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Naumova E, Lesichkova S, Milenova V, Yankova P, Murdjeva M, Mihailova S. Primary immunodeficiencies in Bulgaria - achievements and challenges of the PID National Expert Center. Front Immunol 2022; 13:922752. [PMID: 36211402 PMCID: PMC9535737 DOI: 10.3389/fimmu.2022.922752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/09/2022] [Indexed: 11/24/2022] Open
Abstract
Tremendous progress has been made in the recognition of primary immune deficiencies (PIDs) in Bulgaria since in 2005 we have joined the J Project Central-Eastern European collaborative program. Ten years later an Expert Centre (ExpC) for Rare Diseases - Primary Immune Deficiencies at the University Hospital “Alexandrovska”- Sofia was established. In May 2017 The National Register of Patients with Rare Diseases also became operational as a database containing clinical and genetic information for Bulgarian patients with PID. The transfer of data and information on Bulgarian PID patients to the European Primary Immunodeficiency Database, managed by the European Society for Primary Immunodeficiency (ESID) has started in 2020. The total number of registered patients now is 191 (100 men and 91 women), with more than half of them being children (106; 55.5%). Regular updating of the information in the register showed that 5.2% of patients are deceased and the majority (94.8%) is a subject to continuous monitoring as it has been reported for other European countries as well. With the establishment of the ExpC, the dynamics in the diagnosis and registration of patients with PID significantly intensified. For a period of 5 years (2016-2021) 101 patients were evaluated and registered in comparison with previous period - before ExpC establishment when only 89 patients were diagnosed. The most common pathology was humoral immune deficiency (85 patients; 44.5%). Ninety-six (50.3%) of the patients underwent genetic testing, and 66. 7% had genetically confirmed diagnosis. Three of the variants have not been reported in population databases. Following genetic investigation confirmation of the initial phenotypic diagnosis was achieved in 82.8% of cases and change in the diagnosis - in 17%. Sixty-two patients were on regular replacement or specific therapy, and the rest received symptomatic and supportive treatment. In summary, we present the first epidemiological report of PIDs in Bulgaria, based on the National PID register. Data on the clinical, phenotypic and genetic characteristics of PID patients provided important information about the nature of primary immunodeficiency diseases in our country.
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Affiliation(s)
- Elissaveta Naumova
- Clinic of Clinical Immunology with Stem Cell Bank, Expert Center for Rare Diseases-PID, University Hospital “Alexandrovska”, Sofia, Bulgaria
- Department of Clinical Immunology, Faculty of Medicine, Medical University, Sofia, Bulgaria
- *Correspondence: Elissaveta Naumova,
| | - Spaska Lesichkova
- Clinic of Clinical Immunology with Stem Cell Bank, Expert Center for Rare Diseases-PID, University Hospital “Alexandrovska”, Sofia, Bulgaria
- Department of Clinical Immunology, Faculty of Medicine, Medical University, Sofia, Bulgaria
| | - Veneta Milenova
- Clinic of Clinical Immunology with Stem Cell Bank, Expert Center for Rare Diseases-PID, University Hospital “Alexandrovska”, Sofia, Bulgaria
| | - Petya Yankova
- Clinic of Clinical Immunology with Stem Cell Bank, Expert Center for Rare Diseases-PID, University Hospital “Alexandrovska”, Sofia, Bulgaria
- Department of Clinical Immunology, Faculty of Medicine, Medical University, Sofia, Bulgaria
| | - Marianna Murdjeva
- Department of Microbiology and Immunology, Faculty of Pharmacy, Research Institute, Medical University, Plovdiv, Bulgaria
| | - Snezhina Mihailova
- Clinic of Clinical Immunology with Stem Cell Bank, Expert Center for Rare Diseases-PID, University Hospital “Alexandrovska”, Sofia, Bulgaria
- Department of Clinical Immunology, Faculty of Medicine, Medical University, Sofia, Bulgaria
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Ganeva M, Petrova G, Mihailova S, Gesheva N, Nedevska M, Boyadzhiev M, Shivachev P, Stefanov S. STING-associated vasculopathy with onset in infancy: the first case in Bulgaria and review of the literature. BIOTECHNOL BIOTEC EQ 2022. [DOI: 10.1080/13102818.2022.2112909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- Margarita Ganeva
- Department of Pediatric Rheumatology, University Children’s Hospital “Ivan Mitev”, Medical University of Sofia, Sofia, Bulgaria
| | - Guergana Petrova
- Department of Pediatric Diseases, Alexandrovska Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Snezhina Mihailova
- Department of Clinical Immunology with Stem Cell Bank, Alexandrovska Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Nevena Gesheva
- Department of Clinical Immunology with Stem Cell Bank, Alexandrovska Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Mariya Nedevska
- Imaging Studies Department, Saint Ekaterina University Multiprofile Hospital for Active Treatment, Medical University of Sofia, Sofia, Bulgaria
| | - Martin Boyadzhiev
- Pediatric Department, Saint Marina Hospital, Medical University of Varna, Varna, Bulgaria
| | - Petar Shivachev
- Pediatric Department, Saint Marina Hospital, Medical University of Varna, Varna, Bulgaria
| | - Stefan Stefanov
- Department of Pediatric Rheumatology, University Children’s Hospital “Ivan Mitev”, Medical University of Sofia, Sofia, Bulgaria
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Geier CB, Farmer JR, Foldvari Z, Ujhazi B, Steininger J, Sleasman JW, Parikh S, Dilley MA, Pai SY, Henderson L, Hazen M, Neven B, Moshous D, Sharapova SO, Mihailova S, Yankova P, Naumova E, Özen S, Byram K, Fernandez J, Wolf HM, Eibl MM, Notarangelo LD, Calabrese LH, Walter JE. Vasculitis as a Major Morbidity Factor in Patients With Partial RAG Deficiency. Front Immunol 2020; 11:574738. [PMID: 33193364 PMCID: PMC7609967 DOI: 10.3389/fimmu.2020.574738] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 06/21/2020] [Accepted: 08/31/2020] [Indexed: 12/30/2022] Open
Abstract
Vasculitis can be a life-threatening complication associated with high mortality and morbidity among patients with primary immunodeficiencies (PIDs), including variants of severe and combined immunodeficiencies ((S)CID). Our understanding of vasculitis in partial defects in recombination activating gene (RAG) deficiency, a prototype of (S)CIDs, is limited with no published systematic evaluation of diagnostic and therapeutic modalities. In this report, we sought to establish the clinical, laboratory features, and treatment outcome of patients with vasculitis due to partial RAG deficiency. Vasculitis was a major complication in eight (13%) of 62 patients in our cohort with partial RAG deficiency with features of infections and immune dysregulation. Vasculitis occurred early in life, often as first sign of disease (50%) and was complicated by significant end organ damage. Viral infections often preceded the onset of predominately non-granulomatous-small vessel vasculitis. Autoantibodies against cytokines (IFN-α, -ω, and IL-12) were detected in a large fraction of the cases tested (80%), whereas the majority of patients were anti-neutrophil cytoplasmic antibodies (ANCA) negative (>80%). Genetic diagnosis of RAG deficiency was delayed up to 2 years from the onset of vasculitis. Clinical cases with sole skin manifestation responded well to first-line steroid treatment, whereas systemic vasculitis with severe end-organ complications required second-line immunosuppression and/or hematopoietic stem cell transplantation (HSCT) for definitive management. In conclusion, our data suggest that vasculitis in partial RAG deficiency is prevalent among patients with partial RAG deficiency and is associated with high morbidity. Therefore, partial RAG deficiency should be included in the differential diagnosis of patients with early-onset systemic vasculitis. Diagnostic serology may be misleading with ANCA negative findings, and search for conventional autoantibodies should be extended to include those targeting cytokines.
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Affiliation(s)
| | - Jocelyn R Farmer
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Zsofia Foldvari
- Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - Boglarka Ujhazi
- University of South Florida and Johns Hopkins All Children's Hospital, Saint Petersburg, FL, United States
| | | | - John W Sleasman
- Division of Allergy, Immunology and Pulmonary Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Suhag Parikh
- Emory University School of Medicine, Atlanta, GA, United States
| | - Meredith A Dilley
- Department of Immunology, Harvard Medical School, Boston Children's Hospital, Boston, MA, United States
| | - Sung-Yun Pai
- Division of Hematology-Oncology, Harvard Medical School, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Lauren Henderson
- Division of Immunology, Department of Rheumatology, Boston Children's Hospital, Boston, MA, United States
| | - Melissa Hazen
- Division of Immunology, Department of Rheumatology, Boston Children's Hospital, Boston, MA, United States
| | - Benedicte Neven
- Imagine Institute, Paris Descartes-Sorbonne Paris Cité University, Paris, France.,Pediatric Hematology-Immunology and Rheumatology Unit, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Laboratory "Immunogenetics of Pediatric autoimmune diseases", INSERM UMR1163, Institut Imagine, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Despina Moshous
- Imagine Institute, Paris Descartes-Sorbonne Paris Cité University, Paris, France.,Pediatric Hematology-Immunology and Rheumatology Unit, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Laboratory of Genome Dynamics in The Immune System, Paris, France
| | - Svetlana O Sharapova
- Research Department, Belarusian Research Center for Pediatric Oncology, Hematology and Immunology, Minsk, Belarus
| | - Snezhina Mihailova
- Department of Clinical Immunology Medical University of Sofia, Sofia, Bulgaria
| | - Petya Yankova
- Department of Clinical Immunology Medical University of Sofia, Sofia, Bulgaria
| | - Elisaveta Naumova
- Department of Clinical Immunology Medical University of Sofia, Sofia, Bulgaria
| | - Seza Özen
- Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kevin Byram
- Cleveland Clinic Center for Vasculitis Care and Research, Cleveland, OH, United States
| | - James Fernandez
- Cleveland Clinic Center for Vasculitis Care and Research, Cleveland, OH, United States
| | - Hermann M Wolf
- Immunology Outpatient Clinic, Vienna, Austria.,Sigmund Freud Private University- Medical School, Vienna, Austria
| | - Martha M Eibl
- Immunology Outpatient Clinic, Vienna, Austria.,Biomedizinische Forschungs GmbH, Vienna, Austria
| | - Luigi D Notarangelo
- Laboratory of Clinical Immunology and Microbiology, NIAID, National Institutes of Health, Bethesda, MD, United States
| | - Leonard H Calabrese
- Cleveland Clinic Center for Vasculitis Care and Research, Cleveland, OH, United States
| | - Jolan E Walter
- University of South Florida at Johns Hopkins All Children's Hospital, Saint Petersburg, FL, United States.,Division of Allergy and Immunology, Massachusetts General Hospital for Children, Boston, MA, United States
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Calabrese L, Geier C, Farmer J, Foldvari Z, Ujhazi B, Eibl M, Wolf H, Sleasman J, Parikh S, Dilley M, Pai SY, Henderson L, Hazen M, Neven B, Sharapova S, Mihailova S, Byram K, Fernandez J, Yankova P, Walter J. 174. VASCULITIS AS A MAJOR MORBIDITY FACTOR IN PATIENTS WITH HYPOMORPHIC RAG VARIANTS. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez060.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | | | - Boglarka Ujhazi
- Johns Hopkins All Children’s Hospital Saint Petersburg, FL USA
| | - Martha Eibl
- Immunology Outpatient Clinic Vienna, Austria
| | | | | | - Suhag Parikh
- Duke University School of Medicine Durham, NC USA
| | | | | | | | | | | | | | | | | | | | | | - Jolan Walter
- Johns Hopkins All Children’s Hospital Saint Petersburg, FL USA
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Mihailova S, Ivanova-Genova E, Lukanov T, Stoyanova V, Milanova V, Naumova E. A study of TNF-α, TGF-β, IL-10, IL-6, and IFN-γ gene polymorphisms in patients with depression. J Neuroimmunol 2016; 293:123-128. [PMID: 27049572 DOI: 10.1016/j.jneuroim.2016.03.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/24/2016] [Accepted: 03/07/2016] [Indexed: 01/12/2023]
Abstract
In the last decade it was found that functional polymorphisms in the promoter and/or coding regions of regulatory genes are likely to pre-determine the phenotype manifestation of a certain cytokine profile, and thus could be used as disease-associated markers. Having in mind the hypothesis of impaired cytokine regulation in depressive disorder, as well as the diverse population-dependent results for cytokine polymorphisms, we investigated the relation between the cytokine gene polymorphisms of key pro- and anti-inflammatory cytokines (TNF-α, TGF-β, IL-10, IL-6, IFN-γ) and susceptibility as well as clinical course of depression in Bulgarians. The study included 80 patients with depression (50 women and 30 men) and 50 healthy controls. Simultaneous analysis of eight polymorphic positions in the cytokine genes listed was performed by PCR-SSP method. The results revealed significant predominance of TGF-β TT (+869) genotype (previously described as predicting low expression activity of TGF-β) in patients (41.3%) compared to healthy subjects (21.2%) (p=0.05, OR=2.62). Furthermore T/T G/C combined genotype (+869, +915) in the same gene was negatively associated with disease recurrence. Additionally we found that certain IL-10 genotypes associated with low gene expression seemed to shape moderate disease manifestation. In conclusion our results mainly demonstrated prevalence of a low-expression TGF-β1 profile in the patients. Thus, although in an indirect way, we supported the hypothesis of impaired immunosuppression by means of Th3 regulation in major depressive disorders.
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Affiliation(s)
- Snezhina Mihailova
- Department of Clinical Immunology, University Hospital "Alexandrovska", Medical University, 1, "G. Sofiisky" Str., Sofia 1431, Bulgaria.
| | - Elena Ivanova-Genova
- Department of Psychiatry, University Hospital "Alexandrovska", Medical University, 1, G. Sofiisky Str., Sofia 1431, Bulgaria.
| | - Tzvetelin Lukanov
- Department of Clinical Immunology, University Hospital "Alexandrovska", Medical University, 1, "G. Sofiisky" Str., Sofia 1431, Bulgaria.
| | - Vesela Stoyanova
- Department of Psychiatry, University Hospital "Alexandrovska", Medical University, 1, G. Sofiisky Str., Sofia 1431, Bulgaria.
| | - Vihra Milanova
- Department of Psychiatry, University Hospital "Alexandrovska", Medical University, 1, G. Sofiisky Str., Sofia 1431, Bulgaria.
| | - Elissaveta Naumova
- Department of Clinical Immunology, University Hospital "Alexandrovska", Medical University, 1, "G. Sofiisky" Str., Sofia 1431, Bulgaria.
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Ivanova M, Mihailova S, Tyfekchiev N, Michailova A, Naumova E. HLA-A, -B and -DRB1 alleles and cytokine polymorphism frequencies in a population from Bulgaria. Hum Immunol 2004. [DOI: 10.1016/j.humimm.2004.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Guencheva G, Popova P, Davidkova G, Mincheva V, Mihailova S, Bogdanov A, Pacelli E, Auteri A. Determination of cytokine release after in vivo and in vitro administration of Deodan (a preparation from Lactobacillus bulgaricus "LB51") by the rabbit pyrogen test. Int J Immunopharmacol 1992; 14:1429-36. [PMID: 1464475 DOI: 10.1016/0192-0561(92)90015-d] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We investigated the in vivo and in vitro cytokine inducing effects of Deodan, an oral preparation from Lactobacillus bulgaricus "LB-51", using the rabbit pyrogen test. In the first experimental approach we administered Deodan, or its chromatographically purified fraction, via the i.m. or i.v. routes. Low doses of Deodan i.m. caused the formation of a single temperature peak, whereas large doses produced a biphasic temperature curve. Intravenous injection of Deodan produced a monophasic fever in all tested doses. Chromatographically purified Deodan injected i.v. to rabbits caused a febrile response with a dose-dependent pattern, strikingly similar to that of lipopolysaccharide. LAL-testing of Deodan, however, showed that the preparation does not contain endotoxin. In in vivo neutralization studies we demonstrated that IL-1, TNF alpha, and IL-6 mediate the rabbit febrile response to Deodan. Interestingly, the effects of Deodan on the production of TNF alpha and IL-6 were more pronounced than its IL-1 inducing activity. In the second approach, we injected supernatants from mononuclear cells incubated with nonpyrogenic doses of Deodan, intravenously to rabbits ("monocyte type" of pyrogen test). Rapid-onset monophasic fevers were observed, typical for the rabbit pyrogen reaction to i.v. administration of exogenous IL-1 and TNF. Finally, we demonstrated the presence of pyrogenic cytokines in the supernatants from macrophages of Deodan-treated mice. Together, these results indicate that Deodan induces the production of cytokines with endogenous pyrogenic activity.
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Affiliation(s)
- G Guencheva
- Institute for State Control of Drugs, Sofia, Bulgaria
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