1
|
Malik S, Jeanpierre L, Cianferoni A, Ruffner M, Sullivan KE. A patient with Pitt-Hopkins syndrome with concomitant common variable immunodeficiency. Am J Med Genet A 2024; 194:e63490. [PMID: 38066705 DOI: 10.1002/ajmg.a.63490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 03/10/2024]
Abstract
In patients with 18q deletion syndrome (18q-), immunodeficiency, autoimmunity, and allergies have been described in a subset. Pitt-Hopkins syndrome represents a specific subset of patients with 18q- who have a proximal deletion involving the TCF4 gene or a TCF4 variant. Immunodeficiency has been reported in the overall 18q- population; however, immunodeficiency with Pitt-Hopkins syndrome has not been highlighted. This case report details the immunologic evaluations and the associated infections seen in a young adult with Pitt-Hopkins syndrome to underscore the challenges of managing adults with a complex phenotype who develop frequent infections. This patient with Pitt-Hopkins syndrome ultimately fulfilled the diagnostic criteria for common variable immunodeficiency. Immunoglobulin replacement has led to a somewhat improved infection pattern, although she continues to have aspiration events leading to pneumonia. This case highlights the clinical evolution of Pitt-Hopkins syndrome and serves as a reminder that immunodeficiency can occur in this syndrome.
Collapse
Affiliation(s)
- Shahzara Malik
- College of Medicine and Health Sciences, Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai, United Arab Emirates
| | - Latoya Jeanpierre
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Melanie Ruffner
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | |
Collapse
|
2
|
Bai X, Zheng L, Ma S, Kan X. Prenatal diagnosis of chromosome 18 long arm deletion syndrome by high-throughput sequencing: Two case reports. Medicine (Baltimore) 2021; 100:e28143. [PMID: 34918667 PMCID: PMC8677896 DOI: 10.1097/md.0000000000028143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/17/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Chromosome 18 long arm deletion syndrome is a group of clinical syndromes caused by partial or total genetic material deletion of the long arm of chromosome 18 (18q), whose clinical manifestations are related to presentation and developmental abnormalities in various aspects such as intelligence, face, and movement. Prenatal diagnosis of this syndrome is challenging because of its low incidence and uncharacteristic prenatal clinical performance. In this paper, 2 cases of partial deletion of 18q found in prenatal amniotic fluid examination by high-throughput sequencing were reported and analyzed. PATIENT CONCERNS In patient 1, non-invasive prenatal gene detection at 21 + 2 weeks of gestation suggests a risk of trisomy 18. In patient 2, ultrasound examination at 21 + 2 weeks of gestation revealed a single live fetus, but it was difficult to pinpoint whether the fetus had only 1 umbilical artery to supply blood. DIAGNOSIS AND INTERVENTION The 18q deletion syndrome was diagnosed by chromosome karyotype analysis and high-throughput sequencing. OUTCOMES The pregnancies were terminated due to the abnormal chromosome. LESSON This report adds novel variants to the genetic profile of 18q deletion, in order to enrich the genetic data of long arm deletion of 18 chromosomes and provide better services for pre-screening, diagnosis, and genetic counseling for this disease.
Collapse
|
3
|
Hogendorf A, Zieliński M, Constantinou M, Śmigiel R, Wierzba J, Wyka K, Wędrychowicz A, Jakubiuk-Tomaszuk A, Budzynska E, Piotrowicz M, Lipska-Ziętkiewicz BS, Kaczorowska E, Cieślikowska A, Kutkowska-Kaźmierczak A, Fijak-Moskal J, Kugaudo M, Kosińska-Urbańska M, Szadkowska A, Borowiec M, Niedźwiecki M, Trzonkowski P, Młynarski W. Immune Dysregulation in Patients With Chromosome 18q Deletions-Searching for Putative Loci for Autoimmunity and Immunodeficiency. Front Immunol 2021; 12:742834. [PMID: 34867966 PMCID: PMC8637865 DOI: 10.3389/fimmu.2021.742834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/22/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Autoimmune disorders, IgA deficiency, and allergies seem to be common among individuals with 18q deletion syndrome [OMIM 601808]. We aimed to determine the prevalence, mechanism, and genetic background of autoimmunity, immune deficiency, and allergy in a cohort of patients with 18q deletions. Material and Methods Medical registries and social media were used to recruit the patients. Microarray oligonucleotide comparative genomic hybridization (aCGH) (Agilent, Santa Clara, CA, USA) was performed in all patients to identify size and location of chromosome 18 deletion. Clinical evaluation and medical record collection were performed in each of the study participants. The history of autoimmune disorders, severe and/or recurrent infections, and symptoms of allergy were noted. Total immunoglobulin IgG, IgA, IgM, IgE, and IgG1-4 serum levels were measured using nephelometry and ELISA methods. Lymphocyte T subset phenotyping was performed in 24 subjects from 18q del cohort. To predict the most promising candidate genes, we used the ENDEAVOUR-a free web resource for gene prioritization. Results 18q deletion was confirmed by means of array CGH analysis in 27 individuals, 15 (55.6%) females and 12 males, referred to the project by specialists in medical genetics, diabetology, or pediatric endocrinology between May 2015 and December 2019. The mean age at examination was 11.8 years (min-max: 4.0-33.5). Autoimmune disorders were present in 14/27 (51.8%) of the cohort. In eight of patients, symptoms of immune deficiency coexisted with autoimmunity. Allergy was reported in nine of 27 (33.4%) patients. Over 89% of patients presented with at list one type of immunoglobulin (IgA, IgM, IgG, IgE, and IgG1-4) deficiency and eight of 25 (32%) had abnormalities in at least two major immunoglobulin (IgG, IgA, IgM) measurements (CVID-like phenotype). Patients with 18q del exhibited a significantly decreased CD4, Treg FOXP3+, TregFOXP3+Helios+, and TemCD4 cell numbers in comparison with the control groups of 24 T1DM patients and 28 healthy controls. Conclusions Patients with 18q deletions frequently suffer from autoimmune disorders, recurrent infections, and allergy due to immune dysregulation presenting with variable antibody deficiencies and T-regulatory cell deficiency (CD4+CD25+CD127lowFOXP3+). The spectrum of speculations regarding which gene might be responsible for such phenotype ranges from single gene haploinsufficiency to deletion of a cluster of immunogenes located distally to 18q21.
Collapse
Affiliation(s)
- Anna Hogendorf
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland
| | - Maciej Zieliński
- Department of Medical Immunology, Medical University of Gdansk, Gdansk, Poland
| | - Maria Constantinou
- Department of Clinical Genetics, Medical University of Lodz, Lodz, Poland
| | - Robert Śmigiel
- Department of Pediatrics, Division of Pediatrics and Rare Disorders, Wroclaw Medical University, Warsaw, Poland
| | - Jolanta Wierzba
- Department of Internal and Pediatric Nursing, Medical University of Gdansk, Gdansk, Poland
| | - Krystyna Wyka
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| | - Anna Wędrychowicz
- Polish-American Pediatric Institute, Jagiellonian University Collegium Medicum, Department of Pediatric and Adolescent Endocrinology, Cracow, Poland
| | - Anna Jakubiuk-Tomaszuk
- Department of Pediatric Neurology and Rehabilitation, Medical University of Bialystok, Białystok, Poland
| | - Edyta Budzynska
- Department of Clinical Genetics, Medical University of Lodz, Lodz, Poland
| | - Malgorzata Piotrowicz
- Department of Genetics, Polish Mother’s Memorial Hospital—Research Institute, Lodz, Poland
| | - Beata S. Lipska-Ziętkiewicz
- Clinical Genetics Unit, Department of Biology and Medical Genetics, Medical University of Gdansk, Gdansk, Poland
| | - Ewa Kaczorowska
- Department of Biology and Medical Genetics, Medical University of Gdansk, Gdansk, Poland
| | - Agata Cieślikowska
- Department of Medical Genetics, Children’s Memorial Health Institute, Warsaw, Poland
| | | | - Jolanta Fijak-Moskal
- Outpatient Genetic Clinic, University Children’s Hospital of Cracow, Cracow, Poland
| | - Monika Kugaudo
- Department of Children and Adolescent Psychiatry, University Clinical Center, Pediatric Teaching Clinical Hospital Warsaw, Warsaw, Poland
| | | | - Agnieszka Szadkowska
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, Medical University of Lodz, Lodz, Poland
| | - Maciej Borowiec
- Department of Clinical Genetics, Medical University of Lodz, Lodz, Poland
| | - Maciej Niedźwiecki
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Piotr Trzonkowski
- Department of Medical Immunology, Medical University of Gdansk, Gdansk, Poland
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Lodz, Poland
| |
Collapse
|
4
|
Hogendorf A, Szadkowska A, Michalak A, Surman M, Trojan-Borczynska K, Młynarski W, Janczar S. Subcutaneous immunoglobulin replacement therapy in a patient with 18q deletion syndrome, primary immune deficiency, and type 1 diabetes. Int J Immunopathol Pharmacol 2021; 35:20587384211039400. [PMID: 34514903 PMCID: PMC8442480 DOI: 10.1177/20587384211039400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
18q deletion syndrome (OMIM #601808) results from a deletion of a part of a long
arm of 18 chromosome and is characterized by mental retardation and congenital
malformations. We present an exceptional case of a 12-year-old girl with severe
phenotype of 18q deletion syndrome, frequent infections, type 1 diabetes,
autoimmune thyroiditis, and vitiligo. At first, the patient was diagnosed with
selective immunoglobulin A (sIgAD) which explained her susceptibility to both
infections and autoimmunity. With time, sIgAD progressed to common variable
immune deficiency-like (CVID-like) disorder. She had a minimum of 12 infections
per year, approximately twice as many courses of different antibiotics and up to
three hospitalizations annually, making the treatment of diabetes difficult. Due
to safety issues (increased risk of adverse reaction to blood products) and
patient’s convenience, subcutaneous IgG (SCIG) replacement therapy was
initiated. We noticed a substantial decrease in the number of infections and
improvement of metabolic control of diabetes.
Collapse
Affiliation(s)
- Anna Hogendorf
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, 37808Medical University of Lodz, Lodz, Poland
| | - Agnieszka Szadkowska
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, 37808Medical University of Lodz, Lodz, Poland
| | - Arkadiusz Michalak
- Department of Pediatrics, Diabetology, Endocrinology and Nephrology, 37808Medical University of Lodz, Lodz, Poland
| | - Marta Surman
- Department of Clinical Immunology, University Children's Hospital, Kraków, Poland
| | | | - Wojciech Młynarski
- Department of Pediatrics, Oncology and Hematology, 37808Medical University of Lodz, Lodz, Poland
| | - Szymon Janczar
- Department of Pediatrics, Oncology and Hematology, 37808Medical University of Lodz, Lodz, Poland
| |
Collapse
|
5
|
Hogendorf A, Szymańska M, Krasińska J, Baranowska-Jaźwiecka A, Ancuta M, Charubczyk A, Wyka K, Drozdz I, Sokolowska-Gadoux M, Zarebska J, Michalak A, Szadkowska A, Jarosz-Chobot P, Młynarski W. Clinical heterogeneity among pediatric patients with autoimmune type 1 diabetes stratified by immunoglobulin deficiency. Pediatr Diabetes 2021; 22:707-716. [PMID: 33840156 DOI: 10.1111/pedi.13208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/16/2021] [Accepted: 04/06/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Type 1 diabetes (T1D) may coexist with primary immunodeficiencies, indicating a shared genetic background. OBJECTIVE To evaluate the prevalence and clinical characteristics of immunoglobulin deficiency (IgD) among children with T1D. METHODS Serum samples and medical history questionnaires were obtained during routine visits from T1D patients aged 4-18 years. IgG, IgA, IgM, and IgE were measured by nephelometry and enzyme-linked immunosorbent assay (ELISA). IgG and IgM deficiency (IgGD, IgMD) were defined as IgG/IgM >2 standard deviations (SD) below age-adjusted mean. IgE deficiency was defined as IgE <2 kIU/L. IgA deficiency (IgAD) was defined as IgA >2 SD below age-adjusted mean irrespective of other immunoglobulin classes (absolute if <0.07 g/L, partial otherwise) and as selective IgAD when IgA >2 SD below age-adjusted mean with normal IgG and IgM (absolute if <0.07 g/L, partial otherwise). RESULTS Among 395 patients (53.4% boys) with the median age of 11.2 (8.4-13.7) and diabetes duration 3.6 (1.1-6.0) years, 90 (22.8%) were found to have hypogammaglobulinemia. The IgGD and IgAD were the most common each in 40/395 (10.1%). Complex IgD was found in seven patients. Increased odds of infection-related hospitalization (compared to children without any IgD) was related to having any kind of IgD and IgAD; OR (95%CI) = 2.1 (1.2-3.7) and 3.7 (1.8-7.5), respectively. Furthermore, IgAD was associated with having a first-degree relative with T1D OR (95%CI) = 3.3 (1.4-7.6) and suffering from non-autoimmune comorbidities 3.3 (1.4-7.6), especially neurological disorders 3.5 (1.2-10.5). CONCLUSIONS IgDs frequently coexist with T1D and may be associated with several autoimmune and nonimmune related disorders suggesting their common genetic background.
Collapse
Affiliation(s)
- Anna Hogendorf
- Department of Pediatrics, Diabetology, Endocrinology, and Nephrology, Medical University of Łódź, Łódź, Poland
| | - Małgorzata Szymańska
- Department of Pediatrics, Diabetology, Endocrinology, and Nephrology, Medical University of Łódź, Łódź, Poland
| | - Joanna Krasińska
- Department of Pediatrics, Oncology, and Hematology, Medical University of Łódź, Łódź, Poland
| | - Anna Baranowska-Jaźwiecka
- Department of Pediatrics, Diabetology, Endocrinology, and Nephrology, Medical University of Łódź, Łódź, Poland
| | - Marta Ancuta
- Department of Pediatrics, Diabetology, Endocrinology, and Nephrology, Medical University of Łódź, Łódź, Poland
| | - Anna Charubczyk
- Department of Pediatrics, Diabetology, Endocrinology, and Nephrology, Medical University of Łódź, Łódź, Poland
| | - Krystyna Wyka
- Department of Pediatrics, Oncology, and Hematology, Medical University of Łódź, Łódź, Poland
| | - Izabela Drozdz
- Department of Pediatrics, Oncology, and Hematology, Medical University of Łódź, Łódź, Poland.,Department of Clinical Genetics, Medical University of Łódź, Łódź, Poland
| | | | - Joanna Zarebska
- Department of Children's Diabetology, John Paul II Upper Silesian Child Health Centre, Katowice, Poland
| | - Arkadiusz Michalak
- Department of Pediatrics, Diabetology, Endocrinology, and Nephrology, Medical University of Łódź, Łódź, Poland.,Department of Biostatistics and Translational Medicine, Medical University of Łódź, Łódź, Poland
| | - Agnieszka Szadkowska
- Department of Pediatrics, Diabetology, Endocrinology, and Nephrology, Medical University of Łódź, Łódź, Poland
| | | | - Wojciech Młynarski
- Department of Pediatrics, Oncology, and Hematology, Medical University of Łódź, Łódź, Poland
| |
Collapse
|
6
|
Hashimoto's Thyroiditis and Graves' Disease in Genetic Syndromes in Pediatric Age. Genes (Basel) 2021; 12:genes12020222. [PMID: 33557156 PMCID: PMC7913917 DOI: 10.3390/genes12020222] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 12/18/2022] Open
Abstract
Autoimmune thyroid diseases (AITDs), including Hashimoto’s thyroiditis (HT) and Graves’ disease (GD), are the most common cause of acquired thyroid disorder during childhood and adolescence. Our purpose was to assess the main features of AITDs when they occur in association with genetic syndromes. We conducted a systematic review of the literature, covering the last 20 years, through MEDLINE via PubMed and EMBASE databases, in order to identify studies focused on the relation between AITDs and genetic syndromes in children and adolescents. From the 1654 references initially identified, 90 articles were selected for our final evaluation. Turner syndrome, Down syndrome, Klinefelter syndrome, neurofibromatosis type 1, Noonan syndrome, 22q11.2 deletion syndrome, Prader–Willi syndrome, Williams syndrome and 18q deletion syndrome were evaluated. Our analysis confirmed that AITDs show peculiar phenotypic patterns when they occur in association with some genetic disorders, especially chromosomopathies. To improve clinical practice and healthcare in children and adolescents with genetic syndromes, an accurate screening and monitoring of thyroid function and autoimmunity should be performed. Furthermore, maintaining adequate thyroid hormone levels is important to avoid aggravating growth and cognitive deficits that are not infrequently present in the syndromes analyzed.
Collapse
|