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Bianchi C, Margot H, Fernandes H, Pasquet M, Priqueler L, Roy-Peaud F, Bauduer F, Bayart S, Garnier N, Fain O, Van Gils J, Joly SB, Rialland F, Paillard C, Deparis M, Lambilliotte A, Leblanc T, Fahd M, Leverger G, Héritier S, Geneviève D, Rieux-Laucat F, Picard C, Neyraud C, Aladjidi N. Autoimmune cytopenia and Kabuki syndrome in paediatrics: Insights in 11 patients. Br J Haematol 2024; 204:1899-1907. [PMID: 38432067 DOI: 10.1111/bjh.19387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 02/16/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
Kabuki syndrome (KS) is now listed in the Human Inborn Errors of Immunity (IEI) Classification. It is a rare disease caused by KMT2D and KDM6A variants, dominated by intellectual disability and characteristic facial features. Recurrently, pathogenic variants are identified in those genes in patients examined for autoimmune cytopenia (AIC), but interpretation remains challenging. This study aims to describe the genetic diagnosis and the clinical management of patients with paediatric-onset AIC and KS. Among 11 patients with AIC and KS, all had chronic immune thrombocytopenic purpura, and seven had Evans syndrome. All had other associated immunopathological manifestations, mainly symptomatic hypogammaglobinaemia. They had a median of 8 (5-10) KS-associated manifestations. Pathogenic variants were detected in KMT2D gene without clustering, during the immunological work-up of AIC in three cases, and the clinical strategy to validate them is emphasized. Eight patients received second-line treatments, mainly rituximab and mycophenolate mofetil. With a median follow-up of 17 (2-31) years, 8/10 alive patients still needed treatment for AIC. First-line paediatricians should be able to recognize and confirm KS in children with ITP or multiple AIC, to provide early appropriate clinical management and specific long-term follow-up. The epigenetic immune dysregulation in KS opens exciting new perspectives.
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MESH Headings
- Humans
- Vestibular Diseases/genetics
- Vestibular Diseases/diagnosis
- Child
- Face/abnormalities
- Female
- Male
- Child, Preschool
- Abnormalities, Multiple/genetics
- Adolescent
- Histone Demethylases/genetics
- Neoplasm Proteins/genetics
- Hematologic Diseases/genetics
- DNA-Binding Proteins/genetics
- Purpura, Thrombocytopenic, Idiopathic/genetics
- Purpura, Thrombocytopenic, Idiopathic/therapy
- Purpura, Thrombocytopenic, Idiopathic/diagnosis
- Infant
- Thrombocytopenia/genetics
- Thrombocytopenia/diagnosis
- Thrombocytopenia/etiology
- Thrombocytopenia/therapy
- Anemia, Hemolytic, Autoimmune/genetics
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/therapy
- Autoimmune Diseases/genetics
- Autoimmune Diseases/diagnosis
- Rituximab/therapeutic use
- Mutation
- Cytopenia
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Affiliation(s)
- Chloé Bianchi
- Pediatric Haemato-Immunology, CIC1401, INSERM CICP, National Reference Center for Autoimmune Cytopenias in Children (CEREVANCE), Bordeaux University Hospital, Bordeaux, France
| | - Henri Margot
- Department of Medical Genetics, MRGM INSERM U1211, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Helder Fernandes
- Pediatric Haemato-Immunology, CIC1401, INSERM CICP, National Reference Center for Autoimmune Cytopenias in Children (CEREVANCE), Bordeaux University Hospital, Bordeaux, France
| | - Marlène Pasquet
- Pediatric Oncology Immunology Hematology Unit, Children's University Hospital, Toulouse, France
| | - Laurence Priqueler
- Department of Pediatrics, Mont de Marsan Hospital Center, Mont de Marsan, France
| | | | | | - Sophie Bayart
- Pediatric Hematology Unit, Rennes University Hospital, Rennes, France
| | - Nathalie Garnier
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, Lyon, France
| | - Olivier Fain
- Sorbonne Université, Service de Médecine Interne, AP-HP Hôpital Saint Antoine, Paris, France
| | - Julien Van Gils
- Department of Medical Genetics, MRGM INSERM U1211, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | | | - Fanny Rialland
- Pediatric Oncology Immunology Hematology Unit, Nantes University Hospital, Nantes, France
| | - Catherine Paillard
- Department of Pediatric Hematology and Oncology, Hautepierre University Hospital, Strasbourg, France
| | - Marianna Deparis
- Pediatric Oncology-Hematology Unit, Caen University Hospital, Caen, France
| | - Anne Lambilliotte
- Department of Pediatric Hematology, Jeanne de Flandre Hospital, Lille University Hospital, Lille, France
| | - Thierry Leblanc
- Pediatric Hematology Unit, National Reference Center for Autoimmune Cytopenias in Children (CEREVANCE) Robert-Debré University Hospital, AP-HP, Paris, France
| | - Mony Fahd
- Pediatric Hematology Unit, National Reference Center for Autoimmune Cytopenias in Children (CEREVANCE) Robert-Debré University Hospital, AP-HP, Paris, France
| | - Guy Leverger
- Sorbonne University, AP-HP, National Reference Center for Autoimmune Cytopenias in Children (CEREVANCE) Armand Trousseau Hospital, Pediatric Hematology Oncology Unit, Paris, France
| | - Sébastien Héritier
- Sorbonne University, AP-HP, National Reference Center for Autoimmune Cytopenias in Children (CEREVANCE) Armand Trousseau Hospital, Pediatric Hematology Oncology Unit, Paris, France
| | - David Geneviève
- Department of Medical Genetics, Montpellier University Hospital, Montpellier University, INSERM U1183, Reference Center for Rare Disease Malformative Syndromes, Montpellier, France
| | - Frédéric Rieux-Laucat
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, IMAGINE Institute, Unité Mixte de recherche (UMR) 1163, INSERM, Paris, France
| | - Capucine Picard
- Study Center for Primary Immunodeficiencies, Necker Hospital for Sick Children, Assistance Publique-Hopitaux de Paris (AP-HP), Université de Paris cité, Paris, France
| | - Caroline Neyraud
- Pediatric Haemato-Immunology, CIC1401, INSERM CICP, National Reference Center for Autoimmune Cytopenias in Children (CEREVANCE), Bordeaux University Hospital, Bordeaux, France
| | - Nathalie Aladjidi
- Pediatric Haemato-Immunology, CIC1401, INSERM CICP, National Reference Center for Autoimmune Cytopenias in Children (CEREVANCE), Bordeaux University Hospital, Bordeaux, France
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Boussard C, Delage L, Gajardo T, Kauskot A, Batignes M, Goudin N, Stolzenberg MC, Brunaud C, Panikulam P, Riller Q, Moya-Nilges M, Solarz J, Repérant C, Durel B, Bordet JC, Pellé O, Lebreton C, Magérus A, Pirabakaran V, Vargas P, Dupichaud S, Jeanpierre M, Vinit A, Zarhrate M, Masson C, Aladjidi N, Arkwright PD, Bader-Meunier B, Baron Joly S, Benadiba J, Bernard E, Berrebi D, Bodemer C, Castelle M, Charbit-Henrion F, Chbihi M, Debray A, Drabent P, Fraitag S, Hié M, Landman-Parker J, Lhermitte L, Moshous D, Rohrlich P, Ruemmele F, Welfringer-Morin A, Tusseau M, Belot A, Cerf-Bensussan N, Roelens M, Picard C, Neven B, Fischer A, Callebaut I, Ménager M, Sepulveda FE, Adam F, Rieux-Laucat F. DOCK11 deficiency in patients with X-linked actinopathy and autoimmunity. Blood 2023; 141:2713-2726. [PMID: 36952639 DOI: 10.1182/blood.2022018486] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 02/28/2023] [Accepted: 03/19/2023] [Indexed: 03/25/2023] Open
Abstract
Dedicator of cytokinesis (DOCK) proteins play a central role in actin cytoskeleton regulation. This is highlighted by the DOCK2 and DOCK8 deficiencies leading to actinopathies and immune deficiencies. DOCK8 and DOCK11 activate CDC42, a Rho-guanosine triphosphate hydrolases involved in actin cytoskeleton dynamics, among many cellular functions. The role of DOCK11 in human immune disease has been long suspected but, to the best of our knowledge, has never been described to date. We studied 8 male patients, from 7 unrelated families, with hemizygous DOCK11 missense variants leading to reduced DOCK11 expression. The patients were presenting with early-onset autoimmunity, including cytopenia, systemic lupus erythematosus, skin, and digestive manifestations. Patients' platelets exhibited abnormal ultrastructural morphology and spreading as well as impaired CDC42 activity. In vitro activated T cells and B-lymphoblastoid cell lines from patients exhibited aberrant protrusions and abnormal migration speed in confined channels concomitant with altered actin polymerization during migration. Knock down of DOCK11 recapitulated these abnormal cellular phenotypes in monocytes-derived dendritic cells and primary activated T cells from healthy controls. Lastly, in line with the patients' autoimmune manifestations, we also observed abnormal regulatory T-cell (Treg) phenotype with profoundly reduced FOXP3 and IKZF2 expression. Moreover, we found reduced T-cell proliferation and impaired STAT5B phosphorylation upon interleukin-2 stimulation of the patients' lymphocytes. In conclusion, DOCK11 deficiency is a new X-linked immune-related actinopathy leading to impaired CDC42 activity and STAT5 activation, and is associated with abnormal actin cytoskeleton remodeling as well as Treg phenotype, culminating in immune dysregulation and severe early-onset autoimmunity.
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Affiliation(s)
- Charlotte Boussard
- Université Paris Cité, Paris, France
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Institut Imagine, INSERM UMR-S_1163, Paris, France
| | - Laure Delage
- Université Paris Cité, Paris, France
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Institut Imagine, INSERM UMR-S_1163, Paris, France
| | - Tania Gajardo
- Université Paris Cité, Paris, France
- Laboratory of Molecular Basis of Altered Immune Homeostasis, Institut Imagine, INSERM UMR-S_1163, Paris, France
| | - Alexandre Kauskot
- INSERM, UMR_S1176, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Maxime Batignes
- Université Paris Cité, Paris, France
- Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Institut Imagine, Atip-Avenir Team, INSERM UMR 1163, Paris, France
| | - Nicolas Goudin
- Université Paris Cité, Paris, France
- Necker Bio-image Analysis Platform, Structure Fédérative de Recherche Necker, INSERM US24, CNRS UMS3633, Paris, France
| | - Marie-Claude Stolzenberg
- Université Paris Cité, Paris, France
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Institut Imagine, INSERM UMR-S_1163, Paris, France
| | - Camille Brunaud
- Université Paris Cité, Paris, France
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Institut Imagine, INSERM UMR-S_1163, Paris, France
| | - Patricia Panikulam
- Université Paris Cité, Paris, France
- Laboratory of Molecular Basis of Altered Immune Homeostasis, Institut Imagine, INSERM UMR-S_1163, Paris, France
| | - Quentin Riller
- Université Paris Cité, Paris, France
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Institut Imagine, INSERM UMR-S_1163, Paris, France
| | | | - Jean Solarz
- INSERM, UMR_S1176, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | | | - Béatrice Durel
- Université Paris Cité, Paris, France
- Cell Imaging Platform, Structure Fédérative de Recherche Necker, INSERM US24, CNRS UMS3633, Paris, France
| | - Jean-Claude Bordet
- Laboratoire d'Hémostase, Centre de Biologie Est, Hospices Civils de Lyon, Bron, France
| | - Olivier Pellé
- Université Paris Cité, Paris, France
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Institut Imagine, INSERM UMR-S_1163, Paris, France
- Flow Cytometry Core Facility, Structure Fédérative de Recherche Necker INSERM US24, CNRS UMS3633, Paris, France
| | - Corinne Lebreton
- Université Paris Cité, Paris, France
- Laboratory of Intestinal Immunity, Université Paris Cité, Imagine Institute, INSERM UMR-S_1163, Paris, France
| | - Aude Magérus
- Université Paris Cité, Paris, France
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Institut Imagine, INSERM UMR-S_1163, Paris, France
| | - Vithura Pirabakaran
- Université Paris Cité, Paris, France
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Institut Imagine, INSERM UMR-S_1163, Paris, France
| | - Pablo Vargas
- Université Paris Cité, Paris, France
- Institut Necker Enfants Malades, INSERM U1151/CNRS UMR 8253, Université de Paris, Paris, France
| | | | - Marie Jeanpierre
- Université Paris Cité, Paris, France
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Institut Imagine, INSERM UMR-S_1163, Paris, France
| | - Angélique Vinit
- Sorbonne Université, UMS037, PASS, Plateforme de cytométrie de la Pitié-Salpêtrière CyPS, Paris, France
| | - Mohammed Zarhrate
- Université Paris Cité, Paris, France
- Genomics Core Facility, Institut Imagine-Structure Fédérative de Recherche Necker, INSERM U1163 et INSERM US24/CNRS UAR3633, Université Paris Cité, Paris, France
| | - Cécile Masson
- Université Paris Cité, Paris, France
- Bioinformatics Core Facility, Institut Imagine-Structure Fédérative de Recherche Necker, INSERM U1163 et INSERM US24/CNRS UAR3633, Université Paris Cité, Paris, France
| | - Nathalie Aladjidi
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant, Bordeaux, France
- Pediatric Oncology Hematology Unit, University Hospital, Plurithématique CIC, Centre d'Investigation Clinique, 1401, INSERM, Bordeaux, France
| | - Peter D Arkwright
- Lydia Becker Institute of Immunology and Inflammation, University of Manchester & Department of Pediatric Allergy and Immunology, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Brigitte Bader-Meunier
- Université Paris Cité, Paris, France
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Institut Imagine, INSERM UMR-S_1163, Paris, France
- Pediatric Immunology, Hematology and Rheumatology Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children, Paris, France
| | | | - Joy Benadiba
- Department of Pediatric Hematology-Oncology, Nice University Hospital, Nice, France
| | - Elise Bernard
- Departement of General Pediatrics, Centre Hospitalier de Mayotte, Mamoudzou, France
| | - Dominique Berrebi
- Department of Pediatric Pathology, Hôpital Robert-Debré, Hôpital Universitaire Robert-Debré, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christine Bodemer
- Université Paris Cité, Paris, France
- Department of Dermatology, Referral Center for Genodermatoses and Rare Skin Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Martin Castelle
- Université Paris Cité, Paris, France
- Pediatric Immunology, Hematology and Rheumatology Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fabienne Charbit-Henrion
- Laboratory of Intestinal Immunity, Université Paris Cité, Imagine Institute, INSERM UMR-S_1163, Paris, France
- Department of Pediatric Gastroenterology, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
- Department of Genomic Medecine for Rare Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
- Department of Pediatric Nephrology, Rheumatology, Dermatology, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children, Hôpital Femme Mère Enfant, CHU Lyon, Bron, France
| | - Marwa Chbihi
- Université Paris Cité, Paris, France
- Pediatric Immunology, Hematology and Rheumatology Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Agathe Debray
- Departement of General Pediatrics and Infectious Diseases, Hôpital Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Philippe Drabent
- Université Paris Cité, Paris, France
- Department of Anatomopathology, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Sylvie Fraitag
- Université Paris Cité, Paris, France
- Department of Anatomopathology, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Miguel Hié
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, Service de Médecine Interne 2, Institut E3M, INSERM UMRS 1135, Centre d'Immunologie et des Maladies Infectieuses-Paris, Paris, France
| | - Judith Landman-Parker
- Sorbonne Université, Department of Pediatric Hematology Oncology, Hôpital Armand-Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ludovic Lhermitte
- Université Paris Cité, Paris, France
- Laboratory of Onco-Haematology, Assistance Publique-Hôpitaux de Paris, Université de Paris Cité, Institut Necker-Enfants Malades, INSERM UMR 1151, Paris, France
| | - Despina Moshous
- Université Paris Cité, Paris, France
- Pediatric Immunology, Hematology and Rheumatology Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Laboratory of Genome Dynamics in the Immune System, Université Paris Cité, Imagine Institute, INSERM UMR 1163, Paris, France
- French National Reference Center for Primary Immune Deficiencies, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre Rohrlich
- Department of Pediatric Hematology-Oncology, Nice University Hospital, Nice, France
| | - Frank Ruemmele
- Université Paris Cité, Paris, France
- Laboratory of Intestinal Immunity, Université Paris Cité, Imagine Institute, INSERM UMR-S_1163, Paris, France
- Department of Pediatric Gastroenterology, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Anne Welfringer-Morin
- Université Paris Cité, Paris, France
- Department of Dermatology, Referral Center for Genodermatoses and Rare Skin Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Maud Tusseau
- Centre International de Recherche en Infectiologie, Univ Lyon, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France
| | - Alexandre Belot
- Centre International de Recherche en Infectiologie, Univ Lyon, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France
- Department of Pediatric Nephrology, Rheumatology, Dermatology, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children, Hôpital Femme Mère Enfant, CHU Lyon, Bron, France
| | - Nadine Cerf-Bensussan
- Université Paris Cité, Paris, France
- Laboratory of Intestinal Immunity, Université Paris Cité, Imagine Institute, INSERM UMR-S_1163, Paris, France
| | - Marie Roelens
- Université Paris Cité, Paris, France
- Study Center for Primary Immunodeficiencies, Hôpital Necker-Enfants Malades University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Capucine Picard
- Université Paris Cité, Paris, France
- French National Reference Center for Primary Immune Deficiencies, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Study Center for Primary Immunodeficiencies, Hôpital Necker-Enfants Malades University, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Bénédicte Neven
- Université Paris Cité, Paris, France
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Institut Imagine, INSERM UMR-S_1163, Paris, France
- Pediatric Immunology, Hematology and Rheumatology Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alain Fischer
- Université Paris Cité, Paris, France
- Université Paris Cité, Imagine Institute, INSERM UMR 1163, Paris, France
- Department of Pediatric Immuno-Haematology and Rheumatology, Reference Center for Rheumatic, AutoImmune and Systemic Diseases in Children, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Collège de France, Paris, France
| | - Isabelle Callebaut
- Sorbonne Université, Muséum National d'Histoire Naturelle, CNRS UMR 7590, Institut de Minéralogie, de Physique des Matériaux et de Cosmochimie, Paris, France
| | - Mickaël Ménager
- Université Paris Cité, Paris, France
- Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Institut Imagine, Atip-Avenir Team, INSERM UMR 1163, Paris, France
- Labtech Single-Cell@Imagine, Imagine Institute, INSERM UMR-S_1163, Paris, France
| | - Fernando E Sepulveda
- Université Paris Cité, Paris, France
- Laboratory of Molecular Basis of Altered Immune Homeostasis, Institut Imagine, INSERM UMR-S_1163, Paris, France
| | - Frédéric Adam
- INSERM, UMR_S1176, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Frédéric Rieux-Laucat
- Université Paris Cité, Paris, France
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Institut Imagine, INSERM UMR-S_1163, Paris, France
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