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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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2
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Longhurst HJ, Dempster J, Lorenzo L, Buckland M, Grigoriadou S, Symons C, Bethune C, Fabien V, Bangs C, Garcez T. Real-world outcomes in hereditary angioedema: first experience from the Icatibant Outcome Survey in the United Kingdom. Allergy Asthma Clin Immunol 2018; 14:28. [PMID: 30127805 PMCID: PMC6091163 DOI: 10.1186/s13223-018-0253-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 04/09/2018] [Indexed: 12/16/2022] Open
Abstract
Background Hereditary angioedema (HAE) is a potentially life-threatening, bradykinin-mediated disease, often misdiagnosed and under-treated, with long diagnostic delays. There are limited real-world data on best-practice management of HAE in the UK. Objectives To characterize the clinical profile, management and outcomes of patients with HAE type I and II from three specialist centres in the UK using data from the Icatibant Outcome Survey (IOS; Shire, Zug, Switzerland), an international observational study monitoring safety and effectiveness of icatibant, a selective bradykinin B2 receptor antagonist. Methods We performed retrospective analyses of IOS data for patients with HAE type I and II from three centres in the UK and compared UK data with pooled IOS data from 10 countries (48 centres). Results Analyses included 73 UK and 579 non-UK patients with HAE type I or II. Median diagnostic delay was 6.2 and 5.9 years, respectively. Analysis of data collected from February 2008 to July 2016 included 286 icatibant-treated attacks in 58 UK patients and 2553 icatibant-treated attacks in 436 non-UK patients (median of 3.0 attacks per patient in both groups). More attacks were treated by icatibant self-administration in UK patients (95.8%) than in non-UK patients (86.8%, p < 0.001). Time to icatibant treatment, time to resolution and attack duration were not significantly different in the UK versus non-UK patients. Conclusion UK patients from the specialist centres studied report similar diagnostic delay and similar icatibant treatment outcomes to their non-UK counterparts. However, improvements in the timely diagnosis of HAE are still required. Trial registration ClinicalTrials.gov NCT01034969
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Affiliation(s)
- Hilary J Longhurst
- 1Department of Clinical Biochemistry and Immunology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - John Dempster
- 2Department of Immunology, Barts Health NHS Trust, London, UK
| | - Lorena Lorenzo
- 2Department of Immunology, Barts Health NHS Trust, London, UK
| | | | | | - Christine Symons
- 3Department of Immunology, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Claire Bethune
- 3Department of Immunology, Plymouth Hospitals NHS Trust, Plymouth, UK
| | | | - Catherine Bangs
- Department of Immunology, Central Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - Tomaz Garcez
- Department of Immunology, Central Manchester University Hospital NHS Foundation Trust, Manchester, UK
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3
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Maccari ME, Abolhassani H, Aghamohammadi A, Aiuti A, Aleinikova O, Bangs C, Baris S, Barzaghi F, Baxendale H, Buckland M, Burns SO, Cancrini C, Cant A, Cathébras P, Cavazzana M, Chandra A, Conti F, Coulter T, Devlin LA, Edgar JDM, Faust S, Fischer A, Garcia-Prat M, Hammarström L, Heeg M, Jolles S, Karakoc-Aydiner E, Kindle G, Kiykim A, Kumararatne D, Grimbacher B, Longhurst H, Mahlaoui N, Milota T, Moreira F, Moshous D, Mukhina A, Neth O, Neven B, Nieters A, Olbrich P, Ozen A, Pachlopnik Schmid J, Picard C, Prader S, Rae W, Reichenbach J, Rusch S, Savic S, Scarselli A, Scheible R, Sediva A, Sharapova SO, Shcherbina A, Slatter M, Soler-Palacin P, Stanislas A, Suarez F, Tucci F, Uhlmann A, van Montfrans J, Warnatz K, Williams AP, Wood P, Kracker S, Condliffe AM, Ehl S. Disease Evolution and Response to Rapamycin in Activated Phosphoinositide 3-Kinase δ Syndrome: The European Society for Immunodeficiencies-Activated Phosphoinositide 3-Kinase δ Syndrome Registry. Front Immunol 2018; 9:543. [PMID: 29599784 PMCID: PMC5863269 DOI: 10.3389/fimmu.2018.00543] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 03/02/2018] [Indexed: 02/02/2023] Open
Abstract
Activated phosphoinositide 3-kinase (PI3K) δ Syndrome (APDS), caused by autosomal dominant mutations in PIK3CD (APDS1) or PIK3R1 (APDS2), is a heterogeneous primary immunodeficiency. While initial cohort-descriptions summarized the spectrum of clinical and immunological manifestations, questions about long-term disease evolution and response to therapy remain. The prospective European Society for Immunodeficiencies (ESID)-APDS registry aims to characterize the disease course, identify outcome predictors, and evaluate treatment responses. So far, 77 patients have been recruited (51 APDS1, 26 APDS2). Analysis of disease evolution in the first 68 patients pinpoints the early occurrence of recurrent respiratory infections followed by chronic lymphoproliferation, gastrointestinal manifestations, and cytopenias. Although most manifestations occur by age 15, adult-onset and asymptomatic courses were documented. Bronchiectasis was observed in 24/40 APDS1 patients who received a CT-scan compared with 4/15 APDS2 patients. By age 20, half of the patients had received at least one immunosuppressant, but 2-3 lines of immunosuppressive therapy were not unusual before age 10. Response to rapamycin was rated by physician visual analog scale as good in 10, moderate in 9, and poor in 7. Lymphoproliferation showed the best response (8 complete, 11 partial, 6 no remission), while bowel inflammation (3 complete, 3 partial, 9 no remission) and cytopenia (3 complete, 2 partial, 9 no remission) responded less well. Hence, non-lymphoproliferative manifestations should be a key target for novel therapies. This report from the ESID-APDS registry provides comprehensive baseline documentation for a growing cohort that will be followed prospectively to establish prognostic factors and identify patients for treatment studies.
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Affiliation(s)
- Maria Elena Maccari
- Center for Chronic Immunodeficiency, Medical Center
– University of Freiburg, Freiburg,
Germany,Department of Pediatrics and Adolescent Medicine,
Medical Center – University of Freiburg,
Freiburg, Germany,*Correspondence: Maria Elena Maccari,
| | - Hassan Abolhassani
- Division of Clinical Immunology, Department of
Laboratory Medicine, Karolinska Institute at Karolinska University Hospital
Huddinge, Stockholm,
Sweden,Research Center for Immunodeficiencies, Pediatric
Center of Excellence, Children’s Medical Center, Tehran University of Medical
Sciences, Tehran, Iran
| | - Asghar Aghamohammadi
- Research Center for Immunodeficiencies, Pediatric
Center of Excellence, Children’s Medical Center, Tehran University of Medical
Sciences, Tehran, Iran
| | - Alessandro Aiuti
- San Raffaele Telethon Institute for Gene Therapy
(SR-TIGET), Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS
San Raffaele Scientific Institute, Milan,
Italy
| | - Olga Aleinikova
- Research Department, Belarusian Research Center for
Pediatric Oncology, Hematology and Immunology,
Minsk, Belarus
| | - Catherine Bangs
- Central Manchester University Hospitals NHS
Foundation Trust, Manchester, United
Kingdom
| | - Safa Baris
- Division of Pediatric Allergy/Immunology, Marmara
University, Istanbul,
Turkey
| | - Federica Barzaghi
- San Raffaele Telethon Institute for Gene Therapy
(SR-TIGET), Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS
San Raffaele Scientific Institute, Milan,
Italy
| | - Helen Baxendale
- Cambridge Centre for Lung Defense, Papworth
Hospital, Cambridge, United
Kingdom
| | - Matthew Buckland
- Institute of Immunity and Transplantation, Royal
Free Hospital, London, United
Kingdom
| | - Siobhan O. Burns
- Institute of Immunity and Transplantation, Royal
Free Hospital, London, United
Kingdom
| | - Caterina Cancrini
- University Department of Pediatrics, Bambino
Gesù Children’s Hospital IRCCS,
Rome, Italy,Department of Systems Medicine, University of
Rome Tor Vergata, Rome,
Italy
| | - Andrew Cant
- Department of Paediatric Immunology, Newcastle
upon Tyne Hospital NHS Foundation Trust, Newcastle upon
Tyne, United Kingdom
| | - Pascal Cathébras
- Internal Medicine, University Hospital of
Saint-Etienne, Saint-Etienne,
France
| | - Marina Cavazzana
- Biotherapy Department, Assistance
Publique-Hôpitaux de Paris (AP-HP), Necker Children’s
Hospital, Paris, France,Laboratory of Human Lymphohematopoiesis, INSERM
UMR 1163, Imagine Institute, Paris,
France,Paris Descartes-Sorbonne Paris Cité
University, Paris,
France
| | - Anita Chandra
- Department of Clinical Immunology, Addenbrookes
Hospital, Cambridge, United
Kingdom,Department of Medicine, University of
Cambridge, Cambridge, United
Kingdom
| | - Francesca Conti
- University Department of Pediatrics, Bambino
Gesù Children’s Hospital IRCCS,
Rome, Italy,Department of Systems Medicine, University of
Rome Tor Vergata, Rome,
Italy
| | - Tanya Coulter
- Regional Immunology Service, The Royal Hospitals
& Queen’s University, Belfast,
United Kingdom
| | - Lisa A. Devlin
- Regional Immunology Service, The Royal Hospitals
& Queen’s University, Belfast,
United Kingdom
| | - J. David M. Edgar
- Regional Immunology Service, The Royal Hospitals
& Queen’s University, Belfast,
United Kingdom
| | - Saul Faust
- NIHR Clinical Research Facility, University
Hospital Southampton NHSFT, Southampton,
United Kingdom
| | - Alain Fischer
- Paris Descartes-Sorbonne Paris Cité
University, Paris,
France,Department of Pediatric Immunology, Hematology
and Rheumatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Necker
Children’s Hospital, Paris,
France,INSERM UMR 1163, Imagine Institute,
Paris, France
| | - Marina Garcia-Prat
- Pediatric Infectious Diseases and
Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall
d’Hebron Research Institute (VHIR),
Barcelona, Spain
| | - Lennart Hammarström
- Division of Clinical Immunology, Department of
Laboratory Medicine, Karolinska Institute at Karolinska University Hospital
Huddinge, Stockholm,
Sweden
| | - Maximilian Heeg
- Center for Chronic Immunodeficiency, Medical Center
– University of Freiburg, Freiburg,
Germany,Department of Pediatrics and Adolescent Medicine,
Medical Center – University of Freiburg,
Freiburg, Germany
| | - Stephen Jolles
- Immunodeficiency Centre for Wales, University
Hospital of Wales, Cardiff, United
Kingdom
| | | | - Gerhard Kindle
- Center for Chronic Immunodeficiency, Medical Center
– University of Freiburg, Freiburg,
Germany
| | - Ayca Kiykim
- Division of Pediatric Allergy/Immunology, Marmara
University, Istanbul,
Turkey
| | | | - Bodo Grimbacher
- Center for Chronic Immunodeficiency, Medical Center
– University of Freiburg, Freiburg,
Germany
| | - Hilary Longhurst
- Institute of Immunity and Transplantation, Royal
Free Hospital, London, United
Kingdom
| | - Nizar Mahlaoui
- Department of Pediatric Immunology, Hematology
and Rheumatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Necker
Children’s Hospital, Paris,
France,French National Reference Center for Primary
Immune Deficiencies (CEREDIH), Necker Enfants Malades University Hospital, Assistance
Publique-Hôpitaux de Paris, Paris,
France
| | - Tomas Milota
- Department of Immunology, 2nd Faculty of Medicine
Charles University and Motol University Hospital,
Prague, Czechia
| | - Fernando Moreira
- Institute of Immunity and Transplantation, Royal
Free Hospital, London, United
Kingdom
| | - Despina Moshous
- Paris Descartes-Sorbonne Paris Cité
University, Paris,
France,Department of Pediatric Immunology, Hematology
and Rheumatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Necker
Children’s Hospital, Paris,
France,INSERM UMR 1163, Imagine Institute,
Paris, France
| | - Anna Mukhina
- Department of Immunology, Research and Clinical
Center for Pediatric Hematology, Oncology and Immunology,
Moscow, Russia
| | - Olaf Neth
- Sección de Infectologıa,
Rheumatología and Inmunodeficiencias, Unidad de Pediatria, Hospital Virgen
del Rocıo, Instituto de Biomedicina de Sevilla (IBiS),
Sevilla, Spain
| | - Benedicte Neven
- Paris Descartes-Sorbonne Paris Cité
University, Paris,
France,Department of Pediatric Immunology, Hematology
and Rheumatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Necker
Children’s Hospital, Paris,
France,Laboratory of Immunogenetics of Pediatric
Autoimmunity, INSERM UMR 1163, Imagine Institute,
Paris, France
| | - Alexandra Nieters
- Center for Chronic Immunodeficiency, Medical Center
– University of Freiburg, Freiburg,
Germany
| | - Peter Olbrich
- Sección de Infectologıa,
Rheumatología and Inmunodeficiencias, Unidad de Pediatria, Hospital Virgen
del Rocıo, Instituto de Biomedicina de Sevilla (IBiS),
Sevilla, Spain
| | - Ahmet Ozen
- Division of Pediatric Allergy/Immunology, Marmara
University, Istanbul,
Turkey
| | - Jana Pachlopnik Schmid
- Division of Immunology, University
Children’s Hospital Zurich and Children’s Research Centre, University
Zurich, Zurich,
Switzerland
| | - Capucine Picard
- Study Center for Primary Immunodeficiencies,
Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris
(AP-HP), Necker Medical School, Paris,
France,Laboratory of Lymphocyte Activation and
Susceptibility to EBV Infection, INSERM UMR 1163, Imagine Institute,
Paris, France
| | - Seraina Prader
- Division of Immunology, University
Children’s Hospital Zurich and Children’s Research Centre, University
Zurich, Zurich,
Switzerland
| | - William Rae
- NIHR Clinical Research Facility, University
Hospital Southampton NHSFT, Southampton,
United Kingdom
| | - Janine Reichenbach
- Division of Immunology, University
Children’s Hospital Zurich and Children’s Research Centre, University
Zurich, Zurich,
Switzerland
| | - Stephan Rusch
- Center for Chronic Immunodeficiency, Medical Center
– University of Freiburg, Freiburg,
Germany
| | - Sinisa Savic
- Study Center for Primary Immunodeficiencies,
Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris
(AP-HP), Necker Medical School, Paris,
France
| | - Alessia Scarselli
- University Department of Pediatrics, Bambino
Gesù Children’s Hospital IRCCS,
Rome, Italy,Department of Systems Medicine, University of
Rome Tor Vergata, Rome,
Italy
| | - Raphael Scheible
- Center for Chronic Immunodeficiency, Medical Center
– University of Freiburg, Freiburg,
Germany
| | - Anna Sediva
- Department of Immunology, 2nd Faculty of Medicine
Charles University and Motol University Hospital,
Prague, Czechia
| | - Svetlana O. Sharapova
- Research Department, Belarusian Research Center for
Pediatric Oncology, Hematology and Immunology,
Minsk, Belarus
| | - Anna Shcherbina
- Department of Immunology, Research and Clinical
Center for Pediatric Hematology, Oncology and Immunology,
Moscow, Russia
| | - Mary Slatter
- Department of Systems Medicine, University of
Rome Tor Vergata, Rome,
Italy
| | - Pere Soler-Palacin
- Pediatric Infectious Diseases and
Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall
d’Hebron Research Institute (VHIR),
Barcelona, Spain
| | - Aurelie Stanislas
- Biotherapy Department, Assistance
Publique-Hôpitaux de Paris (AP-HP), Necker Children’s
Hospital, Paris, France
| | | | - Francesca Tucci
- San Raffaele Telethon Institute for Gene Therapy
(SR-TIGET), Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS
San Raffaele Scientific Institute, Milan,
Italy
| | - Annette Uhlmann
- Center for Chronic Immunodeficiency, Medical Center
– University of Freiburg, Freiburg,
Germany
| | | | - Klaus Warnatz
- Center for Chronic Immunodeficiency, Medical Center
– University of Freiburg, Freiburg,
Germany
| | - Anthony Peter Williams
- NIHR Clinical Research Facility, University
Hospital Southampton NHSFT, Southampton,
United Kingdom
| | - Phil Wood
- Department of Clinical Immunology and Allergy, St
James’s University Hospital, Leeds,
United Kingdom
| | - Sven Kracker
- Laboratory of Human Lymphohematopoiesis, INSERM
UMR 1163, Imagine Institute, Paris,
France,Paris Descartes-Sorbonne Paris Cité
University, Paris,
France
| | - Alison Mary Condliffe
- Department of Infection, Immunity and
Cardiovascular Science, University of Sheffield,
Sheffield, United Kingdom
| | - Stephan Ehl
- Center for Chronic Immunodeficiency, Medical Center
– University of Freiburg, Freiburg,
Germany,Department of Pediatrics and Adolescent Medicine,
Medical Center – University of Freiburg,
Freiburg, Germany
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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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5
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Hodkinson JP, Bangs C, Wartenberg-Demand A, Bauhofer A, Langohr P, Buckland MS, Guzman D, Yong PFK, Kiani-Alikhan S. Erratum to: Low IgA and IgM is Associated with a Higher Prevalence of Bronchiectasis in Primary Antibody Deficiency. J Clin Immunol 2017; 37:332. [PMID: 28386703 DOI: 10.1007/s10875-017-0392-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Catherine Bangs
- Central Manchester University Hospitals NHS Foundation Trust, London, UK
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6
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Hodkinson JP, Bangs C, Wartenberg-Demand A, Bauhofer A, Langohr P, Buckland MS, Guzman D, Yong PFK, Kiani-Alikhan S. Low IgA and IgM Is Associated with a Higher Prevalence of Bronchiectasis in Primary Antibody Deficiency. J Clin Immunol 2017; 37:329-331. [PMID: 28293897 DOI: 10.1007/s10875-017-0381-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 03/02/2017] [Indexed: 02/07/2023]
Affiliation(s)
| | - Catherine Bangs
- Central Manchester University Hospitals NHS Foundation Trust, London, UK
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7
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Brent J, Guzman D, Bangs C, Grimbacher B, Fayolle C, Huissoon A, Bethune C, Thomas M, Patel S, Jolles S, Alachkar H, Kumaratne D, Baxendale H, Edgar JD, Helbert M, Hambleton S, Arkwright PD. Clinical and laboratory correlates of lung disease and cancer in adults with idiopathic hypogammaglobulinaemia. Clin Exp Immunol 2016; 184:73-82. [PMID: 26646609 DOI: 10.1111/cei.12748] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 12/31/2022] Open
Abstract
Idiopathic hypogammaglobulinaemia, including common variable immune deficiency (CVID), has a heterogeneous clinical phenotype. This study used data from the national UK Primary Immune Deficiency (UKPID) registry to examine factors associated with adverse outcomes, particularly lung damage and malignancy. A total of 801 adults labelled with idiopathic hypogammaglobulinaemia and CVID aged 18-96 years from 10 UK cities were recruited using the UKPID registry database. Clinical and laboratory data (leucocyte numbers and serum immunoglobulin concentrations) were collated and analysed using uni- and multivariate statistics. Low serum immunoglobulin (Ig)G pre-immunoglobulin replacement therapy was the key factor associated with lower respiratory tract infections (LRTI) and history of LRTI was the main factor associated with bronchiectasis. History of overt LRTI was also associated with a significantly shorter delay in diagnosis and commencing immunoglobulin replacement therapy [5 (range 1-13 years) versus 9 (range 2-24) years]. Patients with bronchiectasis started immunoglobulin replacement therapy significantly later than those without this complication [7 (range 2-22) years versus 5 (range 1-13) years]. Patients with a history of LRTI had higher serum IgG concentrations on therapy and were twice as likely to be on prophylactic antibiotics. Ensuring prompt commencement of immunoglobulin therapy in patients with idiopathic hypogammaglobulinaemia is likely to help prevent LRTI and subsequent bronchiectasis. Cancer was the only factor associated with mortality. Overt cancer, both haematological and non-haematological, was associated with significantly lower absolute CD8(+) T cell but not natural killer (NK) cell numbers, raising the question as to what extent immune senescence, particularly of CD8(+) T cells, might contribute to the increased risk of cancers as individuals age.
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Affiliation(s)
- J Brent
- Paediatric Allergy and Immunology, University of Manchester, Manchester
| | - D Guzman
- UK-PIN UKPID Registry Team, London and Manchester.,Immunology, Royal Free Hospital, London
| | - C Bangs
- Paediatric Allergy and Immunology, University of Manchester, Manchester.,UK-PIN UKPID Registry Team, London and Manchester
| | - B Grimbacher
- UK-PIN UKPID Registry Team, London and Manchester
| | - C Fayolle
- Immunology, St Bartholomew's Hospital, London
| | - A Huissoon
- West Midlands Immunodeficiency Centre, Birmingham Heartlands Hospital, Birmingham
| | - C Bethune
- Immunology, Derriford Hospital, Plymouth
| | - M Thomas
- Immunology, NHS Greater Glasgow and Clyde, Glasgow
| | - S Patel
- Immunology, John Radcliffe Hospital, Oxford
| | - S Jolles
- Department of Immunology, University Hospital of Wales, Cardiff
| | - H Alachkar
- Immunology, Salford Royal Foundation Trust, Manchester
| | - D Kumaratne
- Immunology, Addenbrookes Hospital, Cambridge
| | | | - J D Edgar
- Regional Immunology Service, the Royal Hospitals, Belfast
| | - M Helbert
- Department of Immunology, Manchester Royal Infirmary, Manchester
| | - S Hambleton
- Primary Immunodeficiency Group, Newcastle University, Newcastle upon Tyne, UK
| | - P D Arkwright
- Paediatric Allergy and Immunology, University of Manchester, Manchester
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8
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Helbert MR, Bangs C, Bishop M, Molesworth A, Ironside J. No evidence of asymptomatic variant CJD infection in immunodeficiency patients treated with UK-sourced immunoglobulin. Vox Sang 2015; 110:282-4. [PMID: 26529032 DOI: 10.1111/vox.12358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/18/2015] [Accepted: 09/20/2015] [Indexed: 11/28/2022]
Abstract
Surveillance of 75 immunodeficiency patients exposed to UK-sourced immunoglobulin, including batches derived from donors who went on to develop vCJD, has not detected any clinical cases of vCJD, or of asymptomatic infection in 15 patients with available tissue samples of sufficient quality for testing.
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Affiliation(s)
- M R Helbert
- Central Manchester University Hospitals, Manchester, UK
| | - C Bangs
- Central Manchester University Hospitals, Manchester, UK
| | - M Bishop
- National Creutzfeldt-Jakob Disease Research and Surveillance Unit, University of Edinburgh, Edinburgh, UK
| | - A Molesworth
- National Creutzfeldt-Jakob Disease Research and Surveillance Unit, University of Edinburgh, Edinburgh, UK
| | - J Ironside
- National Creutzfeldt-Jakob Disease Research and Surveillance Unit, University of Edinburgh, Edinburgh, UK
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9
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Jolles S, Williams P, Carne E, Mian H, Huissoon A, Wong G, Hackett S, Lortan J, Platts V, Longhurst H, Grigoriadou S, Dempster J, Deacock S, Khan S, Darroch J, Simon C, Thomas M, Pavaladurai V, Alachkar H, Herwadkar A, Abinun M, Arkwright P, Tarzi M, Helbert M, Bangs C, Pastacaldi C, Phillips C, Bennett H, El-Shanawany T. A UK national audit of hereditary and acquired angioedema. Clin Exp Immunol 2014; 175:59-67. [PMID: 23786259 DOI: 10.1111/cei.12159] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2013] [Indexed: 11/28/2022] Open
Abstract
Hereditary angioedema (HAE) and acquired angioedema (AAE) are rare life-threatening conditions caused by deficiency of C1 inhibitor (C1INH). Both are characterized by recurrent unpredictable episodes of mucosal swelling involving three main areas: the skin, gastrointestinal tract and larynx. Swelling in the gastrointestinal tract results in abdominal pain and vomiting, while swelling in the larynx may be fatal. There are limited UK data on these patients to help improve practice and understand more clearly the burden of disease. An audit tool was designed, informed by the published UK consensus document and clinical practice, and sent to clinicians involved in the care of HAE patients through a number of national organizations. Data sets on 376 patients were received from 14 centres in England, Scotland and Wales. There were 55 deaths from HAE in 33 families, emphasizing the potentially lethal nature of this disease. These data also show that there is a significant diagnostic delay of on average 10 years for type I HAE, 18 years for type II HAE and 5 years for AAE. For HAE the average annual frequency of swellings per patient affecting the periphery was eight, abdomen 5 and airway 0·5, with wide individual variation. The impact on quality of life was rated as moderate or severe by 37% of adult patients. The audit has helped to define the burden of disease in the UK and has aided planning new treatments for UK patients.
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Affiliation(s)
- S Jolles
- Department of Immunology, University Hospital of Wales, Cardiff, UK
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10
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Edgar JDM, Buckland M, Guzman D, Conlon NP, Knerr V, Bangs C, Reiser V, Panahloo Z, Workman S, Slatter M, Gennery AR, Davies EG, Allwood Z, Arkwright PD, Helbert M, Longhurst HJ, Grigoriadou S, Devlin LA, Huissoon A, Krishna MT, Hackett S, Kumararatne DS, Condliffe AM, Baxendale H, Henderson K, Bethune C, Symons C, Wood P, Ford K, Patel S, Jain R, Jolles S, El-Shanawany T, Alachkar H, Herwadkar A, Sargur R, Shrimpton A, Hayman G, Abuzakouk M, Spickett G, Darroch CJ, Paulus S, Marshall SE, McDermott EM, Heath PT, Herriot R, Noorani S, Turner M, Khan S, Grimbacher B. The United Kingdom Primary Immune Deficiency (UKPID) Registry: report of the first 4 years' activity 2008-2012. Clin Exp Immunol 2014; 175:68-78. [PMID: 23841717 PMCID: PMC3898556 DOI: 10.1111/cei.12172] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [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: 07/04/2013] [Indexed: 12/11/2022] Open
Abstract
This report summarizes the establishment of the first national online registry of primary immune deficency in the United Kingdom, the United Kingdom Primary Immunodeficiency (UKPID Registry). This UKPID Registry is based on the European Society for Immune Deficiency (ESID) registry platform, hosted on servers at the Royal Free site of University College, London. It is accessible to users through the website of the United Kingdom Primary Immunodeficiency Network (www.ukpin.org.uk). Twenty-seven centres in the United Kingdom are actively contributing data, with an additional nine centres completing their ethical and governance approvals to participate. This indicates that 36 of 38 (95%) of recognized centres in the United Kingdom have engaged with this project. To date, 2229 patients have been enrolled, with a notable increasing rate of recruitment in the past 12 months. Data are presented on the range of diagnoses recorded, estimated minimum disease prevalence, geographical distribution of patients across the United Kingdom, age at presentation, diagnostic delay, treatment modalities used and evidence of their monitoring and effectiveness.
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Affiliation(s)
- J D M Edgar
- Regional Immunology Service, The Royal Hospitals, Belfast, East Yorkshire; Centre for Infection and Immunity, Queen's University Belfast, Belfast, East Yorkshire
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Nagler A, Binet C, Mackichan ML, Negrin R, Bangs C, Donlon T, Greenberg P. Impact of marrow cytogenetics and morphology on in vitro hematopoiesis in the myelodysplastic syndromes: comparison between recombinant human granulocyte colony-stimulating factor (CSF) and granulocyte-monocyte CSF. Blood 1990; 76:1299-307. [PMID: 1698477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Marrow cells from 36 patients with myelodysplastic syndromes (MDS) (13 refractory anemia [RA], 14 refractory anemia with excess of blasts [RAEB], 9 RAEB in transformation [RAEB-T]) were evaluated for their in vitro proliferative and differentiative responsiveness to recombinant human granulocyte colony-stimulating factor (G-CSF) or granulocyte-monocyte CSF (GM-CSF). GM-CSF exerted a stronger proliferative stimulus than G-CSF for marrow myeloid clonal growth (CFU-GM) in these patients (44 v 12 colonies per 10(5) nonadherent buoyant bone marrow cells [NAB], respectively, P less than .025). GM-CSF stimulated increased CFU-GM growth in the 16 patients with abnormal marrow cytogenetics in comparison with the 20 patients who had normal cytogenetics (52 and 30 colonies per 10(5) NAB, respectively, P less than .05), whereas no such difference could be demonstrated with G-CSF (11 and 16 colonies per 10(5) NAB, respectively). In contrast, granulocytic differentiation of marrow cells was induced in liquid culture by G-CSF in 15 of 32 (47% patients), while GM-CSF did so in only 4 of 18 (22%) patients (P less than .025) including, for RAEB/RAEB-T patients: 9 of 18 versus 0 of 9, respectively (P less than .025). For MDS patients with normal cytogenetics, G-CSF- and GM-CSF-induced marrow cell granulocytic differentiation in 12 of 18 (67%) versus 3 of 11 (27%), respectively (P less than .025), contrasted with granulocytic induction in only 3 of 14 (21%) and 1 of 7 (14%) patients with abnormal cytogenetics, respectively. We conclude that G-CSF has greater granulocytic differentiative and less proliferative activity for MDS marrow cells than GM-CSF in vitro, particularly for RAEB/RAEB-T patients and those with normal cytogenetics.
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Affiliation(s)
- A Nagler
- Department of Medicine, Stanford University Medical Center, CA 94305
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12
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Bangs C. The frozen patient: do's and dont's of immediate treatment. RN 1979; 42:42-4. [PMID: 259310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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