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Singanayagam A, Klapsa D, Burton-Fanning S, Hand J, Wilton T, Stephens L, Mate R, Shillitoe B, Celma C, Slatter M, Flood T, Gopal R, Martin J, Zambon M. Asymptomatic immunodeficiency-associated vaccine-derived poliovirus infections in two UK children. Nat Commun 2023; 14:3413. [PMID: 37296153 PMCID: PMC10251316 DOI: 10.1038/s41467-023-39094-0] [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: 12/09/2022] [Accepted: 05/18/2023] [Indexed: 06/12/2023] Open
Abstract
Increasing detections of vaccine-derived poliovirus (VDPV) globally, including in countries previously declared polio free, is a public health emergency of international concern. Individuals with primary immunodeficiency (PID) can excrete polioviruses for prolonged periods, which could act as a source of cryptic transmission of viruses with potential to cause neurological disease. Here, we report on the detection of immunodeficiency-associated VDPVs (iVDPV) from two asymptomatic male PID children in the UK in 2019. The first child cleared poliovirus with increased doses of intravenous immunoglobulin, the second child following haematopoetic stem cell transplantation. We perform genetic and phenotypic characterisation of the infecting strains, demonstrating intra-host evolution and a neurovirulent phenotype in transgenic mice. Our findings highlight a pressing need to strengthen polio surveillance. Systematic collection of stool from asymptomatic PID patients who are at high risk for poliovirus excretion could improve the ability to detect and contain iVDPVs.
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Affiliation(s)
- Anika Singanayagam
- Polio Reference Service, UK Health Security Agency, Colindale, London, UK.
- Department of Infectious Disease, Imperial College London, London, UK.
| | - Dimitra Klapsa
- Division of Vaccines, National Institute for Biological Standards and Control, Medicines and Healthcare products Regulatory Agency, Potters Bar, London, UK
| | - Shirelle Burton-Fanning
- Microbiology and Virology Services, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Julian Hand
- Polio Reference Service, UK Health Security Agency, Colindale, London, UK
| | - Thomas Wilton
- Division of Vaccines, National Institute for Biological Standards and Control, Medicines and Healthcare products Regulatory Agency, Potters Bar, London, UK
| | - Laura Stephens
- Division of Vaccines, National Institute for Biological Standards and Control, Medicines and Healthcare products Regulatory Agency, Potters Bar, London, UK
| | - Ryan Mate
- Division of Vaccines, National Institute for Biological Standards and Control, Medicines and Healthcare products Regulatory Agency, Potters Bar, London, UK
| | - Benjamin Shillitoe
- Paediatric Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Cristina Celma
- Polio Reference Service, UK Health Security Agency, Colindale, London, UK
| | - Mary Slatter
- Paediatric Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Terry Flood
- Paediatric Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Robin Gopal
- Polio Reference Service, UK Health Security Agency, Colindale, London, UK
| | - Javier Martin
- Division of Vaccines, National Institute for Biological Standards and Control, Medicines and Healthcare products Regulatory Agency, Potters Bar, London, UK
| | - Maria Zambon
- Polio Reference Service, UK Health Security Agency, Colindale, London, UK.
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2
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Ramanathan S, Veramendi-Espinoza L, Shillitoe B, Flinn A, Owens S, Williams E, Emonts M, Hambleton S, Burton-Fanning S, Waugh S, Flood T, Gennery AR, Slatter M, Nademi Z. Haploidentical CD3 + TCR αβ/CD19 +-depleted HSCT for MHC class II deficiency and persistent SARS-CoV-2 pneumonitis. J Allergy Clin Immunol Glob 2023; 2:101-104. [PMID: 36210925 PMCID: PMC9531933 DOI: 10.1016/j.jacig.2022.08.006] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022]
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection leads to coronavirus disease 2019 (COVID-19), which can range from a mild illness to a severe phenotype characterized by acute respiratory distress needing mechanical ventilation. Children with combined immunodeficiencies might be unable to mount a sufficient cellular and humoral immune response against COVID-19 and have persistent disease. Objective Our aim was to describe a child with combined immunodeficiency and a favorable post-hematopoietic stem cell transplant (HSCT) course following a haploidentical HSCT in the presence of persistent SARS-CoV-2 infection. Methods A 13-month-old girl with MHC class II deficiency developed persistent pre-HSCT SARS-CoV-2 infection. Faced with a significant challenge of balancing the risk of progressive infection due to an incompetent immune system with the danger of inflammatory pneumonitis peri-immune reconstitution after HSCT, the patient's physicians performed a maternal (with a recent history of COVID-19 infection) haploidentical HSCT. The patient received regdanvimab (after stem cell infusion) and remdesivir (before and after stem cell infusion). Results The patient exhibited a gradual increase in her cycle threshold values, implying a reduction in viral RNA with concomitant expansion in the CD3 lymphocyte subset and clinical and radiologic improvement. Conclusions Combination of adoptive transfer of maternal CD45RO+ memory addback T lymphocytes after haploidentical HSCT and use of regdanvimab (a SARS-CoV-2-neutralizing mAb) and remdesivir may have led to the successful outcome in our patient with severe immunodeficiency after she had undergone HSCT. This case highlights the role of novel antiviral strategies (mAbs and CD45RO+ memory T lymphocytes) in contributing to viral clearance in a challenging clinical scenario.
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Affiliation(s)
- Subramaniam Ramanathan
- Children’s Hematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom
| | - Liz Veramendi-Espinoza
- Immunology and Allergy Division. Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Benjamin Shillitoe
- Children’s Hematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom
| | - Aisling Flinn
- Children’s Hematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom
| | - Stephen Owens
- Children’s Hematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom
| | - Eleri Williams
- Children’s Hematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom
| | - Marieke Emonts
- Children’s Hematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sophie Hambleton
- Children’s Hematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Shirelle Burton-Fanning
- Department of Microbiology and Virology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Sheila Waugh
- Department of Microbiology and Virology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Terence Flood
- Children’s Hematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom
| | - Andrew R. Gennery
- Children’s Hematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mary Slatter
- Children’s Hematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Zohreh Nademi
- Children’s Hematopoietic Stem Cell Transplant Unit, Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom,Corresponding author: Zohreh Nademi, PhD, Children's Haematopoietic Stem Cell Transplant, Great Noth Children's Hospital, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, United Kingdom
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3
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Faulkner AL, Grayling M, Shillitoe B, Brodlie M, Michaelis LJ. Characterising the allergic profile of children with cystic fibrosis. Immun Inflamm Dis 2022; 10:60-69. [PMID: 34570951 PMCID: PMC8669696 DOI: 10.1002/iid3.540] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 08/17/2021] [Accepted: 09/01/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cystic fibrosis (CF) is a genetic condition that affects multiple organ systems. Allergic bronchopulmonary aspergillosis (ABPA) is a well-recognised problem but other allergic conditions are less well documented in CF. OBJECTIVE To characterise the allergic profile of a cohort of children with CF, with a focus on those with ABPA. METHODS A cohort of children with CF were interviewed and retrospective data were collected regarding their allergic histories and other relevant clinical features. RESULTS The cohort included 37 children with median age of 9 years (interquartile range: 6-12). There was a history of ≥1 allergic condition(s) in 28/37 children (76%). The most common allergic condition was allergic rhinitis (AR) in 21/37 (57%) and 16 of these 21 children (76%) had another allergic condition. All children with ABPA (8) had another allergic condition. In some children ABPA exacerbations appeared to be seasonal, suggesting possible cross-sensitisation between Aspergillus fumigatus and aeroallergens associated with seasonal AR. Allergic conditions were also common in children with Pseudomonas aeruginosa infection.
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Affiliation(s)
- Amy L. Faulkner
- Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Michael Grayling
- Population Health Sciences Institute, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Benjamin Shillitoe
- Department of Immunology, Allergy, and Infectious Diseases, Great North Children's HospitalNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Malcolm Brodlie
- Translational and Clinical Research Institute, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
- Paediatric Respiratory Medicine, Great North Children's HospitalNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Louise J. Michaelis
- Population Health Sciences Institute, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
- Department of Immunology, Allergy, and Infectious Diseases, Great North Children's HospitalNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
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4
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Shillitoe B, Bangs C, Guzman D, Gennery AR, Longhurst HJ, Slatter M, Edgar DM, Thomas M, Worth A, Huissoon A, Arkwright PD, Jolles S, Bourne H, Alachkar H, Savic S, Kumararatne DS, Patel S, Baxendale H, Noorani S, Yong PFK, Waruiru C, Pavaladurai V, Kelleher P, Herriot R, Bernatonienne J, Bhole M, Steele C, Hayman G, Richter A, Gompels M, Chopra C, Garcez T, Buckland M. The United Kingdom Primary Immune Deficiency (UKPID) registry 2012 to 2017. Clin Exp Immunol 2019; 192:284-291. [PMID: 29878323 DOI: 10.1111/cei.13125] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2018] [Indexed: 01/25/2023] Open
Abstract
This is the second report of the United Kingdom Primary Immunodeficiency (UKPID) registry. The registry will be a decade old in 2018 and, as of August 2017, had recruited 4758 patients encompassing 97% of immunology centres within the United Kingdom. This represents a doubling of recruitment into the registry since we reported on 2229 patients included in our first report of 2013. Minimum PID prevalence in the United Kingdom is currently 5·90/100 000 and an average incidence of PID between 1980 and 2000 of 7·6 cases per 100 000 UK live births. Data are presented on the frequency of diseases recorded, disease prevalence, diagnostic delay and treatment modality, including haematopoietic stem cell transplantation (HSCT) and gene therapy. The registry provides valuable information to clinicians, researchers, service commissioners and industry alike on PID within the United Kingdom, which may not otherwise be available without the existence of a well-established registry.
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Affiliation(s)
- B Shillitoe
- On behalf of the UKPIN Registry Committee, UKPIN, London, UK.,Great North Children's Hospital, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - C Bangs
- On behalf of the UKPIN Registry Committee, UKPIN, London, UK.,Manchester University NHS Foundation Trust, Manchester, UK
| | - D Guzman
- On behalf of the UKPIN Registry Committee, UKPIN, London, UK.,UCL Centre for Immunodeficiency, Royal Free Hospital, London, UK
| | - A R Gennery
- On behalf of the UKPIN Registry Committee, UKPIN, London, UK.,Great North Children's Hospital, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - H J Longhurst
- Addenbrooke's Hospital, Cambridge Universities NHS Foundation Trust, Cambridge, UK
| | - M Slatter
- Great North Children's Hospital, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | | | - M Thomas
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | - A Worth
- On behalf of the UKPIN Registry Committee, UKPIN, London, UK.,Great Ormond Street Hospital and Institute of Child Health, London, UK
| | - A Huissoon
- Heart of England NHS Foundation Trust, Birmingham, Birmingham, UK
| | - P D Arkwright
- Manchester University NHS Foundation Trust, Manchester, UK
| | - S Jolles
- University Hospital of Wales, Cardiff, UK
| | - H Bourne
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - H Alachkar
- Salford Royal NHS Foundation Trust, Salford, UK
| | - S Savic
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D S Kumararatne
- Addenbrooke's Hospital, Cambridge Universities NHS Foundation Trust, Cambridge, UK
| | - S Patel
- John Radcliffe Hospital, Headington, Oxford, UK
| | - H Baxendale
- Papworth NHS Foundation Trust, Cambridge, UK
| | - S Noorani
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - P F K Yong
- Frimley Health NHS Foundation Trust, Frimley, UK
| | - C Waruiru
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - V Pavaladurai
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - P Kelleher
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - J Bernatonienne
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - M Bhole
- The Dudley Group NHS Foundation Trust, Dudley, UK
| | | | - G Hayman
- Epsom and St Helier University Hospitals NHS Trust, St Helier, UK
| | - A Richter
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Gompels
- North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | | | - T Garcez
- Manchester University NHS Foundation Trust, Manchester, UK
| | - M Buckland
- On behalf of the UKPIN Registry Committee, UKPIN, London, UK.,UCL Centre for Immunodeficiency, Royal Free Hospital, London, UK.,Great Ormond Street Hospital and Institute of Child Health, London, UK
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5
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Stubbs A, Bangs C, Shillitoe B, Edgar JD, Burns SO, Thomas M, Alachkar H, Buckland M, McDermott E, Arumugakani G, Jolles MS, Herriot R, Arkwright PD. Bronchiectasis and deteriorating lung function in agammaglobulinaemia despite immunoglobulin replacement therapy. Clin Exp Immunol 2018; 191:212-219. [PMID: 28990652 PMCID: PMC5758375 DOI: 10.1111/cei.13068] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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] [Accepted: 09/14/2017] [Indexed: 12/21/2022] Open
Abstract
Immunoglobulin replacement therapy enhances survival and reduces infection risk in patients with agammaglobulinaemia. We hypothesized that despite regular immunoglobulin therapy, some patients will experience ongoing respiratory infections and develop progressive bronchiectasis with deteriorating lung function. One hundred and thirty-nine (70%) of 199 patients aged 1-80 years from nine cities in the United Kingdom with agammaglobulinaemia currently listed on the UK Primary Immune Deficiency (UKPID) registry were recruited into this retrospective case study and their clinical and laboratory features analysed; 94% were male, 78% of whom had Bruton tyrosine kinase (BTK) gene mutations. All patients were on immunoglobulin replacement therapy and 52% had commenced therapy by the time they were 2 years old. Sixty per cent were also taking prophylactic oral antibiotics; 56% of patients had radiological evidence of bronchiectasis, which developed between the ages of 7 and 45 years. Multivariate analysis showed that three factors were associated significantly with bronchiectasis: reaching 18 years old [relative risk (RR) = 14·2, 95% confidence interval (CI) = 2·7-74·6], history of pneumonia (RR = 3·9, 95% CI = 1·1-13·8) and intravenous immunoglobulin (IVIG) rather than subcutaneous immunoglobulin (SCIG) = (RR = 3·5, 95% CI = 1·2-10·1), while starting immunoglobulin replacement after reaching 2 years of age, gender and recent serum IgG concentration were not associated significantly. Independent of age, patients with bronchiectasis had significantly poorer lung function [predicted forced expiratory volume in 1 s 74% (50-91)] than those without this complication [92% (84-101)] (P < 0·001). We conclude that despite immunoglobulin replacement therapy, many patients with agammaglobulinaemia can develop chronic lung disease and progressive impairment of lung function.
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Affiliation(s)
- A. Stubbs
- Paediatric Allergy and ImmunologyUniversity of ManchesterManchesterManchesterUK
| | - C. Bangs
- Paediatric Allergy and ImmunologyUniversity of ManchesterManchesterManchesterUK
- UKPIN UKPID Registry TeamUKPINLondonUK
| | - B. Shillitoe
- Department of ImmunologyGreat Northern Children's HospitalNewcastle upon TyneUK
| | - J. D. Edgar
- UKPIN UKPID Registry TeamUKPINLondonUK
- Regional Immunology ServiceThe Royal HospitalsBelfastUK
| | - S. O. Burns
- Department of ImmunologyRoyal Free Hospital, Institute of Immunology and Transplantation, University CollegeLondonUK
| | - M. Thomas
- ImmunologyNHS Greater Glasgow & ClydeGlasgowUK
| | - H. Alachkar
- ImmunologySalford Royal Foundation TrustManchesterUK
| | - M. Buckland
- UKPIN UKPID Registry TeamUKPINLondonUK
- ImmunologySt Bartholomew's HospitalLondonUK
| | | | | | - M. S. Jolles
- Department of ImmunologyUniversity Hospital of WalesCardiffUK
| | - R. Herriot
- ImmunologyAberdeen Royal InfirmaryAberdeenUK
| | - P. D. Arkwright
- Paediatric Allergy and ImmunologyUniversity of ManchesterManchesterManchesterUK
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6
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Shillitoe B. Mr. Jonathan Hutchinson's Lettsomian Lectures. West J Med 1886. [DOI: 10.1136/bmj.1.1309.228] [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: 11/04/2022]
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7
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Shillitoe B. Mr. Jonathan Hutchinson's Lettsomian Lectures. West J Med 1886. [DOI: 10.1136/bmj.1.1308.174] [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: 11/04/2022]
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