1
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Perelygina L, Faisthalab R, Abernathy E, Chen MH, Hao L, Bercovitch L, Bayer DK, Noroski LM, Lam MT, Cicalese MP, Al-Herz W, Nanda A, Hajjar J, Vanden Driessche K, Schroven S, Leysen J, Rosenbach M, Peters P, Raedler J, Albert MH, Abraham RS, Rangarjan HG, Buchbinder D, Kobrynski L, Pham-Huy A, Dhossche J, Cunningham Rundles C, Meyer AK, Theos A, Atkinson TP, Musiek A, Adeli M, Derichs U, Walz C, Krüger R, von Bernuth H, Klein C, Icenogle J, Hauck F, Sullivan KE. Rubella Virus Infected Macrophages and Neutrophils Define Patterns of Granulomatous Inflammation in Inborn and Acquired Errors of Immunity. Front Immunol 2022; 12:796065. [PMID: 35003119 PMCID: PMC8728873 DOI: 10.3389/fimmu.2021.796065] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/30/2021] [Indexed: 01/08/2023] Open
Abstract
Rubella virus (RuV) has recently been found in association with granulomatous inflammation of the skin and several internal organs in patients with inborn errors of immunity (IEI). The cellular tropism and molecular mechanisms of RuV persistence and pathogenesis in select immunocompromised hosts are not clear. We provide clinical, immunological, virological, and histological data on a cohort of 28 patients with a broad spectrum of IEI and RuV-associated granulomas in skin and nine extracutaneous tissues to further delineate this relationship. Combined immunodeficiency was the most frequent diagnosis (67.8%) among patients. Patients with previously undocumented conditions, i.e., humoral immunodeficiencies, a secondary immunodeficiency, and a defect of innate immunity were identified as being susceptible to RuV-associated granulomas. Hematopoietic cell transplantation was the most successful treatment in this case series resulting in granuloma resolution; steroids, and TNF-α and IL-1R inhibitors were moderately effective. In addition to M2 macrophages, neutrophils were identified by immunohistochemical analysis as a novel cell type infected with RuV. Four patterns of RuV-associated granulomatous inflammation were classified based on the structural organization of granulomas and identity and location of cell types harboring RuV antigen. Identification of conditions that increase susceptibility to RuV-associated granulomas combined with structural characterization of the granulomas may lead to a better understanding of the pathogenesis of RuV-associated granulomas and discover new targets for therapeutic interventions.
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Affiliation(s)
- Ludmila Perelygina
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA, United States
| | - Raeesa Faisthalab
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA, United States
| | - Emily Abernathy
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA, United States
| | - Min-Hsin Chen
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA, United States
| | - LiJuan Hao
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA, United States
| | - Lionel Bercovitch
- Department of Dermatology, Hasbro Children's Hospital and Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Diana K Bayer
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States
| | - Lenora M Noroski
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Michael T Lam
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Maria Pia Cicalese
- Pediatric Immunohematology and Bone Marrow Transplantation Unit and San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Istituto di Ricovero e Cura a Carattere Scientifico (National Institute for Research and Treatment) (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Waleed Al-Herz
- Department of Pediatrics, Kuwait University, Kuwait City, Kuwait.,Allergy and Clinical Immunology Unit, Department of Pediatrics, Al-Sabah Hospital, Kuwait City, Kuwait
| | - Arti Nanda
- Pediatric Dermatology Unit, As'ad Al-Hamad Dermatology Center, Al-sabah Hospital, Kuwait City, Kuwait
| | - Joud Hajjar
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Koen Vanden Driessche
- Department of Pediatrics, Queen Mathilde Mother and Child Centre, Antwerp University Hospital, Antwerp, Belgium
| | - Shari Schroven
- Department of Pediatrics, Queen Mathilde Mother and Child Centre, Antwerp University Hospital, Antwerp, Belgium
| | - Julie Leysen
- Department of Dermatology, Queen Mathilde Mother and Child Centre, Antwerp University Hospital, Antwerp, Belgium
| | - Misha Rosenbach
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Philipp Peters
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Johannes Raedler
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Michael H Albert
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Roshini S Abraham
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, United States
| | - Hemalatha G Rangarjan
- Department of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children's Hospital, Columbus, OH, United States
| | - David Buchbinder
- Department of Hematology, Children's Hospital of Orange County, Orange, CA, United States.,Department of Pediatrics, University of California at Irvine, Orange, CA, United States
| | - Lisa Kobrynski
- Allergy/Immunology Section, Emory University, Atlanta, GA, United States
| | - Anne Pham-Huy
- Department of Pediatrics, University of Ottawa and Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Julie Dhossche
- Department of Dermatology, Oregon Health and Science University, Portland, OR, United States
| | - Charlotte Cunningham Rundles
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Anna K Meyer
- Department of Pediatrics, National Jewish Health, Denver, CO, United States
| | - Amy Theos
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - T Prescott Atkinson
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Amy Musiek
- Division of Dermatology, Washington University School of Medicine, St. Louis, MO, United States
| | - Mehdi Adeli
- Division of Immunology and Allergy, Sidra Medicine and Hamad Medical Corporation, Doha, Qatar
| | - Ute Derichs
- Center for Pediatric and Adolescent Medicine, University Medical Hospital Mainz, Mainz, Germany
| | - Christoph Walz
- Institute of Pathology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Renate Krüger
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Horst von Bernuth
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Labor Berlin GmbH, Department of Immunology, Berlin, Germany
| | - Christoph Klein
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Joseph Icenogle
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA, United States
| | - Fabian Hauck
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Kathleen E Sullivan
- Division of Allergy Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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2
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Kumar D, Prince C, Bennett CM, Briones M, Lucas L, Russell A, Patel K, Chonat S, Graciaa S, Edington H, White MH, Kobrynski L, Abdalgani M, Parikh S, Chandra S, Bleesing J, Marsh R, Park S, Waller EK, Prahalad S, Chandrakasan S. T-follicular helper cell expansion and chronic T-cell activation are characteristic immune anomalies in Evans syndrome. Blood 2022; 139:369-383. [PMID: 34424963 PMCID: PMC8777200 DOI: 10.1182/blood.2021012924] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/02/2021] [Indexed: 11/20/2022] Open
Abstract
Pediatric Evans syndrome (pES) is increasingly identified as the presenting manifestation of several inborn errors of immunity. Despite an improved understanding of genetic defects in pES, the underlying immunobiology of pES is poorly defined, and characteristic diagnostic immune parameters are lacking. We describe the immune characteristics of 24 patients with pES and compared them with 22 patients with chronic immune thrombocytopenia (cITP) and 24 healthy controls (HCs). Compared with patients with cITP and HC, patients with pES had increased circulating T-follicular helper cells (cTfh), increased T-cell activation, and decreased naïve CD4+ T cells for age. Despite normal or high immunoglobulin G (IgG) in most pES at presentation, class-switched memory B cells were decreased. Within the cTfh subset, we noted features of postactivation exhaustion with upregulation of several canonical checkpoint inhibitors. T-cell receptor β chain (TCR-β) repertoire analysis of cTfh cells revealed increased oligoclonality in patients with pES compared with HCs. Among patients with pES, those without a known gene defect had a similar characteristic immune abnormality as patients with defined genetic defects. Similarly, patients with pES with normal IgG had similar T-cell abnormalities as patients with low IgG. Because genetic defects have been identified in less than half of patients with pES, our findings of similar immune abnormalities across all patients with pES help establish a common characteristic immunopathology in pES, irrespective of the underlying genetic etiology.
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MESH Headings
- Adolescent
- Adult
- Anemia, Hemolytic, Autoimmune/immunology
- Anemia, Hemolytic, Autoimmune/pathology
- Child
- Child, Preschool
- Female
- Humans
- Infant
- Lymphocyte Activation
- Male
- Purpura, Thrombocytopenic, Idiopathic/immunology
- Purpura, Thrombocytopenic, Idiopathic/pathology
- T-Lymphocytes, Helper-Inducer/immunology
- T-Lymphocytes, Helper-Inducer/pathology
- Thrombocytopenia/immunology
- Thrombocytopenia/pathology
- Young Adult
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Affiliation(s)
- Deepak Kumar
- Aflac Cancer and Blood Disorder Center, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Chengyu Prince
- Aflac Cancer and Blood Disorder Center, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Carolyn M Bennett
- Aflac Cancer and Blood Disorder Center, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Michael Briones
- Aflac Cancer and Blood Disorder Center, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Laura Lucas
- Aflac Cancer and Blood Disorder Center, Children's Healthcare of Atlanta, Atlanta; GA
| | - Athena Russell
- Genetics and Molecular Biology Graduate Program, Laney Graduate School, Emory University, Atlanta, GA
| | - Kiran Patel
- Allergy/Immunology Section, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Satheesh Chonat
- Aflac Cancer and Blood Disorder Center, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Sara Graciaa
- Aflac Cancer and Blood Disorder Center, Children's Healthcare of Atlanta, Atlanta; GA
| | - Holly Edington
- Aflac Cancer and Blood Disorder Center, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Michael H White
- Aflac Cancer and Blood Disorder Center, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Lisa Kobrynski
- Allergy/Immunology Section, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | | | - Suhag Parikh
- Aflac Cancer and Blood Disorder Center, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Sharat Chandra
- Division of Bone Marrow Transplantation and Immune Deficiency, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jack Bleesing
- Division of Bone Marrow Transplantation and Immune Deficiency, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Rebecca Marsh
- Division of Bone Marrow Transplantation and Immune Deficiency, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Sunita Park
- Department of Pathology, Children's Healthcare of Atlanta, Atlanta, GA
| | - Edmund K Waller
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA; and
| | - Sampath Prahalad
- Division of Pediatric Rheumatology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Shanmuganathan Chandrakasan
- Aflac Cancer and Blood Disorder Center, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
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3
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Dorsey M, Wright NAM, Chaimowitz NS, Dávila Saldaña BJ, Miller H, Keller MD, Thakar MS, Shah AJ, Abu-Arja R, Andolina J, Aquino V, Barnum JL, Bednarski JJ, Bhatia M, Bonilla FA, Butte MJ, Bunin NJ, Burroughs LM, Chandra S, Chaudhury S, Chen K, Chong H, Cuvelier G, Dalal J, DeFelice ML, DeSantes KB, Forbes LR, Gillio A, Goldman F, Joshi AY, Kapoor N, Knutsen AP, Kobrynski L, Lieberman JA, Leiding JW, Oshrine B, Patel KP, Prockop S, Quigg TC, Quinones R, Schultz KR, Seroogy C, Shyr D, Siegel S, Smith AR, Torgerson TR, Vander Lugt MT, Yu LC, Cowan MJ, Buckley RH, Dvorak CC, Griffith LM, Haddad E, Kohn DB, Logan B, Notarangelo LD, Pai SY, Puck J, Pulsipher MA, Heimall J. Correction to: Infections in Infants with SCID: Isolation, Infection Screening and Prophylaxis in PIDTC Centers. J Clin Immunol 2020; 41:498-500. [PMID: 33274413 DOI: 10.1007/s10875-020-00917-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Morna Dorsey
- Division of Pediatric Allergy, Immunology, & Bone Marrow Transplant, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Nicola A M Wright
- Division of Hematology/Immunology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Natalia S Chaimowitz
- Section of Immunology, Allergy and Retrovirology, Department of Pediatrics, William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Blachy J Dávila Saldaña
- Division of Blood and Marrow Transplantation, Children's National Medical Center, Washington, DC, USA.,Department of Pediatrics, George Washington University, Washington, DC, USA
| | - Holly Miller
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Michael D Keller
- Division of Allergy & Immunology, Children's National Health System, and Division of Pediatrics, George Washington University, Washington, DC, USA
| | - Monica S Thakar
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - Ami J Shah
- Division of Stem Cell Transplantation and Regenerative Medicine, Lucille Packard Children's Hospital, Stanford School of Medicine, Stanford, CA, USA
| | | | - Jeffrey Andolina
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | | | - J L Barnum
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Jeffrey J Bednarski
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Monica Bhatia
- Pediatric Stem Cell Transplant Columbia, University Irving Medical Center, New York, NY, USA
| | - Francisco A Bonilla
- Northeast Allergy, Asthma & Immunology (private practice), Leominster, MA, USA
| | - Manish J Butte
- Division of Immunology, Allergy, and Rheumatology, Department of Pediatrics, University of California Los Angeles, Los Angeles, CA, USA
| | - Nancy J Bunin
- Cellular Therapy and Transplant Section, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lauri M Burroughs
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - Sharat Chandra
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sonali Chaudhury
- Division of Pediatric Hematology, Oncology, Stem Cell Transplantation, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Karin Chen
- Division of Allergy and Immunology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Hey Chong
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Geoff Cuvelier
- Pediatric Blood and Marrow Transplant Program, CancerCare Manitoba, Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jignesh Dalal
- Pediatric Bone Marrow Transplant, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Magee L DeFelice
- Division of Allergy and Immunology, Nemours/AI duPont Hospital for Children, Wilmington, DE, USA
| | - Kenneth B DeSantes
- Division of Hematology, Oncology and Bone Marrow Transplant, Department of Pediatrics, University of Wisconsin School of Medicine, Madison, WI, USA
| | - Lisa R Forbes
- William T Shearer Center for Human Immunobiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Alfred Gillio
- Joseph M Sanzari's Childrens Hospital, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Fred Goldman
- Department of Pediatrics, Division of Hematology Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Avni Y Joshi
- Pediatric and Adult Allergy/Immunology, Mayo Clinic, Rochester, MN, USA
| | - Neena Kapoor
- Section of Transplantation and Cellular Therapy, Children's Hospital Los Angeles Cancer and Blood Diseases Institute, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Alan P Knutsen
- Pediatric Allergy and Immunology, Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Lisa Kobrynski
- Children's Healthcare of Atlanta, Emory University Department of Pediatrics, Allergy and Immunology, Atlanta, GA, USA
| | - Jay A Lieberman
- Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jennifer W Leiding
- Division of Allergy and Immunology, Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA.,Johns Hopkins All Children's Hospital, Cancer and Blood Disorders Institute, St. Petersburg, FL, USA
| | - Benjamin Oshrine
- Division of Allergy and Immunology, Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
| | | | - Susan Prockop
- Department of Pediatrics, Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Troy C Quigg
- Pediatric Blood and Marrow Transplantation Program, Methodist Children's Hospital, San Antonio, TX, USA
| | - Ralph Quinones
- Pediatric Hematology, Oncology and Bone Marrow Transplant, Children's Hospital Colorado, Aurora, CO, USA
| | - Kirk R Schultz
- Michael Cuccione Childhood Cancer Research Program, BC Children's Hospital and Research Institute, Vancouver, British Columbia, Canada
| | - Christine Seroogy
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - David Shyr
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, UT, USA.,Division of Stem Cell Transplant, Department of Pediatrics, Stanford Medicine, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Subhadra Siegel
- Division of Pediatric Pulmonology, Allergy and Immunology and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Angela R Smith
- Pediatric Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Troy R Torgerson
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - Mark T Vander Lugt
- Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, MI, USA
| | - Lolie C Yu
- Division of Heme-Onc/HSCT, Children's Hospital/LSUHSC, New Orleans, LA, USA
| | - Morton J Cowan
- Division of Pediatric Allergy, Immunology, & Bone Marrow Transplant, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Rebecca H Buckley
- Division of Allergy and Immunology, Department of Pediatrics and Department of Immunology, Duke University School of Medicine, Durham, NC, USA
| | - Christopher C Dvorak
- Division of Pediatric Allergy, Immunology, & Bone Marrow Transplant, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Linda M Griffith
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Elie Haddad
- Pediatric Immunology and Rheumatology Division, CHU Sainte-Justine, Department of Pediatrics, Department of Microbiology, Immunology and Infectious Disease, University of Montreal, Montreal, QC, Canada
| | - Donald B Kohn
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Brent Logan
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Luigi D Notarangelo
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Sung-Yun Pai
- Division of Hematology-Oncology, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jennifer Puck
- Division of Pediatric Allergy, Immunology, & Bone Marrow Transplant, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Michael A Pulsipher
- Section of Transplantation and Cellular Therapy, Children's Hospital Los Angeles Cancer and Blood Diseases Institute, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Jennifer Heimall
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Wood 3301, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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4
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Nawaz S, Lee G, Tison K, Kobrynski L. M272 STAT1 GAIN-OF-FUNCTION MUTATION IN A PATIENT WITH MULTIFOCAL ENTEROCOLITIS, SLE, AND FAMILY HISTORY OF CMC. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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5
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Dorsey MJ, Wright NAM, Chaimowitz NS, Dávila Saldaña BJ, Miller H, Keller MD, Thakar MS, Shah AJ, Abu-Arja R, Andolina J, Aquino V, Barnum JL, Bednarski JJ, Bhatia M, Bonilla FA, Butte MJ, Bunin NJ, Chandra S, Chaudhury S, Chen K, Chong H, Cuvelier GDE, Dalal J, DeFelice ML, DeSantes KB, Forbes LR, Gillio A, Goldman F, Joshi AY, Kapoor N, Knutsen AP, Kobrynski L, Lieberman JA, Leiding JW, Oshrine B, Patel KP, Prockop S, Quigg TC, Quinones R, Schultz KR, Seroogy C, Shyr D, Siegel S, Smith AR, Torgerson TR, Vander Lugt MT, Yu LC, Cowan MJ, Buckley RH, Dvorak CC, Griffith LM, Haddad E, Kohn DB, Logan B, Notarangelo LD, Pai SY, Puck J, Pulsipher MA, Heimall J. Infections in Infants with SCID: Isolation, Infection Screening, and Prophylaxis in PIDTC Centers. J Clin Immunol 2020; 41:38-50. [PMID: 33006109 DOI: 10.1007/s10875-020-00865-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/07/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE The Primary Immune Deficiency Treatment Consortium (PIDTC) enrolled children with severe combined immunodeficiency (SCID) in a prospective natural history study of hematopoietic stem cell transplant (HSCT) outcomes over the last decade. Despite newborn screening (NBS) for SCID, infections occurred prior to HSCT. This study's objectives were to define the types and timing of infection prior to HSCT in patients diagnosed via NBS or by family history (FH) and to understand the breadth of strategies employed at PIDTC centers for infection prevention. METHODS We analyzed retrospective data on infections and pre-transplant management in patients with SCID diagnosed by NBS and/or FH and treated with HSCT between 2010 and 2014. PIDTC centers were surveyed in 2018 to understand their practices and protocols for pre-HSCT management. RESULTS Infections were more common in patients diagnosed via NBS (55%) versus those diagnosed via FH (19%) (p = 0.012). Outpatient versus inpatient management did not impact infections (47% vs 35%, respectively; p = 0.423). There was no consensus among PIDTC survey respondents as to the best setting (inpatient vs outpatient) for pre-HSCT management. While isolation practices varied, immunoglobulin replacement and antimicrobial prophylaxis were more uniformly implemented. CONCLUSION Infants with SCID diagnosed due to FH had lower rates of infection and proceeded to HSCT more quickly than did those diagnosed via NBS. Pre-HSCT management practices were highly variable between centers, although uses of prophylaxis and immunoglobulin support were more consistent. This study demonstrates a critical need for development of evidence-based guidelines for the pre-HSCT management of infants with SCID following an abnormal NBS. TRIAL REGISTRATION NCT01186913.
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Affiliation(s)
- Morna J Dorsey
- Division of Pediatric Allergy, Immunology, & Bone Marrow Transplant, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Nicola A M Wright
- Division of Hematology/Immunology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Natalia S Chaimowitz
- Section of Immunology, Allergy and Retrovirology, Department of Pediatrics, William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Blachy J Dávila Saldaña
- Division of Blood and Marrow Transplantation, Children's National Medical Center, Washington, DC, USA.,Department of Pediatrics, George Washington University, Washington, DC, USA
| | - Holly Miller
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Michael D Keller
- Division of Allergy & Immunology, Children's National Health System, and Division of Pediatrics, George Washington University, Washington, DC, USA
| | - Monica S Thakar
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - Ami J Shah
- Division of Stem Cell Transplantation and Regenerative Medicine, Lucille Packard Children's Hospital, Stanford School of Medicine, Stanford, CA, USA
| | | | - Jeffrey Andolina
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | | | - J L Barnum
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Jeffrey J Bednarski
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Monica Bhatia
- Pediatric Stem Cell Transplant Columbia, University Irving Medical Center, New York, NY, USA
| | - Francisco A Bonilla
- Northeast Allergy, Asthma & Immunology (private practice), Leominster, MA, USA
| | - Manish J Butte
- Division of Immunology, Allergy, and Rheumatology, Department of Pediatrics, University of California Los Angeles, Los Angeles, CA, USA
| | - Nancy J Bunin
- Cellular Therapy and Transplant Section, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sharat Chandra
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sonali Chaudhury
- Division of Pediatric Hematology, Oncology, Stem Cell Transplantation, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Karin Chen
- Division of Allergy and Immunology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Hey Chong
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Geoffrey D E Cuvelier
- Pediatric Blood and Marrow Transplant Program, CancerCare Manitoba, Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jignesh Dalal
- Pediatric Bone Marrow Transplant, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Magee L DeFelice
- Division of Allergy and Immunology, Nemours/AI duPont Hospital for Children, Wilmington, DE, USA
| | - Kenneth B DeSantes
- Division of Hematology, Oncology and Bone Marrow Transplant, Department of Pediatrics, University of Wisconsin School of Medicine, Madison, WI, USA
| | - Lisa R Forbes
- William T Shearer Center for Human Immunobiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Alfred Gillio
- Joseph M Sanzari's Childrens Hospital, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Fred Goldman
- Department of Pediatrics, Division of Hematology Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Avni Y Joshi
- Pediatric and Adult Allergy/Immunology, Mayo Clinic, Rochester, MN, USA
| | - Neena Kapoor
- Section of Transplantation and Cellular Therapy, Children's Hospital Los Angeles Cancer and Blood Diseases Institute, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Alan P Knutsen
- Pediatric Allergy and Immunology, Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Lisa Kobrynski
- Children's Healthcare of Atlanta, Emory University Department of Pediatrics, Allergy and Immunology, Atlanta, GA, USA
| | - Jay A Lieberman
- Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jennifer W Leiding
- Division of Allergy and Immunology, Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA.,Johns Hopkins All Children's Hospital, Cancer and Blood Disorders Institute, St. Petersburg, FL, USA
| | - Benjamin Oshrine
- Johns Hopkins All Children's Hospital, Cancer and Blood Disorders Institute, St. Petersburg, FL, USA
| | | | - Susan Prockop
- Department of Pediatrics, Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Troy C Quigg
- Pediatric Blood and Marrow Transplantation Program, Methodist Children's Hospital, San Antonio, TX, USA
| | - Ralph Quinones
- Pediatric Hematology, Oncology and Bone Marrow Transplant, Children's Hospital Colorado, Aurora, CO, USA
| | - Kirk R Schultz
- Michael Cuccione Childhood Cancer Research Program, BC Children's Hospital and Research Institute, Vancouver, British Columbia, Canada
| | - Christine Seroogy
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - David Shyr
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, UT, USA.,Division of Stem Cell Transplant, Department of Pediatrics, Stanford Medicine, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Subhadra Siegel
- Division of Pediatric Pulmonology, Allergy and Immunology and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Angela R Smith
- Pediatric Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Troy R Torgerson
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - Mark T Vander Lugt
- Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, MI, USA
| | - Lolie C Yu
- Division of Heme-Onc/HSCT, Children's Hospital/LSUHSC, New Orleans, LA, USA
| | - Morton J Cowan
- Division of Pediatric Allergy, Immunology, & Bone Marrow Transplant, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Rebecca H Buckley
- Division of Allergy and Immunology, Department of Pediatrics and Department of Immunology, Duke University School of Medicine, Durham, NC, USA
| | - Christopher C Dvorak
- Division of Pediatric Allergy, Immunology, & Bone Marrow Transplant, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Linda M Griffith
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Elie Haddad
- Pediatric Immunology and Rheumatology Division, CHU Sainte-Justine, Department of Pediatrics, Department of Microbiology, Immunology and Infectious Disease, University of Montreal, Montreal, QC, Canada
| | - Donald B Kohn
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Brent Logan
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Luigi D Notarangelo
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Sung-Yun Pai
- Division of Hematology-Oncology, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jennifer Puck
- Division of Pediatric Allergy, Immunology, & Bone Marrow Transplant, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Michael A Pulsipher
- Section of Transplantation and Cellular Therapy, Children's Hospital Los Angeles Cancer and Blood Diseases Institute, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Jennifer Heimall
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Wood 3301, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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6
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Sacco KA, Smith MJ, Bahna SL, Buchbinder D, Burkhardt J, Cooper MA, Hartog NL, Kobrynski L, Patel KP, Abraham RS. NAPDH Oxidase-Specific Flow Cytometry Allows for Rapid Genetic Triage and Classification of Novel Variants in Chronic Granulomatous Disease. J Clin Immunol 2019; 40:191-202. [DOI: 10.1007/s10875-019-00712-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 10/21/2019] [Indexed: 01/11/2023]
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7
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Shams M, Kobrynski L. Management of ADA-Deficient SCID Patient on Adagen During Pregnancy. J Clin Immunol 2019; 39:846-848. [PMID: 31620946 DOI: 10.1007/s10875-019-00692-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 09/16/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Marissa Shams
- Emory University School of Medicine, Atlanta, GA, USA. .,The Emory Clinic, Atlanta, GA, USA.
| | - Lisa Kobrynski
- Emory University School of Medicine, Atlanta, GA, USA.,Children's Healthcare of Atlanta, Atlanta, GA, USA
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8
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Shamriz O, Patel K, Marsh RA, Bleesing J, Joshi AY, Lucas L, Prince C, Pencheva BB, Kobrynski L, Chandrakasan S. Hypogammaglobulinemia with decreased class-switched B-cells and dysregulated T-follicular-helper cells in IPEX syndrome. Clin Immunol 2018; 197:219-223. [PMID: 30368009 DOI: 10.1016/j.clim.2018.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 07/29/2018] [Revised: 09/27/2018] [Accepted: 10/11/2018] [Indexed: 12/21/2022]
Abstract
Early onset multisystem autoimmunity is commonly the defining feature of IPEX. Recurrent sinopulmonary infections and CVID-like phenotype were not previously recognized as a presentation in IPEX. Herein, we describe three extended family members with IPEX. In addition to autoimmunity, all three had a CVID-like presentation consisting of recurrent sinopulmonary infections, hypogammaglobulinemia and B-cell class switching defect. In vitro studies have shown that the B cell class switching defect is not B cell intrinsic. Additionally, a marked increase in circulating T follicular helper (cTFH) cells with high IFN-γ and IL-17 secretion on stimulation was noted in our patients. The dysregulated cTFH cells could contribute to a decreased B cell class switching. However, the exact mechanism of how expanded and dysregulated cTFH lead to B cell class switching defect and hypogammaglobulinemia in our patients is not clear. Our study could extend the clinical spectrum of IPEX to include a CVID-like presentation.
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Affiliation(s)
- Oded Shamriz
- Division of Bone Marrow Transplant, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA; Pediatric Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Kiran Patel
- Allergy/Immunology, Emory University, Atlanta, GA, USA
| | - Rebecca A Marsh
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jacob Bleesing
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Avni Y Joshi
- Division of Pediatric Allergy and Immunology, Mayo Clinic Children's Center, Rochester, MN, USA
| | - Laura Lucas
- Division of Bone Marrow Transplant, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Chengyu Prince
- Division of Bone Marrow Transplant, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Bojana B Pencheva
- Pediatric Cancer Predisposition Clinic, Aflac Cancer and Blood Disorders Center, Atlanta, GA, USA
| | | | - Shanmuganathan Chandrakasan
- Division of Bone Marrow Transplant, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.
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9
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Heimall JR, Hagin D, Hajjar J, Henrickson SE, Hernandez-Trujillo HS, Itan Y, Kobrynski L, Paris K, Torgerson TR, Verbsky JW, Wasserman RL, Hsieh EWY, Bleesing JJ, Chou JS, Lawrence MG, Marsh RA, Rosenzweig SD, Orange JS, Abraham RS. Correction to: Use of Genetic Testing for Primary Immunodeficiency Patients. J Clin Immunol 2018; 38:540-541. [PMID: 29781065 DOI: 10.1007/s10875-018-0510-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The original version of this article unfortunately contained mistakes in some of the author names and affiliations. The correct list of author names and affiliations is below, with the corrections in bold.
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Affiliation(s)
- Jennifer R Heimall
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, University of Pennsylvania, Wood Building 3rd Floor, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - David Hagin
- Allergy and Immunology Division, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Joud Hajjar
- Department of Pediatrics, Section of Immunology, Allergy and Rheumatology, Baylor College of Medicine, Houston, TX, USA
| | - Sarah E Henrickson
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.,Institute for Immunology, University of Pennsylvania, Philadelphia, PA, USA
| | - Hillary S Hernandez-Trujillo
- Division of Infectious Disease & Immunology, Connecticut Children's Medical Center, Hartford, CT, USA.,CT Asthma and Allergy Center, Hartford, West, CT, USA
| | - Yuval Itan
- Icahn School of Medicine at Mount Sinai, The Charles Bronfman Institute for Personalized Medicine, New York, NY, USA.,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Kenneth Paris
- Division of Allergy-Immunology, LSU Health Sciences Center, Children's Hospital, New Orleans, LA, USA
| | - Troy R Torgerson
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - James W Verbsky
- Pediatrics and Microbiology and Molecular Genetics Section of Pediatric Rheumatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Elena W Y Hsieh
- Department of Immunology and Microbiology, Department of Pediatrics, Division of Allergy and Immunology, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Jack J Bleesing
- Division of Bone Marrow Transplantation and Immune Deficiency, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Janet S Chou
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Monica G Lawrence
- Division of Asthma, Allergy and Clinical Immunology, University of Virginia Health System, Charlottesville, VA, USA
| | - Rebecca A Marsh
- Bone Marrow Transplantation and Immune Deficiency, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Jordan S Orange
- Immunology, Allergy and Rheumatology, Director, Center for Human Immunobiology, Texas Children's Hospital, Houston, TX, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Roshini S Abraham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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10
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Heimall JR, Hagin D, Hajjar J, Henrickson SE, Hernandez-Trujillo HS, Tan Y, Kobrynski L, Paris K, Torgerson TR, Verbsky JW, Wasserman RL, Hsieh EWY, Blessing JJ, Chou JS, Lawrence MG, Marsh RA, Rosenzweig SD, Orange JS, Abraham RS. Use of Genetic Testing for Primary Immunodeficiency Patients. J Clin Immunol 2018; 38:320-329. [PMID: 29675737 DOI: 10.1007/s10875-018-0489-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 03/16/2018] [Indexed: 12/11/2022]
Abstract
Genetic testing plays a critical role in diagnosis for many primary immunodeficiency diseases. The goals of this report are to outline some of the challenges that clinical immunologists face routinely in the use of genetic testing for patient care. In addition, we provide a review of the types of genetic testing used in the diagnosis of PID, including their strengths and limitations. We describe the strengths and limitations of different genetic testing approaches for specific clinical contexts that raise concern for specific PID disorders in light of the challenges reported by the clinical immunologist members of the CIS in a recent membership survey. Finally, we delineate the CIS's recommendations for the use of genetic testing in light of these issues.
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Affiliation(s)
- Jennifer R Heimall
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, University of Pennsylvania, Wood Building 3rd Floor, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - David Hagin
- Allergy and Immunology Division, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Joud Hajjar
- Department of Pediatrics, Section of Immunology, Allergy and Rheumatology, Baylor College of Medicine, Houston, TX, USA
| | - Sarah E Henrickson
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, University of Pennsylvania, Wood Building 3rd Floor, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Wherry Lab, University of Pennsylvania, Philadelphia, PA, USA
| | - Hillary S Hernandez-Trujillo
- Division of Infectious Disease & Immunology, Connecticut Children's Medical Center, Hartford, CT, USA
- CT Asthma and Allergy Center, West Hartford, CT, USA
| | - Yuval Tan
- The Charles Bronfman Institute of Personalized Medicine, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Kenneth Paris
- Division of Allergy-Immunology, LSU Health Sciences Center, Children's Hospital, New Orleans, LA, USA
| | - Troy R Torgerson
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - James W Verbsky
- Pediatrics and Microbiology and Molecular Genetics Section of Pediatric Rheumatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Elena W Y Hsieh
- Department of Immunology and Microbiology, Department of Pediatrics, Division of Allergy and Immunology, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Jack J Blessing
- Division of Bone Marrow Transplantation and Immune Deficiency, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Janet S Chou
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Monica G Lawrence
- Division of Asthma, Allergy and Clinical Immunology, University of Virginia Health System, Charlottesville, VA, USA
| | - Rebecca A Marsh
- Bone Marrow Transplantation and Immune Deficiency, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Jordan S Orange
- Center for Human Immunobiology, Texas Children's Hospital, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Roshini S Abraham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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11
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Paris K, Hussain I, Darter A, Kobrynski L, Berner T, McCoy B, Rabbat C, Yel L. P281 Adverse events and infusion parameters of IG20GLY in PIDD patients whose pre-study treatment was IVIG. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Boudjemia K, Wasserman R, Stein M, Kobrynski L, Leibl H, Yel L. Sécurité d’emploi, efficacité et tolérance à long terme de la perfusion sous-cutanée d’immunoglobulines G facilitée par la hyaluronidase humaine recombinante chez des enfants et des adultes atteints de déficit immunitaire primitif (DIP). Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.03.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Stein M, Wasserman R, Melamed I, Gupta S, Kobrynski L, Rubinstein A, Rabbat C, Engl W, McCoy B, Leibl H, Yel L. P254 Local adverse reactions decreased over time during IGHY treatment in patients with PIDD. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Russo C, Kobrynski L. P194 22Q11.2 deletion syndrome with severe congenital neutropenia. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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de la Morena MT, Leonard D, Torgerson TR, Cabral-Marques O, Slatter M, Aghamohammadi A, Chandra S, Murguia-Favela L, Bonilla FA, Kanariou M, Damrongwatanasuk R, Kuo CY, Dvorak CC, Meyts I, Chen K, Kobrynski L, Kapoor N, Richter D, DiGiovanni D, Dhalla F, Farmaki E, Speckmann C, Español T, Shcherbina A, Hanson IC, Litzman J, Routes JM, Wong M, Fuleihan R, Seneviratne SL, Small TN, Janda A, Bezrodnik L, Seger R, Raccio AG, Edgar JDM, Chou J, Abbott JK, van Montfrans J, González-Granado LI, Bunin N, Kutukculer N, Gray P, Seminario G, Pasic S, Aquino V, Wysocki C, Abolhassani H, Dorsey M, Cunningham-Rundles C, Knutsen AP, Sleasman J, Costa Carvalho BT, Condino-Neto A, Grunebaum E, Chapel H, Ochs HD, Filipovich A, Cowan M, Gennery A, Cant A, Notarangelo LD, Roifman CM. Long-term outcomes of 176 patients with X-linked hyper-IgM syndrome treated with or without hematopoietic cell transplantation. J Allergy Clin Immunol 2016; 139:1282-1292. [PMID: 27697500 DOI: 10.1016/j.jaci.2016.07.039] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [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: 01/25/2016] [Revised: 06/29/2016] [Accepted: 07/26/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND X-linked hyper-IgM syndrome (XHIGM) is a primary immunodeficiency with high morbidity and mortality compared with those seen in healthy subjects. Hematopoietic cell transplantation (HCT) has been considered a curative therapy, but the procedure has inherent complications and might not be available for all patients. OBJECTIVES We sought to collect data on the clinical presentation, treatment, and follow-up of a large sample of patients with XHIGM to (1) compare long-term overall survival and general well-being of patients treated with or without HCT along with clinical factors associated with mortality and (2) summarize clinical practice and risk factors in the subgroup of patients treated with HCT. METHODS Physicians caring for patients with primary immunodeficiency diseases were identified through the Jeffrey Modell Foundation, United States Immunodeficiency Network, Latin American Society for Immunodeficiency, and Primary Immune Deficiency Treatment Consortium. Data were collected with a Research Electronic Data Capture Web application. Survival from time of diagnosis or transplantation was estimated by using the Kaplan-Meier method compared with log-rank tests and modeled by using proportional hazards regression. RESULTS Twenty-eight clinical sites provided data on 189 patients given a diagnosis of XHIGM between 1964 and 2013; 176 had valid follow-up and vital status information. Sixty-seven (38%) patients received HCT. The average follow-up time was 8.5 ± 7.2 years (range, 0.1-36.2 years). No difference in overall survival was observed between patients treated with or without HCT (P = .671). However, risk associated with HCT decreased for diagnosis years 1987-1995; the hazard ratio was significantly less than 1 for diagnosis years 1995-1999. Liver disease was a significant predictor of overall survival (hazard ratio, 4.9; 95% confidence limits, 2.2-10.8; P < .001). Among survivors, those treated with HCT had higher median Karnofsky/Lansky scores than those treated without HCT (P < .001). Among patients receiving HCT, 27 (40%) had graft-versus-host disease, and most deaths occurred within 1 year of transplantation. CONCLUSION No difference in survival was observed between patients treated with or without HCT across all diagnosis years (1964-2013). However, survivors treated with HCT experienced somewhat greater well-being, and hazards associated with HCT decreased, reaching levels of significantly less risk in the late 1990s. Among patients treated with HCT, treatment at an early age is associated with improved survival. Optimism remains guarded as additional evidence accumulates.
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Affiliation(s)
- M Teresa de la Morena
- University of Texas Southwestern Medical Center and Children's Medical Center, Children's Health, Dallas, Tex.
| | - David Leonard
- University of Texas Southwestern Medical Center and Children's Medical Center, Children's Health, Dallas, Tex
| | - Troy R Torgerson
- University of Washington and Seattle Children's Research Institute, Seattle, Wash
| | | | - Mary Slatter
- Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Asghar Aghamohammadi
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sharat Chandra
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | | | - Caroline Y Kuo
- Geffen SOM at David Geffen School of Medicine at UCLA, Los Angeles, Calif
| | | | | | - Karin Chen
- University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Neena Kapoor
- Children's Hospital Los Angeles, Keck School of Medicine, Los Angeles, Calif
| | | | | | | | | | - Carsten Speckmann
- Department of Pediatrics and Adolescent Medicine, Center for Chronic Immunodeficiency University Medical Center, Freiburg, Germany
| | | | - Anna Shcherbina
- Research and Clinical Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | | | - Jiri Litzman
- Department of Clinical Immunology and Allergology, St Anne's University Hospital in Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | - Melanie Wong
- Children's Hospital at Westmead, Sydney, Australia
| | - Ramsay Fuleihan
- Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Ill
| | | | - Trudy N Small
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Ales Janda
- University Hospital Motol, Prague, Czech Republic
| | | | | | | | | | - Janet Chou
- Children's Hospital Boston, Boston, Mass
| | | | - Joris van Montfrans
- Division Pediatrics, Pediatrische Immunologie en Infectieziekten, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands
| | - Luis Ignacio González-Granado
- Unidad de Immunodeficiencias Primarias y la Unidad de Hematología y Oncología Pediátrica, Instituto de Investigacíon Hospital 12 de Octubre, Madrid, Spain
| | - Nancy Bunin
- Children's Hospital of Philadelphia, Philadelphia, Pa
| | | | - Paul Gray
- Sydney Children's Hospital, Randwick, Australia
| | | | - Srdjan Pasic
- Mother & Child Health Institute, Belgrade, Serbia
| | - Victor Aquino
- University of Texas Southwestern Medical Center and Children's Medical Center, Children's Health, Dallas, Tex
| | - Christian Wysocki
- University of Texas Southwestern Medical Center and Children's Medical Center, Children's Health, Dallas, Tex
| | - Hassan Abolhassani
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | | | - Beatriz Tavares Costa Carvalho
- Division of Allergy-Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - Antonio Condino-Neto
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | | | | | - Hans D Ochs
- University of Washington and Seattle Children's Research Institute, Seattle, Wash
| | | | | | - Andrew Gennery
- Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Andrew Cant
- Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Luigi D Notarangelo
- Laboratory of Host Defenses, NIAID, National Institutes of Health, Bethesda, Md
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16
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Wasserman RL, Melamed I, Kobrynski L, Puck J, Gupta S, Doralt J, Sharkhawy M, Engl W, Leibl H, Gelmont D, Yel L. Recombinant human hyaluronidase facilitated subcutaneous immunoglobulin treatment in pediatric patients with primary immunodeficiencies: long-term efficacy, safety and tolerability. Immunotherapy 2016; 8:1175-86. [PMID: 27468136 DOI: 10.2217/imt-2016-0066] [Citation(s) in RCA: 21] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
AIM To assess the long-term efficacy, safety and tolerability of recombinant human hyaluronidase-facilitated subcutaneous infusion of immunoglobulin (Ig) (fSCIG; HYQVIA(®); IGHy) in children aged <18 years. PATIENTS & METHODS Patients with primary immunodeficiency diseases were included in the studies. IGHy was administered every 3 or 4 weeks. RESULTS Validated acute serious bacterial infections were reported at 0.08/patient-year (four pneumonia episodes in three patients). No serious adverse drug reaction (ADR) was reported, and rates of local and systemic ADRs were low (0.09/infusion and 0.1/infusion). Infection rates were low (3.02/patient-year) with sustained Ig trough levels (median: 1009 mg/dl). Of 674 IGHy infusions, 97.2% required no change of administration due to ADR, in most (82.5%) with one infusion site. No patient developed neutralizing anti-rHuPH20 antibodies. Postpivotal study, 100% of patients aged <14 years or their caregivers and 85.7% of patients aged 14 to <18 years expressed preference for IGHy compared with Ig administered intravenously or Ig administered subcutaneously. CONCLUSION These studies, with the longest (maximum: 3.3 years) duration of any reported Ig replacement trials in children with primary immunodeficiency diseases, showed low infection, local and systemic reaction rates along with well-tolerated infusions given in a single site.
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Affiliation(s)
| | | | | | - Jennifer Puck
- University of California, San Francisco, San Francisco, CA, USA
| | - Sudhir Gupta
- University of California, Irvine, Irvine, CA, USA
| | - Jennifer Doralt
- Baxalta Innovations GmbH, now part of Shire, Vienna, Austria
| | | | - Werner Engl
- Baxalta Innovations GmbH, now part of Shire, Vienna, Austria
| | - Heinz Leibl
- Baxalta Innovations GmbH, now part of Shire, Vienna, Austria
| | - David Gelmont
- Baxalta US Inc., now part of Shire, Cambridge, MA, USA
| | - Leman Yel
- University of California, Irvine, Irvine, CA, USA.,Baxalta US Inc., now part of Shire, Cambridge, MA, USA
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17
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Wasserman RL, Melamed I, Stein MR, Engl W, Sharkhawy M, Leibl H, Puck J, Rubinstein A, Kobrynski L, Gupta S, Grant AJ, Ratnayake A, Richmond WG, Church J, Yel L, Gelmont D. Long-Term Tolerability, Safety, and Efficacy of Recombinant Human Hyaluronidase-Facilitated Subcutaneous Infusion of Human Immunoglobulin for Primary Immunodeficiency. J Clin Immunol 2016; 36:571-82. [PMID: 27220317 PMCID: PMC4940441 DOI: 10.1007/s10875-016-0298-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 05/11/2016] [Indexed: 11/27/2022]
Abstract
Purpose Treatment of primary immunodeficiency diseases (PIDD) with subcutaneous (SC) infusions of IgG preceded by injection of recombinant human hyaluronidase (rHuPH20) (IGHy) to increase SC tissue permeability was evaluated in two consecutive, prospective, non-controlled, multi-center studies. Methods Subjects >4 years of age received SC IgG replacement at a weekly dose equivalent of 108 % of their previous intravenous (IV) dose, facilitated by prior injection of 75 U/g IgG of rHuPH20. Starting with weekly SC infusions, the interval was increased (ramped-up) to a 3- or 4-week schedule. Results Eighty-three subjects (24 < 18 years; 59 ≥ 18 years) received 2729 infusions (excluding ramp-up) at a mean dose of 0.155 g/kg/week in the pivotal and 0.156 g/kg/week in the extension study. IGHy exposure exceeded 30 months in 48 subjects. During 187.7 subject-years of IGHy exposure, 2005 adverse events (AEs) (10.68 per subject-year) occurred. The rate of related systemic AEs during consecutive 1-year periods remained low; the rate of related local AEs decreased from 3.68/subject-year in months 1–12 to approximately 1.50/subject-year after 30 months of treatment. Fifteen subjects transiently developed anti-rHuPH20 binding antibody. There was no difference in AE rates in these subjects before and after the first titer increase to ≥1:160. The rate of infections during IGHy exposure was 2.99 per subject-year and did not increase during the studies. Annual infection rates were 3.02 in subjects <18 years and 2.98 in subjects ≥18 years. Conclusions Long-term replacement therapy with IGHy was safe and effective in 83 pediatric and adult subjects with PIDD. Electronic supplementary material The online version of this article (doi:10.1007/s10875-016-0298-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Isaac Melamed
- IMMUNOe Clinical Research Center, Centennial, CO, USA
| | - Mark R Stein
- Allergy Associates of the Palm Beaches, North Palm Beach, FL, USA
| | | | | | | | - Jennifer Puck
- University of California San Francisco, San Francisco, CA, USA
| | - Arye Rubinstein
- Allergy & Immunology Division, Montefiore Medical Center, Bronx, NY, USA
| | - Lisa Kobrynski
- Emory Children's Center, Emory University, Atlanta, GA, USA
| | | | | | | | | | - Joseph Church
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | - David Gelmont
- Baxalta US Inc., Westlake Village, CA, 91362-3811, USA.
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18
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Ding Y, Thompson JD, Kobrynski L, Ojodu J, Zarbalian G, Grosse SD. Cost-Effectiveness/Cost-Benefit Analysis of Newborn Screening for Severe Combined Immune Deficiency in Washington State. J Pediatr 2016; 172:127-35. [PMID: 26876279 PMCID: PMC4846488 DOI: 10.1016/j.jpeds.2016.01.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 12/16/2015] [Accepted: 01/07/2016] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate the expected cost-effectiveness and net benefit of the recent implementation of newborn screening (NBS) for severe combined immunodeficiency (SCID) in Washington State. STUDY DESIGN We constructed a decision analysis model to estimate the costs and benefits of NBS in an annual birth cohort of 86 600 infants based on projections of avoided infant deaths. Point estimates and ranges for input variables, including the birth prevalence of SCID, proportion detected asymptomatically without screening through family history, screening test characteristics, survival rates, and costs of screening, diagnosis, and treatment were derived from published estimates, expert opinion, and the Washington NBS program. We estimated treatment costs stratified by age of identification and SCID type (with or without adenosine deaminase deficiency). Economic benefit was estimated using values of $4.2 and $9.0 million per death averted. We performed sensitivity analyses to evaluate the influence of key variables on the incremental cost-effectiveness ratio (ICER) of net direct cost per life-year saved. RESULTS Our model predicts an additional 1.19 newborn infants with SCID detected preclinically through screening, in addition to those who would have been detected early through family history, and 0.40 deaths averted annually. Our base-case model suggests an ICER of $35 311 per life-year saved, and a benefit-cost ratio of either 5.31 or 2.71. Sensitivity analyses found ICER values <$100 000 and positive net benefit for plausible assumptions on all variables. CONCLUSIONS Our model suggests that NBS for SCID in Washington is likely to be cost-effective and to show positive net economic benefit.
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Affiliation(s)
- Yao Ding
- Association of Public Health Laboratories, Newborn Screening and Genetics, Silver Spring, MD
| | - John D. Thompson
- Washington State Department of Health, Office of Newborn Screening, Shoreline, WA
| | - Lisa Kobrynski
- Allergy Division, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Jelili Ojodu
- Association of Public Health Laboratories, Newborn Screening and Genetics, Silver Spring, MD
| | - Guisou Zarbalian
- Association of Public Health Laboratories, Newborn Screening and Genetics, Silver Spring, MD
| | - Scott D. Grosse
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA
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19
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Patel NC, Gallagher JL, Ochs HD, Atkinson TP, Wahlstrom J, Dorsey M, Bonilla FA, Heimall J, Kobrynski L, Morris D, Haddad E. Subcutaneous Immunoglobulin Replacement Therapy with Hizentra® is Safe and Effective in Children Less Than 5 Years of Age. J Clin Immunol 2015; 35:558-65. [PMID: 26336818 PMCID: PMC4572047 DOI: 10.1007/s10875-015-0190-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 08/17/2015] [Indexed: 11/29/2022]
Abstract
Background Hizentra® (IGSC 20 %) is a 20 % liquid IgG product approved for subcutaneous administration in adults and children 2 years of age and older who have primary immunodeficiency disease (PIDD). There is limited information about the use of IGSC 20 % in very young children including those less than 5 years of age. Methods A retrospective chart review involved 88 PIDD infants and children less than 5 years of age who received Hizentra®. Results The mean age at the start of Hizentra® was 34 months (range 2 to 59 months). IGSC 20 % was administered weekly to 86 infants (two additional infants received twice weekly and three times weekly infusions, respectively) and included an average of 63 infusions (range 6–182) for an observation period up to 45.5 months. Infusion by manual delivery occurred in 15 patients. The mean dose was 674 mg/kg/4 weeks. The mean IgG level was 942 mg/dL while on IGSC 20 %, compared to a mean trough IgG level of 794 mg/dL (p < 0.0001) during intravenous or subcutaneous IgG administration prior to IGSC 20 %. Average infusion time was 47 (range 5–120) minutes, and the median number of infusion sites was 2 (range 1–4). Local reactions were mostly mild and observed in 36/88 (41 %) children. No serious adverse events were reported. A significant increase in weight percentile (7 % ± 19.2, p = 0.0012) among subjects was observed during IGSC 20 % administration. The rate of serious bacterial infections was 0.067 per patient-year while receiving IGSC 20 %, similar to previously reported efficacy studies. Conclusions Hizentra® is effective in preventing infections, and is well tolerated in children less than age 5 years.
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Affiliation(s)
- Niraj C Patel
- Department of Pediatrics, Section of Infectious Disease and Immunology, Levine Children's Hospital at Carolinas Medical Center, PO Box 32861, Charlotte, NC, 28203, USA.
| | - Joel L Gallagher
- Department of Pediatrics, Section of Infectious Disease and Immunology, Levine Children's Hospital at Carolinas Medical Center, PO Box 32861, Charlotte, NC, 28203, USA.,Medical College of Wisconsin, Milwaukee, WI, USA
| | - Hans D Ochs
- Department of Pediatrics, Seattle Children's Research Institute and University of Washington, Seattle, WA, USA
| | | | - Justin Wahlstrom
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Morna Dorsey
- Department of Pediatrics, University of California, San Francisco, CA, USA.,Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | | | - Jennifer Heimall
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lisa Kobrynski
- Department of Pediatrics, Emory University, Atlanta, GA, USA
| | | | - Elie Haddad
- Department of Pediatrics, Department of Microbiology, Infectiology, and Immunology, University of Montreal, Québec, Canada
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20
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Archer SR, Abramowsky CR, Kobrynski L, Simoneaux S, Vogler LB, Ricketts RR, Parker C, Elawahbdeh N, Shehata BM. Malakoplakia and primary immunodeficiency. J Pediatr 2014; 165:1053-6. [PMID: 25155967 DOI: 10.1016/j.jpeds.2014.07.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 05/21/2014] [Accepted: 07/16/2014] [Indexed: 11/24/2022]
Abstract
Malakoplakia, a rare granulomatous disease caused by impaired macrophage response, has been reported only rarely in children. We report 3 unique cases, with lesions occurring in unusual locations in children with primary immune deficiencies.
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Affiliation(s)
- Sydney R Archer
- Department of Pathology, Children's Healthcare of Atlanta, Atlanta, GA; Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA
| | - Carlos R Abramowsky
- Department of Pathology, Children's Healthcare of Atlanta, Atlanta, GA; Department of Pathology, Emory University School of Medicine, Atlanta, GA
| | - Lisa Kobrynski
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA
| | - Stephen Simoneaux
- Department of Pediatric Radiology, Emory University School of Medicine, Atlanta, GA
| | - Larry B Vogler
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA
| | - Richard R Ricketts
- Department of Pediatric Surgery, Emory University School of Medicine, Atlanta, GA
| | - Cecily Parker
- Department of Pathology, Children's Healthcare of Atlanta, Atlanta, GA
| | - Nancy Elawahbdeh
- Department of Pathology, Children's Healthcare of Atlanta, Atlanta, GA
| | - Bahig M Shehata
- Department of Pathology, Children's Healthcare of Atlanta, Atlanta, GA; Department of Pathology, Emory University School of Medicine, Atlanta, GA.
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21
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Kobrynski L, Powell RW, Bowen S. Prevalence and morbidity of primary immunodeficiency diseases, United States 2001-2007. J Clin Immunol 2014; 34:954-61. [PMID: 25257253 DOI: 10.1007/s10875-014-0102-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 09/17/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Few studies have estimated population prevalence and morbidity of primary immunodeficiency diseases (PIDD). We used administrative healthcare databases to estimate the prevalence of PIDD diagnoses in the United States from 2001 to 2007. METHODS MarketScan databases compile claims from commercial health insurance plans and Medicaid, recording individual diagnoses for outpatient encounters and hospital stays. We used a cross sectional survey to estimate prevalence of PIDD using related ICD-9 codes (279.0, 279.1, 279.2, 279.8, 279.9, 288.1 and 288.2). Persons with secondary immunodeficiency diagnoses were excluded from analysis. RESULTS Between 2001 and 2007, prevalence of any PIDD diagnosis increased from 38.9 to 50.5 per 100,000 among privately insured and from 29.1 to 41.1 per 100,000 among publicly insured persons. B cell defects predominated. Prevalence was more than twice as high among Whites as among Blacks or Hispanics. CONCLUSION In this large database, we found a higher prevalence of diagnosed PIDD than has been reported previously from registries. Increased awareness may have contributed to the increasing prevalence.
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Affiliation(s)
- Lisa Kobrynski
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Dr., Atlanta, GA, 30322, USA,
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22
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Koontz D, Baecher K, Kobrynski L, Nikolova S, Gallagher M. A pyrosequencing-based assay for the rapid detection of the 22q11.2 deletion in DNA from buccal and dried blood spot samples. J Mol Diagn 2014; 16:533-540. [PMID: 24973633 DOI: 10.1016/j.jmoldx.2014.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/01/2014] [Accepted: 05/27/2014] [Indexed: 10/25/2022] Open
Abstract
The 22q11.2 deletion syndrome is one of the most common deletion syndromes in newborns. Some affected newborns may be diagnosed shortly after birth because of the presence of heart defects, palatal defects, or severe immune deficiencies. However, diagnosis is often delayed in patients presenting with other associated conditions that would benefit from early recognition and treatment, such as speech delays, learning difficulties, and schizophrenia. Fluorescence in situ hybridization (FISH) is the gold standard for deletion detection, but it is costly and time consuming and requires a whole blood specimen. Our goal was to develop a suitable assay for population-based screening of easily collectible specimens, such as buccal swabs and dried blood spots (DBS). We designed a pyrosequencing assay and validated it using DNA from FISH-confirmed 22q11 deletion syndrome patients and normal controls. We tested DBS from nine patients and paired buccal cell and venous blood specimens from 20 patients. Results were 100% concordant with FISH assay results. DNA samples from normal controls (n = 180 cell lines, n = 15 DBS, and n = 88 buccal specimens) were negative for the deletion. Limiting dilution experiments demonstrated that accurate results could be obtained from as little as 1 ng of DNA. This method represents a reliable and low-cost alternative for detection of the common 22q11.2 microdeletions and can be adapted to high-throughput population screening.
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Affiliation(s)
- Deborah Koontz
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Kirsten Baecher
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa Kobrynski
- Allergy and Immunology Section, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Stanimila Nikolova
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Margaret Gallagher
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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23
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Routes J, Abinun M, Al-Herz W, Bustamante J, Condino-Neto A, De La Morena MT, Etzioni A, Gambineri E, Haddad E, Kobrynski L, Le Deist F, Nonoyama S, Oliveira JB, Perez E, Picard C, Rezaei N, Sleasman J, Sullivan KE, Torgerson T. ICON: the early diagnosis of congenital immunodeficiencies. J Clin Immunol 2014; 34:398-424. [PMID: 24619621 DOI: 10.1007/s10875-014-0003-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 02/17/2014] [Indexed: 01/27/2023]
Abstract
Primary immunodeficiencies are intrinsic defects in the immune system that result in a predisposition to infection and are frequently accompanied by a propensity to autoimmunity and/or immunedysregulation. Primary immunodeficiencies can be divided into innate immunodeficiencies, phagocytic deficiencies, complement deficiencies, disorders of T cells and B cells (combined immunodeficiencies), antibody deficiencies and immunodeficiencies associated with syndromes. Diseases of immune dysregulation and autoinflammatory disorder are many times also included although the immunodeficiency in these disorders are often secondary to the autoimmunity or immune dysregulation and/or secondary immunosuppression used to control these disorders. Congenital primary immunodeficiencies typically manifest early in life although delayed onset are increasingly recognized. The early diagnosis of congenital immunodeficiencies is essential for optimal management and improved outcomes. In this International Consensus (ICON) document, we provide the salient features of the most common congenital immunodeficiencies.
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Affiliation(s)
- John Routes
- Department of Pediatrics, Medical College of Wisconsin, and Children's Research Institute, Milwaukee, WI, 53226-4874, USA,
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24
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Patel K, Akhter J, Kobrynski L, Benjamin Gathmann MA, Davis O, Sullivan KE. Immunoglobulin deficiencies: the B-lymphocyte side of DiGeorge Syndrome. J Pediatr 2012; 161:950-3. [PMID: 22809661 DOI: 10.1016/j.jpeds.2012.06.018] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 05/17/2012] [Accepted: 06/07/2012] [Indexed: 11/16/2022]
Abstract
DiGeorge syndrome is associated with a T-lymphocyte immunodeficiency. The prevalence of hypogammaglobulinemia has not been reported. We found that 3% of patients with DiGeorge syndrome were receiving immunoglobulin replacement therapy and 6% of patients over the age of 3 years had hypogammaglobulinemia. We conclude that DiGeorge syndrome is associated with significant humoral immune deficiency.
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Affiliation(s)
- Kiran Patel
- Division of Allergy Immunology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
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25
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Abstract
Since the 1950s, replacement of immunoglobulin G using human immunoglobulin has been the standard treatment for primary immunodeficiency diseases with defects in antibody production. These patients suffer from recurrent and severe infections, which cause lung damage and shorten their life span. Immunoglobulins given intravenously (IVIG) every 3-4 weeks are effective in preventing serious bacterial infections and improving the quality of life for treated patients. Administration of immunoglobulin subcutaneously (SCIG) is equally effective in preventing infections and has a lower incidence of serious adverse effects compared to IVIG. The tolerability and acceptability of SCIG has been demonstrated in numerous studies showing improvements in quality of life and a preference for subcutaneous immunoglobulin therapy in patients with antibody deficiencies.
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Affiliation(s)
- Lisa Kobrynski
- Department of Pediatrics, Emory University, Atlanta, GA, USA
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26
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Demuth KA, Kobrynski L, Galina M, Chimento JS, Shaw J. Allergy academy: a novel program for allergy nursing and clinic staff education. Ann Allergy Asthma Immunol 2012; 109:72-4. [PMID: 22727162 DOI: 10.1016/j.anai.2012.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 03/24/2012] [Accepted: 04/20/2012] [Indexed: 10/28/2022]
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27
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Veerapandiyan A, Abdul-Rahman OA, Adam MP, Lyons MJ, Manning M, Coleman K, Kobrynski L, Taneja D, Schoch K, Zimmerman HH, Shashi V. Chromosome 22q11.2 deletion syndrome in African-American patients: a diagnostic challenge. Am J Med Genet A 2011; 155A:2186-95. [PMID: 21834039 DOI: 10.1002/ajmg.a.34226] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 06/09/2011] [Indexed: 11/08/2022]
Abstract
Chromosome 22q11.2 deletion syndrome (22q11DS) is associated with numerous and variable clinical manifestations including conotruncal heart abnormalities, palatal anomalies, hypoparathyroidism, immune deficiency, and cognitive deficits. The clinical suspicion of this syndrome is often heightened by the presence of characteristic facial features. A previous report highlighted the under-diagnosis of this condition in African Americans, thought to be related to a paucity of typical facial features. We ascertained the largest cohort (n = 50) of African-American individuals with 22q11DS reported thus far, across five genetics centers in the United States and report on their facial and other phenotypic features. About 3/4 of our cohort has at least one dysmorphic facial feature. Auricular abnormalities, especially small ears, are the most common dysmorphic facial feature followed by nasal and ocular abnormalities. Skeletal findings are seen in about 2/3 of our cohort, higher than the typical frequency reported in 22q11DS. Cardiac anomalies, developmental delay, and palatal abnormalities are seen at a lower frequency in our cohort. Thus, it is evident that the features traditionally associated with 22q11DS are difficult to recognize in African-American individuals with this syndrome, due to both altered frequencies of major anomalies and a non-classic facial appearance. Therefore, a high index of suspicion is needed to recognize 22q11DS in African-American individuals.
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Affiliation(s)
- Aravindhan Veerapandiyan
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina 27710, USA
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28
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Wasserman RL, Melamed I, Kobrynski L, Strausbaugh SD, Stein MR, Sharkhawy M, Engl W, Leibl H, Sobolevsky L, Gelmont D, Schiff RI, Grossman WJ. Efficacy, safety, and pharmacokinetics of a 10% liquid immune globulin preparation (GAMMAGARD LIQUID, 10%) administered subcutaneously in subjects with primary immunodeficiency disease. J Clin Immunol 2011; 31:323-31. [PMID: 21424824 DOI: 10.1007/s10875-011-9512-z] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 02/21/2011] [Indexed: 11/26/2022]
Abstract
A multi-center, prospective, open-label study was conducted in primary immunodeficiency disease patients to determine the tolerability and pharmacokinetics of a 10% liquid IgG preparation administered subcutaneously. Forty-nine subjects (3-77 years old) were enrolled. Pharmacokinetic equivalence of subcutaneous treatment was achieved at a median dose of 137% of the intravenous dose, with a mean trough IgG level of 1,202 mg/dL at the end of the assessment period. The overall infection rate during subcutaneous treatment was 4.1 per subject-year. Three acute serious bacterial infections were reported, resulting in a rate of 0.067 per subject-year. A low overall rate of temporally associated adverse events (8%), and a very low rate of infusion site adverse events (2.8%), was seen at volumes up to 30 mL/site and rates ≤ 30 mL/h/site. Thus, subcutaneous replacement therapy with a 10% IgG preparation proved effective, safe and well-tolerated in our study population of subjects with primary immunodeficiency disease.
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29
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Waltenburg R, Kobrynski L, Reyes M, Bowen S, Khoury MJ. Primary immunodeficiency diseases: Practice among primary care providers and awareness among the general public, United States, 2008. Genet Med 2010; 12:792-800. [DOI: 10.1097/gim.0b013e3181f3e2c9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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30
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Brown JV, Demi AS, Celano MP, Bakeman R, Kobrynski L, Wilson SR. A home visiting asthma education program: challenges to program implementation. Health Educ Behav 2005; 32:42-56. [PMID: 15642753 DOI: 10.1177/1090198104266895] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study describes the implementation of a nurse home visiting asthma education program for low-income African American families of young children with asthma. Of 55 families, 71% completed the program consisting of eight lessons. The achievement of learning objectives was predicted by caregiver factors, such as education, presence of father or surrogate father in the household, and safety of the neighborhood, but not by child factors, such as age or severity of asthma as implied by the prescribed asthma medication regimen. Incompatibility between the scheduling needs of the families and the nurse home visitors was a major obstacle in delivering the program on time, despite the flexibility of the nurse home visitors. The authors suggest that future home-based asthma education programs contain a more limited number of home visits but add telephone follow-ups and address the broader needs of low-income families that most likely function as barriers to program success.
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Affiliation(s)
- Josephine V Brown
- Department of Psychology, Georgia State University, Atlanta, GA 30303-3083, USA.
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Kalman L, Lindegren ML, Kobrynski L, Vogt R, Hannon H, Howard JT, Buckley R. Mutations in genes required for T-cell development:IL7R, CD45, IL2RG, JAK3, RAG1, RAG2, ARTEMIS, and ADA and severe combined immunodeficiency: HuGE review. Genet Med 2004; 6:16-26. [PMID: 14726805 DOI: 10.1097/01.gim.0000105752.80592.a3] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Severe combined immunodeficiency (SCID) is an inherited immune disorder characterized by T-cell lymphopenia (TCLP), a profound lack of cellular (T-cell) and humoral (B-cell) immunity and, in some cases, decreased NK-cell number and function. Affected children develop severe bacterial and viral infections within the first 6 months of life and die before 1 year of age without treatment. Mutations in any of eight known genes: IL2RG, ARTEMIS, RAG1, RAG2, ADA, CD45, JAK3, and IL7R cause SCID. Mutations in unidentified genes may also cause SCID. Population-based genotype and allelic frequencies of these gene defects have not been measured. Some minimal estimates of SCID prevalence are presented. Currently, hematopoietic stem cell transplants are the standard treatment. In clinical trials, gene therapy has been used to reconstitute immune function in patients with IL2RG and ADA defects. The availability of effective therapies, plus the short asymptomatic period after birth, (when stem-cell transplantation is most effective), make SCID a potentially good candidate for newborn screening. Dried blood spots are currently collected from all infants at birth for newborn metabolic screening. Tests for TCLP on dried blood spots could be developed as a screen for SCID. Because SCID may be unrecognized, with infant deaths from infection attributed to other causes, newborn screening is the only way to ascertain true birth prevalence. Validated tests and pilot population studies are necessary to determine newborn screening's potential for identifying infants with SCID.
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Affiliation(s)
- Lisa Kalman
- Centers for Disease Control and Prevention, Newborn Screening Quality Assurance Program, Office of Genomics and Disease Prevention, Atlanta, Georgia, USA
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Lindegren ML, Kobrynski L, Rasmussen SA, Moore CA, Grosse SD, Vanderford ML, Spira TJ, McDougal JS, Vogt RF, Hannon WH, Kalman LV, Chen B, Mattson M, Baker TG, Khoury M. Applying public health strategies to primary immunodeficiency diseases: a potential approach to genetic disorders. MMWR Recomm Rep 2004; 53:1-29. [PMID: 14724556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
Primary immunodeficiency (PI) diseases are a group of primarily single-gene disorders of the immune system. Approximately 100 separate PI diseases have been described, but <20 probably account for >90% of cases. Although diverse, PI diseases share the common feature of susceptibility to infection and result in substantial morbidity and shortened life spans. Most important, prompt diagnosis and treatment can now lead to life-saving treatment and result in marked improvements in the quality and length of life for persons with PI diseases. In November 2001, a workshop was convened by CDC in Atlanta, Georgia, to discuss ways to improve health outcomes among persons with PI disease. A multidisciplinary panel of persons knowledgeable in PI diseases and public health met to identify and discuss public health strategies that can be applied to PI diseases and possibly for other genetic disorders. A systematic assessment based on the established public health framework was applied to the growing group of PI diseases, whose diverse genetic mutations span multiple components of the immune system but all lead to increased incidence and severity of infections. During the meeting, specialists in clinical immunology, public health, genetics, pediatrics, health communication, and ethics from state and federal agencies, academic centers, professional organizations, and advocacy foundations discussed the four components of the public health framework as they relate to PI diseases. These four components include 1) public health assessment (application of traditional public health methods to assess the occurrence and impact of PI diseases on communities); 2) population-based interventions (development, implementation, and evaluation of screening tests administered to newborns and clinical algorithms for early recognition of symptomatic persons to facilitate the earliest possible diagnosis and treatment for PI diseases); 3) evaluation of screening and diagnostic tools (to ensure their quality and appropriateness for identification of patients with PI diseases); and 4) communication (communication with and information dissemination to health-care providers and the public to facilitate prompt and appropriate diagnosis and intervention). The working group's deliberations focused on challenges and opportunities, priority research questions, and recommendations for future action for these four components. These recommendations, developed by workshop participants, will be useful to medical and public health professionals who are evaluating methods to increase recognition of PI diseases and other genetic disorders.
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Affiliation(s)
- Mary Lou Lindegren
- Office of Genomics and Disease Prevention, National Center for Environmental Health, CDC, Atlanta, Georgia, USA
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Gow KW, Kobrynski L, Abramowsky C, Lloyd D. Massive Benign Thymic Hyperplasia in a Six-Month-Old Girl: Case Report. Am Surg 2003. [DOI: 10.1177/000313480306900814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 6-month-old girl presented with respiratory symptoms with a large right-sided mediastinal mass noted on diagnostic imaging. Percutaneous biopsy revealed normal thymic tissue. Steroids were administered with no response. Right thoracotomy and complete thymectomy were performed. The specimen weighed approximately eight to ten times normal weight, and histology and flow cytometry revealed normal thymic tissue consistent with benign hyperplasia. The child has remained tumor free for a year since surgery. The rare nature of this tumor leads us to report this case and review the current literature.
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Affiliation(s)
- Kenneth W. Gow
- From the Departments of Surgery, Children's Healthcare of Atlanta at Egleston and Emory University, Atlanta, Georgia
| | - Lisa Kobrynski
- Departments of Pediatrics, Children's Healthcare of Atlanta at Egleston and Emory University, Atlanta, Georgia
| | - Carlos Abramowsky
- Pathology, Children's Healthcare of Atlanta at Egleston and Emory University, Atlanta, Georgia
| | - David Lloyd
- Departments of Pediatrics, Children's Healthcare of Atlanta at Egleston and Emory University, Atlanta, Georgia
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Gow KW, Kobrynski L, Abramowsky C, Lloyd D. Massive benign thymic hyperplasia in a six-month-old girl: case report. Am Surg 2003; 69:717-9. [PMID: 12953831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
A 6-month-old girl presented with respiratory symptoms with a large right-sided mediastinal mass noted on diagnostic imaging. Percutaneous biopsy revealed normal thymic tissue. Steroids were administered with no response. Right thoracotomy and complete thymectomy were performed. The specimen weighed approximately eight to ten times normal weight, and histology and flow cytometry revealed normal thymic tissue consistent with benign hyperplasia. The child has remained tumor free for a year since surgery. The rare nature of this tumor leads us to report this case and review the current literature.
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Affiliation(s)
- Kenneth W Gow
- Department of Surgery, Children's Healthcare of Atlanta at Egleston and Emory University, Atlanta, Georgia, USA
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Brown JV, Bakeman R, Celano MP, Demi AS, Kobrynski L, Wilson SR. Home-based asthma education of young low-income children and their families. J Pediatr Psychol 2002; 27:677-88. [PMID: 12403858 DOI: 10.1093/jpepsy/27.8.677] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To conduct a controlled trial of a home-based education program for low-income caregivers of young children with asthma. METHODS Participants were randomized to treatment-eight weekly asthma education sessions adapted from the Wee Wheezers program (n = 49)-or usual care (n = 46). Baseline and 3- and 12-month follow-up data were gathered from caregivers and from children's medical records. RESULTS Treatment was associated with less bother from asthma symptoms, more symptom-free days, and better caregiver quality of life at follow-up for children 1-3, but not those 4-6, years of age. Treatment and control groups did not differ in caregiver asthma management behavior or children's acute care utilization. CONCLUSIONS This home-based asthma education program was most effective with younger children; perhaps their caregivers were more motivated to learn about asthma management. Targeting psychosocial factors associated with asthma morbidity might also enhance the efficacy of asthma education for these families.
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Kourtis AP, Abramowsky C, Ibegbu C, Kobrynski L. Enlargement of the thymus in a child with chronic granulomatous disease receiving interferon gamma therapy. Arch Pathol Lab Med 1998; 122:562-5. [PMID: 9625428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Both an enlarged thymus (with normal results on histologic examination) and an increase in the percentage of peripheral CD4+CD45RA+ (naive) T lymphocytes developed in a child with chronic granulomatous disease receiving long-term interferon gamma therapy. The thymic regrowth may be secondary to interferon gamma therapy or to overstimulation of his compromised immune system by recurrent infections. To our knowledge, an association between enlargement of the thymus and either chronic granulomatous disease or interferon gamma has not been previously reported.
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Affiliation(s)
- A P Kourtis
- Division of Pediatric Infectious Diseases, Epidemiology, and Immunology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30303, USA
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Kobrynski L, Tanimune L, Pawlowski NA, Douglas SD, Campbell DE. A comparison of electrochemiluminescence and flow cytometry for the detection of natural latex-specific human immunoglobulin E. Clin Diagn Lab Immunol 1996; 3:42-6. [PMID: 8770502 PMCID: PMC170245 DOI: 10.1128/cdli.3.1.42-46.1996] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In vitro correlates of type 1 hypersensitivity to natural latex (NL) proteins continue to be limited by both sensitivity and specificity. Methods which have detection limits in the picogram range, namely, radioallergosorbent assays (RAST) and enzyme-linked immunosorbent assays (ELISA), are inadequate for the identification of NL hypersensitivity in certain at-risk groups, such as health care workers. A flow cytometry assay (FCA), previously shown to be comparable to RAST and ELISA in the identification of NL-sensitized pediatric patients with spina bifida, was compared with electrochemiluminescence (ECL) in the evaluation of pediatric patients with spina bifida and NL-sensitized adult health care workers. As with RAST and ELISA, ECL is capable of detecting picogram amounts of specific analyte. The ECL assay detected NL-specific immunoglobulin E (NL-IgE) in three of six health care workers with strong histories of NL hypersensitivity. All six patients were negative by FCA. Further, 2 of 11 spina bifida patients found to be NL-IgE negative by FCA were NL-IgE positive by ECL. These findings suggest that in sensitivity the ECL assay is an improvement over the FCA for the identification of NL-sensitive individuals.
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Affiliation(s)
- L Kobrynski
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia 19104, USA
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Kobrynski L, Chitayat D, Zahed L, McGregor D, Rochon L, Brownstein S, Vekemans M, Albert DL. Trisomy 22 and facioauriculovertebral (Goldenhar) sequence. Am J Med Genet 1993; 46:68-71. [PMID: 8494034 DOI: 10.1002/ajmg.1320460111] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We report on an infant girl born with complete trisomy 22 and left hemifacial microsomia, ear anomaly, and limbal and epibulbar complex choristoma. Trisomy 22 was confirmed by prometaphase chromosome analysis and in situ hybridization. This patient extends the list of chromosome abnormalities associated with apparent Golenhar sequence and emphasizes the importance of chromosome analysis in the investigation of patients with this condition. A detailed ophthalmopathological investigation is reported.
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Affiliation(s)
- L Kobrynski
- Department of Pediatrics, Montreal Children's Hospital, Quebec, Canada
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