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Chang LX, Zhang L, Gao YM, Zhu XF. [Two cases of cytopenia associated with multiple malformations]. Zhongguo Dang Dai Er Ke Za Zhi 2024; 26:410-413. [PMID: 38660906 DOI: 10.7499/j.issn.1008-8830.2311058] [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] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
The first patient, a 10-year-old girl, presented with pancytopenia and recurrent epistaxis, along with a history of repeated upper respiratory infections, café-au-lait spots, and microcephaly. Genetic testing revealed compound heterozygous mutations in the DNA ligase IV (LIG4) gene, leading to a diagnosis of LIG4 syndrome. The second patient, a 6-year-old girl, was seen for persistent thrombocytopenia lasting over two years and was noted to have short stature, hyperpigmented skin, and hand malformations. She had a positive result from chromosome breakage test. She was diagnosed with Fanconi anemia complementation group A. Despite similar clinical presentations, the two children were diagnosed with different disorders, suggesting that children with hemocytopenia and malformations should not only be evaluated for hematological diseases but also be screened for other potential underlying conditions such as immune system disorders.
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Affiliation(s)
- Li-Xian Chang
- Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/State Key Laboratory of Experimental Hematology/National Clinical Research Center for Blood Diseases/Haihe Laboratory of Cell Ecosystem, Tianjin 300020, China (changlixian@ihcams. ac.cn)
| | - Li Zhang
- Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/State Key Laboratory of Experimental Hematology/National Clinical Research Center for Blood Diseases/Haihe Laboratory of Cell Ecosystem, Tianjin 300020, China (changlixian@ihcams. ac.cn)
| | - Yi-Man Gao
- Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/State Key Laboratory of Experimental Hematology/National Clinical Research Center for Blood Diseases/Haihe Laboratory of Cell Ecosystem, Tianjin 300020, China (changlixian@ihcams. ac.cn)
| | - Xiao-Fan Zhu
- Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/State Key Laboratory of Experimental Hematology/National Clinical Research Center for Blood Diseases/Haihe Laboratory of Cell Ecosystem, Tianjin 300020, China (changlixian@ihcams. ac.cn)
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2
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O'Neill C, Nwachukwu N, Vergara-Lluri M, Hagiya A, O'Connell CL. Clinical and pathological features of clonal cytopenia of undetermined significance presenting with isolated thrombocytopenia (CCUS-IT). Eur J Haematol 2024; 112:594-600. [PMID: 38088145 DOI: 10.1111/ejh.14149] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 03/19/2024]
Abstract
BACKGROUND Clonal cytopenia of undetermined significance (CCUS) is defined as somatic mutations of myeloid malignancy-associated genes in the blood or bone marrow with one or more persistent unexplained cytopenias that do not meet diagnostic criteria for a defined myeloid neoplasm. CCUS with isolated thrombocytopenia (CCUS-IT) is rare. METHODS This is a retrospective case series of patients with prolonged isolated thrombocytopenia, a pathogenic mutation on a myeloid molecular panel, and a bone marrow biopsy with morphologic atypia below the WHO-defined diagnostic threshold for dysplasia. RESULTS Five male patients were identified with a median age at CCUS-IT diagnosis of 61 years (56-74). Median duration of thrombocytopenia prior to CCUS-IT diagnosis was 4 years (3-12), and median platelet count at CCUS-IT diagnosis was 41 × 103 /μL (26-80). All patients had megakaryocytic hyperplasia and megakaryocytes with hyperchromasia and high nuclear-cytoplasmic ratio. Pathogenic SRSF2 mutations were identified in all 5 patients with median variant allele frequency of 36% (28%-50%). Three patients were treated with IVIg and/or steroids with no response; one of three responded to thrombopoietin receptor agonists. Three patients progressed to MDS and one to AML. DISCUSSION We describe the clinicopathological features of CCUS-IT which can mimic immune thrombocytopenia.
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Affiliation(s)
- Caitlin O'Neill
- Jane Anne Nohl Division of Hematology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Nneka Nwachukwu
- Jane Anne Nohl Division of Hematology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Maria Vergara-Lluri
- Department of Pathology, Hematopathology Section, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Ashley Hagiya
- Department of Pathology, Hematopathology Section, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Casey L O'Connell
- Jane Anne Nohl Division of Hematology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Lin GL, Chang HH, Lin WT, Liou YS, Lai YL, Hsieh MH, Chen PK, Liao CY, Tsai CC, Wang TF, Chu SC, Kau JH, Huang HH, Hsu HL, Sun DS. Dachshund Homolog 1: Unveiling Its Potential Role in Megakaryopoiesis and Bacillus anthracis Lethal Toxin-Induced Thrombocytopenia. Int J Mol Sci 2024; 25:3102. [PMID: 38542074 PMCID: PMC10970148 DOI: 10.3390/ijms25063102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Lethal toxin (LT) is the critical virulence factor of Bacillus anthracis, the causative agent of anthrax. One common symptom observed in patients with anthrax is thrombocytopenia, which has also been observed in mice injected with LT. Our previous study demonstrated that LT induces thrombocytopenia by suppressing megakaryopoiesis, but the precise molecular mechanisms behind this phenomenon remain unknown. In this study, we utilized 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced megakaryocytic differentiation in human erythroleukemia (HEL) cells to identify genes involved in LT-induced megakaryocytic suppression. Through cDNA microarray analysis, we identified Dachshund homolog 1 (DACH1) as a gene that was upregulated upon TPA treatment but downregulated in the presence of TPA and LT, purified from the culture supernatants of B. anthracis. To investigate the function of DACH1 in megakaryocytic differentiation, we employed short hairpin RNA technology to knock down DACH1 expression in HEL cells and assessed its effect on differentiation. Our data revealed that the knockdown of DACH1 expression suppressed megakaryocytic differentiation, particularly in polyploidization. We demonstrated that one mechanism by which B. anthracis LT induces suppression of polyploidization in HEL cells is through the cleavage of MEK1/2. This cleavage results in the downregulation of the ERK signaling pathway, thereby suppressing DACH1 gene expression and inhibiting polyploidization. Additionally, we found that known megakaryopoiesis-related genes, such as FOSB, ZFP36L1, RUNX1, FLI1, AHR, and GFI1B genes may be positively regulated by DACH1. Furthermore, we observed an upregulation of DACH1 during in vitro differentiation of CD34-megakaryocytes and downregulation of DACH1 in patients with thrombocytopenia. In summary, our findings shed light on one of the molecular mechanisms behind LT-induced thrombocytopenia and unveil a previously unknown role for DACH1 in megakaryopoiesis.
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Affiliation(s)
- Guan-Ling Lin
- Institute of Medical Sciences, Tzu Chi University, Hualien 97004, Taiwan; (G.-L.L.); (H.-H.C.); (P.-K.C.)
- Integration Center of Traditional Chinese and Modern Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien 97004, Taiwan; (W.-T.L.); (Y.-S.L.); (Y.-L.L.); (M.-H.H.)
| | - Hsin-Hou Chang
- Institute of Medical Sciences, Tzu Chi University, Hualien 97004, Taiwan; (G.-L.L.); (H.-H.C.); (P.-K.C.)
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien 97004, Taiwan; (W.-T.L.); (Y.-S.L.); (Y.-L.L.); (M.-H.H.)
| | - Wei-Ting Lin
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien 97004, Taiwan; (W.-T.L.); (Y.-S.L.); (Y.-L.L.); (M.-H.H.)
| | - Yu-Shan Liou
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien 97004, Taiwan; (W.-T.L.); (Y.-S.L.); (Y.-L.L.); (M.-H.H.)
| | - Yi-Ling Lai
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien 97004, Taiwan; (W.-T.L.); (Y.-S.L.); (Y.-L.L.); (M.-H.H.)
| | - Min-Hua Hsieh
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien 97004, Taiwan; (W.-T.L.); (Y.-S.L.); (Y.-L.L.); (M.-H.H.)
| | - Po-Kong Chen
- Institute of Medical Sciences, Tzu Chi University, Hualien 97004, Taiwan; (G.-L.L.); (H.-H.C.); (P.-K.C.)
| | - Chi-Yuan Liao
- Department of Obstetrics and Gynecology, Mennonite Christian Hospital, Hualien 97004, Taiwan; (C.-Y.L.); (C.-C.T.)
| | - Chi-Chih Tsai
- Department of Obstetrics and Gynecology, Mennonite Christian Hospital, Hualien 97004, Taiwan; (C.-Y.L.); (C.-C.T.)
| | - Tso-Fu Wang
- Department of Hematology and Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan; (T.-F.W.); (S.-C.C.)
- Department of Medicine, College of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Buddhist Tzu Chi Stem Cells Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan
| | - Sung-Chao Chu
- Department of Hematology and Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan; (T.-F.W.); (S.-C.C.)
- Department of Medicine, College of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Buddhist Tzu Chi Stem Cells Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan
| | - Jyh-Hwa Kau
- Institute of Preventive Medicine, National Defense Medical Center, Taipei 11490, Taiwan; (J.-H.K.); (H.-H.H.); (H.-L.H.)
| | - Hsin-Hsien Huang
- Institute of Preventive Medicine, National Defense Medical Center, Taipei 11490, Taiwan; (J.-H.K.); (H.-H.H.); (H.-L.H.)
| | - Hui-Ling Hsu
- Institute of Preventive Medicine, National Defense Medical Center, Taipei 11490, Taiwan; (J.-H.K.); (H.-H.H.); (H.-L.H.)
| | - Der-Shan Sun
- Institute of Medical Sciences, Tzu Chi University, Hualien 97004, Taiwan; (G.-L.L.); (H.-H.C.); (P.-K.C.)
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien 97004, Taiwan; (W.-T.L.); (Y.-S.L.); (Y.-L.L.); (M.-H.H.)
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Wang L, Huang J, Li X. Marked Underestimation of Platelet Count and a Characteristic Platelet Histogram as Clues to MYH9-Related Disorders. Clin Lab 2024; 70. [PMID: 38469783 DOI: 10.7754/clin.lab.2023.230918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND The rapid development of automatic blood cell analyzers has greatly optimized complete blood count results. However, erroneous results relevant to automatic blood cell analyzers still exist. Pseudothrombocytopenia can be observed in both cases of anticoagulant-induced platelet aggregation, and the presence of large and giant platelets. METHODS A rare case of a MYH9-related disorder, in which marked underestimation of platelet count was led by large and giant platelets using the impedance count by an automated hematology analyzer. Moreover, lancet-shaped and Dohle body-like cytoplasmic inclusions were detected in almost all white blood cells of the patient. RESULTS The platelet count was done by an optical platelet counter or a fluorescence platelet counter, and peripheral blood smear was evaluated. In addition, the diagnosis of MYH9-related disorder was established by the molecular findings. CONCLUSIONS Identification of the peripheral blood smear and familial history will eliminate the need for further laboratory testing and bone marrow examination.
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Pardo LM, Aanicai R, Zonic E, Hakonen AH, Zielske S, Bauer P, Bertoli-Avella AM. Adding to the evidence of gene-disease association of RAP1B and syndromic thrombocytopenia. Clin Genet 2024; 105:196-201. [PMID: 37850357 DOI: 10.1111/cge.14438] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023]
Abstract
Syndromic constitutive thrombocytopenia encompasses a heterogeneous group of disorders characterised by quantitative and qualitative defects of platelets while featuring other malformations. Recently, heterozygous, de novo variants in RAP1B were reported in three cases of syndromic thrombocytopenia. Here, we report two additional, unrelated individuals identified retrospectively in our data repository with heterozygous variants in RAP1B: NM_001010942.2(RAP1B):c.35G>A, p.(Gly12Glu) (de novo) and NM_001010942.2(RAP1B):c.178G>A, p.(Gly60Arg). Both individuals had thrombocytopenia, as well as congenital malformations, and neurological, behavioural, and dysmorphic features, in line with previous reports. Our data supports the causal role of monoallelic RAP1B variants that disrupt RAP1B GTPase activity in syndromic congenital thrombocytopenia.
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Affiliation(s)
- Luba M Pardo
- Medical Genetics, Reporting & Research, CENTOGENE GmbH, Rostock, Germany
| | - Ruxandra Aanicai
- Medical Genetics, Reporting & Research, CENTOGENE GmbH, Rostock, Germany
| | - Emir Zonic
- Medical Genetics, Reporting & Research, CENTOGENE GmbH, Rostock, Germany
| | - Anna H Hakonen
- Department of Clinical Genetics, HUSLAB, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Susan Zielske
- Medical Genetics, Reporting & Research, CENTOGENE GmbH, Rostock, Germany
| | - Peter Bauer
- Medical Genetics, Reporting & Research, CENTOGENE GmbH, Rostock, Germany
- Department of Internal Medicine III - Hematology, Oncology, and Palliative Medicine, University of Rostock, Rostock, Germany
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Ellis ML, Terreaux A, Alwis I, Smythe R, Perdomo J, Eckly A, Cranmer SL, Passam FH, Maclean J, Schoenwaelder SM, Ruggeri ZM, Lanza F, Taoudi S, Yuan Y, Jackson SP. GPIbα-filamin A interaction regulates megakaryocyte localization and budding during platelet biogenesis. Blood 2024; 143:342-356. [PMID: 37922495 DOI: 10.1182/blood.2023021292] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/27/2023] [Accepted: 10/24/2023] [Indexed: 11/05/2023] Open
Abstract
ABSTRACT Glycoprotein Ibα (GPIbα) is expressed on the surface of platelets and megakaryocytes (MKs) and anchored to the membrane skeleton by filamin A (flnA). Although GPIb and flnA have fundamental roles in platelet biogenesis, the nature of this interaction in megakaryocyte biology remains ill-defined. We generated a mouse model expressing either human wild-type (WT) GPIbα (hGPIbαWT) or a flnA-binding mutant (hGPIbαFW) and lacking endogenous mouse GPIbα. Mice expressing the mutant GPIbα transgene exhibited macrothrombocytopenia with preserved GPIb surface expression. Platelet clearance was normal and differentiation of MKs to proplatelets was unimpaired in hGPIbαFW mice. The most striking abnormalities in hGPIbαFW MKs were the defective formation of the demarcation membrane system (DMS) and the redistribution of flnA from the cytoplasm to the peripheral margin of MKs. These abnormalities led to disorganized internal MK membranes and the generation of enlarged megakaryocyte membrane buds. The defective flnA-GPIbα interaction also resulted in misdirected release of buds away from the vasculature into bone marrow interstitium. Restoring the linkage between flnA and GPIbα corrected the flnA redistribution within MKs and DMS ultrastructural defects as well as restored normal bud size and release into sinusoids. These studies define a new mechanism of macrothrombocytopenia resulting from dysregulated MK budding. The link between flnA and GPIbα is not essential for the MK budding process, however, it plays a major role in regulating the structure of the DMS, bud morphogenesis, and the localized release of buds into the circulation.
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Affiliation(s)
- Marc L Ellis
- Thrombosis Research Group, The Heart Institute, Newtown, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Antoine Terreaux
- Blood Cell Formation Lab, Walter and Eliza Hall Institute, Parkville, VIC, Australia
| | - Imala Alwis
- Thrombosis Research Group, The Heart Institute, Newtown, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Rhyll Smythe
- Thrombosis Research Group, The Heart Institute, Newtown, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Jose Perdomo
- Haematology Research Unit, St George and Sutherland Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Anita Eckly
- Université de Strasbourg, INSERM, French Blood Establishment (EFS) Grand Est, BPPS UMR-S 1255, FMTS, Strasbourg, France
| | - Susan L Cranmer
- Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
| | - Freda H Passam
- Thrombosis Research Group, The Heart Institute, Newtown, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Jessica Maclean
- Thrombosis Research Group, The Heart Institute, Newtown, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Simone M Schoenwaelder
- Thrombosis Research Group, The Heart Institute, Newtown, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Zaverio M Ruggeri
- Department of Molecular Medicine, MERU-Roon Research Center on Vascular Biology, The Scripps Research Institute, La Jolla, CA
| | - Francois Lanza
- Université de Strasbourg, INSERM, French Blood Establishment (EFS) Grand Est, BPPS UMR-S 1255, FMTS, Strasbourg, France
| | - Samir Taoudi
- Blood Cell Formation Lab, Walter and Eliza Hall Institute, Parkville, VIC, Australia
- The University of Melbourne, Parkville, VIC, Australia
| | - Yuping Yuan
- Thrombosis Research Group, The Heart Institute, Newtown, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Shaun P Jackson
- Thrombosis Research Group, The Heart Institute, Newtown, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- Department of Molecular Medicine, MERU-Roon Research Center on Vascular Biology, The Scripps Research Institute, La Jolla, CA
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Huang D, Jiang M, Zhu Y, Li D, Lu X, Gao J. A novel missense mutation in the MECOM gene in a Chinese boy with radioulnar synostosis with amegakaryocytic thrombocytopenia. BMC Pediatr 2024; 24:62. [PMID: 38245683 PMCID: PMC10799460 DOI: 10.1186/s12887-024-04552-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/11/2024] [Indexed: 01/22/2024] Open
Abstract
Radioulnar synostosis with amegakaryocytic thrombocytopenia (RUSAT) type 2, caused by MDS1 and EVI1 complex locus (MECOM) gene mutations, is a rare inherited bone marrow failure syndrome (IBMFS) with skeletal anomalies, characterized by varying presentation of congenital thrombocytopenia (progressing to pancytopenia), bilateral proximal radioulnar synostosis, and other skeletal abnormalities. Due to limited knowledge and heterogenous manifestations, clinical diagnosis of the disease is challenging. Here we reported a novel MECOM mutation in a Chinese boy with typical clinical features for RUSAT-2. Trio-based whole exome sequencing of buccal swab revealed a novel heterozygous missense mutation in exon 11 of the MECOM gene (chr3:168818673; NM_001105078.3:c.2285G > A). The results strongly suggest that the variant was a germline mutation and disease-causing mutation. The patient received matched unrelated donor hematopoetic stem cell transplantation (HSCT). This finding was not only expanded the pathogenic mutation spectrum of MECOM gene, but also provided key information for clinical diagnosis and treatment of RUSAT-2.
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Affiliation(s)
- Duowen Huang
- Department of Pediatric Hematology and Oncology, West China Second University Hospital, Sichuan University, No. 20 Section 3, South Renmin Road, Chengdu, 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan Province, China
| | - Mingyan Jiang
- Department of Pediatric Hematology and Oncology, West China Second University Hospital, Sichuan University, No. 20 Section 3, South Renmin Road, Chengdu, 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan Province, China
| | - Yiping Zhu
- Department of Pediatric Hematology and Oncology, West China Second University Hospital, Sichuan University, No. 20 Section 3, South Renmin Road, Chengdu, 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan Province, China
| | - Dongjun Li
- Department of Pediatric Hematology and Oncology, West China Second University Hospital, Sichuan University, No. 20 Section 3, South Renmin Road, Chengdu, 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan Province, China
| | - Xiaoxi Lu
- Department of Pediatric Hematology and Oncology, West China Second University Hospital, Sichuan University, No. 20 Section 3, South Renmin Road, Chengdu, 610041, Sichuan Province, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan Province, China.
| | - Ju Gao
- Department of Pediatric Hematology and Oncology, West China Second University Hospital, Sichuan University, No. 20 Section 3, South Renmin Road, Chengdu, 610041, Sichuan Province, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, Sichuan Province, China.
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Bayegi SN, Hamidieh AA, Behfar M, Saghazadeh A, Bozorgmehr M, Tajik N, Delbandi AA, Delavari S, Shekarabi M, Rezaei N. The Reconstitution of T-cells after Allogeneic Hematopoietic Stem Cell Transplant in a Pediatric Patient with Congenital Amegakaryocytic Thrombocytopenia (CAMT). Endocr Metab Immune Disord Drug Targets 2024; 24:265-272. [PMID: 37526450 DOI: 10.2174/1871530323666230801100113] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/08/2023] [Accepted: 06/27/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Congenital amegakaryocytic thrombocytopenia (CAMT) is a bone marrow failure syndrome with autosomal recessive inheritance characterized by the lack of megakaryocytes and thrombocytopenia. The cause of the disease is a mutation in the c-Mpl gene, which encodes the thrombopoietin (TPO) receptor. The main treatment for this genetic disorder is an allogeneic hematopoietic stem cell transplant (allo-HSCT). However, transplant-related mortality, development of acute and chronic graft-versushost disease (GvHD), and susceptibility to opportunistic infections are major barriers to transplantation. Delay in the reconstitution of T cells and imbalance in the regeneration of distinct functional CD4 and CD8 T-cell subsets mainly affect post-transplant complications. We report a case of CAMT, who developed acute GvHD but had no signs and symptoms of chronic GvHD following allo-HSCT. CASE PRESENTATION At the age of four, she presented with petechiae and purpura. In laboratory investigations, pancytopenia without organomegaly, and cellularity less than 5% in bone marrow biopsy, were observed. A primary diagnosis of idiopathic aplastic anemia was made, and she was treated with prednisolone, cyclosporine, and anti-thymocyte globulin (ATG), which did not respond. Genetic analysis revealed the mutation c.1481T>G (p. L494W) in exon 10 of the c-Mpl gene, and the diagnosis of CAMT was confirmed. The patient underwent allo-HSCT from a healthy sibling donor. Alloimmunization reactions and immune disorders were present due to long-term treatment with immunosuppressive medications and repeated blood and platelet transfusions. Hence, the regeneration of T-lymphocytes after allo-HSCT was evaluated. CONCLUSION Successful treatment of acute GvHD prevented advancing the condition to chronic GvHD, and this was accompanied by delayed T-cell reconstitution through an increase in Treg:Tcons ratio.
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Affiliation(s)
- Shideh Namazi Bayegi
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Pediatric Cell and Gene Therapy Research Center, Gene, Cell & Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Ali Hamidieh
- Pediatric Cell and Gene Therapy Research Center, Gene, Cell & Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Behfar
- Pediatric Cell and Gene Therapy Research Center, Gene, Cell & Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amene Saghazadeh
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Systematic Review and Metaanalysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mahmood Bozorgmehr
- Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nader Tajik
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Immunology Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Ali-Akbar Delbandi
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Immunology Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Samaneh Delavari
- Systematic Review and Metaanalysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Primary Immunodeficiency Diseases Network (PIDNet), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mehdi Shekarabi
- Immunology Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
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Shirai Y, Miura K, Hamada R, Ishikura K, Kunishima S, Hattori M. A nationwide survey of MYH9-related disease in Japan. Clin Exp Nephrol 2024; 28:40-49. [PMID: 37733142 DOI: 10.1007/s10157-023-02404-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND MYH9-related disease (MYH9-RD) is characterized by congenital macrothrombocytopenia, Döhle body-like granulocyte inclusions, and nephropathy, which may progress to end-stage kidney disease (ESKD). However, information on the effects of renin-angiotensin system (RAS) inhibitors on kidney survival is currently lacking and the outcomes of kidney replacement therapy (KRT) in MYH9-RD are largely unknown. METHODS We conducted a cross-sectional nationwide survey by sending questionnaires to 145 institutions in Japan and analyzed data for 49 patients. RESULTS The median patient age was 27 years. Genetic analysis was performed in 37 (76%) patients. Twenty-four patients (65%) had MYH9 variants affecting the motor domain of non-muscle myosin heavy chain-IIA, and these patients had poorer kidney survival than those with variants affecting the tail domain (P = 0.02). There was no significant difference in kidney survival between patients treated with and without RAS inhibitors. Hemodialysis and peritoneal dialysis were performed in 16 and 7 patients, respectively. There were no major bleeding complications during the perioperative period or during follow-up, except for one patient. Most of the 11 patients who underwent kidney transplantation required perioperative red cell concentrate transfusions, but there was no graft loss during the median posttransplant observational period of 2.0 (interquartile range, 1.3-6.8) years. CONCLUSION Our study demonstrated no beneficial effect of RAS inhibitors on kidney function in patients with MYH9-RD, indicating the need for further studies with more patients. All modalities of KRT are feasible options for MYH9-RD patients who progress to ESKD, with adequate attention to bleeding complications.
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Affiliation(s)
- Yoko Shirai
- Department of Pediatric Nephrology, Tokyo Women's Medical University, 8-1, Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Kenichiro Miura
- Department of Pediatric Nephrology, Tokyo Women's Medical University, 8-1, Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan
| | - Riku Hamada
- Department of Nephrology and Rheumatology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Kenji Ishikura
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Shinji Kunishima
- School of Health Science, Gifu University of Medical Science, Seki, Japan
| | - Motoshi Hattori
- Department of Pediatric Nephrology, Tokyo Women's Medical University, 8-1, Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan.
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10
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Zhang H, Villar-Prados A, Bussel JB, Zehnder JL. The highs and lows of cyclic thrombocytopenia. Br J Haematol 2024; 204:56-67. [PMID: 38083878 PMCID: PMC10906350 DOI: 10.1111/bjh.19239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 01/11/2024]
Abstract
Cyclic thrombocytopenia (CTP) is characterized by periodic platelet oscillation with substantial amplitude. Most CTP cases have a thrombocytopenic background and are often misdiagnosed as immune thrombocytopenia with erratically effective treatment choices. CTP also occurs during hydroxyurea treatment in patients with myeloproliferative diseases. While the aetiology of CTP remains uncertain, here we evaluate historical, theoretical and clinical findings to provide a framework for understanding CTP pathophysiology. CTP retains the intrinsic oscillatory factors defined by the homeostatic regulation of platelet count, presenting as reciprocal platelet/thrombopoietin oscillations and stable oscillation periodicity. Moreover, CTP patients possess pathogenic factors destabilizing the platelet homeostatic system thereby creating opportunities for external perturbations to initiate and sustain the exaggerated platelet oscillations. Beyond humoral and cell-mediated autoimmunity, we propose recently uncovered germline and somatic genetic variants, such as those of MPL, STAT3 or DNMT3A, as pathogenic factors in thrombocytopenia-related CTP. Likewise, the JAK2 V617F or BCR::ABL1 translocation that drives underlying myeloproliferative diseases may also play a pathogenic role in hydroxyurea-induced CTP, where hydroxyurea treatment can serve as both a trigger and a pathogenic factor of platelet oscillation. Elucidating the pathogenic landscape of CTP provides an opportunity for targeted therapeutic approaches in the future.
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Affiliation(s)
- Haiyu Zhang
- Department of Pathology. Stanford University School of Medicine, Stanford, California, 94305
| | - Alejandro Villar-Prados
- Department of Medicine, Division of Hematology and Oncology. Stanford University School of Medicine, Stanford, California, 94305
| | - James B. Bussel
- Department of Pediatrics. Division of Oncology/Hematology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, NY, 10065
| | - James L. Zehnder
- Department of Pathology and Department of Medicine, Division of Hematology. Stanford University School of Medicine, Stanford, California, 94305
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11
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Sundaramoorthi H, Fallatah W, Mary J, Jagadeeswaran P. Discovery of seven hox genes in zebrafish thrombopoiesis. Blood Cells Mol Dis 2024; 104:102796. [PMID: 37717409 DOI: 10.1016/j.bcmd.2023.102796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/19/2023]
Abstract
Thrombopoiesis is the production of platelets from megakaryocytes in the bone marrow of mammals. In fish, thrombopoiesis involves the formation of thrombocytes without megakaryocyte-like precursors but derived from erythrocyte thrombocyte bi-functional precursor cells. One unique feature of thrombocyte differentiation involves the maturation of young thrombocytes in circulation. In this study, we investigated the role of hox genes in zebrafish thrombopoiesis to model platelet production. We selected hoxa10b, hoxb2a, hoxc5a, hoxd3a, and hoxc11b from thrombocyte RNA expression data, and checked whether they are expressed in young or mature thrombocytes. We found hoxa10b, hoxb2a, hoxc5a, and hoxd3a were expressed in both young and mature thrombocytes and hoxc11b was expressed in only young thrombocytes. We then performed knockdowns of these 5 hox genes and found hoxc11b knockdown resulted in thrombocytosis and the rest showed thrombocytopenia. To identify hox genes that could have been missed by the above datasets, we performed knockdowns 47 hox genes in the zebrafish genome and found hoxa9a, and hoxb1a knockdowns resulted in thrombocytopenia and they were expressed in both young and mature thrombocytes. In conclusion, our comprehensive knockdown study identified Hoxa10b, Hoxb2a, Hoxc5a, Hoxd3a, Hoxa9a, and Hoxb1a, as positive regulators and Hoxc11b, as a negative regulator for thrombocyte development.
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Affiliation(s)
- Hemalatha Sundaramoorthi
- Department of Biological Sciences, University of North Texas, Denton, TX 76203, United States of America
| | - Weam Fallatah
- Department of Biological Sciences, University of North Texas, Denton, TX 76203, United States of America
| | - Jabila Mary
- Department of Biological Sciences, University of North Texas, Denton, TX 76203, United States of America
| | - Pudur Jagadeeswaran
- Department of Biological Sciences, University of North Texas, Denton, TX 76203, United States of America.
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12
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Manohar S, Gofin Y, Streff H, Vossaert L, Camacho P, Murali CN. A familial deletion of 10p12.1 associated with thrombocytopenia. Am J Med Genet A 2024; 194:77-81. [PMID: 37746810 DOI: 10.1002/ajmg.a.63403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 08/23/2023] [Accepted: 09/01/2023] [Indexed: 09/26/2023]
Abstract
Thrombocytopenia can be inherited or acquired from a variety of causes. While hereditary causes of thrombocytopenia are rare, several genes have been associated with the condition. In this report, we describe an 18-year-old man and his mother, both of whom have congenital thrombocytopenia. Exome sequencing in the man revealed a 1006 kb maternally inherited deletion in the 10p12.1 region (arr[GRCh37] 10p12.1(27378928_28384564)x1) of uncertain clinical significance. This deletion in the THC2 locus includes genes ANKRD26, known to be involved in normal megakaryocyte differentiation, and MASTL, which some studies suggest is linked to autosomal dominant thrombocytopenia. In the family presented here, the deletion segregated with the congenital thrombocytopenia phenotype, suggesting that haploinsufficiency of one or both genes may be the cause. To our knowledge, this is the first report of a deletion of the THC2 locus associated with thrombocytopenia. Future functional studies of deletions of the THC2 locus may elucidate the mechanism for this phenotype observed clinically.
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Affiliation(s)
- Sujal Manohar
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Yoel Gofin
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Haley Streff
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Liesbeth Vossaert
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Pamela Camacho
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer and Hematology Centers, Houston, Texas, USA
| | - Chaya N Murali
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
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13
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Zhang Y, Zuo Z, Yu W, Xu A. Unveiling the hidden clues: Döhle body-like inclusions as morphological markers for MYH9-related disorders: A case report. Medicine (Baltimore) 2023; 102:e36735. [PMID: 38134071 PMCID: PMC10735054 DOI: 10.1097/md.0000000000036735] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
RATIONALE This study aimed to address the diagnostic challenges associated with MYH9-related disorders (MYH9-RDs) and highlight the importance of recognizing Döhle body-like inclusions as crucial diagnostic markers for this condition. PATIENT CONCERNS Patients with MYH9-RDs often present with mild and diverse clinical characteristics, leading to misdiagnosis, delayed diagnosis, and inappropriate treatments, such as hormonal therapy and splenectomy. This section highlights the significance of understanding atypical clinical presentations and their impact on patients' well-being. DIAGNOSES This section emphasizes the misdiagnosis of MYH9-RDs as immune thrombocytopenia due to overlapping clinical features. This highlights the need for a comprehensive approach, including detailed personal and family history, careful review of peripheral blood smears, and identification of Döhle body-like inclusions to differentiate MYH9-RDs from other conditions. INTERVENTION This study advocates for a shift in the diagnostic approach, urging physicians to pay closer attention to the morphological features observed in peripheral blood smears, particularly the presence of Döhle body-like inclusions and large platelets. This emphasizes the importance of avoiding unnecessary diagnostic studies through effective utilization of this simple and reliable method. OUTCOMES By adopting a comprehensive approach that combines gene sequencing with morphological analysis, an accurate diagnosis of MYH9-RDs can be achieved. Early identification of MYH9-RDs allows for appropriate management strategies, genetic counseling, and prevention of complications associated with the condition. LESSONS This section highlights the lessons learned from this study, emphasizing the need for increased awareness among healthcare professionals about MYH9-RDs and the importance of incorporating peripheral blood smear evaluations into the diagnostic process. This emphasizes the significance of accurate diagnosis to prevent unnecessary treatments and ensure appropriate patient care.
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Affiliation(s)
- Yan Zhang
- Department of Clinical Laboratory, Xixi Hospital of Hangzhou, Hangzhou, Zhejiang, China
| | - Zhongbao Zuo
- Department of Clinical Laboratory, Xixi Hospital of Hangzhou, Hangzhou, Zhejiang, China
| | - Wenyan Yu
- Department of Clinical Laboratory, Xixi Hospital of Hangzhou, Hangzhou, Zhejiang, China
| | - Aifang Xu
- Department of Clinical Laboratory, Xixi Hospital of Hangzhou, Hangzhou, Zhejiang, China
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14
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Cunningham L, Merguerian M, Calvo KR, Davis J, Deuitch NT, Dulau-Florea A, Patel N, Yu K, Sacco K, Bhattacharya S, Passi M, Ozkaya N, De Leon S, Chong S, Craft K, Diemer J, Bresciani E, O’Brien K, Andrews EJ, Park N, Hathaway L, Cowen EW, Heller T, Ryan K, Barochia A, Nghiem K, Niemela J, Rosenzweig S, Young DJ, Frischmeyer-Guerrerio PA, Braylan R, Liu PP. Natural history study of patients with familial platelet disorder with associated myeloid malignancy. Blood 2023; 142:2146-2158. [PMID: 37738626 PMCID: PMC10733826 DOI: 10.1182/blood.2023019746] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 08/09/2023] [Accepted: 08/30/2023] [Indexed: 09/24/2023] Open
Abstract
ABSTRACT Deleterious germ line RUNX1 variants cause the autosomal dominant familial platelet disorder with associated myeloid malignancy (FPDMM), characterized by thrombocytopenia, platelet dysfunction, and a predisposition to hematologic malignancies (HMs). We launched a FPDMM natural history study and, from January 2019 to December 2021, enrolled 214 participants, including 111 patients with 39 different RUNX1 variants from 45 unrelated families. Seventy of 77 patients had thrombocytopenia, 18 of 18 had abnormal platelet aggregometry, 16 of 35 had decreased platelet dense granules, and 28 of 55 had abnormal bleeding scores. Nonmalignant bone marrows showed increased numbers of megakaryocytes in 12 of 55 patients, dysmegakaryopoiesis in 42 of 55, and reduced cellularity for age in 30 of 55 adult and 17 of 21 pediatric cases. Of 111 patients, 19 were diagnosed with HMs, including myelodysplastic syndrome, acute myeloid leukemia, chronic myelomonocytic leukemia, acute lymphoblastic leukemia, and smoldering myeloma. Of those 19, 18 were relapsed or refractory to upfront therapy and referred for stem cell transplantation. In addition, 28 of 45 families had at least 1 member with HM. Moreover, 42 of 45 patients had allergic symptoms, and 24 of 30 had gastrointestinal (GI) symptoms. Our results highlight the importance of a multidisciplinary approach, early malignancy detection, and wider awareness of inherited disorders. This actively accruing, longitudinal study will genotype and phenotype more patients with FPDMM, which may lead to a better understanding of the disease pathogenesis and clinical course, which may then inform preventive and therapeutic interventions. This trial was registered at www.clinicaltrials.gov as #NCT03854318.
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Affiliation(s)
- Lea Cunningham
- Oncogenesis and Development Section, Translational and Functional Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
- Immune Deficiency Cellular Therapy Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Matthew Merguerian
- Oncogenesis and Development Section, Translational and Functional Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Katherine R. Calvo
- Department of Laboratory Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD
| | - Joie Davis
- Oncogenesis and Development Section, Translational and Functional Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Natalie T. Deuitch
- Oncogenesis and Development Section, Translational and Functional Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Alina Dulau-Florea
- Department of Laboratory Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD
| | - Nisha Patel
- Department of Laboratory Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD
| | - Kai Yu
- Oncogenesis and Development Section, Translational and Functional Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Keith Sacco
- Laboratory of Allergic Disease, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Sumona Bhattacharya
- Digestive Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Monica Passi
- Digestive Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Neval Ozkaya
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Seila De Leon
- Department of Laboratory Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD
| | - Shawn Chong
- Oncogenesis and Development Section, Translational and Functional Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Kathleen Craft
- Oncogenesis and Development Section, Translational and Functional Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Jamie Diemer
- Oncogenesis and Development Section, Translational and Functional Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Erica Bresciani
- Oncogenesis and Development Section, Translational and Functional Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Kevin O’Brien
- Office of Clinical Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Elizabeth J. Andrews
- Oncogenesis and Development Section, Translational and Functional Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
- Immune Deficiency Cellular Therapy Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Nguyen Park
- Office of Clinical Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Londa Hathaway
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | - Edward W. Cowen
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | - Theo Heller
- Translational Hepatology Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Kerry Ryan
- Laboratory of Asthma and Lung Inflammation, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Amisha Barochia
- Laboratory of Asthma and Lung Inflammation, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Khanh Nghiem
- Department of Laboratory Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD
| | - Julie Niemela
- Department of Laboratory Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD
| | - Sergio Rosenzweig
- Department of Laboratory Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD
| | - David J. Young
- Laboratory of Molecular Hematopoiesis, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Pamela A. Frischmeyer-Guerrerio
- Laboratory of Allergic Disease, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Raul Braylan
- Department of Laboratory Medicine, National Institutes of Health Clinical Center, National Institutes of Health, Bethesda, MD
| | - Paul P. Liu
- Oncogenesis and Development Section, Translational and Functional Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
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15
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Jiang D, Rosenlind K, Baxter S, Gernsheimer T, Gulsuner S, Allenspach EJ, Keel SB. Evaluating the prevalence of inborn errors of immunity in adults with chronic immune thrombocytopenia or Evans syndrome. Blood Adv 2023; 7:7202-7208. [PMID: 37792884 PMCID: PMC10702780 DOI: 10.1182/bloodadvances.2023011042] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 10/06/2023] Open
Abstract
Inborn errors of immunity (IEIs) are monogenic disorders that predispose patients to immune dysregulation, autoimmunity, and infection. Autoimmune cytopenias, such as immune thrombocytopenia (ITP) and Evans syndrome (a combination of ITP and autoimmune hemolytic anemia), are increasingly recognized phenotypes of IEI. Although recent findings suggest that IEIs may commonly underlie pediatric ITP and Evans syndrome, its prevalence in adult patients with these disorders remains undefined. This study sought to estimate the prevalence of underlying IEIs among adults with persistent or chronic ITP or Evans syndrome using a next-generation sequencing panel encompassing >370 genes implicated in IEIs. Forty-four subjects were enrolled from an outpatient adult hematology clinic at a tertiary referral center in the United States, with a median age of 49 years (range, 20-83). Fourteen subjects (31.8%) had secondary ITP, including 8 (18.2%) with Evans syndrome. No cases of IEI were identified despite a high representation of subjects with a personal history of autoimmunity (45.5%) and early onset of disease (median age at diagnosis of 40 years [range, 2-77]), including 20.5% who were initially diagnosed as children. Eight subjects (18.2%) were found to be carriers of pathogenic IEI variants, which, in their heterozygous state, are not disease-causing. One case of TUBB1-related congenital thrombocytopenia was identified. Although systematic screening for IEI has been proposed for pediatric patients with Evans syndrome, findings from this real-world study suggest that inclusion of genetic testing for IEI in the routine work-up of adults with ITP and Evans syndrome has a low diagnostic yield.
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MESH Headings
- Humans
- Adult
- Child
- Young Adult
- Middle Aged
- Aged
- Aged, 80 and over
- Child, Preschool
- Adolescent
- Anemia, Hemolytic, Autoimmune/epidemiology
- Anemia, Hemolytic, Autoimmune/genetics
- Anemia, Hemolytic, Autoimmune/complications
- Purpura, Thrombocytopenic, Idiopathic/epidemiology
- Purpura, Thrombocytopenic, Idiopathic/genetics
- Purpura, Thrombocytopenic, Idiopathic/complications
- Autoimmunity
- Prevalence
- Thrombocytopenia/epidemiology
- Thrombocytopenia/genetics
- Thrombocytopenia/complications
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Affiliation(s)
- Debbie Jiang
- Division of Hematology, University of Washington, Seattle, WA
- Fred Hutchinson Cancer Center, Seattle, WA
- Division of Hematology, Massachusetts General Hospital, Boston, MA
| | | | - Sarah Baxter
- Division of Rheumatology, Seattle Children’s Hospital, Seattle, WA
| | - Terry Gernsheimer
- Division of Hematology, University of Washington, Seattle, WA
- Fred Hutchinson Cancer Center, Seattle, WA
| | | | | | - Siobán B. Keel
- Division of Hematology, University of Washington, Seattle, WA
- Fred Hutchinson Cancer Center, Seattle, WA
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16
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Wang D, Shan C, Gao T, Liu J, Zhang R, Zhang Q, Chang H, Lin Y. [Genetic analysis of a child with atypical Hemolytic uremic syndrome and nephrotic-range proteinuria]. Zhonghua Yi Xue Yi Chuan Xue Za Zhi 2023; 40:1560-1565. [PMID: 37994143 DOI: 10.3760/cma.j.cn511374-20220915-00625] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
OBJECTIVE To explore the clinical characteristics and genetic etiology for a child with atypical Hemolytic uremic syndrome (aHUS) in conjunct with nephrotic level proteinuria. METHODS A child patient who had visited the Affiliated Hospital of Qingdao University on June 25, 2020 was selected as the study subject. Clinical data of the patient was collected. Whole exome sequencing (WES) was carried out for the child, and candidate variant was verified by Sanger sequencing of the child and his parents. RESULTS The child, an 8-month-old male, had presented mainly with edema, oliguria, hematuria, nephrotic level proteinuria, anemia, thrombocytopenia, increased creatinine and urea, hypercholesterolemia but normal complement levels. Genetic testing revealed that he has harbored compound heterozygous variants of the DGKE gene, namely c.12_18dupGAGGCGG (p.P7fs*37) and c.1042G>T (p.D348Y), which were respectively inherited from his father and mother. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the variants were classified as likely pathogenic and variant of uncertain significance, respectively. By combining his clinical manifestations and results of genetic testing, the child was diagnosed with aHUS with nephrotic level proteinuria. CONCLUSION For infants and young children with aHUS in conjunct with nephrotic level proteinuria, variants of the DGKE gene should be screened. Above finding has expanded the mutational spectrum of the DGKE gene.
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Affiliation(s)
- Dahai Wang
- Department of Pediatric Nephrology, Rheumatology and Immunology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, China.
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17
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Singh N, Bhatia P, Jamwal M, Khadwal AR, Chhabra S, Hira JK, Das R, Sharma P. First reported co-occurrence of "GATA1-mutated X-linked thrombocytopenia with thalassemia (XLTT)" with heterozygous β-thalassemia. Int J Lab Hematol 2023; 45:999-1002. [PMID: 37382348 DOI: 10.1111/ijlh.14130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/15/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Namrata Singh
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prateek Bhatia
- Department of Pediatric Medicine, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manu Jamwal
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alka Rani Khadwal
- Department of Clinical Hematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjeev Chhabra
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jasbir Kaur Hira
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reena Das
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prashant Sharma
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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18
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Pang C, Wu X, Nikuze L, Wei H. Analysis of clinical characteristics and treatment efficacy in two pediatric cases of ANKRD26-related thrombocytopenia. Platelets 2023; 34:2262607. [PMID: 37852929 DOI: 10.1080/09537104.2023.2262607] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/19/2023] [Indexed: 10/20/2023]
Abstract
ANKRD26-related thrombocytopenia (ANKRD26-RT or THC2, MIM 188 000), an autosomal dominant thrombocytopenia, is unresponsive to immunosuppressive therapy and susceptible to hematological malignancies. A large number of pediatric patients are diagnosed with immune thrombocytopenia (ITP) every year; however, thrombocytopenia of genetic origin is often missed. Extensive characterization of ANKRD26-RT will help prevent missed diagnosis and misdiagnosis. Furthermore, identification of ANKRD26-RT will help in the formulation of an accurate diagnosis and a treatment plan. In our study, we report cases of two Chinese pediatric patients with ANKRD26-RT and analyze their clinical characteristics, gene mutations, and treatment modalities. Both patients were 1-year-old and presented with mild bleeding (World Health Organization(WHO) score grade 1), different degrees of platelet reduction, normal mean platelet volume, and megakaryocyte maturation impairment not obvious. Genetic tests revealed that both patients had ANKRD26 gene mutations.Patient 1 had a mutation c.-140C>G of the 5' untranslated region (UTR), and patient 2 had a mutation of c.-127A>T of 5'UTR. Both patients were treated with eltrombopag, and the treatment was no response, with no adverse reactions.
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Affiliation(s)
- Congfei Pang
- Department of Pediatrics, The Sixth Affiliated Hospital of Guangxi Medical University: The First People's Hospital of Yulin, Yulin, Guangxi, P.R. China
| | - Xiaomei Wu
- Department of Pediatrics, Red Cross Hospital of Yulin city, Yulin, Guangxi, P.R. China
| | | | - Hongying Wei
- Department of Pediatrics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, P.R. China
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19
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Wang X, Chen M, Hu L, Tan C, Li X, Xue P, Jiang Y, Bao P, Yu T, Li F, Xiao Y, Ran Q, Li Z, Chen L. Humanized mouse models for inherited thrombocytopenia studies. Platelets 2023; 34:2267676. [PMID: 37849076 DOI: 10.1080/09537104.2023.2267676] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023]
Abstract
Inherited thrombocytopenia (IT) is a group of hereditary disorders characterized by a reduced platelet count as the main clinical manifestation, and often with abnormal platelet function, which can subsequently lead to impaired hemostasis. In the past decades, humanized mouse models (HMMs), that are mice engrafted with human cells or genes, have been widely used in different research areas including immunology, oncology, and virology. With advances of the development of immunodeficient mice, the engraftment, and reconstitution of functional human platelets in HMM permit studies of occurrence and development of platelet disorders including IT and treatment strategies. This article mainly reviews the development of humanized mice models, the construction methods, research status, and problems of using humanized mice for the in vivo study of human thrombopoiesis.
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Affiliation(s)
- Xiaojie Wang
- Laboratory of Radiation Biology, Department of Blood Transfusion, Laboratory Medicine Center, The Second Affiliated Hospital, Army Medical University, Chongqing, China
- Basic Research Innovation Center for Prevention and Treatment of Acute Radiation Syndrome, The Second Affiliated Hospital, Third Military Medical University, Chongqing, China
| | - Maoshan Chen
- Laboratory of Radiation Biology, Department of Blood Transfusion, Laboratory Medicine Center, The Second Affiliated Hospital, Army Medical University, Chongqing, China
- Basic Research Innovation Center for Prevention and Treatment of Acute Radiation Syndrome, The Second Affiliated Hospital, Third Military Medical University, Chongqing, China
- Laboratory of Precision Medicine, Laboratory Medicine Center, The Second Affiliated Hospital, Third Military Medical University, Chongqing, China
| | - Lanyue Hu
- Laboratory of Radiation Biology, Department of Blood Transfusion, Laboratory Medicine Center, The Second Affiliated Hospital, Army Medical University, Chongqing, China
- Basic Research Innovation Center for Prevention and Treatment of Acute Radiation Syndrome, The Second Affiliated Hospital, Third Military Medical University, Chongqing, China
| | - Chengning Tan
- Laboratory of Radiation Biology, Department of Blood Transfusion, Laboratory Medicine Center, The Second Affiliated Hospital, Army Medical University, Chongqing, China
- Basic Research Innovation Center for Prevention and Treatment of Acute Radiation Syndrome, The Second Affiliated Hospital, Third Military Medical University, Chongqing, China
| | - Xiaoliang Li
- Laboratory of Radiation Biology, Department of Blood Transfusion, Laboratory Medicine Center, The Second Affiliated Hospital, Army Medical University, Chongqing, China
- Basic Research Innovation Center for Prevention and Treatment of Acute Radiation Syndrome, The Second Affiliated Hospital, Third Military Medical University, Chongqing, China
| | - Peipei Xue
- Laboratory of Radiation Biology, Department of Blood Transfusion, Laboratory Medicine Center, The Second Affiliated Hospital, Army Medical University, Chongqing, China
- Basic Research Innovation Center for Prevention and Treatment of Acute Radiation Syndrome, The Second Affiliated Hospital, Third Military Medical University, Chongqing, China
| | - Yangzhou Jiang
- Laboratory of Radiation Biology, Department of Blood Transfusion, Laboratory Medicine Center, The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Peipei Bao
- Laboratory of Radiation Biology, Department of Blood Transfusion, Laboratory Medicine Center, The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Teng Yu
- Laboratory of Radiation Biology, Department of Blood Transfusion, Laboratory Medicine Center, The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Fengjie Li
- Laboratory of Radiation Biology, Department of Blood Transfusion, Laboratory Medicine Center, The Second Affiliated Hospital, Army Medical University, Chongqing, China
- Basic Research Innovation Center for Prevention and Treatment of Acute Radiation Syndrome, The Second Affiliated Hospital, Third Military Medical University, Chongqing, China
| | - Yanni Xiao
- Laboratory of Radiation Biology, Department of Blood Transfusion, Laboratory Medicine Center, The Second Affiliated Hospital, Army Medical University, Chongqing, China
- Basic Research Innovation Center for Prevention and Treatment of Acute Radiation Syndrome, The Second Affiliated Hospital, Third Military Medical University, Chongqing, China
| | - Qian Ran
- Laboratory of Radiation Biology, Department of Blood Transfusion, Laboratory Medicine Center, The Second Affiliated Hospital, Army Medical University, Chongqing, China
- Basic Research Innovation Center for Prevention and Treatment of Acute Radiation Syndrome, The Second Affiliated Hospital, Third Military Medical University, Chongqing, China
| | - Zhongjun Li
- Laboratory of Radiation Biology, Department of Blood Transfusion, Laboratory Medicine Center, The Second Affiliated Hospital, Army Medical University, Chongqing, China
- Basic Research Innovation Center for Prevention and Treatment of Acute Radiation Syndrome, The Second Affiliated Hospital, Third Military Medical University, Chongqing, China
- Laboratory of Precision Medicine, Laboratory Medicine Center, The Second Affiliated Hospital, Third Military Medical University, Chongqing, China
| | - Li Chen
- Laboratory of Radiation Biology, Department of Blood Transfusion, Laboratory Medicine Center, The Second Affiliated Hospital, Army Medical University, Chongqing, China
- Basic Research Innovation Center for Prevention and Treatment of Acute Radiation Syndrome, The Second Affiliated Hospital, Third Military Medical University, Chongqing, China
- Laboratory of Precision Medicine, Laboratory Medicine Center, The Second Affiliated Hospital, Third Military Medical University, Chongqing, China
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20
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Louzao M, Vargas MT, Meseguer E, Pedrote Amador B, Perez Simón JA, Mingot-Castellano ME. Successful use of thrombopoietin analogs in thrombocytopenia associated with MYH-9 mutation. Ann Hematol 2023; 102:3283-3284. [PMID: 37610462 DOI: 10.1007/s00277-023-05386-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023]
Affiliation(s)
- María Louzao
- Hematology Department, Hospital Universitario Virgen del Rocio, Instituto de Biomedicina de Sevilla, Seville, Spain
| | - María Teresa Vargas
- Hematology Department, Hospital Universitario Virgen del Rocio, Instituto de Biomedicina de Sevilla, Seville, Spain
| | - Emma Meseguer
- Hematology Department, Hospital Universitario Virgen del Rocio, Instituto de Biomedicina de Sevilla, Seville, Spain
| | - Begoña Pedrote Amador
- Hematology Department, Hospital Universitario Virgen del Rocio, Instituto de Biomedicina de Sevilla, Seville, Spain
| | - Jose Antonio Perez Simón
- Hematology Department, Hospital Universitario Virgen del Rocio, Instituto de Biomedicina de Sevilla, Seville, Spain
| | - María Eva Mingot-Castellano
- Hematology Department, Hospital Universitario Virgen del Rocio, Instituto de Biomedicina de Sevilla, Seville, Spain.
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21
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Sun XH, Liu Q, Wu SN, Xu WH, Chen K, Shao JB, Jiang H. Cytopenia: a report of haplo-cord transplantation in twin brothers caused by a novel germline GATA1 mutation and family survey. Ann Hematol 2023; 102:3177-3184. [PMID: 37460606 DOI: 10.1007/s00277-023-05363-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 07/07/2023] [Indexed: 10/12/2023]
Abstract
Cytopenia due to the abnormal regulation of GATA1 could manifest as varying degrees of thrombocytopenia and/or anemia and more severely in male children than in female children. Here, we describe the case of pancytopenic and transfusion-dependent twin brothers at our center whose bone marrow puncture revealed low bone marrow hyperplasia. Whole-exome sequencing revealed that the twins had a new germline GATA1 mutation (nm_002049: exon 3:c.515 T >C:p.F172S), which confirmed the diagnosis of GATA1 mutation-related pancytopenia. The mutation was inherited from their mother, who was heterozygous for the mutation. Sanger sequencing verified the pathogenicity of the mutation. Further family morbidity survey confirmed that GATA1 mutation-related pancytopenia is an X-linked recessive genetic disorder. We developed haploid hematopoietic stem cell transplantation programs for twins, with the father as the only donor, and finally, the hematopoietic reconstruction was successful. Although they experienced acute graft-versus-host disease, hemorrhagic cystitis, and a viral infection in the early stage, no abnormal manifestations or transplant-related complications were observed 3 months after transplantation. Through hematopoietic stem cell transplantation technology for one donor and two receptors, we eventually cured the twins. The p.F172S variant in the new germline GATA1 mutation may play an essential role in the pathogenesis of GATA1 mutation-related cytopenia.
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Affiliation(s)
- Xing-Hua Sun
- Department of Hematology and Oncology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 24, Lane 1400, Beijing West Road, Jing'an District, Shanghai, 200040, China
| | - Qin Liu
- Department of Hematology and Oncology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 24, Lane 1400, Beijing West Road, Jing'an District, Shanghai, 200040, China
| | - Sheng-Nan Wu
- Central Laboratory, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wu-Hen Xu
- Central Laboratory, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Kai Chen
- Department of Hematology and Oncology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 24, Lane 1400, Beijing West Road, Jing'an District, Shanghai, 200040, China.
| | - Jing-Bo Shao
- Department of Hematology and Oncology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 24, Lane 1400, Beijing West Road, Jing'an District, Shanghai, 200040, China
| | - Hui Jiang
- Department of Hematology and Oncology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 24, Lane 1400, Beijing West Road, Jing'an District, Shanghai, 200040, China
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22
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Novak W, Berner J, Svaton M, Jimenez-Heredia R, Segarra-Roca A, Frohne A, Guiliani S, Rouhani D, Eder SK, Rottal A, Trapin D, Scheuchenstuhl A, Pickl WF, Simonitsch-Klupp I, Kager L, Boztug K. Evans syndrome caused by a deleterious mutation affecting the adaptor protein SASH3. Br J Haematol 2023; 203:678-683. [PMID: 37646304 DOI: 10.1111/bjh.19061] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 09/01/2023]
Abstract
Increasing evidence suggests multilineage cytopenias (also known as Evans syndrome) may be caused by inborn errors of immunity (IEI) with immune dysregulation. We studied a patient with autoimmune haemolytic anaemia and immune thrombocytopenia and identified a germline mutation in SASH3 (c.862C>T;p.Arg288Ter), indicating a recently identified IEI. Immunohistochemistry performed after clinically indicated splenectomy revealed severe hypoplasia/absence of germinal centres. The autoimmune phenotype was associated with an increased CD21low T-bet+ CD11c+ subset along with decreased regulatory T cells, impaired T-cell proliferation and T-cell exhaustion. The younger brother carries the same SASH3 mutation and shares immunophenotypic features but is currently clinical asymptomatic, indicating heterogeneity of SASH3 deficiency.
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Affiliation(s)
- Wolfgang Novak
- St. Anna Children's Hospital, Vienna, Austria
- Medical University of Vienna, Department of Pediatrics and Adolescent Medicine, Vienna, Austria
| | - Jakob Berner
- St. Anna Children's Hospital, Vienna, Austria
- Medical University of Vienna, Department of Pediatrics and Adolescent Medicine, Vienna, Austria
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
- Department of Dermatology, Venerology and Allergology, Klinik Landstrasse, Vienna, Austria
| | - Michael Svaton
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Raul Jimenez-Heredia
- St. Anna Children's Hospital, Vienna, Austria
- Medical University of Vienna, Department of Pediatrics and Adolescent Medicine, Vienna, Austria
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
| | - Anna Segarra-Roca
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
| | - Alexandra Frohne
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
| | - Sarah Guiliani
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - David Rouhani
- St. Anna Children's Hospital, Vienna, Austria
- Medical University of Vienna, Department of Pediatrics and Adolescent Medicine, Vienna, Austria
| | - Sebastian K Eder
- St. Anna Children's Hospital, Vienna, Austria
- Medical University of Vienna, Department of Pediatrics and Adolescent Medicine, Vienna, Austria
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Arno Rottal
- Medical University of Vienna, Center for Pathophysiology, Infectiology and Immunology, Institute of Immunology, Vienna, Austria
| | - Doris Trapin
- Medical University of Vienna, Center for Pathophysiology, Infectiology and Immunology, Institute of Immunology, Vienna, Austria
| | - Anja Scheuchenstuhl
- Medical University of Vienna, Center for Pathophysiology, Infectiology and Immunology, Institute of Immunology, Vienna, Austria
| | - Winfried F Pickl
- Medical University of Vienna, Center for Pathophysiology, Infectiology and Immunology, Institute of Immunology, Vienna, Austria
| | | | - Leo Kager
- St. Anna Children's Hospital, Vienna, Austria
- Medical University of Vienna, Department of Pediatrics and Adolescent Medicine, Vienna, Austria
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Kaan Boztug
- St. Anna Children's Hospital, Vienna, Austria
- Medical University of Vienna, Department of Pediatrics and Adolescent Medicine, Vienna, Austria
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
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23
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Baris S, Boluk SO. A novel mutation in DNMT3B gene causing ICF1 syndrome in an infant with refractory thrombocytopenia. Clin Immunol 2023; 256:109779. [PMID: 37741519 DOI: 10.1016/j.clim.2023.109779] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND ICF syndrome is a rare autosomal recessive condition characterized by immunodeficiency, centromeric instability, and facial abnormalities. It is a clinical condition that depends on the mutation of a few particular genes and is caused by methylation disruption in chromosomes 1, 9, and 16 to varying degrees. CASE PRESENTATION The 9-months old, female patient was admitted to our clinic for treatment-resistant thrombocytopenia, chronic diarrhea and sepsis. Immunological investigations revealed agammaglobulinemia. In the genetic analysis by NGS of the patient, who had dysmorphic facial findings as well as a history of parental consanguinity, it was determined that she had a novel mutation in the DNMT3B gene, which is one of the responsible genes of ICF, as homozygous. The patient, who was started on regular immunoglobulin replacement therapy and antibiotic therapy, was referred to a center with a stem cell transplant unit to continue her follow-up. CONCLUSIONS Although autoimmunity has not been commonly reported in previous studies in ICF syndrome, which has a varied clinical presentation, a homozygous mutation in the DNMT3B gene was discovered in a 9-month-old patient with refractory thrombocytopenia and agammaglobulinemia. Examining the literature reveals that this mutation is a novel mutation.
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Affiliation(s)
- Savas Baris
- Aydin Maternity and Pediatrics Hospital, Department of Genetics, Aydin, Turkey.
| | - Selime Ozen Boluk
- Aydin Maternity and Pediatrics Hospital, Department of Pediatric Immunology and Allergic Diseases, Aydin, Turkey
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24
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Li Y, Wang XY, Li YF, Li DX, Hu X, Zhu L, You AG, Wang HF, Ye Y, Guo WS, Huang XY. [The epidemiology and pathogeny investigation of two clusters of severe fever with thrombocytopenia syndrome disease outbreaking in Henan Province, 2022]. Zhonghua Yu Fang Yi Xue Za Zhi 2023; 57:1719-1724. [PMID: 37859394 DOI: 10.3760/cma.j.cn112150-20221130-01162] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
To investigate two clusters of severe fever with thrombocytopenia syndrome virus (SFTSV) in Xinyang City, Henan Province, in 2022, and analyze their causes, transmission route, risk factors, and the characteristics of virus genetic variation. Case search and case investigation were carried out according to the case definition. Blood samples from cases, family members and neighbors and samples of biological vectors were collected for RT-PCR to detect SFTSV. The whole genome sequencing and bioinformatics analysis were performed on the collected positive samples. A total of two clustered outbreaks occurred, involving two initial cases and ten secondary cases, all of which were family recurrent cases. Among them, nine secondary cases had close contact with the blood of the initial case, and it was determined that close contact with blood was the main risk factor for the two clustered outbreaks. After genome sequencing analysis, we found that the SFTSV genotype in two cases was type A, which was closely related to previous endemic strains in Xinyang. The nucleotide sequence of the SFTSV in the case was highly homologous, with a total of nine amino acid mutation sites in the coding region. It was not ruled out that its mutation sites might have an impact on the outbreak of the epidemic.
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Affiliation(s)
- Y Li
- Henan Key Laboratory of Infectious Disease Microbiology/Infectious Disease Control and Prevention Institute, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
| | - X Y Wang
- Henan Key Laboratory of Infectious Disease Microbiology/Infectious Disease Control and Prevention Institute, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Y F Li
- Henan Key Laboratory of Infectious Disease Microbiology/Infectious Disease Control and Prevention Institute, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
| | - D X Li
- Henan Key Laboratory of Infectious Disease Microbiology/Infectious Disease Control and Prevention Institute, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
| | - X Hu
- Henan Key Laboratory of Infectious Disease Microbiology/Infectious Disease Control and Prevention Institute, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
| | - L Zhu
- Henan Key Laboratory of Infectious Disease Microbiology/Infectious Disease Control and Prevention Institute, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
| | - A G You
- Henan Key Laboratory of Infectious Disease Microbiology/Infectious Disease Control and Prevention Institute, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
| | - H F Wang
- Henan Key Laboratory of Infectious Disease Microbiology/Infectious Disease Control and Prevention Institute, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
| | - Y Ye
- Henan Key Laboratory of Infectious Disease Microbiology/Infectious Disease Control and Prevention Institute, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
| | - W S Guo
- Henan Key Laboratory of Infectious Disease Microbiology/Infectious Disease Control and Prevention Institute, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
| | - X Y Huang
- Henan Key Laboratory of Infectious Disease Microbiology/Infectious Disease Control and Prevention Institute, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
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25
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Komeno Y, Uchiyama T, Kawano F, Kurihara Y, Kurokawa M, Ohara O, Kunishima S, Ishiguro A. Inherited macrothrombocytopenia due to a novel splice donor site mutation in ITGB3. Ann Hematol 2023; 102:2947-2949. [PMID: 37515626 DOI: 10.1007/s00277-023-05387-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/24/2023] [Indexed: 07/31/2023]
Affiliation(s)
- Yukiko Komeno
- Department of Hematology, Japan Community Healthcare Organization (JCHO) Tokyo Yamate Medical Center, Tokyo, Japan.
| | - Toru Uchiyama
- Department of Human Genetics, National Center for Child Health and Development, Tokyo, Japan
| | - Fuyuko Kawano
- Division of Advanced Medicine for Virus Infections, National Center for Child Health and Development, Tokyo, Japan
| | - Yuya Kurihara
- Department of Hematology and Oncology, The University of Tokyo, Tokyo, Japan
| | - Mineo Kurokawa
- Department of Hematology and Oncology, The University of Tokyo, Tokyo, Japan
| | - Osamu Ohara
- Department of Applied Genomics, Kazusa DNA Research Institute, Chiba, Japan
| | - Shinji Kunishima
- Department of Medical Technology, Gifu University of Medical Science, Gifu, Japan
| | - Akira Ishiguro
- Division of Hematology, National Center for Child Health and Development, Tokyo, Japan
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26
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Kanduła Z, Janowski M, Więckowska B, Paczkowska E, Mroczkowska-Bękarciak A, Sobas M, Lewandowski K. High molecular risk variants, severe thrombocytopenia and large unstained cells count affect the outcome in primary myelofibrosis. J Appl Genet 2023; 64:479-491. [PMID: 37507589 PMCID: PMC10457229 DOI: 10.1007/s13353-023-00771-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
Apart from the driver mutations, high molecular risk (HMR) variants and other factors have been reported to influence the prognosis of primary myelofibrosis (PMF). The aim of our study was to investigate the impact of laboratory and molecular characteristics at the time of diagnosis (TOD) on the PMF outcome. The study group consisted of 82 patients recruited from three Polish university centers. Among the driver mutations, only CALR type 1 positively influenced the overall survival (OS). The risk of progression to accelerated or blastic disease phase (AP/BP) did not depend on the driver mutation type, but was closely associated with the presence of HMR variants (p = 0.0062). The risk of death (ROD) was higher in patients with HMR variants (OR[95%CI] = 4.33[1.52;12.34], p = 0.0044) and in patients with a platelet count at the TOD between 50-100 G/L (HR[95%CI] = 2.66[1.11;6.35]) and < 50 G/L (HR[95%CI] = 8.44[2.50;28.44]). Median survival time was 7.8, 2.2 and 1.4 years in patients with large unstained cells (LUC) count of [0.0-0.2], (0.2-0.4] and > 0.4 G/L at the TOD, respectively. We found an unexpected, hitherto undescribed, association between LUC count at the TOD and PMF prognosis. Our analysis led to the following conclusions: in PMF patients at the TOD 1) the presence of HMR variants, especially combined, is associated with an increased risk of progression to the AP and BP, and shorter OS, 2) severe thrombocytopenia confers worse prognosis than the moderate one, 3) LUC count is closely related with the disease phase, and associated with the ROD and OS.
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Affiliation(s)
- Zuzanna Kanduła
- Department of Hematology and Bone Marrow Transplantation, Poznań University of Medical Sciences, Poznan, Poland
| | - Michał Janowski
- Department of General Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Barbara Więckowska
- Department of Computer Science and Statistics, Poznań University of Medical Sciences, Poznan, Poland
| | - Edyta Paczkowska
- Department of General Pathology, Pomeranian Medical University, Szczecin, Poland
| | | | - Marta Sobas
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Medical University, Wrocław, Poland
| | - Krzysztof Lewandowski
- Department of Hematology and Bone Marrow Transplantation, Poznań University of Medical Sciences, Poznan, Poland
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27
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Bigot T, Gabinaud E, Hannouche L, Sbarra V, Andersen E, Bastelica D, Falaise C, Bernot D, Ibrahim-Kosta M, Morange PE, Loosveld M, Saultier P, Payet-Bornet D, Alessi MC, Potier D, Poggi M. Single-cell analysis of megakaryopoiesis in peripheral CD34 + cells: insights into ETV6-related thrombocytopenia. J Thromb Haemost 2023; 21:2528-2544. [PMID: 37085035 DOI: 10.1016/j.jtha.2023.04.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/21/2023] [Accepted: 04/04/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Germline mutations in the ETV6 transcription factor gene are responsible for familial thrombocytopenia and leukemia predisposition syndrome. Although previous studies have shown that ETV6 plays an important role in megakaryocyte (MK) maturation and platelet formation, the mechanisms by which ETV6 dysfunction promotes thrombocytopenia remain unclear. OBJECTIVES To decipher the transcriptional mechanisms and gene regulatory network linking ETV6 germline mutations and thrombocytopenia. METHODS Presuming that ETV6 mutations result in selective effects at a particular cell stage, we applied single-cell RNA sequencing to understand gene expression changes during megakaryopoiesis in peripheral CD34+ cells from healthy controls and patients with ETV6-related thrombocytopenia. RESULTS Analysis of gene expression and regulon activity revealed distinct clusters partitioned into 7 major cell stages: hematopoietic stem/progenitor cells, common-myeloid progenitors (CMPs), MK-primed CMPs, granulocyte-monocyte progenitors, MK-erythroid progenitors (MEPs), progenitor MKs/mature MKs, and platelet-like particles. We observed a differentiation trajectory in which MEPs developed directly from hematopoietic stem/progenitor cells and bypassed the CMP stage. ETV6 deficiency led to the development of aberrant cells as early as the MEP stage, which intensified at the progenitor MK/mature MK stage, with a highly deregulated core "ribosome biogenesis" pathway. Indeed, increased translation levels have been documented in patient CD34+-derived MKs with overexpression of ribosomal protein S6 and phosphorylated ribosomal protein S6 in both CD34+-derived MKs and platelets. Treatment of patient MKs with the ribosomal biogenesis inhibitor CX-5461 resulted in an increase in platelet-like particles. CONCLUSION These findings provide novel insight into both megakaryopoiesis and the link among ETV6, translation, and platelet production.
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Affiliation(s)
- Timothée Bigot
- Aix-Marseille Univ, INSERM, INRAe, C2VN, Marseille, France
| | - Elisa Gabinaud
- Aix-Marseille Univ, INSERM, INRAe, C2VN, Marseille, France
| | | | | | - Elisa Andersen
- Aix-Marseille Univ, INSERM, INRAe, C2VN, Marseille, France
| | | | | | - Denis Bernot
- Aix-Marseille Univ, INSERM, INRAe, C2VN, Marseille, France
| | | | | | - Marie Loosveld
- Aix-Marseille Univ, CNRS, INSERM, CIML, Marseille, France
| | - Paul Saultier
- Aix-Marseille Univ, INSERM, INRAe, C2VN, Marseille, France
| | | | - Marie-Christine Alessi
- Aix-Marseille Univ, INSERM, INRAe, C2VN, Marseille, France; AP-HM, CHU Timone, CRPP, Marseille, France
| | | | - Marjorie Poggi
- Aix-Marseille Univ, INSERM, INRAe, C2VN, Marseille, France.
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Camacho V. Translate or differentiate? Molecular mechanisms of ETV6-related thrombocytopenia. J Thromb Haemost 2023; 21:2367-2369. [PMID: 37597896 DOI: 10.1016/j.jtha.2023.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 08/21/2023]
Affiliation(s)
- Virginia Camacho
- Vascular Biology Program, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.
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29
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Bülbül MC, Avcı Ş, Yelken B, Koçak B, Akay OM. Successful Kidney Transplantation in MYH-9-Related Disease Presenting with Severe Macrothrombocytopenia. Turk J Haematol 2023; 40:232-233. [PMID: 37278342 PMCID: PMC10476248 DOI: 10.4274/tjh.galenos.2023.2023-0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/06/2023] [Indexed: 06/07/2023] Open
Affiliation(s)
| | - Şahin Avcı
- Koç University Hospital, Clinic of Medical Genetics, İstanbul, Türkiye
| | - Berna Yelken
- Koç University Hospital, Clinic of Organ Transplant Center, İstanbul, Türkiye
| | - Burak Koçak
- Koç University Hospital, Clinic of Organ Transplant Center, İstanbul, Türkiye
| | - Olga Meltem Akay
- Koç University Hospital, Clinic of Hematology, İstanbul, Türkiye
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30
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Jiang W, Xu Y, Fu Z, Hu M, Wu Q, Ji Y, Li JZ, Gong Y, Zhou H. Genetic analysis and functional study of a novel ABCG5 mutation in sitosterolemia with hematologic disease. Gene 2023; 879:147596. [PMID: 37390873 DOI: 10.1016/j.gene.2023.147596] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 07/02/2023]
Abstract
Sitosterolemia is a rare autosomal recessive hereditary disease caused by loss-of-function genetic mutations in either ATP-binding cassette subfamily G member 5 or member 8 (ABCG5 or ABCG8). Here, we investigate novel variants in ABCG5 and ABCG8 that are associated with the sitosterolemia phenotype. We describe a 32-year-old woman with hypercholesterolemia, tendon and hip xanthomas, autoimmune hemolytic anemia and macrothrombocytopenia from early life, which make us highly suspicious of the possibility of sitosterolemia. A novel homozygous variant in ABCG5 (c.1769C>A, p.S590X) was identified by genomic sequencing. We also examined the lipid profile, especially plant sterols levels, using gas chromatography-mass spectrometry. Functional studies, including western blotting and immunofluorescence staining, showed that the nonsense mutation ABCG5 1769C>A hinders the formation of ABCG5 and ABCG8 heterodimers and the function of transporting sterols. Our study expands the knowledge of variants in sitosterolemia and provides diagnosis and treatment recommendations.
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Affiliation(s)
- Wanzi Jiang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University and Jiangsu Province Hospital, Nanjing, China
| | - Yiwen Xu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University and Jiangsu Province Hospital, Nanjing, China
| | - Zhenzhen Fu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University and Jiangsu Province Hospital, Nanjing, China
| | - Moran Hu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University and Jiangsu Province Hospital, Nanjing, China
| | - Qinyi Wu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University and Jiangsu Province Hospital, Nanjing, China
| | - Yong Ji
- Key Laboratory of Cardiovascular and Cerebrovascular Medicine, Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China; The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Suzhou, China
| | - John Zhong Li
- The Key Laboratory of Rare Metabolic Disease, Department of Biochemistry and Molecular Biology, The Key Laboratory of Human Functional Genomics of Jiangsu Province, Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, China
| | - Yingyun Gong
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University and Jiangsu Province Hospital, Nanjing, China.
| | - Hongwen Zhou
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanjing Medical University and Jiangsu Province Hospital, Nanjing, China.
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31
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Strauss G, Mott K, Klopocki E, Schulze H. Thrombocytopenia Absent Radius (TAR)-Syndrome: From Current Genetics to Patient Self-Empowerment. Hamostaseologie 2023; 43:252-260. [PMID: 37611607 DOI: 10.1055/a-2088-1801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Thrombocytopenia absent radius (TAR) syndrome is a rare form of hereditary thrombocytopenia associated with a bilateral radial aplasia. TAR syndrome is genetically defined by the combination of a microdeletion on chromosome 1 which includes the gene RBM8A, and a single nucleotide polymorphism (SNP) in the second RBM8A allele. While most patients with TAR syndrome harbor a SNP in either the 5' UTR region or in intron 1 of RBM8A, further SNPs associated with TAR syndrome are still being identified. Here, we report on the current understanding of the genetic basis, diagnosis, and therapy of TAR syndrome and discuss patient self-empowerment by enabling networking and exchange between affected individuals and families.
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Affiliation(s)
- Gabriele Strauss
- Department of Paediatric Haematology and Oncology, Helios-Klinikum Buch, Berlin, Germany
| | - Kristina Mott
- Institute of Experimental Biomedicine I, University Hospital Würzburg, Würzburg, Germany
| | - Eva Klopocki
- Institute of Human Genetics, University of Würzburg, Würzburg, Germany
| | - Harald Schulze
- Institute of Experimental Biomedicine I, University Hospital Würzburg, Würzburg, Germany
- Center for Rare Blood Cell Disorders, Center for Rare Diseases, University Hospital Würzburg, Würzburg, Germany
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32
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Ciftciler R, Balasar Ö, Keyik H, Ciftciler AE. Hereditary thrombocytopenia with familial novel mutation in MYH9 gene: A familial case report. Transfus Apher Sci 2023; 62:103710. [PMID: 37076359 DOI: 10.1016/j.transci.2023.103710] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/06/2022] [Accepted: 04/05/2023] [Indexed: 04/21/2023]
Abstract
One of the rarest types of hereditary thrombocytopenia is the MYH9-related disorder. This spectrum of disorders is characterized by large platelets with or without leukocyte inclusion bodies, a decrease in the total number of platelets, and autosomal dominant inheritance. Proteinuric nephropathy that frequently progresses to end-stage renal failure, as well as the beginning of progressive high-frequency sensorineural hearing loss in young adults, is also associated with MYH9-related disorder. In this case report, we presented three family members who had thrombocytopenia and in whom a heterozygous novel 22 bp deletion (c.4274_4295del) was detected which is located in exon 31 of the MYH9 gene. There was no evidence of bleeding in the family members we presented and thrombocytopenia was detected incidentally. Additionally, renal failure, hearing loss, presenile cataracts, and clinical symptoms were not detected in these family members. This novel mutation detected in the MYH9 gene has not been reported in the literature before.
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Affiliation(s)
- Rafiye Ciftciler
- Department of Hematology, Selcuk University, Faculty of Medicine, Konya, Turkey.
| | - Özgur Balasar
- Department of Medical Genetic, Konya City Hospital, Konya, Turkey
| | - Hilal Keyik
- Department of Pediatric Hematology, Konya City Hospital, Konya, Turkey
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33
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Al-Tawil MM, Kamal TM, Borham OM, Abd El-Ghany SM. Interleukin-1 Receptor Antagonist Gene Polymorphisms in Egyptian Children and Adolescents With Primary Immune Thrombocytopenia: Association With Disease Susceptibility, Response to Therapy, and Outcome. J Pediatr Hematol Oncol 2023; 45:e650-e654. [PMID: 36730987 DOI: 10.1097/mph.0000000000002570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 09/06/2022] [Indexed: 02/04/2023]
Abstract
Immune thrombocytopenia (ITP) is one of the most common hematologic disorders with poorly predictable clinical course and outcome. We studied the distribution of interleukin 1 receptor antagonist (IL-1Ra) gene polymorphism (intron-2) among children and adolescents with ITP and correlated IL-1Ra gene polymorphism to disease susceptibility, response to therapy, and outcome. Sixty children with ITP (mean age: 9.2±4.5 y) and 100 healthy controls (mean age: 8.83±4.05 y) were enrolled. The frequencies of the allele A2 and genotype A1A2 were significantly higher in patients compared with controls ( P <0.0001, P =0.0008, respectively). Allele A2 conferred 3.1 times increased relative risk for disease development. Allele A2 and genotypes A1A2 and A2A2 were significantly more frequent among remitted patients ( P =0.028 and 0.024, respectively). There was no significant difference between different genotypes and alleles regarding bleeding score ( P >0.05). Patients with polymorphic allele A2 (A1A2/A2A2) showed significantly better response to steroids than those with homozygous wild allele A1 ( P =0.028). IL-1Ra polymorphism might contribute to the susceptibility to ITP in Egyptian children. The presence of A2 polymorphic allele of IL-1Ra gene was found to be associated with better disease outcome and response to steroids than those with homozygous wild allele.
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Affiliation(s)
| | - Tarek M Kamal
- Human Genetics Unit, Department of Paediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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34
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Marconi C, Pecci A, Palombo F, Melazzini F, Bottega R, Nardi E, Bozzi V, Faleschini M, Barozzi S, Giangregorio T, Magini P, Balduini CL, Savoia A, Seri M, Noris P, Pippucci T. Exome sequencing in 116 patients with inherited thrombocytopenia that remained of unknown origin after systematic phenotype-driven diagnostic workup. Haematologica 2023; 108:1909-1919. [PMID: 36519321 PMCID: PMC10316235 DOI: 10.3324/haematol.2022.280993] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/29/2022] [Indexed: 11/01/2023] Open
Abstract
Inherited thrombocytopenias (IT) are genetic diseases characterized by low platelet count, sometimes associated with congenital defects or a predisposition to develop additional conditions. Next-generation sequencing has substantially improved our knowledge of IT, with more than 40 genes identified so far, but obtaining a molecular diagnosis remains a challenge especially for patients with non-syndromic forms, having no clinical or functional phenotypes that raise suspicion about specific genes. We performed exome sequencing (ES) in a cohort of 116 IT patients (89 families), still undiagnosed after a previously validated phenotype-driven diagnostic algorithm including a targeted analysis of suspected genes. ES achieved a diagnostic yield of 36%, with a gain of 16% over the diagnostic algorithm. This can be explained by genetic heterogeneity and unspecific genotype-phenotype relationships that make the simultaneous analysis of all the genes, enabled by ES, the most reasonable strategy. Furthermore, ES disentangled situations that had been puzzling because of atypical inheritance, sex-related effects or false negative laboratory results. Finally, ES-based copy number variant analysis disclosed an unexpectedly high prevalence of RUNX1 deletions, predisposing to hematologic malignancies. Our findings demonstrate that ES, including copy number variant analysis, can substantially contribute to the diagnosis of IT and can solve diagnostic problems that would otherwise remain a challenge.
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Affiliation(s)
- Caterina Marconi
- Department of Medical and Surgical Science, University of Bologna, Bologna
| | - Alessandro Pecci
- Department of Internal Medicine, University of Pavia, Pavia, Italy; Medicina Generale 1, IRCCS Policlinico San Matteo Foundation, Pavia
| | - Flavia Palombo
- Department of Medical and Surgical Science, University of Bologna, Bologna
| | - Federica Melazzini
- Department of Internal Medicine, University of Pavia, Pavia, Italy; Medicina Generale 1, IRCCS Policlinico San Matteo Foundation, Pavia
| | - Roberta Bottega
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste
| | - Elena Nardi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna
| | - Valeria Bozzi
- Medicina Generale 1, IRCCS Policlinico San Matteo Foundation, Pavia
| | | | - Serena Barozzi
- Medicina Generale 1, IRCCS Policlinico San Matteo Foundation, Pavia
| | | | - Pamela Magini
- Medical Genetics Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna
| | | | - Anna Savoia
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy; Department of Medical Sciences, University of Trieste, Trieste
| | - Marco Seri
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy; Medical Genetics Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna.
| | - Patrizia Noris
- Department of Internal Medicine, University of Pavia, Pavia, Italy; Medicina Generale 1, IRCCS Policlinico San Matteo Foundation, Pavia
| | - Tommaso Pippucci
- Medical Genetics Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna
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35
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Hsu AP. Not too little, not too much: the impact of mutation types in Wiskott-Aldrich syndrome and RAC2 patients. Clin Exp Immunol 2023; 212:137-146. [PMID: 36617178 PMCID: PMC10128166 DOI: 10.1093/cei/uxad001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/23/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
Primary immune deficiencies (PIDs) are genetic disorders impacting the appropriate development or functioning of any portion of the immune system. The broad adoption of high-throughput sequencing has driven discovery of new genes as well as expanded phenotypes associated with known genes. Beginning with the identification of WAS mutations in patients with severe Wiskott-Aldrich Syndrome, recognition of WAS mutations in additional patients has revealed phenotypes including isolated thrombocytopenia and X-linked neutropenia. Likewise RAC2 patients present with vastly different phenotypes depending on the mutation-ranging from reticular dysgenesis or severe neutrophil dysfunction with neonatal presentation to later onset common variable immune deficiency. This review examines genotype-phenotype correlations in patients with WAS (Wiskott-Aldrich Syndrome) and RAC2 mutations, highlighting functional protein domains, how mutations alter protein interactions, and how specific mutations can affect isolated functions of the protein leading to disparate phenotypes.
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Affiliation(s)
- Amy P Hsu
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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36
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Palma-Barqueros V, Bury L, Kunishima S, et al. Expanding the genetic spectrum of TUBB1-related thrombocytopenia. Blood Adv. 2021;5(24):5453-5467. Blood Adv 2023; 7:877. [PMID: 36920438 DOI: 10.1182/bloodadvances.2022007189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
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37
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Zhu W, Zheng Y, Yu M, Wu Y, Wei J, Zhou L, Fu G, Schneider N, Jones C, Irani M, Padmanabhan A, Aster R, Wang D, Wen R. Cloned antibodies from patients with HIT provide new clues to HIT pathogenesis. Blood 2023; 141:1060-1069. [PMID: 36493339 PMCID: PMC10023725 DOI: 10.1182/blood.2022017612] [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: 08/19/2022] [Revised: 11/01/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022] Open
Abstract
Heparin-induced thrombocytopenia (HIT) is a serious adverse drug reaction characterized by antibodies that recognize platelet factor 4/heparin complexes (PF4/H) and activate platelets to create a prothrombotic state. Although a high percentage of heparin-treated patients produce antibodies to PF4/H, only a subset also makes antibodies that are platelet activating (PA). A close correlation between PA antibodies and the likelihood of experiencing HIT has been demonstrated in clinical studies, but how PA (presumptively pathogenic) and nonactivating (NA) (presumptively benign) antibodies differ from each other at the molecular level is unknown. To address this issue, we cloned 7 PA and 47 NA PF4/H-binding antibodies from 6 patients with HIT and characterized their structural and functional properties. Findings showed that PA clones differed significantly from NA clones in possessing 1 of 2 heavy chain complementarity-determining region 3 (HCDR3) motifs, RX1-2R/KX1-2R/H (RKH) and YYYYY (Y5), in an unusually long complementarity-determining region 3 (≥20 residues). Mutagenic studies showed that modification of either motif in PA clones reduced or abolished their PA activity and that appropriate amino acid substitutions in HCDR3 of NA clones can cause them to become PA. Repertoire sequencing showed that the frequency of peripheral blood IgG+ B cells possessing RKH or Y5 was significantly higher in patients with HIT than in patients without HIT given heparin, indicating expansion of B cells possessing RKH or Y5 in HIT. These findings imply that antibodies possessing RKH or Y5 are relevant to HIT pathogenesis and suggest new approaches to diagnosis and treatment of this condition.
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Affiliation(s)
- Wen Zhu
- Versiti Blood Research Institute, Milwaukee, WI
- Department of Microbiology & Immunology, Medical College of Wisconsin, Milwaukee, WI
| | | | - Mei Yu
- Versiti Blood Research Institute, Milwaukee, WI
| | - Yaling Wu
- Versiti Blood Research Institute, Milwaukee, WI
- Biomedical Research Center of South China, College of Life Sciences, Fujian Normal University, Fuzhou, Fujian, China
| | - Jianhui Wei
- Versiti Blood Research Institute, Milwaukee, WI
- Biomedical Research Center of South China, College of Life Sciences, Fujian Normal University, Fuzhou, Fujian, China
| | - Lu Zhou
- Versiti Blood Research Institute, Milwaukee, WI
- Department of Microbiology & Immunology, Medical College of Wisconsin, Milwaukee, WI
| | - Guoping Fu
- Versiti Blood Research Institute, Milwaukee, WI
| | | | | | - Mehraboon Irani
- Versiti Blood Research Institute, Milwaukee, WI
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
| | - Anand Padmanabhan
- Versiti Blood Research Institute, Milwaukee, WI
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN
| | - Richard Aster
- Versiti Blood Research Institute, Milwaukee, WI
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Demin Wang
- Versiti Blood Research Institute, Milwaukee, WI
- Department of Microbiology & Immunology, Medical College of Wisconsin, Milwaukee, WI
| | - Renren Wen
- Versiti Blood Research Institute, Milwaukee, WI
- Department of Microbiology & Immunology, Medical College of Wisconsin, Milwaukee, WI
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38
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Tan JH, Ahmad Azahari AHS, Ali A, Ismail NAS. Scoping Review on Epigenetic Mechanisms in Primary Immune Thrombocytopenia. Genes (Basel) 2023; 14:555. [PMID: 36980827 PMCID: PMC10048672 DOI: 10.3390/genes14030555] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/07/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Immune Thrombocytopenia (ITP) is an autoimmune blood disorder that involves multiple pathways responsible for the homeostasis of the immune system. Numerous pieces of literature have proposed the potential of immune-related genes as diagnostic and prognostic biomarkers, which mostly implicate the role of B cells and T cells in the pathogenesis of ITP. However, a more in-depth understanding is required of how these immune-related genes are regulated. Thus, this scoping review aims to collate evidence and further elucidate each possible epigenetics mechanism in the regulation of immunological pathways pertinent to the pathogenesis of ITP. This encompasses DNA methylation, histone modification, and non-coding RNA. A total of 41 studies were scrutinized to further clarify how each of the epigenetics mechanisms is related to the pathogenesis of ITP. Identifying epigenetics mechanisms will provide a new paradigm that may assist in the diagnosis and treatment of immune thrombocytopenia.
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Affiliation(s)
- Jian Hong Tan
- Department of Paediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Cheras, Kuala Lumpur 56000, Malaysia
| | - Ahmad Hazim Syakir Ahmad Azahari
- Department of Paediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Cheras, Kuala Lumpur 56000, Malaysia
| | - Adli Ali
- Department of Paediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Cheras, Kuala Lumpur 56000, Malaysia
- Research Centre, Hospital Tunku Ampuan Besar Tuanku Aishah Rohani, UKM Specialist Children’s Hospital, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Cheras, Kuala Lumpur 56000, Malaysia
| | - Noor Akmal Shareela Ismail
- Research Centre, Hospital Tunku Ampuan Besar Tuanku Aishah Rohani, UKM Specialist Children’s Hospital, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Cheras, Kuala Lumpur 56000, Malaysia
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Cheras, Kuala Lumpur 56000, Malaysia
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39
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Marín-Quílez A, Di Buduo CA, Díaz-Ajenjo L, Abbonante V, Vuelta E, Soprano PM, Miguel-García C, Santos-Mínguez S, Serramito-Gómez I, Ruiz-Sala P, Peñarrubia MJ, Pardal E, Hernández-Rivas JM, González-Porras JR, García-Tuñón I, Benito R, Rivera J, Balduini A, Bastida JM. Novel variants in GALE cause syndromic macrothrombocytopenia by disrupting glycosylation and thrombopoiesis. Blood 2023; 141:406-421. [PMID: 36395340 PMCID: PMC10644051 DOI: 10.1182/blood.2022016995] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022] Open
Abstract
Glycosylation is recognized as a key process for proper megakaryopoiesis and platelet formation. The enzyme uridine diphosphate (UDP)-galactose-4-epimerase, encoded by GALE, is involved in galactose metabolism and protein glycosylation. Here, we studied 3 patients from 2 unrelated families who showed lifelong severe thrombocytopenia, bleeding diathesis, mental retardation, mitral valve prolapse, and jaundice. Whole-exome sequencing revealed 4 variants that affect GALE, 3 of those previously unreported (Pedigree A, p.Lys78ValfsX32 and p.Thr150Met; Pedigree B, p.Val128Met; and p.Leu223Pro). Platelet phenotype analysis showed giant and/or grey platelets, impaired platelet aggregation, and severely reduced alpha and dense granule secretion. Enzymatic activity of the UDP-galactose-4-epimerase enzyme was severely decreased in all patients. Immunoblotting of platelet lysates revealed reduced GALE protein levels, a significant decrease in N-acetyl-lactosamine (LacNAc), showing a hypoglycosylation pattern, reduced surface expression of gylcoprotein Ibα-IX-V (GPIbα-IX-V) complex and mature β1 integrin, and increased apoptosis. In vitro studies performed with patients-derived megakaryocytes showed normal ploidy and maturation but decreased proplatelet formation because of the impaired glycosylation of the GPIbα and β1 integrin, and reduced externalization to megakaryocyte and platelet membranes. Altered distribution of filamin A and actin and delocalization of the von Willebrand factor were also shown. Overall, this study expands our knowledge of GALE-related thrombocytopenia and emphasizes the critical role of GALE in the physiological glycosylation of key proteins involved in platelet production and function.
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Affiliation(s)
- Ana Marín-Quílez
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Centro de Investigación del Cáncer (CIC), Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Universidad de Salamanca-Centro Superior de Investigaciones Científicas (CSIC), Salamanca, Spain
| | | | - Lorena Díaz-Ajenjo
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Centro de Investigación del Cáncer (CIC), Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Universidad de Salamanca-Centro Superior de Investigaciones Científicas (CSIC), Salamanca, Spain
| | - Vittorio Abbonante
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Elena Vuelta
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Centro de Investigación del Cáncer (CIC), Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Universidad de Salamanca-Centro Superior de Investigaciones Científicas (CSIC), Salamanca, Spain
| | | | - Cristina Miguel-García
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Centro de Investigación del Cáncer (CIC), Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Universidad de Salamanca-Centro Superior de Investigaciones Científicas (CSIC), Salamanca, Spain
| | - Sandra Santos-Mínguez
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Centro de Investigación del Cáncer (CIC), Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Universidad de Salamanca-Centro Superior de Investigaciones Científicas (CSIC), Salamanca, Spain
| | - Inmaculada Serramito-Gómez
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Centro de Investigación del Cáncer (CIC), Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Universidad de Salamanca-Centro Superior de Investigaciones Científicas (CSIC), Salamanca, Spain
| | - Pedro Ruiz-Sala
- Centro de Diagnóstico de Enfermedades Moleculares, Universidad Autónoma de Madrid, CIBERER, IdIPAZ, Madrid, Spain
| | - María Jesús Peñarrubia
- Servicio de Hematología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Emilia Pardal
- Servicio de Hematología, Hospital Virgen del Puerto, Plasencia, Spain
| | - Jesús María Hernández-Rivas
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Centro de Investigación del Cáncer (CIC), Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Universidad de Salamanca-Centro Superior de Investigaciones Científicas (CSIC), Salamanca, Spain
- Servicio de Hematología, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain
| | - José Ramón González-Porras
- Servicio de Hematología, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain
| | - Ignacio García-Tuñón
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Centro de Investigación del Cáncer (CIC), Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Universidad de Salamanca-Centro Superior de Investigaciones Científicas (CSIC), Salamanca, Spain
- Departamento de Biomedicina y Biotecnología, Universidad de Alcalá, Alcalá de Henares, Spain
| | - Rocío Benito
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Centro de Investigación del Cáncer (CIC), Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Universidad de Salamanca-Centro Superior de Investigaciones Científicas (CSIC), Salamanca, Spain
| | - José Rivera
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB)-Pascual Parrilla, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Murcia, Spain
| | - Alessandra Balduini
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- Department of Biomedical Engineering, Tufts University, Medford, MA
| | - José María Bastida
- Servicio de Hematología, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain
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Mazharian A, Maître B, Bornert A, Hennequin D, Lourenco-Rodrigues M, Geer MJ, Smith CW, Heising S, Walter M, Montel F, Walker LSK, de la Salle H, Watson SP, Gachet C, Senis YA. Treatment of congenital thrombocytopenia and decreased collagen reactivity in G6b-B-deficient mice. Blood Adv 2023; 7:46-59. [PMID: 36269841 PMCID: PMC9813534 DOI: 10.1182/bloodadvances.2022008873] [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: 09/02/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 01/18/2023] Open
Abstract
Mice lacking the immunoreceptor tyrosine-based inhibition motif-containing co-inhibitory receptor G6b-B (Mpig6b, G6b knockout, KO) are born with a complex megakaryocyte (MK) per platelet phenotype, characterized by severe macrothrombocytopenia, expansion of the MK population, and focal myelofibrosis in the bone marrow and spleen. Platelets are almost completely devoid of the glycoprotein VI (GPVI)-FcRγ-chain collagen receptor complex, have reduced collagen integrin α2β1, elevated Syk tyrosine kinase activity, and a subset has increased surface immunoglobulins. A similar phenotype was recently reported in patients with null and loss-of-function mutations in MPIG6B. To better understand the cause and treatment of this pathology, we used pharmacological- and genetic-based approaches to rescue platelet counts and function in G6b KO mice. Intravenous immunoglobulin resulted in a transient partial recovery of platelet counts, whereas immune deficiency did not affect platelet counts or receptor expression in G6b KO mice. Syk loss-of-function (R41A) rescued macrothrombocytopenia, GPVI and α2β1 expression in G6b KO mice, whereas treatment with the Syk kinase inhibitor BI1002494 partially rescued platelet count but had no effect on GPVI and α2β1 expression or bleeding. The Src family kinase inhibitor dasatinib was not beneficial in G6b KO mice. In contrast, treatment with the thrombopoietin mimetic romiplostim rescued thrombocytopenia, GPVI expression, and platelet reactivity to collagen, suggesting that it may be a promising therapeutic option for patients lacking functional G6b-B. Intriguingly, GPVI and α2β1 expression were significantly downregulated in romiplostim-treated wild-type mice, whereas GPVI was upregulated in romiplostim-treated G6b KO mice, suggesting a cell intrinsic feedback mechanism that autoregulates platelet reactivity depending on physiological needs.
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Affiliation(s)
- Alexandra Mazharian
- Université de Strasbourg, INSERM, Etablissement Français du Sang Grand-Est, Unité Mixte de Recherche-S 1255, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Blandine Maître
- Université de Strasbourg, INSERM, Etablissement Français du Sang Grand-Est, Unité Mixte de Recherche-S 1255, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Alicia Bornert
- Université de Strasbourg, INSERM, Etablissement Français du Sang Grand-Est, Unité Mixte de Recherche-S 1255, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Desline Hennequin
- Université de Strasbourg, INSERM, Etablissement Français du Sang Grand-Est, Unité Mixte de Recherche-S 1255, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Marc Lourenco-Rodrigues
- Université de Strasbourg, INSERM, Etablissement Français du Sang Grand-Est, Unité Mixte de Recherche-S 1255, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Mitchell J. Geer
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, NYU Langone Health, New York, NY
| | - Christopher W. Smith
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Silke Heising
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Michaela Walter
- Boehringer Ingelheim Pharma GmbH and Company KG, Ingelheim, Germany
| | - Florian Montel
- Boehringer Ingelheim Pharma GmbH and Company KG, Ingelheim, Germany
| | - Lucy S. K. Walker
- Division of Infection and Immunity, Institute of Immunity and Transplantation, University College London, Royal Free Campus, London, United Kingdom
| | - Henri de la Salle
- Université de Strasbourg, INSERM, Etablissement Français du Sang Grand-Est, Unité Mixte de Recherche-S 1255, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Steve P. Watson
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Christian Gachet
- Université de Strasbourg, INSERM, Etablissement Français du Sang Grand-Est, Unité Mixte de Recherche-S 1255, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Yotis A. Senis
- Université de Strasbourg, INSERM, Etablissement Français du Sang Grand-Est, Unité Mixte de Recherche-S 1255, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
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Shah YB, Lin P, Chen S, Zheng A, Alcaraz W, Towne MC, Gabriel C, Bhoj EJ, Lambert MP, Olson TS, Frank DM, Ellis CA, Babushok DV. Inherited bone marrow failure with macrothrombocytopenia due to germline tubulin beta class I (TUBB) variant. Br J Haematol 2023; 200:222-228. [PMID: 36207145 PMCID: PMC10989998 DOI: 10.1111/bjh.18491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/30/2022] [Accepted: 09/19/2022] [Indexed: 01/14/2023]
Abstract
Germline mutations in tubulin beta class I (TUBB), which encodes one of the β-tubulin isoforms, were previously associated with neurological and cutaneous abnormalities. Here, we describe the first case of inherited bone marrow (BM) failure, including marked thrombocytopenia, morphological abnormalities, and cortical dysplasia, associated with a de novo p.D249V variant in TUBB. Mutant TUBB had abnormal cellular localisation in transfected cells. Following interferon/ribavirin therapy administered for transfusion-acquired hepatitis C, severe pancytopenia and BM aplasia ensued, which was unresponsive to immunosuppression. Acquired chromosome arm 6p loss of heterozygosity was identified, leading to somatic loss of the mutant TUBB allele.
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Affiliation(s)
- Yash B. Shah
- Comprehensive Bone Marrow Failure Center, Children’s Hospital of Philadelphia, Philadelphia, PA, US
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ping Lin
- Comprehensive Bone Marrow Failure Center, Children’s Hospital of Philadelphia, Philadelphia, PA, US
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Stone Chen
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Alan Zheng
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Courtney Gabriel
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth J. Bhoj
- Division of Human Genetics, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michele P. Lambert
- Division of Hematology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Timothy S. Olson
- Comprehensive Bone Marrow Failure Center, Children’s Hospital of Philadelphia, Philadelphia, PA, US
- Division of Oncology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dale M. Frank
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Colin A. Ellis
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Daria V. Babushok
- Comprehensive Bone Marrow Failure Center, Children’s Hospital of Philadelphia, Philadelphia, PA, US
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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42
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Li J, Rong L, Wang J, Fang Y. Umbilical cord blood transplantation for MYH9-related disorders. Pediatr Blood Cancer 2022; 69:e29711. [PMID: 35441449 DOI: 10.1002/pbc.29711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/23/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Jian Li
- Department of Hematology and Oncology, Children's Hospital of Nanjing Medical University, Nanjing, China
- Key Laboratory of Hematology, Nanjing Medical University Nanjing, Nanjing, China
| | - Liucheng Rong
- Department of Hematology and Oncology, Children's Hospital of Nanjing Medical University, Nanjing, China
- Key Laboratory of Hematology, Nanjing Medical University Nanjing, Nanjing, China
| | - Jun Wang
- Department of Hematology and Oncology, Children's Hospital of Nanjing Medical University, Nanjing, China
- Key Laboratory of Hematology, Nanjing Medical University Nanjing, Nanjing, China
| | - Yongjun Fang
- Department of Hematology and Oncology, Children's Hospital of Nanjing Medical University, Nanjing, China
- Key Laboratory of Hematology, Nanjing Medical University Nanjing, Nanjing, China
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43
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Sethi SK, Goel S, Vadhera A, Raaj H, Mahato SK, Jha PK, Bansal SB, Raina R. Familial kidney failure with macro-thrombocytopenia: Answers. Pediatr Nephrol 2022; 37:1801-1803. [PMID: 35166924 DOI: 10.1007/s00467-022-05459-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Sidharth Kumar Sethi
- Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, 122001, India
| | - Shalini Goel
- Department of Pathology, Medanta, The Medicity, Gurgaon, Haryana, India, 122001
| | | | - Hritik Raaj
- Maulana Azad Medical College, New Delhi, 110002, India
| | | | - Pranaw Kumar Jha
- Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India, 122001
| | | | - Rupesh Raina
- Pediatric Nephrology, Akron Children's Hospital, Akron, 44308-1062, OH, USA.
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44
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Sethi SK, Goel S, Vadhera A, Raaj H, Mahato SK, Jha P, Bansal S, Raina R. Familial kidney failure with macro-thrombocytopenia: Questions. Pediatr Nephrol 2022; 37:1799-1800. [PMID: 35166923 DOI: 10.1007/s00467-022-05425-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Sidharth Kumar Sethi
- Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India, 122001
| | - Shalini Goel
- Department of Pathology, Medanta, The Medicity, Gurgaon, Haryana, India, 122001
| | | | - Hritik Raaj
- Maulana Azad Medical College, New Delhi, 110002, India
| | | | - Pranaw Jha
- Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India, 122001
| | - Shyam Bansal
- Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India, 122001
| | - Rupesh Raina
- Pediatric Nephrology, Akron Children's Hospital, Akron, OH, USA.
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45
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Yang L, Wu L, Meng P, Zhang X, Zhao D, Lin Q, Zhang Y. Generation of a thrombopoietin-deficient thrombocytopenia model in zebrafish. J Thromb Haemost 2022; 20:1900-1909. [PMID: 35622056 DOI: 10.1111/jth.15772] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/17/2022] [Accepted: 05/21/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The production of platelets is tightly regulated by thrombopoietin (THPO). Mutations in the THPO gene cause thrombocytopenia. Although mice lacking Thpo present with thrombocytopenia, predicting phenotypes and pathogenicity of novel THPO mutations in mice is limited. Zebrafish can be a powerful tool for fast validation and study of candidate genes of human hematological diseases and have already been used as a model of human thrombocytopenia. OBJECTIVES We aim to investigate the role of Thpo in zebrafish thrombopoiesis and to establish a Thpo-deficient zebrafish model. The model could be applied for illustrating the clinically discovered human THPO variants of which the clinical significance is not known and to evaluate the effect of THPO receptor agonists (THPO-Ras), as well as a screening platform for new drugs. METHODS We generated a thpo loss-of-function zebrafish model using CRISPR/Cas9. After disruption of zebrafish thpo, thposzy6 zebrafish presented with a significant reduction of thpo expression and developed thrombocytopenia. Furthermore, we performed in vivo studies with zebrafish with the thposzy6 mutation and found two human clinical point mutations (c.091C > T and c.112C > T) that were responsible for the thrombocytopenia phenotype. In addition, effects of THPO-RAs used as therapeutics against thrombocytopenia were evaluated in the Tg(mpl:eGFP);thposzy6 line. RESULTS AND CONCLUSIONS Zebrafish with the mutation thposzy6 presented with a significant reduction of thpo expression and developed thrombocytopenia. Thpo loss-of-function zebrafish model can serve as a valuable preclinical model for thrombocytopenia caused by thpo-deficiency, as well as a tool to study human clinical THPO variants and evaluate the effect of THPO-RAs.
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Affiliation(s)
- Lian Yang
- Division of Cell, Developmental and Integrative Biology, School of Medicine, South China University of Technology, Guangzhou, China
| | - Liangliang Wu
- Division of Cell, Developmental and Integrative Biology, School of Medicine, South China University of Technology, Guangzhou, China
- Department of Hematology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Panpan Meng
- Division of Cell, Developmental and Integrative Biology, School of Medicine, South China University of Technology, Guangzhou, China
| | - Xuebing Zhang
- Division of Cell, Developmental and Integrative Biology, School of Medicine, South China University of Technology, Guangzhou, China
| | - Dejian Zhao
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Qing Lin
- Division of Cell, Developmental and Integrative Biology, School of Medicine, South China University of Technology, Guangzhou, China
| | - Yiyue Zhang
- Division of Cell, Developmental and Integrative Biology, School of Medicine, South China University of Technology, Guangzhou, China
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46
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Karnes JH, Rollin J, Giles JB, Martinez KL, Steiner HE, Shaffer CM, Momozawa Y, Inai C, Bombin A, Shi M, Mosley JD, Stanaway I, Selleng K, Thiele T, Mushiroda T, Pouplard C, Heddle NM, Kubo M, Phillips EJ, Warkentin TE, Gruel Y, Greinacher A, Roden DM. ABO O blood group as a risk factor for platelet reactivity in heparin-induced thrombocytopenia. Blood 2022; 140:274-284. [PMID: 35377938 PMCID: PMC9305089 DOI: 10.1182/blood.2021014240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 03/08/2022] [Indexed: 11/20/2022] Open
Abstract
Heparin-induced thrombocytopenia (HIT) is an unpredictable, potentially catastrophic adverse effect resulting from an immune response to platelet factor 4 (PF4)/heparin complexes. We performed a genome-wide association study (GWAS) with positive functional assay as the outcome in a large discovery cohort of patients divided into 3 groups: (1) functional assay-positive cases (n = 1269), (2) antibody-positive (functional assay-negative) controls (n = 1131), and (3) antibody-negative controls (n = 1766). Significant associations (α = 5 × 10-8) were investigated in a replication cohort (α = 0.05) of functional assay-confirmed HIT cases (n = 177), antibody-positive (function assay-negative) controls (n = 258), and antibody-negative controls (n = 351). We observed a strong association for positive functional assay with increasing PF4/heparin immunoglobulin-G (IgG) level (odds ratio [OR], 16.53; 95% confidence interval [CI], 13.83-19.74; P = 1.51 × 10-209) and female sex (OR, 1.15; 95% CI, 1.01-1.32; P = .034). The rs8176719 C insertion variant in ABO was significantly associated with positive functional assay status in the discovery cohort (frequency = 0.41; OR, 0.751; 95% CI, 0.682-0.828; P = 7.80 × 10-9) and in the replication cohort (OR, 0.467; 95% CI, 0.228-0.954; P = .0367). The rs8176719 C insertion, which encodes all non-O blood group alleles, had a protective effect, indicating that the rs8176719 C deletion and the O blood group were risk factors for HIT (O blood group OR, 1.42; 95% CI, 1.26-1.61; P = 3.09 × 10-8). Meta-analyses indicated that the ABO association was independent of PF4/heparin IgG levels and was stronger when functional assay-positive cases were compared with antibody-positive (functional assay-negative) controls than with antibody-negative controls. Sequencing and fine-mapping of ABO demonstrated that rs8176719 was the causal single nucleotide polymorphism (SNP). Our results clarify the biology underlying HIT pathogenesis with ramifications for prediction and may have important implications for related conditions, such as vaccine-induced thrombotic thrombocytopenia.
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Affiliation(s)
- Jason H Karnes
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, AZ
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Jerome Rollin
- Regional University Hospital Centre Tours, Department of Hemostasis, Tours, France
- University of Tours, EA7501 GICC, Tours, France
| | - Jason B Giles
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, AZ
| | - Kiana L Martinez
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, AZ
| | - Heidi E Steiner
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, AZ
| | | | - Yukihide Momozawa
- RIKEN Center for Integrative Medical Sciences (IMS), Yokohama, Kanagawa, Japan
| | - Chihiro Inai
- RIKEN Center for Integrative Medical Sciences (IMS), Yokohama, Kanagawa, Japan
| | - Andrei Bombin
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Mingjian Shi
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Jonathan D Mosley
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Ian Stanaway
- Department of Medicine, Kidney Research Institute, University of Washington, Seattle, WA
| | - Kathleen Selleng
- Institute of Immunology and Transfusion Medicine, University of Greifswald, Greifswald, Germany
| | - Thomas Thiele
- Institute of Immunology and Transfusion Medicine, University of Greifswald, Greifswald, Germany
| | - Taisei Mushiroda
- RIKEN Center for Integrative Medical Sciences (IMS), Yokohama, Kanagawa, Japan
| | - Claire Pouplard
- Regional University Hospital Centre Tours, Department of Hemostasis, Tours, France
- University of Tours, EA7501 GICC, Tours, France
| | - Nancy M Heddle
- Department of Medicine, McMaster University, Hamilton, ON, Canada; and
| | - Michiaki Kubo
- RIKEN Center for Integrative Medical Sciences (IMS), Yokohama, Kanagawa, Japan
| | - Elizabeth J Phillips
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN
| | | | - Yves Gruel
- Regional University Hospital Centre Tours, Department of Hemostasis, Tours, France
- University of Tours, EA7501 GICC, Tours, France
| | - Andreas Greinacher
- Institute of Immunology and Transfusion Medicine, University of Greifswald, Greifswald, Germany
| | - Dan M Roden
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN
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Abstract
The inherited thrombocytopenia syndromes are a group of disorders characterized primarily by quantitative defects in platelet number, though with a variety demonstrating qualitative defects and/or extrahematopoietic findings. Through collaborative international efforts applying next-generation sequencing approaches, the list of genetic syndromes that cause thrombocytopenia has expanded significantly in recent years, now with over 40 genes implicated. In this review, we focus on what is known about the genetic etiology of inherited thrombocytopenia syndromes and how the field has worked to validate new genetic discoveries. We highlight the important role for the clinician in identifying a germline genetic diagnosis and strategies for identifying novel causes through research-based endeavors.
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Affiliation(s)
- Julia T Warren
- Division of Hematology-Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Jorge Di Paola
- Division of Hematology-Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
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Sun XY, Xue Y, Wang YP, Huang J, Lin RF, Kang MY, Fang YJ. [Clinical phenotype and genotype of Gaucher disease in 14 children]. Zhonghua Er Ke Za Zhi 2022; 60:527-532. [PMID: 35658357 DOI: 10.3760/cma.j.cn112140-20220228-00159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To analyze the clinical and genetical characteristics of children with Gaucher disease and to explore the relationship between genotype and phenotype. Methods: In this retrospective study, the clinical data of 14 children with Gaucher disease diagnosed in Children's Hospital of Nanjing Medical University from August 2016 to October 2021 were analyzed. Their general conditions, clinical manifestations, laboratory tests and gene variations were collected, followed by the analysis of the clinical phenotypes and genotypes. Results: Among 14 children diagnosed with Gaucher disease, 9 were males and 5 were females, with the age of diagnosis ranging from 0.7 to 15.8 years. There were 10 patients with type 1 Gaucher disease, 2 patients with type 2, and 2 patients with type 3. The most common clinical manifestations were splenomegaly, thrombocytopenia (14 cases), hepatomegaly (8 cases) and anemia (8 cases). There were 6 patients with growth retardation, and 5 patients lag in height compared with their peers. Bone abnormalities were revealed by magnetic resonance imaging in 7 type 1 Gaucher disease patients, but only 1 patient experienced bone pain. Patients with type 2 and type 3 Gaucher disease also presented with convulsions, nystagmus and hearing loss. Gaucher cells were found in bone marrow smears in 12 patients. The glucocerebrosidase gene variations identified in 13 patients were heterozygous and in 1 type 1 patient was homozygous of L483P. L483P variation accounted for 33%(10/30) of the variation alleles, followed by V414L, D448H and R159W. The variation alleles were L483P and L422R, F252I and L483P in 2 children with severe neurological manifestations of Gaucher disease. A novel variation c.22A>G was detected. Conclusions: Splenomegaly and thrombocytopenia are the main clinical presentations of Gaucher disease in children and bone lesions revealed by radiologic imaging appear prior to the occurrence of bone diseases, type 2 and type 3 Gaucher disease also present growth retardation and neurological manifestation. The most frequent variant allele is L483P, which are detected in all 3 subtypes of Gaucher disease. The L422R, F252I gene variants correlated with the neuronopathic phenotype.
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Affiliation(s)
- X Y Sun
- Department of Hematological Oncology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Y Xue
- Department of Hematological Oncology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Y P Wang
- Department of Hematological Oncology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - J Huang
- Department of Hematological Oncology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - R F Lin
- Department of Hematological Oncology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - M Y Kang
- Department of Hematological Oncology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Y J Fang
- Department of Hematological Oncology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
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49
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Liu JX, Wang CJ, Dai JH, Zhang MX, Lyu M, Sun YQ, Jiang B. [Pedigree Analysis of ACTN1-Related Thrombocytopenia Attributed to A Novel Mutation]. Zhongguo Shi Yan Xue Ye Xue Za Zhi 2022; 30:565-570. [PMID: 35395998 DOI: 10.19746/j.cnki.issn.1009-2137.2022.02.041] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
UNLABELLED AbstractObjective: To investigate the clinical phenotype and genotype of an ACTN1-associated thrombocytopenic family and explore its molecular pathogenesis. METHODS All the family members' peripheral blood was collected for routine blood tests, blood smear, coagulation function, and platelet aggregation test. Flow cytometry was used to detect the expression of platelet CD41 and CD61. The proband and her father were tested bone marrow cytomorphology. Whole-exome sequencing techniques were performed to detect and uncover mutant loci of suspected pathogenic genes. Bioinformatics was used to assess the conserved nature of the mutated loci and to analyze the effect of the mutated genes leading to the function of the corresponding amino acid sequences. RESULTS The platelet count of the proband was 88×109/L, and the blood smear showed dumbbell-shaped platelets, snake-shaped platelets and platelets of various sizes. Her bone marrow cytomorphology revealed normal megakaryocyte morphology with a count of 270. The platelet count of the proband's father was 74×109/L, with large platelets and platelets of various sizes observed in the blood smear, and the morphology of megakaryocytes was normal in bone marrow with a megakaryocyte count of 239. Her grandfather had a platelet count of 83×109/L, with snake-shaped platelets and platelets of various sizes on blood smears. Other family members were normal in all tests. The missense mutation c.2396G > A in exon 20 of the ACTN1 gene in the proband resulted in the mutation of 799 amino acids of the encoded protein, i.e., Arg, to His. The sequencing results of her father and grandfather at this locus were found to be consistent with her. Furthermore, bioinformatics analysis indicated that the locus was highly conserved across species and that variation in this locus might lead to functional impairment of the protein. The protein model analysis demonstrated that α-actin-1 at position 799 Arg and Glu at position 811 could form a critical salt bridge which stabilizes the conformation of the Ca2+ binding loop within the calmodulin-like motif. the mutation of R799H lost this critical salt bridge and destabilized this structural domain. CONCLUSION In the present study, the newly uncovered missense mutation c.2396G>A in exon 20 of the ACTN1 gene is potentially the molecular mechanism for the thrombocytopenia.
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Affiliation(s)
- Jian-Xin Liu
- Department of Hematology, Peking University International Hospital, Beijing 102206, China
| | - Chun-Jian Wang
- Department of Hematology, Peking University International Hospital, Beijing 102206, China
| | - Ju-Hua Dai
- Department of Clinical Laboratory Examination, Peking University International Hospital, Beijing 102206, China
| | - Mei-Xiang Zhang
- Department of Hematology, Peking University International Hospital, Beijing 102206, China,E-mail:
| | - Meng Lyu
- Department of Hematology, Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China
| | - Yu-Qian Sun
- Department of Hematology, Peking University People's Hospital, Peking University Institute of Hematology, Beijing 100044, China
| | - Bin Jiang
- Department of Hematology, Peking University International Hospital, Beijing 102206, China
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50
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Heazlewood SY, Ahmad T, Mohenska M, Guo BB, Gangatirkar P, Josefsson EC, Ellis SL, Ratnadiwakara M, Cao H, Cao B, Heazlewood CK, Williams B, Fulton M, White JF, Ramialison M, Nilsson SK, Änkö ML. The RNA-binding protein SRSF3 has an essential role in megakaryocyte maturation and platelet production. Blood 2022; 139:1359-1373. [PMID: 34852174 PMCID: PMC8900270 DOI: 10.1182/blood.2021013826] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/06/2021] [Indexed: 11/20/2022] Open
Abstract
RNA processing is increasingly recognized as a critical control point in the regulation of different hematopoietic lineages including megakaryocytes responsible for the production of platelets. Platelets are anucleate cytoplasts that contain a rich repertoire of RNAs encoding proteins with essential platelet functions derived from the parent megakaryocyte. It is largely unknown how RNA binding proteins contribute to the development and functions of megakaryocytes and platelets. We show that serine-arginine-rich splicing factor 3 (SRSF3) is essential for megakaryocyte maturation and generation of functional platelets. Megakaryocyte-specific deletion of Srsf3 in mice led to macrothrombocytopenia characterized by megakaryocyte maturation arrest, dramatically reduced platelet counts, and abnormally large functionally compromised platelets. SRSF3 deficient megakaryocytes failed to reprogram their transcriptome during maturation and to load platelets with RNAs required for normal platelet function. SRSF3 depletion led to nuclear accumulation of megakaryocyte mRNAs, demonstrating that SRSF3 deploys similar RNA regulatory mechanisms in megakaryocytes as in other cell types. Our study further suggests that SRSF3 plays a role in sorting cytoplasmic megakaryocyte RNAs into platelets and demonstrates how SRSF3-mediated RNA processing forms a central part of megakaryocyte gene regulation. Understanding SRSF3 functions in megakaryocytes and platelets provides key insights into normal thrombopoiesis and platelet pathologies as SRSF3 RNA targets in megakaryocytes are associated with platelet diseases.
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Affiliation(s)
- Shen Y Heazlewood
- Biomedical Manufacturing CSIRO, VIC, Australia
- Australian Regenerative Medicine Institute, Monash University, VIC, Australia
| | - Tanveer Ahmad
- Biomedical Manufacturing CSIRO, VIC, Australia
- Australian Regenerative Medicine Institute, Monash University, VIC, Australia
| | - Monika Mohenska
- Australian Regenerative Medicine Institute, Monash University, VIC, Australia
| | - Belinda B Guo
- School of Biomedical Sciences, Pathology and Laboratory Science, University of Western Australia, WA, Australia
| | | | - Emma C Josefsson
- Walter and Eliza Hall Institute of Medical Research, VIC, Australia
- Department of Medical Biology, The University of Melbourne, VIC, Australia
| | - Sarah L Ellis
- Peter MacCallum Cancer Centre, and Sir Peter MacCallum Department of Oncology, University of Melbourne, VIC, Australia
- Olivia Newton-John Cancer Research Institute, Microscopy Facility and School of Cancer Medicine, La Trobe University, VIC, Australia
| | - Madara Ratnadiwakara
- Australian Regenerative Medicine Institute, Monash University, VIC, Australia
- Hudson Institute of Medical Research, VIC, Australia; and
- Department of Molecular and Translational Sciences, Monash University, VIC, Australia
| | - Huimin Cao
- Biomedical Manufacturing CSIRO, VIC, Australia
- Australian Regenerative Medicine Institute, Monash University, VIC, Australia
| | - Benjamin Cao
- Biomedical Manufacturing CSIRO, VIC, Australia
- Australian Regenerative Medicine Institute, Monash University, VIC, Australia
| | - Chad K Heazlewood
- Biomedical Manufacturing CSIRO, VIC, Australia
- Australian Regenerative Medicine Institute, Monash University, VIC, Australia
| | - Brenda Williams
- Biomedical Manufacturing CSIRO, VIC, Australia
- Australian Regenerative Medicine Institute, Monash University, VIC, Australia
| | - Madeline Fulton
- Biomedical Manufacturing CSIRO, VIC, Australia
- Australian Regenerative Medicine Institute, Monash University, VIC, Australia
| | | | - Mirana Ramialison
- Australian Regenerative Medicine Institute, Monash University, VIC, Australia
| | - Susan K Nilsson
- Biomedical Manufacturing CSIRO, VIC, Australia
- Australian Regenerative Medicine Institute, Monash University, VIC, Australia
| | - Minna-Liisa Änkö
- Australian Regenerative Medicine Institute, Monash University, VIC, Australia
- Hudson Institute of Medical Research, VIC, Australia; and
- Department of Molecular and Translational Sciences, Monash University, VIC, Australia
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