Cartilage-hair hypoplasia: Effect of thymus transplants

[Cartilage-hair hypoplasia]

Cartilage-hair hypoplasia is a rare, autosomal recessive primary immunodeficiency disorder characterized by predominantly T-cell deficiency and metaphyseal chondrodysplasia. The authors summarize current knowledge on molecular genetics, diagnostic characteristics and therapeutic options of this inherited immunodeficiency.

Cartilage-hair hypoplasia--clinical manifestations in 108 Finnish patients

Cartilage-hair hypoplasia is an autosomal recessive metaphyseal chondrodysplasia with short-limbed short stature, hypoplastic hair, and defective immunity and erythrogenesis. We have analysed the clinical outcome of 108 Finnish patients. Birth length was below -2.0 SD in 70% of the patients; the adult heights ranged from -11.4 SD to -5.2 SD. The sitting height percentage was increased in all but 4 patients. Six patients had normal hair. Increased ligamentous laxity was present in 95%, limited extension of the elbows in 92%, increased lumbar lordosis in 85%, thoracal deformity in 68%, genu varum in 63% and scoliosis in 21% of the patients. Defective cellular immunity had been observed in 88% and increased susceptibility to infections in 56% of the patients. Six patients had died of primary infections. The incidence of malignancies was 6%. Childhood anaemia had occurred in 79% of the patients. It was usually mild, but severe in 14 patients. Hirschsprung disease had been observed in 8, anal stenosis in 1 and oesophageal atresia in 1 patient. The intrafamilial variation of the syndrome was considerable as studied in 16 sibships.

Cartilage hair hypoplasia, metaphyseal chondrodysplasia type McKusick: description of seven patients and review of the literature

We describe 7 cases of cartilage hair hypoplasia (CHH) with emphasis on the clinical and immunological aspects. The literature on CHH is reviewed and symptoms in 63 non-Amish cases are summarized. In this autosomal recessive disorder the immunodeficiency, hair abnormalities, and severity of skeletal involvement show extremely variable expressivity, between and within families. Two of the 3 sib-pairs among our cases demonstrate the great difference in expression within one family. At adult age roentgenological abnormalities can be very mild, or even absent. An impairment in cell-mediated immunity is present in all of our cases and seems a consistent manifestation in CHH; however, sometimes it is very subtle and without clinical symptoms.

Infectious complications of the primary immunodeficiencies

The primary manifestation of the immunodeficiencies is undue susceptibility to infection. This means too many, too severe, too prolonged, too complicated and too unusual infections. Infections in immunodeficiency have a characteristic cause depending on the nature of the immune deficiency. Antibody deficiencies are associated with infections with gram-positive infections. Cellular immune deficiencies are associated with mycobacterial, protozoan, fungus, virus, and opportunistic bacterial infection. Phagocytic disorders are associated with staphylococcal, fungal, and gram-negative organisms. Complement disorders are associated by neisserial infections. Infections have also been implicated in the pathogenesis of some immunodeficiencies in some circumstances. These include human T lymphotropic virus type III (HTLV-III), rubella virus, cytomegalovirus, and Epstein-Barr virus. Several infectious syndromes in specific immunodeficiencies have been identified. Examples include enteric cytopathic human orphan (ECHO) virus encephalitis in agammaglobulinemia, and meningococcal meningitis in C6 deficiency. Infections can also be induced by live vaccines given in immunodeficiency (e.g., paralytic polio in agammaglobulinemia.) Unusual infectious syndromes will be illustrated including parainfluenza infection in severe combined and immunodeficiency, Legionella pneumonia in chronic granulomatous disease, and Cryptosporidium infection in hyper-IgM immunodeficiency.

Family studies of immunoglobulin levels in Iraq

The extent of the contribution of genetic and environmental factors to the variation in levels of serum immunoglobulin G, A, M and E was studied among families of Arabs and Kurds of Iraq. Heritability (h2) values were calculated from offspring-parent, offspring-mid-parent and sib-sib comparisons and were all positive and moderate. All values were significant for all four immunoglobulins, being generally lower in Arabs than in Kurds. The h2 estimate based on offspring-parent and offspring-mid-parent were generally lower than those based on sib-sib comparisons, suggesting that these values were inflated by the common environment of full sibs. Genetic correlations between IgG--IgE and IgG--IgA were relatively high, reflecting a common regulation in the level of these immunoglobulins. IgM showed low genetic correlation with other immunoglobulins. All environment correlations were positive, and rather higher in the Kurds than the Arabs, indicating that environmental factors influence the level of all four classes of immunoglobulins.

Combined immunodeficiency and vaccine-related poliomyelitis in a child with cartilage-hair hypoplasia

Patients previously described with cartilage-hair hypoplasia, a distinctive form of short-limbed dwarfism, have been found to have deficient cell-mediated immunity with intact antibody-mediated immunity. The patient with cartilage-hair hypoplasia described in the present report is unusual in that she had both deficient antibody-mediated immunity and deficient cell-mediated immunity. In addition, she developed severe, vaccine-related paralytic poliomyelitis. This complication suggests that live viral vaccines should not be administered to children with short-limbed dwarfism until the form of short-limbed dwarfism is established and immunologic evaluation is performed when indicated.

Small intestinal disease in T cell deficiency

Biopsies of the proximal small bowel were obtained in four children with impairment of cell-mediated immunity, chronic diarrhia, and malabsorption; one child had an isolated T cell defect and three had significant B and T cell defects. All of them had malabsorption and, in addition to alterations of the small bowel epithelium, large vacuolated macrophages were seen in the lamina propria in all biopsies. Electron microscopy demonstrated lipid and patches of small pleomorphic inclusions within the macrophages. Since large vacuolated macrophages have also been described in Whipple's disease and chronic granulomatous disease, we suggest the possibility of a common thread of defective host defense and gastrointestinal malfunction in these three conditions.