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Janssen LMA, Reijnen ICGM, Milito C, Edgar D, Chapel H, de Vries E. Protocol for the unclassified primary antibody deficiency (unPAD) study: Characterization and classification of patients using the ESID online Registry. PLoS One 2022; 17:e0266083. [PMID: 35333892 PMCID: PMC9045688 DOI: 10.1371/journal.pone.0266083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background Primary antibody deficiencies (PADs) without an identified monogenetic origin
form the largest and most heterogeneous group of primary immunodeficiencies.
These patients often remain undiagnosed for years and many present to
medical attention in adulthood after several infections risking structural
complications. Not much is known about their treatment, comorbidities, or
prognosis, nor whether the various immunological forms (decreased total IgG,
IgG subclass(es), IgM, IgA, specific antibody responses, alone or in
combination(s)) should be considered as separate, clearly definable
subgroups. The unclassified primary antibody deficiency (unPAD) study aims
to describe in detail all PAD patients without an
identified specific monogenetic defect regarding their demographical,
clinical, and immunological characteristics at presentation and during
follow-up. In constructing these patterns, the unPAD study aims to reduce
the number of missed and unidentified PAD patients in the future. In
addition, this study will focus on subclassifying unPAD to support the
identification of patients at higher risk for infection or immune
dysregulation related complications, enabling the development of
personalized follow-up and treatment plans. Methods and analysis We present a protocol for a multicenter observational cohort study using the
ESID online Registry. Patients of all ages who have given informed consent
for participation in the ESID online Registry and fulfill the ESID Clinical
Working Definitions for ‘unclassified antibody deficiency’, ‘deficiency of
specific IgG’, ‘IgA with IgG subclass deficiency’, ‘isolated IgG subclass
deficiency’, ‘selective IgM deficiency’, ‘selective IgA deficiency’ or
‘common variable immunodeficiency’ will be included. For all patients, basic
characteristics can be registered at first registration and yearly
thereafter in level 1 forms. Detailed characteristics of the patients can be
registered in level 2 forms. Consecutive follow-up forms can be added
indefinitely. To ensure the quality of the collected data, all data will be
fully monitored before they are exported from the ESID online Registry for
analysis. Outcomes will be the clinical and immunological characteristics of
unPAD at presentation and during follow-up. Subgroup analyses will be made
based on demographical, clinical and immunological characteristics.
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Affiliation(s)
- Lisanne M. A. Janssen
- Department of Tranzo, TSB, Tilburg University, Tilburg, the
Netherlands
- Department of Pediatrics, Amalia Children’s hospital, Nijmegen, the
Netherlands
| | | | - Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome, Rome,
Italy
| | - David Edgar
- Department of Immunology, St James’s Hospital, Dublin & (ii) Trinity
College, Dublun, Ireland
| | - Helen Chapel
- Primary Immunodeficiency Unit, Nuffield Department of Medicine,
University of Oxford, Oxford, United Kingdom
| | - Esther de Vries
- Department of Tranzo, TSB, Tilburg University, Tilburg, the
Netherlands
- Laboratory of Medical Microbiology and Immunology, Elisabeth-Tweesteden
Hospital, Tilburg, the Netherlands
- * E-mail:
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Bogaert DJA, De Bruyne M, Debacker V, Depuydt P, De Preter K, Bonroy C, Philippé J, Bordon V, Lambrecht BN, Kerre T, Cerutti A, Vermaelen KY, Haerynck F, Dullaers M. The immunophenotypic fingerprint of patients with primary antibody deficiencies is partially present in their asymptomatic first-degree relatives. Haematologica 2016; 102:192-202. [PMID: 27634199 DOI: 10.3324/haematol.2016.149112] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/08/2016] [Indexed: 11/09/2022] Open
Abstract
The etiology of primary antibody deficiencies is largely unknown. Beside rare monogenic forms, the majority of cases seem to have a more complex genetic basis. Whereas common variable immunodeficiency has been investigated in depth, there are only a few reports on milder primary antibody deficiencies such as idiopathic primary hypogammaglobulinemia and IgG subclass deficiency. We performed flow cytometric immunophenotyping in 33 patients with common variable immunodeficiency, 23 with idiopathic primary hypogammaglobulinemia and 21 with IgG subclass deficiency, as well as in 47 asymptomatic first-degree family members of patients and 101 unrelated healthy controls. All three groups of patients showed decreased memory B- and naïve T-cell subsets and decreased B-cell activating factor receptor expression. In contrast, circulating follicular helper T-cell frequency and expression of inducible T-cell co-stimulator and chemokine receptors were only significantly altered in patients with common variable immunodeficiency. Asymptomatic first-degree family members of patients demonstrated similar, albeit intermediate, alterations in naïve and memory B- and T-cell subsets. About 13% of asymptomatic relatives had an abnormal peripheral B-cell composition. Furthermore, asymptomatic relatives showed decreased levels of CD4+ recent thymic emigrants and increased central memory T cells. Serum IgG and IgM levels were also significantly lower in asymptomatic relatives than in healthy controls. We conclude that, in our cohort, the immunophenotypic landscape of primary antibody deficiencies comprises a spectrum, in which some alterations are shared between all primary antibody deficiencies whereas others are only associated with common variable immunodeficiency. Importantly, asymptomatic first-degree family members of patients were found to have an intermediate phenotype for peripheral B- and T-cell subsets.
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Affiliation(s)
- Delfien J A Bogaert
- Clinical Immunology Research Laboratory, Department of Pulmonary Medicine, Ghent University Hospital, Belgium.,Department of Pediatric Immunology and Pulmonology, Centre for Primary Immunodeficiency, Jeffrey Modell Diagnosis and Research Centre, Ghent University Hospital, Belgium.,Center for Medical Genetics, Ghent University and Ghent University Hospital, Belgium.,Laboratory of Immunoregulation, VIB Inflammation Research Center, Ghent, Belgium
| | - Marieke De Bruyne
- Clinical Immunology Research Laboratory, Department of Pulmonary Medicine, Ghent University Hospital, Belgium.,Center for Medical Genetics, Ghent University and Ghent University Hospital, Belgium
| | - Veronique Debacker
- Clinical Immunology Research Laboratory, Department of Pulmonary Medicine, Ghent University Hospital, Belgium.,Tumor Immunology Laboratory, Department of Pulmonary Medicine, Ghent University Hospital, Belgium
| | - Pauline Depuydt
- Center for Medical Genetics, Ghent University and Ghent University Hospital, Belgium.,Cancer Research Institute, Ghent University, Belgium
| | - Katleen De Preter
- Center for Medical Genetics, Ghent University and Ghent University Hospital, Belgium.,Cancer Research Institute, Ghent University, Belgium
| | - Carolien Bonroy
- Department of Laboratory Medicine, Ghent University Hospital, Belgium
| | - Jan Philippé
- Department of Laboratory Medicine, Ghent University Hospital, Belgium.,Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Belgium
| | - Victoria Bordon
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Ghent University Hospital, Belgium
| | - Bart N Lambrecht
- Laboratory of Immunoregulation, VIB Inflammation Research Center, Ghent, Belgium.,Department of Internal Medicine, Ghent University, Belgium.,Department of Pulmonology, Ghent University Hospital, Belgium
| | - Tessa Kerre
- Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Belgium.,Department of Internal Medicine, Ghent University, Belgium.,Department of Hematology, Ghent University Hospital, Belgium
| | - Andrea Cerutti
- Department of Medicine, The Immunology Institute, Mount Sinai School of Medicine, New York, NY, USA and.,B Cell Biology Laboratory, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Karim Y Vermaelen
- Tumor Immunology Laboratory, Department of Pulmonary Medicine, Ghent University Hospital, Belgium.,Department of Internal Medicine, Ghent University, Belgium.,Department of Pulmonology, Ghent University Hospital, Belgium
| | - Filomeen Haerynck
- Clinical Immunology Research Laboratory, Department of Pulmonary Medicine, Ghent University Hospital, Belgium.,Department of Pediatric Immunology and Pulmonology, Centre for Primary Immunodeficiency, Jeffrey Modell Diagnosis and Research Centre, Ghent University Hospital, Belgium
| | - Melissa Dullaers
- Clinical Immunology Research Laboratory, Department of Pulmonary Medicine, Ghent University Hospital, Belgium .,Laboratory of Immunoregulation, VIB Inflammation Research Center, Ghent, Belgium.,Department of Internal Medicine, Ghent University, Belgium
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Piquer Gibert M, Alsina L, Giner Muñoz MT, Cruz Martínez O, Ruiz Echevarria K, Dominguez O, Plaza Martín AM, Arostegui JI, de Valles G, Juan Otero M, Martin-Mateos MA. Non-Hodgkin lymphoma in pediatric patients with common variable immunodeficiency. Eur J Pediatr 2015; 174:1069-76. [PMID: 25749928 DOI: 10.1007/s00431-015-2508-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 02/04/2015] [Accepted: 02/13/2015] [Indexed: 12/14/2022]
Abstract
UNLABELLED Common variable immunodeficiency (CVID) is a heterogeneous primary immunodeficiency associated with an increased risk of malignancy in adulthood, with lymphoma as one of the major causes of death. The aim of this study is to describe those malignancies detected in our cohort of pediatric CVID patients. We reviewed the clinical and laboratory data and the treatments and their outcomes in all pediatric CVID patients from our institution that developed a neoplasia. Four malignancies were diagnosed in three out of 27 pediatric CVID patients. Three malignancies were non-Hodgkin lymphoma (NHL) of B cell origin (mean age at diagnosis: 8 years old), and the remaining was a low-grade astrocytoma. Among NHL, two were mucosa-associated lymphoid tissue (MALT) lymphomas and one was associated with Epstein-Barr virus infection. NHL developed before CVID diagnosis in two patients. CVID patients showed different clinical phenotypes and belonged to different groups according Euroclass and Pediatric classification criteria. CONCLUSIONS Malignancies, especially lymphoma, may develop in pediatric CVID patients with no previous signs of lymphoid hyperplasia and even before CVID diagnosis. Consequently, strategies for cancer prevention and/or early diagnosis are required in pediatric CVID patients.
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Affiliation(s)
- Monica Piquer Gibert
- Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu-Universitat de Barcelona, Passeig Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain,
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Almejún MB, Sajaroff E, Galicchio M, Oleastro M, Bernasconi A, Zelazko M, Danielian S. Immunological characteristics and two novel mutations in TACI in a cohort of 28 pediatric patients with common variable immunodeficiency. J Clin Immunol 2011; 32:89-97. [PMID: 22076597 DOI: 10.1007/s10875-011-9613-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 10/25/2011] [Indexed: 11/28/2022]
Abstract
Common variable immunodeficiency (CVID) is a heterogeneous syndrome characterized by impaired immunoglobulin production. Mutations in the gene encoding TACI (TNFRSF13B) were previously found to be associated with CVID. Previous studies have identified a variety of sequence variants in TACI where A181E and C104R were the most common, with variable frequencies in different ethnic populations. So far, no mutations were identified in the recently reported "TACI highly conserved" (THC) cytoplasmic domain, important for the induction of class switch recombination. Our study evaluated immunological and clinical data on a cohort of 28 Argentinean pediatric CVID patients and allowed the identification of two novel mutations in TNFRSF13B, including one, S231R, affecting the highly conserved THC domain. In contrast, none of the patients presented with A181E and C104R mutations.
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Affiliation(s)
- María B Almejún
- Servicio de Immunología y Reumatología, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
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