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Bekir M, Karakoç Aydıner E, Yıldızeli ŞO, Öğülür İ, Kocakaya D, Barış S, Eryüksel E, Özen A, Ceyhan BB. Primary Immun Deficiency in Patients with Non-Cystic Fibrosis Bronchiectasis and Its Relationship with Clinical Parameters. Turk Thorac J 2021; 22:37-44. [PMID: 33646102 DOI: 10.5152/turkthoracj.2020.19077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 03/08/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Bronchiectasis is characterized by chronic respiratory infection. The role of immunodeficiency in this disease is poorly studied in relation to clinical indices. The primary aim of this study was to determine the frequency of these neglected altered immune status by evaluating immunoglobulins, lymphocyte subsets, complement levels, and neutrophil function, and to assess its relationship with clinical parameters in adult patients with non-cystic fibrosis bronchiectasis (NCFB). MATERIAL AND METHODS A total of 74 (30 men and 44 women with a mean age of 47±17 years) adult patients with stable NCFB were enrolled in this study. The bronchiectasis severity index (BSI) and FACED (F:FEV1, A: Age, C: Chronic colonization, E: Extension, D: Dyspnea) scores were assessed. Peripheral blood samples were collected for the detection of total IgG, IgA, IgM, IgE, and IgG subclasses and C3 and C4 levels. The counts of CD3, CD4, CD8, CD19, CD16/56 expressing peripheral blood lymphocytes and neutrophil oxidative function were evaluated. RESULTS In the study population, BSI and FACED severity index scores increased with longer duration of the disease (p=0.01 and p=0.040, respectively). Of the 74 patients, 27 (37%) showed humoral aberrations. The number of male patients were higher in this group (p=0.03). High serum total IgE levels were associated with high scores in BSI (moderate-severe group versus mild group, p=0.030). Patients with bronchiectasis demonstrated lower CD3+ T cell count, lower CD4+ T helper cell percentage, and lower CD4+ T cell count (p=0.031, p=0.030, p=0.029, respectively) than healthy subjects. A significant negative correlation was found between the percentage and count of CD16/56+ natural killer (NK) cells and the number of exacerbations within the past year (r=-0.230, p=0.049 and r=-0.264, p=0.023, respectively). CONCLUSION Humoral aberrations in adult patients with NCFB were found to be frequent. IgE levels were related to high scores for disease severity indices. Furthermore, patients with low percentage and counts of NK cells had higher rates of exacerbations. These results emphasize the importance of immune function assessment in adult patients with NCFB.
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Affiliation(s)
- Melahat Bekir
- Department of Pulmonary Medicine and Critical Care, Marmara University School of Medicine, İstanbul, Turkey
| | - Elif Karakoç Aydıner
- Department of Pediatric Immunology and Allergy, Marmara University School of Medicine, İstanbul, Turkey
| | - Şehnaz Olgun Yıldızeli
- Department of Pulmonary Medicine and Critical Care, Marmara University School of Medicine, İstanbul, Turkey
| | - İsmail Öğülür
- Department of Pediatric Immunology and Allergy, Marmara University School of Medicine, İstanbul, Turkey
| | - Derya Kocakaya
- Department of Pulmonary Medicine and Critical Care, Marmara University School of Medicine, İstanbul, Turkey
| | - Safa Barış
- Department of Pediatric Immunology and Allergy, Marmara University School of Medicine, İstanbul, Turkey
| | - Emel Eryüksel
- Department of Pulmonary Medicine and Critical Care, Marmara University School of Medicine, İstanbul, Turkey
| | - Ahmet Özen
- Department of Pediatric Immunology and Allergy, Marmara University School of Medicine, İstanbul, Turkey
| | - Berrin Bağcı Ceyhan
- Department of Pulmonary Medicine and Critical Care, Marmara University School of Medicine, İstanbul, Turkey
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Uygun DFK, Uygun V, Karasu GT, Daloğlu H, Öztürkmen SI, Çelmeli F, Törün SH, Özen A, Barış S, Aydıner EK, Yalçın K, Kılıç SÇ, Hazar V, Bingöl A, Yeşilipek A. Hematopoietic stem cell transplantation in CD40 ligand deficiency: A single-center experience. Pediatr Transplant 2020; 24:e13768. [PMID: 32573870 DOI: 10.1111/petr.13768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/15/2020] [Accepted: 05/26/2020] [Indexed: 11/30/2022]
Abstract
Deficiency of the CD40L, expressed on the surface of T lymphocytes, is caused by mutations in the glycoprotein CD40L (CD154) gene. Resulting defective humoral and cellular responses cause a clinical presentation that includes recurrent sinopulmonary bacterial infections, opportunistic infections, sclerosing cholangitis, neutropenia, and autoimmune manifestations. HSCT represents the only curative treatment modality. However, the therapeutic decision to use HSCT proves challenging in many cases, mainly due to the lack of a phenotype-genotype correlation. We retrospectively reviewed patients with CD40L deficiency who were transplanted in Antalya and Göztepe MedicalPark Pediatric HSCT units from 2014 to 2019 and followed by Akdeniz University School of Medicine Department of Pediatric Immunology. The records of eight male cases, including one set of twins, were evaluated retrospectively. As two transplants each were performed on the twins, a total of ten transplants were evaluated. Conditioning regimens were predominantly based on myeloablative protocols, except for the twins, who received a non-myeloablative regimen for their first transplantation. Median neutrophil and platelet engraftment days were 13 (range 10-19) and 14 (range 10-42) days, respectively. In seven of ten transplants, a CMV reactivation was developed without morbidity. None of the patients developed GVHD, except for one mild case of acute GVHD. All patients survived, and the median follow-up was 852 days. Our data show that HSCT for patients with CD40 ligand deficiency is a potentially effective treatment for long-term disease control.
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Affiliation(s)
| | - Vedat Uygun
- Department of Pediatric Bone Marrow Transplantation Unit, MedicalPark Antalya Hospital, Istinye University, Antalya, Turkey
| | - Gülsün Tezcan Karasu
- Department of Pediatric Bone Marrow Transplantation Unit, MedicalPark Göztepe Hospital, İstinye University School of Medicine, İstanbul, Turkey
| | - Hayriye Daloğlu
- Department of Pediatric Bone Marrow Transplantation Unit, MedicalPark Antalya Hospital, Antalya, Turkey
| | - Seda Irmak Öztürkmen
- Department of Pediatric Bone Marrow Transplantation Unit, MedicalPark Antalya Hospital, Antalya, Turkey
| | - Fatih Çelmeli
- Department of Allergy and Immunology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
| | - Selda Hançerli Törün
- Department of Pediatric Infection, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Ahmet Özen
- Pendik Department of Pediatric Allergy and Immunology, School of Medicine, Marmara University, İstanbul, Turkey
| | - Safa Barış
- Pendik Department of Pediatric Allergy and Immunology, School of Medicine, Marmara University, İstanbul, Turkey
| | - Elif Karakoç Aydıner
- Pendik Department of Pediatric Allergy and Immunology, School of Medicine, Marmara University, İstanbul, Turkey
| | - Koray Yalçın
- Department of Pediatric Bone Marrow Transplantation Unit, MedicalPark Göztepe Hospital, İstanbul, Turkey
| | - Suar Çakı Kılıç
- Department of Pediatric Bone Marrow Transplantation Unit, MedicalPark Göztepe Hospital, İstanbul, Turkey
| | - Volkan Hazar
- Department of Pediatric Bone Marrow Transplantation Unit, MedicalPark Göztepe Hospital, İstanbul, Turkey
| | - Ayşen Bingöl
- Department of Pediatric Allergy and Immunology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Akif Yeşilipek
- Department of Pediatric Bone Marrow Transplantation Unit, MedicalPark Antalya Hospital, Antalya, Turkey
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Duramaz BB, Türel Ö, Akkoç G, Yozgat CY, Kasap NA, Aydıner EK, Bustamante J. Interleukin 12-23 deficiency in the interferon gamma pathway in a 6-month-old toddler who has BCG vaccine complications. Dermatol Ther 2020; 33:e13999. [PMID: 32654369 DOI: 10.1111/dth.13999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Burcu Bursal Duramaz
- Department of Pediatric Infectious Diseases, Bezmialem Vakif University, Istanbul, Turkey
| | - Özden Türel
- Department of Pediatric Infectious Diseases, Bezmialem Vakif University, Istanbul, Turkey
| | - Gülşen Akkoç
- Department of Pediatric Infectious Diseases, Van Research and Training Hospital, University of Health Sciences, Van, Turkey
| | | | | | - Elif Karakoç Aydıner
- Department of Pediatric Allergy and Immunology, Marmara University's Pendik Research and Training Hospital, Istanbul, Turkey
| | - Jacinta Bustamante
- Laboratory of Human Genetics of Infectious Diseases, Institut National De La Santé Et De La Recherche Médicale, Paris, France
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Nain E, Kıykım A, Kasap NA, Barış S, Özen A, Aydıner EK. Immediate adverse reactions to intravenous immunoglobulin in primary immune deficiencies: a single center experience. Turk J Pediatr 2020; 62:379-386. [PMID: 32558411 DOI: 10.24953/turkjped.2020.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Adverse reactions related to intravenous immunoglobulin (IVIG) infusions vary from 1 to 81%, with an average of 20%. They may be classified as immediate; occurring during the infusion itself or delayed; occurring after the infusion has been ceased. In the present study, we aimed to evaluate the frequency of immediate adverse reactions due to IVIG infusions in primary immune deficiency (PID) patients. METHODS The study population was composed of 109 patients. A total of 763 infusions were recorded for demographic data and adverse reactions. RESULTS The participants included 32 girls (29%) and 77 boys (71%). The mean age was 11.8 ± 5.7 years (0.6- 33.5 years). Early adverse events (AE) were recorded in 34 (4.5%) among 763 IVIG infusions including 30 mild (88.2%), 3 moderate (8.8%) and 1 severe (2.9%). The most common immediate adverse reactions were fever (29.4%) and headache (29.4%). The risk of AE was higher among primary antibody deficiency (PAD), compared to combined immunodeficiency (OR 2.61, 95%CI 1.061-6.475; p = 0.037). CONCLUSIONS Use of various intravenous immunoglobulin treatments should be considered with regard to side effect profiles observed. In our cohort, PID patient experienced mostly mild AE; PAD was associated with an increased risk of AE.
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Affiliation(s)
- Ercan Nain
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Ayça Kıykım
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Nurhan Aruci Kasap
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Safa Barış
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Ahmet Özen
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Elif Karakoç Aydıner
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Marmara University Faculty of Medicine, İstanbul, Turkey
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Karakoç Aydıner E, Kıykım A, Barış S, Özen A, Barlan I. Use of subcutaneous immunoglobulin in primary immune deficiencies. Turk Arch Pediatr 2016; 51:8-14. [PMID: 27103859 DOI: 10.5152/turkpediatriars.2016.3058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 11/27/2015] [Indexed: 11/22/2022]
Abstract
AIM Immunoglobulin replacement therapy is required to reduce the frequency and severity of infections in patients with primary antibody deficiencies. Immunoglobulin G (IgG) can be administered intramuscularly, intravenously or subcutaneously. We aimed to evaluate the efficacy, dose adjustment and adverse events in subcutaneous immunoglobulin therapy by retrospectively presenting the records of 16 patients who received subcutaneous immunoglobulin therapy. MATERIAL AND METHODS The demographic findings, clinical and laboratory findings, subcutaneous immunoglobulin dosage and dose frequency, infusion time, area and methods, adverse events and frequency of infections were obtained from patient files and recorded. RESULTS Sixteen patients (seven female, nine male) aged between 0-33 years who were diagnosed with primary immune deficiency and treated with subcutaneous immunoglobulin were enrolled. All patients had been receiving intravenous imunoglobulin (5-10%) at a dose of 0.33-1.25 gr/kg/dose with two-four week intervals before subcutaneous immunoglobulin. Subcutaneous immunoglobulin (10%) was administered at a dose of 0.03-0.43 gr/kg/dose with one-two week intervals. No significant difference was found between serum through IgG levels before administration of intravenous imunoglobulin and steady state IgG levels during subcutaneous immunoglobulin therapy. When five patients whose serum through IgG levels were below 600 mg/dL were evaluated, however, a significant increase was found in steady state IgG levels with subcutaneous immunoglobulin therapy (p=0.043). In a ten-month follow-up period, seven infections were observed in four patients (three upper respiratory infectons, two lower respiratory tract infections and three acute gastroenteritis). No acute severe bacterial infection was observed. Local advers reaction was reported in only 10 of 180 infusions (6%). No serious adverse events were reported. All 16 patients were willing to continue IgG replacement therapy by subcutaneous administration. CONCLUSIONS Ig replacement therapy by subcutaneous route is an efficient, safe and easy option which is eligible for individual administration. Home therapy is feasible for patients with primary immune deficiency, if informed consent is obtained and sufficient education is ensured.
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Affiliation(s)
- Elif Karakoç Aydıner
- Clinic of Pediatric Allergy and Immunology, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
| | - Ayça Kıykım
- Clinic of Pediatric Allergy and Immunology, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
| | - Safa Barış
- Clinic of Pediatric Allergy and Immunology, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
| | - Ahmet Özen
- Clinic of Pediatric Allergy and Immunology, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
| | - Işıl Barlan
- Clinic of Pediatric Allergy and Immunology, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
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Aydıner Ö, Karakoç Aydıner E, Akpınar İ, Turan S, Bereket A. Normative Data of Thyroid Volume-Ultrasonographic Evaluation of 422 Subjects Aged 0-55 Years. J Clin Res Pediatr Endocrinol 2015; 7:98-101. [PMID: 26316430 PMCID: PMC4563193 DOI: 10.4274/jcrpe.1818] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To establish local normative data of thyroid volume assessed by ultrasonography in subjects aged 0-55 years living in İstanbul, Turkey. METHODS Subjects without any known history of thyroid disease, of major surgery and/or chronic disease were enrolled in the study and evaluated by physical examination and thyroid ultrasonography. Thyroid gland and isthmus at usual location, each lateral lobe volume with three dimensions, ectopic thyroid tissue and echogenicity of the gland were assessed. RESULTS Initially, 494 subjects were enrolled in the study. Subjects showing heterogeneous thyroid parenchyma (n=21) and/or nodule (n=51) in ultrasonography were excluded. Final analysis covered 422 subjects (216 males, 206 females). Thyroid volume was found to significantly correlate with height, weight, age and body surface area (r=0.661, r=0.712, r=0.772 and r=0.779, respectively; p<0.0001 for all). These correlations were even stronger in subjects younger than 18 years (r=0.758, r=0.800, r=0.815 and r=0.802, respectively; p<0.0001 for all). CONCLUSION The study provides updated reference norms for thyroid volume in Turkish subjects which can be used in the diagnosis and follow-up of patients with thyroid diseases.
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Affiliation(s)
- Ömer Aydıner
- Anadolu Health Center, Clinic of Radiology, İstanbul, Turkey
| | - Elif Karakoç Aydıner
- Marmara University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Allergy and Immunology, İstanbul, Turkey Phone: +90 216 625 28 40 E-mail:
| | - İhsan Akpınar
- Marmara University Faculty of Medicine, Department of Radiology, İstanbul, Turkey
| | - Serap Turan
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Abdullah Bereket
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
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Baris S, Schulze I, Ozen A, Karakoç Aydıner E, Altuncu E, Karasu GT, Ozturk N, Lorenz M, Schwarz K, Vraetz T, Ehl S, Barlan IB. Clinical heterogeneity of immunodysregulation, polyendocrinopathy, enteropathy, X-linked: pulmonary involvement as a non-classical disease manifestation. J Clin Immunol 2014; 34:601-6. [PMID: 24916357 DOI: 10.1007/s10875-014-0059-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 05/15/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE IPEX (Immunodysregulation, Polyendocrinopathy, Enteropathy, X-linked) is a rare X-linked recessive life-threatening disorder characterized by autoimmunity and early death. Pulmonary complication related with IPEX has not been elucidated exactly. Here, we report 4 IPEX patients, 3 of which died from severe pulmonary disease. METHODS Clinical data and laboratory findings including autoantibodies, immunoglobulin levels as well as number of T, B and NK cells were evaluated. FOXP3 expression and T reg activity were analyzed. The FOXP3 gene was sequenced and RNA analysis was performed. RESULTS Patient I (PI) presented with nephrotic syndrome at 3 years of age and then developed autoimmune hepatitis without eczema, enteropathy or high IgE and died at 9 years of age due to acute respiratory distress syndrome (ARDS). Two cousins of PI had the same hypomorphic splice site mutation leading to a deletion of 27 amino acids, but normal FOXP3 protein expression and normal suppressive capacity of T reg in a proliferation inhibition assay. However, they exhibited typical symptoms such as eczema, diabetes and enteropathy with eosinophilia at early age (PII, PIII) and were transplanted in infancy. One of them had severe respiratory distress right after birth (PIII). Patient IV from another family presented with chronic diarrhea without autoimmune manifestations and died due to ARDS. CONCLUSION Lung disease related to IPEX syndrome has not been reported before and this entity could be a critical factor in disease outcome.
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Affiliation(s)
- Safa Baris
- Division of Pediatric Allergy and Immunology, Marmara Medical Faculty, Istanbul, Turkey,
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