1
|
Nunes-Santos CJ, Koh C, Rai A, Sacco K, Marciano BE, Kleiner DE, Marko J, Bergerson JRE, Stack M, Rivera MM, Constantine G, Strober W, Uzel G, Fuss IJ, Notarangelo LD, Holland SM, Rosenzweig SD, Heller T. Nodular regenerative hyperplasia in X-linked agammaglobulinemia: An underestimated and severe complication. J Allergy Clin Immunol 2022; 149:400-409.e3. [PMID: 34087243 PMCID: PMC8633079 DOI: 10.1016/j.jaci.2021.05.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 03/04/2021] [Revised: 04/30/2021] [Accepted: 05/14/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Late-onset complications in X-linked agammaglobulinemia (XLA) are increasingly recognized. Nodular regenerative hyperplasia (NRH) has been reported in primary immunodeficiency but data in XLA are limited. OBJECTIVES This study sought to describe NRH prevalence, associated features, and impact in patients with XLA. METHODS Medical records of all patients with XLA referred to the National Institutes of Health between October 1994 and June 2019 were reviewed. Liver biopsies were performed when clinically indicated. Patients were stratified into NRH+ or NRH- groups, according to their NRH biopsy status. Fisher exact test and Mann-Whitney test were used for statistical comparisons. RESULTS Records of 21 patients with XLA were reviewed, with a cumulative follow-up of 129 patient-years. Eight patients underwent ≥1 liver biopsy of whom 6 (29% of the National Institutes of Health XLA cohort) were NRH+. The median age at NRH diagnosis was 20 years (range, 17-31). Among patients who had liver biopsies, alkaline phosphatase levels were only increased in patients who were NRH+ (P = .04). Persistently low platelet count (<100,000 per μL for >6 months), mildly to highly elevated hepatic venous pressure gradient and either hepatomegaly and/or splenomegaly were present in all patients who were NRH+. In opposition, persistently low platelet counts were not seen in patients who were NRH-, and hepatosplenomegaly was observed in only 1 patient who was NRH-. Hepatic venous pressure gradient was normal in the only patient tested who was NRH-. All-cause mortality was higher among patients who were NRH+ (5 of 6, 83%) than in the rest of the cohort (1 of 15, 7% among patients who were NRH- and who were classified as unknown; P = .002). CONCLUSIONS NRH is an underreported, frequent, and severe complication in XLA, which is associated with increased morbidity and mortality.
Collapse
Affiliation(s)
- CJ Nunes-Santos
- Immunology Service, Department of Laboratory Medicine, National Institutes of Health (NIH) Clinical Center, Bethesda, MD, USA
| | - C Koh
- Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, NIH, Bethesda, MD, USA
| | - A Rai
- Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, NIH, Bethesda, MD, USA
| | - K Sacco
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - BE Marciano
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - DE Kleiner
- Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, MD, USA
| | - J Marko
- Department of Radiology and Imaging Sciences, Clinical Center, NIH, Bethesda, MD
| | - JRE Bergerson
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - M Stack
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - MM Rivera
- Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, NIH, Bethesda, MD, USA
| | - G Constantine
- National Institute of Allergy and Infectious Diseases Allergy and Immunology Fellowship Program, NIH, Bethesda, Maryland
| | - W Strober
- Mucosal Immunity Section, Laboratory of Host Defenses, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - G Uzel
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - IJ Fuss
- Mucosal Immunity Section, Laboratory of Host Defenses, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - LD Notarangelo
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - SM Holland
- Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
| | - SD Rosenzweig
- Immunology Service, Department of Laboratory Medicine, National Institutes of Health (NIH) Clinical Center, Bethesda, MD, USA, corresponding authors Sergio D. Rosenzweig, MD, PhD, ; Immunology Service, Department of Laboratory Medicine, NIH Clinical Center, Building 10, Room 2C306, 10 Center Drive, Bethesda, MD, 20892 and Theo Heller, MD, ; Translational Hepatology Section, Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, NIH, 10 Center Drive, Bethesda, MD 20892
| | - T Heller
- Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, NIH, Bethesda, MD, USA, corresponding authors Sergio D. Rosenzweig, MD, PhD, ; Immunology Service, Department of Laboratory Medicine, NIH Clinical Center, Building 10, Room 2C306, 10 Center Drive, Bethesda, MD, 20892 and Theo Heller, MD, ; Translational Hepatology Section, Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, NIH, 10 Center Drive, Bethesda, MD 20892
| |
Collapse
|
2
|
Veenbergen S, Li P, Raatgeep HC, Lindenbergh-Kortleve DJ, Simons-Oosterhuis Y, Farrel A, Costes LMM, Joosse ME, van Berkel LA, de Ruiter LF, van Leeuwen MA, Winter D, Holland SM, Freeman AF, Wakabayashi Y, Zhu J, de Ridder L, Driessen GJ, Escher JC, Leonard WJ, Samsom JN. IL-10 signaling in dendritic cells controls IL-1β-mediated IFNγ secretion by human CD4 + T cells: relevance to inflammatory bowel disease. Mucosal Immunol 2019; 12:1201-1211. [PMID: 31417161 PMCID: PMC6752724 DOI: 10.1038/s41385-019-0194-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 07/24/2019] [Indexed: 02/04/2023]
Abstract
Uncontrolled interferon γ (IFNγ)-mediated T-cell responses to commensal microbiota are a driver of inflammatory bowel disease (IBD). Interleukin-10 (IL-10) is crucial for controlling these T-cell responses, but the precise mechanism of inhibition remains unclear. A better understanding of how IL-10 exerts its suppressive function may allow identification of individuals with suboptimal IL-10 function among the heterogeneous population of IBD patients. Using cells from patients with an IL10RA deficiency or STAT3 mutations, we demonstrate that IL-10 signaling in monocyte-derived dendritic cells (moDCs), but not T cells, is essential for controlling IFNγ-secreting CD4+ T cells. Deficiency in IL-10 signaling dramatically increased IL-1β release by moDCs. IL-1β boosted IFNγ secretion by CD4+ T cells either directly or indirectly by stimulating moDCs to secrete IL-12. As predicted a signature of IL-10 dysfunction was observed in a subgroup of pediatric IBD patients having higher IL-1β expression in activated immune cells and macroscopically affected intestinal tissue. In agreement, reduced IL10RA expression was detected in peripheral blood mononuclear cells and a subgroup of pediatric IBD patients exhibited diminished IL-10 responsiveness. Our data unveil an important mechanism by which IL-10 controls IFNγ-secreting CD4+ T cells in humans and identifies IL-1β as a potential classifier for a subgroup of IBD patients.
Collapse
Affiliation(s)
- S Veenbergen
- Laboratory of Pediatrics, division Gastroenterology and Nutrition, Erasmus University Medical Center, Rotterdam, the Netherlands.,Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, USA.,To whom correspondence should be addressed: , Dr. Janneke N. Samsom, PhD; Erasmus University Medical Center-Sophia Children’s Hospital, Laboratory of Pediatrics, division Gastroenterology and Nutrition, Room Ee1567A, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Tel: +31-(0)10-7043444; Fax: +31-(0)10-7044761; Sharon Veenbergen:
| | - P Li
- Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, USA
| | - HC Raatgeep
- Laboratory of Pediatrics, division Gastroenterology and Nutrition, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - DJ Lindenbergh-Kortleve
- Laboratory of Pediatrics, division Gastroenterology and Nutrition, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Y Simons-Oosterhuis
- Laboratory of Pediatrics, division Gastroenterology and Nutrition, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - A Farrel
- Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, USA
| | - LMM Costes
- Laboratory of Pediatrics, division Gastroenterology and Nutrition, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - ME Joosse
- Laboratory of Pediatrics, division Gastroenterology and Nutrition, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - LA van Berkel
- Laboratory of Pediatrics, division Gastroenterology and Nutrition, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - LF de Ruiter
- Laboratory of Pediatrics, division Gastroenterology and Nutrition, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - MA van Leeuwen
- Laboratory of Pediatrics, division Gastroenterology and Nutrition, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - D Winter
- Department of Pediatric Gastroenterology, Sophia Children’s Hospital-Erasmus University Medical Center, Rotterdam, the Netherlands
| | - SM Holland
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, USA
| | - AF Freeman
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, USA
| | - Y Wakabayashi
- DNA Sequencing and Genomics Core, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, USA
| | - J Zhu
- DNA Sequencing and Genomics Core, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, USA
| | - L de Ridder
- Department of Pediatric Gastroenterology, Sophia Children’s Hospital-Erasmus University Medical Center, Rotterdam, the Netherlands
| | - GJ Driessen
- Department of Pediatric Infectious Disease and Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Haga Teaching Hospital, Juliana Children’s Hospital, The Hague, the Netherlands
| | - JC Escher
- Department of Pediatric Gastroenterology, Sophia Children’s Hospital-Erasmus University Medical Center, Rotterdam, the Netherlands
| | - WJ Leonard
- Laboratory of Molecular Immunology and the Immunology Center, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, USA
| | - JN Samsom
- Laboratory of Pediatrics, division Gastroenterology and Nutrition, Erasmus University Medical Center, Rotterdam, the Netherlands.,To whom correspondence should be addressed: , Dr. Janneke N. Samsom, PhD; Erasmus University Medical Center-Sophia Children’s Hospital, Laboratory of Pediatrics, division Gastroenterology and Nutrition, Room Ee1567A, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Tel: +31-(0)10-7043444; Fax: +31-(0)10-7044761; Sharon Veenbergen:
| |
Collapse
|
3
|
Spolski R, West EE, Li P, Veenbergen S, Yung S, Kazemian M, Oh J, Yu ZX, Freeman AF, Holland SM, Murphy PM, Leonard WJ. IL-21/type I interferon interplay regulates neutrophil-dependent innate immune responses to Staphylococcus aureus. eLife 2019; 8:45501. [PMID: 30969166 PMCID: PMC6504231 DOI: 10.7554/elife.45501] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 01/24/2019] [Accepted: 04/09/2019] [Indexed: 12/24/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a major hospital- and community-acquired pathogen, but the mechanisms underlying host-defense to MRSA remain poorly understood. Here, we investigated the role of IL-21 in this process. When administered intra-tracheally into wild-type mice, IL-21 induced granzymes and augmented clearance of pulmonary MRSA but not when neutrophils were depleted or a granzyme B inhibitor was added. Correspondingly, IL-21 induced MRSA killing by human peripheral blood neutrophils. Unexpectedly, however, basal MRSA clearance was also enhanced when IL-21 signaling was blocked, both in Il21r KO mice and in wild-type mice injected with IL-21R-Fc fusion-protein. This correlated with increased type I interferon and an IFN-related gene signature, and indeed anti-IFNAR1 treatment diminished MRSA clearance in these animals. Moreover, we found that IFNβ induced granzyme B and promoted MRSA clearance in a granzyme B-dependent fashion. These results reveal an interplay between IL-21 and type I IFN in the innate immune response to MRSA.
Collapse
Affiliation(s)
- Rosanne Spolski
- Laboratory of Molecular Immunology, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, United States.,Immunology Center, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, United States
| | - Erin E West
- Laboratory of Molecular Immunology, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, United States.,Immunology Center, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, United States
| | - Peng Li
- Laboratory of Molecular Immunology, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, United States.,Immunology Center, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, United States
| | - Sharon Veenbergen
- Laboratory of Molecular Immunology, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, United States
| | - Sunny Yung
- Laboratory of Molecular Immunology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, United States
| | - Majid Kazemian
- Laboratory of Molecular Immunology, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, United States.,Immunology Center, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, United States
| | - Jangsuk Oh
- Laboratory of Molecular Immunology, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, United States.,Immunology Center, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, United States
| | - Zu-Xi Yu
- The Pathology Core, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, United States
| | - Alexandra F Freeman
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, United States
| | - Stephen M Holland
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, United States
| | - Philip M Murphy
- Laboratory of Molecular Immunology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, United States
| | - Warren J Leonard
- Laboratory of Molecular Immunology, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, United States.,Immunology Center, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, United States
| |
Collapse
|
4
|
Shah NN, Parta M, Baird K, Rafei H, Cole K, Holland SM, Hickstein DD. Monozygotic twins with GATA2 deficiency: same haploidentical-related donor, different severity of GvHD. Bone Marrow Transplant 2017; 52:1580-1582. [PMID: 28825694 DOI: 10.1038/bmt.2017.180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- N N Shah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - M Parta
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., NCI Campus at Frederick, Frederick, MD, USA
| | - K Baird
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.,Office of Tissues and Advanced Therapies, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - H Rafei
- George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - K Cole
- Office of the Clinical Director, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - S M Holland
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - D D Hickstein
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
5
|
Wingfield LR, Liu J, Hu M, Bianchi D, Hauck K, Driscoll B, Gallin JI, Malech HL, Holland SM, Van Waes C. Nine patients with chronic granulomatous disease having selective neck dissection for severe cervical lymphadenitis. Clin Otolaryngol 2017; 43:335-340. [PMID: 28727298 DOI: 10.1111/coa.12943] [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] [Accepted: 07/09/2017] [Indexed: 11/30/2022]
Affiliation(s)
- L R Wingfield
- Head and Neck Surgery Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD, USA
| | - J Liu
- Head and Neck Surgery Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD, USA
| | - M Hu
- Head and Neck Surgery Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD, USA
| | - D Bianchi
- Head and Neck Surgery Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD, USA
| | - K Hauck
- Head and Neck Surgery Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD, USA
| | - B Driscoll
- Head and Neck Surgery Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD, USA
| | - J I Gallin
- Laboratory of Host Defenses, National Institutes of Health, Bethesda, MD, USA
| | - H L Malech
- Laboratory of Host Defenses, National Institutes of Health, Bethesda, MD, USA
| | - S M Holland
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - C Van Waes
- Head and Neck Surgery Branch, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
6
|
Lyons JJ, Liu Y, Ma CA, Yu X, O'Connell MP, Lawrence MG, Zhang Y, Karpe K, Zhao M, Siegel AM, Stone KD, Nelson C, Jones N, DiMaggio T, Darnell DN, Mendoza-Caamal E, Orozco L, Hughes JD, McElwee J, Hohman RJ, Frischmeyer-Guerrerio PA, Rothenberg ME, Freeman AF, Holland SM, Milner JD. Correction: ERBIN deficiency links STAT3 and TGF-β pathway defects with atopy in humans. J Exp Med 2017; 214:1201. [PMID: 28289052 PMCID: PMC5379980 DOI: 10.1084/jem.2016143503082017c] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
7
|
Lyons JJ, Liu Y, Ma CA, Yu X, O'Connell MP, Lawrence MG, Zhang Y, Karpe K, Zhao M, Siegel AM, Stone KD, Nelson C, Jones N, DiMaggio T, Darnell DN, Mendoza-Caamal E, Orozco L, Hughes JD, McElwee J, Hohman RJ, Frischmeyer-Guerrerio PA, Rothenberg ME, Freeman AF, Holland SM, Milner JD. ERBIN deficiency links STAT3 and TGF-β pathway defects with atopy in humans. J Exp Med 2017; 214:669-680. [PMID: 28126831 PMCID: PMC5339676 DOI: 10.1084/jem.20161435] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/02/2016] [Accepted: 12/21/2016] [Indexed: 12/19/2022] Open
Abstract
Lyons et al. show that STAT3 negatively regulates TGF-β signaling via ERBIN and that cell-intrinsic deregulation of TGF-β pathway activation promotes the IL-4/IL-4Rα/GATA3 axis to support atopic phenotypes in humans. Nonimmunological connective tissue phenotypes in humans are common among some congenital and acquired allergic diseases. Several of these congenital disorders have been associated with either increased TGF-β activity or impaired STAT3 activation, suggesting that these pathways might intersect and that their disruption may contribute to atopy. In this study, we show that STAT3 negatively regulates TGF-β signaling via ERBB2-interacting protein (ERBIN), a SMAD anchor for receptor activation and SMAD2/3 binding protein. Individuals with dominant-negative STAT3 mutations (STAT3mut) or a loss-of-function mutation in ERBB2IP (ERBB2IPmut) have evidence of deregulated TGF-β signaling with increased regulatory T cells and total FOXP3 expression. These naturally occurring mutations, recapitulated in vitro, impair STAT3–ERBIN–SMAD2/3 complex formation and fail to constrain nuclear pSMAD2/3 in response to TGF-β. In turn, cell-intrinsic deregulation of TGF-β signaling is associated with increased functional IL-4Rα expression on naive lymphocytes and can induce expression and activation of the IL-4/IL-4Rα/GATA3 axis in vitro. These findings link increased TGF-β pathway activation in ERBB2IPmut and STAT3mut patient lymphocytes with increased T helper type 2 cytokine expression and elevated IgE.
Collapse
Affiliation(s)
- J J Lyons
- Genetics and Pathogenesis of Allergy Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Y Liu
- Genetics and Pathogenesis of Allergy Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - C A Ma
- Genetics and Pathogenesis of Allergy Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - X Yu
- Genetics and Pathogenesis of Allergy Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - M P O'Connell
- Genetics and Pathogenesis of Allergy Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - M G Lawrence
- Division of Asthma, Allergy, and Immunology, Department of Medicine, University of Virginia, Charlottesville, VA 22903
| | - Y Zhang
- Genetics and Pathogenesis of Allergy Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - K Karpe
- Genetics and Pathogenesis of Allergy Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - M Zhao
- Research Technologies Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - A M Siegel
- Genetics and Pathogenesis of Allergy Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - K D Stone
- Genetics and Pathogenesis of Allergy Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - C Nelson
- Genetics and Pathogenesis of Allergy Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - N Jones
- Clinical Research Directorate/CRMP, Leidos Biomedical Research Inc., NCI Campus at Frederick, Frederick, MD 21702
| | - T DiMaggio
- Genetics and Pathogenesis of Allergy Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - D N Darnell
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - E Mendoza-Caamal
- National Institute of Genomic Medicine, 14610 Mexico City, Mexico
| | - L Orozco
- National Institute of Genomic Medicine, 14610 Mexico City, Mexico
| | - J D Hughes
- Merck Research Laboratories, Merck & Co. Inc., Boston, MA 02115
| | - J McElwee
- Merck Research Laboratories, Merck & Co. Inc., Boston, MA 02115
| | - R J Hohman
- Research Technologies Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - P A Frischmeyer-Guerrerio
- Food Allergy Research Unit, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - M E Rothenberg
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229
| | - A F Freeman
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - S M Holland
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - J D Milner
- Genetics and Pathogenesis of Allergy Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| |
Collapse
|
8
|
Fleshner M, Olivier KN, Shaw PA, Adjemian J, Strollo S, Claypool RJ, Folio L, Zelazny A, Holland SM, Prevots DR. Mortality among patients with pulmonary non-tuberculous mycobacteria disease. Int J Tuberc Lung Dis 2017; 20:582-7. [PMID: 27084809 DOI: 10.5588/ijtld.15.0807] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
SETTING Tertiary referral center, National Institutes of Health (NIH), USA. OBJECTIVE To estimate the mortality rate and its correlates among persons with pulmonary non-tuberculous mycobacteria (PNTM) disease. DESIGN A retrospective review of 106 patients who were treated at the NIH Clinical Center and met American Thoracic Society/Infectious Diseases Society of America criteria for PNTM. Eligible patients were aged ⩾18 years and did not have cystic fibrosis or human immunodeficiency virus (HIV) infection. RESULTS Of 106 patients followed for a median of 4.9 years, 27 (25%) died during follow-up, for a mortality rate of 4.2 per 100 person-years. The population was predominantly female (88%) and White (88%), with infrequent comorbidities. Fibrocavitary disease (adjusted hazard ratio [aHR] 3.3, 95% confidence interval [CI] 1.3-8.3) and pulmonary hypertension (aHR 2.1, 95%CI 0.9-5.1) were associated with a significantly elevated risk of mortality in survival analysis. CONCLUSIONS PNTM remains a serious public health concern, with a consistently elevated mortality rate across multiple populations. Significant risk factors for death include fibrocavitary disease and pulmonary hypertension. Further research is needed to more specifically identify clinical and microbiologic factors that jointly influence disease outcome.
Collapse
Affiliation(s)
- M Fleshner
- Epidemiology Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - K N Olivier
- Cardiovascular and Pulmonary Branch, National Heart, Lung and Blood Institute, NIH, Bethesda, Maryland, USA
| | - P A Shaw
- Biostatistics Research Branch, Division of Clinical Research, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - J Adjemian
- Epidemiology Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, USA
| | - S Strollo
- Epidemiology Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, USA
| | - R J Claypool
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, USA
| | - L Folio
- Department of Radiology and Imaging Sciences, Clinical Center, NIH, Bethesda, USA
| | - A Zelazny
- Department of Laboratory Medicine, Clinical Center, NIH, Bethesda, Maryland, USA
| | - S M Holland
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, USA
| | - D R Prevots
- Epidemiology Unit, Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Bethesda, USA
| |
Collapse
|
9
|
Jancel T, Shaw PA, Hallahan CW, Kim T, Freeman AF, Holland SM, Penzak SR. Therapeutic drug monitoring of posaconazole oral suspension in paediatric patients younger than 13 years of age: a retrospective analysis and literature review. J Clin Pharm Ther 2016; 42:75-79. [PMID: 27982447 DOI: 10.1111/jcpt.12483] [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] [Received: 05/19/2016] [Accepted: 10/25/2016] [Indexed: 02/04/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Posaconazole is an extended-spectrum triazole antifungal with activity against a variety of clinically significant yeasts and moulds. Posaconazole is not currently approved by the U.S. Food and Drug Administration for use in children younger than 13 years of age. Our primary objective was to describe the dosing and observed trough concentrations with posaconazole oral suspension in paediatric patients at the National Institutes of Health Clinical Center (Bethesda, MD). METHODS This retrospective single-centre study reviewed paediatric patients younger than 13 years of age initiated on posaconazole oral suspension. Patients were included if they were initiated on posaconazole for prophylaxis or treatment for fungal infections from September 2006 through March 2013 with at least one trough concentration collected after at least 7 days of therapy. RESULTS AND DISCUSSION A total of 20 male patients were included, of whom 15 (75%) had chronic granulomatous disease. The median age of patients was 6·5 years (range: 2·8-10·7). A total of 79 posaconazole trough concentrations were measured in patients receiving posaconazole as prophylaxis (n = 8) or treatment (n = 12). Posaconazole dose referenced to total body weight ranged from 10·0 to 49·2 mg/kg/day. Posaconazole trough concentrations ranged from undetectable (<50 ng/mL) up to 3620 ng/mL and were ≥500, ≥700 and ≥1250 ng/mL in 95%, 60% and 25% of patients, respectively. WHAT IS NEW AND CONCLUSIONS Patients younger than 13 years of age had highly variable trough concentrations, and recommendations for the appropriate dosing of posaconazole oral suspension remain challenging. Until studies are conducted to determine the appropriate dosing of posaconazole in this patient population, therapeutic drug monitoring should be considered to ensure adequate posaconazole exposure.
Collapse
Affiliation(s)
- T Jancel
- Office of Surveillance and Epidemiology, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - P A Shaw
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - C W Hallahan
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - T Kim
- Clinical Center Pharmacy Department, National Institutes of Health, Bethesda, MD, USA
| | - A F Freeman
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - S M Holland
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - S R Penzak
- Department of Pharmacotherapy, University of North Texas System College of Pharmacy, Fort Worth, TX, USA
| |
Collapse
|
10
|
Holland SM, Dodwell DG, Krimmel DA, de Fiebre CM. Retrospective analyses of optical coherence tomography in recurrent macular edema following intravitreal therapy in patients with retinal vein occlusion. BMC Ophthalmol 2015; 15:117. [PMID: 26337708 PMCID: PMC4559365 DOI: 10.1186/s12886-015-0107-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/20/2015] [Indexed: 11/16/2022] Open
Abstract
Background Optical coherence tomography has focused mainly on central subfield thickness to quantify macular edema in central and branch retinal vein occlusion. We examined macular fields other than the central subfield to determine if they are possibly independent indicators of recurrent macular edema. Methods Single center, retrospective, consecutive case study of patients with recurrent macular edema secondary to either central or branch retinal vein occlusion. Thickness estimates of serial domain optical coherence tomography macular fields were obtained at the time of recurrent macular edema and analyzed retrospectively. Changes were expressed as a percentage of previous baseline levels. Change in thickness at each retreatment episode as well as average changes in thickness were calculated for each macular field for each eye. Data were analyzed via analysis of variance and Fisher’s post hoc analyses. The macular field which most frequently had the largest percent increase at the time of recurrence was also assessed using averages for each subject as well as for each retreatment episode. Individual episodes of recurrent macular edema were also examined to ascertain the frequency in which there was minimal foveal edema (<15 μm increase), but non-foveal edema was considered severe enough to warrant retreatment. Results 429 episodes of recurrent macular edema in 80 eyes were examined. In addition to the central subfield, the average mean change in thickness of the most affected quadrant (central vein occlusion) or hemisphere (branch vein occlusion) of the extrafoveal 3 mm band had the largest mean changes and also most frequently had the largest increases at the time of recurrent macular edema. In approximately 20 % of both central and branch occlusions, recurrent macular edema was detected in non-central macular fields in the absence of significant edema in the central subfield. Conclusions Analyses of non-central macular fields as well as the central subfield may be useful in the early detection and treatment of recurrent macular edema in retinal vein occlusion.
Collapse
Affiliation(s)
- Stephen M Holland
- Illinois Retina Center, Springfield, IL, 62704, USA. .,Southern Illinois University School of Medicine, Springfield, IL, 62702, USA. .,Department of Ophthalmology, Loyola University Stritch School of Medicine, 2160 S First Ave, Maywood, IL, 60153, USA.
| | - David G Dodwell
- Illinois Retina Center, Springfield, IL, 62704, USA.,Southern Illinois University School of Medicine, Springfield, IL, 62702, USA
| | - Darrel A Krimmel
- Illinois Retina Center, Springfield, IL, 62704, USA. .,Krimmel Consulting, 98 Laconwood Dr., Springfield, IL, 62712, USA.
| | | |
Collapse
|
11
|
Kil N, Holland SM, Stein TV. Experiential benefits, place meanings, and environmental setting preferences between proximate and distant visitors to a national scenic trail. Environ Manage 2015; 55:1109-1123. [PMID: 25579621 DOI: 10.1007/s00267-015-0445-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 01/02/2015] [Indexed: 06/04/2023]
Abstract
Effective management of conserved natural areas often requires a good understanding of recreation visitors who possess various values for those areas. This study examined differences in experiential benefits sought, place meanings, and environmental setting preferences between proximate and distant visitors to a publicly managed national scenic trail, which transects a variety of conserved public lands. Data were collected using on-site post-hike interviews with visitors at low, moderate, and high use trailheads. Proximate visitors sought mental and physical health more strongly than distant visitors, while distant visitors sought environmental exploration more strongly than proximate visitors. No significant difference in family bonding and achievement benefits existed between the two groups. Meanings related to place dependence, family identity, community identity, and place identity were more strongly ascribed by proximate visitors, and both groups rated ecological integrity meanings highly. Distant visitors showed stronger tendencies toward preferring a lesser level of trail development, lower level of encounters with other groups, and higher level of natural landscapes, which indicated an inclination toward natural settings. These findings indicate a managerially relevant role of the degree of proximity to environmental resources on individuals' recreation behaviors, meanings ascribed to the resources and setting conditions. Understanding differences and similarities between groups dichotomized by proximity to natural resources should advance more effective management of recreation and benefit opportunities for diverse visitor groups.
Collapse
Affiliation(s)
- Namyun Kil
- School of Natural Resources, University of Nebraska-Lincoln, 304 Hardin Hall, Lincoln, NE, 68583, USA,
| | | | | |
Collapse
|
12
|
West ES, Kingsbery MY, Mintz EM, Hsu AP, Holland SM, Rady PL, Tyring SK, Grossman ME. Generalized verrucosis in a patient with GATA2 deficiency. Br J Dermatol 2015; 170:1182-6. [PMID: 24359037 DOI: 10.1111/bjd.12794] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2013] [Indexed: 12/16/2022]
Abstract
Generalized verrucosis is a characteristic of several genetic and immunodeficiency disorders including epidermodysplasia verruciformis; warts, hypogammaglobulinaemia, infections and myelokathexis (WHIM) syndrome; warts, immunodeficiency, lymphoedema and anogenital dysplasia (WILD) syndrome; severe combined immune deficiency and HIV, among others. In recent years, it has been consistently recognized in patients with GATA2 deficiency, a novel immunodeficiency syndrome characterized by monocytopenia, B-cell and natural killer-cell lymphopenia, and a tendency to develop myeloid leukaemias and disseminated mycobacterial, human papillomavirus (HPV) and opportunistic fungal infections. Mutations in GATA2 cause haploinsufficiency and track in families as an autosomal dominant immunodeficiency. GATA2 is a transcription factor involved in early haematopoietic differentiation and lymphatic and vascular development. We describe a case of generalized verrucosis with HPV type 57 presenting in a young man with GATA2 deficiency. GATA2 deficiency is a novel dominant immunodeficiency that is often recognized later in life and should be considered in the differential diagnosis of patients with generalized verrucosis.
Collapse
Affiliation(s)
- E S West
- Department of Dermatology, Columbia University Medical Center, 161 Fort Washington Avenue 12th Floor, New York, NY, 10032, U.S.A
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Betts K, Abusleme L, Freeman AF, Sarmadi M, Fahle G, Pittaluga S, Cuellar-Rodriguez J, Hickstein D, Holland SM, Su H, Moutsopoulos NM. A 17-year old patient with DOCK8 deficiency, severe oral HSV-1 and aggressive periodontitis - a case of virally induced periodontitis? J Clin Virol 2014; 63:46-50. [PMID: 25600604 DOI: 10.1016/j.jcv.2014.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 08/04/2014] [Revised: 10/30/2014] [Accepted: 12/03/2014] [Indexed: 11/19/2022]
Abstract
We present a 17-year old girl with DOCK-8 deficiency, severe untreated oral HSV-1 infection and associated aggressive periodontitis. DOCK-8 deficiency is a primary immunodeficiency, caused by biallelicloss-of-function mutations in the DOCK8 gene, often leading to severe viral and fungal mucocutaneous infections. Nevertheless, to date DOCK8 has not been associated with severe periodontitis and inflammatory bone loss around teeth. Understanding whether DOCK8 deficiency or severe HSV-1 infection underlies susceptibility to periodontitis is central to this case and may provide insights into susceptibility factors for periodontitis in the general population. Our clinical and microbiological data suggest that severe HSV-1 infection is the driver of periodontal inflammation in this case.
Collapse
Affiliation(s)
- K Betts
- Oral Immunity and Inflammation Unit, OPCB, NIDCR, NIH, United States
| | - L Abusleme
- Oral Immunity and Inflammation Unit, OPCB, NIDCR, NIH, United States
| | - A F Freeman
- Laboratory of Clinical Infectious Diseases, NIAID, NIH, United States
| | - M Sarmadi
- Oral Immunity and Inflammation Unit, OPCB, NIDCR, NIH, United States
| | - G Fahle
- Department of Laboratory Medicine, Clinical Center, NIH, United States
| | - S Pittaluga
- Laboratory of Pathology, Center for Cancer Research, NCI, NIH, United States
| | | | - D Hickstein
- Experimental Transplantation and Immunology Branch, NCI, NIH, United States
| | - S M Holland
- Laboratory of Clinical Infectious Diseases, NIAID, NIH, United States
| | - H Su
- Laboratory of Host Defense, NIAID, NIH, United States
| | - N M Moutsopoulos
- Oral Immunity and Inflammation Unit, OPCB, NIDCR, NIH, United States.
| |
Collapse
|
14
|
Haverkamp MH, van de Vosse E, Goldbach-Mansky R, Holland SM. Impaired cytokine responses in patients with cryopyrin-associated periodic syndrome (CAPS). Clin Exp Immunol 2014; 177:720-31. [PMID: 24773462 DOI: 10.1111/cei.12361] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2014] [Indexed: 12/01/2022] Open
Abstract
Cryopyrin-associated periodic syndrome (CAPS) is characterized by dysregulated inflammation with excessive interleukin (IL)-1β activation and secretion. Neonatal-onset multi-system inflammatory disease (NOMID) is the most severe form. We explored cytokine responses in 32 CAPS patients before and after IL-1β blocking therapy. We measured cytokines produced by activated peripheral blood monuclear cells (PBMCs) from treated and untreated CAPS patients after stimulation for 48 h with phytohaemagglutinin (PHA), PHA plus IL-12, lipopolysaccharide (LPS) or LPS plus interferon (IFN)-γ. We measured IL-1β, IL-6, IL-10, tumour necrosis factor (TNF), IL-12p70 and IFN-γ in the supernatants. PBMCs from three untreated CAPS patients were cultured in the presence of the IL-1β blocker Anakinra. Fifty healthy individuals served as controls. CAPS patients had high spontaneous production of IL-1β, IL-6, TNF and IFN-γ by unstimulated cells. However, stimulation indexes (SIs, ratio of stimulated to unstimulated production) of these cytokines to PHA and LPS were low in NOMID patients compared to controls. Unstimulated IL-10 and IL-12p70 production was normal, but up-regulation after PHA and LPS was also low. LPS plus IFN-γ inadequately up-regulated the production of IL-1β, IL-6, TNF and IL-10 in CAPS patients. In-vitro but not in-vivo treatment with Anakinra improved SIs by lowering spontaneous cytokine production. However, in-vitro treatment did not improve the low stimulated cytokine levels. Activating mutations in NLRP3 in CAPS are correlated with poor SIs to PHA, LPS and IFN-γ. The impairment in stimulated cytokine responses in spite of IL-1β blocking therapy suggests a broader intrinsic defect in CAPS patients, which is not corrected by targeting IL-1β.
Collapse
Affiliation(s)
- M H Haverkamp
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands; Laboratory of Clinical Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | | | | |
Collapse
|
15
|
Liu Y, Jesus AA, Marrero B, Yang D, Ramsey SE, Sanchez GAM, Tenbrock K, Wittkowski H, Jones OY, Kuehn HS, Lee CCR, DiMattia MA, Cowen EW, Gonzalez B, Palmer I, DiGiovanna JJ, Biancotto A, Kim H, Tsai WL, Trier AM, Huang Y, Stone DL, Hill S, Kim HJ, St Hilaire C, Gurprasad S, Plass N, Chapelle D, Horkayne-Szakaly I, Foell D, Barysenka A, Candotti F, Holland SM, Hughes JD, Mehmet H, Issekutz AC, Raffeld M, McElwee J, Fontana JR, Minniti CP, Moir S, Kastner DL, Gadina M, Steven AC, Wingfield PT, Brooks SR, Rosenzweig SD, Fleisher TA, Deng Z, Boehm M, Paller AS, Goldbach-Mansky R. Activated STING in a vascular and pulmonary syndrome. N Engl J Med 2014; 371:507-518. [PMID: 25029335 PMCID: PMC4174543 DOI: 10.1056/nejmoa1312625] [Citation(s) in RCA: 910] [Impact Index Per Article: 91.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The study of autoinflammatory diseases has uncovered mechanisms underlying cytokine dysregulation and inflammation. METHODS We analyzed the DNA of an index patient with early-onset systemic inflammation, cutaneous vasculopathy, and pulmonary inflammation. We sequenced a candidate gene, TMEM173, encoding the stimulator of interferon genes (STING), in this patient and in five unrelated children with similar clinical phenotypes. Four children were evaluated clinically and immunologically. With the STING ligand cyclic guanosine monophosphate-adenosine monophosphate (cGAMP), we stimulated peripheral-blood mononuclear cells and fibroblasts from patients and controls, as well as commercially obtained endothelial cells, and then assayed transcription of IFNB1, the gene encoding interferon-β, in the stimulated cells. We analyzed IFNB1 reporter levels in HEK293T cells cotransfected with mutant or nonmutant STING constructs. Mutant STING leads to increased phosphorylation of signal transducer and activator of transcription 1 (STAT1), so we tested the effect of Janus kinase (JAK) inhibitors on STAT1 phosphorylation in lymphocytes from the affected children and controls. RESULTS We identified three mutations in exon 5 of TMEM173 in the six patients. Elevated transcription of IFNB1 and other gene targets of STING in peripheral-blood mononuclear cells from the patients indicated constitutive activation of the pathway that cannot be further up-regulated with stimulation. On stimulation with cGAMP, fibroblasts from the patients showed increased transcription of IFNB1 but not of the genes encoding interleukin-1 (IL1), interleukin-6 (IL6), or tumor necrosis factor (TNF). HEK293T cells transfected with mutant constructs show elevated IFNB1 reporter levels. STING is expressed in endothelial cells, and exposure of these cells to cGAMP resulted in endothelial activation and apoptosis. Constitutive up-regulation of phosphorylated STAT1 in patients' lymphocytes was reduced by JAK inhibitors. CONCLUSIONS STING-associated vasculopathy with onset in infancy (SAVI) is an autoinflammatory disease caused by gain-of-function mutations in TMEM173. (Funded by the Intramural Research Program of the National Institute of Arthritis and Musculoskeletal and Skin Diseases; ClinicalTrials.gov number, NCT00059748.).
Collapse
Affiliation(s)
- Y Liu
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A A Jesus
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - B Marrero
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - D Yang
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S E Ramsey
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - G A Montealegre Sanchez
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - K Tenbrock
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - H Wittkowski
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - O Y Jones
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - H S Kuehn
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - C-C R Lee
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - M A DiMattia
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - E W Cowen
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - B Gonzalez
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - I Palmer
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - J J DiGiovanna
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A Biancotto
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - H Kim
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - W L Tsai
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A M Trier
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - Y Huang
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - D L Stone
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S Hill
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - H J Kim
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - C St Hilaire
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S Gurprasad
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - N Plass
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - D Chapelle
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - I Horkayne-Szakaly
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - D Foell
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A Barysenka
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - F Candotti
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S M Holland
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - J D Hughes
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - H Mehmet
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A C Issekutz
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - M Raffeld
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - J McElwee
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - J R Fontana
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - C P Minniti
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S Moir
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - D L Kastner
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - M Gadina
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A C Steven
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - P T Wingfield
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S R Brooks
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S D Rosenzweig
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - T A Fleisher
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - Z Deng
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - M Boehm
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A S Paller
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - R Goldbach-Mansky
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| |
Collapse
|
16
|
Liu Y, Jesus AA, Marrero B, Yang D, Ramsey SE, Sanchez GAM, Tenbrock K, Wittkowski H, Jones OY, Kuehn HS, Lee CCR, DiMattia MA, Cowen EW, Gonzalez B, Palmer I, DiGiovanna JJ, Biancotto A, Kim H, Tsai WL, Trier AM, Huang Y, Stone DL, Hill S, Kim HJ, St Hilaire C, Gurprasad S, Plass N, Chapelle D, Horkayne-Szakaly I, Foell D, Barysenka A, Candotti F, Holland SM, Hughes JD, Mehmet H, Issekutz AC, Raffeld M, McElwee J, Fontana JR, Minniti CP, Moir S, Kastner DL, Gadina M, Steven AC, Wingfield PT, Brooks SR, Rosenzweig SD, Fleisher TA, Deng Z, Boehm M, Paller AS, Goldbach-Mansky R. Activated STING in a vascular and pulmonary syndrome. N Engl J Med 2014. [PMID: 25029335 DOI: 10.1056/nejmoa1312625)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND The study of autoinflammatory diseases has uncovered mechanisms underlying cytokine dysregulation and inflammation. METHODS We analyzed the DNA of an index patient with early-onset systemic inflammation, cutaneous vasculopathy, and pulmonary inflammation. We sequenced a candidate gene, TMEM173, encoding the stimulator of interferon genes (STING), in this patient and in five unrelated children with similar clinical phenotypes. Four children were evaluated clinically and immunologically. With the STING ligand cyclic guanosine monophosphate-adenosine monophosphate (cGAMP), we stimulated peripheral-blood mononuclear cells and fibroblasts from patients and controls, as well as commercially obtained endothelial cells, and then assayed transcription of IFNB1, the gene encoding interferon-β, in the stimulated cells. We analyzed IFNB1 reporter levels in HEK293T cells cotransfected with mutant or nonmutant STING constructs. Mutant STING leads to increased phosphorylation of signal transducer and activator of transcription 1 (STAT1), so we tested the effect of Janus kinase (JAK) inhibitors on STAT1 phosphorylation in lymphocytes from the affected children and controls. RESULTS We identified three mutations in exon 5 of TMEM173 in the six patients. Elevated transcription of IFNB1 and other gene targets of STING in peripheral-blood mononuclear cells from the patients indicated constitutive activation of the pathway that cannot be further up-regulated with stimulation. On stimulation with cGAMP, fibroblasts from the patients showed increased transcription of IFNB1 but not of the genes encoding interleukin-1 (IL1), interleukin-6 (IL6), or tumor necrosis factor (TNF). HEK293T cells transfected with mutant constructs show elevated IFNB1 reporter levels. STING is expressed in endothelial cells, and exposure of these cells to cGAMP resulted in endothelial activation and apoptosis. Constitutive up-regulation of phosphorylated STAT1 in patients' lymphocytes was reduced by JAK inhibitors. CONCLUSIONS STING-associated vasculopathy with onset in infancy (SAVI) is an autoinflammatory disease caused by gain-of-function mutations in TMEM173. (Funded by the Intramural Research Program of the National Institute of Arthritis and Musculoskeletal and Skin Diseases; ClinicalTrials.gov number, NCT00059748.).
Collapse
Affiliation(s)
- Y Liu
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A A Jesus
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - B Marrero
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - D Yang
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S E Ramsey
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - G A Montealegre Sanchez
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - K Tenbrock
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - H Wittkowski
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - O Y Jones
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - H S Kuehn
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - C-C R Lee
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - M A DiMattia
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - E W Cowen
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - B Gonzalez
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - I Palmer
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - J J DiGiovanna
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A Biancotto
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - H Kim
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - W L Tsai
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A M Trier
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - Y Huang
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - D L Stone
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S Hill
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - H J Kim
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - C St Hilaire
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S Gurprasad
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - N Plass
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - D Chapelle
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - I Horkayne-Szakaly
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - D Foell
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A Barysenka
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - F Candotti
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S M Holland
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - J D Hughes
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - H Mehmet
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A C Issekutz
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - M Raffeld
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - J McElwee
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - J R Fontana
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - C P Minniti
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S Moir
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - D L Kastner
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - M Gadina
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A C Steven
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - P T Wingfield
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S R Brooks
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - S D Rosenzweig
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - T A Fleisher
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - Z Deng
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - M Boehm
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - A S Paller
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| | - R Goldbach-Mansky
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (Y.L., A.A.J., B.M., G.A.M.S., M.A.D., I.P., H.K., W.L.T., A.M.T., Y.H., N.P., D.C., M.G., A.C.S., P.T.W., S.R.B., Z.D., R.G-M.), National Cancer Institute (C.-C.R.L., E.W.C., J.J.D., M.R.), National Heart, Lung, and Blood Institute (D.Y., A. Biancotto, C.S.H., J.R.F., C.P.M., M.B.), Department of Laboratory Medicine (H.S.K., S.G., S.D.R., T.A.F.), National Human Genome Research Institute (D.L.S., F.C., D.L.K.), Department of Radiology and Imaging Services (S.H.), National Institute on Deafness and Other Communication Disorders (H.J.K.), and National Institute of Allergy and Infectious Diseases (S.M.H., S.M.) - all at the National Institutes of Health (NIH), and Walter Reed National Military Medical Center (O.Y.J., I.H.-S.) - both in Bethesda, MD; Dalhousie University, Halifax, NS, Canada (S.E.R., A.C.I.); Rheinisch-Westfaelische Technische Hochschule Aachen, Aachen (K.T.), and University Hospital of Muenster, Muenster (H.W., D.F., A. Barysenka) - both in Germany; Luis Calvo Mackenna Hospital, Santiago, Chile (B.G.); Merck Research Laboratories, Boston (J.D.H., H.M., J.M.); and Northwestern University Feinberg School of Medicine, Chicago (A.S.P.)
| |
Collapse
|
17
|
Bax HI, Freeman AF, Ding L, Hsu AP, Marciano B, Kristosturyan E, Jancel T, Spalding C, Pechacek J, Olivier KN, Barnhart LA, Boris L, Frein C, Claypool RJ, Anderson V, Zerbe CS, Holland SM, Sampaio EP. Interferon alpha treatment of patients with impaired interferon gamma signaling. J Clin Immunol 2013; 33:991-1001. [PMID: 23512243 PMCID: PMC4136390 DOI: 10.1007/s10875-013-9882-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [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: 12/03/2012] [Accepted: 02/27/2013] [Indexed: 11/27/2022]
Abstract
Patients with deficiency in the interferon gamma receptor (IFN-γR) are unable to respond properly to IFN-γ and develop severe infections with nontuberculous mycobacteria (NTM). IFN-γ and IFN-α are known to signal through STAT1 and activate many downstream effector genes in common. Therefore, we added IFN-α for treatment of patients with disseminated mycobacterial disease in an effort to complement their IFN-γ signaling defect. We treated four patients with IFN-γR deficiency with adjunctive IFN-α therapy in addition to best available antimicrobial therapy, with or without IFN-γ, depending on the defect. During IFN-α treatment, ex vivo induction of IFN target genes was detected. In addition, IFN-α driven gene expression in patients' cells and mycobacteria induced cytokine response were observed in vitro. Clinical responses varied in these patients. IFN-α therapy was associated with either improvement or stabilization of disease. In no case was disease exacerbated. In patients with profoundly impaired IFN-γ signaling who have refractory infections, IFN-α may have adjunctive anti-mycobacterial effects.
Collapse
Affiliation(s)
- H I Bax
- Immunopathogenesis Section, Laboratory of Clinical Infectious Diseases, NIAID, NIH, CRC B3-4233 MSC 1684, Bethesda, MD 20892-1684, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Mizesko MC, Banerjee PP, Monaco-Shawver L, Mace EM, Bernal W, Sawalle-Belohradsky J, Belohradsky B, Heinz V, Freeman AF, Sullivan KE, Holland SM, Torgerson TR, Al-Herz W, Chou J, Hanson IC, Albert MH, Geha RS, Renner ED, Orange JS. A2.23 Impaired Natural Killer Cell Function in DOCK8 Deficiency. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-203215.23] [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: 11/03/2022]
|
19
|
Paulson ML, Olivier KN, Holland SM. Pulmonary non-tuberculous mycobacterial infection in congenital contractural arachnodactyly. Int J Tuberc Lung Dis 2012; 16:561-3. [PMID: 22325249 DOI: 10.5588/ijtld.11.0301] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Congenital contractural arachnodactyly (CCA) is caused by mutations within the fibrillin-2 gene (FBN2), which is crucial for microfibril structure. Affected individuals may have contractures, chest wall deformities, scoliosis, abnormal ear folding and elongated limbs. We describe a novel FBN2 mutation in a woman with CCA who also had pulmonary non-tuberculous mycobacteria (NTM) infection. The population with pulmonary NTM infections shares phenotypic features with CCA, such as elongated body habitus, scoliosis and pectus deformities. While it is unlikely that FBN2 defects account for susceptibility to NTM infection in the majority of cases, the overlap between these two diseases suggests some shared pathophysiology.
Collapse
Affiliation(s)
- M L Paulson
- Laboratory of Clinical Infectious Diseases, SAIC-Frederick, Inc. National Cancer Institute-Frederick, Frederick, Maryland, USA
| | | | | |
Collapse
|
20
|
Kil N, Holland SM, Stein TV. Identifying differences between off-highway vehicle (OHV) and non-OHV user groups for recreation resource planning. Environ Manage 2012; 50:365-380. [PMID: 22752733 DOI: 10.1007/s00267-012-9892-8] [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] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 05/24/2012] [Indexed: 06/01/2023]
Abstract
Off-highway vehicle (OHV) riding is among the fastest growing recreational activities in the United States. However, little research exists about the central components of outcomes-focused management (OFM) as it relates to motorized recreation. Utilizing a two-activity dichotomy, OHV and non-OHV centric user groups were compared on several key concepts associated with OFM, including desired experiences, perceived and desired recreation opportunity spectrum-type settings, and intentional behaviors (i.e., place-protective behavior, spending-time intentions) toward potential changes in settings. Results indicated that the two groups were different in terms of intensity and relative rankings of their perceived experiences and settings. Although both groups preferred social bonding, stress relief, nostalgia and learning experiences, the OHV user group ranked using equipment and achieving physical fitness experiences as more important than the non-OHV group. The non-OHV user group preferred enjoying nature and solitude/tranquility experiences more strongly than the OHV user group. Further analysis found that both groups perceived settings that they recreated in to be pristine and preferred such conditions, and both groups preferred moderate levels of rules and regulations. Finally, the OHV user group was more reactive to rules and regulations, while the non-OHV user group expressed stronger intentions to protect the environmental quality of recreation areas. The results suggest that planners and managers who understand OHV user's perceptions and behaviors could provide enhanced recreation opportunities potentially providing additional beneficial outcomes for motorized and non-motorized groups in spatially different zones. Additional implications for planners and managers and future studies are discussed.
Collapse
Affiliation(s)
- Namyun Kil
- Department of Tourism Management, Woosong University, 17-2 Jayang-dong, Dong-gu, Daejeon, 300-718, South Korea.
| | | | | |
Collapse
|
21
|
Fathi AR, Vortmeyer A, Holland SM, Pluta RM. Intracranial aneurysms associated with hyperimmunoglobulinaemia E (Job) syndrome: report of two cases. J Neurol Neurosurg Psychiatry 2011; 82:704-6. [PMID: 20861064 DOI: 10.1136/jnnp.2009.198283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
22
|
Heim KF, Fleisher TA, Stroncek DF, Holland SM, Gallin JI, Malech HL, Leitman SF. The relationship between alloimmunization and posttransfusion granulocyte survival: experience in a chronic granulomatous disease cohort. Transfusion 2010; 51:1154-62. [PMID: 21175646 DOI: 10.1111/j.1537-2995.2010.02993.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The efficacy of granulocyte transfusions in patients with HLA alloimmunization is uncertain. A flow cytometric assay using dihydrorhodamine 123 (DHR), a marker for cellular NADPH oxidase activity, was used to monitor the differential survival of transfused oxidase-positive granulocytes in alloimmunized patients with chronic granulomatous disease (CGD). STUDY DESIGN AND METHODS Ten patients with CGD and serious infections were treated with daily granulocyte transfusions derived from steroid and granulocyte-colony-stimulating factor-stimulated donors. The proportion of neutrophils with intact oxidase activity was quantitated by DHR fluorescence on samples drawn before and 1 hour after transfusion. The incidence of acute transfusion reactions was correlated with the results of DHR fluorescence and biweekly HLA serologic screening assays. RESULTS Eight of 10 patients experienced acute adverse reactions in association with granulocyte transfusions. Four had only chills and/or fever, and four experienced respiratory compromise; all eight exhibited HLA alloimmunization. Mean (± SD) oxidase-positive cell recovery was 19.7 ± 17.4% (n = 15 transfusions) versus 0.95 ± 1.59% (n = 16) in the absence and presence of HLA allosensitization, respectively (p < 0.01). Greater than 1% in vivo recovery of DHR-enhancing donor granulocytes was strongly correlated with lack of HLA alloimmunization. CONCLUSION The ability to detect DHR-positive donor granulocytes by flow cytometry is strongly correlated with absence of HLA alloimmunization and lack of acute reactions to granulocyte transfusions in patients with CGD. If HLA antibodies are present and the survival of donor granulocytes is low by DHR analysis, transfusions should be discontinued, avoiding a therapy associated with high risk and unclear benefit.
Collapse
Affiliation(s)
- K F Heim
- Department of Transfusion Medicine and Laboratory Medicine, Warren Grant Magnuson Clinical Center and the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892-1184, USA
| | | | | | | | | | | | | |
Collapse
|
23
|
Abstract
Autosomal dominant hyper IgE (HIES or Job's) syndrome is a rare primary immune deficiency characterized by eczema, recurrent skin and lung infections, extremely elevated serum IgE, and a variety of connective tissue and skeletal abnormalities. Individuals with HIES share a characteristic facial appearance and many oral manifestations including retained primary dentition, a high arched palate, variations of the oral mucosa and gingiva, and recurrent oral candidiasis. Mutations in STAT3 account for the majority, if not all, of the cases of autosomal dominant HIES, but the pathogenesis of the many varied features remains poorly understood. In this review, we discuss the clinical phenotype of HIES including immunologic and non-immunologic features, the genetics of HIES, and treatment.
Collapse
Affiliation(s)
- A F Freeman
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | | |
Collapse
|
24
|
Herzlich AA, Yeh S, Shen D, Ding X, Uzel G, Holland SM, Chan C. Identification of Pseudomonas aeruginosa DNA in a chorioretinal lesion associated with chronic granulomatous disease. J Clin Pathol 2008; 61:1229-30. [DOI: 10.1136/jcp.2008.059147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
25
|
Abstract
AIM Hyperimmunoglobulin-E syndrome (HIES) is a primary immunodeficiency characterized by eczema, recurrent skin and lung infections with pneumatocoele formation, and extremely elevated serum immunoglobulin-E. The precise immunologic defect and genetic etiology remain unknown. Non-immunologic findings include characteristic facial features (prominent forehead, fleshy nasal tip, and increased interalar distance); skeletal involvement (pathological fractures, scoliosis, and craniosynostosis); and retention of primary teeth. This study aims to characterize intraoral soft tissue findings in HIES patients. METHODS Sixty HIES patients (4-54 years, 27 males, 33 females) received intraoral and radiographic evaluations. Chronological dental development was also assessed. RESULTS Lesions of the hard palate and dorsal tongue were found in 55% and 60% of patients, respectively. Palatal lesions ranged from a generalized surface keratosis to a midline sagittal fibrotic bridge. Tongue lesions consisted of multiple fissures and a midline cleft. On the lip and buccal mucosa, keratotic plaques and/or surface fissures were found in 8% and 23% of patients, respectively. Manifested in 76.7% of patients, the intraoral lesions were significantly more prevalent than the characteristic facial traits (P=0.0013). CONCLUSIONS Alterations in oral mucosa and gingiva were present in the majority of HIES patients. These novel intraoral findings may facilitate the diagnosis of HIES.
Collapse
Affiliation(s)
- D L Domingo
- National Institute of Dental and Craniofacial Research, Bethesda, MD 20892, USA.
| | | | | | | | | | | | | |
Collapse
|
26
|
Santos PE, Piontelli E, Shea YR, Galluzzo ML, Holland SM, Zelazko ME, Rosenzweig SD. Penicillium piceum infection: diagnosis and successful treatment in chronic granulomatous disease. Med Mycol 2007; 44:749-53. [PMID: 17127632 DOI: 10.1080/13693780600967089] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [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: 10/24/2022] Open
Abstract
Infections due to Penicillium species other than P.marneffei are rare. We identified a boy with X-linked chronic granulomatous disease (X-CGD) with a pulmonary nodule and adjacent rib osteomyelitis caused by Penicillium piceum. The only sign of infection was an elevated sedimentation rate. P. piceum was isolated by fine needle aspirate and from excised infected tissues. Surgical removal and one year of voriconazole treatment were very well tolerated and led to complete recovery. Microbiological, microscopic and molecular studies support the fungal diagnosis. P. piceum should be considered as a relevant pathogen in immunocompromised patients.
Collapse
Affiliation(s)
- P E Santos
- Laboratorio de Microbiología, Hospital de Pediatría J. P. Garrahan, Buenos Aires, Argentina
| | | | | | | | | | | | | |
Collapse
|
27
|
Yim JJ, Lee HW, Lee HS, Kim YW, Han SK, Shim YS, Holland SM. The association between microsatellite polymorphisms in intron II of the human Toll-like receptor 2 gene and tuberculosis among Koreans. Genes Immun 2006; 7:150-5. [PMID: 16437124 DOI: 10.1038/sj.gene.6364274] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [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: 01/20/2023]
Abstract
The observation that Toll-like receptor (TLR)2-deficient mice are highly susceptible to mycobacteria suggests that mutations altering TLR2 expression may impair host response to Mycobacterium tuberculosis. We evaluated the association between guanine-thymine (GT) repeat polymorphism in intron II of the TLR2 gene and the presence of tuberculosis (TB) in Koreans. The numbers of GT repeats were determined by PCR and gene scans for 176 TB patients and 196 controls. The recombinant TLR2 promoter/exonI/exonII/intronII/luciferase constructs including three representative repeats: (GT)13, (GT)20, and (GT)24 were transfected into K562 cells, and luciferase activities were estimated and compared. The expression of TLR2 on CD14+ peripheral blood mononuclear cells (PBMC) from healthy volunteers were measured with flow cytometry. Genotypes with shorter GT repeats were more common among TB patients (49.4 vs 37.7%, P=0.02). This observation was confirmed among 82 other TB patients as a validation cohort. Shorter GT repeats were associated with weaker promoter activities and lower TLR2 expression on CD14+ PBMCs. In conclusion, the development of TB disease in Koreans was associated with shorter GT repeats in intron II of the TLR2 gene. This association is correlated with lower expression of TLR2 through weaker promoter activity for genes with shorter GT repeats.
Collapse
Affiliation(s)
- J-J Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, and Lung Institute, Seoul National University College of Medicine, Chongno-Gu, Seoul, Republic of Korea
| | | | | | | | | | | | | |
Collapse
|
28
|
|
29
|
Haverkamp MH, van Dissel JT, Holland SM. Human host genetic factors in nontuberculous mycobacterial infection: lessons from single gene disorders affecting innate and adaptive immunity and lessons from molecular defects in interferon-gamma-dependent signaling. Microbes Infect 2006; 8:1157-66. [PMID: 16520075 DOI: 10.1016/j.micinf.2005.10.029] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [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: 08/11/2005] [Accepted: 10/19/2005] [Indexed: 10/25/2022]
Abstract
Mendelian defects in interferon-gamma (IFN-gamma) signaling most commonly lead to infection with nontuberculous mycobacteria. Mutations have been identified in the genes encoding IFN-gamma-receptor-1, IFN-gamma-receptor-2 and Stat-1. Partial and complete deficiencies in signaling are found, leading to parallel clinical, pathological, and cellular phenotypes. These rare defects have led to better molecular and mechanistic understanding of the role of IFN-gamma in the human immune system.
Collapse
Affiliation(s)
- M H Haverkamp
- Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef, Postbus 9600, 2300 RC Leiden, The Netherlands.
| | | | | |
Collapse
|
30
|
Bolanowski A, Mannon RB, Holland SM, Malech HL, Aschan J, Palmblad J, Hale DA, Kirk AD. Successful renal transplantation in patients with chronic granulomatous disease. Am J Transplant 2006; 6:636-9. [PMID: 16468977 DOI: 10.1111/j.1600-6143.2006.01232.x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Chronic granulomatous disease (CGD) is a genetic disease caused by structural mutations in the enzyme NADPH oxidase that results in severe immunodeficiency. End-stage renal disease occurs in this patient population, and is often attributed to the necessary use of nephrotoxic anti-infectives. In this report, we present the experiences of two centers in transplantation of three patients with CGD: one transplanted with CGD, one cured of his CGD with bone marrow transplantation who subsequently underwent kidney transplantation and one that received a kidney transplant prior to being cured of CGD via a sequential peripheral blood stem cell transplant (SCT). All three recipients have enjoyed excellent outcomes. Their courses demonstrate the absolute requirements for a multidisciplinary and compulsive approach before, during and after transplantation. These case reports also highlight the unexpectedly benign effects of immunosuppressive therapy in this patient population.
Collapse
Affiliation(s)
- A Bolanowski
- Department of Surgery, National Naval Medical Center, Bethesda, Maryland, USA
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Abstract
Asthma is the commonest pre-existing medical condition to complicate pregnancy. Acute severe asthma in pregnancy is rare, but poses difficult problems. In particular, the decision about when and where to deliver the fetus is complex, since maternal response to asthma treatment is unpredictable. We report the successful management of a parturient presenting with acute severe asthma at 37 weeks' gestation. The controversies involved and the importance of adopting a multi-disciplinary team approach to optimise maternal and neonatal outcomes are discussed.
Collapse
Affiliation(s)
- S M Holland
- Department of Anaesthesia, North Hampshire Hospital, Basingstoke, UK.
| | | |
Collapse
|
32
|
Abstract
Primary immunodeficiencies are rare and usually first manifest during childhood. Invasive aspergillosis is the leading cause of mortality in chronic granulomatous disease (CGD), reflecting the key role of the phagocyte NADPH oxidase in host defense against opportunistic fungi. Despite interferon-gamma prophylaxis, invasive filamentous fungal infections are a persistent problem in CGD. Key principles of management of fungal infections involve early recognition and aggressive treatment and appropriate surgical debridement of localized disease. Because CGD is a disorder of phagocyte stem cells in which the gene defects are well defined, it is a model disease to evaluate immune reconstitution through stem cell transplantation and gene therapy. Patients with the hyper-IgE syndrome with recurrent infections (Job syndrome) are prone to colonization of lung cavities (pneumatoceles) by Aspergillus species leading to local invasion and rarely disseminated infection. Other primary phagocytic disorders, T-cell disorders, and mitochondrial disorders are uncommonly associated with invasive aspergillosis. Taken together, these rare primary immunodeficiencies highlight the complex coordination of both innate and acquired pathways mediating host defense against Aspergillus infection.
Collapse
Affiliation(s)
- N G Almyroudis
- SUNY at Buffalo, Division of Infectious Diseases, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
| | | | | |
Collapse
|
33
|
Ramsey KH, Sigar IM, Rana SV, Gupta J, Holland SM, Byrne GI, Morrow JD. Inducible nitric oxide synthase regulates production of isoprostanes in vivo during chlamydial genital infection in mice. Infect Immun 2004; 71:7183-7. [PMID: 14638813 PMCID: PMC308939 DOI: 10.1128/iai.71.12.7183-7187.2003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 11/20/2022] Open
Abstract
Urinary nitrite and F(2)-isoprostanes, an index of oxidant stress, were elevated during chlamydial genital infection of mice. Enhancement of urinary nitrite and F(2)-isoprostanes was observed in phagocyte oxidase-deficient mice. Inhibition of inducible nitric oxide synthase reduced isoprostane excretion. We conclude that nitrogen radicals induce F(2)-isoprostane production and excretion during murine chlamydial genital infection.
Collapse
Affiliation(s)
- K H Ramsey
- Department of Microbiology, Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, Illinois 60515, USA.
| | | | | | | | | | | | | |
Collapse
|
34
|
Tobin E, Rohwedder A, Holland SM, Philips B, Carlson JA. Recurrent 'sterile' verrucous cyst abscesses and epidermodysplasia verruciformis-like eruption associated with idiopathic CD4 lymphopenia. Br J Dermatol 2003; 149:627-33. [PMID: 14511000 DOI: 10.1046/j.1365-2133.2003.05543.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Rupture of follicular (epidermoid) cysts is believed to be the consequence of bacterial infection. We report a 24-year-old man with idiopathic CD4 lymphopenia and chronic Mycobacterium avium intracellulare infection who developed multiple, recurring painful abscesses over the distal extremities that increased in number and severity when systemic steroid and interferon-gamma treatment was instituted for interstitial lung disease. Cultures were consistently negative for microorganisms, but pathological examination revealed ruptured epidermoid cyst walls with human papillomavirus (HPV) viropathic changes (keratinocytes with perinuclear halos and abundant basophilic keratohyaline granules). Cutaneous examination showed numerous, widespread flat-topped papules and achromic macules over the extremities, head and neck. Nested polymerase chain reaction analysis for HPV DNA revealed that the abscess-related cyst walls harboured epidermodysplasia verruciformis (EV)-associated HPV types 20, 24, alb-7 (AY013872) and 80. His cutaneous lesions harboured HPV types 3, 8 and 80. Similar to past reports, our patient developed an EV-like eruption in the setting of immunodeficiency. In this instance, EV-associated HPV infection of the follicular infundibular epithelium or pre-existing cysts in the setting of immunodeficiency may have led to cystic growth, rupture and subsequent painful inflammation.
Collapse
Affiliation(s)
- E Tobin
- Upstate Infectious Disease, 567 New Scotland Ave., Albany, NY 12208, USA
| | | | | | | | | |
Collapse
|
35
|
Dickerman RD, Stevens QE, Rak R, Dorman SE, Holland SM, Nguyen TT. Isolated intracranial infection with Mycobacterium avium complex. J Neurosurg Sci 2003; 47:101-5; discussion 105. [PMID: 14618138] [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: 04/27/2023]
Abstract
UNLABELLED Mycobacterium avium-M. complex (MAC) has been linked to devastating respiratory and systemic illnesses in patients, especially in those who are immunosuppressed. The purpose of this study is to describe a case of isolated central nervous system (CNS) infection with MAC. This is a single case report of a patient with isolated intracranial mycobacterial infection. SETTING the patient was treated and the immunohistochemical investigations were undertaken at the National Institutes of Health in Bethesda, Maryland, USA. INTERVENTION the patient initially was treated with a cocktail of antimycobacterial medications. However, because his disease was refractory, he underwent a suboccipital craniotomy and evacuation of his cerebellar mass. The patient was determined to have a low production of interferon-gamma (INF-gamma) and tumor necrosis factor-alpha (TNF-alpha) when compared to normal values. Despite extensive radiographic imaging studies and biopsies, there was no evidence of another focus of MAC infection in this patient. We conclude that intracranial infectious lesions in patients such as ours should be treated with conventional systemic antibiotic regimens as the first-line of therapy. We suggest neurosurgical intervention in medically refractory cases of intracranial infections.
Collapse
Affiliation(s)
- R D Dickerman
- Department of Neurosurgery, Long Island Jewish Hospital, New Hyde Park, NY 11004, USA.
| | | | | | | | | | | |
Collapse
|
36
|
Kottilil S, Malech HL, Gill VJ, Holland SM. Infections with Haemophilus species in chronic granulomatous disease: insights into the interaction of bacterial catalase and H2O2 production. Clin Immunol 2003; 106:226-30. [PMID: 12706409 DOI: 10.1016/s1521-6616(02)00048-7] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Chronic granulomatous disease (CGD) is a rare inherited disorder in which phagocytes are incapable of generating bactericidal-reactive oxygen derivatives. Typically these patients are susceptible to life-threatening infections with catalase-producing organisms. Haemophilus species, particularly H. paraphrophilus, are not associated with CGD infections, because these organisms rarely if ever produce catalase. Haemophilus species are part of the indigenous oral microbial flora and, other than H. influenzae, are rarely recognized as pathogens. They are fastidious and require additional growth factors and capnophilic culture conditions for optimal growth and identification. Here we describe three cases of infection with non-H. influenzae (NHI) Haemophilus species in CGD patients. These organisms were catalase-negative and therefore not expected to be virulent in CGD patients, but they were also H(2)O(2) production-negative, thereby negating the putative loss of virulence of being catalase-negative. These are the first reports of NHI Haemophilus species in CGD and reinforce the critical need for careful microbiologic evaluation of infections in CGD patients.
Collapse
Affiliation(s)
- S Kottilil
- Laboratory of Immunoregulation, NIAID, NIH, Bethesda, MD 20892, USA
| | | | | | | |
Collapse
|
37
|
Affiliation(s)
- B Grimbacher
- Department of Rheumatology and Clinical Immunology, Medical Center, University of Freiburg, Hugstetterstrasse 55, 79106 Freiburg, Germany
| | | | | |
Collapse
|
38
|
Rosenzweig S, Dorman SE, Roesler J, Palacios J, Zelazko M, Holland SM. 561del4 defines a novel small deletion hotspot in the interferon-gamma receptor 1 chain. Clin Immunol 2002; 102:25-7. [PMID: 11781064 DOI: 10.1006/clim.2001.5135] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [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: 11/22/2022]
Abstract
Patients with a dominant small deletion (818del4, hotspot) in the interferon-gamma receptor 1 (IFNGR1) gene (6q23-q24) and increased susceptibility to mycobacterial infections have been recently reported. We describe a female patient homozygous for a 4-bp deletion in exon 5 of IFNGR1 (561del4) who developed postvaccinal disseminated Bacille Calmette-Guerin infection. She was born to unrelated Argentinean parents, each of whom was heterozygous for this mutation. 561del4 has been previously described as a maternally inherited mutation in a compound heterozygous German patient. By single nucleotide polymorphism analysis of the areas surrounding the deletion, we showed the independent inheritance of 561del4 in three heterozygous carriers. Polypurine runs and "direct repeats," previously shown to be associated with areas of recurrent small deletions, were found in the flanking region of 561del4. The independent inheritance of three identical mutational events defines 561del4 as a new hotspot in the IFNGR1 gene.
Collapse
|
39
|
Abstract
Primary immunodeficiency diseases comprise over 100 conditions, each associated with a variety of viral, bacterial, fungal and protozoan infections. M. tuberculosis and less virulent mycobacteria, such as bacille Calmette-Guérin vaccines and environmental non-tuberculous mycobacteria, may cause severe disease in patients with primary immunodeficiency diseases. However, no previous review has dealt with the issue of which primary immunodeficiency diseases predispose affected individuals to mycobacterial disease. This information is very useful, not only increasing our understanding of human immunity to mycobacteria, but also for the diagnostic investigation of patients with mycobacteriosis. We review here the medical literature on cases of mycobacterial disease in patients with primary immunodeficiency diseases.
Collapse
Affiliation(s)
- J Reichenbach
- Laboratoire de Génétique Humaine des Maladies Infectieuses, Université René Descartes, Faculté de Médecine Necker Enfants Malades, Paris, France
| | | | | | | | | | | |
Collapse
|
40
|
Ramsey KH, Sigar IM, Rana SV, Gupta J, Holland SM, Byrne GI. Role for inducible nitric oxide synthase in protection from chronic Chlamydia trachomatis urogenital disease in mice and its regulation by oxygen free radicals. Infect Immun 2001; 69:7374-9. [PMID: 11705910 PMCID: PMC98824 DOI: 10.1128/iai.69.12.7374-7379.2001] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [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: 01/18/2023] Open
Abstract
It has been previously reported that although inducible nitric oxide synthase (iNOS) gene knockout (NOS2(-/-)) mice resolve Chlamydia trachomatis genital infection, the production of reactive nitrogen species (RNS) via iNOS protects a significant proportion of mice from hydrosalpinx formation and infertility. We now report that higher in vivo RNS production correlates with mouse strain-related innate resistance to hydrosalpinx formation. We also show that mice with a deletion of a key component of phagocyte NADPH oxidase (p47(phox-/-)) resolve infection, produce greater amounts of RNS in vivo, and sustain lower rates of hydrosalpinx formation than both wild-type (WT) NOS2(+/+) and NOS2(-/-) controls. When we induced an in vivo chemical block in iNOS activity in p47(phox-/-) mice using N(G)-monomethyl-L-arginine (L-NMMA), a large proportion of these mice eventually succumbed to opportunistic infections, but not before they resolved their chlamydial infections. Interestingly, when compared to WT and untreated p47(phox-/-) controls, L-NMMA-treated p47(phox-/-) mice resolved their infections more rapidly. However, L-NMMA-treated p47(phox-/-) mice lost resistance to chronic chlamydial disease, as evidenced by an increased rate of hydrosalpinx formation that was comparable to that for NOS2(-/-) mice. We conclude that phagocyte oxidase-derived reactive oxygen species (ROS) regulate RNS during chlamydial urogenital infection in the mouse. We further conclude that while neither phagocyte oxidase-derived ROS nor iNOS-derived RNS are essential for resolution of infection, RNS protect from chronic chlamydial disease in this model.
Collapse
Affiliation(s)
- K H Ramsey
- Microbiology Department, Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, Illinois 60515, USA. kramse@.midwestern.edu
| | | | | | | | | | | |
Collapse
|
41
|
Barry-Lane PA, Patterson C, van der Merwe M, Hu Z, Holland SM, Yeh ET, Runge MS. p47phox is required for atherosclerotic lesion progression in ApoE(-/-) mice. J Clin Invest 2001; 108:1513-22. [PMID: 11714743 PMCID: PMC209414 DOI: 10.1172/jci11927] [Citation(s) in RCA: 145] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
NADPH oxidase is upregulated in smooth muscle cells (SMCs) in response to growth factor stimulation, concomitant with increased reactive oxygen species (ROS) production. We investigated the role of ROS production by NADPH oxidase in SMC responses to growth factors and in atherosclerotic lesion formation in ApoE(-/-) mice. SMCs from wild-type, p47phox(-/-), and gp91phox(-/-) mice differed markedly with respect to growth factor responsiveness and ROS generation. p47phox(-/-) SMCs had diminished superoxide production and a decreased proliferative response to growth factors compared with wild-type cells, whereas the response of gp91phox(-/-) SMCs was indistinguishable from that of wild-type SMCs. The relevance of these in vitro observations was tested by measuring atherosclerotic lesion formation in genetically modified (wild-type, p47phox(-/-), ApoE(-/-), and ApoE(-/-)/p47phox(-/-)) mice. ApoE(-/-)/p47phox(-/-) mice had less total lesion area than ApoE(-/-) mice, regardless of whether mice were fed standard chow or a high-fat diet. Together, these studies provide convincing support for the hypothesis that superoxide generation in general, and NADPH oxidase in particular, have a requisite role in atherosclerotic lesion formation, and they provide a rationale for further studies to dissect the contributions of ROS to vascular lesion formation.
Collapse
Affiliation(s)
- P A Barry-Lane
- Sealy Center for Molecular Cardiology, University of Texas Medical Branch, Galveston, Texas, USA
| | | | | | | | | | | | | |
Collapse
|
42
|
Barry-Lane PA, Patterson C, van der Merwe M, Hu Z, Holland SM, Yeh ET, Runge MS. p47phox is required for atherosclerotic lesion progression in ApoE–/– mice. J Clin Invest 2001. [DOI: 10.1172/jci200111927] [Citation(s) in RCA: 382] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
43
|
Sterling TR, Dorman SE, Chaisson RE, Ding L, Hackman J, Moore K, Holland SM. Human immunodeficiency virus-seronegative adults with extrapulmonary tuberculosis have abnormal innate immune responses. Clin Infect Dis 2001; 33:976-82. [PMID: 11528568 DOI: 10.1086/322670] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [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] [Received: 12/20/2000] [Revised: 02/13/2001] [Indexed: 11/03/2022] Open
Abstract
Extrapulmonary tuberculosis is presumably a marker of underlying immunodeficiency, but cytokine response pathways in these patients have not been well studied. Cytokine responses of peripheral blood mononuclear cells from human immunodeficiency virus-seronegative adults with prior culture-confirmed extrapulmonary tuberculosis were compared with those of persons with latent Mycobacterium tuberculosis infection. Mitogen-stimulated interferon (IFN)-gamma production, interleukin (IL)-12 production, and IFN-gamma receptor- and IL-12 receptor-mediated cytokine production did not differ between case patients and control patients. However, median resting IL-8 production was significantly lower in case patients than control patients (8051 vs. 19,290 pg/mL; P=.009). In addition, the median tumor necrosis factor (TNF)-alpha response was lower in case patients than control patients after stimulation with lipopolysaccharide (833 vs. 1149 pg/mL; P=.06) and lipopolysaccharide plus IFN-gamma (3301 vs. 4411 pg/mL; P=.04). These abnormalities in resting IL-8 and lipopolysaccharide-induced TNF-alpha production were not associated with IFN-gamma or IL-12 abnormalities and were detected up to several years after cure of disease, suggesting an abnormality in innate immunity.
Collapse
Affiliation(s)
- T R Sterling
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
Leukocyte adhesion deficiency 1 (LAD-1) is characterized by absent or dysfunctional beta2 integrin (CD18), leading to defective chemotaxis, adherence, phagocytosis, and bacterial killing. Colitis, except for rare intestinal necrotizing events, is not a well-recognized feature of this immunodeficiency. A case of nonspecific colitis clinically resembling Crohn's disease in a patient with the severe form of LAD-1 (0.5% < CD18) has been previously reported. We describe an adult patient with the moderate form of LAD-1 and chronic colitis characterized by extensive inflammation and ulceration of the right colon and terminal ileum, leading to adhesions and strictures. The chronic colitis described in this article associated with the dysfunctional neutrophils of LAD-1 represents a distinct pathology from the commonly encountered forms of inflammatory bowel disease (IBD). The existence of active IBD in the presence of dysfunctional CD18/CD11(a-b) intercellular adhesion molecules (ICAM-1) interaction is relevant to the proposed targeting of ICAM-1 for the treatment of Crohn's disease.
Collapse
Affiliation(s)
- G Uzel
- Immunology Services, Department of Laboratory Medicine, National Cancer Institute NIH, Bethesda, Maryland, USA
| | | | | | | |
Collapse
|
45
|
Koay MA, Christman JW, Segal BH, Venkatakrishnan A, Blackwell TR, Holland SM, Blackwell TS. Impaired pulmonary NF-kappaB activation in response to lipopolysaccharide in NADPH oxidase-deficient mice. Infect Immun 2001; 69:5991-6. [PMID: 11553535 PMCID: PMC98726 DOI: 10.1128/iai.69.10.5991-5996.2001] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [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: 02/02/2023] Open
Abstract
Reactive oxygen species (ROS) are thought to be involved in intracellular signaling, including activation of the transcription factor NF-kappaB. We investigated the role of NADPH oxidase in the NF-kappaB activation pathway by utilizing knockout mice (p47phox-/-) lacking the p47phox component of NADPH oxidase. Wild-type (WT) controls and p47phox-/- mice were treated with intraperitoneal (i.p.) Escherichia coli lipopolysaccharide (LPS) (5 or 20 microg/g of body weight). LPS-induced NF-kappaB binding activity and accumulation of RelA in nuclear protein extracts of lung tissue were markedly increased in WT compared to p47phox-/- mice 90 min after treatment with 20 but not 5 microg of i.p. LPS per g. In another model of lung inflammation, RelA nuclear translocation was reduced in p47phox-/- mice compared to WT mice following treatment with aerosolized LPS. In contrast to NF-kappaB activation in p47phox-/- mice, LPS-induced production of macrophage inflammatory protein 2 in the lungs and neutrophilic lung inflammation were not diminished in these mice compared to WT mice. We conclude that LPS-induced NF-kappaB activation is deficient in the lungs of p47phox-/- mice compared to WT mice, but this abnormality does not result in overt alteration in the acute inflammatory response.
Collapse
Affiliation(s)
- M A Koay
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 27232, USA
| | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
The convergence of innate and adaptive immunity is critical for host defense, allowing for early protection and the generation of specific responses. STAT-4 is at that point of convergence, unifying the IFNalpha and IL-12 pathways. Activation of STAT-4 is crucial to T cell polarization, B cell and NK cell activation, and the control of intracellular pathogens. However, techniques to detect phosphorylated STAT-4 are cumbersome and require many cells. We have developed a flow cytometric detection technique to investigate IL-12 signaling in human peripheral blood mononuclear cells. Using different polyclonal antibodies that recognize either total STAT-4 protein or tyrosine-phosphorylated STAT-4, we can easily detect IL-12 and IFNalpha signaling in PHA/IL-2 blasts derived from peripheral blood lymphocytes. This technique not only allows us to evaluate IL-12 signaling, but it is also less time consuming and labor intensive than alternative methods. Using this flow cytometry-based method, we should be able to detect patients with defects in IL-12 receptor signal transduction, who typically present with disseminated nontuberculous mycobacterial infections.
Collapse
Affiliation(s)
- G Uzel
- Immunology Service, Warren Grant Magnuson Clinical Center, Bethesda, Maryland 20892, USA
| | | | | | | |
Collapse
|
47
|
Jackson SH, Miller GF, Segal BH, Mardiney M, Domachowske JB, Gallin JI, Holland SM. IFN-gamma is effective in reducing infections in the mouse model of chronic granulomatous disease (CGD). J Interferon Cytokine Res 2001; 21:567-73. [PMID: 11559434 DOI: 10.1089/10799900152547821] [Citation(s) in RCA: 32] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Chronic granulomatous disease (CGD) is a genetic disorder characterized by recurrent bacterial and fungal infections and tissue granuloma formation. CGD phagocytes are unable to generate superoxide because of mutations in any of four proteins of the phagocyte NADPH oxidase. Prophylactic recombinant human interferon-gamma (IFN-gamma) has been shown to reduce the frequency and severity of infections in CGD patients, but its mechanism(s) remains undefined, and its benefit has been questioned. We investigated the prophylactic effect of IFN-gamma in the mouse model of the major autosomal recessive (p47(phox)) form of CGD. In a prospective, randomized, placebo-controlled study, we compared IFN-gamma, 20,000 U administered subcutaneously (s.c.) three times weekly, to placebo in 118 p47(phox-/-) mice. By 6 weeks of study, there were 3 infections in the IFN-gamma group compared with 13 infections in the placebo group (77% reduction in infections, p<0.01). By 18 months of study, there were 7 infections in the IFN-gamma group compared with 18 infections in the placebo group (39% reduction in infections, p<0.01). Two animals receiving IFN-gamma had seizures after 7 months in the study. No other toxicities were observed. Peripheral blood phagocytes from IFN-gamma treated p47(phox-/-) mice produced no superoxide, excluding restoration of the oxidative burst as a mechanism for the IFN-gamma effect. There were no differences in either peritoneal macrophage nitrate production or thioglycollate-induced peritoneal exudate between treatment groups. This animal model demonstrates a prophylactic benefit of IFN-gamma similar to that seen in humans and provides an opportunity to investigate the mechanism(s) of action for IFN-gamma in CGD.
Collapse
MESH Headings
- Abscess/enzymology
- Abscess/genetics
- Abscess/prevention & control
- Animals
- Disease Models, Animal
- Drug Evaluation, Preclinical
- Granulomatous Disease, Chronic/enzymology
- Granulomatous Disease, Chronic/genetics
- Granulomatous Disease, Chronic/microbiology
- Granulomatous Disease, Chronic/pathology
- Interferon-gamma/therapeutic use
- Macrophages, Peritoneal/enzymology
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- NADPH Oxidases
- Nitric Oxide Synthase/genetics
- Nitric Oxide Synthase/metabolism
- Peritonitis/enzymology
- Peritonitis/genetics
- Peritonitis/prevention & control
- Phosphoproteins/deficiency
- Phosphoproteins/genetics
- Prospective Studies
- Random Allocation
- Recombinant Proteins
- Respiratory Burst/genetics
- Skin Diseases, Infectious/enzymology
- Skin Diseases, Infectious/genetics
- Skin Diseases, Infectious/prevention & control
- Thioglycolates/administration & dosage
Collapse
Affiliation(s)
- S H Jackson
- The Laboratory of Host Defenses, NIAID, NIH, Bethesda, MD 20892, USA
| | | | | | | | | | | | | |
Collapse
|
48
|
Sereti I, Holland SM. Disseminated nocardiosis in a patient with X-linked chronic granulomatous disease and human immunodeficiency virus infection. Clin Infect Dis 2001; 33:235-9. [PMID: 11418884 DOI: 10.1086/321818] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2000] [Revised: 11/07/2000] [Indexed: 11/03/2022] Open
Abstract
We report the first case of HIV infection in a patient with underlying X-linked chronic granulomatous disease (CGD) who presented with hepatopulmonary nocardiosis. Despite the coexistence of CGD and HIV, the response to therapy was normal, and no unusual sequelae were noted. The patient's high virus burden was successfully repressed with antiretroviral therapy, suggesting that the nicotinamide adenine dinucleotide phosphate oxidase system is not essential for active viral replication or response to antiretroviral agents.
Collapse
Affiliation(s)
- I Sereti
- Laboratory of Immunoregulation, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892-1886, USA
| | | |
Collapse
|
49
|
Dupuis S, Dargemont C, Fieschi C, Thomassin N, Rosenzweig S, Harris J, Holland SM, Schreiber RD, Casanova JL. Impairment of mycobacterial but not viral immunity by a germline human STAT1 mutation. Science 2001; 293:300-3. [PMID: 11452125 DOI: 10.1126/science.1061154] [Citation(s) in RCA: 364] [Impact Index Per Article: 15.8] [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: 11/02/2022]
Abstract
Interferons (IFN) alpha/beta and gamma induce the formation of two transcriptional activators: gamma-activating factor (GAF) and interferon-stimulated gamma factor 3 (ISGF3). We report a natural heterozygous germline STAT1 mutation associated with susceptibility to mycobacterial but not viral disease. This mutation causes a loss of GAF and ISGF3 activation but is dominant for one cellular phenotype and recessive for the other. It impairs the nuclear accumulation of GAF but not of ISGF3 in heterozygous cells stimulated by IFNs. Thus, the antimycobacterial, but not the antiviral, effects of human IFNs are principally mediated by GAF.
Collapse
Affiliation(s)
- S Dupuis
- Laboratoire de Génétique Humaine des Maladies Infectieuses, Université de Paris René Descartes-INSERM UMR550, Faculté de Médecine Necker-Enfants Malades, 75015 Paris, France
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
BACKGROUND Previous investigations provide evidence that an enzyme related to the phagocyte NADPH oxidase produces superoxide in the blood vessel wall. These data, however, are confounded by observations that both NADPH and NADH serve as substrates for superoxide production in vascular cells. To clarify this issue, we compared the superoxide-generating capabilities of vascular smooth muscle cells (VSMCs) derived from wild-type (p47phox(+/+); phagocyte oxidase) mice with those from mice that lack p47phox (p47phox(-/-); "knockout"), an essential component of the phagocyte NADPH oxidase. METHODS AND RESULTS VSMCs were derived from aortic explants harvested from p47phox(+/+) or p47phox(-/-) mice. VSMCs from p47phox(+/+) but not those from p47phox(-/-) mice produced superoxide after stimulation by phorbol myristate acetate. Consistent with this, p47phox was detected only in p47phox(+/+) VSMCs. p47phox-transduced p47phox(-/-) but not enhanced green fluorescent protein-transduced p47phox(-/-) VSMCs generated significant levels of superoxide after stimulation by angiotensin II or platelet-derived growth factor-BB (PDGF-BB). Enhanced expression of recombinant p47phox in p47phox-transduced p47phox(-/-) cells correlated with superoxide production in these cells. CONCLUSIONS These data provide direct functional proof that an oxidase requiring the p47phox component mediates superoxide release from VSMCs in the blood vessel wall in response to angiotensin II or PDGF-BB.
Collapse
MESH Headings
- Actins/biosynthesis
- Angiotensin II/pharmacology
- Animals
- Aorta
- Becaplermin
- Cells, Cultured
- Female
- Fluorescent Antibody Technique, Indirect
- Genes, Reporter
- Granulomatous Disease, Chronic/genetics
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Microscopy, Phase-Contrast
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/metabolism
- NADPH Oxidases/metabolism
- Phosphoproteins/deficiency
- Phosphoproteins/genetics
- Phosphoproteins/metabolism
- Platelet-Derived Growth Factor/pharmacology
- Proto-Oncogene Proteins c-sis
- Recombinant Proteins/genetics
- Recombinant Proteins/metabolism
- Retroviridae/genetics
- Superoxides/metabolism
- Tetradecanoylphorbol Acetate/pharmacology
- Transduction, Genetic
Collapse
Affiliation(s)
- M C Lavigne
- Laboratory of Host Defenses, National Institutes of Health, National Institute of Allergy and Infectious Diseases, Bethesda, Md, USA
| | | | | | | |
Collapse
|