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Guevara-Hoyer K, Vasconcelos J, Marques L, Fernandes AA, Ochoa-Grullón J, Marinho A, Sequeira T, Gil C, Rodríguez de la Peña A, Serrano García I, Recio MJ, Fernández-Arquero M, Pérez de Diego R, Ramos JT, Neves E, Sánchez-Ramón S. Variable immunodeficiency study: Evaluation of two European cohorts within a variety of clinical phenotypes. Immunol Lett 2020; 223:78-88. [PMID: 32344018 DOI: 10.1016/j.imlet.2020.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/02/2020] [Accepted: 03/16/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Given the wide heterogeneity of common variable immunodeficiency (CVID), several groups have proposed clinical and immunological classifications to better define follow-up and prognostic algorithms. The present study aims to validate recent clinical and laboratory algorithms, based on different combinations of CVID biomarkers, to provide more personalized treatment and follow-up strategies. METHODS We analysed clinical and immunological features of 80 patients with suspected or diagnosed CVID, in two reference centres of Portugal and Spain. Clinical manifestations were categorized into clinical phenotyping proposed by Chapel et al. [1] that included cytopenia; polyclonal lymphocytic infiltration; unexplained enteropathy; and no disease-related complications. RESULTS 76% of patients in our cohort entered one of the four categories of clinical phenotyping, without overlap (cytopenia; polyclonal lymphocytic infiltration; unexplained enteropathy; and no disease-related complications). The most prominent phenotype was "cytopenia" (40%) followed by "polyclonal lymphocytic infiltration" (19%). The remaining 24% patients of our cohort had overlap of 2 clinical phenotypes (cytopenia and unexplained enteropathy mainly). A delay of CVID diagnosis in more than 6 years presented 3.7-fold higher risk of developing lymphoproliferation and/or malignancy (p < 0.05), and was associated with increased CD8+CD45RO + T-lymphocytes (p < 0.05). An association between decreased switched-memory B cells with lymphoproliferation and malignancy was observed (p < 0.03 and p < 0.05, respectively). CD4 + T-lymphocytopenia correlated with autoimmune phenotype, with 30% prevalence (p < 0.05). HLA-DR7 expression was related to CVID onset in early life in our patients (13 vs 25 years), and DQ2.5 or DQ2.2 with unexplained enteropathy (p < 0.05). CONCLUSIONS The phenotypic and genetic study is crucial for an adequate clinical orientation of CVID patients. In these two independent cohorts of patients, classification based in clinical and laboratory algorithms, provides more personalized treatment and follow-up strategies.
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Affiliation(s)
- Kissy Guevara-Hoyer
- Department of Immunology, IML and IdSSC, Hospital Clínico San Carlos, Madrid, Spain; Department of Immunology, Ophthalmology and ENT, School of Medicine, Complutense University, Madrid, Spain; Immunodeficiency Interdepartmental Group (GIID), Madrid, Spain
| | - Julia Vasconcelos
- Department of Immunology, Centro Hospitalar e Universitário Do Porto, Porto, Portugal
| | - Laura Marques
- Department of Pediatrics, Centro Hospitalar e Universitário Do Porto, Porto, Portugal
| | | | - Juliana Ochoa-Grullón
- Department of Immunology, IML and IdSSC, Hospital Clínico San Carlos, Madrid, Spain; Department of Immunology, Ophthalmology and ENT, School of Medicine, Complutense University, Madrid, Spain; Immunodeficiency Interdepartmental Group (GIID), Madrid, Spain
| | - Antonio Marinho
- Clinical Immunology Unit, Centro Hospitalar e Universitário Do Porto, Porto, Portugal
| | - Teresa Sequeira
- Clinical Immunology Unit, Centro Hospitalar e Universitário Do Porto, Porto, Portugal
| | - Celia Gil
- Department of Pediatrics, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Irene Serrano García
- Department of Epidemiology and Preventive Medicine, Hospital Clínico San Carlos, Madrid, Spain
| | - M José Recio
- Department of Immunology, Ophthalmology and ENT, School of Medicine, Complutense University, Madrid, Spain; Immunodeficiency Interdepartmental Group (GIID), Madrid, Spain
| | - Miguel Fernández-Arquero
- Department of Immunology, IML and IdSSC, Hospital Clínico San Carlos, Madrid, Spain; Department of Immunology, Ophthalmology and ENT, School of Medicine, Complutense University, Madrid, Spain; Immunodeficiency Interdepartmental Group (GIID), Madrid, Spain
| | - Rebeca Pérez de Diego
- Immunodeficiency Interdepartmental Group (GIID), Madrid, Spain; Laboratory of Immunogenetics of Human Diseases, IdiPAZ Institute for Health Research, Madrid, Spain
| | - José Tomas Ramos
- Department of Pediatrics, Hospital Clínico San Carlos, Madrid, Spain
| | - Esmeralda Neves
- Department of Immunology, Centro Hospitalar e Universitário Do Porto, Porto, Portugal
| | - Silvia Sánchez-Ramón
- Department of Immunology, IML and IdSSC, Hospital Clínico San Carlos, Madrid, Spain; Department of Immunology, Ophthalmology and ENT, School of Medicine, Complutense University, Madrid, Spain; Immunodeficiency Interdepartmental Group (GIID), Madrid, Spain.
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Agarwal S, Cunningham-Rundles C. Autoimmunity in common variable immunodeficiency. Ann Allergy Asthma Immunol 2019; 123:454-460. [PMID: 31349011 DOI: 10.1016/j.anai.2019.07.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Common variable immunodeficiency (CVID) is a primary immunodeficiency that is clinically heterogeneous, characterized by both infectious and noninfectious complications. Although the hallmark of disease presentation is commonly a history of recurrent sinopulmonary infections, autoimmunity and noninfectious inflammatory conditions are increasingly associated with CVID. DATA SOURCES A comprehensive literature search using PubMed of basic science and clinical articles was performed. STUDY SELECTIONS Articles discussing the association of autoimmunity with primary immunodeficiency, specifically CVID, were selected. RESULTS The most common autoimmune conditions are cytopenias, including immune thrombocytopenia purpura and hemolytic anemia, but organ-specific autoimmune/inflammatory complications involving the gastrointestinal, skin, joints, connective tissue, and respiratory tract. In most cases, immunoglobulin replacement therapy does not ameliorate or treat these inflammatory complications, and additional immunomodulatory treatments are needed. CONCLUSION Mechanisms producing these conditions are poorly understood but include cytokine and cellular inflammatory pathways, and loss of tolerance to self-antigens through the multiple signaling molecules and pathways common to tolerance and immune deficiency.
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Affiliation(s)
- Shradha Agarwal
- Icahn School of Medicine at Mount Sinai, Division of Allergy and Clinical Immunology, Department of Medicine, New York, New York.
| | - Charlotte Cunningham-Rundles
- Icahn School of Medicine at Mount Sinai, Division of Allergy and Clinical Immunology, Department of Medicine, New York, New York
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Doll R, Johnson J, Tcheurekdjian H, Hostoffer R. Common variable immune deficiency associated with pemphigoid. Ann Allergy Asthma Immunol 2016; 118:122. [PMID: 27865716 DOI: 10.1016/j.anai.2016.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/20/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Rayna Doll
- Verde Valley Medical Center, Cottonwood, Arizona.
| | - John Johnson
- Conjoint Allergy/Immunology Fellowship, University Hospitals Regional Medical Centers, Cleveland, Ohio
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