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Tuna Kırsaçlıoğlu C, Frohne A, Kuloğlu Z, Kristofersdottir I, Demir E, Altuntaş C, Haskoloğlu ZŞ, Çobanoğlu FN, Kendirli T, Özdemir H, Özçakar ZB, Savaş B, Doğu F, İkincioğulları A, Boztug K, Kansu A. Very-early-onset Inflammatory Bowel Disease in an Infant with a Partial RIPK1 Deletion. J Clin Immunol 2024; 44:108. [PMID: 38676845 PMCID: PMC11055784 DOI: 10.1007/s10875-024-01707-8] [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: 06/23/2023] [Accepted: 04/10/2024] [Indexed: 04/29/2024]
Abstract
The monogenic causes of very-early-onset inflammatory bowel disease (VEO-IBD) have been defined by genetic studies, which were usually related to primary immunodeficiencies. Receptor-interacting serine/threonine-protein kinase-1 (RIPK1) protein is an important signalling molecule in inflammation and cell death pathways. Its deficiency may lead to various clinical features linked to immunodeficiency and/or inflammation, including IBD. Here, we discuss an infant with malnutrition, VEO-IBD, recurrent infections and polyathritis who has a homozygous partial deletion in RIPK1 gene.
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Affiliation(s)
- Ceyda Tuna Kırsaçlıoğlu
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara University School of Medicine, Ankara, Türkiye, Turkey.
| | - Alexandra Frohne
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Zarife Kuloğlu
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara University School of Medicine, Ankara, Türkiye, Turkey
| | | | - Engin Demir
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara University School of Medicine, Ankara, Türkiye, Turkey
| | - Cansu Altuntaş
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara University School of Medicine, Ankara, Türkiye, Turkey
| | - Zehra Şule Haskoloğlu
- Department of Pediatrics, Division of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Türkiye, Turkey
| | - Fatma Nazan Çobanoğlu
- Department of Pediatrics, Division of Pediatric Pulmonology, Ankara University School of Medicine, Ankara, Türkiye, Turkey
| | - Tanıl Kendirli
- Department of Pediatrics, Division of Pediatric Intensive care, Ankara University School of Medicine, Ankara, Türkiye, Turkey
| | - Halil Özdemir
- Department of Pediatrics, Division of Pediatric Infectious Disease, Ankara University School of Medicine, Ankara, Türkiye, Turkey
| | - Zeynep Birsin Özçakar
- Department of Pediatrics, Division of Pediatric Nephrology and Rheumotology, Ankara University School of Medicine, Ankara, Türkiye, Turkey
| | - Berna Savaş
- Department of Pathology, Ankara University School of Medicine, Ankara, Türkiye, Turkey
| | - Figen Doğu
- Department of Pediatrics, Division of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Türkiye, Turkey
| | - Aydan İkincioğulları
- Department of Pediatrics, Division of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Türkiye, Turkey
| | - Kaan Boztug
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
- Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
- Department of Pediatrics and Adolescent Medicine, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Aydan Kansu
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara University School of Medicine, Ankara, Türkiye, Turkey
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Haskoloğlu Ş, Öztürk G, Deveci Demirbaş N, Akal C, İslamoğlu C, Baskın K, Heper A, Erdeve Ö, Ceylaner S, Doğu F, İkincioğulları A. Junctional Epidermolysis Bullosa Linked to Homozygous Mutation in LAMC2 Gene: A Case Report With Eosinophil-Rich Inflammatory Infiltrate. Am J Dermatopathol 2024:00000372-990000000-00339. [PMID: 38648026 DOI: 10.1097/dad.0000000000002714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
ABSTRACT Junctional epidermolysis bullosa (JEB) is a rare, incurable, devastating, and mostly fatal congenital genetic disorder characterized by painful blistering of the skin and mucous membranes in response to minor trauma or pressure. JEB is classified roughly into 2 subtypes: JEB-Herlitz is caused by mutations on genes encoding laminin-332. The authors present a patient consulted with a suspicion of primary immunodeficiency due to skin sores that started at the age of 1 month and a history of 3 siblings who died with similar sores, who was diagnosed with JEB-Herlitz after detecting a homozygous LAMC2 gene mutation in WES analysis. Microscopic evaluation of hematoxylin and eosin-stained sections showed vesicle formation with subepidermal separation, which is accompanied by striking neutrophil and eosinophil leukocyte infiltration both in the vesicle and papillary dermis (eosinophil-rich inflammatory infiltrate). Such a histopathological finding has been rarely reported in this condition.
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Affiliation(s)
- Şule Haskoloğlu
- Faculty of Medicine, Department of Pediatric Immunology and Allergy, Ankara University, Ankara, Turkey
| | - Gökcan Öztürk
- Faculty of Medicine, Department of Pediatric Immunology and Allergy, Ankara University, Ankara, Turkey
| | - Nazlı Deveci Demirbaş
- Faculty of Medicine, Department of Pediatric Immunology and Allergy, Ankara University, Ankara, Turkey
| | - Can Akal
- Faculty of Medicine, Department of Pediatric Immunology and Allergy, Ankara University, Ankara, Turkey
| | - Candan İslamoğlu
- Faculty of Medicine, Department of Pediatric Immunology and Allergy, Ankara University, Ankara, Turkey
| | - Kübra Baskın
- Faculty of Medicine, Department of Pediatric Immunology and Allergy, Ankara University, Ankara, Turkey
| | - Aylin Heper
- Faculty of Medicine, Department of Medical Pathology, Ankara University, Ankara, Turkey
| | - Ömer Erdeve
- Faculty of Medicine, Department of Neonatology, Ankara University, Ankara, Turkey; and
| | - Serdar Ceylaner
- Intergen Genetic and Rare Diseases Diagnosis and Research Center, Ankara, Turkey
| | - Figen Doğu
- Faculty of Medicine, Department of Pediatric Immunology and Allergy, Ankara University, Ankara, Turkey
| | - Aydan İkincioğulları
- Faculty of Medicine, Department of Pediatric Immunology and Allergy, Ankara University, Ankara, Turkey
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Öztürk G, Bayrakoğlu D, Haskoloğlu Ş, Baskın K, Deveci N, İnce E, İleri T, Çakmaklı H, Ertem M, İkincioğulları A, Doğu F. ST2 and Reg3α: Can they predict aGvHD, steroid refractoriness and transplant-related mortality in pediatric patients after HSCT? Hematol Transfus Cell Ther 2024:S2531-1379(24)00074-9. [PMID: 38658297 DOI: 10.1016/j.htct.2024.02.026] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 12/18/2023] [Accepted: 02/27/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND/AIM There are several complications of hematopoietic stem cell transplantation. Without any doubt, most important of these is aGvHD that increases transplant-related mortality. The aim of this study is to investigate whether ST-2 and Reg3α levels measured at an early stage in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation can be individual biomarkers identifying future GvHD and predicting treatment response. MATERIALS AND METHODS From January 2019 to January 2021, 27 patients undergoing hematopoietic stem cell transplantation for primary immunodeficiency or hematopoietic diseases formed the study group. During their follow-up, the patients were classified into two groups as those developing and those not developing aGvHD. Nineteen healthy volunteers from a similar age group who needed their blood samples drawn for other reasons and who did not have any history of chronic disease, infection or medication use formed the control group. Blood samples of patients scheduled to have allogeneic HSCT were obtained before the administration of the preparative regimen, on Day +7 post-transplant and on the day of diagnosis if they developed aGvHD. Serum samples were stored at -20ºC until the day of processing. ST2 and Reg3α levels were measured using the ELISA method. RESULTS For patients who developed aGvHD (n = 13), ST2 levels obtained before the transplantation, on Day +7 post-transplant and on the day of aGvHD diagnosis (in patients developing GvHD) were significantly higher compared to the healthy Control Group (p-value <0.05). As regards to the samples obtained on the same days, ST2 levels did not differ significantly among patients who developed and those who did not develop GvHD (n = 14; p-value >0.05). ST2 levels of samples obtained on the days that acute skin and gastrointestinal tract GvHD developed did not differ significantly between these two groups (p-value >0.05). Reg3α levels of the pre-transplant samples, on Day +7 after the transplantation and on the day of aGvHD diagnosis did not show any difference between any of the groups (p-value >0.05). As only two patients died after transplantation, thus correlation of ST2 and Reg3α levels with transplant-related mortality could not be proven. CONCLUSION The results of this study suggest that ST2 and Reg3α levels are neither diagnostic nor prognostic or predictive biomarkers of aGvHD, steroid resistance or transplant-related mortality in pediatric patients. This study can be regarded as a pilot study because of the small patient population; more research involving a larger patient population is required.
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Affiliation(s)
- Gökcan Öztürk
- Ankara University School of Medicine, Department of Pediatric Immunology and Allergy, Ankara, Turkey.
| | - Deniz Bayrakoğlu
- Ankara University School of Medicine, Department of Pediatric Immunology and Allergy, Ankara, Turkey
| | - Şule Haskoloğlu
- Ankara University School of Medicine, Department of Pediatric Immunology and Allergy, Ankara, Turkey
| | - Kübra Baskın
- Ankara University School of Medicine, Department of Pediatric Immunology and Allergy, Ankara, Turkey
| | - Nazlı Deveci
- Ankara University School of Medicine, Department of Pediatric Immunology and Allergy, Ankara, Turkey
| | - Elif İnce
- Ankara University School of Medicine, Department of Pediatric Hematology, Ankara, Turkey
| | - Talia İleri
- Ankara University School of Medicine, Department of Pediatric Hematology, Ankara, Turkey
| | - Hasan Çakmaklı
- Ankara University School of Medicine, Department of Pediatric Hematology, Ankara, Turkey
| | - Mehmet Ertem
- Ankara University School of Medicine, Department of Pediatric Hematology, Ankara, Turkey
| | - Aydan İkincioğulları
- Ankara University School of Medicine, Department of Pediatric Hematology, Ankara, Turkey
| | - Figen Doğu
- Ankara University School of Medicine, Department of Pediatric Immunology and Allergy, Ankara, Turkey
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Öztürk G, Haskoloğlu Ş, Deveci N, Erkmen H, Çelik NA, Sucak G, Ceylaner S, İkincioğulları A, Doğu F. Lymphoproliferation, Autoimmunity, and Recurrent Infections: Which Primary Immunodeficiency? Turk Arch Pediatr 2023; 59:106-108. [PMID: 37737227 PMCID: PMC10837574 DOI: 10.5152/turkarchpediatr.2023.23157] [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: 07/14/2023] [Accepted: 08/08/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Gökcan Öztürk
- Department of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Şule Haskoloğlu
- Department of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Nazlı Deveci
- Department of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hasret Erkmen
- Department of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Nur Ayça Çelik
- Department of Pediatric Health and Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Gülsan Sucak
- Medical Park Bahçeşehir Hospital, Clinic of Hematology and Transplantation, İstanbul, Turkey
| | | | - Aydan İkincioğulları
- Department of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Figen Doğu
- Department of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Turkey
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Öztürk M, Botan E, Gün E, Baskin AK, İslamoğlu C, Erkol GH, Havan M, Çakmak FH, Haskoloğlu Ş, İleri T, İnce E, Doğu F, Ertem M, İkinciogullari A, Kendirli T. The Determining Factors for Outcome of Pediatric Intensive Care Admitted Children After Stem Cell Transplantation. J Pediatr Hematol Oncol 2023; 45:e768-e772. [PMID: 36706283 DOI: 10.1097/mph.0000000000002610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/07/2022] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Requiring pediatric intensive care unit (PICU) admission relates to high mortality and morbidity in patients who received hematopoietic stem cell transplantation (HSCT). In this study, we aimed to evaluate the indications for PICU admission, treatments, and the determining risk factors for morbidity and mortality in patients who had allogeneic HSCT from various donors. MATERIALS AND METHODS In this retrospective study, we enrolled to patients who required the PICU after receiving allogeneic HSCT at our Pediatric Bone Marrow Transplantation Unit between 2005 and 2020. We evaluated to indication to PICU admission, applications, mortality rate, and the determining factors to outcomes. RESULTS Thirty-three (7%) patients had 47 PICU admissions and 471 patients underwent bone marrow transplantation during 16-year study period. Also, 14 repeated episodes were registered in 9 different patients. The median age of PICU admitted patients was 4 (0.3 to 18) years and 29 (62%) were male. The main reasons for PICU admission were a respiratory failure, sepsis, and neurological event in 20, 8, and 7 patients, respectively. The average length of PICU stay was 14.5 (1 to 80) days, 14 (43%) of patients survived and the mortality rate was 57%. Multiple organ failure ( P =0.001), need for respiratory support ( P =0.007), inotrope agents ( P =0.001), and renal replacement therapy ( P =0.013) were found as significant risk factors for mortality. CONCLUSIONS Allogeneic HSCT recipients need PICU admission because of its related different life-threatening complications. But there is a good chance of survival with quality PICU care and different advanced organ support methods.
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Affiliation(s)
| | - Edin Botan
- Division of Pediatric Critical Care Medicine
| | - Emrah Gün
- Division of Pediatric Critical Care Medicine
| | | | | | - Gül Hatice Erkol
- Department of Pediatric Hematology and Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Merve Havan
- Division of Pediatric Critical Care Medicine
| | - Fatih Hasan Çakmak
- Department of Pediatric Hematology and Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Talia İleri
- Department of Pediatric Hematology and Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Elif İnce
- Department of Pediatric Hematology and Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Figen Doğu
- Department of Pediatric Allergy and Immunology
| | - Mehmet Ertem
- Department of Pediatric Hematology and Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
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Öztürk G, Parlar T, Haskoloğlu Ş, Baskın K, Deveci N, Çiftçi E, Doğu F, İkincioğulları A. Eosinophilia and Increased Immunoglobulin E: Is It Really a Primary Immunodeficiency? A Diagnostic Challenge. Turk Arch Pediatr 2023; 58:336-338. [PMID: 37144269 DOI: 10.5152/turkarchpediatr.2023.22312] [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] [Indexed: 05/06/2023]
Affiliation(s)
- Gökcan Öztürk
- Department of Pediatric Health and Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tutku Parlar
- Department of Pediatric Health and Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Şule Haskoloğlu
- Department of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Kübra Baskın
- Department of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Nazlı Deveci
- Department of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ergin Çiftçi
- Department of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Figen Doğu
- Department of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Aydan İkincioğulları
- Department of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Turkey
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Kavgacı A, Bayrakoğlu D, Bal SK, Haskoloğlu Ş, Çullas-İlarslan NE, Topçu S, Okulu E, İslamoğlu C, Arıkan M, Doğu F, İkincioğulları KA. Evaluation of thymopoiesis in healthy Turkish children aged 0-6 years. Turk J Pediatr 2023; 65:73-80. [PMID: 36866987 DOI: 10.24953/turkjped.2021.5190] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Early diagnosis and effective treatment serve as life-saving procedures for primary immunodeficiencies (PIDs) which are very common and a major public health problem in Turkey. Severe combined immunodeficiency (SCID) is constitutively a T-cell defect in which naïve T-cell development is defective due to the mutations in genes responsible for the T cell differentiation and insufficient thymopoiesis. So, assessment of thymopoiesis is very important in the diagnosis of SCID and several combined immune deficiencies (CIDs). METHODS The purpose of this study is to examine thymopoiesis in healthy children via measurement of recent thymic emigrants (RTE); T lymphocytes that express CD4, CD45RA and CD31 to establish the RTE reference values in Turkish children. RTE were measured in the peripheral blood (PB) of 120 healthy infants and children between 0-6 years including cord blood samples, by flow cytometry. RESULTS The absolute count of RTE cells and their relative ratios were found to be higher during the first year of life, being highest at the 6th month and tending to decrease significantly by age following birth (p=0.001). In the cord blood group, both values were lower than those in the 6-month-old group. The absolute lymphocyte count (ALC) varying by age, was found to reduce to 1850/mm³ in 4-years and after. CONCLUSIONS Here we evaluated normal thymopoiesis and established the normal reference levels of RTE cells in the peripheral blood of healthy children aged between 0-6 years. We believe that the collected data will contribute to early diagnosis and monitoring of immune reconstitution; serving as an additional fast and reliable marker for many PID patients especially for SCID including many other CIDs, especially in nations where newborn screening (NBS) via T cell receptor excision circles (TREC) has not yet become available.
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Affiliation(s)
- Akif Kavgacı
- Department of Pediatrics, Ankara University Faculty of Medicine, Ankara
| | - Deniz Bayrakoğlu
- Department of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Ankara
| | - Sevgi Köstel Bal
- Department of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Ankara
| | - Şule Haskoloğlu
- Department of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Ankara
| | | | - Seda Topçu
- Department of Social Pediatrics, Ankara University Faculty of Medicine, Ankara
| | - Emel Okulu
- Department of Neonatology, Ankara University,Faculty of Medicine, Ankara, Türkiye
| | - Candan İslamoğlu
- Department of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Ankara
| | - Meltem Arıkan
- Department of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Ankara
| | - Figen Doğu
- Department of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Ankara
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Çelik GE, Aydin Ö, Güloğlu D, Seçil D, Melli M, Doğu F, Ikinciogullari A, Sin BA, Demirel Y, Misirligil Z. What happens to basophils and tryptase, LXA 4 and CysLTs during aspirin desensitization? J Asthma 2022:1-11. [PMID: 36472920 DOI: 10.1080/02770903.2022.2156352] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Aspirin desensitization (AD) is an effective treatment in patients with non-steroidal anti-inflammatory drugs (NSAID)-exacerbated respiratory disease (NERD) by providing inhibitory effect on symptoms and polyp recurrence. However, limited data is available on how AD works. We aimed to study comprehensively the mechanisms underlying AD by examining basophil activation (CD203c upregulation), mediator-releases of tryptase, CysLT, and LXA4, and LTB4 receptor expression for the first 3 months of AD. METHODS The study was conducted in patients with NERD who underwent AD (group 1: n = 23), patients with NERD who received no desensitization (group 2: n = 22), and healthy volunteers (group 3, n = 13). All participants provided blood samples for flow cytometry studies (CD203c and LTB4 receptor), and mediator releases (CysLT, LXA4, and tryptase) for the relevant time points determined. RESULTS All baseline parameters of CD203c and LTB4 receptor expressions, tryptase, CysLT, and LXA4 releases were similar in each group (p > 0.05). In group 1, CD203c started to be upregulated at the time of reactions during AD, and continued to be high for 3 months when compared to controls. All other study parameters were comparable with baseline and at the other time points in each group (p > 0.05). CONCLUSION Although basophils are active during the first 3 months of AD, no releases of CysLT, tryptase or LXA4 exist. Therefore, our results suggest that despite active basophils, inhibition of mediators can at least partly explain underlying the mechanism in the first three months of AD.
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Affiliation(s)
- Gülfem E Çelik
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Dikimevi/Ankara, Turkey
| | - Ömür Aydin
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Dikimevi/Ankara, Turkey
| | - Deniz Güloğlu
- Division of Pediatric Allergy and Immunology, Ankara University School of Medicine, Dikimevi/Ankara, Turkey
| | - Derya Seçil
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Dikimevi/Ankara, Turkey
| | - Mehmet Melli
- Department of Medical Pharmacology, Ankara University School of Medicine, Dikimevi/Ankara, Turkey
| | - Figen Doğu
- Division of Pediatric Allergy and Immunology, Ankara University School of Medicine, Dikimevi/Ankara, Turkey
| | - Aydan Ikinciogullari
- Division of Pediatric Allergy and Immunology, Ankara University School of Medicine, Dikimevi/Ankara, Turkey
| | - Betül A Sin
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Dikimevi/Ankara, Turkey
| | - Yavuz Demirel
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Dikimevi/Ankara, Turkey
| | - Zeynep Misirligil
- Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Dikimevi/Ankara, Turkey
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Çiftçi E, İnceli HB, Özdemir H, Haskoloğlu Ş, Doğu F. BCGitis’e Bağlı Lokal Apse. J Pediatr Inf 2022. [DOI: 10.5578/ced.20229631] [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: 12/23/2022]
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Çiftçi E, İnceli HB, Özdemir H, Haskoloğlu Ş, Doğu F. Local abscess due to BCGitis. J Pediatr Inf 2022. [DOI: 10.5578/ced.20229615] [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: 12/23/2022]
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Özen S, Özdemir H, Evren E, Taşkın EÇ, Arga G, Konca HK, Çakmaklı HF, Haskoloğlu Ş, Okulu E, Dinçaslan H, İnce E, İleri T, Taçyıldız N, Doğu F, Us E, Karahan ZC, Fitöz S, Kendirli T, Kuloğlu Z, Tutar E, İkincioğulları A, Ünal E, Ertem M, İnce E, Çiftçi E. The role of galactomannan test results in the diagnosis of pediatric invasive aspergillosis. Infect Dis (Lond) 2021; 54:269-276. [PMID: 34842498 DOI: 10.1080/23744235.2021.2008486] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Invasive aspergillosis (IA) is an important cause of morbidity and mortality in immunosuppressed children. Early detection of the infection can improve prognosis in this patient population. OBJECTIVES To investigate the utility of Aspergillus galactomannan antigen assay (GM-EIA) as a diagnostic tool for IA in at-risk paediatric patients. PATIENTS/METHODS For the study, 659 GM-EIA results from 59 patients diagnosed with IA and 3368 GM-EIA results from 351 subjects without evidence for IA (controls) were reviewed retrospectively. Three cut-off values (i.e. ≥0.5, ≥1, ≥1.5) were specified to determine GM-EIA positivity. RESULTS The median age was 6.3 years for boys and 14.5 years for girls. There was a significant difference between the girls and boys in terms of age (p < 0.01). For proven/probable/possible IA patients, sensitivity of 67.8% and specificity of 59.8% were detected when the ≥0.5 cut-off value was used for GM-EIA-positivity. The specificity increased to 80% at the cut-off of ≥1 and to 88% at the cut-off of ≥1.5. False positivity rates were 9.14, 3, and 1.45% at the ≥0.5, ≥1 and ≥1.5 cut-offs respectively. In the proven/probable IA group, sensitivity and negative predictive values were 86.9 and 97.2% at the ≥0.5 cut-off, 85.7 and 97.9%, at the ≥1 cut-off and 84.2 and 98.1% at ≥1.5 cut-off respectively. The positive likelihood ratio was 7.57 and the odds ratio was 42.67 at ≥1.5 cut-off. CONCLUSION The GM-EIA may be used for both screening and diagnostic purposes in paediatric patients using a cut-off value of ≥1.5 for GM-EIA positivity.
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Affiliation(s)
- Seval Özen
- Division of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Halil Özdemir
- Division of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ebru Evren
- Department of Medical Microbiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Esra Çakmak Taşkın
- Division of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Gül Arga
- Division of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hatice Kübra Konca
- Division of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hasan Fatih Çakmaklı
- Division of Pediatric Hematology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Şule Haskoloğlu
- Division of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Emel Okulu
- Division of Neonatology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Handan Dinçaslan
- Division of Pediatric Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Elif İnce
- Division of Pediatric Hematology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Talia İleri
- Division of Pediatric Hematology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Nurdan Taçyıldız
- Division of Pediatric Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Figen Doğu
- Division of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ebru Us
- Department of Medical Microbiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Ceren Karahan
- Department of Medical Microbiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Suat Fitöz
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Division of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Zarife Kuloğlu
- Division of Pediatric Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ercan Tutar
- Division of Pediatric Cardiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Aydan İkincioğulları
- Division of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Emel Ünal
- Division of Pediatric Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Ertem
- Division of Pediatric Hematology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Erdal İnce
- Division of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ergin Çiftçi
- Division of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
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12
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Haskoloğlu Ş, Öztürk A, Öztürk G, Kostel Bal S, İslamoğlu C, Baskın K, Ceylaner S, Tufan Satıroğlu L, Doğu F, İkincioğulları A. Clinical Features and Outcomes of 23 Patients with Wiskott-Aldrich Syndrome: A Single-Center Experience. Turk J Haematol 2020; 37:271-281. [PMID: 32812413 PMCID: PMC7702658 DOI: 10.4274/tjh.galenos.2020.2020.0334] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objective Wiskott-Aldrich syndrome (WAS) is an X-linked primary immune deficiency characterized by microthrombocytopenia, eczema, and recurrent infections. We aimed to evaluate the clinical features and outcomes of a WAS cohort. Materials and Methods We retrospectively evaluated the clinical courses, immunological features, treatments, and outcomes in a total of 23 WAS patients together with data related to 11 transplanted cases among them between 1982 and 2019. Results Before admission, 11 patients (48%) were misdiagnosed with immune thrombocytopenia. WAS scores were mostly 4 or 5. Eleven patients were transplanted and they had an overall survival rate of 100% during a median follow-up period of 8.5 years (range: 8 months to 20 years). Five patients who were not transplanted died at a median of 7 years (range: 2-26 years). Nontransplanted patients had high morbidity due to organ damage, mostly caused by autoimmunity, bleeding, and infections. Two novel mutations were also defined. Conclusion All male babies with microthrombocytopenia should be evaluated for WAS. Hematopoietic stem cell transplantation should be performed at the earliest age with the best possible donors.
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Affiliation(s)
- Şule Haskoloğlu
- Ankara University School of Medicine, Department of Pediatrics, Division of Immunology and Allergy, Ankara, Turkey
| | - Ayşenur Öztürk
- Ankara University School of Medicine, Department of Pediatrics, Division of Genetic Diseases, Ankara, Turkey
| | - Gökcan Öztürk
- Ankara University School of Medicine, Department of Pediatrics, Ankara, Turkey
| | - Sevgi Kostel Bal
- Ankara University School of Medicine, Department of Pediatrics, Division of Immunology and Allergy, Ankara, Turkey
| | - Candan İslamoğlu
- Ankara University School of Medicine, Department of Pediatrics, Division of Immunology and Allergy, Ankara, Turkey
| | - Kübra Baskın
- Ankara University School of Medicine, Department of Pediatrics, Division of Immunology and Allergy, Ankara, Turkey
| | | | - Lale Tufan Satıroğlu
- Ankara University School of Medicine, Department of Pediatrics, Division of Genetic Diseases, Ankara, Turkey
| | - Figen Doğu
- Ankara University School of Medicine, Department of Pediatrics, Division of Immunology and Allergy, Ankara, Turkey
| | - Aydan İkincioğulları
- Ankara University School of Medicine, Department of Pediatrics, Division of Immunology and Allergy, Ankara, Turkey
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13
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HASKOLOĞLU ZŞ, Aytekin C, Köstel Bal S, İslamoğlu C, Baskın K, Yavuz Z, Altun D, Ceylaner S, Doğu F, İkincioğulları A. Does the Hyper IgM Phenotype Affect Prognosis in Ataxia Telangiectasia? Asthma Allergy Immunol 2020. [DOI: 10.21911/aai.523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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14
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Kuloglu Z, Balcı D, Haskoloğlu ZŞ, Kendirli T, Bingöl-Koloğlu M, Tuna-Kırsaçlıoğlu C, Bal S, Selbuz S, Kırımker O, Savaş B, Altuntaş C, Güner ŞN, Can ÖS, Karayalçın K, Doğu F, Kansu Tanca A, İkincioğulları A. Allogeneic hematopoietic stem cell and liver transplantation in a young girl with dedicator of cytokinesis 8 protein deficiency. Pediatr Transplant 2019; 23:e13545. [PMID: 31297914 DOI: 10.1111/petr.13545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 05/14/2019] [Accepted: 06/08/2019] [Indexed: 11/28/2022]
Abstract
DOCK8 deficiency is a rare inherited combined immunodeficiency, caused by mutations in the DOCK8 gene. We describe a case with DOCK8 deficiency associated with severe CLD in whom orthotopic LT was performed successfully after allogeneic HSCT. A 5 year-old girl with DOCK8 deficiency presented with mild direct hyperbilirubinemia and abnormal GGT level and without a previous history of jaundice. She had severe growth retardation, hepatosplenomegaly and generalized eczema. Progressive worsening of CLD was observed within 4 months. Investigations for etiology of liver disease were negative. Liver biopsy showed bridging necrosis, cholestasis and, cirrhosis. Recurrent immune hemolytic crisis and several viral infections developed in follow-up. She underwent whole cadaveric LT for end-stage liver disease (ESLD) 1 year after allogenic HSCT from a full matched related donor. The postoperative course was uneventful. The patient is alive with normal liver function and moderate skin graft versus host disease for 36 months after LT. In conclusion DOCK8 deficiency can be associated with severe CLD. Successful LT following HSCT is possible in patients with ESLD in DOCK8 deficiency. The timing of LT is challenging in patients requiring both HSCT and LT since conditioning regimens for HSCT can be highly hepatotoxic and the patients with suboptimal liver function can become decompensated during HSCT.
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Affiliation(s)
- Zarife Kuloglu
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara University School of Medicine, Ankara, Turkey
| | - Deniz Balcı
- Deparment of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Zehra Şule Haskoloğlu
- Division of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Division of Pediatric Intensive Care, Ankara University School of Medicine, Ankara, Turkey
| | - Meltem Bingöl-Koloğlu
- Deparment of Pediatric Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Ceyda Tuna-Kırsaçlıoğlu
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara University School of Medicine, Ankara, Turkey
| | - Sevgi Bal
- Division of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Suna Selbuz
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara University School of Medicine, Ankara, Turkey
| | - Onur Kırımker
- Deparment of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Berna Savaş
- Deparment of Pathology, Ankara University School of Medicine, Ankara, Turkey
| | - Cansu Altuntaş
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara University School of Medicine, Ankara, Turkey
| | - Şükrü Nail Güner
- Division of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Özlem Selvi Can
- Department of Anesthesiology and Reanimation, Ankara University School of Medicine, Ankara, Turkey
| | - Kaan Karayalçın
- Deparment of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Figen Doğu
- Division of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Aydan Kansu Tanca
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Ankara University School of Medicine, Ankara, Turkey
| | - Aydan İkincioğulları
- Division of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
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15
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Aydin SE, Freeman AF, Al-Herz W, Al-Mousa HA, Arnaout RK, Aydin RC, Barlogis V, Belohradsky BH, Bonfim C, Bredius RG, Chu JI, Ciocarlie OC, Doğu F, Gaspar HB, Geha RS, Gennery AR, Hauck F, Hawwari A, Hickstein DD, Hoenig M, Ikinciogullari A, Klein C, Kumar A, Ifversen MRS, Matthes S, Metin A, Neven B, Pai SY, Parikh SH, Picard C, Renner ED, Sanal Ö, Schulz AS, Schuster F, Shah NN, Shereck EB, Slatter MA, Su HC, van Montfrans J, Woessmann W, Ziegler JB, Albert MH. Hematopoietic Stem Cell Transplantation as Treatment for Patients with DOCK8 Deficiency. J Allergy Clin Immunol Pract 2018; 7:848-855. [PMID: 30391550 DOI: 10.1016/j.jaip.2018.10.035] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/21/2018] [Accepted: 10/22/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Biallelic variations in the dedicator of cytokinesis 8 (DOCK8) gene cause a combined immunodeficiency with eczema, recurrent bacterial and viral infections, and malignancy. Natural disease outcome is dismal, but allogeneic hematopoietic stem cell transplantation (HSCT) can cure the disease. OBJECTIVE To determine outcome of HSCT for DOCK8 deficiency and define possible outcome variables. METHODS We performed a retrospective study of the results of HSCT in a large international cohort of DOCK8-deficient patients. RESULTS We identified 81 patients from 22 centers transplanted at a median age of 9.7 years (range, 0.7-27.2 years) between 1995 and 2015. After median follow-up of 26 months (range, 3-135 months), 68 (84%) patients are alive. Severe acute (III-IV) or chronic graft versus host disease occurred in 11% and 10%, respectively. Causes of death were infections (n = 5), graft versus host disease (5), multiorgan failure (2), and preexistent lymphoma (1). Survival after matched related (n = 40) or unrelated (35) HSCT was 89% and 81%, respectively. Reduced-toxicity conditioning based on either treosulfan or reduced-dose busulfan resulted in superior survival compared with fully myeloablative busulfan-based regimens (97% vs 78%; P = .049). Ninety-six percent of patients younger than 8 years at HSCT survived, compared with 78% of those 8 years and older (P = .06). Of the 73 patients with chimerism data available, 65 (89%) had more than 90% donor T-cell chimerism at last follow-up. Not all disease manifestations responded equally well to HSCT: eczema, infections, and mollusca resolved quicker than food allergies or failure to thrive. CONCLUSIONS HSCT is curative in most DOCK8-deficient patients, confirming this approach as the treatment of choice. HSCT using a reduced-toxicity regimen may offer the best chance for survival.
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Affiliation(s)
- Susanne E Aydin
- Dr von Hauner University Children's Hospital, Ludwig Maximilians Universität, Munich, Germany
| | - Alexandra F Freeman
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Waleed Al-Herz
- Department of Pediatrics, Al-Sabah Hospital, Kuwait, Kuwait
| | - Hamoud A Al-Mousa
- Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Rand K Arnaout
- Department of Medicine, Allergy & Immunology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Roland C Aydin
- Dr von Hauner University Children's Hospital, Ludwig Maximilians Universität, Munich, Germany
| | - Vincent Barlogis
- Pediatric Hematology, Assistance publique des Hopitaux de Marseille, Marseille, France
| | | | - Carmem Bonfim
- Pediatric Blood and Marrow Transplantation Program, Hospital de Clinicas, Federal University of Parana, Curitiba, Brazil
| | | | - Julia I Chu
- Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | - Oana C Ciocarlie
- Department of Bone Marrow Transplantation, Great Ormond Street Hospital NHS Trust, London, United Kingdom
| | - Figen Doğu
- Department of Pediatric Immunology & Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Hubert B Gaspar
- Molecular Immunology Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Raif S Geha
- Department of Immunology, Boston Children's Hospital, Boston, Mass
| | - Andrew R Gennery
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fabian Hauck
- Dr von Hauner University Children's Hospital, Ludwig Maximilians Universität, Munich, Germany
| | - Abbas Hawwari
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | | | - Manfred Hoenig
- Department of Pediatrics, University Medical Center Ulm, Ulm, Germany
| | - Aydan Ikinciogullari
- Department of Pediatric Immunology & Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Christoph Klein
- Dr von Hauner University Children's Hospital, Ludwig Maximilians Universität, Munich, Germany
| | - Ashish Kumar
- BMT/Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Marianne R S Ifversen
- Department for Children and Adolescents, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Matthes
- Stem Cell Transplantation, St Anna Children's Hospital, Vienna, Austria
| | - Ayse Metin
- Pediatric Immunology, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Benedicte Neven
- Department for Pediatric Immuno-Hematology and Rheumatology, Necker Hospital, Paris, France
| | - Sung-Yun Pai
- Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Mass
| | - Suhag H Parikh
- Pediatric Blood and Marrow Transplant Program, Duke University Medical Center, Durham, NC
| | - Capucine Picard
- Study Center of Primary Immunodeficiency, Necker Children's Hospital, Paris, France
| | | | - Özden Sanal
- Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Ansgar S Schulz
- Department of Pediatrics, University Medical Center Ulm, Ulm, Germany
| | - Friedhelm Schuster
- Department of Pediatrics, Düsseldorf University Hospital, Düsseldorf, Germany
| | - Nirali N Shah
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Md
| | - Evan B Shereck
- Pediatric Hematology/Oncology, Oregon & Health Science University, Portland, Ore
| | - Mary A Slatter
- Paediatric BMT, Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
| | - Helen C Su
- Laboratory of Clinical Immunology and Microbiology, NIAID, National Institutes of Health, Bethesda, Md
| | - Joris van Montfrans
- Pediatric Immunology and Infectious Diseases, UMC Utrecht, Utrecht, The Netherlands
| | - Wilhelm Woessmann
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - John B Ziegler
- Immunology & Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Michael H Albert
- Dr von Hauner University Children's Hospital, Ludwig Maximilians Universität, Munich, Germany.
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16
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Şıklar Z, de Franco E, Johnson M, Flanagan S, Ellard S, Ceylaner S, Boztuğ K, Doğu F, İkincioğulları A, Kuloğlu Z, Kansu A, Berberoğlu M. Monogenic Diabetes Not Caused By Mutations in Mody Genes: A Very Heterogenous Group of Diabetes. Exp Clin Endocrinol Diabetes 2017; 126:612-618. [DOI: 10.1055/s-0043-120571] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractMonogenic diabetes represents a heterogeneous group of disorders resulting from a single gene defect leading to disruption of insulin secretion or a reduction in the number of beta cells. Despite the classification of monogenic diabetes into neonatal diabetes or maturity onset diabetes of the young (MODY) according to age of onset, not every case can be classified into those 2 groups. We evaluated patients with monogenic diabetes diagnosed during the last 10 year period. Type 1 DM, MODY, and patients with negative autoantibodies and no mutation in a known gene were excluded from the study. Thirteen patients were diagnosed with monogenic diabetes in Department of Pediatric Endocrinology, Ankara University School of Medicine, Ankara, Turkey. Five of them were diagnosed after 6 months of age. Five had a KATP channel defect. Mutations in genes resulting in destruction of beta cells were detected in 7 patients, with 4 cases having a WFS, 2 an LRBA, and one a IL2RA mutation. Additional systemic findings were seen in 6/13 patients, with 5/6 having severe immune system dysfunction. Treatment with sulphonylurea was successful in two patients.. The other patients were given insulin in differing doses. Four patients died during follow-up, three of which had immune system dysfunction. Monogenic diabetes can be diagnosed after 6 months of age, even with positive autoantibodies. Immune dysfunction was a common feature in our cohort and should be investigated in all patients with early-onset monogenic diabetes. Mortality of patients with monogenic diabetes and additional autoimmunity was high in our cohort and is likely to reflect the multisystem nature of these diseases.
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Affiliation(s)
- Zeynep Şıklar
- Department of Pediatric Endocrinology, Ankara University School of Medicine, Ankara, Turkey
| | - Elisa de Franco
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Matthew Johnson
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Sarah Flanagan
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Sian Ellard
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | | | - Kaan Boztuğ
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Figen Doğu
- Department of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Aydan İkincioğulları
- Department of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey
| | - Zarife Kuloğlu
- Department of Pediatric Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Aydan Kansu
- Department of Pediatric Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Merih Berberoğlu
- Department of Pediatric Endocrinology, Ankara University School of Medicine, Ankara, Turkey
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17
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Şıklar Z, Karataş D, Doğu F, Hacıhamdioğlu B, İkincioğulları A, Berberoğlu M. Regulatory T Cells and Vitamin D Status in Children with Chronic Autoimmune Thyroiditis. J Clin Res Pediatr Endocrinol 2016; 8:276-81. [PMID: 27086659 PMCID: PMC5096490 DOI: 10.4274/jcrpe.2766] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE It is suggested that vitamin D is one of the factors that can regulate the function of Treg cells. In this study, the relationships between Treg cells and vitamin D levels was investigated in pediatric chronic autoimmune thyroiditis (CAT) patients. METHODS Thirty-two children with CAT and 24 healthy subjects were studied. FOXP3 expressing CD4+CD25+high Foxp3+T cells were identified as Treg cells. At diagnosis, 25-hydroxycholecalciferol (25OHD3) levels were determined in all patients. FOXP3 expression was measured before and after vitamin D replacement therapy in patients having low levels of 25OHD3. RESULTS In the CAT patients, Treg cell levels did not differ from the control group, while the frequency of vitamin D deficiency was higher and FOXP3 molecule expression was lower. FOXP3 molecule expression significantly increased in CAT patients having vitamin D deficiency who were given vitamin D replacement. CONCLUSION FOXP3 expression is decreased in pediatric CAT patients. This reduction seems to be associated with vitamin D levels. Vitamin D can play a role in enhancing natural Treg cell functions.
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Affiliation(s)
- Zeynep Şıklar
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey, E-mail:
| | - Deniz Karataş
- Ankara University Faculty of Medicine, Department of Pediatric Immunology-Allergy, Ankara, Turkey
| | - Figen Doğu
- Ankara University Faculty of Medicine, Department of Pediatric Immunology-Allergy, Ankara, Turkey
| | - Bülent Hacıhamdioğlu
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Aydan İkincioğulları
- Ankara University Faculty of Medicine, Department of Pediatric Immunology-Allergy, Ankara, Turkey
| | - Merih Berberoğlu
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
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18
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Köstel-Bal AS, Kaymak S, Haskoloğlu Ş, Kuloğlu Z, Ensari A, Doğu F, Kansu A, İkincioğulları A. A Clinical Approach to a Child with Hypoalbuminemia and Lymphopenia. J Clin Immunol 2016; 36:370-3. [PMID: 27026169 DOI: 10.1007/s10875-016-0274-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/18/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Ayse Sevgi Köstel-Bal
- Department of Pediatric Immunology, Ankara University Faculty of Medicine, 06590, Cebeci, Ankara, Turkey.
| | - Suna Kaymak
- Department of Pediatric Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Şule Haskoloğlu
- Department of Pediatric Immunology, Ankara University Faculty of Medicine, 06590, Cebeci, Ankara, Turkey
| | - Zarife Kuloğlu
- Department of Pediatric Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Arzu Ensari
- Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Figen Doğu
- Department of Pediatric Immunology, Ankara University Faculty of Medicine, 06590, Cebeci, Ankara, Turkey
| | - Aydan Kansu
- Department of Pediatric Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Aydan İkincioğulları
- Department of Pediatric Immunology, Ankara University Faculty of Medicine, 06590, Cebeci, Ankara, Turkey
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Özyörük D, Yavuz G, Dinçaslan H, Cabı-Unal E, Taçyıldız N, Karataş D, Doğu F, İkincioğulları A. Serum IL-13 levels at diagnosis and remission in children with malignant lymphoma. Turk J Pediatr 2016; 58:246-253. [PMID: 28266188 DOI: 10.24953/turkjped.2016.03.003] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Interleukin (IL)-13 has been reported to have a role in the pathogenesis of lymphoma through recent molecular studies predominantly in adult patients. As malignant lymphomas in children differ from adult counterparts in terms of histology and response to treatment, we aimed to determine the serum IL-13 levels of patients with lymphoma; its relation with clinical-laboratory parameters and to look for any correlation of serum IL-13 levels with different prognostic factors in children. Twenty-eight patients with malignant lymphoma and 20 age-matched healthy controls were included in the study. The median serum IL-13 level at diagnosis (range 0.59-68 pg/ml, median 3.40 pg/ml) was higher than that in remission (range 0.14-12.2 pg/ml, median 1.60 pg/ml) in the HL group (p < 0.05). Remarkably, median serum IL-13 level of patients with nodular sclerosis at diagnosis was higher than those with mixed-cellularity (p < 0.05) and declined to normal limits during remission (p < 0.05). In Burkitt's lymphoma (BL) subgroup, the median (range 2.94-154 pg/ml, median 4.5 pg/ml) was high and declined to normal levels during remission (range 0.55-11.30 pg/ml, median 1.57 pg/ml) and the difference was significant (p < 0.05). In terms of prognostic factors, serum IL-13 levels were found to be associated with white blood cells counts only in HL group. Although the number of patients is limited in our study, we found that the serum IL-13 levels exhibit variances in different histopathologic groups. IL-13 might have a role in histopathogenesis of lymphoma, but seems to have no prognostic significance. Nevertheless, more molecular studies are needed to evaluate the pathogenesis of HL.
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Affiliation(s)
- Derya Özyörük
- Divisions of Pediatric Oncology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Gülsan Yavuz
- Divisions of Pediatric Oncology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Handan Dinçaslan
- Divisions of Pediatric Oncology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Emel Cabı-Unal
- Divisions of Pediatric Oncology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Nurdan Taçyıldız
- Divisions of Pediatric Oncology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Deniz Karataş
- Divisions of Pediatric Immunology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Figen Doğu
- Divisions of Pediatric Immunology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Aydan İkincioğulları
- Divisions of Pediatric Immunology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
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Cipe FE, Aydogmus C, Serwas NK, Tuğcu D, Demirkaya M, Biçici FA, Hocaoglu AB, Doğu F, Boztuğ K. ITK Deficiency: How can EBV be Treated Before Lymphoma? Pediatr Blood Cancer 2015; 62:2247-8. [PMID: 26174447 DOI: 10.1002/pbc.25648] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/04/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Funda Erol Cipe
- Department of Pediatric Allergy-Immunology, Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey
| | - Cigdem Aydogmus
- Department of Pediatric Allergy-Immunology, Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey
| | - Nina Kathrin Serwas
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Deniz Tuğcu
- Department of Hematology-Oncology, Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey
| | - Metin Demirkaya
- Department of Hematology-Oncology, Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey
| | - Ferhan Akıcı Biçici
- Department of Hematology-Oncology, Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey
| | - Arzu Babayigit Hocaoglu
- Department of Pediatric Allergy-Immunology, Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey
| | - Figen Doğu
- Department of Pediatric Allergy-Immunology, Ankara University School of Medicine, Ankara, Turkey
| | - Kaan Boztuğ
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria.,Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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21
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Dobbs K, Domínguez Conde C, Zhang SY, Parolini S, Audry M, Chou J, Haapaniemi E, Keles S, Bilic I, Okada S, Massaad MJ, Rounioja S, Alwahadneh AM, Serwas NK, Capuder K, Ciftci E, Felgentreff K, Ohsumi TK, Pedergnana V, Boisson B, Haskoloğlu S, Ensari A, Schuster M, Moretta A, Itan Y, Patrizi O, Rozenberg F, Lebon P, Saarela J, Knip M, Petrovski S, Goldstein DB, Parrott RE, Savas B, Schambach A, Tabellini G, Bock C, Chatila T, Comeau AM, Geha RS, Abel L, Buckley RH, Ikincioğullari A, Al-Herz W, Helminen M, Doğu F, Casanova JL, Boztuğ K, Notarangelo LD. Inherited DOCK2 Deficiency in Patients with Early-Onset Invasive Infections. N Engl J Med 2015; 372:2409-22. [PMID: 26083206 PMCID: PMC4480434 DOI: 10.1056/nejmoa1413462] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Combined immunodeficiencies are marked by inborn errors of T-cell immunity in which the T cells that are present are quantitatively or functionally deficient. Impaired humoral immunity is also common. Patients have severe infections, autoimmunity, or both. The specific molecular, cellular, and clinical features of many types of combined immunodeficiencies remain unknown. Methods We performed genetic and cellular immunologic studies involving five unrelated children with early-onset invasive bacterial and viral infections, lymphopenia, and defective T-cell, B-cell, and natural killer (NK)-cell responses. Two patients died early in childhood; after allogeneic hematopoietic stem-cell transplantation, the other three had normalization of T-cell function and clinical improvement. Results We identified biallelic mutations in the dedicator of cytokinesis 2 gene (DOCK2) in these five patients. RAC1 activation was impaired in the T cells. Chemokine-induced migration and actin polymerization were defective in the T cells, B cells, and NK cells. NK-cell degranulation was also affected. Interferon-α and interferon-λ production by peripheral-blood mononuclear cells was diminished after viral infection. Moreover, in DOCK2-deficient fibroblasts, viral replication was increased and virus-induced cell death was enhanced; these conditions were normalized by treatment with interferon alfa-2b or after expression of wild-type DOCK2. Conclusions Autosomal recessive DOCK2 deficiency is a new mendelian disorder with pleiotropic defects of hematopoietic and nonhematopoietic immunity. Children with clinical features of combined immunodeficiencies, especially with early-onset, invasive infections, may have this condition. (Supported by the National Institutes of Health and others.).
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22
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Yaman A, Kuloğlu Z, Doğu F, İkincioğulları A, Ensari A, Çiftçi E, Kansu A. Intractable colitis associated with chronic granulomatous disease in a young girl. Turk J Pediatr 2015; 57:189-191. [PMID: 26690604] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Chronic granulomatous disease (CGD) is an autosomal recessive or X-linked disorder caused by NADPH oxidase deficiency leading to an impaired ability of reactive superoxide anion and metabolite formation and recurring severe bacterial and fungal infections, with a high mortality rate. Diarrhea, colitis, ileus, perirectal abscess formation and anal fissures are reported gastrointestinal findings in these patients. We report a case of intractable colitis associated with CGD in a young girl.
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Affiliation(s)
- Aytaç Yaman
- Division of Pediatric Gastroenterology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey.
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23
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Willmann KL, Klaver S, Doğu F, Santos-Valente E, Garncarz W, Bilic I, Mace E, Salzer E, Domínguez Conde C, Sic H, Májek P, Banerjee PP, Vladimer GI, Haskoloğlu Ş, Gökalp Bolkent M, Küpesiz A, Condino-Neto A, Colinge J, Superti-Furga G, Pickl WF, van Zelm MC, Eibel H, Orange JS, Ikincioğulları A, Boztuğ K. Biallelic loss-of-function mutation in NIK causes a primary immunodeficiency with multifaceted aberrant lymphoid immunity. Nat Commun 2014; 5:5360. [PMID: 25406581 PMCID: PMC4263125 DOI: 10.1038/ncomms6360] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 09/23/2014] [Indexed: 12/18/2022] Open
Abstract
Primary immunodeficiency disorders enable identification of genes with crucial roles in the human immune system. Here we study patients suffering from recurrent bacterial, viral and Cryptosporidium infections, and identify a biallelic mutation in the MAP3K14 gene encoding NIK (NF-κB-inducing kinase). Loss of kinase activity of mutant NIK, predicted by in silico analysis and confirmed by functional assays, leads to defective activation of both canonical and non-canonical NF-κB signalling. Patients with mutated NIK exhibit B-cell lymphopenia, decreased frequencies of class-switched memory B cells and hypogammaglobulinemia due to impaired B-cell survival, and impaired ICOSL expression. Although overall T-cell numbers are normal, both follicular helper and memory T cells are perturbed. Natural killer (NK) cells are decreased and exhibit defective activation, leading to impaired formation of NK-cell immunological synapses. Collectively, our data illustrate the non-redundant role for NIK in human immune responses, demonstrating that loss-of-function mutations in NIK can cause multiple aberrations of lymphoid immunity.
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Affiliation(s)
- Katharina L. Willmann
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
| | - Stefanie Klaver
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-900, Brazil
| | - Figen Doğu
- Department of Pediatric Immunology and Allergy, Ankara University Medical School, Ankara 06100, Turkey
| | - Elisangela Santos-Valente
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
| | - Wojciech Garncarz
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
| | - Ivan Bilic
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
| | - Emily Mace
- Center for Human Immunobiology, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas 77030, USA
| | - Elisabeth Salzer
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
| | - Cecilia Domínguez Conde
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
| | - Heiko Sic
- Centre of Chronic Immunodeficiency, University Medical Centre Freiburg, Freiburg 79180, Germany
| | - Peter Májek
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
| | - Pinaki P. Banerjee
- Center for Human Immunobiology, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas 77030, USA
| | - Gregory I. Vladimer
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
| | - Şule Haskoloğlu
- Department of Pediatric Immunology and Allergy, Ankara University Medical School, Ankara 06100, Turkey
| | - Musa Gökalp Bolkent
- Department of Pediatric Immunology and Allergy, Ankara University Medical School, Ankara 06100, Turkey
| | - Alphan Küpesiz
- Department of Pediatric Hematology, Akdeniz University Medical School, Antalya 07985, Turkey
| | - Antonio Condino-Neto
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-900, Brazil
| | - Jacques Colinge
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
| | - Giulio Superti-Furga
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
| | - Winfried F. Pickl
- Christian Doppler Laboratory for Immunomodulation and Institute of Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna 1090, Austria
| | - Menno C. van Zelm
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam 3015GE, The Netherlands
| | - Hermann Eibel
- Centre of Chronic Immunodeficiency, University Medical Centre Freiburg, Freiburg 79180, Germany
| | - Jordan S. Orange
- Center for Human Immunobiology, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas 77030, USA
| | - Aydan Ikincioğulları
- Department of Pediatric Immunology and Allergy, Ankara University Medical School, Ankara 06100, Turkey
| | - Kaan Boztuğ
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna 1090, Austria
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna 1090, Austria
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24
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Odek C, Kendirli T, Doğu F, Yaman A, Vatansever G, Cipe F, Haskoloğlu S, Ateş C, Ince E, Ikincioğullari A. Patients with primary immunodeficiencies in pediatric intensive care unit: outcomes and mortality-related risk factors. J Clin Immunol 2014; 34:309-15. [PMID: 24510376 DOI: 10.1007/s10875-014-9994-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 01/26/2014] [Indexed: 12/31/2022]
Abstract
PURPOSES The aims of this study were to review the frequency, characteristics, and the clinical course of primary immunodeficiency (PID) patients admitted to pediatric intensive care unit (PICU) and attempt to identify factors related with mortality that might predict a poor outcome. METHODS We performed a retrospective review of children with PID aged 1 month to 18 years and admitted to PICU from January 2002 to January 2012 in our tertiary teaching children's hospital. RESULTS There were a total of 51 patients accounting for 71 admissions to the PICU. The most common diagnosis was severe combined immunodeficiency. Respiratory problems were the leading cause for admission. A total of 20 patients received hematopoietic stem cell transplantation. Immune reconstitution was achieved in 9 (45 %) patients and eight of them did survive. In all 56 % of all admission episodes resulted in survival. Risk factors for mortality included requirement of mechanical ventilation (P < .001), number of organ system failure (P = .013), need for renal replacement therapy (P < .001), use of inotropes (P < .001), higher Pediatric Logistic Organ Dysfunction (PELOD) score (P = .005), and length of PICU stay (P < .001). CONCLUSIONS This is the first study regarding the outcome and mortality-related risk factors for PID patients requiring PICU admission. We suggest that PICU management is as important as early diagnosis and treatment for these patients. Prediction of those at risk for poorer outcome might be beneficial for accurate intensive care management and survival.
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Affiliation(s)
- Cağlar Odek
- Department of Pediatrics, Division of Pediatric Critical Care, Ankara University Faculty of Medicine, Ankara, Turkey,
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25
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Cipe FE, Doğu F, Güloğlu D, Aytekin C, Polat M, Biyikli Z, Ikincioğullari A. B-cell subsets in patients with transient hypogammaglobulinemia of infancy, partial IgA deficiency, and selective IgM deficiency. J Investig Allergol Clin Immunol 2013; 23:94-100. [PMID: 23654075] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND The pathogenesis of some primary humoral immunodeficiencies, such as transient hypogammaglobulinemia of infancy (THI) and immunoglobulin (Ig) A deficiency, remains unknown and can render diagnosis problematic. OBJECTIVE In the present study, we used flow cytometry to analyze peripheral blood B-cell subsets in patients with THI and unclassified hypogammaglobulinemia (UCH), partial IgA deficiency, and selective IgM deficiency. METHODS The study population comprised 41 patients with hypogammaglobulinemia (THI, 18; UCH, 23), 16 patients with partial IgA deficiency, and 16 patients with selective IgM deficiency who were admitted to Ankara University Department of Pediatric Immunology-Allergy between January 2010 and April 2011, as well as 29 healthy controls. B-cell subsets were examined according to the EUROclass classification. RESULTS Age at diagnosis in the hypogammaglobulinemia group ranged between-14 months and 13 years (median, 26 months). Naive B-cell percentages were significantly higher and activated B-cell values lower in the THI patients than in the UCH patients and age-matched healthy controls. Nonswitched (IgM+CD27+IgD+) memory B-cell values were found to be significantly lower in patients with selective IgM deficiency than in healthy controls. No significant differences in B-cell subsets were found in patients with partial IgA deficiency. CONCLUSIONS Previous reports show that reduced class-switched memory B cell values are associated with CVID, THI, and selective IgA deficiency. Our findings did not support these reports. Furthermore, we observed that naive B cell values were higher in patients with THI. A maturation defect could play a role in the pathogenesis of THI.
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Affiliation(s)
- F E Cipe
- Department of Pediatric Immunology-Allergy, Ankara University School of Medicine, Ankara, Turkey.
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26
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Odek C, Kendirli T, Cipe F, Katlan B, Doğu F. Pressure-induced angioedema associated with endotracheal tube: successful treatment with epinephrine in two cases. Eur J Pediatr 2012; 171:1573-5. [PMID: 22527569 DOI: 10.1007/s00431-012-1738-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 04/03/2012] [Indexed: 11/30/2022]
Abstract
UNLABELLED Pressure-induced urticaria is a non-immunoglobulin E-mediated type of urticaria. Some patients only have angioedema, and the term pressure-induced angioedema (PIA) is more appropriate for them. PIA has not previously been reported in association with endotracheal tube. Here we describe two patients who developed PIA after endotracheal intubation. There were no histories of angioedema, drug and food allergy in both patients. Tests for specific aero-allergens and latex were negative. Serum total immunoglobulin E and C4 levels were in normal ranges. Antihistamines and intravenous steroid therapy were ineffective. Angioedema regressed with intravenous epinephrine infusion and did not relapse after extubation. CONCLUSION We suggest that endotracheal tubes can cause PIA. Epinephrine therapy should be used early at treatment, especially in the patients who are at great risk for life-threatening airway problems.
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Affiliation(s)
- Cağlar Odek
- Department of Pediatric Critical Care, Ankara University Faculty of Medicine, 06100 Ankara, Turkey.
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27
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Belet N, Ciftçi E, Aysev D, Güriz H, Uysal Z, Taçyildiz N, Atasay B, Doğu F, Kendirli T, Kuloğlu Z, Ince E, Doğru U. Invasive Candida infections in children: the clinical characteristics and species distribution and antifungal susceptibility of Candida spp. Turk J Pediatr 2011; 53:489-498. [PMID: 22272448] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The aims of the study were to examine the distribution of Candida spp. isolated from sterile body sites, the antifungal susceptibility of the isolates to amphotericin B, fluconazole, voriconazole, and caspofungin, and factors affecting mortality with invasive Candida infections in children. Thirty-five children with invasive candidiasis between January 2004 and January 2008 were evaluated retrospectively. The antifungal susceptibility of isolated Candida species was studied by Etest. Of the invasive Candida infections, 65.7% were due to C. albicans. The second most common isolated species was C. parapsilosis (11.4%). The rates of resistance to fluconazole, amphotericin B and voriconazole were 8.5%, 2.8% and 5.7%, respectively. Caspofungin was the most effective antifungal agent. 22.8% of the patients died in the first 30 days. In univariate analyses, increased mortality was associated with stay in the intensive care unit, the presence of central venous catheter (CVC), failure to remove CVC, and mechanical ventilation.
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Affiliation(s)
- Nurşen Belet
- Department of Pediatric Infectious Diseases, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
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28
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Yüksek M, Erol F, Güloğlu D, Doğu F, Elhan AH, Babacan E, Ikincioğullari A. Regulatory T cell levels in children with asthma. Turk J Pediatr 2011; 53:532-536. [PMID: 22272454] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Natural regulatory T (nTreg) cells are described by expression of a specific transcription factor, FOXP3, on CD4+CD25+ cells. They play very important roles in the suppression of allergic reactions and disorders. The aim of this study was to obtain peripheral blood Treg levels among atopic asthmatic patients before and during inhaled steroid treatment and to observe the effect of these cells on the pathogenesis and treatment of asthma. CD4+CD25+FOXP3+ T cells obtained from 20 healthy donors and from 16 atopic asthmatic patients before and after inhaled glucocorticoid treatment were examined by flow cytometer. The levels of CD4+CD25+ FOXP3+ Treg cells were higher in asthmatic children who had been receiving inhaled glucocorticoids, when compared to the control group and to the patients' levels before treatment (p<0.05). The present study suggests that at least one of the anti-inflammatory effects of inhaled glucocorticoids in asthma depends upon induction of Treg cells.
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Affiliation(s)
- Mutlu Yüksek
- Department of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Turkey
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29
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Hacıhamdioğlu B, Berberoğlu M, Şıklar Z, Doğu F, Bilir P, Erdeve ŞS, İkincioğulları A, Öçal G. Case report: two patients with partial DiGeorge syndrome presenting with attention disorder and learning difficulties. J Clin Res Pediatr Endocrinol 2011; 3:95-7. [PMID: 21750639 PMCID: PMC3119448 DOI: 10.4274/jcrpe.v3i2.19] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 04/01/2011] [Indexed: 12/01/2022] Open
Abstract
DiGeorge syndrome (DGS) has classically been characterized by the triad of clinical features including congenital cardiac defects, immune deficiencies secondary to aplasia or hypoplasia of the thymus, and hypocalcaemia due to small or absent parathyroid glands. The phenotypic features of these patients are much more variable and extensive than previously recognized. The acknowledgement of similarities and phenotypic overlap of DGS with other disorders associated with genetic defects in 22q11 has led to an expanded description of the phenotypic features of DGS including palatal/speech abnormalities, as well as cognitive, neurological and psychiatric disorders. Here, we report the cases of two DGS patients with dysmorphic facial features who were initially admitted to the Psychiatry Department for attention disorder and learning difficulties.
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Affiliation(s)
- Bülent Hacıhamdioğlu
- Ankara University School of Medicine, Department of Pediatric Endocrinology, Cebeci, Ankara, Turkey.
| | - Merih Berberoğlu
- Ankara University School of Medicine, Department of Pediatric Endocrinology, Cebeci, Ankara, Turkey
| | - Zeynep Şıklar
- Ankara University School of Medicine, Department of Pediatric Endocrinology, Cebeci, Ankara, Turkey
| | - Figen Doğu
- Ankara University School of Medicine, Department of Pediatric Immunology, Cebeci, Ankara, Turkey
| | - Pelin Bilir
- Ankara University School of Medicine, Department of Pediatric Endocrinology, Cebeci, Ankara, Turkey
| | - Şenay Savaş Erdeve
- Ankara University School of Medicine, Department of Pediatric Immunology, Cebeci, Ankara, Turkey
| | - Aydan İkincioğulları
- Ankara University School of Medicine, Department of Pediatric Immunology, Cebeci, Ankara, Turkey
| | - Gönül Öçal
- Ankara University School of Medicine, Department of Pediatric Endocrinology, Cebeci, Ankara, Turkey
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Erol Cipe F, Doğu F, Sucuoğlu D, Aysev D, Ikincioğulları A. Asymptomatic catheter related Rhizobium radiobacter infection in a haploidentical hemapoetic stem cell recipient. J Infect Dev Ctries 2010; 4:530-2. [PMID: 20818107 DOI: 10.3855/jidc.1009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2010] [Accepted: 04/30/2010] [Indexed: 10/31/2022] Open
Abstract
Catheter related infections are reported as one of the most common source of nosocomial infections. Rhizobium radibacter infections are generally manifested by fever and leukocytosis. Here, a 14 months-old girl diagnosed as T (-) B (-) NK (+) severe combined immunodeficiency (SCID) is presented. She had received repeated (x3) unconditioned haploidentical hematopoetic stem cell transplantations. During the follow-up, she has been arised an asymptomatic infection with R. Radiobacter, which was isolated from central venous catheter and peripheral blood while she was clinically stable, free of symptoms, fever or leukocytosis. She was treated successfully with cefepime and amikacin and did not require catheter removal. So, it is once more clear that the blood cultures should be obtained on regular basis from all patients with an intravascular device, even they were asymptomatic.
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Affiliation(s)
- Funda Erol Cipe
- Ankara University School of Medicine, Department of Pediatric Immunology-Allergy, Ankara, Turkey.
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31
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Cipe FE, Soygür T, Doğu F, Erdoğan O, Bozdoğan G, Ikincioğullari A. Late onset hemorrhagic cystitis in a hematopoietic stem cell recipient: treatment with intravesical hyaluronic acid. Pediatr Transplant 2010; 14:E79-82. [PMID: 19344339 DOI: 10.1111/j.1399-3046.2009.01169.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HC is a common complication following HSCT. Risk factors include viral infections, cyclophosphamide and busulfan usage, pelvic irradiation, older age at transplantation, allogeneic HSCT and GvHD. The severity of HC ranges from mild hematuria to life-threatening bleeding. Here, we present a seven-and-a-half-yr-old boy with Wiskott-Aldrich syndrome who experienced a late onset Grade III hemorrhagic cystitis following HSCT from his fully matched sibling. A Grade I GvHD localized to skin developed on day +11 and prednisolone therapy was given between the 11th and 22nd d. Myeloid and platelet engraftments were achieved +13 and +16 d, respectively. A gross hematuria began on the 21st post-transplant day. The urine cultures for bacterial or fungal organisms were negative. Urine analysis by PCR revealed a CMV viruria. Following systemic ganciclovir treatment, urinary CMV became negative but hemorrhagic cystitis did not improve. Due to the probability of existing BK virus or adenovirus, two doses of cidofovir were administered intravesically. As he continued to have painful hematuria with large clot formations, two doses of intravesical hyaluronic acid were applied. Macroscopic hematuria resolved within four d after the second dose. Complete remission was achieved on day +77. Finally, intravesical administration of hyaluronic acid seems to be effective and safe and can be a promising treatment in patients suffering from severe and late onset HC.
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Affiliation(s)
- Funda Erol Cipe
- Department of Pediatric Immunology-Allergy, Ankara University, School of Medicine, Ankara, Turkey
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32
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Yüksek M, Ikincioğullari A, Doğu F, Elhan A, Yüksek N, Reisli I, Babacan E. Primary immune deficiency disease awareness among a group of Turkish physicians. Turk J Pediatr 2010; 52:372-377. [PMID: 21043382] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Primary immunodeficiencies (PIDs) are a relatively common occurrence in countries where consanguineous marriages are widespread. A principal factor leading to misdiagnosis and ensuing complications can be the lack of knowledge and proper evaluation. The aim of this study was to assess PID awareness and the identification of diagnostic criteria leading to correct diagnosis. Seven hundred eighty-six questionnaires with 71 items were distributed to physicians attending the 41st National Congress of Pediatrics (2005) and to pediatric residents of two university hospitals from different cities in Turkey. The 217 completed questionnaires revealed that family history (91.2%), consanguineous marriages (87.1%), infant deaths (70.0%), persistent thrush (90.3%), hospitalization for recurrent cellulitis (70.5%), chronic diarrhea due to giardiasis (62.2%), recurrent oral aphthous lesions (58.5%), telangiectasia (82.0%), failure to thrive (78.8%), absence of tonsil tissue (74.7%), oculocutaneous albinism (73.7%), and resistant sinusitis (71.0%) were cited among important indicators of PID. However, neonatal tetany (77.9%), liver abscess (61.3%) and poliomyelitis following oral polio vaccination (51.2%) were not considered as related to PID. Although white blood cell (WBC) and differential were chosen as the preferred initial tests, leukocytosis and lymphopenia were also not judged as related to PID. More comprehensive pre/postgraduate education in PID appears to be necessary for physicians in Turkey.
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Affiliation(s)
- Mutlu Yüksek
- Department of Pediatric Immunology, Ankara University Faculty of Medicine, Ankara, Turkey
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İkincioğulları A, Doğu F, Aytekin C, Çipe F, Yüksek M, Bozdoğan G, Yıldıran A, Güloğlu D, Babacan E. Combined Immunodeficiencies: Clinical, Immunological Features And Outcome Of 56 Cases From A Single Institution. J Allergy Clin Immunol 2010. [DOI: 10.1016/j.jaci.2009.12.294] [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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Tutar E, Aypar E, Atalay S, Yavuz G, Doğu F. Percutaneous transcatheter retrieval of intracardiac central venous catheter fragments in two infants using Amplatz Goose Neck snare. Turk J Pediatr 2009; 51:519-523. [PMID: 20112614] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Central venous catheter (CVC) fracture with embolization is a serious and rare complication, and few cases have been reported in children. Catheter fragments may cause cardiac perforation, arrythmias, pulmonary embolism, and sepsis. We report the successful retrieval of intracardiac CVC fragments by percutaneous transcatheter technique in two infants, aged 8 and 15 months. Double-lumen 7 French Hickman CVCs were accidentally fractured during their removal. Chest radiographs of the two patients revealed migrated intracardiac catheter fragments extending from the superior vena cava (SVC) to the right atrium and from the SVC to the right ventricle, respectively. The procedure was performed under ketamine anesthesia and fluoroscopic guidance using a percutaneous femoral vein approach. Nitinol Amplatz Goose Neck snares (10 mm in diameter) were used to successfully retrieve the catheter fragments without any complication. Percutaneous transcatheter retrieval of catheter fragments using Goose Neck snare is a safe and successful technique and can be chosen before resorting to surgery, which has potential risks related to general anesthesia, thoracotomy and cardiopulmonary bypass.
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Affiliation(s)
- Ercan Tutar
- Sections of Pediatric Cardiology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
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Kendirli T, İkincioğullari A, Ekim M, Doğu F, Yalçınkaya F, Yüksel S, Özçakar Z, Güloğlu D, Doğanay B, Babacan E. Soluble CD27 Levels in Children with Acute and Chronic Renal Failure. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Aytekin C, Doğu F, Ikincioğullari A, Eğin Y, Yüksek M, Bozdoğan G, Akar N, Babacan E. [TGF-Beta1-915G/C and TNF-alpha-308G/A polymorphisms in children with asthma]. Tuberk Toraks 2009; 57:62-67. [PMID: 19533439] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
TGF-Beta1 is a pro and antiinflammatory cytokine and plays an important role in airway remodelling in asthma. TNF-alpha is a proinflammatory cytokine that involved in the pathogenesis of asthma. Cytokine production is under genetic control, and certain single nucleotide polymorphisms (SNPs), which lead to allelic variants of cytokine genes are associated with higher or lower cytokine production in vitro. In some studies TGF-Beta1-915G/C and TNF-alpha-308G/A polymorphisms are found to be more prevalent and associated with asthma. The aim of this study is to investigate the frequency of TGF-Beta1-915G/C and TNF-alpha-308G/A polymorphisms and to determine whether or not these polymorphisms are associated with the development of asthma in children. 46 asthmatic children and 67 healthy controls were investigated by LightCycler PCR analysis for TGF-Beta1-915G/C and TNF-alpha-308G/A polymorphisms. The frequency of TGF-Beta1-915G/C and TNF-alpha-308G/A polymorphisms in asthmatic children were 15.2% and 23.9% respectively while the corresponding figures were 8.9% and 23.8% in the control group (p> 0.05). The risk of asthma development was not associated for TGF-Beta1 915G/C (OR: 0.54, 95% CI: 0.17-1.75) and TNF-alpha-308G/A (OR: 0.99, 95% CI: 0.41-2.40) polymorphisms. These results indicated that, the frequency of TGF-Beta1 915G/C and TNF-alpha-308G/A polymorphisms did not show any difference in asthmatic children compared to healthy controls and these polymorphisms do not seem to influence suspectibilty to asthma.
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Affiliation(s)
- Caner Aytekin
- Division of Pediatric Immunology-Allergy, Department of Pediatric Health and Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey.
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Kendirli T, Ikincioğullari A, Doğu F, Babacan E. Peripheral blood lymphocyte subsets in children with frequent upper respiratory tract infections. Turk J Pediatr 2008; 50:63-66. [PMID: 18365594] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
It is a common and well-known fact that infants and preschool children undergo frequent episodes of upper respiratory tract infections. The majority of these children do not have a recognized immunodeficiency. The aim of the present study was to evaluate the effects of frequent upper respiratory tract infections on cellular immunity, using peripheral blood lymphocyte subsets and activation markers as defining parameters. The study group consisted of 16 children (aged 2-6 years) with frequent upper respiratory tract infections; 30 age-matched healthy children served as controls. Peripheral blood T, B, NK cells; T lymphocyte subsets; naive and memory cells; and activation markers were analyzed by using monoclonal antibodies and flow cytometry. White blood cell count (WBC) was found to be markedly increased in the study group compared to controls (p < 0.05). The absolute number of lymphocytes was also higher than that of the healthy children. The relative size of the CD3+CD8+ T lymphocytes and the relative and absolute numbers of CD3-CD16+56+ NK cells were found to be higher in patients than the controls. All the remaining percentages and numbers of the T cell subgroups including naive and memory cells and B lymphocytes did not show any difference, while CD3+CD25+ cell numbers were markedly increased (p < 0.05). In conclusion, the examination of peripheral blood lymphocyte subsets in children with frequent upper respiratory tract infections is important in evaluating cellular immune alterations due to antigenic stimulation; however, it is neither essential nor cost-effective in the management of the disease. This study has shown that both the percentage and absolute numbers of peripheral blood lymphocyte subsets maintain their normal status in children with frequent upper respiratory tract infections.
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Affiliation(s)
- Tanil Kendirli
- Department of Pediatric Allergy and Immunology, Ankara University Faculty of Medicine, Ankara, Turkey
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38
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Uysal Z, Ertem M, Talia İleri D, Doğu F, Azık FM, İkincioğulları A, Gözdaşoğlu S. An autoimmune lymphoproliferative syndrome initially diagnosed as Evans syndrome. Turk J Haematol 2007; 24:80-84. [PMID: 27263622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Autoimmune lymphoproliferative syndrome (ALPS) is a rare childhood disorder characterized by chronic non-malignant lymphoproliferation and autoimmunity. Patients with ALPS frequently exhibit episodic and intermittent, severe autoimmune- induced hemolytic anemia, thrombocytopenia or combined cytopenias. The co-occurrence of immune-mediated cytopenias, autoimmune thrombocytopenia and autoimmune hemolytic anemia is also known as Evans syndrome. This report describes a child who presented with Evans syndrome symptoms and who, after the detection of increased percentage of double negative T cell population in the peripheral blood, was diagnosed as ALPS. He received several courses of treatment including glucocorticoids, cyclosporine A (Cs A), and intravenous immunoglobulin (IVIG) without any clinical benefit and was treated with the antimalarial drug Fansidar®. With administration of Fansidar® (half tablet per week; containing 250 mg of pyrimethamine and 12.5 mg of sulfadoxine) combined with immunosuppressive drugs, clinical status and laboratory findings temporarily improved. After two months, the patient underwent laparoscopic splenectomy because of worsening of thrombocytopenia refractory to the treatment. There was a transient beneficial effect from splenectomy. We were unable to stop immunosuppressive therapy and Fansidar®; however, this combined therapy was successful in decreasing the number of hospitalizations and controlled his clinical symptoms more effectively for six months. Unfortunately, he was admitted to a regional hospital with high fever and died at the age of three.
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Doğu F, Ikincioğullari A, Fricker D, Bozdoğan G, Aytekin C, Ileri M, Teziç T, Babacan E, De La Salle H. A novel mutation for TAP deficiency and its possible association with Toxoplasmosis. Parasitol Int 2006; 55:219-22. [PMID: 16624613 DOI: 10.1016/j.parint.2006.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Revised: 02/24/2006] [Accepted: 02/28/2006] [Indexed: 11/26/2022]
Abstract
We describe two siblings (a male patient and his older sister) with a novel mutation in the peptide transporter associated to antigen processing (TAP). The index case presented with not only granulomatous skin lesions and recurrent sino-pulmonary infections, often associated with this deficiency, but also a severe pulmonary toxoplasmosis. His toxoplasmosis and skin lesions were successfully treated.
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Affiliation(s)
- Figen Doğu
- Ankara University School of Medicine, Department of Pediatric Immunology-Allergy, and Dr. Sami Ulus Chidren's Hospital, Ankara, Turkey.
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40
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Doğu F, Kurtuluş-Ulküer M, Bilge Y, Bozdoğan G, Ulküer U, Malhatun E, Ikincioğullari A, Babacan E. Stable mixed chimerism after hematopoietic stem cell transplantation in Wiskott-Aldrich syndrome. Pediatr Transplant 2006; 10:395-9. [PMID: 16677369 DOI: 10.1111/j.1399-3046.2005.00458.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Wiskott-Aldrich syndrome (WAS) is a primary immunodeficiency disease characterized by thrombocytopenia, eczema, impaired cellular and humoral immunity, and increased susceptibility to malignancy and autoimmunity. The only curative treatment for WAS is hematopoietic stem cell transplantation, especially in the presence of a matched sibling donor or matched unrelated donor. Here, we report the case of a 2.5-yr-old boy with WAS that resulted in mixed chimerism after having received bone marrow from his phenotypically identical grandfather. Although the patient has persistent thrombocytopenia (platelet counts 50-80 x 10(9)/L), he is currently alive and doing well at 36 months post-transplant and is free of any bleeding episodes.
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Affiliation(s)
- Figen Doğu
- Department of Pediatric Immunology & Allergy, Ankara University, Ankara, Turkey.
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Doğu F, Ariga T, Ikincioğullari A, Bozdoğan G, Aytekin C, Metin A, Babacan E. A case of Wiskott-Aldrich syndrome with de novo mutation at exon 4. Turk J Pediatr 2006; 48:66-8. [PMID: 16562789] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Wiskott-Aldrich syndrome (WAS) is an X-linked disorder characterized by thrombocytopenia, eczema and immunodeficiency. Clinical features of the disease are highly varied; therefore, the diagnosis is sometimes difficult, especially in solitary cases or cases with milder forms of the disease. However, the identification of the WASP gene has made possible a definite WAS diagnosis for these cases. In this report, we present a 26-month-old boy who had received several ineffective treatments for chronic immune thrombocytopenic purpura. He was then suspected to have WAS because of the early onset of thrombocytopenia and small platelets. The diagnosis became definite with the detection of a de novo mutation at exon 4 of the WASP gene, Arg138Pro, through mutation analysis.
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Affiliation(s)
- Figen Doğu
- Department of Pediatric Immunology and Allergy, Ankara University Faculty of Medicine, Ankara, Turkey
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İkincioğullari A, Doğu F, Bozdoğan G, Eğin Y, Reisli İ, Gökdemir D, Babacan E. Serum sFas and sFas-Ligand Levels in Childhood Asthma. ACTA ACUST UNITED AC 2004. [DOI: 10.1089/0883187041269887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Doğu F, Ikincioğullari A, Babacan E. Transient hypogammaglobulinemia of infancy and early childhood: outcome of 30 cases. Turk J Pediatr 2004; 46:120-4. [PMID: 15214739] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Tansient hypogammaglobulinemia of infancy (THI) is characterized by an abnormal delay in the onset of immunoglobulin synthesis. In the present study, clinical and immunological data and outcome of 30 patients with THI are presented. Between 1995-2001, 464 patients with frequent upper and lower airway infections admitted to the Pediatric Immunology and Allergy outpatient clinic; 30 of them (aged between 6-46 months) were diagnosed as THI. Patients had periodic evaluations at 3-6 month intervals until their condition had improved clinically and immunoglobulins had normalized. In 21 patients immunoglobulin levels reached normal age-matched levels at a median age of 27 months. In nine patients (aged 25-57 months) immunoglobulin levels were still under 2SD for age and various IgG subclass deficiencies were detected in five of them. The results of the present study indicated that THI is not a rare disease. Long-term follow-up with detailed clinical and laboratory evaluations is needed in these patients.
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Affiliation(s)
- Figen Doğu
- Department of Pediatric Immunology and Allergy, Ankara University, Faculty of Medicine, Ankara, Turkey
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Ikincioğullari A, Kendirli T, Doğu F, Eğin Y, Reisli I, Cin S, Babacan E. Peripheral blood lymphocyte subsets in healthy Turkish children. Turk J Pediatr 2004; 46:125-30. [PMID: 15214740] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Immunophenotyping of peripheral blood lymphocyte subpopulations is essential for the diagnosis and follow-up of children with immunodeficiencies and other immune disorders. The relative size and absolute number distributions (median and 5-95%) of lymphocyte subsets, including cord blood (Coulter, EPICS-XL) were examined by flow cytometry in 190 healthy subjects from birth to 18 years of age with a view to obtaining normal reference values for Turkish children of the following age groups: cord blood (n:29), birth to 1 year (n:41), 1 to 2 years (n:30), 2 to 6 years (n:30), 6 to 10 years (n:30), and 10 to 18 years (n:30). The relative size of CD2+, CD3+CD16-56-, CD3+CD8+ T lymphocytes increased while the relative size and absolute counts of those together with CD3+CD4+ and CD19+, CD20+ B lymphocytes decreased with age. The percentage of CD3-CD16+56+ NK cells increased from 0-1 year to 10-18 years; however, absolute count of CD3-CD16+56+ NK cells remained stable and unchanged in all age groups. The relative size and absolute count of activation markers (CD3+CD25+ and HLADR+) decreased from 0-1 year through 10-18 years age group. This study has once more demonstrated that both the percentage and the absolute number of lymphocyte subsets in cord blood and peripheral blood of healthy infants and children changed with age. Therefore, comparison of results to those of age-matched healthy controls is of utmost importance in the reliable and accurate evaluation of lymphocyte subsets reflecting cellular immunity in children.
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Affiliation(s)
- Aydan Ikincioğullari
- Department of Pediatric Immunology and Allergy, Ankara University, Faculty of Medicine, Ankara, Turkey
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Abstract
OBJECTIVE Tonsils and adenoids are lymphoid tissues that are located in the pharynx and play an important role against invading antigens of the upper respiratory tract. The present study analyses serum immunoglobulin levels and peripheral blood (PB) lymphocyte subsets in children, 24-48 h prior to and 4-6 weeks after adenotonsillectomy, in order to determine early effects of adenotonsillectomy on the immune system. METHODS The study population consists of 15 children (aged 4-10 years) who underwent adenotonsillectomy because of adenoidal hypertrophy and chronic tonsillitis and 15 age-matched healthy children without a history of adenotonsillectomy. Serum IgG, IgA and IgM levels were measured by nephelometry. PB lymphocyte subsets were analysed by using monoclonal antibodies and flow cytometry. RESULTS Children with chronic tonsillitis have increased levels of CD19+ B lymphocytes compared to healthy controls in the pre-operative period. The percentage of B lymphocytes bearing CD23 was found to be significantly higher in patients, most likely representing in vivo B lymphocyte activation due to chronic antigenic stimulation. After the adenotonsillectomy, despite ongoing B lymphocyte activation, CD8+ T lymphocyte levels increased and B cell levels returned to normal. A slight decrease in serum IgG, IgA and IgM levels was detected in the post-operative period compared to prior levels. CONCLUSION Adenotonsillectomy performed in children leads to alterations that may reflect a compensatory response of the developing immune system after the removal of the lymphoid tissue in the setting of chronic antigenic stimulation. However, these changes do not cause significant immune deficiency.
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Affiliation(s)
- Aykut Ikincioğullari
- 1.ENT Department of Ankara Numune Research and Training Hospital, Ankara, Turkey
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46
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Doğu F, Ikincioğullari A, Eğin Y, Babacan E. Circulating adhesion molecule levels in childhood asthma. Indian Pediatr 2002; 39:1017-21. [PMID: 12466571] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
The present study aims at comparing the levels of circulating forms of E-selectin, ICAM-1 and VCAM-1 in 10 patients with acute asthma, 10 stable atopic asthmatics, 10 nonatopic stable asthmatics and 10 age-matched healthy children. sE-selectin levels of patients with acute asthma were found to be significantly higher than that of the other three groups. The insignificant rise in sICAM-1 levels was attributed to the usage of inhaler corticosteroids. Serum sE-selectin and sICAM-1 seem to be promising serological markers for monitoring disease activity in childhood asthma.
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Affiliation(s)
- Figen Doğu
- Department of pediatric Immunology-Allergy, Ankara University, School of Medicine, Ankara, Turkey.
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Ikincioğullari A, Doğu F, Ciftci E, Unal E, Ertem M, Reisli I, Adiyaman S, Yildiran ST, Erekul S, Babacan E. An intensive approach to the treatment of disseminated BCG infection in a SCID patient. Bone Marrow Transplant 2002; 30:45-7. [PMID: 12105777 DOI: 10.1038/sj.bmt.1703578] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2001] [Accepted: 01/24/2002] [Indexed: 11/09/2022]
Abstract
There is an appreciable mortality associated with BMT in patients with SCID and advanced BCG infection. We present a girl with T-B+ SCID complicated by spina ventosa and disseminated BCG osteitis after receiving a fully matched sibling marrow transplant. Considerable progression characterised by two clinical activations and multiple pleural and perivertebral abscess formations occurred with conventional anti-mycobacterial chemotherapy. She finally recovered with full immune reconstitution after BMT and intensive treatment comprising five conventional and alternative agents that she received for 36 months. No side-effects and/or complications have been seen other than hearing loss.
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Affiliation(s)
- A Ikincioğullari
- Ankara University Medical School, Pediatric Bone Marrow Transplantation Unit, Ankara, Turkey
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Tekin M, Doğu F, Taçyíldiz N, Akar E, Ikincioğullari A, Oğur G, Yavuz G, Babacan E, Akar N. 657del5 mutation in the NBS1 gene is associated with Nijmegen breakage syndrome in a Turkish family. Clin Genet 2002; 62:84-8. [PMID: 12123493 DOI: 10.1034/j.1399-0004.2002.620112.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We report on a consanguineous Turkish family whose first son died of anal atresia and whose second son presented with severe pre- and post-natal growth retardation as well as striking microcephaly, immunodeficiency, congenital heart disease, chromosomal instability and rhabdomyosarcoma in the anal region. The proband was found to carry the homozygous 657del5 mutation in the NBS1 gene, which is responsible for Nijmegen breakage syndrome (NBS) in most of the Slav populations. Our family, the first diagnosed with NBS in the Turkish population, represents one of the most severely affected examples of the syndrome, with profound pre- and post-natal growth retardation associated with structural abnormalities, and expands the clinical spectrum of this rare disorder.
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Affiliation(s)
- Mustafa Tekin
- Division of Pediatric Molecular Pathology and Genetics, Department of Pediatrics, Ankara University School of Medicine, Dikimevi 06100, Ankara, Turkey.
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Uysal Z, Doğu F, Kürekçi AE, Culha VK, Deda G, Ekim M, Akar N, Erterm M, Ikincioğullari A, Babacan E, Gözdaşoğlu S. Recurrent arterial thrombosis in a child: primary antiphospholipid antibody syndrome. Pediatr Hematol Oncol 2002; 19:59-66. [PMID: 11787868 DOI: 10.1080/088800102753356202] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Antiphospholipid antibody syndrome (APS) is characterized by the association of recurrent arterial or venous thrombosis or recurrent fetal wastage and the presence of circulating antiphospholipid antibodies, detected as anticardiolipin antibodies or lupus anticoagulant. The authors report an 8-year-old girl, who presented with central retinal artery occlusion and live do reticularis and was diagnosed as APS. Despite the proper anticoagulant treatment she had several cerebral ischemic events and died 29 months after the diagnosis. A larger number of pediatric case investigations will be required for better understanding and treating this rare thrombotic disorder.
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Affiliation(s)
- Zümrüt Uysal
- Department of Pediatric Hematology, Ankara University, School of Medicine, Turkey
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50
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Ikincioğullari A, Doğu F, Babacan E, Oflaz G, Ertem U, Yavuz G, Unal E, Gözdaşoğlu S, Taçyildiz N, Dağdemir A, Cavdar AO. Natural killer cell numbers and cytotoxic activity in pediatric Hodgkin disease. Pediatr Hematol Oncol 2000; 17:133-9. [PMID: 10734655 DOI: 10.1080/088800100276488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In this study peripheral blood natural killer (NK) cell activity was evaluated in 17 pediatric cases with Hodgkin disease (HD) (9 untreated, 8 in remission) and 20 age-matched healthy children. Peripheral blood CD16 and CD56 molecule expressions were also examined. No difference related to NK cell numbers and cytotoxic activity was detected at either stage of the disease. In cases in which long-term remission has been achieved (> or = 5 years) NK cell activity was slightly but not significantly increased in parallel with remission duration. Finally, no relation between NK cell activity and the etiology, prognosis, and severity of the disease has been established in children with HD.
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Affiliation(s)
- A Ikincioğullari
- Department of Pediatric Immunology-Allergy, Ankara University Medical School, Turkey
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