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Gernez Y, Narula M, Cepika AM, Valdes Camacho J, Hoyte EG, Mouradian K, Glader B, Singh D, Sathi B, Rao L, Tolin AL, Weinberg KI, Lewis DB, Bacchetta R, Weinacht KG. Case report: Refractory Evans syndrome in two patients with spondyloenchondrodysplasia with immune dysregulation treated successfully with JAK1/JAK2 inhibition. Front Immunol 2024; 14:1328005. [PMID: 38347954 PMCID: PMC10859398 DOI: 10.3389/fimmu.2023.1328005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/28/2023] [Indexed: 02/15/2024] Open
Abstract
Biallelic mutations in the ACP5 gene cause spondyloenchondrodysplasia with immune dysregulation (SPENCDI). SPENCDI is characterized by the phenotypic triad of skeletal dysplasia, innate and adaptive immune dysfunction, and variable neurologic findings ranging from asymptomatic brain calcifications to severe developmental delay with spasticity. Immune dysregulation in SPENCDI is often refractory to standard immunosuppressive treatments. Here, we present the cases of two patients with SPENCDI and recalcitrant autoimmune cytopenias who demonstrated a favorable clinical response to targeted JAK inhibition over a period of more than 3 years. One of the patients exhibited steadily rising IgG levels and a bone marrow biopsy revealed smoldering multiple myeloma. A review of the literature uncovered that approximately half of the SPENCDI patients reported to date exhibited increased IgG levels. Screening for multiple myeloma in SPENCDI patients with rising IgG levels should therefore be considered.
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Affiliation(s)
- Yael Gernez
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Mansi Narula
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Alma-Martina Cepika
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Juanita Valdes Camacho
- Division of Allergy and Immunology, Department of Pediatrics, Louisiana State University (LSU) Health, Shreveport, LA, United States
| | - Elisabeth G. Hoyte
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Kirsten Mouradian
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Bertil Glader
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Deepika Singh
- Division of Rheumatology, Department of Pediatrics, Valley Children Hospital, Madera, CA, United States
| | - Bindu Sathi
- Division of Hematology, Department of Pediatrics, Valley Children Hospital, Madera, CA, United States
| | - Latha Rao
- Division of Hematology, Department of Pediatrics, Valley Children Hospital, Madera, CA, United States
| | - Ana L. Tolin
- Division of Immunology, Department of Pediatrics, Hospital Pediatrico Dr. Humberto Notti, Mendoza, Argentina
| | - Kenneth I. Weinberg
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - David B. Lewis
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Rosa Bacchetta
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
| | - Katja G. Weinacht
- Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, CA, United States
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Borna Š, Lee E, Nideffer J, Ramachandran A, Wang B, Baker J, Mavers M, Lakshmanan U, Narula M, Garrett AKH, Schulze J, Olek S, Marois L, Gernez Y, Bhatia M, Chong HJ, Walter J, Kitcharoensakkul M, Lang A, Cooper MA, Bertaina A, Roncarolo MG, Meffre E, Bacchetta R. Identification of unstable regulatory and autoreactive effector T cells that are expanded in patients with FOXP3 mutations. Sci Transl Med 2023; 15:eadg6822. [PMID: 38117899 PMCID: PMC11070150 DOI: 10.1126/scitranslmed.adg6822] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/14/2023] [Accepted: 11/17/2023] [Indexed: 12/22/2023]
Abstract
Studies of the monogenic autoimmune disease immunodysregulation polyendocrinopathy enteropathy X-linked syndrome (IPEX) have elucidated the essential function of the transcription factor FOXP3 and thymic-derived regulatory T cells (Tregs) in controlling peripheral tolerance. However, the presence and the source of autoreactive T cells in IPEX remain undetermined. Here, we investigated how FOXP3 deficiency affects the T cell receptor (TCR) repertoire and Treg stability in vivo and compared T cell abnormalities in patients with IPEX with those in patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy syndrome (APECED). To study Tregs independently of their phenotype and to analyze T cell autoreactivity, we combined Treg-specific demethylation region analyses, single-cell multiomic profiling, and bulk TCR sequencing. We found that patients with IPEX, unlike patients with APECED, have expanded autoreactive T cells originating from both autoreactive effector T cells (Teffs) and Tregs. In addition, a fraction of the expanded Tregs from patients with IPEX lost their phenotypic and functional markers, including CD25 and FOXP3. Functional experiments with CRISPR-Cas9-mediated FOXP3 knockout Tregs and Tregs from patients with IPEX indicated that the patients' Tregs gain a TH2-skewed Teff-like function, which is consistent with immune dysregulation observed in these patients. Analyses of FOXP3 mutation-carrier mothers and a patient with IPEX after hematopoietic stem cell transplantation indicated that Tregs expressing nonmutated FOXP3 prevent the accumulation of autoreactive Teffs and unstable Tregs. These findings could be directly used for diagnostic and prognostic purposes and for monitoring the effects of immunomodulatory treatments.
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Affiliation(s)
- Šimon Borna
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Esmond Lee
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jason Nideffer
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Akshaya Ramachandran
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Bing Wang
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jeanette Baker
- Department of Medicine, Division of Blood and Marrow Transplantation, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Melissa Mavers
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Uma Lakshmanan
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Mansi Narula
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Amy Kang-hee Garrett
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | | | - Sven Olek
- Ivana Turbachova Laboratory for Epigenetics, Precision for Medicine GmbH, Berlin, 12489, Germany
| | - Louis Marois
- Department of Medicine, Immunology and Allergy Service, CHU de Québec – Laval University, Quebec, G1V 4G2, Canada
| | - Yael Gernez
- Department of Pediatrics, Division of Allergy, Rheumatology and Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Monica Bhatia
- Columbia University Irving Medical Center, NY, NY 10032, USA
| | - Hey Jin Chong
- Division of Allergy and Immunology, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, 15224, Pa, USA
| | - Jolan Walter
- Division of Allergy and Immunology, Department of Pediatrics, Johns Hopkins All Children’s Hospital, University of South Florida, St. Petersburg, 33701, FL, USA
| | - Maleewan Kitcharoensakkul
- Divisions of Rheumatology/Immunology, and Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, 63110, USA
| | - Abigail Lang
- Department of Pediatrics, Division of Allergy and Immunology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 60611, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Megan A. Cooper
- Department of pediatrics, division of Rheumatology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, 63110, USA
| | - Alice Bertaina
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Center for Definitive and Curative Medicine (CDCM), Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Maria Grazia Roncarolo
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Center for Definitive and Curative Medicine (CDCM), Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Eric Meffre
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, 269 Campus Drive West, Stanford, CA 94305, USA
| | - Rosa Bacchetta
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Center for Definitive and Curative Medicine (CDCM), Stanford University School of Medicine, Stanford, CA 94305, USA
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Solomon BD, Skaljic M, Liu LY, Yan D, Sheahon KM, Broderick L, Hoffman HM, Beres SJ, Brown RA, Teng JMC, Gernez Y. Mimickers of Classical Urticaria: Cryopyrin-Associated Autoinflammatory Syndrome Presenting as Isolated Urticaria in an Infant. J Allergy Clin Immunol Pract 2023; 11:941-942. [PMID: 36720659 DOI: 10.1016/j.jaip.2022.12.037] [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] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 01/30/2023]
Affiliation(s)
- Benjamin D Solomon
- Department of Pediatrics, Division of Allergy and Immunology, Stanford School of Medicine, Stanford, Calif.
| | - Meliha Skaljic
- Department of Dermatology, Stanford University School of Medicine, Stanford, Calif
| | - Lucy Y Liu
- Department of Dermatology, Stanford University School of Medicine, Stanford, Calif
| | - Di Yan
- Department of Dermatology, Stanford University School of Medicine, Stanford, Calif; Department of Pathology, Division of Dermatopathology, Stanford University School of Medicine, Stanford, Calif
| | - Kathleen M Sheahon
- Department of Dermatology, Stanford University School of Medicine, Stanford, Calif; Department of Pathology, Division of Dermatopathology, Stanford University School of Medicine, Stanford, Calif
| | - Lori Broderick
- Department of Pediatrics, Division of Allergy, Immunology, Rheumatology and Kawasaki Disease, University of California, San Diego, Calif
| | - Hal M Hoffman
- Department of Pediatrics, Division of Allergy, Immunology, Rheumatology and Kawasaki Disease, University of California, San Diego, Calif; Rady Children's Hospital, San Diego, Calif
| | - Shannon J Beres
- Department of Ophthalmology, Division of Neuro-ophthalmology, Stanford School of Medicine, Stanford, Calif
| | - Ryanne A Brown
- Department of Dermatology, Stanford University School of Medicine, Stanford, Calif; Department of Pathology, Division of Dermatopathology, Stanford University School of Medicine, Stanford, Calif
| | - Joyce M C Teng
- Department of Dermatology, Stanford University School of Medicine, Stanford, Calif
| | - Yael Gernez
- Department of Pediatrics, Division of Allergy and Immunology, Stanford School of Medicine, Stanford, Calif
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Narula M, Lakshmanan U, Borna S, Schulze JJ, Holmes TH, Harre N, Kirkey M, Ramachandran A, Tagi VM, Barzaghi F, Grunebaum E, Upton JEM, Hong-Diep Kim V, Wysocki C, Dimitriades VR, Weinberg K, Weinacht KG, Gernez Y, Sathi BK, Schelotto M, Johnson M, Olek S, Sachsenmaier C, Roncarolo MG, Bacchetta R. Epigenetic and immunological indicators of IPEX disease in subjects with FOXP3 gene mutation. J Allergy Clin Immunol 2023; 151:233-246.e10. [PMID: 36152823 DOI: 10.1016/j.jaci.2022.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 04/28/2022] [Revised: 08/16/2022] [Accepted: 09/09/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Forkhead box protein 3 (FOXP3) is the master transcription factor in CD4+CD25hiCD127lo regulatory T (Treg) cells. Mutations in FOXP3 result in IPEX (immune dysregulation, polyendocrinopathy, enteropathy, X-linked) syndrome. Clinical presentation of IPEX syndrome is broader than initially described, challenging the understanding of the disease, its evolution, and treatment choice. OBJECTIVE We sought to study the type and extent of immunologic abnormalities that remain ill-defined in IPEX, across genetic and clinical heterogeneity. METHODS We performed Treg-cell-specific epigenetic quantification and immunologic characterization of severe "typical" (n = 6) and "atypical" or asymptomatic (n = 9) patients with IPEX. RESULTS Increased number of cells with Treg-cell-Specific Demethylated Region demethylation in FOXP3 is a consistent feature in patients with IPEX, with (1) highest values in those with typical IPEX, (2) increased values in subjects with pathogenic FOXP3 but still no symptoms, and (3) gradual increase over the course of disease progression. Large-scale profiling using Luminex identified plasma inflammatory signature of macrophage activation and TH2 polarization, with cytokines previously not associated with IPEX pathology, including CCL22, CCL17, CCL15, and IL-13, and the inflammatory markers TNF-α, IL-1A, IL-8, sFasL, and CXCL9. Similarly, both Treg-cell and Teff compartments, studied by Mass Cytometry by Time-Of-Flight, were skewed toward the TH2 compartment, especially in typical IPEX. CONCLUSIONS Elevated TSDR-demethylated cells, combined with elevation of plasmatic and cellular markers of a polarized type 2 inflammatory immune response, extends our understanding of IPEX diagnosis and heterogeneity.
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Affiliation(s)
- Mansi Narula
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Uma Lakshmanan
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Simon Borna
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, Calif
| | | | - Tyson H Holmes
- Human Immune Monitoring Center, Institute for Immunity, Transplantation and Infection, Stanford University School of Medicine, Stanford, Calif
| | - Nicholas Harre
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Matthew Kirkey
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Akshaya Ramachandran
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Veronica Maria Tagi
- San Raffaele Telethon Institute for Gene Therapy, Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute Milan, Milan, Italy
| | - Federica Barzaghi
- San Raffaele Telethon Institute for Gene Therapy, Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute Milan, Milan, Italy
| | - Eyal Grunebaum
- Division of Immunology and Allergy, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Julia E M Upton
- Division of Immunology and Allergy, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Vy Hong-Diep Kim
- Division of Immunology and Allergy, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Christian Wysocki
- Department of Internal Medicine, Pediatrics, Allergy and Immunology, UT Southwestern Medical Center, Dallas, Tex
| | - Victoria R Dimitriades
- Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, UC Davis Health Medical Center, Sacramento, Calif
| | - Kenneth Weinberg
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Katja G Weinacht
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Yael Gernez
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, Stanford University School of Medicine, Stanford, Calif
| | | | | | - Matthew Johnson
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, United Kingdom
| | - Sven Olek
- Ivana Turbachova Laboratory of Epigenetics, Precision for Medicine GmbH, Berlin, Germany
| | | | - Maria-Grazia Roncarolo
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, Calif; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, Calif; Center for Definitive and Curative Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Rosa Bacchetta
- Department of Pediatrics, Division of Hematology, Oncology, Stem Cell Transplantation and Regenerative Medicine, Stanford University School of Medicine, Stanford, Calif; Center for Definitive and Curative Medicine, Stanford University School of Medicine, Stanford, Calif.
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Zheng H, Yonker L, Donado M, Solomon B, Boribong B, Gernez Y, Maecker H, Sigal N, Kinane B, Arvin A, Khatri P, Weinacht K. 299. Systems immunology profiling of treatment-naïve children with multisystem inflammatory syndrome. Open Forum Infect Dis 2022. [PMCID: PMC9751956 DOI: 10.1093/ofid/ofac492.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Multisystem inflammatory syndrome in children (MIS-C) is a severe post-infectious complication occurring weeks after SARS-CoV-2 infection. The exact mechanisms leading to immune dysregulation and organ damage remain incompletely understood. Progress in understanding the immunopathology underlying MIS-C has been halted by limited availability of pre-treatment patient samples and confounding effects of immunomodulatory treatment on previously studied specimens. Methods In this study, we have restricted enrollment to treatment-naïve patients with MIS-C and used a systems biology approach combining CyTOF, single cell transcriptomics, serum cytokine profiling and T cell receptor sequencing to dissect how immune responses in children with MIS-C differ from children with mild SARS-CoV2 infection, adults with severe COVID-19 and healthy individuals. We also integrated single cell transcriptomics datasets from post-treatment MIS-C samples to study how immune responses change along disease course. Results We identified increased activation markers and antigen presentation across multiple immune cell types in MIS-C patients from both CyTOF and single cell transcriptomics data. Importantly, in PBMCs of MIS-C patients, we identified a distinct subset of proinflammatory monocytes, with increased expression of interferon gamma response genes combined with a signature of enhanced complement expression, antigen processing and presentation, which was not observed in post-treatment MIS-C samples. Interestingly, this monocyte population bears resemblance to a subset of monocytes that emerges after the BNT162b2 mRNA vaccine booster. In addition, in PBMCs of MIS-C patients, we identify increased proportion of proliferating T/NK cells, suggesting distinct T cell expansions in MIS-C. T and NK cells in MIS-C samples also showed increased cell cytotoxicity markers. Conclusion Taken together, treatment-naïve MIS-C samples display distinct monocyte clusters, activated antigen presentation and complement expression, and increased T and NK cell cytotoxicity, which may account for the clinical presentation of MIS-C. Disclosures Purvesh Khatri, PhD, Cepheid, Inc.: Advisor/Consultant|Inflammatix, Inc.: Advisor/Consultant|Inflammatix, Inc.: Inflammatix is in negotiations to license the 9-gene signature discussed here.|Inflammatix, Inc.: Stocks/Bonds.
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Affiliation(s)
- Hong Zheng
- Stanford university, Stanford, California
| | - Lael Yonker
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | | | | | | | | | - Ann Arvin
- Stanford University, Stanford, California
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Tran N, Gernez Y, Dunham T, Weinacht K, McGhee S. SCIDISH – AN UNPREDICTED CASE OF T CELL LYMPHOPENIA, HYPOCALCEMIA, AND SKELETAL ANOMALIES. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.876] [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: 11/11/2022]
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7
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Dunham T, Tran N, Hernandez J, Gernez Y. A CHRONIC GRANULOMATOUS DISEASE-LIKE PRESENTATION OF AUTOSOMAL RECESSIVE PROTEIN KINASE C DELTA DEFICIENCY. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.899] [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: 11/11/2022]
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8
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Collen LV, Salgado CA, Bao B, Janssen E, Weir D, Goldsmith J, Leichtner A, Sabery Khavari N, Gernez Y, Snapper SB. Cytotoxic T Lymphocyte Antigen 4 Haploinsufficiency Presenting As Refractory Celiac-Like Disease: Case Report. Front Immunol 2022; 13:894648. [PMID: 35935971 PMCID: PMC9352891 DOI: 10.3389/fimmu.2022.894648] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Primary immunodeficiency may present with treatment-refractory enteropathy. We present two patients with celiac/celiac-like disease diagnosed in early childhood and refractory to the gluten-free diet. One patient had features of multi-system autoimmunity, whereas the other had celiac-like disease as an isolated clinical finding. Both patients underwent genetic testing given disease refractoriness and were ultimately diagnosed with cytotoxic T lymphocyte antigen 4 (CTLA4) haploinsufficiency. They are both now in complete clinical and endoscopic remission on abatacept. CTLA4 haploinsufficiency has incomplete penetrance and significant phenotypic heterogeneity but should be considered in the differential diagnosis of refractory celiac/celiac-like disease, as treatment implications are significant.
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Affiliation(s)
- Lauren V. Collen
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Carlos Andres Salgado
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Bin Bao
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Erin Janssen
- Division of Immunology, Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Dascha Weir
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Jeffrey Goldsmith
- Department of Pathology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Alan Leichtner
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Nasim Sabery Khavari
- Division of Pediatric Gastroenterology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Yael Gernez
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Scott B. Snapper
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
- *Correspondence: Scott B. Snapper,
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9
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Gernez Y, Murugesan K, Cortales CR, Banaei N, Hoyte L, Pinsky BA, Lewis DB, Pham MN. Immunogenicity of a third COVID-19 messenger RNA vaccine dose in primary immunodeficiency disorder patients with functional B-cell defects. J Allergy Clin Immunol Pract 2022; 10:1385-1388.e2. [PMID: 35259538 PMCID: PMC8897836 DOI: 10.1016/j.jaip.2022.02.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/19/2022] [Accepted: 02/11/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Yael Gernez
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | - Kanagavel Murugesan
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif
| | - Cristina R Cortales
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif
| | - Niaz Banaei
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif; Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, Calif; Clinical Microbiology Laboratory, Stanford Health Care, Stanford, Calif
| | - Lisa Hoyte
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | - Benjamin A Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif; Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, Calif; Clinical Virology Laboratory, Stanford Health Care, Stanford, Calif
| | - David B Lewis
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | - Michele N Pham
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Internal Medicine, University of California, San Francisco, Calif.
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10
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Pham MN, Murugesan K, Banaei N, Pinsky BA, Tang M, Hoyte E, Lewis DB, Gernez Y. Immunogenicity and Tolerability of COVID-19 mRNA Vaccines in PID patients with functional B-cell defects. J Allergy Clin Immunol 2021; 149:907-911.e3. [PMID: 34952033 PMCID: PMC8690218 DOI: 10.1016/j.jaci.2021.11.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 12/03/2022]
Abstract
Background Data on the safety and efficacy of coronavirus disease 2019 (COVID-19) vaccination in people with a range of primary immunodeficiencies (PIDs) are lacking because these patients were excluded from COVID-19 vaccine trials. This information may help in clinical management of this vulnerable patient group. Objective We assessed humoral and T-cell immune responses after 2 doses of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger RNA (mRNA) vaccines in patients with PID and functional B-cell defects. Methods A double-center retrospective review was performed of patients with PID who completed COVID-19 mRNA vaccination and who had humoral responses assessed through SARS-CoV-2 spike protein receptor binding domain (RBD) IgG antibody levels with reflex assessment of the antibody to block RBD binding to angiotensin-converting enzyme 2 (ACE2; hereafter referred to as ACE2 receptor blocking activity, as a surrogate test for neutralization) and T-cell response evaluated by an IFN-γ release assay. Immunization reactogenicity was also reviewed. Results A total of 33 patients with humoral defect were evaluated; 69.6% received BNT162b2 vaccine (Pfizer-BioNTech) and 30.3% received mRNA-1273 (Moderna). The mRNA vaccines were generally well tolerated without severe reactions. The IFN-γ release assay result was positive in 24 (77.4%) of 31 patients. Sixteen of 33 subjects had detectable RBD-specific IgG responses, but only 2 of these 16 subjects had an ACE2 receptor blocking activity level of ≥50%. Conclusion Vaccination of this cohort of patients with PID with COVID-19 mRNA vaccines was safe, and cellular immunity was stimulated in most subjects. However, antibody responses to the spike protein RBD were less consistent, and, when detected, were not effective at ACE2 blocking.
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Affiliation(s)
- Michele N Pham
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Internal Medicine, University of California, San Francisco, Calif
| | - Kanagavel Murugesan
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif
| | - Niaz Banaei
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif; Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, Calif; Clinical Microbiology Laboratory, Stanford Health Care, Stanford, Calif
| | - Benjamin A Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif; Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, Calif; Clinical Virology Laboratory, Stanford Health Care, Stanford, Calif
| | - Monica Tang
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Internal Medicine, University of California, San Francisco, Calif
| | - Elisabeth Hoyte
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | - David B Lewis
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | - Yael Gernez
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif.
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11
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Hsu CH, Requena L, LeBoit PE, Gernez Y. Masquerader of Lip Angioedema After Lip Injection. J Allergy Clin Immunol Pract 2021; 9:2472-2473. [PMID: 33664002 DOI: 10.1016/j.jaip.2020.12.058] [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] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Chih-Hsin Hsu
- Division of Allergy and Immunology, Department of Pediatrics, Stanford School of Medicine, Stanford, Calif.
| | - Luis Requena
- Department of Dermatology, Universidad Autonoma, Madrid, Spain
| | - Philip E LeBoit
- Department of Dermatopathology and Oral Pathology, UCSF, San Francisco, Calif
| | - Yael Gernez
- Division of Allergy and Immunology, Department of Pediatrics, Stanford School of Medicine, Stanford, Calif.
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12
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Zhu L, Camacho JV, Gernez Y, Liu A. M031 DRESSED FOR SUCCESS: BRAF INHIBITOR DESENSITIZATION AFTER DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYSTEMS (DRESS). Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Tran N, Zhu L, Gernez Y. M243 X-LINKED AGAMMAGLOBULINEMIA IN A PATIENT WITH RECURRENT UNILATERAL OTITIS MEDIA AND FAILURE TO THRIVE. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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14
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Fialkowski A, Gernez Y, Arya P, Weinacht KG, Kinane TB, Yonker LM. Insight into the pediatric and adult dichotomy of COVID-19: Age-related differences in the immune response to SARS-CoV-2 infection. Pediatr Pulmonol 2020; 55:2556-2564. [PMID: 32710693 DOI: 10.1002/ppul.24981] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/09/2020] [Accepted: 07/21/2020] [Indexed: 12/17/2022]
Abstract
The difference in morbidity and mortality between adult and pediatric coronavirus disease 2019 infections is dramatic. Understanding pediatric-specific acute and delayed immune responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is critical for the development of vaccination strategies, immune-targeted therapies, and treatment and prevention of multisystem inflammatory syndrome in children. The goal of this review is to highlight research developments in the understanding of the immune responses to SARS-CoV-2 infections, with a specific focus on age-related immune responses.
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Affiliation(s)
| | - Yael Gernez
- Department of Pediatric Allergy and Immunology, Stanford University, Stanford, California
| | - Puneeta Arya
- Harvard Medical School, Boston, Massachusetts.,Division of Cardiology, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Katja G Weinacht
- Department of Stem Cell Transplantation and Regenerative Medicine, Stanford University, Stanford, California
| | - T Bernard Kinane
- Harvard Medical School, Boston, Massachusetts.,Division of Pulmonary, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Lael M Yonker
- Harvard Medical School, Boston, Massachusetts.,Division of Pulmonary, Massachusetts General Hospital for Children, Boston, Massachusetts
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15
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Lo RM, Liu AY, Valdez TA, Gernez Y. Dupilumab use in recalcitrant allergic fungal rhinosinusitis. Ann Allergy Asthma Immunol 2020; 125:617-619. [PMID: 32707161 DOI: 10.1016/j.anai.2020.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Rachelle M Lo
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics Stanford University School of Medicine, Stanford, California.
| | - Anne Y Liu
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics Stanford University School of Medicine, Stanford, California; Division of Infectious Diseases, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Tulio A Valdez
- Department of Otolaryngology, Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Yael Gernez
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics Stanford University School of Medicine, Stanford, California
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16
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Lee IT, Arioka M, Kleinman SH, Gernez Y. Masqueraders of angioedema after a dental procedure. Ann Allergy Asthma Immunol 2020; 124:536-541. [PMID: 32205197 DOI: 10.1016/j.anai.2020.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/20/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Ivan T Lee
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
| | - Masaki Arioka
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California; Department of Clinical Pharmacology, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Sara H Kleinman
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Yael Gernez
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
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17
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Siddiqi AE, Liu AY, Charville GW, Kunder CA, Uzel G, Sadighi Akha AA, Oak J, Martin B, Sacha J, Lewis DB, Gernez Y. Disseminated Pneumocystis jirovecii Infection with Osteomyelitis in a Patient with CTLA-4 Haploinsufficiency. J Clin Immunol 2020; 40:412-414. [PMID: 31955317 DOI: 10.1007/s10875-020-00748-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/09/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Aminaa E Siddiqi
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford School of Medicine, 269 Campus Drive, CCSR Suite 3215, Stanford, CA, 94305-5366, USA
| | - Anne Y Liu
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford School of Medicine, 269 Campus Drive, CCSR Suite 3215, Stanford, CA, 94305-5366, USA.,Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford School of Medicine, Stanford, CA, USA
| | | | | | - Gulbu Uzel
- National Institutes of Allergy and Infectious Disease NIH, Bethesda, MD, USA
| | - Amir A Sadighi Akha
- Division of Clinical Biochemistry & Immunology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jean Oak
- Department of Pathology, Stanford School of Medicine, Stanford, CA, USA
| | - Beth Martin
- Division of Hematology, Department of Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Joshua Sacha
- Division of Allergy and Clinical Immunology, David Grant USAF Medical Center in Travis AFB, Fairfield, CA, USA
| | - David B Lewis
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford School of Medicine, 269 Campus Drive, CCSR Suite 3215, Stanford, CA, 94305-5366, USA
| | - Yael Gernez
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford School of Medicine, 269 Campus Drive, CCSR Suite 3215, Stanford, CA, 94305-5366, USA.
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18
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Gernez Y, de Jesus AA, Alsaleem H, Macaubas C, Roy A, Lovell D, Jagadeesh KA, Alehashemi S, Erdman L, Grimley M, Talarico S, Bacchetta R, Lewis DB, Canna SW, Laxer RM, Mellins ED, Goldbach-Mansky R, Weinacht KG. Severe autoinflammation in 4 patients with C-terminal variants in cell division control protein 42 homolog (CDC42) successfully treated with IL-1β inhibition. J Allergy Clin Immunol 2019. [PMID: 31271789 DOI: 10.1016/j.jaci.2019.06.017)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Yael Gernez
- Division of Allergy and Immunology, Department of Pediatrics, Stanford School of Medicine, Stanford, Calif.
| | - Adriana A de Jesus
- Translational Autoinflammatory Diseases Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Md
| | - Hanouf Alsaleem
- Department of Pediatric Rheumatology, University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Claudia Macaubas
- Division of Human Gene Therapy, Department of Pediatrics, Stanford School of Medicine, Stanford, Calif
| | - Amitava Roy
- Bioinformatics and Computational Biosciences Branch (BCBB) OCICB Rocky Mountain Laboratories, NIAID, NIH, Hamilton, Mont
| | - Daniel Lovell
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Sara Alehashemi
- Translational Autoinflammatory Diseases Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Md
| | - Laura Erdman
- Department of Pediatric Rheumatology, University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael Grimley
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Susanna Talarico
- Department of Pediatric Rheumatology, University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rosa Bacchetta
- Division of Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, Calif
| | - David B Lewis
- Division of Allergy and Immunology, Department of Pediatrics, Stanford School of Medicine, Stanford, Calif
| | - Scott W Canna
- Division of Rheumatology/RK Mellon Institute, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pa
| | - Ron M Laxer
- Department of Pediatric Rheumatology, University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth D Mellins
- Division of Human Gene Therapy, Department of Pediatrics, Stanford School of Medicine, Stanford, Calif
| | - Raphaela Goldbach-Mansky
- Translational Autoinflammatory Diseases Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Md
| | - Katja G Weinacht
- Division of Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, Calif.
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19
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Gernez Y, de Jesus AA, Alsaleem H, Macaubas C, Roy A, Lovell D, Jagadeesh KA, Alehashemi S, Erdman L, Grimley M, Talarico S, Bacchetta R, Lewis DB, Canna SW, Laxer RM, Mellins ED, Goldbach-Mansky R, Weinacht KG. Severe autoinflammation in 4 patients with C-terminal variants in cell division control protein 42 homolog (CDC42) successfully treated with IL-1β inhibition. J Allergy Clin Immunol 2019; 144:1122-1125.e6. [PMID: 31271789 DOI: 10.1016/j.jaci.2019.06.017] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/14/2019] [Accepted: 06/19/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Yael Gernez
- Division of Allergy and Immunology, Department of Pediatrics, Stanford School of Medicine, Stanford, Calif.
| | - Adriana A de Jesus
- Translational Autoinflammatory Diseases Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Md
| | - Hanouf Alsaleem
- Department of Pediatric Rheumatology, University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Claudia Macaubas
- Division of Human Gene Therapy, Department of Pediatrics, Stanford School of Medicine, Stanford, Calif
| | - Amitava Roy
- Bioinformatics and Computational Biosciences Branch (BCBB) OCICB Rocky Mountain Laboratories, NIAID, NIH, Hamilton, Mont
| | - Daniel Lovell
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Sara Alehashemi
- Translational Autoinflammatory Diseases Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Md
| | - Laura Erdman
- Department of Pediatric Rheumatology, University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael Grimley
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Susanna Talarico
- Department of Pediatric Rheumatology, University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rosa Bacchetta
- Division of Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, Calif
| | - David B Lewis
- Division of Allergy and Immunology, Department of Pediatrics, Stanford School of Medicine, Stanford, Calif
| | - Scott W Canna
- Division of Rheumatology/RK Mellon Institute, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pa
| | - Ron M Laxer
- Department of Pediatric Rheumatology, University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth D Mellins
- Division of Human Gene Therapy, Department of Pediatrics, Stanford School of Medicine, Stanford, Calif
| | - Raphaela Goldbach-Mansky
- Translational Autoinflammatory Diseases Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Md
| | - Katja G Weinacht
- Division of Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, Calif.
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20
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Gernez Y, Baker MG, Maglione PJ. Humoral immunodeficiencies: conferred risk of infections and benefits of immunoglobulin replacement therapy. Transfusion 2019; 58 Suppl 3:3056-3064. [PMID: 30536429 PMCID: PMC6939302 DOI: 10.1111/trf.15020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 10/05/2018] [Indexed: 02/06/2023]
Abstract
Primary immunodeficiency (PID) diseases result from genetic defects of the immune system that increase a patient's susceptibility to infections. The types of infections that occur in patients with PID diseases are dictated largely by the nature of the immunodeficiency, which can be defined by dysfunction of cellular or humoral defenses. An increasing number of PID diseases, including those with both cellular and humoral defects, have antibody deficiency as a major feature, and as a result can benefit from immunoglobulin replacement therapy. In fact, the most common PID diseases worldwide are antibody deficiencies and include common variable immunodeficiency, congenital agammaglobulinemia, hyper‐IgM syndrome, specific antibody deficiency, and Good syndrome. Although immunoglobulin replacement therapy is the cornerstone of treatment for the majority of these conditions, a thorough understanding of the specific infections for which these patients are at increased risk can hasten diagnosis and guide additional therapies. Moreover, the infection trends in some patients with PID disease who have profound defects of cellular immunity, such as autosomal‐dominant hyper‐IgE syndrome (Job/Buckley syndrome) or dedicator of cytokinesis 8 (DOCK8) deficiency, suggest that select patients might benefit from immunoglobulin replacement therapy even if their immunodeficiency is not limited to antibody defects. In this review, we provide an overview of the predisposition to infections seen in PID disease that may benefit from immunoglobulin replacement therapy.
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Affiliation(s)
- Yael Gernez
- Division of Allergy and Immunology, Department of Pediatrics, Stanford School of Medicine, Stanford, California
| | - Mary Grace Baker
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Paul J Maglione
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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21
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Forrest OA, Chopyk DM, Gernez Y, Brown MR, Conrad CK, Moss RB, Tangpricha V, Peng L, Tirouvanziam R. Resistin is elevated in cystic fibrosis sputum and correlates negatively with lung function. J Cyst Fibros 2019; 18:64-70. [DOI: 10.1016/j.jcf.2018.05.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/30/2018] [Accepted: 05/31/2018] [Indexed: 01/04/2023]
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22
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Saenz R, Chen M, Ahmed A, Gernez Y. THE DIFFICULT MANAGEMENT OF THREE PATIENTS WITH NETHERTON SYNDROME. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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23
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Gernez Y, Sicherer SH, Wang J. Variability in diagnosis and management of acquired cold-induced urticaria. The Journal of Allergy and Clinical Immunology: In Practice 2018. [DOI: 10.1016/j.jaip.2017.12.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Gernez Y, Sicherer SH, Wang J. Results of A Survey on the Frequency and the Criteria for Epinephrine Autoinjector Prescription in Patients with Acquired Cold-Induced Urticaria (ACIU). J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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25
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Gernez Y, Freeman AF, Holland SM, Garabedian E, Patel NC, Puck JM, Sullivan KE, Akhter J, Secord E, Chen K, Buckley R, Haddad E, Ochs HD, Fuleihan R, Routes J, Muskat M, Lugar P, Mancini J, Cunningham-Rundles C. Autosomal Dominant Hyper-IgE Syndrome in the USIDNET Registry. J Allergy Clin Immunol Pract 2017; 6:996-1001. [PMID: 28939137 DOI: 10.1016/j.jaip.2017.06.041] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/02/2017] [Accepted: 06/20/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Autosomal dominant hyper-IgE syndrome (AD-HIES) is a rare condition. OBJECTIVE Data from the USIDNET Registry provide a resource to examine the characteristics of patients with rare immune deficiency diseases. METHODS A query was submitted to the USIDNET requesting deidentified data for patients with physician-diagnosed AD-HIES through July 2016. RESULTS Data on 85 patients diagnosed with AD-HIES (50 males; 35 females) born between 1950 and 2013, collected by 14 physicians from 25 states and Quebec, were entered into the USIDNET Registry by July 2016. Cumulative follow-up was 2157 years. Of these patients, 45.9% had a family history of HIES. The complications reported included skin abscesses (74.4%), eczema (57.7%), retained primary teeth (41.4%), fractures (39%), scoliosis (34.1%), and cancer (7%). Reported allergic diseases included food (37.8%), environmental (18%), and drugs (42.7%). The mean serum IgE level was 8383.7 kU/mL and was inversely correlated to the patient's age. A total of 49.4% had eosinophilia; 56% were known to be on trimethoprim-sulfamethoxazole, 26.6% on antifungal coverage, and 30.6% on immunoglobulin replacement therapy. Pneumonias were more commonly attributed to Staphylococcus aureus (55.3%) or Aspergillus fumigatus (22.4%); 19.5% had a history of lung abscess; these were most often associated with Pseudomonas aeruginosa (P Fisher's exact test = .029) or A. fumigatus (P Fisher's exact test = .016). Lung abscesses were significantly associated with drug reactions (P χ2 = .01; odds ratio: 4.03 [1.2-12.97]), depression (P Fisher's exact test = .036), and lower Karnofsky index scores (P Mann-Whitney = .007). DISCUSSION Data from the USIDNET Registry summarize the currently reported clinical characteristics of a large cohort of subjects with AD-HIES.
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Affiliation(s)
- Yael Gernez
- Division of Allergy and Clinical Immunology, Icahn School of Medicine, Mount Sinai, New York, NY
| | - Alexandra F Freeman
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Steven M Holland
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Elizabeth Garabedian
- National Institutes of Health, National Human Genome Research Institute, Office of the Clinical Director, Bethesda, Md
| | - Niraj C Patel
- Division of Infectious Disease and Immunology, Department of Pediatrics, Levine Children's Hospital, Carolinas Medical Center, Charlotte, NC
| | - Jennifer M Puck
- Department of Pediatrics, University of California San Francisco School of Medicine and UCSF Benioff Children's Hospital, San Francisco, Calif
| | - Kathleen E Sullivan
- Division of Allergy and Clinical Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Javeed Akhter
- Department of Pediatric Pulmonology, Advocate Hope Children's Hospital, Oak Lawn, Ill
| | - Elizabeth Secord
- Allergy, Asthma, and Immunology, Children's Hospital of Michigan Specialty Center-Detroit, Detroit, Mich
| | - Karin Chen
- Division of Allergy and Immunology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Rebecca Buckley
- Department of Immunology, Duke University Medical Center, Durham, NC
| | - Elie Haddad
- Division of Allergy, Clinical Immunology and Rheumatology, CHU Sainte Justine, Montreal, Quebec, Canada
| | - Hans D Ochs
- Department of Pediatrics, University of Washington and Seattle Children's Research Institute, Seattle, Wash
| | - Ramsay Fuleihan
- Division of Pediatric, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - John Routes
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis
| | - Mica Muskat
- Department of Pediatrics, University of California San Francisco School of Medicine and UCSF Benioff Children's Hospital, San Francisco, Calif
| | - Patricia Lugar
- Department of Immunology, Duke University Medical Center, Durham, NC
| | - Julien Mancini
- Aix Marseille University, INSERM, IRD, UMR912 SESSTIM, APHM, Marseille, France
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Busse PJ, Gernez Y. Clinical and biological response to rituximab treatment in 3 patients with acquired C1-inhibitor deficiency. Ann Allergy Asthma Immunol 2017; 119:380-382. [PMID: 28866304 DOI: 10.1016/j.anai.2017.07.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/13/2017] [Accepted: 07/28/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Paula J Busse
- Division of Allergy and Clinical Immunology, Icahn School of Medicine, Mount Sinai, New York, New York.
| | - Yael Gernez
- Division of Allergy and Clinical Immunology, Icahn School of Medicine, Mount Sinai, New York, New York
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Gernez Y, Nowak-Węgrzyn A. Immunotherapy for Food Allergy: Are We There Yet? The Journal of Allergy and Clinical Immunology: In Practice 2017; 5:250-272. [DOI: 10.1016/j.jaip.2016.12.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/23/2016] [Accepted: 12/19/2016] [Indexed: 12/21/2022]
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Pham M, Gernez Y, Cunningham-Rundles C. P186 Case of signal transducer and activator of transcription (STAT) 3 gain of function mutation. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Smith T, Gernez Y, Tsuang A, Muller S, Buchbinder E. P078 Novel Sacubitril/Valsartan (Entresto) desensitization protocol: a case report. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.087] [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: 11/28/2022]
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Gernez Y, Waters J, Tirouvanziam R, Herzenberg L, Moss R. Basophil activation test determination of CD63 combined with CD203c is not superior to CD203c alone in identifying allergic bronchopulmonary aspergillosis in cystic fibrosis. J Allergy Clin Immunol 2016; 138:1195-1196. [DOI: 10.1016/j.jaci.2016.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/18/2016] [Accepted: 04/01/2016] [Indexed: 02/08/2023]
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Gernez Y, Tsuang A, Smith TD, Shahjehan K, Hui Y, Maglione PJ, Cunningham-Rundles C. Hemoptysis in a Patient with Elevated Immunoglobulin E. J Allergy Clin Immunol Pract 2016; 4:1054-1058. [PMID: 27693026 DOI: 10.1016/j.jaip.2016.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/15/2016] [Accepted: 08/19/2016] [Indexed: 12/19/2022]
Abstract
Recurrent pneumonia with cavitation leading to pneumatoceles, secondary fungal infections, and hemoptysis are major causes of mortality and morbidity in patients with hyper-IgE syndrome. Prevention and aggressive treatment of pneumonia in these patients are essential to prevent further lung damage, but treatment may be delayed because the classic signs/symptoms of infection such as fever, chills, or rigors may be lacking. Early imaging to identify infection is essential for diagnosis and treatment. The mainstay of therapy is continuous, full-dose daily trimethoprim-sulfamethoxazole and commonly fungal coverage. Because hyper-IgE syndrome is a progressive disease, patients' condition may worsen despite compliance with prophylactic therapy.
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Affiliation(s)
- Yael Gernez
- Division of Allergy and Clinical Immunology, Icahn School of Medicine, Mount Sinai, New York, NY
| | - Angela Tsuang
- Division of Allergy and Clinical Immunology, Icahn School of Medicine, Mount Sinai, New York, NY
| | - Tukisa D Smith
- Division of Allergy and Clinical Immunology, Icahn School of Medicine, Mount Sinai, New York, NY
| | - Khurram Shahjehan
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine, Mount Sinai, New York, NY
| | - Yiqun Hui
- Division of Allergy and Clinical Immunology, Icahn School of Medicine, Mount Sinai, New York, NY
| | - Paul J Maglione
- Division of Allergy and Clinical Immunology, Icahn School of Medicine, Mount Sinai, New York, NY
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Orlova DY, Zimmerman N, Meehan S, Meehan C, Waters J, Ghosn EEB, Filatenkov A, Kolyagin GA, Gernez Y, Tsuda S, Moore W, Moss RB, Herzenberg LA, Walther G. Earth Mover's Distance (EMD): A True Metric for Comparing Biomarker Expression Levels in Cell Populations. PLoS One 2016; 11:e0151859. [PMID: 27008164 PMCID: PMC4805242 DOI: 10.1371/journal.pone.0151859] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 03/04/2016] [Indexed: 01/26/2023] Open
Abstract
Changes in the frequencies of cell subsets that (co)express characteristic biomarkers, or levels of the biomarkers on the subsets, are widely used as indices of drug response, disease prognosis, stem cell reconstitution, etc. However, although the currently available computational “gating” tools accurately reveal subset frequencies and marker expression levels, they fail to enable statistically reliable judgements as to whether these frequencies and expression levels differ significantly between/among subject groups. Here we introduce flow cytometry data analysis pipeline which includes the Earth Mover’s Distance (EMD) metric as solution to this problem. Well known as an informative quantitative measure of differences between distributions, we present three exemplary studies showing that EMD 1) reveals clinically-relevant shifts in two markers on blood basophils responding to an offending allergen; 2) shows that ablative tumor radiation induces significant changes in the murine colon cancer tumor microenvironment; and, 3) ranks immunological differences in mouse peritoneal cavity cells harvested from three genetically distinct mouse strains.
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Affiliation(s)
- Darya Y. Orlova
- Department of Genetics, Stanford University School of Medicine, Stanford, California, United States of America
- * E-mail: ; (DYO); (GW)
| | - Noah Zimmerman
- Department of Statistics, Stanford University, Stanford, California, United States of America
| | - Stephen Meehan
- Department of Statistics, Stanford University, Stanford, California, United States of America
| | - Connor Meehan
- Department of Mathematics, California Institute of Technology, Pasadena, California, United States of America
| | - Jeffrey Waters
- Department of Genetics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Eliver E. B. Ghosn
- Department of Genetics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Alexander Filatenkov
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Gleb A. Kolyagin
- Independent Researcher, Menlo Park, California, United States of America
| | - Yael Gernez
- Department of Genetics, Stanford University School of Medicine, Stanford, California, United States of America
- Department of Allergy and Immunology, Mount Sinai Hospital, New York, New York, United States of America
| | - Shanel Tsuda
- Department of Genetics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Wayne Moore
- Department of Genetics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Richard B. Moss
- Center for Excellence in Pulmonary Biology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Leonore A. Herzenberg
- Department of Genetics, Stanford University School of Medicine, Stanford, California, United States of America
| | - Guenther Walther
- Department of Statistics, Stanford University, Stanford, California, United States of America
- * E-mail: ; (DYO); (GW)
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Gernez Y, Waters J, Mirković B, Lavelle GM, Dunn CE, Davies ZA, Everson C, Tirouvanziam R, Silver E, Wallenstein S, Chotirmall SH, McElvaney NG, Herzenberg LA, Moss RB. Blood basophil activation is a reliable biomarker of allergic bronchopulmonary aspergillosis in cystic fibrosis. Eur Respir J 2015; 47:177-85. [DOI: 10.1183/13993003.01068-2015] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 08/14/2015] [Indexed: 12/16/2022]
Abstract
The diagnosis of cystic fibrosis (CF) patients with allergic bronchopulmonary aspergillosis (ABPA) is clinically challenging, due to the absence of an objective biological test. Since blood basophils play a major role in allergic responses, we hypothesised that changes in their surface activation pattern discriminate between CF patients with and without ABPA.We conducted a prospective longitudinal study (Stanford cohort) comparing basophil activation test CD203c levels by flow cytometry before and after activation withAspergillus fumigatusallergen extract or recombinantAspf1 in 20 CF patients with ABPA (CF-ABPA) and in two comparison groups: CF patients withA. fumigatuscolonisation (AC) but without ABPA (CF-AC; n=13) and CF patients without either AC or ABPA (CF; n=12). Patients were tested every 6 months and when ill with pulmonary exacerbation. We also conducted cross-sectional validation in a separate patient set (Dublin cohort).Basophil CD203c surface expression reliably discriminated CF-ABPA from CF-AC and CF over time. Ex vivostimulation withA. fumigatusextract or recombinantAspf1 produced similar results within the Stanford (p<0.0001) and the Dublin cohorts. CF-ABPA patients were likelier to have elevated specific IgE toA. fumigatusand were less frequently co-infected withStaphylococcus aureus.Basophil CD203c upregulation is a suitable diagnostic and stable monitoring biomarker of ABPA in CF.
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Mirković B, Lavelle GM, Azim AA, Helma K, Gargoum FS, Molloy K, Gernez Y, Dunne K, Renwick J, Murphy P, Moss RB, Greene CM, Gunaratnam C, Chotirmall SH, McElvaney NG. The basophil surface marker CD203c identifies Aspergillus species sensitization in patients with cystic fibrosis. J Allergy Clin Immunol 2015; 137:436-443.e9. [PMID: 26388311 DOI: 10.1016/j.jaci.2015.07.045] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [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: 04/19/2015] [Revised: 07/04/2015] [Accepted: 07/17/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Colonization by Aspergillus fumigatus in patients with cystic fibrosis (CF) can cause A fumigatus sensitization and/or allergic bronchopulmonary aspergillosis (ABPA), which affects pulmonary function and clinical outcomes. Recent studies show that specific allergens upregulate the surface-expressed basophil marker CD203c in sensitized subjects, a response that can be readily measured by using flow cytometry. OBJECTIVE We sought to identify A fumigatus sensitization in patients with CF by using the basophil activation test (BAT). METHODS Patients with CF attending Beaumont Hospital were screened for study inclusion. BAT was used to identify A fumigatus sensitization. Serologic (total and A fumigatus-specific IgE), pulmonary function, and body mass index measurements were performed. RESULTS The BAT discriminates A fumigatus-sensitized from nonsensitized patients with CF. Persistent isolation of A fumigatus in sputum is a significant risk factor for A fumigatus sensitization. Levels of the A fumigatus-stimulated basophil activation marker CD203c inversely correlated with pulmonary function and body mass index in A fumigatus-sensitized but not nonsensitized patients with CF. Total and A fumigatus-specific IgE, but not IgG, levels are increased in A fumigatus-sensitized patients with CF and ABPA when compared with those in A fumigatus-sensitized and nonsensitized patients with CF without ABPA. Itraconazole treatment did not affect A fumigatus sensitization. CONCLUSION Combining the BAT with routine serologic testing allows classification of patients with CF into 3 groups: nonsensitized, A fumigatus-sensitized, and ABPA. Accurate and prompt identification of A fumigatus-associated clinical status might allow early and targeted therapeutic intervention, potentially improving clinical outcomes.
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Affiliation(s)
- Bojana Mirković
- Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Gillian M Lavelle
- Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Ahmed Abdul Azim
- Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Kristine Helma
- Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Fatma S Gargoum
- Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Kevin Molloy
- Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Yael Gernez
- Department of Genetics, Stanford University School of Medicine, Stanford, Calif
| | - Katie Dunne
- Clinical Microbiology Department, Trinity College Dublin, the Adelaide and Meath Hospital incorporating the National Children's Hospital, Tallaght, Dublin, Ireland
| | - Julie Renwick
- Clinical Microbiology Department, Trinity College Dublin, the Adelaide and Meath Hospital incorporating the National Children's Hospital, Tallaght, Dublin, Ireland
| | - Philip Murphy
- Clinical Microbiology Department, Trinity College Dublin, the Adelaide and Meath Hospital incorporating the National Children's Hospital, Tallaght, Dublin, Ireland
| | - Richard B Moss
- Center for Excellence in Pulmonary Biology, Department of Paediatrics, Stanford University School of Medicine, Stanford, Calif
| | - Catherine M Greene
- Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Cedric Gunaratnam
- Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
| | - Noel G McElvaney
- Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
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Gernez Y, Waters J, Dunn C, Davies Z, Tirouvanziam R, Everson C, Tamaresis J, Herzenberg L, Moss RB. Basophil Activation Is a Reliable Biomarker Of Allergic Bronchopulmonary Aspergillosis (ABPA) In CF: One Year Results Of a Longitudinal Cohort Study. J Allergy Clin Immunol 2014. [DOI: 10.1016/j.jaci.2013.12.229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Moss R, Waters J, Dunn C, Davies Z, Everson C, Tirouvanziam R, Tameresis J, Herzenberg L, Gernez Y. WS22.1 Basophil activation is a reliable biomarker of allergic bronchopulmonary aspergillosis (ABPA) in CF: Interim results of a longitudinal cohort study. J Cyst Fibros 2013. [DOI: 10.1016/s1569-1993(13)60138-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gernez Y, Everson C, Dunn C, Fernandez-Becker N, Gudiputi L, Davies Z, Herzenberg L, Tirouvanziam R, Moss R. WS9.7 Modulatory effects of Aspergillus colonization and ABPA on blood and sputum eosinophils and neutrophils in CF. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60066-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gernez Y, Dunn CE, Everson C, Mitsunaga E, Gudiputi L, Krasinska K, Davies ZA, Herzenberg LA, Tirouvanziam R, Moss RB. Blood basophils from cystic fibrosis patients with allergic bronchopulmonary aspergillosis are primed and hyper-responsive to stimulation by aspergillus allergens. J Cyst Fibros 2012; 11:502-10. [PMID: 22608296 DOI: 10.1016/j.jcf.2012.04.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 04/13/2012] [Accepted: 04/13/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Fifteen to sixty percent of cystic fibrosis patients harbor Aspergillus fumigatus (Af) in their airways (CF-AC) and some will develop allergic bronchopulmonary aspergillosis (CF-ABPA). Since basophils play a key role in allergy, we hypothesized that they would display alterations in CF-ABPA patients compared to CF-AC or patients without Af colonization (CF). METHODS Using flow cytometry, we measured CD203c, CD63 and CD123 levels on basophils from CF-ABPA (N=11), CF-AC (N=14), and CF (N=12) patients before and after ex vivo stimulation with Af allergens. RESULTS Baseline CD203c was increased in basophils from CF-ABPA compared to CF-AC and CF patients. Af extract and recombinant Aspf1 stimulated basophils from CF-ABPA patients to markedly upregulate CD203c, along with modest upregulation of CD63 and a CD123 downward trend. Plasma TARC/CCL17 at baseline and post-stimulation cell supernatant histamine levels were similar in the three groups. CONCLUSIONS In CF-ABPA, blood basophils are primed and hyperresponsive to Af allergen stimulation.
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Affiliation(s)
- Yael Gernez
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA.
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Gernez Y, Tirouvanziam R, Reshamwala N, Yu G, Weldon BC, Galli SJ, Herzenberg LA, Nadeau KC. Modulation of mTOR effector phosphoproteins in blood basophils from allergic patients. J Clin Immunol 2012; 32:565-73. [PMID: 22350221 DOI: 10.1007/s10875-012-9651-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 01/10/2012] [Indexed: 02/07/2023]
Abstract
The mammalian target of rapamycin (mTOR) pathway contributes to various immunoinflammatory processes. Yet, its potential involvement in basophil responses in allergy remains unclear. In this pilot study, we quantified two key mTOR effector phosphoproteins, the eukaryotic initiation factor 4E (peIF4E) and S6 ribosomal protein (pS6rp), in blood basophils from nut allergy patients (NA, N = 16) and healthy controls (HC, N = 13). Without stimulation in vitro, basophil peIF4E levels were higher in NA than HC subjects (P = 0.014). Stimulation with nut (offending) but not chicken / rice (non-offending) extract increased basophil peIF4E and pS6rp levels (+32%, P = 0.018, and +98%, P = 0.0026, respectively) in NA but not HC subjects, concomitant with increased surface levels of CD203c and CD63, both known to reflect basophil activation. Pre-treatment with the mTOR inhibitor rapamycin decreased pS6rp and CD203c responses in nut extract-stimulated basophils in NA subjects. Thus, basophil responses to offending allergens are associated with modulation of mTOR effector phosphoproteins.
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Affiliation(s)
- Yael Gernez
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA
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Gernez Y, Everson C, Mitsunaga E, Dunn C, Herzenberg L, Tirouvanziam R, Moss R. Specific Induction Of CD203c Expression In Blood Basophils Discriminates Between CF patients With Aspergillus Colonization And Those With CF-ABPA. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Gernez Y, Tirouvanziam R, Dunn C, Everson C, Davis Z, Herzenberg L, Moss R. 184* Basophil CD203c as a potential clinically relevant biomarker in cystic fibrosis and allergic bronchopulmonary aspergillosis. J Cyst Fibros 2011. [DOI: 10.1016/s1569-1993(11)60200-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gernez Y, Tirouvanziam R, Yu G, Ghosn EEB, Reshamwala N, Nguyen T, Tsai M, Galli SJ, Herzenberg LA, Herzenberg LA, Nadeau KC. Basophil CD203c levels are increased at baseline and can be used to monitor omalizumab treatment in subjects with nut allergy. Int Arch Allergy Immunol 2010; 154:318-27. [PMID: 20975283 DOI: 10.1159/000321824] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Accepted: 05/04/2010] [Indexed: 11/19/2022] Open
Abstract
RATIONALE Basophils contribute to anaphylaxis and allergies. We examined the utility of assessing basophil-associated surface antigens (CD11b/CD63/CD123/CD203c/CD294) in characterizing and monitoring subjects with nut allergy. METHODS We used flow cytometry to analyze basophils at baseline (without any activation) and after ex vivo stimulation of whole blood by addition of nut or other allergens for 2, 10, and 30 min. We also evaluated whether basophil expression of CD11b/CD63/CD123/CD203c/CD294 was altered in subjects treated with anti-IgE monoclonal antibody (omalizumab) to reduce plasma levels of IgE. RESULTS We demonstrate that basophil CD203c levels are increased at baseline in subjects with nut allergy compared to healthy controls (13 subjects in each group, p < 0.0001). Furthermore, we confirm that significantly increased expression of CD203c occurs on subject basophils when stimulated with the allergen to which the subject is sensitive and can be detected rapidly (10 min of stimulation, n = 11, p < 0.0008). In 5 subjects with severe peanut allergy, basophil CD203c expression following stimulation with peanut allergen was significantly decreased (p < 0.05) after 4 and 8 weeks of omalizumab treatment but returned toward pretreatment levels after treatment cessation. CONCLUSIONS Subjects with nut allergy show an increase of basophil CD203c levels at baseline and following rapid ex vivo stimulation with nut allergen. Both can be reduced by omalizumab therapy. These results highlight the potential of using basophil CD203c levels for baseline diagnosis and therapeutic monitoring in subjects with nut allergy.
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Affiliation(s)
- Yael Gernez
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
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Patel AJ, Fuentebella J, Gernez Y, Nguyen T, Bass D, Berquist W, Cox K, Sibley E, Kerner J, Nadeau K. Increased HLA-DR expression on tissue eosinophils in eosinophilic esophagitis. J Pediatr Gastroenterol Nutr 2010; 51:290-4. [PMID: 20639774 DOI: 10.1097/mpg.0b013e3181e083e7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of the study was to investigate whether eosinophils have increased human leukocyte antigen (HLA)-DR expression in subjects with eosinophilic esophagitis (EoE) compared with controls. PATIENTS AND METHODS Patients who were undergoing an upper endoscopy with biopsies for suspected gastroesophageal reflux disease (GERD) or EoE at Lucile Packard Children's Hospital were enrolled. In total, the blood and tissue samples of 10 healthy controls (HC), 11 subjects with GERD, and 10 with EoE were studied. Multiple tissue staining to identify eosinophils (via eosinophil cationic protein-clone EG2) and major histocompatibility complex class II cell surface receptors (via HLA-DR) was performed via immunohistochemistry. The peripheral blood was analyzed using flow cytometry to detect eosinophil HLA-DR expression among these subjects. RESULTS In the tissue, a greater proportion of eosinophils expressed HLA-DR among the subjects with EoE (mean 0.83 +/- 0.14, n = 9) relative to those with GERD (mean 0.18 +/- 0.19, n = 8, P < 0.01) and HC (mean 0.18 +/- 0.13, n = 6, P < 0.01). In total, 6 participants (4 HC subjects and 2 subjects with GERD) did not have any eosinophils identified on tissue staining and were unable to be included in the present statistical analysis. In the blood, there was no statistically significant difference in eosinophil HLA-DR expression among HC subjects (mean 415 +/- 217, n = 6), subjects with GERD (mean 507 +/- 429, n = 2), and those with EoE (mean 334 +/- 181, n = 6). CONCLUSIONS These data demonstrate that the eosinophils from the esophagus of subjects with EoE have increased HLA-DR expression within this tissue.
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Affiliation(s)
- Anup J Patel
- Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA.
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Gernez Y, Tirouvanziam R, Yu G, Reshamwala N, Tsai M, Galli S, Herzenberg L, Nadeau K. Human Basophils: New Mechanisms Of Action And Role In Food Allergy. J Allergy Clin Immunol 2010. [DOI: 10.1016/j.jaci.2009.12.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gernez Y, Atkuri K, Guyen N, Herzenberg L, Tirouvanziam R, Nadeau K. Cd161 Defines Functional Memory Subset Of Cd4 And Cd8 In Asthma. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Nguyen T, Gernez Y, Fuentebella J, Patel A, Herzenberg L, Tirouvanziam R, Nadeau K. F.102. Enhanced Expression of CD66b on Peripheral Blood Granulocytes in Eosinophilic Esophagitis. Clin Immunol 2009. [DOI: 10.1016/j.clim.2009.03.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
INTRODUCTION Stridor in the post extubation period occurs frequently and is most commonly caused by laryngeal oedema. During this period, the trachea can also be obstructed by pseudomembranes. CASE REPORT We report the case of a 59 year old woman who required re-intubation, 15 days after extubation because of the acute onset of severe respiratory distress secondary to pseudomembranes in her trachea. CONCLUSION It is essential that physicians who care for patients during the post extubation period are aware of this severe and life threatening cause of stridor. Definitive treatment with the rigid bronchoscope allows for rapid recanalisation of the airway.
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Affiliation(s)
- Y Gernez
- Unité d'Endoscopie thoracique, Pôle Cardiovasculaire et Thoracique, Hôpital Sainte Marguerite, Marseille.
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Gernez Y, Tirouvanziam R, Nguyen KD, Herzenberg LA, Krensky AM, Nadeau KC. Altered phosphorylated signal transducer and activator of transcription profile of CD4+CD161+ T cells in asthma: modulation by allergic status and oral corticosteroids. J Allergy Clin Immunol 2007; 120:1441-8. [PMID: 17919711 DOI: 10.1016/j.jaci.2007.08.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 08/02/2007] [Accepted: 08/06/2007] [Indexed: 01/21/2023]
Abstract
BACKGROUND Asthma is a complex immunologic disorder linked to altered cytokine signaling. OBJECTIVE We tested whether asthmatic patients showed any change in cytokine-dependent signal transducer and activator of transcription (STAT) levels, focusing on the central/effector-memory CD4(+)CD161(+) subset, which represents 15% to 25% of circulating T cells. METHODS We quantified intracellular levels of active phosphorylated STAT (phospho-STAT) 1, 3, 5, and 6 by means of flow cytometry, without any activation or expansion. RESULTS Baseline phospho-STAT1 and phospho-STAT6 levels were increased in CD4(+)CD161(+) T cells from asthmatic patients compared with those from healthy control subjects (by 10- and 8-fold, respectively). This asthma-associated alteration was both subset specific because no change was seen in CD4(+)CD161(-)CD25(+) (regulatory T cells) and CD4(+)CD161(-)CD25(-) subsets and isoform specific because phospho-STAT5 and phospho-STAT3 levels were unchanged. Among asthmatic patients, phospho-STAT1 and phospho-STAT6 levels correlated negatively with each other, suggesting antagonistic regulation. Oral corticosteroid (OCS) treatment significantly decreased phospho-STAT6 and IL-4 levels but not phospho-STAT1 levels. Disease parameters showing significant correlations with phospho-STAT1, phospho-STAT6, or both included age at onset, plasma IgE levels, and levels of the T(H)2 cytokines IL-4 and IL-10 and the T(H)1 cytokine IL-2. Overall, combined phospho-STAT1 and phospho-STAT6 measurements showed excellent predictive value for identifying (1) asthmatic patients versus healthy control subjects, (2) allergic versus nonallergic asthmatic patients, and (3) asthmatic patients taking versus those not taking OCSs. CONCLUSION Baseline changes in phospho-STAT1 and phospho-STAT6 levels in blood CD4(+)CD161(+) T cells identify asthmatic patients and mirror their allergic status and response to OCSs. CLINICAL IMPLICATIONS These results confirm the pathologic importance of activated STAT1 and STAT6 in asthma and suggest their potential use as clinical biomarkers.
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Affiliation(s)
- Yael Gernez
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
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Abstract
INTRODUCTION Carboplatin is a chemotherapeutic agent used frequently in thoracic medicine on account of its relatively good tolerance. Nevertheless hypersensitivity reactions have been described. CASE REPORTS We report the cases of 2 patients, treated for undifferentiated bronchial carcinoma and carcinoma of the breast, presenting with hypersensitivity reactions to carboplatin developing after 6 and 8 courses respectively. The first patient presented with an irritant maculo-papular rash and the second with severe hypotension and bronchospasm. Neither of these reactions was fatal. Both of these reactions occurred when generic carboplatin was substituted for the propriety preparation. CONCLUSION Hypersensitivity reactions to carboplatin should be recognised by respiratory physicians on account of their potential seriousness and their occurrence after several courses of treatment. This takes on particular importance at a time when plans for domiciliary treatment of patients are being considered. In addition a national survey of hypersensitivity to carboplatin should be considered by the regional drug safety centres.
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Affiliation(s)
- Y Gernez
- Faculté de Médecine, Université de la Méditerranée, Service de pneumologie-allergologie. Hôpital Sainte-Marguerite. Marseille, France
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