and polymorphisms, to delineate points of consensus and issues requiring further study. We ask whether the immunologic profile can guide predictions as to which microbial triggers could exploit these defects and thereby initiate and/or perpetuate chronic enteritis. Finally, we outline potential clinical implications of this model, from immunologic assessment of patients to the selection of therapeutic interventions.
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Affiliation(s)
- Donald C Vinh
- Department of Medicine, McGill University Health Centre, Montreal, QC, H3G 1A4, Canada
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