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McDonnell J, Cousins K, Younger MEM, Lane A, Abolhassani H, Abraham RS, Al-Tamemi S, Aldave-Becerra JC, Al-Faris EH, Alfaro-Murillo A, AlKhater SA, Alsaati N, Doss AMA, Anderson M, Angarola E, Ariue B, Arnold DE, Assa'ad AH, Aytekin C, Bank M, Bergerson JRE, Bleesing J, Boesing J, Bouso C, Brodszki N, Cabanillas D, Cady C, Callahan MA, Caorsi R, Carbone J, Carrabba M, Castagnoli R, Catanzaro JR, Chan S, Chandra S, Chapdelaine H, Chavoshzadeh Z, Chong HJ, Connors L, Consonni F, Correa-Jimenez O, Cunningham-Rundles C, D'Astous-Gauthier K, Delmonte OM, Demirdag YY, Deshpande DR, Diaz-Cabrera NM, Dimitriades VR, El-Owaidy R, ElGhazali G, Al-Hammadi S, Fabio G, Faure AS, Feng J, Fernandez JM, Fill L, Franco GR, Frenck RW, Fuleihan RL, Giardino G, Galant-Swafford J, Gambineri E, Garabedian EK, Geerlinks AV, Goudouris E, Grecco O, Pan-Hammarström Q, Khani HHK, Hammarström L, Hartog NL, Heimall J, Hernandez-Molina G, Horner CC, Hostoffer RW, Hristova N, Hsiao KC, Ivankovich-Escoto G, Jaber F, Jalil M, Jamee M, Jean T, Jeong S, Jhaveri D, Jordan MB, Joshi AY, Kalkat A, Kanarek HJ, Kellner ES, Khojah A, Khoury R, Kokron CM, Kumar A, Lecerf K, Lehman HK, Leiding JW, Lesmana H, Lim XR, Lopes JP, López AL, Tarquini L, Lundgren IS, Magnusson J, Marinho AKBB, Marseglia GL, Martone GM, Mechtler AG, Mendonca L, Milner JD, Mustillo PJ, Naderi AG, Naviglio S, Nell J, Niebur HB, Notarangelo L, Oleastro M, Ortega-López MC, Patel NR, Petrovic G, Pignata C, Porras O, Prince BT, Puck JM, Qamar N, Rabusin M, Raje N, Regairaz L, Risma KA, Ristagno EH, Routes J, Roxo-Junior P, Salemi N, Scalchunes C, Schuval SJ, Seneviratne SL, Shankar A, Sherkat R, Shin JJ, Siddiqi A, Signa S, Sobh A, Lima FMS, Stenehjem KK, Tam JS, Tang M, Barros MT, Verbsky J, Vergadi E, Voelker DH, Volpi S, Wall LA, Wang C, Williams KW, Wu EY, Wu SS, Zhou JJ, Cook A, Sullivan KE, Marsh R. COVID-19 Vaccination in Patients with Inborn Errors of Immunity Reduces Hospitalization and Critical Care Needs Related to COVID-19: a USIDNET Report. J Clin Immunol 2024; 44:86. [PMID: 38578389 PMCID: PMC10997719 DOI: 10.1007/s10875-023-01613-5] [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: 08/02/2023] [Accepted: 10/08/2023] [Indexed: 04/06/2024]
Abstract
BACKGROUND The CDC and ACIP recommend COVID-19 vaccination for patients with inborn errors of immunity (IEI). Not much is known about vaccine safety in IEI, and whether vaccination attenuates infection severity in IEI. OBJECTIVE To estimate COVID-19 vaccination safety and examine effect on outcomes in patients with IEI. METHODS We built a secure registry database in conjunction with the US Immunodeficiency Network to examine vaccination frequency and indicators of safety and effectiveness in IEI patients. The registry opened on January 1, 2022, and closed on August 19, 2022. RESULTS Physicians entered data on 1245 patients from 24 countries. The most common diagnoses were antibody deficiencies (63.7%). At least one COVID-19 vaccine was administered to 806 patients (64.7%), and 216 patients received vaccination prior to the development of COVID-19. The most common vaccines administered were mRNA-based (84.0%). Seventeen patients were reported to seek outpatient clinic or emergency room care for a vaccine-related complication, and one patient was hospitalized for symptomatic anemia. Eight hundred twenty-three patients (66.1%) experienced COVID-19 infection. Of these, 156 patients required hospitalization (19.0%), 47 required ICU care (5.7%), and 28 died (3.4%). Rates of hospitalization (9.3% versus 24.4%, p < 0.001), ICU admission (2.8% versus 7.6%, p = 0.013), and death (2.3% versus 4.3%, p = 0.202) in patients who had COVID-19 were lower in patients who received vaccination prior to infection. In adjusted logistic regression analysis, not having at least one COVID-19 vaccine significantly increased the odds of hospitalization and ICU admission. CONCLUSION Vaccination for COVID-19 in the IEI population appears safe and attenuates COVID-19 severity.
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Affiliation(s)
- John McDonnell
- Pediatric Allergy and Immunology, Cleveland Clinic Children's Hospital, 9500 Euclid Ave/R3, Cleveland, OH, 44195, USA.
| | - Kimberley Cousins
- Clinical Immunology, Departments of Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Adam Lane
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Hassan Abolhassani
- Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Roshini S Abraham
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, USA
- Dept of Pathology, The Ohio State Univ Wexner College of Medicine, Columbus, USA
| | - Salem Al-Tamemi
- Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Eman Hesham Al-Faris
- Department of Internal Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Alberto Alfaro-Murillo
- Department of Internal Medicine and Clinical Immunology, Hospital San Juan de Dios, San José, Costa Rica
| | - Suzan A AlKhater
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- King Fahd Hospital of University, Al-Khobar, Saudi Arabia
| | - Nouf Alsaati
- Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alexa Michelle Altman Doss
- Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Melissa Anderson
- Division of Allergy Immunology Pulmonary and Sleep Medicine, Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Ernestina Angarola
- Immunology and Histocompatibility Unit, Hospital C. G. Durand, Buenos Aires, Argentina
| | - Barbara Ariue
- Department of Pediatrics, Division of Allergy and Immunology, Loma Linda Children's Hospital, Loma Linda, CA, USA
| | - Danielle E Arnold
- Immune Deficiency-Cellular Therapy Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Amal H Assa'ad
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Caner Aytekin
- Department of Pediatric Immunology, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Meaghan Bank
- Department of Internal Medicine, Louisiana State University Health Sciences Center, New Orleans, USA
| | - Jenna R E Bergerson
- Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Rockville, MD, USA
| | - Jack Bleesing
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - John Boesing
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Carolina Bouso
- Immunology Department, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Nicholas Brodszki
- Department of Pediatric Immunology, Children's Hospital, Lund University Hospital, Lund, Sweden
| | - Diana Cabanillas
- Immunology Unit-Hospital Sor María Ludovica, La Plata, Argentina
| | - Carol Cady
- Community Medical Center, Missoula, MT, USA
| | | | - Roberta Caorsi
- Center for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy
| | - Javier Carbone
- Immunology Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - Maria Carrabba
- Department of Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Castagnoli
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jason R Catanzaro
- Section of Pulmonology, Allergy, Immunology and Sleep Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Samantha Chan
- Department of Clinical Immunology & Allergy, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Sharat Chandra
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Hugo Chapdelaine
- Clinical Immunology, Montreal Clinical Research Institute, Université de Montréal, Montreal, Canada
| | - Zahra Chavoshzadeh
- Immunology and Allergy Department, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hey Jin Chong
- Division of Allergy and Immunology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lori Connors
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Filippo Consonni
- Centre of Excellence, Division of Pediatric Oncology and Hematology, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Oscar Correa-Jimenez
- Pediatric Pulmonology and Immunology Research Group, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Charlotte Cunningham-Rundles
- Clinical Immunology, Departments of Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Yesim Yilmaz Demirdag
- Division of Basic and Clinical Immunology, Department of Medicine, University of California, Irvine, CA, USA
| | - Deepti R Deshpande
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Natalie M Diaz-Cabrera
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Victoria R Dimitriades
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of California Davis Health, Sacramento, CA, USA
| | - Rasha El-Owaidy
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Gehad ElGhazali
- Abu Dhabi and College of Medicine and Health Sciences, Sheikh Khalifa Medical City, Union71 - Purehealth, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Suleiman Al-Hammadi
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Giovanna Fabio
- Department of Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Jin Feng
- Clinical Immunology, Department of Medicine at Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James M Fernandez
- Department of Allergy & Clinical Immunology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Lauren Fill
- University Hospitals, Cleveland Medical Centers, Cleveland, OH, USA
| | - Guacira R Franco
- Division of Clinical Immunology and Allergy, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Robert W Frenck
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Infectious Disease, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ramsay L Fuleihan
- Division of Pediatric Allergy, Immunology and Rheumatology, Columbia University Medical Center, New York, NY, USA
| | - Giuliana Giardino
- Pediatric Section, Department of Translational Medical Science, Federico II University, Naples, Italy
| | | | - Eleonora Gambineri
- Centre of Excellence, Division of Pediatric Oncology and Hematology, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Elizabeth K Garabedian
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ashley V Geerlinks
- Pediatric Hematology and Oncology, Children's Hospital, Western University, London, ON, Canada
| | - Ekaterini Goudouris
- Division of Allergy and Clinical Immunology - IPPMG, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Octavio Grecco
- Division of Clinical Immunology and Allergy, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Hedieh Haji Khodaverdi Khani
- Immunology and Allergy Department, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Lennart Hammarström
- Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden
| | - Nicholas L Hartog
- Helen DeVos Children's Hospital Division of Allergy and Immunology, Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - Jennifer Heimall
- Division of Allergy and Immunology, Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Gabriela Hernandez-Molina
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Caroline C Horner
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Nataliya Hristova
- Department of Clinical Immunology and Stem Cell Bank, University Hospital Álexandrovska, Sofia, Bulgaria
| | - Kuang-Chih Hsiao
- Starship Child Health, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Clinical Immunogenomics Research Consortium Australasia, Sydney, Australia
| | - Gabriela Ivankovich-Escoto
- Department of Pediatrics, Caja Costarricense de Seguro Social, Hospital Nacional de Niños, San José, Costa Rica
| | - Faris Jaber
- Clinical Immunology, Department of Medicine at Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maaz Jalil
- Advanced ENT & Allergy, Medford, NJ, USA
| | - Mahnaz Jamee
- Pediatric Nephrology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tiffany Jean
- Division of Basic and Clinical Immunology, Department of Medicine, University of California, Irvine, CA, USA
| | - Stephanie Jeong
- Clinical Immunology, Department of Medicine at Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Devi Jhaveri
- Allergy Immunology Associates Inc., Allergy Immunology Fellowship Associate Program Director University Hospitals of Cleveland Medical Center, Cleveland, USA
| | - Michael B Jordan
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Immunobiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Avni Y Joshi
- Mayo Clinic Children's Center, Pediatric and Adult Allergy and Immunology, Mayo Clinic, Rochester, MN, USA
| | - Amanpreet Kalkat
- University Hospitals, Cleveland Medical Centers, Cleveland, OH, USA
| | | | - Erinn S Kellner
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Amer Khojah
- Department of Pediatrics, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ruby Khoury
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Cristina M Kokron
- Division of Clinical Immunology and Allergy, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ashish Kumar
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kelsey Lecerf
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
| | - Heather K Lehman
- Department of Pediatrics, University of Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Jennifer W Leiding
- Division of Allergy and Immunology, Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA
| | - Harry Lesmana
- Molecular Medicine, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Xin Rong Lim
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Joao Pedro Lopes
- UH Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Ana Laura López
- Unidad de Inmunología E Histocompatibilidad, Hospital Dr. Carlos G. Durand, Buenos Aires, Argentina
| | - Lucia Tarquini
- Section of Pathological Anatomy and Histopathology, Polytechnic University of the Marche Region, 60020, Ancona, Italy
| | - Ingrid S Lundgren
- Pediatric Infectious Diseases, St. Luke's Children's Hospital, Boise, ID, USA
| | | | - Ana Karolina B B Marinho
- Division of Clinical Immunology and Allergy, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Gian Luigi Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giulia M Martone
- Department of Pediatrics, University of Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Annamaria G Mechtler
- University of Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Leonardo Mendonca
- Division of Clinical Immunology and Allergy, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Center for Rare and Immunological Diseases, Hospital 9 de Julho - Rede DASA, São Paulo, Brazil
| | - Joshua D Milner
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Peter J Mustillo
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University Wexner College of Medicine, Columbus, OH, USA
| | - Asal Gharib Naderi
- Allergy & Immunology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Samuele Naviglio
- Pediatric Hematology-Oncology, Institute for Maternal and Child Health IRCCS "Burlo Garofolo,", Trieste, Italy
| | - Jeremy Nell
- Department of Infection and Tropical Medicine, Newcastle Upon Tyne Hospitals National Health Service (NHS) Foundation Trust and Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Hana B Niebur
- Department of Pediatrics, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE, USA
| | - Luigi Notarangelo
- Laboratory of Clinical Immunology and Microbiology, NIAID, NIH, Rockville, MD, USA
| | - Matias Oleastro
- Immunology Department, Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - María Claudia Ortega-López
- Division of Pediatrics, Allergy and Clinical Immunology, Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Neil R Patel
- Department of Pediatrics, Children's National Hospital, Washington, D.C., USA
| | - Gordana Petrovic
- Department of Clinical Immunology and Allergology, Institute of Mother and Child Health, Belgrade, Serbia
| | - Claudio Pignata
- Pediatrics, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Oscar Porras
- Pediatric Immunology and Rheumatology Department, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera,", San José, Costa Rica
| | - Benjamin T Prince
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University Wexner College of Medicine, Columbus, OH, USA
| | - Jennifer M Puck
- Division of Allergy and Immunology and Blood and Marrow Transplantation, Department of Pediatrics, University of California San Francisco School of Medicine and UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Nashmia Qamar
- Division of Allergy and Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Marco Rabusin
- Pediatric Hematology-Oncology, Institute for Maternal and Child Health IRCCS "Burlo Garofolo,", Trieste, Italy
| | - Nikita Raje
- Division of Allergy Immunology Pulmonary and Sleep Medicine, Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Lorena Regairaz
- Chief of Immunology Unit, Children's Hospital "Sor María Ludovica, Buenos Aires, Argentina
| | - Kimberly A Risma
- Division of Allergy Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - John Routes
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Persio Roxo-Junior
- Division of Immunology and Allergy, Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Negin Salemi
- Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Susan J Schuval
- Division of Allergy and Immunology, Stony Brook Children's Hospital, Stony Brook, NY, USA
| | | | - Ashwin Shankar
- University Hospitals, Cleveland Medical Centers, Cleveland, OH, USA
| | - Roya Sherkat
- Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Junghee Jenny Shin
- Section of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Sara Signa
- Center for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy
| | - Ali Sobh
- Department of Pediatrics, Faculty of Medicine, Mansoura University Children's Hospital, Mansoura University, Mansoura, Egypt
| | - Fabiana Mascarenhas Souza Lima
- Division of Clinical Immunology and Allergy, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Kristen K Stenehjem
- Department of Pediatrics, Children's National Hospital, Washington, D.C., USA
| | | | - Monica Tang
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco, USA
| | - Myrthes Toledo Barros
- Division of Clinical Immunology and Allergy, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - James Verbsky
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Eleni Vergadi
- Department of Paediatrics, Medical School, University of Crete, Rethymno, Greece
| | - Dayne H Voelker
- Division of Allergy and Immunology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Stefano Volpi
- Center for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy
- Dipartimento Di NeuroscienzeRiabilitazioneOftalmologiaGenetica e Scienze Materno Infantili, University of Genoa, 16132, Genoa, Italy
| | - Luke A Wall
- Section of Allergy Immunology, Department of Pediatrics, Louisiana State University Health and Children's Hospital New Orleans, New Orleans, LA, USA
| | - Christine Wang
- Section of Rheumatology, Department of Pediatrics, Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kelli W Williams
- Division of Pediatric Pulmonology, Allergy and Immunology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Eveline Y Wu
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shan Shan Wu
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Allergy and Immunology Associates Inc., Mayfield Heights, OH, USA
| | - Jessie J Zhou
- Department of Clinical Immunology & Allergy, The Royal Melbourne Hospital, Melbourne, Australia
| | - Alexandria Cook
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kathleen E Sullivan
- Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rebecca Marsh
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Costin C, Morgan G, Khojah A, Klein-Gitelman M, Pachman LM. Lower NK cell numbers in children with untreated juvenile dermatomyositis during the COVID-19 pandemic. Clin Immunol Commun 2023; 3:42-45. [PMID: 38014397 PMCID: PMC9938532 DOI: 10.1016/j.clicom.2023.02.007] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023]
Abstract
RNA viruses have been posited as triggers for Juvenile Dermatomyositis (JDM). The COVID-19 pandemic proved a unique opportunity to observe the effect of a novel RNA virus on JDM incidence and phenotype. We found the incidence of JDM increased from average of 6.9 cases per year from 2012 to 2019 to 9 cases per year from 2020 to 2021. We compared markers of disease activity in the patients diagnosed with JDM prior to and during the pandemic and found that patients diagnosed with JDM during the pandemic had significantly lower average NK cell counts 90.75(± 76) vs 163(±120) (P = 0.038) and NK cell percentage 3.63% (±2.3) vs. 6.6% (±4.1), (P = 0.008). Other markers of JDM did not significantly change. This study suggests that COVID-19 may be a viral trigger for JDM in selected cases and that NK cell dysregulation may be of particular interest in future research of virally triggered JDM.
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Affiliation(s)
- Christopher Costin
- Division of Pediatric Rheumatology, Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, 225 East Chicago Ave, Box 50, Chicago IL, USA
| | - Gabrielle Morgan
- Division of Pediatric Rheumatology, Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, 225 East Chicago Ave, Box 50, Chicago IL, USA
| | - Amer Khojah
- Pediatric Department, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Marisa Klein-Gitelman
- Division of Pediatric Rheumatology, Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, 225 East Chicago Ave, Box 50, Chicago IL, USA
| | - Lauren M Pachman
- Division of Pediatric Rheumatology, Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, 225 East Chicago Ave, Box 50, Chicago IL, USA
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Khojah A, Morgan G, Klein-Gitelman MS, Pachman LM. Juvenile dermatomyositis: association between nail fold capillary end row loop- area under the curve- and disease damage indicators. Pediatr Rheumatol Online J 2023; 21:137. [PMID: 37957619 PMCID: PMC10641947 DOI: 10.1186/s12969-023-00919-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Juvenile Dermatomyositis (JDM) is a rare autoimmune disease characterized by skin and muscle inflammation. The loss of nail fold capillary end row loops (ERL) is evidence of small vessel involvement in JDM. This study aimed to examine the specific association of ERL over the disease course with evidence of JDM disease damage. METHODS We analyzed data from 68 initially treatment-naïve JDM children who had been observed for at least five years with multiple ERL density assessments. The JDM disease course were categorized into monocyclic short, monocyclic long, polycyclic, and chronic. The ERL capillary count was cumulatively evaluated using the area under the curve (AUC) method. RESULTS The mean ERL density for the treatment-naive JDM was significantly lower than that of their healthy age-matched controls (4.8 ± 1.6 /mm vs. 7.9 ± 0.9 /mm; p < 0.0001). The ERL AUC was significantly lower in children with a chronic disease course compared to those with a monocyclic short (p = 0.001) or monocyclic long disease course (p = 0.013). JDM patients with lipodystrophy had lower ERL AUC than those without lipodystrophy (p = 0.04). There was no association between ERL AUC and calcifications or fractures. CONCLUSION Persistently decreased ERL capillary density, reflected by low ERL AUC, is associated with a chronic disease course and lipodystrophy in JDM. Despite medical therapy, the mean ERL count remained below normal even after five years, particularly in polycyclic and chronic cases. It is not clear that restoring normal capillary density is currently feasible in children with JDM.
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Affiliation(s)
- Amer Khojah
- Department of Pediatrics, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 50, Chicago, IL, 60611, USA
| | - Gabrielle Morgan
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 50, Chicago, IL, 60611, USA
| | - Marisa S Klein-Gitelman
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 50, Chicago, IL, 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lauren M Pachman
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 50, Chicago, IL, 60611, USA.
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Pachman LM, Morgan G, Klein-Gitelman MS, Ahsan N, Khojah A. Nailfold capillary density in 140 untreated children with juvenile dermatomyositis: an indicator of disease activity. Pediatr Rheumatol Online J 2023; 21:118. [PMID: 37828536 PMCID: PMC10571265 DOI: 10.1186/s12969-023-00903-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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/30/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND We lack a reliable indicator of disease activity in Juvenile Dermatomyositis (JDM), a rare disease. The goal of this study is to identify the association of nailfold capillary End Row Loop (ERL) loss with disease damage in children with newly diagnosed, untreated JDM. FINDINGS We enrolled 140 untreated JDM and 46 age, race and sex matched healthy controls, ages 2-17. We selected items from the Juvenile Myositis Registry for analysis. Variables include average ERL density of 8 fingers, average capillary pattern, hemorrhages, and clinical and laboratory correlates. Laboratory data includes Myositis Specific Antibodies (MSA), disease activity scores (DAS), Childhood Myositis Assessment Scale (CMAS), and standard clinical serologic data. The reduced mean ERL density is 5.1 ± 1.5/mm for untreated JDM vs 7.9 ± 0.9/mm for healthy controls, p < 0.0001, and is associated with DAS-skin, r = -0.27 p = 0.014, which did not change within the age range tested. Untreated JDM with MSA Tif-1-γ had the lowest ERL density, (p = 0.037); their ERL patterns were primarily "open" and the presence of hemorrhages in the nailfold matrix was associated with dysphagia (p = 0.004). CONCLUSIONS Decreased JDM ERL density is associated with increased clinical symptoms; nailfold hemorrhages are associated with dysphagia. Duration of untreated disease symptoms and MSA, modify NFC shape. We speculate nailfold characteristics are useful indicators of disease activity in children with JDM before start of therapy.
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Affiliation(s)
- Lauren M Pachman
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 50, Chicago, IL, 60611, USA.
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Gabrielle Morgan
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 50, Chicago, IL, 60611, USA
| | - Marisa S Klein-Gitelman
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 50, Chicago, IL, 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Najah Ahsan
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 50, Chicago, IL, 60611, USA
| | - Amer Khojah
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 50, Chicago, IL, 60611, USA
- Department of Pediatrics, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
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Alzahrani L, Alshareef HH, Alghamdi HF, Melebary R, Badahdah SN, Melebary R, Binhussein M, Khojah I, Bukhari A, Khojah A. Food Allergy: Knowledge and Attitude of Primary School Teachers in Makkah Region, Saudi Arabia. Cureus 2023; 15:e45203. [PMID: 37842477 PMCID: PMC10576194 DOI: 10.7759/cureus.45203] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/17/2023] Open
Abstract
Food allergy is a serious and potentially life-threatening medical condition that affects both adults and children. School teachers are considered to be among the first line of defense in identifying and responding to such situations, as 22% of food allergic reactions occur in schools. It is, therefore, important to understand the knowledge and attitudes of school teachers toward food allergy. This study is a descriptive, cross-sectional investigation conducted using an online questionnaire from December 2022 to February 2023. We collected data from 413 primary school teachers in Makkah region, Saudi Arabia. SPSS version 21 (IBM Corp., Armonk, NY) was used to analyze the data. Out of 413 teachers who met the inclusion criteria, only 14.5% demonstrated good awareness levels (scoring above 60% on the knowledge questionnaire) regarding food allergy, with young teachers making up the highest proportion as 26.1% of younger teachers had good awareness levels compared to 8.8% of teachers aged 51-60 years (p = 0.012). Additionally, 46.7% of the teachers knew the symptoms of a severe allergic reaction, and only 16.7% knew that they should use an epinephrine pen as the first step in managing a severe allergic reaction. School teachers have insufficient knowledge about food allergies, underscoring the importance of establishing school policies to handle food allergies. Such policies should encompass the adoption of a comprehensive food allergy action plan, training programs for school personnel, and educational campaigns.
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Affiliation(s)
| | | | | | - Renad Melebary
- College of Medicine, Umm Al-Qura University, Makkah, SAU
| | | | - Razan Melebary
- College of Medicine, Umm Al-Qura University, Makkah, SAU
| | | | - Imad Khojah
- Department of Emergency Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | | | - Amer Khojah
- College of Medicine, Umm Al-Qura University, Makkah, SAU
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Khojah A, Morgan G, Klein-Gitelman MS, Pachman LM. Juvenile Dermatomyositis: Association between Nail Fold Capillary End Row Loops Area Under the Curve and Disease Damage Indicators. Res Sq 2023:rs.3.rs-3235841. [PMID: 37674726 PMCID: PMC10479441 DOI: 10.21203/rs.3.rs-3235841/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Background Juvenile Dermatomyositis (JDM) is a rare autoimmune disease characterized by skin and muscle inflammation. The loss of nail fold capillary end row loops (ERL) is evidence of small vessel involvement in JDM. This study aimed to examine the association of ERL over the disease course and evidence of disease damage. Methods We analyzed data from 68 initially treatment-naïve JDM children who had been observed for at least five years with multiple ERL density assessments. The JDM disease courses were categorized into monocyclic short, monocyclic long, polycyclic, and chronic. The ERL capillary count was cumulatively evaluated using the area under the curve (AUC) method. Results The mean ERL density for the treatment-naive JDM was significantly lower than that of their healthy controls (4.8±1.6 /mm vs. 7.9±0.9 /mm; p <0.0001). The ERL AUC was significantly lower in children with chronic disease course compared to those with monocyclic short (p =0.001) or monocyclic long disease course (p =0.013). JDM patients with lipodystrophy had lower ERL AUC than those without lipodystrophy (p =0.04). There was no association between ERL AUC and calcifications or fractures. Conclusion Persistently decreased ERL capillary density, evident by low ERL AUC, is associated with chronic disease course and lipodystrophy in JDM. Despite medical therapy, the mean ERL count remained below normal even after five years, particularly in polycyclic and chronic cases. Therefore, the goal of restoring normal capillary density in children with JDM might be challenging and require novel therapeutic strategies targeting their underlying endothelial dysfunction.
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Costin C, Khojah A, Ochfeld E, Morgan G, Subramanian S, Klein-Gitelman M, Tan XD, Pachman LM. B Cell Lymphocytosis in Juvenile Dermatomyositis. Diagnostics (Basel) 2023; 13:2626. [PMID: 37627885 PMCID: PMC10453137 DOI: 10.3390/diagnostics13162626] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/21/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
In this study, we determined if B lymphocytosis may serve as a JDM biomarker for disease activity. Children with untreated JDM were divided into two groups based on age-adjusted B cell percentage (determined through flow cytometry): 90 JDM in the normal B cell group and 45 in the high B cell group. We compared through T-testing the age, sex, ethnicity, duration of untreated disease (DUD), disease activity scores for skin (sDAS), muscle (mDAS), total (tDAS), CMAS, and neopterin between these two groups. The patients in the high B cell group had a higher tDAS (p = 0.009), mDAS (p = 0.021), and neopterin (p = 0.0365). Secondary analyses included B cell values over time and BAFF levels in matched patients with JM (juvenile myositis) and concurrent interstitial lung disease (ILD); JM alone and healthy controls Patient B cell percentage and number was significantly higher after 3-6 months of therapy and then significantly lower on completion of therapy (p =< 0.0001). The JM groups had higher BAFF levels than controls 1304 vs. 692 ng/mL (p = 0.0124). This study supports B cell lymphocytosis as a JDM disease-activity biomarker and bolsters the basis for B cell-directed therapies in JDM.
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Affiliation(s)
- Christopher Costin
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Amer Khojah
- Department of Pediatrics, College of Medicine, Umm Al-Qura University, Makkah 24341-6660, Saudi Arabia
| | - Elisa Ochfeld
- Division of Allergy and Immunology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Gabrielle Morgan
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Saravanan Subramanian
- Department of Pediatrics, College of Medicine, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Marisa Klein-Gitelman
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Xiao-Di Tan
- Department of Pediatrics, College of Medicine, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Lauren M. Pachman
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
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Pazhanisamy A, Jorge SD, Zimmermann MT, Kitcharoensakkul M, Abdalgani M, Khojah A, Victor C, Rueda C, Urrutia R, Abraham RS. Advanced computational analysis of CD40LG variants in atypical X-linked hyper-IgM syndrome. Clin Immunol 2023; 253:109692. [PMID: 37433422 DOI: 10.1016/j.clim.2023.109692] [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: 03/29/2023] [Revised: 05/31/2023] [Accepted: 07/03/2023] [Indexed: 07/13/2023]
Abstract
X-Linked Hyper-IgM Syndrome is caused by pathogenic variants in CD40LG. Three patients with atypical clinical and immunological features were identified with variants in CD40LG requiring further characterization. Flow cytometry was used to evaluate CD40L protein expression and binding capacity to a surrogate receptor, CD40-muIg. Though functional anomalies were observed, there was still a lack of clarity regarding the underlying mechanism. We developed structural models for wild-type and the three variants of CD40L protein observed in these patients (p. Lys143Asn, Leu225Ser and Met36Arg) to evaluate structural alterations by molecular mechanic calculations, and assess protein movement by molecular dynamic simulations. These studies demonstrate that functional analysis of variants of unknown significance in CD40LG can be supplemented by advanced computational analysis in atypical clinical contexts. These studies in combination identify the deleterious effects of these variants and potential mechanisms for protein dysfunction.
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Affiliation(s)
- Amudha Pazhanisamy
- Department of Pediatrics, Nationwide Children's Hospital, OH, USA; The Ohio State University Wexner Medical Center, OH, USA
| | | | | | - Maleewan Kitcharoensakkul
- Division of Rheumatology/Immunology, Department of Pediatrics, Washington University in St. Louis, MO, USA
| | | | - Amer Khojah
- Department of Pediatrics, Umm Al-Qura University, Saudi Arabia
| | - Christian Victor
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, OH, USA
| | - Cesar Rueda
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, OH, USA
| | | | - Roshini S Abraham
- The Ohio State University Wexner Medical Center, OH, USA; Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, OH, USA.
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Gunderman LM, Asano T, Casanova JL, Boisson B, Khojah A. Novel NF-kappa B Inhibitor Alpha Gain-of-Function Variant in an Infant with Lymphocytosis and Recurrent Serratia Bacteremia. J Clin Immunol 2023; 43:1122-1126. [PMID: 37036561 DOI: 10.1007/s10875-023-01481-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: 06/22/2022] [Accepted: 03/24/2023] [Indexed: 04/11/2023]
Affiliation(s)
- Lauren M Gunderman
- Department of Allergy and Immunology, Ann & Robert H Lurie Children's Hospital of Chicago, 225 E. Chicago Avenue, Box 60, Chicago, IL, USA.
| | - Takaki Asano
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
| | - Jean-Laurent Casanova
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Paris, France
- Imagine Institute, University Paris Cité, Paris, France
- Department of Pediatrics, Necker Hospital for Sick Children, Paris, France
- Howard Hughes Medical Institute, New York, NY, USA
| | - Bertrand Boisson
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Paris, France
- Imagine Institute, University Paris Cité, Paris, France
| | - Amer Khojah
- Pediatrics Department, College of Medicine at Umm Al-Qura University, Mecca, Saudi Arabia
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Bukhari A, Khojah A, Marin W, Khramtsov A, Khramtsova G, Costin C, Morgan G, Ramesh P, Klein-Gitelman MS, Le Poole IC, Pachman LM. Increased Otoferlin Expression in B Cells Is Associated with Muscle Weakness in Untreated Juvenile Dermatomyositis: A Pilot Study. Int J Mol Sci 2023; 24:10553. [PMID: 37445728 PMCID: PMC10341737 DOI: 10.3390/ijms241310553] [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: 05/02/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
Otoferlin mRNA expression is increased in JDM patients' PBMCs and muscle compared to healthy controls. This study aims to evaluate the role of otoferlin in JDM disease pathophysiology and its association with disease activity in untreated children with JDM. A total of 26 untreated JDM (88.5% female, 92.3% white, non-Hispanic) and 15 healthy controls were included in this study. Otoferlin mRNA expression was determined by qRT-PCR before and a few months after therapy. Detailed flow cytometry of various cell surface markers and cytoplasmic otoferlin was performed to identify cells expressing otoferlin. In addition, muscle otoferlin expression was evaluated in situ in six untreated JDM patients and three healthy controls. There was a significant increase in otoferlin expression in JDM children compared to controls (Median 67.5 vs. 2.1; p = 0.001). There was a positive correlation between mRNA otoferlin expression and the following disease activity markers: disease activity scores (DAS)-total (rs = 0.62, p < 0.001); childhood myositis assessment scale (CMAS) (rs = -0.61, p = 0.002); neopterin (rs = 0.57, p = 0.004) and von Willebrand factor antigen (vWF: Ag) (rs = 0.60, p = 0.004). Most of the otoferlin-positive cells were unswitched B cells (63-99.4%), with 65-75% of them expressing plasmablast markers (CD19+, IgM+, CD38hi, CD24-). The findings of this pilot study suggest that otoferlin expression is associated with muscle weakness, making it a possible biomarker of disease activity. Additionally, B cells and plasmablasts were the primary cells expressing otoferlin.
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Affiliation(s)
- Ameera Bukhari
- College of Science, Taif University, Taif 21944, Saudi Arabia
| | - Amer Khojah
- Department of Pediatrics, College of Medicine, Umm Al-Qura University, Makkah 24381, Saudi Arabia
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Wilfredo Marin
- Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA (G.K.)
| | - Andrey Khramtsov
- Department of Pathology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Galina Khramtsova
- Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA (G.K.)
| | - Christopher Costin
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Gabrielle Morgan
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Prathyaya Ramesh
- Department of Pathology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
- Department of Dermatology, Microbiology & Immunology, Northwestern University, Chicago, IL 60611, USA
| | - Marisa S. Klein-Gitelman
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - I. Caroline Le Poole
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Department of Dermatology, Microbiology & Immunology, Northwestern University, Chicago, IL 60611, USA
| | - Lauren M. Pachman
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Gibbs E, Khojah A, Morgan G, Ehwerhemuepha L, Pachman LM. The von Willebrand Factor Antigen Reflects the Juvenile Dermatomyositis Disease Activity Score. Biomedicines 2023; 11:biomedicines11020552. [PMID: 36831088 PMCID: PMC9953073 DOI: 10.3390/biomedicines11020552] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE This study determined if an accessible, serologic indicator of vascular disease activity, the von Willebrand factor antigen (vWF:Ag), was useful to assess disease activity in children with juvenile dermatomyositis (JDM), a rare disease, but the most common of the pediatric inflammatory myopathies. METHODS A total of 305 children, median age 10 years, 72.5% female, 76.5% white, with definite/probable JDM at diagnosis, were enrolled in the Ann & Robert H. Lurie Cure JM Juvenile Myositis Repository, a longitudinal database. Disease Activity Score (DAS) and vWF:Ag data were obtained at each visit. These data were analyzed using generalized estimating equation (GEE) models (both linear and logistic) to determine if vWF:Ag reflects disease severity in children with JDM. A secondary analysis was performed for untreated active JDM to exclude the effect of medications on vWF:Ag. RESULT The vWF:Ag test was elevated in 25% of untreated JDM. We found that patients with elevated vWF:Ag had a 2.55-fold higher DAS total (CI95: 1.83-3.27, p < 0.001). Patients with difficulty swallowing had 2.57 higher odds of elevated vWF:Ag (CI95: 1.5-4.38, p < 0.001); those with more generalized skin involvement had 2.58-fold higher odds of elevated vWF:Ag (CI95: 1.27-5.23, p = 0.006); and those with eyelid peripheral blood vessel dilation had 1.32-fold higher odds of elevated vWF:Ag (CI95: 1.01-1.72, p = 0.036). Untreated JDM with elevated vWF:Ag had more muscle weakness and higher muscle enzymes, neopterin and erythrocyte sedimentation rate compared to JDM patients with a normal vWF:Ag. CONCLUSION vWF:Ag elevation is a widely accessible concomitant of active disease in 25% of JDM.
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Affiliation(s)
- Ellie Gibbs
- Department of Biological Sciences, Wellesley College, Wellesley, MA 02481, USA
| | - Amer Khojah
- Department of Pediatrics, College of Medicine, Umm Al-Qura University, Makkah 21421, Saudi Arabia
| | - Gabrielle Morgan
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Cure-JM Center of Excellence in Juvenile Myositis Research and Care, Chicago, IL 60611, USA
| | - Louis Ehwerhemuepha
- Computational Research, Children’s Hospital of Orange County Research Institute, Orange, CA 92868, USA
| | - Lauren M. Pachman
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Cure-JM Center of Excellence in Juvenile Myositis Research and Care, Chicago, IL 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Correspondence:
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Hartono S, Li M, Laky K, Khojah A, Scimone E, Lin A, Guerrerio P. Clinical and Immunologic Phenotype of Patients with SMAD4 Gain-of-Function Mutations. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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McAuley J, Gunderman L, Khojah A. THROMBOCYTOPENIA, HYPOGAMMAGLOBULINEMIA, AND POOR VACCINE RESPONSE IN A PATIENT WITH TAKENOUCHI-KOSAKI SYNDROME. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Barth syndrome (BTHS) is an X linked recessive disorder caused by a mutation in the tafazzin (TAZ) gene classically associated with the triad of neutropaenia and cardiac and skeletal myopathies. Here we present a case of BTHS in a 2-month-old male patient found to have a novel variant of the TAZ gene (hemizygous c.639G>A) leading to early termination of the tafazzin protein (p.Trp213Ter) with presumed loss of function. Our patient was found to have dilated cardiomyopathy, cyclic neutropaenia and growth delays, which in combination with genetic work-up confirmed the diagnosis of BTHS. He also experienced repeated bacterial and viral infections, prompting an immunological work-up which revealed persistent B cell lymphopaenia and hypogammaglobulinaemia. He ultimately required subcutaneous immunoglobulin replacement and GM-CSF for ongoing hypogammaglobulinaemia and neutropaenia. To our knowledge, this case is the first report of BTHS associated with B cell lymphopaenia and hypogammaglobulinaemia.
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Affiliation(s)
- Elizabeth Kudlaty
- Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Neha Agnihotri
- Allergy and Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amer Khojah
- Pediatrics, Umm Al-Qura University College of Medicine, Makkah, Saudi Arabia
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Gunderman LM, Valika T, Carol H, Khojah A. Improvement of SLC29A3 spectrum disorder-related sensorineural hearing loss after initiation of IL-6 inhibitor. BMJ Case Rep 2022; 15:15/6/e249191. [DOI: 10.1136/bcr-2022-249191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Tocilizumab is reported to reduce systemic inflammation in individuals with SLC29A3 spectrum disorder, but its effect on hearing loss has not been described. The authors present a boy toddler with a history of prematurity, dysphagia, hypersplenism, hyperpigmentation, short height and hearing loss who was referred to the immunology clinic. He initially presented shortly after birth with abnormal hearing screens followed by positive urine test for cytomegalovirus. However, the infection was determined to be postnatally acquired and hearing loss most likely from genetic causes given a family history of hearing loss and consanguinity. A pathogenic variant in SLC29A3 was found on whole-exome sequencing and given concern for SLC29A3 spectrum disorder, steroids were started. Following concerns for development of side effects with chronic steroid use, he was switched to interleukin 6 inhibitor therapy. The patient’s inflammatory markers decreased on tocilizumab, and his sensorineural hearing loss was notable for improvement and stabilisation on therapy.
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Ochfeld E, Hans V, Marin W, Ahsan N, Morgan G, Pachman LM, Khojah A. Coding joint: kappa-deleting recombination excision circle ratio and B cell activating factor level: predicting juvenile dermatomyositis rituximab response, a proof-of-concept study. BMC Rheumatol 2022; 6:36. [PMID: 35527253 PMCID: PMC9082850 DOI: 10.1186/s41927-022-00265-z] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/24/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND This pilot study's primary aim was to determine if oligoclonal B cell expansion in children with Juvenile Dermatomyositis (JDM) predicts response to Rituximab therapy. We evaluated: (1) tissue B cell depletion efficacy by measuring the ratio of Coding joint (CJ) to Kappa-deleting recombination excision circle (KREC) DNA, and (2) serum BAFF level upon B cell recovery. METHODS CJ and KREC values were measured via qPCR assessment of serial PBMC stored (- 80 °C) in the CureJM Center's BioRepository. Serum BAFF was quantitated by Mesoscale® technology. Oligoclonal B cell expansion was defined as a CJ:KREC ≥ 8 prior to Rituximab therapy. Detection of a CJ:KREC ratio ≤ 2.5 in the first sample after Rituximab was designated as adequate B cell depletion. A significant clinical response to therapy was defined as improvement in Disease Activity Score (DAS) by at least 2 points on consecutive visits within the first 12 months of therapy. RESULTS Six out of nine children with JDM showed oligoclonal B cell expansion prior to Rituximab (CJ:KREC ≥ 8). Of those 6 patients, 4 had evidence of effective B cell depletion after Rituximab (CJ:KREC ≤ 2.5), and all 4 of those subjects displayed a significant clinical response to Rituximab. Serum BAFF level increased in 8/9 children after Rituximab. CONCLUSIONS In this proof-of-concept study, JDM patients with oligoclonal B cell expansion prior to Rituximab have more favorable clinical outcomes after Rituximab. We speculate: (1) B cell depletion post-Rituximab predicts JDM clinical response; (2) increased BAFF post-Rituximab may contribute to disease flare.
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Affiliation(s)
- Elisa Ochfeld
- Pediatric Allergy-Immunology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box #60, Chicago, IL, 60611, USA
- Division of Allergy-Immunology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Victoria Hans
- Cure JM Center of Excellence, Stanley Manne Research Center, Chicago, IL, USA
| | - Wil Marin
- Cure JM Center of Excellence, Stanley Manne Research Center, Chicago, IL, USA
| | - Najah Ahsan
- Cure JM Center of Excellence, Stanley Manne Research Center, Chicago, IL, USA
| | - Gabrielle Morgan
- Cure JM Center of Excellence, Stanley Manne Research Center, Chicago, IL, USA
| | - Lauren M Pachman
- Cure JM Center of Excellence, Stanley Manne Research Center, Chicago, IL, USA
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Amer Khojah
- Pediatric Allergy-Immunology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box #60, Chicago, IL, 60611, USA.
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
- Pediatric Department, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
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Padem N, Wright H, Fuleihan R, Garabedian E, Suez D, Cunningham-Rundles C, Marsh RA, Khojah A. Rheumatologic diseases in patients with inborn errors of immunity in the USIDNET registry. Clin Rheumatol 2022; 41:2197-2203. [PMID: 35099673 DOI: 10.1007/s10067-021-06044-4] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/10/2021] [Accepted: 12/28/2021] [Indexed: 02/08/2023]
Abstract
There is a gap in clinical knowledge regarding associations between specific inborn errors of immunity (IEIs) and rheumatologic diseases. This study reports the frequency of rheumatologic conditions in a large cohort of patients with IEI using the USIDNET (United States Immunodeficiency Network) registry. We used the USIDNET registry to conduct the analysis. We included all IEI patients within the registry for whom a diagnosed rheumatologic disease was reported. The total number of patients with IEI in our query was 5058. Among those, 278 (5.49%) patients had a diagnosis of rheumatologic disease. This cohort included 172 (61.8%) female and 106 (38.2%) male patients. Rheumatologic complications were highest in the interferonopathies (66.6%), autoimmune lymphoproliferative syndrome (ALPS) (13.7%), and immunoglobulin G subclass deficiency (IgGSD) (11.11%). Additionally, disease patterns were noted to be different in various IEI disease groups. Inflammatory myopathies were the most common rheumatologic condition in patients with X-linked agammaglobulinemia (1.65%), Sjogren's syndrome was the most common rheumatologic disease reported in ALPS patients (6.85%), and systemic lupus erythematosus was the most common rheumatologic disease in patients with chronic mucocutaneous candidiasis (CMC) (7.41%). Rheumatoid arthritis (RA) report rate was highest in patients with IgGSD (3.70%), specific antibody deficiency (SAD) (3.66%), and ALPS (2.74%). This study reports that rheumatologic diseases are frequently observed in patients with IEI. The frequency of different rheumatologic conditions was variable based on the underlying diagnosis. Clinicians caring for patients with IEI should be vigilant to monitor for rheumatologic complications. Key Points • The rates of reported rheumatologic diseases in the USIDNET registry are different in individual IEIs. • Further studies are needed to guide clinicians for detecting rheumatologic conditions earlier in patients with IEI.
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Affiliation(s)
- N Padem
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, 705 Riley Hospital Dr, ROC 4270, Indianapolis, IN, 46202, USA.
| | - H Wright
- United States Immunodeficiency Network, Towson, MD, USA
| | - R Fuleihan
- Division of Allergy, Immunology and Rheumatology, Columbia University Irving Medical Center, New York, NY, USA
| | - E Garabedian
- Division of Intramural Research, National Human Genome Research Institute, NIH, Bethesda, MD, USA
| | - D Suez
- Allergy, Asthma & Immunology Clinic, PA, Irving, TX, USA
| | - C Cunningham-Rundles
- Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - R A Marsh
- Department of Pediatrics, University of Cincinnati, Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - A Khojah
- Department of Pediatrics, College of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
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Khojah A, Morgan G, Pachman LM. Clues to Disease Activity in Juvenile Dermatomyositis: Neopterin and Other Biomarkers. Diagnostics (Basel) 2021; 12:8. [PMID: 35054173 PMCID: PMC8774344 DOI: 10.3390/diagnostics12010008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/17/2022] Open
Abstract
Easily accessible biomarkers are urgently needed to evaluate immune activation in Juvenile Dermatomyositis (JDM). The goal of this retrospective study is to define immunological and clinical differences between untreated JDM patients with either normal or elevated (>10 mmol/L) levels of neopterin, a biomarker of macrophage activation. We included all JDM with neopterin data obtained before initiating medical therapy. We assessed T, B, NK cell populations, muscle enzymes, and disease activity scores for skin (sDAS), muscle (mDAS), total (tDAS), the duration of untreated disease, disease course, and myositis-specific antibody (MSA). Seventy-nine percent of 139 untreated JDM patients had elevated serum neopterin. The group with elevated neopterin had significantly more active disease: tDAS 11.9 vs. 8.1 (p < 0.0001), mDAS 5.8 vs. 3.1 (p < 0.0001), sDAS 6.1 vs. 4.9 (p = 0.0002), aldolase 24.0 vs. 7.6 U/L (p < 0.0001), von Willebrand factor antigen (p < 0.0001), and ESR 19.8 vs. 11.5 mm/hr (p = 0.01). The flow cytometry documented both reduced T cells (1494 vs. 2278/mm3, p = 0.008) and NK cells (145 vs. 240/mm3, p = 0.003). TNFα-308AA/AG polymorphism was more common in children with elevated neopterin than TNFα-308GG (p 0.05). We conclude that the availability of neopterin data will contribute to the rapid assessment of untreated JDM disease activity.
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Affiliation(s)
- Amer Khojah
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA;
- Division of Allergy & Immunology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Gabrielle Morgan
- Cure JM Center of Excellence, Stanley Manne Research Center, Chicago, IL 60611, USA;
| | - Lauren M. Pachman
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA;
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Cure JM Center of Excellence, Stanley Manne Research Center, Chicago, IL 60611, USA;
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Khojah A, Liu V, Morgan G, Shore RM, Pachman LM. Changes in total body fat and body mass index among children with juvenile dermatomyositis treated with high-dose glucocorticoids. Pediatr Rheumatol Online J 2021; 19:118. [PMID: 34376205 PMCID: PMC8353815 DOI: 10.1186/s12969-021-00622-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/03/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE High-dose glucocorticoids (GC) remain the primary therapy to induce remission in Juvenile Dermatomyositis (JDM). Studies of the natural history of GC associated weight gain in children are very limited, especially in the JDM population. This study aims to measure BMI changes in a cohort of JDM subjects over 60 months and to examine the changes in body composition by DXA. METHODS We included all subjects with JDM who had 5 years of follow-up data and multiple DXA studies. BMI and total body fat (TBF) percentiles were calculated based on the CDC published percentile charts. To study the natural history of weight gain and TBF, we assessed the data at four-time points (T0 = baseline, T1 > 1.5 years, T2 = 1.51-3.49 years, T3 = 3.5-5 years). RESULTS 68 subjects (78% female, 70% white) were included in this retrospective study. Paired T-test showed a significant increase in the mean BMI percentile by 17.5 points (P = 0.004) after the initiation of medical treatment, followed by a gradual decrease over the study period. However, the TBF percentile did not change over the study period. TBF in the last visit (T3) had a strong correlation with the T1 BMI, and T1 TBF percentile (correlation coefficients 0.63, 0.56 P < 0.001, 0.002 respectively). Also, there was a positive correlation (correlation coefficients 0.39, P = 0.002) between the TBF percentile and muscle DAS but not the skin DAS. CONCLUSIONS Although the BMI percentile decreased throughout the study, the TBF percentile remained high until the end of the study (60 months). This finding raises the concern that some of the reduction in the BMI percentile could reflect a drop in the lean body mass from muscle wasting rather than actual fat loss.
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Affiliation(s)
- Amer Khojah
- Division of Pediatric Rheumatology, Department of Pediatric, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA. .,Division of Allergy & Immunology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. .,Cure JM Center of Excellence, Stanley Manne Research Center, Chicago, IL, USA.
| | - Victoria Liu
- Cure JM Center of Excellence, Stanley Manne Research Center, Chicago, IL USA
| | - Gabrielle Morgan
- Cure JM Center of Excellence, Stanley Manne Research Center, Chicago, IL USA
| | - Richard M. Shore
- grid.413808.60000 0004 0388 2248Department of Medical Imaging, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Lauren M. Pachman
- grid.413808.60000 0004 0388 2248Division of Pediatric Rheumatology, Department of Pediatric, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611 USA ,Cure JM Center of Excellence, Stanley Manne Research Center, Chicago, IL USA
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20
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Ochfeld E, Curran ML, Chiarella SE, Ardalan K, Khojah A. A Case Report of SAVI Mimicking Early-Onset ANCA Vasculitis. J Clin Immunol 2021; 41:1652-1655. [PMID: 34089458 DOI: 10.1007/s10875-021-01072-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/20/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Elisa Ochfeld
- Pediatric Allergy-Immunology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box #60, Chicago, IL, 60611, USA. .,Division of Allergy- Immunology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Megan L Curran
- Section of Rheumatology, Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Kaveh Ardalan
- Division of Pediatric Rheumatology, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.,Division of Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Departments of Pediatrics and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amer Khojah
- Pediatric Allergy-Immunology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box #60, Chicago, IL, 60611, USA.,Division of Allergy- Immunology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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21
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Oman Evans M, Petersen MM, Khojah A, Jyonouchi SC, Edwardson GS, Khan YW, Connelly JA, Morris D, Majumdar S, McDermott DH, Walter JE, Murphy PM. Correction to: TREC Screening for WHIM Syndrome. J Clin Immunol 2021; 41:629-630. [PMID: 33506316 PMCID: PMC11027512 DOI: 10.1007/s10875-021-00976-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | | | - Amer Khojah
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | - George S Edwardson
- Wright-Patterson Medical Center, Wright-Patterson Air Force Base, Wright-Patterson AFB, OH, USA
| | | | | | | | - Shamik Majumdar
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - David H McDermott
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jolan E Walter
- University of South Florida and Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
- Massachusetts General Hospital for Children, Boston, MA, USA
| | - Philip M Murphy
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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22
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Khojah A, Liu V, Savani SI, Morgan G, Shore R, Bellm J, Pachman LM. Studies of 96 children with Juvenile Dermatomyositis: P155/140, is associated with loss of nailfold capillaries, but not generalized lipodystrophy. Arthritis Care Res (Hoboken) 2020; 74:1065-1069. [PMID: 33290639 DOI: 10.1002/acr.24535] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/02/2020] [Accepted: 12/03/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Myositis-specific antibodies (MSA) facilitate grouping children with Juvenile Dermatomyositis (JDM) into distinct phenotypes. Aim one of this study investigates the link between anti-P155/140 and lipodystrophy as determined by DXA assessment of fat distribution. Aim two examines the relationship between anti-P155/140 and damage to the nailfold capillary system. METHODS Children with JDM followed for a minimum of five years were included. The study population was divided into three groups (anti-P155/140, other MSA, and MSA negative). Lipodystrophy was assessed by physician assessment and DXA fat distribution (Trunk:Leg fat ratio). Documentation of nailfold capillary end-row loops (ERL) was obtained at diagnosis RESULTS: 96 subjects (44% anti-P155/140, 23% other MSA, 33% MSA negative) were included. There was no significant difference in age, disease activity scores or lipodystrophy between the three groups. The Trunk:Leg fat ratios were similar among the three groups at different time points. However, the anti-P155/140 group had significantly decreased (ERL) count (p-value = 0.006) at baseline as well as a prolonged duration of untreated disease at diagnosis (p-value = 0.027). Also, the anti-P155/140 group has fewer patients with monophasic disease course than the other two groups (p-value = 0.008) CONCLUSIONS: Generalized lipodystrophy frequency was equivalent in all three groups based on physician assessments and Trunk:Leg fat ratios. The anti-P155/140 group had a greater loss of ERL, suggesting that this MSA may impact the vascular component of JDM.
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Affiliation(s)
- Amer Khojah
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Division of Allergy & Immunology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Cure JM Center of Excellence, Stanley Manne Research Center, Chicago, IL, USA
| | - Victoria Liu
- Cure JM Center of Excellence, Stanley Manne Research Center, Chicago, IL, USA
| | - Sonia I Savani
- Medical University of South Carolina, Charleston, SC, USA
| | - Gabrielle Morgan
- Cure JM Center of Excellence, Stanley Manne Research Center, Chicago, IL, USA
| | - Richard Shore
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jackie Bellm
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Lauren M Pachman
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Cure JM Center of Excellence, Stanley Manne Research Center, Chicago, IL, USA
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Ochfeld E, Srdanovic N, Garabedian E, Sullivan K, Marsh R, Puck J, Khojah A. Characterizing Pneumocystis jirovecii Pneumonia in patients with Primary Immunodeficiency Disorders, Data from the US Immunodeficiency Network (USIDNET) Registry. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Investigators from University of California Los Angeles studied the presence of different T cell subset population in the brain tissue of 7 patients with Rasmussen encephalitis, a rare neuroinflammatory disorder characterized by intractable seizures and usually associated with progressive hemi cerebral atrophy, who underwent brain surgery and compared them to patients with focal cortical dysplasia.
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Affiliation(s)
- Amer Khojah
- Division of Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Marisa Klein-Gitelman
- Division of Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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Batwa SA, Ashshi AM, Kamfar FF, Ahmad J, Idris S, Khojah A, Al-Qadi NM, Refaat B. Prevalence of cytomegalovirus, and its effect on the expression of inducible and endothelial nitric oxide synthases in Fallopian tubes collected from women with and without ectopic pregnancy. Eur J Clin Microbiol Infect Dis 2015; 35:103-10. [DOI: 10.1007/s10096-015-2514-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 10/23/2015] [Indexed: 10/22/2022]
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26
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Loizou D, Enav B, Komlodi-Pasztor E, Hider P, Kim-Chang J, Noonan L, Taber T, Kaushal S, Limgala R, Brown M, Gupta R, Balba N, Goker-Alpan O, Khojah A, Alpan O. A pilot study of omalizumab in eosinophilic esophagitis. PLoS One 2015; 10:e0113483. [PMID: 25789989 PMCID: PMC4366078 DOI: 10.1371/journal.pone.0113483] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 10/10/2014] [Indexed: 02/06/2023] Open
Abstract
Eosinophilic disorders of the gastrointestinal tract are an emerging subset of immune pathologies within the spectrum of allergic inflammation. Eosinophilic Esophagitis (EoE), once considered a rare disease, is increasing in incidence, with a rate of over 1 in 10,000 in the US, for unknown reasons. The clinical management of EoE is challenging, thus there is an urgent need for understanding the etiology and pathophysiology of this eosinophilic disease to develop better therapeutic approaches. In this open label, single arm, unblinded study, we evaluated the effects of an anti-IgE treatment, omalizumab, on local inflammation in the esophagus and clinical correlates in patients with EoE. Omalizumab was administered for 12 weeks to 15 subjects with long standing EoE. There were no serious side effects from the treatment. Esophageal tissue inflammation was assessed both before and after therapy. After 3 months on omalizumab, although tissue Immunoglobulin E (IgE) levels were significantly reduced in all but two of the subjects, we found that full remission of EoE, which is defined as histologic and clinical improvement only in 33% of the patients. The decrease in tryptase-positive cells and eosinophils correlated significantly with the clinical outcome as measured by improvement in endoscopy and symptom scores, respectively. Omalizumab-induced remission of EoE was limited to subjects with low peripheral blood absolute eosinophil counts. These findings demonstrate that in a subset of EoE patients, IgE plays a role in the pathophysiology of the disease and that anti-IgE therapy with omalizumab may result in disease remission. Since this study is open label there is the potential for bias, hence the need for a larger double blind placebo controlled study. The data presented in this pilot study provides a foundation for proper patient selection to maximize clinical efficacy.
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Affiliation(s)
- Denise Loizou
- Section on Immunopathogenesis, Food Allergy and Eosinophilic Disorders Program, O&O ALPAN, LLC, Fairfax, VA, United States of America
- Amerimmune, Fairfax, VA, United States of America
| | - Benjamin Enav
- Pediatric Gastroenterology of Northern Virginia, Lorton, VA, United States of America
| | - Edina Komlodi-Pasztor
- Section on Immunopathogenesis, Food Allergy and Eosinophilic Disorders Program, O&O ALPAN, LLC, Fairfax, VA, United States of America
- Lysosomal Storage Disorders Section, O&O ALPAN, LLC, Fairfax, VA, United States of America
| | - Pamela Hider
- Section on Immunopathogenesis, Food Allergy and Eosinophilic Disorders Program, O&O ALPAN, LLC, Fairfax, VA, United States of America
- Lysosomal Storage Disorders Section, O&O ALPAN, LLC, Fairfax, VA, United States of America
| | - Julie Kim-Chang
- Section on Immunopathogenesis, Food Allergy and Eosinophilic Disorders Program, O&O ALPAN, LLC, Fairfax, VA, United States of America
| | - Laura Noonan
- Section on Immunopathogenesis, Food Allergy and Eosinophilic Disorders Program, O&O ALPAN, LLC, Fairfax, VA, United States of America
| | - Tabitha Taber
- Section on Immunopathogenesis, Food Allergy and Eosinophilic Disorders Program, O&O ALPAN, LLC, Fairfax, VA, United States of America
- Lysosomal Storage Disorders Section, O&O ALPAN, LLC, Fairfax, VA, United States of America
| | - Suhasini Kaushal
- Section on Immunopathogenesis, Food Allergy and Eosinophilic Disorders Program, O&O ALPAN, LLC, Fairfax, VA, United States of America
| | - Renuka Limgala
- Section on Immunopathogenesis, Food Allergy and Eosinophilic Disorders Program, O&O ALPAN, LLC, Fairfax, VA, United States of America
- Lysosomal Storage Disorders Section, O&O ALPAN, LLC, Fairfax, VA, United States of America
| | | | - Raavi Gupta
- Amerimmune, Fairfax, VA, United States of America
| | - Nader Balba
- Gastroenterology Associates of Northern Virginia, Fairfax, VA, United States of America
| | - Ozlem Goker-Alpan
- Lysosomal Storage Disorders Section, O&O ALPAN, LLC, Fairfax, VA, United States of America
| | - Amer Khojah
- Section on Immunopathogenesis, Food Allergy and Eosinophilic Disorders Program, O&O ALPAN, LLC, Fairfax, VA, United States of America
| | - Oral Alpan
- Section on Immunopathogenesis, Food Allergy and Eosinophilic Disorders Program, O&O ALPAN, LLC, Fairfax, VA, United States of America
- Amerimmune, Fairfax, VA, United States of America
- * E-mail:
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