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Delplanque M, Galicier L, Oziol E, Ducharme-Bénard S, Oksenhendler E, Buob D, Grateau G, Boutboul D, Georgin-Lavialle S. AA Amyloidosis Secondary to Primary Immune Deficiency: About 40 Cases Including 2 New French Cases and a Systematic Literature Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2021; 9:745-752.e1. [PMID: 33007500 DOI: 10.1016/j.jaip.2020.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Primary immune deficiencies (PIDs) are a heterogeneous group of disorders resulting from defects in immune system. They lead to increased susceptibility to infections and immune dysregulation. The resulting chronic inflammation can induce long-term complications, including AA amyloidosis (AAA). OBJECTIVES To present the French cases of PID-related AAA and perform a systematic literature review to determine its main features and predisposing factors. METHODS A systematic literature review was performed by searching MEDLINE up until 2019. New French cases were identified with the help of the Reference Center for Auto-Inflammatory Diseases and AA Amyloidosis and the Reference Center for Hereditary Immune Deficiencies. RESULTS Forty patients were identified including 2 new French cases. PIDs were varied: immunoglobulin deficits (n = 30), chronic granulomatous disease (n = 3), hyper-IgM syndrome (n = 3), hereditary complete C4 deficiency (n = 1), leucocyte adhesion deficiency type 1 (n = 1), hyper-IgE syndrome (n = 1), and Chediak-Higashi syndrome (n = 1). The mean age at PID diagnosis was 22.2 ± 16.02 years. Renal involvement was the most common manifestation of AAA (80%). Infections were extremely heterogeneous; bacterial infection with pulmonary involvement was the most frequent. Bronchiectasis was particularly common (52.5%). The delay between the first symptoms of PID and AAA diagnosis was 16.18 ± 7 years. Thirteen concomitant diagnoses were made. Twenty patients died during follow-up. CONCLUSION AAA is a rare life-threatening complication of PID, especially in cases of long diagnostic and therapeutic delays. Bronchiectasis should be considered as a warning sign of chronic inflammation and increased risk of AAA.
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Affiliation(s)
- Marion Delplanque
- Sorbonne Université, AP-HP, Hôpital Tenon, Service de médecine interne, Centre de référence des maladies auto-inflammatoires et des amyloses d'origine inflammatoire (CEREMAIA), GRC-28 (Groupe de recherche clinique amylose AA Sorbonne univeristé), Paris, France
| | - Lionel Galicier
- Service d'Immunopathologie Clinique, Hôpital Saint Louis, AP-HP, Paris, France
| | - Eric Oziol
- Service de Médecine Interne, Centre Hospitalier de Béziers, Béziers, France
| | | | - Eric Oksenhendler
- Service d'Immunopathologie Clinique, Hôpital Saint Louis, AP-HP, Paris, France
| | - David Buob
- Sorbonne Université, AP-HP, Hôpital Tenon, Service d'Anatomie et Cytologie pathologiques, Paris, France
| | - Gilles Grateau
- Sorbonne Université, AP-HP, Hôpital Tenon, Service de médecine interne, Centre de référence des maladies auto-inflammatoires et des amyloses d'origine inflammatoire (CEREMAIA), GRC-28 (Groupe de recherche clinique amylose AA Sorbonne univeristé), Paris, France
| | - David Boutboul
- Service d'Immunopathologie Clinique, Hôpital Saint Louis, AP-HP, Paris, France
| | - Sophie Georgin-Lavialle
- Sorbonne Université, AP-HP, Hôpital Tenon, Service de médecine interne, Centre de référence des maladies auto-inflammatoires et des amyloses d'origine inflammatoire (CEREMAIA), GRC-28 (Groupe de recherche clinique amylose AA Sorbonne univeristé), Paris, France.
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Shirazi TN, Snow J, Ham L, Raglan GB, Wiggs EA, Summers AC, Toro C, Introne WJ. The neuropsychological phenotype of Chediak-Higashi disease. Orphanet J Rare Dis 2019; 14:101. [PMID: 31060595 PMCID: PMC6503440 DOI: 10.1186/s13023-019-1049-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 03/19/2019] [Indexed: 01/23/2023] Open
Abstract
Background/objectives Chediak-Higashi Disease (CHD) is a rare autosomal disorder, purported to have cognitive and neurological impairments. Prior descriptions of cognitive impairment, however, are solely based on subjective, unstructured observations rather than on formal neuropsychological measures. Methods Four pediatric and 14 adult patients with diagnostically confirmed CHD were administered a neuropsychological battery assessing memory, attention, processing speed, psychomotor speed, language fluency, executive function, and general intelligence. Nine of the adult patients received follow-up evaluations to elucidate the longitudinal progression or stability of cognition over time. Results Pediatric CHD patients performed within the average range. Adult patients, however, performed below average on nearly all measures administered, and endorsed subjective reports of learning difficulties and poor academic performance in childhood. In particular, patients struggled with memory and psychomotor speed tasks, with 75% or more of patients scoring in the bottom 2.3 percentile in these two domains. No significant declines in cognition were observed among the patients who completed follow-up evaluations (M = 39.90, SD = 8.03 months between visits). Exploratory analyses suggested that adult patients who had classic CHD and previously received bone marrow transplants (BMTs; n = 3) exhibited moderately greater cognitive impairment than adult patients who had atypical CHD and had not received BMTs (n = 10). Conclusions Adult patients with CHD uniformly exhibit deficits in multiple domains, but in psychomotor speed and memory, in particular. Based on their neuropsychological profile, their ability to hold jobs and succeed in school may require support and special accommodations. The source of cognitive deficits is probably multifactorial including central nervous system involvement in CHD, and, for those transplanted, BMT-related side effects and complications. Absence of cognitive decline at three-year follow-up is encouraging but does not exclude progression at a slower time-scale. Future work should elucidate the possible effects and timing of BMT on cognition, as well as the mechanisms driving neuropsychological impairment in CHD.
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Affiliation(s)
- Talia N Shirazi
- National Institute of Mental Health, 10 Center Drive, MSC 1274, Bethesda, MD, 20892, USA
| | - Joseph Snow
- National Institute of Mental Health, 10 Center Drive, MSC 1274, Bethesda, MD, 20892, USA.
| | - Lillian Ham
- National Institute of Mental Health, 10 Center Drive, MSC 1274, Bethesda, MD, 20892, USA
| | - Greta B Raglan
- National Institute of Mental Health, 10 Center Drive, MSC 1274, Bethesda, MD, 20892, USA
| | - Edythe A Wiggs
- National Human Genome Research Institute, Bethesda, MD, USA
| | - Angela C Summers
- National Institute of Mental Health, 10 Center Drive, MSC 1274, Bethesda, MD, 20892, USA
| | - Camilo Toro
- National Human Genome Research Institute, Bethesda, MD, USA
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Weisfeld-Adams JD, Mehta L, Rucker JC, Dembitzer FR, Szporn A, Lublin FD, Introne WJ, Bhambhani V, Chicka MC, Cho C. Atypical Chédiak-Higashi syndrome with attenuated phenotype: three adult siblings homozygous for a novel LYST deletion and with neurodegenerative disease. Orphanet J Rare Dis 2013; 8:46. [PMID: 23521865 PMCID: PMC3610301 DOI: 10.1186/1750-1172-8-46] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 03/09/2013] [Indexed: 02/08/2023] Open
Abstract
Background Mutations in LYST, a gene encoding a putative lysosomal trafficking protein, cause Chédiak-Higashi syndrome (CHS), an autosomal recessive disorder typically characterized by infantile-onset hemophagocytic syndrome and immunodeficiency, and oculocutaneous albinism. A small number of reports of rare, attenuated forms of CHS exist, with affected individuals exhibiting progressive neurodegenerative disease beginning in early adulthood with cognitive decline, parkinsonism, features of spinocerebellar degeneration, and peripheral neuropathy, as well as subtle pigmentary abnormalities and subclinical or absent immune dysfunction. Methods In a consanguineous Pakistani kindred with clinical phenotypes consistent with attenuated CHS, we performed SNP array-based homozygosity mapping and whole gene sequencing of LYST. Results We identified three individuals homozygous for a novel six base pair in-frame deletion in LYST (c.9827_9832ATACAA), predicting the loss of asparagine and threonine residues from the LYST transcript (p.Asn3276_Thr3277del), and segregating with the phenotype in this family. Conclusions We further characterize the neurologic features of the attenuated form of CHS, and discuss pathophysiologic mechanisms underlying the neurodegenerative components of CHS. Attenuated CHS is phenotypically heterogenous and should be considered when young adults develop neurodegenerative disease and have pigmentary abnormalities. We briefly discuss surveillance and management of patients with CHS-related neurodegeneration.
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Affiliation(s)
- James D Weisfeld-Adams
- Department of Genetics & Genomic Sciences, Mount Sinai School of Medicine, New York, NY, USA.
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Silveira-Moriyama L, Moriyama TS, Gabbi TVB, Ranvaud R, Barbosa ER. Chediak-Higashi syndrome with parkinsonism. Mov Disord 2004; 19:472-5. [PMID: 15077248 DOI: 10.1002/mds.10677] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Chediak-Higashi syndrome (CHS), typically presents with partial albinism and severe hematological abnormalities. About 10% of the patients have a mild adult form associated with various neurological manifestations. We describe the case of a 24-year-old woman with parkinsonism that responded well to antiparkinsonian drugs.
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Delcourt-Debruyne EM, Boutigny HR, Hildebrand HF. Features of severe periodontal disease in a teenager with Chédiak-Higashi syndrome. J Periodontol 2000; 71:816-24. [PMID: 10872965 DOI: 10.1902/jop.2000.71.5.816] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Chédiak-Higashi syndrome (C-HS) is a rare congenital disease characterized by defective neutrophil function with abnormal lysosomal inclusions, neutropenia, and reduced chemotaxis. The complete syndrome includes oculocutaneous albinism with photophobia, neurologic features, recurrent infections, and enterocolitis. METHODS A 14-year-old male C-HS patient was referred to us because of serious periodontal destruction with acute inflamed gingiva and ulcers. Clinical and biological investigations were performed, leading to the diagnosis of C-HS. RESULTS Laboratory findings included neutropenia and hypergammaglobulinemia. Peripheral blood smears showed giant granules in neutrophils, eosinophils, and granulocytes. Bone marrow smears showed giant inclusions in leukocyte precursor cells. These granules and inclusions were characteristic of Chédiak-Higashi syndrome. Oral radiographic status showed extensive loss of alveolar bone leading, in most cases, to tooth exfoliation. Bacteria often associated with periodontitis were detected in subgingival plaque samples, including Fusobacterium nucleatum, Campylobacter rectus, Prevotella melaninogenica, Peptostreptococcus anaerobius, and Clostridium sp. Biopsies of periodontal tissues for light and electronic microscopic examinations revealed massive bacterial invasion of the epithelial tissue, epithelial cells, and connective tissue. Ultrastructural observations of periodontal polymorphonuclear leukocytes showed defective granulation, with abnormal granules not discharging their lysosomal content against engulfed bacteria. Viable dividing bacteria were found in the cytoplasm. CONCLUSIONS In this case, early-onset periodontitis seems to be the expression of C-HS granulocyte deficiency. Periodontal treatment of these patients is often unsuccessful. This case report illustrates the importance of the dentist in initiating clinical and biological investigations in such early aggressive periodontitis in young patients.
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Barbosa MDFS, Barrat FJ, Tchernev VT, Nguyen QA, Mishra VS, Colman SD, Pastural E, Dufourcq-Lagelouse R, Fischer A, Holcombe RF, Wallace MR, Brandt SJ, de Saint Basile G, Kingsmore SF. Identification of mutations in two major mRNA isoforms of the Chediak-Higashi syndrome gene in human and mouse. Hum Mol Genet 1997; 6:1091-8. [PMID: 9215680 PMCID: PMC2871070 DOI: 10.1093/hmg/6.7.1091] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Chediak-Higashi syndrome is an autosomal recessive, immune deficiency disorder of human (CHS) and mouse (beige, bg) that is characterized by abnormal intracellular protein transport to, and from, the lysosome. Recent reports have described the identification of homologous genes that are mutated in human CHS and bg mice. Here we report the sequences of two major mRNA isoforms of the CHS gene in human and mouse. These isoforms differ both in size and in sequence at the 3' end of their coding domains, with the smaller isoform (approximately 5.8 kb) arising from incomplete splicing and reading through an intron. These mRNAs also differ in tissue distribution of transcription and in predicted biological properties. Novel mutations were identified within the region of the coding domain common to both isoforms in three CHS patients: C-->T transitions that generated stop codons (R50X and Q1029X) were found in two patients, and a novel frameshift mutation (deletion of nucleotides 3073 and 3074 of the coding domain) was found in a third. Northern blots of lymphoblastoid mRNA from CHS patients revealed loss of the largest transcript (approximately 13.5 kb) in two of seven CHS patients, while the small mRNA was undiminished in abundance. These results suggest that the small isoform alone cannot complement Chediak-Higashi syndrome.
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Affiliation(s)
- Maria D. F. S. Barbosa
- Departments of Medicine, Pathology, Center for Mammalian Genetics, University of Florida, Gainesville, FL 32610-0221, USA
| | - Franck J. Barrat
- INSERM U 429, Hopital Necker-Enfants Malades, 75743 Paris, Cedex 15, France
| | - Velizar T. Tchernev
- Departments of Medicine, Pathology, Center for Mammalian Genetics, University of Florida, Gainesville, FL 32610-0221, USA
| | - Quan A. Nguyen
- Departments of Medicine, Pathology, Center for Mammalian Genetics, University of Florida, Gainesville, FL 32610-0221, USA
| | - Vishnu S. Mishra
- Departments of Medicine, Pathology, Center for Mammalian Genetics, University of Florida, Gainesville, FL 32610-0221, USA
| | - Steven D. Colman
- Department of Pediatrics, Center for Mammalian Genetics, University of Florida, Gainesville, FL 32610-0221, USA
| | - Elodie Pastural
- INSERM U 429, Hopital Necker-Enfants Malades, 75743 Paris, Cedex 15, France
| | | | - Alain Fischer
- INSERM U 429, Hopital Necker-Enfants Malades, 75743 Paris, Cedex 15, France
| | - Randall F. Holcombe
- Departments of Medicine, Microbiology and Immunology, Louisiana State University Medical Center, Shreveport, LA 33932, USA
| | - Margaret R. Wallace
- Department of Pediatrics, Center for Mammalian Genetics, University of Florida, Gainesville, FL 32610-0221, USA
| | - Stephen J. Brandt
- Departments of Medicine and Cell Biology, Vanderbilt University, Nashville, TN 37232, USA
| | | | - Stephen F. Kingsmore
- Departments of Medicine, Pathology, Center for Mammalian Genetics, University of Florida, Gainesville, FL 32610-0221, USA
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Uyama E, Hirano T, Ito K, Nakashima H, Sugimoto M, Naito M, Uchino M, Ando M. Adult Chédiak-Higashi syndrome presenting as parkinsonism and dementia. Acta Neurol Scand 1994; 89:175-83. [PMID: 8030398 DOI: 10.1111/j.1600-0404.1994.tb01657.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Chédiak-Higashi syndrome (CHS) in children can be a fatal disease. We describe the oldest known CHS patient first seen with a neurologic disorder in early adult life. From the age of 22, this 39-year-old woman developed mental deterioration, parkinsonism including resting tremor at the tongue, mandible, and hands, oculogyric crisis, muscular atrophy of limbs, and loss of tendon reflexes. MRI showed marked temporal dominant brain atrophy and diffuse spinal cord atrophy. Partial albinism, pan-leukocytic giant granules, and profoundly decreased NK-cell activity were compatible with childhood CHS, but apparently normal neutrophil function prolonged her survival. Stimulated proliferation of lymphocytes was less than 40% that of normal controls.
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Affiliation(s)
- E Uyama
- First Department of Internal Medicine, Kumamoto University School of Medicine, Japan
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Abstract
Chédiak-Higashi syndrome (CHS) is a rare autosomal recessive disorder postulated to result from lack of regulation of fusion of the primary lysosomes. In this report we present the MR and CT features of the brain in a patient with known CHS. These findings include diffuse atrophy of the brain with diffuse periventricular decreased density identified with CT, as well as increased signal on the T2-weighted images and lack of enhancement on the T1-weighted images in the periventricular and corona radiata regions.
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Affiliation(s)
- R Ballard
- Department of Radiology, Duke University Medical Center, Durham, NC 27710
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Uchino M, Uyama E, Hirano T, Nakamura T, Fukushima T, Ando M. A histochemical and electron microscopic study of skeletal muscle in an adult case of Chédiak-Higashi syndrome. Acta Neuropathol 1993; 86:521-4. [PMID: 8310803 DOI: 10.1007/bf00228590] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
To clarify the muscle pathology findings of a 39-year-old female Chédiak-Higashi syndrome (CHS) case with diffuse limb muscle atrophy, histochemical and electron microscopic studies were performed. In addition to neurogenic muscle atrophy due to the peripheral neuropathy, the most striking change seen by light microscopy was the widespread appearance of acid phosphatase-positive granules in many normal-looking muscle fibers. Coincident with the histochemical findings, electron microscopy showed many autophagic vacuoles containing glycogen particles and membranous structures in almost all muscle fibers. Although further studies are necessary, diffuse distribution of acid phosphatase-positive granules (autophagic vacuoles) in the skeletal muscle may reflect one of the generalized lysosomal abnormalities in CHS.
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Affiliation(s)
- M Uchino
- First Department of Internal Medicine, Kumamoto University Medical School, Japan
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