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França TT, Barreiros LA, Salgado RC, Napoleão SMDS, Gomes LN, Ferreira JFS, Prando C, Weber CW, Di Gesu RSW, Montenegro C, Aranda CS, Kuntze G, Staines-Boone AT, Venegas-Montoya E, Becerra JCA, Bezrodnik L, Di Giovanni D, Moreira I, Seminario GA, Raccio ACG, Dorna MDB, Rosário-Filho NA, Chong-Neto HJ, de Carvalho E, Grotta MB, Orellana JC, Dominguez MG, Porras O, Sasia L, Salvucci K, Garip E, Leite LFB, Forte WCN, Pinto-Mariz F, Goudouris E, Nuñez MEN, Schelotto M, Ruiz LB, Liberatore DI, Ochs HD, Cabral-Marques O, Condino-Neto A. CD40 Ligand Deficiency in Latin America: Clinical, Immunological, and Genetic Characteristics. J Clin Immunol 2022; 42:514-526. [PMID: 34982304 DOI: 10.1007/s10875-021-01182-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/16/2021] [Indexed: 12/14/2022]
Abstract
CD40 ligand (CD40L) deficiency is a rare inborn error of immunity presenting with heterogeneous clinical manifestations. While a detailed characterization of patients affected by CD40L deficiency is essential to an accurate diagnosis and management, information about this disorder in Latin American patients is limited. We retrospectively analyzed data from 50 patients collected by the Latin American Society for Immunodeficiencies registry or provided by affiliated physicians to characterize the clinical, laboratory, and molecular features of Latin American patients with CD40L deficiency. The median age at disease onset and diagnosis was 7 months and 17 months, respectively, with a median diagnosis delay of 1 year. Forty-seven patients were genetically characterized revealing 6 novel mutations in the CD40LG gene. Pneumonia was the most common first symptom reported (66%). Initial immunoglobulin levels were variable among patients. Pneumonia (86%), upper respiratory tract infections (70%), neutropenia (70%), and gastrointestinal manifestations (60%) were the most prevalent clinical symptoms throughout life. Thirty-five infectious agents were reported, five of which were not previously described in CD40L deficient patients, representing the largest number of pathogens reported to date in a cohort of CD40L deficient patients. The characterization of the largest cohort of Latin American patients with CD40L deficiency adds novel insights to the recognition of this disorder, helping to fulfill unmet needs and gaps in the diagnosis and management of patients with CD40L deficiency.
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Affiliation(s)
- Tábata Takahashi França
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.
| | - Lucila Akune Barreiros
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Ranieri Coelho Salgado
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | | | - Lillian Nunes Gomes
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | | | - Carolina Prando
- Hospital Pequeno Príncipe, Curitiba, Brazil.,Faculdades Pequeno Príncipe, Curitiba, Brazil.,Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Brazil
| | | | | | | | - Carolina Sanchez Aranda
- Serviço de Alergia e Imunologia, Departamento de Pediatria, Universidade Federal de São Paulo, São Paulo, Brazil.,Jeffrey Modell Center São Paulo, São Paulo, Brazil
| | | | - Aidé Tamara Staines-Boone
- Immunology Service, Hospital de Especialidades Unidad Médica de Alta Especialidad (UMAE, Instituto Mexicano del Seguro Social (IMSS), Monterrey, México
| | - Edna Venegas-Montoya
- Immunology Service, Hospital de Especialidades Unidad Médica de Alta Especialidad (UMAE, Instituto Mexicano del Seguro Social (IMSS), Monterrey, México
| | | | - Liliana Bezrodnik
- Grupo de Imunologia, Hospital de Niños Ricardo Gutierrez, Buenos Aires, Argentina
| | - Daniela Di Giovanni
- Grupo de Imunologia, Hospital de Niños Ricardo Gutierrez, Buenos Aires, Argentina
| | - Ileana Moreira
- Grupo de Imunologia, Hospital de Niños Ricardo Gutierrez, Buenos Aires, Argentina
| | | | | | - Mayra de Barros Dorna
- Divisão de Alergia e Imunologia, Departamento de Pediatria, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Elisa de Carvalho
- Gastroenterology and Hepatology Clínic, Brasilia Childrens Hospital, Brasília, Brazil
| | | | - Julio Cesar Orellana
- Division Alergia e Imunologia Clinica, Hospital de Niños de La Santísima Trinidad, Córdoba, Argentina
| | | | - Oscar Porras
- Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, San José, Costa Rica
| | - Laura Sasia
- Hospital Infantil Municipal de Córdoba, Córdoba, Argentina
| | | | - Emilio Garip
- Hospital Infantil Municipal de Córdoba, Córdoba, Argentina
| | - Luiz Fernando Bacarini Leite
- Department of Pediatrics, Immunodeficiency Sector, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | | | - Fernanda Pinto-Mariz
- Department of Pediatrics, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ekaterini Goudouris
- Department of Pediatrics, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - María Enriqueta Nuñez Nuñez
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Hospital Civil de Guadalajara Dr. Juan I. Menchaca, Guadalajara, México
| | | | - Laura Berrón Ruiz
- Unidad de Investigación en Inmunodeficiencias, Instituto Nacional de Pediatría, Ciudad del México, México
| | | | - Hans D Ochs
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, WA, USA
| | - Otavio Cabral-Marques
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.,Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil.,Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), São Paulo, Brazil
| | - Antonio Condino-Neto
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil. .,Jeffrey Modell Center São Paulo, São Paulo, Brazil.
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