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Zanchi C, Locatelli M, Cerullo D, Aumiller V, Corna D, Rottoli D, Schubert S, Noris M, Tomasoni S, Remuzzi G, Zoja C, Benigni A. Efficacy of GalNAc C3 siRNAs in factor H-deficient mice with C3 glomerulopathy. Mol Immunol 2024; 168:10-16. [PMID: 38368725 DOI: 10.1016/j.molimm.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/17/2024] [Accepted: 02/12/2024] [Indexed: 02/20/2024]
Abstract
Complement alternative pathway (AP) dysregulation drives C3 glomerulopathy (C3G), a rare renal disorder characterized by glomerular C3 deposition and glomerular damage, for which no effective treatments are available. Blockade of complement C3 is emerging as a viable therapeutic option. In an earlier study we showed that SLN500, a small interfering RNA targeting liver C3 synthesis, was able to limit AP dysregulation and glomerular C3d deposits in mice with partial factor H (FH) deficiency (Cfh+/- mice). Here, we assessed the pharmacological effects of SLN501 - an optimized SLN500 version - in mice with complete FH deficiency (Cfh-/- mice) that exhibit a more severe C3G phenotype. SLN501 effectively prevented liver C3 synthesis, thus limiting AP dysregulation, glomerular C3d deposits and the development of ultrastructural alterations. These data provide firm evidence of the use of siRNA-mediated liver C3 gene silencing as a potential therapy for treating C3G patients with either partial or complete FH loss of function.
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Affiliation(s)
- Cristina Zanchi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Monica Locatelli
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Domenico Cerullo
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | | | - Daniela Corna
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Daniela Rottoli
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | | | - Marina Noris
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Susanna Tomasoni
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Carlamaria Zoja
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy
| | - Ariela Benigni
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Bergamo, Italy.
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Massey V, Nguyen CTE, François T, De Bruycker JJ, Bonnefoy A, Lapeyraque AL, Decaluwe H. CNS Inflammation as the First Sign of Complement Factor I Deficiency: A Severe Myelitis Treated With Intense Immunotherapy and Eculizumab. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200191. [PMID: 38134378 PMCID: PMC10751016 DOI: 10.1212/nxi.0000000000200191] [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] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/30/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Complement factor I (CFI) deficiency is a rare autosomal recessive inborn error of immunity. In this report, we highlight that complete CFI deficiency may present with isolated and severe CNS inflammation without associated systemic features nor prior non-CNS episodes. This inflammation may respond to complement blockade therapy. METHODS This is a case description of a young girl with severe longitudinal transverse myelitis treated with aggressive immunotherapy that included eculizumab. Published cases of CFI-associated CNS inflammation were reviewed and discussed. RESULTS A primary immunodeficiency panel revealed 2 germline pathogenic variants in the CFI gene. Further complement testing of the index case and her family confirmed complete CFI deficiency. DISCUSSION We describe a unique case of severe spinal inflammation secondary to complete CFI deficiency. Although rare, isolated CNS inflammation may be the primary manifestation of complete CFI deficiency. To halt the uncontrolled complement-mediated inflammation associated with CFI deficiency, prompt targeted blockade of the complement pathway using eculizumab may be life changing in the acute phase. Long-lasting blockade of the complement pathway is also essential to prevent relapse in this subgroup of patients.
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Affiliation(s)
- Valérie Massey
- From the Immunology and Rheumatology Division (V.M., J.J.D.B., H.D.), Department of Pediatrics, Sainte-Justine University Hospital Center; Allergy and Immunology Division (V.M.), Sacré-Coeur Hospital; Neurology Division (C.-T.E.N.), Department of Pediatrics; Intensive Care Division (T.F., A.B.), Department of Pediatrics; Clinical Department of Laboratory Medicine (A.B.), OPTILAB; and Nephrology Division (A.-L.L.), Department of Pediatrics, Sainte-Justine University Hospital Center, Montreal, Canada
| | - Cam-Tu Emilie Nguyen
- From the Immunology and Rheumatology Division (V.M., J.J.D.B., H.D.), Department of Pediatrics, Sainte-Justine University Hospital Center; Allergy and Immunology Division (V.M.), Sacré-Coeur Hospital; Neurology Division (C.-T.E.N.), Department of Pediatrics; Intensive Care Division (T.F., A.B.), Department of Pediatrics; Clinical Department of Laboratory Medicine (A.B.), OPTILAB; and Nephrology Division (A.-L.L.), Department of Pediatrics, Sainte-Justine University Hospital Center, Montreal, Canada
| | - Tine François
- From the Immunology and Rheumatology Division (V.M., J.J.D.B., H.D.), Department of Pediatrics, Sainte-Justine University Hospital Center; Allergy and Immunology Division (V.M.), Sacré-Coeur Hospital; Neurology Division (C.-T.E.N.), Department of Pediatrics; Intensive Care Division (T.F., A.B.), Department of Pediatrics; Clinical Department of Laboratory Medicine (A.B.), OPTILAB; and Nephrology Division (A.-L.L.), Department of Pediatrics, Sainte-Justine University Hospital Center, Montreal, Canada
| | - Jean Jacques De Bruycker
- From the Immunology and Rheumatology Division (V.M., J.J.D.B., H.D.), Department of Pediatrics, Sainte-Justine University Hospital Center; Allergy and Immunology Division (V.M.), Sacré-Coeur Hospital; Neurology Division (C.-T.E.N.), Department of Pediatrics; Intensive Care Division (T.F., A.B.), Department of Pediatrics; Clinical Department of Laboratory Medicine (A.B.), OPTILAB; and Nephrology Division (A.-L.L.), Department of Pediatrics, Sainte-Justine University Hospital Center, Montreal, Canada
| | - Arnaud Bonnefoy
- From the Immunology and Rheumatology Division (V.M., J.J.D.B., H.D.), Department of Pediatrics, Sainte-Justine University Hospital Center; Allergy and Immunology Division (V.M.), Sacré-Coeur Hospital; Neurology Division (C.-T.E.N.), Department of Pediatrics; Intensive Care Division (T.F., A.B.), Department of Pediatrics; Clinical Department of Laboratory Medicine (A.B.), OPTILAB; and Nephrology Division (A.-L.L.), Department of Pediatrics, Sainte-Justine University Hospital Center, Montreal, Canada
| | - Anne-Laure Lapeyraque
- From the Immunology and Rheumatology Division (V.M., J.J.D.B., H.D.), Department of Pediatrics, Sainte-Justine University Hospital Center; Allergy and Immunology Division (V.M.), Sacré-Coeur Hospital; Neurology Division (C.-T.E.N.), Department of Pediatrics; Intensive Care Division (T.F., A.B.), Department of Pediatrics; Clinical Department of Laboratory Medicine (A.B.), OPTILAB; and Nephrology Division (A.-L.L.), Department of Pediatrics, Sainte-Justine University Hospital Center, Montreal, Canada
| | - Hélène Decaluwe
- From the Immunology and Rheumatology Division (V.M., J.J.D.B., H.D.), Department of Pediatrics, Sainte-Justine University Hospital Center; Allergy and Immunology Division (V.M.), Sacré-Coeur Hospital; Neurology Division (C.-T.E.N.), Department of Pediatrics; Intensive Care Division (T.F., A.B.), Department of Pediatrics; Clinical Department of Laboratory Medicine (A.B.), OPTILAB; and Nephrology Division (A.-L.L.), Department of Pediatrics, Sainte-Justine University Hospital Center, Montreal, Canada
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Kleer JS, Skattum L, Dubler D, Fischer I, Zgraggen A, Mundwiler E, Kim MJ, Trendelenburg M. Complement C1s deficiency in a male Caucasian patient with systemic lupus erythematosus: a case report. Front Immunol 2024; 14:1257525. [PMID: 38469558 PMCID: PMC10925646 DOI: 10.3389/fimmu.2023.1257525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/17/2023] [Indexed: 03/13/2024] Open
Abstract
Deficiencies of the early complement components of the classical pathway (CP) are well-documented in association with systemic lupus erythematosus (SLE) or SLE-like syndromes and severe pyogenic infections. Among these, complete C1s deficiency has been reported in nine cases so far. Here, we describe a 34-year-old male patient who presented with severe, recurrent infections since childhood, including meningitides with pneumococci and meningococci, erysipelas, subcutaneous abscess, and recurrent infections of the upper airways. The patient also exhibited adult-onset SLE, meeting 7/11 of the ACR criteria and 34 of the 2019 EULAR/ACR classification criteria, along with class IV-G (A) proliferative lupus nephritis (LN). A screening of the complement cascade showed immeasurably low CH50, while the alternative pathway (AP) function was normal. Subsequent determination of complement components revealed undetectable C1s with low levels of C1r and C1q, normal C3, and slightly elevated C4 and C2 concentrations. The patient had no anti-C1q antibodies. Renal biopsy showed class IV-G (A) LN with complement C1q positivity along the glomerular basement membranes (GBMs) and weak deposition of IgG, IgM, and complement C3 and C4 in the mesangium and GBM. In an ELISA-based functional assay determining C4d deposition, the patient's absent complement activity was fully restored by adding C1s. The genome of the patient was analyzed by whole genome sequencing showing two truncating variants in the C1S gene. One mutation was located at nucleotide 514 in exon 5, caused by a nucleotide substitution from G to T, resulting in a nonsense mutation from Gly172 (p.Gly172*). The other mutation was located at nucleotide 750 in exon 7, where C was replaced by a G, resulting in a nonsense mutation from Tyr250 (p.Tyr250*). Both mutations create a premature stop codon and have not previously been reported in the literature. These genetic findings, combined with the absence of C1s in the circulation, strongly suggest a compound heterozygote C1s deficiency in our patient, without additional defect within the complement cascade. As in a previous C1s deficiency case, the patient responded well to rituximab. The present case highlights unanswered questions regarding the CP's role in SLE etiopathogenesis.
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Affiliation(s)
- Jessica S. Kleer
- Laboratory of Clinical Immunology, Department of Biomedicine, University of Basel, Basel, Switzerland
- Division of Internal Medicine, University Hospital, Basel, Switzerland
| | - Lillemor Skattum
- Department of Laboratory Medicine, Section of Microbiology, Immunology and Glycobiology, Lund University, and Clinical Immunology and Transfusion Medicine, Region Skåne, Lund, Sweden
| | - Denise Dubler
- Laboratory of Clinical Immunology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Ingeborg Fischer
- Division of Pathology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Armin Zgraggen
- Division of Rheumatology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Esther Mundwiler
- Division of Laboratory Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Min Jeong Kim
- Division of Nephrology , Cantonal Hospital Aarau, Aarau, Switzerland
| | - Marten Trendelenburg
- Laboratory of Clinical Immunology, Department of Biomedicine, University of Basel, Basel, Switzerland
- Division of Internal Medicine, University Hospital, Basel, Switzerland
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Shindo R, Abe R, Oku K, Tanaka T, Matsueda Y, Wada T, Arinuma Y, Tanaka S, Ikenoue T, Miyakawa Y, Yamaoka K. Involvement of the complement system in immune thrombocytopenia: review of the literature. Immunol Med 2023; 46:182-190. [PMID: 37237432 DOI: 10.1080/25785826.2023.2213976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
Immune thrombocytopenia (ITP) is a thrombocytopenic condition induced by autoimmune mechanisms and includes secondary ITP with underlying diseases such as connective tissue diseases (CTD). In recent years, it has been elucidated that the subsets of the ITP are associated with complement abnormalities but much remains unclear. To perform a literature review and identify the characteristics of complement abnormalities in ITP. PUBMED was used to collect the literature published up to June 2022 related to ITP and complement abnormalities. Primary and secondary ITP (CTD-related) were examined. Out of the collected articles, 17 were extracted. Eight articles were related to primary ITP (pITP) and 9 to CTD-related ITP. Analysis of the literature revealed that the ITP severity was inversely correlated with serum C3, C4 levels in both ITP subgroups. In pITP, a wide range of complement abnormalities was reported, including abnormalities of initial proteins, complement regulatory proteins, or the end products. In CTD-related ITP, reported complement abnormalities were limited to the initial proteins. Activation of the early complement system, mainly through activation of C3 and its precursor protein C4, was reported for both ITPs. On the other hand, more extensive complement activation has been reported in pITP.
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Affiliation(s)
- Risa Shindo
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Sagamihara, Japan
| | - Ryohei Abe
- Department of Hematology, Saitama Medical University Hospital, Saitama, Japan
| | - Kenji Oku
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tomoki Tanaka
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yu Matsueda
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tatsuhiko Wada
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yoshiyuki Arinuma
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Sagamihara, Japan
| | - Sumiaki Tanaka
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Sagamihara, Japan
- Department of Rheumatology, Kitasato University Medical Center, Kitamoto, Japan
| | - Tatsuyoshi Ikenoue
- Data Science and AI Innovation Research Promotion Center, Shiga University, Hikone, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshitaka Miyakawa
- Department of Hematology, Saitama Medical University Hospital, Saitama, Japan
| | - Kunihiro Yamaoka
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Sagamihara, Japan
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5
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Moundir A, Ouair H, Benhsaien I, Jeddane L, Rada N, Amenzoui N, Jouhadi Z, Adnane F, Hafidi NE, Kili A, Bourhanbour Drissi A, Babakhouya A, Benmiloud S, Hbibi M, Benajiba N, Hida M, Bouskraoui M, Mahraoui C, Admou B, Bakkouri JE, Ailal F, Bousfiha AA. Genetic Diagnosis of Inborn Errors of Immunity in an Emerging Country: a Retrospective Study of 216 Moroccan Patients. J Clin Immunol 2023; 43:485-494. [PMID: 36367635 DOI: 10.1007/s10875-022-01398-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE Genetic testing provides great support to validate the clinical diagnosis of inborn errors of immunity (IEI). However, the high cost and advanced technology make these tests inaccessible to a large proportion of patients in low-income countries. In the present study, we aim to evaluate the Moroccan experience in genetic testing and to report the main molecular features and difficulties encountered in genetic diagnosis. METHODS We performed a multi-center retrospective analysis of all patients with a molecular diagnosis and registered in the national registry between 2010 and 2022. To estimate the impact of the newly identified mutations, we calculated the Combined Annotation Dependent Depletion (CADD) score and the mutation significance cutoff (MSC) for each variant. RESULTS A total of 216 (29%) patients received a genetic diagnosis out of 742 patients with IEI included in the registry. All genetic tests were performed in the context of thesis projects (40%) or international collaborations (60%). A set of 55 genetic defects were identified, including 7 newly reported: SNORA31, TBX21, SPPL2A, TYK2, RLTPR, ZNF341, and STAT2 GOF. Genetic diagnoses were more frequent in the defects of innate and intrinsic immunity with a percentage of 78%, while antibody deficiencies had a lower frequency with a percentage of 17.5%. Only one genetic diagnosis has been made in the complement deficiency group. The most commonly used molecular techniques were Sanger sequencing (37%) followed by targeted gene sequencing (31%). CONCLUSION The thesis projects and collaborations were beneficial as they allowed us to provide a definitive genetic diagnosis to 29% of the patients and to contribute to the identification of new genetic defects and mutations. These results offer insight into the progress made in genetic diagnoses of IEI in Morocco, which would provide a baseline for improving the clinical management of patients with IEI.
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Affiliation(s)
- Abderrahmane Moundir
- Clinical Immunology, Inflammation and Allergy Laboratory (LICIA), Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Hind Ouair
- Clinical Immunology, Inflammation and Allergy Laboratory (LICIA), Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Ibtihal Benhsaien
- Clinical Immunology, Inflammation and Allergy Laboratory (LICIA), Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Department of Pediatric Infectious Diseases and Clinical Immunology, A. Harouchi Children Hospital, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Leila Jeddane
- Clinical Immunology, Inflammation and Allergy Laboratory (LICIA), Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Laboratoire National de Référence, Mohamed VI University of Health Sciences, Casablanca, Morocco
| | - Nouredine Rada
- Department of Pediatric Infectious Diseases, Mohammed VI University Hospital, Marrakech, Morocco
| | - Naïma Amenzoui
- Department of Pediatric Infectious Diseases and Clinical Immunology, A. Harouchi Children Hospital, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Zineb Jouhadi
- Department of Pediatric Infectious Diseases and Clinical Immunology, A. Harouchi Children Hospital, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Fatima Adnane
- Department of Pediatric Infectious Diseases and Clinical Immunology, A. Harouchi Children Hospital, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Naïma El Hafidi
- Department of Pediatric Infectious Diseases, Ibn Sina University Hospital, Rabat, Morocco
| | - Amina Kili
- Department of Pediatric Hemato-Oncology, Ibn Sina University Hospital, Rabat, Morocco
| | - Asmaa Bourhanbour Drissi
- Clinical Immunology, Inflammation and Allergy Laboratory (LICIA), Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Immunology Laboratory, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Abdeladim Babakhouya
- Department of Pediatric Infectious Diseases, Hassan II University Hospital, Fes, Morocco
| | - Sarra Benmiloud
- Department of Pediatric Infectious Diseases, Hassan II University Hospital, Fes, Morocco
| | - Mohamed Hbibi
- Department of Pediatric Infectious Diseases, Hassan II University Hospital, Fes, Morocco
| | - Noufissa Benajiba
- Department of Pediatrics, Mohammed VI University Hospital, Oujda, Morocco
| | - Mustapha Hida
- Department of Pediatric Infectious Diseases, Hassan II University Hospital, Fes, Morocco
| | - Mohamed Bouskraoui
- Department of Pediatric Infectious Diseases, Mohammed VI University Hospital, Marrakech, Morocco
| | - Chafiq Mahraoui
- Pneumo-Allergology Unit, Rabat Children Hospital, Faculty of Medicine, Mohammed V University, Rabat, Morocco
| | - Brahim Admou
- Immunology Laboratory, Mohammed VI University Hospital, Marrakech, Morocco
| | - Jalila El Bakkouri
- Clinical Immunology, Inflammation and Allergy Laboratory (LICIA), Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Immunology Laboratory, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Fatima Ailal
- Clinical Immunology, Inflammation and Allergy Laboratory (LICIA), Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
- Department of Pediatric Infectious Diseases and Clinical Immunology, A. Harouchi Children Hospital, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Ahmed Aziz Bousfiha
- Clinical Immunology, Inflammation and Allergy Laboratory (LICIA), Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
- Department of Pediatric Infectious Diseases and Clinical Immunology, A. Harouchi Children Hospital, Ibn Rochd University Hospital, Casablanca, Morocco.
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Szilágyi Á, Csuka D, Geier CB, Prohászka Z. Complement Genetics for the Practicing Allergist Immunologist: Focus on Complement Deficiencies. J Allergy Clin Immunol Pract 2022; 10:1703-1711. [PMID: 35272074 DOI: 10.1016/j.jaip.2022.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
Complement deficiencies have been considered to be rare for many decades, but this assumption is changing year by year. Recognition of these conditions significantly increases thanks to the availability of different testing approaches and due to clinical awareness. Furthermore, sequencing technologies (including Sanger sequencing, targeted gene panels, and whole exome/genome sequencing) may facilitate the identification of the underlying disease-causing genetic background. On the other hand, functional characterization of the identified possibly pathogenic variations and performing family studies, as illustrated by some of our cases, remain similarly important to establish a precise clinical diagnosis facilitating the most appropriate management. Here, we present 4 illustrative cases with complement deficiencies of diverse etiologies and also provide an educative, step-by-step description on how to identify the underlying cause of complement deficiency based on the results of complement laboratory testing.
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Affiliation(s)
- Ágnes Szilágyi
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Dorottya Csuka
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Christoph B Geier
- Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Freiburg, Germany; Center for Chronic Immunodeficiency (CCI), University Medical Center Freiburg, Freiburg, Germany
| | - Zoltán Prohászka
- Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary; Research Group for Immunology and Haematology, Semmelweis University-Eötvös Loránd Research Network (Office for Supported Research Groups), Budapest, Hungary.
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7
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Ali YM, Lynch NJ, Khatri P, Bamigbola IE, Chan ACY, Yabuki M, Demopulos GA, Heeney JL, Pai S, Baxendale H, Schwaeble WJ. Secondary Complement Deficiency Impairs Anti-Microbial Immunity to Klebsiella pneumoniae and Staphylococcus aureus During Severe Acute COVID-19. Front Immunol 2022; 13:841759. [PMID: 35572551 PMCID: PMC9094484 DOI: 10.3389/fimmu.2022.841759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/21/2022] [Indexed: 01/08/2023] Open
Abstract
A high incidence of secondary Klebsiella pneumoniae and Staphylococcus aureus infection were observed in patients with severe COVID-19. The cause of this predisposition to infection is unclear. Our data demonstrate consumption of complement in acute COVID-19 patients reflected by low levels of C3, C4, and loss of haemolytic activity. Given that the elimination of Gram-negative bacteria depends in part on complement-mediated lysis, we hypothesised that secondary hypocomplementaemia is rendering the antibody-dependent classical pathway activation inactive and compromises serum bactericidal activity (SBA). 217 patients with severe COVID-19 were studied. 142 patients suffered secondary bacterial infections. Klebsiella species were the most common Gram-negative organism, found in 58 patients, while S. aureus was the dominant Gram-positive organism found in 22 patients. Hypocomplementaemia was observed in patients with acute severe COVID-19 but not in convalescent survivors three months after discharge. Sera from patients with acute COVID-19 were unable to opsonise either K. pneumoniae or S. aureus and had impaired complement-mediated killing of Klebsiella. We conclude that hyperactivation of complement during acute COVID-19 leads to secondary hypocomplementaemia and predisposes to opportunistic infections.
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Affiliation(s)
- Youssif M. Ali
- Department of Veterinary Medicine, School of Biological Sciences, University of Cambridge, Cambridge, United Kingdom
- Department of Microbiology and Immunology, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
- *Correspondence: Youssif M. Ali, ; Wilhelm J. Schwaeble,
| | - Nicholas J. Lynch
- Department of Veterinary Medicine, School of Biological Sciences, University of Cambridge, Cambridge, United Kingdom
| | - Priyanka Khatri
- Department of Veterinary Medicine, School of Biological Sciences, University of Cambridge, Cambridge, United Kingdom
| | - Ifeoluwa E. Bamigbola
- Department of Veterinary Medicine, School of Biological Sciences, University of Cambridge, Cambridge, United Kingdom
| | - Andrew C. Y. Chan
- Department of Veterinary Medicine, School of Biological Sciences, University of Cambridge, Cambridge, United Kingdom
| | | | | | - Jonathan L. Heeney
- Department of Veterinary Medicine, School of Biological Sciences, University of Cambridge, Cambridge, United Kingdom
| | - Sumita Pai
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Helen Baxendale
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Wilhelm J. Schwaeble
- Department of Veterinary Medicine, School of Biological Sciences, University of Cambridge, Cambridge, United Kingdom
- *Correspondence: Youssif M. Ali, ; Wilhelm J. Schwaeble,
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8
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Hassan S, Szeto MD, Sivesind TE, Memon R, Muneem A, Victoire A, Magin PJ, van Driel ML, Nashawaty M, Dellavalle RP. From the Cochrane Library: Interventions for infantile seborrheic dermatitis (including cradle cap). J Am Acad Dermatol 2021; 86:e87-e88. [PMID: 34571061 DOI: 10.1016/j.jaad.2021.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/30/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Shahzeb Hassan
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mindy D Szeto
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Torunn E Sivesind
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Rohail Memon
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Abraar Muneem
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Anousha Victoire
- University of Newcastle, Discipline of General Practice, School of Medicine and Public Health, Callaghan, New South Wales, Australia
| | - Parker J Magin
- University of Newcastle, Discipline of General Practice, School of Medicine and Public Health, Callaghan, New South Wales, Australia
| | - Mieke L van Driel
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | | | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado.
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9
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Králíčková P, Andrýs C, Freiberger T, Krejsek J. Inherited C2-complement deficiency: variable clinical manifestation (case reports and review). Vnitr Lek 2020; 66:87-91. [PMID: 32942894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
C2 deficiency represents the most frequent type of a complement deficiency. Clinical manifestation includes infections caused by encapsulated bacteria (Steptococcus pneumoniae, Neisseria meningitidis) such as meningitis, gonitis, pneumonia or septicaemia. A causative treatment has not been available yet. A prophylactic vaccination and/or a long-term antibiotics prophylaxis are recommended. Here we report 2 patients from 2 unrelated families. The first patient suffered from recurrent otitis in his childhood. He underwent osteomyelitis, meningitis complicates with hear-loss, and one episode of pneumonia during adulthood. The second index patient underwent uncomplicated meningitis in his preschool age. He has been treated for recurrent upper-airways infections later. His sister has been completely asymptomatic. The deletion 28 bp (c.841-849+19del28) in C2-gene was detected in all of them in homozygous form. Our paper highlights the variability of a clinical manifestation in homozygous carriers, ranged from asymptomatic cases to patients with history of severe complications. The diagnosis is frequently made even in adulthood.
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10
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Sobotková M. Complement deficiencies. Vnitr Lek 2020; 66:346-352. [PMID: 33380138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Complement system plays a crucial role in innate imunity. Complement deficiencies are often associated with severe infections, usually meningoccocal, pneumococcal or caused by Haemophilus influenzae, or with autoimmune diseases, especially systemic lupus erythematodes. Inherited complement deficiencies are very rare although their prevalence in population may be underestimated due to lower availability of adequate laboratory testing. Acquired complement deficiencies accompany other underlying diseases and often are caused by increased consumption and only partial.
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11
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Rocha AP, Borges M, Neves C, Neves JF. [H Factor Deficiency: A Case with an Atypical Presentation]. ACTA MEDICA PORT 2019; 32:158-161. [PMID: 30896397 DOI: 10.20344/amp.10301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 04/11/2018] [Accepted: 04/13/2018] [Indexed: 11/20/2022]
Abstract
We report a case of an 18-month-old boy with H factor deficiency with atypical presentation: recurrent acute otitis media and several maternal family members with autoimmune disorders (vitiligo, thyroiditis and immune trombocytopenia). Blood tests revealed low C3 and AH50, as well as low properdin and H factor. I factor was normal. CFH gene molecular test confirmed the H factor deficiency diagnosis. This child had none of the typical manifestations of this disorder, namely Neisseria meningitidis infection or renal disease (glomerulonephritis and atypical haemolytic uremic syndrome). Autoimmune family history and correct interpretation of blood tests' results were crucial for this diagnosis.
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Affiliation(s)
- Ana Paula Rocha
- Unidade de Imunodeficiências Primárias. Serviço de Pediatria. Hospital Dona Estefânia. Centro Hospitalar Lisboa Central. Lisboa. Portugal
| | - Madalena Borges
- Unidade de Imunodeficiências Primárias. Serviço de Pediatria. Hospital Dona Estefânia. Centro Hospitalar Lisboa Central. Lisboa. Portugal
| | - Conceição Neves
- Unidade de Imunodeficiências Primárias. Serviço de Pediatria. Hospital Dona Estefânia. Centro Hospitalar Lisboa Central. Lisboa. Portugal
| | - João Farela Neves
- Unidade de Imunodeficiências Primárias. Serviço de Pediatria. Hospital Dona Estefânia. Centro Hospitalar Lisboa Central. Lisboa. Chronic Diseases Research Center. NOVA Medical School. Lisboa. Portugal
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12
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Sng CCT, O'Byrne S, Prigozhin DM, Bauer MR, Harvey JC, Ruhle M, Challis BG, Lear S, Roberts LD, Workman S, Janowitz T, Magiera L, Doffinger R, Buckland MS, Jodrell DJ, Semple RK, Wilson TJ, Modis Y, Thaventhiran JED. A type III complement factor D deficiency: Structural insights for inhibition of the alternative pathway. J Allergy Clin Immunol 2018; 142:311-314.e6. [PMID: 29522842 PMCID: PMC6034011 DOI: 10.1016/j.jaci.2018.01.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/02/2018] [Accepted: 01/16/2018] [Indexed: 01/24/2023]
Affiliation(s)
| | - Sorcha O'Byrne
- Department of Clinical Immunology, Cambridge University Hospitals National Health Service Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Daniil M Prigozhin
- Molecular Immunity Unit, Department of Medicine, Medical Research Council (MRC) Laboratory of Molecular Biology, Cambridge, United Kingdom
| | - Matthias R Bauer
- Division of Structural Studies, MRC Laboratory of Molecular Biology, Cambridge, United Kingdom
| | - Jennifer C Harvey
- Department of Immunology, Royal Free London National Health Service Foundation Trust, London, United Kingdom
| | - Michelle Ruhle
- Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Ben G Challis
- Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Sara Lear
- Department of Clinical Immunology, Cambridge University Hospitals National Health Service Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Lee D Roberts
- Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds Institute of Genetics, Health and Therapeutics (LIGHT) Laboratories, University of Leeds, Leeds, United Kingdom
| | - Sarita Workman
- Department of Immunology, Royal Free London National Health Service Foundation Trust, London, United Kingdom
| | - Tobias Janowitz
- Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - Lukasz Magiera
- Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - Rainer Doffinger
- Department of Clinical Immunology, Cambridge University Hospitals National Health Service Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Matthew S Buckland
- Department of Immunology, Royal Free London National Health Service Foundation Trust, London, United Kingdom
| | - Duncan J Jodrell
- Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - Robert K Semple
- Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, United Kingdom; University of Edinburgh Centre for Cardiovascular Sciences, Queen's Medical Research Institute, Little France Crescent, Edinburgh, United Kingdom
| | | | - Yorgo Modis
- Molecular Immunity Unit, Department of Medicine, Medical Research Council (MRC) Laboratory of Molecular Biology, Cambridge, United Kingdom
| | - James E D Thaventhiran
- Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Department of Clinical Immunology, Cambridge University Hospitals National Health Service Trust, Addenbrooke's Hospital, Cambridge, United Kingdom; Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom; MRC Toxicology Unit, University of Leicester, Leicester, United Kingdom.
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13
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Taylor RP, Lindorfer MA, Cook EM, Beurskens FJ, Schuurman J, Parren PWHI, Zent CS, VanDerMeid KR, Burack R, Mizuno M, Morgan BP. Hexamerization-enhanced CD20 antibody mediates complement-dependent cytotoxicity in serum genetically deficient in C9. Clin Immunol 2017; 181:24-28. [PMID: 28578024 DOI: 10.1016/j.clim.2017.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/21/2017] [Accepted: 05/19/2017] [Indexed: 01/22/2023]
Abstract
We examined complement-dependent cytotoxicity (CDC) by hexamer formation-enhanced CD20 mAb Hx-7D8 of patient-derived chronic lymphocytic leukemia (CLL) cells that are relatively resistant to CDC. CDC was analyzed in normal human serum (NHS) and serum from an individual genetically deficient for C9. Hx-7D8 was able to kill up to 80% of CLL cells in complete absence of C9. We conclude that the narrow C5b-8 pores formed without C9 are sufficient for CDC due to efficient antibody-mediated hexamer formation. In the absence of C9, we observed transient intracellular increases of Ca2+ during CDC (as assessed with FLUO-4) that were extended in time. This suggests that small C5b-8 pores allow Ca2+ to enter the cell, while dissipation of the fluorescent signal accompanying cell disintegration is delayed. The Ca2+ signal is retained concomitantly with TOPRO-3 (viability dye) staining, thereby confirming that Ca2+ influx represents the most proximate mediator of cell death by CDC.
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Affiliation(s)
- Ronald P Taylor
- Department of Biochemistry and Molecular Genetics, University of Virginia School of Medicine, USA.
| | - Margaret A Lindorfer
- Department of Biochemistry and Molecular Genetics, University of Virginia School of Medicine, USA
| | - Erika M Cook
- Department of Biochemistry and Molecular Genetics, University of Virginia School of Medicine, USA
| | | | | | - Paul W H I Parren
- Genmab, The Netherlands; Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, The Netherlands
| | - Clive S Zent
- Wilmot Cancer Institute, University of Rochester Medical Center, USA
| | - Karl R VanDerMeid
- Wilmot Cancer Institute, University of Rochester Medical Center, USA
| | - Richard Burack
- Pathology Department, University of Rochester Medical Center, USA
| | | | - B Paul Morgan
- Division of Infection & Immunity, School of Medicine, Cardiff University, United Kingdom
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14
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Chen JY, Wu YL, Mok MY, Wu YJJ, Lintner KE, Wang CM, Chung EK, Yang Y, Zhou B, Wang H, Yu D, Alhomosh A, Jones K, Spencer CH, Nagaraja HN, Lau YL, Lau CS, Yu CY. Effects of Complement C4 Gene Copy Number Variations, Size Dichotomy, and C4A Deficiency on Genetic Risk and Clinical Presentation of Systemic Lupus Erythematosus in East Asian Populations. Arthritis Rheumatol 2016; 68:1442-1453. [PMID: 26814708 PMCID: PMC5114127 DOI: 10.1002/art.39589] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 01/07/2016] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Human complement C4 is complex, with multiple layers of diversity. The aims of this study were to elucidate the copy number variations (CNVs) of C4A and C4B in relation to disease risk in systemic lupus erythematosus (SLE), and to compare the basis of race-specific C4A deficiency between East Asians and individuals of European descent. METHODS The East Asian study population included 999 SLE patients and 1,347 healthy subjects. Variations in gene copy numbers (GCNs) of total C4, C4A, and C4B, as well as C4-Long and C4-Short genes, were determined and validated using independent genotyping technologies. Genomic regions with C4B96 were investigated to determine the basis of the most basic C4B protein occurring concurrently with C4A deficiency. RESULTS In East Asians, high GCNs of total C4 and C4A were strongly protective against SLE, whereas low and medium GCNs of total C4 and C4A, and the absence of C4-Short genes, were risk factors for SLE. Homozygous C4A deficiency was infrequent in East Asian subjects, but had an odds ratio (OR) of 12.4 (P = 0.0015) for SLE disease susceptibility. Low serum complement levels were strongly associated with low GCNs of total C4 (OR 3.19, P = 7.3 × 10(-7) ) and C4B (OR 2.53, P = 2.5 × 10(-5) ). Patients with low serum complement levels had high frequencies of anti-double-stranded DNA antibodies (OR 4.96, P = 9.7 × 10(-17) ), hemolytic anemia (OR 3.89, P = 3.6 × 10(-10) ), and renal disease (OR 2.18, P = 8.5 × 10(-6) ). The monomodular-Short haplotype found to be prevalent in European Americans with C4A deficiency, which was in linkage disequilibrium with HLA-DRB1*0301, was scarce in East Asians. Instead, most East Asian subjects with C4A deficiency were found to have a recombinant haplotype with bimodular C4-Long and C4-Short genes, encoding C4B1 and C4B96, which was linked to HLA-DRB1*1501. DNA sequencing revealed an E920K polymorphism in C4B96. CONCLUSION C4 CNVs and deficiency of C4A both play an important role in the risk and manifestations of SLE in East Asian and European populations.
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Affiliation(s)
- Ji Yih Chen
- Department of Medicine, Division of Allergy, Immunology and Rheumatology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan, Republic of China
| | - Yee Ling Wu
- Center for Molecular and Human Genetics, The Research Institute and Division of Pediatric Rheumatology, Nationwide Children's Hospital; and Department of Pediatrics, The Ohio State University, 700 Children's Drive, Columbus, Ohio 43205, USA
| | - Mo Yin Mok
- Division of Rheumatology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yeong-Jian Jan Wu
- Department of Medicine, Division of Allergy, Immunology and Rheumatology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan, Republic of China
| | - Katherine E. Lintner
- Center for Molecular and Human Genetics, The Research Institute and Division of Pediatric Rheumatology, Nationwide Children's Hospital; and Department of Pediatrics, The Ohio State University, 700 Children's Drive, Columbus, Ohio 43205, USA
| | - Chin-Man Wang
- Department of Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan, Republic of China
| | - Erwin K. Chung
- Center for Molecular and Human Genetics, The Research Institute and Division of Pediatric Rheumatology, Nationwide Children's Hospital; and Department of Pediatrics, The Ohio State University, 700 Children's Drive, Columbus, Ohio 43205, USA
| | - Yan Yang
- Center for Molecular and Human Genetics, The Research Institute and Division of Pediatric Rheumatology, Nationwide Children's Hospital; and Department of Pediatrics, The Ohio State University, 700 Children's Drive, Columbus, Ohio 43205, USA
| | - Bi Zhou
- Center for Molecular and Human Genetics, The Research Institute and Division of Pediatric Rheumatology, Nationwide Children's Hospital; and Department of Pediatrics, The Ohio State University, 700 Children's Drive, Columbus, Ohio 43205, USA
| | - Huanyu Wang
- Center for Molecular and Human Genetics, The Research Institute and Division of Pediatric Rheumatology, Nationwide Children's Hospital; and Department of Pediatrics, The Ohio State University, 700 Children's Drive, Columbus, Ohio 43205, USA
| | - Dennis Yu
- Center for Molecular and Human Genetics, The Research Institute and Division of Pediatric Rheumatology, Nationwide Children's Hospital; and Department of Pediatrics, The Ohio State University, 700 Children's Drive, Columbus, Ohio 43205, USA
| | - Alaaedin Alhomosh
- Center for Molecular and Human Genetics, The Research Institute and Division of Pediatric Rheumatology, Nationwide Children's Hospital; and Department of Pediatrics, The Ohio State University, 700 Children's Drive, Columbus, Ohio 43205, USA
| | - Karla Jones
- Center for Molecular and Human Genetics, The Research Institute and Division of Pediatric Rheumatology, Nationwide Children's Hospital; and Department of Pediatrics, The Ohio State University, 700 Children's Drive, Columbus, Ohio 43205, USA
| | - Charles H. Spencer
- Center for Molecular and Human Genetics, The Research Institute and Division of Pediatric Rheumatology, Nationwide Children's Hospital; and Department of Pediatrics, The Ohio State University, 700 Children's Drive, Columbus, Ohio 43205, USA
| | - Haikady N. Nagaraja
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio 43201, USA
| | - Yu Lung Lau
- Department of Pediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Chak-Sing Lau
- Division of Rheumatology, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - C. Yung Yu
- Center for Molecular and Human Genetics, The Research Institute and Division of Pediatric Rheumatology, Nationwide Children's Hospital; and Department of Pediatrics, The Ohio State University, 700 Children's Drive, Columbus, Ohio 43205, USA
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15
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Vernon KA, Ruseva MM, Cook HT, Botto M, Malik TH, Pickering MC. Partial Complement Factor H Deficiency Associates with C3 Glomerulopathy and Thrombotic Microangiopathy. J Am Soc Nephrol 2016; 27:1334-42. [PMID: 26374608 PMCID: PMC4849824 DOI: 10.1681/asn.2015030295] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 03/18/2015] [Accepted: 07/28/2015] [Indexed: 11/03/2022] Open
Abstract
The complement-mediated renal diseases C3 glomerulopathy (C3G) and atypical hemolytic uremic syndrome (aHUS) strongly associate with inherited and acquired abnormalities in the regulation of the complement alternative pathway (AP). The major negative regulator of the AP is the plasma protein complement factor H (FH). Abnormalities in FH result in uncontrolled activation of C3 through the AP and associate with susceptibility to both C3G and aHUS. Although previously developed FH-deficient animal models have provided important insights into the mechanisms underlying susceptibility to these unique phenotypes, these models do not entirely reproduce the clinical observations. FH is predominantly synthesized in the liver. We generated mice with hepatocyte-specific FH deficiency and showed that these animals have reduced plasma FH levels with secondary reduction in plasma C3. Unlike mice with complete FH deficiency, hepatocyte-specific FH-deficient animals developed neither plasma C5 depletion nor accumulation of C3 along the glomerular basement membrane. In contrast, subtotal FH deficiency associated with mesangial C3 accumulation consistent with C3G. Although there was no evidence of spontaneous thrombotic microangiopathy, the hepatocyte-specific FH-deficient animals developed severe C5-dependent thrombotic microangiopathy after induction of complement activation within the kidney by accelerated serum nephrotoxic nephritis. Taken together, our data indicate that subtotal FH deficiency can give rise to either spontaneous C3G or aHUS after a complement-activating trigger within the kidney and that the latter is C5 dependent.
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Affiliation(s)
- Katherine A Vernon
- Centre for Complement and Inflammation Research, Imperial College, London, United Kingdom
| | - Marieta M Ruseva
- Centre for Complement and Inflammation Research, Imperial College, London, United Kingdom
| | - H Terence Cook
- Centre for Complement and Inflammation Research, Imperial College, London, United Kingdom
| | - Marina Botto
- Centre for Complement and Inflammation Research, Imperial College, London, United Kingdom
| | - Talat H Malik
- Centre for Complement and Inflammation Research, Imperial College, London, United Kingdom
| | - Matthew C Pickering
- Centre for Complement and Inflammation Research, Imperial College, London, United Kingdom
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16
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Abstract
Patients with end-stage renal disease (ESRD) due to atypical HUS (aHUS) now have several potential options that can enable successful kidney transplantation. This editorial addresses these options by considering key factors that are important when making an individual treatment decision.
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Affiliation(s)
- Jeffrey Saland
- Mount Sinai Medical School, 1 Gustave L. Levy Pl, New York, NY, 10029, USA,
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17
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Abstract
Variations in several complement genes are now known to be significant risk factors for the development of age-related macular degeneration (AMD). Despite dramatic effects on disease susceptibility, the underlying mechanisms by which common polymorphisms in complement proteins alter disease risk have remained unclear. Genetically modified mice in which the activity of the complement has been altered are available and can be used to investigate the role of complement in the pathogenesis of AMD. In this mini review, we will discuss some existing complement models of AMD and our efforts to develop and characterize the ocular phenotype in a variety of mice in which complement is either chronically activated or inhibited. A spectrum of complement dysregulation was modeled on the APOE4 AMD mouse model by crossing these mice to complement factor H knockout (cfh-/-) mice to test the impact of excess complement activation, and by crossing them to soluble-complement-receptor-1-related protein y (sCrry) mice, in which sCrry acts as a potent inhibitor of mouse complement acting in a manner similar to CFH. In addition, we have also generated humanized CFH mice expressing normal and risk variants of CFH.
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Affiliation(s)
- Jin-Dong Ding
- Department of Ophthalmology, Duke University Medical Center, 2351 Erwin Rd, 27710, Durham, NC, USA,
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18
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Fujimura Y. [Atypical hemolytic uremic syndrome]. Rinsho Ketsueki 2013; 54:1897-1906. [PMID: 24064841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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19
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Affiliation(s)
- Leticia A Shanley
- University of Texas Southwestern Medical Center, Dallas, TX 75235, USA.
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20
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Uslu-Gökceoğlu A, Doğan CS, Comak E, Koyun M, Akman S. Atypical hemolytic uremic syndrome due to factor H autoantibody. Turk J Pediatr 2013; 55:86-89. [PMID: 23692839] [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]
Abstract
Atypical hemolytic uremic syndrome (aHUS) is a disease caused by pathologies in the alternative complement system. The prevalence of aHUS is 10% of all aHUS cases. The subgroup of aHUS designated as DEAP (DEficiency of CFHR Proteins and CFH Autoantibody Positive)-HUS because of autoantibody to complement factor H (CFH) and CFH-related protein deficiency is seen very rarely, and the prevalence is 6% of all aHUS cases in the literature. We present here a female patient with DEAP-HUS. A 7.5-year-old girl with recurrent attacks of HUS had low C3 level. We initiated plasmapheresis treatment. After further analysis of the complement system, the result was compatible with DEAP-HUS, so we initiated immunosuppressive treatment. There were also family members with deficiency of CFHR-1 and CFHR-3, but they had no CFH autoantibody and no symptoms of HUS. In atypical cases of HUS, we should investigate complement status, especially for factor H autoantibody, for which treatment options differ from those of the other types of aHUS.
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Affiliation(s)
- Arife Uslu-Gökceoğlu
- Department of Pediatrics, Akdeniz University Faculty of Medicine, Antalya, Turkey.
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21
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22
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Carr R, Cataland SR. Relapse of aHUS after discontinuation of therapy with eculizumab in a patient with aHUS and factor H mutation. Ann Hematol 2012; 92:845-6. [PMID: 23154867 DOI: 10.1007/s00277-012-1622-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 10/31/2012] [Indexed: 11/26/2022]
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23
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FORRAI G. [INCREASED INCIDENCE OF CAMPTODACTYLIA AND LEINER'S DISEASE IN THE SAME FAMILY]. Wien Klin Wochenschr 1965; 77:259-60. [PMID: 14311477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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24
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MIDDLEKAMP JN, LANE CW. FLUOCINOLONE ACETONIDE TREATMENT OF LEINER'S DISEASE. J Pediatr 1964; 65:784-5. [PMID: 14221184 DOI: 10.1016/s0022-3476(64)80168-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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OVIEDOPADILLA G. [OUR EXPERIENCE IN LEINER'S DISEASE]. Rev Med Hondur 1964; 32:201-15. [PMID: 14230432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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26
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HORVATH G. [CONTRIBUTIONS AND CLINICAL OBSERVATIONS ON THE ETIOPATHOGENESIS AND THERAPY OF LEINER'S DISEASE]. Hautarzt 1964; 15:188-91. [PMID: 14217839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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27
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ZVER'KOVA FA, LITVINOK NV. [Gangrene of the skin in erythroderma desquamativum in a child]. Vestn Dermatol Venerol 1962; 36:77-9. [PMID: 14004132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
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28
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LEVY JM. [Erythroderma desquamativum. Eczema in the infant]. Strasb Med 1962; 13:574-6. [PMID: 13930268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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29
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MONNET P, COUDERT J, GAUTHIER J, BRUNAT M. [Erythroderma desquamativum in newborn infants. Unusual severe form with very early onset, perhaps familial]. Arch Fr Pediatr 1962; 19:243-8. [PMID: 14475403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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30
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KUNDRATITZ K. [On the problem of the relationship of erythroderma desquamativum to seborrheic dermatitis]. Hautarzt 1962; 13:81-4. [PMID: 14460542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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31
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KORAC D, NIKOLIC V, PAVLOVIC-KENTERA V. [Contribution to the study of the blood protein system in children with erythroderma desquamativum]. Acta Med Iugosl 1962; 16:1-14. [PMID: 14034727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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32
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BARIL E, DAGENAIS-PERUSSE P, HAZARD E, OUADAHI S. [The use of biotin in Leiner-Moussus disease]. Union Med Can 1961; 90:623-4. [PMID: 13686989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
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MASLOV PE, BELIAKOVA AG. [Clinical aspects, therapy and prevention of Leiner's erythroderma desquamativum]. Vestn Rentgenol Radiol 1960; 34:43-8. [PMID: 13767795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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KUNDRATITZ K. [On Leiner's disease, erythroderma desquamativum]. Pediatr Int (Roma) 1960; 10:353-67. [PMID: 14460541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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FRANK K. [Studies on protein metabolism in Leiner's disease]. Monatsschr Kinderheilkd (1902) 1960; 108:25-8. [PMID: 13824510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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ROUGICHITCH OS, SOUBITCH M. [An easy method of treatment of erythroderma desquamativum]. Arch Fr Pediatr 1960; 17:516-8. [PMID: 13743967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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FOURNIER A, PAULI A, DERREUMAUX L. [Convulsions in infants caused by administration of asterol; four cases]. J Sci Med Lille 1959; 77:158-66. [PMID: 13655271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
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GERLOCZY F, BENCZE B, MALIK T, UGRAY E. [Vitamin E metabolism in atrophic infants. IV. Vitamin E metabolism in infants suffering from Leiner's disease]. Ann Paediatr 1959; 192:166-90. [PMID: 13637491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
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ECKARDT F, KUNAD T. [Erythrodermia desquamativa-Leiner]. Kinderarztl Prax 1958; 26:443-51. [PMID: 13611948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
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SPAET TH, RATNOFF OD, GRAHAM JB, SCHULMAN I, ROSENTHAL RL. Deletion of plasma thromboplastin factor D deficiency. J Lab Clin Med 1958; 52:634-40. [PMID: 13588176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
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CRAWFORD LV. Treatment of allergic eczema versus seborrheic infantile eczema. J Pediatr 1958; 53:99-106. [PMID: 13564374 DOI: 10.1016/s0022-3476(58)80201-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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FERENCZ P, BODA D. [Origin of hypoproteinmia in Leiner's disease in infants]. Monatsschr Kinderheilkd (1902) 1958; 106:234-5. [PMID: 13552572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
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NICOLINI A, QUARTI M. [Presence of the staphylococcic infectious factor in etiopathogenesis of erythroderma desquamativum (Leiner's disease)]. Minerva Pediatr 1958; 10:55-61. [PMID: 13541138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
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VACCARINI G. [Prednisone therapy as diagnostic criterion in differentiation of Leiner's disease and generalized diathetic eczema seborrhoeicum in infants]. Arch Ital Pediatr Pueric 1958; 19:168-70. [PMID: 13596080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
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POLIAKOVA KK. [Case of desquamative erythroderma as a specific form of dermatosis in infant (Leiner's disease)]. Arkh Patol 1958; 20:66-70. [PMID: 13596240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
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BENCZE B, GERLOCZY F, MALIK T, UGRAY M. [Vitamin metabolism of atrophic infants. VIII. Vitamin A metabolism in Leiner's disease of infants]. Gyermekgyogyaszat 1957; 8:349-56. [PMID: 13538345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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GERLOCZY F, BENCZE B, MALIK T, UGRAY M. [Vitamin metabolism of atrophic infants. V. Vitamin E metabolism of atrophic infants in Leiner's disease]. Gyermekgyogyaszat 1957; 8:264-77. [PMID: 13501649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
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MONTAGNANI A, PISANI M. [Devergie's pityriasis rubra pilaris following exfoliative erythroderma]. Minerva Dermatol 1957; 32:327-34. [PMID: 13503806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
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LIEBNER E, FLORIAN E. [Etiology of dermatitis seborrheica and erythrodermia desquamativum of the infant. I. The role of Candida albicans]. Ann Paediatr 1957; 189:129-53. [PMID: 13470576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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